Pain Control Strategies Research Articles

Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research.

Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate the exploration of alternatives. This narrative review highlights the potential of nerve blocks as a safe and effective strategy for post-surgical pain control. This review explores the use of various nerve block techniques tailored to specific surgical procedures. These include nerve blocks for abdominal surgeries; fascial plane blocks for chest surgeries; nerve blocks for arm surgeries; and nerve blocks for lower limb surgery including; femoral, hip, and knee surgeries. By targeting specific nerves, these blocks can provide targeted pain relief without the negative side effects associated with opioids. Emerging evidence suggests that nerve blocks can be as effective as opioids in managing pain, while potentially offering additional benefits such as faster recovery, improved patient satisfaction, and reduced reliance on opioids. However, the effectiveness of nerve blocks varies depending on type of surgery, and in individual patients. Rebound pain, which temporary increase in pain after a block wears off, can occur. In addition, some techniques require specialized guidance for accurate placement. In conclusion, nerve blocks show great promise as effective alternatives for managing post-surgical pain. They can reduce the need for opioids and their side effects, leading to better patient outcomes and satisfaction. Future studies should assess the long-term impacts of specific nerve blocks on mortality rates, cost-effectiveness, and their incorporation into multimodal pain management approaches to further enhance post-surgical care.

Can a Continuous Wound Infiltration System Replace Intravenous Patient-Controlled Analgesia for Postoperative Pain Management after a Single-Port Access Laparoscopy?

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

Patient and provider perspectives on pain and other dimensions of anesthesia experience for cesarean delivery: A qualitative study.

There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery. Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved. A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans. Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries.

Exploring distraction techniques and parental satisfaction during infant immunization: a pilot study in aspirational district Darrang and non-aspirational districts Karimganj of Assam

Background: In India, the percentage of children aged 12-23 months who have had full immunization coverage (FIC) has increased dramatically from 62% to 76%. UNICEF, 2022. As stated in the WHO report for 2022. Global coverage decreased to 81% in 2021 from 86% in 2019. Methods: The study’s methodology involved studying how the 4 S’s technique, oral sucrose, and each of them affect parents’ satisfaction and infants’ perception of pain after vaccination in Darrang aspirational and Karimganj non-aspirational districts. Eighty infants were involved in the pilot project, split into four groups of ten infants each. Results: In the study at Civil Hospital Mangaldoi, group C reported the highest parental satisfaction (mean=3.2) with no dissatisfaction and the lowest mean pain intensity (1.3, SD=0.48). Group A had 100% satisfaction (mean=3.1, SD=0.31), group B had 90% satisfaction (mean=3.0, SD=0.47), and the control group had the lowest satisfaction (30%, mean=2.3, SD=0.67) with 70% dissatisfaction. Group C’s outcomes demonstrate both the highest satisfaction and the least intense, most consistent pain perception among participants. Conclusions: This study’s conclusion emphasizes how critical it is to overcome vaccine reluctance and enhance immunization experiences by employing efficient pain control strategies. The findings support the implementation of interventions such as sucrose administration and other pharmacological and non-pharmacological approaches to reduce pain associated with vaccinations, particularly in paediatric populations.

How is postoperative pain after hip and knee replacement managed? An analysis of two large hospitals in Australia

BackgroundMultimodal analgesia regimens are recommended for the postoperative period after hip and knee replacement surgeries. However, there are no data on practice patterns for analgesic use in the immediate postoperative period after hip and knee replacements in Australia.ObjectivesTo describe analgesic prescribing patterns in the inpatient postoperative phase for patients undergoing hip and knee replacement.MethodsRetrospective study of electronic medical record data from two major hospitals in Sydney, Australia. We identified analgesic medication prescriptions for all patients aged 18 years and older who underwent hip or knee replacement surgery in 2019. We extracted data on pain medications prescribed while in the ward up until discharge. These were grouped into distinct categories based on the Anatomical Therapeutic Chemical classification. We described the frequency (%) of pain medications used by category and computed the average oral morphine equivalent daily dose (OMEDD) during hospitalisation.ResultsWe identified 1282 surgeries in 1225 patients. Patients had a mean (SD) age of 69 (11.8) years; most (57.1%) were female. Over 99% of patients were prescribed opioid analgesics and paracetamol during their hospital stay. Most patients (61.4%) were managed with paracetamol and opioids only. The most common prescribed opioid was oxycodone (87.3% of patients). Only 19% of patients were prescribed nonsteroidal anti-inflammatories (NSAIDs). The median (IQR) average daily OMEDD was 50.2 mg (30.3–77.9).ConclusionWe identified high use of opioids analgesics as the main strategies for pain control after hip and knee replacement in hospital. Other analgesics were much less frequently used, such as NSAIDs, and always in combination with opioids and paracetamol.

Periarticular cocktail injection is more useful than nerve blocks for pain management after anterior cruciate ligament reconstruction

BackgroundAnterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction. MethodsThis retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test. ResultsThere were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008). ConclusionsFollowing ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.

Addressing the Quandary of Chronic Pain: Learning From Phenomenological Research

Considerable research in recent years has explored the phenomenological experience of patients living with chronic pain. Numerous studies describe pain as a threat to the self and as the target of mostly unsuccessful medical or psychological interventions. Chronic pain, for many sufferers, represents a quandary. It is an alien experience—an impediment or burden imposed on the self—and also one that is intimately familiar, a condition in which the individual with pain is living. The quandary elicits continual engagement in threat detection and efforts to alleviate distress by pursuing pain control strategies of various kinds, many of which exacerbate the pain experience over time. The urge to escape from pain alternates with the pull to be heard, to convey the unique experience of pain and its onus to another. Amid this intractable experience, the patient in pain continually vacillates between urgent efforts to eradicate pain and to define the experience in terms that others, particularly medical practitioners, can understand and validate. Current interventions in medicine and clinical psychology may inadvertently perpetuate the quandary of chronic pain by participating in efforts to reduce or contain the physical symptoms of pain while failing to attend to the patient’s articulation of life experience. A descriptive alternative to mechanistic and functionalist approaches to the psychological treatment of pain offers an alternative to intervention strategies that perpetuate the quandary of chronic pain. Such an approach has the potential to help individuals embrace all aspects of themselves and lead fuller and richer lives.

Enhanced Recovery After Surgery Orthopaedics Program in a Community-Based Health Care System.

Enhanced Recovery After Surgery programs are common among healthcare systems and various surgical disciplines. Although evidence supporting the physiological rationale of multiple nutrition, physical activity, and pain control strategies before, during, and after surgical procedures is accumulating, implementing such strategies may pose a substantial challenge. The purpose of this quality improvement initiative was to outline the development, workflow, and implementation of an Enhanced Recovery After Surgery program for same-day total joint replacement procedures in a rural healthcare setting. This was not just an academic exercise. Our leadership had a strong desire to support our patients by identifying ways to hasten their recovery so that they can return to their preferred activities.

Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial

ObjectiveReconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). Material and methodsDouble-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. ResultsThe intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ​± ​1.0 vs. 1.3 ​± ​0.6 in the epidural group; p ​= ​0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ​± ​15 vs. 102 ​± ​11 in the epidural group (p ​= ​0.001). ConclusionsEpidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications. Level of evidence2.

Perioperative pain management after scapular tip free flap harvesting for head and neck reconstruction using mini-catheters to inject the local anesthetic.

Although functional and esthetic results after the use of a scapular tip free flap (STFF) in head and neck reconstruction, and the related donor-site morbidity, have been extensively described, data regarding acute postoperative donor-site pain management are lacking. Purpose of this study is to explore the use of mini-catheters to administer local anesthetics for donor-site pain management after reconstruction using STFF. Patients who underwent head and neck reconstruction using a STFF were prospectively enrolled and, through a perineural catheter placed in the donor site during the surgical procedure, a bolus of chirochaine was injected before the patient regained consciousness and at 8, 16, and 24 h postoperatively. Before and 40 min after each dose administration, donor-site pain on a numerical rating scale (NRS; 0-10) was evaluated. Study population consisted of 20 patients (40-88 years). At 8 h, the pain scores before and after the injection were 0-10 (mean 3.35) and 0-5 (mean 1.25), respectively. At 16 h, the pain scores before and after the injection were 0-8 (mean 2.55) and 0-4 (mean 0.55), respectively. At 24 h, the pain scores before and after the injection were 0-8 (mean 1.30) and 0-4 (mean 0.30), respectively. Statistical analysis confirmed a significant difference between the pain scores before and after administration at 8, 16, and 24 h (p < 0.001, p < 0.001, and p = 0.003, respectively). Mini-catheters for local anesthetic administration represent an effective strategy for pain control after STFF harvesting for head and neck reconstruction.

Formulation and assessment of penetration potential of Risedronate chitosan nanoparticles loaded transdermal gel in the management of osteoporosis: In vitro and ex vivo screening

Osteoporosis targeting by transdermal distribution has drawn a lot of attention as a cutting-edge, environmentally friendly platform for sustainable pain management. We investigate a novel biocompatible transdermal gel (RCNGL) containing biodegradable chitosan nanoparticles and Risedronate (RS) to treat osteoporosis. The RCNGL was formulated using the Pluronic F 127 co-polymer system and the ionic gelation process. The formulation showed a robust architecture of nanoparticle dispersion with a nano-size range of 201.8 nm when it was thoroughly analysed for Scanning Electron Microscopy, Dynamic electron Microscopy and transmission electron microscopy. At various temperatures, the entrapment efficiency was 67.53±1.05% with steady rheology and respectable porosity, validating FT-IR spectra that showed structural compatibility of RS with other excipients. The drug release test resulted in an 88% RS gel release, supporting sustained release kinetics. The ex vivo Franz diffusion study and in vitro cell uptake and distribution experiments revealed clear cell uptake and distribution with notable skin permeation displaying >70% RS release in mouse epidermal tissue. Overall, our research shows that biodegradable RCNGL may offer a potential osteoporosis and pain control strategy in clinical platforms using passive targeting.

Impact of common surgical and anaesthetic strategies for pain control after elective gastrointestinal surgery: cohort study

Introduction: Poor pain control after surgery is associated with chronic pain and opioid dependence. This study aimed to determine the incidence of patient reported pain control failure following gastrointestinal surgery, and to evaluate the impact of common preventative surgical and anaesthetic strategies.&#x0D; Methods: Data were extracted from an electronic health record that linked real-time, ward-based pain scores with prescribing data. Adults undergoing major elective gastrointestinal surgery in 2011-18 were included. The primary endpoint was early pain control failure (≥1 instances of moderate or severe pain on postoperative days 0-2). Secondary outcomes were late (postoperative days 3-5) and persistent (both early and late) pain control failure.&#x0D; Results: Of 2238 patients, half underwent planned open surgery (50.3%, 1126/2238). Patient controlled analgesia (PCA) was initially used in 49.7% (1113/2238) and epidural in 35.0% (784/2238). Early (54%, 1211/2238), late (33.7%, 755/2238), and persistent (24.9%, 557/2238) pain control failures occurred frequently. In multivariable analyses, minimally invasive surgery was associated with fewer early, late, and persistent pain control failures than open surgery. There was no association between initial epidural analgesia and early or persistent pain control failure, but there was an association with increased late failure (OR 1.37, 95% CI 1.08-1.73, p=0.009). Of patients with initial epidural analgesia, 39.3% (308/784) were subsequently converted to PCA.&#x0D; Conclusion: Epidural analgesia offered no advantage over PCA, with pain control failure common irrespective of analgesic strategy. Increasing the uptake of minimally invasive surgery, through medical advances to down-stage disease, may offer a path to effectively improve postoperative pain failure.

Labor Pain Management

Labor pain is a complex and multifaceted revel that substantially impacts the birthing manner. Effective pain control is vital to improve maternal comfort, reduce strain, and beautify normal childbirth satisfaction. This assessment explores various strategies for hard work pain control, encompassing both pharmacological and non-pharmacological processes. Pharmacological methods encompass epidural analgesia, spinal blocks, and systemic medicines, which offer extensive pain alleviation but might also convey capability aspect effects and dangers. Non-pharmacological techniques, including respiratory strategies, hydrotherapy, acupuncture, and continuous exertions assist, offer alternative or complementary pain comfort with minimum adverse outcomes. The mixing of those methods into individualized pain control plans can deal with the various wishes and choices of laboring girls. Moreover, the function of healthcare carriers, in particular midwives and obstetricians, in facilitating informed picks and helping girls’ pain management choices is vital. This assessment underscores the importance of a holistic and affected person-focused technique to labor pain management, advocating for the combination of evidencebased practices with personalized care to optimize outcomes for both mother and baby.

Practice of Nonpharmacological Pain Control Strategies Among Nurses Working in Public Hospitals of West Arsi Zone, Ethiopia.

Nonpharmacological pain control strategies combine numerous strategies that contain nondrug measures for pain remedies for sufferers. To assess the practice of nonpharmacological pain control strategies among nurses working in public hospitals of West Arsi zone, Ethiopia, 2022. An institutional-based cross-sectional study design was employed from April 15 to May 30, 2022. The total sample size was 422 and a simple random sampling technique was used. Data were entered using Epi-information 4.6 version and analyzed using SPSS version 25. Multicollinearity was checked by considering the variance inflation factor and tolerance. The goodness of fit test was done using the Hosmer-Lemeshow goodness of fit check. Binary logistic regression analysis was done and variables with a p-value of < 0.25 within the bivariable analysis were taken into the multivariable analysis. Statistical significance was declared at a p-value of < 0.05 with an adjusted odds ratio (AOR) and 95% confidence interval (CI). The practice of nonpharmacological pain control strategies was 53.8% (95% CI: 48.9-58.7). Age of 30-39 years old (AOR: 2.28, 95% CI: 1.34-3.86), educational status bachelor's degree (AOR: 2.25, 95% CI: 1.47-4.45), marital status married (AOR: 0.46, 95% CI: 0.28-0.73), and having training (AOR: 1.98, 95% CI: 1.23-3.17) were found to be significantly associated with practice of nonpharmacological pain control strategies. About five in 10 nurses working in West Arsi zone public hospitals had good practice of nonpharmacological pain control strategies. Age, educational status, marital status, and training were found to be significantly associated with practice. Therefore, improving the educational status of nurses through various opportunities such as continued professional development and regular updating, and training nurses about methods may increase the nurses' practice toward nonpharmacological pain control strategies.

Paediatric Palliative Care: Challenges and Opportunities for Nurses: A Literature Review

Background: Paediatric palliative care is a specialized approach designed to improve the quality of life for children facing life-limiting illnesses, and their families. This comprehensive review explores the various interventions implemented within the realm of paediatric palliative care, encompassing physical, emotional, social, and spiritual dimensions. Methods : A systematic literature search was conducted across major medical databases, identifying studies, reviews, and guidelines related to paediatric palliative care interventions. The selected articles were critically appraised to extract information on diverse aspects of care, including symptom management, psychosocial support, family-centred approaches, and ethical considerations. Results: The review synthesizes evidence on the holistic nature of paediatric palliative care, highlighting the effectiveness of multidisciplinary teams in addressing the complex needs of children and their families. Physical symptom management, encompassing pain control and other symptom alleviation strategies, emerged as a crucial component. Psychosocial support interventions, including counselling and therapeutic approaches, were found to enhance emotional well-being for both children and their caregivers. Discussion: Effective communication emerged as a fundamental aspect, fostering shared decision-making and open dialogue about the child’s illness, prognosis, and treatment options. The family-centred approach recognized the pivotal role of families in the care continuum, emphasizing their needs and preferences. Ethical considerations surrounding end-of-life care were explored, emphasizing the importance of navigating complex decision-making processes with sensitivity and respect for cultural and religious beliefs. Conclusion: Paediatric palliative care, as revealed through this comprehensive review, constitutes a multifaceted and evolving field. The integration of diverse interventions, coupled with ongoing research and advancements, underscores the commitment to enhancing the quality of life for children facing life-limiting illnesses and their families. Future directions include continued collaboration between healthcare professionals, increased awareness, and further research to optimize care practices and outcomes in paediatric palliative care. Keywords: paediatric palliative care, multidisciplinary care, symptom management, psychosocial support, family-centred care, ethical considerations

Poke Plan: An Initiative to Improve Distraction and Pain Mitigation With Venous Access in Hospitalized Children.

Adequate pain control and anxiety relief during peripheral intravenous cannula (PIV) placement improves patient, parental, and staff satisfaction and reduces health care-induced stress in children. We noted a low rate of analgesic/anxiolysis use (<20%) and child life utilization (3%) in our institution. This quality improvement project was initiated to increase pain mitigation strategies in hospitalized children requiring PIV access. From November 2020 to March 2021, we created a key driver diagram and summarized possible interventions with the aim to increase our use of pain control strategies to >40% and child life utilization to 25%. For 12 months, 8 Plan-Do-Study-Act cycles were conducted focusing on nursing education and training, improved documentation, electronic medical record optimization, easy access to analgesics and anxiolytics, family involvement, and weekly huddles. Our primary measure was the percentage use of pain medications for PIV access. The utilization of PIV experts from the ICU (advanced practice registered nurses and physicians) served as the balancing measure. A total of 883 patient charts were reviewed. The use of topical anesthetics and anxiolytics increased from 16.2% at baseline to 78.9% after the implementation of the quality improvement project. Eighty percent of parents reported their child was kept comfortable during the procedure using pain mitigation and comfort measures. A slight increase from 2% to 5.8% was noted in the utilization of advanced practice registered nurses and intensivists. Implementation of a standardized approach for PIV placement improved team communication and provided better preparation for pain control before needle insertions in hospitalized children.

Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study

BackgroundParasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively.MethodsWe designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction.ResultsNinety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00–3.00), 2.00 (0.00–5.50), and 15.60 mg (9.60–30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group.ConclusionsBoth SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs.

Shoulder pain management strategies and early functional outcome after arthroscopic rotator cuff tear repair. A randomized controlled study

BackgroundThe management of acute postoperative pain after rotator cuff surgery can be challenging. To our knowledge, there are no data available in the literature correlating satisfactory pain control with improvement in terms of function. The purposes of the present study were to evaluate: 1) pain pattern after arthroscopic rotator cuff repair in patients operated with two different techniques (transosseous vs transosseous equivalent); 2) safety/efficacy of three different pharmacological pain control strategies; 3) possible relationship between a correct shoulder pain management protocol in the early post-operative period and patients’ functional improvement. Methods114 patients underwent rotator cuff tear repair, either with a Transosseus or a Transosseus equivalent technique. 62 (54%) were male and 52 (46%) were female. The average age was 59 ± 9 years. They were randomly assigned into three different pain management protocols: Paracetamol as needed (max 3 tablets/day) for 1 week (Protocol A), Paracetamol + Codein 1 tablet three times per day for 7 days (Protocol B), or Paracetamol + Ibuprofen 1 tablet two times per day for 7 days (Protocol C). Immediate passive mobilization of the operated shoulder was allowed. VAS and Passive Flexion values were recorded at 7 (T1), 15 (T2) and 30 (T3) days post-surgery. DASH values were recorded at 90 days post-surgery. All patients were asked to register any kind of signs/symptoms that may appear during drug assumption according to each pain management protocols. ResultsAll the pain management protocols administered were well tolerated by all the study population, and no adverse signs/symptoms were highlighted during drug assumption.Pain pattern: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean VAS at each time point examined when compared to Protocol B and C (p < 0,05). In patients within Protocol A, no statistically significant differences were found at each point time examined comparing the two surgical techniques, with the exception of T2, where the TO was associated with an higher VAS value than TOE (p < 0.05). No differences were highlighted in Protocol B and C when comparing the values between two surgical techniques.ROM: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean PROM at each time point examined when compared to Protocol B and C (p < 0,05). In the TO group, patients within Protocol B had better PROM values at T1 (p < 0,05) and T2 (p < 0,05) compared to Protocol C, but no differences were highlighted at T3. In the TOE group, no statistically significant differences were found between patients within Protocol B and C at each time point examined.DASH: In the TO group, no statistically significant differences were found regarding the DASH values comparing Protocol B vs Protocol C, but they were highlighted comparing the values between Protocol A and Protocol B (p < 0,05), and between Protocol A and Protocol C (p < 0,05). Similar results were recorded in the TOE group. ConclusionPost-operative pain is influenced by the surgical technique used being transosseous more painful in the first 15 days after surgery. Oral anti-inflammatory drugs are a feasible strategy to appropriately control post-operative pain. An association between Paracetamol and either Codein or Ibuprofen can lead to better outcomes in terms of VAS reduction and early recovery of passive ROM.

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy.

Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8h after surgery, and 1, 2, and 3days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. ClinicalTrials.gov Identifier: NCT05733741.

Virtual reality for pain management: an umbrella review.

Virtual reality is a promising pain control strategy for various pain conditions. This umbrella review of systematic reviews and meta-analyses aims to evaluate the analgesic effects of virtual reality. We searched for the relevant reviews in Scopus, PubMed and Cochrane library. Our primary outcome was pain, with secondary outcomes including disability, general health status, patient satisfaction, depression, balance, fear of movement, and adverse events. The quality of included articles was evaluated using the AMSTAR-2 tool. 21 systematic reviews and meta-analyses with 274 studies and 17,680 patients were included in this review. All the reviews concluded benefits of virtual reality in managing pain conditions, including chronic and pain. This umbrella review demonstrates successful application of virtual reality in pain control, including perioperative, periprocedural, and chronic pain settings. Virtual reality can be used as an alternative therapy for pain management in children and adults.