Treatment Of Acute Postoperative Pain Research Articles

Transcutaneous electrical nerve stimulation for the treatment of acute postoperative pain following spine surgery: a scoping review.

Given the ubiquity and severity of postoperative pain following spine surgery, developing adequate pain management modalities is critical. Transcutaneous electrical nerve stimulation (TENS) is a promising noninvasive modality that is well studied for managing postoperative pain following a variety of surgeries, but data on using TENS for pain management in the acute postoperative period of spine surgery are limited. Therefore, this review aimed to recapitulate the existing evidence for the use of TENS in postoperative pain management for spine surgery and explore the potential of this modality moving forward. A scoping review was conducted according to 2020 PRISMA guidelines. Two independently operating reviewers then conducted a systematic search of PubMed, Embase, and Scopus databases to identify studies that reported the use of TENS for the treatment of acute postoperative pain following spine surgery. The following data were abstracted from included studies: study type, sample size, demographics, surgery details, comparison group, assessment parameters, timing of postoperative assessment, TENS technical characteristics, relevant findings, length of hospital stay, complications with TENS, and notable limitations. Nine hundred thirty-two publications were screened, resulting in 6 studies included in this review, all of which were prospective clinical trials. The publication dates ranged from 1980 to 2011. Spine surgery types varied; the most common was posterior lumbar interbody fusion. No studies evaluated pain control in cervical- or thoracic-only surgeries. All 6 studies evaluated the level of postoperative pain directly. Five of the 6 studies that directly examined postoperative pain reported lower levels of pharmacological analgesia usage in the TENS groups compared with controls, with 4 of these studies reporting this difference as statistically significant. Length of hospital stay was evaluated in 2 studies, both of which reported decreases in mean length of stay, but these differences were not significant. Notably, every study reported distinct TENS administration parameters while also reporting similar results. This review concludes that TENS is effective at reducing postoperative pain in spine surgery. Further investigation is needed regarding the optimal settings for TENS administration, as well as efficacy in the thoracic and cervical spine.

Time Effect on Acute Postoperative Pain After Total Knee Replacement Surgery: An Exploratory Study Using the Experience Sampling Method.

Acute postoperative pain (APP) is the main cause of postoperative dissatisfaction; however, traditional methods of pain assessment provide limited insights into the dynamics and development of APP. This study used the experience sampling method (ESM) to understand the dynamics of APP over time in relation to various patient factors. Forty patients scheduled to undergo total knee replacement surgery were recruited in this study. Following an initial assessment, a short report questionnaire was sent to the patients via 10 digital alerts per day to assess the pain levels during two preoperative and the first 6 postoperative days. The data were analyzed using multilevel regression including random intercept and slope. Thirty-two patients submitted the pre-specified minimum of 30% of their short reports, yielding 1217 records. The analysis revealed significant (P<0.001) linear and quadratic decreases in APP and a quadratic time effect. The lowest between-days and within-day pain levels were observed on postoperative day 4.8 and during the time slot 3.8 or approximately 19:15, respectively. Significant random intercepts and slopes were noted, indicating variations in the mean pain level between patients and a decrease in pain. None of the 10 patient factors had any confounding effect. Using ESM data combined with multilevel analysis, we were able to evaluate the postoperative pain course while considering inter-individual differences in the baseline pain level and non-linear pain course over time. The findings of this study could aid clinicians in personalizing the treatment for APP.

Tapentadol Immediate Release (IR) versus Morphine Hydrochloride for Postoperative Analgesia of Patients Undergoing Total Abdominal Hysterectomy-A Prospective Cohort Study.

Background and Objectives: This study aimed to examine the efficacy of tapentadol immediate release (IR) and morphine hydrochloride in the treatment of acute postoperative pain after total abdominal hysterectomy, as well as to examine the frequency of opioid-related side effects in observed patients. Materials and Methods: The prospective observational study was conducted over five months, and it included a total number of 100 patients. The two cohorts had different types of postoperative analgesia, and the effects were observed for 24 h postoperatively, by following the pain scores on NRS (Numerical Pain Scale), contentment with analgesia, and opioid-related side effects. Results: Statistical significance was found when assessing pain 24 h after surgery while coughing, where patients in the tapentadol IR group had significantly higher mean pain scores (p < 0.01). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in the tapentadol IR group (p = 0.005). Vertigo appeared significantly more in patients from the morphine group (p = 0.03). Conclusions: Tapentadol IR (immediate release) and morphine hydrochloride are both effective analgesics used in the first 24 h after total transabdominal hysterectomy. Overall satisfaction of patients with analgesia was good. The frequency of side effects was higher in the morphine group, with statistical significance regarding the vertigo.

The Preoperative Use of Gabapentinoids for the Treatment of Acute Postoperative Pain Following Lumbar Spine Fixation Surgery

A prospective, randomized, controlled, and double-blind trial. Postoperative pain following posterior fixation is caused not only by tissue injury during surgery and is related to inflammatory, neuropathic, and visceral pain. This study aims toanswer the question "Is there a role of gabapentinoids in reducing postoperative pain?" In addition, it demonstrates which gabapentinoidsmaybe used for how long and at what dose. The study was planned as a prospective, randomized, double-blind study. Lumbar posterior fixationwasincluded and patientswere divided into 9 groups. Gabapentinoids and a placebo were administered. Postoperative pain at hours1,6,12, and 24 was evaluated by VAS RESULTS: This study consisted of 252 patients (141 women, 111 men). The median age was 51.62 years. A statistically significant difference was found when VAS-1, VAS-6, VAS-12, and VAS-24 scores were compared between all groups (p˂0.001). Single and low doses of gabapentinoids were found to be ineffective (p˃0.05). Long-term and high-dosegabapentinoids had complications (p˂0.001). Single and high doses of gabapentinoids were effective and safe (p˂0.001). Postoperativeuse of gabapentin for controlling early and late-stage pain is safe and effective. singlesingle and high-dose gabapentin was the first choice. A single and high dose of pregabalin is the second choice.

Pregabalin as an effective treatment for acute postoperative pain following spinal surgery without major side effects: protocol for a prospective, randomized controlled, double-blinded trial

BackgroundPatients experience considerable postoperative pain after spinal surgery. As the spine is located at the centre of the body and supports body weight, severe postoperative pain hinders upper body elevation and gait which can lead to various complications, including pulmonary deterioration and pressure sores. It is important to effectively control postoperative pain to prevent such complications. Gabapentinoids are widely used as preemptive multimodal analgesia, but their effects and side effects are dose-dependent. This study was designed to examine the efficacy and side effects of varying doses of postoperative pregabalin for the treatment of postoperative pain after spinal surgery.MethodsThis is a prospective, randomized controlled, double-blind study. A total of 132 participants will be randomly assigned to the placebo (n = 33) group or to the pregabalin 25 mg (n = 33), 50 mg (n = 33), or 75 mg (n = 33) groups. Each participant will be administered placebo or pregabalin once prior to surgery and every 12 h after surgery for 72 h. The primary outcome will be the visual analogue scale pain score, total dose of administered intravenous patient-controlled analgesia, and frequency of rescue analgesic administered for 72 h from arrival to the general ward after surgery, subdivided into four periods: 1–6 h, 6–24 h, 24–48 h, and 48–72 h. The secondary outcomes will be the incidence and frequency of nausea and vomiting due to intravenous patient-controlled analgesia. Safety will be assessed by monitoring the occurrence of side effects such as sedation, dizziness, headache, visual disturbance, and swelling.DiscussionPregabalin is already widely used as preemptive analgesia and, unlike nonsteroidal anti-inflammatory drugs, is not associated with a risk of nonunion after spinal surgery. A recent meta-analysis demonstrated the analgesic efficacy and opioid-sparing effect of gabapentinoids with significantly decreased risks of nausea, vomiting, and pruritus. This study will provide evidence for the optimal dosage of pregabalin for the treatment of postoperative pain after spinal surgery.Trial registrationClinicalTrials.gov NCT05478382. Registered on 26 July 2022.

Laparoscopic transversus abdominis plane block reduces postoperative opioid requirements after laparoscopic cholecystectomy

BackgroundSurgeons directly contribute to the over-prescription of opioids. Alternative postoperative pain management strategies are necessary to reduce opioid dispensation and combat the opioid epidemic. We set out to examine the effectiveness of a laparoscopic transversus abdominis plane block on reducing opioid requirements after laparoscopic cholecystectomy. MethodsIn a retrospective cohort analysis, we compared opioid naïve patients who underwent an elective, outpatient laparoscopic cholecystectomy with a transversus abdominis plane block with patients who underwent a laparoscopic cholecystectomy alone between January 2018 and June 2021 at a single institution. Patient characteristics, perioperative pain scores, and postoperative analgesic requirements were compared between cohorts. ResultsThere were 200 patients included in the study (laparoscopic cholecystectomy with a transversus abdominis plane block, n = 100; laparoscopic cholecystectomy alone, n = 100). The average postoperative pain scores in the postanesthesia care unit were equivalent between the groups (laparoscopic cholecystectomy with a transversus abdominis plane block = 3.39 versus laparoscopic cholecystectomy alone = 4.17, P = .12), with the mean postanesthesia care unit opioid requirements significantly lower in patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block (12.1 vs 20.4 oral morphine equivalents, P < .001). Patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block were prescribed fewer opioids on discharge (mean 77.5 vs 92.9 oral morphine equivalents, P < .05) and reported using a lower proportion of their opioid prescription at follow-up (83.2% vs 100%, P < .001). Of the patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block, 65% reported using over-the-counter pain medications compared with 82% of patients receiving laparoscopic cholecystectomy alone (P < .001). ConclusionPerforming a laparoscopic transversus abdominis plane block during elective laparoscopic cholecystectomy is a safe and effective strategy to reduce postoperative opioid requirements for the treatment of acute postoperative pain.

Treatment of acute postoperative pain in patients undergoing open abdominal aortic repair (current state of the problem)

The epidemiology of acute postoperative pain and complications associated with inadequately controlled acute postoperative pain syndrome were considered. The paper presents treatments for acute postoperative pain, the clinical value of multimodal analgesia in enhanced recovery, and reduction of mortality in patients undergoing open abdominal aortic repair. The problem associated with the limitations of the methods in postoperative pain management after open surgical abdominal aortic repair is also considered. The paper also presents alternative methods of multimodal analgesia in patients undergoing other abdominal surgery. The choice of the optimal method in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair is now significantly limited, as a comparative analysis of alternative methods of analgesia and epidural analgesia in vascular surgery was not conducted. Multicenter studies on multimodal analgesia in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair are therefore required when deviating from the standard protocol.

Sublingual Sufentanil vs. Intravenous Fentanyl for the Treatment of Acute Postoperative Pain in the Ambulatory Surgery Center: A Randomized Clinical Trial.

Objectives Sublingual sufentanil is a novel opioid medication to treat moderate to severe pain postoperatively. This study's aim was to determine if a single dose of a sublingual sufentanil tablet (SST) is as efficacious as a single dose of intravenous (IV) fentanyl in readiness to discharge from ambulatory surgery. Methods This was a two-arm, parallel group, randomized prospective outcomes study conducted at a single, free-standing ambulatory surgery center. Patients aged 18–80 undergoing general anesthesia who developed a postoperative pain score of ≥ 4 were enrolled and randomized to receive either 30 mcg SST or 50 mcg IV fentanyl. After their initial randomized dose, rescue IV fentanyl followed by oral oxycodone if needed. Recovery length of stay from arrival in the postanesthesia care unit until readiness to discharge criteria was met based on phase 2 discharge criteria. Results 75 patients were analyzed. Readiness to discharge from the recovery room was not significantly different between either group (IV fentanyl median 65 minutes; IQR 56–89; SST 73 min, IQR 58–89; p=0.903). There was no significant difference in the amount of morphine equivalents (MME) of rescue opioids needed (IV fentanyl median rescue MME of 22.5, IQR 13.1–23.4; SST median rescue MME of 15.0, IQR 7.5–30.0; p=0.742). The change in pain from PACU initially, and on discharge was not significantly different (IV fentanyl initial pain minus pain on discharge median 3, IQR 2–4; SST initial pain minus pain on discharge median 4, IQR 2–5.5; p=0.079). There was no difference in the six-item screener and the Overall Benefit of Analgesic Survey Score. Discussion. In conclusion, patients who received a sublingual sufentanil 30 mcg tablet had no significant differences in PACU length of stay or rescue analgesic usage when compared to intravenous fentanyl 50 mcg.

Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis.

IntroductionOrthopedic procedures have been associated with increased pain, making perioperative analgesia a major clinical concern. We assessed the efficacy and safety of intravenous parecoxib administration during the perioperative period for postoperative pain relief after orthopedic surgery in adults.MethodsPubMed, Cochrane Library, EMBASE, and clinicaltrial.gov were searched from inception to 23 August 2021 without language restrictions. Randomized controlled trials comparing intravenous parecoxib with placebo or another active treatment for acute postoperative pain in adults after orthopedic surgery were included. The primary outcomes were the pain scores and cumulative morphine consumption. The secondary outcomes included the proportion of patients requiring rescue analgesics and the incidence of adverse events. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered on the International Prospective Register of Systematic Reviews Registration (PROSPERO).ResultsTwenty-seven trials (n = 2840) from more than 20 countries involving six types of orthopedic surgery met the inclusion criteria. Compared with placebo, intravenous parecoxib administration led to reductions in postoperative resting pain scores at 6, 12, 24, and 48 h [mean difference (MD) −0.87, 95% confidence interval [CI] −1.71 to −0.03; MD −0.86, 95% CI −1.26 to −0.46; MD −0.57, 95% CI −0.84 to −0.31; MD −0.40, 95% CI −0.69 to −0.11, respectively], postoperative movement pain scores at 24 and 48 h (MD −0.66, 95% CI −1.14 to −0.19; MD −0.78, 95% CI −1.16 to −0.39, respectively), cumulative morphine consumption (MD −11.30 mg, 95% CI −14.79 to −7.81 mg), and the proportion of patients requiring rescue analgesia (relative risk 0.83, 95% CI 0.77–0.89). There was no difference in the incidence of adverse events between groups.ConclusionLow to moderate evidence indicates that parecoxib might be an effective and safe analgesic in perioperative orthopedic settings. It relieves postoperative orthopedic pain while sparing opioid analgesic consumption without increasing the incidence of adverse events.PROSPERO RegistrationCRD42021274939.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00400-1.

Perioperative management of acute pain by multimodal analgesia after laparoscopic sleeve gastrectomy: A prospective cohort study

BackgroundBariatric surgery has been shown to be the most effective treatment in achieving and maintaining weight loss and reducing obesity-related morbidities. Adequate measurement and control of pain allows for better postoperative outcomes and substantial reduction of complications, especially in subjects with morbid obesity. The aim of this study was to investigate the efficacy of postoperative analgesia via the utilization of a multimodal approach and to determine predictors of postoperative pain severity in patients undergoing laparoscopic sleeve gastrectomy (LSG). MethodsThis is a prospective cohort study designed to evaluate a perioperative multimodal analgesia protocol (i.e. subcutaneous/subfascial and intraperitoneal instillation of Ropivacaine; nonsteroidal anti-inflammatory agents; paracetamol and minimal dose of oral opioids) in subjects undergoing LSG. Evaluation of postoperative analgesia was performed at 1, 4 and 24 h after surgery through employment of chromatic visual analogue scales (VAS). ResultsBetween February and June 2019, a total of 48 consecutive patients affected by morbid obesity (mean BMI 41.83±5.51 kg/m2) underwent LSG. Mean operative time was 106±31.56 min. Only 8 patients (16.6%) required Morphine rescue in order to bring VAS at rest to ≤5. Pearsons’ coefficient showed a negative pCO2 correlation before surgery and both VAS scores measured at rest and during activity at different time points. P/F ratio and pCO2 measured before surgery were strong predictors of VAS >5 at rest and during activity (AUC=0.981 and AUC=0.980, respectively). ConclusionsThe identification of pain predictors could aid in foreseeing those patients requiring supplementary analgesia. Hence, a tailored analgesia protocol could be performed for each patient, improving pain management and perioperative outcomes. A multimodal analgesic protocol appears to represent the gold standard in the treatment of acute postoperative pain, especially in patients with morbid obesity, who require a rapid retrieval of physiologic functions in order to reduce the risk of postoperative complications.

Acute post-operative pain: A systematic review

Post-operative pain management is very important part of surgical care. Improper management of perioperative pain can result in increased hospital stay, cast of treatment, morbidity or mortality. This review aims to present key considerations for postoperative pain management. Searches of the Cochrane, PubMed and Google Scholar databases were performed using terms postoperative pain, pain management, acute pain ,and analgesia. Result and conclusion. Effective treatment of acute postoperative pain is possible when we utilize a true multimodal approach which includes non-pharmacological and pharmaceutical strategies.

English

BACKGROUND Presence of pain is as old as that of humankind. From ancient times, pain has followed surgeons as well as anaesthesiologists like a shadow which is not seperable.1 Postoperative pain is an acute pain which can affect nearly all organ functions and can leads to postoperative period morbidity and mortality. Pharmacological treatment using intravenous opioids is an effective and popular method to treat the pain.2 In this study the researcher compared the analgesic efficacy and side effects of intravenousNalbuphine and Tramadol in those patients undergoing Lower limb Orthopaedic procedures. To investigate the effect of Nalbuphine and Tramadol on post-operative pain and to compare the side effects among Nalbuphine and Tramadol group in patient admitted in Travancore Medical College, Kollam during the period from January 2019 to September 2019. METHODS This study was a prospective observational study. The study population comprises, 140 patients falling within the inclusion criteria who had given consent for participating in this study. Sub arachnoid block is commonly followed in our Anesthesiologydepartment for Lower limb orthopaedic procedures 3 to 3.5ml of 0.5% hyperbaricbupivacaine via 25 G spinal needle. No analgesic or sedative will be given intra operatively.Patients who had received Injection Nalbuphine 0.15 mg/kg IV diluted till 10 ml volume innormal saline and Injection Tramadol 2 mg/kg IV diluted till 10 ml volume of normal salinewere grouped as N (n=70) and T (n=70) respectively. Post-operative pain was assessed usingVAS, onset of drug effect and duration of action of each dose of drug. Side effects of drugsassessed using the variables such as incidence of postoperative nausea and vomiting (PONV),Ramsay sedation scores, respiratory rate and SpO2. VAS score assessed initially every5 minutes till 15 minutes, then every 30 minutes till 2 Hrs, then 3 Hrs, 4 Hrs, 5 Hrs, 6 Hrs,8 Hrs, 12 Hrs, 16 Hrs, 20 Hrs and 24 Hrs. Ramsay sedation scores, respiratory rate and SpO2 were assessed initially every 5minute till 15minutes, every 30minute till 2 hours, then at 4 Hrs, 6 Hrs, 8 Hrs, 12 Hrs,16 Hrs, 20 Hrs and 24 Hrs duration. RESULTS From the results we found that with successive doses it Nalbuphine proven to be having significantly longer duration of analgesia than Tramadol after the third dose. Based on the VAS scores Group T is more effective in controlling pain initially, butlater on pain scores significantly less with Group N became more effective. Side effects likenausea and vomiting is comparable between two groups but incidence more in Group T.Respiratory depression side effects is also comparable between the two groups but incidencemore for Group N. CONCLUSIONS Nalbuphine 0.15 mg/kg can be an effective tool in the treatment of acutepostoperative pain in lower limb orthopaedic procedures. Both Nalbuphine and Tramadol canbe a good alternative in the multimodal therapy of acute postoperative analgesia. KEY WORDS Nalbuphine, Tramadol, Lower Limb Orthopaedic Surgeries, Sub Arachnoid Block

CANCER PAIN AND THERAPY.

Cancer pain is not a homogenous and clearly understood pathological process. The best treatment is a combination of drug and non-drug measures. Pain is divided into visceral, bone or neuropathic pain and has characteristics of continuous or intermittent pain. Cancer bone pain therapy remains centered on strong opioid, radiotherapy and bisphosphonates. Invasive procedures are aimed to improve neurological function, ambulation and pain relief. Solid tumors often demand surgery. Treatment of acute postoperative pain is crucial for the prevention of chronic pain. Chemotherapy and radiation sometimes also cause pain. The management of cancer pain has improved because of rapid diagnosis and treatment, understanding of analgesics and the cooperation of patients and their family. The presence of special pain centers in hospitals also raise standard of cancer pain management. Drug therapy with non-opioid, opioid and adjuvant drugs is the base of such management. The side effects must be monitored and timely treated. Methods of regional nerve blockade in pain control are numerous. Placement of epidural, intrathecal and subcutaneous catheters, conductive nerve blocks with continuous delivery of mixed local anesthetics are very successful for selected patients. Conventional physical therapy involving lymphatic drainage is useful. Acupuncture, psychotherapy and similar methods are also applicable.

Open-Label Placebo Treatment for Acute Postoperative Pain (OLP-POP Study): Study Protocol of a Randomized Controlled Trial.

Introduction: Open-label placebos have been proposed as way of using long recognized analgesic placebo effects in an ethical manner. Recent evidence shows efficacy of open-label placebos for clinical conditions, but there is need for more research on open-label placebos in acute pain. In the treatment of acute postoperative pain, minimization of opioid related side effects remains one of the key challenges. Therefore, this study aims at investigating the potential of adding unconditioned open-label placebos to treatment as usual as a means of reducing opioid consumption and its related side effects in patients with acute postoperative pain.Methods and Analysis: This is the protocol of an ongoing single site randomized controlled trial. The first patient was enrolled in May 2020. In total, 70 patients suffering from acute postoperative pain following dorsal lumbar interbody fusion are randomized to either a treatment as usual group or an experimental intervention group. The treatment as usual group consists of participants receiving a patient-controlled morphine pump. On day 1 and 2 post-surgery, patients in the intervention group receive, in addition to treatment as usual, two open-label placebo injections per day along with an evidence-based treatment rationale explaining the mechanisms of placebos. The primary outcome is measured by means of self-administered morphine during day 1 and 2 post-surgery. Several other outcome measures including pain intensity and adverse events as well as potential predictors of placebo response are assessed. Analysis of covariance will be used to answer the primary research question and additional statistical techniques such as generalized linear mixed models will be applied to model the temporal course of morphine consumption.Discussion: This study will provide valuable insights into the efficacy of open-label placebos in acute pain and will potentially constitute an important step toward the implementation of open-label placebos in the clinical management of acute postoperative pain. In addition, it will shed light on a cost-efficient and patient-centered strategy to reduce opioid consumption and its related side effects, without any loss in pain management efficacy.Ethics and Dissemination: The “Ethikkommission Nordwest- und Zentralschweiz” (BASEC2020-00099) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal.Clinical Trial Registration: The study is registered at ClinicalTrials.gov (NCT04339023) and is listed in the Swiss national registry at kofam.ch (SNCTP000003720).

Cost-effectiveness of tapentadol immediate release versus oxycodone immediate release for acute post-operative pain after major hip surgeries

Objective To evaluate the cost-effectiveness of tapentadol immediate-release (IR) versus oxycodone IR for post-operative pain after a major hip surgery. Methods This study has been conducted using an Australian societal perspective, focusing on adult patients after a major hip surgery. A cost-effectiveness analysis was conducted using a decision-analytic model. The model incorporated drug and other resource costs, the probability of opioid-related adverse events, and quality-adjusted life months (QALM) in each treatment arm. A willingness to pay (WTP) threshold of AU$2500 was used per QALM gained. A probabilistic sensitivity analysis was conducted to examine the uncertainty of the assumptions. The primary outcome was the incremental cost-effectiveness ratio (ICER) of tapentadol IR versus oxycodone IR, expressed as Australian dollars (AU$) per QALM gained. Results Tapentadol IR dominated oxycodone IR, with a cost savings of AU$201 and an increase in QALM by 0.014. The ICER was −13,946 AU$/QALM (negative value attributed to numerator). In the probabilistic sensitivity analysis, 84.2% of the simulations were in favour of tapentadol IR at the WTP threshold. Conclusions Tapentadol IR may be more cost-effective than oxycodone IR for the treatment of acute postoperative pain after major hip surgeries.

A Comparative Study of the efficacy of preoperative of oral Pregabalin and placebo on acute Postoperative Pain After Coronary Artery Bypass Graft Surgery

Abstract Background Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive pregabalin on post CABG surgery pain control. Objective To study the effect of pregabalin administration before surgery in the treatment of acute postoperative pain after coronary artery bypass surgery. To study the effect of pregabalin on the consumption of opioids for acute postoperative pain. Patients and Methods Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries. Results Analysis of VAS in the first 24 hours after extubation showed significant difference between Groups 1 and 2. Analysis of systolic blood pressure and heart rate in the first 24 hours showed no significant difference between Groups 1 and 2. It is important to note that because the observed “average” differences in systolic blood pressure and heart rate between groups were small, the clinical significance of such differences can be questioned. Furthermore, it would not be realistic to expect a big, dramatic benefit from a single intervention in a complex, multifactorial care process, such as in cardiac surgery. Given the complexity of these cases, we believe that even a small reduction in pain intensity is a meaningful improvement as we all try to improve care for these patients. Conclusion Pregabalin can be effective for reduction of post CABG pain and have better patient satisfaction if given preemptively with single dose preoperatively.

Efficacy of Preemptive Analgesia with Pregabalin in Orthognathic Surgery-A Systematic Review

Background: Orthognathic surgery is a treatment approach that is used for correcting the congenital or developmental anomalies of maxilla and mandible as well as secondary deformities of trauma. During these procedure saws, chisels, separators, and plate screw systems are used. Postoperative pain is an acute pain that is accompanied by the inflammatory process that occurs as a result of surgical trauma, and gradually decreases with tissue recovery. The analgesic prevents the establishment of the central sensitization due to incisional injury (only covers the surgical period) and prevents the establishment of the central sensitization (covering the surgical and early postoperative periods). Pregabalin is a structural gama-aminobutyric acid (GABA) analogue. It has been shown in recent studies that pregabalin, which is involved in chronical pain treatment, can also be involved in acute postoperative pain treatment.&#x0D; Objectives: The aim of this systematic review is to assess the efficacy of preemptive analgesia with pregabalin on postoperative pain in orthognathic surgery.&#x0D; Materials and Methods: The Data Bases of PubMed, Cochrane and Google scholar were searched for the related topics along with a complimentary manual search of all oral surgery journals till September 2019. Articles were selected based on the inclusion criteria, which included all RCTs.&#x0D; Results: From this systematic review it is concluded that pre-emptive analgesia with pregabalin is effective in lowering acute postoperative pain in the patients who have undergone orthognathic surgery.&#x0D; Conclusion: In this systematic review we have concluded that, on average, a single dose of pregabalin was shown to decrease post-operative pain. More studies have to be done to evaluate the efficacy of the drug.

Supporting pharmacogenetic-guided opioid prescriptions for post-operative pain: The design, protocol and preliminary results of the OTP study

The interindividual variability in opioid response is an issue that contributes to the ongoing opioid crisis. Current evidence suggests this variability can be attributed to genetic factors. The pharmacogenetics of Opioid Treatment for acute post-operative Pain (OTP) project was a prospective study that aimed to identify genetic markers associated with opioid treatment outcomes. Healthy patients undergoing third-molar extractions were recruited from dental offices located within the Greater Toronto Area. Participants were evaluated using the Brief Pain Inventory Short Form, the Opioid Related Symptom Distress Scale, and the Leeds Dependence Questionnaire. Seventy-two participants had an active opioid prescription. Participants were prescribed one of the following opioids: codeine, morphine, hydromorphone, tramadol, or oxycodone. The majority of participants were female (57%), ranging from 16 to 44 years of age. Pain severity, pain interference, and side effects declined over the seven-day post-operative period. Additionally, 4% of participants displayed medium to high risk of dependence. It is anticipated that OTP will enable the development of a genetic test for opioid use and facilitate the introduction of this test into routine healthcare practice. The OTP study represents a novel approach to opioid treatment and has significant implications for future interventions targeting the ongoing opioid crisis. Employing a pharmacogenomic-guided strategy for prescribing opioids may improve patients’ response to this treatment and, in so doing, increase adherence to the target treatment plan. Optimized prescriptions may also provide public healthcare systems with beneficial savings and reduce the risks associated with opioid use.

Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology

Satisfactory pain relief is a fundamental right of every patient suffering from pain. Despite the developments on pharmachologic treatment modalities and interventions for pain control, inadequacy of postoperative pain management is still a major problem. After surgical intervention, 66% of patients experience moderate to severe pain during discharge, 9% after two weeks. Untreated postoperative pain may lead to prolonged hospital stay, increased intensive care needs, development of chronic pain, and reduced the patients quality of life. In the following guideline all aspects of postoperative pain briefly evaluated. The clinical practice of postoperative analgesia, recommendations, the diagnosis, assessment and pharmachologic treatment of acute postoperative pain with the current available agents in Turkey are discussed in this article. Our aim is to promote awareness of effective, and safe postoperative pain management strategies to meet the needs of the patients; minor patient groups, such as paediatric population, pregnant patients, elderly, patient with high body mass index and covid 19 diesease. Despite all the recommendations, any guidelines special cases where standard modalities fail to treat postoperative pain management as in patients with chronic pain who previously used opioids, drug addicts, the patient should be consulted with an pain specialist.

Multimodal Analgesia: Polypharmacy in Pain Relief or Rational Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Pain Chronicity

Pain is the psychophysiological reaction of an entire organism to a damaging factor. According to the literature, 30.0–75.0 % of patients suffer from severe pain in the postoperative period. The greatest risk of chronicity is severe pain after highly traumatic operations and in cases where there is a neuropathic component of acute pain. The purpose of the work is to evaluate the feasibility of using non-steroidal anti-inflammatory drugs with multimodal analgesia to prevent pain chronicity. Despite the detailed mechanisms of pain formation, to date, there is no ideal analgesic or method for the treatment of acute postoperative pain of high intensity. The most significant complication in the use of opioid analgesics is iatrogenic hyperalgesia, which leads to an increase in the intensity of acute postoperative pain, which is also a risk factor for the formation of chronic postoperative pain. It is possible to get closer to solving the problem of adequate postoperative analgesia only by implementing the concept of multimodal analgesia in the clinic, which involves the simultaneous use of two or more analgesics that have different mechanisms of action and have a synergistic effect. The use of the non-steroidal anti-inflammatory drugs as part of multimodal analgesia reduces the risk of their long-term use, due to effective analgesia and prevention of chronic pain syndrome.