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Clinical Updates on Perioperative Pain Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 12509

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Special Issue Editors

Prof. Dr. Felice Eugenio Agro

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Guest Editor

Anesthesia, Intensive Care and Pain Management, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Interests: anesthesia; airway management; difficult airway; mechanical ventilation; extraglottic airway devices; resuscitation; analgesia; pain management; regional anesthesia; neuromuscular monitoring; COVID-19; fluid therapy

Dr. Giuseppe Pascarella

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Guest Editor

Anesthesia, Intensive Care and Pain Management, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Interests: anesthesia and intensive care; airway management; regional anesthesia; analgesia; pain management; postoperative pain; knee replacement arthroplasties; breast surgery; thoracotomy; orthopedic surgery; hip surgery; ultrasound

Dr. Fabio Costa

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Guest Editor

Anesthesia, Intensive Care and Pain Management, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Interests: anesthesia and intensive care; pain management; regional anethesia; analgesia; postoperative pain; knee replacement arthroplasties; breast surgery; thoracotomy; orthopedic surgery; hip surgery; ultrasound

Special Issue Information

Dear Colleagues,

Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors. Optimal perioperative pain management positively impacts on the quality of patients’ recovery, reducing the incidence of complications.

For this reason, multimodal approaches including regional anesthesia techniques, analgesics drugs, and rehabilitation programs play a key role in the field of research with the aim to improve perioperative analgesia. For this Special Issue, we welcome original high-quality works about the use of innovative regional anesthesia techniques including neuraxial blocks, peripheral nerve blocks, and fascial plane blocks to treat perioperative pain. Moreover, papers investigating the use of specific drugs, rehabilitation protocols, or innovative devices to manage perioperative analgesia will also be considered. Accepted manuscripts may be in the form of research papers, case reports, original studies, laboratory investigations, or reviews.

Prof. Dr. Felice Eugenio Agro
Dr. Giuseppe Pascarella
Dr. Fabio Costa
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

anesthesia and intensive care
pain management
spinal anesthesia
postoperative pain
breast surgery
fascial plane blocks
abdominal surgery
cardiac surgery
thoracotomy
knee surgery
orthopedic surgery
hip surgery
ultrasound

Published Papers (8 papers)

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Research

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10 pages, 550 KiB

Open AccessArticle

The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study

by Marina Stojanović, Milana Marinković, Biljana Miličić, Milan Stojičić, Marko Jović, Milan Jovanović, Jelena Isaković Subotić, Milana Jurišić, Miodrag Karamarković, Aleksandra Đekić, Kristina Radenović, Jovan Mihaljević, Ivan Radosavljević, Branko Suđecki, Milan Savić, Marko Kostić, Željko Garabinović and Jelena Jeremić

J. Clin. Med. 2024, 13(3), 764; https://doi.org/10.3390/jcm13030764 - 29 Jan 2024

Viewed by 779

Abstract

Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia—typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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12 pages, 2859 KiB

Open AccessArticle

Severe Postoperative Pain in Total Knee Arthroplasty Patients: Risk Factors, Insights and Implications for Pain Management via a Digital Health Approach

by Julien Lebleu, Andries Pauwels, Hervé Poilvache, Philippe Anract and Anissa Belbachir

J. Clin. Med. 2023, 12(24), 7695; https://doi.org/10.3390/jcm12247695 - 15 Dec 2023

Viewed by 1124

Abstract

Up to 25% of patients undergoing knee arthroplasty report chronic pain postoperatively. Early identification of high-risk individuals can enhance pain management strategies. This retrospective analysis investigates the incidence of severe postoperative pain and its associated risk factors among 740 patients who underwent total knee arthroplasty. Utilizing a digital application, patients provided comprehensive data encompassing pre- and postoperative pain levels, analgesic usage, and completed a chronic pain risk assessment. Participants were categorized into two distinct groups based on their pain status at three months post-op: Group D+ (14%), characterized by pain scores exceeding 40/100 and/or the utilization of level 2 or 3 analgesics, and Group D− (86%), who did not meet these criteria. An analysis of pain trajectories within these groups revealed a non-linear progression, with specific patterns emerging amongst those predisposed to chronic pain. Notably, patients with a trajectory towards chronic pain exhibited a plateau in pain intensity approximately three weeks post-surgery. Significant preoperative risk factors were identified, including elevated initial pain levels, the presence of comorbidities, pain in other body areas, heightened joint sensitivity and stiffness. This study highlights the utility of digital platforms in enhancing patient care, particularly through the continuous monitoring of pain. Such an approach facilitates the early identification of potential complications and enables timely interventions. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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8 pages, 586 KiB

Open AccessArticle

The Effect of Cold Application to the Lateral Neck Area on Peripheral Vascular Access Pain: A Randomised Controlled Study

by Senay Canikli Adıgüzel, Dilan Akyurt, Gökçe Ültan Özgen, Hatice Bahadır Altun, Aleyna Çakır, Mustafa Süren and İsmail Okan

J. Clin. Med. 2023, 12(19), 6273; https://doi.org/10.3390/jcm12196273 - 28 Sep 2023

Viewed by 844

Abstract

Introduction: Various types of vagus nerve stimulation are employed in the treatment of a range of conditions, including depression, anxiety, epilepsy, headache, tinnitus, atrial fibrillation, schizophrenia, and musculoskeletal pain. The objective of this study was to apply vagal stimulation to the neck area using standardised cold, and then analyse the level of vascular access discomfort experienced by individuals who underwent venous cannulation from the dorsal side of the hand prior to anaesthesia. Materials and Methods: A total of 180 patients, aged 18–75, who were scheduled to undergo elective surgery, were categorised into three distinct groups: the Sham group (Group S), the Control group (Group K), and the Cold group (Group M), with each group consisting of 60 individuals. Bilateral cold application to the lateral side of the neck was performed prior to the commencement of vascular access in Group M patients, followed by the subsequent opening of vascular access. The alterations in heart rate among patients was assessed subsequent to the application of cold and following the establishment of vascular access. The participants were instructed to assess their level of vascular access pain on a numerical pain scale (NRS) ranging from 0 to 10. Results: A statistically significant difference (p = 0.035) was seen when comparing the pain ratings of patients during vascular access. The study revealed that the NRS values exhibited a statistically significant decrease in Group M compared to both Group K (p = 0.038) and Group S (p = 0.048). Group M had a higher prevalence of individuals experiencing mild pain compared to other groups, and the difference was statistically significant (p = 0.029). In Group M, the average heart rate following vagal stimulation exhibited a statistically significant decrease compared to the average heart rate observed at the beginning of the study (p < 0.05). Upon comparing the original heart rate measurements with the heart rate values following vascular access, it was observed that there was an elevation in heart rate for both Group S and Group K. Conversely, Group M exhibited a decrease in heart rate after vascular access when compared to the initial heart rate values. Conclusions: In the present investigation, it was discovered that the application of cold to the neck region resulted in a drop in heart rate among the patients, which persisted throughout the process of vascular access. Furthermore, the level of pain experienced by these individuals was reduced during vascular access procedures. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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13 pages, 796 KiB

Open AccessArticle

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

by Patrick Reinbacher, Gregor A. Schittek, Alexander Draschl, Andrzej Hecker, Andreas Leithner, Sebastian Martin Klim, Kevin Brunnader, Amir Koutp, Georg Hauer and Patrick Sadoghi

J. Clin. Med. 2023, 12(15), 5088; https://doi.org/10.3390/jcm12155088 - 02 Aug 2023

Cited by 2 | Viewed by 1139

Abstract

Background: This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). Methods: Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. Results: Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. Conclusion: Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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11 pages, 1098 KiB

Open AccessEditor’s ChoiceArticle

Ultrasound Guided Parasternal Block for Perioperative Analgesia in Cardiac Surgery: A Prospective Study

by Giuseppe Pascarella, Fabio Costa, Giulia Nonnis, Alessandro Strumia, Domenico Sarubbi, Lorenzo Schiavoni, Annalaura Di Pumpo, Lara Mortini, Stefania Grande, Andrea Attanasio, Giovanni Gadotti, Alessandro De Cassai, Alessia Mattei, Antonio Nenna, Massimo Chello, Rita Cataldo, Felice Eugenio Agrò and Massimiliano Carassiti

J. Clin. Med. 2023, 12(5), 2060; https://doi.org/10.3390/jcm12052060 - 06 Mar 2023

Cited by 15 | Viewed by 4605

Abstract

Ultrasound guided parasternal block is a regional anaesthesia technique targeting the anterior branches of intercostal nerves, which supply the anterior thoracic wall. The aim of this prospective study is to assess the efficacy of parasternal block to manage postoperative analgesia and reduce opioid consumption in patients undergoing cardiac surgery throughout sternotomy. A total of 126 consecutive patients were allocated to two different groups, receiving (Parasternal group) or not (Control group) preoperative ultrasound guided bilateral parasternal block with 20 mL of 0.5% ropivacaine per side. The following data were recorded: postoperative pain expressed by a 0–10 numeric rating scale (NRS), intraoperative fentanyl consumption, postoperative morphine consumption, time to extubation and perioperative pulmonary performance at incentive spirometry. Postoperative NRS was not significantly different between Parasternal and Control groups with a median (IQR) of 2 (0–4.5) vs. 3 (0–6) upon awakening (p = 0.07); 0 (0–3) vs. 2 (0–4) at 6 h (p = 0.46); 0 (0–2) vs. 0 (0–2) at 12 h (p = 0.57). Postoperative morphine consumption was similar among groups. However, intraoperative fentanyl consumption was significantly lower in the Parasternal group [406.3 ± 81.6 mcg vs. 864.3 ± 154.4, (p < 0.001)]. Parasternal group showed shorter times to extubation [(191 ± 58 min vs. 305 ± 72 min, (p)] and better performance at incentive spirometer with a median (IQR) of 2 raised balls (1–2) vs. 1 (1–2) after awakening (p = 0.04). Ultrasound guided parasternal block provided an optimal perioperative analgesia with a significant reduction in intraoperative opioid consumption, time to extubation and a better postoperative performance at spirometry when compared to the Control group. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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Review

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13 pages, 1960 KiB

Open AccessReview

The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Dmitriy Viderman, Mina Aubakirova, Fatima Nabidollayeva and Yerkin G. Abdildin

J. Clin. Med. 2023, 12(24), 7513; https://doi.org/10.3390/jcm12247513 - 05 Dec 2023

Viewed by 819

Abstract

Surgical interventions in hip fracture have been associated with multiple adverse events, including perioperative hypotension and mortality, making the choice of the anesthetic method for this procedure crucial. There is still no consensus on whether regional (RA) or general (GA) anesthesia should be used to maintain hemodynamic stability and more favorable outcomes. Therefore, this meta-analysis examines the differences between RA and GA groups in the incidence of mortality, intraoperative hypotension, and other intra- and postoperative complications. The comparison is essential given the rising global prevalence of hip fractures and the need to optimize anesthesia strategies for improved patient outcomes, particularly in an aging population. We followed PRISMA guidelines (PROSPERO #CRD42022320413). We conducted the search for studies published in English before March 2022 in PubMed, Google Scholar, and the Cochrane Library. We included RCTs that compared general and regional anesthesia in adult patients having hip fracture surgical interventions. The primary outcome was perioperative mortality. The secondary outcomes were peri- or postoperative complications and duration of hospital stay. We conducted a meta-analysis in RevMan (version 5.4). We examined the quality of the methodology with the Cochrane risk of bias 2 tool, while the quality of evidence was determined with GRADE. Fifteen studies with 4110 patients were included. Our findings revealed no significant difference between general and regional anesthesia in risk of perioperative mortality (RR = 1.42 [0.96, 2.10], p-value = 0.08), intraoperative complications, or duration of hospital length of stay. Our results suggest that regional anesthesia and general anesthesia have comparable safety and can be used as alternatives based on specific patient requirements. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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Other

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24 pages, 6407 KiB

Open AccessSystematic Review

The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Acute Pain and Other Postoperative Outcomes: A Systematic Review with Meta-Analysis

by Dmitriy Viderman, Fatima Nabidollayeva, Mina Aubakirova, Nurzhamal Sadir, Karina Tapinova, Ramil Tankacheyev and Yerkin G. Abdildin

J. Clin. Med. 2024, 13(2), 427; https://doi.org/10.3390/jcm13020427 - 12 Jan 2024

Viewed by 1268

Abstract

This study aimed to investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in postoperative acute pain control. PubMed, Scopus, and Cochrane Library were searched on 1–8 December 2022, for randomized controlled trials on the analgesic effects of TENS. The outcomes were pain intensity and opioid use (primary), and postoperative (PO) adverse events, blood pressure, and the duration of hospital stay (secondary); PROSPERO CRD42022333335. A total of 40 articles were included in the meta-analysis. Pain intensity at rest and during coughing for all types of surgeries combined was lower in the TENS group (standardized mean difference (SMD) = −0.51 [−0.61, −0.41], p < 0.00001, 29 studies, and −1.28 [−2.46, −0.09], p-value = 0.03, six studies, respectively). There was a statistically significant decrease in morphine requirements, as well as in the incidence of postoperative nausea and vomiting, dizziness, and pruritus. There was no difference between the groups in postoperative pain intensity during walking, in blood pressure, and only a borderline difference in the length of hospital stay. The subgroup analysis by surgery type did not show significant differences between the groups in pain severity at rest. Thus, TENS has a potential for pain control and postoperative recovery outcomes. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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11 pages, 1375 KiB

Open AccessBrief Report

Pain Management and Functional Recovery after Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty: A Prospective, Randomized, Double-Blinded Clinical Trial

by Małgorzata Domagalska, Bahadir Ciftci, Tomasz Reysner, Jerzy Kolasiński, Katarzyna Wieczorowska-Tobis and Grzegorz Kowalski

J. Clin. Med. 2023, 12(15), 4931; https://doi.org/10.3390/jcm12154931 - 27 Jul 2023

Cited by 3 | Viewed by 1360

Abstract

Background: The immediate postoperative period after total hip arthroplasty can be associated with significant pain. Therefore, this study aimed to evaluate the effect of pericapsular nerve block on pain management and functional recovery after total hip arthroplasty. Methods: This prospective, randomized, double-blinded, placebo-controlled trial was conducted on 489 adult patients scheduled for total hip arthroplasty, ASA 1–2, operated under spinal analgesia. Participants were assigned to receive either a pericapsular nerve group (PENG) block with 20 mL of 0.5% ropivacaine or a sham block. Results: The primary outcome measure was the postoperative NRS score in motion. The secondary outcomes were cumulative opioid consumption, the time to the first opioid, and functional recovery. Demographic characteristics were similar in both groups. Intraoperative pain scores were significantly lower in patients who received the PENG block than in the control group (p < 0.0001). Also, the time to the first opioid was considerably longer in the PENG group (p < 0.0001). Additionally, 24% of PENG patients did not require opioids (p < 0.0001). Conclusions: The pericapsular nerve group showed significantly decreased opioid consumption and improved functional recovery. Pericapsular nerve group block improved pain management and postoperative functional recovery following total hip arthroplasty. Full article

(This article belongs to the Special Issue Clinical Updates on Perioperative Pain Management)

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