Perioperative Pain Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 19061

Special Issue Editor


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Guest Editor
Department of Anesthesiology, Hospital Cologne-Holweide, University Witten-Herdecke, Neufelder Strasse 32, 51067 Cologne, Germany
Interests: anesthesia; intensive care medicine; malignant hyperthermia; thoracic anesthesia; regional anesthesia; airway management; obstetric anesthesia; pain management

Special Issue Information

Dear Colleagues,

Perioperative pain therapy is a multidisciplinary, multiprofessional challenge. Patient pain perception depends on a variety of influencing factors, such as general handling of pain, preexisting chronic pain, depression, anxiety, age, etc., which are certainly not addressed enough in everyday clinical practice. Preventive concepts, minimal invasive surgery, fast-track concepts, regional anesthesia, certain intravenous drugs applied while and after general anesthesia, reduced use of postoperative opioids, and the intraoperative use of distraction devices during regional anesthesia such as virtual reality glasses, etc. can all be useful to reduce postoperative pain. An intervention-related standardization of postoperative pain therapies with pain-level-adjusted escalating schemes should certainly be considered common sense. Furthermore, a postoperative acute pain service is an important part of structural quality for the supervision and management of patients with continuous pain procedures on the one hand and for the care of complex postoperative pain syndromes on the other.

From a shorter-term perspective, a low level of postoperative pain is a crucial outcome parameter that affects patient satisfaction, early mobilization, length of hospital stay, and finally the economic success of a surgical unit. In the longer term, another important goal of optimal perioperative pain therapy is the prevention of postsurgical chronic pain.

Prof. Dr. Mark Ulrich Gerbershagen
Guest Editor

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Keywords

  • pain prevention
  • minimal invasive surgery
  • postoperative pain
  • chronic pain
  • regional anesthesia
  • postoperative acute pain service
  • fast track
  • opioids
  • patient satisfaction
  • comorbidity
 

Published Papers (16 papers)

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Research

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11 pages, 1110 KiB  
Article
Efficacy of Lidocaine Spray for Pain Reduction during Colposcopy-Directed Cervical Biopsies: A Randomized Controlled Trial
by Ornwitsanate Mongkolmafai, Dhammapoj Jeerakornpassawat, Charuwan Tantipalakorn, Kittipat Charoenkwan, Prapaporn Suprasert, Jatupol Srisomboon and Theera Tongsong
Medicina 2024, 60(4), 630; https://doi.org/10.3390/medicina60040630 - 13 Apr 2024
Viewed by 196
Abstract
Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to [...] Read more.
Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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10 pages, 925 KiB  
Article
The Relationship between Pre-Anesthetic Analgesia and Nociception (ANI) and Propofol Injection Pain among Patients Receiving Remifentanil: A Prospective, Randomized, Controlled Study
by Cheolhyeong Lee, Cheol Lee, Junsung Lim, Jeongki Park, Jaehak Jung, Hayoung Lee and Myeongjong Lee
Medicina 2024, 60(2), 273; https://doi.org/10.3390/medicina60020273 - 05 Feb 2024
Viewed by 813
Abstract
Background and Objectives: The analgesia/nociception index (ANI) potentially monitors nociceptive status during anesthesia, but its link to preoperative pain sensitivity is unclear. We investigated the relationship between pre-anesthetic ANI scores and propofol injection pain (PIP) in patients receiving remifentanil. Materials and Methods [...] Read more.
Background and Objectives: The analgesia/nociception index (ANI) potentially monitors nociceptive status during anesthesia, but its link to preoperative pain sensitivity is unclear. We investigated the relationship between pre-anesthetic ANI scores and propofol injection pain (PIP) in patients receiving remifentanil. Materials and Methods: This study included 124 male patients aged 19–60 undergoing general anesthesia (ASA class I or II). Patients were randomized to group R (n = 62, remifentanil 4 ng/mL) or group C (n = 62, saline). The primary outcome was the association between PIP and ANI. Secondary outcomes included the incidence and severity of PIP or rocuronium-induced withdrawal movement (RIWM) and their association with ANI. Results: PIP and RIWM incidence and severity were lower in group R than in group C. A weak negative correlation between PIP and ANI at pre-induction (rpb = −0.21, p = 0.02, rpb = −0.37, p < 0.01) and a moderate negative correlation during propofol injection (rpb = −0.48, p = 0.02) were observed. A significant negative correlation was found between RIWM and ANI during rocuronium injection (τb = −0.61, p < 0.01). AUC, cut-off value, specificity, and sensitivity in ANI at pre-induction for predicting PIP were 0.67 (p = 0.02), 59, 76%, and 55%, respectively. AUC, cut-off value, specificity, and sensitivity in ANI during propofol injection for PIP were 0.77 (p < 0.01), 65, 81%, and 67%, respectively. Conclusions: ANI scores demonstrated significant differences between groups, suggesting potential predictive value for PIP despite the low pre-induction AUC value. This study highlights the potential of using ANI scores to predict and manage PIP in patients receiving remifentanil. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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9 pages, 1154 KiB  
Article
Postoperative Cognitive Impairment and Pain Perception after Abdominal Surgery—Could Immersive Virtual Reality Bring More? A Clinical Approach
by Gabriela Droc, Sebastian Isac, Elisabeta Nita, Cristina Martac, Miruna Jipa, Diana Irene Mihai, Cristian Cobilinschi, Andrada-Georgiana Badea, Damiana Ojog, Bogdan Pavel, Maria-Daniela Tanasescu and Teodora Isac
Medicina 2023, 59(11), 2034; https://doi.org/10.3390/medicina59112034 - 17 Nov 2023
Viewed by 1707
Abstract
Background and Objectives: Impaired cognition and pain after surgery contribute to prolonged hospital stays and increased mortality rates. Thus, the development of preemptive algorithms for reducing their impact should be prioritized. The main objectives of the present study were to evaluate the [...] Read more.
Background and Objectives: Impaired cognition and pain after surgery contribute to prolonged hospital stays and increased mortality rates. Thus, the development of preemptive algorithms for reducing their impact should be prioritized. The main objectives of the present study were to evaluate the efficiency of using virtual reality (VR) to treat postoperative cognitive decline and pain perception. Materials and Methods: The study was a prospective, monocentric, clinical study that included 51 patients who have undergone major abdominal surgery. The patients were divided into two groups: Control (n = 25) and VR (n = 26). The VR sessions consisted of 5–8 min exposure at 24–48 h after surgery. We considered the outcome variables, the mini-mental state examination, and visual analogue scale at 24–48 h after surgery. The dependent variables were age, social status, educational level, and duration of surgery. Results: We did not observe any differences in postoperative cognition deficit with regard to VR. The VR, however, successfully reduced postoperative pain intensity. Moreover, the patients’ age, surgery duration, level of education, and social status influenced the MMSE score at 24–48 h after surgery. Conclusions: Even if using VR does not alleviate short-term postoperative cognitive impairments, it could affect pain perception. Further studies are needed to support the use of VR in perioperative contexts. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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10 pages, 1335 KiB  
Article
Does Adding an IPACK Block to the Suprainguinal Fascia Iliaca Block Improve the Quality of Analgesia in Patients Undergoing Knee Arthroplasty under Spinal Anesthesia? A Retrospective Cohort Study
by Hatice Selcuk Kusderci, Caner Genc, Şenay Canikli Adiguzel, Nizamettin Güzel, Serkan Tulgar, Mustafa Suren and Ersin Koksal
Medicina 2023, 59(10), 1870; https://doi.org/10.3390/medicina59101870 - 20 Oct 2023
Viewed by 1239
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between [...] Read more.
Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I–III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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11 pages, 1660 KiB  
Article
Assessing Continuous Epidural Infusion and Programmed Intermittent Epidural Bolus for Their Effectiveness in Providing Labor Analgesia: A Mono-Centric Retrospective Comparative Study
by Shao-Lun Tsao, Wen-Tyng Li, Li-Yun Chang, Pin-Hung Yeh, Liang-Tsai Yeh, Ling-Jun Liu and Chao-Bin Yeh
Medicina 2023, 59(9), 1579; https://doi.org/10.3390/medicina59091579 - 30 Aug 2023
Viewed by 1104
Abstract
Background and Objectives: Local anesthetics administered via epidural catheters have evolved from intermittent top-ups to simultaneous administration of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) using the same device. The latest programmed intermittent epidural bolus (PIEB) model is believed to [...] Read more.
Background and Objectives: Local anesthetics administered via epidural catheters have evolved from intermittent top-ups to simultaneous administration of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) using the same device. The latest programmed intermittent epidural bolus (PIEB) model is believed to create a wider and more even distribution of analgesia inside the epidural space. The switch from CEI + PCEA to PIEB + PCEA in our department began in 2018; however, we received conflicting feedback regarding workload from the quality assurance team. This study aimed to investigate the benefits and drawbacks of this conversion, including the differences in acute pain service (APS) staff workload, maternal satisfaction, side effects, and complications before and after the changeover. Materials and Methods: Items from the APS records included total delivery time, average local anesthetic dosage, and the formerly mentioned items. The incidence of side effects, the association between the duration of delivery and total dosage, and hourly medication usage in the time subgroups of the CEI and PIEB groups were compared. The staff workload incurred from rescue bolus injection, catheter adjustment, and dosage adjustment was also analyzed. Results: The final analysis included 214 and 272 cases of CEI + PCEA and PIEB + PCEA for labor analgesia, respectively. The total amount of medication and average hourly dosage were significantly lower in the PIEB + PCEA group. The incidences of dosage change, manual bolus, extra visits per patient, and lidocaine use for rescue bolus were greater in the PIEB + PCEA group, indicating an increased staff workload. However, the two groups did not differ in CS rates, labor time, maternal satisfaction, and side effects. Conclusions: This study revealed that while PIEB + PCEA maintained the advantage of decreasing total drug doses, it inadvertently increased the staff burden. Increased workload might be a consideration in clinical settings when choosing between different methods of PCEA. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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11 pages, 749 KiB  
Article
Pre-Trauma Pain Is the Strongest Predictor of Persistent Enhanced Pain Patterns after Severe Trauma: Results of a Single-Centre Retrospective Study
by Katharina Fetz, Rolf Lefering and Sigune Kaske
Medicina 2023, 59(7), 1327; https://doi.org/10.3390/medicina59071327 - 19 Jul 2023
Viewed by 1069
Abstract
Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients’ quality of life, affecting physical, emotional, and social functioning. [...] Read more.
Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients’ quality of life, affecting physical, emotional, and social functioning. This study aimed to investigate the pain patterns of trauma patients before and after severe trauma, and identify the predictors of persisting pain after injury. Materials and Methods: A total of 596 patients of a level-one trauma centre with severe trauma were included in this study. The Trauma Outcome Profile Scale was used to assess pain severity before and after trauma, and a logistic regression analysis was performed to determine the most significant predictors of relevant pain after severe trauma. Results: The mean age of the included patients was 48.2 years, and 72% were males. The most frequent cause of injury was traffic accidents, and the mean Injury Severity Score was 17.6. Nearly half of the patients experienced reduced pain-related quality of life after trauma, with persisting pain predominantly occurring in the neck, spine, shoulder, pelvis, hip, knee, and feet. Even minor injuries led to increased pain scores. Preexisting pain before injury (OR: 5.43; CI: 2.60–11.34), older age (OR: 2.09, CI: 1.22–3.27), female gender (OR: 1.08, CI: 0.73–1.59), and high injury severity (OR: 1.80, CI: 1.20–2.69) were identified as significant predictors of enhanced pain. Conclusions: These findings highlight the importance of considering pre-existing pain, body area, and injury severity in assessing the risk of persistent pain in trauma patients. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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9 pages, 1389 KiB  
Article
Influence of Intraoperative Nociception during Hip or Knee Arthroplasty with Supplementary Regional Anaesthesia on Postoperative Pain and Opioid Consumption
by Claudia Neumann, Lena Gehlen, Leonie Weinhold, Nadine Straßberger-Nerschbach, Martin Soehle, Evgeniya Kornilov and Marcus Thudium
Medicina 2023, 59(6), 1166; https://doi.org/10.3390/medicina59061166 - 17 Jun 2023
Viewed by 1256
Abstract
Background and Objectives: Early postoperative mobilization is central for postoperative outcomes after lower extremity joint replacement surgery. By providing adequate pain control, regional anaesthesia plays an important role for postoperative mobilization. It was the objective of this study to investigate the use [...] Read more.
Background and Objectives: Early postoperative mobilization is central for postoperative outcomes after lower extremity joint replacement surgery. By providing adequate pain control, regional anaesthesia plays an important role for postoperative mobilization. It was the objective of this study to investigate the use of the nociception level index (NOL) to determine the effect of regional anaesthesia in hip or knee arthroplasty patients undergoing general anaesthesia with additional peripheral nerve block. Materials and Methods: Patients received general anaesthesia, and continuous NOL monitoring was established before anaesthesia induction. Depending on the type of surgery, regional anaesthesia was performed with a Fascia Iliaca Block or an Adductor Canal Block. Results: For the final analysis, 35 patients remained, 18 with hip and 17 with knee arthroplasty. We found no significant difference in postoperative pain between hip or knee arthroplasty groups. NOL increase at the time of skin incision was the only parameter associated with postoperative pain measured using a numerical rating scale (NRS > 3) after 24 h in movement (−12.3 vs. +119%, p = 0.005). There was no association with intraoperative NOL values and postoperative opioid consumption, nor was there an association between secondary parameters (bispectral index, heart rate) and postoperative pain levels. Conclusions: Intraoperative NOL changes may indicate regional anaesthesia effectiveness and could be associated with postoperative pain levels. This remains to be confirmed in a larger study. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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11 pages, 825 KiB  
Article
Pupillary Pain Index Predicts Postoperative Pain but Not the Effect of Peripheral Regional Anaesthesia in Patients Undergoing Total Hip or Total Knee Arthroplasty: An Observational Study
by Evgeniya Kornilov, Lena Gehlen, Dana Yacobi, Martin Soehle, Ana Kowark and Marcus Thudium
Medicina 2023, 59(5), 826; https://doi.org/10.3390/medicina59050826 - 23 Apr 2023
Cited by 1 | Viewed by 1305
Abstract
Background and Objectives: The pupillary pain index (PPI) allows the evaluation of intraoperative nociception by measuring pupillary reaction after a localized electrical stimulus. It was the objective of this observational cohort study to investigate the pupillary pain index (PPI) as a method [...] Read more.
Background and Objectives: The pupillary pain index (PPI) allows the evaluation of intraoperative nociception by measuring pupillary reaction after a localized electrical stimulus. It was the objective of this observational cohort study to investigate the pupillary pain index (PPI) as a method to evaluate the fascia iliaca block (FIB) or adductor canal block (ACB) sensory areas during general anaesthesia in orthopaedic patients with lower-extremity joint replacement surgery. Materials and Methods: Orthopaedic patients undergoing hip or knee arthroplasty were included. After anaesthesia induction, patients received an ultrasound-guided single-shot FIB or ACB with 30 mL and 20 mL of 0.375% ropivacaine, respectively. Anaesthesia was maintained with isoflurane or propofol/remifentanil. The first PPI measurements were performed after anaesthesia induction and before block insertion, the second at the end of surgery. Pupillometry scores were evaluated in the area of the femoral or saphenous nerve (target) and C3 dermatome (control). Primary outcomes were differences between PPIs before and after peripheral block insertion as well as the relationship between PPIs and postoperative pain scores; secondary outcomes were the relationship between PPIs and opioid requirements after surgery. Results: PPI decreased significantly from the first to the second measurement (4.17 ± 2.7 vs. 1.6 ± 1.2, p < 0.001 for target; 4.46 ± 2.7 vs. 2.17 ± 2.1, p < 0.001 for control). Control and target measurements did not show significant differences. A linear regression analysis showed that early postoperative pain scores could be predicted with intraoperative piritramide with improved prediction after adding PPI scores, PCA opioids and surgery type. Forty-eight-hour pain scores at rest and in movement were correlated with intraoperative piritramide and control PPI after the PNB in movement and with second-postoperative-day opioids and target PPI scores before block insertion, respectively. Conclusions: While the effect of an FIB and ACB could not be shown with PPI postoperative pain scores due to a large effect of opioids, perioperative PPI was shown to be associated with postoperative pain. These results suggest that preoperative PPI may be used to predict postoperative pain. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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8 pages, 836 KiB  
Article
Effectiveness of Nitrous Oxide versus Pethidine/Midazolam for Pain Relief in Minor Gynecological Operative Procedures: A Randomized Controlled Trial
by Napas Lohtrakul, Chanane Wanapirak and Theera Tongsong
Medicina 2023, 59(3), 611; https://doi.org/10.3390/medicina59030611 - 20 Mar 2023
Viewed by 1502
Abstract
Aim and Objective: To compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox®) with intravenous opioids (pethidine/midazolam) in reducing pain during minor gynecological operative procedures, including manual vacuum aspiration (MVA), fractional curettage and dilatation and curettage. Materials and Methods: Patients [...] Read more.
Aim and Objective: To compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox®) with intravenous opioids (pethidine/midazolam) in reducing pain during minor gynecological operative procedures, including manual vacuum aspiration (MVA), fractional curettage and dilatation and curettage. Materials and Methods: Patients undergoing minor gynecological procedures from August 2021 to December 2022 were randomized to receive nitrous oxide or intravenous pethidine (50–75 micrograms) plus midazolam (2 mg). Pain scores during and post-procedure, satisfaction level, and side effects were assessed and compared. Results: A total of 106 patients met the inclusion criteria, including 53 in the pethidine/midazolam group and 53 in the nitrous oxide group. Baseline characteristics were comparable (p-value > 0.05). Pain scores during, immediately and 30 min after procedures were not significantly different in two groups (4.94 ± 3.15, 2.74 ± 2.57, 1.58 ± 2.13 vs. 5.47 ± 2.80, 2.98 ± 2.70, 1.64 ± 2.70; p-value: 0.174, 0.634, 0.889, for pethidine/midazolam vs. nitrous oxide group, respectively. Satisfaction scores were comparable in both groups (p-value > 0.05). However, the rate of side effects was significantly lower in the nitrous oxide group (3.8% vs. 28.3%; p-value 0.001). Additionally, the discharge scores showed a significantly faster recovery time in the nitrous oxide group at 60 and 90 min after the procedure; median (IQR): 10 (9–10) vs. 9 (8–10) and 10 (10–10) vs. 10 (8.5–10); p-value 0.002 and 0.029, respectively). Conclusions: Nitrous oxide is as effective as pethidine/midazolam for pain relief in minor gynecological operative procedures but associated with significantly lower side effects and significantly faster recovery time. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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Review

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11 pages, 285 KiB  
Review
Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept
by Mark Ulrich Gerbershagen and Hanaa Baagil
Medicina 2024, 60(3), 358; https://doi.org/10.3390/medicina60030358 - 21 Feb 2024
Viewed by 637
Abstract
Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that [...] Read more.
Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that a perioperative multimodal pain concept should be used for caesarean delivery. This pain concept should include neuraxial opioids for spinal anesthesia, acetaminophen, NSAIDs, intravenous dexamethasone, and postoperative local or regional anesthetic procedures. Long-acting lipophobic opioids (diamorphine and morphine) have a significant analgesic advantage over short-acting lipophilic opioids (sufentanil and fentanyl). The risk of clinically relevant respiratory depression after neuraxial long-acting opioids is nowadays considered negligible, even if the data situation is weak in this regard. The question remains as to whether a pain concept that is ideally adapted to a neuraxial short-acting opioid shows benefit to a pain concept that is optimally adapted to neuraxial morphine. If long-acting opioids are used, the timing of each additional component of the multimodal analgesia strategy could ideally be adjusted to this longer duration of action. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
15 pages, 6100 KiB  
Review
Continuous Interscalene Brachial Plexus Blocks: An Anatomical Challenge between Scylla and Charybdis?
by Rainer J. Litz, Georg C. Feigl, Daniel Radny, Thomas Weiß, Peter Schwarzkopf and Tim Mäcken
Medicina 2024, 60(2), 233; https://doi.org/10.3390/medicina60020233 - 29 Jan 2024
Viewed by 807
Abstract
Brachial plexus blocks at the interscalene level are frequently chosen by physicians and recommended by textbooks for providing regional anesthesia and analgesia to patients scheduled for shoulder surgery. Published data concerning interscalene single-injection or continuous brachial plexus blocks report good analgesic effects. The [...] Read more.
Brachial plexus blocks at the interscalene level are frequently chosen by physicians and recommended by textbooks for providing regional anesthesia and analgesia to patients scheduled for shoulder surgery. Published data concerning interscalene single-injection or continuous brachial plexus blocks report good analgesic effects. The principle of interscalene catheters is to extend analgesia beyond the duration of the local anesthetic’s effect through continuous infusion, as opposed to a single injection. However, in addition to the recognized beneficial effects of interscalene blocks, whether administered as a single injection or through a catheter, there have been reports of consequences ranging from minor side effects to severe, life-threatening complications. Both can be simply explained by direct mispuncture, as well as undesired local anesthetic spread or misplaced catheters. In particular, catheters pose a high risk when advanced or placed uncontrollably, a fact confirmed by reports of fatal outcomes. Secondary catheter dislocations explain side effects or loss of effectiveness that may occur hours or days after the initial correct function has been observed. From an anatomical and physiological perspective, this appears logical: the catheter tip must be placed near the plexus in an anatomically tight and confined space. Thus, the catheter’s position may be altered with the movement of the neck or shoulder, e.g., during physiotherapy. The safe use of interscalene catheters is therefore a balance between high analgesia quality and the control of side effects and complications, much like the passage between Scylla and Charybdis. We are convinced that the anatomical basis crucial for the brachial plexus block procedure at the interscalene level is not sufficiently depicted in the common regional anesthesia literature or textbooks. We would like to provide a comprehensive anatomical survey of the lateral neck, with special attention paid to the safe placement of interscalene catheters. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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11 pages, 333 KiB  
Review
Preoperative Anxiety Impact on Anesthetic and Analgesic Use
by Hanaa Baagil, Hamzah Baagil and Mark Ulrich Gerbershagen
Medicina 2023, 59(12), 2069; https://doi.org/10.3390/medicina59122069 - 23 Nov 2023
Cited by 1 | Viewed by 1502
Abstract
Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and [...] Read more.
Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual’s pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
8 pages, 277 KiB  
Review
Local Wound Infiltration for Thyroidectomized Patients in the Era of Multimodal Analgesia
by Stiliani Laskou, Georgia Tsaousi, Chryssa Pourzitaki, Labrini Loukipoudi, Georgios Papazisis, Isaak Kesisoglou and Konstantinos Sapalidis
Medicina 2023, 59(9), 1662; https://doi.org/10.3390/medicina59091662 - 14 Sep 2023
Viewed by 641
Abstract
The first few hours following thyroidectomy are the most crucial for pain management. Adequate postoperative pain control, reduction in opioid abuse and the possibility of implementing one-day operations are the considered parameters when developing the postoperative analgesic strategy. A study of the available [...] Read more.
The first few hours following thyroidectomy are the most crucial for pain management. Adequate postoperative pain control, reduction in opioid abuse and the possibility of implementing one-day operations are the considered parameters when developing the postoperative analgesic strategy. A study of the available literature was conducted, exploring the efficacy of (open) thyroidectomy wound infiltration. Seventeen full-text RCTs were extracted. Local anesthetics and non-steroidal anti-inflammatory drugs were infiltrated. Emphasis was given to postoperative pain scores and requirements for rescue analgesia with opioids. Most authors agree that local wound infiltration for thyroidectomized patients is effective in the management of postoperative pain parameters. In the era of multimodal analgesia, thyroidectomy wound infiltration could represent an essential adjunct contributing to lower VAS scores and reduced opioid requirements. Full article
(This article belongs to the Special Issue Perioperative Pain Management)

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6 pages, 649 KiB  
Case Report
Percutaneous Gastrostomy Tube Placement under Quadratus Lumborum Block: A Case Report
by Gundega Ose, Irina Evansa, Nikita Ivanovs, Natalija Zlobina, Indulis Vanags and Olegs Sabelnikovs
Medicina 2023, 59(12), 2106; https://doi.org/10.3390/medicina59122106 - 30 Nov 2023
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Abstract
The quadratus lumborum block is a technique that is not widely applied in abdominal surgery. The influence of the mode of anesthesia on the outcome of polymorbid patients is a controversial issue in the medical literature. We report a case in which we [...] Read more.
The quadratus lumborum block is a technique that is not widely applied in abdominal surgery. The influence of the mode of anesthesia on the outcome of polymorbid patients is a controversial issue in the medical literature. We report a case in which we performed a quadratus lumborum block type 2 on a woman who was admitted to Riga’s 1st hospital in need of gastrostomy, due to difficulty swallowing solid foods and liquids caused by hypopharynx carcinoma. On account of the patient’s difficult airway, general anesthesia was deemed unsafe for the patient, with a risk of patient death. Percutaneous gastrostomy tube placement under a quadratus lumborum block type 2 was performed successfully. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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17 pages, 3941 KiB  
Systematic Review
A Systematic Review and Meta-Analysis Comparing the Effectiveness of Transversus Abdominis Plane Block and Caudal Block for Relief of Postoperative Pain in Children Who Underwent Lower Abdominal Surgeries
by Dan Xiao, Yiyuan Sun, Fang Gong, Yu Yin and Yue Wang
Medicina 2023, 59(9), 1527; https://doi.org/10.3390/medicina59091527 - 24 Aug 2023
Cited by 1 | Viewed by 1055
Abstract
Background and Objectives: Postoperative pain after lower abdominal surgery is typically severe. Traditionally, in pediatric anesthesia, a caudal block (CB) has been used for pain management in these cases. Nowadays, a transversus abdominis plane block (TAPB) seems to be an effective alternative. [...] Read more.
Background and Objectives: Postoperative pain after lower abdominal surgery is typically severe. Traditionally, in pediatric anesthesia, a caudal block (CB) has been used for pain management in these cases. Nowadays, a transversus abdominis plane block (TAPB) seems to be an effective alternative. However, which technique for perioperative analgesia is better and more effective remains unclear in children who undergo abdominal surgeries. The aim of this study was to compare the efficacy and safety of a TAPB and CB for pain management in children after abdominal surgery by conducting a meta-analysis of published papers in this area. Methods: We conducted a thorough search of PubMed, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trials (RCTs) that compared a TAPB and CB for pain management in children who had abdominal surgery. Two researchers screened and assessed all the information with RevMan5.3 used for this meta-analysis. Pain scores, the total dose of rescue analgesic given, the mean duration of analgesia, the intraoperative and postoperative hemodynamic conditions 24 h after surgery, and adverse events were compared. Results: 15 RCTs that involved a total of 970 pediatric patients were included in this study. The results of this meta-analysis showed that there were no significant differences between the 2 groups in terms of postoperative pain scores at 1 h (SMD = 0.35; 95% CI = −0.54 to 1.24; p = 0.44, I2 = 94%), 6 h (SMD = −0.10; 95% CI = −0.44 to −0.23; p = 0.55, I2 = 69%), 12 h (SMD = −0.02; 95% CI = −0.45 to −0.40; p = 0.93, I2 = 80%), and 24 h (SMD = −0.66; 95% CI = −1.57 to −0.25; p = 0.15, I2 = 94%); additional analgesic requirement (OR 0.25; 95% CI 0.09 to 0.63; p = 0.004, I2 = 72%); total dose of rescue analgesic given in 24 h (SMD = −0.37; 95% CI = −1.33 to −0.58; p = 0.44; I2 = 97%); mean duration of analgesia (SMD = 1.29; 95% CI = 0.01 to 2.57; p = 0.05, I2 = 98%); parents’ satisfaction (SMD = 0.44; 95% CI = −0.12 to 1.0; p = 0.12; I2 = 80%); and intraoperative and postoperative hemodynamic conditions 24 h after the surgery and adverse events (SMD = 0.78; 95% CI = 0.22 to 2.82; p = 0.70; I2 = 62%). Compared to a CB, a TAPB resulted in a small but significant reduction in additional analgesic requirement after surgery (OR 0.25; 95% CI 0.09 to 0.63; p = 0.004). Conclusions: TAPBs and CBs result in similar efficient early analgesia and safety profiles in children undergoing abdominal surgeries. Moreover, no disparities were observed for adverse effects between TAPBs and CBs. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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17 pages, 3153 KiB  
Systematic Review
Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis
by Tanyong Pipanmekaporn, Prangmalee Leurcharusmee, Yodying Punjasawadwong, Jiraporn Khorana, Artid Samerchua, Wariya Sukhupragarn, Isaraporn Sukuam, Nutchanart Bunchungmongkol and Surasak Saokaew
Medicina 2023, 59(2), 275; https://doi.org/10.3390/medicina59020275 - 31 Jan 2023
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Abstract
Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which [...] Read more.
Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Materials and methods: Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication’s inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD −1.75, 95% CI −3.47 to −0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. Conclusion: This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status. Full article
(This article belongs to the Special Issue Perioperative Pain Management)
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