RESUMEN

INTRODUCTION: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. METHODS: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). RESULTS: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. CONCLUSION: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week.

Asunto(s)

Hernia Inguinal , Herniorrafia , Ensayos Clínicos Controlados Aleatorios como Asunto , Técnicas de Sutura , Humanos , Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tempo Operativo , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Mallas Quirúrgicas , Técnicas de Sutura/efectos adversos , Suturas/efectos adversos

RESUMEN

BACKGROUND: Perioperative hypothermia in plastic surgery has underestimated risks, including increased risk of infection, cardiac events, blood loss, prolonged recovery time, and increased nausea, pain, and opioid usage. Inadequate preventive measures can result in up to 4 hours of normothermia restoration. OBJECTIVES: The aim was to compare the impact of different strategies for normothermia during plastic surgery procedures and their relationship with clinical outcomes. METHODS: A nonrandomized clinical trial was conducted in a single center in Bogota, Colombia. We enrolled adult patients undergoing body contouring surgery and divided them into 4 intervention groups with different measures to control body temperature. Univariate and bivariate analyses were performed, comparing several clinical symptoms to evaluate outcomes. RESULTS: A total of 197 patients were analyzed. Most of them were females (84.3%). Mean age was 38.6 years, and the median procedure duration was 260 minutes. Demographic and clinical characteristics did not exhibit significant differences between the groups. There were notable variations in temperature measurements at crucial moments during the surgical procedure among the groups, attributed to the implementation of distinct thermal protective strategies. Group comparisons showed a relationship between hypothermia and increased nausea, vomiting, shivering, pain, and additional analgesia requirements. CONCLUSIONS: Incorporation of active thermal protective measures, such as Blanketrol or HotDog, during body contouring procedures, markedly diminishes the risk of hypothermia and enhances overall clinical outcomes. Implementing these active measures to maintain the patient in a state of normothermia not only improves operating room efficiency but also leads to a reduction in recovery room duration.

Asunto(s)

Contorneado Corporal , Hipotermia , Humanos , Femenino , Adulto , Masculino , Hipotermia/prevención & control , Hipotermia/etiología , Persona de Mediana Edad , Contorneado Corporal/efectos adversos , Contorneado Corporal/métodos , Resultado del Tratamiento , Adulto Joven , Colombia , Temperatura Corporal/fisiología , Regulación de la Temperatura Corporal , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/diagnóstico , Factores de Tiempo

RESUMEN

BACKGROUND: Emergence delirium remains a major postoperative concern for children undergoing surgery. Nalbuphine is a synthetic mixed agonist-antagonist opioid, which is believed to reduce the incidence of emergence delirium in children. The primary objective was to examine the effect of nalbuphine on emergence delirium in children undergoing surgery. METHODS: Databases of MEDLINE, EMBASE, and CENTRAL were searched from their starting dates until April 2023. Randomized Clinical Trials (RCT) and observational studies comparing nalbuphine and control in children undergoing surgery were included. RESULTS: Eight studies (n = 1466 patients) were eligible for inclusion of data analysis. Compared to the control, our pooled data showed that the nalbuphine group was associated with lower incidence of emergence delirium (RR = 0.38, 95% CI [0.30, 0.47], p < 0.001) and reduced postoperative pain scores (MD = -0.98, 95% CI [-1.92, -0.04], p = 0.04). CONCLUSIONS: This review showed the administration of nalbuphine is associated with significant decrease in the incidence of emergence delirium and postoperative pain scores among children undergoing surgery. However, due to limited sample size, high degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to explore the efficacy of nalbuphine on emergence delirium among the pediatric population.

Asunto(s)

Analgésicos Opioides , Delirio del Despertar , Nalbufina , Niño , Humanos , Analgésicos Opioides/administración & dosificación , Delirio del Despertar/epidemiología , Delirio del Despertar/prevención & control , Incidencia , Nalbufina/administración & dosificación , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

OBJECTIVES: The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of preoperative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a previous study of pain and opioid use following MSL (Tsang et al.). METHODS: A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were administered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and present pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statistical analysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. RESULTS: Eighty-nine patients were included (mean age 52.8 ± 17.3 years, 40 males). All patients received preoperative 1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scores were 5 [2-11], 21 [12.3-56.8], and 3 [2-3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioid requirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043-1.548), p = 0.017) and total laryngoscope suspension time (OR (95%CI) = 0.791 (0.651-0.962, p = 0.019)). This cohort demonstrated reduced opioid usage on POD1 compared with Tsang et al (23%). CONCLUSIONS: Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use following MSL. Anesthesia time correlated with need for postoperative opioids. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:4625-4635, 2024.

Asunto(s)

Acetaminofén , Analgésicos no Narcóticos , Analgésicos Opioides , Laringoscopía , Dimensión del Dolor , Dolor Postoperatorio , Humanos , Acetaminofén/uso terapéutico , Acetaminofén/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Laringoscopía/métodos , Estudios Prospectivos , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Adulto , Cuidados Preoperatorios/métodos , Anciano

RESUMEN

BACKGROUND: The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. METHODS: This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. RESULTS: We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. CONCLUSIONS: These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

Asunto(s)

Analgésicos Opioides , Dolor Postoperatorio , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/psicología , Catastrofización/diagnóstico , Catastrofización/psicología , Estrés Psicológico/diagnóstico

Asunto(s)

Artroplastia de Reemplazo de Cadera , Bloqueo Nervioso , Humanos , Anestésicos Locales/efectos adversos , Artroplastia de Reemplazo de Cadera/efectos adversos , Nervio Femoral , Anestesia Local/efectos adversos , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control

Asunto(s)

Artroplastia de Reemplazo de Cadera , Bloqueo Nervioso , Humanos , Anestésicos Locales , Artroplastia de Reemplazo de Cadera/efectos adversos , Nervio Femoral , Bloqueo Nervioso/efectos adversos , Anestesia Local , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control

RESUMEN

BACKGROUND: This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). METHODS: Sixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay. RESULTS: There were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours). CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT05087862.

Asunto(s)

Anestésicos Locales , Artroplastia de Reemplazo de Cadera , Humanos , Anestésicos Locales/efectos adversos , Analgésicos Opioides/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Artroplastia de Reemplazo de Cadera/efectos adversos , Nervio Femoral , Bupivacaína/uso terapéutico , Morfina/uso terapéutico

RESUMEN

Considering the widespread use of rabbits in research that potentially causes pain and discomfort and the limited number of pain assessment validated tools in this species, we aimed to develop and validate a scale of acute postoperative pain in rabbits (RPBS). Footage of 58 rabbits from previous studies were used, recorded at 'baseline' (before orthopaedic and soft tissue surgeries), 'pain' (after surgery), 'analgesia' (after analgesic), and '24h post' (24 hours after surgery). The videos were randomised and assessed twice by four evaluators, within one-month interval between evaluations. After content validation, RBPS was further refined using the criteria from the validation. According to the principal component analysis, RPBS was considered unidimensional. The intra- and inter-observer reliability was excellent (ICC>0.80) for all evaluators. There was a high Spearman's correlation of the RPBS with unidimensional scales (>0.80) and a moderate correlation with the Rabbit Grimace Scale (0.68), confirming criterion validity. According to the mixed linear model, the scale was responsive, shown by the increase in pain scores after surgery. Construct validity was confirmed by known-group approach and internal relationships among items. Adequate item-total correlation (>0.3) was observed for all items, except for the attention to the affected area (0.04). The internal consistency was very good (Cronbach's α coefficient = 0.78; Mcdonald's ω coefficient = 0.83). The cut-off score for rescue analgesia was ≥3, with an area under the curve >0.95, demonstrating a high discriminatory capacity of the instrument. Scores 3 and 4 were within the uncertainty diagnostic zone. Specificity was 87% and sensitivity was 90%. It was concluded that the RPBS presented content, criterion, and construct validities, responsiveness, and reliability to assess acute pain in rabbits submitted to orthopaedic and soft tissue surgeries. The cut-off for rescue analgesia serves as a basis for the administration of analgesics to rabbits submitted to painful procedures.

Asunto(s)

Agnosia , Analgesia , Animales , Manejo del Dolor , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Psicometría , Conejos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios

RESUMEN

BACKGROUND: Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for patients, which can cause several complications. One strategy that aims to alleviate these phenomena is listening to music as a non-pharmacological intervention. The aim of this study is to evaluate the effect of listening to music on preoperative state-anxiety, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery. METHODS: A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who agree to participate in the research and sign a free and informed consent form. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups: experimental (subjected to listening to music for 20 min in the pre- and postoperative period) or control (standard care in the pre- and postoperative period), using a randomization scheme generated by the Randomization.com website. The sample size calculation was obtained after conducting a pilot study. DISCUSSION: The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols for listening to music, to minimize anxiety and pain in cardiac surgery. TRIAL REGISTRATION: ReBEC RBR-8mdyhd . Posted on December 10, 2019.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos , Musicoterapia , Música , Adolescente , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/prevención & control , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Humanos , Musicoterapia/métodos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Proyectos Piloto , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

Background: Pain is the leading cause of animal suffering, hence the importance of validated tools to ensure its appropriate evaluation and treatment. We aimed to test the psychometric properties of the short form of the Unesp-Botucatu Feline Pain Scale (UFEPS-SF) in eight languages. Methods: The original scale was condensed from ten to four items. The content validation was performed by five specialists in veterinary anesthesia and analgesia. The English version of the scale was translated and back-translated into Chinese, French, German, Italian, Japanese, Portuguese and Spanish by fluent English and native speaker translators. Videos of the perioperative period of 30 cats submitted to ovariohysterectomy (preoperative, after surgery, after rescue analgesia and 24 h after surgery) were randomly evaluated twice (one-month interval) by one evaluator for each language unaware of the pain condition. After watching each video, the evaluators scored the unidimensional, UFEPS-SF and Glasgow composite multidimensional feline pain scales. Statistical analyses were carried out using R software for intra and interobserver reliability, principal component analysis, criteria concurrent and predictive validities, construct validity, item-total correlation, internal consistency, specificity, sensitivity, the definition of the intervention score for rescue analgesia and diagnostic uncertainty zone, according to the receiver operating characteristic (ROC) curve. Results: UFEPS-SF intra- and inter-observer reliability were ≥0.92 and 0.84, respectively, for all observers. According to the principal component analysis, UFEPS-SF is a unidimensional scale. Concurrent criterion validity was confirmed by the high correlation between UFEPS-SF and all other scales (≥0.9). The total score and all items of UFEPS-SF increased after surgery (pain), decreased to baseline after analgesia and were intermediate at 24 h after surgery (moderate pain), confirming responsiveness and construct validity. Item total correlation of each item (0.68-0.83) confirmed that the items contributed homogeneously to the total score. Internal consistency was excellent (≥0.9) for all items. Both specificity (baseline) and sensitivity (after surgery) based on the Youden index was 99% (97-100%). The suggestive cut-off score for the administration of analgesia according to the ROC curve was ≥4 out of 12. The diagnostic uncertainty zone ranged from 3 to 4. The area under the curve of 0.99 indicated excellent discriminatory capacity of UFEPS-SF. Conclusions: The UFEPS-SF and its items, assessed by experienced evaluators, demonstrated very good repeatability and reproducibility, content, criterion and construct validities, item-total correlation, internal consistency, excellent sensitivity and specificity and a cut-off point indicating the need for rescue analgesia in Chinese, French, English, German, Italian, Japanese, Portuguese and Spanish.

Asunto(s)

Analgesia , Dolor Postoperatorio , Gatos , Animales , Reproducibilidad de los Resultados , Dolor Postoperatorio/diagnóstico , Analgesia/veterinaria , Lenguaje , Traducción

RESUMEN

BACKGROUND: The Brief Measure of Emotional Preoperative Stress (B-MEPS) was developed to evaluate the preoperative individual vulnerability to emotional stress. To obtain a refined version of B-MEPS suitable for an app approach, this study aimed: (i) to identify items with more discriminant properties; (ii) to classify the level of preoperative emotional stress based on cut-off points; (iii) to assess concurrent validity through correlation with the Central Sensitization Inventory (CSI) score; (iv) to confirm whether the refined version of B-MEPS is an adequate predictive measure for identification of patients prone to intense postoperative pain. METHODS: We include 1016 patients who had undergone surgical procedures in a teaching hospital. The generalized partial credit model of item response theory and latent class model were employed, respectively, to reduce the number of items and to create cut-off points. We applied the CSI and assessed pain by Visual Analog Scale (0-10) and by the amount of postoperative morphine consumption. RESULTS: The refined B-MEPS shows satisfactory reliability (Cronbach's alpha 0.79). Preoperative emotional stress, according to the cut-off points, is classified into categories: low, intermediate or high stress. The refined B-MEPS exhibited a linear association with the CSI scores (r2 = 0.53, p < 0.01). Patients with higher levels of emotional stress displayed a positive association with moderate to severe pain and greater morphine consumption. CONCLUSION: The refined version of B-MEPS, along with an interface of easy applicability, assess emotional vulnerability at the bedside before surgery. This app may support studies focused on intervening with perioperative stress levels.

Asunto(s)

Aplicaciones Móviles/estadística & datos numéricos , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Periodo Preoperatorio , Distrés Psicológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/psicología , Estudios Prospectivos , Psicometría , Encuestas y Cuestionarios

RESUMEN

The Analgesia Nociception Index (ANI), an objective measure of pain based on heart rate variability (HRV), has its usefulness in awake patients still unclear. This systematic review and meta-analysis aimed to assess ANI's accuracy compared to self-reported pain measures in conscious individuals undergoing medical procedures or painful stimuli. PubMed, Ovid, Web of Science, Scopus, Embase, and grey literature were searched until March 2021. Of the 832 identified citations, 16 studies complied with the eligibility criteria. A meta-analysis including nine studies demonstrated a weak negative correlation between ANI and NRS for pain assessment in individuals in the post-anesthetic recovery room (r = - 0.0984, 95% CI = - 0.397 to 0.220, I2 = 95.82%), or in those submitted to electrical stimulus (r = - 0.089; 95% CI = - 0.390 to 0.228, I2 = 0%). The evidence to use ANI in conscious individuals is weak compared to self-report measures of pain, yet ANI explains a part of self-report. Therefore, some individuals may be benefited from the use of ANI during procedures or in the immediate postoperative period.

Asunto(s)

Estado de Conciencia/fisiología , Frecuencia Cardíaca/fisiología , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Autoinforme , Vigilia/fisiología , Periodo de Recuperación de la Anestesia , Humanos , Periodo Posoperatorio

RESUMEN

Proper pain therapy requires adequate pain assessment. This study evaluated the reliability and validity of the Unesp-Botucatu horse acute pain scale (UHAPS), the Orthopedic Composite Pain Scale (CPS) and unidimensional scales in horses admitted for orthopedic and soft tissue surgery. Forty-two horses were assessed and videotaped before surgery, up to 4 hours postoperatively, up to 3 hours after analgesic treatment, and 24 hours postoperatively (168 video clips). After six evaluators viewing each edited video clip twice in random order at a 20-day interval, they chose whether analgesia would be indicated and applied the Simple Descriptive, Numeric and Visual Analog scales, CPS, and UHAPS. For all evaluators, intra-observer reliability of UHAPS and CPS ranged from 0.70 to 0.97. Reproducibility was variable among the evaluators and ranged from poor to very good for all scales. Principal component analysis showed a weak association among 50% and 62% of the UHAPS and CPS items, respectively. Criterion validity based on Spearman correlation among all scales was above 0.67. Internal consistency was minimally acceptable (0.51-0.64). Item-total correlation was acceptable (0.3-0.7) for 50% and 38% of UHAPS and CPS items, respectively. UHAPS and CPS were specific (90% and 79% respectively), but both were not sensitive (43 and 38%, respectively). Construct validity (responsiveness) was confirmed for all scales because pain scores increased after surgery. The cut-off point for rescue analgesia was ≥ 5 and ≥ 7 for the UHAPS and CPS, respectively. All scales presented adequate repeatability, criterion validity, and partial responsiveness. Both composite scales showed poor association among items, minimally acceptable internal consistency, and weak sensitivity, indicating that they are suboptimal instruments for assessing postoperative pain. Both composite scales require further refinement with the exclusion of redundant or needless items and reduction of their maximum score applied to each item or should be replaced by other tools.

Asunto(s)

Enfermedades de los Caballos/diagnóstico , Manejo del Dolor/veterinaria , Dimensión del Dolor/veterinaria , Dolor Postoperatorio/veterinaria , Animales , Femenino , Enfermedades de los Caballos/cirugía , Caballos , Masculino , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/cirugía

RESUMEN

STUDY DESIGN: Retrospective cohort study at a single institution. Patients undergoing specific, elective spinal procedures between 2012 and 2018. OBJECTIVE: The aim of thi stsudy was to investigate the relationship between opioid prescriptions during the immediate, post-discharge period, and patient-reported pain outcomes. SUMMARY OF BACKGROUND DATA: Medically prescribed opiates contribute to the opioid crisis, manifesting in significant mortality and economic burden. Although opioids are a mainstay of pain amelioration following spinal surgery, prescription practices are heterogeneous. METHODS: Inclusion criteria included: patients who underwent one of 10 spinal procedures (Table 1); patients with preoperative, postoperative day (POD 1, and POD 30 pain scores reported on the visual analog scale (VAS); patients discharged without a complicated perioperative course. Opioids were converted to morphine milligram equivalents per day (MME/day) using a standard reference table. χ2, Kruskal-Wallis, and logistic regression were utilized to investigate associations between clinical variables and postoperative pain scores. Univariate and multivariable linear regression models with Stepwise selection (cut off: P = 0.05) were employed as appropriate on POD 30 VAS pain scores. RESULTS: Smoking status and postoperative LOS were associated with opioid prescription doses. Patients prescribed opioids <40 MME/day, equivalent to five tablets of 5 mg oxycodone/day, showed no significant difference in POD 30 VAS score (ß coefficient: 0.095, P  = 0.752) when compared to patients who received the highest-dose opioids (>80 MME/day-equivalent to 10 tablets of 5 mg oxycodone/day). Adjusted multivariable logistic regression analysis revealed that postoperative opioid dosage/prescription was not a significant predictor of patients reporting at least 50% pain improvement, suggesting that 40 MME/day is sufficient to maintain patient satisfaction. CONCLUSION: Patients receiving the lowest dosage of opioid prescriptions with sufficient nonopiate analgesics did not report worse pain relief at POD 30 compared to those receiving higher opioid prescriptions. In light of the opioid epidemic, this study supports initial dosing recommendations by the American Society for Addiction Medicine.Level of Evidence: 3.

Asunto(s)

Analgésicos Opioides , Narcóticos , Cuidados Posteriores , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Alta del Paciente , Pautas de la Práctica en Medicina , Prescripciones , Estudios Retrospectivos

RESUMEN

BACKGROUND: This randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%. METHODS: Forty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours. RESULTS: Compared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; p<0.001) and 6 hours (25% vs 85%; p<0.001). Furthermore, pericapsular nerve group block also provided better preservation of hip adduction at 3 hours (p=0.023) as well as decreased sensory block of the anterior, lateral, and medial thighs at all measurement intervals (all p≤0.014). No clinically significant intergroup differences were found in terms of postoperative pain scores, cumulative opioid consumption at 24 and 48 hours, ability to perform physiotherapy, opioid-related side effects, and length of hospital stay. CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT04402450.

Asunto(s)

Artroplastia de Reemplazo de Cadera , Bloqueo Nervioso , Artroplastia de Reemplazo de Cadera/efectos adversos , Fascia/diagnóstico por imagen , Nervio Femoral/diagnóstico por imagen , Humanos , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control

RESUMEN

The purpose of this systematic review was to analyze the influence of occlusal reduction on the postoperative pain levels after endodontic treatment (instrumentation and obturation of the root canal system). This review followed the PRISMA statement and was registered at PROSPERO (CRD42018107918). Two independent reviewers searched the Lilacs, Cochrane Library, PubMed (Medline), Web of Science, Scopus, Scielo, and ScienceDirect for articles published until April 2021. The research question was, "Does occlusal reduction decrease postoperative pain in endodontically treated teeth?". Only randomized clinical trials were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (presence or absence of pain). The search strategies retrieved 4114 studies. Twelve studies were included for qualitative analysis and nine for quantitative analysis. The meta-analysis results did not reveal a significant difference in the reduction of postoperative pain levels for endodontic instrumentation at 6, 12, 24, 48 h and for endodontic obturation at 6 or 12 h after occlusal reduction. According to the GRADE tool, the analyzed outcome was classified as having a moderate level of certainty. It is concluded that occlusal reduction does not interfere with postoperative pain levels after endodontic treatment.

Asunto(s)

Ajuste Oclusal , Dolor Postoperatorio/etiología , Dolor Postoperatorio/terapia , Obturación del Conducto Radicular/efectos adversos , Humanos , Ajuste Oclusal/métodos , Manejo del Dolor , Dolor Postoperatorio/diagnóstico , Obturación del Conducto Radicular/métodos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy. OBJECTIVE: To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy. DESIGN: Randomised, double-blinded, placebo-controlled trial. SETTING: Tertiary referral centre, Brasília, Brazil. Recruitment: July 2015 to July 2017. PATIENTS: Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75 years. Four were excluded. INTERVENTIONS: All underwent general anaesthesia. The intervention group received a bolus of 0.5 mg kg-1 of esmolol over 10 min followed by a continuous infusion of 100 µg kg-1 min-1. The placebo group received saline. MAIN OUTCOME MEASURES: The primary outcome was pain at rest 24 h after mastectomy as measured by a 0 to 10 numeric rating scale. RESULTS: Pain scores at rest 24 h after mastectomy were lower in esmolol-treated patients compared with placebo (mean difference = -1.51, 95% confidence interval (CI), -2.36 to -0.65, P = 0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (P = 0.009 and P = 0.013, respectively), on discharge from PACU (P = 0.009 and P = 0.015), 12 h (P = 0.01 and P = 0.007) and on effort in the 24 postoperative hours (P = 0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean difference  = -2.52 mg, 95% CI = -3.67 to -1.38, P < 0.001). The length of hospital stay was shorter for the esmolol group (mean difference = -6.9 h, 95% CI, -13.4 to -0.31, P = 0.040). CONCLUSION: Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy. TRIAL REGISTRATION: ClinicalTrials/NCT02466542.

Asunto(s)

Neoplasias de la Mama , Analgésicos Opioides , Brasil , Método Doble Ciego , Femenino , Humanos , Mastectomía/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Propanolaminas

RESUMEN

BACKGROUND: Opioid abuse has been an increasing problem since the 1990s. With over 47,000 opioid related deaths recorded in 2017 alone, concerns have been raised regarding the dangers of introducing opioids perioperatively to patients undergoing major surgeries. OBJECTIVES: The present study proposes to examine the frequency, amount, and trends in post-operative opioid consumption in patients undergoing orthopedic surgical procedures. STUDY DESIGN: This was a randomized, retrospective questionnaire-based study. SETTING: Patients who underwent any type of orthopedic surgery at the University of Pennsylvania Presbyterian Hospital from 1/1/2018 to 3/12/2019 were randomly selected and called during the summer of 2019. METHODS: In this retrospective questionnaire-based study, 828 patients were called by telephone in the summer of 2019. These patients were asked a variety of questions involving opioid consumption behavior post-surgery. The study ended after receiving responses from 200 patients. RESULTS: Nineteen (9.5%) patients reported positively for experiencing euphoria while taking opioids post-surgery. Of the 200 patients contacted, 6 patients (3%) reported switching to marijuana instead of opioids. Thirty-eight (19%) patients preferred to take no opioids at all post-surgery, and one patient was found to have given their prescription to a family member or friend. Twenty-one patients (10.5%) were found to have been taking opioids for non-severe pain. Blacks and whites were the most common racial demographics, making up 84 and 109 of the totals, respectively. The odds ratios for all of the predictors showed that the relative risk for opioid misuse was higher for black patients than white patients (OR = 3.034). There was no relationship between the intra- and post-operative opioid administration and long-term opioid misuse. LIMITATIONS: Patients are self-selected and had the option to opt out of the study when contacted. Some patients may not have been available to answer the phone when our study was being conducted. This study was only conducted for orthopedic patients and for patients who received surgery at the University of Pennsylvania Presbyterian Hospital, thus affecting the demographics for our research. CONCLUSIONS: Prescription opioid misuse is more common among the black population. The total opioid consumption is frequently lower than the quantity prescribed. Patients frequently use opioids even though they feel that pain is insufficient to deserve such an intervention. Euphoria is experienced by a significant number of patients taking prescription opioids Often patients do not take any opioids, although they had prescriptions.

Asunto(s)

Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/diagnóstico , Procedimientos Ortopédicos/tendencias , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/psicología , Procedimientos Ortopédicos/efectos adversos , Dolor Postoperatorio/psicología , Pautas de la Práctica en Medicina/tendencias , Distribución Aleatoria , Estudios Retrospectivos , Adulto Joven

RESUMEN

OBJECTIVE: To assess prescribing and refilling trends of narcotics in postoperative urology patients at our institution. Although the opioid epidemic remains a public health threat, no series has assessed prescribing patterns across urologic surgery disciplines following discharge. METHODS: All urologic surgeries were retrospectively reviewed from May 2017-April 2018. Demographics, comorbidities, and postoperative pain management strategies were analyzed. Narcotics usage following surgery were reported in total morphine equivalents (TME). Opioid refill rate was characterized by medical specialty and stratified by urologic discipline. RESULTS: 817 cases were reviewed. Mean age and TME at discharge was 57±15.6 years and 35.43±19.5 mg, respectively. 13.6% (mean age 55±15.9) received a narcotic refill following discharge (mean TME/refill 37.7±28.9 mg). A higher proportion of patients with a pre-operative opioid prescription received a refill compared to opioid naïve patients (38.2% vs 21.6%, P < .01). Refill rate did not differ between urologic subspecialties (P = .3). Urologists were only responsible for 20.4% of all refills filled, despite all patients continuing follow-up with their surgeon. Procedures with the highest rates of post-operative refills were in oncology, male reconstruction/trauma and endourology. Patients with a history of chronic pain (OR 1.9, CI 1.1-3.3) preoperative narcotic prescription (OR 1.6, CI 1.0-2.6), and higher ASA score (OR 1.8, CI 1.6-2.8) were more likely to obtain a postoperative opioid prescription refill. CONCLUSION: Approximately 1 in 7 postoperative urology patients receive a postoperative narcotics refill; however, nearly two-thirds receive refills exclusively from non-urologic providers. Attempts to avoid overprescribing of postoperative narcotics need to account for both surgeon and nonsurgeon sources of opioid refills.

Asunto(s)

Analgésicos Opioides/administración & dosificación , Manejo del Dolor , Dolor Postoperatorio , Procedimientos Quirúrgicos Urológicos/efectos adversos , Femenino , Personal de Salud/clasificación , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Manejo del Dolor/métodos , Manejo del Dolor/normas , Manejo del Dolor/estadística & datos numéricos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Alta del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Mejoramiento de la Calidad/organización & administración , Estados Unidos/epidemiología , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos