RESUMEN
Minipigs are widely used in biomedical research for translational studies. However, information about pain elicited by experimental procedures is lacking. Non-invasive methods as quantitative sensory testing and conditioned pain modulation are particularly attractive. Our overarching aim was to explore and refine these methods for assessing post-operative pain in minipigs after myocardial infarction. As first step, we aimed at defining mechanical and thermal thresholds in healthy adults Göttingen Minipigs, evaluating their reliability, and testing their modifications after the application of a conditioning stimulus. Thresholds were assessed at different body sites before and after a painful conditioning stimulus (CS) (cuffed tourniquet) and sham CS (uncuffed tourniquet) in eleven animals. Thresholds' reliability was assessed using interclass correlation coefficient (ICC). The effect of the CS was assessed calculating absolute change, percentage change of the thresholds and standard error of measurement. Baseline mechanical thresholds (Newton) were: left hindlimb 81 [73; 81]; left forearm 81 [72.1; 81]; right forearm 81 [76; 81]; left chest 80.5 [68; 81]; right chest 81 [76.5; 81]; left neck 81 [70.3; 81]; right neck 74.8 [62.3; 80.5]. Reliability of mechanical thresholds was good at right chest (ICC = 0.835) and moderate at left chest (ICC = 0.591), left hindlimb (ICC = 0.606) and left neck (ICC = 0.518). Thermal thresholds showed poor reliability in all the tested sites. A modulatory effect was present at right chest, but it was seen when both a painful CS and a sham CS was applied. Minipigs tendentially showed a pro-nociceptive profile (i.e. conditioning pain facilitation). The measured thresholds are a reference for future trials in this species. Mechanical thresholds showed to be more reliable and, therefore, more useful, than thermal ones. The pain facilitation might be explained by the phenomenon of stress induced hyperalgesia, but this finding needs to be further investigated with a stricter paradigm.
Asunto(s)
Umbral del Dolor , Porcinos Enanos , Animales , Porcinos , Umbral del Dolor/fisiología , Masculino , Femenino , Reproducibilidad de los Resultados , Dimensión del Dolor/métodos , Dolor Postoperatorio/fisiopatología , Infarto del Miocardio/fisiopatologíaRESUMEN
OBJECTIVES: This study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a "probable" versus "no or possible" nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response. METHODS: A secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed. RESULTS: Thirty (15.22%-approach 4 pain locations) and 46 (23.35%-approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group. DISCUSSION: This study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.
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Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Dimensión del Dolor , Humanos , Femenino , Osteoartritis de la Rodilla/cirugía , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Masculino , Estudios Prospectivos , Dimensión del Dolor/métodos , Anciano , Persona de Mediana Edad , Estudios Longitudinales , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/psicología , Índice de Severidad de la Enfermedad , Bélgica , Países Bajos , Dolor/diagnóstico , Dolor/fisiopatología , Dolor/etiologíaRESUMEN
Pain catastrophizing is an exaggerated focus on pain sensations. It may be an independent factor influencing pain and functional outcomes of knee arthroplasty. We aimed to evaluate the association between pre-operative pain catastrophizing with pain and function outcomes up to one year after knee arthroplasty. We used data from a cohort study of patients undergoing primary knee arthroplasty (either total or unicompartmental arthroplasty) for knee osteoarthritis. Pain catastrophizing was assessed pre-operatively using the Pain Catastrophizing scale (PCS). Other baseline variables included demographics, body mass index, radiographic severity, anxiety, depression, and knee pain and function assessed using the Western Ontario and McMaster University Index (WOMAC). Patients completed the WOMAC at 6- and 12-months after arthroplasty. WOMAC pain and function scores were converted to interval scale and the association of PCS and changes of WOMAC pain and function were evaluated in generalized linear regression models with adjustment with confounding variables. Of the 1136 patients who underwent arthroplasty (70% female, 84% Chinese, 92% total knee arthroplasty), 1102 and 1089 provided data at 6- and 12-months post-operatively. Mean (± SD) age of patients was 65.9 (± 7.0) years. PCS was associated with a change in WOMAC pain at both 6-months and 12-months (ß = - 0.04, 95% confidence interval: - 0.06, - 0.02; P < 0.001) post-operatively after adjustment in multivariable models; as well as change in WOMAC function at 6-months and 12-months. In this large cohort study, pre-operative pain catastrophizing was associated with lower improvements in pain and function at 6-months and 12-months after arthroplasty.
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Artroplastia de Reemplazo de Rodilla , Catastrofización , Osteoartritis de la Rodilla , Humanos , Femenino , Masculino , Osteoartritis de la Rodilla/cirugía , Osteoartritis de la Rodilla/psicología , Osteoartritis de la Rodilla/fisiopatología , Catastrofización/psicología , Anciano , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/psicología , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Estudios de Cohortes , Dolor/psicología , Dolor/fisiopatologíaRESUMEN
(1) Background: This study aimed to describe upper-limb (UL) movement quality parameters in women after breast cancer surgery and to explore their clinical relevance in relation to post-surgical pain and disability. (2) Methods: UL movement quality was assessed in 30 women before and 3 weeks after surgery for breast cancer. Via accelerometer data captured from a sensor located at the distal end of the forearm on the operated side, various movement quality parameters (local dynamic stability, movement predictability, movement smoothness, movement symmetry, and movement variability) were investigated while women performed a cyclic, weighted reaching task. At both test moments, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire was filled out to assess UL disability and pain severity. (3) Results: No significant differences in movement quality parameters were found between the pre-surgical and post-surgical time points. No significant correlations between post-operative UL disability or pain severity and movement quality were found. (4) Conclusions: From this study sample, no apparent clinically relevant movement quality parameters could be derived for a cyclic, weighted reaching task. This suggests that the search for an easy-to-use, quantitative analysis tool for UL qualitative functioning to be used in research and clinical practice should continue.
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Neoplasias de la Mama , Movimiento , Extremidad Superior , Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/fisiopatología , Persona de Mediana Edad , Extremidad Superior/fisiopatología , Extremidad Superior/fisiología , Movimiento/fisiología , Anciano , Adulto , Encuestas y Cuestionarios , Acelerometría/métodos , Dolor Postoperatorio/fisiopatologíaRESUMEN
BACKGROUND: The degree of postoperative pain and defecation function in colorectal cancer will affect patients' prognosis. Therefore, exploring the correlation between postoperative pain and defecation function, and analyzing the related factors, will help to improve the quality of patients' prognosis. METHODS: A total of 94 patients with colorectal cancer admitted to our hospital from March 2022 to June 2023 were retrospectively selected for study. The visual analog scale (VAS) was used to evaluate the pain level of the patients. The low anterior resection syndrome (LARS) scale was used to evaluate bowel function of the patients, and the incidence of LARS was recorded. The patients were grouped according to whether or not they had the complications of LARS, and they were divided into the groups of concurrent LARS and non-concurrent LARS. The patients' anorectal pressure was measured, and the measurements included maximum tolerated volume (MTV), anorectal resting pressure (ARP), and maximum squeeze pressure (MSP). Pearson's correlation coefficient was used to test associations between anal defecation function and postoperative pain and anorectal manometry. Logistic regression was used to test predictors of concurrent LARS, and the value of each of the indices for prediction of LARS was examined using the receiver operating characteristic (ROC). RESULTS: Patients' VAS scores were positively correlated with LARS scores (p < 0.05). A total of 22 patients with VAS score ≥20 points were found to have a LARS incidence of 23.40% based on the LARS score. The VAS score was higher in the concurrent LARS group than in the non-concurrent LARS group (p < 0.05). The concurrent LARS group had a higher percentage of patients with age ≥60 years, body mass index ≥24 kg/m2, anastomotic position <5 cm from the anal verge, preoperative radiotherapy, and anastomotic fistula than the non-current LARS group (p < 0.05). The levels of MTV, ARP, and MSP were lower in patients in the concurrent LARS group than in the non-current LARS group (p < 0.05). Patients' LARS scores were negatively correlated with MTV (r = -0.420), ARP (r = -0.300) and MSP (r = -0.220) levels (p < 0.05). Logistic regression analysis showed that anastomotic position <5 cm from the anal verge, preoperative radiotherapy, anastomotic fistula, high VAS level, and low MTV level were all significant predictors of concurrent LARS. Anastomotic position, whether or not radiotherapy was administered preoperatively, anastomotic fistula, VAS score, and MSP level all had high sensitivity and specificity for prediction of concurrent LARS, and the combined area under the curve (AUC) of each index was 0.921, sensitivity was 0.818, and specificity was 0.944. CONCLUSION: LARS is strongly associated with the patient's pain level, and factors such as anastomotic position <5 cm from the anal verge, preoperative radiotherapy, anastomotic fistula, high VAS level, and low MTV level will increase the risk of concurrent LARS in patients.
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Neoplasias Colorrectales , Defecación , Dolor Postoperatorio , Humanos , Masculino , Femenino , Estudios Retrospectivos , Pronóstico , Persona de Mediana Edad , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/complicaciones , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Anciano , Canal Anal/fisiopatología , Dimensión del Dolor , Manometría , AdultoRESUMEN
OBJECTIVE: To investigate the changes in vertebral function after minimally invasive surgery in patients with thoracolumbar spinal fractures and investigate the impact of percutaneous minimally invasive surgery on patients' quality of life by following up the patients in the long term. METHODS: A retrospective analysis was performed to select 80 patients with thoracolumbar spinal fractures treated in our hospital from April 2013 to October 2018, and the patients were divided into a study group and a control group according to the difference in their choice of procedure. The two groups were compared in terms of perioperative wound pain, serum creatine kinase (CK) activity, and C-reactive protein (CRP) levels, and the two groups were followed up for 2 years to compare the changes in anterior vertebral body height and Cobb's angle during the follow-up period and to compare the differences in quality of life between the two groups. RESULTS: (1) The pain level of patients in the study group was significantly lower than that of the control group at the 1st and 3rd postoperative days (p < 0.05). (2) The CK activity and CPR level of patients in the study group were significantly lower than that of the control group at the 1st and 3rd postoperative days (p < 0.05). (3) Compared with the preoperative period, the height of the anterior border of the vertebral body and the Cobb's angle in both groups showed significant changes at 7 d, 6 months, one year, and two years after surgery (p < 0.05), suggesting that both procedures can significantly restore the height of the injured vertebra and improve the function of the vertebral body. (4) The somatic, physical, and psychological functions of patients in the study group were significantly greater than those in the control group at 6 months postoperatively (p > 0.05). CONCLUSION: Compared to traditional open surgery, minimally invasive percutaneous surgery for thoracolumbar fractures can significantly reduce perioperative pain and improve perioperative stress in patients, while achieving better surgical outcomes and a significantly improved quality of life in patients at long-term follow-up.
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Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Ortopédicos/métodos , Fracturas de la Columna Vertebral/cirugía , Adulto , Biología Computacional , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Ortopédicos/efectos adversos , Dolor Postoperatorio/fisiopatología , Tornillos Pediculares , Calidad de Vida , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/fisiopatología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugíaRESUMEN
BACKGROUND This single-center study compared the effect of combined thoracic paravertebral block (TPVB) and general anesthesia vs general anesthesia alone on postoperative stress and pain in patients undergoing laparoscopic radical nephrectomy. MATERIAL AND METHODS Patients undergoing laparoscopic radical nephrectomy were selected and randomized into a study group given TPVB combined with general anesthesia (n=43) and a reference group (n=43) given general anesthesia. The perioperative clinical indicators, blood pressure, pulse rate, visual analog scale (VAS) score, and adverse reactions were compared. RESULTS Perioperative clinical indicators of the study group (other than operation duration) were superior to those of the reference group (P<0.05). At 90 min in the operation, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were lower than before anesthesia (t=7.691, 10.017, and 7.728, P<0.05). SBP, DBP, and pulse rate at 90 minutes during operation were significantly lower in the study group than in the reference group (t=7.582, 8.754, and 6.682, P<0.01). The study group had lower VAS scores both during activity and at rest 48 h after the operation than in the reference group (t=5.171 and 6.025, P<0.001). The total incidence of adverse reactions in the study group was lower than in the reference group (χ²=5.018, P=0.024). CONCLUSIONS The findings from this study from a single center showed that TPVB combined with general anesthesia for patients undergoing laparoscopic radical nephrectomy significantly reduced postoperative pain and stress.
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Anestesia General , Nefrectomía , Bloqueo Nervioso , Dolor Postoperatorio , Complicaciones Posoperatorias , Nervios Torácicos , Adulto , Anestesia General/efectos adversos , Anestesia General/métodos , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Nefrectomía/efectos adversos , Nefrectomía/métodos , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/prevención & control , Atención Perioperativa/métodos , Atención Perioperativa/estadística & datos numéricos , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Resultado del TratamientoRESUMEN
Over 185,000 limb amputations are performed in the United States annually, many of which are due to the sequelae of peripheral vascular disease. Symptomatic neuromas remain a significant source of postamputation morbidity and contribute to both phantom limb (PLP) and residual limb pain (RLP). While many interventions have been proposed for the treatment of symptomatic neuromas, conventional methods lead to a high incidence of neuroma recurrence. Furthermore, these existing methods do not facilitate an ability to properly interface with myoelectric prosthetic devices. The Regenerative Peripheral Nerve Interface (RPNI) was developed to overcome these limitations. The RPNI consists of an autologous free muscle graft secured around the end of a transected nerve. The muscle graft provides regenerating axons with end organs to reinnervate, thereby preventing neuroma formation. We have shown that this simple, reproducible, and safe surgical technique successfully treats and prevents neuroma formation in major limb amputations. In this paper, we describe RPNI surgery in the setting of major limb amputation and highlight the promising results of RPNIs in our animal and clinical studies.
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Amputación Quirúrgica , Pierna/cirugía , Músculo Esquelético/cirugía , Regeneración Nerviosa , Neuroma/prevención & control , Dolor Postoperatorio/prevención & control , Nervios Periféricos/cirugía , Amputación Quirúrgica/efectos adversos , Humanos , Pierna/inervación , Músculo Esquelético/inervación , Neuroma/etiología , Neuroma/fisiopatología , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Nervios Periféricos/fisiopatología , Trasplante Autólogo , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the phenomenon of rebound pain associated with peripheral nerve blocks in the setting of trauma and orthopedic surgery, to know its characteristics, pathophysiological mechanisms, risk factors, preventive and treatment measures. METHODOLOGY: Non-systematic bibliographic review of articles in English, in medical databases PubMed, Google Scholar, Embase, Epistemonikos and Cochrane library in January 2021, restricting the search to articles published in the last five years. A total of 58 articles related to rebound pain in the context of orthopedic and trauma surgery were identified according to the inclusion and exclusion criteria. RESULTS: It was evidenced that there is still no consensus on its definition, although it presents repeated characteristics, such as acute and transitory pain, which occurs after the resolution of the peripheral nerve block. An incidence of up to 50% is described in the outpatient setting, but there is no data outside this setting. Its pathophysiology is complex and not yet fully understood, however, a peripheral sensitization component could determine a higher incidence of the phenomenon. Recognized risk factors correspond to trauma and orthopedic surgeries of the upper limb with dense peripheral nerve blocks and young female patients. In relation to its prevention, dexamethasone and dexmedetomidine stand out as promising adjuvants that together with a multimodal analgesia scheme can mitigate its appearance. CONCLUSIONS: Understanding the impact of rebound pain, its characteristics, risk factors, preventive measures and benefits of multimodal analgesia, is part of a comprehensive clinical practice to avoid the negative consequences of increased use of health resources, as well as to reduce the consumption of opioids and their known adverse effects.
OBJETIVOS : Describir el fenómeno de dolor de rebote asociado a bloqueos de nervio periférico en el entorno de cirugía traumatoló- gica y ortopédica, conocer sus características, mecanismos fisiopatológicos, factores de riesgo, medidas preventivas y de tratamiento. METODOLOGÍA: Revisión bibliográfica no sistemática de artículos en inglés, en bases de datos médicas PubMed, GoogleScholar, Embase, Epistemonikos y Cochrane library en enero del 2021, restringiéndose la búsqueda a los artículos publicados en los últimos cinco años. Se identificaron un total de 67 artículos relacionados a dolor de rebote en contexto de cirugía ortopédica y traumatológica según los criterios de inclusión y exclusión. RESULTADOS: Se evidenció que aún no existe un consenso en su definición, no obstante presenta características reiteradas, como ser un dolor agudo y transitorio, que ocurre posterior a la resolución del bloqueo de nervio periférico. Se describe una incidencia en el ámbito ambulatorio de hasta 50%, pero sin datos fuera de este entorno. Su fisiopatología es compleja y todavía no se comprende en su totalidad, sin embargo, un componente de sensibilización periférica podría determinar una mayor incidencia del fenómeno. Factores de riesgo reconocidos corresponden a cirugías traumatológicas y ortopédicas de miembro superior con bloqueos de nervio periférico densos y pacientes jóvenes de sexo femenino. En relación a su prevención destacan dexametasona y dexmedetomidina como adyuvantes prometedores que junto a un esquema de analgesia multimodal pueden mitigar su aparición. CONCLUSIONES: Entender el impacto del dolor de rebote, sus características, factores de riesgo, medidas preventivas y beneficios de la analgesia multimodal, forma parte de una práctica clínica integral para evitar las consecuencias negativas de una mayor utilización de recursos sanitarios, como también reducir el consumo de opioides y de sus efectos adversos conocidos
Asunto(s)
Humanos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Anestesia de Conducción/efectos adversos , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/fisiopatología , Nervios Periféricos , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the clinical effects and survival prognosis of radical gastrectomy assisted by external vision in gastric cancer. METHODS: A total of 60 hospitalized gastric cancer patients from June 2016 to December 2018 were selected and divided into the observation group and control group according to different surgical procedures. The control group was treated with traditional open radical gastrectomy, while the observation group was treated with radical gastrectomy assisted by an external vision microscope. Relevant surgical indicators, visual analogue scale (VAS), postoperative complications, and life quality assessment were analyzed and compared between the two groups. RESULTS: The incision length and intraoperative blood loss in the observation group were smaller than those in the control group, and the difference was statistically significant (P < 0.05); compared with the control group, the observation group had significantly shorter hospital stay, earlier postoperative first exhaust time, and lower gastric fluid volume at the 3rd day after surgery (P < 0.05). The pain scores of the observation group at 1, 4, and 12 weeks after surgery were lower than those of the control group (P < 0.05), and the difference was significant. The quality of life scores at the 1st week and 12th week after surgery showed that the dysphagia symptom scores of the observation group and the control group were significantly reduced but the two groups had significant differences in fatigue, physical function, pain score, postoperative pain, and overall quality of life. The observation group was significantly better than the control group (P < 0.05). Follow-up studies showed no significant difference between mortality and cancer recurrence (P > 0.05); the patients recovered well at postoperation, and the diet of the observation group was better than that of the control group (P < 0.05); gastric reflux and knife pain were less than those of the control group (P < 0.05). CONCLUSION: Radical gastrectomy assisted by external vision for gastric cancer yields clinical benefits for gastric cancer patients, which not only dramatically shortened the length of hospital stay but also effectively ameliorated the quality of life of patients, all indicating that external vision-assisted surgery was significantly better than traditional gastrectomy in improving the postoperative quality of life of gastric cancer patients in the absence of increasing the risk of adverse events.
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Gastrectomía/métodos , Neoplasias Gástricas/cirugía , Anciano , China , Biología Computacional , Femenino , Gastrectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Complicaciones Posoperatorias/etiología , Pronóstico , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND: As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors' clinical experience, they hypothesize that pain scores are lower in older patients. METHODS: In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. RESULTS: A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; ß = -0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. CONCLUSIONS: The authors' findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient.
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Envejecimiento/fisiología , Dimensión del Dolor/tendencias , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/fisiopatología , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
BACKGROUND The reasons for foot and ankle pain following total knee arthroplasty (TKA) for knee varus osteoarthritis are unknown. This retrospective study aimed to investigate the risk factors for postoperative foot and ankle pain in patients with varus osteoarthritis of the knee who underwent TKA. MATERIAL AND METHODS We enrolled 90 patients who underwent TKA for varus knee osteoarthritis. The visual analog scale (VAS) was used to evaluate patients' foot or ankle pain before and after surgery. The correlation between independent variables (eg, age, sex, body mass index [BMI], ankle osteoarthritis, and varus angle) and foot and ankle pain in patients with osteoarthritis of the knee was measured. Moreover, radiological changes were compared between the groups with and without worsened pain. RESULTS No significant difference in VAS was found between patients <60 and ≥60 years of age (P>0.05). Male sex and BMI <30 kg/m² were weakly correlated with preoperative foot or ankle pain. However, patients with varus of ≥6° and preexisting ankle osteoarthritis had a higher incidence of foot or ankle pain before surgery. Moreover, no significant differences in radiological changes were found between the groups with and without worsened foot or ankle pain after surgery (P>0.05). CONCLUSIONS In male patients with osteoarthritis of the knee, a BMI <30 kg/m², varus of <6°, and no preexisting ankle osteoarthritis were protective factors for foot and ankle pain. TKA corrected knee and ankle malalignment. Therefore, postoperative foot and ankle pain was not associated only with TKA surgery.
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Tobillo/fisiopatología , Artroplastia de Reemplazo de Rodilla , Pie/fisiopatología , Osteoartritis de la Rodilla/cirugía , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/fisiopatología , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/epidemiología , Gravedad del Paciente , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
INTRODUCTION: More than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain. OBJECTIVE: Assess and describe the management of postoperative pain after CR, and the practices amongst specialists in different countries. METHODS: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. RESULTS: At day 7 post CR, 97% of the surgeons observed pain amongst their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women. CONCLUSION: Pain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimisation of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.
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Clítoris/lesiones , Bloqueo Nervioso/normas , Dolor Postoperatorio/tratamiento farmacológico , Nervio Pudendo/efectos de los fármacos , Adulto , Austria , Bélgica , Burkina Faso , Canadá , Circuncisión Femenina/métodos , Clítoris/efectos de los fármacos , Clítoris/fisiopatología , Côte d'Ivoire , Egipto , Femenino , Francia , Alemania , Humanos , Bloqueo Nervioso/métodos , Bloqueo Nervioso/estadística & datos numéricos , Países Bajos , Dolor Postoperatorio/fisiopatología , Guías de Práctica Clínica como Asunto , Nervio Pudendo/fisiopatología , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/normas , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Senegal , España , Encuestas y Cuestionarios , Suecia , Suiza , Estados UnidosRESUMEN
Chronic postsurgical pain (CPSP) is a serious problem. We developed a mouse model of CPSP induced by electrocautery and examined the mechanism of CPSP. In this mouse model, while both incision and electrocautery each produced acute allodynia, persistent allodynia was only observed after electrocautery. Under these conditions, we found that the mRNA levels of Small proline rich protein 1A (Sprr1a) and Annexin A10 (Anxa10), which are the key modulators of neuropathic pain, in the spinal cord were more potently and persistently increased by electrocautery than by incision. Furthermore, these genes were overexpressed almost exclusively in chronic postsurgical pain-activated neurons. This event was associated with decreased levels of tri-methylated histone H3 at Lys27 and increased levels of acetylated histone H3 at Lys27 at their promoter regions. On the other hand, persistent allodynia and overexpression of Sprr1a and Anxa10 after electrocautery were dramatically suppressed by systemic administration of GSK-J4, which is a selective H3K27 demethylase inhibitor. These results suggest that the effects of electrocautery contribute to CPSP along with synaptic plasticity and epigenetic modification.
Asunto(s)
Anexinas/biosíntesis , Proteínas Ricas en Prolina del Estrato Córneo/biosíntesis , Electrocoagulación/efectos adversos , Código de Histonas , Hiperalgesia/etiología , Proteínas del Tejido Nervioso/biosíntesis , Neuralgia/genética , Neuronas/fisiología , Dolor Postoperatorio/genética , Médula Espinal/fisiopatología , Animales , Anexinas/genética , Benzazepinas/farmacología , Benzazepinas/uso terapéutico , Proteínas Ricas en Prolina del Estrato Córneo/genética , Modelos Animales de Enfermedad , Femenino , Traumatismos de los Pies/fisiopatología , Regulación de la Expresión Génica , Técnicas de Sustitución del Gen , Genes Reporteros , Genes fos , Histonas/metabolismo , Hiperalgesia/tratamiento farmacológico , Hiperalgesia/fisiopatología , Histona Demetilasas con Dominio de Jumonji/antagonistas & inhibidores , Lisina/metabolismo , Masculino , Metilación , Ratones , Ratones Endogámicos C57BL , Proteínas del Tejido Nervioso/genética , Neuralgia/tratamiento farmacológico , Neuralgia/fisiopatología , Neuronas/efectos de los fármacos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/fisiopatología , Pirimidinas/farmacología , Pirimidinas/uso terapéutico , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Tamoxifeno/análogos & derivados , Tamoxifeno/farmacologíaRESUMEN
INTRODUCTION: Opioids for managing postoperative pain are associated with side effects including opioid-induced respiratory depression (OIRD) and gastrointestinal complications. Opioids induce analgesia via G-protein signaling, while adverse effects are mediated by the ß-arrestin pathway. Oliceridine is a biased ligand that preferentially activates G-protein signaling over ß-arrestin, theoretically reducing adverse effects. Oliceridine has been approved by the Food and Drug Administration to treat acute pain severe enough to require intravenous opioid analgesics. AREAS COVERED: Preclinical and clinical trials demonstrate the analgesic efficacy of oliceridine. Available evidence suggests that oliceridine may have a lower risk of OIRD and gastrointestinal complications compared to conventional opioids. EXPERT OPINION: The analgesic efficacy of oliceridine has been evaluated in several clinical trials. However, safety data were obtained from an open-label observational study and studies assessing adverse effects as secondary outcomes, as post-hoc analyses, or from retrospective studies. These may be affected by gaps in detecting adverse events, heterogeneity in the original studies, and the limitations of retrospective studies. Prospective trials examining the safety of oliceridine versus conventional opioids are needed. Studies are also needed to assess the safety and efficacy of oliceridine in obstetric and pediatric populations, and in the context of multimodal analgesia and Enhanced Recovery after Surgery protocols.
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Analgésicos Opioides/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Compuestos de Espiro/administración & dosificación , Tiofenos/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Animales , Humanos , Dolor Postoperatorio/fisiopatología , Índice de Severidad de la Enfermedad , Transducción de Señal/efectos de los fármacos , Compuestos de Espiro/efectos adversos , Compuestos de Espiro/farmacología , Tiofenos/efectos adversos , Tiofenos/farmacologíaRESUMEN
BACKGROUND: Persistent postsurgical pain after total knee arthroplasty is a common problem and a major reason for patient dissatisfaction. This secondary analysis aimed to investigate the effects of anesthesia (spinal vs. general) and tourniquet use on persistent pain after total knee arthroplasty. METHODS: In this secondary analysis of a previously presented parallel, single-center, randomized trial, 404 patients scheduled for total knee arthroplasty were randomized to spinal versus general anesthesia and no-tourniquet versus tourniquet groups. Patients assessed pain using the Brief Pain Inventory-short form preoperatively and 3 and 12 months postoperatively. The prespecified main outcome was the change in "average pain" measured with numerical 0 to 10 rating scale 1 yr postoperatively. The threshold for clinical importance between groups was set to 1.0. RESULTS: The change in average pain scores 1 yr postoperatively did not differ between the spinal and general anesthesia groups (-2.6 [SD 2.5] vs. -2.3 [SD 2.5], respectively; mean difference, -0.4; 95% CI, -0.9 to 0.1; P = 0.150). The no-tourniquet group reported a smaller decrease in the average pain scores than the tourniquet group (-2.1 [SD 2.7] vs. -2.8 [SD 2.3]; mean difference, 0.6; 95% CI, 0.1 to 1.1; P = 0.012). After 1 yr, the scores concerning the mean of four pain severity variables (numerical rating scale) decreased more in the spinal than in the general anesthesia group (-2.3 [SD 2.2] vs. -1.8 [SD 2.1]; mean difference, -0.5; 95% CI, -0.9 to -0.05; P = 0.029) and less in the no-tourniquet than in the tourniquet group (-1.7 [SD 2.3] vs. -2.3 [SD 2.0]; mean difference, 0.6; 95% CI, 0.2 to 1.0; P = 0.005). None of the differences in pain scores reached the threshold for clinical importance. CONCLUSIONS: The type of anesthesia (spinal vs. general) or tourniquet use has no clinically important effect on persistent postsurgical pain after total knee arthroplasty.
Asunto(s)
Anestesia Epidural/métodos , Anestesia General/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Dolor Postoperatorio/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Torniquetes , Anciano , Anestesia Epidural/efectos adversos , Anestesia General/efectos adversos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Recuperación de la Función/fisiología , Torniquetes/efectos adversos , Resultado del TratamientoRESUMEN
AIMS: Chronification of postoperative pain is a common clinical phenomenon following surgical operation, and it perplexes a great number of patients. Estrogen and its membrane receptor (G protein-coupled estrogen receptor, GPER) play a crucial role in pain regulation. Here, we explored the role of GPER in the rostral ventromedial medulla (RVM) during chronic postoperative pain and search for the possible mechanism. METHODS AND RESULTS: Postoperative pain was induced in mice or rats via a plantar incision surgery. Behavioral tests were conducted to detect both thermal and mechanical pain, showing a small part (16.2%) of mice developed into pain persisting state with consistent low pain threshold on 14 days after incision surgery compared with the pain recovery mice. Immunofluorescent staining assay revealed that the GPER-positive neurons in the RVM were significantly activated in pain persisting rats. In addition, RT-PCR and immunoblot analyses showed that the levels of GPER and phosphorylated µ-type opioid receptor (p-MOR) in the RVM of pain persisting mice were apparently increased on 14 days after incision surgery. Furthermore, chemogenetic activation of GPER-positive neurons in the RVM of Gper-Cre mice could reverse the pain threshold of pain recovery mice. Conversely, chemogenetic inhibition of GPER-positive neurons in the RVM could prevent mice from being in the pain persistent state. CONCLUSION: Our findings demonstrated that the GPER in the RVM was responsible for the chronification of postoperative pain and the downstream pathway might be involved in MOR phosphorylation.
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Dolor Crónico/genética , Bulbo Raquídeo/efectos de los fármacos , Dolor Postoperatorio/genética , Receptores de Estrógenos/genética , Receptores Acoplados a Proteínas G/genética , Animales , Dolor Crónico/fisiopatología , Hiperalgesia/psicología , Masculino , Ratones , Ratones Endogámicos C57BL , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Ratas , Ratas Sprague-Dawley , Receptores Opioides mu/efectos de los fármacos , Receptores Opioides mu/genéticaRESUMEN
Residual intra-peritoneal gas may be associated with post-laparoscopic shoulder pain (PLSP), which is a frequently and disturbance compliant after surgery. Herein, we aimed to examine whether expiring residual gas via a surgical drain reduces the frequency and intensity of PLSP in the first day after laparoscopic cholecystectomy. 448 participants were enrolled in this prospective cohort study. The incidence and severity of PLSP after surgery were recorded. Of these, the cumulative incidence of PLSP in the drain group was lower particularly at the 12th postoperative hour (18.3% vs. 27.6%; P = 0.022), 24th postoperative hour (28.8% vs. 38.1%; P = 0.039), and throughout the first postoperative day (P = 0.035). The drain group had less severe PLSP (crude Odds ratio, 0.66; P = .036). After adjustment using inverse probability of treatment weighting, the drain group also had a significant lower PLSP incidence (adjusted hazard ratio = 0.61, P < 0.001), and less severe PLSP (adjusted odds ratio = 0.56, P < 0.001). In conclusion, the maneuver about passive force to expel residual gas, surgical drain use, contributes to reduce the incidence and severity of PLSP, suggesting that to minimize residual gas at the end of surgery is useful to attenuate PLSP.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Drenaje/métodos , Dolor Postoperatorio/terapia , Dolor de Hombro/terapia , Adolescente , Adulto , China/epidemiología , Femenino , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/fisiopatología , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/fisiopatología , Náusea y Vómito Posoperatorios/terapia , Dolor de Hombro/etiología , Dolor de Hombro/fisiopatología , Adulto JovenRESUMEN
To efficiently prolong analgesic effects, we developed osmotically balanced, large unilamellar liposomes (~ 6 µm in diameter) in which highly concentrated bupivacaine (up to 30 mg/mL) was encapsulated, and their sustained bupivacaine release was highly effective in relieving postoperative pain over 24 h in a rat model. Our reverse-phase evaporation method based on non-toxic alcohol, ethanol, enabled simple and cost-effective production of bupivacaine-loaded liposomes, of which osmotic pressure was readily balanced to improve the structural stability of the enlarged unilamellar liposomes along with extension of their shelf life (> a month). The in vitro release profile verified that the release duration of the bupivacaine-loaded liposomes extended up to 6 days. For the in vivo study, male Sprague-Dawley rats were used for the incisional pain model, simulating postoperative pain, and the mechanical withdrawal threshold (MWT) was measured using a von Frey filament. Compared to the control group that received intraplantar administration of normal saline, the group of liposomal bupivacaine showed that the initially increased MWT gradually decreased up to 24 h, and importantly, the analgesic effect of the liposomal bupivacaine was maintained 6 times longer than that of bupivacaine only, proving the potential of effective long-acting anesthetics.