Journal of pain research
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Journal of pain research · Jan 2018
ReviewParavertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives.
The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. ⋯ For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.
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Journal of pain research · Jan 2018
Presence of pain on three or more days of the week is associated with worse patient reported outcomes in adults with sickle cell disease.
While acute episodic pain is the hallmark of sickle cell disease (SCD), transition to chronic pain is a major cause of morbidity and impaired quality of life. One of the core diagnostic criteria used by Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy (AAPT) to define chronic SCD pain is the presence of pain on a "majority of days" in the past 6 months in one or more locations. The frequency characteristic of "majority of days" is adapted from the criteria of 15 days or more per month, used to define chronic migraine, but there are inadequate data to support this cutoff in SCD. ⋯ We did not find any difference in median PROMIS pain scores between adults aged ≤35 years compared with those aged ≥35 years. In linear regression models, after adjustment for age and sex, the presence of pain on 3 or more days a week was found to be associated with worse pain interference and anxiety. These data support the clinical relevance of the frequency characteristic of pain on a "majority of days" in the definition of chronic SCD pain, and provide the rationale for prospective studies to validate the clinical definition of chronic pain in SCD.
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Journal of pain research · Jan 2018
Peripheral and spinal TRPA1 channels contribute to formalin-induced long-lasting mechanical hypersensitivity.
Transient receptor potential ankyrin 1 (TRPA1) is a non-selective cation channel expressed by a subset of nociceptive neurons that acts as a multimodal receptor. Its activity contributes to modulate nociceptive transmission in acute inflammatory pain. However, the role of this channel in chronic pain has been less studied. The purpose of this study was to investigate the local peripheral and spinal participation of TRPA1 channels in formalin-induced long-lasting hypersensitivity. ⋯ Results indicate that TRPA1 expressed in the DRG and spinal cord plays a relevant role in formalin-induced long-lasting secondary nociceptive hypersensitivity.
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Journal of pain research · Jan 2018
Effects of propofol anesthesia versus sevoflurane anesthesia on postoperative pain after radical gastrectomy: a randomized controlled trial.
After a radical gastrectomy, patients may experience severe pain. Some studies have reported that the use of propofol significantly reduced postoperative pain, while others have argued that this effect was not significant. Thus, we aimed to assess whether anesthesia with propofol could help to reduce pain after an open radical gastrectomy procedure. ⋯ Overall, the multimodal analgesic approach reduced postoperative pain after an open radical gastrectomy procedure in all patients anesthetized with either propofol or sevoflurane. Furthermore, our results indicated better analgesic outcome for the propofol group, especially in the early postoperative period.
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Journal of pain research · Jan 2018
Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation.
The spread patterns between different injectate volumes have not yet been investigated in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study was undertaken to compare the spread pattern and nerve involvements of different volumes of dye using this technique. ⋯ The clinical efficacy of this technique using the 5-mL injectate seems unlikely to arise from the blockade of GON alone. Instead, its efficacy likely arises from the blockade of most nerves originating from the dorsal ramus of the upper cervical spinal nerve at the suboccipital area. Even using 1 mL of injectate may not guarantee blockade of the GON alone.