Articles: postoperative-pain.
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Randomized Controlled Trial Multicenter Study
Analgesia for major laparoscopic abdominal surgery: a randomised feasibility trial using intrathecal morphine.
Effective pain control enhances patient recovery after surgery. Laparoscopic techniques for major abdominal surgery are increasingly utilised to reduce surgical trauma. Intrathecal morphine is an attractive analgesic option that is gaining popularity. ⋯ For secondary endpoints, fewer patients in the intrathecal morphine group required opioids in the post-anaesthesia care unit, their postoperative pain scores at rest were lower across the four time-points measured (p = 0.007), but not dynamic pain scores (p = 0.061), and pruritus was more common following intrathecal morphine (p = 0.007). Total oral morphine equivalents until postoperative day 3 were less in the intrathecal morphine group (median (95%CI) difference 82 (-13 to 168) mg), but this reduction was not statistically significant (p = 0.10). These findings support conducting a definitive clinical trial.
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Observational Study
Association of Pre-operative Functional Disability with Chronic Postsurgical Pain: A Prospective Observational Study.
Chronic postsurgical pain negatively affects postoperative recovery. We aimed to assess the association between preoperative functional disability and chronic postsurgical pain. ⋯ Our study showed that in patients who undergo elective abdominal surgery, 12% with preoperative functional disability experience chronic postsurgical pain after 1 year. Preoperative functional disability is associated with chronic postsurgical pain, use of preoperative pain medications and acute postoperative pain. Patients with preoperative functional disability have higher pain numerical rating scale scores at any postoperative measurement point.
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Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical companies, nearly quadrupled. Cesarean delivery is the most common surgical procedure performed in the United States and opioids are most often chosen to manage post-operative pain. Research has shown that women, who deliver via cesarean section, are prescribed an excess of opioid tablets upon discharge and often store them in unsecure locations. Furthermore, the vast majority, are not disposed of properly. ⋯ Engaging post-operative patients in decisions regarding pain management, educating women on multi-modal methods to manage pain, and providing women with a means to properly dispose of excess tablets, can reduce opioid tablets available for misuse and diversion in the community.
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J Clin Monit Comput · Apr 2022
Nociception level index: do intra-operative values allow the prediction of acute postoperative pain?
Nociception Level Index (NOL) guided analgesia has previously been found to correlate with noxious stimuli during surgery. It was aim of this study to investigate the relationship between intra-operative NOL and acute postoperative pain. After IRB approval, 80 patients scheduled for non-emergency surgery were enrolled. ⋯ The NOL reaction to skin incision, but not NOL during surgery appears to allow the exclusion and, to a lesser degree the prediction of moderate-severe pain in PACU. The results may also strengthen the manufacturers recommendation of an intraoperative NOL range of 10-25. Australian New Zealand Clinical Trials Registry: ACTRN12619001596190.