Articles: postoperative-pain.
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Randomized Controlled Trial
Perioperative Opioid Use and Dosage Trajectories Vary Depending on Pain Outcome Classification and Bodily Pain in Patients who Catastrophize About Their Pain: A Secondary Analysis of a Randomized Trial in Knee Arthroplasty.
Opioid use and dosage following knee arthroplasty (KA) has not been reported for subgroups with persistent moderate pain versus rapidly improving mild pain, externally validated from prior work. We determined if opioid use and dosage varied for persons classified into these externally validated subgroups. A secondary purpose determined if bodily pain scores are associated with the outcome subgroup. ⋯ The persistent moderate pain subgroup is at greater risk of opioid use and greater opioid dosages and should be targeted for preoperative screening and interventions to reduce opioid use and potential opioid misuse. PERSPECTIVE: More frequent and higher opioid dosage following KA was found for the persistent moderate pain subgroup compared to the other subgroup. Patients with persistent pain had worse catastrophizing, contralateral and ipsilateral lower extremity pain, low back pain, and whole body pain compared to the rapidly improving mild pain subgroup.
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Paediatric anaesthesia · May 2024
Randomized Controlled TrialPerioperative methadone for posterior spinal fusion in adolescents: Results from a double-blind randomized-controlled trial.
Posterior spinal fusion is the most common surgical procedure performed for correction of adolescent idiopathic scoliosis in the United States. Intraoperative methadone has been shown to improve pain control in adult patients undergoing complex spine surgery, and current pediatric studies show encouraging results; however, prospective randomized-controlled trials are lacking in the pediatric literature. ⋯ A two-dose intraoperative methadone regimen resulted in decreased opioid consumption compared to morphine. Although the clinical significance of these results may be limited, the analgesic equipoise without increased opioid-related side effects and potential for a lower incidence of chronic pain may tip the balance in favor of routine methadone use for adolescents undergoing posterior spinal fusion.
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Review
Regional anaesthesia truncal blocks for acute postoperative pain and recovery: a narrative review.
Significant acute postoperative pain remains prevalent among patients who undergo truncal surgery and is associated with increased morbidity, prolonged patient recovery, and increased healthcare costs. The provision of high-quality postoperative analgesia is an important component of postoperative care, particularly within enhanced recovery programmes. Regional anaesthetic techniques have become increasingly prevalent within multimodal analgesic regimens and the widespread adoption of ultrasonography has facilitated the development of novel fascial plane blocks. ⋯ However, use of these blocks is debated in regional anaesthesia circles because of limitations in our understanding of their mechanisms of action. This narrative review evaluates available evidence for the analgesic efficacy of the most commonly practised fascial plane blocks in breast, thoracic, and abdominal truncal surgery, in particular their efficacy compared with systemic analgesia, alternative blocks, and neuraxial techniques. We also highlight areas where investigations are ongoing and suggest priorities for original investigations.
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To evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. ⋯ Superficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.
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Journal of neurosurgery · May 2024
Assessment of postoperative pain, dysesthesia, and weather sensitivity after pterional and temporal neurosurgical approaches.
Many neurosurgical approaches require incision of the temporal muscle (TM). Consequently, patients often report reduced opening of the mouth, facial asymmetry, numbness, and pain after lateral craniotomies. A systematic assessment of these postoperative subjective complaints is lacking in the literature. Therefore, in this study, the authors evaluate subjective complaints after pterional, frontolateral-extended pterional, or temporal craniotomy using a 6-item questionnaire. They examine the association of these subjective complaints with the extent of the mobilization of the TM. ⋯ Subjective complaints in patients following lateral craniotomy can be detected. As the extent of the mobilized TM relevantly influenced pain in the mastication muscles, the authors conclude that one should sparsely mobilize the TM. Furthermore, a neurosurgeon should be aware and warn the patient of subjective postoperative complaints and inform the patient about their natural course.