Chronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single-nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery.

A genome-wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split-half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain.

One locus (rs185545327) reached genome-wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p < 1 × 10-6). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain-related genes (SRPK2, PDE4D). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group.

This study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the PDE4D gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision-making through individualised risk assessments.

Prehabilitation aims to improve preoperative health before surgery to reduce complications. Reducing anxiety helps prevent postoperative pain, stress and sleep disturbances. Listening to music through headphones or earpieces in the hospital directly preoperatively, intraoperatively and postoperatively has been shown to ameliorate anxiety, stress, pain and sleep disorders. This randomised controlled trial will investigate the effect of active music listening at home 1 week before surgery as a prehabilitation modality on preoperative anxiety compared with standard care.

This study is a multicentre randomised controlled trial that will include 116 patients. The study population consists of adults undergoing elective oncological colorectal surgery. The intervention group will be advised to listen to recorded music three times per day for 20 min, starting 1 week prior to surgery, using headphones or earpieces. Both groups will receive standard care during hospitalisation. The primary outcome is patient-reported preoperative anxiety using the State-Trait Anxiety IndexInventory 6. Secondary outcomes are patient-reported stress, delirium incidence, medication usage, postoperative pain, complication rate, length of stay, adherence to the intervention, quality of life and healthcare-related costs.

This study protocol has been approved by the Medical Ethical Review Board of Erasmus Medical Center on 15 December 2022 (MEC-2022-9415). The trial will be carried out following the updated Declaration of Helsinki principles and Good Clinical Practice guidelines. Study results will be published and reported in a peer-reviewed journal according to the Consolidated Standards of Reporting Trials guidelines.

NCT05982184.

Interpectoral and pectoserratus plane blocks are fascial plane blocks that are used during anterolateral superficial chest wall surgery. However, the true analgesic efficacy of these blocks in oncological breast surgery is unclear because of the diversity of breast-surgery procedures. The primary hypothesis of this study was that these blocks reduce the incidence of acute pain.

This double-blinded, multicenter, randomized controlled study included 185 patients. Patients were randomized equally into two groups at a 1:1 ratio according to the type of interfascial injection received (ropivacaine vs. saline). The incidence of analgesic rescue during the first 3 postoperative hours was the primary outcome measure.

The authors enrolled 182 women. The analgesic rescue incidence was lower in the ropivacaine group. Interpectoral and pectoserratus plane blocks with ropivacaine had an incidence of analgesic rescue of 43 % (n = 37) versus 61 % (n = 50) in patients given the placebo (relative risk = 0.70; 95 % CI = 0.52 to 0.94; p = 0.02). Interpectoral and pectoserratus plane blocks with ropivacaine are associated with a 30 % reduction in the use of rescue analgesics.

Interpectoral and pectoserratus plane blocks reduced the incidence of analgesic rescue and reduced the postoperative pain score to the mild range after oncological breast-conserving surgery and sentinel lymph-node biopsy.

Background Researching modifiable preoperative risk factors is essential for improving outcomes following total joint replacement (TJR). This study explores whether preoperative sleep performance influences pain and recovery in the early postoperative period. Methods This prospective observational study was conducted at an academic elective orthopedic hospital, recruiting patients undergoing total hip replacement (THR) and total knee replacement (TKR). Preoperative sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measured outcomes included pain, oral morphine use, day of crutch mobility, independent bed transfer, and hospital length of stay. Results No statistically significant associations were found between preoperative PSQI scores and primary outcomes, although sex differences existed in THR patients regarding early postoperative pain. The correlation between PSQI and hospital stay was weakly positive for THR (r = 0.223, p = 0.082) and negligible for TKR (r = 0.041, p = 0.807). PSQI showed no significant correlation with early mobility (THR: r = 0.111, p = 0.391; TKR: r = 0.115, p = 0.491) or postoperative morphine use (THR: r = 0.108, p = 0.403; TKR: r = 0.170, p = 0.309). Female THR patients had higher pain scores on days 0 and 1 and poorer PSQI scores. Conclusions Preoperative sleep hygiene was not associated with hospital stay, mobility, or pain in the immediate postoperative period after TJR. However, sleep may impact long-term recovery, highlighting the need for further research on modifiable preoperative factors and sex differences in post-TJR rehabilitation.

Preoperative anxiety is common, and most patients experiencing preoperative anxiety would welcome support to cope with their anxiety. Studies examining the effectiveness of information to reduce anxiety have been inconsistent. In addition, it is unclear whether results reported to be statistically significant are also clinically relevant. This study's primary objective was to test the hypothesis that a personalized and information-based intervention would reduce anesthesia-related anxiety.

In this single-center, prospective, randomized, controlled trial, 122 adults awaiting elective surgery under general anesthesia were randomized (1:1) to receive a personalized and information-based intervention in addition to standard preanesthetic consultation (intervention group) or standard preanesthetic consultation (control group) the day before surgery. Anxiety was assessed at two time points before and at four time points after randomization until induction of anesthesia to state their anxiety level using the Amsterdam Preoperative Anxiety and Information Scale (two items each for anesthesia- and surgery-related anxiety, with each item's score range being 1 to 5). Constrained linear mixed models were used to analyze the intervention effects. Patients' subjective changes in anxiety (reduced vs . not reduced) and associated numeric scores were used to determine the minimal clinically important difference.

The intervention led to reduced anesthesia- and surgery-related anxiety in the intervention group compared to the control group after randomization (indicated by significant two-way interactions for anesthesia-related anxiety [F(5, 96.291) = 7.449; P < 0.001] and surgery-related anxiety [F(5, 112.486) = 5.466; P < 0.001]. The minimal clinically important differences in Amsterdam Preoperative Anxiety and Information Scale anxiety scores were 1.03 and 1.13 points for anesthesia- and surgery-related anxiety, respectively.

A personalized and information-based intervention can reduce anesthesia- and surgery-related anxiety to a statistically significant and clinically relevant degree. Future studies should include an active control group to evaluate this intervention's specific effects, which may be helpful only in patients seeking anxiety-reducing interventions.

Pain management in pregnant and postpartum people with an opioid use disorder requires a balance among the risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around the social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement from the Society for Obstetric Anesthesia and Perinatology, the Society for Maternal-Fetal Medicine, and the American Society of Regional Anesthesia and Pain Medicine provides a framework for pain management in obstetrical patients with opioid use disorder. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to healthcare providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for opioid use disorder (eg, buprenorphine, methadone), considerations regarding urine drug testing and other social aspects of care for maternal-infant dyads, and a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and the complications associated with opioid use disorder in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with opioid use disorder in the context of pregnancy to improve maternal and perinatal outcomes.

Pain is a multidimensional and subjective experience, and its perception is influenced by sensory, emotional, and behavioral factors. This work aims to evaluate the influence of depression and anxiety in the quantitative and qualitative assessment of chronic pain.

This is a cross-sectional study carried out at the Multidisciplinary Pain Center of the Clinical Hospital of the Federal University of Minas Gerais. A total of 103 patients were interviewed and evaluated using the following instruments: McGill Questionnaire, visual numerical scale, Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF-36.

The affective, sensory and miscellaneous categories of anxious patients were higher than the nonanxious population (p < 0.05). In the depressed population, the "affective" category was higher than the nondepressed population (p < 0.05). Regarding the anxious and depressed population, the affective, sensory and miscellaneous categories were superior to the nonanxious and nondepressed population (p < 0.05).

Depression and anxiety are the most common psychiatric disorders in the population with chronic pain, with a prevalence of 30-40%. In the presence of anxiety and depression, a worse qualitative evaluation was observed. The higher the scores obtained in the assessment of these two mental disorders, the higher the pain index found, and the higher pain index correlates with a lower quality of life.

The presence of anxiety and depression altered the qualitative assessment of pain, making it more unpleasant. The pain index correlated with quality of life without, however, being related to pain intensity.

The impact of demographic- and surgical factors on individual perioperative opioid requirements is not fully understood. Anaesthesia personnel adjust opioid administrations based on their own clinical experience, expert opinions and local guidelines. This survey aimed to assess the current practice of anaesthesia personnel regarding intraoperative opioid treatment for postoperative analgesia and rescue opioid dosing strategies in the post-anaesthesia care unit in Denmark.

We conducted a cross-sectional online survey with 37 questions addressing pain management and opioid-dosing strategies. Local site investigators from 46 of 47 public Danish anaesthesia departments distributed the survey. Data collection took place from 5 February to 30 April 2024.

Of the 4187 survey participants, 2025 (48%) answered. Intra- and postoperative opioid doses were adjusted based on chronic pain, age, preoperative opioid use, body weight and type of surgery. Between 84% and 89% of respondents adhered to and had perioperative pain management guidelines available. Respondents preferred intraoperative fentanyl (44%) and morphine (36%) to prevent postoperative pain. Median intraoperative intravenous morphine equivalents ranged from 0.12 to 0.38 mg/kg in clinical scenarios. In these cases, the following variables were assembled in different combinations to assess their impact on dosing: age (30 vs. 65 years), sex (female vs. male), ASA score (1 vs. 3) and type of surgery (anterior cruciate ligament vs. laparoscopic cholecystectomy surgery). Respondents preferred intravenous morphine and fentanyl for moderate and severe postoperative pain, respectively. Median postoperative rescue doses were 0.06-0.12 mg/kg in clinical scenarios based on shifting combinations of the variables: age (30 vs. 65 years), ASA score (1 vs. 3) and degree of expected pain (moderate vs. severe).

Respondents preferred fentanyl and morphine for postoperative pain control with considerable variation in choice of opioid and morphine equivalent dose. Respondents expressed that guidelines were highly available and strongly adhered to. Opioid dosing was predominantly guided by chronic pain, age, preoperative opioid use, body weight and type of surgery.

Whether postoperative nausea and vomiting (PONV) contributes to increased postoperative pain (POP) remains unclear, although POP is reported to cause PONV.

This study aimed to determine whether PONV following minor oral and maxillofacial surgery (OMS) under general anesthesia increases POP.

The researchers implemented a retrospective cohort study. Patients who presented to Saitama Medical University Hospital between January 2021 and August 2022 and who required minor OMS under general anesthesia were identified from a review of electronic records. The inclusion criteria were patients aged between 16 and 65 years and nasal intubation via inhalational or propofol-based total intravenous general anesthesia. The exclusion criterion was patients who had diseases affecting POP or PONV.

The primary predictor variable was the occurrence of PONV (yes/no) at 2 hours postoperatively.

The main outcome variable was POP measured on a 100 mm visual analog scale (VAS) at 2 hours postoperatively. The secondary outcome was the timing of POP, which was measured at 6 hours.

Covariates included patient-related factors (age, body mass index, American Society of Anesthesiologists Physical Status, smoking status, and history of PONV or motion sickness), anesthesia-related factors (intraoperative analgesics, intraoperative antiemetics, duration of anesthesia, and anesthesia type), and surgery-related factors (surgery type and duration of surgery).

Analyses were used for ordinal, categorical, and continuous variables. The POP VAS values were compared between each measurement time with repeated-measures analysis of variance. A P value < .05 indicated statistical significance.

The sample included 148 patients with a mean age of 40 ± 16.5 years, 66 (44.6%) of whom were male. The incidence of PONV was 31 (20.9%) at 0 to 2 hours, 7 (4.7%) at 2 to 6 hours, and 0 (0%) at 6 to 24 hours. POP VAS scores were significantly higher in the PONV group than in the non-PONV group at 2 hours. The mean VAS score at 2 hours was 40.5 ± 29.2 (PONV group) versus 29.8 ± 23.7 (non-PONV group) (P = .03); the VAS score at 6 hours was 41.0 ± 29.4 (PONV group) compared with 25.4 ± 26.4 (non-PONV group) (P = .13).

Our present study revealed that PONV is associated with increased POP in patients undergoing minor OMS under general anesthesia.

To identify factors associated with poor postoperative pain experience by examining patient-related and procedural variables.

An exploratory secondary analysis was conducted on data from 971 adult patients undergoing elective surgery under general anesthesia across five French teaching hospitals. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Pain, sleep quality and well-being were measured preoperatively and postoperatively using visual analog scales (VAS). The primary endpoint was the patient experience measured by the Evaluation du Vécu de l'Anesthésie Generale (EVAN-G) questionnaire on postoperative day 1, with poor pain experience defined as a score below the 25th percentile on the EVAN-G pain dimension. Univariate and multivariate logistic regression analyses were performed to identify factors associated with poor pain experience.

Poor pain experience was reported by 271 patients (27.9%). Multivariate analysis identified intraoperative use of remifentanil and sufentanil as an independent predictor of poor pain experience with an OR of 26.96 (95% CI 2.17 to 334.23, p=0.01). Additionally, age (OR 0.97, p=0.003), absence of premedication (OR 0.49, p=0.035) and orthopedic surgery (OR 0.29, p=0.005) were associated with a lower likelihood of poor pain experience. Conversely, American Society of Anesthesiologists (ASA) 3 status (OR 5.09, p=0.028), postoperative anxiolytic use (OR 8.20, p<0.001), amnesia (OR 1.58, p=0.001), higher VAS pain (p<0.001) and lower well-being scores (p=0.007) on day 1 were predictors of poor pain experience.

The intraoperative use of remifentanil and sufentanil is independently associated with poorer postoperative pain experience. These findings highlight the need to reassess intraoperative analgesic strategies to enhance patient outcomes and reduce postoperative complications.

Deeper understanding of the mechanisms of postoperative pain is critical for developing more effective pain management strategies. The present animal study explored the function of four p38 mitogen-activated protein kinase (MAPK) subclasses (α, β, γ, and δ) in dorsal root ganglion (DRG) in the development of post-incisional pain hypersensitivity.

The amount of p38 MAPK subclass mRNA in the DRG of male Sprague-Dawley rats was quantified using real-time PCR. Localization of p38 MAPK expression was analyzed by immunohistochemistry using subclass-selective antibodies. The effects of a p38α MAPK inhibitor on plantar incision-induced pain hypersensitivity was assessed using behavioral tests to measure mechanical and thermal sensitivity. The impact of the inhibitor on phosphorylated p38 MAPK expression was also analyzed by immunohistochemistry.

Four p38 MAPK subclass mRNA were identified in the DRG, with p38α, β, and γ MAPK showing significant expression. p38α and γ MAPK were identified in the DRG neurons, whereas p38β MAPK was distributed in satellite glial cells. Selective inhibition of p38α MAPK reduced both mechanical and thermal hypersensitivity following plantar incision. Treatment with the p38α MAPK inhibitor decreased the expression of phosphorylated p38 MAPK in the DRG.

These results demonstrated the distinct roles of p38 MAPK subclasses in the DRG, with p38α MAPK playing a dominant role in the development of pain hypersensitivity after tissue injury. Targeting p38α MAPK might be a promising therapeutic strategy for managing postoperative pain.

Postoperative pain in ambulatory surgery (AS) continues to be a recurrent problem despite anesthetic and surgical advances. Analgesic prescription and follow-up by patients at home may be a determining factor. Our objective was to evaluate analgesic prescription and its impact on the intensity of postoperative pain at 24 h and 7 days in an AS unit.

Retrospective cohort study of patients undergoing AS. Anthropometric data, ASA classification, surgery, anesthesia, analgesic prescription and postoperative pain. A telephone call was made by nurses to evaluate the DAP at 24 h and one week after surgery.

A total of 875 patients, 62% women, aged 50 ± 17 years, were studied. Orthopedic (45.4%); head and neck (19.5%); general (10.6%); vascular (11.9%); plastic (2.4%) and gynecological (10.2%) surgery was performed. Multimodal analgesia was prescribed: 83.7%, combination of nonsteroidal anti-inflammatory drug (NSAID) + paracetamol + metamizole: 70.79%; opioid + paracetamol or NSAID or in monotherapy:13.1%; monotherapy with paracetamol (15%) or NSAID (1.15%). Some 62.45% were prescribed "if pain" and 61.87% had rescue analgesia. At 24 h the median (IQR) of pain on the self-assessing verbal scale was 3 (2-5) and at one week 2 (0-4). The presence of moderate-severe pain was 46% at 24 h and 31% at one week after surgery.

Our results show great variability in analgesic prescription with insufficient control of postoperative pain in ambulatory surgery. Although the multimodal analgesic strategy has been widely used, opioid prescription has been insufficient in surgeries associated with moderate to severe pain.

Obesity, chronic pain, and aging are prevalent global challenges with profound implications for health and well-being. Central to these processes are adrenal hormones, particularly cortisol and dehydroepiandrosterone (DHEA), along with its sulfated form (DHEAS). Cortisol, essential for stress adaptation, can have adverse effects on pain perception and aging when dysregulated, while DHEA/S possess properties that may mitigate these effects. This review explores the roles of cortisol and DHEA/S in the contexts of obesity, acute and chronic pain, aging, and age-related diseases. We examine the hormonal balance, specifically the cortisol-to-DHEA ratio (CDR), as a key marker of stress system functionality and its impact on pain sensitivity, neurodegeneration, and physical decline. Elevated CDR and decreased DHEA/S levels are associated with worsened outcomes, including increased frailty, immune dysfunction, and the progression of age-related conditions such as osteoporosis and Alzheimer's disease. This review synthesizes the current literature to highlight the complex interplay between these hormones and their broader implications for health. It aims to provide insights into potential future therapies to improve pain management and promote healthy weight and aging. By investigating these mechanisms, this work contributes to a deeper understanding of the physiological intersections between pain, aging, and the endocrine system.

Postoperative pain significantly affects many surgical patients. While opioids are crucial for pain management, they come with unwanted side effects. Alternatives like nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate (NMDA) receptor antagonists, and regional anesthesia techniques such as nerve blocks are utilized, but these also have limitations. This underscores the need for complementary non-pharmacological interventions to enhance postoperative pain control and reduce opioid dependence. This study aimed to synthesize evidence on the efficacy of nondrug approaches for managing postoperative pain. The study examined the effects of non-pharmacological interventions such as preoperative patient education, mind-body modalities, and physical therapies. Findings suggest that these approaches can reduce pain intensity, decrease opioid consumption, and enhance recovery outcomes. The study also highlighted the pivotal role of healthcare professionals in implementing these strategies. However, it identified workload constraints and insufficient training as barriers to effective utilization in clinical practice. Integrating non-pharmacological interventions into multimodal pain management regimens can improve postoperative pain control and reduce reliance on opioids. Further research is crucial to definitively establish the efficacy of individual interventions and optimize their combined use in clinical practice. Additionally, enhanced training programs for nurses and initiatives to facilitate the implementation of these strategies are necessary for their successful adoption.

Background: Acute postoperative pain is a common problem in clinical practice and merits attention considering its potential long-term adverse effects. This systematic review covers current knowledge on methods for individual prediction of postoperative pain. Methods: A systematic literature search was conducted using the PubMed, EMBASE, and CINAHL databases for original studies with adult patients published in English between 2016 and 2022. Inclusion required assessment of risk factors preoperatively and assessment of postoperative pain. No reviews, meta-analyses, or study protocols were included, nor studies with outcomes other than pain or where risk factor analysis was not performed preoperatively. A two peer-reviewed system was utilized using the screening and data collection tool Covidence, with a focus on new tools for preoperative pain prediction. The results were only analyzed qualitatively. Results: The search yielded 1950 abstracts to be screened. In total, 208 articles were subjected to full-text review, and 107 articles were included in the data synthesis of this review. The evaluated scientific methods were grouped and analyzed separately. Psychometric questionnaires and methods for quantitative sensory testing are still being studied. New methods proposed include the evaluation of pain induced by tourniquet inflation, venous cannulation, or pin-prick stimulation, the analgesia/nociception index, electroencephalographic recording, and other new equipment developed for this purpose. Conclusion: Various screening methods have been proposed to identify patients prone to postoperative pain. The focus has shifted from procedure-specific to individualized strategies to improve early management of pain. However, many traditional predictive methods still have a questionable role in clinical practice. Trial Registration: ClinicalTrials.gov identifier: CRD42022298479.

This observational cohort study aimed to identify predictive factors associated with pain-related quality of recovery among patients undergoing elective gastrointestinal and hepato-pancreato-biliary surgery.

This study involved a secondary analysis of the data collected from five hospitals across all healthcare regions in Norway to validate the Norwegian version of the Quality of Recovery-15 (QoR-15NO). The sample consisted of 268 adult patients who underwent elective gastrointestinal and hepato-pancreato-biliary surgery between September 2021 and May 2022. Data were collected using QoR-15NO upon admission for surgery and on the first postoperative day, and surgery severity was classified using the Surgical Outcome Risk Tool. A linear mixed model and multivariate linear regression were used to investigate associations between postoperative scores and possible predictive clinically relevant factors.

The results of this study showed that postoperative pain was significantly associated with age, gender, severity of surgery, and changes from pre- to postoperative status. Younger patients, compared to older patients (b=0.23, 95% CI: [0.03, 0.41]), female patients (b=-0.61, 95% CI: [-1.19, -0.04]), patients undergoing minor and intermediate surgeries compared to major surgeries (b=0.96, 95% CI: [0.00, 1.92]) all reported higher levels of postoperative pain. There was a significant decline in QoR post-surgery due to increased pain severity (b=-1.91, 95% CI: [-2.33, -1.50]; p <0.001). No clinically significant associations were found between ASA physical status, surgery duration, and pain-related QoR.

This study identified age, gender, and surgery severity as key predictors of postoperative pain. Younger and female patients and those undergoing minor surgeries are at higher risk for severe postoperative pain. Proactive approaches for minor surgeries and tailored pain management for younger patients and females might enhance recovery and postoperative pain outcomes. Thus, future research should focus on the long-term effects of individualized pain management and additional strategies for high-risk patient groups.

Methods for identifying high-pain responders undergoing total knee arthroplasty remain important to improve individualized pain management. This study aimed at evaluating pre- and perioperative predictors of pain on Days 2-7 after total knee arthroplasty.

This is a secondary analysis of data from 227 patients participating in two randomized trials. Pain outcomes were mean pain during walking on Days 2-7 and on Days 2, 4 and 7. Multivariable linear and logistic regressions were carried out in two steps. First, only preoperative available variables including demographics, comorbidities, pain catastrophizing scale and preoperative pain were evaluated while controlling for trial intervention and recruitment site. In the second step, perioperative variables and pain during walking 24 h postoperatively were added.

The model with only preoperative predictors for mean pain Days 2-7 showed preoperative pain (R-squared 0.097) as the only predictor. In the second model, adding postoperative available variables, only pain 24 h postoperatively (R-squared 0.248) was significant, with a significant main effect of recruitment site. Results for the separate day analysis similarly showed preoperative pain and pain during walking 24 h postoperatively as predictors. The overall best sensitivity (60%) and specificity (74%) for predicting a high-subacute postoperative pain response on Days 2-7 was with cut-off values of VAS 45.5 (out of 100) for pain during walking 24 h postoperatively.

Postoperative pain during walking at 24 h is predictive of subacute postoperative pain on Days 2-7 after total knee arthroplasty, while preoperative pain was only a weak predictor.

This study investigated factors associated with pain after total knee arthroplasty beyond the immediate postoperative period. The analysis revealed significant associations between preoperative pain levels and, particularly, pain 24 h postoperatively, with subsequent subacute pain the following week. These findings can assist in identifying patients who would benefit from enhanced, individualized analgesic interventions to facilitate postoperative recovery.

Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients.

This prospective cohort study included adult patients (≥ 18 yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption.

We analyzed 344 patients (58 ± 15 years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3 days [IQR 1-5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7-20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0-7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98-0.99]), higher preoperative anxiety (1.02 [95%CI 1.00-1.04]), rectal resections (IRR 1.45 [95%CI 1.09-1.94]), and number of pills prescribed (1.02 [95%CI 1.01-1.03]).

A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation.

Severe pain after foot/ankle surgeries is often underestimated because these procedures are perceived as less extensive than other orthopedic surgeries. However, surgeries involving the bones and joints in the foot and ankle can result in intense pain.

This study aimed to identify the incidence and risk factors associated with postoperative moderate to severe pain.

We reviewed the medical records of 334 patients undergoing foot/ankle surgery under spinal anesthesia. The maximum numeric rating scale (NRS) pain scores were recorded at 12-hour intervals for 48 hours postsurgery, and the incidence of postoperative pain was calculated. Patients were then classified into two groups based on their maximum NRS score from the first postoperative day: those with no or mild pain (NRS score of 0-3) and those with moderate to severe pain (NRS score of 4-10). We collected variables related to the patient, surgery, and anesthesia and used logistic regression analysis to identify the factors associated with moderate to severe pain.

Approximately 67% of patients experienced moderate to severe pain on the first day after foot/ankle surgery, with the peak severity occurring during the initial 12 hours. Performing spinal anesthesia alone (adjusted risk ratio [ARR], 1.44; 95% confidence interval [CI], 1.21-1.71; p < .001) and hindfoot/ankle surgery (ARR, 1.22; 95% CI, 1.03-1.44; p = .020) were identified as independent risk factors for moderate to severe pain.

Due to the high incidence of severe pain following foot/ankle surgery, patients who had spinal anesthetic alone or underwent hindfoot/ankle surgery are more likely to experience moderate to severe pain. Improved pain management measures are crucial for these patients to achieve better outcomes.

Propofol injection pain (PIP) is a frequent adverse effect during anesthesia induction, impacting patient comfort and satisfaction. Esketamine has been shown to alleviate PIP, but the optimal dose, especially in relation to preoperative anxiety levels, remains unclear. Preoperative anxiety may heighten pain perception and influence analgesic requirements.

A randomized, double-blind, controlled trial was conducted at The Affiliated Women and Children's Hospital of Ningbo University. A total of 150 eligible patients scheduled for painless abortion were assessed using the Spielberger State Anxiety Inventory - State form (STAI-S) and categorized into non-anxious (STAI-S score <40) and anxious (STAI-S score ≥40) groups. Patients were randomized using a computer-generated random number table to receive one of five escalating doses of esketamine (0.10, 0.12, 0.14, 0.17, or 0.20 mg/kg) prior to propofol administration. The primary outcome was the occurrence of PIP, assessed using Ambesh's four-point pain scale. Secondary outcomes included hemodynamic parameters and adverse events such as hypotension, bradycardia, and hypoxemia.

A clear dose-response relationship was observed, with higher doses of esketamine significantly reducing the incidence of PIP in both groups. Anxious patients required higher doses of esketamine to achieve comparable pain relief to non-anxious patients. The effective dose for 50% of patients (ED50) in the non-anxious group was 0.114 mg/kg (95% CI: 0.096-0.129 mg/kg), whereas it was 0.133 mg/kg (95% CI: 0.117-0.146 mg/kg) in the anxious group, with the difference being statistically significant (P < 0.05). No significant differences were observed between groups in terms of adverse events or hemodynamic stability.

Preoperative anxiety significantly increases the ED50 of esketamine required to alleviate propofol injection pain in patients undergoing painless abortion. Anxious patients require higher doses of esketamine to achieve effective analgesia. Individualizing esketamine dosing based on preoperative anxiety levels may enhance patient comfort and optimize pain management during anesthesia.

The purpose of this study was to determine the reliability and validity of the pressure algometer in predicting gynecological surgery pain. We looked into the predictive value of preoperative pain sensitivity to gynecological pain and the relationship between preoperative pressure pain threshold (PPT), pressure pain tolerance (PTO), and postoperative pain outcomes.

Reliability test: We recruited 60 volunteers at Nantong University. For three consecutive days, two examiners measured the pain sensitivity of each participant using a pressure algometer. Its test-retest and intra-rater reliability were assessed using the intraclass correlation coefficient (ICC). Validity test: We selected patients who underwent gynecological surgery in a hospital for the validity test. Before surgery, we assessed the patient's pain sensitivity to various stimuli. To determine the relationship between preoperative pain sensitivity and postoperative pain, we collected postoperative Numerical Rating Scale (NRS) and sufentanil consumption data.

The algometer revealed a high test-retest and intra-rater reliability. According to the calculation of Youden's index, there was a 73.1% chance of patients with moderate to severe postoperative pain having a PTO <6.22 N, and patients with PTO <6.22 N had an 87.5% probability of moderate to severe postoperative pain.

The pressure algometer has a high degree of accuracy in measuring the PPT and PTO of normal healthy individuals, making it a reliable tool for quantifying pain sensitivity. PTO can be used to predict the occurrence of moderate to severe postoperative pain.

With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures.

Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting.

While sex differences are known to have a clinically relevant impact on the response to pain therapy, current data are still largely equivocal on sex-specific postoperative pain management. The aim of this study is to determine whether sex predicts differences in pain management in patients undergoing ventral hernia repair (VHR).

This was a retrospective analysis of prospectively collected data for VHR from the Abdominal Core Health Quality Collaborative. The study population included all opioid-naïve adults, undergoing nonemergent initial management of uncomplicated VHR. Multinominal logistic regression was used to explore if postoperative opioid regimens differed by patient sex.

The final study population included 1325 males (mean age 54 y, 86.7% White, 62.9% open repairs, 75.9% mesh) and 827 females (mean age 51, 75.7% White, 52.5% open repairs, 69.5% mesh). Unadjusted analysis showed that an opioid sparing regimen was offered to 62.27% female patients and 66.34% male patients. Adjusted analysis demonstrated female patients were less likely to receive an opioid-sparing pain regimen when compared to male patients (odds ratio = 0.647, 95% confidence interval: (0.46-0.909), P = 0.012).

Despite having a higher analgesic response than their male counterparts, as well as having a significantly lower morphine consumption postoperatively, female patients were less likely to receive an opioid-sparing regimen. These results show that there is a pressing need to educate clinicians on how sex-specific differences in pain and analgesia may affect opioid prescribing practices. Enhancing clinician awareness about sex-specific differences in pain and analgesia could potentially inform better prescribing practices and promote more equitable postoperative care.

Acute post-surgical pain is managed inadequately in many patients undergoing surgery. Several prognostic risk prediction models have been developed to identify patients at high risk of developing moderate to severe acute post-surgical pain. The aim of this systematic review was to describe and evaluate the methodological conduct of these prediction models.

We searched MEDLINE, EMBASE and CINAHL for studies of prognostic risk prediction models for acute post-surgical pain using predetermined criteria. Prediction model performance was evaluated according to discrimination and calibration. Adherence to TRIPOD guidelines was assessed. Risk of bias and applicability was independently assessed by two reviewers using the prediction model risk of bias assessment tool.

We included 14 studies reporting on 17 prediction models. The most common predictors identified in final prediction models included age; surgery type; sex or gender; anxiety or fear of surgery; pre-operative pain intensity; pre-operative analgesic use; pain catastrophising; and expected surgical incision size. Discrimination, measured by the area under receiver operating characteristic curves or c-statistic, ranged from 0.61 to 0.83. Calibration was only reported for seven models. The median (IQR [range]) overall adherence rate to TRIPOD items was 62 (53-66 [47-72])%. All prediction models were at high risk of bias.

Effective prediction models could support the prevention and treatment of acute post-surgical pain; however, existing models are at high risk of bias which may affect their reliability to inform practice. Consideration should be given to the goals, timing of intended use and desired outcomes of a prediction model before development.

Patients undergoing surgery experience perioperative anxiety and pain. Music has been shown to reduce perioperative anxiety, pain and medication requirement. This study assessed the feasibility and effectiveness of implementing a perioperative music intervention.

A prospective pre- and post-implementation pilot study was conducted to assess adherence to the intervention and the initial effect of music on postoperative pain scores (Numerical Rating Scale, 0-10) compared to a control group. Secondary outcomes encompassed pain scores throughout hospital admission, anxiety levels, medication usage, complications and hospital stay length.

Adherence to the music intervention was preoperative 95.2%, intraoperative 95.7%, postoperative 31.9% and overall 29.7%. The intervention did influence postoperative pain. Patient's willingness to receive music was high (73%), they appreciated the intervention (median 8.0, interquartile range 7.0-9.0) and healthcare professionals were willing to apply the intervention. Music significantly reduced postoperative anxiety (2.0 vs. 3.0, p = 0.02) and the consumption of benzodiazepines on the first postoperative day (number of patients: zero [0%] vs. five [10%], p = 0.04).

Implementation of music resulted in reduced postoperative anxiety and decreased consumption of benzodiazepines, and the strategy was feasible, but adjustments are needed to improve postoperative adherence. Both patients and healthcare professionals had a positive attitude towards the intervention.

To determine the incidence of chronic postsurgical pain (CPSP) in women after open thoracotomy. Secondary objectives were to compare relevant patient and procedural variables between women and men.

Observational cohort study.

Ten university-affiliated hospitals.

Ninety-six women and 137 men.

Scheduled open thoracotomy.

Pain histories, psychological measures, and perceived health status and catastrophizing scores were obtained. The diagnosis of chronic postsurgical pain was by physical examination at 4 months. Standard preoperative, intraoperative, and postoperative data were also recorded.

The chronic postsurgical pain incidence was significantly higher in women (53.1%) than in men (38.0%) (p = 0.023). At baseline, women had significantly worse scores on psychological measures (perception of mental state [p = 0.01], depression [p = 0.006], and catastrophizing [p < 0.001]). Women also reported more preoperative pain in the operative area (p = 0.011) and other areas (p = 0.030).

These findings show that the incidence of physician-diagnosed chronic postsurgical pain is higher in women than in men after surgeries involving thoracotomy. Sex and gender should be included in future clinical research on pain in surgical settings.

Surgical fear is present in many patients awaiting surgery. However, a validated Italian version of the Surgical Fear Questionnaire (SFQ) was not available yet. Therefore, the aim of this study was to translate the SFQ into Italian and to test its reliability and validity.

Design: prospective cohort study on Italian-speaking Swiss patients scheduled for a minimally invasive spinal procedure or spinal surgery. After forward and back translation and a pilot test, reliability and validity of the 8-item SFQ was assessed using the intraclass correlation coefficient, (ICC), Cronbach's alpha, confirmatory factor analysis (CFA), and Spearman's correlation coefficient.

Results on 63 patients revealed median SFQ-total scores of 22 (minimum-maximum: 0-68) at inclusion and 22.5 (0-70) one week before surgery. Test-retest reliability between first and second SFQ-total score was high, ICC=0.947 (95% CI: 0.912-0.968). Internal consistency of the SFQ-total score at both assessment times were high, Cronbach's alphas 0.916 and 0.931 respectively. This was also the case for the subscale short-term fear, item 1-4 and long-term fear, item 5-8 (range 0.853-0.909). CFA-results for a one-factor and a two-factor model favored the two-factor model. Correlations with pain catastrophizing, other anxiety measures, and health status were weak and only state anxiety assessed by PROMIS reached statistical significance.

We conclude that the Italian version of the SFQ is suitable for use in practice and has a high reliability. Validity and sensitivity need additional testing on a larger population.

Pain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience associated with, or resembling, that is associated with actual or potential tissue damage. In Ethiopia, where healthcare facilities and offerings are expanding to handle countless patients requiring surgical intervention, managing acute postoperative pain is a serious concern.

To assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023.

This is an institution-based cross-sectional study. A structured data collection format was used to collect data from 219 participants. Bivariable and multivariable logistic regression analyses described the association between independent and dependent variables.

Of 219 patients, 180 (82.2 %) had acute postoperative pain. The prevalence of moderate to severe pain was 34.24 %. Preoperative anxiety, the use of intraoperative analgesics, and duration of surgery were the main factors associated with the prevalence of acute postoperative pain.

Our study revealed that the overall prevalence of postoperative pain was relatively low in the study area. This suggests that the attention given to postoperative pain recognition and management is better than that in other areas. However, the finding of a significant gap in managing postoperative pain underscores the need for further improvements in pain management practices. This should motivate us to commit to change, particularly in the identified areas of concern, such as preoperative anxiety, use of intraoperative analgesics, and duration of surgery.

Effective postoperative pain management is critical for pediatric craniotomies. Scalp nerve block (SNB) interventions present a potential solution, yet their comparative benefits in preoperative and postoperative settings remain unclear. This study investigated the analgesic effects of SNB in pediatric craniotomy patients by comparing preoperative versus postoperative administration.

This randomized trial included 180 children (1-12 years) who underwent elective craniotomy and were assigned to the preoperative, postoperative, or nonblocking control group. The outcomes included cumulative sufentanil use, pain scores (1, 2, 4, 24, 48 h postoperation), rescue medicine utilization, postoperative complications (24, 48 h), and hospitalization length. The primary outcome was total sufentanil use within 24 h postsurgery.

Total sufentanil use (µg·kg- 1) in the postoperative block group was significantly lower than that in the nonblocking control group at 1 h (P < 0.001, 95% CI [-0.024 to -0.006]), 2 h (P < 0.001, 95% CI [-0.054 to -0.020]), 4 h (P < 0.001, 95% CI [-0.089 to -0.032]), 24 h (P < 0.001, 95% CI [-0.192 to -0.047]), and 48 h (P = 0.010, 95% CI [-0.208 to -0.022]) postoperation. Additionally, sufentanil use in the preoperative block group was significantly lower than that in the nonblocking control group at 1 h (P = 0.004, 95% CI [-0.021 to -0.003]), 2 h (P < 0.001, 95% CI [-0.043 to -0.010]), and 4 h (P = 0.002, 95% CI [-0.069 to -0.013]). Within 24 h postoperation, the use of sufentanil in the postoperative block group was significantly lower than that in the preoperative block group (P = 0.014, 95% CI [-0.157 to -0.013]).

Compared with preoperative SNB or nonblocking, postoperative SNB significantly reduces postoperative sufentanil use within 24 h for pediatric patients undergoing craniotomy, highlighting its potential as an effective analgesic intervention in this population.

The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800017386) on 27/07/2018, under the title "A study of scalp nerve block for neurosurgical analgesia in children with craniotomy."

Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia, and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for OUD (eg, buprenorphine, methadone), considerations regarding urine drug testing, and other social aspects of care for maternal-infant dyads, as well as a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and complications associated with OUD in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with OUD in the context of pregnancy to improve maternal and perinatal outcomes.

In the ICU, opioids treat pain and improve ventilator tolerance as part of an analgosedation approach. Identifying predictors of opioid consumption during the ICU course might highlight actionable items to reduce opioid consumption.

To identify risk factors for opioid use during a postoperative ICU course.

Patients enrolled in the Michigan Genomics Initiative single-center prospective observational cohort study completed baseline preoperative sociodemographic and mental/physical health questionnaires and provided blood samples for genetic analysis. Included patients were 18 years old and older, admitted to ICU postoperatively, and received opioids postoperatively.

The primary outcome was ICU mean daily oral morphine equivalent (OME) use. The association between OME and phenotypic risk factors and genetic variants previously associated with pain were analyzed through univariable and multivariable linear regression models.

The cohort consisted of 1865 mixed-surgical patients with mean age of 56 years (sd, 15 yr). Preoperative opioid users were more likely to continue to receive opioids throughout their ICU stay than opioid-naive patients. OME (log10 scale) was most strongly associated with ICU mechanical ventilation (β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; effect size 1.85 for receiving > 24 hours of mechanical ventilation), preoperative opioid use (β = 0.22; 95% CI, 0.16-0.29; p < 0.0001; effect size 1.67 for receiving preoperative opioids), major surgery (β = 0.21; 95% CI, 0.12-0.30; p < 0.0001; effect size 1.62 compared with minor surgery), and current/former illicit drug use (β = 0.12; 95% CI, 0.01-0.23; p = 0.04; effect size 1.30 for drug use). Younger age, centralized pain, and longer anesthetic duration were also significantly associated with OME but with smaller effect sizes. Selected genetic variants (FKBP5, COMT, and OPRM1) were not associated with OME use.

Mechanical ventilation and preoperative opioids were the strongest risk factors for postoperative ICU opioid consumption, whereas psychologic factors and genetic variants were not associated.

Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting.

The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA).

This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded.

The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA.

The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24 hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents.

The study covariates included demographic, surgical, and anesthesia characteristics.

Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher's exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P < .05.

354 participants were included in the study (262 in the nerve block group, mean age 22.5 ± 4.0 years; 92 in the PCA group, mean age 22.6 ± 4.4 years; P = .81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P = .18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio = 0.67, 95% confidence interval: 0.22-2.01, P = .48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio = 0.34, 95% confidence interval: 0.18-0.65, P = .001).

For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a lower POV risk.

Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP.

Adult patients scheduled for laparoscopic surgery undergo pain-sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain-sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain-tolerant) are randomized to opioid-free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery.

Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain.

Prospectively posted at ClinicalTrials.gov, identifier NCT04751812.

The purpose of our study was to investigate the effect of gender on postoperative pain, sleep quality, and recovery outcomes in patients undergoing VATS surgery under general anesthesia.

Perioperative peripheral blood inflammatory markers system inflammation Index (SII) was recorded for perioperative inflammatory response. The visual analog scale (VAS) was used to evaluate pain level. And the Athens Insomnia Scale (AIS) was evaluated on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3) for postoperative sleep.

In this prospective cohort study, 79 males and 79 females were consecutively included. Females had significantly higher pain score (both rest and cough pain) compared to the males at 3 h after the surgery (3.85 ± 1.2 vs. 3.16 ± 1.1) (rest) (p < 0.001) and 5.10 ± 1.3 vs. 4.46 ± 1.6 (coughing) (p = 0.006)). Patients in the male group had significantly lower AIS scores than those in the female group at Sleep POD 1 and Sleep POD 3 (p = 0.024 and p = 0.045). And in both groups, postoperative SII was increased and statistically significant compared to preoperative SII (p < 0.001, respectively). Women presented higher levels of SII on the first day after surgery, and the increase of postoperative SII in females groups was significantly higher than that in male group when compared to preoperative SII (1806.33 ± 1314.8 vs 1430.55 ± 958.4) (p = 0.042).

These findings highlight the complex multidimensional nature of postoperative pain, nausea and vomiting, sleep quality and the potential contributory role of sex in shaping these outcomes. Women had worse sleep quality, higher postoperative inflammatory response level and pain level than men.

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (-0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (-0.16, 0.91)), depression on POD2 (aSMD = 0.31 (-0.23, 0.84)) and POD4 (aSMD = 0.24 (-0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (-0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing.

Introduction Orthognathic surgery frequently leads to immediate postoperative pain (IPP) and postoperative nausea and vomiting (PONV), impacting patient recovery and satisfaction. This study aims to identify key determinants contributing to IPP and PONV following orthognathic surgery. Methods A retrospective cohort study was conducted involving patients who underwent orthognathic surgery at Kurume University Hospital between January 2020 and December 2023. Patients were divided into two groups: "mandible alone" and "bimaxillary." Independent variables, including patient-related, surgery-related, and anesthesia-related variables, were evaluated against IPP and PONV using multivariate logistic regression analysis. Results The study enrolled 181 patients who underwent orthognathic surgery with an average age of 26.6 ± 8.1 years (range: 16-54 years), of which 139 patients (76.8%) were women. Multivariate analysis identified low body mass index (BMI) as a common significant related factor for both IPP (adjusted odds ratio {OR}, 3.70; P = 0.0034) and PONV (adjusted OR, 2.80; P = 0.022). Inhalation anesthesia was significantly associated with IPP (adjusted OR, 9.07; P = 0.049), while higher blood loss and increased local anesthesia volumes were associated with PONV (adjusted OR, 0.35 and 0.31; P = 0.005 and 0.016, respectively). Conclusion BMI, total blood loss, anesthesia method, and the total amount of local anesthesia may be significant related factors of postoperative complications following orthognathic surgery. These findings can inform preoperative assessments and anesthesia management to improve patient outcomes.

Despite advancements in postoperative pain management, approximately 20% of patients still experience severe pain within the first 24 hours post-surgery. Previous studies utilizing machine learning have shown promise in predicting postoperative pain with various models. This study investigates postoperative pain predictors using a machine learning approach based on physiological indicators and demographic factors in a Mexican cohort.

We conducted a retrospective case-control study to assess pain determinants at Post-anesthesia Care Unit (PACU) discharge at Hospital Ángeles Lomas in Mexico City. Data were collected from 550 patients discharged from the PACU, including 292 cases and 258 controls, covering a range of surgical procedures and illnesses. Machine learning techniques were employed to develop a predictive model for postoperative pain. Physiological responses, such as blood pressure, heart rate, respiratory rate, and anesthesia type, were recorded prior to PACU admission.

Significant differences were found between cases and controls, with factors such as sex, anesthesia type, and physiological responses influencing postoperative pain. Visual analog scale (VAS) scores at PACU admission were predictive of pain at discharge.

Our findings reinforce existing literature by highlighting sex-based disparities in pain experiences and the influence of anesthesia type on pain levels. The logistic regression model developed, incorporating physiological responses and sex, shows potential for refining pain management strategies. Limitations include the lack of detailed surgical data and psychological factors, and validation in a prospective cohort. Future research should focus on more comprehensive predictive models and longitudinal studies to further improve postoperative pain management.

This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research.

Current ML models leverage diverse datasets, algorithmic techniques, and validation methods to identify predictive biomarkers, risk factors, and phenotypic signatures associated with increased acute and chronic postoperative pain and persistent opioid use. ML models demonstrate satisfactory performance to predict pain outcomes and their prognostic trajectories, identify modifiable risk factors and at-risk patients who benefit from targeted pain management strategies, and show promise in pain prevention applications. However, further evidence is needed to evaluate the reliability, generalizability, effectiveness, and safety of ML-driven approaches before their integration into perioperative pain management practices.

Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care.