Monitoring of pain and nociception in critical care patients unable to self-report pain remains challenging. Technical nociception monitors could provide valuable support. Here, we investigated the Nociception Level Index (NOL) and the PainSensor for their ability to predict and detect behavioral responsiveness to two potentially painful clinical interventions.

We included 196 critical care patients undergoing endotracheal suctioning (n = 149) and positioning (n = 47). Clinical responsiveness was graded using the Behavioral Pain Scale (BPS). As potential predictors of responsiveness, we recorded data from the NOL and PainSensor along with a variety of nociception-unspecific confounders, including the Richmond Agitation-Sedation Scale (RASS). We assessed their ability to predict behavioral responsiveness using prediction probability.

Both nociception monitors predicted behavioral responsiveness to endotracheal suctioning (NOL 0.67 [0.61-0.74, 95 % confidence interval], PainSensor 0.57 [0.51-0.63]), but neither outperformed the RASS (0.73 [0.68-0.77]). Behavioral responsiveness to positioning was predicted by the NOL (0.80 [0.66-0.94]) but not the PainSensor (0.54 [0.40-0.67]). Again, neither outperformed the RASS (0.68 [0.56-0.80]).

Both nociception monitors can predict behavioral responsiveness to nociceptive clinical stimulation. However, the added value of nociception monitors for detecting pain and nociception in critical care patients remains questionable, as readily available non-technical observational scales show a comparable performance.

Adductor canal blocks (ACBs) have been associated with reduced pain following total knee arthroplasty (TKA). There is a paucity of evidence regarding whether these early differences impact longer term outcomes. This study aimed to identify whether using ACB in TKA was associated with improvements in both early and late outcomes.

Patients who underwent a unilateral TKA between 2021 and 2022 were retrospectively assessed for pain scores, time to first mobilization and opioid use over the first 72 h. At 6 weeks, complications, pain scores and opioid use were assessed. At 12 months validated patient reported outcome measures (PROMs) and patient satisfaction with their surgery were assessed.

262 unilateral TKA, of whom 129 received ACB (ACB group) and 133 did not (control group) were assessed. The ACB group had significantly lower median day 1 pain (median difference -0.44 (-0.09 to -0.79), p = 0.015). There was no significant difference between groups for pain after 24 h, time to mobilization or opioid use over 72 h. There was no significant difference in pain (p = 0.892), opioid use (p = 0.913) or complications (p = 0.348) at 6 weeks, or median change in PROMs (p = 0.436 and p = 0.307), opioid use (p = 0.187), or satisfaction with surgery (p = 0.262) at 12 months.

ACBs were associated with a clinically insignificant difference in median pain on day 1. there was no association with pain after 24 h, opioid use, time to mobilization or longer term outcomes. Our findings do not support the use of routine ACB during TKA.

Evidence to support the effectiveness of intrathecal morphine in patients undergoing minimally invasive abdominal surgery is largely based on small, single-centre studies. We therefore designed a large, multi-centre clinical trial to investigate the effect of intrathecal morphine with local anaesthetic on patient postoperative quality of recovery. The primary objective is to compare quality of recovery on postoperative Day 1. The secondary objectives are to compare opioid consumption, pain scores, and opioid-related adverse events.

This multi-centre, prospective, randomised controlled trial will recruit 280 adult patients undergoing minimally invasive major abdominal surgery. The intervention group will receive 200 mcg of intrathecal morphine with local anaesthetic, as part of a multimodal analgesic strategy. Following safety analysis after the first 100 patients the dose of ITM will increase to 300 mcg. The control group will receive non-neuraxial multimodal analgesia.

This trial is expected to provide evidence on the effectiveness and the safety of two different ITM doses with local anaesthetic in major minimally invasive abdominal surgery.

ACTRN12623001347651 (ANZCTR Registry Number).

1.0, May 2, 2024.

Phase 3 clinical trials in moderate-to-severe acute pain have shown that co-crystal of tramadol-celecoxib (CTC) has improved efficacy and comparable tolerability versus immediate-release tramadol 50 mg alone, with a similar tramadol daily dose, over a 48-h treatment period. However, it is not known how first-dose tolerability compares, given that the administered dose of tramadol is higher in CTC 200 mg (88 mg) versus immediate-release tramadol 50 mg. This was explored in a post hoc analysis of a pivotal phase 3 trial.

A randomized, double-blind, factorial, active- and placebo-controlled phase 3 trial was conducted in patients with moderate-to-severe acute postoperative pain (NCT03108482) and has been previously reported. This post hoc analysis evaluated the prevalence of the four most common study drug-related, opioid-associated, treatment-emergent adverse reactions reported in phase 3 CTC clinical trials: somnolence, nausea, dizziness, and vomiting. Prevalence was evaluated in 2-h intervals, up to 6 h post first dose (just before second-dose administration) of CTC 200 mg or immediate-release tramadol 50 mg p.o. Descriptive analysis was performed.

Each group comprised 183 participants for analysis. The proportions of patients reporting drug-related, treatment-emergent adverse reactions of somnolence, nausea, dizziness, and vomiting were similar between treatment groups at 2, 4, and 6 h following the first dose.

This post hoc analysis indicates that the higher dose of tramadol (88 mg) given in CTC 200 mg did not result in an increase in drug-related adverse reactions after first-dose administration, and had a similar tolerability profile, compared with immediate-release tramadol 50 mg alone (the lowest dose recommended for the management of moderate-to-severe acute pain). This is in line with earlier findings for the 48-h treatment period of this phase 3 trial and may be explained by CTC's differentiated physiochemical properties related to its co-crystal structure. These findings may have utility for practicing clinicians.

ClinicalTrials.gov identifier, NCT03108482.

The efficacy of the transcanal endoscopic approach in tympanoplasty, cholesteatoma removal, and stapedotomy is detailed. This study reviews evidence on the feasibility of endoscopic ossiculoplasty as a suitable alternative to traditional microscopic ossiculoplasty.

PubMed, Embase, and Cochrane Library were searched from inception to 19 June 2024 for articles comparing endoscopic and microscopic ossicular chain reconstruction.

This systematic review was conducted in accordance with PRISMA guidelines. The primary outcomes assessed include air bone gap closure, pre-operative and post-operative air bone gap, pure tone audiometry, and word recognition scores. The secondary outcomes include operation time, surgical success, and surgical complications. These outcomes between microscopic and endoscopic techniques were pooled and compared as mean differences using a random-effects model. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) scale were adopted to assess for study bias in observational studies and randomized controlled trials, respectively.

This study included five studies comprising 504 patients. While endoscopic ossiculoplasty had shorter operating durations (95% CI -42.97 to -1.57), it conferred comparable air bone gap closure (95% CI -0.34 to 3.76), post-operative pure tone audiogram (95% CI 10.97-18.77), and surgical success. Additional qualitative strengths identified in endoscopic ear surgery include improvements in visualization, decreased need for supplemental incisions, excellent ergonomics, and reduced post-operative pain.

Overall, endoscopic ossiculoplasty may confer comparable audiological outcomes to microscopic ossiculoplasty and may serve as a reasonable alternative surgical approach. Laryngoscope, 135:1899-1907, 2025.

Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery.

We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery.

The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (<500 μg) in the reviewed studies.

This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays.

PROSPERO-registry CRD42021233936.

To compare the analgesic effects of intrathecal neostigmine with bupivacaine, morphine with bupivacaine and bupivacaine alone among patients undergoing surgical procedures below the umbilicus.

A multicentre prospective cohort study was conducted from 29 May to 29 August 2023 at Wolaita Sodo University Comprehensive Specialized Hospital, Nigest Mohammed Eleni Memorial Comprehensive Specialized Hospital and Werabe Comprehensive Specialized Hospital. A systematic random sampling technique was used to select the participants from the sample of 180.

The study included American Society of Anesthesiologists classes I and II patients aged 18-85 years scheduled for elective surgeries under spinal anaesthesia with bupivacaine with neostigmine (50 µg), bupivacaine with morphine (100 µg) and bupivacaine alone at a dose of 17.5 mg.

The duration of pain relief, the severity of pain and the time of first analgesic requirement.

Postoperative complications such as respiratory depression, pruritus, nausea and vomiting RESULTS: Administration of intrathecal bupivacaine with neostigmine group (NG) and morphine group (MG), respectively, produces a long duration of postoperative analgesia with a first analgesia request mean time of 9.4±3.18 and 9.65±4.9, while using bupivacaine group (BG) alone produces a shorter duration of postoperative analgesia with a mean first analgesia request time of 3.58±0.98 hours. The mean visual analog scale scores in 28 hours were 0.99, 0.79 and 2.05 for the NG, MG and BG, respectively. The overall postoperative pain severity was highest in the BG. The mean total analgesic consumption was 77.5, 73.8 and 189.2 mg for diclofenac, whereas 54.2, 63.9 and 151.7 mg for tramadol in the NG, MG and BG, respectively. Incidence of nausea (31.3%) and vomiting (30%) was highest in the NG, while pruritus (15%) and respiratory depression (15%) were more in the MG.

Compared with BG, MG and NG had longer-lasting postoperative analgesic effects, less severe pain and required fewer analgesics overall. Patients in the NG had more incidences of nausea and vomiting. The incidences of pruritus and respiratory depression were highest in the MG. Effective analgesia appeared to work better in the MG and NG. We recommend morphine and neostigmine as adjuvants to local anaesthetics for effective postoperative analgesia. We also recommend researchers compare different doses of neostigmine and morphine as adjuvants to bupivacaine in further studies.

Instrumented spinal surgery is a frequently performed and painful intervention, with severe pain often lasting for three days. Opioids are the cornerstone of treatment of postoperative pain, but can induce severe side effects, dependence, and addiction. Novel local anesthetic applications, such as erector spinae plane blocks, and sustained release formulations have the potential to decrease opioid consumption without analgesic compromise but have limited efficacy beyond 24 h. A mismatch in duration of pain and duration of non-opioid analgesia is thus present in spine surgery. This study assessed the feasibility of a robust hydrogel for three days of sustained and stationary bupivacaine delivery, designed for co-implantation with pedicle screws, in a sheep model for spinal surgery. Fifteen sheep received six hydrogel rings loaded with bupivacaine mounted on pedicle screws (total dose 220 mg). Wound and systemic drug levels, hydrogel degradation and histological response were assessed. Moreover, in-vivo drug release was correlated to in-vitro release (IVIVC). Rings stayed in place after surgery and displayed a first-order release profile in-vivo over 72 h, with excellent IVIVC. Ring intactness after implantation did not affect release. Bupivacaine wound fluid levels exceeded plasma levels 2300-fold, and plasma bupivacaine levels were well below toxic thresholds through 168 h. Histological analysis of implant sites revealed a conventional foreign-body response that subsided during follow-up. Hydrogels degraded completely in 9 months. The present hydrogel has the potential to provide safe, localized, and sustained analgesia following instrumented spinal surgery.

Background: Postoperative pain is an unpleasant experience for the patient and impairs postoperative functional outcomes. The current literature on the influence of preoperative predictors on postoperative pain outcomes remains limited. This study aimed to identify sociodemographic, clinical, psychological, and temperamental predictors of postoperative pain in patients undergoing surgery for degenerative disc disease (DDD). Methods: Eighty-one adults with DDD, qualified for neurosurgical intervention, were enrolled. All patients underwent neurological and psychiatric evaluations, as well as preoperative pain assessments using the Visual Analogue Scale (VAS) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychological assessments included the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Somatic Symptom Scale, temperament, and personality inventories (e.g., FCB-TI, NEO-FFI), and cognitive tests (Trail Making Test, Digit Span Test). Postoperative pain was re-evaluated with the VAS 12 weeks after surgery. Data were analyzed using univariate and multivariate statistical methods. Results: Univariate analyses revealed significant differences between the defined groups regarding lack of improvement of pain 12 weeks after surgery compared to preoperative VAS, systolic blood pressure, and four scales from the WHYMPI. However, stepwise logistic regression identified only preoperative VAS score as an independent predictor of postoperative pain improvement. Receiver Operating Characteristic analysis and Youden's index indicated a preoperative VAS cut-off score of 6 as the most predictive. Conclusions: A VAS score of 6 or more before surgery independently predicts the absence of chronic pain 12 weeks postoperatively for patients without neurological deficits. Moreover, given the complexity of this topic, further prospective, randomized controlled research is essential.

This integrative review describes using mindfulness to reduce pain and anxiety during the perioperative period in surgical patients. As an exploratory aim, the relationship between mindfulness and opioid use after surgery was also explored.

CINAHL, PubMed and EMBASE databases were queried to identify articles examining the relationship between mindfulness, postoperative pain and opioid consumption, and preoperative anxiety in patients undergoing surgery. Seventeen studies were included in the review, encompassing 1,454 patients.

Twelve articles focused on postoperative pain as the primary outcome and 11 of these reported that mindfulness decreased pain scores, mainly after postoperative day seven. Of these 12, seven studies measured opioid consumption and two reported an association between mindfulness and reduction in the use of opioid pain medications. Five articles focused on preoperative anxiety as the primary outcome, and two demonstrated that mindfulness was associated with a statistically significant reduction in anxiety.

Evidence suggests that mindfulness has a significant impact on postoperative pain, particularly pain more than one week after surgery. There was limited evidence supporting the use of mindfulness to reduce opioid consumption postoperatively. Similarly, mixed effects were reported describing the use of mindfulness to reduce anxiety before surgery. More research is needed to investigate the impact of mindfulness on pain after surgery and opioid consumption, as well as its impact on anxiety before surgery.

Integrating mindfulness into surgical pathways could have positive effects on pain and anxiety for patients during the perioperative and postoperative phases of care.

Postoperative pain management remains a massive challenge after renal surgeries. The erector spinae plane block (ESPB) is a promising regional analgesia for pain management after nephrectomy. Unlike other regional anesthesia techniques, ESPB is relatively simple to perform and has been shown to provide effective pain relief in various surgical contexts. We aim to evaluate the analgesic effects of ESPB after nephrectomy, with the goal of providing evidence-based guidance for postoperative pain management in nephrectomy patients.

A comprehensive and meticulous literature search was conducted on PubMed, Scopus, Web of Science, and Cochrane Library till September 2024. Review Manager software was used to pool dichotomous and continuous data. We employed the risk of bias tool to evaluate the quality of the evidence, ensuring a thorough and robust analysis.

This systematic review identified fourteen clinical trials of 897 patients that met the inclusion criteria. Meta-analysis results demonstrated that the ESPB significantly reduced pain scores at rest compared to no block at 30 min, 1 h, and 2 h postoperatively (p < 0.00001). In the intermediate recovery phase, ESPB also resulted in significantly lower pain scores at 4, 6, and 12 h (p < 0.001). At 24 h, ESPB continued to show a significant pain reduction compared to no block (SMD = -0.65, p < 0.0001). Less opioid consumption and prolonged time to first rescue analgesia were noticed in ESPB groups (MD = -29.56 mg, p < 0.00001), (SMD = 3.56 min, p = 0.001) respectively. ESPB showed a lower risk of postoperative nausea and vomiting.

This review demonstrated significant postoperative analgesic effects of ESPB with lower risks of postoperative nausea and vomiting in nephrectomy. However, the need for further studies to provide conclusive evidence is urgent and paramount in our field.

Acute pain is a common complaint in the pediatric emergency department. Ketorolac, a nonsteroidal anti-inflammatory drug, is approved for use in adults but remains underinvestigated in pediatric patients. This meta-analysis aims to evaluate the efficacy and safety of Ketorolac for acute pain management in children.

A systematic search was conducted using electronic databases, including PubMed, Web of Science, Scopus, and CENTRAL. Studies investigating the use of Ketorolac for acute pain in children were included. We followed the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0).

Twenty-four studies were included in this systematic review. The mean change in pain scores with Ketorolac was -2.06 (95% CI: -5.01 to 0.88, P<0.01). The pooled rate of pain freedom at discharge in 103 patients across 3 studies was 66.06% (95% CI: 49.64-82.47, P=0.02). The pooled rate of discharge from the emergency department in 130 patients across three studies was 85.34% (95% CI: 58.83-100, P<0.01). The pooled rate of gastrointestinal adverse events in 267 patients across four studies was 1.53% (95% CI: 0.00-3.39, P=0.07).

Ketorolac appears to be a safe and effective option for managing acute pain in the pediatric population. The results indicate significant pain reduction and a relatively low risk of adverse events. However, randomized controlled trials are necessary to validate these findings and establish appropriate dosing regimens.

To examine the association between early mobilization after hip fracture surgery and the risk of long-term opioid therapy at 1-year follow-up.

Long-term opioid therapy is a common complication after hip fracture surgery. Mobilization within 24 h after surgery is associated with a lower risk of long-term opioid therapy compared to mobilization between 24 and 36 h.

Early mobilization is one of the key elements of the successful patient recovery for reducing risk of complications and mortality after hip fracture surgery.

Early mobilization after hip fracture operation is associated with better clinical outcomes, but its impact on long-term opioid therapy (LTOT) remains unclear.

Using Danish population-based registries we included patients aged ≥ 65 who underwent surgery for a first-time hip fracture between 2016 and 2021 (n = 36,229). LTOT was defined as redeeming ≥ 2 prescriptions between 31 and 365 days of surgery. Using stabilized inverse probability of treatment (sIPT) weighing, we calculated risks and risk differences with 95% confidence intervals (CI) for opioid use balancing mobilization groups ≤ 24 h vs 24-36 h on measured confounders and taking death into consideration.

67.3% of all patients were women and the median age was 82.6 years (75.8; 88.6). 75% of patients were mobilized ≤ 24 h of surgery, whereas 8% were mobilized between 24 and 36 h, 4.9% > 36 h, and 12.1% had missing data on mobilization. Patients mobilized ≤ 24 h and 24-36 h were similar in age, fracture type, and marital status, but those mobilized ≤ 24 h had fewer comorbidities, better pre-fracture mobility, and a higher social position. They also had a lower risk of LTOT (29.99%) compared to those mobilized 24-36 h (33.42%), with a weighted risk difference of 3.44% (95% CI 1.58-5.30).

LTOT is common after hip fracture surgery. Mobilization ≤ 24 h after surgery is associated with a lower risk of LTOT compared to mobilization between 24 and 36 h. Early mobilization is one of the key elements of successful patient recovery for reducing complications and mortality after hip fracture surgery.

The impact of parental psychological factors on post-operative pain management in children is not well understood, but is important. The aim of this study was to determine the relationship between parental anxiety, pain catastrophizing about child pain, and opioid administration in children undergoing tonsillectomy.

This was a multicenter prospective cohort study from four different centers between 2022 and 2023. All parents of children undergoing adenotonsillectomy were included. Parental levels of anxiety and pain catastrophizing were assessed using the State-Trait Anxiety inventory (STAI), a Numeric Anxiety Scale (NAS), and the Pain Catastrophizing Scale-Parent Version (PCS-P). Post-operative analgesia data was collected on post-operative days (POD) 1, 3, 7, and 10.

236 patients were included. Mean child age was 5.1 years old (SD 2.8). Mean baseline parental PCS-P score was 34.4 and NAS was 6.1. Higher PCS-P and NAS scores corresponded to increased odds of opioid administration in the early postoperative period (POD 1 and 3 [aOR 1.16, 95 % CI [1.03-2.99])). Children with a communication delay (aOR 4.75, 95 % CI [2.35-9.59]) and young children (aOR 1.73, 95 % CI [1.45-2.56]) also had increased opioid administration in the early postoperative period (POD1 & 3).

Parents who have higher anxiety and tendencies to catastrophize are more likely to administer opioids early in the postoperative period. Children with limited communication skills are more likely to receive greater amounts of opioids after tonsillectomy. Interventions such as targeted screening for parental mental health, peri-operative counseling, and tailored pain control programs represent promising avenues for improving pain management.

The purpose of this study was to identify preoperative factors associated with worse postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores 2 years after hand and wrist surgery. We hypothesized that older age, more comorbidities, increased substance use, and lower socioeconomic status would correlate with worse 2-year PROMIS PI scores.

This study was a retrospective review of prospectively acquired data on 253 patients. Surveys were administered within 1 week of surgery and 2 years postoperatively. Bivariate and multivariable analyses were conducted to identify significant predictors of worse 2-year PROMIS PI scores and change in PROMIS PI scores.

Older age, higher body mass index, more comorbidities, lower preoperative expectations, more prior surgeries, unemployment, smoking, higher American Society of Anesthesiologists (ASA) score, and multiple other socio-demographic factors were correlated with worse 2-year PROMIS PI scores (P ≤ .018). Similar factors were also correlated with less improvement in 2-year PROMIS PI scores (P ≤ .048). Worse scores on all preoperative patient-reported outcome measures correlated with worse 2-year PROMIS PI scores (P ≤ .007). Multivariable analysis identified smoking history, less frequent alcohol consumption, worse preoperative PROMIS social satisfaction and Numeric Pain Scale whole body scores, and higher ASA scores as independent predictors of worse 2-year PROMIS PI. The same factors in addition to better baseline PROMIS PI were predictive of less improvement in 2-year PROMIS PI.

Numerous preoperative factors were predictive of worse postoperative 2-year PROMIS PI and less improvement in 2-year PROMIS PI for patients undergoing hand and wrist surgery.

Local anesthetics are commonly used for postoperative pain relief but have limited effectiveness due to their short half-life and low molecular weight. Various sustained-release systems have been explored but face challenges such as low encapsulation efficiency in liposomes, rapid degradation and limited release durations of hydrogel, and difficulties with injectability in combined microsphere/hydrogel. This study presents a double cross-linked hydrogel (Bup/PO) made from aminated poloxamer 407 (P407) and oxidized hyaluronic acid (OHA), cross-linked via oxime bonds and hydrophobic interactions. Rheological analysis showed that the hydrogel exhibited temperature sensitivity, with a storage modulus of up to 10,000 Pa at 37 °C, significantly higher than pure P407. In vitro, the hydrogel provided sustained bupivacaine release for up to 8 days. In vivo, a rat sciatic nerve block model demonstrated that the Bup/PO hydrogel significantly extended the mechanical pain threshold for 32 h and thermal pain threshold for 48 h. The hydrogel was fully biodegradable within 21 days, with mild reversible inflammation and no neurotoxicity. This study introduces a double-cross-linking mechanism that improves hydrogel stability, mechanical properties, and drug release, offering a promising solution for long-term postoperative pain management and regional anesthesia.

Postoperative pain following spine surgery remains a challenge for patients, surgeons and healthcare facilities. This study aimed to evaluate the postoperative analgesic efficacy of gelfoam soaked in pethidine combined with levobupivacaine, compared to gelfoam soaked in levobupivacaine alone in single-level lumbar laminectomy patients.

This was a prospective, randomized, double blinded study. A total of 90 patients of either sex, aged 18 to 60 years with ASA class I or II planned for single-level lumbar laminectomy were randomly assigned into three equal groups: group A (levobupivacaine plus pethidine): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml pethidine 50 mg, group B (levobupivacaine alone): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml of 0.9 % sodium chloride; and group C (control group): epidural gelfoam soaked with 2 ml of 0.9 % sodium chloride. Total analgesic consumption, time to first rescue analgesic request, time to ambulate, postoperative VAS scores, vital signs and adverse effects were recorded.

Demographic and baseline patients' data were comparable among the 3 groups. Group B had lower total analgesic consumption, prolonged time to first rescue analgesia, earlier ambulation, and lower VAS scores in the first 24 h in compared to control group C. Significant differences were found between groups A and B in total analgesic consumption, time to first rescue analgesia, and VAS score in the first 24 h. However, no significant differences were found between the two groups regarding time of ambulation and average VAS scores 24 to 48 h after surgery. There were no significant differences in the occurrence of adverse effects among the 3 groups.

This study demonstrated that the addition of pethidine to epidural levobupivacaine in a gelfoam soaked form enhanced the postoperative analgesia in patients undergoing single-level lumbar laminectomy in terms of reduced total analgesic consumption, prolonged time to first rescue analgesia and lower postoperative pain scores.

Neuraxial opioids are commonly used after cesarean delivery (CD). However, they are not commonly used after vaginal delivery (VD) though some studies have suggested they may be beneficial from a pain perspective. However, they did not evaluate other potential benefits including patient satisfaction, impact on postpartum depression and breastfeeding (BF) success, or side effects such as pruritus.

Parturients who delivered vaginally with epidural analgesia were randomized to receive either 2 mg of preservative-free morphine (4 mL) or saline (4 mL) via the epidural catheter within 1 hour of VD. Routine analgesics were unchanged and included q 6-hour dosing of acetaminophen 975 mg orally and ketorolac 30 mg intravenous (IV). Hydromorphone 2 mg or oxycodone 10 mg were offered for breakthrough pain. Our primary outcome was opiate consumption in the first 24 hours after drug administration. Secondary outcomes included pain scores at 24 hours and 1 week postpartum as well as opiate consumption up to 1 week postpartum. Additional end points such as obstetric quality of recovery score (OBS-QOR10) breast feeding success, and an Edinburgh Postnatal Depression Score (EPDS) were also obtained.

Data were analyzed for 157 parturients, 80 in the morphine group and 77 in the saline group. No difference was observed in the EDPS score predelivery or intention to BF. We found a statistically significant difference in the use of opioids in the first 24 hours, 3.8% (95% confidence interval [CI], 0.9%-11.3%) vs 14.3% (7.7%-24.5%) in the morphine and saline groups, respectively; and in total opioid dose, median (interquartile range, IQR [range]) of morphine milligram equivalent vs 0 (0-0 [0-47.5]) vs 0 (0-0 [0-72]), P = .023, in the morphine and saline groups, respectively. Verbal pain scores (0-10) at 24 hours were lower in the morphine group (median (IQR [range): 2.0 (1-4 [0-10]) vs 3.0 (1.5-5.0 [0-10]), P = .043. There was a greater incidence of pruritus in the morphine group versus saline group, 37.5% (95% CI, 27.1%-49.1%) vs 18.2% (95% CI, 10.6%-29.0%), P = .008. We did not find any differences in the OBS-QOR10, BF success, or EPDS at 6 weeks PP ( P < .05).

A single epidural dose of 2 mg preservative-free morphine after VD was effective at decreasing pain and opioid use at 24 hours after VD but came at the cost of increased pruritus. We did not detect any differences in BF, recovery scores, or PPD. Future studies should focus on elucidating the role of neuraxial preservative-free morphine after VD.

Pain after thoracic surgery is often significant, which can disrupt normal respiratory mechanics and impair the clearance of secretions, thus increasing the risk of postoperative respiratory complications. Poorly controlled acute pain can lead to persistent post-thoracotomy pain and continued opioid use that can affect quality of life. With the increased awareness of opioid-associated adverse effects and recent emphasis on enhanced recovery, opioid-sparing multimodal analgesia has been used widely for acute pain management after thoracic surgery. This practice advisory reviews, evaluates, and summarizes the recent literature related to pharmacological therapies and non-pharmacological therapies used for postoperative pain management after thoracic surgery and offers guidance to providers in making appropriate pain management decisions for their patients.

The analgesic efficacy of intercostal nerve block (ICNB) in adults undergoing thoracic surgery and the optimal extent of nerve block remain unclear. To evaluate the analgesic efficacy of ICNB and the optimal extent of nerve block in adults undergoing thoracoscopic surgery, we conducted a prospective cohort study of post-thoracoscopic pain.

We conducted a prospective observational cohort study to assess the postoperative pain intensity scores and other relevant factors associated with different ICNB techniques for pain management in thoracoscopic surgery in a tertiary hospital in Beijing, China. Postoperative pain management was categorized into three groups: the ICNB single-site injection (ICNB SI) group, in which the third to fifth intercostal nerves were blocked with 1 mL of 0.5% ropivacaine at each costal level; the ICNB incision-specific multi-site injection (ICNB ISMSI) group, in which the third to eighth intercostal nerves were blocked with 1 mL of 0.5% ropivacaine at each costal level; and the non-ICNB anesthesia group, which did not undergo any block.

Pain intensity scores (visual analog scale, VAS) in the ICNB SI group were significantly lower than those in the ICNB ISMSI group within 24 hours after surgery (4.9±2.4 vs. 6.2±2.0). Within 24 hours after surgery (day 0), no significant difference in pain intensity scores was observed between the ICNB ISMSI group and the non-ICNB group (6.2±2.0 vs. 6.3±2.1). Additionally, ICNB was effective in reducing pain following thoracoscopic surgery, with analgesic effects lasting up to 4 days postoperatively. Long-term follow-up showed lower incidence of chronic chest pain and better quality of life (QL-Index) in the ICNB groups compared to the non-ICNB group (QL-Index scores: 9.18±0.7 at 3 months in the ICNB group vs. 8.67±0.5 in the non-ICNB group).

Thoracic incision-specific multi-site injections were not superior to single injections of ICNB in terms of post-thoracoscopic analgesia. The single-injection approach (ICNB SI) maintained analgesia for 4 days after thoracoscopic surgery, while the multisite injection (ICNB ISMSI) did not demonstrate this prolonged effect. Further research is needed to elucidate the exact mechanisms underlying these differential analgesic effects in clinical practice.

Opioids are the mainstay of pain management in scoliosis surgery. We hypothesized that in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgery, perioperative intravenous (IV) lidocaine would reduce postoperative opioid requirement and pain scores. In this retrospective observational before-and-after study, we identified AIS patients who underwent single-stage PSF at a tertiary university hospital from 2020 to 2022. All patients received total intravenous anesthesia. The Lidocaine group received a bolus of 1.5 mg/kg IV lidocaine prior to induction, followed by infusion at 2 mg/kg/h. At wound closure, the rate was reduced to 1 mg/kg/h and continued for 30 min in recovery. All patients received patient-controlled analgesia (PCA) morphine postoperatively. The primary outcome was total morphine consumption in the first 24 h. The secondary outcome was mean pain scores over 48 h using a numerical rating scale. We included 115 patients: 59 in the Usual Care group and 56 in the Lidocaine group. Postoperative morphine use in the first 24 h showed no significant difference (Lidocaine: 13.5 ± 8.9 mg vs Usual Care: 13.9 ± 10.6 mg; P = 0.821). The cumulative morphine milligram equivalents per kilogram bodyweight at 48 h was 0.43 mg/kg. Mean pain scores were higher in the Lidocaine group in the first 48 h (4.25 ± 0.37 vs 3.67 ± 1.46; P = 0.03). Perioperative IV lidocaine administered as an analgesic adjunct for AIS surgery did not reduce postoperative morphine requirement. Although pain scores were statistically higher in patients receiving intravenous lidocaine, the difference was minimal and lacked clinical significance.

Studies have shown that non-opioid analgesic drugs can reduce the pain of patients after bariatric surgery. Ropivacaine and dexmedetomidine are associated with high efficacy and safety in managing postoperative complications. We evaluated the effectiveness of ropivacaine alone and in combination with dexmedetomidine in improving outcomes after sleeve gastrectomy surgery.

This double-blind, randomized clinical trial, included patients undergoing bariatric surgery in 2022 and 2023. The participants were randomly divided into three groups: treated with ropivacaine alone (group A), ropivacaine and dexmedetomidine combination (group B), or normal saline (group C). Pain scores, morphine consumption, and postoperative nausea and vomiting (PONV) were assessed over 24 h.

All groups showed reduced pain, but group B had significantly lower VAS scores than groups A and C at 4-24 h postoperatively, with the highest difference achieved by group B compared to control at 12-h time point (β =  - 2.5, P < 0.001). Morphine use was lowest in group B (4.38 ± 1.24 mg vs. 6.04 ± 2.07 mg in group A and 7.50 ± 2.55 mg in group C; P < 0.001). PONV incidence was also lower in group B (8.3% vs. 29.2% in group A and 50% in group C; P = 0.008).

The ropivacaine and dexmedetomidine combination therapy was associated with a greater pain relief effect after sleeve gastrectomy, a greater reduction in the need to take opioids, and a lower frequency of PONV compared to the ropivacaine alone or placebo.

Postoperative pain control following adenotonsillectomy in the pediatric population poses a great challenge to care providers. Multi-modal pain management regimes including NSAIDs such as intraoperative ketorolac usage has been purposed for many years. However, the effectiveness of ketorolac to reduce post-tonsillectomy pain and opioid-related side effects is controversial. The study was to evaluate the opioid-sparing effect of an intraoperative intravenous single dose of ketorolac in children undergoing adenotonsillectomy. We also assessed the effectiveness of perioperative ketorolac on alleviating the common adverse effects of opioid usage.

With IRB approval, a total of 142 pediatric patients aged between 3 and 12 years undergoing elective adenotonsillectomy were randomized to receive either placebo or 0.5 mg/kg ketorolac intraoperatively with other pain management remaining the same. The primary outcomes were postoperative pain scores and postoperative rescue pain medication usage. Common postoperative anesthesia-related complications such as nausea, vomiting and postoperative rebleeding were assessed.

We found that ketorolac usage decreased the overall postoperative pain scores significantly (Max FLACC score 4.3 ± 2.6 for ketorolac vs. 5.9 ± 3.0 for placebo). However, intraoperative single-dose ketorolac administration did not reduce postoperative rescue opioid usage, nor decrease the rates of postoperative nausea and vomiting. We did not observe significant postoperative bleeding or other complications associated with ketorolac usage.

While intraoperative ketorolac usage reduces the overall postoperative pain score, it does not decrease the postoperative opioid consumption in our current practice regime. Ketorolac may be a good multi-modal pain management adjunct without increased postoperative complications such as rebleeding.

The serratus posterior superior intercostal plane block (SPSIPB) is a newly described truncal block. This study aimed to compare the effects of SPSIPB with conventional methods on postoperative opioid consumption and pain scores within 24 h postoperatively.

This randomized controlled trial included 60 patients aged 18-65 years with an American Society of Anesthesiologists Physical Status of I-III. Patients were randomly assigned to either the SPSIPB or the control group. The primary outcome was cumulative opioid consumption within the first 24 h postoperatively. Secondary outcomes included resting and dynamic Numerical Rating Scale (NRS) pain scores, Quality of Recovery (QoR)-15 questionnaire scores, intraoperative remifentanil consumption, and the incidence of postoperative nausea and vomiting.

Total tramadol consumption was significantly lower in the SPSIPB group during the first 12 h and at the end of the 24th hour postoperatively compared with the control group (p < 0.05). The dynamic NRS score at 0 h postoperatively was lower in the SPSIPB group (p = 0.001), whereas no significant differences in NRS scores were observed at other time-points. The postoperative QoR-15 scores were significantly higher in the SPSIPB group compared with the control group. Furthermore, the SPSIPB group had significantly lower intraoperative remifentanil consumption (p = 0.003). Nausea and vomiting were more frequent at 12 and 24 h postoperatively in the control group compared with the SPSIPB group.

Serratus posterior superior intercostal plane block significantly reduced opioid use, and improved recovery quality after oncoplastic breast surgery.

NCT06225908, registered at ClinicalTrials.gov.

Quality of Recovery (QoR) is a multidimensional construct that includes physical, psychological, and functional domains and is a key indicator of surgical outcomes. Better QoR is linked to shorter hospital stays, fewer complications, and greater patient satisfaction.

This study evaluates the QoR of postoperative orthopedic patients in Jordan, focusing on the impact of pain, pain management, and emotional distress on recovery.

A cross-sectional study was conducted with 300 postoperative orthopedic patients within 24 h of surgery. Data included demographic and clinical information, preoperative and postoperative pain, and patient-reported outcomes using the Depression Anxiety and Stress Scale (DASS), Pain Catastrophizing Scale (PCS), and the Quality of Recovery-40 (QoR-40) questionnaire. Statistical analyses included t-tests, ANOVA, correlation, and linear regression.

The mean QoR-40 score was 156.48 ± 19.65, with 61 % reporting a "good recovery", 36.7 % an "excellent recovery", and 2.6 % a "poor recovery". Higher preoperative and postoperative pain correlated with lower QoR scores (r = -0.26 and -0.46, p < 0.001). Greater opioid consumption in the first 24 h post-surgery correlated with better recovery (B = 0.28, p = 0.00). Emotional distress, particularly pain catastrophizing (B = -0.22, p = 0.01) and stress (B = -0.48, p = 0.00), was associated with a negative impact on QoR. Additionally, nonsmokers, married individuals, unemployed patients, and those undergoing arthroscopy reported better recovery (p < 0.001).

Findings highlight the importance of integrated physical and emotional management strategies to optimize QoR, reduce complications, and enhance patient satisfaction.

In this study, we aimed to investigate the effects of bilateral rectus sheath blocks (RSBs) and oblique subcostal transversus abdominis plane (OSTAP) blocks on mechanical power (MP) in patients receiving laparoscopic cholecystectomy under general anesthesia. Additionally, we sought to evaluate the impact of these blocks on postoperative pain and quality of patient recovery.

In this prospective, double-blind study, 66 patients who underwent laparoscopic cholecystectomy were randomized into two groups: Group C (control), which received a standard analgesic intravenous regimen; and Group B (block), which received bilateral RSB and OSTAP blocks. Intraoperative mechanical power was measured for all patients. Postoperative pain was assessed using visual analog scale (VAS) scores, and recovery quality was measured using the 15-item quality of recovery (QoR-15) questionnaire.

The mechanical power values for patients in Group C were consistently greater at all measured times: baseline, before bridion, and after bridion. Although the difference at baseline was not statistically significant, significant differences were observed before and after bridion (p values = 0.112, 0.021, and 0.003, respectively). Patients in Group B exhibited significantly lower VAS scores at all time points (30 min, 2 h, 8 h, and 24 h) (p < 0.05). Additionally, essential variations were noted in the administration of rescue analgesia between the groups (p < 0.001). Regarding tramadol consumption, Group C patients had significantly greater values [84 (74-156) vs. 0 (0-75), median (25-75th percentiles)] (p < 0.001). For the QoR-15 scores, Group C also had significantly greater values [129 (124-133) vs. 122 (115-125), median (25-75th percentiles)] (p < 0.001).

Bilateral RSB and OSTAP blocks significantly reduce mechanical power during surgery. Moreover, they significantly decrease postoperative pain and analgesic consumption and increase patient recovery scores.

The study protocol was registered in the international database ClinicalTrials.gov (registration no. NCT06202040). This study was conducted between December 2023 and January 2024 at the Department of Anesthesiology and Reanimation of Konya City Hospital.

Pain management in children remains a challenge. Postoperative pain assessment, which currently relies on behavioral and subjective scales, could be enhanced by the identification of single nucleotide polymorphisms effect on pain thresholds and opioid metabolism. This study explores the impact of nine SNPs-rs1799971, rs4680, rs4633, rs6269, rs4818 (with catechol-o-methyltransferase haplotypes), rs7832704, rs1801253, and rs1045642-on postoperative pain intensity, opioid requirements, coanalgesic use, C-reactive protein levels, and post-anesthesia care unit length of stay. This study involved 42 pediatric patients undergoing scoliosis correction surgery with postoperative sufentanil infusion. The genotyping was performed using real-time PCR with peripheral blood samples. Patients with the rs1801253 ADRB1 GG genotype showed significantly lower 24 h NRS pain ratings (p = 0.032) and lower sufentanil infusion rates at the level of statistical tendency (p = 0.093). Patients with the rs1205 CRP CT genotype had a shorter PACU length of stay (p = 0.012). In contrast, those with the rs1045642 ABCB1 GG genotype had a longer PACU stay by 0.72 h (p = 0.046). No significant associations were found for OPRM1 rs1799971, COMT, or ENPP2 SNPs. ADRB1 rs1801253may be a novel SNP indicating higher postoperative pain risk, while rs1205 CRP and rs1045642 ABCB1 could predict increased care requirements in PACUs. The ADRB1 rs1801253 SNP may also predict opioid demand. These results suggest SNPs should be considered in acute pain assessment.

This investigation aimed to establish the optimal dosing parameters of oliceridine for postoperative pain control in laparoscopic cholecystectomy (LC) procedures. Using Dixon and Massey's up-and-down sequential allocation method, the median effective dose (ED50) and the dose required for 95% effective dose (ED95) were determined, alongside an evaluation of the agent's safety profile.

In this prospective trial, 82 participants scheduled for LC were enrolled and randomly assigned to receive either oliceridine or saline (control). Prior to surgical incision, the intervention group received varying doses of intravenous oliceridine, while control subjects received equivalent volumes of saline solution. Post-surgical pain management involved standardized multimodal analgesic protocols for both cohorts. Baseline demographic data was documented for all participants. Pain evaluations using the 11-point verbal numeric rating scale (NRS) at 15 min, 30 min, and 2h post-extubation. Using Dixon's up-and-down methodology, the ED50 and ED95 were determined. Hemodynamic variables were tracked and pain levels quantified throughout the procedure. The study protocol included monitoring post-anesthetic recovery characteristics and documenting adverse effects.

Probability unit regression analysis indicated that the ED50 of oliceridine for the prevention of early postoperative pain was calculated to be 18.45 µg/kg (95% CI: 16.85-19.82 µg/kg), while the ED95 was determined to be 22.39 µg/kg (95% CI: 20.75-26.98 µg/kg). Statistical analysis showed comparable rates of adverse events between study groups (p > 0.05). Additional analyses demonstrated similar outcomes between oliceridine and control cohorts regarding hemodynamic stability, and adverse effect profiles. Pain management satisfaction assessment at 24 hours post-LC revealed high approval rates in the oliceridine group, with 90% of patients (36/40, p=0.31) and 97.5% of surgeons (39/40, p=0.03) expressing satisfaction, regardless of administered dose.

Our findings establish that for early postoperative pain management, oliceridine demonstrates optimal therapeutic efficacy at an ED50 of 18.45 ug/kg, with the ED95 determined to be 22.39 ug/kg.

Postoperative pain control in cardiac surgery is often managed with opioid medications. Insufficient analgesia can result in complications including splinting, pneumonia, and delay of appropriate rehabilitation. Given the risks and adverse effects of opioids including sedation, respiratory depression, delirium, and decreased gastrointestinal motility, hyperalgesia and potential for addiction, strategies for opioid reduction are likely to improve outcomes, therefore multimodal opioid sparing pain regimens are preferred. Recently, there is increased evidence that low dose Ketamine, an N-methyl-D-Aspartate (NMDA) receptor antagonist, is safe and effective for analgesia in postoperative patients and may be appropriate to this setting.

This is a single center, retrospective, observational, cohort study over a one year period involving postoperative adult cardiac surgery comparing those who received a single dose of postoperative ketamine, 0.3 mg/kg over 30 min, with those who did not receive any ketamine. Other analgesic protocols were similar between groups and did not include additional ketamine. A total of 120 patient charts were reviewed, of which 96 met inclusion criteria, 32 in the ketamine group and 64 in the standard care group. Charts were reviewed for opioid and other pain medication requirements during the postoperative period and on discharge, and for secondary outcomes: hospital length of stay, ICU length of stay, in-hospital and 30-day mortality, 30-day readmission, and rates of delirium, emergence reactions, and need for escalated respiratory support.

The group who received postoperative ketamine required 28.8 morphine milligram equivalents (MME) less postoperative opioid (90.1 mg vs 118.9 mg, p = 0.167), and was prescribed an average of 15.8 MME less on discharge (p < 0.001). Intraoperatively, both groups received 1000 mg acetaminophen, 2 mg intravenous morphine and 100 mcg fentanyl, 26 MME, by protocol. No ketamine was administered intraoperatively or preoperatively. The groups differed in respect to operation type and controlling for this parameter failed to achieve significance in needs during admission (p = 0.215), but remained significant on discharge (p = 0.02). The non-ketamine group received more ketorolac (15.5 vs 10.1, p = 0.06). The ketamine group required less acetaminophen but more gabapentin. There was no difference in hospital or ICU length of stay. There was no delirium or mortality in either group. Respiratory depression occurred in 15 patients who all subsequently received ketamine. No patient developed respiratory depression after ketamine.

Ketamine may be a reasonable choice for postoperative cardiac surgery analgesia and may reduce the need for opioids on discharge, and possibly during admission.

Multimodal analgesia (MA) is a cornerstone in perioperative pain management, enhancing pain relief and minimizing opioid consumption by targeting various pain pathways. This study conducts a bibliometric analysis of MA research from 2013 to 2023 to understand its development and impact on perioperative care.

A comprehensive literature search of the Web of Science Core Collection (WOSCC) was conducted, covering publications from January 2013 to December 2023. Data were analyzed using VOSviewer and other bibliometric tools to identify publication trends, key contributors, and emerging research themes.

The analysis identified 1,939 studies on MA, with a notable increase in annual publications since 2020. The USA, China, and Canada were the leading contributors. Key terms like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Enhanced Recovery After Surgery (ERAS), and Patient-Controlled Analgesia (PCA) were frequently associated with MA. Significant journals included the Cureus Journal of Medical Science and Anesthesia and Analgesia. Influential authors such as Richard D. Urman and Henrik Kehlet were highlighted for their contributions. The research showed significant advancements and growing global interest in MA.

The study underscores the growing importance of MA in perioperative pain management, with significant contributions from leading countries and researchers. Future research should focus on optimizing pain management protocols, enhancing patient recovery, and reducing opioid dependency through MA.

Effective pain management after total knee arthroplasty (TKA) is essential for recovery. Continuous peripheral nerve blocks (PNBc) are often believed to provide superior pain relief compared with single-injection peripheral nerve blocks (PNBs). However, multidimensional pain-related patient-reported outcomes (PROs) have not been extensively studied.

Based on registry data, this study compared pain intensities summarized as a pain composite score (PCS) and postoperative opioid use between PNBc and PNBs nerve blocks in patients undergoing TKA, and evaluated additional PROs.

Data from 4,328 adults undergoing TKA enrolled in the PAIN OUT registry (ClinicalTrials.gov NCT02083835) were analyzed. Patients were categorized into general anesthesia (GA) or spinal anesthesia (SA), with subgroups general anesthesia only (GA-o) or spinal anesthesia only (SA-o), and combinations with single-injection PNB (GA&PNBs and SA&PNBs) or continuous PNB via catheter (GA&PNBc and SA&PNBc). The primary end point was PCS, summarizing pain intensities and time in severe pain during the first 24 hours. Secondary end points included opioid use and additional PROs.

The use of GA&PNBc was associated with a higher PCS (+0.5 [0.0-0.9], P = 0.035) compared with GA&PNBs, while PCS was similar between SA&PNBs and SA&PNBc. Opioid use was more frequent in GA&PNBc (+20.3%) and SA&PNBc (+50.8%) compared with the respective PNBs groups (P < 0.001). Patient-reported outcomes were higher in PNBc groups (median score 3.2 vs 2.7-2.9 in other groups; P < 0.001).

Continuous PNBc showed no clear advantage over PNBs in pain relief, opioid use, or further PROs. Future research should incorporate comprehensive PROs to better evaluate analgesic techniques in TKA.

Study designProspective, randomized controlled study.ObjectiveTo assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy.Methods88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded.ResultsThe total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; P < .001), muscle relaxant usage (46.14 + 6.18 mg vs 59.32 + 3.97 mg; P < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; P < .01), and intra-operative blood loss (233.18 + 66.08 mL vs 409.77 + 115.41 mL; P < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group's pain score was significantly higher (P < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control (P < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) (P < .001).ConclusionIn patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.

Total abdominal hysterectomy (TAH) is a common surgical procedure. Erector spinae plane block (ESPB) and intrathecal morphine (ITM) provide adequate postoperative (PO) analgesia. However, ITM side effects may limit its use. Researchers investigated the efficacy of bilateral ultrasound-guided ESPB on PO pain and analgesic consumption compared to ITM in the first 24 h following TAH under general anesthesia.

120 patients premedicated with 3 mg intravenous granisetron were randomized into three equal groups: bilateral ultrasound-guided ESPB, ITM or control group. The primary outcome of this study was the time to first request for a rescue analgesic (tramadol).

Compared to the control group, the ESPB and ITM groups showed higher time to first request for a rescue analgesic and lower total tramadol consumption 24 h following surgery (P < 0.001) with significant differences between the ESPB and ITM groups (P < 0.001). The ITM group showed lower pain scores and lower readings of both serum glucose and cortisol levels compared to the other two groups 24 h after surgery (P < 0.001). The ITM group also had higher incidences of nausea and pruritus 24 h after surgery (P < 0.001). The use of a single intrathecal injection of 0.3 mg morphine did not show any respiratory depression.

0.3 mg intrathecal morphine was superior to erector spinae plane block for postoperative pain relief, 24 h after surgery, regarding attenuated stress response, lower pain scores at rest and on coughing and lower tramadol consumption. IRB: IRB 00006379//31-1-2022.

ClinicalTrials.gov Identifier: NCT05218733.

Despite the opioid crisis and a growing call for minimizing opioid use, opioids remain an important part of postoperative pain management, with more than 80% of patients filling at least 1 opioid prescription following total joint replacements (TJRs). Little is known as to whether state laws that restrict or cap opioids for acute pain reduce post-TJR opioid use.

To evaluate the association of an opioid cap law in New York (Section 3331) with post-TJR opioid prescribing.

This cohort study analyzed Medicare data from 2014 to 2019 for New York and California (control state). Participants were Medicare beneficiaries who underwent elective TJRs before (April 2014 to June 2016) or after (August 2016 to September 2019) Section 3331 implementation. Data were analyzed from June 2023 to August 2024.

Implementation of New York Section 3331 in July 2016.

The primary end point was total morphine milligram equivalents (MMEs) filled from discharge to day 7, days 8 to 30, and days 31 to 90 after TJR. Key independent variables were legislation phase (before or after Section 3331 implementation), treatment or control state, and the interactions between these 2 variables. Difference-in-differences regression models were used to assess the association of interest.

The pre-Section 3331 cohort included 32 253 TJR encounters among 31 028 patients, of whom 9924 (31.98%) underwent TJRs in New York hospitals. The mean (SD) age of the cohort was 73.43 (5.49) years; 19 442 encounters (60.28%) were among females. The estimated change in total MMEs filled in the 7-day post-TJR period after vs before Section 3331 implementation was -135.08 (95% CI, -146.62 to -123.53; P < .001) in California and -178.00 (95% CI, -191.98 to -164.02; P < .001) in New York, resulting in a Section 3331-associated change of -42.92 MMEs (95% CI, -61.04 to -24.80 MMEs; P < .001) in New York compared with California. Section 3331 was not associated with statistically significant changes in total MMEs filled in the 8 to 30-day and 31 to 90-day post-TJR periods.

The findings of this retrospective cohort study of TJRs among Medicare beneficiaries suggest that New York Section 3331 achieved its intended objective, as it was associated with reduced opioid fills in the immediate 7-day post-TJR period in New York compared with California. Additional refinements may further reduce opioid prescribing in New York, and these findings may serve as a foundation for refining laws in other states that may not achieve their intended targets or have not implemented similar laws.

Recent studies suggest that duloxetine administration before non-laparoscopic surgery may reduce postoperative pain and analgesic requirement without increasing adverse event occurrence.

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on preoperative administration of duloxetine versus placebo for postoperative pain relief in adults undergoing laparoscopic surgery, assessing efficacy- and safety-related outcomes.

We systematically searched MEDLINE, Embase, and Cochrane Library, covering all records up to July 19, 2024. Inclusion criteria consisted of RCTs comparing preoperative administration of duloxetine versus placebo in adults undergoing laparoscopic surgery and reporting at least one outcome of interest. The random-effects model was used to estimate the mean difference (MD) and risk ratio (RR), along with their respective 95% confidence intervals (95%CIs).

We included four RCTs (227 patients). Compared with placebo, duloxetine provided a statistically lower pain scores at 2 (MD - 1.04; 95%CI - 1.75, - 0.33), 4 (MD - 1.28; 95%CI - 1.77, - 0.79), 8 (MD - 1.22; 95%CI - 1.72, - 0.72), 12 (MD - 1.64; 95%CI - 2.88, - 0.41), and 24 h (MD - 1.05; 95%CI - 1.72, - 0.39) after surgery. Duloxetine also granted a statistically longer time to first analgesic requirement (MD 128.38 min; 95%CI 41.31, 215.46), compared with placebo. Additionally, the duloxetine group had a significantly lower risk of nausea/vomiting (RR 0.48; 95%CI 0.25, 0.90), while there were no significant differences between both groups for the risk of dizziness, headache, and somnolence.

Compared with placebo, duloxetine administration before laparoscopic surgery significantly minimized postoperative pain intensity, delayed analgesic requirement, and reduced nausea/vomiting risk.

Transdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has yet to be evaluated.

To evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft.

This triple-blinded, randomized controlled trial included 30 subjects in the age range of 18 to 60 years with benign mandibular pathologies. Subjects visiting the outpatient department of the Dept. of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, India, were included in the study. Subjects with known allergies to any drugs, using sedatives, alcohol, pregnant and lactating mothers, and with respiratory problems were excluded.

The predictor variable was postoperative pain management and subjects were randomly assigned to TBP or a placebo patch group.

It was the postoperative pain, which was measured by visual analog scale (VAS) for 7 consecutive days. Secondary outcome variables were requirement of rescue analgesics and drug-related adverse effects.

Age at surgery, sex, diagnosis, duration of the operation, and amount of fentanyl used during the operation were covariates.

Descriptive statistics, Mann-Whitney U test, χ2, repeated measures analysis of variance, and post-hoc analysis (Bonferroni test) were used. A P value <.05 was considered a level of statistical significance.

Thirty subjects were randomly allocated to TBP and control group. The mean VAS score during the study period was 0.8 ± 2.37, and 3.49 ± 2.37 in TBP and control group subjects respectively (P < .001). Compared to control group, the mean VAS score in TBP group subjects were significantly less till the end of postoperative day 4 (P < .001). The mean rescue analgesic requirement during the postoperative period was 5.33 ± 15.8 mg and 47.6 ± 37.7 mg in the TBP and control group subjects, respectively (P < .001). Nausea was the most common drug-related adverse effect in both the group subjects (46.7%) (P > .9).

The highest VAS score in TBP group subjects was 1.53 ± 0.92 on the morning of postoperative day 1, whereas it was 6.47 ± 1.3 at 6 hours after operation in control group subjects. Thus, a TBP was adequate for the management of postoperative pain following mandibular resection and reconstruction.

Patients after thoracic surgery experience significant pain that can disrupt normal respiratory mechanics, increase the risk of respiratory complications, and impair recovery. Poorly controlled postoperative pain can develop into persistent postoperative pain. In addition, using opioids for pain control in the thoracic surgical population makes them more susceptible to opioid-related side effects due to their pre-existing comorbidities. The lack of consensus on how to effectively attain pain control after thoracic surgery has resulted in variability in the analgesic regimens utilized by providers across institutions and practices. The overall goal of this practice advisory is to identify opportunities for improvement in the postoperative pain management of thoracic surgical patients and provide guidance to perioperative providers through the provision of evidence-based recommendations.