Advances in Postoperative Pain Management and Chronic Postoperative Pain

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 30003

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Guest Editor
Unit of Anesthesiology, Intensive Care Medicine and Pain Medicine, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
Interests: awareness anesthesia; anesthesia brain monitoring; memory and anesthesia; postoperative delirium; postoperative cognitive dysfunction; opioids research; pain assessment
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Special Issue Information

Dear Colleagues,

Acute pain is usually associated with a specific illness or trauma. It is expected to be limited to its time to repair the damage. The most characteristic acute pain is postoperative pain (POP). It is generally predictable and characterized by its strong intensity and short duration. The clinical features of POP vary from subject to subject and in the same patient over time. This variability is due to the pre-existing pathology and location, type, and invasiveness of the surgery. However, the characteristics of POP also depend on other components, such as psychological factors that intersect with cultural, religious, socio-economic aspects, and others.

Clinically, POP involves a constellation of unpleasant sensory and emotional experiences associated or not with autonomic and behavioral responses. The complex humoral responses that initially work to maintain the homeostasis, when excessive and prolonged, can cause organic, psychological, and behavioral alterations (e.g., anxiety, insomnia, depression, etc.) and can become particularly difficult to treat. Consequently, if not properly treated, POP can assume the characteristics of a complex chronic pain issue. Remarkably, chronic POP (CPOP) is defined by painful symptomatology in the operated area unrelated to previous pain, present for more than 3 months, and without any link to surgical complications.

This Special Issue will identify the gaps in the prevention, diagnosis, and management of POP/CPOP based on a combination of original research and review papers.

Topics will include:

  • The epidemiology of POP/CPOP;
  • The role of genetics and other mechanisms involved in the development of POP and its chronicization (preclinical research);
  • Clinical features of POP in different populations (e.g., in children) and surgical settings (e.g., robotic surgery);
  • Diagnostic approaches;
  • Prevention of POP/CPOP;
  • Interventions for POP/CPOP management.
  • Psychological issues;
  • New strategies useful for diagnosis and therapy (e.g., AI-based approaches).

Dr. Marco Cascella
Guest Editor

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Keywords

  • postoperative pain
  • chronic postoperative pain
  • pain mechanisms
  • postoperative pain management
  • physiopathology of chronic postoperative pain
  • local anesthetics
  • non-invasive analgesic procedures
  • opioids

Published Papers (13 papers)

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Editorial

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4 pages, 205 KiB  
Editorial
Editorial for the Special Issue: “Advances in Postoperative Pain Management and Chronic Postoperative Pain”
by Marco Cascella
J. Clin. Med. 2022, 11(22), 6667; https://doi.org/10.3390/jcm11226667 - 10 Nov 2022
Viewed by 1229
Abstract
Acute and chronic pain are two completely distinct universes [...] Full article

Research

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11 pages, 2199 KiB  
Article
Sublingual Sufentanil Tablet System (SSTS-Zalviso®) for Postoperative Analgesia after Orthopedic Surgery: A Retrospective Study
by Andrea Angelini, Gian Mario Parise, Mariachiara Cerchiaro, Francesco Ambrosio, Paolo Navalesi and Pietro Ruggieri
J. Clin. Med. 2022, 11(22), 6864; https://doi.org/10.3390/jcm11226864 - 21 Nov 2022
Cited by 2 | Viewed by 1576
Abstract
Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso®) with the traditional strategies used for the control of postoperative pain to establish if there is an actual benefit for the patient [...] Read more.
Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso®) with the traditional strategies used for the control of postoperative pain to establish if there is an actual benefit for the patient and healthcare personnel. Materials and Methods: A retrospective study was conducted to compare the efficacy of SSTS in the management of postoperative pain after orthopedic surgery between October 2018 and June 2020. We analyzed 50 patients who underwent a total knee arthroplasty (TKA). The control group consisted of 21 patients who underwent TKA and during the hospitalized recovery received a continuous femoral nerve block (cFNB). The statistical study was conducted with a level of significance p = 0.05 using “U” test, Mann–Whitney, to verify if patients had a better control of pain and fewer calls for rescue analgesia. Results: Patients involved in the study showed a significant reduction in pain intensity with the use of SSTS in the 24 h following surgery (p = 0.0568), also a drastic drop of the calls for rescue analgesia (p < 0.0001) reduces the number of calls for its control. Conclusions: This study demonstrates how SSTS might reduce pain intensity in the first 24 h after surgery and reduce the number of calls for its control, indicating better analgesic coverage and implying reduced interventions from healthcare personnel. This could allow a redistribution of resources and a reduction in the use of analgesic drugs in wards where the SSTS is used. Full article
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11 pages, 2538 KiB  
Article
Real Time Ultrasound-Guided Thoracic Epidural Catheterization with Patients in the Lateral Decubitus Position without Flexion of Knees and Neck: A Preliminary Investigation
by Yuexin Huang, Tingting Li, Tianhong Wang, Yanhuan Wei, Liulin Xiong, Tinghua Wang and Fei Liu
J. Clin. Med. 2022, 11(21), 6459; https://doi.org/10.3390/jcm11216459 - 31 Oct 2022
Cited by 2 | Viewed by 4222
Abstract
Objectives: For some patients, such as pregnant women, it can be difficult to maintain the ideal “forehead to knees” position for several minutes for epidural catheter placement. We conducted this study to investigate the feasibility of real-time ultrasound-guided (US) epidural catheterization under a [...] Read more.
Objectives: For some patients, such as pregnant women, it can be difficult to maintain the ideal “forehead to knees” position for several minutes for epidural catheter placement. We conducted this study to investigate the feasibility of real-time ultrasound-guided (US) epidural catheterization under a comfortable lateral position without flexion of knees and neck. Materials and Methods: 60 patients aged 18-80 years with a body mass index of 18-30 kg/m2 after general surgery were included. In a comfortable left lateral position, thoracic epidural catheterization was performed under real-time US for postoperative analgesia. The visibility of the neuraxial structures, procedural time from needle insertion to loss of resistance in the epidural space, the number of needle redirections, success rate of epidural catheter placement and postoperative analgesic effect were recorded. Results: In the paramedian oblique sagittal view, the well visible of vertebral lamina, intervertebral space and posterior complex under ultrasound were as high as 93.33%, 81.67% and 70.00%, respectively. The success rate of thoracic epidural catheterization was as high as 91.67%, and the satisfactory postoperative analgesic effect was 98.2% for patients without nausea, pruritus and other discomfort. Discussion: Thoracic epidural catheterization with patients in the lateral position without flexion of knees and neck under real time ultrasound guidance has a high success rate and strong feasibility. This visual manipulation makes epidural catheterization not only “easier” to perform, but also reduces the requirements of the procedure. Full article
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8 pages, 1401 KiB  
Article
Erector Spinae Plane Block Decreases Chronic Postoperative Pain Severity in Patients Undergoing Coronary Artery Bypass Grafting
by Marcin Wiech, Sławomir Żurek, Arkadiusz Kurowicki, Beata Horeczy, Mirosław Czuczwar, Paweł Piwowarczyk, Kazimierz Widenka and Michał Borys
J. Clin. Med. 2022, 11(19), 5949; https://doi.org/10.3390/jcm11195949 - 9 Oct 2022
Cited by 10 | Viewed by 1690
Abstract
Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients’ moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using [...] Read more.
Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients’ moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients’ satisfaction and reduce perioperative complications. Full article
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15 pages, 2508 KiB  
Article
Different Machine Learning Approaches for Implementing Telehealth-Based Cancer Pain Management Strategies
by Marco Cascella, Sergio Coluccia, Federica Monaco, Daniela Schiavo, Davide Nocerino, Mariacinzia Grizzuti, Maria Cristina Romano and Arturo Cuomo
J. Clin. Med. 2022, 11(18), 5484; https://doi.org/10.3390/jcm11185484 - 19 Sep 2022
Cited by 13 | Viewed by 2160
Abstract
Background: The most effective strategy for managing cancer pain remotely should be better defined. There is a need to identify those patients who require increased attention and calibrated follow-up programs. Methods: Machine learning (ML) models were developed using the data prospectively obtained from [...] Read more.
Background: The most effective strategy for managing cancer pain remotely should be better defined. There is a need to identify those patients who require increased attention and calibrated follow-up programs. Methods: Machine learning (ML) models were developed using the data prospectively obtained from a single-center program of telemedicine-based cancer pain management. These models included random forest (RF), gradient boosting machine (GBM), artificial neural network (ANN), and the LASSO–RIDGE algorithm. Thirteen demographic, social, clinical, and therapeutic variables were adopted to define the conditions that can affect the number of teleconsultations. After ML validation, the risk analysis for more than one remote consultation was assessed in target individuals. Results: The data from 158 patients were collected. In the training set, the accuracy was about 95% and 98% for ANN and RF, respectively. Nevertheless, the best accuracy on the test set was obtained with RF (70%). The ML-based simulations showed that young age (<55 years), lung cancer, and occurrence of breakthrough cancer pain help to predict the number of remote consultations. Elderly patients (>75 years) with bone metastases may require more telemedicine-based clinical evaluations. Conclusion: ML-based analyses may enable clinicians to identify the best model for predicting the need for more remote consultations. It could be useful for calibrating care interventions and resource allocation. Full article
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9 pages, 843 KiB  
Article
The Analgesic Efficacy of the Single Erector Spinae Plane Block with Intercostal Nerve Block Is Not Inferior to That of the Thoracic Paravertebral Block with Intercostal Nerve Block in Video-Assisted Thoracic Surgery
by Sujin Kim, Seung Woo Song, Hyejin Do, Jinwon Hong, Chun Sung Byun and Ji-Hyoung Park
J. Clin. Med. 2022, 11(18), 5452; https://doi.org/10.3390/jcm11185452 - 16 Sep 2022
Cited by 4 | Viewed by 1785
Abstract
This monocentric, single-blinded, randomized controlled noninferiority trial investigated the analgesic efficacy of erector spinae plane block (ESPB) combined with intercostal nerve block (ICNB) compared to that of thoracic paravertebral block (PVB) with ICNB in 52 patients undergoing video-assisted thoracic surgery (VATS). The endpoints [...] Read more.
This monocentric, single-blinded, randomized controlled noninferiority trial investigated the analgesic efficacy of erector spinae plane block (ESPB) combined with intercostal nerve block (ICNB) compared to that of thoracic paravertebral block (PVB) with ICNB in 52 patients undergoing video-assisted thoracic surgery (VATS). The endpoints included the difference in visual analog scale (VAS) scores for pain (0–10, where 10 = worst imaginable pain) in the postanesthetic care unit (PACU) and 24 and 48 h postoperatively between the ESPB and PVB groups. The secondary endpoints included patient satisfaction (1–5, where 5 = extremely satisfied) and total analgesic requirement in morphine milligram equivalents (MME). Median VAS scores were not significantly different between the groups (PACU: 2.0 (1.8, 5.3) vs. 2.0 (2.0, 4.0), p = 0.970; 24 h: 2.0 (0.8, 3.0) vs. 2.0 (1.0, 3.5), p = 0.993; 48 h: 1.0 (0.0, 3.5) vs. 1.0 (0.0, 5.0), p = 0.985). The upper limit of the 95% CI for the differences (PACU: 1.428, 24 h: 1.052, 48 h: 1.176) was within the predefined noninferiority margin of 2. Total doses of rescue analgesics (110.24 ± 103.64 vs. 118.40 ± 93.52 MME, p = 0.767) and satisfaction scores (3.5 (3.0, 4.0) vs. 4.0 (3.0, 5.0), p = 0.227) were similar. Thus, the ESPB combined with ICNB may be an efficacious option after VATS. Full article
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14 pages, 1288 KiB  
Article
Early Postoperative Pain Trajectories after Posterolateral and Axillary Approaches to Thoracic Surgery: A Prospective Monocentric Observational Study
by Pascaline Dorges, Mireille Michel-Cherqui, Julien Fessler, Barbara Székély, Edouard Sage, Matthieu Glorion, Titouan Kennel, Marc Fischler, Valeria Martinez, Alexandre Vallée and Morgan Le Guen
J. Clin. Med. 2022, 11(17), 5152; https://doi.org/10.3390/jcm11175152 - 31 Aug 2022
Cited by 4 | Viewed by 1251
Abstract
Less-invasive thoracotomies may reduce early postoperative pain. The aims of this study were to identify pain trajectories from postoperative days 0–5 after posterolateral and axillary thoracotomies and to identify potential factors related to the worst trajectory. Patients undergoing a posterolateral (92 patients) or [...] Read more.
Less-invasive thoracotomies may reduce early postoperative pain. The aims of this study were to identify pain trajectories from postoperative days 0–5 after posterolateral and axillary thoracotomies and to identify potential factors related to the worst trajectory. Patients undergoing a posterolateral (92 patients) or axillary (89 patients) thoracotomy between July 2014 and November 2015 were analyzed in this prospective monocentric cohort study. The best-fitting model resulted in four pain trajectory groups: trajectory 1, the “worst”, with 29.8% of the patients with permanent significant pain; trajectory 2 with patients with low pain (32.6%); trajectory 3 with patients with a steep decrease in pain (22.7%); and trajectory 4 with patients with a steep increase (14.9%). According to a multinomial logistic model multivariable analysis, some predictive factors allow for differentiation between trajectory groups 1 and 2. Risk factors for permanent pain are the existence of preoperative pain (OR = 6.94, CI 95% (1.54–31.27)) and scar length (OR = 1.20 (1.05–1.38)). In contrast, ASA class III is a protective factor in group 1 (OR = 0.02 (0.001–0.52)). In conclusion, early postoperative pain can be characterized by four trajectories and preoperative pain is a major factor for the worst trajectory of early postoperative pain. Full article
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9 pages, 242 KiB  
Article
Is the Erector Spinae Plane Block Effective for More than Perioperative Pain? A Retrospective Analysis
by Uri Hochberg, Silviu Brill, Dror Ofir, Khalil Salame, Zvi Lidar, Gilad Regev and Morsi Khashan
J. Clin. Med. 2022, 11(16), 4902; https://doi.org/10.3390/jcm11164902 - 21 Aug 2022
Cited by 3 | Viewed by 1644
Abstract
Introduction: The thoracic Erector Spinae Plane Block (ESPB) is an ultrasound-guided block that has gained popularity and is widely used in acute pain setups. However, data regarding its role in chronic and cancer-related pain are anecdotal. Material and Methods: The study is a [...] Read more.
Introduction: The thoracic Erector Spinae Plane Block (ESPB) is an ultrasound-guided block that has gained popularity and is widely used in acute pain setups. However, data regarding its role in chronic and cancer-related pain are anecdotal. Material and Methods: The study is a retrospective analysis of patients who underwent ESPB. The cohort was divided into subgroups based on three determinants: etiology, pain type, and chronicity. Results: One hundred and ten patients were included, and genders were affected equally. The average age was 61.2 ± 16.1 years. The whole group had a statistically significant reduction in a numerical rating scale (NRS) (7.4 ± 1.4 vs. 5.0 ± 2.6, p-value > 0.001). NRS reduction for 45 patients (41%) exceeded 50% of the pre-procedural NRS. The mean follow-up was 7.9 ± 4.6 weeks. Baseline and post-procedure NRS were comparable between all subgroups. The post-procedural NRS was significantly lower than the pre-procedural score within each group. The proportion of patients with over 50% improvement in NRS was lower for those with symptom duration above 12 months (p-value = 0.02). Conclusions: Thoracic ESPB is a simple and safe technique. The results support the possible role of ESPB for chronic as well as cancer-related pain. Full article
10 pages, 558 KiB  
Article
The Lack of Analgesic Efficacy of Nefopam after Video-Assisted Thoracoscopic Surgery for Lung Cancer: A Randomized, Single-Blinded, Controlled Trial
by Hyean Yeo, Ji Won Choi, Seungwon Lee, Woo Seog Sim, Soo Jung Park, Heejoon Jeong, Mikyung Yang, Hyun Joo Ahn, Jie Ae Kim and Eun Ji Lee
J. Clin. Med. 2022, 11(16), 4849; https://doi.org/10.3390/jcm11164849 - 18 Aug 2022
Cited by 3 | Viewed by 1646
Abstract
Nefopam is a centrally acting non-opioid analgesic, and its efficacy in multimodal analgesia has been reported. This study aimed to assess the analgesic efficacy of intraoperative nefopam on postoperative pain after video-assisted thoracoscopic surgery (VATS) for lung cancer. Participants were randomly assigned to [...] Read more.
Nefopam is a centrally acting non-opioid analgesic, and its efficacy in multimodal analgesia has been reported. This study aimed to assess the analgesic efficacy of intraoperative nefopam on postoperative pain after video-assisted thoracoscopic surgery (VATS) for lung cancer. Participants were randomly assigned to either the nefopam or the control group. The nefopam group received 20 mg of nefopam after induction and 15 min before the end of surgery. The control group received saline. The primary outcome was cumulative opioid consumption during the 6 h postoperatively. Pain intensities, the time to first request for rescue analgesia, adverse events during the 72 h postoperatively, and the incidence of chronic pain 3 months after surgery were evaluated. Ninety-nine patients were included in the analysis. Total opioid consumption during the 6 h postoperatively was comparable between the groups (nefopam group [n = 50] vs. control group [n = 49], 19.8 [13.5–25.3] mg vs. 20.3 [13.9–27.0] mg; median difference: −1.55, 95% CI: −6.64 to 3.69; p = 0.356). Pain intensity during the 72 h postoperatively and the incidence of chronic pain 3 months after surgery did not differ between the groups. Intraoperative nefopam did not decrease acute postoperative opioid consumption or pain intensity, nor did it reduce the incidence of chronic pain after VATS. Full article
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9 pages, 910 KiB  
Article
No Gender Differences in Pain Perception and Medication after Lumbar Spine Sequestrectomy—A Reanalysis of a Randomized Controlled Clinical Trial
by Christa K. Raak, Thomas Ostermann, Anna-Li Schönenberg-Tu, Oliver Fricke, David D. Martin, Sibylle Robens and Wolfram Scharbrodt
J. Clin. Med. 2022, 11(9), 2333; https://doi.org/10.3390/jcm11092333 - 22 Apr 2022
Cited by 3 | Viewed by 1861
Abstract
Background: Gender issues have received increasing attention in clinical research of the past years, and biological sex has been introduced as a moderating variable in experimental pain perception. However, in clinical studies of acute pain and gender, there are conflicting results. In particular, [...] Read more.
Background: Gender issues have received increasing attention in clinical research of the past years, and biological sex has been introduced as a moderating variable in experimental pain perception. However, in clinical studies of acute pain and gender, there are conflicting results. In particular, there are limited data on the impact of gender differences after spinal sequestrectomy. The aim of this work is to examine gender differences in postoperative pain and pain medication consumption in an inpatient clinical setting. Methods: Data of a completed double-blind RCT was subdivided by gender and reanalyzed by means of an analysis of variance in repeated measures. Outcomes included pain severity measured on a VAS, affective (SES-A) and sensory pain perception (SES-S) and morphine equivalent doses (MED) of analgesics after spinal sequestrectomy. Results: In total, 42 female (47.73%) and 46 male (52.27%) patients were analyzed. No differences in pain severity (VAS: Gender × Time F = 0.35; (df = 2, 86); p = 0.708), affective and sensory pain perception (SES-A: Gender × Time F = 0.08; (df = 2, 86); p = 0.919; SES-S: Gender × Time F = 0.06; (df = 2, 86); p = 0.939) or post-operative opioid use between men and women (MEDs: Gender × Time F = 1.44; (df = 2, 86); p = 0.227) could be observed. Conclusions: This reanalysis of an RCT with respect to gender differences is to our knowledge the first attempt to investigate the role of gender in pain perception and medication after lumbar spine sequestrectomy. In contrast to other studies, we were not able to show significant differences between male and female patients in all pain-related outcomes. Apart from well-established pain management, psychological reasons such as gender-specific response biases or the observer effect might explain our results. Trial registration: The study was registered as a regulatory phase IV study at the German Clinical Trials Register (DRKS), an open-access online register for clinical trials conducted in Germany (Reg-No: DRKS00007913). Full article
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Review

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12 pages, 5381 KiB  
Review
Effect of Intravenous Ketamine on Hypocranial Pressure Symptoms in Patients with Spinal Anesthetic Cesarean Sections: A Systematic Review and Meta-Analysis
by Xiaoshen Liang, Xin Yang, Shuang Liang, Yu Zhang, Zhuofeng Ding, Qulian Guo and Changsheng Huang
J. Clin. Med. 2022, 11(14), 4129; https://doi.org/10.3390/jcm11144129 - 16 Jul 2022
Cited by 2 | Viewed by 1990
Abstract
Background: Pregnant women are more likely to suffer post-puncture symptoms such as headaches and nausea due to the outflow of cerebrospinal fluid after spinal anesthesia. Because ketamine has the effect of raising intracranial pressure, it may be able to improve the symptoms of [...] Read more.
Background: Pregnant women are more likely to suffer post-puncture symptoms such as headaches and nausea due to the outflow of cerebrospinal fluid after spinal anesthesia. Because ketamine has the effect of raising intracranial pressure, it may be able to improve the symptoms of perioperative hypocranial pressure and effectively prevent the occurrence of hypocranial pressure-related side effects. Method: Keywords such as ketamine, cesarean section, and spinal anesthesia were searched in databases including Medline, Embase, Web of Science, and Cochrane from 1976 to 2021. Thirteen randomized controlled trials were selected for the meta-analysis. Results: A total of 12 randomized trials involving 2099 participants fulfilled the inclusion criteria. There was no significant association between ketamine and the risk of headaches compared to the placebo (RR = 1.12; 95% CI: 0.53, 2.35; p = 0.77; I² = 62%). There was no significant association between ketamine and nausea compared to the placebo (RR = 0.66; 95% CI: 0.40, 1.09; p = 0.10; I² = 57%). No significant associations between ketamine or the placebo and vomiting were found (RR = 0.94; 95% CI: 0.53, 1.67; p = 0.83; I² = 72%). Conclusion: Intravenous ketamine does not improve the symptoms caused by low intracranial pressure after spinal anesthesia in patients undergoing cesarean section. Full article
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Other

41 pages, 598 KiB  
Systematic Review
Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review
by Abdalkarem Fedgash Alsharari, Faud Hamdi Abuadas, Yaser Salman Alnassrallah and Dauda Salihu
J. Clin. Med. 2022, 11(23), 6896; https://doi.org/10.3390/jcm11236896 - 22 Nov 2022
Cited by 10 | Viewed by 3785
Abstract
Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there [...] Read more.
Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane Library) were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures. Full article
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10 pages, 2140 KiB  
Case Report
A Modified Approach for Ultrasound-Guided Thoracic Paravertebral Block via Thoracic Intervertebral Foramen in an Adolescent Patient: A Case Report
by Emiliano Petrucci, Franco Marinangeli, Barbara Pizzi, Francesco Sciorio, Gioele Marrocco, Massimo Antonio Innamorato, Marco Cascella and Alessandro Vittori
J. Clin. Med. 2022, 11(9), 2646; https://doi.org/10.3390/jcm11092646 - 8 May 2022
Cited by 2 | Viewed by 3640
Abstract
This case report describes a modified approach for a thoracic paravertebral block by performing a bilateral ultrasound-assisted injection of 12 mL of 0.5% levobupivacaine near the thoracic intervertebral foramen, combined with general anesthesia, in a patient who underwent emergent laparotomy for small intestinal [...] Read more.
This case report describes a modified approach for a thoracic paravertebral block by performing a bilateral ultrasound-assisted injection of 12 mL of 0.5% levobupivacaine near the thoracic intervertebral foramen, combined with general anesthesia, in a patient who underwent emergent laparotomy for small intestinal volvulus. Two continuous catheter sets were used for a bilateral continuous block with levobupivacaine 0.25% at a rate of 5–8 mL/h. No complications during the execution of the block were recorded. No supplemental opioids were administered and the patient was hemodynamically stable, requiring no pharmacological cardiovascular support during surgery. At the end of the surgical procedure, the patient received a continuous flow of 0.2% levobupivacaine as postoperative analgesia, at a basal flow of 4 mL/h per each side, a bolus of 4 mL, and a lockout time of 60 min was used. The postoperative pain on the Numeric Rating Scale was 2 at rest and it was 4 in motion, without neurological or respiratory sequelae due to block in the first 72 h after surgery. Full article
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