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Perioperative Multimodal Analgesia for Postoperative Pain

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (15 January 2023) | Viewed by 5474

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Special Issue Editors

Dr. I-Cheng Lu

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Guest Editor

1. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
2. Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Interests: anesthesia; intraoperative neural monitoring (IONM); thyroid surgery; multimodal analgesia; enhanced recovery after surgery

Prof. Dr. Yen-Chin Liu

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Guest Editor

Faculty of Medicine, School of Post-Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Interests: animal pain model; neurological function recovery; pain research

Special Issue Information

Dear Colleagues,

Insufficient analgesia is associated with several poor postoperative outcomes for patients. In recent decades, multimodal analgesia has been used to enhance recovery after surgery.

Perioperative multimodal analgesia consists of various analgesic agents with analgesic techniques acting on different pain mechanisms. Since opioids act as double-edged swords in pain management, opioid-sparing multimodal analgesia effects are also valuable in terms of healthcare quality. The expansion of regional block approaches from extremity to trunk represents a promising technique and also a challenge for healthcare providers. Another aspect of pain management is modern techniques to monitor intraoperative pain response, such as the analgesia nociception index (ANI), surgical pleth index (SPI) and nociception level (NOL), which are commercially available.

The aim of this Special Issue is to gather submissions covering a wide range of topics on perioperative multimodal analgesia and intraoperative pain monitoring. The scope of the issue also covers a wide range of with a focus on analgesic agents, regional block techniques, novel analgesic or novel use of traditional drug, opioid-sparing effects and chronic postsurgical pain. It is my pleasure to announce this Special Issue entitled “Perioperative Multimodal Analgesia for Postoperative Pain” to address all the above considerations. Any paper on any subject appropriate to this Special Issue is welcome. Submissions in the form of original articles, meta-analyses and reviews are particularly welcome.

Dr. I-Cheng Lu
Prof. Dr. Yen-Chin Liu
Guest Editors

Manuscript Submission Information

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Keywords

multimodal analgesia
postoperative pain management
chronic postsurgical pain
regional block
opioid-sparing
enhanced recovery
pain monitoring

Published Papers (3 papers)

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Research

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10 pages, 922 KiB

Open AccessArticle

Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy

by Tz-Ping Gau, Sheng-Hua Wu, Jui-Mei Huang, Wen-Ling Lu, Tzu-Yen Huang, I-Cheng Lu and Che-Wei Wu

Medicina 2023, 59(5), 855; https://doi.org/10.3390/medicina59050855 - 28 Apr 2023

Cited by 1 | Viewed by 1454

Abstract

Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy. Full article

(This article belongs to the Special Issue Perioperative Multimodal Analgesia for Postoperative Pain)

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10 pages, 705 KiB

Open AccessArticle

Comparison of Post-Cesarean Pain Perception of General Versus Regional Anesthesia, a Single-Center Study

by Danka Mostic Stanisic, Nevena Kalezic, Aleksandar Rakic, Nina Rajovic, Tatjana Ilic Mostic, Jelena Cumic, Jelena Stulic, Ivana Rudic Biljic Erski, Nevena Divac, Natasa Milic and Radan Stojanovic

Medicina 2023, 59(1), 44; https://doi.org/10.3390/medicina59010044 - 27 Dec 2022

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Abstract

Background and Objectives: Pain during and after the procedure remains the leading concern among women undergoing cesarean section. Numerous studies have concluded that the type of anesthesia used during a cesarean section undoubtedly affects the intensity and experience of pain after the operation. Materials and Methods: This prospective cohort study was conducted at the Clinic for Gynecology and Obstetrics, Clinical Center “Dragisa Misovic—Dedinje”, Belgrade, Serbia. Patients at term pregnancy (37–42 weeks of gestation) with an ASA I score who delivered under general (GEA) or regional anesthesia (RA) by cesarean section were included in the study. Following the procedure, we assessed pain using the Serbian McGill questionnaire (SF–MPQ), Visual Analogue Scale (VAS) and the pain attributes questionnaire at pre-established time intervals of 2, 12, and 24 h after the procedure. Additionally, time to patient’s functional recovery was noted. We also recorded the time to the first independent mobilization, first oral intake, and lactation establishment. Results: GEA was performed for 284 deliveries while RA was performed for 249. GEA had significantly higher postoperative sensory and affective pain levels within intervals of 2, 12, and 24 h after cesarean section. GEA had significantly higher postoperative VAS pain levels. On pain attribute scale intensity, GEA had significantly higher postoperative pain levels within all intervals. Patients who received RA had a shorter time to first oral food intake, first independent mobilization, and faster lactation onset in contrast to GEA. Conclusions: The application of RA presented superior postoperative pain relief, resulting in earlier mobilization, shorter time to first oral food intake, and faster lactation onset in contrast to GEA. Full article

(This article belongs to the Special Issue Perioperative Multimodal Analgesia for Postoperative Pain)

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Other

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23 pages, 1569 KiB

Open AccessSystematic Review

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

by Qian Wang, Jing Dong, Xin Ye and Yi-Feng Ren

Medicina 2023, 59(2), 280; https://doi.org/10.3390/medicina59020280 - 31 Jan 2023

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Abstract

Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), −1.53 cm; 95% CI, −2.30 to −0.77) and dynamic (WMD, −1.16 cm; 95% CI, −2.22 to −0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects. Full article

(This article belongs to the Special Issue Perioperative Multimodal Analgesia for Postoperative Pain)

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