Articles: postoperative-pain.
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The innervation of the shoulder-upper-extremity area is complicated and unclear. Regional anesthesia with a brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of the T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether an additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. ⋯ This RCT aims to confirm whether an additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.
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Curr Pain Headache Rep · Feb 2020
ReviewPatient and Surgery-Related Predictors of Acute Postoperative Pain.
The purpose of the present investigation is to provide a comprehensive review of both patient and procedure specific predictors of acute postoperative pain. ⋯ As the global number of surgeries continues to increase, as well as evidence of worse patient outcomes in those who suffer from poorly controlled postoperative pain, it is becoming more critical for perioperative physicians to have a deep understanding of the risks which might lead to increased pain in the immediate postoperative settings. It is also important to recognize potential tools to prevent the development and intensity of surgical pain. This manuscript begins with an investigation of the theorized mechanisms of postoperative pain, at the peripheral and central levels, which is followed by a discussion of current pain evaluation in humans. Additionally, an evaluation of patient- and procedure-specific predictors for the development of acute pain is summarized. As operative and patient specific risk factors continue to be revealed, they will ultimately serve as important tools to provide high-quality individualized patient care aimed at reducing incidence of severe postsurgical pain.
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Curr Pain Headache Rep · Feb 2020
ReviewAn Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery.
This review aims to identify perioperative patient-related factors that are associated with the development of persistent postoperative pain (PPP) in patients undergoing spine surgery. ⋯ Twenty-one studies published between 2000 and 2019 were included in this literature review. The following five patient-related factors were identified to be associated with the development of PPP after spine surgery: anxiety, depression, pain catastrophizing, pain sensitivity, and preoperative opioid consumption. The existing literature suggests that the risk factors for developing chronic pain after spine surgery appear to be similar to those for other types of surgery. Psychological factors and preoperative opioid consumption are associated with developing chronic pain after spinal surgery. Other factors such as gender, age, preoperative pain intensity, and immediate postoperative pain may also be involved but the evidence on this is limited.
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The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study, we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels. ⋯ We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction of potential postoperative pain.
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Randomized Controlled Trial
The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction
To determine the effectiveness of pregabalin and adductor canal block on opioid consumption, postoperative pain, and fast-tracking. ⋯ Preoperative pregabalin (150 mg) reduced postoperative opioid consumption as much as adductor canal block in patients undergoing anterior cruciate ligament reconstruction. The first analgesic requirement was earlier in group C than in groups P and A. In addition, pregabalin can prolong the duration of spinal sensory block and shorten the time required to achieve high fast-tracking scores. We recommend the use of both methods as a part of multimodal analgesia.