BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus ...BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.展开更多
Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate st...Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.展开更多
Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few d...Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).展开更多
Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analg...Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.展开更多
<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective s...<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.展开更多
Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high ...Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality.A series of post-operative complications further affects the prognosis.Post-operative pneumonia(POP)also leads to great morbidity and mortality.This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure.Methods The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei province,China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients.Logistic regression analyses were used to identify the risk factors for POP.Results In the study,31.5%of patients developed POP.Patients with POP had higher proportions of severe oxygenation damage,pneumothorax,reintubation,tracheotomy,renal replacement therapy,arrhythmia,gastrointestinal bleeding,and longer duration of mechanical ventilation,fever,ICU stay,and length of stay(all with P<0.05).The in-hospital mortality was 2.3%.Smoking,preoperative white blood cells,and intraoperative transfusion were the independent risk factors for POP in TAAAD.Conclusion Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP.Furthermore,patients with risk factors should be treated with caution.展开更多
BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial di...BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.展开更多
Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-opera...Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-operative hypersensitivity better than low dose XR in a mouse model of incisional pain.Methods:Mice(n 44)were randomly assigned to 1 of 4 treatment groups:(a)saline(1 ml/kg SC,once);(b)sustained release buprenorphine(Bup-SR,1 mg/kg SC,once);(c)low dose extended-release buprenorphine(XR-lo,3.25 mg/kg SC,once);(d)high dose extended-release buprenorphine(XR-hi,6.5 mg/kg SC,once).On days1,0(4 hours),1,2,and 3,mechanical and thermal hypersensitivities were evaluated,and plasma buprenorphine concentrations were measured.Results:Mechanical(days 0-2)and thermal(days 0-1)hypersensitivities were ob-served in the saline group.Bup-SR,XR-lo,and XR-hi attenuated mechanical hyper-sensitivity on days 0,1,and 2.None of the treatment groups,except XR-Lo on day 0,attenuated thermal hypersensitivity on days 0 or 1.Plasma buprenorphine concen-tration peaked at 4 hours(day 0)in all treatment groups and remained greater than 1 ng/mL on days 0-2.No abnormal clinical observations or gross pathologic findings were seen in any groups.Conclusion:The results indicate XR-hi did not effectively attenuate post-operative hypersensitivity better than XR-lo.Thus both 3.25 and 6.5 mg/kg XR are recom-mended for attenuating post-operative hypersensitivity for at least up to 48 hours in mice.展开更多
BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylacti...BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.展开更多
In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contras...In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.展开更多
In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with ...In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.展开更多
Over the past two decades,the USA has witnessed a steep rise in the incidence of acute cholecystitis(AC),[1]even among children,[2]with over 200,000 cases annually.[3]Patients with AC often present to the emergency de...Over the past two decades,the USA has witnessed a steep rise in the incidence of acute cholecystitis(AC),[1]even among children,[2]with over 200,000 cases annually.[3]Patients with AC often present to the emergency department(ED)experiencing severe distress,with most describing their pain level as“intolerable.”[4]Furthermore,there is usually a considerable delay before surgery,with a median time from diagnosis of AC to surgery of 28.5 h,[5]and a substantial percentage of patients wait as long as 10 d.[6]Prolonged delays before surgery lead to increased opioid use,which is associated with extended hospital stays and higher rates of readmission after cholecystectomy.[7]Furthermore,opioids can lead to vomiting,respiratory depression,delirium,and ultimately addiction.[8]We propose a novel regional anesthesia technique for managing AC:right phrenic nerve blockade.This method could offer improved pain control and a more favorable risk profile in selected patients when compared to current ED practices.展开更多
In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD patho...In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD pathology, damageassociated molecular patterns(DAMPs), including ATP, are released from damaged astrocytes, triggering the activation of innate immune cells. ATP is a central mediator of acute pain in NMOSD.展开更多
In pat i e nt s,a s well as in animal mod e l s,hypersensitivity to external stimuli(hyperalgesia and allodynia)or spontaneous pain is often the first,and the most disabling,symptom of neuropathy(Davis et al.,2020).Th...In pat i e nt s,a s well as in animal mod e l s,hypersensitivity to external stimuli(hyperalgesia and allodynia)or spontaneous pain is often the first,and the most disabling,symptom of neuropathy(Davis et al.,2020).The increased activity of sensitive neurons drives pain development,making ion channel modulation a fundamental target for current pharmacotherapy as well as one of the most investigated by the R&D departments of pharmaceutical companies(Bennett et al.,2019).展开更多
BACKGROUND According to the World Health Organization analgesic ladder,cancer-related pain generally begins with pharmacotherapy in a stepwise approach.Nevertheless,some patients continue to experience poorly controll...BACKGROUND According to the World Health Organization analgesic ladder,cancer-related pain generally begins with pharmacotherapy in a stepwise approach.Nevertheless,some patients continue to experience poorly controlled pain despite medications,particularly when considering adverse effects and self-care quality.Percutaneous cervical cordotomy is an alternative interventional procedure for unremitting unilateral intractable cancer-related pain.CASE SUMMARY The patient was diagnosed with lung cancer with destruction of the brachial plexus and ribs.For 2 mo,the patient experienced progressive severe weakness and pain in the right upper extremity.Notably,the pain intensity reached an extreme level,particularly when lying supine,even under heavy sedation.This heightened pain response posed a significant challenge;as a result,the patient was unable to undergo further evaluation through magnetic resonance imaging.Ultimately,he underwent percutaneous cervical cordotomy for symptom relief,resulting in complete resolution of right arm pain.After a 3-mo follow-up,the pain did not recur,and only a flurbiprofen local patch was required for mild scapular tightness.CONCLUSION Cordotomy,under careful patient selection,appears to enhance the quality of life of patients with unilateral cancerrelated pain.展开更多
Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment.However,it is unclear whether the signals of bone cells in response to mechanical stress are processed...Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment.However,it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain.In this study,we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone prostaglandin E2(PGE2)concentration in response to mechanical loading.Bone PGE2 levels are in proportion to their weight bearing.When weight bearing changes in the tail-suspension mice,the PGE2 concentrations in bones change in line with their weight bearing changes.Deletion of cyclooxygenase-2(COX2)in the osteoblast lineage cells or knockout of receptor 4(EP4)in sensory nerve blunts bone formation in response to mechanical loading.Moreover,knockout of TrkA in sensory nerve also significantly reduces mechanical load-induced bone formation.Moreover,mechanical loading induces cAMP-response element binding protein(CREB)phosphorylation in the hypothalamic arcuate nucleus(ARC)to inhibit sympathetic tyrosine hydroxylase(TH)expression in the paraventricular nucleus(PVN)for osteogenesis.Finally,we show that elevated PGE2 is associated with ankle osteoarthritis(AOA)and pain.Together,our data demonstrate that in response to mechanical loading,skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis,while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.展开更多
Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Met...Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.展开更多
BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gather...BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.展开更多
文摘BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.
文摘Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.
文摘Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).
文摘Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.
文摘<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.
基金supported by the National Natural Science Foundation of China(No.81370134).
文摘Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality.A series of post-operative complications further affects the prognosis.Post-operative pneumonia(POP)also leads to great morbidity and mortality.This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure.Methods The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei province,China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients.Logistic regression analyses were used to identify the risk factors for POP.Results In the study,31.5%of patients developed POP.Patients with POP had higher proportions of severe oxygenation damage,pneumothorax,reintubation,tracheotomy,renal replacement therapy,arrhythmia,gastrointestinal bleeding,and longer duration of mechanical ventilation,fever,ICU stay,and length of stay(all with P<0.05).The in-hospital mortality was 2.3%.Smoking,preoperative white blood cells,and intraoperative transfusion were the independent risk factors for POP in TAAAD.Conclusion Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP.Furthermore,patients with risk factors should be treated with caution.
文摘BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.
文摘Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-operative hypersensitivity better than low dose XR in a mouse model of incisional pain.Methods:Mice(n 44)were randomly assigned to 1 of 4 treatment groups:(a)saline(1 ml/kg SC,once);(b)sustained release buprenorphine(Bup-SR,1 mg/kg SC,once);(c)low dose extended-release buprenorphine(XR-lo,3.25 mg/kg SC,once);(d)high dose extended-release buprenorphine(XR-hi,6.5 mg/kg SC,once).On days1,0(4 hours),1,2,and 3,mechanical and thermal hypersensitivities were evaluated,and plasma buprenorphine concentrations were measured.Results:Mechanical(days 0-2)and thermal(days 0-1)hypersensitivities were ob-served in the saline group.Bup-SR,XR-lo,and XR-hi attenuated mechanical hyper-sensitivity on days 0,1,and 2.None of the treatment groups,except XR-Lo on day 0,attenuated thermal hypersensitivity on days 0 or 1.Plasma buprenorphine concen-tration peaked at 4 hours(day 0)in all treatment groups and remained greater than 1 ng/mL on days 0-2.No abnormal clinical observations or gross pathologic findings were seen in any groups.Conclusion:The results indicate XR-hi did not effectively attenuate post-operative hypersensitivity better than XR-lo.Thus both 3.25 and 6.5 mg/kg XR are recom-mended for attenuating post-operative hypersensitivity for at least up to 48 hours in mice.
文摘BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.
基金Supported by National Research Foundation of Korea Grant,No.00219725.
文摘In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.
基金Supported by The National Research Foundation of Korea Grant funded by the Korea Government,No.00219725.
文摘In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.
文摘Over the past two decades,the USA has witnessed a steep rise in the incidence of acute cholecystitis(AC),[1]even among children,[2]with over 200,000 cases annually.[3]Patients with AC often present to the emergency department(ED)experiencing severe distress,with most describing their pain level as“intolerable.”[4]Furthermore,there is usually a considerable delay before surgery,with a median time from diagnosis of AC to surgery of 28.5 h,[5]and a substantial percentage of patients wait as long as 10 d.[6]Prolonged delays before surgery lead to increased opioid use,which is associated with extended hospital stays and higher rates of readmission after cholecystectomy.[7]Furthermore,opioids can lead to vomiting,respiratory depression,delirium,and ultimately addiction.[8]We propose a novel regional anesthesia technique for managing AC:right phrenic nerve blockade.This method could offer improved pain control and a more favorable risk profile in selected patients when compared to current ED practices.
文摘In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD pathology, damageassociated molecular patterns(DAMPs), including ATP, are released from damaged astrocytes, triggering the activation of innate immune cells. ATP is a central mediator of acute pain in NMOSD.
文摘In pat i e nt s,a s well as in animal mod e l s,hypersensitivity to external stimuli(hyperalgesia and allodynia)or spontaneous pain is often the first,and the most disabling,symptom of neuropathy(Davis et al.,2020).The increased activity of sensitive neurons drives pain development,making ion channel modulation a fundamental target for current pharmacotherapy as well as one of the most investigated by the R&D departments of pharmaceutical companies(Bennett et al.,2019).
文摘BACKGROUND According to the World Health Organization analgesic ladder,cancer-related pain generally begins with pharmacotherapy in a stepwise approach.Nevertheless,some patients continue to experience poorly controlled pain despite medications,particularly when considering adverse effects and self-care quality.Percutaneous cervical cordotomy is an alternative interventional procedure for unremitting unilateral intractable cancer-related pain.CASE SUMMARY The patient was diagnosed with lung cancer with destruction of the brachial plexus and ribs.For 2 mo,the patient experienced progressive severe weakness and pain in the right upper extremity.Notably,the pain intensity reached an extreme level,particularly when lying supine,even under heavy sedation.This heightened pain response posed a significant challenge;as a result,the patient was unable to undergo further evaluation through magnetic resonance imaging.Ultimately,he underwent percutaneous cervical cordotomy for symptom relief,resulting in complete resolution of right arm pain.After a 3-mo follow-up,the pain did not recur,and only a flurbiprofen local patch was required for mild scapular tightness.CONCLUSION Cordotomy,under careful patient selection,appears to enhance the quality of life of patients with unilateral cancerrelated pain.
基金This research was supported by NIH National Institute on Aging under Award Number R01 AG076783,R01 AG068997 and P01 AG066603(to X.C.).
文摘Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment.However,it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain.In this study,we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone prostaglandin E2(PGE2)concentration in response to mechanical loading.Bone PGE2 levels are in proportion to their weight bearing.When weight bearing changes in the tail-suspension mice,the PGE2 concentrations in bones change in line with their weight bearing changes.Deletion of cyclooxygenase-2(COX2)in the osteoblast lineage cells or knockout of receptor 4(EP4)in sensory nerve blunts bone formation in response to mechanical loading.Moreover,knockout of TrkA in sensory nerve also significantly reduces mechanical load-induced bone formation.Moreover,mechanical loading induces cAMP-response element binding protein(CREB)phosphorylation in the hypothalamic arcuate nucleus(ARC)to inhibit sympathetic tyrosine hydroxylase(TH)expression in the paraventricular nucleus(PVN)for osteogenesis.Finally,we show that elevated PGE2 is associated with ankle osteoarthritis(AOA)and pain.Together,our data demonstrate that in response to mechanical loading,skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis,while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.
文摘Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.
文摘BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.