scholarly journals The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review

Anaesthesia ◽  
2021 ◽  
Vol 76 (S1) ◽  
pp. 8-17
Author(s):  
Y.‐Y. K. Chen ◽  
K. A. Boden ◽  
K. L. Schreiber
Keyword(s):  
Postoperative Pain ◽  
Regional Anaesthesia ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Chronic Postoperative Pain

scholarly journals The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sujana Dontukurthy ◽  
Roshanak Mofidi
Keyword(s):  
Pain Control ◽  
Regional Anaesthesia ◽  
Early Mobilization ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Complication Rates ◽  
Early Recovery ◽  
Nerve Blocks ◽  
Anaesthesia Practice

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks. The ease of their performance and the low complication rates, compared with neuraxial anaesthesia, have led to their increased use in the perioperative period. Interfascial plane blocks are often incorporated in the multimodal analgesia regimen in the early recovery and ambulation after surgery protocols for various chest wall and abdominal surgeries. This achieves better pain control and decreases the requirements of opioids in the perioperative period, thereby facilitating early mobilization and discharge. This narrative review focuses on the relevant anatomic considerations, technique for the performance of each block along with its current applications and limitations, and includes a review of the current literature on various interfascial plane blocks in paediatric regional anaesthesia.

Intra- and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis

2015 ◽  
Vol 7 (1) ◽  
pp. 42-54 ◽  
Author(s):  
Elena Klatt ◽  
Thomas Zumbrunn ◽  
Oliver Bandschapp ◽  
Thierry Girard ◽  
Wilhelm Ruppen
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Postoperative Pain ◽  
Regional Anaesthesia ◽  
Meta Analysis ◽  
Sufficient Evidence ◽  
Chronic Postoperative Pain ◽  
Postsurgical Pain ◽  
Number Of Patients ◽  
Pain At Rest

AbstractBackground and aims The development of postoperative chronic pain (POCP) after surgery is a major problem with a considerable socioeconomic impact. It is defined as pain lasting more than the usual healing, often more than 2–6 months. Recent systematic reviews and meta-analyses demonstrate that the N-methyl-D-aspartate-receptor antagonist ketamine given peri- and intraoperatively can reduce immediate postoperative pain, especially if severe postoperative pain is expected and regional anaesthesia techniques are impossible. However, the results concerning the role of ketamine in preventing chronic postoperative pain are conflicting. The aim of this study was to perform a systematic review and a pooled analysis to determine if peri- and intraoperative ketamine can reduce the incidence of chronic postoperative pain.Methods Electronic searches of PubMed, EMBASE and Cochrane including data until September 2013 were conducted. Subsequently, the titles and abstracts were read, and reference lists of reviews and retrieved studies were reviewed for additional studies. Where necessary, authors were contacted to obtain raw data for statistical analysis. Papers reporting on ketamine used in the intra- and postoperative setting with pain measured at least 4 weeks after surgery were identified. For meta-analysis of pain after 1, 3, 6 and 12 months, the results were summarised in a forest plot, indicating the number of patients with and without pain in the ketamine and the control groups. The cut-off value used for the VAS/NRS scales was 3 (range 0–10), which is a generally well-accepted value with clinical impact in view of quality of life.ResultsOur analysis identified ten papers for the comprehensive meta-analysis, including a total of 784 patients. Three papers, which included a total of 303 patients, reported a positive outcome concerning persistent postsurgical pain. In the analysis, only one of nine pooled estimates of postoperative pain at rest or in motion after 1, 3, 6 or 12 months, defined as a value ≥3 on a visual analogue scale of 0–10, indicated a marginally significant pain reduction.Conclusions Based on the currently available data, there is currently not sufficient evidence to support a reduction in chronic pain due to perioperative administration of ketamine. Only the analysis of postoperative pain at rest after 1 month resulted in a marginally significant reduction of chronic postoperative pain using ketamine in the perioperative setting.ImplicationsIt can be hypothesised, that regional anaesthesia in addition to the administration of perioperative ketamine might have a preventive effect on the development of persistent postsurgical pain. An additional high-quality pain relief intra- and postoperatively as well after discharge could be more effective than any particular analgesic method per se. It is an assumption that a low dose infusion ketamine has to be administered for more than 72 h to reduce the risk of chronic postoperative pain.

scholarly journals The Role of Pain Catastrophizing in the Prediction of Acute and Chronic Postoperative Pain

2013 ◽  
Vol 6 (1) ◽  
pp. 176-182 ◽  
Author(s):  
Ran Kremer ◽  
Michal Granot ◽  
David Yarnitsky ◽  
Yonathan Crispel ◽  
Shiri Fadel ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Prospective Observational Study ◽  
Pain Catastrophizing ◽  
Pain Catastrophizing Scale ◽  
Chronic Postoperative Pain ◽  
Unique Role ◽  
Relative Contribution ◽  
Postthoracotomy Pain

Background and Objectives: Despite the established association between greater pain catastrophizing and enhanced postoperative pain, it is still unclear: (i) what is the relative contribution of each of the pain catastrophizing scale (PCS) dimensions in the prediction of acute and chronic postoperative pain; and (ii) whether PCS scores mediate the association between acute and chronic postoperative pain intensity. Methods: The current prospective, observational study was conducted at Rambam Health Care Campus, Haifa, Israel. PCS was obtained in 48 pain-free patients a day before an elective thoracotomy in response to tonic heat pain. Acute postthoracotomy pain (APTP) was assessed during rest, including general pain (Restgeneral), and incision-related pain (Restincision), and in response to provoked physical activity, including hand elevation (Provokedhand) and cough (Provokedcough). Chronic postthoracotomy pain (CPTP) was assessed after 4.5±2.3 months. Results: Of the PCS subscales, only rumination: (i) was correlated with Restgeneral scores (r=0.337, P=0.027); and (ii) predicted chronic postthoracotomy pain in a regression analysis (P=0.001). General PCS and its subscales mediated the correlation between Restgeneral and chronic postthoracotomy pain intensity (Ps<0.006). Conclusions: Findings may elucidate the unique role of the rumination subscale in reflecting an individual's postopertive acute and chronic pain responsiveness. The transition from acute to chronic postoperative pain seems to be facilitated by enhanced pain catastrophizing.

scholarly journals Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Brian M. Radvansky ◽  
Khushbu Shah ◽  
Anant Parikh ◽  
Anthony N. Sifonios ◽  
Vanny Le ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Narrative Review ◽  
Pain Scores ◽  
Long Term Follow Up ◽  
Persistent Postoperative Pain ◽  
Dose Dependent

Objectives. The objective of this narrative review was to examine the usage of ketamine as a postoperative analgesic agent across a wide variety of surgeries.Design. A literature search was performed using the phrases “ketamine” and “postoperative pain.” The authors analyzed the studies that involved testing ketamine’s effectiveness at controlling postoperative pain. Effectiveness was assessed through various outcomes such as the amount of opiate consumption, visual analog scale (VAS) pain scores, and persistent postoperative pain at long-term follow-up.Results. While many different administration protocols were evaluated, delivering ketamine both as a pre- or perioperative bolus and postoperative infusion for up to 48 hours appeared to be the most effective. These effects are dose-dependent. However, a number of studies analyzed showed no benefit in using ketamine versus placebo for controlling postoperative pain. While ketamine is a safe and well-tolerated drug, it does have adverse effects, and there are concerns for possible neurotoxicity and effects on memory.Conclusions. In a number of limited situations, ketamine has shown some efficacy in controlling postoperative pain and decreasing opioid consumption. More randomized controlled trials are necessary to determine the surgical procedures and administrations (i.e., intravenous, epidural) that ketamine is best suited for.

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