scholarly journals Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Don Daniel Ocay ◽  
Mandy M.J. Li ◽  
Pablo Ingelmo ◽  
Jean A. Ouellet ◽  
M. Gabrielle Pagé ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Spinal Fusion ◽  
Acute Pain ◽  
Postoperative Period ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Pain Trajectories

Objectives. Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods. We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results. One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.

scholarly journals FRI0412 DOES SEVERE ACUTE POSTOPERATIVE PAIN RESULT IN MORE LONG-TERM PAIN AFTER TOTAL HIP OR KNEE ARTHROPLASTY (THA OR TKA) FOR OSTEOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 805.2-805
Author(s):  
D. A. J. M. Latijnhouwers ◽  
C. H. Martini ◽  
R. G. H. H. Nelissen ◽  
H. M. J. Van der Linden ◽  
T. P. M. Vliet Vlieland ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Missing Values ◽  
Rating Scale ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Mixed Effect ◽  
Total Hip ◽  
Chronic Postsurgical Pain

Background:Chronic pain is a frequently reported unfavourable outcome of total hip and knee arthroplasties (THA/TKA) (7-23% and 10-34%, respectively) in osteoarthritis (OA) patients (1), which is difficult to treat as underlying mechanisms are not fully understood. Acute postoperative pain has been identified as risk factor for development of long-term pain in other surgical procedures, such as mastectomy and thoracotomy (2). However, the effect of acute postoperative pain on development of long-term pain in THA and TKA patients is unknown.Objectives:To investigate if acute pain following THA/TKA in OA patients is associated with long-term pain and if acute pain affects the course of pain up to 1-year postoperatively.Methods:From a longitudinal multicenter study, OA patients scheduled for primary THA or TKA were included. Acute pain scores, using Numeric Rating Scale (NRS), were routinely collected as part of standard care (≤72 hours after surgery). In case of ≥2 NRS scores the two highest scores were averaged (n=160), else the single score was taken. Pain was dichotomized into severe (NRS≥5) and mild (NRS<5). Pain was assessed preoperatively, at 3 (only THA), 6 and 12 months postoperatively using HOOS/KOOS subscale pain. Separate mixed-effect models for THA and TKA patients were used, with dichotomized acute pain as fixed-effect and long-term pain as outcome, while adjusting for confounders (age, sex, BMI, preoperative pain, mental component scale of the SF12 (MCS-12), and duration of the surgery and hospitalization). We included an interaction between time of measurement and acute postoperative pain to analyse whether effect modification was present. Missing values in preoperative pain and MCS-12 were imputed using multiple imputation methods.Results:81 THA and 87 TKA patients were included, of whom 32.1% and 56.3% reported severe acute pain. The results did not show an associated between severe acute pain and long term pain (THA: β=2.0, 95%-CI:-10.9-7.0; TKA: β=3.8, 95%-CI:-10.6-2.9). Furthermore, It seems that there is no effect present of difference in severity of acute pain and the course of pain over time (THA 6-months: β=6.4, 95%-CI:1.9-10.9 and 12-months: β=0.2, 95%-CI:-4.4-4.8; TKA 12-months: β=3.2, 95%-CI:-0.5-6.8).Conclusion:We did not find an association between acute pain and the development of long-term pain nor that severity of acute pain affects the course of postoperative pain in THA and TKA patients. The fact that THA and TKA patients often experience chronic preoperative pain might be a possible explanation for this finding. Nonetheless, future studies including additional measures of acute pain and pain sensitization in patients with chronic preoperative pain are necessary to draw stronger conclusions.References:[1]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open. 2012;2(1):e000435.[2]Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics. 2009;9(5):723-44.Acknowledgments:We would like to thank the study group that consists of: B.L. Kaptein, Leiden University Medical Center, Leiden; S.B.W Vehmeijer, Reinier de Graaf Hospital, Delft; R. Onstenk, Groene Hart Hospital, Gouda; S.H.M. Verdegaal, Alrijne Hospital, Leiderdorp; H.H. Kaptijn, LangeLand Hospital, Zoetermeer; W.C.M. Marijnissen, Albert Schweitzer Hospital, Dordrecht; P.J. Damen, Waterland Hospital, Hoorn; the NetherlandsDisclosure of Interests:None declared

Acute Postoperative Pain

2017 ◽  
Author(s):  
Kelly Zach ◽  
Julio A. Gonzalez-Sotomayor
Keyword(s):  
Postoperative Pain ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Analgesic Regimen ◽  
Potential Benefits ◽  
Short And Long Term ◽  
Selection Of

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

Basics of Acute Postoperative Pain

2018 ◽  
Vol 1 (2) ◽  
pp. 9-15
Author(s):  
Alaa Ali M. Elzohry MD ◽  
Ali M. El Foli
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Postoperative Period ◽  
Surgical Patients ◽  
Acute Postoperative Pain ◽  
Patient Dissatisfaction ◽  
Post Operative Pain ◽  
Essential Components

Acute pain is an important fear for most patients and influences their recovery and overall experience. Poorly treated, it could lead to undesirable effects and patient dissatisfaction. Hence, it is important to understand, assess and treat acute pain effectively. Pain management has been transferred from intraoperative into per operative period throughout the emergence of modern anesthesiology. Pain management in postoperative period is one of the most essential components of sufficient post-surgical patients care. The objective of this review is to define and demonstrate the risks and different sequelae of acute post operative pain.

scholarly journals TL 18200 - Percutaneous metatarsophalangeal arthrodesis for the treatment of hallux rigidus

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 109S
Author(s):  
Miguel Viana Pereira Filho ◽  
Vitor Baltazar Nogueira ◽  
Mauro Cesar Mattos e Dinato ◽  
Marcio De Farias Freitas
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Symptom Improvement ◽  
Preoperative Pain ◽  
Surgical Wound Dehiscence ◽  
Degree Of Satisfaction ◽  
The Mean

Introduction: Arthrodesis is considered the gold standard treatment for the final stages of hallux rigidus, promoting long-term symptom improvement. Arthrodesis is traditionally performed as open surgery. However, in recent years, the prevalence of minimally invasive surgery has increased due to its decreased aggression to soft tissue, shorter surgical time and association with a more comfortable postoperative period with reduced pain intensity. The objective of the study is to describe the percutaneous metatarsophalangeal arthrodesis technique with a single medial portal and to evaluate postoperative outcomes regarding union time, the presence of residual pain and the degree of satisfaction in a series of 22 patients. Methods: This is a series of 22 patients (23 feet) who underwent surgery between January 2017 and July 2018. The union time was assessed, and the patients reported their pre- and postoperative pain levels using the pain visual analog scale (VAS) and their degree of satisfaction. Surgical wound dehiscence, superficial and deep infection and need for orthopedic hardware removal were considered complications. Results: All patients underwent clinical evaluation. In 3 patients, union could not be assessed due to the lack of postoperative radiographs. Twenty patients were women, and 2 were men. Their mean age was 67.8 years. The mean time between the date of surgery and the evaluation was 51 weeks. The follow-up time ranged from 6 to 24 months, with a mean union time of 9 weeks. The union rate was 80%. Five cases showed no radiographic union, although the patients had stable and asymptomatic arthrodesis that required no revision. There were no cases of postoperative infection. In 3 patients, orthopedic hardware was removed. The mean preoperative pain intensity was 8.73, and the mean postoperative pain intensity was 1.26 (p<0.001). All patients were satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal joint of the hallux potentially provides outcomes similar to those of the conventional method reported in the literature and tends to produce a more comfortable postoperative period and better cosmetic results because it uses smaller incisions.

scholarly journals Effect of Analgesia on Complication Free Postoperative Outcome among Day-Care ENT Surgeries in a Tertiary Care Hospital

2020 ◽  
Vol 7 (49) ◽  
pp. 2923-2927
Author(s):  
Jayachandran C.G ◽  
Sanjay Sahadevan ◽  
Sandhya M.S
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Day Care ◽  
Pain Intensity Score ◽  
Care Hospital ◽  
Female Ratio ◽  
Associated Symptoms ◽  
The Mean ◽  
Care Surgery

BACKGROUND Day-care procedures have become accepted and popular among the surgeons and anaesthesiologists all over the world in recent times especially for ENT surgeries. The economic and financial implications are making them acceptable among the general population also. Alleviating acute pain during immediate postoperative period plays a crucial role in deciding the fitness for discharge of the patient. We wanted to evaluate the pain intensity and observe the role of analgesia in its alleviation in postoperative period following day-care ENT surgeries. METHODS 96 adult patients undergoing various types of day-care surgeries in the department of ENT were included in this study. The pain scores were measured using Verbal Pain Intensity Score (VPIS) at frequent two hourly intervals. Opioids, and Paracetamol were used as analgesics. Antiemetic Ondansetron was used to combat nausea and vomiting. The effect of analgesics was assessed using mean values and Friedman test for repeated measures. RESULTS Out of 96 patients 55 (57.29 %) were males and 41 (42.70 %) were females with a male to female ratio of 1.4:1. The mean age was 31.50 ± 4.15 years. 32 / 96 (33.33 %) ear surgeries, 26 / 96 (27.08 %) nose surgeries, 22 / 96 (22.91 %) throat surgeries and 16 / 96 (16.66 %) head and neck surgeries were performed. Moderate to extremely intense grade pain was noticed in 75 / 93 (80.64 %) patients. CONCLUSIONS The prevalence of moderate to extremely intense acute postoperative pain in 75 / 93 (80.64 %) patients was high. But the analgesics prescribed were effective to control the pain and the mean pain intensity was less than 2 in 14 hours, hence 85 / 96 (88.54 %) patients could be discharged in time. The associated symptoms were managed with supportive care and required no additional medications and these patients were discharged after overnight stay. KEYWORDS Day-Care Surgery, Analgesia, Opioids, VPIS, Associated Symptoms, Postoperative Pain

Slow Dynamics of Acute Postoperative Pain Intensity Time Series Determined via Wavelet Analysis Are Associated With the Risk of Severe Postoperative Day 30 Pain

2021 ◽  
Vol 132 (5) ◽  
pp. 1465-1474
Author(s):  
Raheleh Baharloo ◽  
Jose C. Principe ◽  
Roger B. Fillingim ◽  
Margaret R. Wallace ◽  
Baiming Zou ◽  
...  
Keyword(s):  
Time Series ◽  
Postoperative Pain ◽  
Wavelet Analysis ◽  
Pain Intensity ◽  
Slow Dynamics ◽  
Acute Postoperative Pain

Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study

2016 ◽  
Vol 45 ◽  
pp. 39-42 ◽  
Author(s):  
Akram Alí ◽  
Juan Gonzalo Olivieri ◽  
Fernando Duran-Sindreu ◽  
Francesc Abella ◽  
Miguel Roig ◽  
...  
Keyword(s):  
Clinical Study ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Root Canal ◽  
Root Canal Treatment ◽  
Prospective Clinical Study ◽  
Preoperative Pain

Acute paediatric pain management

2017 ◽  
Author(s):  
Tom G. Hansen
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Regional Anaesthesia ◽  
Pain Threshold ◽  
Age Groups ◽  
Postoperative Pain Management ◽  
Psychological Needs ◽  
Long Term Effects

Paediatric pain management has made great strides in the past few decades in the understanding of developmental neurobiology, developmental pharmacology, the use of analgesics in children, the use of regional techniques in children, and of the psychological needs of children in pain. The consequences of a painful experience on the young nervous system are so significant that long-term effects can occur, resulting in behavioural changes and a lowered pain threshold for months after a painful event. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain are constantly being refined, with newer drugs being used alone and in combination with other drugs, and continue to be explored. Systemic opioids, paracetamol, non-steroidal anti-inflammatories, and regional anaesthesia alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are often best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The safe and effective management of pain in children includes the prevention, recognition, and assessment of pain; early and individualized treatment; and evaluation of the efficacy of treatment. This chapter discusses selected topics in paediatric acute pain management, with more specific emphasis placed on pharmacology and regional anaesthesia in the treatment of acute postoperative pain management.

Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

2016 ◽  
Vol 82 (7) ◽  
pp. 613-621 ◽  
Author(s):  
Steven A. Groene ◽  
Davis W. Heniford ◽  
Tanushree Prasad ◽  
Amy E. Lincourt ◽  
Vedra A. Augenstein
Keyword(s):  
Umbilical Hernia ◽  
Defect Size ◽  
Long Term Outcomes ◽  
Preoperative Pain ◽  
The Mean ◽  
The Difference ◽  
One Year

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

Postoperative Pain Trajectories in Chronic Pain Patients Undergoing Surgery: The Effects of Chronic Opioid Pharmacotherapy on Acute Pain

2011 ◽  
Vol 12 (12) ◽  
pp. 1240-1246 ◽  
Author(s):  
C. Richard Chapman ◽  
Jennifer Davis ◽  
Gary W. Donaldson ◽  
Justin Naylor ◽  
Daniel Winchester
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Chronic Pain Patients ◽  
Pain Trajectories ◽  
Pain Patients
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