Plane Blocks- Effective and Low Risk Procedures for Regional Analgesia and Anesthesia in Acute and Chronic Pain

A Aron-Maor; S Vulfsons

doi:10.36959/577/495

Chronic Pain in Cystic Fibrosis

PEDIATRICS ◽

10.1542/peds.98.4.741 ◽

1996 ◽

Vol 98 (4) ◽

pp. 741-747 ◽

Cited By ~ 1

Author(s):

Sophie Ravilly ◽

Walter Robinson ◽

Santhanam Suresh ◽

Mary Ellen Wohl ◽

Charles B. Berde

Keyword(s):

Cystic Fibrosis ◽

Chronic Pain ◽

Chest Pain ◽

Older Patients ◽

Severe Pain ◽

Pain Treatment ◽

Medical Intervention ◽

Treatment Service ◽

Limb Pain ◽

Regional Analgesia

Objective. The objective of this study was to examine the incidence and therapy of chronic pain in a group of older patients with cystic fibrosis (CF). Patients. We identified two groups of patients followed at the CF Center at Children's Hospital (Boston); the first group consisted of all patients above the age of 5 years who died between 1984 and 1993, and the second was a cohort of 23 additional CF patients who had been referred to the Pain Treatment Service. Design. Medical charts were reviewed for the etiology and therapy of all pain episodes requiring medical intervention. Results. The incidence of chronic pain in this population increased sharply in the last 6 months of life. Headaches (55% of patients) and chest pain (65%) were frequently reported, although back pain (19%), abdominal pain (19%), and limb pain (16%) were also reported. In patients with headache, the main etiologies were hypercarbia or hypoxia, migraine, and sinusitis. The majority of chest pain was musculoskeletal, with pleuritis, pneumothorax, and rib fracture also reported as the cause of chest pain. Interventions. A variety of nonpharmacological and pharmacological therapies were reported. Forty-one patients (53%) had pain severe enough to require opioid treatment, and 10 patients (13%) received opioids for more than 3 months. In eight patients with more severe pain, regional analgesia was found to be particularly effective. Conclusions. Chronic pain is a common problem in CF, particularly as the patient population ages. When administered with caution, opioids have proven to be effective and safe in this population; regional anesthesia can be used to preserve pulmonary toilet while adequately treating severe pain.

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Predicting chronic pain after major traumatic injury

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0040 ◽

2019 ◽

Vol 19 (3) ◽

pp. 453-464 ◽

Cited By ~ 1

Author(s):

Elisabeth B. Powelson ◽

Brianna Mills ◽

William Henderson-Drager ◽

Millie Boyd ◽

Monica S. Vavilala ◽

...

Keyword(s):

Chronic Pain ◽

Electronic Medical Records ◽

Medical Records ◽

Traumatic Injury ◽

Opioid Use ◽

Post Injury ◽

Regional Analgesia ◽

Final Model ◽

Opioid Medications

Abstract Background and aims Chronic pain after traumatic injury and surgery is highly prevalent, and associated with substantial psychosocial co-morbidities and prolonged opioid use. It is currently unclear whether predicting chronic post-injury pain is possible. If so, it is unclear if predicting chronic post-injury pain requires a comprehensive set of variables or can be achieved only with data available from the electronic medical records. In this prospective study, we examined models to predict pain at the site of injury 3–6 months after hospital discharge among adult patients after major traumatic injury requiring surgery. Two models were developed: one with a comprehensive set of predictors and one based only on variables available in the electronic medical records. Methods We examined pre-injury and post-injury clinical variables, and clinical management of pain. Patients were interviewed to assess chronic pain, defined as the presence of pain at the site of injury. Prediction models were developed using forward stepwise regression, using follow-up surveys at 3–6 months. Potential predictors identified a priori were: age; sex; presence of pre-existing chronic pain; intensity of post-operative pain at 6 h; in-hospital opioid consumption; injury severity score (ISS); location of trauma, defined as body region; use of regional analgesia intra- and/or post-operatively; pre-trauma PROMIS Depression, Physical Function, and Anxiety scores; in-hospital Widespread Pain Index and Symptom Severity Score; and number of post-operative non-opioid medications. After the final model was developed, a reduced model, based only on variables available in the electronic medical record was run to understand the “value add” of variables taken from study-specific instruments. Results Of 173 patients who completed the baseline interview, 112 completed the follow-up within 3–6 months. The prevalence of chronic pain was 66%. Opioid use increased from 16% pre-injury to 28% at 3–6 months. The final model included six variables, from an initial set of 24 potential predictors. The apparent area under the ROC curve (AUROC) of 0.78 for predicting pain 3–6 months was optimism-corrected to 0.73. The reduced final model, using only data available from the electronic health records, included post-surgical pain score at 6 h, presence of a head injury, use of regional analgesia, and the number of post-operative non-opioid medications used for pain relief. This reduced model had an apparent AUROC of 0.76, optimism-corrected to 0.72. Conclusions Pain 3–6 months after trauma and surgery is highly prevalent and associated with an increase in opioid use. Chronic pain at the site of injury at 3–6 months after trauma and surgery may be predicted during hospitalization by using routinely collected clinical data. Implications If our model is validated in other populations, it would provide a tool that can be easily implemented by any provider with access to medical records. Patients at risk of developing chronic pain could be selected for studies on preventive strategies, thereby concentrating the interventions to patients who are most likely to transition to chronic pain.

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Guest column Regional analgesia in the management of chronic pain in childhood

Journal of Pain and Symptom Management ◽

10.1016/0885-3924(89)90047-x ◽

1989 ◽

Vol 4 (4) ◽

pp. 232-237 ◽

Cited By ~ 4

Author(s):

Charles B. Berde

Keyword(s):

Chronic Pain ◽

Regional Analgesia

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Anesthesia for Mastectomy with Autologous Flap

Anesthesiology: A Problem-Based Learning Approach ◽

10.1093/med/9780190850692.003.0014 ◽

2018 ◽

pp. 125-130

Author(s):

Eman Nada

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Chronic Pain ◽

Latissimus Dorsi ◽

Transversus Abdominis ◽

Regional Analgesia ◽

Risk Patients ◽

Synthetic Grafts ◽

Flap Perfusion

Mastectomy is performed for treatment of breast cancer or for prophylaxis of high-risk patients. The procedure is usually done under general anesthesia with or without regional analgesia. Reconstructive flap surgery is done to improve the quality of life. Autologous flaps provide better cosmetic and better longer term results than synthetic grafts. Common autologous flaps are transversus abdominis myocutaneous, deep inferior perforator epigastric perforator, and latissimus dorsi flap. Anesthesia plays an important role in the success of surgery. The procedure is long and needs meticulous attention to hemodynamics and maintenance of the flap perfusion which can be challenging. Chronic pain is common after mastectomy procedures; regional anesthesia together with other pharmacological analgesic therapy helps to reduce the development of chronic pain.

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Risk for opioid misuse in chronic pain patients is associated with endogenous opioid system dysregulation

Translational Psychiatry ◽

10.1038/s41398-021-01775-z ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Javier Ballester ◽

Anne K. Baker ◽

Ilkka K. Martikainen ◽

Vincent Koppelmans ◽

Jon-Kar Zubieta ◽

...

Keyword(s):

Chronic Pain ◽

Low Risk ◽

Opioid System ◽

Opioid Misuse ◽

Endogenous Opioid ◽

Indirect Measure ◽

Addictive Disorders ◽

Functional Measures ◽

Chronic Pain Patients ◽

Pain Patients

Abstractµ-Opioid receptors (MOR) are a major target of endogenous and exogenous opioids, including opioid pain medications. The µ-opioid neurotransmitter system is heavily implicated in the pathophysiology of chronic pain and opioid use disorder and, as such, central measures of µ-opioid system functioning are increasingly being considered as putative biomarkers for risk to misuse opioids. To explore the relationship between MOR system function and risk for opioid misuse, 28 subjects with chronic nonspecific back pain completed a clinically validated measure of opioid misuse risk, the Pain Medication Questionnaire (PMQ), and were subsequently separated into high (PMQ > 21) and low (PMQ ≤ 21) opioid misuse risk groups. Chronic pain patients along with 15 control participants underwent two separate [11C]-carfentanil positron emission tomography scans to explore MOR functional measures: one at baseline and one during a sustained pain-stress challenge, with the difference between the two providing an indirect measure of stress-induced endogenous opioid release. We found that chronic pain participants at high risk for opioid misuse displayed higher baseline MOR availability within the right amygdala relative to those at low risk. By contrast, patients at low risk for opioid misuse showed less pain-induced activation of MOR-mediated, endogenous opioid neurotransmission in the nucleus accumbens. This study links human in vivo MOR system functional measures to the development of addictive disorders and provides novel evidence that MORs and µ-opioid system responsivity may underlie risk to misuse opioids among chronic pain patients.

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Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review

BMJ Open ◽

10.1136/bmjopen-2018-028093 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028093 ◽

Cited By ~ 2

Author(s):

Andrew David Beswick ◽

Jane Dennis ◽

Rachael Gooberman-Hill ◽

Ashley William Blom ◽

Vikki Wylde

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Adverse Events ◽

Total Knee Replacement ◽

Knee Replacement ◽

Risk Of Bias ◽

Low Risk ◽

Cochrane Library ◽

Total Knee

ObjectivesFor many people with advanced osteoarthritis, total knee replacement (TKR) is an effective treatment for relieving pain and improving function. Features of perioperative care may be associated with the adverse event of chronic pain 6 months or longer after surgery; effects may be direct, for example, through nerve damage or surgical complications, or indirect through adverse events. This systematic review aims to evaluate whether non-surgical perioperative interventions prevent long-term pain after TKR.MethodsWe conducted a systematic review of perioperative interventions for adults with osteoarthritis receiving primary TKR evaluated in a randomised controlled trial (RCT). We searchedThe Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL until February 2018. After screening, two reviewers evaluated articles. Studies at low risk of bias according to the Cochrane tool were included.InterventionsPerioperative non-surgical interventions; control receiving no intervention or alternative treatment.Primary and secondary outcome measuresPain or score with pain component assessed at 6 months or longer postoperative.Results44 RCTs at low risk of bias assessed long-term pain. Intervention heterogeneity precluded meta-analysis and definitive statements on effectiveness. Good-quality research provided generally weak evidence for small reductions in long-term pain with local infiltration analgesia (three studies), ketamine infusion (one study), pregabalin (one study) and supported early discharge (one study) compared with no intervention. For electric muscle stimulation (two studies), anabolic steroids (one study) and walking training (one study) there was a suggestion of more clinically important benefit. No concerns relating to long-term adverse events were reported. For a range of treatments there was no evidence linking them with unfavourable pain outcomes.ConclusionsTo prevent chronic pain after TKR, several perioperative interventions show benefits and merit further research. Good-quality studies assessing long-term pain after perioperative interventions are feasible and necessary to ensure that patients with osteoarthritis achieve good long-term outcomes after TKR.

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Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00060 ◽

2020 ◽

Vol 29 (4) ◽

pp. 1944-1955 ◽

Cited By ~ 1

Author(s):

Maria Schwarz ◽

Elizabeth C. Ward ◽

Petrea Cornwell ◽

Anne Coccetti ◽

Pamela D'Netto ◽

...

Keyword(s):

At Risk ◽

Allied Health ◽

Assessment Tool ◽

Hospital Setting ◽

Low Risk ◽

False Negatives ◽

Exact Agreement ◽

Risk Patients ◽

Impact Phase ◽

Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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