The Effect of Hypnotherapy on Pain Intensity in Postoperative Patients: A Systematic Review

Background: Pain is a common problem in patients undergoing surgery. The constant postoperative acute pain can affect the physiological and psychological aspects of the patient.Objective: Non-pharmacological therapy is widely used for the treatment of chronic pain. Non-pharmacological therapy needs to be developed in acute postoperative pain due to concerns about the side effects of pharmacological treatment. There is non-pharmacological management that effectively reduces pain intensity, namely hypnotherapy.Methods: The systematic search for this review used the Google Scholar database, Directory of Open Access Journal (DOAJ), ProQuest, and PubMed using keywords (Hypnosis OR Hypnotism OR Hypnoanalysis OR Hypnotherapy OR Hypnotherapies OR Mesmerism) AND (Post-surgical Pain OR Post surgical Pain OR Postsurgical Pain OR Post-operative Pain OR Post operative Pain OR Post-operative Pains OR Postoperative Pain OR Acute Postoperative Pain OR Acute Post-operative Pain OR Acute Post operative Pain). The quality of journals was assessed using the Critical Appraisal Skills Program (CASP) instrument. The synthesis method used was narrative synthesis (narrative synthesis).Results: 10 articles were fully reviewed from 2010-2020. The visualization technique with rapid conversational induction has the best effect than other techniques. The most effective way of conveying suggestions is indirect with a permissive approach. The study results showed that hypnotherapy tended to reduce postoperative pain in minor surgical procedures than in major surgeries.Conclusion: Hypnotherapy affects reducing the pain intensity of postoperative patients. The results of this study recommend that hypnotherapy suggestions and pain measures must be tailored to the patient's condition.

Paw placement during walking is altered by analgesic doses of opioids and post-surgical injury in mice

Hind paw-directed assays are commonly used to study the analgesic effects of opioids in mice. However, opioid-induced hyper-locomotion can obscure results of such assays. We aimed to overcome this potential confound by using gait analysis to observe hind paw usage during walking in mice. We measured changes in paw print area following induction of post-surgical pain (using the paw incision model) and treatment with oxycodone. Paw incision surgery reduced the paw print area of the injured hind paw as the mice avoided placing the incised section of the paw on the floor. Surprisingly, oxycodone caused a tiptoe-like gait in mice, resulting in a reduced paw print area in both hind paws. Further investigation of this opioid-induced phenotype revealed that analgesic doses of oxycodone or morphine dose-dependently reduced hind paw print area in uninjured mice. The gait changes were not dependent on opioid-induced increases in locomotor activity; speed and paw print area had no correlation in opioid-treated mice, and other analgesic compounds that alter locomotor activity did not affect paw print area. Unfortunately, the opioid-induced 'tiptoe' gait phenotype prevented gait analysis from being a viable metric for demonstrating opioid analgesia in injured mice. However, this work reveals an important, previously uncharacterized effect of treatment with analgesic doses of opioids on paw placement. Our characterization of how opioids affect gait has important implications for the use of mice to study opioid pharmacology and suggests that scientists should use caution when using hind paw-directed nociceptive assays to test opioid analgesia in mice.

Modern methods of anesthesia in oncopulmonology (literature review)

This article provides an overview of modern methods of anesthesia and perioperative support in oncopulmonology. Literary sources were searched by journal archives, Medline search electronic databaseб and scientometric databases Scopus and Web of Science, also the Cochrane Library for the last 7 years. The main methods of anesthesiological support in thoracic surgery, modern concepts of perioperative management of patients, the basic principles of preventive and multimodal analgesia as components of the protocol of accelerated recovery are considered. The development and introduction of safe and effective methods of patient antinociceptive protection from acute surgical pain in oncopulmonology remain an important problem of anesthesiology.

Effects of Multimodal Analgesic Protocol, with Buprenorphine and Meloxicam, on Mice Well-Being: A Dose Finding Study

The anesthetic or analgesic agent of choice, route and frequency of anesthetic or analgesic administration, and stressors induce distress during the perioperative period. We evaluated a multimodal analgesic protocol using buprenorphine and meloxicam on the well-being of mice. Twenty-four Slc:ICR male mice were divided into control, anesthesia + analgesia, and surgery + anesthesia + analgesia groups. Tap water (orally: PO) and water for injection (subcutaneous: SC) were administered to the control group. Buprenorphine was administered twice (SC, 0.1 mg/kg/8 h) and meloxicam was administered thrice (PO, 5 mg/kg/24 h) to the anesthesia + analgesia and surgery + anesthesia + analgesia groups. The mice were subjected to laparotomy and assessed for several parameters. Even in absence of surgical pain, the anesthesia + analgesia group presented the same negative effects as the surgery + anesthesia + analgesia group. This multimodal analgesic protocol for mice was expected to have an analgesic effect on pain associated with laparotomy but was not sufficient to prevent food intake and weight decrease. This does not negate the need to administer analgesics, but suggests the need to focus on and care not only about the approach to relieve pain associated with surgery, but also other types of distresses to minimize negative side effects that may interfere with postoperative recovery in mice.

P.153 Profiles and Outcomes of Workers’ Compensation Patients Undergoing Spinal Cord Stimulation for Persistent Post Surgical Pain

Background: The challenges of chronic pain management, and resulting poorer outcomes, in workers’ compensation (WCB) patients has been well established. Spinal cord stimulation (SCS) has been used for the management of low back and radicular neuropathic pain with varying effectiveness and it’s efficacy in the WCB population has been challenged. We sought to examine our experience using SCS in WCB compared to non WCB patients. Methods: A retrospective analysis of 71 WCB patients assessed and treated at the St Pauls Hospital neuromodulation program between 2016-2021 was performed. This group was compared to a cohort on non WCB patients in terms of the likelhood of being offered a trial, proceeding with trial if offered, and the likelhood of a successful trial proceeding to implant. Results: Compared to non WCB, the WCB patients were more likely to be offered a trial (86% vs 77%) and more likely to proceed with a trial if offered (82% vs 71%). Trial to implant ratios were similar in both WCB and non WCB patients (78% vs 77%). Conclusions: WCB patients were more likely to be offered a SCS trial and more likely to accept if offered, compared to non-WCB patients. However, both groups were similar in trial to implant probability.

The effect of using pineapple fresh juice to improve post-surgical pain, ecchymosis and swelling in maxillofacial region

Background: Facial plastic surgeries are usually associated with various post-surgical unde- sirable symptoms, particularly pain, Swelling, and ecchymosis. Depending on the nature of the procedures, these symptoms could last for days, sometimes over a week or more. Considering the optimal efficacy of Bromelain, this study is used to justify the benefits of pre-operative use of Bro- melain found in pineapple using fresh pineapple juice to reduce such complications. Materials and Methods: A randomized clinical study was performed among 100 patients undergoing various facial surgical operations; the patients were randomly divided into two groups; fifty patients received the pre-operative fresh pineapple juice (350ml glass) twice every day, a week before and continued for seven days after surgery. The pain level was determined using a visual an- alog scale, Swelling, and ecchymosis judged by visual inspection. Average scores for all symptoms were added to obtain the clinical sum score for each visit. Results: Pre-operative use of fresh pineapple juice was significantly reduced post-surgical pain, swelling, and ecchymosis with statistically significant results (p<0.005) in each pineapple groups. Conclusion: Bromelain found in pineapple fruit can be used as a successful therapy before var- ious facial surgical procedures to minimize and provide faster recovery from undesirable post-op- erative symptoms.

Perioperative sleep disturbance following mastectomy: A longitudinal investigation of the relationship to pain, opioid use, treatment, and psychosocial symptoms.

192 Background: Sleep disturbance negatively impacts quality of life and recovery. Our objective was to evaluate the relationship between individual patient factors (demographic, surgical, pain, opioid use, and psychosocial factors) and greater sleep disturbance. Methods: In this prospective longitudinal study, patients completed validated measures regarding their sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Objective pain sensitivity measures were evaluated at baseline using quantitative sensory testing. Univariable and multivariable generalized estimating equations (GEE) evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after surgery for breast cancer. Results: Female patients (n = 259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain, psychosocial factors such as anxiety, depression, and affect. While the mean degree of sleep disturbance did not change substantially over time, the link to pain severity appeared to strengthen over the first postoperative year. Independent preoperative predictors of worse sleep disturbance on multivariable longitudinal GEE included younger age (B = -.09, p =.006), opioid use (B = 3.09, p =.02), higher pain (B =.19, p = <.001) and anxiety (B =.45, p = <.001) at baseline. On the other hand, higher basline positive affect (B = -.14, p = <.012) and the surgical category total mastectomy without reconstruction (B = -2.81, p = <.006) were indepently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks post-surgery was associated with disturbed sleep. Conclusions: Sleep disturbance in the first year following surgery for breast cancer varied substantially between individuals. Certain demographic, psychosocial, and pain factors explained more of this variance than surgical procedure, with the exception of total mastectomy without reconstruction that was associated with lower sleep disturbance. Sleep disturbance was associated with increased need for opioids in the perioperative period, and a propensity for more prolonged postoperative opioid use. Pre-surgical interventions in high risk individuals such as anxiety management, boosting positive affect, and controlling pain that have been shown to improve sleep quality could enhance postoperative recovery and decrease opioid use following breast surgery.