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Background: Severe postoperative pain is a significant problem after cesarean sections., Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge., Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5-10)) and TAPB (10 (6-14)) groups than in the CON (16 (11-19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge., Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.

Background: Sparse data exist on the prevalence and severity of chronic postsurgical pain (CPSP) following cesarean section. Our study aimed to compare the effectiveness of trans versus abdominis plane (TAP) block and quadratus lumborum block (QLB) in the prevention of CPSP after cesarean section., Methods: The study was conducted at a tertiary hospital from June 2017 to July 2018 as a prospective, observational trial. We recruited 233 women with singleton pregnancies, above 18 years of age, ≥ 36 weeks of gestation, undergoing cesarean section under spinal anesthesia. The patients received either TAP block or QLB as the primary analgesia technique following cesarean section. The control group consisted of patients without any postsurgical plane block. The incidence and characteristics of chronic pain were evaluated using the Neuropathic Pain Symptom Inventory at the first, third, and sixth months after surgery., Results: Fewer patients in the control group perceived CPSP than in TAP or QLB groups one and three months after cesarean section, but not after six months. Accordingly, CPSP severity was significantly lower in the control group than after plane blocks at the first and third month. No difference in the risk of CPSP was found between different indications for cesarean delivery., Conclusions: CPSP is highly prevalent following cesarean section. The studied plane blocks did not reduce the incidence or severity of CPSP after cesarean section when compared to the standard analgesic regimen.

Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients' moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients' satisfaction and reduce perioperative complications. [ABSTRACT FROM AUTHOR]

In Poland, chronic pain is experienced by 27% of the population, while neuropathic pain, which is the greatest therapeutic challenge, occurs in approximately 7-10% of the general population and in approximately 30% of cancer patients. One of the mechanisms responsible for the occurrence of pain sensations and its chronification is known as the central sensitization consisting in the hypersensitivity of spinal cord neurons and the upper levels of the central nervous system. The stimulation of the N-methyl-D-aspartate receptor complex (NMDAR) by excess of excitatory amino acids plays an important role in the emergence and maintenance of this phenomenon. Ketamine, which is one of the NMDAR antagonists, reduces central hypersensitivity, especially in relation to neuropathic pain components such as allodynia (pain responses to pain stimuli) and hyperalgesia (increased sensitivity to pain stimuli). The article presents characterization and application of ketamine, taking into account all its mechanisms of action based on the results of selected studies. [ABSTRACT FROM AUTHOR]

Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35–50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge. [ABSTRACT FROM AUTHOR]

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies. [ABSTRACT FROM AUTHOR]