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Spinal fusion surgery is one of the most common major surgical procedures in youth. Adolescent idiopathic scoliosis (AIS) is the most frequent reason for corrective spinal fusion. AIS (∼25%–47% of cases) and spinal fusion surgeries are associated with pain, including the development of new onset chronic pain for up to 15% of youth. This research used photovoice approaches to explore the journeys of youth from before, during, and after spinal fusion surgery, to demonstrate their experiences both of and beyond pain. Twenty participants were recruited from a previous study conducted by the senior author's lab. Participants captured photos/videos in their daily life (Phase 1); collected previously taken photos/videos from before/during/after their surgery (Phase 2); and participated in individual interviews to reflexively discuss the meaning behind photos/videos (Phase 3). Before interviews, a questionnaire was administered to assess pain characteristics. Nineteen girls/women with scoliosis and one boy/man with kyphosis (12–19 years old, M age = 16 years) participated; they identified as white (80%), other (15%), and Southeast Asian (5%). The researchers used a reflexive thematic analysis approach, which generated five themes: (1) body aesthetic versus machine; (2) expectations and anticipation of surgery/outcomes; (3) desire of normalcy and freedom; (4) navigating a hoped-for positive surgery experience; and (5) the journey sculpts identity formation and sense of self. Findings support youth advocacy, underscoring the need to validate youth concerns and inform healthcare professionals of the importance of individualized care. Youth perspectives highlighted opportunities for optimizing surgery/healthcare experiences and the psychosocial impacts of scoliosis on body image and appearance. [ABSTRACT FROM AUTHOR]

Getu Ataro Hanago,1 Matthias Siebeck,2 Samuel Jilo Dira,3 Tefera Tadesse,4 Dominik Irnich5 1Department of Anesthesia, Hawassa University, Hawassa, Ethiopia; 2Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany; 3Department of Anthropology, Hawassa University, Hawassa, Ethiopia; 4Institute of Educational Research, Addis Ababa University, Addis Ababa, Ethiopia; 5Multidiciplinary Pain Center, Department of Anesthesiology, LMU University Hospital LMU Munich, Munich, GermanyCorrespondence: Getu Ataro Hanago, Email getsha@yahoo.comBackground: Despite its universal nature; perception, coping, responses, treatment options, and overall experiences of pain are influenced by biopsychosocial factors to various extents. Pain perception, expression, and control are progressively learned behaviors among members of a society and are culture-specific. Effects of ethnicity-related culture (ethnoculture) on pain experience in a broader context have increasingly been reported. However, evidence from ethnoculturally diverse groups of a nation, particularly based on surgical patients, is limited. Therefore, as a qualitative research effort of a broader project aimed at assessing ethnocultural determinants of surgical pain management, this study explored the perception of ethnoculturally diverse patients and families about expressing surgical disease-related pain.Methods: This study follows subjectivist-interpretivist philosophical assumptions as an underpinning research paradigm. We purposively selected 11 patients for in-depth interviews and 12 patients’ family members for focus group discussions in three hospitals of ethnic-based regions of Ethiopia. In the phenomenological frame, thematic analysis was employed.Finding: Ethnocultural background influences how individuals express and respond to pain according to emergent themes of finding— Pain and overlooked cultural influence, Pain expressiveness in cultural context, Stereotypes of pain expressiveness, and Bravehood through stoic response. Pain feelings are commonly hidden where the domestic culture values stoic response to pain compared to ethnoculture where pain expressiveness is encouraged.Conclusion: Individuals can express and respond to pain differently due to ethnocultural diversity within a nation. Researchers and clinicians should consider cultural context while applying the prevailing one-size-fits-all pain assessment tools among surgical patients of a nation with ethnocultural diversity.Keywords: surgical pain, pain and culture, pain expression, pain behavior, pain response, stoic response

Objective: In our study, we investigated the effect of reflexology on patient satisfaction, pain and vital signs after abdominal surgery.Method: This study was conducted as a randomized controlled trial with the participation of 156 abdominal surgery patients hospitalized in the general surgery unit of a training and research hospital. Personal Information Form, Visual Analogue Scale and Newcastle Nursing Care Satisfaction Scale were used in data collection. We performed the data analysis with One-way analysis of variance, Chi-squared test, paired samples t-test, and independent samples t-test.Results: When the pain, vital signs and satisfaction levels of the experimental and control groups were compared, the pain intensity of the experimental group was found to be lower and the level of satisfaction was higher after reflexology (p<0.01). After reflexology, the blood pressure was closer to 120/80 in the experimental group, the respiratory rate was between 16-22 (number/minute), the difference between the experimental and control groups were statistically significant (p<0.01). There was no statistically significant difference between the pulce oximetry values between the experimental and control groups.Conclusion: Surgical pain and non-optimal vital signs that are not well managed after surgery causes various complications and decrease patient satisfaction. The results of our study emphasize the power of reflexology in effective surgical pain management and normalizing vital signs and increasing patient satisfaction. We suggest that reflexology be performed to patients following abdominal surgery. [ABSTRACT FROM AUTHOR]

Postoperative pain causes discomfort and disability, besides high medical costs. The search for better treatments for this pain is essential to improve recovery and reduce morbidity and risk of chronic postoperative pain. Kinins and their receptors contribute to different painful conditions and are among the main painful inflammatory mediators. We investigated the kinin's role in a postoperative pain model in mice and reviewed data associating kinins with this painful condition. The postoperative pain model was induced by an incision in the mice's paw's skin and fascia with the underlying muscle's elevation. Kinin levels were evaluated by enzyme immunoassays in sham or operated animals. Kinin's role in surgical procedure-associated mechanical allodynia was investigated using systemic or local administration of antagonists of the kinin B1 receptor (DALBk or SSR240612) or B2 receptor (Icatibant or FR173657) and a kallikrein inhibitor (aprotinin). Kinin levels increased in mice's serum and plantar tissue after the surgical procedure. All kinin B1 or B2 receptor antagonists and aprotinin reduced incision-induced mechanical allodynia. Although controversial, kinins contribute mainly to the initial phase of postoperative pain. The kallikrein–kinin system can be targeted to relieve this pain, but more investigations are necessary, especially associations with other pharmacologic targets. [ABSTRACT FROM AUTHOR]

Postoperative pain control is essential to optimizing patient outcomes, improving satisfaction, and allowing patients to resume their baseline functional activities. Methadone, a synthetic mu‐opioid agonist, has multiple pharmacologic properties that may be optimal for perioperative use. Compared to other opioids, methadone has a longer duration of action, rapid onset, extended dosing intervals, high oral bioavailability, low cost, lack of active metabolites, and action on multiple receptors. The current literature examining the use of methadone in the perioperative care of children and adolescents is limited and most often reported within the context of spine or cardiothoracic surgery. Overall, these studies support the hypothesis that perioperative methadone in pediatric patients may decrease postoperative pain, opioid consumption, length‐of‐stay, and the incidence of some opioid‐related side effects, like constipation and urinary retention. A variety of protocols for the perioperative use of methadone have been described, including a single intraoperative dose as well as multiple small doses within multimodal pain protocols. The superiority of these protocols has not been established. Like all opioids, methadone has a side effect profile which includes nausea, vomiting, reduced GI motility, sedation, and respiratory depression at high doses. There is also a concern that it can cause QTc prolongation in patients. The primary aim of this educational review is to examine the pharmacologic data, published perioperative protocols, dosing considerations, and risks and benefits associated with inclusion of methadone in analgesic regimens for surgical patients. A secondary aim is to introduce opportunities for research around the perioperative use of methadone in children and adolescents. Based on our review, we would prioritize establishing optimal procedure‐specific methadone protocols, determining generalizability for use in routine pediatric surgeries, and investigating methadone safety and efficacy prospectively as the primary opioid for pain management in the postanesthesia care unit or postsurgical floors. [ABSTRACT FROM AUTHOR]

Acute pain after surgery is common and often leads to chronic post-surgical pain, but neither treatment nor prevention is currently sufficient. We hypothesised that specific protein networks (protein-protein interactions) are relevant for pain after surgery in humans and mice. Standardised surgical incisions were performed in male human volunteers and male mice. Quantitative and qualitative sensory phenotyping were combined with unbiased quantitative mass spectrometry-based proteomics and protein network theory. The primary outcomes were skin protein signature changes in humans and phenotype-specific protein-protein interaction analysis 24 h after incision. Secondary outcomes were interspecies comparison of protein regulation as well as protein-protein interactions after incision and validation of selected proteins in human skin by immunofluorescence. Skin biopsies in 21 human volunteers revealed 119/1569 regulated proteins 24 h after incision. Protein-protein interaction analysis delineated remarkable differences between subjects with small (low responders, n =12) and large incision-related hyperalgesic areas (high responders, n =7), a phenotype most predictive of developing chronic post-surgical pain. Whereas low responders predominantly showed an anti-inflammatory protein signature, high responders exhibited signatures associated with a distinct proteolytic environment and persistent inflammation. Compared to humans, skin biopsies in mice habored even more regulated proteins (435/1871) 24 h after incision with limited overlap between species as assessed by proteome dynamics and PPI. Immunohistochemistry confirmed the expression of high priority candidates in human skin biopsies. Proteome profiling of human skin after incision revealed protein-protein interactions correlated with pain and hyperalgesia, which may be of potential significance for preventing chronic post-surgical pain. Importantly, protein-protein interactions were differentially modulated in mice compared to humans opening new avenues for successful translational research. [ABSTRACT FROM AUTHOR]

Postoperative pain causes discomfort and disability, besides high medical costs. The search for better treatments for this pain is essential to improve recovery and reduce morbidity and risk of chronic postoperative pain. Kinins and their receptors contribute to different painful conditions and are among the main painful inflammatory mediators. We investigated the kinin’s role in a postoperative pain model in mice and reviewed data associating kinins with this painful condition. The postoperative pain model was induced by an incision in the mice’s paw’s skin and fascia with the underlying muscle’s elevation. Kinin levels were evaluated by enzyme immunoassays in sham or operated animals. Kinin’s role in surgical procedure-associated mechanical allodynia was investigated using systemic or local administration of antagonists of the kinin B1 receptor (DALBk or SSR240612) or B2 receptor (Icatibant or FR173657) and a kallikrein inhibitor (aprotinin). Kinin levels increased in mice’s serum and plantar tissue after the surgical procedure. All kinin B1 or B2 receptor antagonists and aprotinin reduced incision-induced mechanical allodynia. Although controversial, kinins contribute mainly to the initial phase of postoperative pain. The kallikrein–kinin system can be targeted to relieve this pain, but more investigations are necessary, especially associations with other pharmacologic targets.

Surgical pain is associated with delirium in patients, and acupuncture can treat pain. However, whether electroacupuncture can attenuate the surgical pain-associated delirium via the gut-brain axis remains unknown. Leveraging a mouse model of foot incision-induced surgical pain and delirium-like behavior, we found that electroacupuncture stimulation at specific acupoints (e.g., DU20 + KI1) attenuated both surgical pain and delirium-like behavior in mice. Mechanistically, mice with incision-induced surgical pain and delirium-like behavior showed gut microbiota imbalance, microglia activation in the spinal cord, somatosensory cortex, and hippocampus, as well as an enhanced dendritic spine elimination in cortex revealed by two-photon imaging. The electroacupuncture regimen that alleviated surgical pain and delirium-like behavior in mice also effectively restored the gut microbiota balance, prevented the microglia activation, and reversed the dendritic spine elimination. These data demonstrated a potentially important gut-brain interactive mechanism underlying the surgical pain-induced delirium in mice. Pending further studies, these findings revealed a possible therapeutic approach in preventing and/or treating postoperative delirium by using perioperative electroacupuncture stimulation in patients. [ABSTRACT FROM AUTHOR]

Objective: To conduct the first systematic review critically examining evidence on whether early male circumcision has short‐ and long‐term adverse psychological effects. Methods: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Google Scholar. Results: Twenty‐four studies with original data met the inclusion criteria. These comprised 11,173 total males, 4340 circumcised in infancy and 6908 uncircumcised. Nineteen were rated 1+, 2++ or 2+, and 5 were rated 2– by SIGN criteria. Neonatal circumcision, particularly without anesthetic, increased vaccination pain response, but had little effect on breastfeeding or cognitive ability. Studies reporting associations with sudden infant death syndrome, autism, alexithymia and impaired sexual function and pleasure had design flaws and were rated 2–. Sexual arousal, touch, pain, and warmth thresholds measured by quantitative sensory testing were not diminished in neonatally circumcised men. Neonatal circumcision was not associated with empathy in men, contradicting the hypothesis that procedural pain causes central nervous system changes. After correcting all associations with socioaffective processing parameters for multiple testing only higher sociosexual desire, dyadic sexual libido/drive, and stress remained significant. The relatively greater sexual activity found in circumcised men might reflect reduced sexual activity in uncircumcised men overall owing to pain and psychological aversion in those with foreskin‐related medical conditions (reverse causality). Most studies employed case‐control designs with limited follow‐up. Studies beyond childhood were prone to confounding. Conclusion: The highest quality evidence suggest that neonatal and later circumcision has limited or no short‐term or long‐term adverse psychological effects. [ABSTRACT FROM AUTHOR]

Objectives: Self-transcendent experiences have been infrequently examined by modern psychological science, despite their purported healing potential. The two studies reported here were designed to test whether surgical patients could achieve self-transcendent states and whether those states predicted better clinical outcomes. Methods: Two, single-site, parallel-group randomized clinical trials (RCTs) involving knee and hip replacement patients were conducted. In Study 1 (N = 196), patients were randomized to a preoperative, 15-min mindfulness of breath or cognitive-behavioral pain psychoeducation intervention. In Study 2 (N = 118), patients were randomized to a preoperative, 20-min mindfulness of breath, mindfulness of pain, or cognitive-behavioral pain psychoeducation intervention. Self-transcendent state and acute clinical symptomology were assessed immediately before and after the preoperative interventions. Postoperative outcomes were also assessed. Results: A brief MBI induced self-transcendent states in a general sample of knee and hip replacement patients (Study 1: F = 36.79, p <.001; Study 2: F = 7.25, p =.001). MBI-induced self-transcendent states were associated with decreases in pain intensity (Study 1: β = −.26, p =.001; Study 2: β = −.30, p =.004), pain unpleasantness (β = −.21, p =.008), and anxiety (β = −.36, p <.001) immediately after the preoperative intervention. The depth of self-transcendent states achieved during meditation before surgery predicted better postoperative physical function (β =.21, p =.033) in Study 1 and less postoperative pain intensity (β = −.35, p =.016) and pain interference (β = −.32, p =.019) in Study 2. Conclusions: These two studies suggest self-transcendence is a therapeutic mechanism of mindfulness that is accessible to a general sample of surgical patients and can improve clinical outcomes. Clinical Trial Registration for Study 1: ClinicalTrials.gov = NCT03665727. Clinical Trial Registration for Study 2: ClinicalTrials.gov = NCT04520958. [ABSTRACT FROM AUTHOR]

Saad Alghamdi Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi ArabiaCorrespondence: Saad AlghamdiLaboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura, University, PO Box 715, Makkah 21955, Saudi ArabiaTel +966 505502114Email ssalghamdi@uqu.edu.saBackground: Postoperative pain remains a major clinical problem as there are limited analgesic strategies that have been proven to be effective in preventing and relieving this type of pain. Natural products, including flavonoids, have distinct pharmacological properties and play an important role in the discovery of analgesic drugs.Materials and Methods: In this study, the flavonoid eriocitrin (eriodictyol 7-O-rutinoside), which is the main flavonoid in lemon fruit (Citrus limon), was mechanistically investigated for its prospective antinociceptive effect in a mouse model of postoperative pain. The antinociceptive property was evaluated by utilizing both tonic (acetic acid-induced writhing behavior) and phasic (hot-plate) nociception modalities. The hindpaw incisional surgery was performed and hyperalgesia was assessed using von Frey filaments.Results: The tested doses of eriocitrin significantly attenuated (P< 0.01, P< 0.001) the chemically-induced tonic visceral nociception (5, 10, 15, and 30 mg/kg) and acute phasic thermal nociception (10, 15, and 30 mg/kg). A significant dose-dependent reduction in the incisional nociceptive hyperalgesia was exhibited by eriocitrin, with a marked antinociception observed at doses of 15 mg/kg (P< 0.05 during 30– 60 minutes) and 30 mg/kg (P< 0.05, P< 0.01 during 30– 120 minutes).Conclusion: The antinociceptive effect of eriocitrin (30 mg/kg) was strongly blocked by the antagonists of the opioid receptor, naltrexone, and GABAA receptor, bicuculline, thereby suggesting the involvement of opioidergic and GABAergic mechanisms in the nociception, reducing proclivity of eriocitrin during transmission of incisional nociception. These results concluded that eriocitrin has a potent antinociceptive effect in postoperative pain conditions, probably mediated through opioid and GABAA receptors.Keywords: flavanones, surgical pain, analgesia, incisional pain, natural products

A 69-year-old female with Crohn's disease was admitted for open ileocecectomy with lysis of adhesions. The plan was to proceed with general endotracheal anesthesia and a thoracic epidural catheter for perioperative analgesia. Epidural access was attempted at the T10-11 and T11-12 interspaces, both of which resulted in accidental dural punctures. On the third attempt, the epidural catheter was inserted at the T9-10 interspace. Both the aspiration and test dose were negative. Thirty minutes later, after induction of general anesthesia, the catheter was again aspirated before the epidural pump was connected. Freely flowing, glucose-positive fluid was obtained, and the catheter was removed for the patient's safety. This case suggests that accidental dural puncture may be a risk factor for inappropriate communication with the subarachnoid space. This can be assumed to increase the risk of unanticipated high or total spinal block and its life-threatening sequelae., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arnaut et al.)

The use of two or more classes of analgesics that act by different modes of action within the pain pathways, leading to additive or, even synergistic analgesia, has been documented as nociceptive information is known to be transmitted through numerous anatomical pathways and by multiple substances. Three patients were scheduled for ovariohysterectomy (OVH), resection and anastomosis and right radical nephrectomy. They received 0.05mgkg-1 1% atropine and 0.01mgkg-1 dexmedetomidine as premedicants; induced and maintained with ketamine 10mgkg-1 and 5mgkghr-1 respectively, 200µgkg-1 butorphanol and 0.03mgkg-1 buprenorphine as analgesics and 5mgkg-1 meloxicam post-operatively. Anaesthestic indices (duration and quality of anaesthesia, analgesia, and the quality of induction) were recorded. Physiological variables (heart rate, respiratory rate, pulse rate, peripheral capillary oxygen saturation and rectal temperature) were measured at 0, thereafter at 15 minutes interval post treatment for one hour. Observed parameters were statistically analyzed by using independent sample 't' test. P<0.05 was considered statistically significant. Quality of induction was fair, anaesthesia lasted for 113.3 ± 5.1 minutes, quality of analgesia was very good and recovery time was 2.8 ± 0.2 minutes. No significant differences were observed in the heart rate (P=0.55), pulse rate (P=0.71), peripheral capillary oxygen saturation (P=0.50) and rectal temperature (P=0.74); but with a significant difference in the respiratory rate (P=0.03). Anaemia was reported in all three patients. [ABSTRACT FROM AUTHOR]

Phillip Aitken,1 Ioana Stanescu,1 Rebecca Playne,1 Jennifer Zhang,1 Christopher MA Frampton,2 Hartley C Atkinson1 1Drug Development, AFT Pharmaceuticals Ltd, Auckland, New Zealand; 2Department of Medicine, University of Otago, Christchurch, New Zealand Introduction: Acetaminophen (APAP) and ibuprofen (IBP) are two analgesic compounds with a long history of use. Both are considered safe at recommended over-the-counter daily doses. Chronic use, high doses, or concomitant medication can produce safety risks for both drugs. APAP is associated with increased risk of hepatic injury, while IBP can produce gastric bleeding and thromboembolic events. Using a combination of APAP and IBP provides superior analgesia without transgressing daily dose limits of each individual drug.Methods: The present study aimed to determine if treatment with a fixed-dose combination (FDC) containing APAP and IBP results in any unexpected adverse events (AEs) and/or changes in the safety profiles of its two ingredients compared to monotherapy. The analysis will examine clinical safety data obtained from either single dose trials, multiple dose trials, a long-term exposure trial, and post-marketing surveillance data of APAP/IBP FDC tablets (Maxigesic®/Combogesic®, AFT Pharmaceuticals Ltd). The largest dataset was obtained by pooling the four randomized-controlled, multiple-dose clinical studies with either APAP 325 mg + IBP 97.5 mg (FDC 325/97.5, three tablets per dose) or APAP 500 mg + IBP 150 mg (FDC 500/150, two tablets per dose). At maximum doses, the two FDCs are bioequivalent, permitting the pooling of data for the analysis of safety. Results: A safety population of 922 patients who received full doses of either FDC, APAP alone, IBP alone, or placebo was compiled from the four studies. A total of 521 AEs were experienced with the incidence of FDC AEs similar to or below either monotherapy group or placebo. The FDC did not alter the incidence and percentage of the most common AEs, including gastrointestinal events and postoperative bleeding. Conclusion: Overall, the FDC is well tolerated and has a strong safety profile at single and multiple doses with improved efficacy over monotherapy. Keywords: paracetamol, nonsteroidal anti-inflammatory drugs, surgical pain, postoperative analgesia, multimodal pain management

Introduction: Pain is considered as a fifth vital sign. Pain management and patients satisfaction with the treatment decreases early postoperative recovery. Aim: The study aim was to assess the satisfaction of pain management among postoperative patients. Materials and Methods: A cross-sectional study was used to conduct a study among 180 postoperative patients’ undergone surgeries (General surgery patients, ortho-paedic surgery and urological surgery patients) at selected hospitals, Puducherry. The purpose of the study was to associate the pain level with satisfaction. The patients were selected based on purposive sampling technique. After obtaining consent, the researcher used numerical pain scale to assess the pain perception of the patient, closed ended questionnaire to assess attitude level and modified short assessment questionnaire for patient satisfaction towards pain management. The study was analysed using Statistical Package for the Social Science (SPSS) software version 20.0. The descriptive statistics was used to assess the level of pain and attitude and inferential statistics like Pearson correlation coefficient were carried out to find the correlation between pain and satisfaction. Results: Severe pain was felt by nearly all (70%) among general surgery patients, 60% in orthopaedic surgery patients and 50% had moderate pain in urological surgery patients respectively. Regarding attitude, majority (78%, 88% and 83%) of the patients had positive attitude towards pain management in General surgery, Orthopaedic and Urology surgery patients. Most (74%) of them were satisfied with their pain management in general surgery patients, whereas in orthopaedic and urological patients, nearly all 90%, 96% of the clients were very satisfied towards pain management. Conclusion: The study concluded, optimal satisfaction toward pain management will increase quality of early postoperative recovery

Introduction: Pain is considered as a fifth vital sign. Pain management and patients satisfaction with the treatment decreases early postoperative recovery. Aim: The study aim was to assess the satisfaction of pain management among postoperative patients. Materials and Methods: A cross-sectional study was used to conduct a study among 180 postoperative patients’ undergone surgeries (General surgery patients, ortho-paedic surgery and urological surgery patients) at selected hospitals, Puducherry. The purpose of the study was to associate the pain level with satisfaction. The patients were selected based on purposive sampling technique. After obtaining consent, the researcher used numerical pain scale to assess the pain perception of the patient, closed ended questionnaire to assess attitude level and modified short assessment questionnaire for patient satisfaction towards pain management. The study was analysed using Statistical Package for the Social Science (SPSS) software version 20.0. The descriptive statistics was used to assess the level of pain and attitude and inferential statistics like Pearson correlation coefficient were carried out to find the correlation between pain and satisfaction. Results: Severe pain was felt by nearly all (70%) among general surgery patients, 60% in orthopaedic surgery patients and 50% had moderate pain in urological surgery patients respectively. Regarding attitude, majority (78%, 88% and 83%) of the patients had positive attitude towards pain management in General surgery, Orthopaedic and Urology surgery patients. Most (74%) of them were satisfied with their pain management in general surgery patients, whereas in orthopaedic and urological patients, nearly all 90%, 96% of the clients were very satisfied towards pain management. Conclusion: The study concluded, optimal satisfaction toward pain management will increase quality of early postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Hydromorphone is an opioid agonist used for pediatric analgesia. Due to lack of data, pediatric dosing (based on adult pharmacokinetic models) is not optimal. Aim: This study characterizes hydromorphone population pharmacokinetics in pediatric surgical patients. Methods: In this prospective observational study, 34 children (4‐18 years, bodyweight 23‐89.6 kg) received multiple intravenous hydromorphone boluses followed by postoperative hydromorphone patient‐controlled analgesia. Arterial blood samples were collected before and at 3, 10, 30, and 90 (and few samples at 1350) minutes after the first dose. Hydromorphone concentrations were measured by validated LC‐MS/MS assay. Nonlinear mixed‐effects modeling was used for pharmacokinetic model development. The final population pharmacokinetic model was evaluated by visual predictive check and bootstrap analysis. Monte Carlo simulations based on the final pharmacokinetic model determined optimal patient‐controlled analgesia parameters to achieve a target of 20 ng/mL (as the median effective analgesic concentration), using minimum effective analgesic concentration of 4 ng/mL as a proxy for patient‐controlled analgesia dose demand, and not exceeding the defined safe upper threshold of 40 ng/mL. Results: Hydromorphone pharmacokinetic profiles were adequately described by a two‐compartmental model with first‐order elimination. Bodyweight was found to be a significant covariate for hydromorphone clearance. Allometrically scaledpharmacokinetic parameter estimates (per 70 kg), systemic clearance (0.748 L/min), volume of distribution (33 L), peripheral clearance (1.57 L/min), and peripheral volume of distribution (146 L) were similar to reported adult parameter estimates. Sex, race, age, and type of surgery were not identified as significant covariates. To identify optimal patient‐controlled analgesia dosing parameters, we simulated several initial loading doses, demand doses, and lockout intervals. Our simulations support an initial patient‐controlled analgesia loading dose of 15 µg/kg followed by a demand dose of 6 µg/kg with lockout intervals of 20 minutes. Conclusions: After intravenous hydromorphone, plasma pharmacokinetic profiles in children undergoing different surgeries were well described by a two‐compartment population allometric pharmacokinetic model using bodyweight as the size descriptor. Model informed simulations identified patient‐controlled analgesia parameters to inform initial settings, with adjustments as needed based on observed individual effects. [ABSTRACT FROM AUTHOR]

This is a narrative review of the published literature on IV ibuprofen (IVIB) as one of the drugs used in multimodal pain management in inpatients and outpatients pre- and postoperatively and for nonsurgical pain or fever. The efficacy, concurrent opioid use, pharmacokinetic properties, tolerability, stress response, and postoperative recovery with IVIB, which were investigated in 9 clinical studies, are presented in this narrative review. In total, 1062 adult patients and healthy volunteers were included in these 9 studies; 757 of these subjects received IVIB, and the remaining 305 received either placebo or a comparator medication. The plasma ibuprofen level with IVIB was twice that with oral ibuprofen, and patients experienced less postoperative pain, decreased opioid use, improved quality of recovery, and reduced postsurgical fatigue and surgical stress response, and used less over-the-counter medication. Overall, preemptive IVIB should be considered in the analgesic regimen for the management of pre- and postoperative pain, as it has a favorable safety profile, with fewer associated adverse events and serious adverse events, significantly lower levels of perioperative cytokines and catecholamines, and improved peri- and postoperative pain control with a decreased use of opioid medications. [ABSTRACT FROM AUTHOR]

Purpose Of Review: The purpose of the present investigation is to provide a comprehensive review of both patient and procedure specific predictors of acute postoperative pain.Recent Findings: As the global number of surgeries continues to increase, as well as evidence of worse patient outcomes in those who suffer from poorly controlled postoperative pain, it is becoming more critical for perioperative physicians to have a deep understanding of the risks which might lead to increased pain in the immediate postoperative settings. It is also important to recognize potential tools to prevent the development and intensity of surgical pain. This manuscript begins with an investigation of the theorized mechanisms of postoperative pain, at the peripheral and central levels, which is followed by a discussion of current pain evaluation in humans. Additionally, an evaluation of patient- and procedure-specific predictors for the development of acute pain is summarized. As operative and patient specific risk factors continue to be revealed, they will ultimately serve as important tools to provide high-quality individualized patient care aimed at reducing incidence of severe postsurgical pain. [ABSTRACT FROM AUTHOR]

Introduction: Acetaminophen (APAP) and ibuprofen (IBP) are two analgesic compounds with a long history of use. Both are considered safe at recommended over-the-counter daily doses. Chronic use, high doses, or concomitant medication can produce safety risks for both drugs. APAP is associated with increased risk of hepatic injury, while IBP can produce gastric bleeding and thromboembolic events. Using a combination of APAP and IBP provides superior analgesia without transgressing daily dose limits of each individual drug. Methods: The present study aimed to determine if treatment with a fixed-dose combination (FDC) containing APAP and IBP results in any unexpected adverse events (AEs) and/or changes in the safety profiles of its two ingredients compared to monotherapy. The analysis will examine clinical safety data obtained from either single dose trials, multiple dose trials, a long-term exposure trial, and post-marketing surveillance data of APAP/IBP FDC tablets (Maxigesic®/Combogesic®, AFT Pharmaceuticals Ltd). The largest dataset was obtained by pooling the four randomized-controlled, multiple-dose clinical studies with either APAP 325 mg + IBP 97.5 mg (FDC 325/97.5, three tablets per dose) or APAP 500 mg + IBP 150 mg (FDC 500/150, two tablets per dose). At maximum doses, the two FDCs are bioequivalent, permitting the pooling of data for the analysis of safety. Results: A safety population of 922 patients who received full doses of either FDC, APAP alone, IBP alone, or placebo was compiled from the four studies. A total of 521 AEs were experienced with the incidence of FDC AEs similar to or below either monotherapy group or placebo. The FDC did not alter the incidence and percentage of the most common AEs, including gastrointestinal events and postoperative bleeding. Conclusion: Overall, the FDC is well tolerated and has a strong safety profile at single and multiple doses with improved efficacy over monotherapy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to derive parameters that might reflect postoperative pain from photoplethysmography (PPG) and verify the derived parameters in postoperative pain assessment. We obtained preoperative and postoperative PPG and 100-mm visual analog scale (VAS) from 65 surgical patients and extracted a total of 51 PPG morphology-based parameters and their normalized parameters from these PPGs obtained. Pain discrimination performances of these derived parameters were assessed by statistical analyses, including Wilcoxon signed rank test with Bonferroni correction, classification accuracy based on logistic regression, and 4-fold cross validation. After comparing these parameters derived from PPG in pre- and post-operative conditions, statistically significant difference was found in 36 of the 51 parameters. Using logistic classification, dynamic between-pulse parameters such as normalized systolic amplitude variation and normalized diastolic amplitude variation showed better pain classification performance than the static within-pulse parameters. VAS score was 0 in every pre-operation condition, but >60 VAS was observed in the post-operative condition. Systolic peak amplitude variation normalized by PPG AC amplitude showed the best performance in classifying post-operative pain, with accuracy, sensitivity, specificity, and positive predictivity values of 79.5, 74.0, 86.0, and 84.5%, respectively. These results are superior to those of the surgical pleth index (SPI, GE Healthcare, Chicago, IL, United States) at 65.9, 65.9, 66.5, and 66.5%, respectively.

The purpose of this study was to derive parameters that might reflect postoperative pain from photoplethysmography (PPG) and verify the derived parameters in postoperative pain assessment. We obtained preoperative and postoperative PPG and 100-mm visual analog scale (VAS) from 65 surgical patients and extracted a total of 51 PPG morphology-based parameters and their normalized parameters from these PPGs obtained. Pain discrimination performances of these derived parameters were assessed by statistical analyses, including Wilcoxon signed rank test with Bonferroni correction, classification accuracy based on logistic regression, and 4-fold cross validation. After comparing these parameters derived from PPG in pre- and post-operative conditions, statistically significant difference was found in 36 of the 51 parameters. Using logistic classification, dynamic between-pulse parameters such as normalized systolic amplitude variation and normalized diastolic amplitude variation showed better pain classification performance than the static within-pulse parameters. VAS score was 0 in every pre-operation condition, but >60 VAS was observed in the post-operative condition. Systolic peak amplitude variation normalized by PPG AC amplitude showed the best performance in classifying post-operative pain, with accuracy, sensitivity, specificity, and positive predictivity values of 79.5, 74.0, 86.0, and 84.5%, respectively. These results are superior to those of the surgical pleth index (SPI, GE Healthcare, Chicago, IL, United States) at 65.9, 65.9, 66.5, and 66.5%, respectively. [ABSTRACT FROM AUTHOR]

Background: Several synthetic meshes are available to reinforce the inguinal region following laparoscopic hernia reduction. We sought to compare postoperative pain of patients who underwent laparoscopic inguinal herniorrhaphy using self-adhering polyester mesh to those who had non-adhering, synthetic mesh implanted using absorbable tacks.Materials and Methods: This study is a retrospective review of patients who underwent primary laparoscopic inguinal herniorrhaphy at the Medical College of Wisconsin between October 2012 and July 2014. Clinical information and perioperative pain scores using the visual analog scale (VAS) were obtained to evaluate immediate pre and postoperative pain.Results: A total of 98 patients (88 male) underwent laparoscopic inguinal herniorrhaphy during the study interval. Forty-two patients received self-adhering mesh and 56 patients received mesh secured with tacks. Patient demographics and comorbidities did not differ significantly between the two groups. There was no difference in preoperative VAS scores between groups. The self-adhering mesh patients had a lower mean VAS change score (less pain). Postoperative complications did not differ between groups apart from a higher observed incidence of seroma in the self-adhering mesh group (p = 0.04). No hernias recurred in either group during the study interval.Conclusions: Self-adhering mesh in laparoscopic inguinal herniorrhaphy resulted in less immediate postoperative pain than tacked mesh as demonstrated by VAS score. Postoperative complications were similar between the two groups. The results of this study demonstrate that laparoscopic inguinal herniorrhaphy using self-adhering mesh is comparable to tacked mesh in regards to short-term complication rates, but show a favorable advantage in regards to immediate postoperative pain. [ABSTRACT FROM AUTHOR]

Acute pain is a prevalent issue for patients recovering from surgical procedures. Methadone has been recognized as a unique option for treatment of surgical pain due to its multiple mechanisms of analgesia and its potential to decrease tolerance to other opioids. Studies of methadone use in postoperative settings are sparse in part due to safety concerns, such as complex pharmacokinetics, risk of respiratory depression, and association with arrhythmias. In this case study of a 70-year-old male with postsurgical abdominal pain, methadone utilization over a period of 9 days resulted in patient-reported analgesia and aided in de-escalating overall opioid use. More studies are needed to develop guidance on how methadone can be used to relieve pain following surgical procedures. [ABSTRACT FROM AUTHOR]

Background Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS. Methods 58 patients undergoing unilateral TKA were randomly assigned to receive 4 20-min sessions (a total of 80 min) of tDCS (2 mA) post-surgery with electrodes placed to create 4 groups: 1) MOTOR (n = 14); anode-motor/cathode-right prefrontal, 2) PREFRONTAL (n = 16); anode-left-prefrontal/cathode-right-sensory, 3) ACTIVE-CONTROL (n = 15); anode-left-temporal-occipital junction/cathode-medial-anterior-premotor-area, and 4) SHAM (n = 13); 0 mA-current stimulation using placements 1 or 2. Patient controlled analgesia (PCA; hydromorphone) use was tracked during the ∼72-h post-surgery. Results Patients in the sham group and the active-control group used 15.4 mg (SD = 14.1) and 16.0 mg (SD = 9.7) of PCA hydromorphone respectively. There was no difference between the slopes of the cumulative PCA usage curves between these two groups (p = 0.25; ns). Patients in the prefrontal tDCS group used an average of 11.7 mg (SD = 5.0) of PCA hydromporhone, and the slope of the cumulative PCA usage curve was significantly lower than sham (p < 0.0001). However, patients in the motor tDCS group used an average of 19.6 mg (SD = 11.9) hydromorphone and the slope of the PCA use curve was significantly higher than sham (p < 0.0001). Conclusions Results from this double-blind cortical-target-optimization study suggest that anodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex may be a reasonable approach to reducing post-TKA opioid requirements. Given the unexpected finding that motor cortex failed to produce an opioid sparing effect in this follow-up trial, further research in the area of post-operative cortical stimulation is still needed. [ABSTRACT FROM AUTHOR]

Objective: In our study, we investigated the effect of reflexology on patient satisfaction, pain and vital signs after abdominal surgery., Method: This study was conducted as a randomized controlled trial with the participation of 156 abdominal surgery patients hospitalized in the general surgery unit of a training and research hospital. Personal Information Form, Visual Analogue Scale and Newcastle Nursing Care Satisfaction Scale were used in data collection. We performed the data analysis with One-way analysis of variance, Chi-squared test, paired samples t-test, and independent samples t-test., Results: When the pain, vital signs and satisfaction levels of the experimental and control groups were compared, the pain intensity of the experimental group was found to be lower and the level of satisfaction was higher after reflexology (p<0.01). After reflexology, the blood pressure was closer to 120/80 in the experimental group, the respiratory rate was between 16-22 (number/minute), the difference between the experimental and control groups were statistically significant (p<0.01). There was no statistically significant difference between the pulce oximetry values between the experimental and control groups., Conclusion: Surgical pain and non-optimal vital signs that are not well managed after surgery causes various complications and decrease patient satisfaction. The results of our study emphasize the power of reflexology in effective surgical pain management and normalizing vital signs and increasing patient satisfaction. We suggest that reflexology be performed to patients following abdominal surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The purpose of this study was to gain a better understanding of parents' perception of their child undergoing postoperative acute abdominal pain. Grounded theory method was used to systematically collect and analyze data. Data were obtained from 17 parents (12 mothers and 5 fathers) by interview and observation. A substantive theory "getting back to normal" was developed while parents were engaged in the process of taking care of their child undergoing a painful abdominal surgical procedure. This process had 5 phases: (a) taking action, (b) waiting, (c) developing a sense of safety, (d) managing, and (e) returning to normal. The major task was that parents were addressing the process of normalizing and that giving information and preparing parents for effectively taking care of their child might be expected to greatly contribute to pain reduction. Nurses need to devote energy to working with parents so that they can be considered a partner in the care.

Acute Interventional Perioperative Pain Service consultants have routinely placed paravertebral nerve block (PVB) catheters for the continuous release of ropivacaine following stage I microtia reconstruction with costal cartilage graft at our institution since 2010. A retrospective chart review from July 2006 was performed to compare the length of hospital stay, median pain score (0-10 scale), and opioid use of patients receiving PVB with those of historical controls. Statistical analysis included t, Mann-Whitney U, and Fisher's exact tests. A total of 15 stage I microtia surgeries were included, 10 with PVB and 5 without. Patients with and without PVB had high peak pain scores (8.4 vs 7.8), remained in the hospital for 3.5 and 3.8 days, and consumed 0.69 and 0.36 mg/kg morphine equivalents, respectively. These findings highlight the feasibility of PVB, but larger studies are needed to optimize pain relief in this population. [ABSTRACT FROM AUTHOR]