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Purpose of Review: Pain management following cardiac surgery is a critical component in optimizing both short- and long-term patient outcomes, with poor pain management associated with significant acute and chronic opioid use, opioid dependence and a significant rate of opioid related adverse drug events. The significant burden of both acute and chronic pain following cardiac surgery has given rise to the need for multimodel analgesic strategies, to optimize outcomes and minimize side effects. Recent Findings: While significant research has focused recently on the additive value of peripheral nerve blocks, less emphasis has been given to the value of non-opioid based analgesics in preference to traditional opioid based anesthetic and analgesic strategies. In this review, we examine the evidence for several common analgesics, highlighting the evidence supporting efficacy following cardiac surgery, as well as the safety concerns with each agent. Summary: We demonstrate the value of a multimodal analgesic strategy to reduce pain scores and improve patient-centered outcomes, and highlight the need for further studies of combination analgesic strategies. [ABSTRACT FROM AUTHOR]

Introduction: therapeutic equivalence has been established in the effectiveness of peripheral nerve blocks in the management of pain in the postoperative period of anterior cruciate ligament reconstruction. However, it is unknown whether this effect is modulated by the anesthesiologist’s experience. The objective was to describe the effectiveness of peripheral nerve blocks during the first 24 hours of the postoperative period, considering patient characteristics and the anesthesiologist’s experience. Material and methods: a retrospective cohort study was conducted from 2015 to 2017. Patients who received a femoral canal block, femoral nerve block, or spinal anesthesia were included. All data were obtained from the patient’s medical records, with pain assessed using a visual analog scale recorded in the medical records. A robust, non-parametric kernel regression model was generated to estimate the effect of the variables. Results: out of 480 clinical records, 168 were included in the analysis. The period of greatest pain was between eight and 12 hours, with a non-success rate of up to 22.9%. No differences were found between peripheral nerve blocks. The anesthesiologist’s experience did not influence the analgesic effect, while the use of a bone-tendon-bone graft determined greater postoperative pain. Conclusion: in minimally invasive procedures, good pain management outcomes could be observed independently of the anesthesiologist’s experience. [ABSTRACT FROM AUTHOR]

Purpose of Review: The present investigation evaluated integration of novel medication technology to enhance treatment options, while improving patient outcomes in acute pain management. In this regard, we focused on determining the role of development and utilization of cutting-edge pharmaceutical advancements, such as targeted drug delivery systems, as well as non-pharmacologic interventions in addressing acute pain states. Further research in this area is warranted related to the need for increased patient comfort and reduced adverse effects. Recent Findings: Recent innovations and techniques are discussed including pharmacologic drugs targeting sodium and calcium channels, peptide-based pharmacologic drugs, and non-medicinal methods of alleviating pain such as soothing music or virtual reality. Summary: The present investigation included review of current literature on the application of these innovative technologies, analyzing mechanisms of action, pharmacokinetics, and clinical effectiveness. Our study also investigated the potential benefits in terms of pain relief, reduced side effects, and improved patient adherence. The research critically examines the challenges and considerations associated with implementing these technologies in acute pain management, considering factors like cost, accessibility, and regulatory aspects. Additionally, case studies and clinical trials are highlighted which demonstrate practical implications of these novel medication technologies in real-world scenarios. The findings aim to provide healthcare professionals with a comprehensive understanding of the evolving landscape in acute pain management while guiding future research and clinical practices toward optimizing their use in enhancing patient care. [ABSTRACT FROM AUTHOR]

Purpose of the Review: Acute pain management remains a challenge and postoperative pain is often undermanaged despite many available treatment options, also including cannabinoids. Recent Findings: In the light of the opioid epidemic, there has been growing interest in alternative care bundles for pain management, including cannabinoids as potential treatment to decrease opioid prescribing. Despite the lack of solid evidence on the efficacy of cannabinoids, their use among patients with pain, including those using opioids, is currently increasing. This use is supported by data suggesting that cannabinoids could potentially contribute to a better pain management and to a reduction in opioid doses while maintaining effective analgesia with minimum side effects. Summary: The scientific basis for supporting the use of cannabis is extensive, although it does not necessarily translate into relevant clinical outcomes. The use of cannabinoids in acute pain did not always consistently show statistically significant results in improving acute pain. Large randomized, controlled trials evaluating diverse cannabis extracts are needed in different clinical pain populations to determine safety and efficacy. [ABSTRACT FROM AUTHOR]

This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed. [ABSTRACT FROM AUTHOR]

In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992–2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management. [ABSTRACT FROM AUTHOR]

Objectives: To identify the core components of acute pain management in children, re‐conceptualise the process and update the existing model to inform nursing research and clinical practice. Background: Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient‐centred approach and a conceptual model which includes the role of parents and partnership. Design: Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children. Methods: A scoping review of peer‐reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used. Results: A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision‐making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process. Conclusion: The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient‐centred. The new collaborative model will promote shared decision‐making for individualised pain assessments, interventions and evaluations. Relevance to clinical practice: Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science. No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works. [ABSTRACT FROM AUTHOR]

Background: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain. Methods: A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative‐enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race. Results: Complete follow‐up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty‐six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4–0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05–5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04–0.08, p < 0.001 vs. 0.10, 95% CI 0.08–0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95). Conclusions: Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing—which have been previously described within the context of this trial—may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort. [ABSTRACT FROM AUTHOR]

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Introduction: Acute trigeminal neuralgia exacerbation is a common reason for frequent emergency department visits, that often occurs while waiting for surgery, but evidence on effective drugs for acute trigeminal neuralgia is scant. Whether lidocaine aerosol could be a rescue option for the treatment of acute trigeminal neuralgia exacerbations is worth exploring. Positive predictors of the analgesic effects of lidocaine aerosol also warrant further investigation. Methods: This is a retrospective study with a total of 152 patients. We analyzed the efficacy of lidocaine aerosol for the treatment of acute trigeminal neuralgia exacerbations. A positive response was considered a decrease in the VAS score of at least 50% at 30 min of treatment. Multivariable logistic analyses were performed to identify predictive factors for lidocaine aerosol response. Results: In the group of 109 responders, the VAS score decreased from 8.3 ± 1.1 cm to 0.8 ± 1.0 cm at 15 min, and 1.7 ± 1.0 cm at 30 min. The effective rate at 15 min and 30 min were 77.6% and 70.4%, respectively. Multivariate logistic analyses showed the treatment may provide better clinical outcomes in V2 trigeminal neuralgia (OR 0.01, 95%Cl 0.001–0.15, p < 0.001), V3 trigeminal neuralgia (OR 0.02, 95%Cl 0.001–0.16, p = 0.001), and V2 + V3 trigeminal neuralgia (OR 0.01, 95%Cl 0.001–0.13, p < 0.001), patients who were taking carbamazepine or oxcarbazepine with a maximum dose (OR 6.15, 95%Cl 2.11–17.93, p = 0.001) were less likely to experience immediate pain relief. Conclusion: Lidocaine aerosol sprayed on oral and/or nasal mucosa is beneficial for immediate pain relief in patients with acute trigeminal neuralgia exacerbations. It is expected to become a promising treatment option for patients with V2 and/or V3 trigeminal neuralgia. [ABSTRACT FROM AUTHOR]

Background: Surgery is a potential or actual threat to a person's integrity, both biopsychosocial and spiritual. One of the treatments for breast cancer is surgery, either tumor removal or mastectomy. The problem that often arises in postoperative patients is pain, which can affect the patient's overall condition. Purpose: The purpose of this study was to determine the effect of pain management with deep breath relaxation therapy on the post operative mammae pain scale. Methods: This case study design uses a descriptive method. The sampling method used was purposive sampling with 2 respondents, namely post-mastectomy patients in the Surgical Room of Muhammadiyah Hospital Palembang, in March 2022. The case study data were taken using interviews, observations and physical examinations carried out descriptively and presented in a narrative manner Results: After implementing acute post-mastectomy pain management with deep breathing relaxation therapy in both case study subjects for 3 days there was a 3 point reduction in pain scale, in patient 1 from pain scale 6 to pain scale 3, in patient 2 from pain scale 5 to a pain scale of 2, and both case study subjects were able to move and fulfill basic needs independently. Conclusion: Acute pain management with deep breathing relaxation therapy can reduce pain scale and help patients move quickly.

Background: Effective analgesia for invasive office-based rhinology procedures can be challenging. While local anesthetics provide the basis for periprocedural analgesia, systemic opioids are often necessary for adequate pain control. Case report: We describe two patients successfully undergoing multiple painful rhinology procedures with the addition of a novel sufentanil 30 mcg sublingual tablet to our standard oral benzodiazepine and local anesthetic protocol. Conclusion: A sufentanil sublingual tablet administered preoperatively provided excellent analgesia throughout the duration of the procedure and was well tolerated. This new analgesic provides a rapid-acting alternative to standard oral opioid analgesics.

Background: Laparoscopic liver surgery has undergone substantial advancements over the past few decades, and the key to this improvement has been an improved understanding of liver anatomy, radiologic imaging, and advancements in anesthesia and postoperative care. This study aimed to compare postoperative opioid consumption in patients receiving intrathecal morphine plus low-dose bupivacaine versus those receiving intravenous morphine. Methods: In this randomized controlled trial, 40 patients were enrolled and randomly assigned to two groups, of which one received 0.2 mg intrathecal morphine plus 0.25% Marcaine in a total volume of 4 mL and the other received intravenous morphine intraoperatively. Pain relief and patient satisfaction were evaluated using the visual analog scale. Intraoperative blood loss was measured at the end of the surgery while morphine consumption was measured by monitoring intravenous patient-controlled morphine at 12, 24, 36, and 48 h postoperatively. Treatment efficacy and complications were documented. Results: Morphine consumption was significantly different in both groups at all time points, although the pain score did not show any difference. Shoulder pain, a common adverse effect of laparoscopic surgery, was significantly lower in the intrathecal group (25% vs. 75%). Blood loss and patient satisfaction were not different between the groups. However, the intrathecal group showed a significantly higher incidence of intraoperative hypotension. Conclusion: Intrathecal morphine with bupivacaine can be used effectively for managing acute post-LLR pain. Thai Clinical trial registry: TCTR20211015004. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the impact of educational interventions on the knowledge and attitude of healthcare professionals (HCPs) regarding sickle cell disease (SCD) pain management in the UK. Background: Variations and inadequate pain management due toHCPs' lack of knowledge and negative attitude is still an ongoing global concern for SCD patients despite availability of effective treatment and evidence‐based guidelines. Several international studies have implemented interventions aimed at improving knowledge, attitude, and pain management. No review on the effectiveness of these interventions was found. Also, no previous intervention done in the UK was found from the thorough search of research databases. However, there are estimated 240,000 genetic carriers with about 12,500–15,000 estimated people living with SCD in the UK. Design: Rapid Evidence Assessment of existing evidence. Methods: A rapid evidence assessment was conducted between March 2021–January 2022 following the PRISMA 2020 guidelines. Included papers must have an educational intervention about SCD or related symptom management where the learners were HCPs. Excluded papers were those not published in English or before 2010. The following databases were searched: CINAHL, MEDLINE, PubMed America and Europe, Scopus, PsycINFO and Web of Science. Data quality was assessed using the Mixed Methods Assessment Tool (MMAT) and analysed using a narrative approach. Results: Ten studies were included in the final review. Overall, they reported improved outcomes in six main themes: knowledge, attitude, perception, adoption, satisfaction and efficiency. Five studies reported statistically significant improvement in at least one outcome, four studies reported positive improvement, and two studies reported no significant improvement in knowledge and attitude. These heterogeneous studies were implemented once, and all designs were prone to bias; this makes it difficult to state how effective interventions are for SCD. Conclusion: Current evidence of positive improvement in HCPs' knowledge and attitude is insufficient for generalisation and recommendation for adoption. However, we believe that implementing validated educational interventions remains essential for effective acute SCD pain management and patient‐centred care. Further research is needed to find a suitable educational intervention that can be replicated. Relevance to clinical practice: Quality SCD education, timely crisis management and reduced patient stigma are crucial in reducing the risk of rapid clinical decompensation to avoid developing life‐threatening complications. Understanding SCD can also support the building of therapeutic relationships between the patient and practitioner. Trial registration: This review was not registered. [ABSTRACT FROM AUTHOR]

Abstract Background Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement. Methods One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR + NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved. Results In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR + NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR + NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P

Background: Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed. Methods: We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients. Results: The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1). Conclusion: We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology.

Appropriate perioperative pain control is essential to aid in patients' recovery after surgery; however, acute postsurgical pain remains poorly treated and there continues to be an overreliance on opiates. Perioperative pain control starts in the operating room, and opiate-free anesthesia (OFA), where no opiates are used intraoperatively, has been proposed as a feasible strategy to further minimize opiates in the perioperative period. In this article, we address the potential benefits and shortcomings of OFA, while exploring tools available to accomplish multimodal anesthesia and ideally OFA, and the evidence behind the techniques proposed. [ABSTRACT FROM AUTHOR]

Effective therapies for acute pain management in trigeminal neuralgia (TN) are limited. We aimed to investigate the role of steroids in TN patients experiencing acute pain flares. We retrospectively reviewed patients presenting to the emergency department of a tertiary care institution between 2014 and 2020 for acute TN pain flares. Patients were divided into those who received steroids versus those who did not. Presenting characteristics, admission and surgical intervention rates, Barrow Neurological Institute pain scores, pain recurrence rates, and surgical intervention within 6 months of discharge were obtained for each patient. Our cohort comprised 151 patients, of whom 40 (26.5%) received steroids before admission and/or discharge. These patients were less likely to undergo surgical intervention to treat acute pain (P = 0.023). Specifically, patients receiving steroids were less likely to undergo combined glycerin and radiofrequency rhizotomy compared with patients not receiving steroids (P = 0.012). Frequency and dosage of opioid administration did not differ between groups. The steroids group demonstrated a lower average Barrow Neurological Institute pain score on discharge compared with the no steroids group (P = 0.013). Patients receiving steroids for acute pain management were less likely to undergo surgical intervention within 6 months of discharge than patients who did not receive steroids (P = 0.033). Steroid administration in patients with acute TN pain flares may reduce the likelihood of surgical intervention both during admission and within 6 months of discharge. Future prospective studies should examine the efficacy of steroids as an adjunctive medication in acute TN pain management. [ABSTRACT FROM AUTHOR]

Management of acute and chronic pain following surgery remains a critical patient management challenge, with poor pain management associated with negative patient satisfaction, increased opioid consumption and a high incidence of adverse events. Chest surgery specifically carries a high incidence of significant early and chronic post operative pain. The high incidence, prolonged duration of pain, and adverse effects associated with chronic opioid analgesia, has given rise to the need for non-opioid pain management strategies. Cryoneurolysis, also known as cryoanalgesia, has emerged as a promising option for both acute and chronic pain management. While cryoneurolysis was first developed over fifty years ago, its utilization was limited by technical implementation challenges and limitations in identifying target structures percutaneously. Advances both in cryoneurolysis delivery devices as well as ultrasound have reinvigorated interest in the technique, with recent studies highlighting the advantages of cryoneurolysis, including its favorable side effect profile, long duration of efficacy and relative technical simplicity. The purpose of this review is to examine techniques for cryoneurolysis, and explore recent evidence for safety and efficacy of the technique following different surgical procedures., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Managing acute postoperative pain in patients on chronic opioid therapy is challenging. There is little data regarding optimal perioperative chronic opioid management. We hypothesized that continuing the home dose of opioid while inpatient following ventral hernia repair (VHR) would reduce total opioid consumption postoperatively., Methods: Chronic opioid users were ordered their home opioid scheduled and our standard multimodal analgesia regimen. At time of discharge, we reviewed inpatient opioid use and prescribed opioids based on morphine milligram equivalent (MME) consumed per our established protocol., Results: VHR was performed in 658 patients with 117 utilizing chronic opioid medications from June 2017 through March 2022; 43 patients were managed on protocol and 74 were not. Inpatient daily MME consumption was similar between groups (34 vs 36 MME; p ​= ​0.285). Patients treated according to protocol received significantly lower MME prescriptions at discharge (80 vs 225 MME; p ​< ​0.001) with similar refills (21.4 vs 25.4 ​%; p ​= ​0.820)., Conclusion: Continuing home opioids for chronic opioid users following VHR resulted in less opioid prescribing with no increase in refills., Competing Interests: Declaration of competing interest The following authors have outside financial interests: Warren (Intuitive – consulting fees, Ethicon/Johnson & Johnson – honorarium for speaking). The authors used no AI or AI assisted technologies in the writing process. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: therapeutic equivalence has been established in the effectiveness of peripheral nerve blocks in the management of pain in the postoperative period of anterior cruciate ligament reconstruction. However, it is unknown whether this effect is modulated by the anesthesiologist's experience. The objective was to describe the effectiveness of peripheral nerve blocks during the first 24 hours of the postoperative period, considering patient characteristics and the anesthesiologist's experience., Material and Methods: a retrospective cohort study was conducted from 2015 to 2017. Patients who received a femoral canal block, femoral nerve block, or spinal anesthesia were included. All data were obtained from the patient's medical records, with pain assessed using a visual analog scale recorded in the medical records. A robust, non-parametric kernel regression model was generated to estimate the effect of the variables., Results: out of 480 clinical records, 168 were included in the analysis. The period of greatest pain was between eight and 12 hours, with a non-success rate of up to 22.9%. No differences were found between peripheral nerve blocks. The anesthesiologist's experience did not influence the analgesic effect, while the use of a bone-tendon-bone graft determined greater postoperative pain., Conclusion: in minimally invasive procedures, good pain management outcomes could be observed independently of the anesthesiologist's experience.

Acetabular fractures are uncommon types of pelvic fractures associated with restricted mobility due to severe pain. The high analgesic demands can be fulfilled by using multimodal analgesia incorporating regional analgesia. The choice of regional analgesia technique depends on the type of acetabular fracture and innervation of the affected components. We report a case series of five patients with acetabular fractures, in whom pre-emptive administration of pericapsular nerve group block provided effective analgesia to facilitate the sitting position for the neuraxial block.

Sacral surgeries are a relatively rare type of spine surgery associated with a significant amount of perioperative pain. The paraspinal interfascial or erector spinae plane block is currently being practiced with promising results in cervical, thoracic, and lumbar spine surgeries. It provides not only effective analgesia but also helps in reducing perioperative opioid consumption. Sacral multifidus plane block is one such variant of paraspinal blocks, which may have an equianalgesic profile. This case report describes a novel application of this block for providing perioperative analgesia in sacral spine surgery.

Background and Aims: The application of ultrasound (USG)-guided interfascial plane blocks in transplant anesthesia is expanding. This study evaluates and compares the postoperative analgesic efficacy of USG-guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in adult individuals undergoing laparoscopic living donor nephrectomy (LLDN). Materials and Methods: A hundred donors of either sex, aged 30–60 years, scheduled to undergo LLDN were randomly allocated into two groups. After completion of the LLDN, USG-guided unilateral TAPB and QLB were performed in lateral position in Groups A (n = 48) and B (n = 48), respectively. A volume of 20 ml of 0.375% ropivacaine was administered in both groups. Postextubation donors were shifted to the postanesthesia care unit (PACU). Heart rate, systolic blood pressure, diastolic blood pressure, and numeric rating scale (NRS) scores were recorded on arrival at PACU at the time of discharge from PACU. Subsequently, the donor was shifted to the intensive care unit, and the vitals and NRS scores (static and dynamic) were monitored postoperatively on the 2nd, 6th, 12th, 18th, and 24th h. Duration of analgesia and the number of donors who needed rescue analgesia were also noted. All the donors were observed for any side effects and complications. P

In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992–2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.

Introduction: Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted. Objective: The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures. Methods: A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords “pediatric,” “burn,” “virtual reality,” and “pain.” We included experimental studies of between- and within-subjects designs in which pediatric patients’ exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis. Results: Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). A random effects meta-analysis model indicated a moderate and significant combined effect size (SMD = 0.60, 95% CI = 0.28–0.93, p = 0.0031) of VR effects on pain intensity ratings with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen’s d = 0.575, 95%CI = 0.11–1.04). Conclusion: Children’s exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures.Objectives: To demonstrate that administering FICB preoperatively to patients with hip or proximal femur fractures in the emergency department (ED) is likely to reduce opioid use and related complications, and to decrease hospital length of stay (LOS).Methods: An unblinded study of adult patients with hip and proximal femur fractures who consented to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the ED. We compared this group with a contemporaneous group of controls who only received systemic opioids. Over the course of approximately 6 months, main outcome measured between the two groups was amount of morphine equivalents given from block administration until 8 h after. We also compared complications such as delirium, constipation, and bleeding rates (oozing from injection site or hematoma formation).Results: A total of 166 patients with hip and proximal femur fractures from August 12, 2018 to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with no significant difference in LOS. A statistically significant difference in opioid-related adverse outcomes was found between the anticoagulated group vs. the no anticoagulation group.Conclusions: FICB is a safe and effective preoperative technique for initial pain management in patients with hip and proximal femur fractures, as it can also be used with additional systemic opioids. FICB administration may reduce systemic opioid use preoperatively, thus reducing opioid-related adverse effects with no significant impact on hospital LOS. [ABSTRACT FROM AUTHOR]

Background and Aims: The application of ultrasound (USG)‑guided interfascial plane blocks in transplant anesthesia is expanding. This study evaluates and compares the postoperative analgesic efficacy of USG‑guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in adult individuals undergoing laparoscopic living donor nephrectomy (LLDN). Materials and Methods: A hundred donors of either sex, aged 30–60 years, scheduled to undergo LLDN were randomly allocated into two groups. After completion of the LLDN, USG‑guided unilateral TAPB and QLB were performed in lateral position in Groups A (n = 48) and B (n = 48), respectively. A volume of 20 ml of 0.375% ropivacaine was administered in both groups. Postextubation donors were shifted to the postanesthesia care unit (PACU). Heart rate, systolic blood pressure, diastolic blood pressure, and numeric rating scale (NRS) scores were recorded on arrival at PACU at the time of discharge from PACU. Subsequently, the donor was shifted to the intensive care unit, and the vitals and NRS scores (static and dynamic) were monitored postoperatively on the 2nd, 6th, 12th, 18th, and 24th h. Duration of analgesia and the number of donors who needed rescue analgesia were also noted. All the donors were observed for any side effects and complications. P <0.05 was considered statistically significant. Results: The NRS score was significantly lower in Group B (QLB) than in Group A (TAPB). Duration of analgesia was significantly prolonged in Group B (11.34 ± 1.53 h) compared to Group A (9.05 ± 1.58 min). (P < 0.001) Conclusion: The QLB effectively prolonged the duration of analgesia, lowers pain scores, and decreases the requirement of rescue analgesia compared to the TAPB. Hence, the donors remain comfortable in the postoperative period without any potential side effects. [ABSTRACT FROM AUTHOR]

This is the first study on acute severe pain management involving sport and exercise medicine Doctors who are leaders in football medicine in their respective countries. An online survey was designed describing the management of acute severe pain in this expert cohort. The survey captured participant sex, age, years working in sports medicine, core specialty and use of clinical practice guidelines (CPGs). Finally, three clinical vignettes exploring the management of acute pain were presented. Forty-four senior team doctors across 55 European countries completed the survey. There were no consistent guidelines proposed, with 33 (75%) participants indicating they did not use any. Methoxyflurane was proposed by 14 (32%) and 13 (30%) participants for female anterior cruciate ligament rupture and male ankle fracture, respectively. Strong opioids were not used in 17 (39%) and 6 (14%) participants regarding female cruciate injuries and male fractures, respectively. Despite 75% of participants having paediatric life support training, eight (18%) participants expressed uncertainty administering medications in this population, and 15 (34%) would avoid using strong opioids altogether. There is a tendency to undertreat pain and avoid strong opioids for reasons including lack of monitoring equipment, anti-doping concerns and lack of comfort treating paediatric patients with opioids. [ABSTRACT FROM AUTHOR]

Opioids are frequently used for acute pain management of musculoskeletal injuries, which can lead to misuse and abuse. This study aimed to identify the opioid prescribing rate for ankle fractures treated nonoperatively in the ambulatory and emergency department setting across a single healthcare system and to identify patients considered at high risk for abuse, misuse, or diversion of prescription opioids that received an opioid. A retrospective cohort study was performed at a large healthcare system. The case list included nonoperatively treated emergency department, urgent care and outpatient clinic visits for ankle fracture and was merged with the Prescription Reporting With Immediate Medication Mapping (PRIMUM) database to identify encounters with prescription for opioids. Descriptive statistics characterize patient demographics, treatment location and prescriber type. Rates of prescribing among subgroups were calculated. There were 1,324 patient encounters identified, of which, 630 (47.6%) received a prescription opioid. The majority of patients were 18-64 years old (60.3%). Patients within this age range were more likely to receive an opioid prescription compared to other age groups (p <.0001). Patients treated in the emergency department were significantly more likely to receive an opioid medication (68.3%) compared to patients treated at urgent care (33.7%) or in the ambulatory setting (16.4%) (p <.0001). Utilizing the PRIMUM tool, 14.2% of prescriptions were provided to patients with at least one risk factor. Despite the recent emphasis on opioid stewardship, 14.2% of patients with risk factors for misuse, abuse, or diversion received opioid analgesics in this study, identifying an area of improvement for prescribers. [ABSTRACT FROM AUTHOR]

The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity. [ABSTRACT FROM AUTHOR]

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Sacral surgeries are a relatively rare type of spine surgery associated with a significant amount of perioperative pain. The paraspinal interfascial or erector spinae plane block is currently being practiced with promising results in cervical, thoracic, and lumbar spine surgeries. It provides not only effective analgesia but also helps in reducing perioperative opioid consumption. Sacral multifidus plane block is one such variant of paraspinal blocks, which may have an equianalgesic profile. This case report describes a novel application of this block for providing perioperative analgesia in sacral spine surgery. [ABSTRACT FROM AUTHOR]

Acetabular fractures are uncommon types of pelvic fractures associated with restricted mobility due to severe pain. The high analgesic demands can be fulfilled by using multimodal analgesia incorporating regional analgesia. The choice of regional analgesia technique depends on the type of acetabular fracture and innervation of the affected components. We report a case series of five patients with acetabular fractures, in whom pre-emptive administration of pericapsular nerve group block provided effective analgesia to facilitate the sitting position for the neuraxial block. [ABSTRACT FROM AUTHOR]

Effective pain control after major surgery in neonates presents many challenges. Parenteral opioids (and co-analgesics) are often used but inadequate analgesia and oversedation are not uncommon. Although continuous thoracic epidural analgesia is highly effective and opioid-sparing, its associated risks and the need for staff with specialised skills and/or neonatal intensive care unit staff buy-in may preclude this option even in many academic centres. We present the case of a six-day-old infant who underwent upper abdominal surgery and received intermittent morphine doses via a tunnelled caudal epidural catheter, which provided satisfactory analgesia and facilitated early extubation. [ABSTRACT FROM AUTHOR]

Background: Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement. Methods: One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR + NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved. Results: In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR + NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR + NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P < 0.001). The per-protocol analysis found a statistically higher success rate for the LOR + NS group compared to the LOR-alone group (98% vs. 82%; P = 0.017) when only patients in whom stimulation was achieved were included. Conclusions: Addition of NS technique did not statistically improve the success rate for epidural placement when analyzed in an intention-to-treat format and was associated with a longer procedural time. In a per-protocol analysis a statistically higher success rate for patients in whom stimulation was obtained highlights the potential benefit of adding NS to LOR. Trial registration: ClinicalTrials.gov identifier NCT03087604 on 3/22/2017; Institutional Review Board Wake Forest School of Medicine IRB00039522, Food and Drug Administration Investigational Device Exemption: G160273. [ABSTRACT FROM AUTHOR]

Background: Pain is the most compelling factor that leads people to visit the emergency department (ED). We aimed to assess patient satisfaction with the management of acute pain in the ED of a tertiary academic hospital, where opioid agents are used on a minimal and limited basis. Methods: This cross-sectional study was conducted over 2 months. A modified questionnaire was administered by telephone to adult patients who had complained of pain and received analgesics in the ED. Multivariate correlational analysis was performed to identify the predictors of patient satisfaction. Results: We included 76 patients (mean age, 40.88 ± 15.47 years) of these, 65 (85%) received non-opioids, while 11 (14%) received an opioid analgesic. Fifty (65%) of total patients thought they had received enough analgesics. Mean initial pain score was 8.11 ± 1.93 while that at discharge was 4.38 ± 3.03. Multivariate regression showed that ED diagnosis [coefficient = −0.23; 95% confidence interval (CI) −0.43, −0.40], chronic analgesic use (coefficient =1.25; 95% CI 0.21, 2.28), type of analgesic administered (coefficient = −1.11; 95% CI −2.66, 0.43), initial pain score (coefficient = 0.39; 95% CI 0.07, 0.71), pain score at discharge (coefficient = −0.51; 95% CI −0.74, −0.29), perception of enough analgesics (coefficient = 2.30; 95% CI 0.97, 3.63), and staff helpfulness (coefficient = 0.19; 95% CI 0.02, 0.38) were significantly associated with patient satisfaction. The type of analgesic was not significantly associated with patient satisfaction (model R2 = 0.54). Conclusion: Our findings indicate that the use of opioid agents did not significantly increase the patients' satisfaction scores. Adjusting patient satisfaction predictors, including the type of analgesic used, will help in optimizing the patients' experience. [SJEMed 2020; 1(2.000): 89-95]