Prostaglandin E2 production in synovial tissue and acute postoperative pain after knee arthroscopy

2010 ◽  
Vol 1 (3) ◽  
pp. 172-172
Author(s):  
Nina Solheim ◽  
Bente Halvorsen ◽  
Leiv Arne Rosseland ◽  
Audun Stubhaug
Keyword(s):  
Postoperative Pain ◽  
Prostaglandin E2 ◽  
Pain Intensity ◽  
Pain Score ◽  
Synovial Tissue ◽  
Inflammatory Mediators ◽  
Knee Arthroscopy ◽  
Local Inflammation ◽  
Acute Postoperative Pain ◽  
Perceived Pain

Abstract Postsurgical inflammation leads to sensitisation of “sleeping” nociceptors, which enhance pain perception and induce hyperalgesia. Prostaglandin E2 plays a central role in this process. Synovial microdialysis technique allows analyses of biological markers of local inflammation simultaneous with a close follow up of the patient’s pain experience. Tissue injury (or surgery) initiates liberation of inflammatory mediators and hyperalgesic substances. This project is translational and aims at exploring the relationship between perceived acute postoperative pain and inflammation. Microdialysis of synovial tissue and pain score after arthroscopy is of special interest to study since the natural pain course and the local inflammation can be observed in patients with no analgesic therapy. Methods This is a clinical observational study of local inflammatory mediators and perceived pain in patients undergoing knee arthroscopy in general anesthesia with propofol, remifentanil and fentanyl. Microdialysis of the synovial membrane was performed in all patients every 20 min for 140 min postoperatively (seven samples). At the same intervals PGE2 was measured and correlated with patients report of pain intensity on a 0–100mm visual analogue scale (VAS). Results Five patients (1 female, 4 male) who did not receive any non-steroidal antiinflammatory drugs or paracetamol were included. The pain intensity was 1–34mmVAS and the PGE2 levels were from 293 pg/ml to 5818 pg/ml. Maximum pain score (mean 23 and SD 12mm VAS) and PGE2 levels (mean 2026 pg/ml and SD 1380 pg/ml) occurred about 40 min after surgery. Correlation analysis shows a significant correlation (R = 0.48, p = 0.004). Conclusion This pilot study indicates a positive correlation between postoperatively perceived pain and local PGE2 concentration.

Slow Dynamics of Acute Postoperative Pain Intensity Time Series Determined via Wavelet Analysis Are Associated With the Risk of Severe Postoperative Day 30 Pain

2021 ◽  
Vol 132 (5) ◽  
pp. 1465-1474
Author(s):  
Raheleh Baharloo ◽  
Jose C. Principe ◽  
Roger B. Fillingim ◽  
Margaret R. Wallace ◽  
Baiming Zou ◽  
...  
Keyword(s):  
Time Series ◽  
Postoperative Pain ◽  
Wavelet Analysis ◽  
Pain Intensity ◽  
Slow Dynamics ◽  
Acute Postoperative Pain

Application of preoperative assessment of pain induced by venous cannulation in predicting postoperative pain in patients under laparoscopic nephrectomy: a prospective study

2020 ◽  
Author(s):  
Fei Peng ◽  
Yanshuang Li ◽  
Yanqiu Ai ◽  
Jianjun Yang ◽  
Yanping Wang
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Pain Score ◽  
Preoperative Assessment ◽  
Laparoscopic Nephrectomy ◽  
Venous Cannulation ◽  
Clinical Trial Registry ◽  
Rescue Analgesia ◽  
Intravenous Analgesia ◽  
Vas Scores

Abstract Backgroud: Postoperative pain is the most prominent concern among surgical patients. It has been reported that venous cannulation-induced pain can predict postoperative pain after laparoscopic cholecystectomy within 90 mins. Its potential in predicting postoperative pain in patients with patient-controlled intravenous analgesia (PCIA) is worth establishing. The purpose of this study was to investigate the application of VCP in predicting postoperative pain in patients with PCIA during the first 24 h after laparoscopic nephrectomy. Methods: 120 patients scheduled for laparoscopic nephrectomy. The nurse recorded the preoperative venous cannulation-induced pain score estimated by patients, and dichotomized the patients into VAS scores < 2.0 group or VAS scores ≥ 2.0 group . After general anesthesia and surgery, all the patients received the patient-controlled intravenous analgesia (PCIA) with sufentanil. The VAS scores at rest and on coughing at 2 h, 4 h, 8 h, 12 h, 24 h, the effective number of presses and the number of needed rescue analgesia within 24 h after surgery were recorded. Results: Venous cannulation-induced pain score was significantly correlated with postoperative pain intensity at rest (rs = 0.64) and during coughing (rs = 0.65), effective times of pressing (rs = 0.59), additional consumption of sufentanil (rs = 0.58). Patients with venous cannulation-induced pain intensity ≥ 2.0 VAS units reported higher levels of postoperative pain intensity at rest (P < 0.0005) and during coughing (P < 0.0005), needed more effective times of pressing (P < 0.0005) and additional consumption of sufentanil (P < 0.0005), and also needed more rescue analgesia (P = 0.01). The odds of risk for moderate or severe postoperative pain (OR 3.5, 95% CI 1.3-9.3) was significantly higher in patients with venous cannulation-induced pain intensity ≥ 2.0 VAS units compared to those < 2.0 VAS units. Conclusions: Preoperative venous cannulation-induced pain can be used to predict postoperative pain intensity in patients with PCIA during the first 24 h after laparoscopic nephrectomy. Trial registration: We registered this study in a Chinese Clinical Trial Registry (ChiCTR) center on July 6 2019 and received the registration number: ChiCTR1900024352. Key words: Venous cannulation, Pain, Postoperative pain, Pain prediction

scholarly journals Guided Relaxation-Based Virtual Reality for Acute Postoperative Pain and Anxiety: A Pilot Study in a Pediatric Population (Preprint)

2020 ◽  
Author(s):  
Vanessa Anne Olbrecht ◽  
Keith T O'Conor ◽  
Sara E Williams ◽  
Chloe O Boehmer ◽  
Gilbert W Marchant ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Pilot Study ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Children And Adolescents ◽  
Anxiety Sensitivity ◽  
Pain Catastrophizing ◽  
Acute Postoperative Pain ◽  
Guided Relaxation ◽  
Pain Unpleasantness

BACKGROUND Distraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce the prolonged pain reduction required to manage sustained postoperative pain. Integration of VR with other pain reducing therapies, like guided relaxation, may enhance their clinical impact. OBJECTIVE The goal of this pilot study was to assess the association of a single guided relaxation-based VR (VR-GR) session with a reduction in postoperative pain and anxiety in children. We also explored whether pain catastrophizing and anxiety sensitivity influenced this association. METHODS A total of 51 children and adolescents (7-21 years) with postoperative pain followed by the Acute Pain Service at Cincinnati Children’s Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. The primary outcome was changes in pain intensity following VR-GR (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS VR-GR decreased pain intensity immediately (p < 0.001) and 30 minutes (p = 0.04) after the VR session, but not at 15 minutes (p = 0.16) post-session. Reductions in pain unpleasantness were observed during all time intervals (p < 0.001 at all intervals). Anxiety was reduced immediately (p = 0.02) but not at 15- (p = 0.08) or 30- (p = 0.30) minutes following VR-GR. Patients with higher CASI reported greater reductions in pain intensity (p = 0.04) and unpleasantness (p = 0.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety. CONCLUSIONS A single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. These results encourage a future randomized clinical trial assessing efficacy of VR-GR. CLINICALTRIAL NCT04556747

scholarly journals Characterization of  self-anticipated surgical pain prior to general anesthesia - a prospective observational study

2021 ◽  
Author(s):  
Wei-Shu Chang ◽  
Yi-Ting Hsieh ◽  
Moa-Chu Chen ◽  
Shu-Ching Chang ◽  
Tzu-Shan Chen ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Observational Study ◽  
General Anesthesia ◽  
Pain Intensity ◽  
Pain Score ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Perioperative Period ◽  
Pain Scores

Abstract Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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