Analysis of SCN9A Gene Variants for Acute and Chronic Postoperative Pain and Morphine Consumption After Total Hysterectomy

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2642-2649
Author(s):  
Junjie Yeo ◽  
Alex T Sia ◽  
Rehana Sultana ◽  
Ban Leong Sng ◽  
Ene-Choo Tan
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Pain Perception ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Morphine Consumption ◽  
Gene Variants ◽  
Chronic Postoperative Pain ◽  
Total Hysterectomy ◽  
Similar Association

Abstract Background Single nucleotide polymorphisms (SNPs) of the voltage-gated sodium channel alpha subunit gene (SCN9A) have been associated with pain in various settings. The aim of this study was to investigate the association of the SNPs to evaluate the influence of common gene variants on chronic postoperative pain (CPSP) and other related pain variables in a cohort of patients who underwent a scheduled hysterectomy. Methods DNA samples from a cohort of 1,075 patients who underwent a scheduled total hysterectomy in our hospital were genotyped for three common SCN9A SNPs using TaqMan assays. Multivariate logistic regression models were used to quantify the association between independent covariates such as pain threshold, pain endurance, pain scores, morphine use, and the presence of chronic pain. Results Frequencies of the minor alleles were different between the different ethnic groups. There was a statistically significant association of rs16851799 with morphine consumption and self-reported postoperative pain for the 1,038 subjects genotyped, with the TT genotype reporting higher pain and using more morphine. For the subpopulation of 446 subjects with chronic pain data, there was a similar association with self-reported postoperative pain and tolerance of pressure pain. Univariate analysis also showed a statistically significant association of rs16851799 with CPSP, whereas multivariable analysis revealed a similar association of rs4387806 with this outcome. There were three haplotypes with different relative frequencies for the CPSP and non-CPSP groups. Conclusions Our results showed that SCN9A polymorphisms could play a role in acute pain perception and the susceptibility to chronic pain.

Is Postoperative Chronic Pain Syndrome Higher with Mesh Repair of Inguinal Hernia?

2010 ◽  
Vol 76 (10) ◽  
pp. 1115-1118 ◽  
Author(s):  
Kristin Masukawa ◽  
Samuel E. Wilson
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Mesh Repair ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Chronic Postoperative Pain ◽  
Anatomic Repair

Chronic postoperative pain has been associated with mesh repair in meta-analysis of clinical trials. We compared the incidence of early complications, recurrence, and chronic pain syndrome in anatomic and mesh repairs in 200 patients. We defined chronic pain syndrome as pain in the inguinal area more than 3 months after inguinal hernia repair, patient referral to pain management, or necessity of a secondary procedure for pain control. The mean follow-up time was 4 years and 2 months for anatomic repair and 3 years and 7 months for mesh repair. The clinical outcomes did not reveal a significant disparity between the 100 consecutive patients who had mesh repair versus the 100 patients who had anatomic repair with regard to the incidence of superficial wound infection (0 vs 2%, P = 0.497), testicular swelling (12 vs 7%, P = 0.335), hematoma (1 vs 0%, P = 0.99), recurrence (3 vs 2%, P = 0.99), or chronic postoperative pain (4 vs 1%, P = 0.369). The anatomic procedure without mesh should continue to be offered to patients who have an initial inguinal hernia repair.

Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery

2014 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Clyde T. Matava, MBCHB ◽  
Mark W. Crawford, MBBS ◽  
Carolyne Pehora, RN ◽  
Basem Naser, MD ◽  
Conor McDonnell, MBCHB
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Morphine Consumption ◽  
Scoliosis Surgery ◽  
Patient Controlled Analgesia ◽  
Duration Of Hospital Stay ◽  
Pain Scores ◽  
Severe Postoperative Pain

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.Methods: The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioidrelated side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant.Results: One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption.Conclusions: The authors have demonstrated that a PCA ratio of demands/deliveries ≥1.5 is predictive of increased opioid requirements and is associated with greater pain scores in the initial 24 hours after surgery, an increased incidence of opioid-related side effects, and duration of hospital stay.

scholarly journals NEUROTRANSMITTER IMBALANCES AND PSYCHOLOGICAL DYSFUNCTIONS AS PREDICATIVE FACTORS OF POSTOPERATIVE CHRONIC PAIN SYNDROME IN OPERATIVE GYNECOLOGY CENTER

2020 ◽  
pp. 48-56
Author(s):  
L.N. Gumenyuk ◽  
L.I. Seytumerova ◽  
A.A. Serafimova ◽  
A.V. Yatsiv
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Depressive Disorders ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Chronic Postoperative Pain ◽  
Group 2 ◽  
Group 1

Chronic postoperative pain is one of the urgent medical and social problems of operative gynecology. The problem is preconditioned by a high prevalence rate, a significant impact on the outcomes of operative therapy and, as a consequence, patients’ quality of life. The goal of the paper is to study the role of preoperative neurotransmitter and psychoemotional dysfunctions in the development of postoperative chronic pain syndrome in an operative gynecology center. Materials and Methods. The study enrolled 156 patients aged 18–45 years who underwent planned surgical treatment for gynecological pathology. Patients were subsequently divided into 2 groups: Group 1 – women with postoperative chronic pain syndrome; Group 2 – women without chronic postoperative pain syndrome. The authors conducted general clinical examination, and also determined the levels of g-aminobutyric acid and β-endorphin in serum of patients using enzyme-linked immunosorbent assay. A visual analogue scale was used to assess quantitative characteristics of pain syndrome. Qualitative characteristics of pain syndrome were assessed according to the McGill Pain Questionnaire. HAM-A and HDRS were used to assess psychoemotional state. Results. Postoperative chronic pain was observed in 39.7 % of patients 12 months after surgery. In the preoperative period, a pain syndrome was registered in all patients. However, there were no significant intergroup differences in its severity. Statistically significant predominance of the affective scale indicators was revealed in the pain syndrome structure in Group 1, while Group 2 demonstrated predominance of the sensory scale indicators (p=0.003). Group 1 demonstrated more pronounced changes in GABA and β-endorphin levels. An inverse correlation was found between the level of β-endorphin and the affective and evaluative McGill questionnaire scales. Various affective pathologies were verified in Group 1. However, depressive disorders dominated. Group 2 demonstrated only subdepression and individual clinically unformed anxiety symptoms. The authors found out depressive disorder correlation with the severity of preoperative pain syndrome according to visual-analogue scale, McGill questionnaire affective scale, and β-endorphin concentration. Conclusion. Neurotransmitter disorders and psychological dysfunctions affect the formation of postoperative chronic pain syndrome. There is a correlation between chronic postoperative pain syndrome, preoperative β-endorphin concentration (r=-0.70; p=0.028), and the severity of depressive disorders (r=0.65; p=0.012), which confirms their role as non-specific prognostic markers while monitoring the postoperative chronic pain syndrome. Keywords: gynecological pathology, postoperative chronic pain syndrome, neurotransmitters, affective disorders. Хроническая послеоперационная боль – одна из актуальных медико-социальных проблем оперативной гинекологии, что обусловлено высоким уровнем распространенности, значительным влиянием на исходы хирургического лечения и, как следствие, качество жизни пациентов. Цель – изучение роли предоперационных нейромедиаторных и психоэмоциональных дисфункций в формировании хронического послеоперационного болевого синдрома в клинике оперативной гинекологии. Материалы и методы. В исследовании приняли участие 156 больных в возрасте от 18 до 45 лет, которым выполнено плановое хирургическое лечение по поводу гинекологической патологии. Пациенты в последующем были разделены на 2 группы: 1-я – женщины с хроническим послеоперационным болевым синдромом; 2-я – пациентки без хронического послеоперационного болевого синдрома. Наряду с общеклиническим обследованием c помощью иммуноферментного анализа определяли уровень кислоты и β-эндорфина в сыворотке крови. С целью оценки количественной характеристики боли применяли визуальную аналоговую шкалу, качественной – болевой опросник McGill, для оценки психоэмоционального статуса – клиническую шкалу HAM-A и HDRS. Результаты. Спустя 12 мес. после оперативного вмешательства хронический послеоперационный болевой синдром наблюдался у 39,7 % обследованных. В предоперационном периоде у всех обследованных отмечался болевой синдром, при этом достоверных межгрупповых различий его интенсивности не выявлено. В структуре болевого синдрома у пациенток 1-й группы выявлено статистически значимое преобладание показателей аффективной шкалы, у женщин 2-й группы – сенсорной (p=0,003). У пациенток 1-й группы изменения уровней ГАМК и β-эндорфина носили более выраженный характер. Установлена обратная корреляционная связь уровня β-эндорфина с показателями аффективной и эвалюативной шкал опросника McGill. Аффективная патология различной степени выраженности верифицирована у всех больных 1-й группы. В структуре преобладали депрессивные нарушения. У пациенток 2-й группы наблюдались лишь субдепрессивные состояния и отдельные, клинически не оформленные симптомы тревоги. Установлены корреляции депрессивных расстройств c выраженностью предоперационного болевого синдрома по визуально-аналоговой шкале, аффективной шкалой опросника McGill, концентрацией β-эндорфина. Выводы. Нейромедиаторные и психологические дисфункции влияют на формирование послеоперационного хронического болевого синдрома. Установлена связь между хроническим послеоперационным болевым синдромом и предоперационными значениями концентрации β-эндорфина (r=-0,70; p=0,028), выраженностью депрессивных расстройств (r=0,65; p=0,012), что подтверждает их роль как неспецифических прогностических маркеров при мониторинге формирования послеоперационного хронического болевого синдрома. Ключевые слова: гинекологическая патология, хронический послеоперационный болевой синдром, нейромедиаторы, аффективные расстройства.

Intra- and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis

2015 ◽  
Vol 7 (1) ◽  
pp. 42-54 ◽  
Author(s):  
Elena Klatt ◽  
Thomas Zumbrunn ◽  
Oliver Bandschapp ◽  
Thierry Girard ◽  
Wilhelm Ruppen
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Postoperative Pain ◽  
Regional Anaesthesia ◽  
Meta Analysis ◽  
Sufficient Evidence ◽  
Chronic Postoperative Pain ◽  
Postsurgical Pain ◽  
Number Of Patients ◽  
Pain At Rest

AbstractBackground and aims The development of postoperative chronic pain (POCP) after surgery is a major problem with a considerable socioeconomic impact. It is defined as pain lasting more than the usual healing, often more than 2–6 months. Recent systematic reviews and meta-analyses demonstrate that the N-methyl-D-aspartate-receptor antagonist ketamine given peri- and intraoperatively can reduce immediate postoperative pain, especially if severe postoperative pain is expected and regional anaesthesia techniques are impossible. However, the results concerning the role of ketamine in preventing chronic postoperative pain are conflicting. The aim of this study was to perform a systematic review and a pooled analysis to determine if peri- and intraoperative ketamine can reduce the incidence of chronic postoperative pain.Methods Electronic searches of PubMed, EMBASE and Cochrane including data until September 2013 were conducted. Subsequently, the titles and abstracts were read, and reference lists of reviews and retrieved studies were reviewed for additional studies. Where necessary, authors were contacted to obtain raw data for statistical analysis. Papers reporting on ketamine used in the intra- and postoperative setting with pain measured at least 4 weeks after surgery were identified. For meta-analysis of pain after 1, 3, 6 and 12 months, the results were summarised in a forest plot, indicating the number of patients with and without pain in the ketamine and the control groups. The cut-off value used for the VAS/NRS scales was 3 (range 0–10), which is a generally well-accepted value with clinical impact in view of quality of life.ResultsOur analysis identified ten papers for the comprehensive meta-analysis, including a total of 784 patients. Three papers, which included a total of 303 patients, reported a positive outcome concerning persistent postsurgical pain. In the analysis, only one of nine pooled estimates of postoperative pain at rest or in motion after 1, 3, 6 or 12 months, defined as a value ≥3 on a visual analogue scale of 0–10, indicated a marginally significant pain reduction.Conclusions Based on the currently available data, there is currently not sufficient evidence to support a reduction in chronic pain due to perioperative administration of ketamine. Only the analysis of postoperative pain at rest after 1 month resulted in a marginally significant reduction of chronic postoperative pain using ketamine in the perioperative setting.ImplicationsIt can be hypothesised, that regional anaesthesia in addition to the administration of perioperative ketamine might have a preventive effect on the development of persistent postsurgical pain. An additional high-quality pain relief intra- and postoperatively as well after discharge could be more effective than any particular analgesic method per se. It is an assumption that a low dose infusion ketamine has to be administered for more than 72 h to reduce the risk of chronic postoperative pain.

scholarly journals Preoperative anxiety induces chronic postoperative pain by activating astrocytes in the anterior cingulate cortex region

2019 ◽  
Vol 65 (9) ◽  
pp. 1174-1180 ◽  
Author(s):  
Damin Gu ◽  
Minmin Zhou ◽  
Chao Han ◽  
Daoyun Lei ◽  
Songhui Xie ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Anterior Cingulate Cortex ◽  
Cingulate Cortex ◽  
Long Term Potentiation ◽  
Preoperative Anxiety ◽  
Anterior Cingulate ◽  
Chronic Postoperative Pain ◽  
Term Potentiation ◽  
Mechanical Thresholds

SUMMARY OBJECTIVE The study aims to explore the relationship between preoperative anxiety and chronic postoperative pain. METHODS A total of forty rats were divided into four groups, control, single-prolonged stress alone, Hysterectomy alone, and SPS+ Hysterectomy. The paw withdrawal mechanical thresholds (PWMT) were examined. qRT-PCR and western blotting assay were performed to detect the GFAP expression in astrocytes isolated from the anterior cingulate cortex (ACC) region. In addition, the long-term potentiation (LTP) in ACC was examined. RESULTS Rats in the SPS group or the Hysterectomy alone group had no significant effect on chronic pain formation, but SPS can significantly induce chronic pain after surgery. Astrocytes were still active, and the LTP was significantly increased three days after modeling in the SPS+Hysterectomy group. CONCLUSIONS anxiety can induce chronic pain by activating astrocytes in the ACC region.

CHRONIC POSTOPERATIVE PAIN AFTER ANTERIOR INGUINAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
A Arango Bravo ◽  
V Sosa Rodríguez ◽  
E Pérez Prudencio ◽  
M Soto Dopazo ◽  
C Nuño Iglesias ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Fixation Method ◽  
Inguinal Hernioplasty ◽  
Chronic Postoperative Pain ◽  
Bilateral Hernia ◽  
The Third

Abstract INTRODUCTION Chronic postoperative pain after inguinal hernia repair is one of the most prevalent sequel after inguinal hernioplasty. MATERIAL AND METHODS A retrospective descriptive study was done, studying 414 patients who underwent programmed anterior inguinal hernioplasty in our centre between 01/01/18 and 12/31/19. Laterality, the type of mesh used and fixation method are studied, as well as the appearance of early postoperative pain, at one month and after the third month. P &lt; 0.05 is considered a statistically significant value. RESULTS Of 414 patients, 90.6% were male, with a mean age of 65.5 years. In 89.1% the surgery was unilateral and 8.7% was hernia recurrence. 46.1% presented pre-surgical pain. 10.4% presented pain in the first check-up and 1.9% chronic pain. In 81.4%, flat mesh was placed, fixing it with suture in 83.6%. Greater pain was observed in the first review in patients operated on for bilateral hernia (22%, p 0.006). No differences were found regarding age, sex or recurrent hernias. In bilateral hernias, recurrent hernias and hernioplasty with plug, more postoperative complications were observed with a p &lt; 0.05. In those patients who present complications, postoperative pain was observed in the first review in 16% (p &lt; 0,05). CONCLUSIONS Patients who underwent bilateral hernioplasty present more complications and greater postoperative pain in the first revision, but not after the third postoperative month. No differences were observed in chronic pain in primary vs recurrent hernias. Post-surgical complications are related to greater initial postoperative pain but not to chronic pain.

Pain Trajectory After Ankle Surgeries for Osteoarthritis

2019 ◽  
Vol 40 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Leah Guichard ◽  
Alexis Vanhaesebrouck ◽  
Dominique Fletcher ◽  
Yves Stiglitz ◽  
Alexandra Rouquette ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Psychological Distress ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Univariate Analysis ◽  
Brief Pain Inventory ◽  
Opioid Consumption ◽  
Preoperative Pain ◽  
Distress Score ◽  
Ankle Surgery

Background: The pain trajectory after ankle surgeries for osteoarthritis is relevant to describe. The purpose of this prospective study was to describe pain after ankle surgery and explore the link between perioperative factors and the development of postoperative pain. Methods: Duration, severity, type of preoperative pain, psychological distress, opioid consumption, and type of surgery were evaluated in 49 patients who were followed for 18 months. Acute postoperative pain in the first 10 days after surgery was modeled by a pain trajectory. Univariate analysis was conducted to identify predictors of acute pain trajectory and chronic pain. Results: Eighty-seven percent of patients had preoperative chronic pain, 34% had a high postoperative pain trajectory, 44% of whom reported chronic pain at 18 months. The patients who developed a high acute pain trajectory had higher preoperative opioid consumption (50% vs 19.4%, P = .04), a higher incidence of preoperative neuropathic pain (68.8% vs 32.3%, P = .02), a higher brief pain inventory score (51.5 vs 34, P = .01), and a higher psychological distress score (8 vs 3, P = .002). The patients who developed chronic pain had a higher brief pain inventory score (42 vs 33, P = .04), a higher psychological distress score (6 vs 4, P = .04), and a higher preoperative pain intensity (8 vs 6, P = .008). No association was found between the type of ankle surgery and pain. Conclusion: Patients with psychological distress and more severe preoperative pain were more at risk to develop acute pain and chronic pain after ankle surgery regardless of the surgery performed. Level of Evidence: Level II, prospective comparative study.

scholarly journals A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective

2019 ◽  
Vol 99 (7) ◽  
pp. 933-945 ◽  
Author(s):  
Lisa Goudman ◽  
Eva Huysmans ◽  
Kelly Ickmans ◽  
Jo Nijs ◽  
Maarten Moens ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Lumbar Radiculopathy ◽  
Lumbar Surgery ◽  
Clinical Perspective ◽  
Chronic Postoperative Pain ◽  
Biopsychosocial Approach ◽  
Neuroscience Education ◽  
Socioeconomic Burden ◽  
General Goals

AbstractAround 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.

scholarly journals Сhronic pain syndrome, risk factors for its development at stage of operative intervention

2021 ◽  
Vol 5 ◽  
pp. 5-13
Author(s):  
A.M. Morozov ◽  
◽  
A.N. Sergeev ◽  
V.A. Kadykov ◽  
S.V. Zhukov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Syndrome ◽  
Prevention Measures ◽  
Chronic Postoperative Pain ◽  
Patients Experience ◽  
Selection Of

At the present time, approximately 80% patients experience postoperative pain which is the leading entity in the overall structure of chronic pain. The aim of this article is investigation of reasons and risk factors underlying its development. Based on the information provided in domestic and international sources in open databases, analysis of these problems has been carried out. Selection of adequate therapy is particularly important against the background of the need for long-term intake of strong analgesics or the impossibility of pain management due to the neurogenic aetiology of the disease. In this connection, it is necessary to study factors predisposing patients to development of chronic postoperative pain and resort to prevention measures in order to reduce the risk of pain syndrome development.

Chronic postoperative pain syndrome - «a pitfall» of modern surgery

2016 ◽  
Vol 10 (1) ◽  
pp. 5-18
Author(s):  
Alexei M. Ovechkin
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Pain Syndrome ◽  
Early Postoperative Period ◽  
Current Data ◽  
Main Role ◽  
Chronic Pain Syndrome ◽  
Preventive Action ◽  
Chronic Postoperative Pain ◽  
Perioperative Analgesia

The overview is devoted to the problem of chronic postoperative pain. At the moment every fifth patient undergone elective or emergency surgery suffers from chronic postoperative pain. The paper presents current data on epidemiology of chronic pain syndrome following different operations, as well as diagnostic criteria and pathophysiological mechanisms of transformation of acute postoperative pain into chronic pain syndrome. Risk factors responsible of formation of chronic postoperative pain are described in details, among which the most valuable are presence of pain before surgery, trauma of the surgery, intensity of pain in early postoperative period. The article discusses modern methods of prophylaxis of chronic postoperative pain. The most perspective drugs for preventive action include gabapentinoids and ketamine in subanesthetic doses. The main role in prophylaxis belongs to regional anesthesia and analgesia. The role of multimodal approach to perioperative analgesia is presented in the work as well.

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