Dynamic analysis of variations in postoperative pain trajectories over time in patients receiving epidural analgesia using latent curve models

ObjectiveThe efficacy of parecoxib as pre-emptive analgesia still remains controversial. This study aimed to investigate how pre-emptive analgesia with parecoxib affected postoperative pain trajectories over time in patients undergoing thoracic surgery.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsWe collected 515 patients undergoing video-assisted thoracoscopic surgery at a tertiary medical centre between September 2016 and August 2017.InterventionsPre-emptive parecoxib before surgery.Primary and secondary outcome measuresDaily numeric rating pain scores in the first postoperative week.ResultsA total of 196 (38.1%) of the recruited patients received parecoxib preoperatively. The latent curve analysis revealed that woman, higher body weight and postoperative use of parecoxib were associated with increased baseline level of pain scores over time (p=0.035, 0.005 and 0.048, respectively) but epidural analgesia and preoperative use of parecoxib were inclined to decrease it (both p<0.001). Regarding the decreasing trends of changes in daily pain scores, older age and epidural analgesia tended to steepen the slope (p=0.014 and <0.001, respectively). Preoperative use of parecoxib were also related to decreased frequency of rescue morphine medication (HR=0.4; 95% CI 0.25 to 0.65).ConclusionsPre-emptive analgesia with parecoxib was associated with decreased baseline pain scores but had no connection with pain decreasing trends over time. Latent curve analysis provided insights into the dynamic relationships among the analgesic modalities, patient characteristics and postoperative pain trajectories.

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Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2019-031936 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031936 ◽

Cited By ~ 4

Author(s):

Ying-Hsuan Tai ◽

Hsiang-Ling Wu ◽

Shih-Pin Lin ◽

Mei-Yung Tsou ◽

Kuang-Yi Chang

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Abdominal Surgery ◽

Influential Factors ◽

Secondary Outcome ◽

Patient Controlled Analgesia ◽

Latent Curve ◽

Latent Curve Models ◽

Pain Trajectories ◽

Complex Relationships

ObjectivesWe aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsPatients receiving IV-PCA after surgery.Primary and secondary outcome measuresPrimary outcome was the postoperative pain scores.ResultsA total of 3376 patients and 20 838 pain score observations were analysed using latent curve models. Female and longer anaesthesia time increased the baseline level of pain (p=0.004 and 0.003, respectively), but abdominal surgery and body weight decreased it (both p<0.001). Regarding the trend of pain resolution, lower abdominal surgery steepened the slope (p<0.001); older age, American Society of Anesthesiologists (ASA) class ≥3 and longer anaesthesia time tended to flatten the slope (p<0.001, =0.019 and <0.001, respectively). PCA settings did not affect the variations in postoperative pain trajectories.ConclusionsPatient demographics, ASA class, anaesthesia time and surgical sites worked together to affect postoperative pain trajectories in patients receiving IV-PCA. Latent curve models provided valuable information about the dynamic and complex relationships between the pain trajectories and their influential factors.

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THE INFLUENCE OF LONELINESS AND RURAL RESIDENCE ON DEPRESSION IN LATER LIFE

Innovation in Aging ◽

10.1093/geroni/igz038.3051 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S828-S828

Author(s):

Na Sun ◽

Cassandra Hua ◽

Xiao Qiu ◽

J Scott Brown

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Later Life ◽

Rural Residence ◽

Time Data ◽

Latent Curve ◽

Rural Residency ◽

Latent Curve Models ◽

Over Time

Abstract Loneliness is associated with depression among older adults. Limited research has examined the role of rurality in relationship to loneliness and depression; the extant research has mixed findings. The socioemotional selectivity theory states that as people age the quality of relationships become more important than the quantity (English & Carstensen, 2016). Individuals in rural areas may have a low quantity of relationships but deeper social ties within the community; thus, they may be less likely to become depressed over time. The association between loneliness and depression may be amplified for people in non-rural areas because they are surrounded by other people but lack close relationships that are most important during the aging process. This study examines the effect of living in rural areas on loneliness on predicting baseline depression and loneliness, as well as changes in these outcomes over time. Data are from the 2006-2014 waves of Health Retirement Study. Regression models examine the relationship between depression loneliness and rural residence controlling for health conditions and demographic characteristics. Latent curve models examine the disparity in trajectories of loneliness and depressive symptoms by urban and rural residence. Older adults who feel lonely (p<.001) and in urban areas (p<.0.05) are more likely to be depressed. Furthermore, the effect of loneliness on depression is weakened by rural residence (p<.05). It is salient to understand the protective effect of rural residency on depression among older adults in the U.S. We discuss implications for policy.

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Mixture Modeling for Lifespan Developmental Research

Oxford Research Encyclopedia of Psychology ◽

10.1093/acrefore/9780190236557.013.364 ◽

2019 ◽

Cited By ~ 3

Author(s):

Alexandre J.S. Morin ◽

David Litalien

Keyword(s):

Mixture Models ◽

Structural Equation ◽

Equation Modeling ◽

Modeling Framework ◽

Mixture Regression ◽

Growth Mixture ◽

Multiple Group ◽

Latent Curve ◽

Latent Curve Models ◽

Over Time

As part of the Generalized Structural Equation Modeling framework, mixture models are person-centered analyses seeking to identify distinct subpopulations, or profiles, of participants differing quantitatively and qualitatively from one another on a configuration of indicators and/or relations among these indicators. Mixture models are typological (resulting in a classification system), probabilistic (each participant having a probability of membership into all profiles based on prototypical similarity), and exploratory (the optimal model is typically selected based on a comparison of alternative specifications) in nature, and can take different forms. Latent profile analyses seek to identify subpopulations of participants differing from one another on a configuration of indicators and can be extended to factor mixture analyses allowing for the incorporation of latent factors to the model. In contrast, mixture regression analyses seek to identify subpopulations of participants’ differing from one another in terms of relations among profile indicators. These analyses can be extended to the multiple-group and/or longitudinal analyses, allowing researchers to conduct tests of profile similarity across different samples of participants or time points, and latent transition analyses can be used to assess probabilities of profiles transition over time among a sample of participants (i.e., within person stability and change in profile membership). Finally, growth mixture analyses are built from latent curve models and seek to identify subpopulations of participants following quantitatively and qualitatively distinct trajectories over time. All of these models can accommodate covariates, used either as predictors, correlates, or outcomes, and can even be extended to tests of mediation and moderation.

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Application of Latent Curve Models in Medical Research - A Review

European Neurological Review ◽

10.17925/enr.2009.04.02.52 ◽

2009 ◽

Vol 4 (2) ◽

pp. 52

Author(s):

Jun-Hao Pan ◽

Xin-Yuan Song ◽

Timothy Kwok ◽

◽

...

Keyword(s):

Medical Research ◽

Fundamental Principle ◽

Statistical Technique ◽

Medical Applications ◽

Individual Change ◽

Medical Field ◽

Latent Curve ◽

Latent Curve Models ◽

The Relationship ◽

Over Time

Recently, latent curve modelling (LCM) has received increasing attention in the analysis of longitudinal data. It is a method to model individual change and to assess the effects of co-variates and the relationship among multiple outcomes. It provides an integrated and flexible approach in modelling developmental processes from both inter- and intra-individual perspectives. Similar to conventional longitudinal analysis, the main objectives of this model are to characterise changes in the response of interest over time and to examine the selected covariates that contribute to those changes. In this article the fundamental principle of LCM is briefly introduced. Several important kinds of LCM, including linear LCM, non-linear LCM, multilevel LCM and mixture LCM, together with their applications in medical research, are reviewed. We believe that this statistical technique should become more popular in medical applications, and that the medical field would benefit from increased use of this powerful and flexible statistical method.

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Assessment of pain during rest and during activities in the postoperative period of cardiac surgery

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3115.2391 ◽

2014 ◽

Vol 22 (1) ◽

pp. 136-143 ◽

Cited By ~ 6

Author(s):

Larissa Coelho de Mello ◽

Silvio Fernando Castro Rosatti ◽

Priscilla Hortense

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Postoperative Complications ◽

Postoperative Period ◽

Pain Assessment ◽

Descriptive Study ◽

Deep Breathing ◽

Cohort Design ◽

Surgical Recovery ◽

Over Time

OBJECTIVE: to assess the intensity and site of pain after Cardiac Surgery through sternotomy during rest and while performing five activities. METHOD: descriptive study with a prospective cohort design. A total of 48 individuals participated in the study. A Multidimensional Scale for Pain Assessment was used. RESULTS: postoperative pain from cardiac surgery was moderate during rest and decreased over time. Pain was also moderate during activities performed on the 1st and 2nd postoperative days and decreased from the 3rd postoperative day, with the exception of coughing, which diminished only on the 6th postoperative day. Coughing, turning over, deep breathing and rest are presented in decreased order of intensity. The region of the sternum was the most frequently reported site of pain. CONCLUSION: the assessment of pain in the individuals who underwent cardiac surgery during rest and during activities is extremely important to adapt management and avoid postoperative complications and delayed surgical recovery.

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Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽

10.1093/qjmed/hcab086.055 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hala Gomaa Salama ◽

Ahmed Ali El- Shebiny ◽

Abd Al Aziz Abdullah Abd Al Aziz ◽

Mariam Mahmoud Ahmed Ali Shehata

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Nerve Block ◽

Femoral Nerve Block ◽

Weight Bearing ◽

Femoral Nerve ◽

Disease Process ◽

Continuous Epidural Analgesia ◽

Significant Difference ◽

Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

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Acomparative Study between Epidural Analgesia of Levobupivacaine with Fentanyl versus Dexmedetomidine for knee replacement surgeries

QJM ◽

10.1093/qjmed/hcab086.093 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Naglaa Mohammed Ali ◽

Ehab Hamed Abd El Mohsen ◽

Rania Maher Hussien ◽

Omar Abd El Gawad Kamel Massoud

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Knee Replacement ◽

Sedation Score ◽

Gamma Aminobutyric Acid ◽

University Hospitals ◽

Research Committee ◽

Duration Of Action ◽

Dose Dependent Decrease ◽

Double Blinded

Abstract Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome. Objective To compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural levobupivacaine in knee replacement surgeries regarding duration of action and the analgesic potency of both drugs. Patients and Methods This prospective double blinded randomized clinical trial study was conducted in Maadi Military and Ain Shams University Hospitals after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent knee replacement surgeries were included in the study their ages range between 21 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30). Results As regards sedation score intraoperative and postoperative, in the present study, we found that Ramsay sedation score was significantly higher in group ‘BD’ when compared to group ‘BF’ intraoperative and postoperative. This finding may be attributed to the sedative properties of dexmedetomidine that is far superior to fentanyl acting by dose-dependent decrease in activity of noradrenergic neurons in the brain stem via post-synaptic receptor-mediated inhibition. This increases gamma-aminobutyric acid (GABA) neurone activity, which mediates central sedative effects. Conclusion Epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for lower limb surgeries. Both adjuvants reduced the epidural dose of levobupivacaine and potentiated its efficacy.

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