Time Series Analysis of the Pain Diary Data Obtained during the Multicenter Study for Hydroxyurea (MSH) Clinical Trial.

Abstract The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) was a randomized double-blind placebo-controlled trial to test whether hydroxyurea could reduce the rate of painful crises in adult patients who had at least three painful crises per year. Daily pain diaries were collected biweekly for 299 MSH patients. Patients rated daily pain on a linear scale 0 through 9. The daily pain data was collected to provide useful information regarding the efficacy of hydroxyurea in reducing the rate of painful crises. The objective of this analysis was to determine if there was an underlying time series pattern associated with the MSH pain diary data, especially one indicative of a calendar or seasonal association. An Unobserved Component Model (UCM) was used to determine, based on empirical data, if there was a cycle and/or trend associated with the time series. The times series started on December 1991 and ended on December 1994. The series was equally spaced and univariate. The equal spacing was a monthly interval. The average pain score for each two- week diary period was used to create each unit of analysis. This analysis considered three groupings of patients: all patients, hydroxyurea patients and placebo patients. The results of the modeling indicated that there was indeed both a cycle and a trend associated with the MSH pain diary data. This is the case for each group of patients considered. All three groups had a cycle pattern that seemed to show a seasonal behavior of average pain scores (the changing of the season seemed to show an approximate transition from trough (Spring) to peak (Fall/Winter) and peak to trough). There was a downward trend in average pain scores for both the all patientsgroup and the hydroxyurea patientsgroup. However, there was an upward trend in average pain score for the placebo patientsgroup. This may reflect the result shown in the MSH Clinical Trial, that HU usage reduced the average pain scores reported by patients.

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The effectiveness of red ginger extract to decreasemenstrual pain level in adolescent at Al Husna 2 Islamic Boarding School Kediri year 2016

International Journal of Health Science and Technology ◽

10.31101/ijhst.v1i2.1108 ◽

2019 ◽

Vol 1 (2) ◽

Author(s):

Rochmanita Sandya Afindaningrum ◽

Rahma Kusuma Dewi

Keyword(s):

Pain Score ◽

Boarding School ◽

Wilcoxon Test ◽

Distribution Data ◽

P Value ◽

Menstrual Pain ◽

Pain Scores ◽

Average Pain ◽

Average Pain Score ◽

Red Ginger

Dismenorea is menstrual problems that is oftenexperienced adolescent and is caused by the occurence of uterine contractions due to increased prostaglandin. The content of gingerol in ginger red can overcome dysmenorrhoea by blocking prostaglandin. The purpose of this study was to know the effect of red ginger drink to the decline in the level of menstrual pain (in adolescent at Boarding school Al Husna 2 Kediri. Pre-experimental research design used by the approach of one group pretest posttest design. The population of this study was all students who experience dismenorea. Sample of adolescents who experience dismenoreawere 17 people with accidental sampling. The average pain score before treatment was 2.53, after treatment average pain score was 1, 59 based on the description, it shows that there was a decrease in pain scores of 0.94 or 37.1%. Normality test is known that the distribution of data in pain scores before being treated distribution is not normal with a p-value of <0.05 while after treated with distribution data is not normal P <0.05, making the results statistically using the Wilcoxon test showed the value of P = 0.000 (p <α = 0,05). There is an influence of red ginger drink to the decline in the level of menstrual pain (dysmenorrhoea) in adolescent at Boarding school Al Husna 2 Kediri. Respondents are advised to drink red ginger when dysmenorrhoea.

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Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2012.10.003 ◽

2013 ◽

Vol 4 (2) ◽

pp. 77-83 ◽

Cited By ~ 8

Author(s):

Jarkko Kalliomäki ◽

Bror Jonzon ◽

Karin Huizar ◽

Michael O’Malley ◽

Anita Andersson ◽

...

Keyword(s):

Neuropathic Pain ◽

Pain Score ◽

Chemokine Receptor ◽

Plasma Levels ◽

Analgesic Efficacy ◽

Treatment Groups ◽

Pain Scores ◽

Average Pain ◽

Average Pain Score ◽

Ccr2 Antagonist

AbstractBackground and aimsPreclinical data suggest that the chemokine receptor 2 (CCR2) is involved in the pathophysiology of neuropathic pain through modulation of neuronal excitability, synaptic transmission and activation of spinal cord microglia. CCR2-antagonists have shown to be effective in preclinical models of neuropathic pain. The aim of this study was to evaluate the analgesic efficacy, safety and tolerability of a novel CCR2-antagonist, AZD2423, in patients with painful diabetic neuropathy (PDN).MethodsThis was a double-blind, randomized, parallel-group, multi-center study in patients with symmetric distal sensory polyneuropathy due to type 1 or 2 diabetes and duration of neuropathic pain between 3 months and 5 years. Concomitant treatment with neuropathic pain medications (e.g. anticonvulsants, tricyclic antidepressants, serotonin-noradrenaline uptake inhibitors, opioids, topical lidocaine or capsaicin) was not allowed. 134 patients with PDN were equally randomized to 28 days oral administration of 20 mg AZD2423,150 mg AZD2423, or placebo. The primary efficacy variable was the change of average pain score from 5-days baseline to the last 5 days of treatment, measured with numerical rating scale (NRS, 0–10). The secondary efficacy measures included NRS worst pain scores, patient global impression of change, pain interference on sleep and activity, and neuropathic pain symptom inventory (NPSI).ResultsThe change of NRS average pain score was not significantly different between treatment groups (AZD2423 20mg: –1.50; AZD2423 150 mg: –1.35; placebo: –1.61). The NPSI total score and three out of five subscores (evoked pain, pressing/deep pain and paresthesia/dysesthesia) tended to be reduced more by AZD2423 150 mg than by placebo. No other secondary efficacy variables differed between treatment groups. The frequency and type of adverse events for AZD2423 were similar to placebo. The achieved plasma levels of AZD2423 in the two dose groups were in line with predictions from pharmacokinetic data previously obtained in healthy volunteers. Dose-dependent increase of plasma levels of the ligand of CCR2 (CCL2; chemokine ligand 2) and decrease of the mean levels of monocytes (–27% by AZD2423 150 mg) suggested that the administrated doses of AZD2423 interacted with the CCR2 target.ConclusionThe CCR2-antagonist AZD2423 showed no analgesic efficacy in PDN based on NRS average pain scores and global and functional pain outcome measures. The NPSI data suggested possible effects on certain sensory components of pain. There were no major safety or tolerability concerns.ImplicationsTreatment with a CCR2-antagonist does not have a clinically important analgesic effect in an overall PDN population.

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Impact of Postoperative Intravenous Acetaminophen on Opioid Requirements and Pain Scores Following Gynecologic Procedures

Journal of Pharmacy Practice ◽

10.1177/0897190014568384 ◽

2016 ◽

Vol 29 (5) ◽

pp. 475-479 ◽

Cited By ~ 2

Author(s):

Laura G. Stoudenmire ◽

Christy M. Norman ◽

Erin Z. Latif

Keyword(s):

Adverse Events ◽

Pain Score ◽

Control Group ◽

Pain Scores ◽

Intravenous Acetaminophen ◽

Average Pain ◽

Average Pain Score ◽

Sparing Effect ◽

The Impact ◽

Postoperative Administration

Objective: This study aims to assess the impact of postoperative intravenous (IV) acetaminophen on opioid requirements and pain scores in patients following gynecologic procedures. Study Design: A retrospective cohort study of patients undergoing gynecologic procedures was conducted to assess the impact of adding scheduled IV acetaminophen to postoperative analgesic regimens. The control group consisted of patients admitted prior to formulary addition of IV acetaminophen; the study group consisted of patients admitted after formulary addition of IV acetaminophen who received scheduled IV acetaminophen for at least the first 24 hours postoperatively. Opioid requirements 0 to 24 hours postoperatively served as the primary end point. Secondary end points included average pain score, cumulative acetaminophen dose, nonopioid analgesic requirements, and rate of adverse events 0 to 24 hours postoperatively. Results: One hundred and thirty-seven patients who underwent a gynecologic procedure from January 2009 to April 2013 were included in this study. Baseline characteristics were similar between the groups. In the first 24 hours postoperatively, there was no difference in opioid requirements between the groups (21 mg [interquartile range, IQR, 15-39.8 mg] vs 32.6 mg [IQR, 16.75-41 mg], P = 0.150). The average pain score and incidence of adverse events did not differ between the 2 groups. Conclusion: Postoperative administration of IV acetaminophen did not provide a significant opioid-sparing effect in patients undergoing gynecologic procedures.

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A Retrospective Analysis of Gabapentinoid and Opioids to Opioid Monotherapy for Pain Relief in Patients with Chronic Neck and Low Back Pain

Pain Medicine ◽

10.1093/pm/pnab006 ◽

2021 ◽

Author(s):

Nebojsa Nick Knezevic ◽

Tabish Aijaz ◽

Alvaro Ortega-Camacho ◽

Kenneth D Candido

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Score ◽

Spinal Pain ◽

Opioid Consumption ◽

Low Back ◽

Pain Scores ◽

Average Pain ◽

Average Pain Score ◽

Chronic Spinal Pain

Abstract Objective We compared the reduction in pain and opioid consumption in patients with chronic spinal pain on concomitant gabapentinoids and opioids with patients using opioids only. Design This was a retrospective chart review of patients with chronic neck or low back pain who were on opioids with at least 24-month follow-up. Setting Single-center pain clinic in an urban setting. Subjects 167 patients with chronic spinal pain lasting at least 6 months. Method Patients on gabapentin or pregabalin were included in the gabapentinoid group, while the other patients were included in the non-gabapentinoid group. Primary outcome was assessment of pain scores measured via a numeric rating scale (NRS), and secondary outcomes were response to the treatment (>2 point reduction on NRS) and daily opioid use measured in morphine milliequivalents. Results Pain scores were reduced in the first 6 months and plateaued after that in both groups. At the end of 24 months, the average pain score was 6.71 in the gabapentinoid group, while the average pain score was 7.18 in the non-gabapentinoid group. There was no statistical significance between the groups (p = 0.28). There was no difference in response to treatment in gabapentinoid group (33.3%) when compared to non-gabapentinoid group (32.7%). We also failed to find any significant difference in daily opioid usage between the two groups. Conclusion: Gabapentinoids may not lead to reduction in pain or opioid consumption in patients with chronic spinal pain. A careful approach must be adopted while prescribing gabapentinoids in the chronic spinal pain patient population.

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Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

Pain Medicine ◽

10.1093/pm/pnaa240 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3437-3442

Author(s):

Hamed Basir Ghafouri ◽

Niloofar Abazarian ◽

Mohammadreza Yasinzadeh ◽

Ehsan Modirian

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Pain Score ◽

Randomized Clinical Trial ◽

Renal Colic ◽

Rating Scale ◽

Pain Scores ◽

Intravenous Paracetamol ◽

Significant Difference ◽

Intranasal Desmopressin

Abstract Objective To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. Design Randomized clinical trial. Setting This study was conducted in the emergency unit of a university hospital. Subjects Patients referred to the emergency room with renal colic. Primary Outcome Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. Methods In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. Results Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (>3) in the desmopressin group (P < 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (>6). Conclusions Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.

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Acupuncture at BL67 for Mild Postpartum Depression: A Prospective Case Series

Acupuncture in Medicine ◽

10.1136/acupmed-2017-011473 ◽

2018 ◽

Vol 36 (5) ◽

pp. 339-342 ◽

Cited By ~ 3

Author(s):

Chen Bin Tian

Keyword(s):

Acupuncture Therapy ◽

Postpartum Depression ◽

Pain Score ◽

Acupuncture Point ◽

Clinical Effects ◽

Hamilton Depression Scale ◽

Hamd Score ◽

Average Pain ◽

Average Pain Score ◽

Pre Treatment

Objective The aim of this study was to explore the effects of acupuncture on mild postpartum depression (PPD). Methods 15 patients diagnosed with PPD were enrolled in the study. Patients who satisfied the inclusion criteria received acupuncture therapy eight times over 4 weeks in the form of two 20-min treatment sessions per week. The treatment site was the BL67 acupuncture point (on the outside of the fifth toenail). After disinfecting the skin on the toes, sterile steel needles were gently inserted into the acupuncture point until the patient started to feel numb or swollen, a sensation known as de qi. Acupuncture was performed by the same doctor using HuanQiu stainless steel needles that were 0.2 mm in diameter and 40 mm in length. The Hamilton Depression Scale (HAMD) was used to evaluate the clinical effects of this therapy. Questionnaires were distributed to patients before therapy and 1 week after therapy and were immediately completed and checked. Results Treatment was associated with symptomatic improvement for all patients who adhered to therapy. The nine patients who completed treatment had an average pain score of 6.66 (SD 0.86); these patients’ average pre-treatment pain score was 10.83 (SD 1.47). Six patients who did not complete treatment had an average pain score of 11.23 (SD 1.48); the average pre-treatment pain score of these patients was 10.5 (SD 2.21). Thus, symptoms did not significantly improve for patients who failed to adhere to the therapy. There was no significant difference between the two groups with respect to HAMD score before treatment (P=0.363). By contrast, asignificant between-group difference in post-treatment HAMD score was detected (P=0.001). Two patients discontinued treatment due to haemorrhage at the site of needling, and four patients discontinued treatment due to the inconvenience of traffic. There were no significant complications. Conclusion Acupuncture therapy at BL67 may alleviate symptoms of mild PPD, however controlled clinical investigations are required to confirm its efficacy and effectiveness for this condition.

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Survivor pain: Experience at an oncology palliative care clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.260 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 260-260

Author(s):

Cristian Zanartu ◽

Lisa Emond ◽

Ann Wojtaszczyk

Keyword(s):

Palliative Care ◽

Cancer Survivors ◽

Risk Mitigation ◽

Opioid Analgesics ◽

The United States ◽

Care Clinic ◽

Pain Scores ◽

Average Pain ◽

Average Pain Score ◽

Opioid Medications

260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.

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Demographic and clinical features do not affect the outcome of combined endovenous therapy to treat leg swelling

Vascular ◽

10.1177/1708538118760742 ◽

2018 ◽

Vol 26 (5) ◽

pp. 472-476 ◽

Cited By ~ 1

Author(s):

Ahmad Alsheekh ◽

Anil Hingorani ◽

Afsha Aurshina ◽

Pavel Kibrik ◽

Natalie Marks ◽

...

Keyword(s):

African Americans ◽

Pain Score ◽

Thermal Ablation ◽

Iliac Vein ◽

Average Degree ◽

Number Of Patients ◽

Average Pain ◽

Average Pain Score ◽

Race Ethnicity ◽

Vein Stenosis

Background There have been well-documented implications of race/ethnicity on the outcome of various vascular diseases, yet there are limited data on risk factors and outcome of lower limb swelling. While many patients improve with endovenous therapy (thermal ablation or iliac vein stenting), some patients’ symptoms persist. The goal of this study was to identify clinical factors including race/ethnicity related to persistent leg swelling after treatment with both iliac vein stenting and thermal ablation. Methods From February 2012 to February 2014, this observational study analyzed data for 173 patients with chronic venous insufficiency who underwent both iliac vein stent placement as well as thermal ablation (radiofrequency ablation or endovenous laser ablation). All procedures of the thermal ablations and the iliac vein stenting were staged. Iliac vein stenosis was identified using intravascular ultrasound of the iliofemoral venous segment showing >50% cross-sectional area or diameter reduction. The patients were queried to the resolution of their leg swelling after both procedures were performed. The resolution of swelling was correlated with age, gender, presenting sign according to CEAP classification, race/ethnicity and degree of iliac vein stenosis. Patients were categorized by Caucasians ( n = 97), African Americans ( n = 27), or Hispanics ( n = 49). Statistical analysis performed using Chi-square and Student’s t test. Results Of the total 173 patients who underwent both endovenous closure and iliac vein stent placements, 117 (67.6%) patients were women. The average age was 67 (±13 SD) years. The average pain score was 2.9(±3.1 SD). The average degree of iliac vein stenosis was 66.5(±13.3 SD). About 56.1% were Caucasians, 15.6% were African Americans, and 28.3% were Hispanics. The number of patients with iliac vein stent thrombosis was 2. One hundred fifty-two (87.9%) patients stated that they had improvement in swelling after combined procedures, 100 (65.8%) patients were women. The average age was 67.3 (±13 SD) years. The average pain score was 2.9 (±3.1 SD). The average degree of iliac vein stenosis was 67.3% (±12.8 SD). About 56.6% were Caucasians, 15.1% were African Americans, and 28.3% were Hispanics. The number of patients with iliac vein stent thrombosis was 1. Twenty-one (12.1%) patients stated they had no improvement after both procedures. Correlating these group factors with the group of patients who improved their swelling after the combined procedures we found the following: 17 (81%) of these patients were females ( P=0.16). The average age was 68.4 (±17 SD) years ( P=0.72 SD). The average pain score was 3.2 (±3.7 SD) ( P=0.68). The average degree of iliac vein stenosis was 60.2% (±15.9 SD) ( P=0.02). Around 52.4% were Caucasians, 19% were African Americans, and 28.6% were Hispanics ( P=0.88). The number of patients with iliac vein stent thrombosis was 1 ( P = 0.1). Conclusion These data suggest that the clinical factors including race are not clinically significant factors in the response to swelling after combined iliac stent and endovenous ablation procedures. Interestingly, a higher degree of iliac vein stenosis was associated with improved resolution of swelling

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Detailing postoperative pain and opioid utilization after periacetabular osteotomy with automated mobile messaging

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz049 ◽

2019 ◽

Vol 6 (4) ◽

pp. 370-376

Author(s):

Christina Hajewski ◽

Chris A Anthony ◽

Edward O Rojas ◽

Robert Westermann ◽

Michael Willey

Keyword(s):

Postoperative Pain ◽

Response Rate ◽

Periacetabular Osteotomy ◽

Pain Medication ◽

Pain Level ◽

Pain Scores ◽

Medication Utilization ◽

Patient Reported ◽

Average Pain ◽

Daily Pain

Abstract In the setting of periacetabular osteotomy (PAO), this investigation sought to (i) describe patient-reported pain scores and opioid utilization in the first 6 weeks following surgery and (ii) evaluate the effectiveness of postoperative communication using a robotic mobile messaging platform. Subjects indicated for PAO were enrolled from a young adult hip clinic. For the first 2 weeks after surgery, subjects received daily mobile messages inquiring about pain level on a 0–10 scale and the number of opioid pain medication tablets they consumed in the previous 24 h. Messaging frequency decreased to 3 per week in Weeks 3–6. Pain scores, opioid utilization and response rates with our mobile messaging platform were quantified for the 6-week postoperative period. Twenty-nine subjects underwent PAO. Twenty-one had concurrent hip arthroscopy. Average daily pain scores decreased over the first four postoperative days. Average pain scores reported were 5.9 ± 1.9, 4.1 ± 3.3 and 3.0 ± 3.5 on Day 1, Day 14 and Week 6, respectively. Reported opioid tablet utilization was 5.0 ± 3.2, 2.2 ± 2.0 and 0.0 ± 0.0 on Days 1 and 14 and at 6 weeks. Response rate for participants completing the 6-week messaging protocol was 84.1%. Patient-reported pain scores decreased over the first two postoperative weeks following PAO before plateauing in weeks 3–6. Opioid pain medication utilization increased in the first postoperative week before gradually declining to no tabs consumed at 6 weeks after PAO. Automated mobile messaging is an effective method of perioperative communication for the collection of pain scores and opioid utilization in patients undergoing PAO.

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P208 PARAVERTEBRAL CATHETER ANALGESIA FOR MINIMALLY INVASIVE IVOR LEWIS OESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.208 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

den Berg J van ◽

K Tabrett ◽

E Cheong

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Pain Score ◽

Epidural Haematoma ◽

Intercostal Nerve ◽

Minimal Invasive ◽

Intercostal Nerve Block ◽

Rescue Analgesia ◽

Average Pain ◽

Average Pain Score

Abstract Background Oesophagectomy is a major complex operation associated with significant morbidity and mortality. Epidural analgesia has long been the gold standard postoperative analgesia but is associated with side-effects like hypotension, epidural haematoma and infection. In an attempt to lower morbidity and enhance recovery postoperatively, we have adopted the use of paravertebral catheter analgesia (PVCA) for patients undergoing totally minimal invasive oesophagectomy (TMIO) . Methods Our objective was to review the current literature about the use of both PVCA and epidural analgesia. In addition, we evaluated the effect of PVCA in a large group of patients undergoing TMIO for cancer. We reviewed the records of 100 consecutive patients who had a TMIO with PVCA, spinal morphine, and PCA. Prospective independent scoring of postoperative pain, length of stay, HDU stay, PVCA failure, the use of patient-controlled analgesia (PCA), and the use of vasoconstrictor medication postoperatively was analysed. Results One hundred consecutive patients received PVCA with PCA after the TMIO. Catheter related failures occurred in 4 cases. The median pain score over each of the 5 days were 0. The average pain score was highest in the first 24 hours and decreased over the next 4 days postoperatively. The use of PCA was highest in the first 2 days and reduced daily over the subsequent 3 days. Seven patients required rescue analgesia in the form of intercostal nerve block. Spinal morphine was successful in 94% of cases. Vasoconstrictors were required in 19% on day 1 and 3% on day 2, postoperatively. Conclusions Intraoperative placement of PVCA results in good postoperative pain control after a TMIO. This technique is simple, safe, reproducible and with very low failure rates. Therefore, it should be used instead of epidural catheter analgesia.

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