scholarly journals Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Michał Borys ◽  
Agata Hanych ◽  
Mirosław Czuczwar
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Paravertebral Block ◽  
Posterolateral Thoracotomy ◽  
Randomized Controlled

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies. The trial was prospectively registered at the Australian New Zealand Clinical Trial Registry (https://www.anzctr.org.au/; ACTRN12616000900415; 07 July 2016).

scholarly journals Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

2020 ◽  
Vol 9 (3) ◽  
pp. 793
Author(s):  
Michał Borys ◽  
Agata Hanych ◽  
Mirosław Czuczwar
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Paravertebral Block ◽  
Posterolateral Thoracotomy ◽  
Randomized Controlled

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

scholarly journals Quadratus lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—a Randomized Controlled Trial

2021 ◽  
Author(s):  
Michal Borys ◽  
Patrycja Szajowska ◽  
Mariusz Jednakiewicz ◽  
Grzegorz Wita ◽  
Tomasz Czarnik ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Controlled Trial ◽  
Persistent Pain ◽  
Pain Severity ◽  
Randomized Controlled ◽  
Quadratus Lumborum ◽  
Persistent Postoperative Pain

Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group and a control (CON) group. At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 hours following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg [interquartile range 23–40 mg] vs. 47.5 mg [35–50 mg]; p<0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p=0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6 and was found to be significantly lower in the QLB group at each evaluation (p<0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

scholarly journals A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jennifer A. Rabbitts ◽  
Chuan Zhou ◽  
Rocio de la Vega ◽  
Homer Aalfs ◽  
Caitlin B. Murray ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Spinal Fusion ◽  
Acute Pain ◽  
Controlled Trial ◽  
Opioid Use ◽  
Cognitive Behavioral Intervention ◽  
Postsurgical Pain ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Background Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. Methods Adolescents 12–18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. Discussion Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. Trial registration NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020

scholarly journals Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—A Randomized Controlled Trial

2021 ◽  
Vol 10 (16) ◽  
pp. 3590
Author(s):  
Michał Borys ◽  
Patrycja Szajowska ◽  
Mariusz Jednakiewicz ◽  
Grzegorz Wita ◽  
Tomasz Czarnik ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Controlled Trial ◽  
Persistent Pain ◽  
Pain Severity ◽  
Randomized Controlled ◽  
Quadratus Lumborum ◽  
Persistent Postoperative Pain

Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35–50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During COVID-19 (Preprint)

2021 ◽  
Author(s):  
Maisa Ziadni ◽  
Lluvia Gonzalez-Castro ◽  
Steven Anderson ◽  
Parthasarathy Krishnamurthy ◽  
Beth D Darnall
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Pain Intensity ◽  
Pain Catastrophizing ◽  
Controlled Trial ◽  
Post Treatment ◽  
Single Session ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
High Engagement

BACKGROUND Pain-cognitive behavioral therapy is an evidence-based treatment for chronic pain, with significant patient burden including healthcare cost, travel, multiple sessions, and lack of access in remote areas. A previously developed and efficacious single-session intervention “Empowered Relief” (ER) based on CBT principles has particular salience and fills an urgent clinical need during COVID-19. However, key questions remain about the efficacy of online-delivered ER. OBJECTIVE The primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered ER group to a waitlist control (WLC) among individuals with chronic pain. We hypothesized that ER would be superior to WLC for reductions in pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months post-treatment. METHODS We conducted a randomized controlled trial involving an online sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to one of the two unblinded study groups: ER (n=50) or a WLC (n=54). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks, 1, 2, and 3 months post-treatment. All study procedures occurred remotely and electronically. The primary outcome was pain catastrophizing one-month post-treatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months post-treatment. Data were collected from September 2020 - February 2021 and analyzed using intention-to-treat analysis. The analytic dataset included participants (18% clinic patients, 82% community) who completed at least one study surveys: ER (n=50) and WLC (n=51). RESULTS Participants (N=101) were 69.3% (70/101) female, with mean age of 49.76 years (SD 13.90; range 24.00-78.00); 32.7% (33/101) had an undergraduate degree, with self-reported chronic pain >= 3 months. Participants reported high engagement (94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and Zoom-platform (92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 -months post-treatment (highest P=.0001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful PCS reductions were found for ER but not for WLC (ER: PCS, -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. CONCLUSIONS Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes and sustained at 3 months. Online delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. CLINICALTRIAL ClinicalTrials.gov Identifier NCT 04546685, Registered on 04 September 2020.

scholarly journals Effect of Two Contrasting Interventions on Upper Limb Chronic Pain and Disability: A Randomized Controlled Trial

2014 ◽  
Vol 2;17 (2;3) ◽  
pp. 145-154 ◽  
Author(s):  
Emil Sundstrup
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Resistance Training ◽  
Muscle Strength ◽  
Usual Care ◽  
Pain Intensity ◽  
Upper Limb ◽  
Controlled Trial ◽  
Training And Education ◽  
Randomized Controlled

Background: Chronic pain and disability of the arm, shoulder, and hand severely affect labor market participation. Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain. An alternative strategy could be to increase physical capacity of the worker by physical conditioning. Objectives: To investigate the effect of 2 contrasting interventions, conventional ergonomic training (usual care) versus resistance training, on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual work. Study Design: Examiner-blinded, parallel-group randomized controlled trial with allocation concealment. Setting: Slaughterhouses located in Denmark, Europe. Methods: Sixty-six adults with chronic pain in the shoulder, elbow/forearm, or hand/wrist and work disability were randomly allocated to 10 weeks of specific resistance training for the shoulder, arm, and hand muscles for 3 x 10 minutes per week, or ergonomic training and education (usual care control group). Pain intensity (average of shoulder, arm, and hand, scale 0 – 10) was the primary outcome, and disability (Work module of DASH questionnaire) as well as isometric shoulder and wrist muscle strength were secondary outcomes. Results: Pain intensity, disability, and muscle strength improved more following resistance training than usual care (P < 0.001, P = 0.05, P < 0.0001, respectively). Pain intensity decreased by 1.5 points (95% confidence interval -2.0 to -0.9) following resistance training compared with usual care, corresponding to an effect size of 0.91 (Cohen’s d). Limitations: Blinding of participants is not possible in behavioral interventions. However, at baseline outcome expectations of the 2 interventions were similar. Conclusion: Resistance training at the workplace results in clinical relevant improvements in pain, disability, and muscle strength in adults with upper limb chronic pain exposed to highly repetitive and forceful manual work. Trial registration: NCT01671267. Key words: Musculoskeletal pain, workability, shoulder pain, elbow pain, tennis elbow, wrist pain

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