Acute Postoperative Pain

2017 ◽  
Author(s):  
Kelly Zach ◽  
Julio A. Gonzalez-Sotomayor
Keyword(s):  
Postoperative Pain ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Analgesic Regimen ◽  
Potential Benefits ◽  
Short And Long Term ◽  
Selection Of

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

scholarly journals Current Status of Distal Embolization in Femoropopliteal Endovascular Interventions

2018 ◽  
Vol 52 (6) ◽  
pp. 440-447 ◽  
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Marianna Gazzetti ◽  
Carlo Catalano ◽  
Fabrizio Fanelli
Keyword(s):  
Management Strategies ◽  
Major Amputation ◽  
Current Status ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Distal Embolization ◽  
Endovascular Interventions ◽  
Atherosclerotic Lesions ◽  
Short And Long Term

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical–radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.

scholarly journals Robot-Assisted, Laparoscopic, and Open Radical Cystectomy (RC): Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry (RIC)

2021 ◽  
Author(s):  
Angelo Porreca ◽  
Gian Maria Busetto ◽  
Michele Colicchia ◽  
Katie Palmer ◽  
Walter Artibani ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Patient Characteristics ◽  
Long Term Outcomes ◽  
Robot Assisted ◽  
Clinical Variables ◽  
Stage Classification ◽  
Short And Long Term ◽  
Open Radical Cystectomy

Abstract Introduction: the Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic.Methods: from 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected. Results: preoperatively, it was found that patients undergoing robotic procedures were younger (p<.001) and more likely to have undergone preoperative neoadjuvant chemotherapy (p<.001) and BCG instillation (p<.001). Hypertension was the most common comorbidity among all patients (55%), and overall, patients undergoing open and laparoscopic RC had a higher Charlson Comorbidities Index (CCI) compared to robotic RC (p<.001). Finally, laparoscopic patients had a lower G-stage classification (p=.003) and open patients had a higher ASA score (p<.001). Conclusion: the present study summarizes the characteristic of patients included in the RIC. Future results will provide invaluable information about outcomes among BC patients undergoing RC. This will inform physicians about the best techniques and course of care based on patient clinical factors and characteristics.

scholarly journals Treatment of MIS-C in Children and Adolescents

2022 ◽  
Author(s):  
Sanaa Mahmoud ◽  
Mostafa El-Kalliny ◽  
Alyaa Kotby ◽  
Mona El-Ganzoury ◽  
Eman Fouda ◽  
...  
Keyword(s):  
Management Strategies ◽  
Biologic Agents ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Thrombotic Risk ◽  
Future Studies ◽  
Management Plans ◽  
Short And Long Term ◽  
Inflammatory Syndrome

Abstract Purpose of Review Different treatment approaches have been described for the management of COVID-19-related multisystem inflammatory syndrome in children (MIS-C), the pathogenesis of which has not yet been fully elucidated. Here, we comprehensively review and summarize the recommendations and management strategies that have been published to date. Recent Findings MIS-C patients are treated with different regimens, mostly revolving around the use of immunomodulatory medications, including IVIG and glucocorticoids as first-tier therapy. Refractoriness to IVIG and glucocorticoids warrants a step-up of immunomodulatory therapy to biologic agents such as anakinra, tocilizumab, and infliximab. Summary We review the current evidence regarding the use of monotherapy versus combination therapy, as well as the current recommendations for assessing thrombotic risk and administering antiplatelet and anticoagulant therapy. We anticipate that future studies will provide evidence for management plans that maximize short- and long-term outcomes.

Perioperative Management of Bleeding and Transfusion for Lung Transplantation

2019 ◽  
Vol 24 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Joseph J. Pena ◽  
Brandi A. Bottiger ◽  
Andrea N. Miltiades
Keyword(s):  
Lung Transplantation ◽  
Point Of Care ◽  
Factor Vii ◽  
Current Evidence ◽  
Blood Product Transfusion ◽  
Long Term Outcomes ◽  
Transfusion Requirements ◽  
Coagulation Testing ◽  
Short And Long Term

Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation.

scholarly journals Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Don Daniel Ocay ◽  
Mandy M.J. Li ◽  
Pablo Ingelmo ◽  
Jean A. Ouellet ◽  
M. Gabrielle Pagé ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Spinal Fusion ◽  
Acute Pain ◽  
Postoperative Period ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Pain Trajectories

Objectives. Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods. We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results. One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.

scholarly journals FRI0412 DOES SEVERE ACUTE POSTOPERATIVE PAIN RESULT IN MORE LONG-TERM PAIN AFTER TOTAL HIP OR KNEE ARTHROPLASTY (THA OR TKA) FOR OSTEOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 805.2-805
Author(s):  
D. A. J. M. Latijnhouwers ◽  
C. H. Martini ◽  
R. G. H. H. Nelissen ◽  
H. M. J. Van der Linden ◽  
T. P. M. Vliet Vlieland ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Missing Values ◽  
Rating Scale ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Mixed Effect ◽  
Total Hip ◽  
Chronic Postsurgical Pain

Background:Chronic pain is a frequently reported unfavourable outcome of total hip and knee arthroplasties (THA/TKA) (7-23% and 10-34%, respectively) in osteoarthritis (OA) patients (1), which is difficult to treat as underlying mechanisms are not fully understood. Acute postoperative pain has been identified as risk factor for development of long-term pain in other surgical procedures, such as mastectomy and thoracotomy (2). However, the effect of acute postoperative pain on development of long-term pain in THA and TKA patients is unknown.Objectives:To investigate if acute pain following THA/TKA in OA patients is associated with long-term pain and if acute pain affects the course of pain up to 1-year postoperatively.Methods:From a longitudinal multicenter study, OA patients scheduled for primary THA or TKA were included. Acute pain scores, using Numeric Rating Scale (NRS), were routinely collected as part of standard care (≤72 hours after surgery). In case of ≥2 NRS scores the two highest scores were averaged (n=160), else the single score was taken. Pain was dichotomized into severe (NRS≥5) and mild (NRS<5). Pain was assessed preoperatively, at 3 (only THA), 6 and 12 months postoperatively using HOOS/KOOS subscale pain. Separate mixed-effect models for THA and TKA patients were used, with dichotomized acute pain as fixed-effect and long-term pain as outcome, while adjusting for confounders (age, sex, BMI, preoperative pain, mental component scale of the SF12 (MCS-12), and duration of the surgery and hospitalization). We included an interaction between time of measurement and acute postoperative pain to analyse whether effect modification was present. Missing values in preoperative pain and MCS-12 were imputed using multiple imputation methods.Results:81 THA and 87 TKA patients were included, of whom 32.1% and 56.3% reported severe acute pain. The results did not show an associated between severe acute pain and long term pain (THA: β=2.0, 95%-CI:-10.9-7.0; TKA: β=3.8, 95%-CI:-10.6-2.9). Furthermore, It seems that there is no effect present of difference in severity of acute pain and the course of pain over time (THA 6-months: β=6.4, 95%-CI:1.9-10.9 and 12-months: β=0.2, 95%-CI:-4.4-4.8; TKA 12-months: β=3.2, 95%-CI:-0.5-6.8).Conclusion:We did not find an association between acute pain and the development of long-term pain nor that severity of acute pain affects the course of postoperative pain in THA and TKA patients. The fact that THA and TKA patients often experience chronic preoperative pain might be a possible explanation for this finding. Nonetheless, future studies including additional measures of acute pain and pain sensitization in patients with chronic preoperative pain are necessary to draw stronger conclusions.References:[1]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open. 2012;2(1):e000435.[2]Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics. 2009;9(5):723-44.Acknowledgments:We would like to thank the study group that consists of: B.L. Kaptein, Leiden University Medical Center, Leiden; S.B.W Vehmeijer, Reinier de Graaf Hospital, Delft; R. Onstenk, Groene Hart Hospital, Gouda; S.H.M. Verdegaal, Alrijne Hospital, Leiderdorp; H.H. Kaptijn, LangeLand Hospital, Zoetermeer; W.C.M. Marijnissen, Albert Schweitzer Hospital, Dordrecht; P.J. Damen, Waterland Hospital, Hoorn; the NetherlandsDisclosure of Interests:None declared

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