scholarly journals Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain

2014 ◽  
Vol 121 (3) ◽  
pp. 591-608 ◽  
Author(s):  
Karen Wong ◽  
Rachel Phelan ◽  
Eija Kalso ◽  
Imelda Galvin ◽  
David Goldstein ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Therapeutic Potential ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Safety Evaluation ◽  
Pain Reduction ◽  
Chronic Postoperative Pain ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Antidepressant Use

Abstract Background: This review evaluates trials of antidepressants for acute and chronic postsurgical pain. Methods: Trials were systematically identified using predefined inclusion and exclusion criteria. Extracted data included the following: pain at rest and with movement, adverse effects, and other outcomes. Results: Fifteen studies (985 participants) of early postoperative pain evaluated amitriptyline (three trials), bicifadine (two trials), desipramine (three trials), duloxetine (one trial), fluoxetine (one trial), fluradoline (one trial), tryptophan (four trials), and venlafaxine (one trial). Three studies (565 participants) of chronic postoperative pain prevention evaluated duloxetine (one trial), escitalopram (one trial), and venlafaxine (one trial). Heterogeneity because of differences in drug, dosing regimen, outcomes, and/or surgical procedure precluded any meta-analyses. Superiority to placebo was reported in 8 of 15 trials for early pain reduction and 1 of 3 trials for chronic pain reduction. The majority of positive trials did not report sufficient data to estimate treatment effect sizes. Many studies had inadequate size, safety evaluation/reporting, procedure specificity, and movement-evoked pain assessment. Conclusions: There is currently insufficient evidence to support the clinical use of antidepressants—beyond controlled investigations—for treatment of acute, or prevention of chronic, postoperative pain. Multiple positive trials suggest the therapeutic potential of antidepressants, which need to be replicated. Other nontrial evidence suggests potential safety concerns of perioperative antidepressant use. Future studies are needed to better define the risk–benefit ratio of antidepressants in postoperative pain management. Higher-quality trials should optimize dosing, timing and duration of antidepressant treatment, trial size, patient selection, safety evaluation and reporting, procedure specificity, and assessment of movement-evoked pain relevant to postoperative functional recovery.

scholarly journals Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery

2020 ◽  
Vol 132 (2) ◽  
pp. 330-342 ◽  
Author(s):  
Glenn S. Murphy ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
Mark A. Deshur ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Spinal Surgery ◽  
Ordinal Data ◽  
Median Score ◽  
Postsurgical Pain ◽  
Surgical Closure ◽  
Chronic Postsurgical Pain ◽  
To Receive ◽  
Weekly Frequency

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures. Methods Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 μg/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann–Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01. Results Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004). Conclusions Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.

scholarly journals Predictive Factors of Chronic Post-Surgical Pain at 6 Months Following Knee Replacement: Influence of Postoperative Pain Trajectory and Genetics

2016 ◽  
Vol 5;19 (5;19) ◽  
pp. E729-E741
Author(s):  
Dr Célia Lloret-Linares
Keyword(s):  
Logistic Regression ◽  
Postoperative Pain ◽  
Knee Replacement ◽  
Predictive Factors ◽  
High Intensity ◽  
Walking Ability ◽  
Single Center ◽  
Multivariate Logistic Regression ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Background: The frequency of chronic postsurgical pain (CPSP) after knee replacement remains high, but might be decreased by improvements to prevention. Objectives: To identify pre- and postsurgical factors predictive of CPSP 6 months after knee replacement. Study Design: Single-center prospective observational study. Setting: An orthopedic unit in a French hospital. Methods: Consecutive patients referred for total or unicompartmental knee arthroplasty from March to July 2013 were prospectively invited to participate in this study. For each patient, we recorded preoperative pain intensity, anxiety and depression levels, and sensitivity and pain thresholds in response to an electrical stimulus. We analyzed OPRM1 and COMT single-nucleotide polymorphisms. Acute postoperative pain (APOP) in the first 5 days after surgery was modeled by a pain trajectory. Changes in the characteristics and consequences of the pain were monitored 3 and 6 months after surgery. Bivariate analysis and multivariate logistic regression were conducted to identify predictors of CPSP. Results: We prospectively evaluated 104 patients in this study, 74 (28.8%) of whom reported CPSP at 6 months. Three preoperative factors were found to be associated with the presence of CPSP in multivariate logistic regression analysis: high school diploma level (OR = 3.83 [1.20 – 12.20]), consequences of pain in terms of walking ability, as assessed with the Brief Pain Inventory short form “walk” item (OR = 4.06 [1.18 – 13.94]), and a lack of physical activity in adulthood (OR = 4.01 [1.33 – 12.10]). One postoperative factor was associated with the presence of CPSP: a high-intensity APOP trajectory. An association of borderline statistical significance was found with the A allele of the COMT gene (OR = 3.4 [0.93 – 12.51]). Two groups of patients were identified on the basis of their APOP trajectory: high (n = 28, 26%) or low (n = 80, 74%) intensity. Patients with high-intensity APOP trajectory had higher anxiety levels and were less able to walk before surgery (P < 0.05). Limitations: This was a single-center study and the sample may have been too small for the detection of some factors predictive of CPSP or to highlight the role of genetic factors. Conclusion: Our findings suggest that several preoperative and postoperative characteristics could be used to facilitate the identification of patients at high risk of CPSP after knee surgery. All therapeutic strategies decreasing APOP, such as anxiety management or performing knee replacement before the pain has a serious effect on ability to walk, may help to decrease the risk of CPSP. Further prospective studies testing specific management practices, including a training program before surgery, are required. Key words: Chronic postsurgical pain, opioids, arthroplasty, pain trajectory, genetics, COMT, predictive factors

scholarly journals Improving Analgesic Efficacy and Safety of Thoracic Paravertebral Block for Breast Surgery: A Mixed-Effects Meta-Analysis

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E757-E780 ◽  
Author(s):  
Abdullah S. Terkawi
Keyword(s):  
Postoperative Pain ◽  
Breast Surgery ◽  
Meta Analysis ◽  
Mixed Effects ◽  
Opioid Consumption ◽  
Paravertebral Block ◽  
Efficacy And Safety ◽  
Thoracic Paravertebral Block ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Background: While most trials of thoracic paravertebral nerve blocks (TPVB) for breast surgery show benefit, their effect on postoperative pain intensity, opioid consumption, and prevention of chronic postsurgical pain varies substantially across studies. Variability may result from use of different drugs and techniques. Objectives: To examine the use of TPVB in breast surgery, and to determine which method(s) provide optimal efficacy and safety. Study Design: Mixed-Effects Meta-Analysis. Methods: We conducted a systematic review of randomized trials comparing TPVB to no intervention using random-effects models. To evaluate the contributions of various techniques, clinical approaches were included as moderators in mixed-effects models. Results: A total of 24 randomized controlled trials (RCTs) with 1,822 patients were included. Use of TPVB decreased postoperative pain scores at rest and movement at the first 2, 24, 48, and 72 hours. TPVB modestly decreased intraoperative and postoperative opioid consumption, reduced nausea and vomiting, and shortened hospitalization, but to a probably clinically irrelevant degree. Blocks also appeared to reduce the incidence of chronic postsurgical pain at 6 months. Adding fentanyl to the TPVB improved pain at rest (at 24, 48, and 72 hours) and movement (at 24 and 72 hours). Multilevel blocks provided better postoperative pain control, but only during movement (at 2, 48, and 72 hours). Fewer procedural complications (especially hypotension, epidural spread, and Horner’s syndrome) occurred when anatomical landmarks were supplemented with ultrasound guidance. Limitations: The number of studies available was limited in the meta-analytic model of incidence of chronic post-surgical pain. Conclusion: TPVB reduces postoperative pain and opioid consumption, and has a limited beneficial effect on the quality of recovery. From all the techniques that were evaluated, only the addition of fentanyl, and performing multilevel blocks were associated with improved acute analgesia. TPVB may reduce chronic postsurgical pain at 6 months. Key words: Thoracic paravertebral block, breast surgery, anesthesia, acute pain, chronic pain, nausea, vomiting, length of stay, techniques, variability, meta-regression, meta-analysis, moderators

Opioid-Induced Hyperalgesia, Tolerance, and Chronic Postsurgical Pain: A Dilemma Complicating Postoperative Pain Management

2018 ◽  
Author(s):  
Dalia H. Elmofty
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Surgical Techniques ◽  
Cyclooxygenase Inhibitors ◽  
Opioid Tolerance ◽  
Postsurgical Pain ◽  
Perioperative Pain ◽  
Chronic Postsurgical Pain ◽  
Opioid Induced Hyperalgesia ◽  
Perioperative Pain Management

Perioperative pain management continues to be a challenge for physicians. Postoperative pain can compromise patient progress and lead to poor outcomes or chronic pain. Opioid medications, the mainstay of treatment for perioperative pain, can cause opioid-induced hyperalgesia and opioid tolerance. Attempts should be made to modify factors that increase the risk for chronic postsurgical pain. Certain patient factors and anesthetic and surgical techniques have been implicated. Incorporating multimodal methods for perioperative pain management using nonconventional opioids, such as methadone, cyclooxygenase inhibitors, NMDA antagonists, and regional techniques can improve outcomes and prevent opioid-induced hyperalgesia, opioid tolerance, and chronic postsurgical pain in patients on long-term opioid therapy.

Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain

2015 ◽  
Vol 59 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Karen Wong ◽  
Rachel Phelan ◽  
Eija Kalso ◽  
Imelda Galvin ◽  
David Goldstein ◽  
...  
Keyword(s):  
Antidepressant Drugs ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Hyperesthesia one year after breast augmentation surgery increases the odds for persisting pain at four years A prospective four-year follow-up study

2010 ◽  
Vol 1 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Torill Kaasa ◽  
Luis Romundstad ◽  
Helge Roald ◽  
Knut Skolleborg ◽  
Audun Stubhaug
Keyword(s):  
Postoperative Pain ◽  
Breast Augmentation ◽  
Summary Score ◽  
Spontaneous Pain ◽  
Acute Postoperative Pain ◽  
Postsurgical Pain ◽  
Follow Up Study ◽  
Chronic Postsurgical Pain ◽  
Sensory Changes

AbstractIn this long-term follow-up study of 175 women, we investigated the prevalence of and factors associated with persisting pain and sensory changes four years after augmentation mammoplasty. Previously the women had participated in an acute postoperative pain study, and follow-up investigations at 6 weeks and 1 year after surgery. In the present study, the women were mailed questionnaires about pain, sensory changes, and affection of daily life, quality of life and pain catastrophizing 4 years after surgery.One hundred and sixteen women answered the questionnaire. The fraction of women reporting evoked- and/or spontaneous pain during the last 24 h had declined from 20% at 1 year to 14% at 4 years. Hyperesthesia had declined from 46% at 1 year to 32% at 4 years, while the change in hypoesthesia was small, 47% at 1 year to 51% at 4 years. Methylprednisolone and parecoxib given pre incisionally reduced acute postoperative pain and reduced the prevalence of hyperesthesia after 6 weeks/1 year, but after 4 years we found no significant differences between the test drug groups. Those having concomitant pain and hyperesthesia at 6 weeks and 1 year had high odds for persisting pain at 4 years (OR 7.8, 95% CI 2.1–29.8, P = 0.003; OR 13.2, 95% CI 2.5–71.3, P = 0.003). In patients without pain but with hyperesthesia at 1 year, the hyperesthesia increased the odds for pain at 4 years (OR 2.6 95% CI 1.1–6.1, P = 0.03). Hypoesthesia at 6 weeks or at 1 year did not affect the odds for pain at 4 years. A good general health condition (mental and physical) was associated with reduced odds for pain at 4 years (OR = 0.56, 95% CI 0.35–0.88, P = 0.01). However, using the Short Form health survey, SF-12, the Mental Component Summary Score seemed to affect the odds for chronic pain more than the Physical Component Summary Score.To conclude, the prevalence of pain and hyperesthesia after breast augmentation declined from 1 to 4 years. Nevertheless, the most striking finding in the current trial was that pain coinciding with hyperesthesia at 6 weeks and 1 year resulted in highly increased odds for persistent postoperative pain. Even hyperesthesia alone, without pain, increased the odds for chronic postsurgical pain. Thus, the present study suggests hyperesthesia as an independent risk factor for chronic postsurgical pain.

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 Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial

2021 ◽  
Vol 18 (17) ◽  
pp. 9138
Author(s):  
Marcin Mieszkowski ◽  
Marek Janiak ◽  
Michał Borys ◽  
Paweł Radkowski ◽  
Marta Mieszkowska ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Pain Therapy ◽  
Control Group ◽  
Block Type ◽  
Type I ◽  
Postsurgical Pain ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Chronic Postsurgical Pain

Background: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). Methods: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients’ satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. Results: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). Conclusions: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

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