adequate anesthesia. We chose this patient-centered outcome, because we know patients who undergo abortion are generally satisfied with their care. 2 More recent studies have recommended patient-centered outcomes as a more accurate measure of patient experience during an abortion procedure; thus, we feel this was an appropriate measurement. 3 The duration of the intervention was the duration of the abortion procedure, which typically lasts 10 minutes or less. We decided to assess satisfaction both immediately after the procedure as well as on postoperative day 1 to see whether there were any differences between the groups at both time points; we found no significant differences. We allowed anesthetists to provide rescue medications of their choosing as per clinic standard. As much as possible, we kept patient treatment during our study similar to standard clinic practice because we wanted to look at real-world use of both of these medications.
Erector spinae plane (ESP) blocks may be an acceptable alternative to thoracic epidural analgesia during the postoperative period in lung transplant patients. In this case report, we describe the use of an ESP block to manage acute postoperative pain in a unilateral lung transplant, although it was inferior to the thoracic epidural, which was eventually placed.
To the Editor It was with great interest and some apprehension that we read "Development of Persistent Opioid Use After Cardiac Surgery" by Brown et al. 1 We agree that new persistent opioid use after surgery is a substantial concern and that excessive opioid prescribing contributes to this phenomenon, but we worry that this article may lead to erroneous conclusions regarding treatment of pain by focusing on persistent opioid consumption strictly as an adverse outcome rather than elucidating a broader problem.Long-term postsurgical pain, defined as pain that persists for more than 90 days after a procedure, is a significant source of morbidity following cardiothoracic procedures. Up to 37% of patients experience persistent postoperative pain 6 months after cardiothoracic surgery, and 17% have pain for more than 2 years. These patients report interference in daily activities and a lower quality of life. 2 Moreover, these patients are infrequently treated or referred to chronic pain specialists. The absence of effective acute pain management is a modifiable predictor for the development of long-term postsurgical pain. 3 While the authors show an association between the amount of opioids prescribed and the likelihood of persistent use, these patients may be prescribed more opioids for longer periods because they experience chronic pain after the acute pain has resolved. The initial increase in opioids prescribed as well as long-term opioid use may be due to a failure of postoperative pain control. We are concerned that studies such as the one by Brown et al 1 may encourage perioperative physicians not to aggressively treat postoperative pain with opioids in an attempt to avoid persistent use, possibly exacerbating this issue.Acute pain should be managed as part of an enhanced recovery after surgery (ERAS) protocol, reducing complications and promoting a return to normal activities. Despite the original ERAS workgroup meeting almost 20 years ago, recommendations for cardiac surgery were published only last year. 4 These guidelines, in our opinion, are imperfect with regards to pain management, recommending medications with significant adverse effects and limited evidence of benefit while lacking reference to procedural pain control modalities, which are a mainstay of modern acute pain management. 5 We can and should do better.While we commend Brown et al 1 for adding to the fund of knowledge surrounding persistent opioid use and cardiac surgery, we worry about the emphasis on opioid prescribing without considering that we are doing a poor job managing patients' surgical pain and ultimately decreasing their quality of life.
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