Avoid Postoperative Pain To Prevent Its Chronification: A Narrative Review

Matamala, Antonio Montero; Hanna, Magdi; Perrot, Serge; Varrassi, Giustino

doi:10.7759/cureus.22243

Cited by 8 publications

(12 citation statements)

References 43 publications

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“…This can pave the way for a faster return to daily activities, leading to decreased health-care costs and, most importantly, an enhanced quality of life for patients. 41 Makhni et al also found a delay in the need for rescue analgesia in the QLB group, which could be attributed to this pain reduction. 34 Interestingly, an RCT examining various abdominal surgeries identified a similar trend with rescue analgesia, suggesting potential broader applications for QLB's benefits.…”

Section: Discussionmentioning

confidence: 85%

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Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

Marcolin,

Amaral,

Motter

et al. 2024

World j. surg.

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IntroductionPostoperative pain management is crucial for patient recovery with Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) emerging as potential techniques. We aimed to compare the analgesic efficacy of QLB and TAPB in patients undergoing inguinal hernia repair.MethodsWe performed a systematic review of Cochrane, EMBASE, and MEDLINE databases to identify randomized controlled trials comparing QLB and TAPB in patients undergoing inguinal hernia repair. Outcomes included postoperative pain and opioid consumption. Statistical analysis was performed using RevMan 5.4. The review protocol was registered at PROSPERO (CRD42023445513).ResultsWe included five RCTs encompassing 255 patients. QLB was associated with a significant decrease in postoperative pain (MD −0.45; 95% CI −0.75 to −0.14; and p = 0.004; I2 = 94%). However, we found no difference in 24‐h opioid consumption between QLB and TAPB groups.ConclusionQLB may offer superior pain reduction. However, its effect on opioid consumption remains unclear.

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Section: Discussionmentioning

confidence: 85%

“…Effective management of postoperative pain curtails the need for excessive analgesics and expedites the recovery processes. This can pave the way for a faster return to daily activities, leading to decreased health‐care costs and, most importantly, an enhanced quality of life for patients 41–43 . Makhni et al.…”

Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

Marcolin,

Amaral,

Motter

et al. 2024

World j. surg.

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“…Perioperative pain control protocols should consider their characteristics when choosing medications, and the analgesic ladder can be used as a reference. It is essential to incorporate non-pharmacological approaches to pain prevention and treatment 8 9. In this sense, nurses together with other members of the healthcare team, can contribute to pain management and perioperative patient education 10…”

Section: Introductionmentioning

confidence: 99%

Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial

de Souza,

Lopes,

Carmo

et al. 2024

BMJ Open

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BackgroundPain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will be to evaluate the impact of PNE on outcomes related to the postoperative period. The hypothesis is that the intervention may positively influence postoperative recovery, contributing to pain control, clinical indications, acceptance and consumption of analgesics and other pharmacological drugs that contribute to its control, as well as psychological aspects, such as anxiety, depression and pain catastrophising.Methods and analysisThis will be an open, parallel, multicentre and randomised controlled clinical trial. A total of 100 participants aged between 18 and 59 years of age, of both genders, who are going to have elective general surgery will be evaluated. The intervention group will participate in a preoperative pain neuroscience educational session and also receive usual preoperative care, while the control group receives usual preoperative care as well. The educational session will last 30 min and consists of a video (5:20 min), a questionnaire about the content, time for participants to express their beliefs, thoughts and doubts. Participants will be evaluated preoperatively and there will be one postintervention evaluation. The intensity and characteristics of pain and anxiety are evaluated as primary outcomes. As secondary outcomes, pain catastrophising and depression are taken into account.Ethics and disseminationThe project was approved by the Research Ethics Committee of the Faculty of Ceilandia, the Research Ethics Committee of the Institute of Strategic Health Management of the Federal District and the Research Council of the Hospital of Brasília—Rede Dasa (CAAE: 28572420.3.0000.8093). Recruitment began in June of 2023. All participants were included in the study only after their written consent. All data obtained will be analysed and distributed through publication in journals and at scientific events.Trial registration numberBrazilian Registry of Clinical Trials (ReBEC) (RBR-23mr7yy).

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“…Untreated or incompletely treated postoperative pain has significant impacts on patients' quality of life, satisfaction with care, duration of hospital stay and healthcare costs [3][4][5]. Poorly controlled acute pain is also a principal contributor to the process of chronification, resulting in persistent postoperative pain [6,7]. Additionally, patients in pain after surgery suffer delays in mobilisation and oral intake, which further increases the associated risk of postsurgical chronic pain [8].…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesised that nociception level index‐guided analgesia would facilitate better postoperative pain control [6]. To test this hypothesis, we undertook a meta‐analysis evaluating the effects of nociception level index‐guided anaesthesia on acute pain and opioid requirements (i.e.…”

Section: Introductionmentioning

confidence: 99%

Effect of nociception level index‐guided intra‐operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta‐analysis

Bornemann‐Cimenti,

Lang‐Illievich,

Kovalevska

et al. 2023

Anaesthesia

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SummaryAcute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra‐operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra‐operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra‐operative analgesia monitoring. However, the impact of devices like nociception level index on postoperative outcomes has not been proven. We undertook a systematic review and meta‐analysis of articles which compared nociception level index‐guided analgesia to standard care. The primary outcomes were pain intensity and opioid consumption during the first 60–120 min after surgery. Secondary outcomes were the incidence of postoperative nausea and vomiting and duration of stay in the post‐anaesthesia care unit. Ten studies, collectively including 662 patients and published between 2019 and 2023, met inclusion criteria for both the qualitative systematic review and quantitative meta‐analysis. Risk of methodological bias was generally low or unclear, and six studies reported a significant conflict of interest relevant to their findings. Our meta‐analysis was performed using a random‐effects model. It found statistically significant benefits of nociception level index‐guided analgesia for early postoperative pain (mean (95%CI) difference ‐0.46 (‐0.88 to ‐0.03) on an 11‐point scale, p = 0.03), and opioid requirement (mean (95%CI) difference ‐1.04 (‐1.94 to ‐0.15) mg intravenous morphine equivalent, p = 0.02). Our meta‐analysis of the current literature finds that nociception level index‐guided analgesia statistically significantly reduces reported postoperative pain intensity and opioid consumption but fails to show clinically relevant outcomes. We found no evidence that nociception level index‐guided analgesia affected postoperative nausea and vomiting nor duration of stay in the post‐anaesthesia care unit.

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Avoid Postoperative Pain To Prevent Its Chronification: A Narrative Review

Cited by 8 publications

References 43 publications

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial

Effect of nociception level index‐guided intra‐operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta‐analysis

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