Chronic postoperative pain: ubiquitous and scarcely appraised: narrative review

Lopes, Alexandre H.; Menezes, Miriam Seligman; Barros, Guilherme Antônio Moreira de

doi:10.1016/j.bjane.2020.10.014

Cited by 11 publications

(6 citation statements)

References 43 publications

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“…Postoperative pain can induce adverse events, such as cardiovascular disease, respiratory depression, digestive and urinary system dysfunction, and neuroendocrine disorders, which bring great discomfort to patients and seriously affect the postoperative recovery of patients ( 31 , 32 ). At the same time, although the use of unreasonable postoperative analgesics can effectively control pain, it can also cause adverse reactions, such as malignant vomiting, dizziness, itchy skin, bradycardia, and low blood pressure ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

Liu

Wang

et al. 2022

Front. Surg.

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ObjectiveThe present study is designed to study the analgesic and sedative effect of different doses of dexmedetomidine combined with butorphanol in continuous analgesia after a cesarean section.MethodsA total of 60 puerperae undergoing a cesarean section recruited from a single center were divided into three groups according to the postoperative continuous analgesia protocol: control group (100 mL of normal saline containing 10 µg/kg fentanyl and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), DB1 group (100 mL of normal saline containing 1.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), and DB2 group (100 mL normal saline containing 2.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h). We compared the blood pressure, heart rate, oxygen saturation, VAS score, Ramsay score, and adverse reactions of puerperae among the three groups after surgery.ResultsThe baseline data all have no significant difference in the three groups (p > 0.05). Compared with those in the control group, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB1 group and DB2 group were significantly decreased at 6, 24, and 48 h (P < 0.05), while the Ramsay scores of the puerperae in DB1 group and DB2 group were significantly increased at 6, 24, and 48 h (p < 0.05). At the same time, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB2 group were significantly lower than those in the DB1 group (P < 0.05), while the Ramsay scores of the puerperae in DB2 group were significantly higher than those in the DB1 group (P < 0.05). Also, there is no significant difference in oxygen saturation and adverse reactions of puerperae among the three groups after surgery (p > 0.05).ConclusionDexmedetomidine combined with butorphanol can improve the analgesic and sedative effects in continuous analgesia after a cesarean section, and the analgesic and sedative effects of dexmedetomidine in the high-dose group are better than those in the low-dose group.

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Section: Discussionmentioning

confidence: 99%

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

Liu

Wang

et al. 2022

Front. Surg.

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“…This report presented a case of chronic postsurgical pain. Although this is a common surgical complication, consensus regarding effective perioperative prevention strategies has not yet been reached 16 . Regional anesthesia techniques seem to reduce the incidence of chronic postsurgical pain in some surgeries, but this is still inconclusive in iliac bone crest harvesting 16,17 .…”

Section: Discussionmentioning

confidence: 99%

“…Although this is a common surgical complication, consensus regarding effective perioperative prevention strategies has not yet been reached 16 . Regional anesthesia techniques seem to reduce the incidence of chronic postsurgical pain in some surgeries, but this is still inconclusive in iliac bone crest harvesting 16,17 . Once chronic postsurgical pain has been established, it's not uncommon for it to be undertreated for some time, due to diagnosis and therapy limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Once chronic postsurgical pain has been established, it's not uncommon for it to be undertreated for some time, due to diagnosis and therapy limitations. Because that can have an impact in patient outcomes, authors stress the importance of a timely diagnosis and adequate timely treatment 16 . The present case was particularly challenging due to the long course of postsurgical pain with inadequate treatment.…”

Section: Discussionmentioning

confidence: 99%

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Dor crônica pós-operatória após artrodese cervical emergencial com enxerto de crista ilíaca - abordagem multimodal para um problema multifatorial. Relato de caso

Sousa¹,

Rodrigues²,

Martins³

2022

BRJP

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BACKGROUND AND OBJECTIVES: Chronic postsurgical pain is a major surgical complication with an impact on quality of life. Persistent pain following cervical fusion with iliac crest graft can be due to patient positioning, cervical surgical technique or nerve injury during iliac crest harvesting. Treatment options for chronic postsurgical pain overlap with those recommended for neuropathic pain. However, other pain mechanisms may be present in these patients. CASE REPORT: Male patient, 51-year-old, with persistent pain five years after emergency cervical arthrodesis with an iliac crest graft. The patient was referred to the chronic pain department (CPD) for management of meralgia paresthetica. However, other significant pain etiologies were found and treated such as nociceptive neck pain, myofascial lumbar pain, and inguinal neuropathic postsurgical pain. The therapeutic approach included multimodal pharmacotherapy with anticonvulsants, antidepressants, weak opioids, topical capsaicin 8% patch, as well as nerve blocks. After almost two years of follow-up, CPD discharge was possible, with minimal pain and return to baseline activity. CONCLUSION: Although the patient had a long course of undertreated postsurgical pain, a multimodal approach targeting different pain etiologies allowed the achievement of satisfactory pain control and return to baseline physical activity.

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“…Chronic postsurgical pain (CPSP) is a potential adverse outcome after surgery with an estimated incidence of up to 50% among postsurgical patients ( 1 ). This chronic pain is accompanied by depression, disability, and reduced quality of life ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

The peripheral Epac1/p-Cav-1 pathway underlies the disruption of the vascular endothelial barrier following skin/muscle incision and retraction-induced chronic postsurgical pain

Chen¹,

Qing²,

Liu³

et al. 2022

Ann Transl Med

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Background: Vascular endothelial barrier disruption is pivotal in the development of acute and chronic pain. Here, we demonstrate a previously unidentified molecular mechanism in which activation of the peripheral Epac1/p-Cav-1 pathway accelerated the disruption of the vascular endothelial barrier, thereby promoting chronic postsurgical pain (CPSP). Methods:We established a rat model of CPSP induced by skin/muscle incision and retraction (SMIR).Pain behaviors were assessed by the mechanical withdrawal threshold (MWT) at different times. Local muscle tissues around the incision were isolated to detect the vascular permeability and the expression of Epac1 and Cav-1. They were assessed by western blot and immunofluorescence staining.Results: SMIR increased vascular endothelial permeability and the number of macrophages and endothelial cells in the muscle tissues around the incision. The peripheral upregulation of Epac1 was macrophagederived, whereas that of p-Cav-1 was both macrophage and endothelial cell-derived in the SMIR model. Moreover, the Epac1 agonist 8-pCPT could induce mechanical sensitivity, increase the expression of p-Cav-1, and disrupt vascular endothelial barrier in normal rats. The Epac1 inhibitor CE3F4 attenuated established SMIR-induced mechanical hyperalgesia, the upregulation of p-Cav-1 and vascular endothelial barrier.Finally, we showed that intrathecal injection of Cav-1siRNA relieved SMIR-induced mechanical allodynia, but had no effects of the expression of Epac1.Conclusions: Collectively, these results revealed a molecular mechanism for modulating CPSP through the peripheral Epac1/Cav-1 pathway. Importantly, targeting Epac1/Cav-1 signaling might be a potential treatment for CPSP.

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Chronic postoperative pain: ubiquitous and scarcely appraised: narrative review

Cited by 11 publications

References 43 publications

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

Dor crônica pós-operatória após artrodese cervical emergencial com enxerto de crista ilíaca - abordagem multimodal para um problema multifatorial. Relato de caso

The peripheral Epac1/p-Cav-1 pathway underlies the disruption of the vascular endothelial barrier following skin/muscle incision and retraction-induced chronic postsurgical pain

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