Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions

Pirie, Katrina; Traer, Emily; Finniss, Damien G; Myles, Paul S.; Riedel, Bernhard

doi:10.1016/j.bja.2022.05.029

Cited by 47 publications

(41 citation statements)

References 134 publications

(103 reference statements)

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“…Postoperative pain and ileus are regarded as the most important factors in treatment costs, due to the prolonged hospital stay [ 9 ]. Nearly 40% of colorectal surgery patients suffer from postoperative intestinal paresis [ 10 ]. Also, a specific problem in abdominal surgery is the occurrence of septic complications, which must be recognized and separated from the postoperative SIRS occurring as an inflammatory response to surgical trauma [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Perioperatively Administered Amino Acids, Lidocaine, and Magnesium on Inflammatory Response and Pain Associated with Abdominal Surgery: A Prospective Clinical Study

et al. 2023

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Background Abdominal surgery is associated with a systemic inflammatory response which facilitates postoperative complications through immune imbalance and hypercatabolism. The aim of the study was to evaluate the effect of the combined perioperative lidocaine, magnesium, and amino acids on postoperative inflammation and pain. Material/Methods This prospective, randomized, double-blind study included 2 groups of patients undergoing abdominal surgery: Group 1 – receiving the aforementioned substances; and Group 2 – control (undergoing conventional general anesthesia). The following parameters were evaluated intraoperatively: arterial blood pressure, end-tidal CO 2 level, urine output, bispectral index, base excess, oxygen saturation, operating room temperature and body temperature (BT), opioid use, and surgery duration; and postoperatively: total leukocyte (WBC), neutrophil, lymphocyte and platelet count; fibrinogen, C-reactive protein (CRP), procalcitonin (PCT) and interleukin (IL)-6 levels; numeric rating scale (NRS) pain level, first flatus and bowel movement, and postoperative complications. The postoperative parameters were evaluated 2 h and 6 h postoperatively, as well as on postoperative days (POD) 1, 2, 3, and 5. Results Group 1 showed lower counts of WBC, neutrophils, and lymphocytes and lower fibrinogen, CRP, PCT, IL-6, and BT in the first 5 POD, as well as NRS scores and time to first flatus/bowel movement. The groups did not differ significantly regarding postoperative complications. Conclusions The isolated effects of lidocaine, magnesium, and amino acids in surgery have been described previously. To the best of our knowledge, this is the first study to show the anti-inflammatory and analgesic effects of simultaneous use of these substances in abdominal surgery.

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Section: Discussionmentioning

confidence: 99%

“…The imperative of fast-track protocols is adequate analgesia with few adverse effects, enabling the patient to function independently and to be discharged sooner [ 9 ]. Effective multimodal analgesia which reduces the need for opioid drugs is one of the key elements in ERAS (enhanced recovery after surgery) protocols [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Perioperatively Administered Amino Acids, Lidocaine, and Magnesium on Inflammatory Response and Pain Associated with Abdominal Surgery: A Prospective Clinical Study

et al. 2023

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“…In a large cohort study using the US National Surgical Quality Improvement Program (NSQIP) database where surgical procedures and type of anaesthesia were matched (264,421 patients received GA and 64,119 patients received neuraxial or regional anaesthesia), there were significantly lower odds of several postoperative complications, especially respiratory complications, and decreased hospital length of stay, but not mortality, when regional anaesthesia was compared with GA (regional analgesia supplementing GA was not accounted for). Several systematic reviews have sought to clarify the role of epidural analgesia in abdominal surgery with the consistent finding that epidural analgesia results in a reduction in rest pain after major abdominal surgery [4].…”

Section: Discussionmentioning

confidence: 99%

Emergency Awake Abdominal Surgery Under Thoracic Epidural Anaesthesia in a High-Risk Patient Within a Resource-Limited Setting

Roux¹,

Wakabayashi²,

Jooma³

2023

Cureus

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Awake abdominal surgery is performed daily around the world for caesarean section surgery under lumbar subarachnoid anaesthesia and/or graded lumbar epidural anaesthesia. Reports of awake abdominal surgery under thoracic epidural anaesthesia (TEA) for patients with bowel obstruction are scarce, as this patient population is at high risk for pulmonary aspiration. In this report, we describe a case in which a graded TEA was successfully used as the sole anaesthetic technique in a patient with severe pulmonary disease undergoing an awake emergency laparotomy for bowel ischaemia for whom no postoperative intensive care monitoring was available. No anaesthetic or surgical complications occurred, and the patient was discharged home seven days after the surgical procedure. A 30-day follow-up revealed no residual anaesthetic or surgical complications, with a return to baseline function.

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“…Погано контрольований післяопераційний біль пов'язаний зі збільшенням захворюваності, негативно впливає на якість життя й функціональне відновлення, а також є фактором ризику хронізації болю й тривалого вживання опіатів. До 10 % пацієнтів, які раніше не приймали опіати, вживають їх на постійній основі після багатьох типів операцій [10]. Існує обмежена кількість досліджень щодо якості відновлення пацієнтів за допомогою спеціальних знеболювальних методів після внутрішньочеревної операції.…”

Section: огляд літературиunclassified

Abdominal hysterectomy and postoperative quality of recovery: emphasis on pain relief

Лахно

Korovai

Zheleznyakov

et al. 2022

PMJUA

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Hysterectomy is a widespread surgical intervention in gynecological practice. Open abdominal hysterectomy is accompanied by a significant algogenic afferent impulse from the site of surgical intervention. Therefore, the search for effective methods of combating postoperative pain is quite urgent. The article analyzes modern approaches to the preventive (preoperative) use of non-narcotic drugs for reliable pain control. Literature data suggest that the combined use of paracetamol, dexketoprofen, nalbuphin, as well as ropivacaine or bupivacaine allows to implement the concept of multimodal analgesia and optimize the recovery process after surgery. The clinical case is given as an example of the use of the specified Step-UP-analgesia of the postoperative period in an overweight patient with varicose veins of the lower extremities and severe history of septic shock. The review of literature and the experience of the authors testify to the considerable potential of multimodal anesthesia following abdominal hysterectomy.

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Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions

Cited by 47 publications

References 134 publications

Impact of Perioperatively Administered Amino Acids, Lidocaine, and Magnesium on Inflammatory Response and Pain Associated with Abdominal Surgery: A Prospective Clinical Study

Impact of Perioperatively Administered Amino Acids, Lidocaine, and Magnesium on Inflammatory Response and Pain Associated with Abdominal Surgery: A Prospective Clinical Study

Emergency Awake Abdominal Surgery Under Thoracic Epidural Anaesthesia in a High-Risk Patient Within a Resource-Limited Setting

Abdominal hysterectomy and postoperative quality of recovery: emphasis on pain relief

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