Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study

Bugada, Dario; Lavand’homme, Patricia; Ambrosoli, Andrea Luigi; Klersy, Catherine; Braschi, A.; Fanelli, Guido; Jotti, Gloria M.R. Saccani; Allegri, Massimo; Baciarello, Marco; Bettinelli, S.; Cobianchi, Lorenzo; Gregori, Manuela De; Matteo, Maria Di; Guarisco, Silvia; Křížová, Pavla; Marangoni, Fábio André; Minella, Cristina E.; Niebel, Thekla; Peloso, Andréa; Repetti, F.

doi:10.1016/j.jclinane.2015.06.008

Cited by 19 publications

(13 citation statements)

References 19 publications

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“…We had previously investigated the association of the background inflammatory state and PPSP in minor surgery, 28 , 29 and this was confirmed here. Inflammation is a key mechanism in postoperative pain and central sensitisation.…”

Section: Discussionsupporting

confidence: 81%

Effects of anaesthesia and analgesia on long-term outcome after total knee replacement

Bugada

Allegri

Gemma

et al. 2017

European Journal of Anaesthesiology

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BACKGROUNDPerioperative regional anaesthesia may protect from persistent postsurgical pain (PPSP) and improve outcome after total knee arthroplasty (TKA).OBJECTIVESAim of this study was to evaluate the impact of regional anaesthesia on PPSP and long-term functional outcome after TKA.DESIGNA web-based prospective observational registry.SETTINGFive Italian Private and University Hospitals from 2012 to 2015.PATIENTSUndergoing primary unilateral TKA, aged more than 18 years, informed consent, American Society of Anesthesiologists (ASA) physical status classes 1 to 3, no previous knee surgery.INTERVENTION(S)Personal data (age, sex, BMI and ASA class), preoperative pain assessed by numerical rating scale (NRS) score, and risk factors for PPSP were registered preoperatively. Data on anaesthetic and analgesic techniques were collected. Postoperative pain (NRS), analgesic consumption, major complications and patient satisfaction were registered up to the time of discharge. PPSP was assessed by a blinded investigator during a phone call after 1, 3 and 6 months, together with patient satisfaction, quality of life (QOL) and walking ability.MAIN OUTCOME MEASURESExperience of PPSP according to the type of peri-operative analgesia.RESULTSFive hundred sixty-three patients completed the follow-up. At 6 months, 21.6% of patients experienced PPSP, whereas autonomy was improved only in 56.3%; QOL was worsened or unchanged in 30.7% of patients and improved in 69.3%. Patients receiving continuous regional anaesthesia (epidural or peripheral nerve block) showed a lower NRS through the whole peri-operative period up to 1 month compared with both single shot peripheral nerve block and those who did not receive any type of regional anaesthesia. No difference was found between these latter two groups. Differences in PPSP at 3 or 6 months were not significantly affected by the type of anaesthesia or postoperative analgesia. A higher NRS score at 1 month, younger age, history of anxiety or depression, pro-inflammatory status, higher BMI and a lower ASA physical status were associated with a higher incidence of PPSP and worsened QOL at 6 months.CONCLUSIONContinuous regional anaesthesia provides analgesic benefit for up to 1 month after surgery, but did not influence PPSP at 6 months. Better pain control at 1 month was associated with reduced PPSP. Patients with higher expectations from surgery, enhanced basal inflammation and a pessimistic outlook are more prone to develop PPSP.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT02147730

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Section: Discussionsupporting

confidence: 81%

Effects of anaesthesia and analgesia on long-term outcome after total knee replacement

Bugada

Allegri

Gemma

et al. 2017

European Journal of Anaesthesiology

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“…4,5 The development of chronic pain (> 3 months) has been linked to the intensity of perioperative pain; therefore, it is conceivable that preemptive multimodal analgesic strategies may also reduce the development of chronic postsurgical pain. [6][7][8] Systemic lidocaine is considered an efficacious multimodal strategy to reduce acute pain. 9 Perioperative lidocaine infusions can attenuate hyperalgesic responses to nociceptive stimuli and may reduce the development of chronic pain.…”

Section: Methodsmentioning

confidence: 99%

“…Multimodal analgesia approaches have been demonstrated to reduce opioid consumption, improve pain management, and reduce postoperative opioid‐induced complications . The development of chronic pain (> 3 months) has been linked to the intensity of perioperative pain; therefore, it is conceivable that preemptive multimodal analgesic strategies may also reduce the development of chronic postsurgical pain …”

Section: Introductionmentioning

confidence: 99%

The Effect of Intraoperative Systemic Lidocaine on Postoperative Persistent Pain Using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Criteria Assessment Following Breast Cancer Surgery: A Randomized, Double‐Blind, Placebo‐Controlled Trial

et al. 2017

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Perioperative infusion of lidocaine has been reported to decrease the incidence of postsurgical pain at 3 and 6 months following mastectomy using dichotomous (yes/no) scoring. Although intravenous lidocaine reduced the reported incidence of pain at rest at 6 months, pain with activity, pain qualities, and the physical or emotional impact of the pain were unaffected. Future studies evaluating postsurgical persistent pain should adhere to the IMMPACT recommendations in order to more accurately describe the effect of an intervention on persistent pain.

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“…Methods and results of our randomized clinical trial can be retrieved on a previous paper published by our group [ 18 ]. In summary, adult patients scheduled for monolateral inguinal hernia repair with anterior approach (open, non-video-laparoscopic approach) and tension-free technique (mesh repair) received either general, spinal, or local anesthesia with field infiltration and were then randomized into two groups: (1) ketorolac 30 mg iv every eight hours for the first 24 hours after surgery and then ketorolac 10 mg per os every eight hours for three days after discharge or (2) tramadol 100 mg iv (50 mg if weighing less than 50 kg) every eight hours for the first 24 hours after surgery and tramadol 37.5 mg/paracetamol 325 mg association (Patrol®) per os every eight hours after discharge.…”

Section: Methodsmentioning

confidence: 99%

Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

Bugada

Lavand’homme

Ambrosoli

et al. 2016

Mediators of Inflammation

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Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.

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Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study

Cited by 19 publications

References 19 publications

Effects of anaesthesia and analgesia on long-term outcome after total knee replacement

Effects of anaesthesia and analgesia on long-term outcome after total knee replacement

The Effect of Intraoperative Systemic Lidocaine on Postoperative Persistent Pain Using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Criteria Assessment Following Breast Cancer Surgery: A Randomized, Double‐Blind, Placebo‐Controlled Trial

Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

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