New modalities of pain treatment after outpatient orthopaedic surgery

Abstract

Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored.

Nature’s wrath—The effect of weather on pain following orthopaedic trauma

“…In the immediate post-operative period, there are many factors that affect patient pain besides weather [25][26][27][28][29][30][31]. Concomitant soft tissue injuries resulting from the initial trauma can be extremely painful and often require significant healing time [25,26].…”

“…Concomitant soft tissue injuries resulting from the initial trauma can be extremely painful and often require significant healing time [25,26]. Procedure related pain is also a substantial contributor to postoperative pain and orthopaedic patients have been shown to have the highest incidence of postoperative pain among surgical subspecialties [27,28]. High levels of preoperative pain and decreased functional status have been shown to increase the perception of pain after treatment [25,29,30].…”

“…High levels of preoperative pain and decreased functional status have been shown to increase the perception of pain after treatment [25,29,30]. Additionally, most patients in the postoperative period derive significant analgesia from pharmacologic pain relievers [28,31]. This can greatly affect patient reported pain depending on how often the patient is using pain medication and whether or not the patient is taking pain medication at the time of VAS survey administration.…”

“…Obviously, patients who live in consistently low barometric pressure environments would not be expected to have more pain following trauma surgery. This study was also limited by variance in pain scores due to factors unrelated to weather conditions, as pain and functional status are both highly confounded by a host of variables [25][26][27][28][29][30][31]. We were not able to account for patients with treatment complications or pre-existing pain conditions.…”

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

“…Some authors underline that monitoring the balance between antinociception and nociception is the way to administer better (more personalized) analgesia [21]. The emergence of new anti-nociceptive drugs in recent years has shown the benefits of combining opioid and non-opioid drugs in order to decrease opioid side effects [22][23][24][25][26][27][28][29].…”