The transition from acute to chronic pain

Lamacraft, Gillian

doi:10.1080/22201173.2010.10872650

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…3,4 Further, increased postoperative pain scores are associated with an increased incidence of chronic pain syndromes. 5,6 Recently, opioid-free and opioid-sparing analgesia protocols have gained popularity due to their proven benefit of avoiding opioid-derived adverse effects. 7,8 Regional analgesia techniques as part of the multimodal approach for post cardiac surgery sternotomy pain have been increasingly used to provide an alternative to traditional opioidmainly analgesia regimens.…”

Section: Introductionmentioning

confidence: 99%

“…Inadequate pain control can potentially be associated with serious adverse effects such as respiratory compromise, 1 increased myocardial work and oxygen demand, 2 delayed mobilization, 3 and prolonged hospital stay 3,4 . Further, increased postoperative pain scores are associated with an increased incidence of chronic pain syndromes 5,6 . Recently, opioid‐free and opioid‐sparing analgesia protocols have gained popularity due to their proven benefit of avoiding opioid‐derived adverse effects 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

King

Stambulic

Hassan

et al. 2022

Journal of Cardiac Surgery

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Background Inadequate pain control after median sternotomy leads to reduced mobilization, increased respiratory complications, and longer hospital stays. Typically, postoperative pain is controlled by opioid analgesics that may have several adverse effects. Parasternal intercostal block (PSB) has emerged as part of a multimodal strategy to control pain after median sternotomy. However, the effectiveness of this intervention on postoperative pain control and analgesic use has not been fully established. Methods and Results We conducted a meta‐analysis to assess the effect of PSB on postoperative pain and analgesic use in adult cardiac surgery patients undergoing median sternotomy. PubMed, Embase, Google Scholar, and the Cochrane database were searched with the following search strategy: ([postoperative pain] or [pain relief] OR [analgesics] or [analgesia] or [nerve block] or [regional block] or [local block] or [regional anesthesia] or [local anesthetic] or [parasternal block] and [sternotomy]) and (humans [filter]). Inclusion criteria were: patients who underwent cardiac surgery via median sternotomy, age >18 and parasternal block (continuous and single dose). Exclusion criteria were: noncardiac surgery, nonparasternal nerve blocks, and the use of NSAIDS in parasternal block. Quality assessment was performed by three independent reviewers via the Cochrane risk of bias assessment tool. Of 1165 total citations, 18 were found to be relevant. Of these 18 citations, 7 citations (N = 2223 patients) reported postoperative pain scores in an extractable format and 11 citations (N = 2155 patients) reported postoperative opioid use in an extractable format. For postoperative opioid use, morphine equivalent doses were calculated for all studies and postoperative pain scores were standardized to a 10‐point visual analog scale for comparison between studies; both these were reported as total opioid use or cumulative score ranging from 24 to 72 h postoperative. All data analyses were run using a random effects model, using a restricted maximum likelihood estimator, to obtain summary standardized mean differences with 95% confidence interval (CI's). For studies which only reported median and interquatile range (IQR), the median was standard deviation was estimated by IQR/1.35. Following median sternotomy both postoperative pain (SMD [95% CI] −0.49 [−0.92 to −0.06]) and postoperative morphine equivalent use (SMD [95% CI] −1.68 [−3.11 to −0.25]) were significantly less in the PSB group. Conclusion Our meta‐analysis suggests that parasternal nerve block significantly reduces postoperative pain and opioid use.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

King

Stambulic

Hassan

et al. 2022

Journal of Cardiac Surgery

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Enhanced Recovery After Surgery (ERAS)

Villalobos¹,

Stoicea²,

Todeschini³

et al. 2019

The Clinical Journal of Pain

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Objectives: The objective of this study was to review the current scientific evidence on the role of Enhanced Recovery After Surgery (ERAS) implementations in reducing postoperative opioid consumption and their potential association with the risk reduction for long-term opioid use, physical opioid dependency, and opioid addiction. Methods: A literature search was conducted using the following medical subject heading keywords: “postoperative pain,” “postoperative pain management,” “multimodal analgesia,” “ERAS,” “Enhanced Recovery,” “opioid-free analgesia,” or “opioid crisis.” Discussion: Identification and management of pre-existing psychosocial factors, comorbid pain entities, and chronic opioid use have a significant impact on the severity of postoperative pain. Different multimodal analgesia approaches have been associated with reduced postoperative pain scores and opioid consumption. Health care providers, patients, and family members should recognize the advantages of opioid-free analgesia techniques in postoperative pain management. As part of ERAS protocols, transitional pain services may consider current therapeutic alternatives for acute and long-term pain management that include minimizing perioperative opioid use and establishing adequate opioid prescription practices.

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The transition from acute to chronic pain

Cited by 2 publications

References 20 publications

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

Enhanced Recovery After Surgery (ERAS)

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