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RESUMEN Objetivo: Describir la cronología, evolución e impacto de la investigación global sobre el dolor crónico posoperatorio. Materiales y métodos: Estudio bibliométrico que utilizó la base de datos Scopus. Se diseñó y validó una búsqueda estructurada que permitió la recolección de metadatos, los cuales se analizaron a través del paquete Bibliometrix del lenguaje de programación R. Se realizó la descripción de las características generales, la evolución y el cálculo de métricas de impacto de la investigación global sobre el dolor crónico postoperatorio. Resultados: Se incluyeron 1496 documentos, con una ventana de tiempo entre 1983 y 2023. El 70,7 % (n = 1059) de la producción total fueron artículos originales, seguido de revisiones (n = 357; 23,8 %). Existió una colaboración internacional del 15,6 %, y, desde 1983, ha existido un crecimiento sostenido de la producción, con un incremento marcado en los últimos 13 años, donde el 2022 fue el año más fecundo (n = 191 documentos publicados). Se identificó que Canadá y Dinamarca lideran el impacto de la investigación global, y cuentan con los autores e instituciones más prolíficas. Sin embargo, Estados Unidos es el país más productivo, ya que lidera una importante colaboración, esencialmente junto a países europeos y latinos. Se encontró que el dolor neuropático, la valoración de factores de riesgo y el manejo del dolor son algunos de los tópicos más frecuentes. En los últimos 10 años, aproximadamente, ha existido un interés persistente en la investigación sobre calidad de vida, predicción, prevención y valoración de factores de riesgo. Últimamente, ha existido especial interés en el estudio del dolor en cirugía toracoscópica videoasistida y construcción de modelos de predicción. Conclusiones: Se reveló un crecimiento sostenido en la investigación global sobre dolor crónico postoperatorio, en los últimos 40 años. Dicho crecimiento ha estado liderado esencialmente por instituciones canadienses y danesas, a pesar de que se ha considerado a Estados Unidos como el país más prolífico. Asimismo, ha existido una transición importante en los tópicos estudiados, se ha pasado del uso de fármacos y determinación de factores de riesgo al estudio de modelos de predicción, sistematización de datos y cirugía videoasistida.
ABSTRACT Objective: To describe the chronology, evolution and impact of global research into chronic postoperative pain. Materials and methods: A bibliometric study was conducted using the Scopus database. A structured search was designed and validated, thereby allowing the collection of metadata, which were analyzed through the Bibliometrix package of the R programming language. The study involved the description of the general characteristics, evolution and calculation of impact metrics of global research into chronic postoperative pain. Results: The study included 1,496 documents, which spanned from 1983 to 2023. Original articles accounted for 70.7 % (n =1,059) of the total output, followed by reviews (n = 357; 23.8 %). There was an international collaboration rate of 15.6 %, and there has been sustained growth in output since 1983, with a sharp increase in the last 13 years, 2022 being the most prolific one (n =191 published documents). It was identified that Canada and Denmark lead the impact of global research and have the most productive authors and institutions. However, the United States is the most prolific country because it leads significant collaboration, mainly with European and Latin American countries. Neuropathic pain, risk factor assessment and pain management were identified as some of the most frequent topics. Over the past approximately 10 years, there has been persistent interest in research on quality of life, prediction, prevention, and risk factor assessment. Recently, there has been interest in studying pain in video-assisted thoracoscopic surgery and developing predictive models. Conclusions: The study revealed sustained growth in global research on chronic postoperative pain over the past 40 years. Such growth has been mainly led by Canadian and Danish institutions, despite the United States being the most prolific country. Moreover, there has been a significant transition in the studied topics, moving from the use of drugs and identification of risk factors to the study of predictive models, data systematization, and video-assisted surgery.
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Fundamento el dolor postoperatorio se considera un dolor con limitaciones de tiempo, a menudo mal controlado. Su manejo representa un gran desafío, ya que la analgesia postoperatoria debe brindar a la madre un control adecuado de este, y a su vez facilitar la atención del bebé. Objetivo evaluar la efectividad de la anestesia subaracnoidea con morfina como tratamiento del dolor postoperatorio en cesárea. Métodos estudio descriptivo y transversal, realizado en el Hospital General Docente Martín Chang Puga, del municipio de Nuevitas, provincia de Camagüey, entre enero de 2021 y diciembre de 2022. La muestra estuvo conformada por 36 pacientes a las cuales se aplicó anestesia subaracnoidea con lidocaína hiperbárica más morfina para la cesárea. Resultados predominó la edad comprendida entre 27-31 años. El 63,9 % de las cesareadas no refirió dolor postoperatorio. Casi la mitad de la población (47,2 %) estudiada presentó efectos secundarios con el uso de la morfina intratecal, principalmente el prurito. El 80,5 % expresó satisfacción con la analgesia postoperatoria. Conclusiones la mayoría de las pacientes encontraron satisfacción con el tratamiento analgésico, a pesar la presencia de efectos adversos, de modo que el uso de morfina intratecal es efectivo en el manejo del dolor poscesárea.
Foundation Postoperative pain is considered time-limited pain, often poorly controlled. Its management represents a great challenge, since postoperative analgesia must provide the mother with adequate control, and at the same time facilitate care for the baby. Objective to evaluate the effectiveness of subarachnoid anesthesia with morphine as a treatment for postoperative pain in cesarean section. Methods descriptive and cross-sectional study carried out at the Martín Chang Puga General Teaching Hospital, in the Nuevitas municipality, Camagüey province, between January 2021 and December 2022. 36 patients to whom subarachnoid anesthesia was applied with Hyperbaric lidocaine plus morphine for cesarean section were considered as the sample. Results the age between 27-31 years predominated. 63.9% of cesarean patients did not report postoperative pain. Almost half of the population (47.2%) studied presented side effects with the use of intrathecal morphine, mainly pruritus. 80.5% expressed satisfaction with postoperative analgesia. Conclusions the majority of patients were satisfied with the analgesic treatment, despite the presence of adverse effects, so that the use of intrathecal morphine is effective in the management of post-cesarean section pain.
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Objective To observe the effect of ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament(QLB-LSAL)and transversus abdominis plane block(TAPB)on analgesia and recovery quality after laparoscopic partial hepatectomy(LPH).Methods Fifty-eight patients underwent elective LPH were selected and divided into the quadratus lumborum group or the transversus abdominis group randomly,with 29 patients in each group.The quadratus lumborum group received bilateral QLB-LSAL,and the transversus abdominis group received bilateral subcostal TAPB block before surgery.Both groups received 20 mL of 0.33%ropivacaine on each side.All patients used patient-controlled intravenous analgesia(PCIA)postoperatively.The numeric rating scale(NRS)scores for rest and movement were recorded at 2,4,6,12,24 and 48 hours postoperatively,as well as the Quality of Recovery-15(QoR-15)scores at 1 day preoperatively,1 and 3 days postoperatively.The perioperative anesthetic agent consumption,PCIA pressing frequency,remedial analgesia use in 48 h,postoperative nausea and vomiting(PONV)incidence and time of first out-of-bed mobilization were also recorded.Results Compared with the transversus abdominis group,the quadratus lumborum group had lower movement NRS scores at 2,4,6,12,24 and 48 hours postoperatively,and lower rest NRS scores at 2,4,6,12 and 24 hours postoperatively(P＜0.05).The quadratus lumborum group had higher QoR-15 scores at 1 and 3 days postoperatively(P＜0.05).Patients in the quadratus lumborum group had reduced perioperative remifentanil and sufentanil consumption,postoperative 48-hour rescue analgesia use,PCIA pressing frequency,PONV incidence and time of first out-of-bed mobilization(P＜0.05).Conclusion QLB-LSAL block provides superior analgesic effects and recovery quality compared to TAPB block after LPH.
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Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.
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Objective:To investigate the analgesic effect of ultrasound-guided transversus abdominis plane block versus ultrasound-guided quadratus lumborum block in older adult patients undergoing inguinal hernia repair surgery. Methods:A total of 150 older adult patients who underwent inguinal hernia repair surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from April 2019 to May 2022 were included in this study. They were randomly divided into a control group ( n = 75) and a study group ( n = 75) using a random number table method. All patients underwent elective laparoscopic tension-free inguinal hernia repair surgery. Patients in the control group received ultrasound-guided transversus abdominis plane block after inguinal hernia repair surgery, while those in the study group received ultrasound-guided quadratus lumborum block. The changes in Visual Analog Scale (VAS) score and Ramsay score within 48 hours after surgery were compared between the two groups. Inflammatory factors and stress factors including serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol, were measured at 24 and 48 hours after surgery. The use of analgesics, drug-related adverse reactions, and incidence of nerve block-related complications within 48 hours after surgery were also compared between the two groups. Results:There was no significant difference in Ramsay score between the two groups at 4, 8, 12, 24, and 48 hours after surgery (all P > 0.05). There was no significant difference in VAS score between the two groups at 4 and 8 hours after surgery (both P > 0.05). At 12, 24, and 48 hours after surgery, the VAS score in the study group was (1.36 ± 0.57) points, (2.05 ± 0.56) points, and (1.79 ± 0.55) points, respectively, which were significantly lower than (1.92 ± 0.59) points, (2.68 ± 0.62) points, and (2.36 ± 0.59) points in the control group ( t = 6.65, 7.31, 5.86, all P < 0.001). At 24 and 48 hours after surgery, serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol levels in the study group [24 hours: (63.89 ± 4.65) ng/L, (156.59 ± 8.62) ng/L, (97.02 ± 6.95) g/L, (36.95 ± 3.26) g/L; 48 hours: (49.66 ± 3.74) ng/L, (131.45 ± 7.73) ng/L, (74.63 ± 5.91) g/L, (30.41 ± 2.96) g/L] were significantly lower than those in the control group [24 hours: (76.42 ± 5.17) ng/L, (189.32 ± 10.41) ng/L, (105.53 ± 7.83) g/L, (45.16 ± 3.74) g/L; 48 hours: (58.15 ± 3.94) ng/L, (162.74 ± 8.49) ng/L, (89.51 ± 6.37) g/L, (36.92 ± 3.31) g/L, t = 10.49-26.38, all P < 0.001]. The proportion of patients who received analgesics within 48 hours after surgery in the study group was 8.00% (6/75), which was significantly lower than 25.33% (19/75) in the control group ( χ2 = 8.11, P = 0.004). The overall incidence of drug-related adverse reactions within 48 hours after surgery in the study group [6.67% (3/75)] was significantly lower than that in the control group [11% (11/75), χ2 = 4.61, P = 0.032]. Conclusion:Compared with ultrasound-guided transversus abdominis plane block, ultrasound-guided quadratus lumborum block better helps alleviate postoperative pain in older adult patients undergoing inguinal hernia repair surgery, inhibits inflammation and stress reactions, reduces the dosage of analgesic drugs, and decreases the incidence of adverse drug reactions.
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Objective:To explore the effects of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy.Methods:A prospective study was conducted on 120 obese patients who underwent laparoscopic sleeve gastrectomy at the Puren Hospital Affiliated to Wuhan University of Science and Technology from July 2020 to July 2022. According to the random number table method, all patients were divided into a control group, a low concentration group, and a high concentration group, with 40 cases in each group. All three groups underwent ultrasound-guided transverse abdominis plane block after general anesthesia induction. The control group was injected with physiological saline, while the low concentration group and high concentration group were injected with 0.25% and 0.50% ropivacaine, respectively. Stress response indicators before and after surgery in three groups [adrenaline (E), cortisol (Cor), free thyroxine (FT4), and C-reactive protein (CRP)], hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR)], glucose and lipid metabolism indicators [fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hour PBG), glycated hemoglobin (HbA 1c), total cholesterol (TC), and triglycerides (TG)] and Visual Analog Scale (VAS) score were compared before and after surgery. Results:On the 1st day after surgery, the levels of E, Cor, FT4, CRP, FBG, 2-hour PBG, HbA 1c, TC, and TG in the high concentration group were lower than those in the control group and low concentration group (all P<0.05); 15 minutes after anesthesia and 2 hours after surgery, the MAP and HR of the high concentration group were higher than those of the control group and the low concentration group (all P<0.05); At 6, 12, and 24 hours after surgery, the VAS score of the high concentration group was lower than that of the control group and the low concentration group (all P<0.05); There was no statistically significant difference in the incidence of airway reactions during anesthesia induction among the three groups ( P>0.05). Conclusions:In laparoscopic sleeve gastrectomy, administering 0.50% concentration of ropivacaine ultrasound-guided plane block of the transverse abdominis muscle has a strong postoperative analgesic effect, which can improve E, Cor, FT4, and CRP levels, and is worthy of clinical application.
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Resumo Objetivo Identificar os efeitos mediadores do medo e ansiedade pré-operatórios sobre a intensidade da dor pós-operatória em pessoas submetidas a cirurgias eletivas até seis meses após cirurgia. Métodos Estudo observacional e longitudinal de análise quantitativa foi realizado com 172 pacientes adultos internados em uma instituição hospitalar e submetidos a cirurgias eletivas. Os instrumentos usados foram: formulário para caracterização de variáveis sociodemográficas, clínicas e cirúrgicas; Escala Hospitalar de Ansiedade e Depressão; Escala de Medos Relacionados a Cirurgia e Escala de Categoria Numérica para dor. As entrevistas foram realizadas no período pré-operatório, 48 horas após a cirurgia e mensalmente até completar seis meses do pós-operatório. Para a análise estatística descritiva das variáveis explanatórias, foram usadas as frequências absoluta e relativa, média, desvio padrão, mediana e os valores mínimo e máximo. A relação entre as variáveis estudadas foi analisada usando as medidas de correlação e dos efeitos mediadores (modelo de equações estruturais; método de máxima verossimilhança). Resultados No período pós-operatório (6 meses), a média de dor variou de 4,86 a 1,19. As médias de ansiedade (7,62) e medo (25,2) relacionados à cirurgia foram calculadas. A análise das variáveis mostrou correlação positiva tanto do medo como da ansiedade pré-operatórios com os níveis de dor mais elevados avaliados em distintos momentos do período pós-operatório. Além disso, a ansiedade pré-operatória exerceu um efeito mediador na relação entre o medo relacionado à cirurgia, manifestado no período pré-operatório, e a dor pós-operatória nas primeiras 48 h após a cirurgia. Conclusão As variáveis psicológicas, medo e ansiedade pré-operatórios, influenciaram a intensidade da dor pós-operatória em pessoas submetidas a cirurgias eletivas. Intervenções de enfermagem voltadas para ansiedade e medo podem ser úteis aos pacientes cirúrgicos.
Resumen Objetivo Identificar los efectos mediadores de la ansiedad y del miedo preoperatorio sobre la intensidad del dolor posoperatorio en personas que realizaron cirugías electivas hasta los seis meses posteriores a la cirugía. Métodos Se realizó un estudio observacional y longitudinal de análisis cuantitativo con 172 pacientes adultos internados en una institución hospitalaria y sometidos a cirugías electivas. Los instrumentos utilizados fueron: formulario para caracterización de variables sociodemográficas, clínicas y quirúrgicas; Escala Hospitalaria de Ansiedad y Depresión; Escala de Miedos Relacionados con Cirugías y Escala de Categoría Numérica del Dolor. Las entrevistas se realizaron en el período preoperatorio, 48 horas después de la cirugía y mensualmente hasta completar seis meses de posoperatorio. Para el análisis estadístico descriptivo de las variables explicativas, se utilizaron las frecuencias absoluta y relativa, promedio, desviación típica, mediana y valores mínimo y máximo. La relación entre las variables estudiadas se analizó utilizando las medidas de correlación y de los efectos mediadores (modelo de ecuaciones estructurales, método de máxima verosimilitud). Resultados En el período posoperatorio (6 meses), el promedio del dolor varió de 4,86 a 1,19. Se calculó el promedio de ansiedad (7,62) y miedo (25,2) relacionado con la cirugía. El análisis de las variables demostró correlación positiva tanto de la ansiedad como del miedo preoperatorio con niveles de dolor más altos evaluados en distintos momentos del período posoperatorio. Además, la ansiedad preoperatoria tuvo un efecto mediador en la relación entre el miedo relacionado con la cirugía (manifestado en el período preoperatorio) y el dolor posoperatorio en las primeras 48 horas después de la cirugía. Conclusión Las variables psicológicas, ansiedad y miedo preoperatorio, influyeron en la intensidad del dolor posoperatorio en personas que realizaron cirugías electivas. Las intervenciones de enfermería orientadas hacia la ansiedad y el miedo pueden ser útiles para pacientes quirúrgicos.
Abstract Objective To identify the mediating effects of preoperative fear and anxiety on postoperative pain intensity in people undergoing elective surgeries up to six months after surgery. Methods This is an observational and longitudinal study with quantitative analysis, carried out with 172 adult patients admitted to a hospital and undergoing elective surgeries. The instruments used were: form for characterizing sociodemographic, clinical and surgical variables; Hospital Anxiety and Depression Scale; Surgical Fear Questionnaire; and Numeric Rating Scale for pain assessment. The interviews were carried out during the preoperative period, 48 hours after surgery and monthly until six months after surgery. For the descriptive statistical analysis of the explanatory variables, the absolute and relative frequencies, mean, standard deviation, median and minimum and maximum values were used. The relationship between the variables studied was analyzed using measures of correlation and mediating effects (structural equation model, maximum likelihood method). Results During the postoperative period (6 months), the mean pain ranged from 4.86 to 1.19. The means for anxiety (7.62) and fear (25.2) related to surgery were calculated. The analysis of variables showed a positive correlation between both preoperative fear and anxiety with the highest pain levels assessed at different moments in the postoperative period. Furthermore, preoperative anxiety exerted a mediating effect on the relationship between fear related to surgery, manifested in the preoperative period, and postoperative pain in the first 48 hours after surgery. Conclusion Psychological variables, such as preoperative fear and anxiety, influenced postoperative pain intensity in people undergoing elective surgeries. Nursing interventions aimed at anxiety and fear may be useful for surgical patients.
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Apesar da evolução da tecnologia minimamente invasiva com procedimentos cirúrgicos extremamente seguros, são recorrentes no período pós-operatório complicações como dor, náusea, vômito, cefaleia, sonolência e depressão respiratória, sendo estes os principais motivos de internações hospitalares prolongadas. A pesquisa da Acupuntura reveste-se portanto de grande interesse, na medida em que poderá traduzir estes conhecimentos milenares, contribuindo para sua aceitação e incorporação no âmbito hospitalar e ambulatorial... (AU)
Despite the evolution of minimally invasive technology with extremely safe surgical procedures, complications such as pain, nausea, vomiting, headache, drowsiness and respiratory depression are recurrent in the postoperative period, being the main reasons for prolonged hospitalizations. A Research in acupuncture is, therefore, of great interest, as it can translate this ancient knowledge, contributing to its acceptance and incorporation in hospital and outpatient settings... (AU)
Apesar de la evolución de la tecnología mínimamente invasiva con procedimientos quirúrgicos extremadamente seguros, complicaciones como dolor, náuseas, vómitos, cefalea, somnolencia y depresión respiratoria son recurrentes en el postoperatorio, siendo los principales motivos de estancia hospitalaria prolongada. Por lo tanto, la investigación en acupuntura es de gran interés, ya que puede traducir este conocimiento antiguo, contribuyendo a su aceptación e incorporación en entornos hospitalarios y ambulatorios.
Sujet(s)
Humains , Mâle , Femelle , Douleur postopératoire , Thérapie par acupuncture , Acupuncture , Effets secondaires indésirables des médicamentsRÉSUMÉ
Timely post-operative pain management in elderly patients is critically important. Given their physiological changes and comorbidities, management in this group of patients is different from the rest of the population. Knowledge of potentially inappropriate medications (Beers criteria) is relevant because of the presence of comorbidities in this population. Although acetaminophen continues to be safe, non-steroidal anti-inflammatory agents produce several adverse effects which need to be considered before they are used. On the other hand, opioids continue to be one of the pillars in analgesia, with due consideration of their adverse affects and interactions, and the need for dose adjustments. Adequate postoperative pain management prevents adverse effects and the risk of developing chronic pain.
El manejo oportuno del dolor en la población anciana durante el periodo posoperatorio es de vital importancia. Este grupo de pacientes, dado sus cambios fisiológicos y comorbilidades, requieren un manejo diferente al resto de la población. Es relevante conocer cuáles medicamentos son potencialmente inapropiados para su uso (criterios de Beers) ante las comorbilidades de esta población. Si bien el acetaminofén continúa siendo seguro, los antiinflamatorios no esteroideos causan varios efectos adversos que ameritan consideración antes de su uso; por su parte, los opioides siguen siendo uno de los pilares analgésicos, teniendo en cuenta sus efectos adversos y valorando la necesidad de ajuste de dosis e interacciones. El adecuado manejo del dolor posoperatorio previene desenlaces adversos y el riesgo de cronificación.
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Avaliar e manejar a dor no período pós-operatório é fundamental, pois a dor aguda, se não ratada, é capaz de alterar diversos sistemas orgânicos. A realidade virtual constitui instrumento promissor de baixo custo para o alívio da dor. Este trabalho objetivou determinar a eficácia da realidade virtual no manejo da dor aguda leve a moderada em pacientes no pós-operatório mediato. Trata-se de um estudo clínico randomizado, realizado em um hospital pediátrico de Curitiba. Os participantes da pesquisa foram randomizados e alocados em dois grupos, submetidos a um vídeo temático relaxante e à realidade virtual. Os dados foram submetidos à análise estatística descritiva e inferencial. A redução da dor proporcionada pela realidade virtual é estatisticamente significativa e superior quando comparada à redução induzida pelo vídeo temático relaxante, podendo otimizar a experiência de hospitalização, com atenção centrada na experiência do paciente, mitigando os efeitos colaterais relacionados ao uso de opioides.
Assessing and managing pain in the post-operative period is essential, as acute pain, if left untreated, can alter several organic systems. Virtual reality is a promising low-cost tool for pain relief. This study aimed to determine the effectiveness of virtual reality in the management of mild to moderate acute pain in patients in the immediate postoperative period. This is a randomized clinical study, carried out in a pediatric hospital in Curitiba. Research participants were randomized and allocated into two groups, and shown a relaxing thematic video and virtual reality. Data were subjected to descriptive and inferential statistical analysis. Pain reduction provided by virtual reality is statistically significant and superior when compared to the reduction induced by the relaxing thematic video, and can optimize the hospitalization experience, with attention focused on the patient's experience, mitigating side effects related to the use of opioids
La evaluación y manejo del dolor en postoperatorio es fundamental. Ya que el dolor agudo, si no se trata, es capaz de alterar varios sistemas. La realidad virtual es un instrumento prometedor de bajo costo para alivio del dolor. Este estudio tuvo como objetivo determinar la efectividad de la realidad virtual en el manejo del dolor agudo en pacientes en postoperatorio inmediato. Se trata de un estudio clínico aleatorizado realizado en un hospital pediátrico de Curitiba. Los sujetos de la investigación fueron aleatorizados y distribuidos en dos grupos, sometidos a un video temático relajante y a la realidad virtual. Los datos fueron sometidos al análisis estadístico descriptivo e inferencial. La reducción del dolor proporcionada por la realidad virtual es estadísticamente significativa y superior en comparación con la reducción inducida por el video temático relajante, que puede optimizar la experiencia de hospitalización, con atención contrada en la experiencia del paciente, mitigando efectos secundarios relacionados con opioides.
Sujet(s)
Douleur postopératoire , Soins infirmiersRÉSUMÉ
OBJECTIVE@#To investigate the incidence and potential influence factors that contribute to chronic post-surgical pain (CPSP) in elderly patients with urinary tract tumors who underwent laparoscopic procedures.@*METHODS@#A retrospective study was conducted to collect the clinical data of 182 elderly patients with urinary tract tumors who were ≥65 years and underwent laparoscopic surgery from October 2021 to March 2022 in Peking University Third Hospital. The patients'demographic information, medical history and the severity of postoperative pain were collected. Telephone follow-ups were made 6 months after surgery, and the patients' CPSP conditions were recorded. The diagnostic criteria of CPSP were referred to the definition made by the International Association for the Study of Pain (IASP): (1) Pain that developed or increased in intensity after surgical procedure and persisted for at least 3 months after surgery; (2) Pain that localized to the surgical field or projected to the innervation territory of a nerve situated around the surgical area; (3) Pain due to pre-existing pain conditions or infections and malignancy was excluded. The patients were divided into two groups based on CPSP diagnosis. Risk factors that predisposed the patients to CPSP were identified using univariate analysis. A multivariate Logistic regression model using back-forward method was designed, including both variables that significantly associated with CPSP in the univariate analysis (P < 0.1), and the variables that were considered to have significant clinical impact on the outcome.@*RESULTS@#Two hundred and sixteen patients with urinary tract tumors who had undergone laparoscopic surgery were included, of whom, 34 (15.7%) were excluded from the study. For the remaining 182 patients, the average age was (72.6±5.2) years, with 146 males and 36 females. The incidence of CPSP at the end of 6 months was 31.9% (58/182). Multiva-riate regression analysis revealed that age ≥75 years (OR=0.29, 95% CI: 0.12-0.73, P=0.008) was the protecting factors for postoperative chronic pain in the elderly patients with urinary tract tumors undergoing surgical treatment, while renal cancer (compared with other types of urinary tract tumors) (OR=3.68, 95% CI: 1.58-8.58, P=0.003), and the 24 h postoperative moderate to severe pain (OR=2.57, 95% CI: 1.14-5.83, P=0.024) were the independent risk factors affecting CPSP.@*CONCLUSION@#Age < 75 years, renal cancer and the 24 h postoperative moderate to severe pain are influence factors of the occurrence of CPSP after laparoscopic surgery in elderly patients with urinary tract tumors. Optimum postoperative multimodal analgesia strategies are suggested to prevent the occurrence of CPSP.
Sujet(s)
Mâle , Femelle , Humains , Sujet âgé , Études rétrospectives , Douleur chronique/diagnostic , Laparoscopie/effets indésirables , Douleur postopératoire/étiologie , Tumeurs du rein/complications , Néphrocarcinome/complications , Facteurs de risqueRÉSUMÉ
Objective:To evaluate the effect of electroacupuncture (EA) on programmed cell death ligand-1 (PD-L1)/programmed cell death receptor-1 (PD-1)/Src-homology region two domain-containing phosphatase-1 (SHP-1) signaling pathway in the dorsal root ganglia (DRG) of rats with acute postoperative pain.Methods:Thirty-nine SPF male Sprague-Dawley rats, weighing 220-250 g, aged 6-8 weeks, were divided into 3 groups ( n=13 each) using a random number table method: control group (group C), abdominal surgery group (group S) and abdominal surgery+ EA group (group S+ EA). Group S and group S+ EA underwent abdominal surgery under isoflurane anesthesia. In S+ EA group, both Zusanli and Sanyinjiao acupoints were selected and stimulated for 30 min with a frequency of 10 Hz continuous wave and a current of 1 mA starting from the end of operation and 2 h after operation. Seven rats were selected from each group for measurement of the mechanical paw withdrawal threshold (MWT), abdominal contraction threshold (ACT), thermal paw withdrawal latency (TWL) and cold paw withdrawal latency (CWL) at 1 day before developing the model (T 0) and 3, 5, 7, 9, 11 and 24 h after developing the model (T 1-6). Six rats in each group were sacrificed at 5 h after the model was prepared, and T 12-L 4 DRG was removed for determination of the expression of interleukin-6 (IL-6), PD-L1, PD-1 and SHP-1 (by Western blot) and expression of PD-L1 in various neurons (by immunofluorescence). Results:There was no significant difference in TWL and CWL between the three groups at different time points ( P>0.05). Compared with group C, MWT at T 1-5 and ACT at T 1-6 were significantly decreased, and the expression of IL-6 in DRG was up-regulated, and the expression of PD-L1, PD-1 and SHP-1 in DRG was down-regulated in group S ( P<0.05). Compared with group S, MWT and ACT were significantly increased at T 1, 2, the expression of IL-6 in DRG was down-regulated, and the expression of PD-L1, PD-1 and SHP-1 in DRG was up-regulated in group S+ EA ( P<0.05). The results of immunofluorescence showed that PD-L1 was expressed on both small diameter neurons (CGRP + neurons and IB4 + neurons) and large diameter neurons (NF200 + neurons) and mainly on CGRP + neurons and IB4 + neurons. There was no significant difference in the expression of PD-L1 in various DRG neurons among the three groups ( P>0.05). Conclusions:The mechanism by which EA relieves acute postoperative pain may be related to activation of the PD-L1/PD-1-SHP-1 signaling pathway in the DRG of rats.
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Objective:To observe the clinical efficacy of acupuncture plus point application in managing pain after thoracoscopic radical lung cancer surgery(TRLCS). Methods:A total of 120 patients undergoing TRLCS were randomized into a treatment group and a control group,with 60 cases in each group.Both groups received patient-controlled intravenous analgesia(PCIA)to relieve postoperative wound pain.The control group did not receive any other interventions.The treatment group started acupuncture treatments 4 h after the surgery with point application between two acupuncture sessions;the acupuncture treatment was conducted 4,24,48,and 72 h after the surgery.At the above 4 time points,the visual analog scale(VAS)score and additional PCIA drug consumption were recorded.The 5-hydroxytryptamine(5-HT)content in the peripheral blood was determined 4 h and 72 h after the surgery. Results:The treatment group was superior to the control group in comparing the total effective rate(P<0.05).After the intervention,the VAS score decreased in both groups(P<0.05);the VAS score presented different decreasing patterns at each time point in the two groups,and the score dropped more significantly in the treatment group than in the control group(P<0.05).The total PICA drug consumption varied in the two groups after the surgery;the additional analgesic consumption was notably smaller in the treatment group than in the control group(P<0.05).The decrease in the 5-HT content in the peripheral blood also varied in the two groups;the peripheral blood 5-HT content was significantly lower in the treatment group than in the control group(P<0.05). Conclusion:Acupuncture plus point application can significantly relieve wound pain after TRLCS.
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Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.
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Objective:To investigate the risk factors of moderate to severe pain in patients with non-small cell lung cancer within 3 days after lobectomy.Methods:The clinical data of 297 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center from December 2020 to June 2021 were retrospectively analyzed. A numerical rating scale was used to score the most severe pain within 3 days after surgery. Pain score ≥ 4 was defined as moderate to severe pain. The risk factors for moderate to severe pain were analyzed by binary Logistic regression. General linear model repeated measures and linear mixed models were used to analyze the trend of risk factors influencing postoperative pain with time.Results:The incidence of moderate to severe pain was 34.2% (102/297), 59.8% (178/297), 66.4% (198/297), and 28.2% (84/297) on days 0, 1, 2, and 3 after surgery respectively. The risk for moderate to severe pain was significantly higher in patients undergoing thoracotomy than patients undergoing thoracoscopic surgery on days 1 ( OR = 1.99, P = 0.009), 2 ( OR = 3.08, P < 0.001), and 3 ( OR = 3.88, P < 0.001) after surgery. However, the risk for moderate to severe pain in patients undergoing thoracotomy was slightly, but not significantly, higher than that in patients undergoing thoracoscopic surgery ( OR = 1.53, P = 0.087). The risk for moderate to severe pain was higher in female patients than male patients on day 2 ( OR = 1.62, P = 0.077), and in particular on day 3 after surgery ( OR = 2.39, P = 0.002). Prophylactic use of parecoxib significantly reduced the risk of moderate to severe pain on day 0 ( OR = 0.32, P = 0.004), 1 ( OR = 0.20, P < 0.001), 2 ( OR = 0.36, P < 0.001) and 3 ( OR = 0.56, P = 0.047). Conclusion:The incidence of moderate to severe pain on days 1 and 2 after lobectomy was relatively high in patients with non-small cell lung cancer. Patients undergoing thoracotomy have a higher risk of moderate to severe pain than those who underwent thoracoscopic surgery. Female patients have a higher risk for moderate to severe pain on days 2 and 3 after surgery than male patients. Prophylactic use of parecoxib can decrease the risk for moderate to severe pain in patients with non-small cell lung cancer.
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Objective:To investigate the effects of a deep deltoid ligament injury on postoperative ankle function and pain in patients with pronation-external rotation ankle fractures.Methods:Thirty patients with pronation-external rotation ankle fractures without deep deltoid ligament injury admitted to Weihai Municipal Hospital from March 2019 to March 2020 were included in the control group. Thirty patients with pronation-external rotation ankle fractures with deep deltoid ligament injury admitted to the same hospital from April 2020 to June 2021 were included in the observation group. Both groups received reduction and internal fixation of pronation-external rotation ankle fractures. American Orthopaedic Foot and Ankle Society score, pain, and quality of life were compared between the two groups.Results:At 1 and 3 months after surgery, American Orthopaedic Foot and Ankle Society scores in the observation group were (69.87 ± 2.89) points and (75.66 ± 4.27) points, which were significantly lower than (81.45 ± 4.78) points, and (93.62 ± 3.54) points in the control group ( t = 11.35, 17.37, both P < 0.01). At 1 and 3 months after surgery, Visual Analogue Scale (VAS) scores in the observation group were (7.16 ± 1.15) points and (5.84 ± 0.52) points, respectively, which were significantly higher than (6.42 ± 0.54) points and (4.28 ± 0.16) points in the control group ( t = 3.19, 15.70, both P < 0.05). At 3 months after surgery, the scores of physical health, mental health, social relationship, and surrounding environment in the observation group were (19.18 ± 1.96) points, (18.67 ± 1.82) points, (17.42 ± 2.54) points, (19.65 ± 2.43) points, respectively, which were significantly lower than (21.65 ± 3.58) points, (23.57 ± 3.56) points, (20.09 ± 3.95) points, (22.38 ± 3.67) points in the control group ( t = 3.31, 6.71, 3.11, 3.39, all P < 0.05). Conclusion:Deep deltoid ligament injury affects the recovery of pronation-external rotation ankle fracture and affects the quality of life. Therefore, it is necessary to repair deep deltoid ligament injury in time in patients with pronation-external rotation ankle fractures.
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Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.
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Objective:To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods:One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups ( n=75) using a random number table: esketamine group (group E) and control group (group C). Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration. After the delivery of the fetus, 0.15 mg/kg (1 mg/ml) esketamine was pumped intravenously for 30 min in the group E, while the same dosage of normal saline was administered in the group C. Furthermore, patients received an intravenous patient controlled intravenous analgesia (PCIA) pump after surgery (100 μg sufentanil + 1.25 mg/kg esketamine + 8 mg ondansetron for the group E, 100 μg sufentanil + 8 mg ondansetron for the group C). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in the initial time of esketamine administration, and 5, 15 min, and 30 min after administration. The pain Numerical Rating Scale (NRS) score at rest and during coughing were recorded at 2, 6, 12, 24 h and 48 h after surgery. The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h, 12-24 h, 24-48 h, 0-24 h and 0-48 h after surgery. Moreover, we recorded the incidence of chronic pain at 3 and 6 months after surgery. Results:There were no significant differences in HR, SBP and DBP between the two groups immediately after administration of esketamine and 5, 15 min and 30 min after administration (all P>0.05). At rest or during coughing, the pain NRS score were significantly lower at 2, 6 h, and 12 h postoperatively in group E compared to group C (all P<0.05). The time to first analgesia in group E was significantly longer than the group C [(176.8±18.3)min vs (148.5±16.9)min, P<0.05]. The cumulative sufentanil consumption was significantly lower in group E during 0-12 h, 12-24 h, 0-24 h and 0-48 h postoperatively than in group C (all P<0.05), but there was no statistical significance between the two groups at 24-48 h ( P>0.05). There were no significant difference between the two groups in the incidence of chronic pain at 3 months and 6 months after surgery ( all P>0.05). The incidence of chronic pain in group E was lower than that in group C at 3 months [13.4%(9/67) vs 18.8%(13/69), P=0.392] and 6 months [10.7%(6/56) vs 16.1%(10/62), P=0.391], but the difference was not statistically significant. Conclusions:Perioperative administration of esketamine provided superior short-term analgesia after cesarean section and did not increase the psychotomimetic adverse event rate. However, the development of chronic pain was not restrained.
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Objective:To evaluate the effects of low-dose esketamine on remifentanil-induced postoperative hyperalgesia in the patients.Methods:Ninety-six American Society of Anesthesiologist Physical Status classificationⅠ or Ⅱ patients, aged 18-60 yr, with body mass index of 18-30 kg/m 2, scheduled for elective thyroidectomy under general anesthesia, were divided into 3 groups ( n=32 each) using a random number table method: control group (group C), esketamine administered before anesthesia induction group (group K1), and esketamine administered immediately after the end of surgery group (group K2). Esketamine 0.4 mg/kg was intravenously injected in group K1, and the equal volume of normal saline was given instead in C and K2 groups at 5 min before anesthesia induction. Anesthesia was induced by intravenous injection of propofol, remifentanil and rocuronium. Remifentanil was intravenously infused at a rate of 0.3 μg · kg -1·min -1 and 1.5%-2.5% sevoflurane was inhaled for anesthesia maintenance. Esketamine 0.4 mg/kg was intravenously injected in group K2 and the equal volume of normal saline was given instead in C and K1 groups immediately after the end of surgery. The mechanical pain thresholds of surgical incision and forearm of non-dominant hand were measured at 1 day before surgery and 30 min, 6 h, 24 h and 48 h after surgery, and flurbiprofen axetil was intravenously injected for rescue analgesia when the NRS score≥4 or the patient needed sedation. The intensity of pain was estimated using numeric rating scale at 30 min, 6 h, 24 h and 48 h after surgery. The intraoperative consumption of remifentanil, use of vasoactive drugs, recovery time, tracheal extubation time, duration of PACU stay, postoperative rescue analgesia and adverse reactions were recorded. Results:Compared with C group, the mechanical pain threshold around surgical incision and of the forearm of non-dominant hand was significantly increased at 30 min and 6 h after surgery in K1 and K2 groups ( P<0.05). Compared with C and K1 groups, the emergence time, tracheal extubation time, and duration of PACU stay were significantly prolonged, and the incidence of hallucinations and increased glandular secretion was increased in group K2 ( P<0.05). There were no significant differences in the consumption of remifentanil, intraoperative utilization rate of atropine and ephedrine, numeric rating scale scores at each time point after surgery, incidence of postoperative nausea and vomiting, and rate of rescue analgesia among the three groups ( P>0.05). Conclusions:Intravenous injection of small dose of esketamine (0.4 mg/kg) before anesthesia induction and immediately after the end of surgery can reduce postoperative hyperalgesia induced by remifentanil, and administration before anesthesia induction provides better efficacy in the patients.
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Objective:To evaluate the role of sphingosine-1-phospho-1 receptor(S1PR1)in the dorsal root ganglion in remifentanil-induced hyperalgesia in rats with incisional pain.Methods:Forty-eight male Sprague-Dawley rats with successful intrathecal and caudal vein catheterization, weighing 260-280 g, aged 2-3 months, were divided into 6 groups ( n= 8 each) using a random number table method: control group (group C), S1PR1 antagonist (FTY720) group (group F), remifentanil group (group R), remifentanil + S1PR1 antagonist (FTY720) group (group R+ F), remifentanil + incisional pain group (group R+ I), and remifentanil + incisional pain + S1PR1 antagonist (FTY720) group (group R+ I+ F). In C group, normal saline 0.1 μg·kg -1·min -1 was intravenously infused for 60 min. In R group, remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In F group, FTY720 3 nmol was intrathecally injected, and 10 min later normal saline 1.0 μg· kg -1·min -1 was infused for 60 min via the caudal vein. In R+ F group, FTY720 3 nmol was intrathecally injected, and 10 min later remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In R+ I group, remifentanil 1.0 μg·kg -1·min -1 was infused for 60 min through the caudal vein while the model of incisional pain was developed. In R+ I+ F group, FTY720 3 nmol was intrathecally injected, 10 min later the incisional pain model was prepared, and remifentanil 1.0 μg·kg -1·min -1 was injected for 60 min through the caudal vein at the same time. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before remifentanil or normal saline infusion (T 0) and 2, 6, 24 and 48 h after stopping remifentanil or normal saline infusion (T 1-4). Rats were sacrificed after the last measurement of pain threshold, and the L 4-6 segments of dorsal root ganglion were taken for determination of the expression of S1PR1, NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), interleukin-1β (IL-1β) and glutamate transporter-1 (GLT-1) protein and mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with C group, the MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and the expression of GLT-1 protein and mRNA in dorsal root ganglion was down-regulated in R group ( P<0.05), and no significant change was found in the parameters mentioned above in group F ( P>0.05). Compared with R group, MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and GLT-1 protein and mRNA expression in dorsal root ganglion was down-regulated in R+ I group, and MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and GLT-1 protein and mRNA expression in the dorsal root ganglion was up-regulated in R+ F group ( P<0.05). Compared with R+ I group, MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and the expression of GLT-1 protein and mRNA in the dorsal root ganglion was up-regulated in R+ I+ F group( P<0.05). Conclusions:The mechanism by which remifentanil induces hyperalgesia is associated with up-regulation of S1PR1 expression, activation of inflammatory factors, and down-regulation of GLT-1 expression in the rats with incisional pain.