Predicting the Severity of Acute Pain after Cesarean Delivery: A Narrative Review.

PURPOSE OF THE REVIEW: Cesarean delivery is one of the most common surgical procedures performed worldwide. Approximately 28-78% of the patients have reported experiencing severe pain after Cesarean delivery, which is associated with adverse outcomes. Current analgesic management strategies employ a one-size-fits-all approach, which may not be suitable for all post-Cesarean patients. Our ongoing research and the purpose of this review are focusing on preoperative risk assessment to identify patients at risk of severe pain or needing higher doses of opioid or other analgesics. RECENT FINDINGS: Recent clinical investigations have found that by utilizing the demographic and psychological evaluations, screening tests, quantitative sensory testing, and assessment of response to local anesthetic infiltration, clinicians were potentially able to stratify the risks for severe post-cesarean pain. Several modalities demonstrated significant correlations with pain outcomes, although most of these correlations were weak to modest. Since consensus statement regarding predicting post-CD pain control are still lacking, these correlations can be clinically helpful. It is possible to identify patients at high risk of developing severe acute pain after cesarean section by preoperative demographic data, screening questionnaires, or other tools. Further studies are needed to identify additional variables or screening tools for more accurate prediction and investigate whether personalized analgesic regimens can lead to improved analgesic outcomes.

Peripheral Nerve Blocks for Cesarean Delivery Analgesia: A Narrative Review.

Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, currently represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. This review discusses the relevant anatomy, current evidence, and advantages and disadvantages of the various peripheral nerve block techniques. Further research is warranted to compare the analgesic efficacy of these techniques, especially newer blocks (e.g., quadratus lumborum blocks and erector spinae plane blocks). Moreover, future studies should determine the safety profile of these blocks (e.g., fascial plane blocks) in the obstetric population because of its increased susceptibility to local anesthetic toxicity.

Decreasing leakage during continuous femoral nerve catheter fixation using 2-octyl cyanoacrylate glue (Dermabond®): a randomized controlled trial.

BACKGROUND: Continuous peripheral nerve catheters (CPNCs) have been used for postoperative pain relief. A common problem encountered with CPNCs is pericatheter leakage, which can lead to dressing adhesive failure. Frequent dressing changes increase the risk of catheter dislodgement and infections. Adhesive glue is effective in securing the peripheral nerve catheter and decreasing leakage around the catheter insertion site. This study aimed to evaluate the incidence of pericatheter leakage with fixation using 2-octyl cyanoacrylate glue (Dermabond®) as compared to sterile strips. METHODS: Thirty patients undergoing unilateral total knee arthroplasty (TKA) with continuous femoral nerve catheter for postoperative analgesia were randomized into the catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) group or the sterile strip group. The primary outcome was the incidence of pericatheter leakage. Secondary outcomes included the frequent of catheter displacement, the difficulty of catheter removal, pain score and patient satisfaction. RESULTS: The incidence of pericatheter leakage at 24 and 48 h was 0% versus 93 and 0% versus 100% in the Dermabond® and sterile strip groups, respectively (P < 0.001). The incidence of displacement at 24 and 48 h was 6.7% versus 93.3 and 6.7% versus 100% in the Dermabond® and sterile strip, respectively (P < 0.001). There was no difference in numeric rating scale, difficulty of catheter removal, or satisfaction scores between groups. CONCLUSIONS: Catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) decreased the incidence of pericatheter leakage, as well as catheter displacement, over 48 h as compared to sterile strip fixation. TRIAL REGISTRATION: This trial was registered on Thai clinical trial registry: TCTR20200228002 , registered 24 February 2020- Retrospectively registered.

Parenteral Parecoxib Provides a Similar Reduction in Opioid Requirement to Single-Shot Sciatic Nerve Block after Total Knee Arthroplasty when Combined with Continuous Femoral Nerve Block.

Objective: Continuous femoral nerve blockade has become an accepted modality in the management of pain after total knee arthroplasty (TKA); however, posterior knee pain can be problematic and often requires additional analgesia. The present study compared the use of parenteral parecoxib to single-shot sciatic block for this purpose. Material and Method: After the Ethic Review Board gave approval, adults undergoing TKA were randomly divided into 3 groups. Group 1 (Gr-F+S) received single-shot sciatic nerve block (SNB) with 0.25% bupivacaine 25 ml in addition to continuous femoral analgesia (CFA) (0.125% bupivacaine 7 ml/h); group 2 (Gr-F+P) received parenteral parecoxib 40 mg q 12 hours with CFA; and group 3 (Gr-F) received only CFA. Assessments were performed at 0, 6, 12, and 24 hours post op. and included the following variables: NRS (numerical rating score) at rest, morphine use, time to first analgesic dose and side effects. Results: Seventy-eight patients were enrolled, with 26 participants in each of the 3 groups. There was no inter-group difference in pain score (NRS). However, morphine requirements in the first 24 hours were significantly increased in Gr-F (17±12 mg) when compared to Gr-F+S (10±7 mg) and Gr-F+P (9±5 mg) (p<0.001). There was no difference in time to first analgesic dose, side effects or patient satisfaction. Conclusion: Parenteral parecoxib and single-shot SNB both significantly reduced morphine requirements when used in combination with femoral nerve blockade after TKA.

A comparison of propofol-LCT with propofol-LCT/MCT on pain of injection.

BACKGROUND: Propofol-Lipuro 1% is consisting of long-chain triglycerides (LCT) and medium-chain triglycerides (MCT) that have been reported to reduce injection pain. OBJECTIVE: To compare the incidence and intensity of injection pain with 1% Propofol-LCT with 1% Propofol-LCT/MCT in female populations for minor surgery under total intravenous anesthesia (TIVA). MATERIAL AND METHOD: One hundred and ten female patients were double-blind randomized into two groups. Group long-chain triglycerdes (L) received 1% propofol-LCT while group long-chain triglycerides/medium-chain triglycerides (L/M) received 1% propofol-LCT/MCT. All patients received no benzodiazepine premedication and fentanyl 1 microg/kg was given 3 minutes before propofol injection. The propofol 1 mg/kg was manually injected at 0.5 mL/sec. The verbal rating score (VRS 0-10) was recorded on pain of injection. VRS > 4 indicates a significant response to pain. RESULTS: There was a significantly greater incidence and intensity of injection pain in group L compared with group L/M (p < 0.001 and p = 0.013 respectively). CONCLUSIONS: Propofol-LCT/MCT is superior to propofol-LCT on reducing pain of injection.