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.

Endotracheal intubation of patients in left semi-prone position before endoscopic retrograde cholangiopancreatography: A randomised controlled study.

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed with the patient in the left semi-prone position. The patients are usually intubated in the supine position and subsequently turned to the left semi-prone position. This turning procedure may cause the injuries to the patient or unstable haemodynamics. Previous studies show that the success rates of intubation in the lateral position are comparable to that of intubation in the supine position, even so, there are some difficulties. Therefore, this study is aimed to investigate the effect of the semi-prone position on the success rate of intubation. Methods: This randomised controlled trial included 88 patients aged 18 to 80 years with an American Society of Anesthesiologists physical status (ASA PS) of I-III with no predicted difficult intubation, and who were undergoing ERCP. The subjects were randomly assigned to be intubated in the supine or semi-prone position. The 44 patients in the supine group were intubated in the supine position. The other 44 patients were intubated in the semi-prone position. The primary outcome was the success rate of the first intubation attempt. Results: There were no differences between the two groups in age, ASA PS and preoperative airway characteristics. Endotracheal intubation was successful in all patients with the first intubation attempt successful in 43 patients (97.7%) in the supine group and 42 (95.5%) in the semi-prone group (P = 0.556). Conclusion: For patients undergoing ERCP, the success rate of endotracheal intubation in the left semi-prone position was comparable to that in the supine position.