RAEducation » Acute Pain

Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com

admin — Tue, 10 Nov 2009 21:33:18 +0000

From the home page of the New York Times. A quick read on a topic of great importance for breast cancer survivors. Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com. Related posts:Rivals Take Aim at the Software Company SAS – NYTimes.com As healthcare attempts to bring electronic records into [...] Related posts:

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The Effect of Perioperative IV Lidocaine on Post-Op Pain and Immune Function

admin — Thu, 29 Oct 2009 13:00:15 +0000

What’s nice about this study is the control group: PCEA! The differences in pain scores were statistically different but of questionable clinical difference. Another study with incremental pain improvements, but importantly reflecting non-incremental changes in perioperative stress response. Also note the higher pain scores despite increased PCEA volume and intra-op opioid use (although, this could increase OR decrease post-op pain depending on your literature purview). A&A via Ovid.

Gabapentin and Ketamine for TAH. Ok, that’s a lot of gabapentin, at least compared to...
Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com From the home page of the New York Times. A...

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A Brief History of the Placebo

admin — Wed, 09 Sep 2009 12:00:32 +0000

Who knew that anesthesia had such an integral role in the modern placebo? A simply fantastic introduction to the topic, from a slightly uncharacteristic source.

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Pain Medicine: Acute and Persistent Postoperative Pain after Breast Surgery

admin — Fri, 24 Apr 2009 12:03:12 +0000

Nearly 60% of women experienced severe pain following breast cancer surgery in this retrospective study. Such pain remained for nearly 1 in 4 women at 1 month after surgery, and nearly 1 in 10 at 6-12 months following surgery.

Non-White race, obesity, and high PACU opioid use were correlated with increased pain at 1 month. Systolic hypertension and older age were correlated with lower pain scores.

There is no mention of the role of regional anesthesia in this study.

Acute and Persistent Postoperative Pain after Breast Surgery

Karamarie Fecho, PhD,* Natalie R. Miller, BS,* Sarah A. Merritt, MD,* Nancy Klauber-DeMore, MD, † C. Scott Hultman, MD, ‡ and William S. Blau, MD, PhD*

*Department of Anesthesiology and Divisions of † Surgical Oncology and ‡ Plastic and Reconstructive Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

ABSTRACT
Objectives. This study’s primary aim was to determine levels of acute and persistent postoperative pain and the incidence of severe postoperative pain after mastectomy. A secondary aim was to examine factors associated with postoperative pain.

Design. A retrospective cohort study of 196 female breast surgery subjects was conducted. Data were collected on: numerical rating scale (NRS) pain scores in the Post Anesthesia Care Unit (PACU) and at 1 month and 6–12 months postoperative; age; race; insurance; obesity; radiotherapy; chemotherapy; hypertension; anesthesia care time; and intraoperative and PACU opioid use. Severe postoperative pain was defined as NAS ≥ 5. Data were analyzed using chi square, Fisher’s exact test or analysis of variance, with α = 0.05.

Results. PACU pain and the incidence of severe PACU pain increased with surgical complexity (P < 0.005). PACU pain scores averaged 4.71 ± 0.24 and 57.7% of subjects experienced severe pain. Postoperative pain scores at 1 or 6–12 months did not vary by surgical complexity and averaged 2.21 ± 0.32 and 0.74 ± 0.22, respectively. Severe postoperative pain was experienced by 22.1% of subjects at 1 month and 8.2% of subjects at 6–12 months. Older age and systolic hypertension were associated with less PACU pain. Non-White race, obesity, and high PACU opioid use were associated with greater postoperative pain at 1 month. Non-White people also had greater postoperative pain at 6–12 months.

Conclusions. The results suggest that nearly 60% of breast surgery patients experience severe acute postoperative pain, with severe pain persisting for 6–12 months in almost 10% of patients.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4637.2009.00611.x About DOI

Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com From the home page of the New York Times. A...
The Effect of Perioperative IV Lidocaine on Post-Op Pain and Immune Function What’s nice about this study is the control group: PCEA!...

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Prolonged use of high-dose morphine impairs angiog…[Anesth Analg. 2008] – PubMed Result

admin — Tue, 30 Dec 2008 02:30:56 +0000

Very interesting.

Prolonged use of high-dose morphine impairs angiog…[Anesth Analg. 2008] – PubMed Result
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Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. [Can J Anaesth. 2008] – PubMed Result

admin — Mon, 01 Dec 2008 11:49:46 +0000

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. [Can J Anaesth. 2008] – PubMed Result
.

Interesting. This study took 2 groups of children undergoing scoliosis surgery under remifentanil, starting dose well within the usual range. One group received morphine (0.15mg/kg) prior to the remi, the other group saline. The group which received the morphine did NOT have decreased post-operative morphine requirements. Instead, this group trended towards increased requirements. All patients who were changed from morphine to hydromophone were also in the morphine group.

The discussion has a nice review of the topic, noting similar findings (or failure, rather) when fentanyl was used as the pretreating agent.

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Continuous thoracic paravertebral block for major breast surgery.

admin — Sat, 22 Nov 2008 01:17:48 +0000

Continuous thoracic paravertebral block for major breast surgery.

Reg Anesth Pain Med. 2006 Sep-Oct;31(5):470-6

Authors: Boezaart AP, Raw RM

PMID: 16952822 [PubMed - indexed for MEDLINE]

An excellent review of thoracic paravertebral blocks. The diagrams along are worth reviewing.

Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com From the home page of the New York Times. A...

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