Study on Regional and Local Anesthesia in the Prevention of Chronic Post-Surgical Pain
- 1. Associate Professor, Anaesthesia, SVS Medical College, Yenugonda, Mahabubnagar, Telangana - 509001
- 2. Assistant Professor, Anaesthesia, SVS Medical College, Yenugonda, Mahabubnagar, Telangana – 509001
Description
Introduction: During regional anesthesia, an anesthetic is injected close to nerves to block pain signals without completely knocking a patient out. Reduced drug doses, a quicker recovery time, and no airway manipulation are just a few of the benefits of regional anesthesia compared to general anesthesia. In order to prevent chronic postoperative pain, however, more research is needed to resolve limitations and optimise outcomes. Aims and Objectives: This research aims to determine if regional and local anesthesia effectively reduces the risk of long-term discomfort following surgery. Methods: The study was conducted for one year and enrolled 75 individuals with knee osteoarthritis who underwent” Local Infiltration Anesthesia (LIA)” or “Ultrasonic-Guided Regional Anesthesia (USRA)”. Comparatively, the USRA group underwent peripheral nerve blocks whereas the LIA group received injections of dexmedetomidine and ropivacaine. No drains or postoperative antibiotics were used, but they were given as a precaution. Together, LIA/USRA and general/spinal anesthesia were used. The patients’ pain levels were measured using the numeric rating scale (NRS), and they were given oral analgesics and postoperative opioids as necessary. Result: Except for the primary anesthetic technique, there were no significant differences in baseline characteristics between the LIA (n=37) and USRA (n=38) groups of subjects. While the LIA group had improved NRS scores during exercise on day one postoperatively, they needed more opioids on the day of surgery. Dexmedetomidine was well tolerated with no reported side effects. The regression analysis showed that sex, LIA type, and anesthesia type were not significant factors. Conclusion: Multimodal analgesia is enhanced by dexmedetomidine’s opioid-sparing effects after total knee arthroplasty, although more study is required.
Abstract (English)
Introduction: During regional anesthesia, an anesthetic is injected close to nerves to block pain signals without completely knocking a patient out. Reduced drug doses, a quicker recovery time, and no airway manipulation are just a few of the benefits of regional anesthesia compared to general anesthesia. In order to prevent chronic postoperative pain, however, more research is needed to resolve limitations and optimise outcomes. Aims and Objectives: This research aims to determine if regional and local anesthesia effectively reduces the risk of long-term discomfort following surgery. Methods: The study was conducted for one year and enrolled 75 individuals with knee osteoarthritis who underwent” Local Infiltration Anesthesia (LIA)” or “Ultrasonic-Guided Regional Anesthesia (USRA)”. Comparatively, the USRA group underwent peripheral nerve blocks whereas the LIA group received injections of dexmedetomidine and ropivacaine. No drains or postoperative antibiotics were used, but they were given as a precaution. Together, LIA/USRA and general/spinal anesthesia were used. The patients’ pain levels were measured using the numeric rating scale (NRS), and they were given oral analgesics and postoperative opioids as necessary. Result: Except for the primary anesthetic technique, there were no significant differences in baseline characteristics between the LIA (n=37) and USRA (n=38) groups of subjects. While the LIA group had improved NRS scores during exercise on day one postoperatively, they needed more opioids on the day of surgery. Dexmedetomidine was well tolerated with no reported side effects. The regression analysis showed that sex, LIA type, and anesthesia type were not significant factors. Conclusion: Multimodal analgesia is enhanced by dexmedetomidine’s opioid-sparing effects after total knee arthroplasty, although more study is required.
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IJPCR,Vol15,Issue6,Article298.pdf
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Additional details
Dates
- Accepted
-
2023-06-26
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue6,Article298.pdf
- Development Status
- Active
References
- 1. Li J, Lam D, King H, Credaroli E, Harmon E, Vadivelu N. Novel Regional Anesthesia for Outpatient Surgery. Curr Pain Headache Rep. 2019 Aug 01;23(10):69. 2. Loizou E, Mayhew DJ, Martlew V, Murthy BVS. Implications of deranged activated partial thromboplastin time for anesthesia and surgery. Anesthesia. 2018 Dec;73(12):1557-1563. 3. Doo AR, Shin YS, Choi JW, Yoo S, Kang S, Son JS. Failed dural puncture during needle-through-needle combined spinal-epidural anesthesia: a case series. J Pain Res. 2019;12:1615- 1619. 4. Werner MU, Kongsgaard UEI. Defining persistent post-surgical pain: is an update required?British Journal of Anaesthesia. 2014; 113: 1–4. 5. Schug SA, Lavand'homme P, Barke A, Korwisi B, Rief W, Treede RD. The IASP classification of chronic pain for ICD-11: chronic postsurgical orposttraumatic pain. Pain2019; 160: 45– 52. 6. Crombie IK, Davies HT, Macrae WA. Cut and thrust: antecedent surgery and trauma among chronic pain clinic patients. Pain1998; 76: 167–71. [PubMed: 9696470] 7. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367: 1618–25. 8. Weinstein EJ, Levene JL, Cohen MS, et al. Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database of Systematic Reviews2018; 6: CD007105. 9. Schug SA, Bruce J. Risk stratification for developing chronic postsurgical pain. Pain Reports. 2017; 2: e627. 10. Uyl N, de Jonge E, Uyl-de Groot C, van der Marel C, Duvekot J. Difficult epidural placement in obese and nonobese pregnant women: a systematic review and meta-analysis. Int J Obstet Anesth. 2019 Nov;40:52-61. 11. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003 Nov;238(5):663-73. 12. Atanassoff PG, Lobato A, Aguilar JL. [Intravenous regional anesthesia with long-acting local anesthetics. An update]. Rev Esp Anestesiol Reanim. 2014 Feb;61(2):87-93. 13. FitzGerald S, Odor PM, Barron A, Pawa A. Breast surgery and regional anesthesia. Best Pract Res Clin Anaesthesiol. 2019 Mar;33(1):95-110. 14. Searle R, Simpson K. Chronic postsurgical pain. Contin Educ Anaesth Crit Care Pain. 2010;10(1):12–4. 15. Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;11(348):g1251. 16. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93(4):1123–33. 17. Vetter TR, Boudreaux AM, Jones KA, Hunter JM Jr, Pittet J-F. The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg 2014;118:1131–6. 18. Mariano ER. Making It Work: Setting up a Regional Anesthesia Program that Provides Value. Anesthesiol Clin 2008;26:681–92. 19. Atchabahian A, Andreae M. Long-term functional outcomes after regional anesthesia: a summary of the published evidence and a recent Cochrane Review. Refresh Courses Anesthesiol 2015;43:15–26. 20. Chapman CR, Vierck CJ. The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. J Pain. 2017;18(4):359. 21. National Center for Chronic Disease Prevention and Health Promotion. "About Chronic Diseases." Centers for Disease Control and Prevention. 28 April 2021, 22. NB Finnerup, SH Sindrup, TS Jensen, The evidence for pharmacological treatment of neuropathic pain Pain, 150 (2010), pp. 573-581 23. H Kehlet, TS Jensen, CJ Woolf Persistent postsurgical pain: risk factors and prevention Lancet, 367 (2006), pp. 1618-1625 24. A.R. Kulkarni, A.L. Pusic, J.B. Hamill, et al. Factors associated with acute postoperative pain following breast reconstruction JPRAS Open, 11 (2017), pp. 1-13 25. Crombie IK, Davies HT, Macrae WA. Cut and thrust: antecedent surgery and trauma among chronic pain clinic patients. Pain. 1998;76:167–171. 26. Gesundheitsberichterstattung des Bundes. Operationen dervollstationären und ambulanten Patientinnen und Patienten. Daten von 2017. 27. H Ju, Y Feng, BX Yang, J Wang Comparison of epidural analgesia and intercostal nerve cryo analgesia for post-thoracotomy pain control Eur J Pain, 2008;12: 378-384.