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Objective: The objective of this study was to evaluate the effects of comfort care on perioperative outcomes and postoperative recovery of breast cancer patients. Evaluating comfort care is important in the context of breast cancer surgery because it can potentially alleviate pain, improve patient comfort, enhance postoperative recovery, and reduce complications, ultimately leading to better patient outcomes., Methods: Between March 2020 and December 2021, 78 patients undergoing breast cancer surgery at our hospital were randomly assigned to receive either routine nursing (routine group) or comfort care (experimental group). The comfort care intervention included various components such as health education, preoperative care, intraoperative care, postoperative care, pain care, and psychological care. The routine group received standard nursing care following medical advice., Results: The patient characteristics between the two groups were comparable. Comfort care resulted in significantly higher visual analog scale (VAS) scores, indicating reduced pain, and better improvement in functional recovery of the upper limb compared to routine nursing. Comfort care was also associated with better postoperative recovery, as evidenced by lower self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores. The experimental group had a significantly lower incidence of complications compared to the routine group. Additionally, the experimental group reported better 24-hour comfort and higher nursing satisfaction., Conclusion: In conclusion, comfort care effectively reduces postoperative pain, promotes postoperative recovery, improves patient emotions, lowers the incidence of complications, and enhances comfort and care satisfaction in breast cancer patients undergoing radical surgery. These findings highlight the importance of incorporating comfort care interventions in the perioperative management of breast cancer patients. Further research and implementation of comfort care strategies may have implications for improving clinical practice and patient outcomes in the future.

Background: Managing postoperative setting, regarding pain and anxiety after cesarean delivery is crucial for the mother's recovery, her emotional well-being, mother-infant bonding and initiating breastfeeding. Although some research have suggested that aromatherapy with lavender essential oil can be effective in reducing pain and anxiety in various medical settings, the efficacy of lavender aromatherapy in the postoperative setting after cesarean delivery is less well-studied. We aimed to assess the effectiveness of lavender essential oil therapy in the management of pain and anxiety after cesarean delivery., Methods: This was a monocentric randomized controlled double-blind trial conducted over a period of five months during 2023. A hundred women undergoing c-sections under spinal anesthesia were enrolled and randomly assigned; using block randomization of 4 items per block with allocation ratio 1:1, into two groups: The aromatherapy group (receiving inhaled Lavender essential oil) versus the placebo group (receiving distilled water instead). The primary outcomes were pain (at rest and after mobilization) and anxiety levels and after the intervention. This trial was registered on clinical-trials.org (NCT06387849)., Results: A total of 100 women were included (50 women in each group aromatherapy and the placebo group). The two groups were comparable regarding baseline characteristics and pre-intervention parameters with no statistically significant difference. After the intervention, the pain at rest (38,76 ± 22,9 vs. 23,84 ± 18,01; p < 0.001), the pain after mobilization (60,28 ± 23,72 vs. 40,12 ± 22,18; p < 0.001), and degree of anxiety (46,76 ± 6,59 vs. 44,3 ± 5,17; p = 0.03) were all significantly lower in the aromatherapy group. No adverse effects were reported by participants in both groups., Conclusion: Aromatherapy using Lavender essential oil is effective in reducing pain and anxiety after cesarean delivery without adverse effects., Competing Interests: Declarations. Ethics Approval and Consent to Participate: The study protocol was approved by the local Institutional Review Board (approval no. 03/2023). This trial was registered on clinical-trials.org (NCT06387849) on April 2024. Competing Interests: The authors declare no competing interests. All included women gave their informed written consent to take part in the study after explaining its purpose., (© 2024. The Author(s).)

Objective: The multicenter, randomized, double-blinded, active-sham controlled trial (high-freQUEncy nerve block for poST amputation pain [QUEST]) was conducted to show the safety and efficacy of a novel, peripherally placed high-frequency nerve block (HFNB) system in treating chronic postamputation pain (PAP) in patients with lower limb amputations. The primary outcomes from QUEST were reported previously. This study presents the long-term, single-cross-over, secondary outcomes of on-demand HFNB treatment for chronic PAP., Materials and Methods: After the three-month randomized period, subjects in the active-sham group were crossed over to receive therapy for 12 months. Subjects self-administered HFNB therapy as needed and reported their pain (numerical rating scale [NRS]; range, 1-10) before and 30 and 120 minutes after each treatment. Pain medication use was reported throughout the study. Pain-days per week and quality of life (QOL) were assessed using the Brief Pain Inventory (BPI). Adverse events (AEs) were recorded for all subjects implanted for 12 months., Results: Of 180 subjects implanted in QUEST, 164 (91%) were included in the cross-over period, and 146 (82%) completed follow-up. By month 12, average NRS pain in the combined cohort was reduced by 2.3 ± 2.2 points (95% CI, 1.7-2.8; p < 0.0001) 30 minutes after treatment and 2.9 ± 2.4 points (95% CI, 2.2-3.6; p < 0.0001) 120 minutes after treatment. Mean pain-days per week were significantly reduced (-3.5 ± 2.7 days; p < 0.001), and subject daily opioid use was reduced by 6.7 ± 29.0 morphine equivalent dose from baseline to month 12 (p = 0.013). Mean BPI-interference scores (QOL) improved by 2.7 ± 2.7 points from baseline (p < 0.001). The incidence of nonserious AEs and serious AEs was 72% (130/180) and 42% (76/180), respectively; serious device-related AEs occurred in 15 of 180 subjects (8%)., Conclusion: Overall, HFNB delivered directly to the damaged peripheral nerve provided sustained, on-demand relief of acute PAP exacerbations, reduced opioid utilization, and improved QOL for patients with lower limb amputations with chronic PAP., Competing Interests: Conflict of Interest Leonardo Kapural reports grants and/or personal fees from Biotronik, Medtronic, Nevro, Presidio, Saluda Medical, Nalu Medical, and Gimer Medical. Erika A. Petersen reports grants and/or personal fees from Biotronik, Medtronic Neuromodulation, Nevro, Presidio Medical, Saluda, and SPR, outside the submitted work. Jason M. Schwalb reports grants from Medtronic, SetPoint, Nevro, MeiraGTX; and salary support for role as codirector of the Michigan Spine Surgery Improvement Collaborative, paid directly to employer from Blue Cross Blue Shield of Michigan, outside the submitted work. Konstantin V. Slavin reports institutional research and education grants from Medtronic, Abbott, Boston Scientific, Neuros, and Stryker; personal and institutional support from Abbott, Biotronik, Integer, Medtronic, Saluda, Stimwave, Synergia, Thermaquil, and WISE; and participation on a Data Safety Monitoring Board for Abbott and Nurami. The remaining authors reported no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures., Recent Findings: Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting., Competing Interests: Declarations. Ethics Approval and Consent to Participate: Not applicable. Consent for Publication: All authors consent to publication. Competing Interests: ADK is an editor in chief for Current Pain and Headache Reports. CLR is an advisor for Augmend Health and a section editor for Current Pain and Headache Reports. ARD is an equity holder of Augmend Health. Human and Animal Rights: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Acute post-surgical pain is managed inadequately in many patients undergoing surgery. Several prognostic risk prediction models have been developed to identify patients at high risk of developing moderate to severe acute post-surgical pain. The aim of this systematic review was to describe and evaluate the methodological conduct of these prediction models., Methods: We searched MEDLINE, EMBASE and CINAHL for studies of prognostic risk prediction models for acute post-surgical pain using predetermined criteria. Prediction model performance was evaluated according to discrimination and calibration. Adherence to TRIPOD guidelines was assessed. Risk of bias and applicability was independently assessed by two reviewers using the prediction model risk of bias assessment tool., Results: We included 14 studies reporting on 17 prediction models. The most common predictors identified in final prediction models included age; surgery type; sex or gender; anxiety or fear of surgery; pre-operative pain intensity; pre-operative analgesic use; pain catastrophising; and expected surgical incision size. Discrimination, measured by the area under receiver operating characteristic curves or c-statistic, ranged from 0.61 to 0.83. Calibration was only reported for seven models. The median (IQR [range]) overall adherence rate to TRIPOD items was 62 (53-66 [47-72])%. All prediction models were at high risk of bias., Conclusions: Effective prediction models could support the prevention and treatment of acute post-surgical pain; however, existing models are at high risk of bias which may affect their reliability to inform practice. Consideration should be given to the goals, timing of intended use and desired outcomes of a prediction model before development., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Haemorrhoids are a common anorectal disease primarily treated through surgery, often leading to complications such as pain. The efficacy of acupuncture in relieving postoperative pain in mixed haemorrhoids has not been well-documented. This study included 90 patients undergoing haemorrhoid surgery and their Visual Analogue Score (VAS), inflammatory factor levels, Hamilton Depression Rating Scale (HAMD), and analgesic drug use were accessed. A rat incisional pain model was also constructed to monitor behavioral responses, with assessments including Sucrose Preference Test (SPT) and Open Field Test (OFT). The levels of ATP and proinflammatory cytokines in the dorsal root ganglion (DRG) were measured using luciferase assay and ELISA. We also examined P2×7 and ERK1/2 levels in DRG tissues of anal incisional pain rat model. In a Chronic Constriction Injury (CCI) rat model treated with BzATP, a potent agonist for P2×7 receptors, followed by acupuncture for 15 days, postoperative pain and behavioral responses were observed and assessed, alongside mechanistic studies of ATP and inflammatory factors in DRG tissues. Patients receiving acupuncture had significantly lower VAS scores, reduced levels of inflammatory factors, improved depression scores, and decreased analgesic drug use. In the animal model, acupuncture increased pain thresholds, improved behavioral responses, reduced ATP content and inflammatory factors, and modulated the P2×7/ERK axis. In the CCI model, BzATP increased P2×7 and ERK1/2 levels, pain sensitivity, and anxiety, which were mitigated by acupuncture. Our data suggest that acupuncture significantly alleviates postoperative pain following haemorrhoid surgery and modulates the pain response through the P2×7/ERK axis., Competing Interests: Declaration of competing interest None., (Copyright © 2025. Published by Elsevier Inc.)

Background: Postoperative pain is a significant yet inadequately managed complication following surgery, and auriculotherapy to alleviate acute postoperative pain (APP) and reduce the use of opioids remains controversial., Methods: We searched the MEDLINE, Web of Science, Embase, Cochrane Library, CINAHL Complete, and ClinicalTrials.gov from inception to January 23, 2024 for all randomized controlled trials (RCTs) of auriculotherapy in the treatment of APP. The extracted data underwent risk of bias assessment, meta-analysis, subgroup analyses, sensitivity analysis, meta-regression analysis, and evidence rating., Results: A total of 24 studies involving 2131 patients were included in the meta-analysis. Low-quality evidence indicated that auriculotherapy was effective in reducing pain intensity at 24 [MD(95 %CI)=-0.64(-1.09, -0.19), I 2 =77 %, P＜0.01], 48 [MD(95 %CI)=-0.49(-0.97, 0.00), I 2 =71 %, P=0.05], and 72 [MD(95 %CI)=-0.80(-1.32, -0.28), I 2 =52 %, P＜0.01] hours after surgery, while moderate-quality evidence showed a decrease in total opioid consumption [MD(95 %CI)=-24.41 OME (-38.28, -10.54), I 2 =95 %, P＜0.01]. However, no significant effects were observed in reducing postoperative nausea or vomiting [RR(95 %CI)=0.61(0.32, 1.16), I 2 =71 %, P=0.13; RR(95 %CI)=0.32(0.09, 1.18), I 2 =71 %, P=0.09; RR (95 %CI)=0.34(0.11, 1.06), I 2 =28 %, P=0.06; for postoperative nausea and vomiting (PONV), postoperative nausea or postoperative vomiting respectively], with evidence ranging from moderate to very low. Additionally, two RCTs found that auriculotherapy could delay the time to the first request for analgesia., Conclusions: The summary estimates indicate that auriculotherapy may be beneficial in reducing APP and opioid consumption in specific surgeries based on low-to-moderate quality evidence. However, high-quality RCTs are still further studied in different surgical populations., Systematic Review Registration: PROSPERO database, CRD42024506989., Competing Interests: Declaration of Competing Interest There are no financial or personal interests or beliefs that could affect the objectivity of the study, and there are no competing interests. The funding sources of this study had no role in role in study design, data collection, data analysis, data interpretation, writing of the report, or submission of the report as an article for publication., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Pain and anxiety are common postoperative problems that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. Reflexology is a nonpharmacologic method used to control pain and anxiety., Objective: The aim of this study was to examine the effects of reflexology hand massage and stroking massage on pain and anxiety in patients in the immediate postoperative period after CABG., Methods: In this double-blind, randomized, placebo-controlled study, we compared the effects of a 20-minute hand-reflexology massage to placebo stroking massage on pain and anxiety in newly extubated patients in the intensive care unit who had undergone CABG surgery. Pain was measured by visual analog scale and anxiety by the State-Trait Anxiety Inventory before and at 5, 30, and 60 minutes post intervention., Results: A total of 48 patients were enrolled: 24 in the intervention group and 24 in the placebo. Mean pain scores were significantly reduced in the group who received reflexology compared with the placebo group ( F = 36.569, P = .000). Mean anxiety scores were significantly reduced at 60 minutes for the reflexology group compared with the control group ( P = .000)., Conclusions: We found that hand reflexology massage was effective in reducing pain and anxiety in patients during the immediate postoperative period after CABG., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients' pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group ( p < 0.05). The accuracy rate of nurses' pain assessments and the awareness rate of patients' pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group ( p < 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group ( p < 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group ( p < 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group ( p < 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group ( p < 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses' pain assessments, increase patients' awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services.

Introduction: Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain., Methods: A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country., Results: We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs., Conclusions: The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

This randomized controlled study aims to investigate the effect of acupressure on pain and postpartum comfort following a cesarean section. The study was conducted with 60 women who underwent cesarean delivery. The participants were randomly assigned to either the intervention or control group. In the intervention group, acupressure was applied to the LI4, SP6, and P6 points for 15 minutes at the 2nd and 4th hours after the cesarean section. In the control group, acupressure was not applied and only routine nursing care was given. Data was collected using a personal information form, Visual Analog Scale (VAS), and Postpartum Comfort Questionnaire (PCQ). Acupressure application was applied to the intervention group at the 2nd and 4th hour after cesarean section. All data collection forms were filled out by women in the intervention group before starting acupressure application at 2 hours after cesarean section. VAS was filled out again after acupressure application at 2 hours. VAS was filled out before and after acupressure application at 4 hours after cesarean section. PSQ was filled out in both groups before discharge. In the study, the intervention group's 2nd (3.03 ± 1.24, p  < .001) and 4th (4.06 ± 1.22, p  < .001) hour posttest VAS scores were lower and PCQ posttest scores (140.6 ± 9.01, p  < .001) were higher than the control group. The results indicate that acupressure intervention applied to points LI4, SP6, and P6 was a useful nonpharmacological treatment for postpartum pain and comfort for the study group.

Anterior Iliac crest bone harvesting (AICBH) is a common surgical procedure with applications in various medical specialties, but it is often accompanied by significant postoperative pain. Effective pain management is therefore essential for optimising patient outcomes. This systematic literature review aimed to evaluate the effectiveness of local donor site pain management interventions in AICBH procedures. It followed the Cochrane Handbook for Systematic Reviews of Interventions version 6.4 guidelines and adhered to the PRISMA 2020 statement for comprehensive and high-quality reporting. A comprehensive search was conducted across PubMed, Cochrane, and Embase to identify relevant studies. Inclusion criteria encompassed randomised controlled trials assessing pain management strategies in AICBH patients. The methodological quality of the included studies was assessed using the Jadad scale. Data extraction focused on medication types, administration modes, pain scores, and use of narcotics. Fourteen eligible studies were included. Methodological quality varied, with most studies demonstrating a low risk of bias. Medication types included amide and opioid groups, administered via single-shot injections or infusion systems. Results indicated that indwelling iliac crest catheters with bupivacaine showed significant postoperative reductions in pain scores and narcotics use compared with other techniques. The findings suggest that use of an indwelling catheter with bupivacaine is an effective pain management strategy for AICBH patients. However, heterogeneity among the studies and a lack of standardised methodologies pose limitations. Further homogeneous and standardised studies are therefore needed to strengthen the evidence base and inform clinical practice., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Postoperative shoulder-tip pain (STP) is a common complication following laparoscopic cholecystectomy (LC). The study seeks to determine whether acupressure can be used as an alternative to medication for pain relief, as medications often come with side effects. This study aims to evaluate the effect of acupressure on pain levels and physiological indicators in patients undergoing LC., Materials and Methods: This double-blind, randomized clinical trial was conducted on 81 patients who underwent LC at Al-Zahra Hospital of Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The patients were divided into two groups: the intervention group, which received acupressure (42 participants), and the control group (39 participants). The selected pressure points were LI11, LI4, SJ5, HT7, P6, and K1. Demographic and clinical data were collected, and the pain level was evaluated using the visual analogue score (VAS). The data was analyzed using SPSS version 16 software with a significance level of p < 0.05., Results: The intervention and control groups were homogeneous in terms of age, gender, duration of surgery, and pethidine consumption (p > 0.05). The average VAS significantly decreased in both the intervention and control groups (p < 0.001). The intervention group had a significantly higher reduced score compared to the control group, 30 min and 72 h after applying acupressure (p < 0.001). Significant differences were observed between the two groups in terms of changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and breath rate (BR) (p < 0.05)., Conclusions: acupressure can effectively improve STP and physiological indicators in patients undergoing LC., Trial Registration No: IRCT20150715023216N14 (Registration date: 2023-01-22, https://irct.behdasht.gov.ir/user/trial/68111/view)., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To determine the effect of aromatherapy on postoperative anxiety and pain in patients undergoing oculoplastic surgery., Methods: A randomized controlled study of 60 patients who underwent monitored anesthesia care sedation for oculoplastic procedures from August 2018 to November 2020. Patients were randomized to an aromatherapy (n = 32) or placebo (n = 28) condition. Anxiety was measured with State-Trait Anxiety Inventory and visual analog scale for anxiety. Pain was measured with a visual analog scale for pain., Results: Compared with control patients, aromatherapy patients had significantly lower postoperative State-Trait Anxiety Inventory state anxiety (24.1 vs. 29.1; p = 0.05) and visual analog scale pain scores (1.9 vs. 3.2; p = 0.05). Aromatherapy patients also had shorter stays in the postanesthesia care unit than control patients (57.7 vs. 79.4 minutes; p = 0.03)., Conclusions: Patients who received aromatherapy reported lower postoperative anxiety and pain. Aromatherapy may be a useful adjuvant analgesic and/or anxiolytic for patients undergoing oculoplastic procedures with monitored anesthesia care sedation., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Background: Nearly half of adult patients undergoing surgery experience moderate or severe postoperative pain. Inadequate pain management hampers postoperative recovery and function and may be associated with adverse outcomes. This multidisciplinary consensus statement provides principles that might aid postoperative recovery, and which should be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients., Methods: We conducted a directed literature review followed by a four-round modified Delphi process to formulate recommendations for organisations and individuals., Results: We make recommendations for the entire peri-operative period, covering pre-admission; admission; intra-operative; post-anaesthetic care unit; ward; intensive care unit; preparation for discharge; and post-discharge phases of care. We also provide generic principles of peri-operative pain management that clinicians should consider throughout the peri-operative pathway, including: assessing pain to facilitate function; use of multimodal analgesia, including regional anaesthesia; non-pharmacological strategies; safe use of opioids; and use of protocols and training for staff in caring for patients with postoperative pain., Conclusions: We hope that with attention to these principles and their implementation, outcomes for adult patients having surgery might be improved., (© 2024 Association of Anaesthetists.)

Background and Purpose: It was aimed to investigate the effects of massage with or without aromatherapy given to patients after colorectal cancer surgery on symptom management in the first three postoperative days., Materials and Methods: This study was carried out with a pretest-posttest randomized controlled design. The study included the aromatherapy massage group (AG; n = 30), the classical massage group (MG; n = 30), and one control group (CG; n = 30). A blend of sweet almond oil, lavender, chamomile, and ginger oil was used in AG. Massage was applied to the foot area, and 20 min of classical massage was performed. Before the pretest, the participants were blinded by not informing them about their group allocations. The analyses were carried out using parametric methods., Results: Postoperative pain varied significantly over time in all three groups (AG: p = 0.007; η 2  = 0.150/MG: p = 0.008; η 2  = 0.559/CG: p = 0.017; η 2  = 0.132). Anxiety was found to differ between CG and AG and between CG and MG (p < 0.05). In all three groups, nausea-vomiting scores significantly decreased over time (AG: p = 0.002; η 2  = 0.211/MG: p = 0.004; η 2  = 0.164/CG: p = 0.021; η 2  = 0.125). Sleep quality was significantly higher in the massage groups than in the control group only on the second postoperative day (p = 0.011)., Conclusion: Aromatherapy massage had no significant effect on pain, fatigue, nausea, or vomiting compared to MG and CG, and sleep quality was higher in the massage groups compared to CG only on the second postoperative day. On the first three postoperative days, the post-intervention anxiety levels of AG and MG were lower than those of CG., Clinicaltrials: GOV.ID: NCT04810299., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effect of aromatherapy through inhalation of Lavandula angustifolia essential oil in relieving pain during the immediate postoperative period of patients undergoing cardiac surgery., Methods: A single-blind, randomized and controlled clinical trial, with 52 patients in the immediate postoperative period of cardiac surgery were randomly distributed into experimental (n = 26) and control (n = 26) groups. The primary outcome was whether or not pain was relieved and secondary outcomes included changes in vital signs, sleep and facial relaxation. The control group received industry standard care and application of an essential oil-free ceramic diffuser necklace. The experimental group received the inhalation intervention with pure Lavandula angustifolia essential oil, with a drop of the oil on a ceramic diffuser necklace at a distance of 15-20 cm from the patient's nose for 30 min. Pain was measured using the Numerical Visual Scale, and vital signs using the multiparametric monitor before the intervention, 10 minutes after its start and 30 minutes after the total end of inhalation. Face relaxation was assessed before and after the intervention and sleep was assessed at the end of inhalation., Results: There was a decrease in pain levels (p < 0.001) 30 min after the end of inhalation in the Experimental Group, with a decrease in the measurements of Mean Blood Pressure (p= 0.008) and Respiratory Rate (p = 0.011). Furthermore, facial relaxation and sleep had a large effect size of 2.54 and 1.28, respectively., Conclusion: Lavandula angustifolia essential oil was effective in relieving pain, causing sleep and relaxation, proving to be a low-cost and easy-to-use tool that the nursing team can use in their care., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: We aim to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation(TEAS) in elderly patients around the perioperative period of hip replacement surgery., Methods: The China National Knowledge Infrastructure(CNKI), Wangfang Data, VIP database, SinoMed, PubMed, and Embase databases were searched for relevant publications until August 2024. All randomized controlled studies evaluating the efficacy and safety of TEAS in patients around the perioperative period of hip replacement surgery. We calculated pooled risk ratio (RR) with 95% CIs for binary outcomes and standardized mean difference (SMD) for continuous outcomes. The Cochrane's Risk of Bias Tool were used to evaluate the quality of studies., Results: A total of 13 studies with 946 patients were included in this analysis. 1-day visual analogue scale (VAS) scores and 2-day VAS scores were significantly lower in the TEAS group compared to the control group (SMD: -0.78, 95% CI: -1.47, -0.09, P = 0.02 and SMD:-0.54, 95% CI:-1.00,-0.09,P = 0.02). Furthermore, 1-day mini-mental state examination (MMSE) scores and 3-day MMSE scores were significantly higher in the TEAS group compared to the control group (SMD: 1.60, 95% CI: 0.68, 2.51,P<0.001 and SMD:1.31, 95% CI:1.03,1.59,P<0.001), along with a lower postoperative cognitive dysfunction rate (RR: 0.55, 95% CI: 0.41, 0.73, P<0.001)., Conclusions: Our meta-analysis demonstrated that TEAS significantly reduces pain and improves cognitive function in patients undergoing hip replacement surgery. Future studies should further investigate the optimal TEAS protocols to maximize these benefits across different population and surgical settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To prospectively investigate the effect of music therapy on patient's anxiety and pain level during retrograde intrarenal surgery under spinal anesthesia. 286 patients aged above 18 years, who underwent Retrograde Intrarenal Surgery (RIRS) under spinal anesthesia for renal or ureteral calculi were evaluated between January 2023 and June 2023 by a prospective, randomized, controlled clinical protocol. Patients were randomized into 2 groups. Group 1 included patients, who listened to music, and Group 2 was comprised of patients, who were not allowed to listen to music. Visual Analog Scale (VAS) results and pain sensation, anxiety level, together with the results of State-Trait Anxiety Inventory (STAI), a self-reported anxiety inventory, were captured. The number of patients, who were randomized to the music group (Group 1) and non-music group (Group 2) was 144 and 142, respectively. Mean heart rate in Group 1 and Group 2 was 60 ± 4.19 and 70 ± 8.36, respectively (p = 0.02), indicative of the fact that mean heart rate was significantly lower in the music group. Heart rate measured post-operatively within the first hour subsequent to the procedure was similar in both groups (p < 0.05). The VAS score was significantly lower in Group 1. STAI score in Group 1 and Group 2 was 45.51 ± 2.968 and 49.16 ± 1.88, respectively. Therefore, there was a statistically significant difference (p < 0.001). Music therapy during the RIRS procedure under spinal anesthesia was associated with a significantly decrease in pain and anxiety scores in patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative recovery and pain in patients undergoing elective endoscopic sinus surgery., Methods: One hundred and six patients scheduled for elective endoscopic sinus surgery were randomly divided into an observation group and a control group, with 53 patients in each group. Patients in both groups received TEAS or sham TEAS, respectively, from 30 min before intravenous anesthesia induction until the end of surgery. Acupoints selected were bilateral Neiguan (PC 6) and Zusanli (ST 36). The quality of requirements-15 (QoR-15) scores were assessed on the day before surgery (T0) and on postoperative days 1 (T1), 2 (T2) and 3 (T3). Pain visual analogue scale (VAS) scores were recorded at T1, T2 and T3. Athens insomnia scale (AIS) scores were measured at T0, T1, T2 and T3 in the two groups. The incidence of postoperative nausea-vomiting and dizziness-headache, usage of analgesics, number of patient-controlled analgesia (PCA) pump presses, and extubating time were also recorded in the two groups., Results: At T1, T2 and T3, the observation group had higher QoR-15 scores ( P <0.01, P <0.001) and lower AIS scores ( P <0.001) than the control group. At T1 and T2, the observation group had lower pain VAS scores than the control group ( P <0.001). The incidence of postoperative nausea-vomiting and dizziness-headache was 24.5% (13/53) and 37.7% (20/53) in the observation group, which were lower than 56.6% (30/53) and 66.0% (35/53) in the control group ( P <0.01). There were no statistically significant differences in the use of rescue analgesics or the number of PCA pump presses between the two groups ( P >0.05). The extubating time was shorter in the observation group compared with that in the control group ( P <0.001)., Conclusion: TEAS could improve postoperative recovery quality, alleviate postoperative pain, improve sleep quality, and reduce the incidence of postoperative nausea and vomiting in patients undergoing elective endoscopic sinus surgery.

Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures., Competing Interests: Competing interests: DMD receives research support from Abbott and SPR therapeutics; speaker and/or consulting fees from Abbott, SPR Therapeutics, Vertos, Pfizer, Myovant, Nalu, and Biotronik; NME receives consulting fees for legal case review and from Pacira; SS receives consulting fees from SPR Therapeutics, Masimo Corp, and Allergan. GS receives consulting fees from Pacira and holds minor stake equity (stock options) in Dorsal Health; MS receives consulting fees and research support from Saluda Medical, consulting fees from Patch technologies, Witness, etc and iVitalie, and holds stock and/or receives consulting fees from Cellarian, Spark Biomedical, Nanomedical Systems, Full Spectrum Healthcare Management, MedAnswers, Reveliance solutions, and Assurance Med Management, (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE., Objective: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children's Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment., Methods: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling., Results: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy., Conclusions: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality., (©Rosella Trò, Angelica Orecchia, Nicola Disma, Paolo Uva, Roberto Cavanna, Nicolò Zanardi, Michele Torre, Marco Massimo Fato. Originally published in JMIR Formative Research (https://formative.jmir.org), 08.10.2024.)

Purpose of Review: It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact., Recent Findings: From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain., Summary: A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To explore the effect of humanistic pain management based on active pain assessment and the visual analog scale in postpartum women after cesarean delivery., Methods: We selected 100 postpartum women who underwent cesarean delivery in Xuzhou Maternity and Child Health Care Hospital from April to December 2021 and divided the postpartum women into a management group and a conventional group, with 50 cases in each group. The conventional group was given routine pain management, while the management group was given humanistic pain management based on active pain assessment and visual analog scale score. The quality of pain management, sleep quality, unhealthy emotion, maternal comfort, breastfeeding rates, and patient compliance in the 2 groups were compared., Results: The most severe degree of pain, the least degree of pain, the frequency of moderate and severe pain, and the influence of pain on sleep were lower in the management group than in the conventional group. The Pittsburgh Sleep Quality Index score was lower and the Self-Rating Anxiety Scale and the Self-Rating Depression Scale scores were higher in the management group than in the conventional group. In addition, the comfort scores for the second day and the third day after delivery were higher in the management group than in the conventional group. The breastfeeding rate and patient compliance were higher in the management group than in the conventional group., Conclusion: Humanistic pain management based on active pain assessment and the visual analog scale can improve the quality of maternal pain management, the quality of sleep, and maternal comfort, ameliorate maternal adverse emotions, and promote breastfeeding and patient compliance.

Purpose of Review: The aim of this review article is to present current recommendations as well as knowledge gaps and controversies pertaining to commonly utilized postoperative pain management after solid organ transplantation in the abdominal cavity., Recent Findings: Postsurgical pain has been identified as one of the major challenges in recovery and treatment after solid organ transplants. Many perioperative interventions and management strategies are available for reducing and managing postoperative pain. Management should be tailored to the individual needs, taking an interdisciplinary and holistic approach and following enhanced recovery after surgery guidelines. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures., Summary: The optimal pain management regimen has not yet been definitively established, and current scientific evidence does not yet support the endorsement of a certain analgesic approach. This objective necessitates the need for high-quality randomized controlled trials., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Pain after craniotomy is often severe and undertreated. Providing adequate analgesia while avoiding medication adverse effects and physiological complications of pain remains a perioperative challenge., Recent Findings: Multimodal pain management includes regional anesthesia and analgesic adjuncts. Strategies aim to reduce or eliminate opioids and the associated side effects. Many individual pharmacologic interventions have been studied with beneficial effects on acute pain following craniotomy. Evidence has been accumulating in support of scalp blockade, nonsteroidal anti-inflammatory drugs (NSAIDs), dexmedetomidine, paracetamol, and gabapentinoids. The strongest evidence supports scalp block in reducing postcraniotomy pain and opioid requirements., Summary: Improving analgesia following craniotomy continues to be a challenge that should be managed with multimodal medications and regional techniques. Additional studies are needed to identify the most effective regimen, balancing efficacy and adverse drug effects., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation., Methods: The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected., Results: Not avaliable until the end of the study., Conclusions: The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Recently, a consensus process specified a core outcome set (COS) of domains to be assessed in each comparative effectiveness research and clinical practice related to acute postoperative pain. Physical function (PF) was one of these domains. The aim of this review was to investigate which patient-reported outcome measures (PROMs) are used to assess PF after total knee arthroplasty (TKA) in clinical trials and if they fulfil basic requirements for a COS of PROMs based on their psychometric properties., Methods: A systematic review of randomized controlled trials and observational studies based on a search in MEDLINE, EMBASE and CENTRAL was undertaken. PROMs and performance measures were extracted and investigated, including evaluation of psychometric properties of PROMs based on COSMIN recommendations., Results: From initially 2896 identified records, 479 studies were included in the qualitative synthesis. Only 87 of these trials (18%) assessed PF using PROMs, whereas especially performance outcome measures were used in 470 studies (98%). Application of the 'COSMIN Risk-of-Bias-Box 1' to 13 of the 14 identified PROMs resulted in insufficient content validity of the included PROMs regarding the target population based on the inauguration or development articles., Conclusion: Our data indicate that a patient-centred postoperative assessment of PF in pain-related clinical trials early after TKA is not common, even though patient-reported assessment is widely recommended. In addition, none of the applied PROMs shows content validity based on their inauguration or development articles for the assessment of postoperative pain-related PF after TKA., Significance: A systematic search for patient-reported outcome measures assessing postoperative, pain-related physical function after total knee arthroplasty in clinical trials and assessment of their content validity revealed none that fulfilled requirements based on COSMIN recommendations., (© 2024 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Purpose of Review: Heart and lung transplantation evolution marked significant milestones. Pioneering efforts of Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements in heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway, and Joel Cooper laid the groundwork for contemporary organ transplantation, offering hope for patients with end-stage heart and pulmonary diseases., Recent Findings: Pretransplant opioid use in heart transplant recipients is linked to higher mortality and opioid dependence posttransplant. Effective pain control is crucial to reduce opioid-related adverse effects and enhance recovery. However, research on specific pain management protocols for heart transplant recipients is limited. In lung transplantation effective pain management is crucial. Studies emphasize the benefits of multimodal strategies, including thoracic epidural analgesia and thoracic paravertebral blocks, to enhance recovery and reduce opioid use. Perioperative pain control challenges in lung transplantation are unique and necessitate careful consideration to prevent complications and improve outcomes., Summary: This review emphasizes the importance of tailored pain management in heart and lung transplant recipients. It advocates for extended follow-up and alternative analgesics to minimize opioid dependency and enhance quality of life. Further high-quality research is needed to optimize postoperative analgesia and improve patient outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research., Recent Findings: Current ML models leverage diverse datasets, algorithmic techniques, and validation methods to identify predictive biomarkers, risk factors, and phenotypic signatures associated with increased acute and chronic postoperative pain and persistent opioid use. ML models demonstrate satisfactory performance to predict pain outcomes and their prognostic trajectories, identify modifiable risk factors and at-risk patients who benefit from targeted pain management strategies, and show promise in pain prevention applications. However, further evidence is needed to evaluate the reliability, generalizability, effectiveness, and safety of ML-driven approaches before their integration into perioperative pain management practices., Summary: Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This study aimed to compile data on the effectiveness of music therapy for patients undergoing cardiothoracic surgery., Background: After cardiac and thoracic surgery, patients often experience physiological and psychological complications, such as anxiety, pain, stress, depression and changes in vital signs, which have a great impact on prognosis., Methods: A systematic search of six databases was performed to identify randomized controlled trials investigating music therapy and cardiothoracic surgery. The data were extracted from the qualified research, the data without heterogeneity were analysed by random-effects model (REM) meta-analysis, and the data with heterogeneity were analysed by fixed-effects model (FEM) meta-analysis. We evaluated anxiety, pain, duration of mechanical ventilation, hospital length of stay, stress hormones, opioid consumption, and vital signs, including heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), diastolic blood pressure (DBP), and systolic blood pressure (SBP) after cardiothoracic surgery. The meta-analysis and sensitivity analysis were performed with RevMan 5.4 and Stata 14 software, and trial sequential analysis was conducted using TSA 0.9.5.10 Beta software. This study was conducted in accordance with the PRISMA guidelines and was registered with PROSPERO., Results: The study included 24 randomized controlled trials with a total of 1576 patients. Our analysis showed that music therapy can significantly reduce the anxiety scores (SMD= -0.74, 95% CI [-0.96, -0.53], p < 0.01) and pain scores (SMD= -1.21, 95% CI [-1.78, -0.65], p < 0.01) of patients after cardiothoracic surgery. Compared with the control group, music therapy dramatically raised postoperative SpO2 (SMD = 0.75, 95% CI [0.11, 1.39], p = 0.02). In addition, the experimental group had significant statistical significance in reducing HR, SBP and opioid consumption. However, there was no significant difference in respiratory rate, stress hormones, diastolic blood pressure, length of hospital stay, or the duration of mechanical ventilation between the two groups., Conclusions: Music therapy can significantly reduce anxiety, pain, HR, SBP, and postoperative opioid use and even improve SpO2 in patients who undergo cardiothoracic surgery. Music therapy has a positive effect on patients after cardiothoracic surgery with few side effects, so it is promising for use in clinics., Trial Registration: RROSPERO (registration number: CRD42023424602)., (© 2024. The Author(s).)

Background: Pain is a prevalent symptom among patients with cancer, significantly impacting their health and quality of life. Stellate ganglion block (SGB) has been employed as a diagnostic, prognostic, or therapeutic intervention for various pain syndromes. This systematic review and meta-analysis aimed to examine the effects of ultrasound-guided SGB on postoperative recovery quality and other functional indicators following cancer surgery., Methods: Data were sourced from PubMed, PEDro, CINAHL, SportDiscus, and Scopus. Inclusion criteria followed the population-intervention-comparison-outcome principle. The evaluation process involved meticulous screening, judicious data extraction, and rigorous assessment of trial methodology quality, conducted independently by 2 researchers. Standardized mean differences with corresponding 95% confidence intervals were pooled using either a random-effects or fixed-effects model., Results: Ultrasound-guided SGB exhibited potential for improving postoperative pain scores after cancer surgery (RR, 7.81 [95% confidence interval (CI), 5.43-10.19]), reducing daily consumption of oxycodone (RR, 0.78 [95% CI, -1.37 to 2.93]) and pregabalin (RR, -22.26 [95% CI, -91.37 to 46.85]), enhancing physical health (RR, -2.50 [95% CI, -11.00 to 6.00]) and mental health (RR, -5.10 [95% CI, -13.45 to 3.25]), and influencing mean arterial pressure (RR, -10.60 [95% CI, -17.92 to -3.27]), mean pulmonary artery pressure (RR, -1.02 [95% CI, -2.83 to 0.79]), heart rate (RR, -11.18 [95% CI, -17.91 to -4.46]), and central venous pressure (RR, -0.05 [95% CI, -1.53 to 1.43]) as effective treatment modalities., Conclusion: This systematic review and meta-analysis suggests that ultrasound-guided SGB therapy is effective in reducing pain levels and improving mobility and quality of life compared to conventional treatments. Therefore, clinicians should consider administering SGBs to patients with chronic cancer pain, emphasizing sensory exercise to achieve a balance between movement and rest., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: In the context of postoperative anal pain, understanding the intricate mechanisms and effective interventions is paramount. This study investigates the role of Muscarinic Acetylcholine Receptors (mAChRs) and the IP3-Ca 2+ -CaM signaling pathway in a rat model of postoperative anal pain, exploring the potential analgesic effects of electroacupuncture., Methods: Comprehensive approaches involving mechanical sensitivity assays, Western blotting, immunohistochemistry, and intracellular calcium concentration measurement were used., Results: The authors found elevated mAChRs expression in the postoperative pain model. Antagonizing mAChRs reduced pain sensitivity and attenuated the IP3-Ca 2+ -CaM pathway. Remarkably, electroacupuncture treatment further mitigated pain, potentially by suppressing this signaling cascade., Interpretation: These findings reveal a novel connection between mAChRs and the IP3-Ca 2+ -CaM pathway in postoperative anal pain and suggest electroacupuncture as a promising avenue for pain relief through these mechanisms, offering insights into innovative strategies for postoperative pain management., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Congenital heart disease is a common birth defect, but advancements in diagnosis and treatment have improved survival rates. Enhanced recovery after surgery (ERAS) programmes have emerged in paediatric cardiac surgery. Multimodal pain management, as a vital part of ERAS programmes, has been found to be effective in reducing pain and improving outcomes in cardiac surgery patients. Traditional methods of pain control using high-dose opioids can lead to complications, so nonopioid analgesics and regional anaesthesia techniques are being used to reduce the consumption. However, there is a significant variability in pain management practices in paediatric cardiac surgery. A network meta-analysis (NMA) is needed to comprehensively compare the effects of different analgesic interventions in this population., Methods and Analysis: A comprehensive electronic literature database search will be performed using electronic databases, mainly including PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials. All randomised controlled trials associated with perioperative pain management for paediatric cardiac surgery will be included. The primary outcome will be visual analogue score or numeric rating scale of pain and total opioid consumption (or equivalent) 24 hours after postoperative tracheal extubation. The Revised Cochrane Risk of Bias Tool will be employed to assess the quality of included articles. A random-effects pairwise meta-analysis will be performed to report the head-to-head comparison. Following the assessment of individual articles, an NMA will be conducted using a Bayesian framework with random-effects' models., Ethics and Dissemination: Ethics approval is not necessary because this study will be based on publications. The results of this study will be published in a peer-reviewed journal., Prospero Registration Number: CRD42023477520., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Percutaneous auricular nerve stimulation (neuromodulation) involves implanting electrodes around the ear and administering an electric current. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial; and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following two ambulatory surgical procedures., Methods: Within the recovery room following cholecystectomy or hernia repair, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied. Participants were randomized to 5 days of either electrical stimulation or sham in a double-blinded fashion., Results: In the first 5 days, the median (IQR) pain level for active stimulation (n=15) was 0.6 (0.3-2.4) vs 2.6 (1.1-3.7) for the sham group (n=15) (p=0.041). Concurrently, the median oxycodone use for the active stimulation group was 0 mg (0-1), compared with 0 mg (0-3) for the sham group (p=0.524). Regarding the highest pain level experienced over the entire 8-day study period, only one participant (7%) who received active stimulation experienced severe pain, versus seven (47%) in those given sham (p=0.031)., Conclusions: Percutaneous auricular neuromodulation reduced pain scores but not opioid requirements during the initial week after cholecystectomy and hernia repair. Given the ease of application as well as a lack of systemic side effects and reported complications, a definitive clinical trial appears warranted., Trial Registration Number: NCT05521516., Competing Interests: Competing interests: BMI, WBA, BA, JFS, ETS, BA, and JJF—the University of California San Diego has received funding and/or product from the following companies for other research studies of these authors: Epimed International (Dallas, Texas, USA), SPR Therapeutics (Cleveland, Ohio, USA), Infutronix (Natick, Massachusetts, USA), Avanos Medical (Irvine, California, USA), Masimo (Irvine, CA, USA), and Varian Medical Systems (Palo Alto, California, USA). Th remaining authors have no conflicts to disclose., (© American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Objective: The objective of this study is to assess the efficacy of auricular point acupressure in relieving postoperative pain and reducing anxiety among patients with perianal abscesses., Methods: We included 61 patients with perianal abscesses who were admitted to the Nantong First People's Hospital between July 2019 and June 2020 and were scheduled to undergo one-stage radical surgery. We divided them into the treatment group (n = 31), where patients were administered preoperative auricular acupressure targeting the bilateral Shenmen, subcortical, and other points. They were instructed to apply pressure five to six times per day, each time for about 3-5 min. Patients in the control group (n = 30) received routine preoperative preparation. The treatment duration for both groups was one week. We compared the two groups using the pain visual analog scale (VAS) scores, the use of additional postoperative analgesics, and scores on the Hamilton anxiety and depression scales pre- and post-surgery at 6 h, 24 h, 48 h, 72 h, and 1 week after surgery, as well as at the time of the first bowel movement., Results: Patients in the treatment group reported lower VAS scores than those of the control group at 48 h, 72 h, 1 week, and at the first defecation post-surgery, and the differences were statistically significant (all P < 0.05). Additional postoperative analgesics were used in seven patients in the treatment group (22.58 %) and in 10 patients in the control group (33.33 %). The difference between the two groups was not statistically significant (χ 2 = 0.88, P = 0.35). Postoperative scores for the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) in the treatment group were significantly lower than those in the control group (P < 0.05)., Conclusion: The results of this study demonstrated that auricular point acupressure was effective in alleviating postoperative pain in patients with perianal abscesses and simultaneously reduced their postoperative psychological stress reactions. This dual effect provided both pain relief and a reduction of anxiety with fewer adverse reactions, making it a safe and effective treatment option., (Copyright © 2024. Published by Elsevier Inc.)

Background and Objective: With the significant advances in breast cancer treatment, the survival rates have improved. Consequently, improving the quality of life for breast cancer survivors has emerged an important issue. In this study, we examined the management of post-mastectomy pain syndrome (PMPS) in breast cancer patients thorough a comprehensive literature review. We introduce the preventive measures and pharmacotherapy for PMPS in breast cancer patients and discuss the effectiveness of psychosocial interventions., Methods: We conducted a literature search for relevant articles in Medline ALL, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Embase, and nine other databases from October 2023 to January 2024. Chronic pain was defined as pain persisting for more than 3 months after breast cancer surgery. The search included terms related to PMPS, psychological interventions, and breast cancer. Data extraction was done independently by two reviewers, and any discrepancies will be discussed to ensure consensus or by a third reviewer., Key Content and Findings: Studies have investigated surgical anesthetics, postoperative medications, and surgical procedures for PMPS prevention, but few have focused on treatment. Our literature search about the usefulness of psychosocial interventions yielded two articles, one was about the usefulness of mindfulness and the other was about the efficacy of yoga., Conclusions: Mindfulness and yoga show potential efficacy for PMPS treatment, but the evidence is limited. More research is needed to confirm these findings and to explore other psychosocial interventions.

Background: Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients., Methods: We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST)., Results: Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078)., Conclusion: The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies., (© 2024. The Author(s), under exclusive licence to The Japanese Breast Cancer Society.)

Introduction: This study was conducted to determine the effects of transcutaneous electrical nerve stimulation (TENS) applied in the early postpartum period after cesarean birth on incision site healing, postoperative recovery, pain, and comfort., Methods: This randomized, single-blind, placebo-controlled study was conducted with 138 women (TENS group n = 46, placebo group n = 46, control group n = 46) who gave birth by cesarean between January and September 2023. TENS was applied twice at a frequency of 100 Hz with a pulse width of 100 microseconds, at 10 to 12 and 14 to 16 hours after birth, for 30 minutes each. Outcomes were measured with the Postoperative Recovery Index; Redness, Edema, Ecchymosis, Discharge, and Approximation Scale; Visual Analogue Scale; and Postpartum Comfort Questionnaire. Outcomes between groups were compared postintervention, correcting for baseline using analysis of covariance. The study was registered at www., Clinicaltrials: gov (NCT05991921)., Results: Mean scores for postoperative recovery were significantly lower (improved) in the TENS group (113.58) compared with the placebo and control groups (134.67, 136.61; P < .001). The postoperative recovery subscales (psychological symptoms, physical activities, appetite symptoms, bowel symptoms, general symptoms) were also significantly decreased in the TENS group compared with the placebo and control groups. Similarly, mean scores for postpartum comfort, and the corresponding physical comfort, psychospiritual comfort, and sociocultural comfort subscales, were significantly improved in the TENS group (110.26) compared with the placebo and control group (83.80, 81.19; P < .05)., Discussion: TENS application can be preferred as an alternative method to increase pain control, recovery, and patient comfort after cesarean birth., (© 2024 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Background: Virtual reality (VR) is a promising tool in a multimodal analgesic approach; however, evidence regarding virtual reality for postsurgical pain is limited. This study investigates the initial effectiveness and feasibility of self-administered virtual reality in postsurgical pain management., Methods: Patients reporting a postsurgical pain score ≥4 were randomized for control or VR, stratified for 3 interventions with varying levels of immersion and interaction. Subjects were instructed to use virtual reality as add-on treatment at least 3 times a day for 10 minutes on days 2 till 4 postoperatively. Primary outcome was the mean daily pain intensity. Results of pain scores were related to patient and intervention characteristics, to explore which characteristics interact with virtual reality effects. Secondary outcomes were analgesic use, anxiety, stress, and feasibility., Results: One hundred patients were included in the analyses: 37 in the control group and 63 for VR. VR did not demonstrate a significant effect on self-reported pain scores (P = .43), nor were specific patient or intervention characteristics associated with greater VR effects. Analgesic usage did not differ between groups. However, there was a trend toward greater cumulative percentages of patients achieving a 30% pain reduction, and significantly lower daily experienced stress (P = .01) and anxiety (P = .03) levels in VR intervention groups. VR was used less than prescribed, mainly because of illness and pain. Adverse events included disorientation, nausea, and fatigue., Conclusions: This explorative study did not demonstrate initial effectiveness of VR as add-on pain treatment regarding pain and analgesic use; however, VR positively affected stress and anxiety. VR is safe and suitable for a wide target audience, and feasibility differed between interventions. Personalizing and improving VR technology may enhance its effectiveness., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The aim of this randomized study was to investigate whether stripping massage (SM) of myofascial trigger points in the lower rhomboid muscle could alleviate chest pain in patients following thoracoscopic surgery. In addition, a literature review was conducted to assess the effectiveness of various pain management techniques. Sixty adult patients who reported a visual analog scale (VAS) score of 4 or higher were randomly assigned to receive conventional analgesics alone (conventional group) or combined with SM twice daily for 2 weeks (SM group). VAS scores and the use of additional analgesics were evaluated on postoperative days 1, 3, 7, 14, and 30. Using the PubMed and Cochrane Library databases, a review of current pain management techniques was carried out up to January 31, 2022. A subgroup analysis was also performed to examine the treatment effect during different surgical periods and techniques. Results showed that the SM group had significantly lower VAS scores on postoperative days 3, 7, 14, and 30 ( p  < 0.001), as well as a shorter hospitalization duration and reduced need for additional analgesics ( p  < 0.001). The literature review included a total of 20 studies (2,342 cases of chest pain relief after thoracoscopic surgery), which indicated that serratus anterior plane (SAP) blocks were commonly used as a perioperative approach to reduce pain and opioid consumption. SM and SAP can both serve as adjuvant treatments for chest pain in patients following thoracoscopic surgery, with SM being a safe and noninvasive pain control option after hospital discharge., Competing Interests: None declared., (Thieme. All rights reserved.)

This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 ℃) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed., (© 2024. The Author(s).)

Background: Central neuropathic pain after foramen magnum decompression (FMD) for Chiari malformation type 1 (CM-1) with syringomyelia can be residual and refractory. Here we present a case of refractory central neuropathic pain after FMD in a CM-1 patient with syringomyelia who achieved improvements in pain following spinal cord stimulation (SCS) using fast-acting sub-perception therapy (FAST™)., Case Presentation: A 76-year-old woman presented with a history of several years of bilateral upper extremity and chest-back pain. CM-1 and syringomyelia were diagnosed. The pain proved drug resistant, so FMD was performed for pain relief. After FMD, magnetic resonance imaging showed shrinkage of the syrinx. Pain was relieved, but bilateral finger, upper arm and thoracic back pain flared-up 10 months later. Due to pharmacotherapy resistance, SCS was planned for the purpose of improving pain. A percutaneous trial of SCS showed no improvement of pain with conventional SCS alone or in combination with Contour™, but the combination of FAST™ and Contour™ did improve pain. Three years after FMD, percutaneous leads and an implantable pulse generator were implanted. The program was set to FAST™ and Contour™. After implantation, pain as assessed using the McGill Pain Questionnaire and visual analog scale was relieved even after reducing dosages of analgesic. No adverse events were encountered., Conclusion: Percutaneously implanted SCS using FAST™ may be effective for refractory pain after FMD for CM-1 with syringomyelia., (© 2024. The Author(s).)

Introduction: Transversus abdominis plane (TAP) blocks are commonly performed for postoperative analgesia in elective cesarean section. Ropivacaine is the most commonly used local anesthetic for TAP blocks. Currently, the concentration of ropivacaine for TAP blocks is various, and increasing number of randomized controlled trials (RCTs) have compared the effects of different concentration of ropivacaine for TAP blocks in cesarean section. This protocol of a systematic review and meta-analysis aims to identify the optimal concentration of ropivacaine for TAP blocks in elective cesarean section., Methods and Analysis: Databases including PubMed, Web of science, the Cochrane library, and EMBASE will be searched from their inception to May 1, 2024. RCTs that investigated the analgesia of different concentrations of ropivacaine for TAP blocks in elective cesarean section will be identified. The analgesia duration will be the primary outcome. Secondary outcomes will include the analgesics consumption over postoperative 24 hours, postoperative pain scores at rest and movement, and the incidence of adverse effects. RevMan 5.4 software will used for statistical analysis. The evidence quality of synthesized results will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach., Ethics and Dissemination: Ethical approval is not applicable. The results of this study will be published on completion., Trial Registration: PROSPERO registration number: CRD42024496907., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)