RESUMO
BACKGROUND: Microvascular decompression (MVD) is an effective treatment for trigeminal neuralgia, but pain recurs in a substantial minority of patients. Two recently published scoring systems by Hardaway et al. and Panczykowski et al. use simple preoperative clinical and imaging features to predict durable pain relief following MVD, but their predictive performance has not been independently validated. This study aimed to compare predictive performance of the Hardaway et al. score (HS) and Panczykowski et al. score (PS) for 1-year, 3-year, and long-term pain-free outcomes after MVD for trigeminal neuralgia. METHODS: HS and PS were computed for a retrospective, single-institution cohort of 68 patients with trigeminal neuralgia who underwent MVD. Primary outcome was pain recurrence after MVD. Predictive performance of HSs and PSs was evaluated with area under the curve sensitivity analysis and regression models for survival analyses at 1 year, 3 years, and last follow-up. RESULTS: Area under the curve for predicting pain-free outcome was higher for PS versus HS at 1 year (0.873 vs. 0.775) and 3 years (0.793 vs. 0.704). Cox proportional hazard models showed that PS better predicted long-term pain-free outcomes compared with HS (P < 0.05). One-year pain-free outcome was best predicted by pain type; longer-term outcomes were better predicted by presence and degree of neurovascular compression on preoperative imaging. CONCLUSIONS: PS is superior to HS in predicting pain-free outcomes after MVD, which may aid in patient selection and counseling. Overall, more significant neurovascular compression of the trigeminal nerve root, and to a lesser extent classical paroxysmal pain, are good predictors of durable pain relief after MVD.
Assuntos
Cirurgia de Descompressão Microvascular/tendências , Manejo da Dor/tendências , Medição da Dor/tendências , Dor/cirurgia , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Pessoa de Meia-Idade , Dor/diagnóstico , Manejo da Dor/métodos , Medição da Dor/métodos , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neuralgia do Trigêmeo/diagnósticoRESUMO
BACKGROUND: Pain trajectories have been described in numerous surgical settings where preoperative characteristics have been used to predict trajectory membership. Suboptimal pain intensity trajectories have been linked to poor longitudinal outcomes. However, numerous biopsychosocial modulators of postoperative pain may also have distinct longitudinal trajectories that may inform additional targets to improve postoperative recovery. METHODS: Patients undergoing total joint arthroplasty, thoracic surgery, spine surgery, major abdominal surgery, or mastectomy completed Patient Reported Outcome Measurement Information System (PROMIS) measures and additional scales preoperatively and at 1 week, 2 weeks, 1 month, 3 months, and 6 months postoperatively. A k-means clustering for longitudinal data was utilized to explore and describe distinct pain impact (PROMIS Pain Interference and Physical Function) trajectories and associated changes in additional biopsychosocial measures. Follow-up analyses examined participant demographics and clinical characteristics associated with trajectory memberships. RESULTS: Three postoperative biopsychosocial symptom clusters were identified across all patients (n = 402): low (35%), average (47%), and high (18%) performance cluster trajectories. Participants undergoing total knee arthroplasty (TKA), spinal surgery, reporting presurgical opioid use, and higher pain catastrophizing scale scores were found to be associated with the low performance trajectory. Patients within the low performance trajectory, while demonstrating small improvements by 6 months, remained mild to moderately impaired in both pain impact and physical health outcomes. Alternatively, participants in the average performance trajectory demonstrated improvement in pain impact to population norms compared to baseline and demonstrated continued improvement across physical and psychological outcomes. Patients within the high performance cluster started within population norms across all measures at baseline and returned to baseline or exceeded baseline values by 6 months postoperatively. Self-reported opioid utilization was significantly higher in the low performance cluster across all time points. While a larger proportion of average performance patients reported opioid utilization during the first postoperative month compared to the high performance cluster, no differences were detected at 6 months postoperatively between these 2 clusters. CONCLUSIONS: These pain impact trajectories build upon previous unidimensional pain intensity trajectories and suggest that additional distinct biopsychosocial measures may have unique trajectories related to cluster assignment. Additionally, these findings highlight the importance of continued pain impact surveillance through the perioperative recovery period to detect patients at risk of experiencing a poor trajectory and subsequently poor longitudinal health outcomes.
Assuntos
Período de Recuperação da Anestesia , Sistemas de Informação/tendências , National Institutes of Health (U.S.)/tendências , Medição da Dor/tendências , Dor Pós-Operatória/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Análise por Conglomerados , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Estudos Prospectivos , Estados Unidos/epidemiologiaRESUMO
A dor é caracterizada como o quinto sinal vital e a capacitação dos profissionais de saúde torna-se fundamental para que o manejo seja realizado de forma efetiva, considerando que o fenômeno dor é multidimensional. Trata-se de pesquisa qualitativa. O foco de nossa geração de conhecimento está nos estudantes dos cursos de Enfermagem, Fisioterapia, Medicina, Odontologia e Psicologia, e profissionais docentes das mesmas áreas, tendo como propósito a identificação da percepção do conhecimento e o uso de instrumentos de mensuração e de avaliação de dor disponíveis na literatura. Foi desenvolvida a escala EMMADOR-SABER após o levantamento dos instrumentos. Após a validação quanto à aparência e conteúdo por 5 juízes convidados, foi realizado o teste piloto com 9 participantes. Em sua forma definitiva, 153 participantes responderam quais os instrumentos que conhecem e já fizeram uso na prática clínica, bem como indicar qual a importância atribuída a cada instrumento. O projeto foi encaminhado ao Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto, em concordância com a Resolução número 466/2012. Os dados foram analisados qualitativamente de forma descritiva e apresentados por meio de gráficos e tabelas. Dentre os participantes da pesquisa, 73,2% foram docentes e 26,8% alunos. Os instrumentos referidos como mais conhecidos foram: Escala Analógica Visual (EVA), seguida da Escala Numérica, Escala Facial de Dor (FPS - R), Escala Descritiva ou Qualitativa e Questionário de McGill. Os instrumentos referidos como mais utilizados foram: Escala Analógica Visual (EVA), Escala Numérica (EN), Escala Facial de Dor (FPS-R), Escala Descritiva ou Qualitativa e Coloured Analogue Scale (CAS). A mediana da importância atribuída aos instrumentos foi de 7,10 numa escala de 0 a 10. O teste não paramétrico de Mann-Whitney verificou que não houve diferença estatisticamente significativa sobre o conhecimento e utilização dos instrumentos quando comparado o grupo de docentes com o grupo de alunos
Pain is characterized as the fifth vital sign and the training of health professionals is essential for effective management, considering that the pain phenomenon is multidimensional. This is qualitative research. The focus of our knowledge generation is on students of Nursing, Physiotherapy, Medicine, Dentistry and Psychology courses, and teaching professionals in the same areas, with the purpose of identifying the perception of knowledge and the use of measurement and evaluation instruments pain available in the literature. The EMMADOR-SABER scale was developed after surveying the instruments. After validation regarding appearance and content by 5 guest judges, a pilot test was carried out with 9 participants. In its definitive form, 153 participants answered which instruments they know and have already used in clinical practice, as well as indicating the importance attributed to each instrument. The project was sent to the Research Ethics Committee of the Ribeirão Preto School of Nursing, in accordance with Resolution number 466/2012. Data were qualitatively analyzed in a descriptive way and presented through graphs and tables. Among the research participants, 73.2% were professors and 26.8% were students. The instruments referred to as the best known were: Visual Analog Scale (VAS), followed by Numerical Scale, Facial Pain Scale (FPS - R), Descriptive or Qualitative Scale and McGill Questionnaire. The instruments referred to as the most used were: Visual Analogue Scale (VAS), Numerical Scale (EN), Facial Pain Scale (FPS-R), Descriptive or Qualitative Scale and Colored Analogue Scale (CAS). The median of importance attributed to the instruments was 7.10 on a scale from 0 to 10. The non-parametric Mann-Whitney test found that there was no statistically significant difference in the knowledge and use of the instruments when comparing the group of professors with the group of students
Assuntos
Humanos , Estudantes , Medição da Dor/tendências , Conhecimento , DocentesRESUMO
BACKGROUND: As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors' clinical experience, they hypothesize that pain scores are lower in older patients. METHODS: In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. RESULTS: A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; ß = -0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. CONCLUSIONS: The authors' findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient.
Assuntos
Envelhecimento/fisiologia , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Patient satisfaction has become an important variable in assessing outcomes after spine surgery. Although minimally invasive surgery (MIS) techniques have become popular owing to reduced perioperative complications compared with open deformity surgery, whether patient-reported postoperative satisfaction differ between the 2 surgical approaches is unclear. The aim of this study was to characterize postoperative patient-reported outcomes (PRO) in patients who underwent open surgery or MIS for adult spinal deformity (ASD). METHODS: PRO scores were prospectively collected for patients undergoing deformity correction surgery between 2016 and 2018. Inclusion criteria were age >18 years, ASD, and completed PRO surveys. Patient demographic, clinical, and radiographic data and PRO survey responses were analyzed. A post hoc analysis comparing patients who were satisfied with their outcome and those who were unsatisfied was performed. RESULTS: Forty patients who underwent operative management of ASD (19 in the open surgery group and 21 in the MIS group) met the criteria for inclusion in this study. Patients in the MIS group reported higher mental health and self-image scores at 6 months; however, at the 12-month follow-up, both the open surgery and MIS groups reported minimal clinically important differences in back pain, leg pain, and functional status. Patient satisfaction scores did not differ based on surgical approach or intraoperative complications. CONCLUSIONS: PRO after open surgery and after MIS for ASD reflected successful outcomes with significant improvements in PRO survey scores but with subtle differences in the postoperative recovery process. The MIS group reported faster recovery with earlier improvement in self-image and mental health scores, which may stem from correction of smaller deformities. At the 12-month follow-up, postoperative satisfaction was high for the majority of patients in both groups.
Assuntos
Saúde Mental/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Qualidade de Vida , Doenças da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Medição da Dor/psicologia , Medição da Dor/tendências , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/tendências , Estudos Prospectivos , Qualidade de Vida/psicologia , Doenças da Coluna Vertebral/psicologiaRESUMO
BACKGROUND: For most procedures, there is insufficient evidence to guide clinicians in the optimal timing of advanced analgesic methods, which should be based on the expected time course of acute postoperative pain severity and aimed at time points where basic analgesia has proven insufficient. METHODS: We conducted a systematic search of the literature of analgesic trials for total hip arthroplasty (THA), extracting and pooling pain scores across studies, weighted for study size. Patients were grouped according to basic anaesthetic method used (general, spinal), and adjuvant analgesic interventions such as nerve blocks, local infiltration analgesia, and multimodal analgesia. Special consideration was given to high-risk populations such as chronic pain or opioid-dependent patients. RESULTS: We identified and analysed 71 trials with 5973 patients and constructed pain trajectories from the available pain scores. In most patients undergoing THA under general anaesthesia on a basic analgesic regimen, postoperative acute pain recedes to a mild level (<4/10) by 4 h after surgery. We note substantial variability in pain intensity even in patients subjected to similar analgesic regimens. Chronic pain or opioid-dependent patients were most often actively excluded from studies, and never analysed separately. CONCLUSIONS: We have demonstrated that it is feasible to construct procedure-specific pain curves to guide clinicians on the timing of advanced analgesic measures. Acute intense postoperative pain after THA should have resolved by 4-6 h after surgery in most patients. However, there is a substantial gap in knowledge on the management of patients with chronic pain and opioid-dependent patients.
Assuntos
Artroplastia de Quadril/tendências , Interpretação Estatística de Dados , Procedimentos Cirúrgicos Eletivos/tendências , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Artroplastia de Quadril/efeitos adversos , Ensaios Clínicos como Assunto/métodos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Manejo da Dor/métodos , Manejo da Dor/tendências , Medição da Dor/métodosRESUMO
BACKGROUND: Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory. METHODS: In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT). RESULTS: We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P=0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups. CONCLUSIONS: There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.
Assuntos
Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Anestesia Intravenosa/métodos , Neoplasias Colorretais/cirurgia , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia Epidural/tendências , Analgesia Controlada pelo Paciente/tendências , Anestesia Intravenosa/tendências , Neoplasias Colorretais/diagnóstico , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/tendências , Dor Pós-Operatória/etiologia , Estudos ProspectivosRESUMO
BACKGROUND: Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone. METHODS: Patients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated. RESULTS: A total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.
Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Estudos de Coortes , Discotomia/tendências , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/tendências , Estudos Prospectivos , Reoperação/métodos , Reoperação/tendências , Fusão Vertebral/tendências , Resultado do TratamentoRESUMO
Current evidence shows that the benefits of epidural analgesia (EA) are not as impressive as believed in the past, while the risks of adverse effects and serious complications are greater than previously estimated. There are many reasons for the decreasing role of epidural technique in clinical practice (table). Indeed, EA can cause harm and hinder early mobilization in enhanced recovery after surgery (ERAS) programmes. Some ERAS interventions are complex, confusing, sometimes contradictory and apparently unimplementable. In spite of much hype and after almost 25 years, the originator of the concept has described the current status of ERAS as 'far from good'. Outpatient surgery setup has been a remarkable success for many major surgical procedures, and it predates ERAS and appears to be a simpler and better model for reducing postoperative morbidity and hospitalization times. Systematic reviews of comparative studies have shown that less invasive and safer but equally effective alternatives to EA are available for almost all major surgical procedures. These include: paravertebral block, peripheral nerve blocks, catheter wound infusion, periarticular local infiltration analgesia, preperitoneal catheters and transversus abdominis plane block. Increasingly, these non-EA methods are being used as surgeon-delivered regional analgesia (RA) techniques. This encouraging trend of active surgeon participation, with anaesthesiologist collaboration, will undoubtedly improve the decades-old twin problems of underused RA techniques and undertreated postoperative pain. The continued use of EA at any institution can only be justified by results from its own audits; however, regrettably only very few institutions perform such regular audits.
Assuntos
Analgesia Epidural/tendências , Anestesia por Condução/tendências , Recuperação Pós-Cirúrgica Melhorada , Manejo da Dor/tendências , Medição da Dor/tendências , Dor Pós-Operatória/prevenção & controle , Analgesia Epidural/métodos , Anestesia por Condução/métodos , Humanos , Manejo da Dor/métodos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Fatores de Risco , Resultado do TratamentoRESUMO
ABSTRACT: Postsurgical patients usually have difficulty in answering the self-report pain scales due to the residual effects of anesthetic or sedative agents in the post-anesthesia care unit (PACU). A comparative analysis of pain assessment tools used in the PACU is lacking.In this prospective observational study, we compared the intensity of pain using the 11-point numeric rating scale (NRS) and the 4-category verbal rating scale (VRS) thrice, 5 minutes after PACU admission, 20 minutes after the first assessment, and just before discharge from the PACU in 200 patients undergone surgery. Spearman rank correlation analysis was used to investigate the correlation between 2 scales, and the weighted kappa (κ) coefficient was performed to evaluate inter-scale reliability. Response rates of the 2 scales were also compared.VRS and NRS were highly correlated during all 3 comparisons (râ=â0.767, 0.714, and 0.653, respectively; Pâ<â.0001). Each category of VRS showed a statistically significant difference in pain intensity measured by NRS during all 3 assessments. Inter-scale reliability had a fair strength of agreement for all 3 measurements (weighted κâ=â0.519, 95% CI: 0.421-0.618; weighted κâ=â0.511, 95% C.I: 0.409-0.613; weighted κâ=â0.452, 95% C.I: 0.352-0.551, respectively). VRS showed a higher response rate for PACU patients compared to NRS in all 3 measurements (96% vs 77.5%, 99% vs 81.5%, and 96.5% vs 86.5%, respectively; Pâ<â.0001).In the PACU, VRS is a reasonable and practical pain intensity measurement tool for postsurgical patients, considering the high correlation between VRS and NRS, and a higher response rate.
Assuntos
Anestésicos/efeitos adversos , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Idoso , Período de Recuperação da Anestesia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/classificação , Estudos Prospectivos , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Escala Visual AnalógicaRESUMO
BACKGROUNDS: The main objective of this study was to compare the pain control efficacy of local administration of Lidocaine with or without the nonsteroidal anti-inflammatory drug, Ketorolac, and local conventional Lidocaine injection in core needle biopsy of the musculoskeletal tumor. METHODS: The current study was a randomized, double-blind controlled clinical trial that included 128 patients with suspected musculoskeletal tumors. Patients were randomly assigned to either the Ketorolac plus Lidocaine (nâ=â64) or Lidocaine group (nâ=â64). The Ketorolac - Lidocaine combination syringe contained 30âmg Ketorolac and 2% Lidocaine - adrenaline dosage, and the Lidocaine syringe contained 2% Lidocaine - adrenaline dosage. The level of pain after core needle biopsy was evaluated for each patient at 1, 6, 12, 24, 48, and >48âhours by a Visual Analog Scale (VAS). The mean VAS changes over time were compared between the Ketorolac plus Lidocaine and Lidocaine groups using a linear mixed model. RESULTS: baseline information including mean age of patients in Lidocaine group (51.5â±â19.4âyears) and in Lidocaine - Ketorolac combination group (50.1â±â18âyears), diagnosis (malignant, benign, metastatic, infection), tumor location (upper and lower extremities, back), VAS score 1-hour post-operation (mild and moderate pain) were noted. The VAS score ratings were significantly lower in Lidocaine - Ketorolac combination group when compared to the Lidocaine group during the 1 to 24âhours post-operation time period. CONCLUSION: Patients receiving Lidocaine - Ketorolac combination dosage had significantly lower VAS scores, and these results confirm that local injection of Lidocaine - Ketorolac combination had a superior pain-controlling effect during the first 24âhours after the biopsy procedure in comparison to Lidocaine injection alone, as measured by VAS score scale.
Assuntos
Biópsia com Agulha de Grande Calibre/efeitos adversos , Cetorolaco/administração & dosagem , Lidocaína/administração & dosagem , Manejo da Dor/métodos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , Humanos , Cetorolaco/uso terapêutico , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Medição da Dor/estatística & dados numéricos , Medição da Dor/tendências , Dor Pós-Operatória/tratamento farmacológico , Neoplasias de Tecidos Moles/patologiaRESUMO
STUDY DESIGN: Retrospective review of a multi-institutional data registry. OBJECTIVE: The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF). SUMMARY OF BACKGROUND DATA: Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain. METHODS: Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs. RESULTS: A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50-69. A higher proportion of elderly experienced postoperative complications (Pâ=â.003) including urinary retention (Pâ=â<.001) and urinary tract infection (Pâ=â.002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (Pâ=â.001) and minor (Pâ=â.002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (Pâ=â<.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (Pâ=â<.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (Pâ=â<.001). Complications had no significant effect on PROs in the elderly. CONCLUSIONS: Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.Level of Evidence: 3.
Assuntos
Colaboração Intersetorial , Vértebras Lombares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/tendências , Fatores Etários , Idoso , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/tendências , Complicações Pós-Operatórias/diagnóstico , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery. METHODS: Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods. RESULTS: Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%). CONCLUSIONS: Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Nervos Periféricos/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/tendências , Bloqueio Nervoso Autônomo/tendências , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Nervos Periféricos/efeitos dos fármacos , Estudos Retrospectivos , Adulto JovemRESUMO
Both posterior decompression and fusion (PDF) and laminoplasty (LAMP) have been used to treat cervical myelopathy due to multilevel ossification of posterior longitudinal ligament (OPLL). However, considerable controversy exists over the choice of the two surgical strategies. Thus, the aim of this study is to compare clinical outcomes of PDF and LAMP for treatment of cervical myelopathy due to multilevel OPLL. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials database to identify relevant clinical studies compared with clinical outcomes of PDF and LAMP for cervical OPLL. The primary outcomes including Japanese Orthopaedic Association (JOA) score and recovery rate of JOA were evaluated, and the secondary outcomes involving visual analogue scale (VAS), cervical curvature, OPLL progression rate, complication rate, reoperation rate and surgical trauma were also evaluated using Stata software. A total of nine studies were included in the current study, involving 324 patients. The current study suggests that compared with LAMP, PDF achieves a lower OPLL progression rate, better postoperative cervical curvature and similar neurological improvement in the treatment of multilevel cervical OPLL. However, PDF has a higher complication rate, more surgical trauma and higher postoperative VAS than LAMP.
Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/tendências , Laminoplastia/tendências , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/tendências , Vértebras Cervicais/patologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Laminoplastia/efeitos adversos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Medição da Dor/métodos , Medição da Dor/tendências , Complicações Pós-Operatórias/diagnóstico , Reoperação/tendências , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective review of prospectively-collected registry data. OBJECTIVES: The aim of this study was to determine how different combinations of preoperative neck pain (NP) and arm pain (AP) influence functional outcomes, patient satisfaction, and return-to-work in patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical radiculopathy (DCR). SUMMARY OF BACKGROUND DATA: Surgeons often base decisions on the traditional belief that the predominance of radicular upper extremity symptoms is a stronger indication for cervical spine surgery than axial pain. However, there is a paucity of literature supporting this notion. METHODS: A prospectively maintained registry was reviewed for all patients who underwent primary ACDF for DCR. Patients were categorized into three groups depending on predominant pain location: AP predominant ([APP]; APâ>âNP), NP predominant ([NPP]; NPâ>âAP), and equal pain predominance ([EPP]; NPâ=âAP). Patients were prospectively followed for at least 2 years. RESULTS: In total, 303 patients were included: 27.4% APP, 38.9% NPP, and 33.7% EPP cases. The APP group was significantly older (Pâ=â0.030), although there were no other preoperative differences among the three groups. After adjusting for baseline differences, the SF-36 Physical Component Summary was significantly better in the APP group at 6 months (Pâ=â0.048) and 2 years (Pâ=â0.039). In addition, they showed a trend towards better 6-month Neck Disability Index (Pâ=â0.077) and 2-year SF-36 Mental Component Summary (Pâ=â0.059). However, an equal proportion of patients in each group achieved the Minimal Clinically Important Difference for each outcome, were satisfied, and returned to work 2 years after surgery. CONCLUSION: Although patients with NPP had slightly poorer function and quality of life, all patients experienced a clinically meaningful improvement in patient-reported outcomes, regardless of the predominant pain location. High rates of satisfaction and return-to-work were also achieved. In the context of proper indications, these findings suggest that ACDF can be equally effective for DCR patients with varying combinations of NP or AP.Level of Evidence: 3.
Assuntos
Vértebras Cervicais/cirurgia , Discotomia/tendências , Satisfação do Paciente , Radiculopatia/cirurgia , Retorno ao Trabalho/tendências , Fusão Vertebral/tendências , Adulto , Discotomia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/psicologia , Cervicalgia/cirurgia , Medição da Dor/psicologia , Medição da Dor/tendências , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida/psicologia , Radiculopatia/psicologia , Estudos Retrospectivos , Retorno ao Trabalho/psicologia , Fusão Vertebral/psicologia , Resultado do TratamentoRESUMO
STUDY DESIGN: Observational multicenter study. OBJECTIVE: The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: There are limited data available on sexual function in patients undergoing surgery for LDH. METHODS: Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain. RESULTS: Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors. CONCLUSION: This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year. LEVEL OF EVIDENCE: 2.
Assuntos
Dor nas Costas/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Medição da Dor/tendências , Comportamento Sexual , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/epidemiologia , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Prospectivos , Sistema de Registros , Inquéritos e Questionários , Resultado do TratamentoRESUMO
STUDY DESIGN: This is a retrospective cohort study. OBJECTIVE: To evaluate the long-term outcomes after surgery for refractory coccygodynia in patients with normal imaging studies compared with patients where imaging shows an anomaly. SUMMARY OF BACKGROUND DATA: Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Most surgeons employ plain radiographs or magnetic resonance imaging (MRI) in their preoperative work-up. These will often show anomalies, but in some cases they do not. We investigated whether these patients do less well than those with abnormal images. METHODS: We operated on 184 patients with coccydynia during a 7-year period and 171 (93%) responded to follow-up questionnaires after 37 (range: 12-85) months. Images of 33 patients were normal and 138 showed some coccygeal pathology. Surgery was considered to have been unsuccessful when respondents stated at review that they were somewhat better, unchanged, or worse. RESULTS: There were no clinically or statistically significant differences in outcome between the groups. Surgery was unsuccessful in 24% of patients with normal images and in 32% among those with abnormal images. The median pain scores (0-10) during the week before review were two (interquartile range [IQR]: 0-3) and one (IQR: 1-5) in the two groups respectively. Similar proportions in the two groups stated that they would not have consented to surgery if they had known the outcome in advance. CONCLUSION: Patients with severe coccydynia who have not responded to conservative treatment should not be denied surgery only because their radiographs or MRI studies look normal. LEVEL OF EVIDENCE: 4.
Assuntos
Cóccix/diagnóstico por imagem , Cóccix/cirurgia , Dor Lombar/diagnóstico por imagem , Dor Lombar/cirurgia , Medição da Dor/tendências , Cuidados Pré-Operatórios/tendências , Adulto , Feminino , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/cirurgia , Medição da Dor/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
STUDY DESIGN: Prospective longitudinal cohort. OBJECTIVES: The aim of this study was to determine whether functional treadmill testing (FTT) demonstrates differences between patients treated operatively and nonoperatively for adult symptomatic lumbar scoliosis (ASLS). SUMMARY OF BACKGROUND DATA: ASLS has become increasingly prevalent as the population ages. ASLS can be accompanied by neurogenic claudication, leading to difficulty walking. FTT may provide a functional tool to evaluate patients with ASLS. METHODS: One hundred and eighty-seven patients who underwent nonoperative (nâ=â88) or operative treatment (nâ=â99) of ASLS with complete baseline and 2-year post-treatment FTTs and concurrent patient-reported outcomes were identified. FTT parameters included maximum speed, time to onset of symptoms, distance ambulated, time ambulated, and Back and Leg pain severity before and after testing. RESULTS: At baseline, patients treated operatively reported worse post-FTT back pain (4.39 vs. 3.45, Pâ=â0.032) than those treated nonoperatively, despite similar ODI, SRS-22 Pain and Activity domain scores. Mean time ambulated (+2.15 vs. -1.20 Pâ=â0.001), pre-FTT back pain (+0.19 vs. -1.60, Pâ<â0.000) and leg pain (+0.25 vs. -0.54, Pâ=â0.024) improved in the operative group but deteriorated in the nonoperative group. On the 2-year follow-up FTT, both groups showed improvement in post-FTT back pain (-0.53 vs. -2.64, Pâ<â0.000) and leg pain (-0.13 vs. -1.54, Pâ=â0.001) severity but the improvement was statistically significantly greater in the operative compared to the nonoperative group. CONCLUSION: FTT results at baseline were worse in patients treated operatively than those treated non-operatively. FTT may be a useful adjunct to assess treatment outcomes in patients with ASLS and may help surgeons counsel patients regarding expectations 2 years after operative or nonoperative treatment for ASLS. At 2-year follow-up, time ambulated deteriorated in patients treated nonoperatively but improved in patients treated operatively. Although both groups showed improvement in post-FTT Back and Leg pain at 2 years, the improvement was greater in the operative compared to the nonoperative group. LEVEL OF EVIDENCE: 2.
Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Teste de Esforço/métodos , Medição da Dor/métodos , Escoliose/diagnóstico , Escoliose/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/epidemiologia , Estudos de Coortes , Teste de Esforço/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/tendências , Medição da Dor/tendências , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Escoliose/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility. METHODS: The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the Institute's Acute Pain Service (APS) policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision. RESULTS: The groups were comparable in terms of age, weight, height, and body mass index distribution (P > 0.05). Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034 and P = 0.04, respectively) and S (P = 0.01 and P = 0.02, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P. CONCLUSIONS: Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Radical Modificada/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Neoplasias da Mama/diagnóstico , Método Duplo-Cego , Fáscia/efeitos dos fármacos , Fáscia/inervação , Feminino , Humanos , Músculos Intercostais/efeitos dos fármacos , Músculos Intercostais/inervação , Músculos Intermediários do Dorso/efeitos dos fármacos , Músculos Intermediários do Dorso/inervação , Mastectomia Radical Modificada/tendências , Pessoa de Meia-Idade , Bloqueio Nervoso/tendências , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Músculos Peitorais/efeitos dos fármacos , Músculos Peitorais/inervação , Estudos ProspectivosRESUMO
OBJECTIVE: Minimally invasive anterior lumbar interbody fusion surgery (MIS ALIF) is a technique that restores disc height and lumbar lordosis through a smaller exposure and less soft-tissue trauma compared to open approaches. The mini-open and laparoscopic assistance techniques are two main forms of MIS ALIF. The authors conducted a systematic review that sought to critically summarize the literature on back pain following MIS ALIF. METHODS: In March 2020, the authors searched the PubMed, Web of Science, and Cochrane Library databases for studies describing back pain visual analog scale (VAS) outcomes after MIS ALIF. The following exclusion criteria were applied to studies evaluated in full text: 1) the study included fewer than 20 patients, 2) the mean follow-up duration was shorter than 12 months, 3) the study did not report back pain VAS score as an outcome measure, and 4) MIS ALIF was not studied specifically. The methodology for the included studies were evaluated for potential biases and assigned a level of evidence. RESULTS: There were a total of 552 patients included from 13 studies. The most common biases were selection and interviewer bias. The majority of studies were retrospective. The mean sample size was 42.3 patients. The mean follow-up duration was approximately 41.8 months. The mean postoperative VAS reduction was 5.1 points. The mean VAS reduction for standalone grafts was 5.9 points, and 5.0 points for those augmented with posterior fixation. The most common complications included bladder or urinary dysfunction, infection, and hardware-related complications. CONCLUSIONS: This was a systematic review of back pain outcomes following MIS ALIF. Back pain VAS score was reduced postoperatively across all studies. The complication rates were low overall. MIS ALIF is safe and effective at reducing back pain in appropriate patient populations.