Pain

Maternal Dissatisfaction and Anesthesia Care

Maternal dissatisfaction was studied in this retrospective study after vaginal or Cesarean delivery.

Maternal dissatisfaction was associated with: pain intensity during the first stage of labour; pain intensity during the second stage of labour; postpartum pain intensity; delay > 15 min in providing epidural analgesia and postpartum headache, pruritus. Non‐Hispanic ethnicity was negatively associated with dissatisfaction. After caesarean delivery, the intensity of postpartum pain, headache and pruritus were linked to dissatisfaction. Hispanic ethnicity also had a negative relationship with dissatisfaction after caesarean delivery.

The lessons learnt should spur timely provision of analgesia at all phases of the delivery process and efforts to minimize and treat side effects.

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Occipital Neuralgia and Greater Occipital Nerve Blocks

Occipital neuralgia is a cause of occipital headache and is amenable to nerve block techniques.

This article discusses the symptomatology and in particular the use of ultrasound in the use of occipital nerve block.

It concludes: “Ultrasound-guided occipital nerve blocks appear to be a relatively safe, effective, and easy procedure for both the diagnosis and treatment of occipital neuralgia…more targeted blocks and potentially allowing for denervation procedures in the future”

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Neuraxial labour analgesia reduces risk of maternal depression at 2 years after childbirth

This prospective study suggests another potential advantage to neuraxial analgesia for vaginal delivery.

It concluded: “For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.”

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Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

Nerve blocks are now almost universal during shoulder surgery for their superior analgesia. This study reviewed post-discharge outcomes.

A decrease in unplanned admissions was found. There was no improvement in other postoperative outcomes such as emergency department visits, readmissions, mortality, or practical costs.

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Consensus Statement on Persistent Postoperative Opioid Use

This statement looked at the definition, incidence and risk factors for persistent postoperative opioid use and how it might be dealt with.

“Patient characteristics associated with an increased risk of persistent postoperative opioid use included preoperative opioid use, depression, substance use disorder, preoperative pain conditions, and smoking.”

They discuss in the free full text how health policy may help to curtail persistent opioid use.

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Regional anaesthesia is associated with less patient satisfaction

At a time where ultrasound guided regional nerve blockade has exploded in popularity for both extremity and trunk surgery, a caveat appears from this prospective study.

About a third of patients undergoing plexus block for upper extremity surgery reported not being fully satisfied; reasons for dissatisfaction following regional anaesthesia are reported as “insufficient anaesthesia prior to surgery”, and “the discomfort of having a long-lasting insensate extremity postoperatively”.

The authors advocate “stronger focus on patient counselling preoperatively, addressing the issues of block failure and prolonged postoperative sensory and motor block.”

There appears to be a mismatch between the enthusiasm of regional anesthesia practitioners and patients satisfaction, as well as the current mantra of “shared decision making”.

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Reducing pain in infants, children, and adolescents

This Cochrane Special Collection highlights the evidence for reducing both chronic and acute pain in infants, children, and adolescents.

Some areas are still devoid of good evidence, but this review includes links to a large number of topics. Chronic pain topics include the use of antidepressants, anti-epileptics, NSAIDS, acetaminophen, and opioids in non-cancer pain. A list of reviews of different opioids for cancer pain is included. Various opioids as well as psychological interventions are surveyed in acute pain management.

The list is comprehensive and full text is available at:

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Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery

The latest newcomer to regional anesthesia in breast cancer surgery is the PEC-2 Block.

This review and meta-analysis shows essentially an equivalence to Paravertebral Block.

“Petoralis-II blocks were noninferior to paravertebral blocks in reducing pain intensity and morphine consumption for the first 24 h after surgery and both were superior to systemic analgesia alone”.

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