Background The comparative efficacy of epidural bupivacaine with Magnesium sulphate and bupivacaine combined with Tramadol in providing postoperative analgesia remains controversial.This study aims to assess the efficacy of epidural postoperative analgesia using a combination of 0.125%of Bupivacaine with 50mg MgSO4, compared to 0.125%of Bupivacaine with 50mg tramadol in patients undergoing surgeries for the lower limbs. Method 60 patients classified as ASA grade I and II were randomly divided into two groups, Group I and Group II, each containing 30 patients. Group I received a total of 9 ml of 0.125% bupivacaine (8 ml) combined with 50mg tramadol (1 ml), while Group II was given 9 ml of 0.125% bupivacaine (8 ml) with 50mg MgSO4 (1 ml). The analgesic effectiveness was evaluated by the onset of analgesia, duration of analgesia, quality of analgesia, and the time taken to administer the first rescue analgesic. Results The onset of analgesia in Group I was recorded as 6.67±0.80 minutes, while Group II had an onset time of 7.67±0.80 minutes (p=0.001). The duration of analgesia for Group I was 5.16±0.72 hours, compared to 4.51±0.62 hours in Group II (p=0.001). The time until the first rescue analgesia was 5.260±0.716 hours for Group I, whereas Group II required 4.617±0.622 hours (p=0.001). Over a 24-hour period, Group I needed an average of 3.47±0.51 rescue doses, while Group II required 3.97±0.49 doses. The quality of analgesia was evaluated in both groups, showing no statistically significant differences. Adverse effects included nausea and vomiting in 4 patients and pruritus in 1 patient in Group I, while Group II experienced hypotension in 4 patients and bradycardia in 2 patients. Mean systolic and diastolic blood pressures were comparable across both groups, with significant differences only at 5, 10, and 15 minutes. The mean heart rates at 5, 10, and 15 minutes were 94.67±4.15, 89.73±3.85, and 85.40±4.40 in Group I, and 97.00±4.09, 92.20±3.46, and 87.53±3.27 in Group II, indicating statistical significance. The mean post-operative VAS scores recorded upto 24hrs. The mean VAS score was 0.40±0.498 and 0.47±0.507 at 2hrs, 2.87±0.730 and 2.93±0.691 at 4 hrs, 1.60±0.621 and 1.87±0.730 at 6hrs, 2.60±0.621 and 2.87±0.507 at 8hrs, 1.87±0.629 and 2.07±0.691 at 12hrs, 2.60±0.621 and 2.67±0.479 at 24hrs respectively. Conclusion Tramadol proved to be more effective than magnesium when combined with bupivacaine, as it led to a faster onset of pain relief, prolonged the duration of analgesia, and decreased the requirement for extra rescue epidural top-up doses within a 24-hour timeframe.

Background. The aim of the study is evaluate the quality and safety of the sedative effect of anesthesia in ambulant ophthalmic surgery by using continuous intravenous infusion of dexmedetomidine. Materials and Methods. Patients were randomized into groups by age (old people from 65 to 75 years old, old age 76 years, middle age, young people, children), by gender (men, women). The physical status of patients was assessed using the ASA scale and the dynamics of vegetatic activity by the Kerdo index. Sedation was assessed using the Richmond Sedation Scale RASS. Results. It was found that the difference in the frequency of adverse effects of the appointment of Dexmedetomidine clearly confirms the need to adjust the dose of Dexmedetomidine, depending on the state of the autonomic nervous system. The use of Dexmedetomidine according to the recommendations made it possible to achieve a safe level of sedation and eliminate side effects in ambulant ophthalmic surgery. Conclusions: Parenteral continuous infusion of Dexmedetomidine provides an effective level of sedation for ambulant ophthalmic surgery and maintaining patient-surgeon contact. Safety is confirmed by a low level of critical incidents, no respiratory depression at the target sedation level. The patency of the upper airways was better compared to previous experience with propofol

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p<0.05) in the control group than in the blockade groups. Both block groups demonstrated lower pain scores at all time points assessed. The latest need for analgesics was in the QLB group. Mean arterial pressure (MAP) values differed only in the first 2 hours after surgery between the CON and TAPB groups (p<0.05). PONV one hour after surgery was more observed in the control group and less in the QLB group (p<0.05). According to the results of a survey conducted on the day after surgery, the number of patients satisfied with the anesthesia and assistance provided in the recovery room in the groups with blockade (TAPB, QLB) was 2.1-5.3% higher (p>0.05). More patients from the QLB group (p<0.05) noted very good and good health, and most patients (p<0.05) from the CON and TAPB group noted satisfactory health. Conclusion. The use of interfascial blocks for postoperative pain relief (TAPB, QLB) after laparoscopic robot-assisted hysterectomy improves the quality of pain relief and the well-being of patients. Benefits of QLB include better pain relief, reduced incidence of PONV, and greater patient satisfaction. TARP has shown equally good results, and this method is easier to perform.

The publication collects and systematizes the main definitions and concepts related to pain sensations of various genesis and their changes in pathological conditions. The work includes terminology with appropriate changes and notes, which was prepared by the working group of the International Association for the Study of Pain (IASP) and is used in numerous reports and scientific publications. The glossary deals mainly with terms and does not contain the classification of pain, which is sufficiently presented in other modern scientific publications. The presented terms and their interpretation will be useful not only to scientists, but also to clinicians and students of medical universities of Ukraine.

Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.

Patients with chronic pain often have sleep disturbances, and many patients receive sleep medications in addition to analgesics. Although there have been scattered reports of negative pain-sleep interactions, only a few reports have investigated the efficacy of sleep medication interventions in patients with chronic pain for improving sleep disturbances and reducing pain. We retrospectively examined whether lemborexant, an orexin receptor antagonist, is effective in improving sleep disturbances and reducing pain in patients with chronic pain. This study was approved by the Ethics Committee of our hospital. The subjects were 26 patients with chronic pain undergoing treatment at our pain clinic between July 2021 and March 2022, who had been diagnosed with insomnia, with an Athens Insomnia Scale (AIS) score of ≥6 and had been started on lemborexant. The AIS score and pain score (Numeric Rating Scale [NRS]) before and after 2 and 4 weeks of starting lemborexant were investigated. Patients who were already taking other sleep medications, such as benzodiazepines were switched to 5 mg of lemborexant after all the other sleep medications were discontinued. Those who had not yet used sleeping pills were started on 5 mg of lemborexant. During the study course, the dose of lemborexant was adjusted at the discretion of the attending physician, based on improvement of insomnia symptoms and secondary symptoms, such as daytime sleepiness and lightheadedness. The study finally included 21 patients, excluding 5 who could not continue taking lemborexant due to side effects, such as lightheadedness. The AIS scores significantly improved, decreasing from baseline (mean ± standard deviation: 12.5 ± 4.9) to 2 weeks (7.8 ± 3.1) and 4 weeks (5.3 ± 2.9) after the start of lemborexant. No significant difference was observed in the degree of improvement in sleep disturbance between patients with or without previous sleep medications, and there was also no statistically significant improvement in the NRS score before (6.1 ± 2.7) and after 2 weeks (5.5 ± 2.3) and 4 weeks (5.9 ± 2.2) from treatment initiation.

ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. RR2-10.2196/25291.

Journal Article Corrected proof The use of immersive audiovisual distraction with virtual reality during pain procedures: a randomized controlled trial Get access Naileshni Singh, MD, Naileshni Singh, MD Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA 95817, United States Corresponding author: Department of Anesthesiology and Pain Medicine, University of California, Davis, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 2700 Sacramento, CA 95817, USA. Email: naisingh@ucdavis.edu https://orcid.org/0000-0002-8838-5325 Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael J Jung, MD, MBA, Michael J Jung, MD, MBA Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA 95817, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Fatima Yusuf, BS, Fatima Yusuf, BS California Health Sciences University, Clovis, CA 93611, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Almas Khan, BS, Almas Khan, BS Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA 95817, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Tiffany Su, MD, Tiffany Su, MD Pain Management Physician, Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ 85015, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Allison Glinka-Przybysz, MD, MPH, Allison Glinka-Przybysz, MD, MPH Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI 53705, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Sandra L Taylor, PhD Sandra L Taylor, PhD Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, CA 95817, United States https://orcid.org/0000-0001-7811-812X Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad066, https://doi.org/10.1093/pm/pnad066 Published: 19 May 2023 Article history Received: 28 February 2023 Revision received: 02 May 2023 Accepted: 11 May 2023 Published: 19 May 2023 Corrected and typeset: 05 June 2023

The purpose of this study was to investigate the analgesic effects of duloxetine, specifically on postoperative pain, opioid consumption, and related side effects following total hip or knee arthroplasty. In this systematic review and meta-analysis, Medline, Cochrane, EMBASE, Scopus, and Web of Science were searched until November 2022 for studies which compared duloxetine with placebo when added to routine pain management protocols. Individual study risk of bias assessment was conducted based on Cochrane risk of bias tool 2. Random effect model meta-analysis was done on mean differences, to evaluate the outcomes. Nine randomized clinical trials (RCT) were included in the final analysis, totaling 806 patients. Duloxetine reduced opioid consumption (oral morphine milligram equivalents) on postoperative days (POD) two (mean difference (MD): - 14.35, p = 0.02), POD three (MD: -13.6, p < 0.001), POD seven (MD: -7.81, p < 0.001), and POD 14 (MD: -12.72, p < 0.001). Duloxetine decreased pain with activity on POD one, three, seven, 14, 90 (All p < 0.05), and pain at rest on POD two, three, seven, 14, and 90 (All p < 0.05). There was no significant difference in the prevalence of the side effects, except for increased risk of somnolence/drowsiness (risk ratio: 1.87, p = 0.007). Current evidence shows low to moderate opioid sparing effects of perioperative duloxetine and a statistically but not clinically significant reduction in pain scores. Patients treated with duloxetine had an increased risk for somnolence and drowsiness.

Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5-S1 disc herniation. Prospective, randomized clinical trial. A university hospital pain management center. The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3rd week and 3rd month compared to baseline (P < .001). Treatment success rate at 3rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (P = .766). CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5-S1 disc herniation. Both approaches can reduce pain and disability, while CESI requires shorter fluoroscopy time and less radiation exposure.