Socioeconomic deprivation and postoperative mortality: a retrospective analysis of prospectively collected data.

Background: Deprivation and inequality are globally increasing. This study aims to explore the relationship between deprivation and postoperative mortality.

Methods: A retrospective analysis was conducted using prospectively collected data from all Aberdeen Royal Infirmary surgical patients from 2011 to 2019.

Opioid-free anaesthesia as a valuable alternative to opioid-based practices: evidence and future challenges.

Opioid-Free-Anesthesia (OFA) offers a valuable alternative model that challenges traditional opioid-based anesthesia practices. Recent studies have tempered expectations regarding the capacity of OFA techniques to improve quality of postoperative pain management and early recovery, in contrast with the clearly decreased risk of postoperative nausea and vomiting. Essentially based on regional anesthesia, non-opioid adjuvants and multimodal analgesia, OFA should be better viewed as a menu rather than a recipe, guided by surgical invasiveness, patient background, expected postoperative pain, and the practitioner's expertise.

Exploring optimal analgesic strategies for chronic limb-threatening ischaemia: a systematic review protocol.

Introduction: Chronic limb-threatening ischaemia (CLTI) represents a severe and debilitating condition characterised by inadequate blood supply to the extremities, leading to acute and persistent pain, ulceration and a heightened risk of limb loss. Patients with CLTI often experience chronic pain that significantly impairs their quality of life. The pain experienced by patients with CLTI can be complex and challenging to manage, requiring a refined approach to balance analgesic efficacy with potential adverse pharmacological effects and pre-existing, competing comorbidities.

Patient preference for intraoperative opioid use and early recovery after noncardiac surgery: protocol for a randomised factorial design trial of opioid-free opioid-based anaesthesia (the PERFECT trial).

Introduction: Although opioids are commonly used to relieve pain associated with surgery, they are not consequence free. Moreover, the USA and many western countries are currently experiencing a significant health crisis because of opioid addiction and its related overdose potential. There have been no studies that have evaluated patient preference regarding opioid use and its potential impact on the quality of recovery.

Perioperative and persistent opioid use after surgery: a scoping review.

Persistent opioid use after surgery is a growing concern, with existing reviews lacking strong predictors beyond prior opioid use. This scoping review aimed to identify knowledge gaps for future research, particularly regarding the impact of the perioperative period (including preoperative, intraoperative, and postoperative) opioid use on persistent opioid use after surgery. A comprehensive database search of prospective studies explored the association between perioperative opioid use and persistent use in adults after surgery.

Patient experience of postoperative pain: a paradigm shift to a holistic approach.

Postoperative pain has many unwanted consequences as it delays immediate recovery and may be a factor leading to chronification of pain. Although many studies have shown a link between acute postoperative pain and persistent pain, many other factors may play a role. Maurice-Szamburski and colleagues have shown that acute postoperative pain is not directly associated with the occurrence of chronic pain, but that the pain component of the Evaluation du Vécu de l'Anesthésie Générale (EVAN-G) questionnaire is associated with this outcome.

Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis.

: Intrathecal morphine (ITM) has been administered in recent years to provide postoperative pain control in non-obstetric surgery; however, current research has limited consideration of the recommendations for regular, basic analgesia from clinical guidelines when exploring its efficacy. This systematic review and meta-analysis aimed to compare ITM against alternative methods of analgesia in the presence of multimodal analgesia, for reducing pain scores within the first 24 h postoperatively. Secondary outcomes included postoperative opioid consumption, incidence of opioid-related effects, and time to mobilisation.

Impact of virtual reality distraction during colonoscopy vs intravenous deep sedation: Results of a single-center randomized controlled trial.

Background And Study Aims: Colonoscopy is associated with discomfort that requires intravenous sedation (IVS). The aim of this randomized controlled trial (RCT) was to explore the feasibility of virtual reality distraction (VRD) for colonoscopy using two primary endpoints: cecal intubation rate and the rate of rescue with IVS.

Patients And Methods: Patients scheduled for elective colonoscopy with IVS were randomized in a 2:1 ratio in favor of VRD, with rescue IVS by propofol if needed.

Recent Advances in Perioperative Analgesia in Thoracic Surgery: A Narrative Review.

Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies in thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and serratus anterior blocks.

Potential influence of different peri-operative analgesic regimens on tumour biology and outcome after oncologic surgery: A narrative review.

The management of peri-operative pain is one of the pillars of anaesthesia and is of particular importance in patients undergoing surgery for solid malignant tumours. Amongst several options, the most commonly employed analgesic regimens involve opioids, NSAIDs and regional anaesthesia techniques with different local anaesthetics. In recent years, several research reports have tried to establish a connection between peri-operative anaesthesia care and outcome after cancer surgery.

A pain research strategy for Europe: A European survey and position paper of the European Pain Federation EFIC.

Background: Pain is the leading cause of disability and reduced quality of life worldwide. Despite the increasing burden for patients and healthcare systems, pain research remains underfunded and under focused. Having stakeholders identify and prioritize areas that need urgent attention in the field will help focus funding topics, reduce 'research waste', improve the effectiveness of pain research and therapy and promote the uptake of research evidence.

Pharmacological interventions for remifentanil-induced hyperalgesia: A systematic review and network meta-analysis of preclinical trials.

Background: To improve perioperative pain management, several interventions have been suggested for the prevention of increased pain sensitivity caused by opioids (called opioid-induced hyperalgesia). It is currently unclear which intervention is the most effective or appropriate in preventing opioid-induced hyperalgesia. Remifentanil is the most investigated opioid causing opioid-induced hyperalgesia.

Persistent post-discharge opioid use and opioid stewardship: A single-centre retrospective cohort study.

Persistent post-operative opioid use is a public health concern contributing to population morbidity and mortality. Opioid stewardship is a strategy adopted to rationalise opioid prescribing and limit harmful use. We describe persistent post-discharge opioid use rates and risk factors in a single-centre cohort and describe the opioid stewardship role of our Acute Pain Service (APS).

Perioperative pain management interventions in opioid user patients: an overview of reviews.

Background: Every year, many opioid users undergo surgery, experiencing increased postoperative complications, inadequate pain control, and opioid-related adverse effects. This overview aims to summarise and critically assess the systematic reviews about perioperative pain management interventions, identify the knowledge gaps, and potentially provide high-quality recommendations to improve postoperative analgesia and surgical outcomes.

Methods: A systematic search was conducted from the following databases, PubMed, Cochrane Database of Systematic Reviews, Embase, APA PsycINFO, CINAHL, AMED, Scopus, PROSPERO, ProQuest, and Epistemonikos, in June 2023.

Syncope in the Emergency Department: A Case Report of a Rare Presentation of Favism.

Consumption of fava beans in a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency, also called favism, can lead to a haemolytic crisis. We report the case of a 69-year-old patient of Iranian origin admitted to the emergency department following syncope. The patient's comprehensive interview and blood analysis revealed that the patient presented a haemolytic crisis triggered by fava beans consumption, due to previously undiagnosed G6PD deficiency.

Does Topical Capsaicin Affect the Central Nervous System in Neuropathic Pain? A Narrative Review.

Research has been conducted investigating the neuronal pathways responsible for the generation of chronic neuropathic pain, including the components of it in conditions such as chronic post-surgical pain, phantom limb pain, and cluster headaches. Forming part of the management of such conditions, capsaicin as a molecule has proven effective. This review has investigated the central nervous system modifications exhibited in such conditions and the pharmacological mechanisms of capsaicin relevant to this.

Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review.

Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion.

Biomarkers in the Immuno-oncology Interface of Triple Negative Breast Cancer: A Scoping Review with Perioperative Considerations.

Purpose Of Review: Identification of biomarkers for immunotherapy treatment in triple negative breast cancer remains crucial for improving outcomes and optimising regimes, particularly in the perioperative setting. There is a need to conduct a scoping review to provide an overview of current research, explore the wider context, and highlight future research considerations in this field.

Recent Findings: The most commonly assessed biomarkers are PD-L1, TILs and CD8 + cells with correlation to outcomes mainly focused on survival.

Experiences and perspectives of adults on using opioids for pain management in the postoperative period: A scoping review.

Background: Opioids play an important role in peri-operative pain management. However, opioid use is challenging for healthcare practitioners and patients because of concerns related to opioid crises, addiction and side effects.

Objective: This review aimed to identify and synthesise the existing evidence related to adults' experiences of opioid use in postoperative pain management.

Patients' perspective on the chronic pain classification in the 11th revision of the International Classification of Diseases (ICD-11): results from an international web-based survey.

The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) aims at improving the lives of persons with the lived experience of chronic pain by providing clearly defined and clinically useful diagnoses that can reduce stigma, facilitate communication, and improve access to pain management, among others. The aim of this study was to assess the perspective of people with chronic pain on these diagnoses. An international web-based survey was distributed among persons with the lived experience of chronic pain.