Dexmedetomidine versus Clonidine Adjuvants to Levobupivacaine for Ultrasound‐Guided Transversus Abdominis Plane Block in Pediatric Laparoscopic Orchiopexy: Randomized, Double‐Blind Study

Abstract

Background

Laparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.

Methods

Ninety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (Group‐B, n=30), or dexmedetomidine (Group‐D, n=30), or clonidine (Group‐C, n=30). Primary outcome was the modified CHEOPS score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score, and complications.

Results

Children of group‐D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 minutes) with p‐value < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p‐value = 0.026). Higher parents’ satisfaction scores were recorded in groups D and C compared to group‐B. Sedation among the study groups revealed significant differences (p‐value = 0.035), but no severe complications were recorded.

Conclusions

Adding dexmedetomidine to levobupivacaine can extend the time of analgesia, reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in pediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anesthetics with good postoperative analgesic profiles.

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Thomas Kenneth Hardy

bmj;371/oct30_9/m4173/FAF1faIn 1962 Thomas Kenneth Hardy (“Ken”) was appointed consultant anaesthetist at Caernarfon and Anglesey General Hospital in Bangor, north Wales. With an interest in pain...

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Digital manikins to self‐report pain on a smartphone: a systematic review of mobile apps

Abstract

Background

Chronic pain is the leading cause of disability. Improving our understanding of pain occurrence and treatment effectiveness requires robust methods to measure pain at scale. Smartphone‐based pain manikins are human‐shaped figures to self‐report location‐specific aspects of pain on people’s personal mobile devices.

Methods

We searched the main app stores to explore the current state of smartphone‐based pain manikins and to formulate recommendations to guide their development in the future.

Results

The search yielded 3,938 apps. Twenty‐eight incorporated a pain manikin and were included in the analysis. For all apps, it was unclear whether they had been tested and had end‐user involvement in the development. Pain intensity and quality could be recorded in 28 and 13 apps, respectively, but this was location‐specific in only 11 and four. Most manikins had two or more views (n=21) and enabled users to shade or select body areas to record pain location (n=17). Seven apps allowed personalising the manikin appearance. Twelve apps calculated at least one metric to summarise manikin reports quantitatively. Twenty‐two apps had an archive of historical manikin reports; only eight offered feedback summarising manikin reports over time.

Conclusions

Several publically available apps incorporated a manikin for pain reporting, but only few enabled recording of location‐specific pain aspects, calculating manikin‐derived quantitative scores, or generating summary feedback. For smartphone‐based manikins to become adopted more widely, future developments should harness manikins’ digital nature and include robust validation studies. Involving end users in the development may increase manikins’ acceptability as a tool to self‐report pain.

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Parallel ascending spinal pathways for affective touch and pain

Nature, Published online: 28 October 2020; doi:10.1038/s41586-020-2860-1

Two populations of neurons with distinct anatomy and receptor expression that convey information from the spinal cord to the brain have different functional properties with respect to touch and pain.

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Thigh pain after a stroke

This axial view of an abdominal and pelvic computed tomogram shows warfarin induced left psoas (black arrow) and retroperitoneal (white arrow) haematomas (fig 1).bmj;371/oct28_2/m3697/F1F1f1Fig 1The...

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Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: a hypothesis‐generating study

Abstract

Background

The purpose of this investigation was to undertake a hypothesis‐generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise.

Methods

One hundred fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20‐minute sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophising, self‐efficacy and knee self‐perception.

Results

Fifty‐five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self‐perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise.

Conclusions

Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise.

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Prior pain exposure and mere possession of a placebo analgesic predict placebo analgesia: Findings from a randomised, double-blinded, controlled trial

Placebo effects occur when an inert substance/treatment procedure induces beneficial psychological/physical change60,90. A significant amount of research investigating the placebo effect is in the realm of pain and analgesia. These researches provided evidence of placebo analgesic response18,75,97, and the magnitude of placebo analgesia varied across studies19,94,96. Researchers had identified several key variables that modulate the placebo responses. For example, researchers have surmised that positive expectancies, introduced through various strategies such as verbal suggestion4,78,96, conditioning67,80 and social observation,22 contributed to placebo analgesia.

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