Newswise — Updated Practice Guidelines from the ASA, full text of the 2009 Annual Rovenstine Lecture and research on risk factors for postoperative pain that continues, can be found in the April 2010 issue of Anesthesiology in print and at www.anesthesiology.org.
New ASA Practice Management Guidelines for Chronic Pain ManagementExperts in pain medicine at ASA developed a broad-based set of evidence based guidelines for all physicians treating patients with pain. The updated guidelines address a wide range of therapies applied to the treatment of pain and incorporate key advancements in the field of pain medicine over the past decade. Therapies addressed in the guideline include: medical management, acupuncture, physical therapy, nerve blocks, ablative procedures, epidural injections, intradiscal procedures, advanced neuromodulation techniques and others.
Predictive Risk Factors for Persistent Postherniotomy Pain – Postoperative Pain That ContinuesSeveral predisposing factors have been suggested to increase the risk for postoperative pain including age, pre-operative pain, anxiety, depression, sensory function and nerve injury. As the relative role of these factors has remained unclear, this study works to identify specific risk groups for persistent postoperative pain, potentially leading to prevention or treatment suggestions for the condition.
Researchers investigated 19 potential predisposing factors for the development of persistent pain following surgery in 463 adult male patients scheduled to undergo primary groin hernia repair. Patients were examined preoperatively using standardized questionnaire including current pain from the hernia, regular pain at other body regions, anxiety and depression screening (HADS), pain coping strategies (PCS), and pain related impairment (AAS). To compare the effect of open Lichtenstein mesh repair vs. laparoscopic glue mesh fixation repair, patients were operated at two high-volume specialist centers.
Pain was assessed during the first week and at 30 days. Using the validated activities assessment scale (AAS) patients were examined again six months after surgery, further assessing sensory function in the groin, pain levels and pain impairment of daily activities. 16 percent of patients with open Lichtenstein mesh repair and 8 percent of patients with laparoscopic repair complained of pain affecting daily activities. Four factors were identified to be independently predictive for development of pain related impairment of daily activities; preoperative AAS-score, preoperative pain-response to a heat stimulus in the area of surgery, 30 day pain intensity and nerve damage or impairment of sensory function at 6 months. Univariate analysis showed that laparoscopic surgery resulted in less nerve injury than open surgery (p <0.001).
Special Article: “We Need Leaders”: The 48th Annual Rovenstine LecturePeter J. Pronovost, M.D., Ph.D., presented the Emery A. Rovenstine Memorial Lecture at the ASA 2009 Annual Meeting in New Orleans, addressing quality and safety in health care. In the published text of this presentation, Dr. Pronovost focuses on the need to improve clinical quality, to recognize the history that anesthesia has in improving quality care and safety, and to set future directions for anesthesia leadership in health care quality and safety.
A noted expert in patient safety, Dr. Pronovost is the author of more than 260 research and review articles, editorials and chapters in the fields of patient safety, Intensive Care Unit care, quality health care, evidence-based medicine and the measurement and evaluation of safety measures. Dr. Pronovost is also the author of the recently published book Safe Patients, Smart Hospitals.
RSS