Different perspectives are needed to understand the pathophysiology of burning mouth syndrome (BMS), including physiological and psychological standpoints. The significance of interoception in chronic pain has been suggested. However, few studies have investigated this relationship in BMS. Therefore, we examined the role of interoception in BMS.This is a cross-sectional study. BMS patients (N = 64) participated in the study. We used interoceptive accuracy (IAc) based on the heartbeat counting task. Then, participants were divided into high and low IAc groups, and their scores on clinical assessment including pain and psychological evaluation were compared.The Visual Analogue Scale scores indicating pain in low IAc patients, but not high IAc patients, were positively correlated with the Beck Depression Inventory-Second Edition (BDI-II) and the State-Trait Anxiety Inventory-State (STAI-S) Scores.Interoception might play a role in the pathophysiology of BMS. International Headache Society’s (IHS) criteria for the diagnosis of primary BMS includes constant intraoral pain with a burning quality, the normal appearance of the oral mucosa, and exclusion of any local or systemic diseases . The patInteroception is defined as the sensations of internal bodily signals such as heartbeat, breath, and thirst . EmerginDi Lernia et al.  have repThe participants in this cross-sectional study were 64 female Japanese BMS patients recruited from a dental anesthesia outpatient department of Hiroshima University Hospital. The diagnosis of primary BMS was made according to the classification of IHS by a trained dental anesthesiologist (author M. D.) with more than 15 years of experience . We clinThe Visual Analogue Scale (VAS) was used as a self-report measure for assessing pain intensity in daily life. Participants rated their mean pain intensity for one week when they felt pain. We also used the Pain Catastrophizing Scale (PCS) , a 13-itThe participants completed the Beck Depression Inventory-Second Edition (BDI-II) , which iWe used the HCT described by Schandry to assess IAc . Particit-tests to assess the differences in VAS, BDI-II, STAI, and PCS scores between the two groups. The threshold for statistical significance was set at p < 0.05. We also conducted Pearson correlation analysis between VAS, IAc, and psychological variables, including PCS, BDI-II, and STAI (STAI-S and STAI-T), to assess group’ associations between these scores. The Bonferroni correction indicated p < 0.05/10 = 0.005. All the data were analyzed using SPSS for Windows 21.0 .We conducted two-sample Table r = 0.53) and STAI-S  scores. Moreover, there was no significant relationship between VAS and any other variable in either groups, although there was a strong association between VAS and PCS scores , low IAc; r = 0.47 (p = 0.007)).As shown in Table This study is the first to investigate the role of IAc and psychological evaluation in BMS patients’ pain intensity. The findings indicated that VAS scores of patients with low IAc, but not in patients with high IAc, were positively correlated with BDI-II and STAI-S.This study found a positive relationship between clinical pain symptoms of low IAc BMS patients and BDI-II or STAI scores. Individuals with low interoception have difficulties in regulating emotions, and it has been suggested that it is important to recognize the bodily states correctly to understand and regulate emotions . EmotionThe present study has several limitations. Our exclusion criteria for participants did not include all possible treatment effects that might influence pain perception, interoception and psychiatric symptoms of patients, such as the use of antidepressants. Furthermore, we did not establish a healthy control group, and therefore we could not show the general association between psychiatric symptoms and interoception, although we could clarify the role of interoception within BMS patients. Finally, BMS patients show general time-dependent changes of symptoms, such as more severe pain in the evening . HoweverThis study found that the pain intensity felt by BMS patients with low interoception was positively associated with depression and anxiety. Therefore, we suggest that research on interoception might contribute to clarifying the pathophysiology of BMS. We expect that improving interoception would become a future treatment option for BMS due to similar research.


Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases  were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics  were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions  were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures.  Laparoscopic cholecystectomy (LC) is a minimally invasive technique that causes mild postoperative discomfort in the parietal, visceral, incisional, and referred regions . In thesRafi  pioneereTAP blocks are effective for a number of abdominal practices, including hysterectomy, cesarean section, cholecystectomy, colectomy, hernia repair, and prostatectomy ,13,14,15Most patients undergoing laparoscopic cholecystectomy experience pain in the first 24 h after surgery, with port sites being the most painful. After laparoscopic surgery, pain is mainly felt as visceral pain due to the trauma of gallbladder resection and parietal pain due to skin incision ;   . Additio< 0.001) . Finally < 0.05) .p = 0.0002) [It is noteworthy that a similar pattern of changes, in which the US-TAP block group had a lower pain experience and analgesic requirement compared with the port infiltration groups, was observed in a study by Khandelwal, Parag, Singh, Anand, and Govil  and by A 0.0002) . Uniquely, Liang, Chen, Zhu, and Zhou  used difp = 0.089) than for US-TAP blockade group (induction)  [Although there does not appear to be a significant difference between the two groups, mean meperidine consumption (mg) was higher in those receiving US-TAP block (after surgery) (34.21) than in those receiving US-TAP block (induction) (32.11) . Postope= 0.089) . p = 0.03) [p = 0.006); however, the intervention groups did not differ significantly [p = 0.001) [p < 0.002) and Nalbuphine (p < 0.001) as rescue analgesics was significantly lower in the US-TAP block (0.25% Bupivacaine) group  than in the US-TAP block  group  [p = 0.48 [p = 0.204) compared with US-TAP block   [p = 0.05) [We found that the US-TAP block group  had higher 24hfentanyl consumption (877.8 mcg) than the US-TAP block group  (566.7 mcg) or the US-TAP block group (0.5% Bupivacaine + Sufentanil)  . Compareficantly . Time to= 0.001) . Intra-o= 0.001) . The per24, 96%) . In contp = 0.48 . Mean Mo= 0.204) . The US- = 0.05) . From ar = 0.05) .p = 0.366) [It appears that the higher the concentration of anesthetics used for the US-TAP block, the lower the experience of pain. Of note, Ra et al.  used 0.2= 0.366) .Because US-OSTAP is a relatively new technology that is essentially the same as TAP block procedures, we compared the analgesic efficacy of ultrasound-guided oblique subcostal transversus abdominis block with transversus abdominis plane block. Intra-operatively, there appears to be no difference between the US-TAP and US-OSTAP blocks in terms of Ketorolac consumption; however, the two groups differ in terms of intra-operative fentanyl consumption (US-TAP: 72.4 and US-OSTAP: 78.1) and postoperative Nalbuphine consumption (US-TAP: 7.3 and US-OSTAP: 8.0), with US-TAP block reporting less consumption . In contp = 0.001) [p = 0.001), and opioid consumption during the first 24 h was significantly lower  [It should be noted that we compared US-OSTAP  with US-OSTAP (Pethidine); however, US-OSTAP (Pethidine) significantly reduced pain scores at 0, 2, 4, 6, 12, and 24 h (= 0.001) . US-OSTA= 0.001) . There w= 0.001) . Therefo= 0.001) . Pain ex= 0.001) . Similar= 0.001) . The US-OSTAP block (Ropivacaine) had a low fentanyl consumption of 122 mcg intra-operatively compared to US-OSTAP  block , compared with 289.8 min in US-TAP block  . PatientThe time for first analgesic consumption using the US-TAP block was 63.72 min compared with the quadratus lumborum block at 70.00 min . Similarp = 0.001 [p ≤0.001 [The analgesic request was found to be higher among those receiving the US-TAP block  as compared to the quadratus lumborum block . Cumulative daily Morphine consumption was significantly higher in the US-TAP block group (6 mg (6–9)) than in the quadratus lumborum block group (3 mg (3–6)),  = 0.001 . The medp ≤0.001 .b.Comparison of different approaches to laparoscopic-assisted transversus abdominal blockadep = 0.025, p = 0.03, and p = 0.007, respectively) as compared to normal saline [In the LAP-TAP group , numerical pain assessment scores were significantly decreased after 1, 3, and 6 h of rest  and opioid requirements (p = 0.021) at 6 h than port infiltration group participants [Compared to port site infiltration, there seems to be no change in LAP-TAP block for pain at rest between the first 3 and 6 h postoperative . Howevericipants .The results of this review show that patients who received 0.9% normal saline for infiltration during laparoscopy reported a high need for rescue analgesia both in the ward  and at PACU  . Comparec.Other known techniquesp < 0.05) . Postoperatively, dynamic VAS was significantly lower in the US-TAPB block group (p < 0.05) than in the two groups receiving PCIA with Sufentanil and Nalbuphine [When bilateral double transversus abdominis plane blockade (BD-TAP) was compared with sham control, higher pain sensation was observed postoperatively in the control group at rest (2 h), during coughing , and during walking , with no change between the two groups at 24 h . Ultrasolbuphine .As shown in As shown in To our knowledge, this is the first review to comprehensively compare the analgesic efficacy of different procedures for laparoscopic cholecystectomy.The seven classes of drugs used before anesthesia (pre-medication) include benzodiazepines , analgesics , prokinetics , anticholinergics (Glycopyrrolate), 5-HT3 antagonists (Ondansetron), H2 receptor blockers , and alkalinizing agents (ringer lactate solution) ,71,74,76Evidence from this study has shown that US-TAP blockade in addition to general anesthesia is more effective than general anesthesia alone for postoperative pain management . Use of Apparently, the addition of 20 mL of normal saline to 0.5% bupivacaine for the US-TAP block might be associated with a lower need for analgesics than in patients who received 10 mL of normal saline to 0.5% bupivacaine . US-TAP US-TAP blockade with 2 mLof Sufentanil on 0.5% Bupivacaine might be associated with a lower opioids requirement than the use of 2 mL of 0.9% saline on 0.5% Bupivacaine or normal saline alone . UniquelPostoperative opioid consumption differs for the different types of blocks, with US-TAP consuming more Fentanyl and US-OSTAP consuming more Nalbuphine . AlthougUS-OSTAP blockade with Ropivacaine is more effective against pain and requires fewer analgesics than normal saline during and after surgery and at PACU . In partLaparoscopically assisted TAP blockade with Bupivacaine plus Periportal injection of normal saline is associated with pain reduction between 1 and 6 h postoperative compared with those who received saline TAP blockade with a periportal injection of Bupivacaine . The useThe port infiltration group seems to have a higher need for analgesics than the US-STA or US-TAP groups . NotablySubcostal US-TAP blockade is associated with lower postoperative opioid consumption compared with US-BRILMA . LikewisThe optimal dose means that symptoms and side effects can be most effectively controlled with the lowest dose of a drug . From thCorroborating the extant literature, our study confirmed the reduction in analgesic consumption 24 h after laparoscopic surgery with TAP blockade or general anesthesia with TAP blockade compared with general anesthesia or no TAP blockade or placebo treatment, with analgesic consumption also reduced after 24 h . ConsistThe modified BRILMA block has been used and was found to reduce intra-operative Fentanyl consumption and postoperative Morphine consumption in supra-umbilical open surgeries such as cholecystectomy and gastrectomy . OSTAP bOpioid consumption varies by plane block procedure. While there are no intra-operative differences between US-TAP and US-OSTAP for Ketorolac, the US-OSTAP group consumed more Fentanyl, while the US-TAP group consumed more Nalbuphine postoperatively using 0.375% of Ropivacaine 40 mL . HoweverThe results of this review have shown that the use of adjuvant in addition to local anesthetics for TAP block procedures could be effective for pain management in laparoscopic cholecystectomy. To improve recovery after surgery and reduce postoperative opioid consumption, opioid-sparing techniques are increasingly used in anesthesia. Evidently, it was found that local anesthetics may be improved, and additional analgesics need to be administered less frequently when Dexmedetomidine is added to local anesthetics during central neuraxial blocks and peripheral nerve blocks . AdditioStudy results by McDonnell et al.  and 115115 suggen-methyl D-aspartate) receptors [A few studies have contributed to the understanding of the modulation of postoperative pain by Esmolol, although its role in modulating pain still remains unclear . Analgeseceptors ,119,120.eceptors . There aeceptors ,123,124;eceptors . Specifieceptors . The mechanism by which Dexamethasone might affect pain management also remains unclear; however, the lack of local blood vessels makes the TAP blockade lasts a long time because of the slow breakdown of local analgesia ,126. AsiThe present systematic review has some limitations. Although all included studies were searched from different countries, we are subject to publication bias because this systematic review includes studies published in English only. Because of the lack of sufficient data, we could not draw conclusions about the clinical significance of the various TAP block procedures. We were also unable to provide information on the long-term effects of the TAP blockade procedures because of a lack of evidence. There were numerous RCTs whose data were not suitable for meta-analysis, either because of a pictorial representation of the data, different methods of measuring outcomes, or inappropriate statistical analysis  or the lack of baseline data. Furthermore, the ASA grade and BMI in the baseline data of patients could have an impact on the tolerance of local anesthetics. Again, the broader inclusion criteria and overall objective may be a limiting factor to consider when planning further studies. In view of these problems, it is advisable to not generalize conclusions from this study to broader clinical settings. However, further studies are needed to clarify the analgesic efficacy of different TAP block procedures at similar doses. The optimal long-term effect of local anesthetics in TAP blockade procedures and the toxicity of local anesthetics should be further investigated.Four different types of anesthetics  have been reported to be used in concentrations ranging from 0.2% to 0.375% for LC procedures. Ten different types of drugs  were reportedly used as supportive agents in addition to local anesthetics for LC. Although concentrations of LA may vary, 20 mL is probably the optimal dose for TAP block procedures and 0.4 mg/kg for port infiltration. However, further quantification is needed to clarify the optimal dose for different anesthetic concentrations. US-TAP blockades performed in addition to general anesthesia were more effective for pain than port infiltration or general anesthesia alone. Postoperative pain perception and opioid consumption were higher in those who received a US-TAP block after surgery than in those who received a block before induction; however, it took a shorter time for those who received a US-TAP block after surgery to require the first analgesics. US-TAP block with normal saline reportedly had higher opioid consumption in 24 h compared with those with Bupivacaine over normal saline or Bupivacaine over Sufentanil. It appears that the higher the concentration of the anesthetic used for US-TAP blockade, the lower the pain sensation, and that an adjuvant to LA could enhance its analgesic effect. Evidently, those who received Ropivacaine at low concentrations required rescue anesthesia in the ward. There seems to be no significant difference between the US-TAP and US-OSTAP. Time to first analgesic intake/request was higher in the groups with US-TAP block compared with quadratus lumborum. However, pain perception between 12 and 24 h was lower in the US-TAP group than in the quadratus lumborum group. This should be clarified in further studies. Compared with the port infiltrations, the LAP-TAP block group reportedly had less pain at rest in the first 3–6 h after surgery. The minimal clinically significant differences for both TAP block procedures and port infiltration appeared to have a large effect size index, but this should be taken with caution because of insufficient evidence. Subcostal US-TAP blockade may be correlated with lower postoperative opioid consumption and reduced need for rescue analgesics compared with US-BRILMA. US-ESP proved to be more effective than US-OSTAP block for postoperative pain within 24 h. Finally, multimodal analgesia could be another strategy for pain management. Analgesia with the TAP blockade significantly reduces opioid consumption and also provides effective analgesia.


This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity. n = 76, group A) and subjects with mouth-opening limitation . Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables.  A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain.  Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression ( Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain. Pain related to temporomandibular disorders (TMDs) is the principal cause of nondental pain in the orofacial region , and amoTMD comprises a varied group of pathologies   with mulClinicians consider bruxism to be an etiological factor for TMD. However, this relationship is controversial mainly because of the different methods used to diagnose bruxism. Methods to diagnose bruxism, such as self-reporting or clinical examination, are prone to potential bias, and some authors have suggested the necessity to improve the methodological approach .Another group of variables is the psychological factors . DepressFinally, some morphological traits concerning TMD have been studied. In this category, presence of malocclusion can be included. Literature shows that at best, certain malocclusion traits are weakly associated with TMD: (1) increased overjet, (2) open bite, (3) Angle Class III malocclusion, and (4) crossbites are some examples . A systeThis study is aimed at determining the possible association between myofascial pain with or without mouth-opening limitation and malocclusion complexity. The study design also included age, gender, bruxism, depression, and chronic pain as variables.α = 0.05). Patients from a School of Dentistry were selected by a nonprobabilistic method from August 2017 to April 2018. Their chief complaint was malocclusion. The inclusion criteria were subjects  on permanent dentition without prior orthodontic treatment that met the Index of Complexity, Outcome, and Need (ICON) evaluation criteria without age restrictions. Exclusion criteria were edentulous patients or those with occlusal restorations in more than 30% of teeth in addition to patients undergoing treatment with analgesic, anti-inflammatory, and/or muscle relaxant medications. Subjects with arthritic conditions or disc displacement accompanied by articular pain or dysfunction were eliminated from the control group. In total, 327 individuals were included in this study (96 cases and 231 controls). To obtain an even age distribution, the subjects were grouped into quartiles: (1) 17 years or less (Q1), (2) from 18 to 21 years (Q2), (3) from 22 to 27 years (Q3), and (4) 28 or more years old (Q4).An observational, prospective, cross-sectional, case-control study was conducted after approval from a research ethics committee was obtained (CIRB-2017-004). Subjects were asked to sign a voluntary consent form and were fully informed about the study's objectives and procedures. Sample size estimation was based on Breslow's protocol for case-control studies . Sample The Axis I of the Research Diagnostic Criteria (RDC) for TMD  was usedAfterwards, the ICON was calculated for each individual following the methods from previous publications , 30 Fig. AccordiA pilot study was performed to quantify the error of measurement for the RDC/TMD test and the ICON. A single operator measured 30 patients two times one week apart. The results were compared through the kappa coefficient of agreement (RDC/TMD: 0.84 and ICON: 0.94).p ≤ 0.05). Subsequently, a multinomial logistic regression was performed, including the variables with p < 0.2 in the bivariate analysis (goodness-of-fit test and Nagelkerke's R2 coefficient were estimated). Finally, the odds ratios and confidence intervals of 95% (95% CI) were measured for both tests .The statistical analysis was performed using the SPSS software, v.20. Moreover, bivariate analysis (Chi-square test) was performed to identify associations between myofascial pain and the following variables: gender, age (divided into quartiles), malocclusion complexity (ICON), depression, and bruxism (n = 219) were female (24.33 ± 9.38 years), and 33% (n = 108) were male (23.97 ± 10.63 years). The minimum and maximum ages were 15 and 69, respectively, with an average age of 24.21 ± 9.8 years.A total of 358 subjects were assessed; 31 were eliminated for the following reasons: 15 had disc displacement without reduction, 8 had arthralgia, 7 osteoarthrosis, and 1 osteoarthritis. The final count was of 327 subjects, of which 67% (n = 61) of the subjects were on the lower level (the same amount was found in the mild level), 32.1% (n = 105) were moderate, 22% (n = 72) were difficult, and 8.6% (n = 28) were very difficult.Concerning malocclusion complexity, 18.7% (Groups A and B were confirmed as 76 (79.17%) patients had myofascial pain without mouth-opening limitation and were included in group A, while 20 (20.83%) had mouth-opening limitation and were included in group B.n = 56) grade I, 25% (n = 19) grade II, and 1.3% (n = 1) grade III. Meanwhile, the distribution in group B was 40% (n = 8) grade I and 30% (n = 6) for grades II and III, respectively (p < 0.001).Group A chronic pain distribution was 73.7% (ectively . A signip < 0.05). Results show that females were more affected in both case groups (p = 0.001). Regarding malocclusion complexity, most of the controls were distributed in the first three ICON levels. However, patients with myofascial pain (groups A and B) were in the last three (p < 0.001) (p < 0.001). Given its respective p value, age was excluded from the multinomial analysis (p = 0.327). However, bruxism was included (p = 0.117). Statistically significant associations were found between myofascial pain levels and the variables gender, malocclusion complexity, and depression (< 0.001) . Concernp < 0.05). A significant association was noted between malocclusion complexity and myofascial pain in group A (p < 0.05). Moreover, an association was recorded between depression and myofascial pain in group B (p < 0.05). The multinomial logistic regression model showed a statistically significant association of gender for both case groups (A and B) (The results suggest that gender, malocclusion complexity, and depression are associated with the presence of myofascial pain. However, their correlation is different when comparing case groups. Results showed that gender and malocclusion complexity correlated in patients without mouth-opening limitations, whereas gender and depression correlated in patients with limitations.The relationship between TMD and gender is well documented in the literature . FemalesHowever, subjects diagnosed with myofascial pain with mouth-opening limitation face more severe clinical features. Apart from the obvious pain and dysfunction, these patients also experienced depression, high levels of chronic pain, and high levels of malocclusion complexity. A study found that a significant number of patients with mouth-opening limitation are depressed . It has As discussed previously, patients with mouth-opening limitations had the highest levels of chronic pain. While the association between chronic pain and depression has previously been reported, it is unclear if there is a strong link in their relationship. However, high levels of chronic pain are accompanied by high depression .Moreover, it is proven that myofascial pain harms the quality of life, especially when accompanied by mandibular dysfunction and depression . In addiIn this study, the individuals with mouth-opening limitations had the highest levels of malocclusion complexity. Thus, high levels of malocclusion complexity, chronic pain, and depression coexist in creating a complicated environment for this group of patients. However, the interactions between these variables should be a subject of further investigation.This study has some limitations. First, as the cases were grouped, the number of patients with mouth-opening limitations might fail to satisfy a suitable group of subjects to contrast the variability in the multinomial model. Second, this study used the RDC/TMD to assess depression, but other psychological conditions not considered could affect the patients' well-being.In conclusion, the results of this study demonstrate that females had greater risk of myofascial pain without mouth-opening limitation and that the highest levels of malocclusion complexity increase the odds of present this condition. Moreover, myofascial pain with mouth-opening limitation frequently coexists with depression and high levels of chronic pain.


Materials and Methods: A retrospective study was conducted to compare the efficacy of SSTS in the management of postoperative pain after orthopedic surgery between October 2018 and June 2020. We analyzed 50 patients who underwent a total knee arthroplasty (TKA). The control group consisted of 21 patients who underwent TKA and during the hospitalized recovery received a continuous femoral nerve block (cFNB). The statistical study was conducted with a level of significance p = 0.05 using “U” test, Mann–Whitney, to verify if patients had a better control of pain and fewer calls for rescue analgesia. Results: Patients involved in the study showed a significant reduction in pain intensity with the use of SSTS in the 24 h following surgery (p = 0.0568), also a drastic drop of the calls for rescue analgesia (p < 0.0001) reduces the number of calls for its control. Conclusions: This study demonstrates how SSTS might reduce pain intensity in the first 24 h after surgery and reduce the number of calls for its control, indicating better analgesic coverage and implying reduced interventions from healthcare personnel. This could allow a redistribution of resources and a reduction in the use of analgesic drugs in wards where the SSTS is used.Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso Postoperative pain after orthopaedic procedures, such as total knee arthroplasty (TKA), is a major problem and represents a challenge. Pain control following TKA is a prerequisite for good outcomes because rehabilitation requires early mobilization and enhanced recovery . TKA has®, Grünenthal GmbH, Aachen, Germany)  four times a day). The reasons for choosing the analgesic technique were not completely at the patient’s discretion, but we consider the ability in terms of drug administration device as a discriminating factor. However, the good preliminary results and the controlled self-administration modality have directed the choice of many patients towards this modality of pain management.The endpoints measured were pain intensity at rest, number of adverse events, number of rescue doses, length of hospital stay, and usability scores. Pain was measured using the numeric rating scale (NRS) (range: 0 = no pain to 10 = worst pain possible). Pain perception during the postoperative period was calculated using the NRS scale at 24 h (T1), 48 h (T2), and 72 h (T3) for both groups. Pain was evaluated in both groups as the mean scores for T1 throughout T3 (T1 to T3 are the three postoperative days). For the SSTS group, pain scores were collected for the day prior to surgery (T-1), the day of surgery at delivery of the SSTS device to the patient (T0), the first administration, and 2-4-8- and 16 h after the first nanotablet. The practicality and manageability of the drug administration device by the staff (nurses) was analyzed through semi-quantitative data  that measure the usability of the device by the staff, and the understanding of how it works by the patient.t-test and among three groups using one-way analysis of variance (ANOVA). The chi-squared test was used for categorical variables. Pain intensity between the groups was also evaluated using the “U” test (Mann–Whitney), comparing the observation at baseline and final follow-up. Statistical significance was set at a p-value of less than 0.05. The data were analyzed using Minitab v.18® . Minitab, Inc.: State College, PA, USA).All data reported in this study are expressed as the mean, standard deviation (SD), range, and median for each value. Continuous variables were compared between two groups using the two-sample The study compared 50 patients in the SSTS drug group and 21 patients in the cFNB group presenting similar characteristics  and differing limitedly to the analgesic technique received.Pain scores. In the SSTS group, the NRS scores were: 2.38 (T1), 3.28 (T2), and 2.34 (T3). The NRS scores for the control group were: 3.81 (T1); 3.43 (T2); and 2.57 (T3). The overall differences in pain intensity and the difference in time point T1 between the groups were significantly different (p = 0.008) (= 0.008) .The NRS evaluated at T2 and T3 and compared between the two groups was not statistically significant .Patients treated in the SSTS group required significantly less rescue doses than those in cFNB control . The mean duration of treatment with SSTS from the first to the last nanotablet received was less than 48 h (no patients used STSS for more than 72 h). Rescue doses were required less often in the SSTS group (66% of SSTS patients) than the cFNB control (100% patients), which resulted in fewer calls and satisfaction of the nursing staff .Adverse events reported in the SSTS group were postoperative nausea and vomiting (PONV 6%), nausea (10%), vomiting (2%), constipation (24%), bladder globe (4%), somnolence (2%), headache (2%), and hypertension (2%) disorientation (6%) . The advp = 0.039)  .Most patients confirmed that the SSTS was easy to use and did not report any difficulties in using the device. Most patients report no motor discomfort and 86% of patients reported complete pain relief. Three patients (6%) discontinued SSTS due to ineffective pain relief after T3, and four (8%) due to the malfunctioning of the device .This study evaluated the efficacy and safety of the SSTS in comparison with a classic multimodal analgesic approach associated with cFNB for pain control in patients treated with TKA. Our results confirmed the efficacy and safety of SSTS in TKA, in agreement with previous studies ,27,28. HThere are two main limitations of the study: (1) as a consequence of the relative small number of patients, it was not possible to conduct a comparative statistical analysis for all possible variables, but only for the main aspects  considered in the study; (2) cFNB provided better analgesia compared with single-shot FNB, however, our control group received only a cFNB plus paracetamol whereby it is well-known that it does not cover the whole pain receptions ,30. For p = 0.002) [p < 0.0001), even if it appeared that the pain intensity was not significantly reduced, except for the mean value of NRS in the first 24 h.Few RCTs have specifically addressed the role of SSTS in postoperative pain. We observed a significant difference in postoperative pain intensity between the two groups, with better control using the SSTS protocol, as reported in other studies. Scardino et al. reported lower pain upon movement in the SSTS group (95 patients) than in the cFNB group  at all time points, and pain was properly managed when local infiltration anesthesia (LIA) was worn off . The eff= 0.002) . However= 0.002) . Other a= 0.002) . Differe= 0.002)  and only= 0.002) . Numerou= 0.002) ,35,36,37Our hypothesis is that SSTS offers a more stable analgesic coverage, distinguishing itself from the strategy used for the controls (ropivacaine + paracetamol), which instead requires continuous rescue intervention to ensure adequate pain control. Furthermore, comparable NRS values but with a higher number of calls suggest that NRS values were not detected every time the patient required rescue intervention but after the therapy had taken effect. This is explained by the fact that in real life, patients complaining of pain are treated without necessarily paying attention to its measurement using appropriate scales. However, we think that a RCT with the combined use of both techniques (SSTS + cFNB) should be carefully evaluated due to promising results. The SSTS system allows the patient to sufficiently control for any pain not being covered by regional analgesia or particularly in case of a failed block, but still, additional regional analgesia may save opioids and thus reduce opioid-related side effects. In addition, a saphenous nerve block may have some advantages over the cFNB regarding motor function and early mobilization.A clear advantage of SSTS is the administration modality, without the need for additional venous access, which reduces the intrinsic risk of infections linked to invasive routes of administration in selected patients . Regarding usability, SSTS was well accepted by both patients and care providers, and Turnbull et al. described SSTS as easy and quick (approximately 4 min per patient), and its functioning is easy to explain to patients. A further advantage of SSTS with sublingual tablets is the oral administration, reducing the risk of infection, analgesic gaps, or conduct obstruction related to the classic pump or IV catheter infusion ,35,38,39p < 0.0001). This in the SSTS group supports the managerial superiority of the SSTS, both in terms of analgesic therapy (self-administered) and the ward, allowing a redistribution of human resources. In fact, nursing staff are not employed in the preparation and administration of analgesic therapy, which increases patient comfort. The second aspect concerns the intrinsic risk, linked to human factors, of possible mistakes in the administration of analgesic therapy. This risk is eliminated by delegating dosage control of analgesia to the device.We reported an extremely significant reduction in calls to nurses (The incidence of adverse effects reported in our study were line with the literature: PONV (6%), with nausea (10%), constipation (24%), disorientation (6%), and bladder globe (4%) the most frequently observed. In a study of 100 patients treated with SSTS after knee or hip arthroplasty, the adverse events reported were nausea (34.9%), vomiting (10.8%), desaturation (7.0%), constipation (4.8%), pruritus (4.8%), headache (4.1%), dizziness (5.1%), and confusion state (2.5%) . Similarp = 0.039). Scardino et al. described how patients in the SSTS group were able to ambulate earlier after surgery and achieve the goals set by the fast-track protocol. Moreover, patients in the SSTS group were all discharged from the hospital within three days of surgery compared to only 36% of the cFNB patients [The mean hospitalization duration was significantly lower in the SSTS group than in the control group  is an investigational patient-controlled system that utilizes the SST system to treat moderate-to-severe acute pain in the hospital setting. This system has advantages over IV PCA and has been demonstrated to provide rapid analgesia and achieve high patient and nurse satisfaction ratings in clinical use. Our data confirm the safety and tolerability of SSTS in the management of postoperative pain, resulting in a high level of patient satisfaction and acceptance of pain control. This study demonstrates how the SSTS reduces the need for interventions by healthcare personnel, allowing a redistribution of resources and a reduction in the use of analgesic drugs. A randomized controlled trial is required to provide a conclusive answer. Since this study only evaluated results directly after surgery, future studies could be expanded with long-term results, preoperative pain scores, and the inclusion of more patients could help obtain significant results.The sublingual sufentanil system (SSTS system, Zalviso


It has been known that ABO blood groups are linked to the phenotypes of certain diseases; however, and the relationship between ABO blood groups and postoperative pain have not been extensively studied, especially in children. This study was to investigate whether there would be an association between the four major ABO blood groups and postoperative pain, as indicated by the differences in pain scores and rescue fentanyl requirements among blood groups in children after adenotonsillectomy.A total of 124 children, aged 3–7 years, ASA I or II, and undergoing elective adenotonsillectomy were enrolled in the study. Postoperative pain was evaluated using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and the rescue fentanyl requirement in post anesthesia care unit (PACU) was analyzed. Pediatric Anesthesia Emergence Delirium (PAED) score and the duration of PACU were recorded. The postoperative nausea and vomiting (PONV) within 24 h were documented.Among four blood type groups, no significant differences were observed regarding surgery time, and the gaps of fentanyl given at the anesthesia induction and the first rescue fentanyl injection in PACU. However, patients from AB and B blood groups had significantly higher pain score at initial CHEOPS assessment and consequently, higher consumption of rescue fentanyl during PACU stay. A significantly higher percentage of patients had received > 1 μg/kg rescue fentanyl. Higher PAED scores were also observed in AB and B blood groups.Paediatric patients with AB and B blood type had higher postoperative CHEOPS pain score and required significantly more fentanyl for pain control than those with A and O blood type after T&A. The initial scores of PAED in patients with AB and B blood type were also higher than that in patients with A and O blood type.The online version contains supplementary material available at 10.1186/s12871-022-01953-6. Clinically, the pain intensity and the perception among the individuals in the same surgical setting vary dramatically . The difAdenoid and tonsillar hypertrophy are common in children and are often as the cause of severe obstructive sleep apnea syndrome (OSAS) . AdenotoThe aim of our study was to investigate whether there was an association between ABO blood types and postoperative pain, as indicated by pain scores and the fentanyl consumption in children underwent T&A.This study  was conducted between May 2019 and November 2020 after approval by the Ethics Committee of QuanZhou Women's and Children's Hospital .The risk and benefits of the study were discussed with families and subsequently, written informed consent was obtained from the parents or legal guardians. All methods were performed in accordance with the relevant guidelines and regulations. All participants followed a standard perioperative care protocol.2, a history of bronchial asthma, and recent opioid use.Patients aged 3–7 years, ASA I or II, and scheduled for elective T&A were enrolled. All children presented a history of parent-reported snoring and restless sleep, and adenoid and tonsillar hypertrophy were diagnosed by an otolaryngologist upon physical examination at physician’s office . The exclusion criteria were: ongoing adenoid and tonsil inflammation, history of previous surgery, craniofacial deformities, mental retardation, and body mass index of > 22 kg/m2 concentrations were maintained at 35–45 mmHg during surgery with pressure-controlled ventilation mode. All children received IV dexamethasone 0.15 mg/kg (maximum 10 mg) and ondansetron 0.1 mg/kg at the end of anesthesia induction and just before starting surgery. No additional fentanyl or other pain medications were administered during the surgery. A radiofrequency ablation surgery were performed in all patients by attending otolaryngologist. HR was recorded continuously and noninvasive MAP was measured every 5 min. Data of vital signs were collected at following time points: baseline (T0), after anesthesia induction (T1), at the beginning of the operation (T2), 10 min (T3) and 20 min (T4) after the surgery started, at the end of the surgery (T5), and after tracheal tube removal (T6).Patients were admitted to hospital on the day before surgery. In the surgical ward, intravenous (IV) access was established and blood was drawn for blood typing. On the day of surgery, the patients were transferred to the surgical waiting area. The maintenance rate of Lactated-Ringer solution was initiated. No pre-medications were administered by study protocol. Continuous pulse oximetry and HR monitoring was started in holding area, and patient was induced with propofol 2 mg/kg. Patients were moved to OR after falling into sleep, and the standard monitors were place immediately. The entire process of induction and transport to OR was completed in less than 2 min.Standard monitoring was applied  and 2 μg/kg fentanyl and 0.6 mg/kg rocuronium were administered to finish the anesthesia induction. The patient was manually ventilated for 2 min with oxygen and sevoflurane, and endotracheal intubation was performed. Anesthesia was maintained with 2%-3.5% sevoflurane and 60% nitrous oxide in oxygen, and ETCOAt the end of surgery, the tracheal tube was removed when the extubation criteria had been met , and patients were transferred to the post anesthesia care unit (PACU). Once the patient had voluntary response , the postoperative Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was evaluated immediately by a designated anesthetist who was blinded to the patient’s grouping. The pain score was re-assessed every 5 min.2 was < 95%. The Pediatric Anesthesia Emergence Delirium (PAED) score was recorded at the same time points as the CHEOPS assessment. Postoperative nausea/vomiting (PONV) and other adverse events, such as airway obstruction or laryngospasm, were also recorded in the recovery room. Patients were transferred to the surgical ward once the discharge criteria had been met .The CHEOPS is an observational tool for measuring postoperative pain in children aged 1–7 years and has six categories of pain behavior: cry, facial, verbal, torso, touch, and legs. The score ranges from 0 to 2 or 1 to 3 which are assigned to each activity, and the total score ranges between 4 and 13, with a score of 4 described as no pain and 13 described as the worst pain. Pain is rated as mild, moderate, or severe when the score falls in the range of 5–7, 8–10, and 11–13, respectively. In this study, a score of ≥ 6 was defined as the presence of uncomfortable pain, which necessitated administration of a bolus of IV fentanyl 0.5 μg/kg as rescue analgesic. If the CHEOPS score ≥ 6 persisted, fentanyl injection was repeated every 5 min for a maximum of four times . Beyond that, 50 μg/kg morphine was administered if the maximally allowed dosage of fentanyl was reached and the patient’s pain was remained at uncomfortable level. IV morphine injection was repeated once . Additional analgesic administration could be used at the anesthesiologist’s discretion. Patients’ vital signs were continuously monitored in the recovery room, and oxygen was supplied via a face mask if the child’s SpOThe primary outcome was postoperative pain indicated by the pain score and total fentanyl consumption among the four major ABO blood groups. The secondary outcomes included PAED scores, incidence of PONV, hypoxia, and other potential complications (laryngospasm) recorded in the recovery room.P < 0.05.Statistical analysis was performed using the SPSS 24.0 Normally distributed data were expressed using mean ± standard deviation and were analyzed using variance analysis. On the other hand, non-normally distributed data were expressed as median with interquartile range (IQR), and analyzed using the Kruskal–Wallis test. Enumeration data were expressed as percentages and analyzed using the chi-square test. Statistical significance was set at A total of 124 children were enrolled and had complete data collected during the study. Table P > 0.05). No significant difference was observed regarding the HR and MAP among groups at each time point , after anesthesia induction (T1), at the beginning of the operation (T2), 10 min (T3) and 20 min (T4) after the surgery started, at the end of the surgery (T5), and after tracheal tube removal (T6).P＜0.01](10 (15 [10.75–18] and 15 [P < 0.01)  and 15 (10–18) vs. 5 3–15.5) and 8 (3–10), .75–18 an–15.5 and01) Fig. b.P < 0.001) (Table The patients in the AB and B blood groups had significantly longer PACU stay and a higher incidence of PONV within 24 h than those in other two blood groups (1) Table .Table 3TThis study was designed to investigate the association between ABO blood types and the postoperative pain. Our results showed that children in the AB and B blood groups had significantly higher CHEOPS pain scores in the PACU after T&A and subsequently required higher rescue fentanyl for pain management. Patients in AB and B blood types had significantly higher PAED scores than those in A and O blood types.T&A is the first line of treatment for OSAS and is the most common procedure performed on children worldwide. Most children would develop moderate or severe post-T&A pain; however, the optimal and effective pain control approaches remain uncertain. Clinically, individual differences regarding pain thresholds and tolerance have been observed and many factors have been involved in the pain perception, including genetic traits . PreviouOur study results showed that paediatric patients in type AB and B blood groups had significantly higher CHEOPS pain scores after T&A and needed more rescue fentanyl for pain control in PACU than those in A and O blood groups. Amalie et al.  found thEffective pain control in children requires precise and valid pain assessment methods (12). The CHEOPS is a popular behavioral observational pain assessment scale developed by Mcgrath et al. in 1984 for measuring postoperative pain in children aged 1–7 years . MultiplMany other factors could affect the individual’s pain perception, such as age, sex, weight or even surgical techniques. In study protocol, we kept a narrow age range and sex balance between groups, and excluded overweight and obese patients, and used a unique surgical technique to minimize the potential interference with the results.Fentanyl has been a popular choice for its reliable sedative and analgesic effects during anaesthesia and surgery. Its onset of action is less than 60 s with a half-life of 90 min and duration of action of 30–60 min. Our results showed that the fentanyl administered during anaesthesia induction could effectively cover the entire surgical times (approximately 40 min) for all groups, and as fentanyl gradually worn off after patient arrived in PACU, patients in AB and B blood groups showed higher pain scores and required more rescue fentanyl afterwards.Perioperative opioid use remains mainstream in pain management; however, their side effects have been a constant concern for patients and clinicians. In our study, children in AB and B blood groups showed higher CHEOPS pain scores and received more rescue fentanyl for pain control but PACU discharge had also been significantly delayed in those two groups as negative effect.PONV, another most commonly undesirable side effect from anaesthesia, is involved in a variety of neurophysiological pathways, including central and peripheral receptor mechanisms (17) and the major risk factors are surgery, anaesthesia, as well as patient related . One stuCurrently, there is no clear research evidence to explain what have exactly contributed to the higher postoperative pain score in AB and B blood group. It could be due to the difference in enzyme activity to affect the rate of opioid metabolism, or the difference in opioid receptor’s distribution and adaption in patients among ABO blood groups. Further studies are required to explore those hypothetical proposals and expected to shed light on this phenomenon of association between pain and ABO blood types.There are limitations to our study that clinician should consider before any conclusions could be made. First, even though our patients had confirmed hypertrophic adenoids and tonsils presenting with airway obstructive symptoms, no sleep study (polysomnography) was conducted to grade the severity of OSAS prior to surgery. Reports have revealed that children with severe OSAS have significantly lower post-T&A opioid requirements than those with mild OSAS (20). However, performing a polysomnographic sleep study in every patient prior to T&A seems less practical in a busy SDS center by considering time-consuming and cost-ineffective matters. Secondly, four major ABO blood types are unequally distributed in the whole human population, which may skew the results to some degree. The distribution of AB, B, O, and A blood types, including Rh +/- is 5.5%, 16%, 45%, and 33.5%, worldwide respectively, and those numbers vary greatly among the countries. We tried to close the gaps of the total participants in each group, especially in AB blood type, to minimize potential statistical errors.Paediatric patients with AB and B blood types had higher postoperative CHEOPS pain scores and required significantly more rescue fentanyl to achieve comfortable pain control than those with A and O blood types after T&A. PAED scores in patients with AB and B blood types were also higher than those in patients with A and O blood type. Prolonged PACU stay and higher incidence of PONV ensued from more fentanyl consumption in AB and B group as the undesirable consequences of narcotics.Additional file 1.Additional file 2.


In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty. Arthroscopic knee surgery is a minimally invasive knee surgery that has been widely carried out at present. As an invasive surgery, it is inevitable to involve anesthesia, complications, postoperative pain, and other problems. At present, spinal anesthesia is the most commonly used anesthesia method in China, while local anesthesia as a simpler anesthesia method has not been widely developed. In the research, a retrospective research of 478 patients who underwent arthroscopic knee surgery under spinal anesthesia or local anesthesia was conducted to compare and analyze the clinical results. Arthroscopic knee surgery is one of the best methods for the treatment of knee osteoarthritis. Postoperative pain and swelling of the affected limb are common complications. Pain affects the recovery of patients and even delays into chronic pain, which affects the daily life of patients in the future, thus affecting the efficacy of surgery. Arthroscopic knee surgery avoids the large surgical incision, reduces many surgical operations, and reduces superficial trauma, but does not reduce the degree of pain. Because the surgically repaired structures inside the joint  are rich in nerve endings, patients can feel painful stimulation, which causes severe pain. The local peripheral nerve compressed by edema or stimulated by inflammatory reaction substances is also one of the causes of pain.Niwas, R. et al. believed that the United Nations World Health Organization (WHO) designated 2000-2010 as the “Bone and Joint Decade” . Bayahyad be the distance between sample points x and x, which is generally required to meet the following conditions as shown in Formula . On the contrary, the more dissimilar the sample points are, the smaller the similarity coefficient value between them is . The other one is distance function. According to the number of characteristic attributes of sample points, the sample is regarded as a point in multidimensional space, so as to define a distance to measure the similarity relationship between sample points. Sample points with a closer distance have a higher similarity, while sample points with a longer distance have a greater difference , 12. The, 1. In oThe Euclidean distance is shown in Formula . (2)dxi,The absolute distance is shown in Formula . (3)dxi,The variance-weighted distance is shown in Formula . (4)dxi,As shown in Formula ,(5)x¯=1The Mahalanobis distance is shown in Formula . (6)dxi,S is the mountain sample point x1, x2, ⋯, and the calculated covariance matrix is shown in Formula x¯=1The correlation coefficients of polymorphic qualitative variables are mainly as follows.γ2 is shown in Formula (The correlation coefficient related to  Formula . (8)γ2=nγ2 itself is also a correlation coefficient, which can be expressed as Formula ( Formula . (9)Gij1That is, one variable is used to predict another variable, and its prediction ability is used as the correlation between the two variables. When the state of variable A is unknown, variable B needs to be predicted. Then, the middle edge and maximum are used as the prediction of state of variable B, which is expressed as Formula . (10)nSbThe principle of pain after knee arthroscopy is as follows. Most articular structures, including synovial tissue, joint capsule, and fat pad, have autonomic nerve endings that can feel pain stimulation and produce pain sensation. Innervation of joints and synovium is reviewed and it is pointed out that the nerves connecting any joint originate in the spinal cord. The joint is usually the primary nerve, the accessory nerve that passes the peripheral nerve near the joint, and the intramuscular nerve branch that passes through the joint capsule. The knee joint also receives cutaneous nerves in the skin. About half of axons are composed of fine fibers, either thin or unmyelinated. Part of them are unmyelinated C fibers, which are responsible for pain transduction that is not active under normal conditions but released when tissue is damaged . MoreoveIn recent years, arthroscopic surgery has increased greatly, which brings new challenges to the postoperative analgesia. Although arthroscopic knee surgery allows patients to avoid the large surgical incisions associated with traditional open surgery, some patients still have persistent pain that can last up to two weeks and result in a slow recovery. A recent research of more than 5,700 surgical patients found that orthopedic surgery was the third most common procedure postoperative pain, accounting for 47.7%. In addition, the same survey found that moderate to severe postoperative pain occurred in 44.5% of arthroscopic knee surgeries. Therefore, postoperative analgesia in arthroscopic surgery is still a problem. And effective postoperative analgesia is very important for arthroscopic surgery, which is also very helpful for hand rehabilitation . EffectiThe basic framework of nursing is the concept of holistic nursing. Holistic nursing lays the foundation for nursing practice and research. The basic orientation of the present situation and future is that the human body and mind are regarded as one, and it is needed to completely take a person as the center. It is not only seeing the disease but also not seeing the patient (centering on the disease), nor is it just the patient but not the health (centering on the patient). The most important thing for people is health, so we must take the health of the people as a whole  for the concepts, including their psychological, physical, and social aspects, serving the whole process of life, the whole process of health and disease, and the fitness of people with family, society, taking all as a consideration of factors. Patients are provided with preventive care , nurturing care (daily care), promoting care , so that nurses can not only treat patients' diseases but also take care of all aspects of health. It can not only provide standardized medical care services for patients but also develop targeted care plans. It not only provides high-quality care to patients during hospitalization but also takes into account the continuous care of patients after they return home to ensure that patients can receive whole-process, continuous, and high-quality care . After tThirty patients from a 3-level hospital were selected to carry on the preliminary experiments. And with the approval of the department head and patients, the cold therapy watch list was designed. Qualitative interviews were conducted with 5 clinical nurses with the title of head nurse and 5 postoperative patients using this treatment. In order to ensure the orderly and smooth conduct of the interview, the interview outline was prepared according to the research purpose and characteristics of the interviewees. During the interview, appropriate questioning should be conducted according to the specific situation to gain an in-depth understanding of relevant issues. In order to know whether they were easy to use, the automatic circulation system of compression cold therapy, clinical effects (effect of relieving pain and swelling), and complaints of discomfort in the process of use were recorded. Then, the opinions were recorded, summarized, and fed back to 3 orthopedic experts  and 1 college nursing expert for consultation. The survey items were modified and supplemented to optimize the research program. The information of experts and interviewees is shown in The patients' data are shown in Clinical nurses believed that they preferred to apply the automatic circulation system of compression cold therapy for cold therapy operation. Because traditional ice cold therapy used ice to apply towels externally, which was not easy to fix the patient and easy to move when they moved. Frequent visits are required. When ice melted, it would wet towels and contaminate the wound. The traditional ice treatment required the nurse to grab ice with bare hands each time she was frostbitten in her youth and the amount of ice was only enough for one patient at a time. The ice compression bag of the automatic circulation system of compression cold therapy is designed in the form of the wrapped cuff style, which was easier to fix and basically did not shift. And the new device could hold enough ice water for more than eight hours with each replacement. It reduced the workload and did not have to worry about the problem of contaminating the wound after dissolving the traditional cold treatment ice, because the ice bucket kept the temperature constant. There were no cases of chilblains. Inpatients believed that the automatic circulation system of compression cold therapy was more comfortable and effective. Patients still liked to use pressure cold treatment automatic circulation system for cold treatment, which was more comfortable. Traditional cold therapy was not fixed well, and it would drop when moving, affecting the patient's activities. It was very cool at the beginning and then was wet. The automatic circulation system of compression cold therapy was a new equipment, which was better than the traditional method. The wound was less painful and the leg was less swollen. The cold treatment was affecting the patient's activity too long. No chilblains had occurred so far, regardless of the cold treatment method.Experts believed that the automatic circulation system of compression cold therapy was a new cold therapy method, which theoretically had the advantages of both cold therapy and pressure therapy. It reduced the nursing work burden and facilitated the operation. But the specific clinical efficacy must be verified through the clinical practice and patients' feelings should be taken into account . The selP > 0.05). There was no significant difference in HSS score of knee joint 48 h after operation (P > 0.05), as shown in A total of 64 patients admitted to the research after the informed consent were randomly divided into the experimental group (the compression cold therapy automatic circulation system treatment group) and the control group (the ice treatment group), with 32 patients in each group. The anesthesia methods used were subarachnoid anesthesia (lumbar anesthesia), continuous epidural anesthesia, or combined lumbar and epidural anesthesia , 21. TheK-Means of pigeons. In this chapter, the experiment verified the differences between grades formed by different K values, and the appropriate grades for the classification model were selected according to the experimental results (see The application of compression cold therapy after knee arthroscopy is an important method to prevent and cure postoperative pain and swelling of patients, which can promote the early activity and early recovery of patients, so as to reduce the length of hospital stay and the dosage of analgesics. Local cold therapy can make local blood vessel contraction, slow blood flow, so that the permeability of capillaries is reduced, tissue fluid extravasation is reduced, local metabolism is slowed down, oxygen consumption is reduced, and muscle tension is weakened, so as to alleviate the pain. Compression reduces the joint leakage and reduces the swelling, which reduces the pain. Compression cold therapy makes full use of the advantages of the cold therapy and compression to reduce the joint blood accumulation and relieve the pain, thus playing an important role in the prevention and treatment of the pain and swelling after the knee arthroscopy. After the introduction of automatic circulation system products of compression cold therapy and the training of knowledge of compression cold therapy, the director, the head nurse, and nurses of the orthopedic joint group jointly worked out the observation table of the cold therapy. Through the preliminary test of compression cold therapy for patients after knee arthroscopy as a case control, the effect of swelling, pain, and other indicators was observed, and good preliminary results were achieved. The results of clinical trials showed that the pain and swelling of the cold therapy group were lower than those of the control group. Patients in the compression cold therapy group had a good compliance, and many patients experienced swelling and pain relief due to the ice treatment , 28. Basults see .On the one hand, postoperative compression therapy of the affected limb not only can stop bleeding and prevent exudation through the physical compression but also can promote exudation and congestion to squeeze into the surrounding normal tissues, thus expanding the absorption area, facilitating absorption, and reducing tissue and joint adhesion, degeneration, and a series of pathological changes. As the situation and trend of postoperative bleeding and exudation are gradually under control, continuous compression cold therapy should be stopped. And prolonging the time of compression cold therapy will cause muscle stiffness, which is not conducive to patients' functional exercise. In addition, the continued compression cold therapy can reduce the venous blood flow and even increase the risk of deep vein thrombosis. This retrospective research showed that local anesthesia in arthroscopic knee surgery was simple and effective and had obvious advantages of light postoperative pain, fewer complications, early recovery of physiological functions, and higher reliability and safety under the conditions of intraoperative analgesia and patient satisfaction similar to spinal anesthesia. Local anesthesia could be used for knee arthroscopy, cleaning and rinsing, free body removal, and even common meniscinoplasty, which was the first choice for outpatient knee arthroscopy. Anesthesia effect and patient satisfaction were expected to be higher when combined with intravenous administration. It was not recommended for patients with infectious arthritis or diffuse proliferative synovitis. Patients with bilateral knee arthroscopy were not involved in this research, which required the further research.


Number of levels fused correlated with the daily opioid consumption . The SRS-24 pain domain scores showed a statistically significant improvement from preoperative levels to two-year follow-up in all three groups . The spondylolisthesis patients had the lowest SRS pain domain scores , reporting more pain two years after surgery, in comparison to AIS  (p = 0.043) and SK  patients (p = 0.049). Persistent postoperative pain in adolescents undergoing posterior spinal fusion is related to disease pathology while higher acute postoperative pain is associated with a more extensive surgery. Spondylolisthesis patients report more chronic pain after surgery compared to AIS and SK patients.Persistent pain after posterior spinal fusion affects 12 to 42% of patients with adolescent idiopathic scoliosis. The incidence of persistent pain among surgically treated children with Scheuermann kyphosis and spondylolisthesis is not known. The aim of our study was to determine the predictors and incidence of acute and chronic postoperative pain in adolescents undergoing posterior spinal fusion surgery. The study was a retrospective analysis of a prospectively collected pediatric spine register data. The study included 213 consecutive patients , aged 10–21 years undergoing posterior spinal fusion at a university hospital between March 2010 and March 2020. The mean (SD) daily postoperative opioid consumption per kilogram was significantly lower in the spondylolisthesis patients 0.36 mg/kg/day (0.17) compared to adolescent idiopathic scoliosis 0.51 mg/kg/day (0.25), and Scheuermann kyphosis 0.52 mg/kg/day (0.25) patients after surgery ( Adolescent idiopathic scoliosis (AIS), Scheuermann kyphosis (SK), and spondylolisthesis are the most common indications for instrumented posterior spinal fusion (PSF) in adolescents. The primary goal of the surgical treatment for AIS and SK is to prevent progression of the deformity ,2,3. In Postoperative pain with nociceptive, neuropathic, and inflammatory components are induced from major tissue trauma after the surgical procedure . NocicepPersistent postoperative pain is defined as a pain on the surgical site lasting over three months after surgery, well beyond the healing process . PersistThe aim of our research was to determine the incidence and the predictors of acute and chronic postoperative pain in adolescents undergoing PSF. We hypothesized that acute pain is associated with the extension of surgery and that chronic postsurgical pain is more dependent on the disease pathology.The study was approved by the Ethics Committee, Hospital District of Southwest Finland (ETMK 95/180/2011 and ETMK 38/1800/2015). Informed consent was obtained from all subjects involved in the study and from their parents if under 18 years old.The study was a retrospective analysis of a prospectively collected pediatric spine register assessing risk factors for acute and persistent pain in adolescents after instrumented PSF surgery. We reviewed 221 patients  entered consecutively into this register between March 2010 and March 2020. The date of last follow-up was 5 October 2022. This spine register is a database of children and adolescents undergoing spinal fusion surgery for AIS, SK, or spondylolisthesis at our university hospital. Eight patients were excluded from further analyses, and all of these were from the AIS group: two patients’ postoperative opioid usage was not adequately documented; two patients needed early re-operation for a neurologic deficit; one patient had a combined anteroposterior approach; one patient had chronic renal insufficiency; one patient had a concomitant neurological condition, and one patient was operated for both AIS and spondylolisthesis, leaving 213 patients for further analyses. The same skilled orthopedic spine surgeon performed surgeries on all the patients. Pain was analyzed using Scoliosis Research Society-24 (SRS-24) outcome questionnaire. The data on opioid consumption was obtained from patient records.The anesthetic management of the AIS, SK and spondylolisthesis patients was standardized. The total intravenous anesthesia protocol has been used unchanged since 2009 in our university hospital. Anesthesia was maintained with target-controlled infusions of propofol and remifentanil titrated to maintain the bispectral index (BIS) within predetermined limits. As all patients received similar weight-based remifentanil infusions intraoperatively, this was not included in the amount of postoperative opioid reported. Muscle relaxant was not used in any of the patients at any time. Dexmedetomidine-infusion (1 µg/kg/h) was used for supplemental hypnosis and analgesia in all patients. Mean arterial pressure was maintained between 65–75 mmHg with noradrenaline infusion if needed. Normothermia was maintained. Neurophysiological measurements were done every 20 min and at certain time points. None of the patients needed postoperative ventilation. n = 62), received intravenous and oral oxycodone as needed. The patients’ oral oxycodone dosages were converted to equivalent intravenous doses (0.6 * per dose) [The majority  of the AIS, SK and spondylolisthesis patients received patient-controlled analgesia (PCA) with oxycodone for the first 48 postoperative hours. The typical oxycodone PCA contained an on-demand oxycodone-bolus of 0.03 mg/kg/dose at a maximum of three doses per hour, with no basal infusion. The patients without PCA (er dose) . PostopePerioperative variables collected included gender, age, height, weight, body mass index (BMI), fusion levels, surgical time, intraoperative blood loss, number of levels fused, length of hospital stay, opioid amount on first 48 h after operation, total opioid consumption during hospital stay, SRS-24 questionnaire preoperatively, six months postoperatively, and two years postoperatively.The patients were mobilized according to our established process. The urinary catheter was removed on day 2 after surgery. The patients were requested to stand up and take a few steps on the first postoperative day. On the second postoperative day the patients were supported to walk around on the ward.The SRS-24 is a disease-specific health-related quality of life questionnaire, which is developed for scoliosis patients. The SRS-24 questionnaire is also used for other spinal surgery patients. Patients filled out the SRS-24 questionnaire preoperatively, and six and 24 months postoperatively. The SRS-24 questionnaire has seven domains: pain, general self-image, general function, general activity, postoperative self-image, postoperative function, and patient satisfaction. The scores in each field range from 1.0 to 5.0, with higher scores pointing out better patient outcomes. A score under 4 in the pain domain was considered clinically relevant and indicated moderate to severe pain . The maxAll AIS and SK patients were operated on using a posterior-only approach and had spinal cord monitoring. Bilateral segmental pedicle screw instrumentation  were used to correct the spinal deformity. Pedicle screws were inserted using a free-hand approach. Apical posterior column osteotomies were performed in all SK patients and in 46 (29.1%) of the AIS patients to facilitate deformity correction. Selection of fusion levels was according to the Lenke classification and last substantially touched vertebra for AIS  and stabAll spondylolisthesis patients had pedicle screw instrumentation with intercorporeal fusion using a TLIF cage  with an autologous bone graft from the decompression. Neural elements were widely decompressed for nerve roots  and cauda equinae. Patients with low-grade spondylolisthesis had pedicle screws inserted into L5 and S1 to reduce the spondylolisthesis and patients with high-grade spondylolisthesis underwent instrumentation from L4 to S1 with pelvic instrumentation .Associations between the opioid consumption and variables  were summarized with descriptive statistics and studied one by one with the Spearman correlation (for continuous variables) and the Kruskal-Wallis test . Associations between chronic pain and explanatory variables  were studied with the Spearman correlation and the Kruskal-Wallis test (three groups). Study group effects with surgical outcomes  were studied with the Kruskal-Wallis test and the Dwass-Steel-Critchlow-Fligner pairwise test. Differences between study groups in the SRS-24 preoperative and two-year postoperative scores, the SRS-24 pain preoperative and two-year postoperative scores and the SRS-24 self-image and two-year postoperative scores were studied with a mixed model for repeated measures. Differences between study groups in the SRS-24 function and activity domain scores were analyzed with the Kruskal-Wallis test.The normality of variables was assessed visually and using the Shapiro-Wilk test. In all tests, the statistical significance level was set at 0.05 (two-tailed). The analyses were carried out using the SAS system, version 9.4 for Windows .A total of 213 consecutive adolescents  and 67 males (31%)) with a mean age of 15.6 years (range 10–21 years) at the time of surgery were included in this study. The cohort consisted of 158 (74.2%) AIS patients, 19 (8.9%) patients with Scheuermann kyphosis and 36 (16.9%) spondylolisthesis patients. The majority of the AIS (114 (72.2%)) and spondylolisthesis (29 (80.6%)) patients were females as opposed to the SK patients, with only 15.8% (3) females. Twenty-three (10.8%) of these patients were under the age of 13 years at the time of surgery. There were significant differences in surgery time, intraoperative blood loss, number of levels fused, and length of hospital stay between the study groups. The Scheuermann patients had the greatest intraoperative blood loss compared to the other patient groups. The spondylolisthesis patients had the longest surgical time and the shortest hospital stay .p < 0.001 in both comparisons (Preoperative mean (SD) SRS-24 pain scores were significantly lower in the spondylolisthesis patients, meaning more pain, 3.24 (0.9) compared to AIS 3.96 (0.7) and SK 4.02 (0.6) patients, parisons . Seventyp < 0.001 for both comparisons. Similarly, preoperative mean (SD) SRS-24 activity scores were significantly lower in spondylolisthesis patients, meaning less activity (3.52 (1.13)) compared to AIS (4.45 (0.81)) and SK (4.57 (0.47)) patients, (p < 0.001 for both comparisons).Preoperative mean (SD) SRS-24 total scores were significantly higher in AIS (4.05 (0.50)) and SK (4.02 (0.49)) patients compared to spondylolisthesis patients (3.55 (0.60)), p < 0.001). Patients’ age, gender, BMI, surgery time, intraoperative blood loss or preoperative pain were not associated with increased opioid consumption postoperatively. The number of fused vertebrae correlated with the daily opioid consumption . There was a statistically significant difference in the opioid consumption after surgery between the three groups. The mean (SD) daily postoperative opioid consumption was significantly lower in the spondylolisthesis patients (0.36 mg/kg/day (0.17)) compared to AIS (0.51 mg/kg/day (0.25)) and SK (0.52 mg/kg/day (0.25)) patients (p = 0.10). There was a correlation between longer surgical time and increased 48 h opioid consumption . Patient gender, intraoperative blood loss or preoperative pain were not associated with increased 48 h oxycodone consumption after surgery. The difference in the oxycodone consumption during first 48 postoperative hours did not reach statistical significance. The mean (SD) 48 h oxycodone consumption in AIS, SK and spondylolisthesis groups were 1.68 mg/kg (1.08), 1.80 mg/kg (0.78) and 1.40 mg/kg (0.75), respectively, (p < 0.001), 3.24 to 4.04 in the spondylolisthesis patients (p < 0.001), and 4.02 to 4.43 in the SK group (p = 0.03), respectively. At two years postoperatively, 11% (14 of 129) of AIS, 7% (1 of 14) of SK, and 16% (4 of 25) of the spondylolisthesis patients reported moderate to severe pain on question 1 in the SRS-24 questionnaire.The SRS-24 pain domain scores showed a statistically significant improvement from preoperative levels to two-year follow-up in all three groups. This domain increased from a mean of 3.96 to 4.31 in the AIS patients (p = 0.043) and SK  (p = 0.049) patients. There was no statistical difference in SRS pain scores between the AIS and SK patients (p = 0.46) at the two-year follow-up. Patients’ age, gender, BMI, surgery time, intraoperative blood loss or preoperative pain were not associated with more persistent postoperative pain.The patients with spondylolisthesis had the lowest SRS pain scores  at two years after surgery in comparison to AIS  (p = 0.26). At the two-year follow-up there was a positive correlation between the scores in self-image and pain in the AIS patients . This correlation between self-image and pain was not seen in the other groups. At the two-year follow-up, 27 (21%) of 129 AIS patients, 3 (20%) of 15 SK patients, and 9 (36%) of 25 patients in the spondylolisthesis group had a SRS pain score under 4  and persistent pain (p < 0.001). Patient gender affected the opioid consumption after surgery (p = 0.013) but not the persistent postoperative pain. Intraoperative blood loss, surgery time or number of fused vertebras were not associated with opioid consumption after surgery nor with persistent postoperative pain.In a subgroup analysis with AIS patients only, there was a correlation between preoperative pain and daily postoperative opioid consumption  predicted acute postoperative pain and greater opioid use during hospital stay. However, diagnosis and disease pathology were stronger predictors for chronic pain. Preoperative pain is a common risk factor for persistent pain after PSF in AIS patients ,17,18,19The indications for PSF differ in patients with AIS, SK, and spondylolisthesis ,24. PatiCarreon et al.  determinThis study represents a retrospective analysis of a prospectively collected pediatric spine register with 213 consecutive adolescents with almost complete preoperative and two-year health-related quality of life data. AIS is the most common indication for spinal fusion in the adolescent age group, while the need for surgery of pediatric spondylolisthesis and Scheuermann kyphosis is much more limited. This resulted in a noticeably larger group of patients in the AIS as compared to SK and spondylolisthesis groups. Therefore, one limitation is the relatively small number of spondylolisthesis and Scheuermann kyphosis patients in the register that included 158 AIS patients but only 19 SK and 36 spondylolisthesis patients. Perioperative pain management was standardized. Health-related quality of life and pain were evaluated using the SRS-24 questionnaire, which is a validated outcome tool for adolescents undergoing instrumented posterior spinal fusion. Surgical management was standardized and included a selection of fusion levels according to the Lenke classification and last substantially touched vertebra for AIS , and oneInstrumented posterior spinal fusion significantly reduced pain two years after surgery in AIS, SK, and spondylolisthesis patients. A larger number of levels fused was associated with a higher postoperative opioid consumption, as patients with AIS and SK required significantly more opioids than the patients with spondylolisthesis. In contrast, spondylolisthesis patients had more persistent pain two years after surgery compared to AIS and SK patients, suggesting that spinal pathology is more predictive of long-term pain.


This mini-review covers recent works on the study of pleasant touch in patients with chronic pain (CP) and its potential use as a treatment. While experiments have demonstrated that pleasant touch, through the activation of CT-afferents and the brain regions involved in its affective value, might reduce the unpleasantness and intensity of induced pain, the interaction between pleasant touch and CP remains under-examined. Some experiments show that CP might disrupt the positive aspects of receiving pleasant touch, while in other studies the perception of pleasantness is preserved. Moreover, only a few attempts have been made to test whether touch can have a modulatory effect on CP, but these results also remain inconclusive. Indeed, while one recent study demonstrated that CT-touch can diminish CP after a short stimulation, another study suggested that pleasant touch might not be sufficient. Future studies should further investigate the psychological and neural interplay between pleasant touch and CP. In the conclusion of this mini-review, we propose a new tool we have recently developed using immersive virtual reality (IVR). The skin is the organ of our body that mediates most of our interactions with the external world . Every cCT-afferents shape our social lives from birth , affectiIt has been demonstrated that pleasant touch can successfully reduce experimentally induced pain . StudiesThe perception of pain, which promotes protection from actual or potential damage , is a coCP is an umbrella term that comprises several types of pain and conditions. For instance, CP can emerge as a main diagnosis  when it cannot be explained by another chronic condition (ICD-11). In this case, its etiology is unknown and comprises many conditions . Differently, secondary CP is a secondary symptom of a variety of underlying conditions such as cancer (chronic cancer pain), surgery or tissue trauma , as reported in the section above, are associated with reduced CT-receptor reactivity and abnormal affective responses in the brain, the analgesic effects of touch might be disrupted in CP patients. In this view, the model proposed by In a more recent study , the autThe studies reviewed here provide contrasting results: while pleasant touch reduces pain in healthy participants (among other benefits to wellbeing), in patients with CP it might not be sufficient to reduce pain. Given the altered perception of pleasant touch at peripheral level  one possibility could be to investigate whether the affective component of pleasant touch is preserved in CP patients. To do so, it might be useful to separate the visual component of touch from the tactile feedback on the body. Indeed, an interesting corpus of studies have investigated the mechanisms behind the vicarious perception of pleasant touch, namely when people observe pleasant touches on others. These studies highlighted that the ratings of observed touch match the velocity tuning of CT afferents : slow plTo conclude, the interplay between pleasant touch and pain in CP patients needs further investigations to unravel the bottom-up and top-down mechanisms at play. We hypothesized that two possible disruptions might be at play here. CT- touch directly activates emotional key nodes such as the insula. On the one hand, in CP patients this activation might be altered, as suggested by the study of Boehme and colleagues in which they demonstrated intact perception of pleasant stimuli but an alteration of stimulus evaluation in patients with fibromyalgia. Thus, restoring the positive affective value of pleasant touch might be a fundamental first step to develop a successful treatment. On the other hand, as suggested by MF: conceptualization, funding acquisition, writing—original draft, writing—review and editing. VN and LP: writing—review and editing. RJB: funding acquisition, and writing—review and editing. All authors contributed to the article and approved the submitted version.