Korean Journal of Pain最新文献

{"title":"Comments on comparing analgesic efficacy of different local blocks after laparoscopic cholecystectomy.","authors":"Xue Gao, Fu-Shan Xue, Xin-Tao Li","doi":"10.3344/kjp.23211","DOIUrl":"https://doi.org/10.3344/kjp.23211","url":null,"abstract":"In a single-center randomized controlled trial including 60 patients who underwent laparoscopic cholecystectomy, Cho et al. [1] compared the postoperative analgesic efficacy of the modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) and subcostal transversus abdominis plane block (TAPB) and showed no significant difference in postoperative pain scores, cumulative analgesic consumption, patient satisfaction with pain control, or incidence of postoperative nausea and vomiting between two techniques. The authors should be congratulated on their excellent work. However, beyond the limitations described in the discussion section, we had several questions about the design and results of this study and wished to get the authors’ responses. First, as an important component of multimodal analgesic strategy, basic analgesics, such as acetaminophen and ketorolac, were intravenously administered during surgery. However, it was unclear why these drugs were not continuously used after surgery. The current protocols for enhanced recovery after surgery for laparoscopic surgery recommend that administration of basic analgesics should be started before or during an operation and regularly executed after surgery, while opioids should only be reserved for rescue analgesia [2]. Even without local blocks, a well-designed multimodal analgesic strategy can also adequately control postoperative pain, keep the patient comfortable, as well as decrease the opioid dose and adverse effects by the synergistic or additive effects of various types of analgesics in the patients undergoing laparoscopic cholecystectomy [3]. Jung et al. [4] demonstrated that even the addition of the bilateral subcostal and lateral TAPB to a standard multimodal analgesic strategy does not improve analgesic outcomes or quality of recovery following laparoscopic cholecystectomy. Second, to keep the patient comfortable, a numeric rating scale (NRS) score of 3 or less is generally considered as satisfactory postoperative pain control [2]. According to figures 3–6 in the article by Cho et al. [1], we noted that the median NRS score of maximum pain intensity during movement within the first 12 hours postoperatively were 5 or more, with large interquartile ranges. Furthermore, a significant proportion of patients had median NRS scores of 4 or more at rest and during coughing and movement within the first 6 hours postoperatively. These results indicate that most patients experienced moderate","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"473-475"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/c3/kjp-36-4-473.PMC10551402.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.","authors":"Gokhan Yildiz, Gevher Rabia Genc Perdecioglu, Damla Yuruk, Ezgi Can, Omer Taylan Akkaya","doi":"10.3344/kjp.23200","DOIUrl":"10.3344/kjp.23200","url":null,"abstract":"<p><strong>Background: </strong>: Genicular nerve neurolysis with phenol and radiofrequency ablation (RFA) are two interventional techniques for treating chronic refractory knee osteoarthritis (KOA) pain. This study aimed to compare the efficacy and adverse effects of both techniques.</p><p><strong>Methods: </strong>: Sixty-four patients responding to diagnostic blockade of the superior medial, superior lateral, and inferior medial genicular nerve under ultrasound guidance were randomly divided into two groups: Group P (2 mL phenol for each genicular nerve) and Group R (RFA 80°C for 60 seconds for each genicular nerve). The numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the effectiveness of the interventions.</p><p><strong>Results: </strong>: RFA and phenol neurolysis of the genicular nerves provided effective analgesia within groups at 1 week, 1 month, and 3 months compared to baseline. There was no significant difference between the groups in terms of NRS and WOMAC scores at all measurement times. At the 3rd month follow-up, 50% or more pain relief was observed in 53.1% of patients in Group P and 50% of patients in Group R. The rate of transient paresthesia was 34.4% in Group P and 6.3% in Group R, and this was significantly higher in Group P.</p><p><strong>Conclusions: </strong>: Neurolysis of the genicular nerves with both RFA and phenol is effective in the management of KOA pain. Phenol may be a good alternative to RFA. Further studies are needed on issues such as dose adjustment to prevent transient paresthesia response.</p>","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"450-457"},"PeriodicalIF":3.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f2/db/kjp-36-4-450.PMC10551393.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards precision pain management-the case for targeting DRP1 in remifentanil-induced hyperalgesia.","authors":"Ki Tae Jung","doi":"10.3344/kjp.23258","DOIUrl":"10.3344/kjp.23258","url":null,"abstract":"short-acting opioid analgesic, remifentanil also causes opioid-induced hyperalgesia (OIH), as opioids paradoxically can increase sensitivity to painful stimuli [1]. The exact mechanisms behind remifentanil-induced hyperalgesia (RIH) are not entirely understood but have been attributed to various factors. Prevention and treatment for RIH are not easy and unpredictable. Tapering or discontinuation is not universally effective and may not be applicable in acute settings where remifentanil is often used [2]. And while adjuvant therapies such as N-methylD-aspartate (NMDA) receptor antagonists or alpha-2 agonists may have a role in managing OIH, more evidence is required [3,4]. In the last issue of the Korean Journal of Pain, the research of Zhou et al. [5] provided insight into a potential therapeutic strategy for RIH and reinforced the importance of the dynamin-related protein 1 (DRP1)mitochondria-reactive oxygen species (ROS) pathway in pain modulation. Upregulation of DRP1, a key protein involved in mitochondrial fission, can lead to excessive mitochondrial fission, which may contribute to mitochondrial dysfunction [6]. Dysfunctional mitochondria may produce excessive ROS, activating pain pathways [7]. DRP1-mediated mitochondrial fission has been shown to play a role in synaptic plasticity [8]. Given that neural plasticity is one of the essential factors in the development of chronic pain and possibly OIH [9], DRP1 upregulation could be a contributing factor. In this study, antisense oligodeoxynucleotides against DRP1 (AS-DRP1), administered intrathecally, relieved pain behavior due to RIH via downregulation of the DRP1-mitochondria-ROS pathway. By reducing DRP1 expression, hyperactivity of the spinal NR2B subunit of the NMDA receptor associated with neural hyperexcitability was reduced [10,11]. These findings emphasize the role of the DRP1-mitochondria-ROS-NMDA pathway in the development of RIH. Inhibiting DRP1 in the spinal cord with AS-DRP1 may offer an effective treatment or prevention of RIH. Interestingly, the authors used antisense oligodeoxynucleotide (ASO) drug delivery methods. ASOs are short, synthetic strands of DNA or RNA that specifically bind to a designated RNA target [12]. By binding to target mRNA, they can modulate post-transcriptional gene expression, preventing the mRNA from being translated into a pro-","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":" ","pages":"405-407"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/48/kjp-36-4-405.PMC10551392.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current status of fibromyalgia in Korea: an electronic population health data study in Korea.","authors":"Cheol-Hyeong Lee,&nbsp;Eun Young Lee,&nbsp;Miyoung Yang,&nbsp;Hyung-Sun Won,&nbsp;Yeon-Dong Kim","doi":"10.3344/kjp.23204","DOIUrl":"https://doi.org/10.3344/kjp.23204","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population.</p><p><strong>Methods: </strong>Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study.</p><p><strong>Results: </strong>The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties.</p><p><strong>Conclusions: </strong>The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.</p>","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"458-464"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/1d/kjp-36-4-458.PMC10551395.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of artificial intelligence in treating chronic back pain.","authors":"Kenny Do,&nbsp;Eric Kawana,&nbsp;Benjamin Vachirakorntong,&nbsp;Jenifer Do,&nbsp;Ross Seibel","doi":"10.3344/kjp.23239","DOIUrl":"https://doi.org/10.3344/kjp.23239","url":null,"abstract":"Chronic back pain is a debilitating disorder that is believed to be experienced by close to a quarter of the adult population globally [1]. With the recent advancements in technology, artificial intelligence (AI) has played a crucial role in healthcare, such as safely filtering patient information, analyzing medical imaging, providing recommendations for diagnoses, and even acting as virtual assistants for both physicians and patients [2]. One of the ways AI has been used in pain medicine and in helping patients with low back pain is aiding in the diagnoses of various conditions through interpretations of MRI, CT, X-ray, and other imaging modalities. Previous studies have already assessed the accuracy of artificial intelligence in diagnosing low back pain associated with spinal stenosis, disc degeneration, and lumbar arthritis [3]. One systematic review found that through the use of various machine learning models, physicians can use AI to differentiate patients with and without low back pain through the analysis of brain MRI [3]. AI can be used to filter and interpret clinical data, electromyography studies, and even physical motion to diagnose or predict the onset of various low back pain conditions. Some studies in the systematic review reported an accuracy of up to over 90% [3]. AI can be used to not only interpret these imaging modalities, but it can be used to enhance and even reconstruct an entire imaging of the spine as well. AI algorithms can be trained to differentiate between noisy and clear MRI or CT images, where this training can be applied by having the software reconstruct high-quality images [4]. This will allow the radiologists, interventional pain physicians, and even spine surgeons to have a better understanding of the disease at hand and how to best operate on patients. Past studies have even mentioned the use of AI to create completely new images from given data. For example, with a given MRI image, AI can be used to translate the information into a synthetic CT image, allowing physicians to obtain a more comprehensive view of a patient’s spine or nerves [4]. Even something as mundane as labeling the different parts can be completed by AI to save the physician's time. AI can also be effectively used to identify pain using neurophysiology-based methods [5]. Electroencephalography (EEG), a technique that records the brain’s electrical impulses, has been used to identify and even measure pain intensity [5,6]. A systematic review examined 22","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"478-480"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/e5/kjp-36-4-478.PMC10551394.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscimol as a treatment for nerve injury-related neuropathic pain: a systematic review and meta-analysis of preclinical studies.","authors":"Hamzah Adel Ramawad,&nbsp;Parsa Paridari,&nbsp;Sajjad Jabermoradi,&nbsp;Pantea Gharin,&nbsp;Amirmohammad Toloui,&nbsp;Saeed Safari,&nbsp;Mahmoud Yousefifard","doi":"10.3344/kjp.23161","DOIUrl":"https://doi.org/10.3344/kjp.23161","url":null,"abstract":"<p><strong>Background: </strong>: Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain.</p><p><strong>Methods: </strong>: Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, I² and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source.</p><p><strong>Results: </strong>: Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; <i>P</i> < 0.0001; I² = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; <i>P</i> < 0.0001; I² = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; <i>P</i> < 0.0001; I² = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (<i>P</i> < 0 .0001).</p><p><strong>Conclusions: </strong>: Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.</p>","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"425-440"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/67/kjp-36-4-425.PMC10551397.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Predictive factors associated with successful response to ultrasound guided genicular radiofrequency ablation.","authors":"Selin Guven Kose,&nbsp;Halil Cihan Kose,&nbsp;Feyza Celikel,&nbsp;Omer Taylan Akkaya","doi":"10.3344/kjp.22109e","DOIUrl":"https://doi.org/10.3344/kjp.22109e","url":null,"abstract":"","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"481"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/57/kjp-36-4-481.PMC10551401.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of the spinal γ-aminobutyric acid receptor in the analgesic effects of intrathecally injected hypertonic saline in spinal nerve-ligated rats.","authors":"Myong-Hwan Karm,&nbsp;Hyun-Jung Kwon,&nbsp;Euiyong Shin,&nbsp;Honggyoon Bae,&nbsp;Young Ki Kim,&nbsp;Seong-Soo Choi","doi":"10.3344/kjp.23162","DOIUrl":"10.3344/kjp.23162","url":null,"abstract":"<p><strong>Background: </strong>: Hypertonic saline is used for treating chronic pain; however, clinical studies that aid in optimizing therapeutic protocols are lacking. We aimed to determine the concentration of intrathecally injected hypertonic saline at which the effect reaches its peak as well as the underlying γ-aminobutyric acid (GABA) receptor-related antinociceptive mechanism.</p><p><strong>Methods: </strong>: Spinal nerve ligation (SNL; left L5 and L6) was performed to induce neuropathic pain in rats weighing 250-300 g. Experiment 1: one week after implanting the intrathecal catheter, 60 rats were assigned randomly to intrathecal injection with 0.45%, 0.9%, 2.5%, 5%, 10%, and 20% NaCl, followed by behavioral testing at baseline and after 30 minutes, 2 hours, 1 day, and 1 week to determine the minimal concentration which produced maximal analgesia. Experiment 2: after determining the optimal intrathecal hypertonic saline concentration, 60 rats were randomly divided into four groups: Sham, hypertonic saline without pretreatment, and hypertonic saline after pretreatment with one of two GABA receptor antagonists (GABA_A [bicuculline], or GABA_B [phaclofen]). Behavioral tests were performed at weeks 1 and 3 following each treatment.</p><p><strong>Results: </strong>: Hypertonic saline at concentrations greater than 5% alleviated SNL-induced mechanical allodynia and had a significant therapeutic effect, while showing a partial time- and dose-dependent antinociceptive effect on thermal and cold hyperalgesia. However, pretreatment with GABA receptor antagonists inhibited the antinociceptive effect of 5% NaCl.</p><p><strong>Conclusions: </strong>: This study indicates that the optimal concentration of hypertonic saline for controlling mechanical allodynia in neuropathic pain is 5%, and that its analgesic effect is related to GABA_A and GABA_B receptors.</p>","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":" ","pages":"441-449"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/d4/kjp-36-4-441.PMC10551396.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10362048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insight into the mandibular nerve at the foramen ovale level for percutaneous radiofrequency thermocoagulation.","authors":"Peng-Bo Zhu,&nbsp;Yeon-Dong Kim,&nbsp;Ha Yeong Jeong,&nbsp;Miyoung Yang,&nbsp;Hyung-Sun Won","doi":"10.3344/kjp.23186","DOIUrl":"https://doi.org/10.3344/kjp.23186","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level.</p><p><strong>Methods: </strong>The study used 50 hemi-half heads from 26 South Korean adult cadavers.</p><p><strong>Results: </strong>The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (<i>P</i> = 0.004).</p><p><strong>Conclusions: </strong>The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.</p>","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"465-472"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/91/kjp-36-4-465.PMC10551399.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing analgesic efficacy of different local blocks after laparoscopic cholecystectomy: author's reply.","authors":"Ho-Jin Lee","doi":"10.3344/kjp.23233","DOIUrl":"https://doi.org/10.3344/kjp.23233","url":null,"abstract":"We express our gratitude to the authors for their valuable comments on our recent study comparing the analgesic effects of modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) and subcostal transversus abdominis plane block (TAPB) [1]. They have raised several questions concerning the study design and results. First, they addressed concerns regarding our analgesic protocol, which did not involve the routine use of nonopioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) after surgery. As the authors rightfully mentioned, non-opioid analgesics like acetaminophen and NSAIDs are widely used for postoperative pain management. We administered these non-opioid analgesics intraoperatively, and, considering the short surgery duration, we believe that their effects sufficiently covered postoperative pain during the fasting period (approximately 6 hours). Additionally, for laparoscopic cholecystectomy, we followed our institution's standard analgesic protocol by administering 40 mg of intravenous nefopam during the first 8 hours postoperatively. Notably, we recently reported on the opioid-sparing and analgesic effects of intravenous nefopam during thoracic surgery [2]. Moreover, 6 hours post-surgery, when patients' pain had significantly decreased and they resumed oral intake, we administered an oral tramadol/ acetaminophen combination tablet as a rescue analgesic. Second, the authors expressed concerns that our study participants may have received insufficient postoperative pain control based on the pain intensity results. Although we administered non-opioid analgesics and performed nerve blockade in both groups, we observed high pain scores immediately after surgery. It is plausible that the participants' responses to the pain assessment might have influenced these results. According to a recent prospective study on the cutoff pain scores for mild, moderate, and severe pain in adult Korean patients, the cutoff score between mild and moderate pain was 5.5 on the numeric rating scale [3]. Our previous prospective study conducted in a post-anesthesia care unit yielded similar results [4]. Since we did not provide specific guidance beyond the numeric rating scale (with 0 indicating no pain and 10 indicating the worst pain imaginable), the participants tended to respond with scores closer to the midpoint of 5 when their consciousness was not entirely clear immediately after surgery. Third, the authors highlighted the high occurrence rate of postoperative nausea and vomiting (PONV) among","PeriodicalId":56252,"journal":{"name":"Korean Journal of Pain","volume":"36 4","pages":"476-477"},"PeriodicalIF":2.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/29/kjp-36-4-476.PMC10551400.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}