Abstracts tive days 2 and 3, with a trend toward better exion on postoperative day 4.

Patients who received GBP postoperatively reported less pruritus than patients who received placebo. There were no differences in pain scores. Conclusions: These results support the use of GBP in the acute postoperative period. Further trials are needed to delineate the optimal dose, timing and duration of GBP use following surgery. PMCID: PMC2706552 [Available on 2010/05/01]. PMID: 19547761 [PubMed - in process]. doi:10.1016/j.acpain.2009.10.008 Predictive factors of postoperative pain after day-case surgery Clin J Pain. 2009 JulAug;25(6):45560. H.F. Gramke, J.M. de Rijke, M. van Kleef, A.G. Kessels, M.L. Peters, M. Sommer, M.A. Marcus Objectives: Despite the growing number of ambulatory operations knowledge of predictive factors of postoperative pain after ambulatory surgery is limited. Therefore, the aim of this study was to identify predictive factors of postoperative pain after ambulatory surgery. Methods: In this cross-sectional study, 648 patients were included. A wide variety of elective ambulatory operations were performed. Pain assessments were made before the operation and during a 4-day period postoperatively, using a 100 mm visual analog scale. Patient characteristics, type of surgery, and type of anesthesia were recorded. In addition, preoperative expectations of postoperative pain by physician and patient were assessed. Finally, several scores about psychologic parameters were measured: pain catastrophizing, surgical anxiety, and optimism. Stepwise logistic regression analysis was performed to identify factors that independently predict the risk of having postoperative pain (dened by a visual analog scale >40 mm) on days 04. Results: The most important predictor of postoperative pain was the presence of preoperative pain. Other predictors were anticipated postoperative pain by the clinician, preoperative high expectations of postoperative pain by the patient, younger age, and fear of short-term consequences of the operation. Regional anesthetic technique compared with general anesthesia decreased the risk of acute postoperative pain only on the day of the operation. Discussion: Several predictive factors of postoperative pain after ambulatory surgery were identied in this study. These factors should be

147 taken into account when planning postoperative analgesia for ambulatory surgery. PMID: 19542791 [PubMed - in process]. doi:10.1016/j.acpain.2009.10.009 The analgesic properties of scalp inltrations with ropivacaine after intracranial tumoral resection Anesth Analg. 2009 Jul;109(1):2404. H. Batoz, O. Verdonck, C. Pellerin, G. Roux, P. Maurette Background: The issue of postoperative pain after neurosurgery is controversial. It has been reported as mild to moderate and its treatment may be inadequate. Inltration of the surgical site with local anesthetics has provided transient benet after craniotomy, but its effect on chronic pain has not been evaluated. Accordingly, we designed the present study to test the hypothesis that ropivacaine inltration of the scalp reduces acute and persistent postoperative pain after intracranial tumor resection. Methods: This was a prospective, single-blinded study. Inclusion criteria were intracranial tumor resection, age 18 or 80 years, and ability to understand and use a visual analog scale (VAS). Exclusion criteria were history of craniotomy, chronic drug abuse, and neurologic disorders. All eligible patients were randomly included in Group I (inltration) or C (control). Postoperative analgesia was IV acetaminophen combined with nalbuphine. At the end of the surgery, Group I received an inltration of the surgical site with 20 mL of ropivacaine 0.75%. Acute pain was evaluated hourly by VAS during the rst 24 h. The analgesic effect of ropivacaine was evaluated based on total consumption of nalbuphine and VAS scores. The incidence of persistent pain and neuropathic pain was assessed at the 2-month postoperative evaluation. We used the Students t-test to compare total nalbuphine consumption, repeated measures analysis of variance with post hoc Bonferroni t-test for VAS score and the Fishers exact test for chronic and neuropathic pain. Results: Fifty-two patients were enrolled, 25 in Group I and 27 in Group C. Demographic and intraoperative data were similar between groups. Group I showed a nonsignicant trend toward reduced nalbuphine consumption during the rst postoperative day, 11.2 9.2 mg vs. 16.6 11.0 mg for Group C (mean SD, P = 0.054). VAS scores were signicantly higher in Group C. Two months after surgery, persistent pain was signicantly lower in Group I,

148 2/24 (8%) vs. 14/25 (56%), P = 0.0003. One patient (4.1%) in Group I versus six (25%) patients in Group C (P = 0.04) experienced neuropathic pain. Conclusions: Because pain is moderate after intracranial tumor resection, there is limited interest in scalp inltrations with ropivacaine in the acute postoperative period. Nevertheless, these inltrations may be relevant for the rehabilitation of neurosurgical patients and their quality of life by limiting the development of persistent pain and particularly neuropathic pain. PMID: 19535716 [PubMed - indexed for MEDLINE]. doi:10.1016/j.acpain.2009.10.010 Randomised clinical trial of the inuence of local subcutaneous inltration versus subcutaneous and deep inltration of local anaesthetic on pain after appendicectomy Colorectal Dis. 2009 Mar 11. [Epub ahead of print]. J.K. Randall, A. Goede, P. Morgan-Warren, S.B. Middleton Introduction: Local anaesthesia is commonly used to provide pain relief after surgery. The aim of this randomised, blinded prospective trial was to evaluate whether local subcutaneous and deep inltration of local anaesthetic provides better post-operative pain control than subcutaneous inltration alone. Methods: Eighty-four patients undergoing open appendicectomy for presumed acute appendicitis were randomly assigned into two groups. Group A received local inltration of the skin prior to incision with bupivacaine whilst group B received half the bupivacaine inltrated into the skin and the other half deep to external oblique to create a local nerve eld blockade. Post-operative pain was assessed, on a scale of 110, at 1, 4, 8 and 24 h post-extubation. Results: At time intervals of 1, 4 and 8 h there was no signicant difference in pain score between group A and group B. At 24 h group B had signicantly lower pain scores than group A (2.34 vs. 3.41, P = 0.016). Conclusion: Both methods of administration of local anaesthetic produced consistently low pain scores in the rst 24 h after appendicectomy. There may be additional benet in a local nerve eld blockade in combination with local anaesthetic skin inltration. PMID: 19508549 [PubMed - as supplied by publisher]. doi:10.1016/j.acpain.2009.10.011

Abstracts

Pharmacology of acute pain

Randomized double-blind placebo controlled crossover study of acetaminophen, ibuprofen, acetaminophen/hydrocodone, and placebo for the relief of pain from a standard painful stimulus Acad Emerg Med. 2009 Sept;16:91114. J.R. Miner Objectives: The objective was to compare subjects change in perceived acute pain from an identical painful stimulus after receiving three separate, commonly used pain medications and placebo. Methods: This was an institutional review boardapproved, randomized, double-blind crossover study of healthy human volunteers. Subjects received 1000 mg of acetaminophen, 800 mg of ibuprofen, the combination of 650 mg of acetaminophen with 10 mg of hydrocodone, or placebo (800 mg of lactose) in a randomized order over four separate occasions each 1 week apart. Prior to receiving the drug on each study day, subjects placed their nondominant hand in a bath of 0 C water for 45 s. The bath was divided into two sections; the larger was the reservoir of cooled water monitored at 0 C, and the other half was lled from constant overow. Water drained from the overow section into the cooling unit and was then pumped up into the base of the reservoir through a diffusion grid. Subjects completed a 100-mm visual analog scale (VAS) representing perceived pain during the exposure. The cold water exposure and VAS were repeated 1 h after receiving the study drug, and then subjects were observed for side effects for 4 h. Data were compared using descriptive statistics, 95% condence intervals (CIs), and repeated-measures analysis of variance (ANOVA). Results: Twenty-ve subjects were enrolled. The mean VAS preexposure was 56.9 mm (15.1 mm; range = 592 mm). The mean decrease in VAS after receiving the study drug for acetaminophen was 10.2% (95% CI = 1.4 to 20.4), for ibuprofen was 6.6% (95% CI = 16.5 to 3.20), for acetaminophen/hydrocodone was 9.5% (95% CI = 1.4 to 20.4), and for placebo was 6.9% (95% CI = 15.2 to 1.4). The range in change in pain scores for all agents was 91.3% to 57.6%. Mild side effects (nausea, dizziness, or somnolence) were reported in 11 subjects (44%) after receiving acetaminophen/hydrocodone; no other side effects were reported. Conclusions: There was a wide range of changes in pain scores from this identical painful