The annual meeting of the American Society of Anesthesiologists was held from Oct. 13 to 17 in San Francisco and attracted approximately 15,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain and total care of surgical patients prior to, during, and after surgery.
Noting that innovative virtual-reality technologies hold promise in reducing children’s anxiety and pain before and after medical procedures and surgery, Thomas J. Caruso, M.D., of Stanford University in California, and colleagues found that by customizing virtual-reality software to be useful in the hospital setting, they were able to find wide application in a variety of clinical settings.
“Two main customizations include cognitive load modulation and horizon reorientation. Load modulation refers to the ability to increase the distractibility of the virtual-reality experience just prior to the anxiety-provoking component of the procedure (such as intravenous line placement). Horizon reorientation refers to the ability to change the orientation of the experience while in use, such as when a patient goes from sitting to lying down,” Caruso explained. “We have used our customized virtual-reality software and customized hardware (modifying off-the-shelf hardware to be infection control-compliant) in thousands of patients in dozens of clinical settings, demonstrating widespread utilization, reduction in anxiety, and reduction in perception of pain.”
According to Caruso, virtual reality is not for every patient, but for the right patient, it is a tool that can ameliorate feelings of anxiety, which may also reduce a patient’s perception of pain and can be the difference between a positive experience and one that is less than optimal.
In another study, Jon Y. Zhou, M.D., of the University of California School of Medicine Davis Medical Center in Sacramento, and colleagues found that peripheral nerve blocks, when performed prior to mastectomy, help decrease the total amount of opioids used for pain control among postoperative breast cancer patients.
“Acute pain after mastectomy is a major problem, and regional anesthesiologists play an important role in providing multimodal pain relief with medications and ultrasound-guided peripheral nerve blocks such as a pectoralis nerve plane block. Intravenous opioids are often used for analgesia but come with dangerous side effects, including respiratory depression and nausea/vomiting, which can delay discharge,” Zhou said. “Ultrasound-guided pectoralis nerve plane blocks are a noninvasive and safe technique that physician anesthesiologists can perform to decrease opioid requirements after mastectomy surgery.”
The investigators found statistically lower opioid requirements in patients who received the pectoralis nerve plane block compared with patients who did not receive the nerve block.
“This study shows that pectoralis nerve blocks can help control pain and decrease opioid requirements after mastectomy surgery,” Zhou added. “This block can be performed safely prior to incision and may help control acute pain after mastectomy and possibly decrease transition to chronic pain after surgery.”
M. Alparslan Turan, M.D., of the Cleveland Clinic, and colleagues found that obese children do not have more pain after surgery, unlike obese adults.
“There is some evidence that suggests adults who are obese might be extra sensitive to pain and therefore need more pain medication after surgery,” Turan said in a statement. “We didn’t find that to be true of children, which suggests that those who fall into the obese category may not require higher doses of opioids as obese adults often do.”
Pain scores were evaluated for 808 children (8 to 18 years of age) who underwent noncardiac surgery at the Cleveland Clinic between 2010 and 2015. The researchers found no association between body mass index and pain 48 hours after urologic, orthopedic, or general surgeries.
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