دورية أكاديمية
أعرض في EDS

Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: a 6-year prospective audit in 60 patients.

التفاصيل البيبلوغرافية
العنوان: Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: a 6-year prospective audit in 60 patients.
المؤلفون: Lee H; Specialty Trainee, Department of Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK., Kukreja Y; Advanced Pain Medicine Fellow, University Hospitals of Leicester NHS Trust, Leicester, UK., Niraj G; Consultant Department of Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
المصدر: Scandinavian journal of pain [Scand J Pain] 2023 Feb 13; Vol. 23 (4), pp. 712-719. Date of Electronic Publication: 2023 Feb 13 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: De Gruyter Country of Publication: Germany NLM ID: 101520867 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1877-8879 (Electronic) Linking ISSN: 18778860 NLM ISO Abbreviation: Scand J Pain Subsets: MEDLINE
أسماء مطبوعة: Publication: 2018- : [Berlin] : De Gruyter
Original Publication: [Maryland Heights, MO] : Elsevier Science, c2010-
مواضيع طبية MeSH: Pain, Intractable* , Fibromyalgia* , Myofascial Pain Syndromes*/complications, Adult ; Humans ; Analgesics, Opioid ; Pain, Postoperative/etiology ; Cholecystectomy/adverse effects
مستخلص: Objectives: Post cholecystectomy pain syndrome can affect over a third of patients undergoing laparoscopic cholecystectomy. Acute exacerbations can result in recurrent emergency admission with excessive healthcare utilization. Standard surgical management appears to focus on visceral aetiology. Abdominal myofascial pain syndrome is a poorly recognised somatic pathology that can cause refractory pain in this cohort. It develops as a result of trigger points in the abdominal musculature. The report describes the pathophysiology and a novel interventional pathway in the management of post cholecystectomy pain secondary to abdominal myofascial pain syndrome.
Methods: The prospective longitudinal audit was performed at a tertiary pain medicine clinic in a university teaching hospital. Over a six-year period, adult patients with refractory abdominal pain following laparoscopic cholecystectomy were included in a structured interventional management pathway. The pathway included two interventions. Intervention I was a combination of abdominal plane blocks and epigastric port site trigger injection with steroids. Patients who failed to report durable relief (>50% pain relief at 12 weeks) were offered pulsed radiofrequency treatment to the abdominal planes (Intervention II). Outcomes included patient satisfaction, change in opioid consumption and impact on emergency visits.
Results: Sixty patients who failed to respond to standard management were offered the pathway. Four patients refused due to needle phobia. Fifty-six patients received Intervention I. Failure rate was 14% (8/56). Forty-eight patients (48/56, 86%) reported significant benefit at 12 weeks while 38 patients reported durable relief at 24 weeks (38/56, 68%). Nine patients received Intervention II and all (100%) reported durable relief. Emergency admissions and opioid consumption were reduced.
Conclusions: Abdominal myofascial pain syndrome is a poorly recognised cause of post cholecystectomy pain. The novel interventional management pathway could be an effective solution in patients who fail to benefit from standard management.
(© 2023 Walter de Gruyter GmbH, Berlin/Boston.)
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فهرسة مساهمة: Keywords: ACNES; abdominal myofascial pain syndrome; abdominal pain; post cholecystectomy syndrome; pulsed radiofrequency treatment
المشرفين على المادة: 0 (Analgesics, Opioid)
تواريخ الأحداث: Date Created: 20230213 Date Completed: 20231023 Latest Revision: 20240226
رمز التحديث: 20240227
DOI: 10.1515/sjpain-2022-0090
PMID: 36779538
قاعدة البيانات: MEDLINE
الوصف
تدمد:1877-8879
DOI:10.1515/sjpain-2022-0090