Regional Anesthesia and Acute Pain Management

Labor is inherently associated with pain. Pain during childbirth arises from both psychological and physiological processes, including myometrial ischemia and tissue stretching. It is considered one of the most painful physiological events experienced by women and has a direct impact on postpartum quality of life. Although pharmacologic pain relief is widely used in current clinical practice, it is often associated with adverse effects and financial costs. These factors, together with patients’ individual and cultural preferences, may encourage the choice of non-pharmacologic methods. This review summarizes fundamental information and presents recent research findings regarding the advantages and disadvantages of pharmacologic and non-pharmacologic methods of labor pain relief. Non-pharmacologic methods activate the body’s endogenous analgesic mechanisms, promote relaxation, reduce anxiety, and enhance birth satisfaction. Their low cost, minimal invasiveness, and absence of significant adverse effects make them an attractive option for many women. These methods can reduce pain intensity and should be integrated into practice when patients prefer to avoid neuraxial analgesia or pharmacologic interventions to ensure a more comfortable labor process. However, limited analgesic efficacy, low prevalence of use, and insufficient knowledge and skills remain barriers to their implementation. Pharmacologic methods of pain relief may be used in patients for whom neuraxial analgesia is contraindicated; however, they are often associated with decreased satisfaction with childbirth, as well as a number of adverse effects (including labor dysfunction, hypotension, elevated body temperature, nausea and vomiting, and prolonged duration of labor) affecting both the mother and the newborn. The choice of analgesic method should be individualized, taking into account maternal preferences, obstetric context, the presence of comorbidities, and their potential impact on labor progression.

BACKGROUND: Cervical disc herniation is one of the most common causes of pain in the upper limbs and shoulder girdle, significantly affecting patients’ quality of life, functional capacity, and sleep.

AIM: To improve treatment outcomes in patients with cervical radiculopathy through the use of epidural analgesia with glucocorticoids.

METHODS: This observational study included 110 patients diagnosed with discogenic cervical radiculopathy. Participants were divided into two groups: the study group (n=50) received interlaminar epidural injections at the cervical spine level with 2% lidocaine (2 mL) and a glucocorticoid (8 mg). The control group (n=60) underwent neurosurgical treatment for discogenic radiculopathy. Pain intensity was assessed using the Numeric Rating Scale (NRS), the Oswestry Disability Index (ODI), and the short-form McGill Pain Questionnaire at baseline and at 1, 3, and 6 months post-treatment.

RESULTS: Baseline mean scores in study group were: NRS 8.04±1.19; ODI 42.56%±2.10; McGill Pain Questionnaire 48.44±5.21. In control group: NRS 8.18±1.27; ODI 42.63%±2.62; McGill Pain Questionnaire 49.20±5.38. By the end of the 6-month follow-up, pain scores in the study group were as follows: NRS 2.64±1.17; ODI 14.28%±2.56; McGill Pain Questionnaire 24.78±3.09. By the end of the 6-month follow-up, pain scores in the control group were as follows: NRS 3.07±1.26; ODI 14.70%±2.47; McGill Pain Questionnaire 25.12±2.66. The p-values for between-group comparisons of pain intensity according to the NRS (p=0.596; p=0.308; p=0.985; p=0.063), ODI (p=0.868; p=0.125; p=0.479; p=0.386), and McGill Pain Questionnaire (p=0.480; p=0.384; p=0.052; p=0.674) at all assessment time points (pre-intervention and at 1, 3, and 6 months) exceeded the significance threshold of 0.050, indicating no statistically significant differences between the interventional and neurosurgical groups.

CONCLUSION: The results of this study indicate that interventional and surgical treatments for cervical radiculopathy yielded comparable effectiveness of the two approaches.

BACKGROUND: The use of intrathecal morphine in cardiac surgery has the potential to enhance postoperative course. Previous studies on the use of intrathecal morphine for optimizing postoperative analgesia and reducing the duration of mechanical ventilation (MV) have shown conflicting results, indicating the need for further clarification.

AIM: To compare the effects of intrathecal morphine at a dose of 200 μg on postoperative course in patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).

METHODS: This prospective single-center study enrolled 42 patients aged >18 years. Patients were divided into two groups: group 1 received anesthesia with sevoflurane and fentanyl; group 2 received intrathecal morphine (200 μg) 60 min prior to induction of general anesthesia. All patients underwent elective cardiac surgery with CPB. Postoperative parameters included acid–base status, blood gas changes, glycemia, extubation time, pain scores, complication rates, and mortality.

RESULTS: Intrathecal morphine administration resulted in a statistically significant reduction in the duration of MV from 300 (247; 435) to 200 (150; 360) min (p=0.017), a decrease in pain intensity by 2.1 points at 6 h postoperatively and by 1.7 points at 18–24 h postoperatively, as well as a reduced need for intravenous morphine administration during the first 24 h after surgery. The number needed to treat was 1.67.

CONCLUSION: The combination of general multicomponent anesthesia with intrathecal morphine contributes to a reduction in MV time, improves the quality of postoperative analgesia, and decreases the need for intravenous opioid administration in cardiac surgery patients.

BACKGROUND: Acute postoperative pain results from the physiological response to surgical stress. Without adequate management, it may not only contribute to early negative outcomes but also increase the risk of chronic postoperative pain. Despite numerous studies, the optimal postoperative analgesic strategy in thoracic surgery remains undefined.

AIM: To perform a comparative assessment of the analgesic effectiveness of continuous erector spinae plane block as part of multimodal analgesia versus continuous thoracic epidural analgesia within a multimodal pain management protocol in patients undergoing extensive thoracic surgery.

METHODS: This prospective randomized study was based on the analysis of analgesia quality and intensity in the early postoperative period in 66 patients who underwent thoracic surgery. Patients received either continuous ultrasound-guided erector spinae plane block (ESPB) in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol, or continuous thoracic epidural analgesia combined with NSAIDs and paracetamol. Pain intensity was assessed using the visual analog scale (VAS) at rest, during movement, and while coughing at 24 h, 72 h, and postoperative day 7. Vital capacity (VC) and peak expiratory flow were assessed at all stages of the study. The study evaluated the impact of the analgesic techniques on blood levels of C-reactive protein, substance P, interleukin-6, and tumor necrosis factor alpha as indirect markers of analgesic effectiveness.

RESULTS: On postoperative day 1, VAS scores for pain during movement and coughing were significantly lower in the study group (30 mm) compared to the control group (30 mm during movement and 40 mm during coughing; p=0.0004). No significant between-group differences in pain intensity during movement and coughing were found at 72 h or day 7 after operation. No significant between-group differences in inflammatory markers were observed at any time point. VC values decreased to 2.9 L on day 1 in both groups (p <0.01). By postoperative day 7, VC values returned to baseline in both groups: 3.6 L in the study group and 3.6 L in the control group (p <0.01).

CONCLUSION: Continuous ESPB ensures effective analgesia in the early postoperative period in patients after open thoracic surgery, comparable in efficacy to thoracic epidural analgesia, and may be used as an alternative.