Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Objectives. Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods. We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results. One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery

Trends in brain research : a bibliometric analysis

Background: Bibliometrics methods have allowed researchers to assess the popularity of brain research through the ever-growing number of brain-related research papers. While many topics of brain research have been covered by previous studies, there is no comprehensive overview of the evolution of brain research and its various specialties and funding practices over a long period of time. Objective: This paper aims to (1) determine how brain research has evolved over time in terms of number of papers, (2) countries' relative and absolute positioning in terms of papers and impact, and (3) how those various trends vary by area. Methods: Using a list of validated keywords, we extracted brain-related articles and journals indexed in the Web of Science over the 1991–2020 period, for a total of 2,467,708 papers. We used three indicators to perform: number of papers, specialization, and research impact. Results: Our results show that over the past 30 years, the number of brain-related papers has grown at a faster pace than science in general, with China being at the forefront of this growth. Different patterns of specialization among countries and funders were also underlined. Finally, the NIH, the European Commission, the National Natural Science Foundation of China, the UK Medical Research Council, and the German Research Foundation were found to be among the top funders. Conclusion: Despite data-related limitations, our findings provide a large-scope snapshot of the evolution of brain research and its funding, which may be used as a baseline for future studies on these topics.Les méthodes d’analyse bibliométrique ont permis aux chercheurs d’évaluer l’intérêt que suscite la recherche sur le cerveau à l’aide du nombre sans cesse croissant de documents dans le domaine. Certes, de nombreux sujets de recherche se rapportant au cerveau ont déjà fait l’objet d’études, mais il n’existe pas de portrait global de l’évolution de la recherche sur le cerveau ni des divers champs de spécialité, pas plus que des pratiques de financement sur une longue période de temps. L’article visait à déterminer : 1) la manière dont la recherche sur le cerveau avait évolué au fil du temps quant au nombre d’articles; 2) la position relative et absolue des pays en ce qui concerne les articles et leur portée; 3) les différentes tendances selon les champs de recherche. L’extraction d’articles et de revues sur le cerveau, indexés dans la plateforme Web of Science, de 1991 à 2020, a été effectuée à l’aide d’une liste de mots clés validés; le nombre total de documents ainsi tirés s’élevait à 2 467 708. La performance a été établie à l’aide de trois indicateurs, soit le nombre d’articles, les champs de spécialité et la portée de la recherche. D’après les résultats de l’étude, le nombre d’articles portant sur le cerveau a connu une croissance supérieure à celle liée à la science en général au cours des 30 dernières années, et c’est la Chine qui se trouve à l’avant-garde de cette croissance. Les pays et les bailleurs de fonds se distinguent également par les différents champs de spécialité. Enfin, les NIH, la Commission européenne, la fondation National Natural Science Foundation of China, le Conseil de recherches médicales du Royaume-Uni et la fondation German Research Foundation figurent parmi les plus grands bailleurs de fonds. Malgré les restrictions liées aux données, l’étude a permis de donner un bon aperçu de l’évolution de la recherche sur le cerveau et des moyens de financement, aperçu qui pourrait servir d’élément de référence aux études à venir sur ces mêmes sujets

Beyond numbers: integrating qualitative analysis into quantitative sensory testing for neuropathic pain

This article investigates the benefits of adopting qualitative and quantitative sensory testing (QQST) in sensory assessment, with a focus on understanding neuropathic pain. The innovative QQST method combines participant qualitative experiences with quantitative psychophysical measurements, offering a more varied interpretation of sensory abnormalities and normal sensory function. This article also explores the steps for the optimization of the method by identifying qualitative signs of sensory abnormalities and standardizing data collection. By leveraging the inherent subjectivity in the test design and participant responses, the QQST method contributes to a more holistic exploration of both normal and abnormal sensory experiences. This article positions the QQST approach as a foundational element within the Sensory Evaluation Network, uniting international experts to harmonize qualitative and quantitative sensory evaluation methods

Clinical Characterization of Pediatric Erythromelalgia: A Single-Center Case Series

Erythromelalgia is a descriptive term for severe burning pain and erythema in the distal extremities relieved by cold and exacerbated by heat. Pediatric case series to date are relatively small. We extracted and analyzed medical record data for 42 pediatric patients to describe clinical characteristics, associated conditions, and responses to treatments. Informed consent was obtained according to an IRB-approved protocol that included gene discovery. Three patients had confirmed Nav1.7 sodium channelopathies, with six additional patients under investigation with novel gene candidates. There was a female predominance (2.5:1), and the median onset age was 12 years (IQR = 3–14). Patients saw a median of three specialists (IQR = 2–3) for a diagnosis. The majority (90%) reported bilateral symptoms. Cooling methods usually provided partial relief, while heat and exercise exacerbated pain. No medication appeared to be consistently effective; commonly prescribed medications included sodium channel blockers (n = 37), topical analgesics (n = 26), gabapentin (n = 22), and aspirin (n = 15). Based on the currently published literature, we believe this cohort is the largest pediatric study of erythromelalgia to date. Many findings are consistent with those of previously published case series. Work is in progress to establish a prospective cohort and multi-center registry