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Treatment of Acute and Periprocedural Pain
Rafael Vazquez, MD; Nicole Z. Spence, MD
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KEY FACTS

  • Terminology

    • Clinical Implications

      • Treatment of Acute Pain

        TERMINOLOGY

        • Definitions

          • Acute pain: Result of insult and is short in duration, usually lasting hours to days; can be intense and unpleasant for patients; can transition into chronic pain
          • Visceral pain: Results from activation of nociceptors of viscera in abdomen, pelvis, or thorax; visceral structures are highly sensitive to distension, ischemia, and inflammation
            • Described as vague, not localized, deep squeeze, pressure, aching
              • i.e., distension of hollow organs, such as bowel, can cause visceral pain
            • Can be felt far from its origin as referred pain (i.e., right upper quadrant pain may manifest as shoulder pain)
          • Somatic pain: Different from visceral pain; nociceptive pain from skin, tissue, or muscle
            • Described as pricking, burning, sharp, or throbbing
          • Neuropathic pain: Pain initiated or caused by lesion or disease in somatosensory nervous system
            • Associated with abnormal sensations (dysesthesia) or pain from normally nonpainful stimuli (allodynia); can be continuous &/or episodic
              • Described as tingling or burning
          • Hyperalgesia: Heightened sensitivity to pain from stimulus that usually provokes pain
          • Allodynia: Perception of pain from stimulus that does not normally provoke pain
          • Dysesthesia: Discomfort that involves abnormal sensations

        CLINICAL IMPLICATIONS

        • Clinical Importance

          Treatment of Acute Periprocedural Pain

          • Principles of Treating Acute Pain

            • Oral Analgesics

              • Intravenous Analgesics

                • Topical Analgesics

                  • Equipment

                    • Medications (For Interventions)

                      • Alternative Modalities

                        • Acute Pain Protocols

                          Selected References

                          1. Bolat MS et al: A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS). Int Urol Nephrol. 51(12):2119-26, 2019
                          2. Chai PR et al: The feasibility and acceptability of a smartphone-based music intervention for acute pain. Proc Annu Hawaii Int Conf Syst Sci. 2019:3917-25, 2019
                          3. Levene JL et al: Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. J Clin Anesth. 55:116-27, 2019
                          4. Machado AFP et al: Effects of thermotherapy and transcutaneous electrical nerve stimulation on patients with primary dysmenorrhea: a randomized, placebo-controlled, double-blind clinical trial. Complement Ther Med. 47:102188, 2019
                          5. Mallari B et al: Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 12:2053-85, 2019
                          6. Prescriber's Digital Reference. https://www.pdr.net/. Reviewed December 16, 2019. Accessed December 16, 2019.
                          7. Saxena P et al: A journey of celecoxib from pain to cancer. Prostaglandins Other Lipid Mediat. 147:106379, 2019
                          8. Sun H et al: Lidocaine inhibits proliferation and metastasis of lung cancer cell via regulation of miR-539/EGFR axis. Artif Cells Nanomed Biotechnol. 47(1):2866-74, 2019
                          9. Thiels CA et al: Chronic use of tramadol after acute pain episode: cohort study. BMJ. 365:l1849, 2019
                          10. Tran DQ et al: Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. ePub, 2019
                          11. Abu Elyazed MM et al: Thoracic paravertebral block for the anesthetic management of percutaneous radiofrequency ablation of liver tumors. J Anaesthesiol Clin Pharmacol. 34(2):166-71, 2018
                          12. Lyu Y et al: What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials. BMC Gastroenterol. 18(1):106, 2018
                          13. Lötsch J et al: Machine-learned selection of psychological questionnaire items relevant to the development of persistent pain after breast cancer surgery. Br J Anaesth. 121(5):1123-32, 2018
                          14. Mitra S et al: New advances in acute postoperative pain management. Curr Pain Headache Rep. 22(5):35, 2018
                          15. Wasserman I et al: Impact of intravenous acetaminophen on perioperative opioid utilization and outcomes in open colectomies: a claims database analysis. Anesthesiology. 129(1):77-88, 2018
                          16. Zhong J et al: Incidence of post-ablation syndrome following image-guided percutaneous cryoablation of renal cell carcinoma: a prospective study. Cardiovasc Intervent Radiol. 41(2):270-6, 2018
                          17. Cata JP et al: Non-steroidal anti-inflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature. Br J Anaesth. 119(4):750-64, 2017
                          18. Grandhi RK et al: Does opioid use cause angiogenesis and metastasis? Pain Med. 18(1):140-51, 2017
                          19. Niraj G et al: Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center. J Clin Anesth. 36:174-7, 2017
                          20. Rodríguez-Rubio L et al: Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis. J Clin Anesth. 39:129-38, 2017
                          21. Yang H et al: Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol. 28(11):1503-11.e2, 2017
                          22. Ahiskalioglu A et al: Effects of a single-dose of pre-emptive pregabalin on postoperative pain and opioid consumption after double-jaw surgery: a randomized controlled trial. J Oral Maxillofac Surg. 74(1):53.e1-7, 2016
                          23. Arumugam S et al: Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis. J Pain Res. 9:631-40, 2016
                          24. Badiola IJ: Can chronic pain be prevented? Anesthesiol Clin. 34(2):303-15, 2016
                          25. Byrne K et al: Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis? Can J Anaesth. 63(2):184-92, 2016
                          26. Dubut J et al: CT-guided paravertebral block for microwave ablation of kidney tumors: a new technique. Abdom Radiol (NY). 41(6):1197-202, 2016
                          27. Kranke P et al: Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. CD009642, 2015
                          28. Sieghart W et al: Transarterial chemoembolization: modalities, indication, and patient selection. J Hepatol. 62(5):1187-95, 2015
                          29. Tan M et al: Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth. 62(2):203-18, 2015
                          30. Andreano A et al: Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol. 25(1):97-105.e1-2, 2014
                          31. Gazzera C et al: Role of paravertebral block anaesthesia during percutaneous transhepatic thermoablation. Radiol Med. 119(8):549-57, 2014
                          32. Reddi D et al: Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgrad Med J. 90(1062):222-7; quiz 226, 2014
                          33. Bhatia A et al: Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes. Anesth Analg. 117(1):236-51, 2013
                          34. Hsieh YC et al: Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma. Clin Radiol. 68(6):600-7, 2013
                          35. Marqués A et al: Ultrasound-guided paravertebral block for management of abdominal pain after transarterial embolization using drug-eluting beads loaded with irinotecan. J Vasc Interv Radiol. 24(9):1416-7, 2013
                          36. Wong I et al: Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth. 23(6):475-95, 2013
                          37. Elmunzer BJ et al: A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 366(15):1414-22, 2012
                          38. López-Álvarez S et al: Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy: a randomized controlled trial. Can J Anaesth. 59(5):442-8, 2012
                          39. Brummett CM et al: Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 49(4):104-16, 2011
                          40. Choi S et al: Is ultrasound guidance advantageous for interventional pain management? A review of acute pain outcomes. Anesth Analg. 113(3):596-604, 2011
                          41. Brummett CM et al: Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block. Reg Anesth Pain Med. 35(5):427-31, 2010
                          42. Esmaoglu A et al: Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 111(6):1548-51, 2010
                          43. Loftus RW et al: Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 113(3):639-46, 2010
                          44. McCarberg BH et al: Topical diclofenac epolamine patch 1.3% for treatment of acute pain caused by soft tissue injury. Int J Clin Pract. 64(11):1546-53, 2010
                          45. McCleane G: Topical application of analgesics: a clinical option in day case anaesthesia? Curr Opin Anaesthesiol. 23(6):704-7, 2010
                          46. Parrington SJ et al: Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med. 35(5):422-6, 2010
                          47. Vadivelu N et al: Buprenorphine in postoperative pain management. Anesthesiol Clin. 28(4):601-9, 2010
                          48. Vieira PA et al: Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 27(3):285-8, 2010
                          49. Arici S et al: Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Agri. 21(2):54-61, 2009
                          50. Brummett CM et al: Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 111(5):1111-9, 2009
                          51. Neil MJ et al: Post surgical pain- the transition from acute to chronic pain. Rev Pain. 3(2):6-9, 2009
                          52. Oifa S et al: Effects of intravenous patient-controlled analgesia with buprenorphine and morphine alone and in combination during the first 12 postoperative hours: a randomized, double-blind, four-arm trial in adults undergoing abdominal surgery. Clin Ther. 31(3):527-41, 2009
                          53. Pöpping DM et al: Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 111(2):406-15, 2009
                          54. Williams BA et al: Future considerations for pharmacologic adjuvants in single-injection peripheral nerve blocks for patients with diabetes mellitus. Reg Anesth Pain Med. 34(5):445-57, 2009
                          55. Agarwal A et al: Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 101(5):700-4, 2008
                          56. Brummett CM et al: Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 109(3):502-11, 2008
                          57. Moryl N et al: Managing an acute pain crisis in a patient with advanced cancer: "this is as much of a crisis as a code". JAMA. 299(12):1457-67, 2008
                          58. McCartney CJ et al: Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 32(4):330-8, 2007
                          59. Mugabure Bujedo B et al: [Multimodal approaches to postoperative pain management and convalescence.] Rev Esp Anestesiol Reanim. 54(1):29-40, 2007
                          60. Peng PW et al: Use of gabapentin for perioperative pain control -- a meta-analysis. Pain Res Manag. 12(2):85-92, 2007
                          61. Gurbet A et al: Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth. 53(7):646-52, 2006
                          62. Mora B et al: Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care. J Urol. 175(5):1737-41; discussion 1741, 2006
                          63. Botting R et al: COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins Leukot Essent Fatty Acids. 72(2):85-7, 2005
                          64. Wah TM et al: Image-guided percutaneous radiofrequency ablation and incidence of post-radiofrequency ablation syndrome: prospective survey. Radiology. 237(3):1097-102, 2005
                          65. Kroin JS et al: Clonidine prolongation of lidocaine analgesia after sciatic nerve block in rats Is mediated via the hyperpolarization-activated cation current, not by alpha-adrenoreceptors. Anesthesiology. 101(2):488-94, 2004
                          66. Mason L et al: Topical NSAIDs for acute pain: a meta-analysis. BMC Fam Pract. 5:10, 2004
                          67. Woolf CJ et al: Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 140(6):441-51, 2004
                          68. Hatsiopoulou O et al: Postprocedure pain management of interventional radiology patients. J Vasc Interv Radiol. 14(11):1373-85, 2003
                          69. Neal JM: Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: neurotoxicity and neural blood flow. Reg Anesth Pain Med. 28(2):124-34, 2003
                          70. Candido KD et al: Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med. 27(2):162-7, 2002
                          71. Hines R et al: Use of lidocaine patch 5% for chronic low back pain: a report of four cases. Pain Med. 3(4):361-5, 2002
                          72. Kara H et al: Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol. 19(1):52-6, 2002
                          73. Marinangeli F et al: Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain. 6(1):35-42, 2002
                          74. Candido KD et al: Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients. Reg Anesth Pain Med. 26(4):352-6, 2001
                          75. Hashimoto K et al: Epinephrine increases the neurotoxic potential of intrathecally administered lidocaine in the rat. Anesthesiology. 94(5):876-81, 2001
                          76. Macrae WA: Chronic pain after surgery. Br J Anaesth. 87(1):88-98, 2001
                          77. Wiffen P et al: Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev. CD001133, 2000
                          78. Koinig H et al: Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 87(1):206-10, 1998
                          79. Gaumann DM et al: Hyperpolarizing afterpotentials in C fibers and local anesthetic effects of clonidine and lidocaine. Pharmacology. 48(1):21-9, 1994
                          80. Benzon HT et al: Onset, intensity of blockade and somatosensory evoked potential changes of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine. Anesth Analg. 76(2):328-32, 1993
                          81. Rowlingson JC: Toxicity of local anesthetic additives. Reg Anesth. 18(6 Suppl):453-60, 1993
                          82. Tetzlaff JE et al: Alkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery. Reg Anesth. 15(5):242-4, 1990
                          83. Myers RR et al: Effects of local anesthesia on nerve blood flow: studies using lidocaine with and without epinephrine. Anesthesiology. 71(5):757-62, 1989
                          84. Woolf CJ et al: The systemic administration of local anaesthetics produces a selective depression of C-afferent fibre evoked activity in the spinal cord. Pain. 23(4):361-74, 1985
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Clinical Implications

                              • Treatment of Acute Pain

                                TERMINOLOGY

                                • Definitions

                                  • Acute pain: Result of insult and is short in duration, usually lasting hours to days; can be intense and unpleasant for patients; can transition into chronic pain
                                  • Visceral pain: Results from activation of nociceptors of viscera in abdomen, pelvis, or thorax; visceral structures are highly sensitive to distension, ischemia, and inflammation
                                    • Described as vague, not localized, deep squeeze, pressure, aching
                                      • i.e., distension of hollow organs, such as bowel, can cause visceral pain
                                    • Can be felt far from its origin as referred pain (i.e., right upper quadrant pain may manifest as shoulder pain)
                                  • Somatic pain: Different from visceral pain; nociceptive pain from skin, tissue, or muscle
                                    • Described as pricking, burning, sharp, or throbbing
                                  • Neuropathic pain: Pain initiated or caused by lesion or disease in somatosensory nervous system
                                    • Associated with abnormal sensations (dysesthesia) or pain from normally nonpainful stimuli (allodynia); can be continuous &/or episodic
                                      • Described as tingling or burning
                                  • Hyperalgesia: Heightened sensitivity to pain from stimulus that usually provokes pain
                                  • Allodynia: Perception of pain from stimulus that does not normally provoke pain
                                  • Dysesthesia: Discomfort that involves abnormal sensations

                                CLINICAL IMPLICATIONS

                                • Clinical Importance

                                  Treatment of Acute Periprocedural Pain

                                  • Principles of Treating Acute Pain

                                    • Oral Analgesics

                                      • Intravenous Analgesics

                                        • Topical Analgesics

                                          • Equipment

                                            • Medications (For Interventions)

                                              • Alternative Modalities

                                                • Acute Pain Protocols

                                                  Selected References

                                                  1. Bolat MS et al: A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS). Int Urol Nephrol. 51(12):2119-26, 2019
                                                  2. Chai PR et al: The feasibility and acceptability of a smartphone-based music intervention for acute pain. Proc Annu Hawaii Int Conf Syst Sci. 2019:3917-25, 2019
                                                  3. Levene JL et al: Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. J Clin Anesth. 55:116-27, 2019
                                                  4. Machado AFP et al: Effects of thermotherapy and transcutaneous electrical nerve stimulation on patients with primary dysmenorrhea: a randomized, placebo-controlled, double-blind clinical trial. Complement Ther Med. 47:102188, 2019
                                                  5. Mallari B et al: Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 12:2053-85, 2019
                                                  6. Prescriber's Digital Reference. https://www.pdr.net/. Reviewed December 16, 2019. Accessed December 16, 2019.
                                                  7. Saxena P et al: A journey of celecoxib from pain to cancer. Prostaglandins Other Lipid Mediat. 147:106379, 2019
                                                  8. Sun H et al: Lidocaine inhibits proliferation and metastasis of lung cancer cell via regulation of miR-539/EGFR axis. Artif Cells Nanomed Biotechnol. 47(1):2866-74, 2019
                                                  9. Thiels CA et al: Chronic use of tramadol after acute pain episode: cohort study. BMJ. 365:l1849, 2019
                                                  10. Tran DQ et al: Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. ePub, 2019
                                                  11. Abu Elyazed MM et al: Thoracic paravertebral block for the anesthetic management of percutaneous radiofrequency ablation of liver tumors. J Anaesthesiol Clin Pharmacol. 34(2):166-71, 2018
                                                  12. Lyu Y et al: What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials. BMC Gastroenterol. 18(1):106, 2018
                                                  13. Lötsch J et al: Machine-learned selection of psychological questionnaire items relevant to the development of persistent pain after breast cancer surgery. Br J Anaesth. 121(5):1123-32, 2018
                                                  14. Mitra S et al: New advances in acute postoperative pain management. Curr Pain Headache Rep. 22(5):35, 2018
                                                  15. Wasserman I et al: Impact of intravenous acetaminophen on perioperative opioid utilization and outcomes in open colectomies: a claims database analysis. Anesthesiology. 129(1):77-88, 2018
                                                  16. Zhong J et al: Incidence of post-ablation syndrome following image-guided percutaneous cryoablation of renal cell carcinoma: a prospective study. Cardiovasc Intervent Radiol. 41(2):270-6, 2018
                                                  17. Cata JP et al: Non-steroidal anti-inflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature. Br J Anaesth. 119(4):750-64, 2017
                                                  18. Grandhi RK et al: Does opioid use cause angiogenesis and metastasis? Pain Med. 18(1):140-51, 2017
                                                  19. Niraj G et al: Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center. J Clin Anesth. 36:174-7, 2017
                                                  20. Rodríguez-Rubio L et al: Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis. J Clin Anesth. 39:129-38, 2017
                                                  21. Yang H et al: Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol. 28(11):1503-11.e2, 2017
                                                  22. Ahiskalioglu A et al: Effects of a single-dose of pre-emptive pregabalin on postoperative pain and opioid consumption after double-jaw surgery: a randomized controlled trial. J Oral Maxillofac Surg. 74(1):53.e1-7, 2016
                                                  23. Arumugam S et al: Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis. J Pain Res. 9:631-40, 2016
                                                  24. Badiola IJ: Can chronic pain be prevented? Anesthesiol Clin. 34(2):303-15, 2016
                                                  25. Byrne K et al: Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis? Can J Anaesth. 63(2):184-92, 2016
                                                  26. Dubut J et al: CT-guided paravertebral block for microwave ablation of kidney tumors: a new technique. Abdom Radiol (NY). 41(6):1197-202, 2016
                                                  27. Kranke P et al: Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. CD009642, 2015
                                                  28. Sieghart W et al: Transarterial chemoembolization: modalities, indication, and patient selection. J Hepatol. 62(5):1187-95, 2015
                                                  29. Tan M et al: Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth. 62(2):203-18, 2015
                                                  30. Andreano A et al: Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol. 25(1):97-105.e1-2, 2014
                                                  31. Gazzera C et al: Role of paravertebral block anaesthesia during percutaneous transhepatic thermoablation. Radiol Med. 119(8):549-57, 2014
                                                  32. Reddi D et al: Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgrad Med J. 90(1062):222-7; quiz 226, 2014
                                                  33. Bhatia A et al: Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes. Anesth Analg. 117(1):236-51, 2013
                                                  34. Hsieh YC et al: Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma. Clin Radiol. 68(6):600-7, 2013
                                                  35. Marqués A et al: Ultrasound-guided paravertebral block for management of abdominal pain after transarterial embolization using drug-eluting beads loaded with irinotecan. J Vasc Interv Radiol. 24(9):1416-7, 2013
                                                  36. Wong I et al: Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth. 23(6):475-95, 2013
                                                  37. Elmunzer BJ et al: A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 366(15):1414-22, 2012
                                                  38. López-Álvarez S et al: Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy: a randomized controlled trial. Can J Anaesth. 59(5):442-8, 2012
                                                  39. Brummett CM et al: Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 49(4):104-16, 2011
                                                  40. Choi S et al: Is ultrasound guidance advantageous for interventional pain management? A review of acute pain outcomes. Anesth Analg. 113(3):596-604, 2011
                                                  41. Brummett CM et al: Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block. Reg Anesth Pain Med. 35(5):427-31, 2010
                                                  42. Esmaoglu A et al: Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 111(6):1548-51, 2010
                                                  43. Loftus RW et al: Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 113(3):639-46, 2010
                                                  44. McCarberg BH et al: Topical diclofenac epolamine patch 1.3% for treatment of acute pain caused by soft tissue injury. Int J Clin Pract. 64(11):1546-53, 2010
                                                  45. McCleane G: Topical application of analgesics: a clinical option in day case anaesthesia? Curr Opin Anaesthesiol. 23(6):704-7, 2010
                                                  46. Parrington SJ et al: Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med. 35(5):422-6, 2010
                                                  47. Vadivelu N et al: Buprenorphine in postoperative pain management. Anesthesiol Clin. 28(4):601-9, 2010
                                                  48. Vieira PA et al: Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 27(3):285-8, 2010
                                                  49. Arici S et al: Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Agri. 21(2):54-61, 2009
                                                  50. Brummett CM et al: Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 111(5):1111-9, 2009
                                                  51. Neil MJ et al: Post surgical pain- the transition from acute to chronic pain. Rev Pain. 3(2):6-9, 2009
                                                  52. Oifa S et al: Effects of intravenous patient-controlled analgesia with buprenorphine and morphine alone and in combination during the first 12 postoperative hours: a randomized, double-blind, four-arm trial in adults undergoing abdominal surgery. Clin Ther. 31(3):527-41, 2009
                                                  53. Pöpping DM et al: Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 111(2):406-15, 2009
                                                  54. Williams BA et al: Future considerations for pharmacologic adjuvants in single-injection peripheral nerve blocks for patients with diabetes mellitus. Reg Anesth Pain Med. 34(5):445-57, 2009
                                                  55. Agarwal A et al: Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 101(5):700-4, 2008
                                                  56. Brummett CM et al: Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 109(3):502-11, 2008
                                                  57. Moryl N et al: Managing an acute pain crisis in a patient with advanced cancer: "this is as much of a crisis as a code". JAMA. 299(12):1457-67, 2008
                                                  58. McCartney CJ et al: Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 32(4):330-8, 2007
                                                  59. Mugabure Bujedo B et al: [Multimodal approaches to postoperative pain management and convalescence.] Rev Esp Anestesiol Reanim. 54(1):29-40, 2007
                                                  60. Peng PW et al: Use of gabapentin for perioperative pain control -- a meta-analysis. Pain Res Manag. 12(2):85-92, 2007
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