A Clinical Experimental Model to Evaluate Analgesic Effect of Remote Ischemic Preconditioning in Acute Postoperative Pain

Abstract

This study aims to evaluate the viability of a clinical model of remote ischemic preconditioning (RIPC) and its analgesic effects. It is a prospective study with twenty (20) patients randomly divided into two groups: control group and RIPC group. The opioid analgesics consumption in the postoperative period, the presence of secondary mechanical hyperalgesia, the scores of postoperative pain by visual analog scale, and the plasma levels interleukins (IL-6) were evaluated. The tourniquet applying after spinal anesthetic block was safe, producing no pain for all patients in the tourniquet group. The total dose of morphine consumption in 24 hours was significantly lower in RIPC group than in the control group (p = 0.0156). The intensity analysis of rest pain, pain during coughing and pain in deep breathing, showed that visual analogue scale (VAS) scores were significantly lower in RIPC group compared to the control group: p = 0.0087, 0.0119, and 0.0015, respectively. There were no differences between groups in the analysis of presence or absence of mechanical hyperalgesia (p = 0.0704) and in the serum levels of IL-6 dosage over time (p < 0.0001). This clinical model of remote ischemic preconditioning promoted satisfactory analgesia in patients undergoing conventional cholecystectomy, without changing serum levels of IL-6.

Ischemic Preconditioning: Modulating Pain Sensitivity and Exercise Performance

“…To date, little work has investigated the use of an IPC protocol on reducing sensitivity to a purposely introduced painful stimulus in healthy individuals. Previous literature, however, has investigated the analgesic effect of IPC in a clinical setting, indicating that postoperative pain intensity (Memtsoudis et al, 2010;Pereira et al, 2016) morphine use (Memtsoudis et al, 2010), and mean hospital stay (Pereira et al, 2016) can be reduced in patients who undergo IPC before a surgical procedure. In like manner, the current study found that IPC can modulate pain sensitivity by reducing total time under pain; in contrast, however, absolute pain intensity was not affected.…”

“…In like manner, the current study found that IPC can modulate pain sensitivity by reducing total time under pain; in contrast, however, absolute pain intensity was not affected. It should be pointed-out that previous clinical research (Memtsoudis et al, 2010;Pereira et al, 2016) evaluated pain intensity in the recovery from a painful stimulus, while the current study evaluated pain intensity during the administration of the painful stimulus and not after its removal. Therefore, it remains possible that IPC can reduce pain intensity during withdrawal of a painful stimulus in young, healthy individuals, and should be considered by future research.…”

“…As such, the local release of endogenous opioids via IPC may act to modulate pain sensitivity. In the clinical setting wherein patients have a preexisting baseline pain, IPC administration prior to surgery can reduce patient-reported post-operative pain (Memtsoudis et al, 2010;Pereira et al, 2016).…”

Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

“…Application of a tourniquet alone in cyclic fashion may also induce hypoalgesia. Cyclic restriction of limb blood flow has been shown to reduce pain following surgery, when applied both post-operatively [113] and perioperatively [114]. Moreover, cyclic application of BFR following an acute bout of muscle damage inducing exercise has been shown to reduce muscle soreness [115].…”

Learning Conditional Acoustic Latent Representation with Gender and Age Attributes for Automatic Pain Level Recognition

“…For example, pain level is one of the major factors used in the triage and acuity scale for emergency department to screen life-threatening patients [14,15]. Assessing pain also helps evaluate the effect of analgesia on postoperative, endodontic and multiple treatments [16,17] and is essential in improving quality of healthcare [18]. Currently, the clinical gold standard in pain assessment is done via individual's self-reported numerical scale.…”