Personalization over Protocolization

Schreiber, Kristin L.; Muehlschlegel, Jochen D.

doi:10.1097/aln.0000000000003695

Cited by 10 publications

(8 citation statements)

References 7 publications

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“…Firstly, preoperative optimisation and early recovery bundles of care have been shown to improve overall outcome, 156 including, potentially, analgesic use 157 . Secondly, recent evidence has underlined the considerable interindividual difference in pain susceptibility, 158 which is influenced by readily identifiable risk factors such as preoperative opioid use, 159 and also biopsychosocial factors that require specific testing to uncover 160 . Thirdly, conversion of any laparoscopic abdominal surgery to open surgery will increase the complexity of postoperative pain management, increasing the need for more intense analgesic methods, such as multimodal analgesia, wound infiltration, 161 or regional anaesthesia 64 .…”

Section: Discussionmentioning

confidence: 99%

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk–benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.

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Section: Discussionmentioning

confidence: 99%

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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Section: Perioperative Pharmacologic Analgesic Strategiesmentioning

confidence: 99%

“…This is relevant to long-term pain recovery as there is substantial evidence demonstrating that postsurgical pain severity and duration are predominantly defined by patient factors. 18 , 80–86 As ERAS protocols often fail to allow for risk adjustment to patient-specific phenotypes, 87 it is essential that as clinicians, we prioritize the care of patients as individuals, including their previous pain experience and baseline characteristics, to determine an appropriate analgesic approach, particularly for those at higher risk of having more severe and prolonged pain after surgery. A regional anesthetic, for example, may be offered based on anatomical considerations of surgery type and the estimated severity of postoperative pain.…”

Section: Perioperative Pharmacologic Analgesic Strategiesmentioning

confidence: 99%

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

Einhorn,

Krishnan,

Poirier

et al. 2024

JPR

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Chronic postsurgical pain (CPSP) affects a significant proportion of children and adolescents after major surgery and is a detriment to both short-and long-term recovery outcomes. While clinical characteristics and psychosocial risk factors for developing CPSP in children and adults are well established in the literature, there has been little progress on the prevention and management of CPSP after pediatric surgery. Limited evidence to support current pharmacologic approaches suggests a fundamentally new paradigm must be considered by clinicians to both conceptualize and address this adverse complication. This narrative review provides a comprehensive evaluation of both the known and emerging mechanisms that support our current understanding of CPSP. Additionally, we discuss the importance of optimizing perioperative analgesic strategies to mitigate CPSP based on individual patient risks. We highlight the importance of postoperative pain trajectories to identify those most at risk for developing CPSP, the early referral to multi-disciplinary pain clinics for comprehensive evaluation and treatment of CPSP, and additional work needed to differentiate CPSP characteristics from other chronic pain syndromes in children. Finally, we recognize ongoing challenges associated with the universal implementation of available knowledge about pediatric CPSP into practically useful care plans for clinicians.

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“…[25][26][27][28] Her work is changing the way we think about personalizing perioperative care in an era of multiple enhanced recovery after surgery protocols that often dictate a one-size fits all approach. 29 Dr. Schreiber has a tremendous record of local, national, and international academic service, ranging from local institutional review board expert review and leadership in research infrastructure, to involvement in the Early-Stage Anesthesia Scholars program as part of International Anesthesia Research Society and serving as an Editor of Anesthesiology. In our own department, she has demonstrated exceptional leadership as the Associate Vice Chair for Research working together with our Vice Chair for Research, Dr. Danny Muehlschlegel.…”

mentioning

confidence: 99%

“…25–28 Her work is changing the way we think about personalizing perioperative care in an era of multiple enhanced recovery after surgery protocols that often dictate a one-size fits all approach. 29…”

mentioning

confidence: 99%

Kristin Schreiber, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

Rathmell

2022

Anesthesiology

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was awarded this year's James E. Cottrell, M.D. Presidential Scholar Award. This is a well-deserved honor for such a superb clinician-scientist. Dr. Schreiber's work has helped us to understand which patients are at highest risk for developing persistent postsurgical pain, while also probing personalized interventions to prevent this often debilitating outcome. I have followed her work, which overlaps with my own areas of research interest, watching her career develop over time, and so it gives me great pleasure to honor Dr. Schreiber with a few words about her career.Kristin received a Bachelor of Science degree with honors, from the University of Wisconsin-Madison (Madison, Wisconsin), majoring in Psychology and German. She then received an M.D./Ph.D. in Neuroscience from the University of Minnesota in Minneapolis, Minnesota. Work for her doctoral thesis investigated the bidirectional cross talk between the nervous and immune systems in pain and infection. She demonstrated this bidirectional communication in two diverse settings: activation of spinal microglia in the development of persistent and widespread pain, 1 and modulation of pathogen adherence and invasion in the gut by the enteric nervous system. 2,3 She went on to complete an Residency in Anesthesiology at the University of Pittsburgh (Pittsburgh, Pennsylvania), where she focused her passion for understanding the development of chronic pain into clinical applications in regional anesthesia 4 and the development of persistent postsurgical pain, 5 contributing to the peer-reviewed literature during a busy clinical residency. Dr. Schreiber joined us at Brigham and Women's Hospital for Regional Anesthesia and Research Fellowships in July 2012, simultaneously joining our faculty, where she is now Associate Professor of Anesthesia at Harvard Medical School and a Staff Anesthesiologist at Brigham and Women's Hospital specializing in Regional Anesthesia. During her 10 yr with our department, she has excelled both clinically as an exceptional Regional Anesthesiologist and a prolific translational Pain Neuroscientist.

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Personalization over Protocolization

Abstract: This editorial accompanies the article on p. 421.

Cited by 10 publications

References 7 publications

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

Kristin Schreiber, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

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