Background: As a subjective sensation, pain is difficult to evaluate objectively. The assessment of pain degree is largely dependent on subjective methods such as the numeric rating scale (NRS). The PainVision^TM system has recently been introduced as an objective pain degree measurement tool. The purpose of this study was to analyze correlations between the NRS and the current perception threshold (CPT), pain equivalent current (PEC), and quantified pain degree (QPD). Methods: Medical records of 398 subjects who visited the pain clinic in a university hospital from March 2017 to February 2019 were retrospectively reviewed. To evaluate the pain degree, NRS, CPT, PEC, and QPD were measured. Subjects were categorized into two groups: the Pain group (n = 355) and the No-pain group (n = 43). Results: The NRS showed a negative correlation with CPT (R = −0.10, p = 0.054) and a positive correlation with QPD (R = 0.13, p = 0.008). Among various diseases, only spinal disease patients showed a negative correlation between CPT and NRS (R = −0.22, p = 0.003). Additionally, there were significant differences in CPT and QPD between the Pain and No-pain groups (p = 0.005 and p = 0.002, respectively). Conclusions: CPT and QPD measured using the PainVision^TM system could be used to estimate pain intensity and the presence of pain. These parameters would be considered useful for predicting pain itself and its intensity.

Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. Here, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient's pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m². There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB’s effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery.

Background: Prediction of difficult airway is important for airway management in patients undergoing surgery. The assessment of airway structures and establishment of protective airway strategies are essential to improve patient safety. However, the association between successful palpation of the cricothyroid membrane and airway predictions has not been fully elucidated in patients undergoing surgery. We investigated this in female patients undergoing non-neck surgery. Methods: A total of 68 female patients were enrolled in this prospective observational cohort study between January 2021 and June 2021 at Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea. Exclusion criteria were male patients and those with neck pathology or neck surgery. The assessment of difficult airway was performed before the induction of anesthesia and was defined by one of the following conditions: inter-incisor distance < 3 fingerbreadths, hyoid-to-mental distance < 3 fingerbreadths, and thyroid-to-hyoid distance < 2 fingerbreadths (the “3-3-2 rule”). The accuracy of palpable identification of the cricothyroid membrane was confirmed by ultrasonography (US). The patients were divided into the non-difficult airway (NDA) group (n = 30) and the difficult airway (DA) group (n = 30). Results: The two groups were comparable in terms of age, but the DA group had higher body mass index (BMI). In airway assessment, 9 patients showed inter-incisor distance < 3 fingerbreadths, 3 patients showed hyoid-to-mental distance < 3 fingerbreadths, and 24 patients showed thyroid-to-hyoid distance < 2 fingerbreadths in the DA group. The rate of successful palpation of the cricothyroid membrane was higher in the patients without than in those with difficult airway variables. Conclusions: Patients with a positive 3-3-2 rule showed a poor palpability of cricothyroid membrane.

Ultrasound-guided interscalene block is a widely used analgesic technique for shoulder surgery, but its optimization is constrained by trade-offs between analgesic efficacy, motor impairment, and hemidiaphragmatic paresis. Shear wave elastography (SWE) quantifies tissue stiffness and has been proposed as a complementary, objective measurement that may help characterize the mechanical environment of nerves and muscles before and after local anesthetic injection. This narrative review synthesizes current evidence on SWE of the brachial plexus and deltoid muscle, with emphasis on technical considerations, reported reference values, and potential relevance to local anesthetic optimization in interscalene block. Available data show that SWE can quantify nerve and muscle mechanical properties, but direct clinical evidence in interscalene block remains limited; reproducibility at the cervical root level is variable; and, to date, no study has validated either brachial plexus SWE as a marker of intraoperative sensory blockade or deltoid SWE as a marker of regional anesthesia-induced motor block. We therefore propose a hypothesis-generating dual-target framework in which paired nerve and muscle SWE is investigated, alongside sensory testing, diaphragmatic assessment, and patient-reported recovery outcomes, as an exploratory surrogate of the local anatomical and mechanical changes that accompany the block, rather than as a direct readout of sensory or motor blockade itself. Standardized acquisition protocols, attention to floor effects in muscle measurements, and prospective validation studies are required before SWE can be considered a clinically actionable tool for patient-centered interscalene block.