Category: Uncategorized

Every five years, anesthesiologists need to earn 125 Continuing Medical Education (CME) credits, and every 10 years, they need to have earned a total of 250 CME credits. These CME credits are critical to maintaining a certification in anesthesiology and being able to practice in the United States. [1,2].

Many institutions, including the Mayo Clinic for example, offer a variety of CME opportunities that includes live courses and conferences, podcasts, and online courses. Anesthesiologists and other physicians can take advantage of what CME options best suit them (within certain limitations).

CME courses aim to keep clinicians up to date on healthcare delivery, clinical practice, quality improvements, medical research and more in order to guide physicians, advanced practice providers, anesthesiologists, nurses, and certified nurse anesthetists best serve a patient. Anesthesiologists can shop around for their own CME credit courses via the American Society of Anesthesiologists’ online portal [3]. You can now specifically search for courses by the type of credit they offer and visit the Education Center dashboard for the latest free courses at any time. The American Society of Anesthesiologists also publishes a CME journal which is free for all American Society of Anesthesiologists members [4]. Other opportunities and databases for CME also exist.

CME credits are integral to board certification by the American Board of Anesthesiologists. This is important because since 1938, American Board of Anesthesiologists certification has been the process for certifying anesthesiologists in the United States. Patients trust board certification to ensure that a physician has acquired the knowledge, skills, and judgement required to provide safe and high-quality specialty care [5].

Though CME requirements do add to an anesthesiologist’s responsibilities, there are significant benefits to acquiring and maintaining certification [5]. Thorough training ensures that an anesthesiologist has the clinical judgment, technical expertise, and scientific knowledge required to provide excellent patient care. In addition, through the continuing education (CME) requirements, an anesthesiologist can stay up to date with the most recent medical advances. Finally, board-certified professionals are required to demonstrate their proficiency through an ongoing rigorous board certification process. Specific requirements for leadership and educational activities ensure physicians consistently meet the highest standards of professionalism.

CME credits continue to be key to maintaining an anesthesiologist’s board certification and ensuring the safest health care delivery possible across the United States.

References

1. CME – The American Board of Anesthesiology. Available at: https://www.theaba.org/maintain-certification/cme/. (Accessed: 9th December 2023)

2. Journal CME – 2023 Full Subscription | American Society of Anesthesiologists (ASA).

Available at: https://www.asahq.org/shop-asa/e023j00w00. (Accessed: 9th December 2023)

3. ShopASA for CME. Available at: https://www.asahq.org/shop-asa#sort=%40searchdate descending. (Accessed: 9th December 2023)

4. CME | Anesthesiology | American Society of Anesthesiologists. Available at: https://pubs.asahq.org/anesthesiology/pages/cme. (Accessed: 9th December 2023)

5. Value of Board Certification – The American Board of Anesthesiology. Available at: https://www.theaba.org/get-certified/value-of-board-certification/. (Accessed: 9th December 2023)

Robotic surgery is a developing field that utilizes the precision of machines to assist surgeons. Several studies demonstrate that robotic surgery is superior to human executed surgery for certain procedures, and there are currently a number of different applications of robotic surgery in medicine. Overall, robotic surgery is typically used to increase control over surgical tools, reduce the invasiveness of a procedure, and incorporate helpful visualizations.

 

Groysman et al. studied a cohort of patients who underwent surgery for oropharyngeal squamous cell carcinoma to compare patient outcomes from non-robotic surgery with those from transoral robotic surgery (TORS). The results showed that non-robotic surgery was more likely to leave residual tumor when compared to TORS. The success rate of TORS is driven by its use of articulating arms which enhances tumor extraction and a high-definition endoscope which enhances visibility.  Because of residual tumor, patients who underwent non-robotic surgery were more likely to receive chemotherapy to treat residual tumor.¹ These possibilities make tumor removal one of the applications of robotic surgery.

 

There are many benefits of robotic surgery, which Gauci et al. categorize in their assessment of implementing robotic techniques to treat advanced colorectal cancer. The minimally invasive approach features smaller incisions, reduced postoperative pain, reduced blood loss and thus faster recovery times. Enhanced visualization reduces complications because it enhances identification and thus dissection. Supportive technologies like indocyanine green integrates with robotic systems for superior anatomical assessments. Surgeons who use robotic technologies report improved comfort and reduced physical demand since these procedures can last up to 8 hours. Dual console surgery allows two surgeons to work on tumor removal simultaneously. The wristed components of robotic systems increase precision which is critical to preserve adjacent organs and blood vessels. Overall clinical outcomes are better; shorter hospital stays, reduced ICU visits and faster recovery have been reported.²

 

Other applications of robotic surgery can improve results in complicated procedures. Gul’s study does an in-depth comparison of complex gynecological procedures that benefit from robotic techniques. Patients with obesity and endometrial cancer, high BMI and fibroid masses, rectovaginal disease, frozen pelvis, or retroperitoneal masses, and those needing neuropelveology procedures (surgeries targeting sacral pudendal nerves), posterior myomectomies, , abdominal mesh vault suspensions and mesh removals are complex pelvic cases that have better suited for robotic surgeries. Like Gauci et al., Gul explains that the enhanced precision and visualization of robotic surgery improve surgical outcomes. In addition to the benefits listed by Gauci et al., robotic systems in gynecology have a 57 Newton grip force, 7 degrees of freedom during wrist like motions, virtual reality, a computer interface, and no hand tremors due to scaling and filtration. Patient benefits can include complete disease removal, early recovery and return to normal activities as well as reduced pain.

 

Ballet et al.’s study reports positive findings for treating pelvic cancers with robotic surgical techniques. The Da Vinci Xi robotic system was selected to replace the typical laparoscopic method which has ergonomic limitations. Purported benefits of this system include that fewer incisions are needed to achieve triangulation of surgical zone, switching to laparotomy is not required when laparoscopy cannot perform complex surgical techniques, and visualization is fully optimized. While patients are usually left with four scars from the standard laparoscopic method, one scar is the outcome when the Da Vinci Xi robotic system is applied.

 

IIn many cases, applications of robotic surgery are improving surgical results across various parameters. These parameters include patient recovery, disease complexity, workplace stress for physicians, scarring and most importantly, disease treatment.⁴ However, it is important to note that robotic surgery is not currently appropriate or applicable to all cases.

 

References

 

1. Groysman M, Gleadhill C, Baker A, Wang SJ, Bearelly S. Comparison of margins and survival between transoral robotic surgery (TORS) and non-robotic endoscopic surgery for oropharyngeal cancer. Am J Otolaryngol. 2023 Nov-Dec;44(6):103982. doi: 10.1016/j.amjoto.2023.103982. Epub 2023 Jul 6. PMID: 37531886.

2. Chahaya Gauci, Praveen Ravindran, Stephen Pillinger, Andrew Craig Lynch, Robotic surgery for multi-visceral resection in locally advanced colorectal cancer: Techniques, benefits and future directions, Laparoscopic, Endoscopic and Robotic Surgery, 2023,ISSN 2468-9009,

3. Nahid Gul. Robotic surgery in gynaecology. Obstetrics, Gynaecology & Reproductive Medicine, Volume 32, Issue 12, 2022, Pages 267-271, ISSN 1751-7214.

4. Elodie Ballet, Clement Rousseau, Tiphaine Raia Barjat, Céline Chauleur, Robotic retroperitoneal para-aortic lymphadenectomy via single-site port, Journal of Gynecology Obstetrics and Human Reproduction, Volume 52, Issue 10, 2023, 102675, ISSN 2468-7847.

The healthcare landscape in the United States is extremely complex, marked by exchanges and relationships between providers, insurance companies, patients, and hospitals. The competition among hospitals has significant potential to affect both healthcare providers and patients. The dynamics of hospital market competition in the US have changed greatly in the past few decades. The Affordable Care Act, passed in 2010, launched Medicare Value-Based Purchasing, informing the discourse surrounding hospital competition in the United States (Haley et al., 2016). The debate over hospital competition in the US remains an important and continuously evolving issue, especially given the substantial amount of healthcare spending in the United States (National CMS, 2017).

In recent years, hospital markets have become increasingly monopolized, with prominent health systems dominating heavily in many areas. In the United States, each region generally has 3 to 5 consolidated healthcare systems (Cutler and Morton, 2013). For example, between 2007 to 2017, the number of hospitals in the US grew from 2741 to 4597. In this same period, the percentage of hospitals in the U.S. affiliated with a health system increased from 53.4% to 64.3%. Remarkably, the number of health systems underwent little change. While the overall hospital market expanded in terms of beds, admissions, and inpatient days from 2007 to 2017, and the size of the overall hospital market has decreased (Johnson and Frakt, 2020).

Of note, hospitals located in more competitive markets have been associated with lower mortality rates for patients dealing with conditions such as myocardial infarction, heart failure, and pneumonia. This may point to potential benefits of hospital market competition. However, policymakers must strive to develop policies that promote a competitive, yet equitable and transparent healthcare marketplace to enhance patient outcomes (Haley et al., 2016).  Some advantages of consolidated health systems are the ability to coordinate complex care across a variety of providers and sites (Cutler and Morton, 2013).

As hospital competition decreases and markets become more concentrated, healthcare costs tend to increase, according to US data (Cutler and Morton, 2013). Concentrated healthcare networks have the leverage to demand higher insurance premiums and out-of-pocket expenses from patients. Policy interventions must therefore target the pricing strategies that these systems enforce on patients (Johnson and Frakt, 2020). At a local level, governments must propose policies that ensure customer protection in the face of market consolidation and a subsequent increase in healthcare costs (Cutler and Morton, 2013)

In conclusion, the landscape of hospital competition in the US is intricate, multifaceted, and in a constant state of flux. While discussing hospital competition, it is crucial to consider various factors, including the quality of care, patient satisfaction, cost innovation, regulation, as well as partnerships and collaboration. By addressing these dynamics, policymakers and relevant stakeholders can ensure a competitive yet fair and transparent healthcare marketplace that benefits patients.

References

Cutler, David M, and Fiona Scott Morton. “Hospitals, market share, and consolidation.” JAMA vol. 310,18 (2013): 1964-70. doi:10.1001/jama.2013.281675

Haley, Donald Robert et al. “The Influence of Hospital Market Competition on Patient Mortality and Total Performance Score.” The health care manager vol. 35,3 (2016): 266-76. doi:10.1097/HCM.0000000000000117

Johnson, Garret, and Austin Frakt. “Hospital markets in the United States, 2007-2017.” Healthcare (Amsterdam, Netherlands) vol. 8,3 (2020): 100445. doi:10.1016/j.hjdsi.2020.100445

National CMS. “Health Expenditures Fact Sheet, 2017.” CMS.Gov, Centers for Medicare & Medicaid Services, 2017, www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet.

Ultrasound technology harnesses high-frequency sound waves beyond the hearing abilities of humans. Ultrasonography operates with probes which generate sound waves and capture what is reflected, which is then transformed into an image on a screen (Li et al., 2020). Portable ultrasound devices have been increasingly integrated into the operating room (OR) and have become a vital tool in modern medicine. Often referred to as point-of-care ultrasound (POCUS), this technology offers real-time imaging capabilities. In the operating room, this allows surgeons to make decisions during procedures quickly and with more information.  

Portable ultrasound can decrease the use of invasive procedures, including exploratory surgery, when it is unnecessary. With ultrasound, surgeons can assess the need for invasive measures more accurately (Bollard, et al., 2021). Portable ultrasound devices also provide real-time feedback in the OR. This enables surgeons to monitor changes and adapt their approach during complex surgery.  

Various surgical disciplines benefit from the incorporation of portable ultrasound in the OR. Some surgeries that utilize portable ultrasound include abdominal surgeries. For example, with portable ultrasound in liver or kidney surgeries, surgeons assess blood flow, identify anatomical variations, and detect abnormalities. The POCUS is especially important in detecting free fluid around the abdominal structures, which poses a surgical emergency (Abu-Zidan & Cevik, 2018). Even in plastic surgery, the portable ultrasound has had unique uses (Safran et al., 2018). Ultrasound can be used to visualize anatomy and offer an energy source for procedures. For example, in hand surgeries, POCUS allows surgeons to localize foreign bodies and guide procedures (Bollard, et al., 2021).  

Portable ultrasound is not only used on the surgeon’s side in the OR. Anesthesiologists use various forms of ultrasound during surgical procedures to monitor patients. For example, they may use transesophageal echocardiography to manage and watch cardiac and non-cardiac patients in the surgical setting. Cardiac ultrasound can detect pulmonary embolism and cardiac tamponade and guide immediate treatment (Kalagara, et al., 2022). Anesthesiologists may also complete ultrasounds of the lung to diagnose hypoxia, confirm proper placement of an endotracheal tube, or locate the cricothyroid membrane when securing an airway. Anesthesia may also do a gastric ultrasound to help understand the gastric contents of a patient. However, this type of ultrasound is more controversial (De Marchi & Massimiliano, 2017). For patients who have challenging airways, need emergency surgery, or have certain comorbidities, gastric ultrasound may help assess aspiration risk (Li et al., 2020).  

Ultrasound is becoming increasingly integrated in medical education. It is critical that medical students, residents, fellows, and physicians receive proper training on POCUS. An ultrasound’s effectiveness is very dependent on the operator’s skill and their ability to read the image produced by the ultrasound (Li et al., 2020). In anesthesia, where POCUS is of great use in the operating room, there is no standardized education. However, more groups have started organizing education series on this topic and creating frameworks for POCUS education (Li et al., 2020).  

In conclusion, the incorporation of portable ultrasound into the operating room is revolutionizing surgery by enhancing precision, reducing invasiveness, and enabling real-time assessment of anatomical structures and surgical procedures. These devices have become indispensable for surgeons across various medical specialties and for anesthesiologists. As ultrasound technology advances, their prevalence in the operating room is bound to grow. It is vital that research continues to assess best practices for utilizing this transformative technology.   

References 

1) Abu-Zidan, Fikri M, and Arif Alper Cevik. “Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced.” World journal of emergency surgery : WJES vol. 13 47. 15 Oct. 2018, doi:10.1186/s13017-018-0209-y 

2) Bollard, Stephanie Marie et al. “The Use of Point of Care Ultrasound in Hand Surgery.” The Journal of hand surgery vol. 46,7 (2021): 602-607. doi:10.1016/j.jhsa.2021.02.004 

3) De Marchi, Lorenzo, and Massimiliano Meineri. “POCUS in perioperative medicine: a North American perspective.” Critical ultrasound journal vol. 9,1 19. 9 Oct. 2017, doi:10.1186/s13089-017-0075-y 

4) Kalagara, Hari et al. “Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist.” Journal of cardiothoracic and vascular anesthesia vol. 36,4 (2022): 1132-1147. doi:10.1053/j.jvca.2021.01.018 

5) Li, Linda et al. “Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview.” Current pain and headache reports vol. 24,5 20. 21 Mar. 2020, doi:10.1007/s11916-020-0847-0 

6) Safran, Tyler et al. “The role of ultrasound technology in plastic surgery.” Journal of plastic, reconstructive & aesthetic surgery : JPRAS vol. 71,3 (2018): 416-424. doi:10.1016/j.bjps.2017.08.031 

Perioperative and regional anesthesia management for patients on anticoagulation can pose a major problem. Typically, anticoagulants, i.e. blood thinners, are prescribed for patients who are at risk for clotting or thromboses. Common indications for this medication include atrial fibrillation, deep venous thromboses, and mechanical heart valves¹. When stopping anticoagulation abruptly, such as for a surgery, rebound hypercoagulability can occur. Meanwhile, keeping a patient on anticoagulation during surgery or neuraxial anesthesia increases the risk of bleeding and hematoma formation. As a result, there are special considerations needed when administering anesthesia to patients on blood thinners. 

One area of anesthesia where these considerations about bleeding risk on blood thinners are especially important is epidurals placed in the spinal cord. Bleeding risk increases with age, presence of a coagulopathy, abnormalities of the spinal cord, or a prolonged indwelling neuraxial catheter while on anticoagulation². Interestingly, the anesthesia management of patients differs depending on what anticoagulant a patient is taking². This is due to the differing pharmacokinetic and pharmacodynamic profile of each anticoagulant class. Further, patient and surgery specific factors must be taken into account when managing an anticoagulant with anesthesia.  

The American Society of Regional Anesthesia and Pain Medicine (ASRA) has summarized practice guidelines and recommendations regarding management of anticoagulant agents for regional anesthesia. This can apply to neuraxial blockades and the removal of catheters including epidurals to reduce risk of hematomas³. However, for patients prior to surgery, the evaluation is different. Bleeding risk is assessed with the HAS-BLED score which represents hypertension, abnormal liver or kidney function, stroke, bleeding history or predisposition, labile International Normalized Ratio [INR], elderly, drugs and alcohol. Each variable is one point, and a score greater than three indicates a high bleeding risk⁴. The HAS-BLED score has been found to be a reliable predictor for perioperative bleeding risk and can be used as a guideline for stratifying patients into low and high risk⁵.  

For patients with recent venous thromboembolism (VTE) or an ischemic stroke, the risk of recurrence or a major cardiovascular event is high. Thus, for these patients, recommendations are to defer surgery up to 3 months for those with a VTE and 9 months for those with a recent ischemic stroke⁶. Further, for patients at particularly high risk for thromboembolism, bridging therapy may be required according to traditional recommendations. This involves replacing a long-acting anticoagulant, such warfarin, with a short-acting one, such as low-molecular weight heparin, prior to surgery. Of note, current data has disputed the efficacy of bridging therapy and thus its use remains in question⁴. 

Overall, while there are guidelines in place from the ASRA for regional anesthesia, perioperative management of anticoagulation requires a different approach. Along with using valid scores like HAS-BLED, using clinical judgement while considering patient factors and the timing of surgery is important.  Both for regional anesthesia and perioperatively, balancing risks and benefits in patients is key. With the development of new oral anticoagulation agents and the decreased need for monitoring, such as with apixaban and dabigatran, considerations for anesthesia for patients on blood thinners may be able to be simplified and streamlined to optimize benefits of surgery while minimizing patient risk of either bleeding or thromboses.   

References 

1. Shaikh SI, Kumari RV, Hegade G et al. Perioperative Considerations and Management of Patients Receiving Anticoagulants. Anesth Essays Res 2017; 11 (1): 10-16. 

2. Horlocker TT. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br J Anaesth 2011; 107 Suppl 1: i96-106. 

3. Gogarten W, Vandermeulen E, Van Aken H et al. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol 2010; 27 (12): 999-1015. 

4. Polania Gutierrez JJ RK. Perioperative Anticoagulation Management. Treasure Island (FL): StatPearls Publishing. 2021. 

5. Omran H, Bauersachs R, Rubenacker S et al. The HAS-BLED score predicts bleedings during bridging of chronic oral anticoagulation. Results from the national multicentre BNK Online bRiDging REgistRy (BORDER). Thromb Haemost 2012; 108 (1): 65-73. 

6. Hornor MA, Duane TM, Ehlers AP et al. American College of Surgeons’ Guidelines for the Perioperative Management of Antithrombotic Medication. J Am Coll Surg 2018; 227 (5): 521-536 e521. 

Non-operating room anesthesia, also known as NORA, refers to the use of anesthesia in settings outside of a traditional operating room. Non-operating room anesthesia is used in intensive care, gastroenterology, cardiology, and other areas of medicine for various diagnostic and interventional procedures (2). While NORA offers several benefits, non-operating room anesthesia has been documented to have a higher incidence of malpractice resulting in preventable deaths compared to traditional anesthesia delivered in operating rooms (5). Implementing precautionary measures to ensure patient safety when delivering non-operating room anesthesia can improve patient outcomes as the use of NORA continues to grow. 

Despite some of its associated safety concerns, non-operating room anesthesia offers a number of benefits to patients. For example, NORA allows for procedures to be performed in settings that are more convenient and comfortable for patients compared to an operating room, such as a doctor’s office or a clinic. This can reduce the need for hospitalization and result in cost savings for patients. Additionally, NORA can improve patient outcomes by allowing patients to undergo less invasive procedures that can be performed more quickly and efficiently (1). 

One of the most common issues with non-operating room anesthesia is that procedures performed outside of the operating room may not have the same safety protocols in place as those in a traditional setting (1). The locations where NORA is performed may not have the proper anesthesia equipment necessary to safely deliver anesthesia and monitor patients. Additionally, the location may lack proper lighting or have restricted mobility that limits access to patients (2). There may also be fewer staff with anesthesia training on site compared to a hospital setting (4). A single anesthesiologist may be responsible for providing all aspects of anesthesia care. Malpractice claims for non-operating room anesthesia have a higher rate of death compared to traditional anesthesia (5). Inadequate oxygenation and ventilation are the most common cause of death in NORA settings, accounting for a third of NORA malpractice claims (5). That being said, with proper safety protocols, non-operating room anesthesia is a valuable part of modern medicine. 

Improving the safety of non-operating room anesthesia requires diligence on the part of providers and appropriate work environments and safety procedures (2). Providers should take care to assess patient risk prior to administering anesthesia, monitor patients’ vitals during the procedure, and provide proper postoperative care. In particular, intraoperative monitoring needs to be held to the same high standards in place in a traditional operating room to ensure proper oxygenation and circulatory function (4). 

Moreover, collaboration between anesthesiologists and staff who are present during non-operating room anesthesia is necessary to develop safety plans when delivering NORA. Conducting comprehensive patient assessments prior to the procedure and offering adequate pain control and postoperative monitoring is essential to improving patient outcomes (4). As technologic advancements in medicine continue to increase, the menu of less invasive procedures suitable for NORA will grow in number. As a result, improved safety measures for non-operating room anesthesia can contribute to higher standards of healthcare for older and high-risk patients (1). 

References 

1. Bonovia et al. “Non-operating room anesthesia in the intensive care unit.” Journal of Clinical Anesthesia, vol. 78, June 2022, doi: 10.1016/j.jclinane.2022.110668 

2. Herman et al. “Morbidity, mortality, and systems safety in non-operating room anesthesia: a narrative review.” British Journal of Anesthesia, vol. 127, no. 5, pp. 729-744, Nov 2021, doi: 10.1016/j.bja.2021.07.007 

3. Maddirala, Subrahmanyam, and Annu Theagrajan. “Non-operating room anaesthesia in children.” Indian journal of anaesthesia vol. 63,9 (2019): 754-762. doi:10.4103/ija.IJA_486_19 

4. Wong, Timothy et al. “Non-Operating Room Anesthesia: Patient Selection and Special Considerations.” Local and regional anesthesia vol. 13 1-9. 8 Jan. 2020, doi:10.2147/LRA.S181458 

5. Woodward, Zachary G et al. “Safety of Non-Operating Room Anesthesia: A Closed Claims Update.” Anesthesiology clinics vol. 35,4 (2017): 569-581. doi:10.1016/j.anclin.2017.07.003 

Getting a good night’s rest before undergoing surgery can help reduce the levels of postoperative pain that you experience and even protect you from developing chronic postoperative pain (1). Sleep and pain have a bidirectional relationship that has been well-established in the medical literature. A decline in sleep quality correlates with an increase in the risk of developing new pain and experiencing an increase in existing pain, while existing pain can also diminish sleep quality (4). Discerning the various factors that can exacerbate acute and chronic pain after surgery is essential for improving the quality of life for patients and developing better methods of pain management. One potential step toward the ongoing goal of reducing pain and improving patient comfort postoperatively is emphasizing the importance of sleep before surgery. 

Eighty percent of surgery patients experience moderate to severe pain immediately after undergoing an operation, and the majority of these patients are still experiencing pain when they are discharged from the hospital (1). As many as ten to fifty percent of patients, furthermore, can develop chronic pain as a result of surgery (1). Research suggests that disrupted sleep the night before surgery plays a major role in exacerbating the severity of postoperative pain. 

In one study, patients with lower sleep efficiency the night before breast-conserving surgery had significantly higher levels of postoperative pain in the weeks following the operation compared to those that did not experience sleep disturbances (5). Accordingly, sleep continuity (having fewer disruptions) appears to have a greater impact on the level of pain a patient experiences after surgery compared to sleep duration (5). This may be because sleep disruption affects the acute stress response that takes place in the body in response to a surgical operation, involving complex interactions between the neuroendocrine, immune, and metabolic systems (5). 

While the reciprocal relationship between sleep and pain and the importance of sleep continuity has been well-established, the mechanisms behind the effect that sleep has on postoperative pain are less clear. In another study, the preemptive administration of caffeine to lab rats who had been deprived of sleep prior to a surgical incision prevented the increase in levels of mechanical hypersensitivity and time to recovery that were seen in the control group, who didn’t receive caffeine (1). The results suggest that the neurotransmission of adenosine—a sleep-promoting neuromodulator that affects sleepiness—may play a role in the relationship between sleep and pain. Since caffeine acts as an adenosine receptor antagonist, it may help reduce postoperative pain in rats who were sleep deprived prior to surgery by affecting adenosine-dependent mechanisms. 

Improving the quality of sleep for patients before surgery is critical to improving surgical outcomes and quality of life for patients. Non-pharmacological and pharmacological methods can be combined to encourage healthier sleep habits in patients, both before, during, and after their time at the hospital. Practicing good sleep hygiene, relaxation techniques, and CBT and ACT-based therapies for treating insomnia can help combat sleep disturbances and improve sleep quality (4). In the case of patients who need pharmacological treatments for sleep, medications like benzodiazepines or supplements like melatonin may help improve sleep in the short-term (4). 

Ultimately, multiple factors affect the severity of postoperative pain, including sociological, demographic, psychological, and biological elements (1). Those who experience surgery-related anxiety due to fear of death, pain, or financial reasons are especially vulnerable to poor sleep the night before surgery. Promoting high-quality sleep through good sleep habits and addressing the sociodemographic factors that may play into poor sleep for a patient can help improve surgical outcomes and prevent patients from developing chronic postoperative pain. 

References 

1. Hambrecht-Wiedbusch, Viviane S et al. “Preemptive Caffeine Administration Blocks the Increase in Postoperative Pain Caused by Previous Sleep Loss in the Rat: A Potential Role for Preoptic Adenosine A2A Receptors in Sleep-Pain Interactions.” Sleep, vol. 40, 9 (2017), zsx116, doi: 10.1093/sleep/zsx116 

2. Luo, ZY., Li, LL., Wang, D. et al. Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study. J Orthop Surg Res 14, 378 (2019). https://doi.org/10.1186/s13018-019-1446-9 

3. Mohammad, Hamid et al. “Sleeping pattern before thoracic surgery: A comparison of baseline and night before surgery.” Heliyon vol. 5,3 e01318. 12 Mar. 2019, doi:10.1016/j.heliyon.2019.e01318] 

4. Sipila, Reetta M. and Eija A. Kalso. “Sleep Well and Recover Faster with Less Pain—A Narrative Review on Sleep in the Perioperative Period.” Journal of Clinical Medicine, vol. 10, 9 (2021). doi: 10.3390/jcm10092000 

5. Wright, Caroline E et al. “Disrupted sleep the night before breast surgery is associated with increased postoperative pain.” Journal of pain and symptom management, vol. 37, 3 (2009): 352-62. doi:10.1016/j.jpainsymman.2008.03.010