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Program
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CME
Declaration

This program features the recording of the webinar Preventing Chronic Postoperative Pain, held on the ESA Academy on September 25, 2018, between 18:00 and 19:00 CEST.
 

Webinar Scientific Faculty 
Host:
Professor Andreas Sandner-Kiesling, MD | Department of Anaesthesiology and Intensive Care Medicine | Medical Director of the Acute Pain Management Optimisation Project | Medical University of Graz, Austria

Speakers:
Professor Patricia Lavand’homme MD, PhD | Department of Anaesthesiology | Head of the Acute Pain Service | Cliniques Universitaires St Luc | University Catholic of Louvain, Brussels, Belgium

Professor Stephan A Schug MD FANZCA FFPMANZCA EDPM | Chair of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia | Director of Pain Medicine, Royal Perth Hospital | Perth, Australia

Scientific Support:
Vesa Kontinen, MD, DMedSci | Head of Department | Department of Anesthesiology and Intensive Care Medicine, Jorvi hospital | Helsinki University Central Hospital & University of Helsinki

Key points of this webinar:
• Preoperative identification of patients at risk for the development of CPP
• Preoperative prevention of the development of CPP
• Intraoperative surgical factors and approaches to prevent CPP
• Intra- and postoperative multimodal analgesia concepts for the prevention of CPP

Content:
1. CPP appears more frequently than considered and can be a serious burden for patients and their family
     a. Six to 56% of patients develop CPP, depending on the type and region of surgery
     b. CPP is most often neuropathic
     c. Neuropathic CPP is usually more excruciating than nociceptive pain, thus more likely affecting the patient’s and his family life.

2. Certain preoperative risk factors support the development of CPP
     a. Moderate to severe preoperative pain lasting longer than one month increases the risk
     b. Ineffective diffuse noxious inhibitory control (DNIC) increases the risk, but the assessment of this factor needs extra preoperative testing
     c. Females are more like to develop CPP compared to males
     d. Preoperative anxiety and psychological vulnerability like catastrophizing increases the likelihood for the development of CPP

3. Prevention of CPP starts preoperatively
     a. Psychological support is recommended in patients with preoperative anxiety or psychological vulnerability
     b. Premedication with pregabalin may reduce the development of CPP

4. Surgeons can support the prevention of CPP
     a. Laparoscopic approaches are less likely to support the development of CPP compared to open surgery, since it involves less nerve damage
     b. Wound infiltration may reduce the need for postoperative analgesia and the development of CPP ESA WEBINAR 2

5. Multimodal analgesia is an effective method to prevent CPP
     a. Neuraxial anaesthesia or peripheral nerve blocks reduce the incidence of CPP
     b. Perioperative pregabalin or ketamine have the greatest probability to reduce the incidence of CPP
     c. Increasing evidence supports the use of intravenous lidocaine perioperatively in the prevention of CPP
     d. Large multicentre RCTs need to provide better evidence for a clear message on the pharmacological prevention of CPP

6. Continuity of care of a patient who has persistent or intensive pain after the surgery
     a. Individualised treatment is needed in the immediate postoperative period, but also studies to support this
     b. Pain management (e.g. tapering of the analgesics or changing to chronic pain treatment) is needed after discharge from hospital (e.g. APS-out patient clinic or other contact)
     c. Prolonged opioid treatment after surgery is one of the reasons behind the opioid crisis in USA and elsewhere, and need to be avoided

Knowledge acquired after attending this program: after this program, the participant knows that … 
• CPP is a frequent and serious threat to postoperative or posttraumatic patients
• If CPP is neuropathic, then it becomes a real burden for the patient and his family
• Surgery tends to a certain percentage of CPP, with some types or regions more likely than others (e.g. amputation, thoracotomy, CABG, mastectomy, etc.)
• Some patients carry a risk for the development of CPP with them, and can be proactively protected
• Surgeons can actively prevent CPP by choosing certain routes of surgical access or application of local anaesthetics
• Anaesthesiologists can also prevent CPP by applying a multimodal analgesic concept to the patient including regional anaesthesia 

Practical skills to be acquired after attending this program: The participant is able to … 
• Filter patients at risk for the development of CPP preoperatively
• Differentiate between surgical approaches with more or less risk for the development of CPP
• Plan an effective multimodal analgesic approach perioperatively
• Develop a standard operating procedure to reduce CPP at his institution. 

Affective skills acquired after attending this program: The participant is aware of:
• CPP as a frequent and serious threat to postoperative or posttraumatic patients.
• That our preventive support is continuously needed
• CPP as a potential real burden for the patient and his family
• The benefit of an implementation concept and protocol for the prevention of CPP in the patients he is responsible for.
• The fact that only a team approach ensures a good CPP prevention including anesthesiologists, surgeons, nurses, psychologists, etc.

Anaesthesiologists and surgeons who are aware of chronic postoperative or posttraumatic pain (CPP) being a frequent threat to patients and who want to prevent its development as best as possible

Pain Specialists who treat these patients and want to update their knowledge about perioperative risk factors and new developments on how to prevent its development

1 CME

Host

•Prof. Dr. Andreas Sandner-Kiesling

Speakers

•Prof. Dr. Stephan A Schug

•Prof. Dr. Patricia Lavand’homme

Scientific Support

•Dr. Vesa Kontinen

The Scientific faculty declares that the material in this webinar is free from any conflict of interest, in accordance with ESA and UEMS guidelines

Webcast on Preventing Chronic Postoperative Pain
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