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Targeted Medicine in Postoperative Pain Management
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Targeted Medicine in Postoperative Pain Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 20 April 2026 | Viewed by 5269

Special Issue Editors

Dr. Martina Rekatsina

E-Mail Website
Guest Editor
Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
Interests: chronic pain management; acute pain management; regional anaesthesia; anaesthesia; perioperative care
Dr. Eleni Moka

E-Mail Website
Guest Editor
Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: regional anaesthesia; acute pain management; cardiothoracic anaesthesia; anaesthesiology; enhanced recovery after surgery; perioperative care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue, "Targeted Medicine in Postoperative Pain Management", aims to provide a comprehensive platform for the latest advancements and innovations in the field of postoperative pain management. This collection seeks to explore targeted therapeutic approaches, precision medicine, and personalized interventions aimed at optimizing pain control and patient outcomes following surgical procedures.

This Special Issue welcomes original research articles, reviews, and clinical studies focusing on novel pharmacological agents, precision drug delivery systems, and individualized treatment regimens for postoperative pain.

By fostering a deeper understanding of targeted medicine in postoperative pain management, this Special Issue endeavors to advance clinical practice and improve the quality of care for surgical patients.

Dr. Martina Rekatsina
Dr. Eleni Moka
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • precision medicine
  • postoperative analgesia
  • pain control
  • drug delivery systems
  • surgical pain management
  • personalized interventions

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Published Papers (4 papers)

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Research

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11 pages, 1338 KB  
Article
Interfascial Injection Pressure Depending on Type of Regional Anesthesia Needle
by Wilk Mateusz, Jedrasiak Karol, Suwalska Aleksandra and Wodarski Piotr
J. Clin. Med. 2026, 15(4), 1458; https://doi.org/10.3390/jcm15041458 - 12 Feb 2026
Viewed by 458
Abstract
Introduction: Reliable identification regarding interfascial spaces proves essential to achieve successful nerve block analgesia; however, ultrasound guided approaches are recognized as challenging, particularly in obese or pediatric patients. In prior cadaveric and clinical investigations, multiple approaches were evaluated to identify methods for measuring [...] Read more.
Introduction: Reliable identification regarding interfascial spaces proves essential to achieve successful nerve block analgesia; however, ultrasound guided approaches are recognized as challenging, particularly in obese or pediatric patients. In prior cadaveric and clinical investigations, multiple approaches were evaluated to identify methods for measuring injection pressures as a function of needle position relative to fascia. Our previous study proposed simpler method of finding interfascial spaces with the needle tip. In this study, it was examined whether needle tip design influences injection pressures during regional anesthesia procedures, via an ex vivo pig specimen setup. Methods: A bespoke apparatus for tracking injection pressure was deployed to enable continuous measurement of intraluminal pressure generated while delivering saline throughout ultrasound guided peripheral nerve block needles conducted within pig thigh specimens. Delivery was performed using an infusion pump. Three types of needles of the same manufacturer (Pajunk) and same diameter (22G) but with different tips (Facet, Facet S and Sprotte) were used to measure injection pressures during penetration through tissues until interfascial plane hydrodissection was created. Statistical analyses were performed to compare pressure levels, variability, and temporal pressure trends. Results: Ninety ultrasound guided injections in porcine thigh tissue were analyzed, with thirty procedures per needle type. Injection pressure differed significantly between intramuscular, fascial puncture, and interfascial phases, showing a distinct puncture peak (p ≤ 3.44 × 10−14). Needle geometry significantly affected pressures across all phases (Kruskal–Wallis intramuscular p = 2.0 × 10−6, puncture p = 7.52 × 10−8, interfascial p = 9.2 × 10−5), with large pairwise effects (Hedges g up to 1.51). The classical tip produced the highest intramuscular and higher interfascial pressures, the sharp tip required the lowest puncture pressure, and the lateral tip yielded the lowest intramuscular and interfascial pressures. Conclusions: Needle tip geometry substantially influences pressure dynamics throughout the injection process, with the classical design associated with the highest fascia-penetration injection pressures and the sharp needle exhibiting the lowest, while the lateral design associated with lowest intramuscular-penetration and interfascial pressures. Full article
(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)
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14 pages, 914 KB  
Article
Pupillary Pain Index-Guided Postoperative Pain Therapy in ENT Surgery: A Randomized Trial
by Marita Windpassinger, Michal Prusak, Lusine Yeghiazaryan, Robin Ristl, Sascha Ott, Lukas M. Müller-Wirtz and Kurt Ruetzler
J. Clin. Med. 2026, 15(2), 462; https://doi.org/10.3390/jcm15020462 - 7 Jan 2026
Viewed by 515
Abstract
Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index—a pupillometry-derived measure of nociception-antinociception balance—may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the [...] Read more.
Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index—a pupillometry-derived measure of nociception-antinociception balance—may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the end of surgery reduces postoperative pain and opioid consumption compared with standard care. Methods: At the end of surgery, a portable infrared pupilometer was used to measure pupillary dilation reflex during stepwise tetanic stimulation (10–60 mA), generating a pupillary pain index score. Adult patients undergoing elective ear-nose-throat surgery under general anesthesia were randomized to pupillary pain index-guided opioid therapy or standard care. Opioid administration in the pupillary pain index group followed predefined pupillary pain index cutoffs; in the control group, analgesia was managed per routine practice. Postoperative opioid consumption and pain—assessed using a numerical rating scale (NRS, 0–10)—were recorded every 30 min for 2 h in the post-anesthesia care unit. Linear models with covariates including remifentanil, weight, nose surgery, and sex were calculated to compare outcomes between groups. Results: Mean (±SD) opioid consumption during the first 2 postoperative hours was 4.9 ± 4.3 mg in the pupillary pain index-guided group and 6.5 ± 4.3 mg in the control group (adjusted p = 0.12). Mean pain scores were 2.0 ± 1.1 and 2.6 ± 1.4, respectively (adjusted p = 0.10). Conclusions: Pupillary pain index-guided analgesia resulted in a nearly 25% reduction in opioid consumption and lower pain scores, although not statistically significant. This suggests that PPI-guided analgesia is not inferior to standard care in terms of pain management. Full article
(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)
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19 pages, 1153 KB  
Article
Prefrontal Cortical Near-Infrared Spectroscopy for Acute Pain Assessment in Infants: A Feasibility Study
by Matthias Nissen and Ralf-Bodo Tröbs
J. Clin. Med. 2025, 14(7), 2525; https://doi.org/10.3390/jcm14072525 - 7 Apr 2025
Cited by 2 | Viewed by 2094
Abstract
Background: Assessing pain in infants is challenging due to their inability to communicate discomfort. Accurate pain evaluation is essential, as unaddressed pain might lead to long-term neurological consequences. This study investigates the use of conventional two-site near-infrared spectroscopy (NIRS) to evaluate hemodynamic responses [...] Read more.
Background: Assessing pain in infants is challenging due to their inability to communicate discomfort. Accurate pain evaluation is essential, as unaddressed pain might lead to long-term neurological consequences. This study investigates the use of conventional two-site near-infrared spectroscopy (NIRS) to evaluate hemodynamic responses in the prefrontal cortex during nociceptive stimuli. Methods: Data were prospectively collected from ten infants undergoing elective heel lance/squeeze (HLS) after surgery. Continuous bilateral NIRS oxygenation monitoring was performed alongside cardiorespiratory and behavioral (Children’s and Infant’s Postoperative Pain Score (CHIPPS)) pain assessments before, during, and after HLS. The primary outcome was the correlation between NIRS response and CHIPPS. Results: The average gestational and postnatal ages were 39 weeks and 49 days. No significant changes in prefrontal oxygenation levels (left, right, combined, ipsilateral, contralateral) were observed during the first ten seconds of HLS compared with baseline. Although CHIPPS and heart rates increased, oxygenation levels remained unchanged throughout the entire HLS event. Significant fluctuations in oxygenation levels from baseline were recorded across all optode configurations, with changes in the lowest oxygenation levels at the contralateral and left hemispheres inversely correlated with CHIPPS and HR changes. Conclusions: While there were subtle alterations in NIRS signals suggesting potential nociceptive-evoked changes, these were inconclusive. By design, the utilized two-site conventional NIRS system may not effectively detect acute pain. Future studies on prefrontal cortical pain processing could benefit from confirmatory NIRS signals from the primary somatosensory and motor regions. Integrating data from fNIRS, fMRI, EEG, along with sympathetic indicators like skin conductance and heart rate variability, would improve the quantification of cortical pain processing in non-verbal infants. Full article
(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)
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Other

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12 pages, 435 KB  
Project Report
Trajectories of Pain in Low-Opioid and Opioid-Based Postoperative Analgesia in Older Patients—Perioperative Clinical Study
by Urszula Kosciuczuk, Marcin Talalaj and Ewa Rynkiewicz-Szczepanska
J. Clin. Med. 2025, 14(13), 4416; https://doi.org/10.3390/jcm14134416 - 20 Jun 2025
Viewed by 1380
Abstract
Background/Objectives: The use of opioid drugs in the elderly population is characterized by an increased risk of sedation and respiratory depression, and in the immediate postoperative period, it is associated with a higher incidence of postoperative delirium. The dilemma of opioid use [...] Read more.
Background/Objectives: The use of opioid drugs in the elderly population is characterized by an increased risk of sedation and respiratory depression, and in the immediate postoperative period, it is associated with a higher incidence of postoperative delirium. The dilemma of opioid use as an element of acute postoperative pain therapy is crucial in elderly patients. Methods: This study was conducted in 80 patients qualified for laparoscopic cholecystectomy under general combined anesthesia. Two methods of analgesia were performed—Low-Opioid Analgesia (LOA) and Opioid-Based Analgesia (OBA)—and pain intensity based on the Numerical Rating Scale (NRS) was assessed at 0–2, 2–6, 6–12, and 12–24 h after surgery. The mean NRS in LOA and OBA was compared in age categories. Pain trajectory in patients over 60 years old was compared between LOA and OBA. Results: The trajectory of analgesia presented a negative slope in LOA for patients over 60 years of age, with reductions in pain intensity of 33%, 25%, and 66%. In OBA, a positive slope trajectory was noted, and pain intensity was higher within 12–24 h after surgery than within 0–2 and 2–6 h. Conclusions: Opioid analgesia in patients over 60 years of age presented a better effect in the immediate postoperative period. Non-opioid analgesia is indicated for patients over 60 years old in the later postoperative period. The model of combined minimal opioid anesthesia and non-opioid postoperative analgesia presents a favorable therapeutic effect for patients over 60 years old. Full article
(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)
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