PMC6582303_01
Patient after hospital admission, showing an abnormal posture (back kyphosis, retracted abdomen)
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When reassessing pain, mechanical allodynia was evidenced by an extreme reaction when the skin was lightly rubbed and stroked with fingers or a gauze, and thermal hyperalgesia was revealed as marked sensitivity when placing an icepack (Figure 1).
Patient during anesthesia recovery with 15 points on the UNESP-Botucatu multidimensional composite pain scale
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The patient continued with abdominal pain (UNESP-Botucatu MCPS score 15/30), mechanical allodynia, thermal hyperalgesia and a facial expression characterized by narrowed eyes (Figure 2).
Patient after multimodal analgesia (12 points on UNESP-Botucatu multidimensional composite pain scale)
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Pain score decreased to 12/30 1 h after EA (Figure 3) but remained higher than the score described for rescue analgesia (>7/30).
Twenty-four hours postoperatively (6 points on UNESP-botucatu multidimensional composite pain scale)
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Twenty-four hours postoperatively, the patient accepted food, showed less response to abdominal palpation and the pain score decreased to 6/30 (Figure 4).
Forty-eight hours postoperatively and after the removal of the wound catheter (12 points on UNESP-Botucatu multidimensional composite pain scale)
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Forty-eight hours postoperatively, the wound catheter was removed, and the pain score increased to 12/30 (Figure 5).
Ninety-six hours postoperatively: the patient was comfortable and had no allodynia
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Forty-eight hours after initiating the ketamine CRI and increasing the dose and frequency of methadone, the patient no longer demonstrated allodynia and the pain score was 8/30 (Figure 6).
Timeline demonstrating the multimodal treatment administered to the patient with allodynia and hyperalgesia until hospital discharge. TAP = transversus abdominis plane; EA = electroacupuncture; CRI = constant rate infusion; IV = intravenous
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