A Comparison Between The Effect of TAP Block and Ilioinguinal, Iliohypogastric Nerve Block on Postoperative Pain in Patients Undergoing InguinalHernia Repair Under General Anesthesia.

ObjectiveThis study aims to assess the current status of acute postoperative pain in adult patients undergoing ophthalmic surgery under general anesthesia and to identify factors associated with moderate to severe postoperative pain, thereby offering insights for improving pain management in ophthalmic surgical patients.MethodsA cross-sectional survey was conducted on 437 adult patients who underwent general anesthesia surgery in the Ophthalmology Department of West China Hospital, Sichuan University. The survey included a general information questionnaire, the Numerical Rating Scale (NRS) for pain, the Huaxi Emotional-Distress Index (HEI) questionnaire, and the Athens Insomnia Scale (AIS).ResultsThe incidence of acute postoperative pain was 95%, with a mild pain incidence of 45.5% and a moderate to severe pain incidence of 49.6%. The average time for postoperative pain to intensify to moderate to severe was 1.50 hours. The possibility of moderate to severe postoperative pain in people over 60 years old was 46% lower than that in people under 60 years old; the possibility of moderate to severe postoperative pain in ethnic minorities was 2.7 times that of Han people; the possibility of postoperative pain in patients undergoing orbital plastic surgery and enucleation of ocular contents+ implantation of ocular prosthesis was 2.64 times and 4.92 times that of those undergoing orbital tumor resection, respectively; the possibility of moderate to severe postoperative pain in patients with suspected insomnia and insomnia was 5.76 times and 12.31 times that of those without sleep disorders, respectively.ConclusionThe incidence of acute postoperative pain in adult patients undergoing general anesthesia in ophthalmology is relatively high. Age, ethnicity, surgical methods, and sleep quality are influencing factors of moderate to severe postoperative pain. Medical staff should further strengthen pain management by addressing these influencing factors to reduce the incidence of moderate to severe postoperative pain in patients.

Background: Effective management of postoperative pain remains a primary concern for anesthesiologists, particularly in day-case procedures like inguinal hernia repair. Adequate pain control can significantly enhance patient satisfaction, reduce hospital stays, and facilitate early mobilization. Two commonly used ultrasound-guided regional anesthesia techniques for managing postoperative pain in this setting are the transversus abdominis plane (TAP) block and the ilioinguinal/iliohypogastric (IH) nerve block. Aim of Study: To compare the analgesic efficacy of TAP block versus IH nerve block in reducing postoperative pain following elective inguinal hernia repair under general anesthesia. Patients and Methods: Sixty patients scheduled for elective inguinal hernia repair were randomly divided into two groups. Group TAP (n=30) received a transversus abdominis plane block, while Group IH (n=30) received an ilioinguinal/iliohypogastric nerve block, both administered postoperatively. Standard intraoperative monitoring included pulse oximetry, continuous ECG, non-invasive blood pressure (NIBP), temperature, and capnography. Pain intensity was assessed using the Visual Analogue Scale (VAS), along with monitoring of pulse rate and blood pressure. Results: At immediate postoperative recovery (Time 1), pain scores showed no significant difference between groups. At one hour (Time 2), a statistically significant difference was observed (TAP: 2.20±0.61 vs IH: 1.90±0.30). At four and eight hours postoperatively (Times 3 and 4), the IH group demonstrated significantly lower VAS scores (p

Scalp nerve block with ropivacaine has been shown to provide perioperative analgesia. However, the best concentration of ropivacaine is still unknown for optimal analgesic effects. We performed a prospective study to evaluate the effects of scalp nerve block with varied concentration of ropivacaine on postoperative pain and intraoperative hemodynamic variables in patients undergoing craniotomy under general anesthesia. Eighty-five patients were randomly assigned to receive scalp block with either 0.2% ropivacaine, 0.33% ropivacaine, 0.5% ropivacaine, or normal saline. Intraoperative hemodynamics and post-operative pain scores at 2, 4, 6, 24 hours postoperatively were recorded. We found that scalp blockage with 0.2% and 0.33% ropivacaine provided adequate postoperative pain relief up to 2 h, while administration of 0.5% ropivacaine had a longer duration of action (up to 4 hour after craniotomy). Scalp nerve block with varied concentration of ropivacaine blunted the increase of mean arterial pressure in response to noxious stimuli during incision, drilling, and sawing skull bone. 0.2% and 0.5% ropivacaine decreased heart rate response to incision and drilling. We concluded that scalp block using 0.5% ropivacaine obtain preferable postoperative analgesia compared to lower concentrations. And scalp block with ropivacaine also reduced hemodynamic fluctuations in craniotomy operations.

Aims: Major abdominal oncologic surgeries cause serious postoperative pain because they contain extensive tissue damage and large skin incision. Therefore, major abdominal oncological surgeries require more opioid consumption. In addition, there is an association between smoking and opioid use. The objective of this study is to evaluate the potential relationships between smoking status and postoperative pain and opioid analgesic consumption in patients after major abdominal oncological surgery. Methods: For the study, the approval was obtained from the Ethics Committee of our instution. 130 patients between 18-75 years of age who underwent elective major abdominal oncological surgery under general anesthesia, had ASA I-III score and was planned for intravenous morphine-controlled analgesia for postoperative analgesia were included in the study. The patients were divided into two groups as smoking (65 patients) and non-smoking (65 patients). ASA scores, age, gender, height, weight, and additional diseases were recorded. Fagerström Test for Nicotine Dependence was applied to patients who had been smoking for at least 1 year. In the postoperative care unit, heart rate, blood pressure, Sp02, values, blood pressure values, Ramsey sedation scores were recorded at 0 hours, 2 hours, 6 hours, 12 hours, 24 hours and 48 hours. At these measurement times, the pain intensity of the patients was evaluated by a visual pain scale. Patients' additional analgesic requirement, total morphine consumption, demand from patient-controlled analgesia device, nausea-vomiting, itching, gas release times, hypotension and dry mouth were recorded. Results: In this study, postoperative 0 hour, 2nd hour, 6th hour, 12th hour, 24th hour and 48th hour VAS scores and the amount of morphine consumed were significantly higher in the smokers compared to non-smokers. In terms of additional analgesic use, it was found that the use of additional analgesics was significantly higher in the group of smokers. Dry mouth and the incidence of nausea/vomiting were significantly higher in smoking patients than in non-smoking patients. Conclusion: It has been found that smoking increases the severity of postoperative pain in patients who underwent major abdominal cancer surgery and these patients need more opioids. We are of the view that while planning postoperative analgesia, effective treatment strategies can be determined by considering that there may be more severe pain in smoking patients.

Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia. Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points. Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001). Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer. A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups. In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05). TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.

Pain Sensitivity and Acute Postoperative Pain in Patients Undergoing Abdominal Surgery: The Mediating Roles of Pain Self-Efficacy and Pain Catastrophizing

Background Pain after CS is a primary concern of women and the provision of effective analgesics is an essential duty for the obstetric anaesthetist. After the application of ultrasound in anesthetic practice, we can now choose between a landmark- or ultrasound-guided TAP block, Ilio- inguinal nerve block (alone or in combination with an Iliohypogastric nerve block) among others. Objective To compare the effect of bilateral ultrasound guided TAP block versus ultrasound guided Ilioinguinal and Iliohypogastric nerve block on post-operative analgesia in patients undergoing elective Cesarean section under spinal anesthesia. Patients and Methods The study was conducted on 64 random patients per each group who were scheduled to undergo elective cesarean section under spinal anesthesia, the two groups were as following; Results As for the comparison between effect of TAP block and ilioinguinal-iliohypogastric block as regard post-operative pain in elective cesarean section under spinal anesthesia, it showed that there is significance regarding the numeric version of the VAS score and its intensity. These findings the TAP block more effective than the ilioinguinal-iliohypogastric block. These findings with our primary and secondary outcomes showed that TAP block has more analgesic effect with respect to ilioinguinal-iliohypogastric block regarding pain assessment but with no significant difference regarding the time till first analgesia postoperative and total analgesics consumption over 24-hour period post-operative. Conclusion The comparison between effect of TAP block and ilioinguinal-iliohypogastric block as regard post-operative pain in elective cesarean section under spinal anesthesia showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity. These findings with our study primary and secondary outcomes showed that TAP block has more analgesic effect with respect to ilioinguinal-iliohypogastric block regarding pain assessment and the time till first analgesia postoperative and total analgesics consumption over 24-hour period post-operative.

The primary goal of this study was to identify the risk factors contributing to moderate-to-severe postoperative pain in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to create a predictive model for these risk factors. A retrospective analysis was performed on a cohort of 375 patients who underwent LSG at Jinan Central Hospital from January 2017 to June 2023. Data for this study was extracted using medical databases. Patients were classified into 2 groups based on their postoperative pain levels: those experiencing moderate-to-severe pain and those not experiencing moderate-to-severe pain. Univariate and multivariate logistic regression analyses were employed to determine which variables were significantly associated with moderate-to-severe pain. Receiver operating characteristic curves were utilized to assess the diagnostic efficacy of different indicators. Additionally, calibration curves and clinical decision curves were applied for model validation. Multifactorial logistic regression analysis identified age, body mass index (BMI), and the modified frailty index (mFI) as independent risk factors for moderate-to-severe postoperative pain in LSG patients. Based on the regression analysis, a predictive model was constructed. The receiver operating characteristic curve for this model demonstrated an area under the curve of 0.96 (95% CI: 0.94–0.97), indicating excellent discriminatory ability between patients likely and unlikely to experience moderate-to-severe pain post-surgery. A scoring system was developed from the predictive model, assigning points to each risk factor. BMI was the most significant predictor (100 points), followed by mFI (30 points) and age (15 points). Calibration analysis showed that the predicted values closely matched the actual values, with a mean error of 0.008, indicating high accuracy of the model. Clinical decision analysis demonstrated a positive net benefit when the threshold probability ranged from 0.001 to 0.999, suggesting broad applicability of the model in clinical decision-making. Age, BMI, and mFI are significant predictors of moderate-to-severe postoperative pain in patients undergoing LSG.

BACKGROUND: Postoperative pain and anxiety affect patients’ recovery and increase the family burden. S-ketamine presents analgesic effects and anti-depressive effects in clinics. The effect of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety remains to be clarified. OBJECTIVES: This study aimed to evaluate the analgesic and anxiolytic effects of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety and explored the risk factors for postoperative pain in patients receiving breast or thyroid surgery under general anesthesia. STUDY DESIGN: A randomized, double-blind, controlled trial. SETTING: A university hospital. METHODS: One hundred twenty patients receiving breast or thyroid surgery, stratified by surgery type, were randomized to S-ketamine and control groups in a 1:1 ratio. S-ketamine (0.3 mg/kg) or an equal volume of normal saline was administrated after anesthesia induction. Visual analog scale (VAS) of pain and self-rating anxiety scale (SAS) were tested before surgery and on postoperative day 1, 2, and 3. VAS and SAS score between the 2 groups were compared, and the risk factors for postoperative moderate to severe pain were explored with logistic regression analysis. RESULTS: Intraoperative S-ketamine decreased VAS and SAS scores on postoperative day 1, 2, and 3 (P &lt; 0.05, 2-way ANOVA for repeated measurements followed by Bonferroni post-analysis). Subgroup analysis showed S-ketamine decreased VAS and SAS scores both in breast surgery and thyroid surgery patients on postoperative day 1, 2, and 3. Logistic regression identified S-ketamine and regular exercise are protective factors, and anxiety before surgery is a risk factor for postoperative moderate to severe pain (P &lt; 0.05). LIMITATIONS: The anxiety score in our study is not so high, which may under-evaluate the anxiolytic effect of S-ketamine. However, S-ketamine decreased the SAS scores postoperatively in our study. CONCLUSIONS: Intraoperative sub-anesthesia dose of S-ketamine reduces postoperative pain and anxiety intensity. Anxiety before surgery is a risk factor, and S-ketamine and regular exercise are protective factors for postoperative pain. The study was registered at www.chictr.org.cn with the number: ChiCTR2200060928. KEY WORDS: S-ketamine, pain, anxiety, breast, thyroid

Sleep disorder dramatically affects people's physical and mental health. Here, we investigated the effect of preoperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia. 120 patients who underwent elective laparoscopic gynecological surgery under general anesthesia in Taizhou Central Hospital from November 2021 to March 2022 were included. According to the score of the Pittsburgh sleep quality index (PSQI), the participating patients were divided into four groups: control group (control group), mild sleep disorder group A (group A), moderate sleep disorder group B (group B), and severe sleep disorder group C (group C), with 30 patients in each group. The changes of mean arterial pressure (MAP) and heart rate (HR) at different time points, operation time, anesthesia time, extubation time, the time when Aldrete score reached 10 points, visual analog score (VAS) serum interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were compared among different groups. Our study demonstrated that there were no significant differences in MAP and HR among the four groups at the same time points (all P > 0.05). Significant differences in the time of extubation and Aldrete score reaching 10 points had been found among the four groups (all P < 0.001), indicating more sleep disorder induced longer extubation and recovery time. There were significant differences in VAS scores among the four groups at both different and the same time points (all P < 0.001), suggesting more sleep disorders induced more pain in the sufferers. Serum IL-6 levels were significantly higher in the three sleep disorder groups than the control group at 6 h and 24 h after the operation (all P < 0.05), while group C has the highest IL-6 levels as compared to the other group (P = 0.09 and P < 0.001, respectively). At 6 h after operation, serum levels of TNF-α in group C were significantly higher than in the control group (P = 0.044), but no significant differences were found in the other two groups (all P > 0.05). Positive correlation with preoperative PSQI score has been found with the times of extubation, the time of Aldrete score reaching 10 points, the VAS at 1 h, 6 h, and 24 h after operation, the level of serum IL-6 at 1 day before operation and 6 h and 24 h after operation, and the TNF-α at 6 h and 24 h after operation (all P < 0.001). The present study showed that the degree of preoperative sleep disorders could affect the quality of postoperative awakening and pain of patients undergoing laparoscopic gynecological surgery under general anesthesia, which might be associated with the aggravation of inflammatory reactions in the body.

The high frequency variability index (HFVI)/analgesia nociception index (ANI) is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This observational study investigated whether intraoperative HFVI/ANI correlates with postoperative pain in patients performed with nerve block under general anesthesia in video/robotic-assisted thoracoscopic surgery (VATS/RATS). We investigated whether maximum postoperative pain at rest and postoperative morphine consumption are associated with HFVI/ANI just before extubation, mean HFVI/ANI during anesthesia, the difference in HFVI/ANI between before and 5min after the start of surgery, and the difference in HFVI/ANI between before and 5min after the nerve block. Data obtained from 48 patients were analyzed. We found no significant association between HFVI/ANI just before extubation and postoperative Numerical Rating Scale (NRS) score. Receiver operating characteristic curve analysis revealed that moderate (NRS > 3) or severe (NRS > 7) postoperative pain could not be predicted by HFVI/ANI just before extubation. In addition, there were no associations between postoperative morphine consumption and HFVI/ANI at any time points. The present study demonstrated that it is difficult to predict the degree of postoperative pain in patients undergoing VATS/RATS under general anesthesia combined with peripheral nerve block, by using HFVI/ANI obtained at multiple time points during general anesthesia.

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.

Background The most commonly performed inguinal surgeries in children include inguinal hernia repair with or without orchidopexy and hydrocele repair. For postoperative pain with these surgeries, a regional analgesic modality such as caudal analgesia (CA), ilioinguinal and iliohypogastric nerve block (IL/IH), or even local infiltration is combined with a general anaesthetic (GA). Regional analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient-parent satisfaction. When compared to intravenous (IV) opioids, regional techniques reduce the risk of side effects such as somnolence, respiratory depression, emesis, and ileus. Patients and Methods: After approval of anesthesia, intensive care and pain management department, scientific and ethical committees, and after informed parental written consents, this prospective randomized clinical trial study was conducted in Ain Shams University Hospitals. This study is considered to be a pilot exploratory study. Forty five children patients were included in the study scheduled for elective inguinal surgeries (e.g.; unilateral inguinal hernia repair, hydrocele repair, or orchidopexy). Patients will be randomized using a random number table and the use of a closed envelopes technique to receive either combined general anesthesia with ultrasound guided caudal block (Group A), combined general anesthesia and ultrasound guided ilioinguinal /iliohypogastric block (Group B), or general anesthesia with intravenous morphine (group C). Results Among 45 children of (27 boys and 18 girls), aged from one to six years old, ASA physical status I–II who were scheduled for elective unilateral inguinal surgeries, fifteen patients received general anesthesia with ultrasound guided caudal epidural anesthesia (1ml/kg bupivacaine 0.25%), fifteen patients received general anesthesia with ultrasound-guided ilioinguinal/ iliohypogastric nerve block (0.5ml/kg bupivacaine 0.25%) and fifteen patient received general anesthesia with intravenous morphine (0.1 mg/kg). Conclusion The current study demonstrated that ultrasound-guided ilioinguinal /iliohypogastric nerve block was more effective than ultrasound guided caudal epidural block or intravenous morphine usage in children aged 1-6 years old undergoing unilateral inguinal surgeries as it carried the advantages of faster onset of action, longer duration of postoperative analgesia, the need of lower volumes of local anesthetic agents with no recorded complications.

BACKGROUND:The effect of ilioinguinal and iliohypogastric (II-IH) nerve block on postoperative pain is well documented when performed before Caesarean section (CS) but the efficacy remains unclear when performed after the surgical procedure. The aim of this study is to investigate the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when performed after CS.METHODS:Sixty ASA I- II patients, scheduled for elective CS were included in the study. After general anaesthesia, patients were allocated into 2 groups randomly. In group I bilateral II-IH block has been performed after the skin closure, with 10 ml of 0.5% ropivacaine on each side. In group II sham block had been performed. For postoperative analgesia all patients received tramadol via i.v patient controlled analgesia. Visual analogue scale (VAS) scored tramadol consumption and side effects.RESULTS:The mean VAS scores in II-IH block group were significantly lower than in sham block group at 6th, 8th, 12th, 24th hours at rest (p < 0.05) and at 6th, 8th hours with movement (p < 0.05). Tramadol usage in II-IH block group was significantly less than in sham block group at all estimated time intervals (p < 0.05). Total tramadol consumption was 331 ± 82 mg in II-IH block group and 622 ± 107 mg in sham block group (p < 0.05).CONCLUSIONS:It was observed that II-IH nerve block when performed after the surgery may reduce analgesic consumption after CS.