Additional Analgesia Research Articles

Agony of Choice: Caudal Block versus Ilioinguinal/Iliohypogastric Nerve Block in Unilateral Orchidopexy.

Objective: This prospective study aimed to compare the efficacy of caudal block (CB) and ilioinguinal/iliohypogastric nerve block (IINB) for providing additional analgesia during unilateral orchidopexy. Methods: Seventy-one boys aged <48 months, classified as ASA I/II, were assigned into CB (n = 37) and IINB (n = 34) groups. Outcome measures included intra- and postoperative analgesic requirements, pain scores, and administration duration. Additional intraoperative analgesia was administered for a 10% increase in heart rate, while postoperative pain was assessed using the Children's and Infants Postoperative Pain Scale (CHIPPS), with scores >4 prompting supplementary analgesia. Monitoring was extended for 24 h post-surgery. Results: CB significantly reduced the need for intraoperative (p < 0.001) and early postoperative (p = 0.008) analgesia compared to IINB. However, the CB group exhibited a slightly higher but non-significant analgesic requirement on the ward. No clinically relevant side effects were observed in either group. Conclusions: Both CB and IINB are effective and safe methods for providing regional analgesia during orchidopexy. CB demonstrates superior efficacy intraoperatively and in the early postoperative period, while IINB may offer advantages in the later recovery phase. However, additional analgesia is often required for orchidopexy, especially in outpatient settings.

Hydromorphone combined with ropivacaine for erector spinae plane block in patients undergoing modified radical mastectomy: A prospective randomized controlled trial.

Combining hydromorphone with ropivacaine in ultrasound-guided erector spinae plane blocks enhances postoperative analgesia and reduces interleukin-6 expression in breast surgery patients. In this study, breast cancer patients undergoing modified radical mastectomy were randomized into 3 groups for anesthesia (30 patients in each group): standard general (group C), Erector Spinae Plane Block (ESPB) with ropivacaine (group R), and ESPB with ropivacaine plus hydromorphone (group HR). Diagnosis: Breast cancer patients. Postsurgery, pain levels, IL-6, anesthetic doses, additional analgesia needs, and recovery milestones were compared to evaluate the efficacy of the ESPB enhancements. The 3 groups were not significantly different in baseline characteristics, operation time, number of cases with postoperative nausea, and serum IL-6 concentrations at T1 (the time of being returned to the ward after surgery). At T2 (at 6:00 in the next morning after surgery), the serum IL-6 concentration in group HR was significantly lower than that in groups R and C (P < .05); the intraoperative doses of remifentanil, sufentanil, and propofol were significantly lower in groups HR and R than those in group C (P < .05); Groups HR and R had significantly lower visual analog scale scores at T3 (4 hours postoperatively), T4 (12 hours postoperatively), and T5 (24 hours postoperatively) than those in group C (P < .05); the proportions of patients receiving postoperative remedial analgesia were significantly lower in groups HR and R than in group C (P < .05); groups HR and R had significantly lower proportions of patients with postoperative nausea than group C (P < .05); the time to the first anal exhaust and the time to the first ambulation after surgery were significantly shorter in groups HR and R than those in group C (P < .05). Hydromorphone combined with ropivacaine for ESPB achieved a greater postoperative analgesic effect for patients receiving MRM under general anesthesia. The combined analgesia caused fewer adverse reactions and inhibited the expression level of the inflammatory factor IL-6 more effectively, thereby facilitating postoperative recovery. ESPB using hydromorphone with ropivacaine improved pain control post-MRM, reduced adverse effects, and more effectively suppressed IL-6, enhancing recovery.

Robotic natural orifice specimen extraction surgery versus robotic transabdominal specimen extraction surgery for early-stage rectal cancer: a multicenter propensity score-matched analysis (in China).

Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. Multicenter retrospective cohort trial. Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140min (125-170min) vs. 140min (120-160min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48h (41-56h) vs. 48h (44-62h), P = 0.049 and 77h (72-94h) vs. 82h (72-96h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7-9 day) vs. 8 day (7-9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P = 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P = 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group. It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol. These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons.

Auricular point acupressure for managing postoperative pain and reducing anxiety in patients with perianal abscesses

ObjectiveThe objective of this study is to assess the efficacy of auricular point acupressure in relieving postoperative pain and reducing anxiety among patients with perianal abscesses. MethodsWe included 61 patients with perianal abscesses who were admitted to the Nantong First People's Hospital between July 2019 and June 2020 and were scheduled to undergo one-stage radical surgery. We divided them into the treatment group (n = 31), where patients were administered preoperative auricular acupressure targeting the bilateral Shenmen, subcortical, and other points. They were instructed to apply pressure five to six times per day, each time for about 3–5 min. Patients in the control group (n = 30) received routine preoperative preparation. The treatment duration for both groups was one week. We compared the two groups using the pain visual analog scale (VAS) scores, the use of additional postoperative analgesics, and scores on the Hamilton anxiety and depression scales pre- and post-surgery at 6 h, 24 h, 48 h, 72 h, and 1 week after surgery, as well as at the time of the first bowel movement. ResultsPatients in the treatment group reported lower VAS scores than those of the control group at 48 h, 72 h, 1 week, and at the first defecation post-surgery, and the differences were statistically significant (all P < 0.05). Additional postoperative analgesics were used in seven patients in the treatment group (22.58 %) and in 10 patients in the control group (33.33 %). The difference between the two groups was not statistically significant (χ2 = 0.88, P = 0.35). Postoperative scores for the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) in the treatment group were significantly lower than those in the control group (P < 0.05). ConclusionThe results of this study demonstrated that auricular point acupressure was effective in alleviating postoperative pain in patients with perianal abscesses and simultaneously reduced their postoperative psychological stress reactions. This dual effect provided both pain relief and a reduction of anxiety with fewer adverse reactions, making it a safe and effective treatment option.

Comparison of the Efficacy of Postoperative Pain Relief in Ultrasound Guided Fascia Illiaca Compartment Block versus Epidural Block on Quality of Recovery (QOR-15) in Patients Undergoing Femoral Surgery

Background: The occurrence of femoral fractures is quite high. The quality of life gets affected to a large extent due to pain and post-operative delirium. Various regional block techniques like Fascia illiaca compartment block, lumbar epidural analgesia, femoral nerve block, etc. have been described for femoral fractures. In this study, we compared the efficacy of post-operative pain relief FICB and Epidural block on quality of recovery (QOR-15) in patients undergoing femoral surgery. Methods: This study included 40 patients wherein 20 patients were given FICB and 20 patients were given Epidural block. The patients were followed up for post-operative pain relief, Quality of Recovery, occurrence of delirium, disability and fraility. Results: Quality of recovery QOR-15 was similar for both the groups preoperatively as well as at 24 hour and 48 hours post-operatively. Additionally, there was no difference in the time taken to administer the block, postoperative VAS score on movement and rest, requirement of additional analgesia and opioid consumption. Moreover, there were no significant differences in WHO disability assessment, modified frailty score, prevalence of delirium, mortality, morbidity and side effects of techniques. However, the total duration of hospital stay (in days) was found to be significantly more in the epidural group as compared with the FICB group (5.75±1.61 vs 4.75±1.16; P=0.38). Conclusion: Ultrasound guided fascia iliaca compartment block is a tangible alternative to epidural block in patients undergoing femoral fracture repair.

Effect of dexmedetomidine infusion on characteristics of spinal anesthesia with hyperbaric bupivacaine: A randomized controlled trial

Dexmedetomidine is a highly selective and potent α2 agonist having both sedative and analgesic properties. This study was aimed to assess the effects of intravenous dexmedetomidine on sensory, motor, haemodynamic parameters and sedation during subarachnoid block (SAB) with 0.5% hyperbaric bupivacaine. Sixty patients undergoing infraumbilical and lower limb surgeries were allocated into 2 groups, group D (n=30) received dexmedetomidine infusion at the rate of 0.5 µg/kg/h over an hour prior to SAB and continued till the end of surgery whereas patients in group C (n=30) received similar volume of normal saline infusion for the same duration. Onset of sensory block was 63.77 ± 7.42 s in group D compared with 126.2 ± 12.83s in group C. Two segment regression time was 177.03 ± 11.64 min in group D and 85.67 ± 10.32 min in group C and analgesia duration was 287.67 ± 14.84 min in group D and 149 ± 13.16 min in group C. Onset of motor block was 3.95 ± 0.65 min in group D and 4.5 ± 0.62 min in group C. Motor blockade duration was prolonged in group D compared with group C. There was significant difference between the groups in respect to block characteristics. Administration of intravenous dexmedetomidine during SAB hastens the onset and prolongs the duration of sensory and motor block. It also provides conscious sedation and additional analgesia.

Lessons from short chest drain management for primary spontaneous pneumothorax.

Video-assisted thoracic surgery (VATS) bullectomy is the mainstay treatment for primary spontaneous pneumothorax (PSP) but we encounter patients with pain due to chest tube. This study investigated the postoperative outcomes of shortened silicone drain as a chest tube after VATS bullectomy to reduce pain. The current study included patients aged < 30years who underwent VATS bullectomy for PSP. Patients with normal intrathoracic lengths of the silicone drain placed in a loop at the apex toward the diaphragm were categorized as Group L, whereas those with the silicone drain shortened to approximately 10cm and placed toward the apex were classified as Group S. Postoperative pain evaluated using a numerical rating scale (NRS) and other perioperative outcomes were compared between the groups. Altogether, 43 patients were included, with 22 in Group L and 21 in Group S, respectively. The NRS before chest tube removal was significantly lower in Group S (mean, 2.1) than in Group L (4.4; p = 0.001). In Group L, 4 patients (p = 0.017) required early chest tube removal than expected due to severe pain whereas none in Group S required this intervention; additionally, more patients needed additional analgesics than in Group S (p = 0.003). In VATS bullectomy for PSP, the pain intensity could be reduced by shortening the intrathoracic length of the silicone drain, compared to a longer intrathoracic length of the silicon drain. Our findings contribute to the establishment of optimal postoperative management of general thoracic surgery.

Advancing mid-rectal cancer surgery: Unveiling the potential of natural orifice specimen extraction surgery in comparison to conventional laparoscopic-assisted resection.

Mid-rectal cancer treatment traditionally involves conventional laparoscopic-assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR. To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long-term prognosis between NOSES and CLAR groups. A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases. The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications. While long-term outcomes (overall survival, disease-free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid-rectal cancer treatment, while maintaining similar long-term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long-term results.

Factors affecting Urethral Catheter Placement Following Flexible Ureterorenoscopy: RIRSearch Study Group

Background/Purpose: To investigate the factors affecting UC placement following flexible ureterorenoscopy (fURS) and the effect of urethral catheter (UC) placement on patient quality of life. Methods: The present study was performed in prospective manner from 1st January 2015 to 30th December 2023, and patients with renal stones smaller than two centimeters who underwent fURS were analyzed for study inclusion. Patients’ demographic characteristics, operative parameters, success of procedure, complications, and VAS score were recorded. Patients were categorized into two groups according to UC placement or not. These groups were compared according to preoperative parameters, intraoperative data, complications, success and VAS at postoperative 6th hour. Results: In total, 324 patients were enrolled into the study. UC was inserted in 170 patients following fURS and was not inserted to 154 patients. In the patient group with UC placement, ratio of male patients (p= 0.002), ratio of anticoagulant use (p= 0.002), preoperative creatinine level (p=0.001), stone size (p= 0.001), stone burden (p= 0.001), and ratio of multiple stones (p= 0.001) were significantly higher. Operation time was significantly longer (p= 0.003) and intraoperative complications (p= 0.045) were significantly higher in patients with UC insertion. Need for additional analgesia and VAS score was significantly lower in patients without UC placement (p= 0.004 vs. p= 0.001). Multivariate analysis revealed that male gender, higher preoperative creatinine level, higher stone size and stone burden, and longer operation time were predictive factors for UC placement following fURS (p= 0.008, p= 0.001, p= 0.001, p= 0.010, and p= 0.001, respectively). Conclusion: The present study demonstrated that UC placement following fURS was associated with increased analgesia requirements and more pain. Moreover, our study demonstrated that male gender, higher preoperative creatinine level, higher stone size and stone volume, and longer operation time resulted in UC insertion after fURS.

Effect of Preemptive Systemic Patient-controlled Analgesia in Evisceration

Purpose: To investigate the effect of preemptive systemic analgesia using patient-controlled analgesia (PCA) on postoperative pain after evisceration.Methods: Of the patients who underwent evisceration under general anesthesia in our hospital, 55 who were able to evaluate pain using a numeral rating scale (NRS) were included. The patients were divided into two groups: group 1 used PCA after surgery, and group 2 used PCA preemptively before surgery. We compared the two groups in terms of the NRS pain scores on the day of surgery and 1, 2, and 3 days after surgery, and according to whether additional analgesics were used.Results: The 55 patients included 17 in group 1 and 38 in group 2. The NRS at 3, 5, and 7 hours on the day of surgery tended to be lower in group 2, but not significantly (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The NRS on days 1 and 2 after surgery was significantly lower in group 2 (&lt;i&gt;p&lt;/i&gt; = 0.014 and &lt;i&gt;p&lt;/i&gt; = 0.027, respectively), and the NRS on day 3 after surgery was also lower, although not significantly (&lt;i&gt;p&lt;/i&gt; = 0.059). Significantly fewer cases required additional analgesics in group 2 compared to group 1 on the day of surgery and 1, 2, and 3 days after surgery (&lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, and &lt;i&gt;p&lt;/i&gt; = 0.008, respectively).Conclusions: Using preemptive systemic PCA in evisceration significantly reduced the postoperative pain, and PCA itself was an effective administration method due to the high rate of pain control without the need for additional analgesics.

Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial

BackgroundDentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations.MethodsThis multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12–25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant’s electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants’ perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.).DiscussionThis real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA.ClinicalTrials.govNCT06275191.

Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy

ObjectiveTo compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA total of 29 female dogs with mammary tumors. MethodsPremedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 μg kg–1 loading dose (LD) and 1 μg kg–1 hour–1; lidocaine 2 mg kg–1 LD and 3 mg kg–1 hour–1; ketamine 1 mg kg–1 LD and 0.6 mg kg–1 hour–1; n = 14] or FLK (fentanyl 5 μg kg–1 LD and 9 μg kg–1 hour–1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe′Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann–Whitney test. ResultsMore dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe′Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. Conclusions and clinical relevanceBased on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

Impact of intra-operative ketamine on postoperative outcomes in abdominal surgery: a narrative review.

Ketamine offers a promising solution to common postoperative issues in abdominal surgery, including pain, nausea, opioid use, and opioid-related side effects. The purpose of this literature review is to analyze the benefits and potential adverse effects associated with the intraoperative utilization of ketamine during abdominal surgeries. A comprehensive search of PubMed and Ovid MEDLINE was conducted by two independent reviewers. Studies were included if they targeted adult patients and evaluated intra-operative use of ketamine for abdominal operations. We identified 13 studies of intraoperative use of ketamine in abdominal surgery. The results of these studies showed improved pain management as demonstrated by lower pain scores, decreased hyperalgesia, and a decreased need for additional analgesics. The results also demonstrated a decrease in opioid consumption during the critical 24-hour postoperative period. However, a few studies reported undesirable side effects such as hallucinations and delirium. The intraoperative use of ketamine holds promise as a valuable adjunct to anesthesia during abdominal surgeries. Studies support its use in improving post-operative pain and decreasing opioid consumption. Due to risks of adverse effects, further studies in larger patient populations may help identify which patients will benefit the most. This review offers a succinct selection of the pertinent literature.

Assessment of ultrasound guided erector spinae plane block for early post-operative analgesia for modified radical mastectomy: a prospective, randomized, controlled study.

Erector spinae plane block is a recently introduced block with a wide range of indications. The aim of the present study was to assess the efficacy and safety of ultrasound-guided erector spinae plane block on early post-operative pain relief in patients undergoing modified radical mastectomy. We conducted a prospective, randomized, controlled study in a tertiary care institute. Sixty-five patients were enrolled. Final analysis was performed on 58 patients randomized into two groups. Ultrasound-guided erector spinae plane block with 25 mL of 0.25% bupivacaine was given using a 18 gauge needle. No block was given in the other group. All patients received general anesthesia. Primary outcome measure was 24-hour analgesic consumption. Secondary outcome measures included intra-operative fentanyl consumption, time to first analgesic request, Visual Analog Scale score, nausea score, sedation score, wound quality and patient satisfaction score. Post-operative additional analgesics and intra-operative fentanyl were significantly reduced in patients receiving erector spinae plane block. Time to rescue analgesia was significantly delayed. Visual Analog Scale score was significantly lower at all time intervals. Post-operative nausea at various time intervals was also less. Patient satisfaction score was also noted on a 5-point scale and there was a statistical significant difference. We concluded that erector spinae plane block is a safe technique and provides good analgesia in breast surgery.

Efficacy of Octyl-Cyanoacrylate Dermabond Adhesive Glue versus Polyglactin 3/0 Suture for Closure of Caesarean Section Skin Incision - A Prospective Randomised Controlled Trial

This was a prospective randomised controlled trial conducted at a tertiary hospital on 82 women who underwent caesarean section aiming to assess the efficacy of octyl-cyanoacrylate tissue adhesive glue versus polyglactin 3/0 suture for the closure of caesarean sections skin incision. The study group consisted of 41 women who underwent skin closure using octyl-cyanoacrylate tissue adhesive glue, whereas 41 women in the control group had subcuticular skin closure using polyglactin 3/0 sutures. The choice of anaesthesia, prophylactic antibiotic, operative technique, and immediate post-operative oral analgesia was standardised between the two groups. Time taken for skin closure, pain score at day 2 and 14, the total analgesia dose needed and duration (day two onwards), and any adverse events were recorded. The time required for skin closure was significantly less in the study group, with a mean difference of 97.7 seconds (170.8 seconds vs 268.5 seconds, p&lt;0.001). Pain scores on day 2 were similar between the two groups (4.0 vs 5.0, p=0.09), whereas pain score on day 14 was significantly lower in the study group (2.0 vs 4.0, p&lt;0.001). The median duration (day two onward) of oral analgesia use was four days in the study group and six days in the control group. The difference was statistically significant (p=&lt;0.001). The median amount of additional analgesia required was a third less in the tissue adhesive group than in the control group. On day 14, surgical site infection was similar in both groups. In conclusion, octyl-cyanoacrylate tissue adhesive glue may safely close a caesarean section skin incision. It was associated with faster application, lesser pain score, and lesser need for analgesia without additional adverse events compared to the conventional suturing method.

Original research: Dexmedetomidine versus ketamine in erector spinae plane block for postoperative analgesia following modified radical mastectomy: A prospective randomized controlled blinded study

ABSTRACT Background A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effectiveness of dexmedetomidine (DEX) versus ketamine as adjuvants to local anaesthetic in erector spinae plane block (ESPB) in MRM. Methods In this randomized controlled trial, 75 women with breast cancer scheduled for MRM were included. All patients underwent ESPB with 30 ml 0.25% bupivacaine and randomized into three equal groups: group A, ESPB group; group B: received 1 µg/kg DEX with the ESPB; and group C: given 0.5 mg/kg Ketamine with the block. Results Compared with group A, VAS score at rest as well as movement were lower considerably in groups B and C (p < 0.05) at 6 h, 12 h, and 24 h. Group B had lower VAS scores at rest at 12 h and 24 h and during movement at 6 h, 12 h, and 24 h (p < 0.05) than group C. In comparison to A Group; B and C Groups required considerably less time to rescue analgesia and consumed significantly fewer total opioids (p < 0.05 and p < 0.001, respectively). In addition, total number of patients who required additional analgesia was markedly reduced in groups B and C compared to group A ;(p < 0.05). Conclusion In MRM surgery, the postoperative opioids consumption and VAS values were lower in both groups DEX and ketamine as an adjuvant to bupivacaine which enhanced the analgesic profile and prolonged ESPB duration compared to ESPB alone, with DEX being superior to ketamine.

A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus.

Ventral hernia repairs, particularly laparoscopic ventral hernia repair (LVHR), have become common procedures among general surgeons worldwide. Despite the benefits of LVHR, acute postoperative pain remains a significant concern. Transversus abdominis plane (TAP) blocks have been employed to alleviate postoperative pain in various laparoscopic procedures. This study aimed to assess the effectiveness of laparoscopic-guided TAP block in laparoscopic IPOM plus and its impact on postoperative pain and analgesic requirements. A randomized controlled trial was conducted at a tertiary care center in India involving 72 patients undergoing laparoscopic IPOM plus. Patients were randomized into two groups: Group I received laparoscopic-guided TAP block, while Group II received standard general anesthesia without TAP block. Pain scores were assessed at 6, 12, and 24h postoperatively using the numerical rating scale. Postoperative analgesic requirements were also recorded. Group I demonstrated significantly lower pain scores at 6 and 24h postoperatively compared to Group II. The need for additional analgesics was significantly lower in Group I (13.8%) compared to Group II (72.2%). There were no significant differences in age, BMI, duration of surgery, or other demographic characteristics between the two groups. The findings of this randomized controlled trial demonstrate the effectiveness of laparoscopic-guided TAP blocks in reducing postoperative pain and analgesic requirements after laparoscopic IPOM plus.

Anaesthetic management in adult reindeer (Rangifer tarandus tarandus) undergoing exploratory laparotomy for jejuno‐jejunal intussusception surgery resection

AbstractA 2‐year‐old, male reindeer (Rangifer tarandus tarandus) presented for further investigations and treatment of acute colic signs. On clinical investigations, an ultrasonographic abdominal exam revealed multiple hypomotile, dilated and fluid‐filled small intestinal loops. Based on clinical findings and increased signs of abdominal pain, small intestine obstruction was suspected, and an exploratory laparotomy was performed. The animal was premedicated with medetomidine (0.003 mg/kg) and butorphanol (0.05 mg/kg) intravenously. General anaesthesia was induced with ketamine (2 mg/kg intravenously) and propofol (3 mg/kg intravenously), and maintained with isoflurane in oxygen. Additional analgesia was provided with methadone (0.1 mg/kg intravenously) and ketamine (0.5 mg/kg intravenously). A jejuno‐jejunal intussusception requiring resection of approximately 6 inches (15 cm) was identified and jejuno‐jejuno anastomosis was performed. Fluid resuscitation was administered for treatment of hypotension during general anaesthesia. Recovery from anaesthesia was uneventful. Nevertheless, the deer was euthanased 5 days later due to clinical deterioration.

Comparative long-term outcomes of natural orifice specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity score-matched analysis.

Natural orifice specimen extraction surgery (NOSES) is currently widely used in left-sided colorectal cancer. Some clinical comparative studies have been conducted, providing evidence of its safety and oncological benefits. However, these studies are typically characterized by small sample sizes and short postoperative follow-up periods. Consequently, in this research, the authors adopt the propensity score matching method to undertake a large-scale retrospective comparative study on NOSES colectomy for left-sided colorectal cancer, with the goal of further augmenting the body of evidence-based medical support for NOSES. This retrospective study involved patients who underwent NOSES colectomy and conventional laparoscopic (CL) colectomy for left-sided colorectal cancer between January 2014 and April 2021. In the NOSES group, specimens were extracted through the anus with the help of a Cai tube (homemade invention: ZL201410168748.2). The patients were matched at a ratio of 1:1 according to age, sex, BMI, tumor diameter, tumor location (descending and splenic flexure colon/ sigmoid colon/ middle and upper rectum), tumor height from anal verge, ASA grade, previous abdominal surgery, clinical pathologic stage, preoperative CEA. After matching, 132 patients in the NOSES group and 132 patients in the CL group were eligible for analysis. Compared with CL group, NOSES group was associated with decreased postoperative maximum pain score (2.6±0.7 vs. 4.7±1.7, P=0.000), less additional analgesia required (6.8 vs. 34.8%, P=0.000), faster time to passage of flatus (2.3±0.6 days vs. 3.3±0.7 days, P=0.000), less wound infection (0.0 vs. 6.1%, P=0.007), and longer operative time (212.5±45.8min vs. 178.0±43.4min, P=0.000). No significant differences were observed in estimated blood loss, time to resume regular diet, postoperative hospital stay, conversion to open surgery or conventional minilaparotomy, total morbidity, readmission, mortality, pathologic outcomes, and Wexner incontinence score between groups. After a median follow-up of 63.0 months, the 5-year overall survival rates were 88.3 versus 85.0% (P=0.487), disease-free survival rates were 82.9 versus 83.6% (P=0.824), and the local recurrence rates were 4.4 versus 4.0% (P=0.667) in the NOSES and CL groups, respectively. This study suggests that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy.

Safety and efficacy of general anesthesia versus spinal anesthesia in percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized &gt;20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. Aims and Objectives: The objective of this study was to assess and compare the efficacy and safety of spinal anesthesia (SA) versus general anesthesia (GA) in PCNL. Materials and Methods: A prospective randomized study included eighty-two patients who were enrolled to receive either SA or GA for PCNL. The study assessed patients’ characteristics, vital parameters, requirements for additional analgesia, and patient satisfaction. In addition, intraoperative and post-operative complications were documented. Patients’ satisfaction was also analyzed. Results: In both groups, the vital parameters were consistently maintained at safe levels during the procedures. Patients in the SA group exhibited a lower analgesia consumption on the 1st post-operative day compared to the GA group (P&lt;0.05). Post-operative hypotension was higher in the SA group than in the GA group (17% vs. 7%). Patients in the GA group reported higher patient satisfaction scores than the SA group (mean 4.39+0.59 vs. 3.81+0.64). Conclusion: Both SA and GA are safe and effective in PCNL. SA is associated with fewer complications and reduced postoperative analgesia consumption. However, GA tends to offer higher satisfaction levels for patients. Each method of anesthesia has its own advantages and disadvantages. The final choice between general and SA should be based on the patient’s condition and surgical team preference.