Analgesia For Control Research Articles

Effects of Water Immersion Versus Epidural as Analgesic Methods during Labor among Low-Risk Women: A 10-Year Retrospective Cohort Study

Background: Adequate pain relief during childbirth is a very important issue for women and healthcare providers. This study investigates the effects on maternal and neonatal outcomes of two analgesic methods during labor: water immersion and epidural analgesia. Methods: In this retrospective observational cohort study at a first-level hospital, in Spain, from 2009 to 2019, 1134 women, low-risk singleton and at term pregnancy, were selected. Among them, 567 women used water immersion; 567 women used epidural analgesia for pain control. Maternal outcomes included mode of birth and perineum condition. Neonatal outcomes included 5 min Apgar score, umbilical cord arterial pH, and Neonatal Intensive Care Unit admissions. Chi-square tests and Mann–Whitney U tests, together with their effect sizes (Cramer’s V, odds ratio, and Cohen’s d) were used to test the main hypotheses. Results: Spontaneous vaginal birth was almost 17 times more likely in the water immersion group (OR = 16.866 [6.540, 43.480], p < 0.001), whereas the odds of having a cesarean birth were almost 40 times higher in the epidural group (OR = 39.346 [3.610, 429.120], p < 0.001). The odds of having an intact perineum were more than two times higher for the water immersion group (OR = 2.606 [1.290, 5.250], p = 0.007), whereas having an episiotomy was more than eight times more likely for the epidural group (OR = 8.307 [2.800, 24.610], p < 0.001). Newborns in the water immersion group showed a better 5 min Apgar score and umbilical cord arterial pH and lower rates in admissions at the Neonatal Intensive Care Unit. Conclusions: Women choosing water immersion as an analgesic method were no more likely to experience adverse outcomes and presented better results than women choosing epidural analgesia.

Buprenorphine for acute pain in older adults: a systematic review with meta-analysis.

Buprenorphine, a partial opioid agonist, has emerging evidence as an alternative to full agonist opioids for treatment of acute pain. This systematic review aimed to evaluate the safety and efficacy of buprenorphine for acute pain in older adults. PubMed Medline, Embase, Cochrane Central Register of Controlled Trials, CINHAL, Web of Science database, and Google Scholar were searched. We included articles that reported buprenorphine as an intervention to treat acute pain among patients 60 years or older. Primary outcome was difference in pain scores for patients treated with buprenorphine compared to other analgesia. Secondary outcomes included adverse events, opioid consumption, and patient satisfaction. Meta-analysis was conducted on difference in pain scores and differences in nausea and vomiting. Twenty-two studies were included (n = 2610). Buprenorphine was administered as nerve blocks in six studies, transdermal in eight, intravenous or intramuscular in five, sublingual in two studies, and both intravenous and sublingual in one study. 10 out of 20 (50%) studies found improved pain control in buprenorphine groups. Meta-analysis found no significant difference in pain scores between buprenorphine and control analgesia at 24 hours (Cohen's d = -0.29 [95% CI -0.85 to 0.27]) and 7 days (Cohen's d = -0.89 [95% CI -2.66-0.88]). Six studies (54.5%) found reduced opioid consumption in patients receiving buprenorphine. There was no difference in adverse effects in most studies. This review did not find buprenorphine to be superior to alternative analgesia; however the mixed results provide scientific rationale for future studies testing buprenorphine in older populations.

Effects of different doses of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy in children.

This study aimed to investigate the effect of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia in developmental hip dislocation in children after Salter osteotomy. The clinical data of 98 children with developmental hip dislocation, who underwent Salter osteotomy in our center between January 2020 and February 2023, were selected. The children were randomly divided into four groups based on the application of patient-controlled intravenous analgesia (sufentanil + granisetron ± dexmedetomidine). All children received 1 µg/kg/day of sufentanil and 3 mg of granisetron. Group A did not receive dexmedetomidine, and Groups B, C, and D received 0.5, 0.75, and 1.0 µg/kg/day of dexmedetomidine, respectively. The pain indicators and immune factor levels of children in each group were compared. The heart rate (HR) and respiratory rate (RR) 2 h after operation in Groups C and D were significantly lower than those in Groups A and B (P < 0.05). The pain scores decreased over time after treatment in all groups. When compared at the same time point, children in Group D had the lowest pain scores, which were significantly lower than the other three groups (P < 0.05). The total consumption of sufentanil in Groups C and D was significantly lower than that in Group A (P < 0.05). On the first day after surgery, the children in Group D had lower levels of serum adrenocorticotropic hormone, interleukin-6, and corticosterone than those in Group A (P < 0.05). Administration of 1.0 µg/kg/day of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy for developmental hip dislocation in children has a better analgesic effect, less consumption of sufentanil, and low incidence of opioid adverse reactions.

Postoperative intravenous patient-controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation.

Postoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S-ICD). In 2020, we introduced intravenous patient-controlled analgesia (IV-PCA) in addition to the conventional, request-based analgesia for postoperative pain control in S-ICD. To determine the effect and safety, we quantitatively assessed the effect of IV-PCA after S-ICD surgery over conventional methods. During the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S-ICD implantation under general anesthesia. While the postoperative pain was addressed with either request-based analgesia (by nonsteroid anti-inflammatory drugs, N = 68, dubbed as "PCA absent") or fentanyl-based IV-PCA in addition to the standard care (N = 45, dubbed as "PCA present"). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1-3: mild pain, 4-6: moderate pain, 7-10: severe pain). Although IV-PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter-group difference was not found significant. IV-PCA suppresses postoperative pain in S-ICD without major safety concerns.

Epidural versus intravenous analgesia for pain control in kidney donors, a retrospective cohort study. Is there a kinship relationship?

Aims: Best care must be provided for live kidney donors, including postoperative pain control. Treatment options include iv intermittent analgesics, iv or epidural patient-controlled analgesia (PCA). In this study we aimed to compare these modalities with respect to their analgesic efficacy. Methods: A retrospective analysis of fifty-eight live donor nephrectomy patients operated in a 7-year-period in a university hospital performed. Investigational Review Board approval has been obtained. Data of the patients’ postoperative analgesia methods, degree of kinship with the recipient, postoperative pain scores, and rescue analgesic and antiemetic use were obtained. Correlation of postoperative pain scores with the analgesia technique was investigated, as well as with the degree of kinship of the donor and recipient. Results: Patient-controlled analgesia provided better postoperative pain control, with the epidural PCA being the best. Moderate to severe pain at 6th postoperative hour in the iv intermittent, iv PCA, and epidural PCA groups was 76, 37, and 14%, respectively. Rescue analgesic use on the day of operation was 32% and 5% in the iv intermittent and iv PCA groups respectively, with no rescue analgesic use in the epidural PCA group. Postoperative antiemetic consumption was also less with the epidural PCA (P=0.024 and P=0.027 for postoperative days 1 and 2, respectively). No correlation was detected between the pain and the degree of kinship. Conclusion: Epidural patient-controlled analgesia provides better postoperative pain control after live donor nephrectomy, compared with intravenous intermittent or patient-controlled analgesia. Postoperative pain scores were not related to the degree of kinship.

Evaluation of a modified ultrasound-assisted technique for mid-thoracic epidural placement: a prospective observational study

BackgroundAlthough mid-thoracic epidural analgesia benefits patients undergoing major surgery, technical difficulties often discourage its use. Improvements in technology are warranted to improve the success rate on first pass and patient comfort. The previously reported ultrasound-assisted technique using a generic needle insertion site failed to demonstrate superiority over conventional landmark techniques. A stratified needle insertion site based on sonoanatomic features may improve the technique.MethodsPatients who presented for elective abdominal or thoracic surgery requesting thoracic epidural analgesia for postoperative pain control were included in this observational study. A modified ultrasound-assisted technique using a stratified needle insertion site based on ultrasound images was adopted. The number of needle passes, needle skin punctures, procedure time, overall success rate, and incidence of procedure complications were recorded.ResultsOne hundred and twenty-eight subjects were included. The first-pass success and overall success rates were 75% (96/128) and 98% (126/128), respectively. In 95% (122/128) of patients, only one needle skin puncture was needed to access the epidural space. The median [IQR] time needed from needle insertion to access the epidural space was 59 [47–122] seconds. No complications were observed during the procedure.ConclusionsThis modified ultrasound-assisted mid-thoracic epidural technique has the potential to improve success rates and reduce the needling time. The data shown in our study may be a feasible basis for a prospective study comparing our ultrasound-assisted epidural placements to conventional landmark-based techniques.

Effectiveness of ESP Block as Post-Operative Analgesia in Comparison with Opioid Analgesia for Laparoscopic Cholecystectomy

Background: In our country, the role of Erector Spinae Plane Block (ESP) for post-operative analgesia in laparoscopic cholecystectomy has not yet been investigated. As a result, the study was designed to compare the effectiveness of ESP block as post-operative analgesia to opioid analgesia for pain control following Laparoscopic Cholecystectomy. Objectives: The aim of the study was to evaluate the effectiveness of ESP block as post-operative analgesia in comparison with opioid analgesia. Methods: This cross-sectional comparative study was conducted at the department of surgery with collaboration of department of Anaesthesiology in CMH for 6 months of period. Before commencement of the study formal ethical clearance was taken from the Ethical Committee of DGMS Army. Total 60 patients, scheduled for laparoscopic cholecystectomy under general anesthesia were included in this study and randomly divided into two groups (30 patients in each group). total 30 Patients, received both GA and ultrasound guided ESP block were assigned as group E and 30 Patients, received GA and opioid analgesia were in group N. Informed written consent was taken from each subject and ethical measures were followed strictly in whole study. Following data collection, data were analyzed by the SPSS 24. Results: In terms of age, sex, BMI and ASA grading, the two groups had identical demographic features (p&gt;0.05 in all cases). There was no significant difference in pre-operative, post-operative, or recovery room heart rate (p&gt;0.05) or mean arterial pressure (p&gt;0.05). In the recovery room, group E has significantly less pain than group N (3.67±0.802 vs 4.3±0.877; p&lt;0.05). A similar improvement was seen in group E at 6, 12 and 24 hours (p&lt;0.05 in all follow ups). Post-operative analgesic consumption was similarly higher in group N at 1, 12, and 24 hours (p&lt;0.05 in all follow up). Except for nausea, which was more common in group N (p&lt;0.05), complications were similar in both groups. ......

Efficacy of Combined Epidural-General Anaesthesia [CEGA] in Attenuating Hemodynamic Responses to Pneumoperitoneum in Laparoscopic Cholecystectomies: A Prospective Randomised Study

Background: Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies.&#x0D; Methods: In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied.&#x0D; Results: Statistical analysis was carried out with SPSS version 20. Statistical value of p&lt;0.05 was considered significant. We noted significant difference in MAP, SBP, DBP, muscle relaxants, Propofol, Fentanyl and lesser pain scores in Group GE than Group G i.e (p&lt;0.001).&#x0D; Conclusion: Combination of epidural and general anaesthesia technique with pre emptive activation has the benefit of better control of hemodynamics .It reduced requirements of analgesics and anaesthetic drugs and had faster recovery with less post operative pain in laparoscopic cholecystectomies.

Comparison of efficacy of thoracic epidural analgesia versus intravenous analgesia for pain control and morbidity in patients of acute pancreatitis.

Comparison of efficacy of thoracic epidural analgesia versus intravenous analgesia for pain control and morbidity in patients of acute pancreatitis.

Application of Butorphanol versus Sufentanil in Multimode Analgesia via Patient Controlled Intravenous Analgesia After Hepatobiliary Surgery: A Retrospective Cohort Study.

We investigate the efficacy and safety of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via patient-controlled intravenous analgesia (PCIA) after hepatobiliary surgery, as compared with sufentanil. Postoperative follow-up data of hepatobiliary surgery patients in Henan Provincial People's Hospital from March 2018 to June 2021 were collected retrospectively and divided into butorphanol group (group B) or sufentanil group (group S) according to the postoperative intravenous controlled analgesia scheme. The baseline characteristics and surgical information of the two groups were matched through propensity score matching (PSM). A total of 3437 patients were screened, and PSM yielded 1816 patients after matching, including 908 in the butorphanol group and 908 in the sufentanil group. Compared with group S, the incidence of moderate-to-severe pain on the first postoperative day and the second postoperative day was lower in group B during rest (3.2% vs 10.9%, P<0.001; 1.2% vs 4.6%, P<0.001), and during movement (7.0% vs 18.9%, P<0.001; 2.6% vs 8.7%, P<0.001). Patients receiving butorphanol had a lower morphine consumption (50mg vs 120mg, P<0.001). The bolus attempts of an analgesic pump in group B were significantly lower than in group S (1 vs 2, P<0.001). Postoperative hospital length of stay was shortened in group B (11d vs 12d, P=0.017). The occurrence of postoperative vomiting was lower in group B (1.4% vs 3.0%, P=0.025) than in group S. However, more patients in group B experienced dizziness (0.9% vs 0.1%, P=0.019). Compared with sufentanil, the application of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via PCIA ameliorated postoperative pain after hepatobiliary surgery, with reduced opioid consumption and shorter postoperative hospital length of stay.

Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery

BackgroundThoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively.MethodsThis randomized controlled trial enrolled 100 patients, who were allocated into three groups: Group M (5 μg/kg morphine intrathecal injection), Group B (5 μg/kg morphine combined with bupivacaine 3 mg intrathecal injection) and Group C (intrathecal sham injection). The primary outcome was the assessment of pain relief using the Numeric Rating Scale (NRS). Additionally, intraoperative remifentanil consumption was quantified at the end of the surgery, and postoperative opioid use was determined by the number of patient-controlled analgesia (PCIA) compressions at 48 h post-surgery. Both the efficacy of the treatments and any complications were meticulously recorded.ResultsPostoperative NRS scores for both rest and exercise at 6, 12, 24, and 48 h were significantly lower in groups M and B than in group C (P<0.05). The intraoperative remifentanil dosage was significantly greater in groups M and C than in group B (P<0.05), while there was no significant difference between groups M and C (P>0.05). There was no significant difference in intraoperative propofol dosage across all three groups (P>0.05). Postoperative dosages of both sufentanil and Nonsteroidal anti‐inflammatory drugs (NSAIDs) were significantly less in groups M and B compared to group C (P<0.05). The time of first analgesic request was later in both groups M and B than in group C (P<0.05). Specific and total scores were elevated at 2 days postoperative when compared to scores at 1 day for all groups (P<0.05). Furthermore, at 1 day and 2 days postoperatively, both specific scores and total scores were higher in groups M and B compared to group C (P<0.05).ConclusionIntrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery.Trial registrationThe trial was registered on ClinicalTrials.gov: ChiCTR2200058544, registered 10/04/2022.

Anesthesia Management via an Automated Control System for Propofol, Remifentanil, and Rocuronium Compared to Management by Anesthesiologists: An Investigator-Initiated Study.

We previously developed an automated total intravenous anesthesia control system that uses new closed-loop system algorithms to administer propofol, remifentanil, and rocuronium based on the bispectral index and train-of-four data. We recently improved this automated control system by adding a safety mechanism and using a modified monitoring device. Patients scheduled for elective surgery were randomly assigned to closed-loop feedback control (automatic group) or the manual administration of propofol, remifentanil, and rocuronium (manual group). The proportion of time during which the proper management of three-agent anesthesia was maintained during surgery was determined as the primary endpoint. The proportion of time during which the three components of sedation, analgesia, and muscle relaxation were adequately controlled was 87.21 ± 12.79% in the automatic group, which was non-inferior to the proportion of 65.19 ± 20.16% in the manual group (p < 0.001). Adverse events during the operative or postoperative observation periods were significantly less frequent in the automatic group (54 patients, 90.0%) than in the manual group (60 patients, 100.0%; p = 0.027). Our three-agent automated control system, which features an improved muscle relaxation monitor and safety mechanism added to the basic control algorithms, maintained sedation, analgesia, and muscle relaxation appropriately in a manner non-inferior to anesthesiologists without compromising safety.

Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: a noninferiority randomised clinical trial

BackgroundOpen major abdominal surgery is one of the most risky surgical procedures for acute postoperative pain. Thoracic epidural analgesia (TEA) has been considered the standard analgesic approach. In different reports, lidocaine i.v. has been shown to have an analgesic efficacy comparable with TEA. We compared the analgesic efficacy of i.v. lidocaine with thoracic epidural analgesia using bupivacaine in patients undergoing major abdominal surgery. MethodsIn this noninferiority clinical trial, 210 patients were randomised to thoracic epidural bupivacaine with morphine or i.v. lidocaine. Dynamic pain at 24 h after surgery was measured using a numerical pain rating scale (NPR), and morphine consumption was also measured. A difference in i.v. the lidocaine-epidural bupivacaine NPR of ≤1 for dynamic pain was considered a noninferiority margin. ResultsThe NPR for dynamic pain in the lidocaine group at 24 h was between 5.7 (1.8) and 5.2 (1.9) in the epidural group, with a difference of 0.53 (95% confidence interval 0.0–1.0). In the first 24 h, the average difference in morphine consumption was 1.8 mg between the i.v. lidocaine and epidural groups (95% confidence interval 1–3 mg). No differences were found in adverse events or complications associated with the procedures. ConclusionsIntravenous lidocaine is noninferior to thoracic epidural analgesia for acute postoperative pain control in major abdomial surgery at 24 h postoperatively. Clinical trials registrationNCT04017013.

Patient-Controlled Epidural Analgesia vs Intravenous Patient-Controlled Analgesia in early recovery and pain control in gynecologic cancer

Patient-Controlled Epidural Analgesia vs Intravenous Patient-Controlled Analgesia in early recovery and pain control in gynecologic cancer

Efficacy and safety of patient-controlled thoracic epidural analgesia alone versus patient-controlled intravenous analgesia with acetaminophen after laparoscopic distal gastrectomy for gastric cancer: a propensity score-matched analysis.

Laparoscopic gastrectomy is a common procedure for early gastric cancer treatment. Improving postoperative pain control enhances patient recovery after surgery. The use of multimodal analgesia can potentially enhance the analgesic effect, minimize side effects, and change the postoperative management. The purpose of this study was to evaluate and compare the efficacies of the use of patient-controlled intravenous analgesia with regular acetaminophen (PCIA + Ace) and patient-controlled thoracic epidural analgesia (PCEA) for postoperative pain control. We retrospectively collected the data of 226 patients who underwent laparoscopic distal gastrectomy (LDG) with delta-shaped anastomosis between 2016 and 2019. After 1:1 propensity-score matching, we compared 83 patients who used PCEA alone (PCEA group) with 83 patients who used PCIA + Ace (PCIA + Ace group). Postoperative pain was assessed using a numeric rating scale (NRS) with scores ranging from 0 to 10. An NRS score ≥ 4 was considered the threshold for additional intravenous rescue medication administration. Although NRS scores at rest were comparable between the PCEA and PCIA + Ace groups, NRS scores of patients in the PCIA + Ace group during coughing or movement were significantly better than those of patients in the PCEA group on postoperative days 2 and 3. The frequency of additional rescue analgesic use was significantly lower in the PCIA + Ace group than in the PCEA group (1.1 vs. 2.7, respectively, p < 0.001). The rate of reduction or interruption of the patient-controlled analgesic dose was higher in the PCEA group than in the PCIA + Ace group (74.6% vs. 95.1%, respectively, p = 0.0002), mainly due to hypotension occurrence in the PCEA group. Physical recovery time, postoperative complication occurrence, and liver enzyme elevation incidence were not significantly different between groups. PCIA + Ace can be safely applied without an increase in complications or deterioration in gastrointestinal function; moreover, PCIA + Ace use may provide better pain control than PCEA use in patients following LDG.

Adductor Canal Block versus Intravenous Patient Controlled Analgesia for Postoperative Pain Control for Primary Total Knee Arthroplasty

Abstract Background Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response. Aim of the Work to compare efficacy, hemodynamic effects, opiate consumption and side effects of Adductor canal block and intravenous patient-controlled analgesia (PCA) in terms of postoperative primary total knee arthroplasty analgesia. Patients and Methods The study was performed upon 60 patients, randomly distributed into two equal groups: Group I: Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery and before extubation with 20 ml of bupivacaine 0.5% and Group II: Patients of this group received intravenous patientcontrolled analgesia (PCA) with Nalbuphine after the end of surgery and before extubation. For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, VAS, Nalbuphine extradoses consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension were recorded. Orthopedic rehabilitation indices were assessed by physiotherapy staff. Results ACB provided more effective analgesia for the first 6 hours but PCA with nalbuphine was superior after and for the rest of 24 postoperative hours. Conclusions Adductor canal block had good control of pain for the first 6 postoperative hours. However, the conventional use of intravenous PCA containing opioids was more effective for the rest of the first 24 postoperative hours.

Comparison of patient-controlled epidural and intravenous analgesia methods for postoperative pain control in patients after hip surgery

Objective: Patients undergoing total hip arthroplasty surgery are usually older and have limited cardiac and pulmonary reserves. Effective postoperative pain control with patient-controlled analgesia (PCA) may contribute to recovery in these patients. In this study, we aimed to compare the effectiveness of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) for pain control after hip arthroplasty. Methods: Our study was carried out in the orthopedic operating room of our hospital on 50 patients undergoing elective hip arthroplasty. At the end of the operation, the patients (n=50) were randomly divided into two groups: Group epidural (Group E) and Group intravenous (Group IV)] using a double-blind selection method, and PCA protocol was started. During the determined follow-up periods, the patients were evaluated regarding hemodynamic data, pain and sedation levels, and possible side effects. Results: In our study, no difference was observed between demographic data, heart rate, respiratory rate and mean blood pressure values ​​in comparisons between two groups. In Group IV compared to Group E, visual analog scale (VAS) values ​​(P&lt;0.001), additional analgesic consumption (P&lt;0.05) and undesirable effects such as nausea-vomiting and sedation (P&lt;0.05) which were observed in postoperative pain follow-up were statistically significantly higher. Conclusion: Our study concluded that for postoperative pain management, the PCEA method has better analgesic performance, improves pain control and reduces the occurrence of side effects in hip arthroplasty compared to the PCIA method.

Involving a Dedicated Epidural-Caring Nurse in Labor Ward Practice Improves Maternal Satisfaction towards Childbirth: A Retrospective Study.

The quality of healthcare is crucially linked to patient satisfaction, particularly in the provision of neuraxial analgesia for labor pain. Neuraxial analgesia for labor pain control should ideally be readily available when requested. However, in real-world practice, anesthesiologists may not always respond immediately to maternal demands, which can compromise the quality of care. To address this issue, this study aimed to evaluate the effectiveness of involving a dedicated nurse in epidural care to improve maternal satisfaction. This study was conducted in a single tertiary center. Medical records of women with singleton pregnancies above 36 gestational weeks who received neuraxial analgesia for labor pain control were reviewed (N = 354). Among them, 104 women (29%) received care from a dedicated nurse. The results showed that involving a dedicated nurse led to higher maternal satisfaction scores before (4.7 ± 0.5 versus 4.5 ± 0.6, p = 0.001), during (4.7 ± 0.6 versus 4.5 ± 0.6, p = 0.002), and at 24 h postpartum (4.7 ± 0.5 versus 4.5 ± 0.5, p = 0.001), without any adverse impact on maternal, neonatal, or epidural-related complications. These findings suggest that allocating a dedicated nurse to epidural care can effectively enhance maternal satisfaction and potentially improve overall care quality.

Can gabapentinoids decrease perioperative opioid requirements in orthopaedic trauma patients? A single-centre retrospective analysis.

Perioperative pain control in patients with orthopaedic trauma/extremity fractures has gained a lot of attraction from the scientific community in the last two decades. In addition to multimodal analgesia, the use of non-opioid drugs like gabapentinoids for pain relief is gradually finding its place in several orthopaedic subspecialties like spinal surgery, arthroplasty, and arthroscopic procedures. We envisage investigating the effectiveness of gabapentin in perioperative pain control in patients with extremity fractures undergoing surgical fixation. This was a retrospective comparative study conducted between January 2020 and January 2022. Patients with isolated fractures of the extremity involving long bones who were treated at our trauma centre, during the study period were divided into two groups based on the analgesics they received. Patients who received gabapentin and paracetamol were placed in group GP and those who received only paracetamol were assigned group NGP. Gabapentin was given in a single dose of 300mg 4h before surgery. Postoperatively, they were given 300mg 12 hourly for 2days. All patients in our trauma centre are usually managed with parenteral paracetamol administration pre and postoperatively. VAS score was calculated postoperatively at 2, 6, 12, 24 and 48h. Patients requiring additional analgesics for pain relief were administered intravenous tramadol or a buprenorphine patch was applied. Patients in both groups were compared in terms of pain control, the additional requirement of opioid analgesics, and any adverse event related to medications. One hundred and nineteen patients were enrolled in the study. Out of 65 patients in the NGP group (non-gabapentin group), 74% of patients received additional opioid analgesics apart from paracetamol. Out of the 54 patients in the GP group (gabapentin group), only 41% required additional opioid analgesia for pain control. There was a significant difference in opioid consumption between the two groups (p < 0.01). VAS scores were not significantly different between the two groups at 2, 4, 6, 12, 24 and 48h. Gender and fracture morphology did not affect opioid intake in the GP group. However, in the non-gabapentin group, there was a significant difference in opioid requirement in patients with intraarticular fractures (p < 0.01). Analgesic requirements vary from patient to patient depending on the injury's severity and surgery duration. However, there are no strict guidelines for pain relief in limb trauma surgeries which often leads to overuse and opioid-related complications or underuse and chronic pain. Gabapentinoids can supplement the analgesic effect of paracetamol in trauma patients during the perioperative period, decreasing the need for opioids.

Serial serum lipase testing after the initial diagnostic workup for inpatients with acute pancreatitis: What is the evidence?

A 35-year-old male with no significant medical history presented to the hospital with acute epigastric pain radiating to his back. Workup revealed a serum lipase of 518 U/L (reference range 0–160 U/L), and computed tomography of the abdomen showed peripancreatic fat-stranding. He does not drink alcohol or take any medications, and the workup was negative for gallstones and hypertriglyceridemia. He was diagnosed with acute idiopathic pancreatitis and admitted to the hospital for management. He received early enteral feeding, intravenous fluid resuscitation, and opioid analgesia for pain control. His pain gradually improved and he was tolerating oral intake. A repeat serum lipase level on hospital day 3 was elevated at 609 U/L. Does this repeat serum lipase value have a role in guiding further clinical decisions?