Analgesia In Elderly Patients Research Articles

The efficacy of preemptive multimodal analgesia in elderly patients undergoing laparoscopic colorectal surgery: a randomized controlled trial

Objective To evaluate the effectiveness of preemptive multimodal analgesiain elderly patients undergoing laparoscopic colorectal surgery. Methods A prospective randomized controlled study was conducted in the Department of Gastrointestinal Surgery of the Second Hospital of Hebei Medical University from January 2022 to December 2022. A total of 133 patients were included according to the criteria and randomly divided into preemptive analgesia (PRA) group (test group, 67patients) and postoperative analgesia (POA) group (control group, 66patients). Results The Visual Analog Scale (VAS)scores of PRA group 24 h, 48 h, and 72 h after operation were lower than those of POA group, and the difference was statistically significant, P < 0.001.The incidences of postoperative gastrointestinal dysfunction (POGD) and postoperative delirium (POD)in PRA group were 13.43% and 8.98%, respectively, which were significantly lower than those in POA group (31.82% and 24.24%), P < 0.05. The levels of IL-6 and IL-10 in PRA group after the operation were 17.54 ± 2.13 ng/L and 15.57 ± 1.71 ng/L respectively, which were lower than those in POA group (25.45 ± 2.95 ng/L and 23.45 ± 1.88 ng/L), P < 0.05. The level of acetylcholinesterase(AchE) was 56.34 ± 5.62 nmol/L in the POA group, which was significantly higher than that in the POA group (49.59 ± 5.52 nmol/L), P < 0.001. Conclusion Preemptive multimodal analgesia can reduce the incidence of POGD and POD in elderly patients undergoing laparoscopic gastrocolic surgery, improve the recovery process of postoperative gastrointestinal function, increase the concentrations of propionic acid and butyric acid in short chain fatty acids (SCFAs) and the number of beneficial intestinal bacteria.

Application of hip capsule peripheral nerve block in early analgesia in elderly patients with hip fracture

Application of hip capsule peripheral nerve block in early analgesia in elderly patients with hip fracture

Application of hip capsule peripheral nerve block in early analgesia in elderly patients with hip fracture.

The objective of the study is to investigate the effect of pericapsular nerve group (PENG) block in early analgesia in elderly patients with hip fracture. A total of 44 elderly patients with hip fracture admitted to our hospital from August 2021 to December 2022 were selected and divided into 2 groups according to different analgesia programs. At T1~T4, the resting and active visual analog scale (VAS) scores in group P were lower than group F (p < 0.05). The resting and active VAS scores at T5 in both groups were no visible differences (p > 0.05). After 30 min of block, systolic blood pressure, diastolic blood pressure, and heart rate were decreased in both groups (p < 0.05), but no obvious difference was found in the two groups (p > 0.05). Before surgery, Pittsburgh Sleep Quality Index (PSQI) and mini-mental state scale (MMSE) scores in both groups were reduced, and PSQI score in group P was lower than that in group F and MMSE score was higher than group F (p < 0.05). PENG technology is safe and effective in the early analgesia of elderly hip fractures. It can effectively block physiological stress response caused by acute trauma, improve pre-operative sleep quality, and reduce the incidence of cognitive dysfunction.

Effects of Continuous versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Abstract Background Continuous spinal anesthesia (CSA) is an anesthetic technique that offers several clinical advantages for anesthesia and analgesia in elderly patients. The level of sensory blockade can be titrated to the desired dermatomal level with great precision with intrathecal (IT) catheters, allowing better control of the hemodynamic consequences of sympathetic blockade associated with spinal anesthesia compared to epidural or single shot spinal techniques. Octogenarians are expected to suffer more from hemodynamic instability with spinal anesthesia. Objective The primary outcome is to compare the incidence of hypotension (defined as decrease in mean arterial blood pressure &amp;gt; 20% from the base line) in continuous spinal anesthesia CSA versus single dose spinal anesthesia in octogenarians undergoing hip surgery. The secondary outcome is to determine the total use of vasopressor (Ephedrine) and the incidence of spinal complications as nausea, vomiting and post Dural puncture headache. Methods This is a randomized controlled clinical trial done at Ain-shams University Hospitals, Cairo, Egypt within a period of 6 months from approval of medical ethics committee. Twenty patients in CSA group received increments of (0.5 ml) of plain bupivacaine 0.5% until T10 level blockade is achieved. Twenty patients in SDA group received single shot of (2.5ml) of bupivacaine 0.5%. Results The main finding of this study is that while MAP was significantly lower between 5-35 minutes (&amp;lt;0.001), it was significantly higher between 40-75 minutes in SDA group than CSA group (0.05).Total bupivacaine dose was significantly higher in SDA (12.5±0.8) group than CSA group (7.6±1.3) (p &amp;lt; 0.001). The total ephedrine dose needed was significantly higher in the SDA group (19.5 ±11.3) than in CSA group (4.5±1.7) (p.0.006). Conclusion The main finding of this study is that for octogenarians undergoing hip surgery, while MAP was significantly lower between 5-35 minutes, it was significantly higher between 40-75 minutes in single dose spinal anesthesia group than continuous spinal anesthesia group. Episodes of bradycardia were similar in both groups. The bupivacaine dose as well as total ephedrine dose was significantly higher in SDA group than CSA group. Groups were similar in the incidence of postoperative complications related to the neuraxial blockade. The impact of these changes on the overall cardiovascular status and outcome in octogenarians undergoing hip surgery could not be determined from our study design.

Effects of buccal acupuncture on postoperative analgesia in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial.

This study aimed to evaluate the efficacy and safety of buccal acupuncture on postoperative analgesia, perioperative stress response and adverse events in elderly patients undergoing laparoscopic radical gastrectomy. It was a prospective, outcome assessor-blinded, randomized controlled trial, involving 90 patients aged 65-80 years who were treated with an elective laparoscopic radical gastrectomy. They were randomly assigned to buccal acupuncture group (Group B) and control group (Group C). Buccal acupuncture was applied to patients of Group B before the induction of general anesthesia, while no additional application was given to those in Group C. Patient-controlled intravenous analgesia (PCIA) with sufentanil was postoperatively performed in both groups. Sufentanil consumption and the Visual Analog Scale (VAS) score within 48 h postoperatively were assessed as primary outcomes. Secondary outcomes included peripheral levels of stress markers, intraoperative consumptions of anesthetic drugs and postoperative recovery. Patients in Group B presented significantly lower VAS scores within 24 h and less consumption of sufentanil within 48 h postoperatively (both p < 0.01). The awaking time, time to extubation and length of stay were significantly shorter in Group B than in Group C (p = 0.005, 0.001 and 0.028, respectively). Compared with Group C, stress response and inflammatory response within 24 h postoperatively were also significantly milder in Group B. The use of buccal acupuncture before general anesthesia induction favors the postoperative analgesic effect and recovery in elderly patients undergoing laparoscopic radical gastrectomy, the mechanism of which involves relieving postoperative stress response and inflammatory response. This study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 15/06/2023 (ChiCTR2300072500).

Continuous Erector Spinae Plane Block for Postoperative Analgesia in Elderly Patients After Thoracoscopic Lobectomy

PurposeCompared the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on postoperative analgesia in elderly patients underwent thoracoscopic lobectomy. DesignThe patients who underwent non-emergent thoracoscopic lobectomy in thoracic surgery department of our hospital from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block(ESPB) group and continuous thoracic paravertebral block(TPVB) group. MethodsFifty elderly patients with thoracoscopic lobectomy under general anesthesia from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block(ESPB) group and continuous thoracic paravertebral block(TPVB) group, with 25 patients in each group. The patients in the two groups were guided by ultrasound with ESPB or TPVB before anesthesia induction. The visual analog scale (VAS) at rest and cough in 2h, 6h, 8h, 12h, 24h, 48h after surgery, the supplementary analgesic dosage of tramadol, time of tube placement, the stay time in post-anesthesia care unit(PACU), the first ambulation time after surgery, the length of postoperative hospital stay and postoperative complications were recorded. FindingsThere were no significant differences between the two groups in VAS score at rest and cough at each time point and supplementary analgesic dosage of tramadol within 48h after surgery (p>0.05). The time of tube placement and the postoperative hospital stay in ESPB group was significantly shorter than that in TPVB group(p<0.05). There were no differences in PACU residence time and first ambulation time between the two groups(p>0.05). There were 4 patients in TPVB group and 2 patients in ESPB group occurred nausea and vomiting(P>0.05), 1 case of pneumothorax and 1 case of fever occurred in TPVB group. There were no incision infection or respiratory depression requiring clinical intervention occurred in both groups. ConclusionsBoth ESPB and TPVB alleviated the patients postoperative pain effectively for elderly patients underwent thoracoscopic lobectomy. Compared with TPVB, ESPB have shorter tube placement time, fewer complications and faster postoperative recovery. Unitsmg/kg, Milligram per kilogram; mL, Millilitres; ml/h, Millilitres per hour; ug/kg, Microgram per kilogram; ml/kg, Millilitres per kilogram; ml/kg/h, Millilitres per kilogram per hour; mg, Milligram. FootnotesNot applicable.

Application of superior iliac fascia block of inguinal ligament combined with patient controlled intravenous analgesia in elderly patients after hip arthroplasty

To compare the effect of patient-controlled intravenous analgesia(PCIA) and superior inguinal ligament iliac fascia block combined with PCIA after hip replacement in the elderly. Total of 82 elderly patients were treated with hip arthroplasty from June 2019 to June 2021 and randomly divided into observation group and control group. There were 42 patients in control group, including 18 males and 24 females, aged from 60 to 78 years old with an average of (70.43±3.67) years old, 28 femoral neck fractures and 14 femoral head necrosis, who received PCIA. The study group consisted of 42 cases, including 20 males and 22 females, aged from 61 to 76 years old with an average of (69.68±3.74) years old, 25 femoral neck fractures and 17 femoral head necrosis, who received superior inguinal ligament iliac fascia block combined with PCIA. Pain visual analogue scale (VAS) and Ramesay sedation scores at 2 h, 6 h, 12 h, 24 h and 48 h after operation were evaluated. In addition, the follow-up results of the total consumption of sufentanil and the total number of PCIA compressions at 48 hours after operation, the first time of landing after surgery, the time of hospital stay, the incidence of adverse reactions, the satisfaction with analgesia of two groups were observed. All patients were followed up for 9 to 24 months with an average of(13.85±2.67) months. There was no significant difference in operation time and intraoperative bleeding between two groups (P>0.05). There was no difference in VAS between two groups at 2 hours after operation (P>0.05), and the VAS of the study group at 6 h, 12 h, 24 h and 48 h after operation were lower than those of the control group(P<0.05). The Ramesay sedation scores of the study group at 2 h, 6 h and 12 h after operation were higher than those of the control group(P<0.05), and there were no differences in Ramesay score between two groups at 24 h and 48 h after operation (P>0.05). The consumption of sufentanil in the study group within 48 hours after operation was lower than that in the control group (P<0.05), and PCIA compression times were lower than those in the control group(P<0.05), and the time of first landing was earlier than that in the control group(P<0.05). There was no significant difference in hospital stay, adverse reaction rate, complications between two groups (P>0.05). The satisfaction of analgesia in the study group was higher than that in the control group (P<0.05). Superior iliac fascia block of inguinal ligament combined with PCIA has significant analgesic and sedative effects after hip arthroplasty in the elderly. It can reduce the amount of sufentanil used and the total number of PCIA compressions, which is conducive to the early activity of patients out of bed, improve the satisfaction of analgesia.

Efficacy and safety analysis of bupivacaine liposome for pericapsular nerve group block for postoperative analgesia in elderly patients with hip replacement

Objective: To investigate the efficacy and safety of bupivacaine liposome for pericapsular nerve group block (PENGB) for postoperative analgesia in elderly patients with total hip replacement. Methods: A total of 42 elderly patients underwent total hip replacement were selected in the Second Affiliated Hospital of Wenzhou Medical University from May to July in 2023, including 19 males and 23 females, aged (68.8±6.3) years, the American Society of Anesthesiologists (ASA) grade Ⅰ to Ⅲ. They were divided into bupivacaine liposome group (observation group) and levobupivacaine hydrochloride group (control group) according to random number table, with 21 cases in each group. All the patients were anesthetized by lumbar anesthesia combined with PENGB. During PENGB, the observation group was injected with 10 ml (133 mg) bupivacaine liposome+5 ml normal saline, and the control group was injected with 10 ml (75 mg) levobupivacaine hydrochloride+5 ml normal saline. The primary outcome measures included the rest and movement visual analogue scale (VAS) scores at 6, 12, 24, 36, 48, 60, and 72 h after operation, the sufentanil consumption in analgesic pump, the numbers of analgesic pump compressions, and the rates of additional parexib sodium use in ward. The secondary outcome measures were the changes in lower limb muscle strength, the length of hospital stay and the occurrence of adverse reactions. Results: There was no significant difference in the rest and movement VAS scores between the two groups at pre-operation and at 6 h after operation (P>0.05);but the rest and movement VAS scores at 12, 24, 36, 48, 60 and 72 h after operation in observation group were significantly lower than those in control group (P<0.05); the rest and movement VAS scores at 6, 12, 24, 36, 48, 60 and 72 h after operation were lower than those at pre-operation in two group (P<0.05). The consumption of sufentanil in analgesic pump and parexib sodium usage in observation group were lower than those in control group at 12, 24, 36 and 48 h after operation (P<0.05). The total number of analgesic pump compressions, the number of effective compressions and the number of ineffective compressions in 48 h in observation group were lower than those in control group (P<0.05). The muscle strength of the lower limbs of all patients were able to move against gravity at 12 h after operation. The incidence of nausea in 48 h after operation in observation group was 9.5% (2/21), which was lower than 42.9% (9/21) in control group (P=0.014). No postoperative vomiting occurred in all patients. The length of the hospital stay was (9.3±2.2) d in observation group and (8.9±1.9) d in control group, and there was no significant difference between the two groups (P=0.500). Conclusion: Compared with levobupivacaine hydrochloride, liposomal bupivacaine in PENGB provides analgesic effects for up to 72 h after total hip replacement in elderly patients, reduces postoperative opioid and other analgesics usage, decreases the incidence of postoperative nausea, and has a minor effect on lower limb movement without prolonging hospitalization.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Block and Three-in-one Block in Elderly Patients Undergoing Hip Surgeries: A Randomised Double-blinded Clinical Trial

Introduction: Hip surgery is a common surgical procedure in the elderly population, leading to significant pain. Ultrasound (USG) guided regional nerve blocks are a newer, safe, and effective postoperative pain control modality for elderly patients. Aim: To compare the analgesic efficacy of Fascia Iliaca Compartment Block (FICB) with the three-in-one block for postoperative analgesia in elderly patients after lower limb orthopaedic surgeries. Materials and Methods: It was a randomised double- blinded study performed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India on 60 elderly patients of Americian Soceity of Anaesthesiologists (ASA) class I-II scheduled for elective hip and femur shaft surgery under spinal anaesthesia.All patients were randomly allocated into two groups. Group A received ultrasound-guided FICB with 35-40 mL of 0.25% bupivacaine, and group B received ultrasound-guided three-in-one block with 35-40 mL of 0.25% bupivacaine after completion of surgery. In the postoperative period, pain was assessed using the Visual Analogue Scale (VAS), and inj. diclofenac sodium 1.5 mg/kg intravenous (i.v.) was given as rescue analgesic whenever VAS was ≥4. The primary outcome was changes in VAS scores at rest and during passive leg elevation between the two groups at various time intervals within 24 hours. Secondary outcomes measured were the duration of analgesia and total rescue analgesic required in 24 hours. Qualitative variables were compared between groups using the Chi-square test. A p-value&lt;0.05 was considered statistically significant. Results: Demographic data were comparable in both groups, with a mean age of 65.11±1.89 years in Group A and 65.57±1.46 years in Group B. The VAS score at rest was significantly lower in Group A compared to Group B at the 6th hour (1.21±1.17 vs. 1.61±0.78) and 12th hour (2.80±0.12 vs. 3.33±0.92), respectively. The VAS score during passive movement was significantly lower in Group A at the 6th hour and 12th hour compared to Group B. The mean time for the first demand of rescue analgesic was 9.27±2.16 hours in the Fascia Iliaca Compartment Block (FICB) group and 6.67±1.45 hours in the three-in-one group. The difference was significant, with a p-value of 0.006. The mean requirement of total rescue analgesia was 133.33±33.27 mg in Group A and 198.53±29.16 mg in Group B, which was statistically significant. Conclusion: The fascia iliaca block had lower pain scores both at rest and during passive movement compared to the three-inone block. Total analgesic requirement was lower in the fascia iliaca group compared to the three-in-one block group.

Ultrasound-guided pericapsular nerve group (PENG) block for early analgesia in elderly patients with hip fractures: a single-center prospective randomized controlled study

BackgroundThe aim of this study was to compare the efficacy of ultrasound-guided PENG (pericapsular nerve group) block and drug therapy with intravenous flurbiprofen for early analgesia in elderly patients with hip fractures after hospitalization.MethodsThis is a single-center, observer-blinded, prospective, randomized, controlled trial. A total of 41 elderly patients (aged 60 or older) with hip fractures were enrolled in the current study. Patients were randomly assigned to two groups: Group P (ultrasound-guided PENG block, 20 mL of 0.375% ropivacaine) and Group F (intravenous flurbiprofen 50 mg). The primary outcome measure was the dynamic (passive straight leg raising 15°) NRS (numerical rating scale 0 to 10) pain scores at different time points. The secondary outcomes were the static NRS scores at different time points, the number of rescue analgesia sessions, patient satisfaction, and the incidence of complications.ResultsPatients in the two groups had comparable baseline characteristics. The group P had lower dynamic and static NRS scores at 15 min, 30 min, 6 h, and 12 h after intervention (P<0.05) than the group F. The highest NRS pain scores in the group P were still lower than the NRS scores in the group F at 30 min-12 h (Group F: 5.57±1.54 vs. Group P: 3.00±1.12, P<0.001), and there was no significant difference between the two groups at 12-24 h (Group F: 6.35±1.79 vs. Group P: 5.90±1.83, P>0.05). The group P had higher satisfaction scores (Group P: 9 (9,9) vs. Group F: 8 (7,8), P<0.001). There was no statistically significant difference in the number of rescue analgesics at 0-12 h or 12-24 h or the incidence of complications between the groups.ConclusionsCompared with intravenous flurbiprofen, ultrasound-guided PENG block provides better early analgesic effects in elderly patients with hip fractures, and a PENG block is safe for elderly patients with hip fractures after hospitalization.Trial registrationThis study was registered in the Chinese Clinical Trial Testing Center (ID: ChiCTR2200062400).

Timing of regional analgesia in elderly patients with blunt chest-wall injury

BackgroundRib fractures represent a typical injury pattern in older people and are associated with respiratory morbidity and mortality. Regional analgesia modalities are adjuncts for pain management, but the optimal timing for their initiation remains understudied. We hypothesized that early regional analgesia would have similar outcomes to late regional analgesia. MethodsWe retrospectively reviewed the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2019. We included patients ≥65 years old admitted with blunt chest wall trauma who received regional analgesia. We divided patients into 2 groups: (1) early regional analgesia (within 24 hours of admission) and (2) late regional analgesia (>24 hours). The outcomes evaluated were ventilator-associated pneumonia, mortality, unplanned intensive care unit admission, unplanned intubation, discharge to home, and duration of stay. Univariable analysis and multivariable logistic regression adjusting for patient and injury characteristics, trauma center level, and respiratory interventions were performed. ResultsIn the study, 2,248 patients were included. The mean (standard deviation) age was 75.3 (6.9), and 52.7% were male. The median injury severity score (interquartile range) was 13 (9–17). The early regional analgesia group had a decreased incidence of unplanned intubation (2.7% vs 5.3%, P = .002), unplanned intensive care unit admission (4.9% vs 8.4%, P < .001), and shorter mean duration of stay (5.5 vs 6.5 days, P = .002). In multivariable analysis, early regional analgesia was associated with decreased odds of unplanned intubation (odds ratio, 0.58; 95% confidence interval, 0.36–0.94; P = .026), unplanned intensive care unit admission (odds ratio, 0.60; 95% confidence interval, 0.041–0.86; P = .006), and increased odds of discharge to home (odds ratio, 1.27; 95% confidence interval, 1.04–1.55; P = .019). After multivariable adjustment, no significant difference was found for ventilator-associated pneumonia or mortality (odds ratio, 0.60; 95% confidence interval, 0.34–1.04; P = .070). ConclusionEarly regional analgesia initiation is associated with improved outcomes in older people with blunt chest wall injuries. Geriatric trauma care bundles targeting early initiation of regional analgesia can potentially decrease complications and resource use.

Efficact of Supplemental Oxygen During Procedural Sedation and Analgesia in Elderly Patients in the Emergency Department

BackgroundThe use of supplemental oxygen (SO) for procedural sedation and analgesia (PSA) is recommended in many guidelines, but the evidence of SO for the elderly is limited. ObjectivesThis study aimed to compare the incidence of hypoxia with or without SO in PSA for the elderly patients. MethodsWe prospectively collected data on all patients undergoing PSA in the emergency department (ED) from May 2017 through December 2021. These data are from the Japanese Procedural SedaTion and Analgesia Registry. We included all elderly patients (65 years and older) who received PSA in the ED. We performed propensity score analysis for inverse probability of treatment weighting (IPTW) to balance the baseline characteristics. The primary outcome was the incidence of hypoxia (SpO2 < 90%), and the secondary outcome was the incidence of bag-valve mask ventilation. ResultsAmong 1465 patients in the registry, we included 816 (55.7%) patients in the analysis. After propensity score method for IPTW, the distributions of confounders were closely balanced between the two groups. The incidence of hypoxia was significantly lower in the SO group compared with the non-SO group (6.2% vs. 19.3%; difference –13.1%; 95% confidence interval [CI] –9.8 to –16.4; p < 0.001). SO was also associated with a lower incidence of bag-valve mask ventilation (5.2% vs. 15.4%; difference –10.2%; 95% CI –7.1 to –13.2; p < 0.001). ConclusionsIn a propensity-matched analysis, SO was associated with a lower incidence of hypoxia in elderly patients during ED PSA.

Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery: A Retrospective, Propensity-Score Matched Study.

For preoperative analgesia during a variety of operations, the erector spinae plane block (ESPB) has grown in popularity. However, its effectiveness in lumbar surgery is still unknown. The purpose of this study was to investigate the potential benefits of ESPB in enhancing analgesic efficacy in elderly individuals following posterior lumbar spine surgery. Patients aged 65years or older who underwent elective posterior lumbar instrumented fusion (with or without decompression) at our institution between January 2019 and June 2022 were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for control and ESPB groups. The primary outcome was opioid consumption at 24h after surgery. Secondary outcomes was visual analog scale (VAS) pain scores at rest in the first 24h. Additional secondary outcomes included number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia, and length of stay. A total of 382 patients were included, of whom 119 received ESPB. The mean age of the study patients was 70.6years old, and 254 (66.5%) were male. After PSM, each group comprised 115 patients. Patients in the ESPB group showed a significantly lower opioid consumption at 24h after surgery. Compared with the control group, VAS pain scores at rest in the first 24h, number of patient-controlled intravenous analgesia (PCIA) pump compressions, ratio of patients requesting rescue analgesia, incidence of nausea and vomiting, and length of stay were significantly reduced in the ESPB group. There were no significant differences between the two groups regarding safety outcomes. ESPB reduces short-term opioid consumption while providing safe and effective analgesia in elderly patients undergoing posterior lumbar surgery.

Evaluation of Two Doses of Intrathecal Clonidine on Analgesia and Haemodynamic Profile in Elderly Patients Undergoing Endoscopic Bladder SurgeriesA Randomised Clinical Trial

Introduction: Endoscopic bladder surgeries like Transurethral Resection Of Prostrate (TURP) and Transurethral Resection Of Bladder Tumour (TURBT) are performed preferably under spinal anaesthesia, using local anaesthetic like bupivacaine along with an adjuvant. Of these adjuvants used, clonidine is gaining popularity because of its safety and various advantages associated with its use. However its effect on haemodynamics, effect on block characteristics and analgesia in elderly patients has not been studied extensively. Aim: To evaluate the analgesic efficacy and safety of clonidine 30 µg and 50 µg, in elderly patients undergoing endoscopic bladder surgeries. Materials and Methods: It was a double blinded randomized control trial, conducted in Department of Anaesthesia, University College of Medical Sciences, Delhi, India, from September 2008 to October 2011. Sixty American Society of Anaesthesiology (ASA) grade I and II patients, of age 50-80 years, undergoing endoscopic bladder surgeries, were randomly allocated into three groups of 20 each. Group C received 12.5 mg of 0.5 % heavy bupivacaine (2.5 mL) without clonidine, while group A and group B received 30 µg and 50 µg, respectively of clonidine. Intraoperative non invasive and invasive haemodynamic monitoring was done. The duration of analgesia (the time from the intrathecal injection to Visual Analog Scale (VAS) score greater than 0 and Bromage Scale 3), quality of anaesthesia and haemodynamic were compared between the three groups. Analysis of variance (ANOVA) for repeated measures was used for analysing the collected data. Tukey’s Honest Significant Difference (HSD) test was applied as post hoc test whenever applicable. Results: The mean duration of complete analgesia was 3.32±1.80 hours in group A, 6.30±1.45 hours in group B, and 2.22±0.92 hours in group C. The duration of complete analgesia was significantly longer in group A and B, when compared to group C. The mean duration of effective analgesia was 6.05±0.88 hours in group A, 8.65±1.75 hours in group B, and 4.68±1.77 hours in group C. The duration of effective analgesia was significantly longer in group A and B, as compared to group C. Following intrathecal injection, there was no significant difference in heart rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), cardiac output, stroke volume, systemic vascular resistance in between groups. There were no significant side effects in any of the groups. Conclusion: Intrathecal clonidine in a dose of 30 µg and 50 µg provides faster onset, better quality and prolonged duration of block with stable haemodynamic and minimal side effects in patients undergoing endoscopic bladder surgeries.

Effects of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia on the early recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer

Objective: To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients' early recovery. Methods: One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021, were divided into two groups (n=55) using a random number table: group S received PCIA, with continuous infusion of S(+)-ketamine combined with sufentanil, while group C received PCIA, with continuous infusion of sufentanil. PCIA was initiated at the end of the surgery, and the formulations were as follows: group S, S(+)-ketamine (1.44 mg/kg), sufentanil (1.05 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline; group C: sufentanil (1.50 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline. Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of remedial analgesia, the effective compressions number of PCI during 48 h after the operation. Time to first ambulation, time to first anal exhaust, time to resume oral feeding were recorded. The occurrence of adverse effects was compared between the two groups. Results: A total of 10 patients were excluded during the study, including 4 cases of conversion to laparotomy, 3 cases of dropping out of the study, and 3 cases with operation time more than 4 hours. Finally, 50 cases in group S and 50 cases in group C completed the study. There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups (all P>0.05). Likewise, there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups (both P>0.05). The total dosage of sufentanil consumption in group S [(64±9) μg] was lower than that in group C [(95±12) μg] within 48 h of PCIA, with a statistically significant difference (P<0.001). Time to first ambulation in group S was (1.1±0.2) d, which was shorter than that in group C [(1.6±0.5) d], and the difference was statistically significant (P<0.001). Likewise, time to first anal exhaust in group S [(1.3±0.4) d] was shorter than that in group C [(1.8±0.6) d], with a statistically significant difference (P<0.001). Additionally, time to resume oral feeding in group S was (2.5±0.6) d, which was shorter than that in group C [(3.1±0.7) d], and there was a statistically significant difference (P<0.001). The incidence of nausea, vomiting and pruritus in group S were 4.0%, 2.0% and 0, which were lower than that in group C (16.0%, 10% and 8.0%, respectively), with statistically significant differences (all P<0.05). No case with psychiatric symptoms was found in both groups. Conclusion: When used for postoperative intravenous analgesia in elderly patients undergoing laparoscopic radical resection of rectal cancer, S(+)-ketamine combined with sufentanil can provide satisfactory analgesic effects, decrease total consumption of sufentanil and the incidence of adverse effects, and thus facilitate patients' early recovery.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study.

IntroductionPostoperative analgesia in elderly patients is still a thorny problem. Ultrasound-guided oblique subcostal transverse abdominis plane block (TAPB) has been demonstrated to provide postoperative analgesia after abdominal surgeries. However, recent studies have suggested that an alternative method, erector spinae plane block (ESPB), might also be effective. In this study, we compared the postoperative analgesic effects of ESPB and TAPB in elderly patients who had undergone laparoscopic colorectal surgery.MethodsSixty-two elderly patients (≥ 65 years old) scheduled for elective laparoscopic colorectal surgery with general anesthesia were randomly allocated to two equally sized groups: ESPB group and TAPB group. The ESPB group had a bilateral erector spinae plane block, and the TAPB group had a bilateral oblique subcostal transverse abdominis plane block. The primary outcome was visual analogue scale (VAS) pain score during the first 24 postoperative hours at resting and active states. The secondary outcomes were postoperative consumption of sufentanil, satisfaction score, the number of patients who required antiemetics, incidence of block-related complications, and other side events.ResultsThere were no demographic differences between two groups. Compared to the TAPB group, the ESPB group had lower VAS pain scores and sufentanil consumption during the first 24 postoperative hours. Additionally, ESPB reduced the occurrence of postoperative nausea and vomiting. Furthermore, the satisfaction score was higher in the ESPB group. No other complications were reported between the two groups.ConclusionsCompared with oblique subcostal TAPB, ESPB more effectively reduced postoperative pain and opioid consumption. Thus, ESPB is suitable for postoperative analgesia in elderly patients who have undergone laparoscopic colorectal surgery.Trial RegistrationChinese Clinical Trial Registry: ChiCTR2000033236.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00329-x.

This Month in Anesthesiology

This Month in Anesthesiology

The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial.

BackgroundPostoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications after major surgery among elderly patients. Dexmedetomidine (DEX) is less frequently explored for its effects in patients with postoperative neurocognitive disorders. This study investigated the effect and optimal dosage of DEX for patient-controlled analgesia (PCA) on POD and early POCD after major surgery among elderly patients.MethodsPatients in four groups received continuous infusion of DEX 0, 100, 200, and 400 μg with sufentanil 150 μg for PCA immediately after surgery. POD and POCD were assessed on postoperative days 1, 2, 3, and 7 by using the Confusion Assessment Method (CAM) and Mini-Mental State Examination (MMSE) scales. Furthermore, the incidence of POD and POCD of all the four groups in postoperative 7 days classified by high risk factors (age, education, surgical site, and surgical category), sedation level, postoperative pain intensity, and side effects were assessed.ResultsThe overall incidence rates of POD and early POCD 7 days after surgery were lower in the DEX 200 μg 400 μg groups than in the DEX 0 μg and 100 μg groups (P < 0.05). Compared with DEX 200 μg, DEX 400 μg reduced early POCD in patients who underwent open surgery (P < 0.05). There were no intergroup differences in the postoperative sedation level, pain intensity, and side effects.ConclusionThe continuous infusion of DEX 200 μg or DEX 400 μg in PCA significantly decreased the incidence of POD and early POCD after major surgery without increasing any side effects. Compared with DEX 200 μg, DEX 400 μg was preferred for reducing early POCD in patients who underwent open surgery.

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

BackgroundLimited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. MethodsA total of 98 patients aged ≥75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. ResultsSpinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. ConclusionIn a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

Observation of Postoperative Analgesia in Elderly Patients with PFNA By Routine Pulsed Lumbar Plexus Administration

Objective to observe the postoperative analgesia of elderly patients with PFNA by pulsed lumbar plexus administration. Methods: 90 patients with PFNA postoperative analgesia were selected and divided into three groups on average. The first group, 30 routine PCIA. The second group received PCEA analgesia after spinal anesthesia. In the third group, the intraoperative lumbar plexus nerve block was completed and the anesthetic catheter was indwelling. The drug administration mode was programmed pulse administration without background dose. The pain index, movement tissue index and the incidence of various adverse reactions were observed after PFNA. Results the pain score of peripheral nerve block program pulse group was significantly lower than that of general anesthesia group, the incidence of motor tissue was lower than that of epidural group, and the incidence of side effects was lower than that of general anesthesia group and epidural group. Conclusion patients with PFNA is mostly elderly patients with varying degrees of system disease and organ function degradation, extra week nerve block program pulse to VAS score is lower and less motor block, fewer side effects, is PFNA more effective postoperative analgesia mode, you can reply as soon as possible to the patient's activity ability, improve the prognosis of patients.