Analgesia In Perioperative Period Research Articles

New strategies for multimodal analgesia in patients with high-risk geriatric cancer in perioperative period.

12046 Background: Perioperative pain (POP) in high-risk geriatric patients with cancer (HRGCP) is an important issue. The purpose of this study was to optimize perioperative analgesia in HRGCP. Methods: This randomized study of the quality and effectiveness of perioperative analgesics included 115 HRGCP aged 64-88 years who underwent surgeries on the organs of the chest, abdomen and pelvis for various cancers. The patients were divided into 2 groups. Group 1 (n = 52): patient-controlled analgesia with morphine and nonsteroidal anti-inflammatory drugs (NSAIDs); group 2 (n = 63): ultrasound-guided bilateral transversus abdominis plane (TAP) block with ropivacaine. Intraoperative and perioperative analgesia was maintained with a continuous infusion of lidocaine, magnesium sulphate, microdoses of fentanyl and NSAIDs. Results and pain syndrome were assessed by monitoring the Efficacy Safety Score (ESS), personal and reactive anxiety, stress response (cortisol, insulin, lactate, glucose), rates of functional activity recovery, the need for opioid analgesics, frequency of postoperative nausea and vomiting (PONV). Results: Patients in group 2 showed a significant decrease in the perioperative need for opioid analgesics and significantly decreased POP. Analysis of variance of mean values revealed statistically lower scores of ESS, visual analogue scale and POP (p < 0.05) during the first 24 hours of perioperative period in group 2 compared with group 1. Patient-controlled analgesia showed analgesic effect in 88.5% (p < 0.05) cases. However, the effect was less pronounced, compared to multimodal analgesia, and did not reduce cognitive disorders. In group 2, opioid-sparing analgesic effect was 95.3% (p < 0.05). Multimodal analgesia reduced the stress response (p < 0.05) in perioperative period and did not cause cognitive dysfunction while reducing PONV episodes, unlike morphine. Despite the minimal doses of narcotic analgesics in group 2, multimodal analgesia provided safe analgesia and functional activity recovery in perioperative period with minimum negative effects of opioids. Conclusions: The strategy of multimodal analgesia based on a combination of intraoperative TAP block and infusions of lidocaine and microdoses of fentanyl can significantly improve the quality of analgesia in perioperative period.

Effects of perioperative transcutaneous electrical acupoint stimulation on postoperative analgesia in patients undergoing shoulder arthroscopic surgery

To observe and evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) at different time points on postoperative analgesia in perioperative period in patients undergoing shoulder arthroscopic surgery, and to explore the optimal time to use TEAS for shoulder arthroscopic surgery. A total of 120 patients undergoing unilateral shoulder arthroscopy under general anesthesia, graded withⅠtoⅡaccording to ASA criteria were randomly divided into 3 groups, 40 patients in each one. The patients in the group A were treated with preoperative TEAS at sham acupoints combined with postoperative TEAS at Hegu (LI 4) and Neiguan (PC 6); the patients in the group B were treated with preoperative TEAS at Hegu (LI 4) and Neiguan (PC 6) combined with postoperative TEAS at sham acupoints; the patients in the group C were treated with TEAS at sham acupoints before and after operation. The parameters of TEAS were dilatational wave, 2 Hz/100 Hz in frequency, 30 min. When the resting-state visual analogue scale (VAS) of incision was more than 3 points, the patient-controlled intravenous analgesia (PCIA) pump of sufentanil was administered to maintain the VAS no more than 3 points. The time point when PCIA pump was firstly used, the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery were recorded. Intraoperative anesthetic doses were recorded in the three groups. The resting-state and task-state VAS were evaluated at 0, 6, 12, 24 hours after surgery; the patient's satisfaction rate and adverse effects were recorded. The time when PCIA pump was firstly used in the group A and the group B was significantly longer than that in the group C, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A and group B were significantly less than those in the group C (all P<0.05); the incidence of postoperative nausea-vomiting and sore throat was reduced (all P<0.05). The time when PCIA pump was firstly used in the group A was significantly longer than that in the group B, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A were significantly less than those in the group B (all P<0.05); no significant difference of the incidence of postoperative nausea-vomiting and sore throat was observed between the group A and group B (both P>0.05). There were no statistically significant difference in VAS score at different postoperative time points and postoperative analgesia satisfaction rate between the two groups (all P>0.05). Perioperative TEAS could improve the postoperative analgesia in patients undergoing arthroscopic shoulder surgery, delay the time when PCIA pump is firstly used, reduce the dosage of postoperative analgesics and adverse events. Compared before surgery, postoperative TEAS has better analgesia.

Auricular Acupressure for Analgesia in Perioperative Period of Total Knee Arthroplasty

We examined whether auricular acupressure (AA) can alleviate postoperative pain and decrease narcotic consumption and its adverse effects for osteoarthritis patients after total knee arthroplasty (TKA). A prospective, randomized, sham control trial comparing AA and a sham control. Department of Orthopedics, the first Hospital affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China. Ninety patients with degenerative osteoarthritis undergoing TKA. The AA group received true AA by embedding vaccaria seeds at four specific AA points (knee joint, shenmen, subcortex, sympathesis) ipsilateral to the surgery site, while the control group received four nonacupuncture points on the auricular helix. Visual analog scale (VAS), the consumption of analgesic via patient-controlled analgesia, the incidence of analgesia-related adverse effects, Hospital for Special Surgery scores (HSS), and range of motion (ROM) were recorded. VAS scores were similar at 12, 24, 36, and 48 h postsurgery (P > 0.05), but AA group scores were lower than those of the control group at 3, 4, 5, and 7 days (P < 0.05). Patients in the AA group consumed lower doses of analgesic than those in the control group after surgery (P < 0.05). The incidence of analgesia-related adverse effects in the AA group was lower than that in the control group (P < 0.05). Although HSS scores were similar in the two groups preoperatively and at 3 months postoperatively (P > 0.05), HSS scores 2 weeks postoperatively were higher in the AA group than in the control group (P < 0.05), but there was no difference between groups in ROM (P > 0.05). Applying auricular acupoint acupressure in the perioperative period of TKA is favorable for alleviating postoperative pain, decreasing opioid consumption and its adverse effects, and promoting early rehabilitation. Also, this intervention has the advantage of lower costs, fewer complications, simple application, and high safety.