Analgesic Strategies Research Articles

Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block vs. rectus sheath block for midline abdominal surgery in a low- and middle-income country: a randomised controlled trial.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and middle-income country. We allocated randomly 72 patients aged 18-65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13-17) h vs. 12 (11-13) h, respectively; p < 0.001). There were no block-related complications in either group. Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid-sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low-and middle-income countries.

Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study.

Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children's Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality.

Modulation of mechanosensation by endogenous dopaminergic signaling in the lateral parabrachial nucleus in mice.

The lateral parabrachial nucleus (LPBN), a crucial hub for integrating and modulating diverse sensory information, is known to express both D1 and D2 dopamine receptors and receive dopaminergic inputs. However, the role of the LPBN's dopaminergic system in somatosensory processing remains largely unexplored. In this study, we investigated whether mechanical sensory stimulation triggers dopamine release in the LPBN and how D1- and D2-like receptor signaling in the LPBN influences mechanosensitivity in mice. We used a G-protein-coupled receptor-based dopamine sensor to monitor dopamine release in the LPBN and a von Frey filament assay to measure the mechanical threshold for nocifensive withdrawal in mouse hind paws after unilateral microinjection of D1- or D2-like receptor antagonist into the LPBN. Noxious mechanical stimulation increased the dopamine sensor signal in the LPBN. Thresholds of nocifensive withdrawal from mechanical stimulation were decreased by the D1-like receptor antagonist SCH-23390 (0.1 µg) but increased by the D2-like receptor antagonist eticlopride (1 µg). In the intraplantar capsaicin injection model that develops mechanical hypersensitivity in the injected paw, the dopamine sensor signal in the LPBN was increased, and eticlopride (1 µg) in the LPBN significantly inhibited the capsaicin-induced mechanical hypersensitivity. These results suggest that endogenous dopaminergic signaling occurs in the LPBN upon noxious mechanical stimulation, inhibiting mechanosensitivity through D1-like receptors while enhancing it through D2-like receptors. D2-like receptor signaling in the LPBN may contribute to an injury-induced increase in mechanical nociception, indicating that inhibiting the receptor within the LPBN could offer potential as a novel analgesic strategy.

Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series

BackgroundPain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function.MethodsThis case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded.ResultsThey experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients.ConclusionsUltrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.

Updating Clinical Practice: Improving Perioperative Pain Management for Adeno-Tonsillectomy in Children.

Perioperative acute pain management in pediatric patients is essential to reduce complications. Adenoidectomy-Tonsillectomy are surgical procedures requiring pain control, and risk minimization for postoperative bleeding, nausea, and vomiting. Despite their known secondary effects, the use of opioid analgesics is still preponderant in pediatric perioperative management. We performed a comprehensive review on adeno-tonsillectomy perioperative pain management in children. We developed and implemented a multimodal analgesia protocol aimed to improve patients' pain management while consistently reducing opioids use. relevant Information was summarized, then compared to our clinical needs. Learnings were used to create and implement a multimodal analgesia protocol that we use in patients 3-9 years-old undergoing adenoidectomy/tonsillectomy. The full protocol is presented. Analgesic strategies have emerged to reduce or avoid the use of opioids. Among these strategies, combining different non-opioid analgesics (Ibuprofen, Paracetamol, Metamizole) has been shown to be an effective and safe pharmacological strategy when implemented as part of perioperative multimodal analgesia protocols. Considerable evidence associating the use of NSAIDs with a bigger risk of postoperative bleeding does not exist. Perioperative management of adenotonsillectomy pain should include preventive and multimodal analgesia, which have shown to provide significantly more effective analgesia than some opioid regimens. Ibuprofen offers highly effective analgesia for postoperative pain, particularly when combined with acetaminophen.

Evaluation of the Physical Compatibility of Intravenous Methocarbamol in Lactated Ringer’s, 0.45% Normal Saline, and Plasma-Lyte A

Background: The need to determine physical compatibility of intravenous admixtures is directly related to patient safety and patient outcomes. While the provision of multi-modal analgesic strategies has increased over the past decade, a paucity of data exists regarding physical compatibility of select medications. Objectives: To evaluate the physical compatibility of methocarbamol in Lactated Ringer’s (LR), 0.45% normal saline (0.45% NaCl), and Plasma-Lyte A (PLA) at concentrations of 4, 10, and 20 mg/mL. Methods: Admixtures were prepared and evaluated using previously validated methods under a laminar flow hood using aseptic technique. Samples were prepared in a triplicate manner, 3 mL aliquots were placed into polymethyl methacrylate cuvettes for evaluation at time points 0, 1, 5, 8, and 24 hours. Visual inspection of samples included assignment of a number: 0—no precipitation, 1—trace evidence of precipitation, 2—slight haze, 3—medium haze, and 4—heavy precipitation. Any evidence of precipitation was considered significant. A variable wavelength spectrophotometer set at 547 nanometers was used to measure absorbance. A change in absorbance of ±0.010 was considered significant. A change in pH of ±0.1 was considered significant. Results: No significant changes occurred relating to visual inspection or absorbance across all concentrations and time points for LR; however, there was a significant change in pH across all concentrations at hour 5. In 0.45% NaCl and PLA, no remarkable changes occurred across all concentrations and time points regarding visual observation, spectrophotometric absorbance, and pH analysis. Conclusions: Methocarbamol at concentrations of 4, 10, and 20 mg/mL is physically compatible for up to 1 hour in LR. Methocarbamol is physically compatible in 0.45% NaCl and PLA for up to 24 hours. Chemical stability tests are warranted to confirm these findings.

Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery.

To consider the clinical anatomy, safety and effectiveness of the suprazygomatic maxillary nerve block in cleft palate surgery. Observational case series. Single cleft centre in the United Kingdom. Patients born with a cleft palate (with or without a cleft lip) undergoing palatal surgery between the ages of 9 months and 18 years. Introduction of suprazygomatic maxillary nerve (SZMN) block using ropivacaine 0.2% into clinical protocol in February 2023. Peri-procedure complications and post-operative opioid administration. The clinical anatomy of the SZMN block is described in a stepwise and pictorial approach from superficial to deep structures. 43 patients underwent surgical interventions involving the palate (either intravelar veloplasty, Furlow palatoplasty or bilateral myomucosal buccinator flaps for palatal lengthening). 22 patients had a general anaesthetic and local anaesthetic infiltration and 21 had an additional SZMN block. There were no local or systemic complications associated with the SZMN block. There was no difference in the total dosing of post-operative (P = .79) opioids between the groups. We demonstrate the feasibility and safety of this procedure without the use of ultrasound guidance in a heterogenous group of paediatric patients undergoing palatal surgery. Regional anaesthesia should be considered as part of the multi-modal analgesic strategy, although it may be difficult to demonstrate a change in opioid use in clinical settings where enhanced recovery techniques are established, and opioid use is already low.

Adverse Effects Associated With Multimodal Analgesic Regimens in Critically Ill, Nonintubated Patients: A Systematic Review and Meta-Analysis

Objective: To evaluate the safety of utilizing multimodal analgesic regimens in critically ill, nonintubated patients. Data Sources: A systematic review was conducted using Embase, MEDLINE, Cochrane, SciELO, Web of Science, and the Korean Journal Index. Clinical trials of critically ill, nonintubated patients that contained complete safety outcomes date, including the incidence of specific adverse drug effects (ADE) associated with a multimodal analgesic medication or regimen, were included. Study Selection and Data Extraction: The primary outcome was the incidence of adverse drug effects associated with multimodal analgesics in comparison to standard-of-care analgesic strategies in our patient population. The secondary outcome was a subgroup analysis of adverse drug effect by type and by medication. Data Synthesis: 10 trials were included in this systematic review, of which 6 were randomized control trials that were evaluated in the meta-analysis. There was no statistically significant difference with respect to the primary outcome (mean difference = −0.11, P = 0.31, 95% CI = [−0.35, 0.13]). The subgroup analysis, which was conducted on randomized clinical control trials that documented a single adjunctive analgesic rather than a multimodal regimen, was stratified by the type of adverse effect encountered and the medication in question. There were no statistically significant findings regarding the incidence of specific ADE. Nonrandomized data included in this study support these findings. Conclusions: While concerns of the additive deleterious adverse effects commonly encountered in polypharmacy are valid, our findings support the use of multimodal analgesic regimens in the provision of analgesic in critically ill, nonintubated patients.

Pharmacokinetic Evaluation of a Topical Extended-release Analgesic in Mice.

Mice often undergo painful procedures and surgeries as part of biomedical research protocols. Buprenorphine, a partial μ-opioid receptor agonist and κ receptor antagonist, is commonly used to alleviate the pain associated with such procedures. Due to its pharmacokinetic profile, buprenorphine requires frequent dosing, resulting in handling stress that can impact animal welfare and study data. A long-acting transdermal buprenorphine formulation (LA-bup) was recently approved for use in cats to provide up to 4 d of postoperative analgesia. In this study, we characterized the pharmacokinetics of a single topical dosing of LA-bup in male and female CD-1 mice administered a 0.36-mg or 18-μL topical dose at select time points. Plasma buprenorphine concentrations were evaluated at 0.25, 0.5, 1, 1.5, 2, 4, 8, 24, 48, and 72 h (n = 3 mice/time point) and remained above the purported therapeutic threshold (1 ng/mL) from 1 to 24 h postadministration. Repeated daily dosing at 24 and 48 h demonstrated plasma levels above 1 ng/mL for up to 72 h with minimal accumulation or changes in maximal concentrations over time. Inadvertent transfer of the topical drug to nondosed mice in the same cage was evaluated by measuring plasma buprenorphine concentrations in nondosed mice cohoused with a single-dosed mouse. Male mice did not demonstrate transfer of drug via grooming or interactions, yet 2 out of 26 nondosed female mice had detectable buprenorphine plasma levels indicating a relatively low incidence of cross-ingestion in cohoused female mice. This study demonstrates that LA-bup is a promising analgesic in mice that could be used for tailored analgesia strategies, depending on the surgical model or duration of analgesic therapy.

Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance.

Advancements in understanding pain physiopathology have historically challenged animals' absence of pain senses. Studies have demonstrated that animals have comparable neural pain pathways, suggesting that cats and dogs likely experience pain similarly to humans. Understanding brain circuits for effective pain control has been crucial to adjusting pain management to the patient's individual responses and current condition. The refinement of analgesic strategies is necessary to better cater to the patient's demands. Cancer pain management searches to ascertain analgesic protocols that enhance patient well-being by minimizing or abolishing pain and reducing its impact on the immune system and cancer cells. Due to their ability to reduce nerve sensitivity, opioids are the mainstay for managing moderate and severe acute pain; however, despite their association with tumor progression, specific opioid agents have immune-protective properties and are considered safe alternatives to analgesia for cancer patients.

The Role of Spinal Anaesthesia with and without Intrathecal Opioid Coadministration in Improving Oncologic Outcomes after Endoscopic Transurethral Cancer Surgery

Spinal anaesthesia (SA) (compared to general) improves postoperative oncologic outcomes in transurethral resection of the bladder tumour (TURBT) for non-muscle invasive bladder cancer (NMIBC). Intrathecal coadministration of opioids does not affect NK cells function, and improves postoperative opioid sparing as well. There are no comparative data on oncologic outcomes of SA with/without intrathecal opioid in TURBT, which is the aim of our study. Seventy ASA I-III patients with NMIBC, aged ≥ 43 (range 43-90), who underwent one or more TURBT under SA were examined retrospectively. Of them, 36 received levobupivacaine 15 mg (L group) and 34 levobupivacaine 12.5 mg + fentanyl 12.5 mcg (LF group) intrathecally. All patients received scheduled Paracetamol 1.0 g/6 h, optional NSAIDs and as needed Tramadol as well. Data regarding demographics, ASA and CCI scores, analgesics consumption, urethrotomies, tumour-related factors (size, number, grade, stage, prior disease-recurrence, adjuvant therapy), tumour risk (low, intermediate, high), oncologic outcomes (recurrence rate/free time after TURB during the regular cystoscopy every 3 months/first year, every six months thereafter) were explored as well. LF patients were older, with less analgesics consumption and with a tendency towards longer recurrence-free time compared to L patients (p=0.074). The recurrence at three months along with prior and new disease-recurrences comprise our minority (n=27) with aggressive course of the disease. Among the rest the majority, LF subgroup (n=19) had lower recurrence rate than L subgroup (n=24) (p=0.03). As part of multimodal analgesic strategy, SA with intrathecal opioid coadministration may play a significant complementary role regarding oncologic outcomes after TURBT for NMIBC.

Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: A randomized controlled factorial trial.

Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection. This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20mL. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0. The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI, 4.0-8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI, 0.2-4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0). For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.

Optimizing Pain Management in Cardiac Surgery: A Review of Analgesic Adjuvants.

Pain management following cardiac surgery is a critical component in optimizing both short- and long-term patient outcomes, with poor pain management associated with significant acute and chronic opioid use, opioid dependence and a significant rate of opioid related adverse drug events. The significant burden of both acute and chronic pain following cardiac surgery has given rise to the need for multimodel analgesic strategies, to optimize outcomes and minimize side effects. While significant research has focused recently on the additive value of peripheral nerve blocks, less emphasis has been given to the value of non-opioid based analgesics in preference to traditional opioid based anesthetic and analgesic strategies. In this review, we examine the evidence for several common analgesics, highlighting the evidence supporting efficacy following cardiac surgery, as well as the safety concerns with each agent. We demonstrate the value of a multimodal analgesic strategy to reduce pain scores and improve patient-centered outcomes, and highlight the need for further studies of combination analgesic strategies.

Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study.

Concerns around delayed emergence and opioid-induced ventilatory impairment in bariatric surgery can lead to intraoperative reliance on short-acting opioids and avoidance of long-acting analgesics with potential sedative effects. Nevertheless, an overly-conservative intraoperative analgesic strategy may result in significant pain at emergence and higher opioid requirements in later phases of care. We sought to establish the pattern of intraoperative analgesic use in bariatric surgical patients as well as their postoperative pain trajectory and opioid requirements. We undertook a single-centre historical cohort study. We explored associations between intraoperative analgesic interventions and pain scores and opioid requirements in postanesthesia care units (PACUs), and associations between the quality of analgesia at emergence and subsequent pain and patient-centred recovery outcomes. We extracted perioperative data for 939 patients who underwent bariatric metabolic surgery between January 2018 and October 2019. Only 39% of patients received long-acting opioids intraoperatively and there was minimal use of nonopioid analgesic adjuncts. Nearly 80% of patients reported moderate-to-severe pain on PACU arrival; 97% of patients received intravenous opioids for rescue analgesia (mean dose, 31mg oral morphine equivalents). Lower pain scores at PACU admission and discharge were associated with subsequent lower inpatient pain scores, lower opioid requirements, shorter time to ambulation, and shorter length of hospital stay. In bariatric surgical patients, effective intraoperative analgesic strategies that improve early pain control may have an impact on recovery and pain experience. Judicious use of intraoperative opioids coupled with opioid-sparing multimodal analgesic techniques should be considered and balanced against concerns regarding opioid-related adverse effects in this patient population.

Comparison of postoperative analgesia effects between subcostal anterior quadratus lumborum block and transversus abdominis plane block in bariatric surgery: a prospective randomized controlled study

BackgroundCurrently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery.Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period.However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV).Methods and designThis study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days.DiscussionOpioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery.Trial registrationChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Oxycodone vs. sufentanil combined with quadratus lumborum block vs. transverse abdominis plane block in laparoscopic major gastrointestinal surgery: A randomized factorial trial protocol

BackgroundMultimodal analgesia plays a key role in enhanced recovery after surgery. Herein, we describe a trial protocol investigating the effects of oxycodone-vs. sufentanil-based patient-controlled analgesia in combination with quadratus lumborum block (QLB) vs. transverse abdominis plane block (TAPB) on quality of recovery following major laparoscopic gastrointestinal surgery. Methodsand analysis: This is a prospective, randomized, controlled clinical trial with a 2 × 2 factorial design. A total of 120 adult patients undergoing laparoscopic major gastrointestinal surgery will be randomized, in a 1:1:1:1 ratio, to receive one of two patient-controlled analgesia regimens (based on oxycodone or sufentanil) and one of two regional blocks (QLB or TAPB). The primary outcome measure of this trial is the quality of recovery at 24 h after surgery, assessed using the 15-item quality of recovery (QoR-15) scale. The secondary outcomes include QoR-15 scores at 48 and 72 h after surgery; visceral and incisional pain at rest and while coughing at 1, 6, 24 and 48 h postoperatively; analgesic consumption within 0–24 h and 24–48 h postoperatively; need for rescue analgesia; postoperative flatus time; postoperative adverse events (sedation, nausea and vomiting, use of antiemetics, respiratory depression, and dizziness); and length of postoperative hospital stay. DiscussionThe results of this trial will provide evidence for the optimal multimodal analgesic strategy to improve the quality of recovery for patients undergoing laparoscopic major gastrointestinal surgery. Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, identifier: ChiCTR2400080766).

Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient&amp;apos;s sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o&amp;apos;clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). &amp;lt;i&amp;gt;Conclusions:&amp;lt;/i&amp;gt;. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

Predicting the Severity of Acute Pain after Cesarean Delivery: A Narrative Review.

Cesarean delivery is one of the most common surgical procedures performed worldwide. Approximately 28-78% of the patients have reported experiencing severe pain after Cesarean delivery, which is associated with adverse outcomes. Current analgesic management strategies employ a one-size-fits-all approach, which may not be suitable for all post-Cesarean patients. Our ongoing research and the purpose of this review are focusing on preoperative risk assessment to identify patients at risk of severe pain or needing higher doses of opioid or other analgesics. Recent clinical investigations have found that by utilizing the demographic and psychological evaluations, screening tests, quantitative sensory testing, and assessment of response to local anesthetic infiltration, clinicians were potentially able to stratify the risks for severe post-cesarean pain. Several modalities demonstrated significant correlations with pain outcomes, although most of these correlations were weak to modest. Since consensus statement regarding predicting post-CD pain control are still lacking, these correlations can be clinically helpful. It is possible to identify patients at high risk of developing severe acute pain after cesarean section by preoperative demographic data, screening questionnaires, or other tools. Further studies are needed to identify additional variables or screening tools for more accurate prediction and investigate whether personalized analgesic regimens can lead to improved analgesic outcomes.

Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach

BackgroundEffective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.MethodsWe conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed.ResultsThe median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.ConclusionsSublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

Local Anaesthesia Techniques in Dogs and Cats: A Review Study

The use of multimodal anaesthesia and analgesia is desirable as part of a complete analgesic plan. Analgesic strategies for perioperative pain treatment include combinations of drugs with different means of action to increase their efficacy and to reduce the required doses and adverse effects. Local anaesthetics prevent the transduction and transmission of painful stimuli through their action on neuronal cell membranes. They undergo minimal systemic absorption and are therefore ideal alternatives to drugs that could result in systemic toxicity. Numerous benefits have been recognised for the use of local anaesthesia, such as a decreased need for systemic analgesics and decreased hospitalisation periods. Local anaesthetics have been used in veterinary medicine in several ways. Anatomical landmarks can be used to identify the target nerves and the clinician can employ an electrical nerve stimulator or ultrasound guidance to perform a more accurate injection. Local anaesthetic techniques can implement other drugs, apart from or in combination with local anaesthetics, such as opioids, α2−adrenergic agonists or vasoconstricting agents. This review article presents and discusses the most common techniques of local anaesthetic use in small animals, with the aim of providing the clinician with further and comprehensive information regarding the analgesic options during the perioperative period.