Analgesic Effect Research Articles

Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial.

For shoulder surgery, distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than the interscalene block (ISB). However, these approaches still show a high incidence of HDP. Recently, the costoclavicular block (CCB) has emerged as a promising technique that could provide effective analgesia while reducing HDP. We hypothesized that CCB would decrease the incidence of HDP compared to ISB, while still providing effective pain relief after surgery. Seventy patients undergoing arthroscopic rotator cuff repair were randomly allocated to receive ultrasound-guided CCB (n = 35) or ISB (n=35). Each group was received a 0.2% ropivacaine (CCB=20ml, ISB=10ml). The primary outcome was the incidence of HDP as a measured by M-mode ultrasound. And diaphragmatic excursion, pulmonary function test, opioid consumption and pain score were evaluated. Sixty-six patients were completed and analyzed. The CCB group had a significantly lower incidence of HDP compared with the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.84±2.24) group than the CCB (0.5±1.22) group (P < 0.001). The decrease in FVC and FEV1 from baseline was significantly greater in the ISB. And there was no significant difference in the opioid consumption during the entire postoperative period between the two groups. Compared to ISB, CCB significantly reduces the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB can be considered a viable option for diaphragmatic-sparing analgesia after shoulder surgery.

Comparison of two approaches to quadratus lumborum block for postoperative analgesia in radical cystectomy: a randomized clinical trial.

The aim of this study was to evaluate the analgesic effects following radical cystectomy using two ultrasound guided QLB techniques: anterior and intramuscular. Sixty patients aged 40-60 years old with ASA I, II were considered for this study. They were divided into two equal groups. Bilateral ultrasound guided QLB was performed via either the anterior (QLBa) or intramuscular (QLBi) approach with 2.5 mg/kg of 0.25% bupivacaine diluted to 20 mL of normal saline after surgery. The primary outcome was the time to the first request for analgesia, while the secondary outcomes were the dose of postoperative morphine consumption, numerical rating scale (NRS) at rest and on movement, Bromage Scale, adverse events, and patient satisfaction. The mean time to first request for analgesia was significantly prolonged in group QLBa (14.7±1.33 hours) compared to group QLBi (9.8±0.72 hours) (P<0.001). NRS either at rest or on movement were not statistically significant until 6 hours postoperatively. At 10, 12, and 14 h, Group QLBi had a significantly higher NRS Score at rest and on movement (P<0.001). Group QLBa had a significantly lower total morphine consumption (5.37±0.49 mg) compared to Group QLBi (6.4±0.77 mg) (P<0.001). The QLBa had higher patient satisfaction than the QLBi. Compared with QLBi, bilateral ultrasound guided QLBa provided a longer time to the first analgesic request, less postoperative opioid consumption, lower NRS at rest and on movement, and higher patients' satisfaction after radical cystectomy under general anesthesia.

Comparison of Low-Dose Naloxone with Ondansetron for Prevention of Sufentanil-Postoperative/Postdischarge Nausea and Vomiting

Background: Sufentanil is extensively used as a powerful painkiller for both initiating and sustaining general anesthesia, thanks to its advantages like potent prolonged action, analgesic effect, and hemodynamic stability. Nonetheless, it's important to consider sufentanil's negative side effects, such as postoperative nausea and vomiting (PONV), during the surgical period. Additionally, Naloxone, an antagonist for opioid receptors, is frequently utilized to counteract the lingering effects of opioids after surgery. Hence, we examined the preventative use of low-dose naloxone on PONV and studied its potential mechanism of action. Methods: After ethical approval and receiving IRCT code, 64 patients were evenly assigned to the naloxone and ondansetron groups prior to surgery. We also monitored the occurrence and intensity of PONV and the use of antiemetic medication within the first 24 hours after surgery. The main focus of our study was to analyze the PONV profile. Results: The mean age was 49.8±15.5 years, the mean weight 71.8±23 kg, and the mean BMI was 23.5±5.2 kg/m2. No significant difference was detected regarding mean oxygen saturation and arterial pressure between the groups at admission, 15, 30, 60, and 90 min after surgery (p&gt; 0.05). Adverse reactions showed no significant difference during the recovery time between the groups (p&gt; 0.05). The PONV severity and incidence are significantly higher in the naloxone group. Conclusion: Naloxone can be used as an antiemetic medicine, besides the ondansetron, and using this agent individually cannot prevent nausea and vomiting effectively.

Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review.

Musculoskeletal pain (MSP) remains one of the leading causes of disability worldwide. Recent approaches to treating this condition have prompted the development of several systematic reviews investigating the efficacy of high-intensity laser therapy (HILT), whose analgesic mechanisms are based on photobiomodulation neural inhibition, endorphin and serotonin release and anti-inflammatory effects. To assess the methodological quality, reliability, and validity of the systematic reviews (SRs) on HILT in MSP. This study is an overview of SRs (umbrella review) with an observational, retrospective, and secondary design.The search considered PubMed, Scopus, Web of Science, CINAHL, Embase, Cochrane Library, ScienceDirect, and Google Scholar databases (updated October 23, 2024).The primary focus was on the methodological quality of the reviews and their reporting of pain intensity results. The HILT effects on pain intensity were reported using mean differences (MD) or standardized mean differences (SMD). The quality assessment was conducted using the A Measurement Instrument to Assess Systematic Reviews 2 checklist (AMSTAR-2), and the findings were synthesized narratively. The MD and SMD obtained from all reviews were presented using forest plots. The Shapiro-Wilk normality test assessed MD and SMD distributions for pain intensity across meta-analyses. The average MD and SMD, along with their respective confidence intervals (CI), were estimated and presented based on the aggregate study outcomes. Twenty SRs were included, fourteen of which conducted meta-analyses covering diverse musculoskeletal disorders such as knee osteoarthritis, epicondylalgia, myofascial pain, frozen shoulder, plantar fasciitis, neck, and low back pain. The primary databases used were PubMed, Web of Science, and the Cochrane Library. The AMSTAR-2 average score was 12.9 points (± 1.8), indicating varying methodological quality with one or two criteria resulting in low or critically low.HILT's best analgesic effects are observed in frozen shoulder disorder (MD = -2.23cm; 95% CI:-3.3,-1.2; p < 0.01), knee osteoarthritis (MD = -1.9cm; 95% CI:-2.0,-1.8;p < 0.01), low back pain (MD = -1.9cm; 95% CI = -2.9,-1.0; p < 0.01), and myofascial pain (MD = -1.9cm; 95% CI:-2.6,-1.2; p < 0.01). Largest effect sizes are for neck pain (SMD = 2.1; 95% CI = 1.2,3.0, p < 0.05) and low back pain (SMD = 1.1 (95% CI = 1.4,0.8; p < 0.01). This review underscores the generally low to critically low methodological quality of SRs on HILT, as assessed by AMSTAR-2. Key areas for improvement for future SRs of RCTs include addressing publication bias, disclosing funding sources, and enhancing search strategies and discussions on heterogeneity. The scarcity of RCTs for conditions such as temporomandibular disorders, carpal tunnel syndrome, and myofascial pain highlights the need for further research. SRs on spinal disorders, frozen shoulder, and neck pain demonstrated the most favorable analgesic effects, providing valuable insights for clinical practice and future RCTs.

Effectiveness and Safety of Gabapentin versus Pregabalin in the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study

Aims/Background Postherpetic neuralgia (PHN) is a common chronic pain disease that persists after the rash (clusters of clear blisters on the surface of the skin) has healed, adversely affecting the quality of life of affected patients. Gabapentin (GPT) and pregabalin (PGB) are two commonly used drugs for the treatment of PHN, but there have been broad concerns regarding their efficacy and safety. Thus, this retrospective cohort study was conducted to investigate the effectiveness and safety of GPT versus PGB in the treatment of PHN. Methods A total of 150 patients with PHN receiving routine antiviral and neurotrophic therapies, admitted between January 2022 and November 2023, were selected. 71 patients who were treated with GPT were included in the control group, while the remaining 79 patients who were given PGB were categorized in the observation group. Information on clinical effectiveness, safety (xerostomia, drowsiness, blurred vision, ataxia, and dizziness), analgesic effect (Visual Analogue Scale [VAS] and time to pain relief), sleep quality (Sleep Quality Scale [SQS] and Pittsburgh Sleep Quality Index [PSQI]), and adverse emotions (Self-rating Anxiety/Depression Scale [SAS/SDS]) was collected for analysis. Results Compared to the control group, the observation group exhibited significantly higher clinical effectiveness of PGB in the treatment of PHN (p &lt; 0.05). In other aspects, the overall incidence of adverse events such as xerostomia, drowsiness, blurred vision, ataxia, and dizziness (p &gt; 0.05) was equivalent in these two groups. In addition, significantly lower VAS, SQS, PSQI, SAS, and SDS scores were observed in the observation group after treatment, compared with the control group (p &lt; 0.05). The observation group showed evidently shorter time to pain relief than the other group (p &lt; 0.05). Conclusion PGB is an effective and safe medication for the treatment of PHN, by improving the analgesic effect and sleep quality, and alleviating negative emotions.

Regional anesthesia in the obese patient

Regional anesthesia in obese patients presents significant challenges due to the high prevalence of comorbidities such as hypertension, diabetes, and obstructive sleep apnea (OSA), which increase the risk of perioperative complications. Additionally, the excess adipose tissue complicates the administration of anesthesia, making it necessary to adjust the technique and dosage of anesthetics to improve safety and surgical outcomes. Obesity, considered a multisystem disease, imposes additional requirements in the management of ventilation, venous access, and effective analgesia.

The Comparative Effect of Morphine on Proliferation of Cancer Cell Lines Originating from Different Organs: An In Vitro Study

Background/Objectives: Opium consumption was recently classified by the International Agency for Research on Cancer (IARC) monograph as carcinogenic to humans based on strong evidence for cancers of the larynx, lung, and urinary bladder, and limited evidence for cancers of the oesophagus, stomach, pancreas, and pharynx. This poses the question of a potential pro-cancer effect of pharmaceutical opioid analgesics. In vitro studies employing a variety of experimental conditions suggest that opioid alkaloids have proliferative or antiproliferative effects. We set out to reconcile this discrepancy and explore the hypothesis that opioids promote cancer cell proliferation in an organ-dependent fashion. Methods: Using strictly controlled conditions, we tested the effect of morphine on the proliferation of a series of human cancer cell lines isolated from organs where cancer risk was linked causally to opium consumption in human studies (i.e., lung, bladder, and larynx), or control organs where no link between cancer risk and opium consumption has been reported in human studies (i.e., breast, colon, prostate). Results: Our results showed a minimal effect on proliferation on any cell line and no trend supporting an organ-specific effect of morphine. Conclusions: This argues against a direct effect of opioids on tumour cell proliferation to support their organ-specific effect.

Post Operative Epidural Analgesia in Pediatric Abdominal Surgery: Comparison of Clonidine and Dexmedetomidine as an Adjuvant

Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population. Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications. Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg). Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries.

Chronic Pain Management by Analgesic Effects of Shoolprashman Mahakashaya Herbal Drugs: A Conceptual Review

Chronic pain can lead to physical limitations, emotional suffering, and social isolation, all of which can seriously impair a person's quality of life. In addition, poor chronic pain diagnosis and management can worsen opioid use disorders and increase the risk of morbidity and mortality among people who suffer from it. Consequently, healthcare professionals must understand chronic pain and implement appropriate treatment strategies. Due to the discovery of analgesic nephropathy and other systemic illnesses brought on by excessive and prolonged use of analgesics, Shoolprashman Mahakashya, an alternate method of managing chronic pain of unknown cause, is referenced in Ayurveda. This article focuses on Shoolprashman Mahakashaya's herbal drug phytoconstituent, which acts as an analgesic, and its mode of action on the pain and inflammatory markers.

O-Acetyl Bakuchiol exhibit Analgesic, Anti-inflammatory and Anti-arthritic effects: A combined in silico and in vivo experimental study.

In the present manuscript, we evaluated the analgesic, anti-inflammatory and anti-arthritic effects of bakuchiol derivative, O-Acetyl bakuchiol (BAc) at 5, 10 and 20 mg/kg p.o. dose in adult female Sprague Dawley rats.BAc at 20 mg/kg p.o. exhibited maximum analgesic (47.4%), anti-inflammatory (66.50%) and antiarthritic effects. Among the different parameters,BAc at 20 mg/kg increased the body weight (2.89%), decreased the paw thickness (72.46%)) and paw inflammation (48.59%) in FCA induced arthritic rats. In hematological/serum and biochemical parameters, BAc at 20 mg/kg brought the altered level of ESR, Hb, HCT, RBC, TLC and platelet count, HDL, cholesterol, triglycerides, CRP and RA factornear to the normal. Moreover, the spleen weight was also reduced in BAc treated rats at 20 mg/kg. Histopathological analysis further revealed that a reduction in paw inflammation was observed in paw ankle joints and no inflammation was observed in brain, liver, lungs and kidney in BAc treated rats at 20 mg/kg p.o. Molecular docking studies further revealed that BAc has better binding affinity for TNF-α (PDB ID: 7JRA) -7.19 kcal/mol comparable to standard methotrexate with binding affinity -9.56 kcal/mol. Therefore, the present investigation provided the basis for the development of BAc as potential candidate for the treatment of arthritis.

A prospective comparative study of levobupivacaine hydrochloride 0.5% with ropivacaine hydrochloride 0.75% for peri-operative epidural anesthesia in infra- umbilical surgeries

Background: Epidural anesthesia is a neuraxial regional anesthesia used to provide surgical anesthesia, to supplement general anesthesia, and to provide intra and post-operative analgesia. Levobupivacaine and ropivacaine are local anesthetic agents used in an epidural. Aims and Objectives: The aim of this study is to evaluate the onset and duration of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects of levobupivacaine and ropivacaine given epidurally for infra-umbilical surgeries. Materials and Methods: This prospective randomized study was conducted in a total of 142 patients undergoing an infra-umbilical surgery, divided into two groups of 71 patients each. Group L received 15 mL of 0.5% levobupivacaine and Group R received 15 mL of 0.75% of ropivacaine. The onset and duration of sensory and motor blockade, duration of analgesia, hemodynamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block is faster with ropivacaine (P&lt;0.05). The duration of sensory and motor block and analgesia was longer with ropivacaine (P&lt;0.05), whereas the incidence of side effects such as hypotension was more with ropivacaine. Conclusion: Our study concluded that ropivacaine produced a superior quality of epidural block but levobupivacaine had a more stable hemodynamic profile.

A comparative study of efficacy of 0.5% intrathecal isobaric ropivacaine, ropivacaine heavy, and bupivacaine heavy for lower abdomen and lower limb surgeries

Background: Lower abdomen and lower limb surgeries can be performed under spinal anesthesia. Ropivacaine is a local anesthetic, belonging to the amino amide group. It is a pure S-enantiomer and is considered to have a better safety profile than bupivacaine. Aims and Objectives: The aim of the study is to compare the efficacy of intrathecal isobaric ropivacaine (IR) 0.5%, ropivacaine heavy 0.75% and bupivacaine heavy 0.5% for lower abdomen and lower limb surgeries. Materials and Methods: This prospective randomized study was conducted in 120 patients scheduled for lower abdomen and lower limb surgeries under spinal anesthesia belonging to ASA Grade I or II. Patients were randomized into three groups of 40 each. Group IR-received 3 mL of 0.5% IR, Group hyperbaric ropivacaine (HR)-received 3 mL of 0.75% heavy Ropivacaine and Group Hemoglobin received 3 mL of 0.5% heavy bupivacaine. The parameters studied were the onset and duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The onset of sensory and motor block was significantly faster in HR followed by hyperbaric bupivacaine (HB) followed by IR. The duration of sensory and motor block was significantly shorter in HR followed by IR followed by HB. Duration of analgesia was longest in HB. Conclusion: HR produced a rapid onset of the sensory and motor block with a shorter duration. HB produced a longer duration of motor and sensory block.

To compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in the subarachnoid block for infraumbilical surgeries

Background: Spinal anesthesia is the neuraxial regional anesthesia technique used in infraumbilical surgeries such as inguinal hernia, hydrocele, hysterectomy, and lower limb surgeries. Levobupivacaine and bupivacaine are local anesthetic agents used for spinal anesthesia. Aims and Objectives: The aim of the study was to compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in subarachnoid blocks for infraumbilical surgeries. Materials and Methods: A total of 112 patients with American Society of Anesthesiologists grades 1 and 2 scheduled for infraumbilical surgeries were randomly divided into two groups. Group L received 3 mL of hyperbaric levobupivacaine, and group B received 3 mL of hyperbaric bupivacaine intrathecally. The onset of sensory block, onset, and duration of motor block, duration of analgesia and time of first rescue analgesia, hemodynamic parameters, and post-operative side effects, if any, were recorded. Results: The time of onset of sensory block at T10 for group L was 03.16±00.29 min and for group B was 02.16±00.27 min and the time of onset of motor block was higher in group L (03.29±00.32 min) compared to group B (02.45±00.32 min). Duration of motor block was significantly shorter in group L (209.80±6.44 min) compared to group B (252.41±11.49 min). All these findings were statistically significant. Conclusion: Levobupivacaine had a delayed onset of sensory and motor block as compared to bupivacaine, but due to its short duration of motor block and better hemodynamic profile, it seems to be a better alternative to bupivacaine.

TRPM8′s Role in the Shift Between Opioid and Cannabinoid Pathways in Electroacupuncture for Inflammatory Pain in Mice

The TRPM8 channel, a temperature-sensitive ion channel, plays a crucial role in various physiological processes, particularly in the modulation of inflammation and nociception. Although electroacupuncture (EA) is a recognized analgesic treatment for pain conditions, its interaction with TRPM8 remains underexplored. This study aims to determine TRPM8′s role in EA-induced analgesia using a murine model of inflammatory pain. Mechanical allodynia, evidenced by a reduced paw withdrawal threshold (PWT), was induced in both wild-type and Trpm8−/− mice through CFA injection. EA applied at the GB34 and LR3 acupoints significantly alleviated mechanical allodynia in both groups. In wild-type mice, the analgesic effects of EA were partially reversed by naloxone (an opioid receptor antagonist) or AM251 (a CB1 receptor antagonist) and fully reversed by their combination. In contrast, only AM251 reversed EA-induced analgesia in Trpm8−/− or TRPM8-inhibited wild-type mice (via AMTB treatment, a TRPM8 antagonist), indicating no involvement of the opioid pathway. Additionally, the combination of menthol, a partial TRPM8 agonist, and EA enhanced analgesia in wild-type mice. In Trpm8−/− or AMTB-pretreated mice, the CB1 receptor agonist WIN 55,212-2 (WIN) exhibited stronger analgesic effects compared to wild-type controls. These findings suggest that EA at LR3 and GB34 mediates analgesia through both opioid and endocannabinoid pathways. TRPM8 is critical for EA to activate the opioid pathway, while its inhibition or deletion shifts the analgesic mechanism towards reliance on the cannabinoid system. Understanding this mechanistic shift may help optimize EA treatment strategies and improve pain management outcomes.

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Effects of general magnetic field therapy in comprehensive medical rehabilitation on the quality of life of patients with breast cancer

BACKGROUND: The Short Form-36 (SF-36) is one of the most widely used tools to assess quality of life in breast cancer patients. According to MEDLINE, the SF-36 is used in 95.0% of research studies to assess the quality of life in various diseases. Advantages of SF-36 include wide availability, ease of use, and high validity. AIM: The aim of the study was to evaluate the effect of general magnetic field therapy in comprehensive medical rehabilitation on the quality of life parameters using a SF-36 questionnaire in breast cancer patients at 2–4 days and 1.0–1.5 months after surgery. MATERIALS AND METHODS: A randomized, placebo-controlled study was conducted in patients (n=107) after surgery for breast cancer. All patients were divided into three groups balanced by age and clinical and functional parameters, and received a course of medical rehabilitation which included individual postoperative sessions of exercise therapy (posture treatment; movement therapy with breathing, general stimulating, special, and relaxation exercises; sensorimotor training using a biofeedback simulator; individual sessions with a medical psychologist; one session of instrumental physiotherapy). Comprehensive medical rehabilitation included fluctuating current therapy in group 1 (n=35), local magnetic field therapy in group 2 (n=35), and general magnetic field therapy in group 3 (n=37). RESULTS: Analysis of quality of life parameters in the early postoperative period demonstrated effectiveness of the comprehensive physical rehabilitation program using exercise therapy, balance boards, and sessions with a psychologist in combination with one of the physical treatment options. Positive results increase patients’ confidence in the success of their rehabilitation. After providing the general magnetic field therapy in comprehensive medical rehabilitation, most of the SF-36 quality of life parameters improved, which indicates the beneficial effects of the general magnetic field on situational and personal anxiety, asthenic and vegetative manifestations, and sleep, as well as prolongation of these effects. Patients who received fluctuating current therapy as part of medical rehabilitation improved their pain index and physical function, probably due to analgesic and anti-inflammatory effects of this treatment option. CONCLUSION: Comprehensive physical rehabilitation combined with physical therapy increases the patient’s independence in daily living, self-care, and mobility.

Preoperative Analgesia Efficacy of Liposomal Bupivacaine Following Pericapsular Nerve Group (PENG) Block in Patients with Hip Fracture: A Randomized Controlled Observer-Blinded Study.

Single-injection pericapsular nerve group (PENG) block with ropivacaine provides clear analgesic effects in preoperative pain management for hip fractures. However, it suffers from insufficient duration, failing to meet the needs of most patients. This single-center, randomized controlled, observer-blinded trial utilizes a novel combination of liposomal bupivacaine (LB) single-injection PENG block to examine its efficacy, duration, and safety in preoperative analgesia for hip fractures, aiming to develop a new preoperative analgesic protocol. Sixty-six patients with hip fractures received ultrasound-guided single-injection PENG block with LB or ropivacaine after admission. The primary outcome was the static and dynamic pain scores measured at 48h post-block. Pain scores at 12, 24, 36, 60, and 72h post-block, rescue analgesia rate, time to first opioid, additional morphine consumption, and adverse events were assessed as the secondary outcomes. LB versus ropivacaine group at 48h post-block, with a median interquartile range (IQR) of 2 (1.0-2.0) versus 3 (2.0-3.0) at static pain score and 2 (1.75-3.0) versus 4 (4.0-5.0) at dynamic pain score. LB group had lower dynamic and static pain scores at other observation points except for the static pain score at 72h, lower pain intensity [sum of pain intensity difference (SPID)0-24, SPID0-48 and SPID0-72], longer time to first opioid, lower additional morphine consumption, and lower incidence of nausea and vomiting. No significant inter-group differences were detected in other secondary outcomes. For preoperative analgesia of hip fractures, LB single-injection PENG block had a similar analgesic intensity and safety as ropivacaine but provided a longer duration of analgesia, reaching 48h and even extending beyond 60h, which reduced opioid consumption and extended time to the first opioid. The protocol was registered in www.chictr.org.cn under the identifier ChiCTR2300072939.

Empathetic solicitude attenuates the affective and sensory dimensions of CO2-induced dyspnea: A randomized parallel arm experimental trial in healthy humans.

Dyspnea testifies to profound suffering in patients and its relief is a priority for caregivers. This can be achieved by correcting causative disorders ("etiopathogenic" approach) or targeting the dyspnea itself ("symptomatic" approach), as is done for pain. Empathetic solicitude from caregivers has an intrinsic analgesic effect, but its effects on dyspnea have not been formally documented. This study tests the hypothesis that the empathetic solicitude behavior of a caregiver during experimental induction of acute and intense dyspnea would have a mitigating effect. In a double-blind, randomized, controlled experimental trial, 80 healthy participants were assigned to a neutral behavior arm or a solicitude behavior arm. During two successive visits (V1 and V2), dyspnea was induced through CO2-rebreathing and (i) assessed in an immediate manner using 10 cm affective and sensory visual analog scales (A-VAS and S-VAS) and (ii) post hoc using the Multidimensional Dyspnea Profile (MDP). A-VAS ratings at the end of the dyspnea challenge were significantly lower at V2 in the "solicitude behavior" arm than in the "neutral behavior" arm (6.69 [3.825-9.67] vs. 8.05 [6.43-10], p = 0.039). There were no significant differences between arms regarding S-VAS. MDP analysis showed that CO2-rebreathing induced dyspnea of the air hunger type, with statistically significant reductions in its intensity and both the sensory and affective dimensions of dyspnea. This study shows that empathetic solicitude can reduce the affective and sensory dimensions of experimentally induced dyspnea in healthy volunteers. Future studies should evaluate the impact of empathetic solicitude on clinical dyspnea.

Metformin attenuates central sensitization by regulating neuroinflammation through the TREM2-SYK signaling pathway in a mouse model of chronic migraine

BackgroundChronic migraine (CM) is a serious neurological disorder. Central sensitization is one of the important pathophysiological mechanisms underlying CM, and microglia-induced neuroinflammation conduces to central sensitization. Triggering receptor expressed on myeloid cells 2 (TREM2) is presented solely in microglia residing within the central nervous system and plays a key role in neuroinflammation. Metformin has been shown to regulate inflammatory responses and exert analgesic effects, but its relationship with CM remains unclear. In the study, we investigated whether metformin modulates TREM2 to improve central sensitization of CM and clarified the potential molecular mechanisms.MethodsA CM mouse model was induced by administration of nitroglycerin (NTG). Behavioral evaluations were conducted using von Frey filaments and hot plate experiments. Western blot and immunofluorescence techniques were employed to investigate the molecular mechanisms. Metformin and the SYK inhibitor R406 were administered to mice to assess their regulatory effects on neuroinflammation and central sensitization. To explore the role of TREM2-SYK in regulating neuroinflammation with metformin, a lentivirus encoding TREM2 was injected into the trigeminal nucleus caudalis (TNC). In vitro experiments were conducted to evaluate the regulation of TREM2-SYK by metformin, involving interventions with LPS, metformin, R406, siTREM2, and TREM2 plasmids.ResultsMetformin and R406 pretreatment can effectively improve hyperalgesia in CM mice. Both metformin and R406 significantly inhibit c-fos and CGRP expression in CM mice, effectively suppressing the activation of microglia and NLRP3 inflammasome induced by NTG. With the administration of NTG, TREM2 expression gradually increased in TNC microglia. Additionally, we observed that metformin significantly inhibits TREM2 and SYK expression in CM mice. Lv-TREM2 attenuated metformin-mediated anti-inflammatory responses. In vitro experiments, knockdown of TREM2 inhibited LPS-induced SYK pathway activation and alleviated inflammatory responses. After the sole overexpression of TREM2, the SYK signaling pathway is activated, resulting in the activation of the NLRP3 inflammasome and an increased expression of pro-inflammatory cytokines; nevertheless, this consequence can be reversed by R406. The overexpression of TREM2 attenuates the inhibition of SYK activity mediated by metformin, and this effect can be reversed by R406.ConclusionsOur findings suggest that metformin attenuates central sensitization in CM by regulating the activation of microglia and NLRP3 inflammasome through the TREM2-SYK pathway.Graphical

The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic. Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size. EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.