Method Of Analgesia Research Articles

Analgesic effect of ultrasound-guided extraoral mandibular nerve block compared to intraoral conductive block of the inferior alveolar nerve after lower third molar alveolectomy: a clinical prospective study

BackgroundThe analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block.MethodsThirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic.ResultsThe US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia.ConclusionUS-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT06009302, identification number: NCT06009302, date of registration: 18/08/2023.

Minimally invasive surgery, precise anesthesia and effective analgesia are crucial for walking within 1 hour after lung surgery.

The clinical effectiveness of enhanced recovery after surgery (ERAS) strategy, which emphasizes a comprehensive intervention without highlighting key points, seems to have reached a bottleneck. This study focuses on surgery, anesthesia and postoperative analgesia as the three key factors, to observe the related manifestations of ERAS in patients undergoing lung surgery with minimal intervention throughout the perioperative period. All patients who underwent lung surgery by micro-invasive video-assisted thoracoscopic surgery (VATS) at Taizhou Municipal Hospital from August 2018 to August 2019 were consecutively enrolled in the study. The clinical data of patients were collected to observe the results of ERAS. The patients were divided into intravenous analgesia group and intercostal nerve block group according to different analgesic methods, and the ERAS results of the two analgesic methods were compared. A total of 242 patients were included in the study. The time from cessation of anesthesia to extubation was 10 [interquartile range (IQR), 9, 12] minutes (min), the time from extubation to limb activity according to instructions was 18 (IQR, 14, 23) min, time to sit up was 18 (IQR, 14, 23) min, time to stand up was 40 (IQR, 35, 46) min, and time to walk was 48 (IQR, 45, 55) min. No patient had any anesthesia complications. Compared with the intravenous analgesia group, the intercostal nerve block group had shorter time to limb activity according to instructions, time to sit up and time to walk after extubation, and lower postoperative pain scores (P<0.05). For patients undergoing thoracic surgery, focusing on surgery, anesthesia and analgesia the three key factors, using micro-invasive VATS to reduce surgical trauma and shorten operation time, precise individualized anesthesia program and effective postoperative analgesia can achieve early autonomous activity of patients after surgery.

A Comparison of the Effectiveness of the Serratus Anterior Plane Block and Erector Spinae Plane Block to that of the Paravertebral Block in the Surgical Treatment of Breast Cancer-A Randomized, Prospective, Single-Blinded Study.

Background/Objectives: The paravertebral block (PVB) is a well-studied, effective method of analgesia for breast surgery. Alternative techniques involving the blockage of intercostal nerve branches are the serratus anterior plane block (SAPB) and the erector spinae plane block (ESPB). However, no studies comparing both fascial blocks to PVB in breast surgery have been published to date. We evaluated the effectiveness of ESPB and SAPB vs. PVB, expressed as the requirement for intraoperative fentanyl, pain intensity at rest and during coughing, and morphine consumption on the first postoperative day. Additional aims were to perform an evaluation of the safety of the block types used. Materials and Methods: A total of 77 women and 1 man with stage I and II clinical breast cancer, aged 18-85 years, were randomized into one of three study groups: SAPB, PVB, and ESPB. Results: There were no statistically significant differences in fentanyl consumption during surgery with respect to the type of block used (p = 0.4246). Morphine consumption in the postoperative period was highest in the ESPB group, averaging 9.4 mg. There was a statistically significant difference in pain intensity from 4 pm on the day of surgery to 8 am the following morning. No complications related to the blocks were observed on the first postoperative day. Conclusions: Both the serratus anterior plane block and the erector spinae plane block were as effective as the paravertebral block in achieving intraoperative analgesia. The serratus anterior plane block was equally as effective as the paravertebral block in achieving postoperative analgesia. The erector spinae plane block was significantly less effective in achieving postoperative analgesia than both the paravertebral block and serratus anterior plane block.

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.

The use of pre-emptive percutaneous cryoanalgesia beforemodified Ravitch funnel chest surgery – a new form ofpostoperative pain management. A report of two clinical cases

Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall, with an estimatedincidence of 1 in 400–1000 births. It typically manifests in the neonatal period but can also appear duringadolescence. Clinical symptoms may arise from compression of the lungs and heart. The standard treatment forPE is surgical intervention. The modified Ravitch procedure is an invasive correction method used to treat pectusexcavatum. This procedure is associated with significant postoperative pain, often exceeding 5 on the numericalrating scale (NRS), which can be difficult to manage with conventional methods such as patient-controlled analgesia(PCA) or continuous thoracic epidural analgesia (cTE). A new alternative adjunct therapy for managing acutepain after thoracic surgery is peripheral nerves cryoablation – a procedure involving temporary blockade of nerveconduction in the intercostal nerves using a narrow range of low temperatures, optimally performed before thesurgical procedure. This results in long-lasting analgesia that allows for a reduction of opioid requirements or evencomplete discontinuation. This paper presents two cases of pediatric patients who, due to invasive thoracic surgicalprocedures, underwent intercostal percutaneous cryoablation (IPC) before the surgery. Performing preemptivepercutaneous intercostal nerve cryoablation reduced opioid intake and allowed for shorter hospital stay, as well assignificantly increased comfort of our patients. The description of these two cases aims to highlight the preemptivecryoablation as a potential, potent, alternative analgesia method adjunct to pharmacotherapy of pain in patientsundergoing extensive thoracic surgical procedures.

Laparoscopy-guided transverse abdominis plane block versus port site infiltration for post-operative pain relief after laparoscopic cholecystectomy.

Post-operative analgesia is an important component of patient satisfaction and early discharge from the hospital. A variety of modalities have been tested and are still evolving. The present study is one such evaluation of a novel technique of laparoscopy-guided transverse abdominis plane (LTAP) block for post-operative analgesia in laparoscopic cholecystectomy. A prospective randomised control trial was conducted to verify the effectiveness of LTAP block over port site local anaesthesia infiltration (PSLAI) for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. This study was done over a period of 18 months in a tertiary hospital. A total of 84 patients were recruited and were divided equally into two groups (LTAP and PSLAI). There was no statistical difference between the two groups with respect to gender distribution, comorbidities, number of gallstones, duration of symptoms and surgery time. The rescue dose of diclofenac requirement was less for the LTAP group in comparison to the PSLAI group. No difference was observed in the pain score at 1st h. However, LTAP proved efficient later in the post-operative course (6 h, 24 h and at discharge). There was significant a difference in the pain scores between the two groups, favouring the LTAP group. Hospital stay in the LTAP group was less in comparison to the PSLAI group. LTAP block is an effective method of post-operative analgesia. It impacts analgesia to the whole anterior abdominal wall for a prolonged period when compared to the PSLAI without adding any extra procedural time.

Exploring the Analgesic Efficacy and mechanisms of low-dose esketamine in pregnant women undergoing cesarean section: A randomized controlled trial

BackgroundPostoperative pain is a prevalent concern following a cesarean section. This study aimed to investigate the effect and mechanism of low-dose (0.1 mg/kg) esketamine on postoperative pain management in pregnant women undergoing cesarean sections, specifically in cases where both patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) were employed. MethodsPregnant women intending to undergo elective cesarean section were divided into four subgroups based on the intravenous administration of esketamine and the specific analgesia methods employed: E1 (0.1 mg/kg esketamine + PCEA), E2 (0.1 mg/kg esketamine + PCIA), C1 (saline + PCEA), and C2 (saline + PCIA). The primary outcome was the maximum pain score within 24 h postoperatively. Secondary outcomes included the pressure pain threshold and tolerance at 30 min and 24 h postoperatively, along with the inflammation and adverse event index scores. ResultsA total of 118 pregnant women were assigned to the four groups: E1 (n = 29), E2 (n = 29), C1 (n = 30), and C2 (n = 30). Compared with those in the control groups (C1 + C2), the maximum postoperative pain scores within 24 h in the esketamine groups (E1 + E2) were significantly lower (4 [2–5] vs. 4 [4–6], P = 0.002), and the E1 group exhibited superior analgesic effects compared with other groups. No significant differences were observed in postoperative hyperalgesia or inflammation across the four groups. Notably, esketamine combined with PCIA increased the incidence of postoperative nausea and vomiting (7 [25 %] vs. 0 [0 %]; P = 0.005). ConclusionThe administration of low-dose (0.1 mg/kg) esketamine effectively alleviates pain following cesarean section, and the analgesic effect is notably enhanced in combination with PCEA. Importantly, these effects do not appear to be mediated through anti-inflammatory mechanisms or the inhibition of hyperalgesia. Clinical trial registration numberNCT05414006.

Comparison of the postoperative effects of the erector spinae plane block and local infiltration analgesia in patients operated with lumbotomy surgery incision: Randomized clinical study.

Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees. Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours. There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 ± 165.23 µg in the intraoperative ESPB group and 296.67 ± 110.59 µg in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 ± 14.47 mg vs 57.23 ± 15.5 mg and additional analgesic-paracetamol: 2.1 ± 1.06 vs 4.27 ± 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 ± 8.1 in the LIA group, while it was 19.33 ± 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05). In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.

Efficacy of Local Anesthesia for Radial Artery Puncture Pain: A Systematic Review and Network Meta-Analysis.

We performed a systematic review and network meta-analysis (NMA) to assist clinicians in determining the optimal patient-specific method of analgesia during radial artery puncture by comparing radial artery puncture procedural pain. We included randomized controlled trials that assessed the prophylactic efficacy of local anesthesia for radial artery puncture-associated pain. We searched the Medical Literature Analysis and Retrieval System Online in January 2023, the Cochrane Central Register of Controlled Trials in January 2023, the Excerpta Medica Database in December 2022, the World Health Organization International Clinical Trials Platform Search Portal in January 2023, and ClinicalTrials.gov in January 2023. We synthesized the pain scores (0-100 scale) using the frequentist random-effects NMA model. We evaluated the confidence in each outcome using the CINeMA tool (https://cinema.ispm.unibe.ch/). We conducted an NMA of 1,619 patients across 14 studies on pain scores during radial artery puncture-related procedures for 12 interventions. Compared with placebo, mepivacaine infiltration and lidocaine spray probably reduce pain (mean difference (MD): -47.67, 95% confidence interval (CI): -61.45 to -33.89, confidence rating (CR): moderate; MD: -27.38, 95% CI: -37.53 to -17.22, CR: moderate). Of the 32 studies included, none reported systemic adverse events, such as anaphylaxis or local anesthetic systemic toxicity, or severe local adverse events. In conclusion, mepivacaine infiltration and lidocaine spray probably reduce the pain associated with radial artery puncture more than other local anesthesia.

Efficacy of Multimodal Analgesia with Transversus Abdominis Plane Block in Comparison with Intrathecal Morphine and Intravenous Patient-Controlled Analgesia after Robot-Assisted Laparoscopic Partial Nephrectomy.

Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62-108] vs. 86 [65-115] vs. 108 [87-126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic.

Comparison between Combination of Proximal Adductor Canal Block and Infiltration between Popliteal Artery and Capsule of Knee (iPACK) with Large-Volume Distal Adductor Canal Block in Facilitating Early Mobilization after Total Knee Replacement: A Randomized, Single-Blind Study

Abstract Background: Adductor canal block (ACB) and infiltration between popliteal artery and capsule of knee (iPACK) are popular block methods for analgesia after total knee replacement (TKR), covering both the anterior and posterior knee. This study aimed to compare the performance of the combination of ACB and iPACK with large-volume distal ACB in facilitating early mobilization after TKR. Patients and Methods: This study was a single-blind, randomized, controlled trial of 30 subjects who underwent TKR. Subjects were randomly assigned to either Group A (the large-volume distal ACB) or Group B (the combination of proximal ACB and iPACK). Outcome variables included postoperative time up and go (TUG) test, numeric rating scale (NRS), postoperative morphine consumption, block-performing time, time to first opioid rescue analgesia, and side effects. Results: This study found that the block-performing time was significantly shorter in Group A compared to Group B (230.67 vs. 509.67, P &lt; 0.001). The mean postoperative TUG test (67 vs. 64, P = 0.78), NRS at all-time points, and postoperative morphine consumption (3 vs. 3 mg, P = 0.85) did not differ significantly. No block-related side effects were found in either group. Conclusion: Large-volume distal ACB is not superior to the combination of proximal ACB and iPACK in facilitating early mobilization after TKR. Block-performing time of distal ACB was shorter compared to the combination of proximal ACB and iPACK.

Clinical Analysis of Different Anesthesia and Analgesia Methods for Patients Undergoing Uniportal Video-assisted Lung Surgery

PurposeA comparison of three intra-op modalities to determine a best and convenient pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural and general anesthesia alone to look at post-operative pain scores in patients. Methods80 patients were enrolled and statistically analyzed. There were three interventions studied: Group S: General Anesthesia with Serratus Plane Block, Group E: General Anesthesia with thoracic epidural, Group G: General Anesthesia only. Outcome measures compared among 3 groups included demographic characters; surgical types; anesthesia and operative time; postoperative pain scores; vitals sign; morphine consumption at 0, 2, 6 hours, day1 and day2 postoperative; incidence of opioid-related adverse events and chronic pain; LOS hospital and overall expenses.The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, LOS(length of stay) hospital and overall hospital expenses were documented, as well as incidence of chronic postoperative pain. FindingsThere was no difference in incidence of opioid-related adverse events and chronic pain, LOS hospital and overall expenses among 3 groups. After investigating factors that may influence LOS hospital and overall expenses, the multivariable analysis indicated only longer operative time was associated with longer hospital stay and more hospital expenses. ImplicationsThis prospective study demonstrates that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses.

The different doses of sufentanil combined with nalmefene in bronchoscopy: a systematic review and meta-analysis.

Bronchoscopy examination is a common clinical diagnostic method. However, due to its unique operational characteristics, the procedure often induces discomfort and pain in patients. The combined use of sufentanil and nalmefene offers advantages in effectively reversing opioid-induced respiratory depression without compromising analgesic effects. However, a comprehensive analysis report on the combined use of different doses of sufentanil and nalmefene in bronchoscopy examinations has not been reported. The aim of this subject is to investigate the application effects of different doses of sufentanil combined with nalmefene in bronchoscopy. Using computer-based and manual methods to retrieve relevant keywords, we searched the databases of PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang from inception to the present to find studies evaluating the application effects of different doses of sufentanil combined with nalmefene in bronchoscopy examinations. The quality of the included studies was assessed, and meta-analysis was conducted using RevMan 5.3 software. A total of six English-language articles, involving randomized controlled trials and reviews, and comprising 774 participants, were finally included. The control group used conventional therapy, whereas the intervention group used different doses of sufentanil combined with nalmefene. Meta-analysis results indicated that compared to conventional therapy, this approach significantly improved vital signs such as systolic blood pressure [SBP; mean difference (MD) =21.44, P<1×10-5] and diastolic blood pressure (DBP; MD =22.52, P<1×10-5), heart rate (HR; MD =25.16, P<1×10-5), and oxygen saturation (SpO2; MD =30.16, P<1×10-5). A total of 4 studies focused on sedative effects, and that of sufentanil combined with nalmefene was significantly superior to conventional therapy (P<1×10-5). Analysis of adverse events showed that the combined therapy had better outcomes in terms of hypertension and tachycardia incidence compared to the control group (P<0.001, P<1×10-5), and Riker sedation-agitation scale (SAS score) was significantly reduced (P<0.05). However, there were no significant differences in other adverse events (P>0.05). Subgroup analysis showed fewer adverse reactions at 0.4 µg/kg sufentanil concentration compared to 0.2 and 0.8 µg/kg, with only hypertension differing significantly. In clinical practice, considering the use of sufentanil combined with nalmefene can improve patients' experience during bronchoscopy examinations. However, it should be noted that this approach may not be suitable for all patients, and clinicians need to choose appropriate analgesic and sedative methods for bronchoscopy examinations based on patients' conditions and individual differences. Furthermore, it is important to recognize that this study has some limitations and further research is needed to evaluate the efficacy and safety of this approach in other types of endoscopic examinations, as well as to compare the effects and safety of different drug combinations.

Визначення психологічного профілю вагітних, які бажають обрати альтернативний варіант розродження

One of the main indicators of the country's development is the health of women and children. Today in Ukraine, there is a significant decrease in the level of physical and moral health among young people, which negatively affects the course of pregnancy and childbirth. At the same time, the term “childbirth experience” is spreading in the obstetric community, which reflects the peculiarities of a woman's own feeling of the process of giving birth to a child, along with the spread of “non-traditional” methods of childbirth, such as vertical childbirth, childbirth in the knee-elbow position, childbirth in water, which aimed precisely at obtaining a positive birth experience. However, in the literature reviewed by us, we found only isolated information about the criteria for selecting patients to be involved in the attempt of alternative birth options. Aim - determine the psychological profile of pregnant women who wish to choose an alternative option for childbirth. Materials and methods. Surveyed 274 pregnant women at 11-12 and 36-37 weeks of pregnancy using a Google form containing 16 questions to determine the psycho-emotional state, mood, plans and fears about future childbirth. Results. The obtained results at 11-12 weeks outlined the psychological profile of pregnant women as a state of pleasure combined with insufficient knowledge about the course of childbirth. The results of the questionnaire at 36-37 weeks show a change in the psychological state in the direction of the development of fatigue with a significant increase in the number of women who are worried about the course of the upcoming childbirth, the pain associated with it, and want to involve close relatives/husband or an outside helper in childbirth. The majority of women have been found to have fear and uncertainty about their own condition during and after childbirth, which is the basis for an in-depth study of the psycho-emotional sphere. It was found that significantly more women want to try an alternative method of childbirth - water birth - 122 (44.5%). Conclusions. The psychological profile of pregnant women who wish to choose an alternative method of childbirth, including water birth, is characterized by a feeling of fear and anxiety before the upcoming birth, fears about the use of pharmacological methods of analgesia, as well as about possible aggression on the part of medical stuff. No conflict of interests was declared by the authors.

Paravertebral vs. Epidural Analgesia for Liver Surgery (PEALS): Protocol for a randomized controlled pilot study

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing. However, TEA has a high failure rate and is associated with potentially devastating complications (spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. The purpose of this pilot RCT is to compare continuous TEA (traditional standard of care is local anesthetic (LA) + opioids) with PVB (traditional standard of care is with LA without opioid) for patients undergoing hepatectomy. We hypothesise that pain outcomes will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, have fewer opioid-related side effects and a shorter hospital length of stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Opioid-sparing effects of ultrasound-guided erector spinae plane block for video-assisted thoracoscopic surgery: a randomized controlled study

BackgroundThe erector spinae plane block (ESPB) is a new analgesic method used in thoracic surgery. However, few studies have characterized their effects on perioperative opioid consumption. We aimed to evaluate the effects of ESPB on perioperative opioid consumption in patients who underwent video-assisted thoracoscopic surgery (VATS).MethodsThis was a randomized, observer-blinded clinical trial at a single-centre academic hospital. Eighty patients were scheduled for thoracoscopic segmentectomy or lobectomy by VATS for lung cancer. Forty participants were randomly assigned to ESPB or control group. All patients received intravenous patient-controlled postoperative analgesia. Perioperative opioid consumption, visual analogue scale (VAS) scores, and adverse events were recorded.ResultsIntraoperative and postoperative opioid consumption and static/dynamic VAS scores were significantly lower in the early hours after VATS in the ESPB group (p < 0.05) than the control group. No significant differences were observed in adverse effects between the two groups.ConclusionsESPB reduced intraoperative opioid consumption and early postoperative pain in patients undergoing VATS. Our findings support the view that ESPB is a safe and highly effective option for regional analgesia for VATS.Trial registrationhttp://www.chictr.org.cn, ChiCTR1800019335.

Paravertebral vs. Epidural Analgesia for Liver Surgery (PEALS): Protocol for a randomized controlled pilot study

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing and reduces cardiorespiratory complications. However, TEA has a high failure rate and is associated with potentially devastating complications (particularly spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. Our purpose is to conduct a blinded, pilot RCT with hepatectomy patients randomised to receive TEA or PVB for perioperative analgesia. We hypothesise that opioid consumption, time to first analgesic request, and pain scores will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, and have fewer adverse events and a shorter hospital stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial

BackgroundFear of pain associated with intrauterine device placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods. ObjectiveTo assess whether instillation of intrauterine mepivacaine before intrauterine device placement alleviates pain more effectively than a placebo. Study DesignWe conducted a multi-center, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing intrauterine device placement. An instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to intrauterine device placement. Pain scores were assessed using a 100 mm Visual Analog Scale at pre-specified time points. Primary outcome measured the difference in Visual Analog Scale pain scores between the intervention group and the placebo group during intrauterine device placement. Secondary outcomes included Visual Analog Scale pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method. ResultsWe enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% CI 5.75-20.87; P<.001): the mepivacaine group had a mean of 53.9 mm (SD 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider’s impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85-19.62; P<.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P=.021). ConclusionThe intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during intrauterine device placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.

Differences in the epidermal pain threshold between different needle puncture sites.

Puncture of the skin by a needle, such as for peripheral nerve block or for intravenous or arterial catheter placement, may cause pain to the patient, so that analgesic method may be required to reduce pain caused by needle puncture. Nevertheless, there is little information as to which puncture sites are more painful than the other. After obtaining an approval of the study by a research ethics committee and written informed consent from all the participants, we studied 30 volunteers to quantify pain threshold at 13 skin sites of the body, using an algometer. Compared with pain threshold at the cubital fossa (which was regarded as the control value), the relative pain threshold was significantly lower (with clinically meaningful difference) at the lateral carpus (median (interquartile range): 0.66 (0.56-0.73)) and the medial carpus (0.80 (0.73-0.94)); and was significantly higher (with clinically meaningful difference) at the olecranon (2.08 (1.93-2.42)), the forehead (1.59 (1.46-1.74)), the upper shoulder (1.52 (1.38-1.79)), and the dorsal shoulder (1.39 (1.18-1.55)). We conclude that there are significant differences in pain threshold between different puncture sites. Analgesic method before needle puncture may be required at the sites where the pain threshold is relatively low.

Comparative analysis of the course of the perioperative period in patients with diabetes during knee and hip arthroplasties

Background. Hip and knee arthroplasty (HKA) are common surgical interventions. In more than 20 % of patients undergoing HKA, diabetes mellitus is detected, which is one of the risk factors for the development of periprosthetic infection and the occurrence of complications in the perioperative period. The purpose: to determine the features of the course of the perioperative period in patients with diabetes during knee and hip replacement. Materials and methods. A retrospective analysis was performed of the inpatient charts of 50 people who underwent HKA against the background of concomitant diabetes. All participants were divided into two groups: 1) patients with hip arthroplasty; 2) patients with knee arthroplasty. The course of the intraoperative and postoperative periods and the development of complications were analyzed. Results. All patients were aged from 38 to 86 years, had increased weight (body mass index of 26.0–29.4 kg/m2). Among the complications, hypertension was most common (64.0 and 68.0 % in the groups, respectively), nausea and vomiting (32.0 and 28.0 %, respectively), disturbances in the rhythm and depth of breathing (16.0 and 20.0 % respectively) were often observed. The need for analgesia in the postoperative period was registered in 96.0 and 100.0 % of cases, which indicates its insufficient quality. Other clinical and anamnestic indicators, the course of the perioperative period and the development of complications were similar in patients undergoing both hip and knee replacements (p &gt; 0.05). Conclusions. Clinical and anamnestic data, the spectrum of existing concomitant pathology, characteristics of carbohydrate metabolism and its disorders, features of the course of the perioperative period and detected complications were of the same type in patients regardless of the location of the intervention. There was no significant difference in the studied parameters (p &gt; 0.05). Identified complications and insufficient effectiveness of postoperative analgesia dictates the need to find optimal methods of perioperative analgesia during HKA.