Analgesic Protocol Research Articles

Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study.

High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.

Comparison between the effects of epidural lidocaine, tramadol, and lidocaine–tramadol on postoperative pain in cats undergoing elective orchiectomy

BackgroundIn veterinary clinical practice, orchiectomy is one of the most common surgical procedures for cats and is performed mainly in young animals. The purpose of this study was to compare three different epidural (EP) analgesic protocols used in cats undergoing orchiectomy in order to determine which protocol resulted in superior outcomes in terms of perioperative analgesia. Twenty-one client-owned male cats were premedicated with a combination of dexmedetomidine (10 µg/kg) and midazolam (0.2 mg/kg) injected intramuscularly. Anesthesia was induced intravenously with propofol. Cats were randomly divided in three treatment groups of seven animals each: Group L received EP lidocaine (2 mg/kg), Group T received EP tramadol (1 mg/kg), and Group LT received EP lidocaine (2 mg/kg) plus tramadol (1 mg/kg). The post-operative pain level was assessed using two different scales: the Glasgow Composite Measure Pain Scale-Feline (CMPS-F) and the Feline Grimace Scale (FGS). Rescue analgesia was administered when the CMPS-F total score was ≥5 or the FGS total score was ≥4.ResultsNo adverse effects related to tramadol or lidocaine were observed. Based on post-operative pain assessments, significant differences between groups were observed according to both pain scoring systems. In particular, in Group LT, the CMPS-F and FGS scores decreased significantly in the first six hours following castration.ConclusionsBased on our results, EP lidocaine plus tramadol provided the best post-operative analgesic effects in cats submitted to orchiectomy lasting 6 h and could also be a choice to consider for longer surgical procedures.

Comparison of Edge of Lamina Block with Thoracic Paravertebral Block and Retrolaminar Block for Analgesic Efficacy in Adult Patients Undergoing Video-Assisted Thoracic Surgery: A Prospective Randomized Study.

A novel ultrasound-guided paravertebral block, the edge laminar block (ELB) was reported recently. However, it was unclear how effective ELB was in comparison with traditional blocking methods. We conducted a trial to compare the analgesic efficacy of ELB with the thoracic paravertebral block (TPVB) and the retrolaminar block (RLB) in patients undergoing video-assisted thoracic surgery (VATS). We identified 90 patients who were scheduled for VATS and randomly assigned them to three groups: ELB group (Group E), TPVB group (Group T), and RLB group (Group R). Each group underwent ELB, TPVB, and RLB, respectively, under ultrasound guidance before general anesthesia induction. All patients received post-operative routine analgesia protocol. Our primary outcome was the extent of dermatomal sensory loss on the midclavicular, midaxillary, and scapular lines, measured using a pinprick 15 minutes after the nerve block. Secondary outcomes included the intraoperative dose of sufentanil, the numerical rating scale (NRS) scores assessed in the post-anesthesia care unit (PACU) and at 6, 12, and 24 hours post-operatively, and pethidine administrated as analgesic rescue dose. The percentages of nerve block range reaching the midclavicular line, midaxillary line, and scapular line in Group E were 96.7%, 93.3%, 93.3%, and 60% in Group T and 30%, 56.7%, and 96.7% in Group R, respectively. Group E had wider dermatomal sensory loss on the midclavicular line and midaxillary line compared to Group R (P < 0.001) and had a wider range compared to Group T on the scapular line (P < 0.001). There was no significant difference in the intraoperative use of sufentanil in the three groups. Post-operative NRS scores at each time point were significantly lower in Group E than those in the other two groups (P < 0.01). ELB had a wider nerve block range and applied better post-operative analgesia in comparison with TPVB and RLB.

Gallstone Ileus of the Sigmoid Colon: Rare cause of Bowl Obstruction in a Case Report

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

Benefits of the Femoral Nerve Block in Total Knee Replacements: Analytical and Descriptive Study of a Series of 35 Cases

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

Remoção cirúrgica de neoformação periocular em peixe-kinguiu (Carassius Auratus) submetido à anestesia com propofol em associação com morfina - relato de caso

ABSTRACT Different anesthetic agents are commonly used during procedures performed in aquaculture to minimize stress and maximize fish welfare during handling. A Kinguio fish was treated with a history of a mass near the left eye. In the clinical evaluation, a pedunculated neoformation was found in the periocular region. The fish was submitted to anesthesia for surgical removal of the mass, which was later referred to histopathological evaluation, revealing myxoma. The anesthesia protocol used 1% propofol at a concentration of 5 mg/liter of water and morphine at a dose of 5 mg/kg, intramuscularly. Immediately after the end of the procedure, the fish was returned to the aquarium and its anesthetic recovery was observed. The objective of this report is to describe a surgical procedure in kinguio fish and to determine the efficacy of propofol associated with morphine in this species. As a result, complete immobilization of the fish was obtained with propofol, reaching the fourth stage of anesthesia and the administration of morphine suggested being able to provide effective and long-lasting analgesia. It is concluded that despite the positive results obtained, anesthesia in fish still needs to be extensively investigated to refine analgesia protocols during procedures that cause pain and stress.

Evaluation of different methods of environmental enrichment to control anxiety in dogs undergoing hemilaminectomy after acute intervertebral disc extrusion: a randomized double-blinded study.

The goal of this randomized, double-blinded, placebo-controlled study was to evaluate the effect of environmental enrichment (EE) on post-operative pain and anxiety in dogs following hemilaminectomy for acute intervertebral disc extrusion (IVDE). Twenty healthy client-owned dogs undergoing a hemilaminectomy for IVDE with the same immediate post-operative analgesia protocol were randomly assigned to either the EE or standard environment (SE) group post-operatively. Recovery was achieved in an intensive care room (SE) or a separate quiet room (EE) equipped with white noise and classical music. EE dogs were also exposed to dog-appeasing pheromones, essential oil scents, and positive human interactions and were provided meals through food toys. A blinded evaluator assessed all dogs using the modified Glasgow Composite Pain Scale (mGCPS) on presentation and at several time points post-operatively. A rescue injection of the opioid methadone was given to the dogs with an mGCPS score of ≥5/20. Dogs received the antidepressant trazodone when anxious behaviors (5 mg/kg) were observed. The mGCPS scores, the latencies to receive the first methadone and trazodone doses and to eat the first meal, the number of methadone and trazodone doses, and the number of meals ingested in the first 24 and 48 h post-surgery were compared using Wilcoxon tests, and Benjamini-Hochberg correction for false discovery rate was applied. Although median mGCPS scores did not differ between the groups, compared to SE dogs (n = 10), EE dogs (n = 6) received trazodone earlier (p = 0.019), were administered fewer methadone injections at 24 h (p = 0.043), and ate more at 48 h post-surgery (p = 0.007). Therefore, EE and anti-anxiety medications could be beneficial in improving the wellbeing of dogs post-operatively.

The effect of deep and superficial serratus anterior plane block on postoperative acute pain for thoracoscopic surgery patients; a prospective randomized trial

Aims: In recent years, video-assisted thoracoscopic surgery (VATS) is increasingly preferred over open thoracotomy. Serratus anterior plane block (SAPB) is the preferred analgesic technique in VATS interventions. This study, it was aimed to compare the postoperative analgesic efficacy of superficial SAPB (SSAPB) and deep SAPB (DSAPB) in patients undergoing lung resection with VATS. Methods: The study was conducted with a prospective, randomized, single-blind design. The ethics committee approval was obtained for the study. The patients, in the age range of 18 to 65 years, with the American Society of Anesthesiologists (ASA) physical status of I-III, and body mass index (BMI) of 18-30 kg/m2, and undergoing lung resection with VATS were included in the study. Patients were informed about the study, and their written consent was obtained. Patients were assigned to DSAPB (Group 1) and SSAPB (Group 2) groups according to the analgesia protocol. Results: After obtaining ethical committee approval, 60 patients were included in the study. Eight patients who converted from VATS to thoracotomy were excluded from the study. There was no statistically significant difference between the groups in terms of demographic characteristics, surgical features, side effects, morphine consumption, and additional analgesic use (p &gt; 0.05). When the groups were evaluated in terms of the duration of the block procedure, it was found to be statistically significantly longer in the SSAPB group than in the DSAPB group (p &lt; 0.001). Conclusion: Both DSAPB and SSAPB were effective and had similar analgesic actions. The shorter block procedure time in DSAPB may be an advantage when considering similar analgesic effects.

Comparison of postoperative analgesic effects of erector spinae plane block and quadratus lumborum block in laparoscopic liver resection: study protocol for a randomized controlled trial

BackgroundCompared with open surgery, laparoscopic liver resection is a minimally invasive surgical technique. However, a number of patients experience moderate-to-severe postoperative pain after laparoscopic liver resection. This study aims to compare the postoperative analgesic effects of erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in patients undergoing laparoscopic liver resection.MethodsOne hundred and fourteen patients undergoing laparoscopic liver resection will be randomly allocated to three groups (control, ESPB, or QLB) in a 1:1:1 ratio. In the control group, participants will receive systemic analgesia consisting of regular NSAIDs and fentanyl-based patient-controlled analgesia (PCA) according to the institutional postoperative analgesia protocol. In the two experimental groups (ESPB or QLB group), the participants will receive preoperative bilateral ESPB or bilateral QLB in addition to systemic analgesia according to the institutional protocol. ESPB will be performed at the 8th thoracic vertebra level with ultrasound guidance before surgery. QLB will be performed in the supine position on the posterior plane of the quadratus lumborum with ultrasound guidance before surgery. The primary outcome is cumulative opioid consumption 24 h after surgery. Secondary outcomes are cumulative opioid consumption, pain severity, opioid-related adverse events, and block-related adverse events at predetermined time points (24, 48, and 72 h after surgery). Differences in plasma ropivacaine concentrations in the ESPB and QLB groups would be investigated, and the quality of postoperative recovery among the groups will be compared.DiscussionThis study will reveal the usefulness of ESPB and QLB in terms of postoperative analgesic efficacy and safety in patients undergoing laparoscopic liver resection. Additionally, the study results will provide information on the analgesic superiority of ESPB versus QLB in the same population.Trial registrationProspectively registered with the Clinical Research Information Service on August 3, 2022; KCT0007599.

Efficacy and Safety of Sufentanil Infusion for Postoperative Analgesia in Cancer Surgery: A Retrospective Cohort Study.

Background Opioids have long been the cornerstone of drugs used for perioperative analgesia. Sufentanil has an advantageous pharmacological profile for its use in continuous intravenous (IV) infusion, yet remains poorly described. Our institution has implemented analgesia protocols with IV sufentanil infusions for cancer surgery with appropriate monitoring. The aim of this study was to evaluate the efficacy and safety of IV sufentanil infusion. Methods A single-center retrospective cohort study was conducted through the analysis of patients' records and the acute pain service database. Inclusion criteria were adult patients admitted for elective cancer surgery and with postoperative IV sufentanil infusion during one year period. Descriptive and inferential statistical analysis was performed by using Software SPSS Statistics (IBM Corp., Armonk USA): Kruskal-Wallis, Mann-Whitney, Chi-square and Fisher tests; Bonferroni chi-square residual analysis, binary logistic regression; p<0.05. Results The study population of 304 patients had a median age of 66 years (22-91) and 229 (75.3%) were men. 38 (12.5%) were chronic opioid users. Head and neck/otorhinolaryngology (ORL) surgery was performed in 155 (51.0%) and abdominopelvic surgery in 123 (40.5%). The median days of IV sufentanil infusion were 2 (1-13). At rest and with movement, analgesia was considered good, i.e., over 90% of patients with visual analogue scale (VAS) pain score ≤ 3. We found that patients submitted to musculoskeletal surgery had higher VAS pain scores; this group also presented older patients with higher American Society of Anesthesiologists (ASA) physical status classification and more chronic opioid users (p<0.05). 144 patients (47.4%) had at least one adverse effect related to IV sufentanil infusion, notably transient and not requiring any specific treatment. These patients were older and had longer infusion periods (p<0.05).237 (98.3%) of the adverse effects occurred during the first 3 days and the most common were: sedation (n=104, 42.8%), hypotension (n=32, 13.2%), hypoxemia (n=31, 12.8%) and nausea/vomiting (n=25, 10.3%). The reported incidence of respiratory depression was 2.9% (n=9), with three patients (1%) requiring advanced treatment. Conclusion Multimodal analgesic protocols with IV sufentanil infusions provided good postoperative analgesia for head and neck/ORL and abdominopelvic cancer surgeries. The adverse effects associated with the IV sufentanil infusions were mild and mainly managed with opioid dose reductions. Our study showed that this approach can be a safe option for postoperative multimodal analgesia in cancer surgery with appropriate monitoring in high-dependency units.

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis.

The current United States opioid epidemic resulted from the overprescribing of opioids by physicians and surgeons in response to deceptive and unlawful marketing campaigns by pharmaceutical companies seeking to profit from opioid sales. Surgeons have a moral obligation to employ evidence-based opioid-sparing analgesia protocols for management of perioperative pain. Recent evidence strongly supports the use of NSAIDs in perioperative pain management, with large studies demonstrating no increased risk of postoperative hemorrhage or renal insult. We present an evidence-based approach for opioid-sparing perioperative pain management, including multimodal analgesia guidelines used at our center for patients undergoing free flap facial reanimation procedures.

Anesthetic and analgesic techniques used for cats undergoing ovariohysterectomies in general practice in the United States

ObjectiveTo better document anesthetic and analgesic protocols used by veterinarians in general practice within the United States (US) when performing elective ovariohysterectomy in cats. Study designCross-sectional survey. PopulationVeterinary practitioners in the US who are members of the Veterinary Information Network Inc. (VIN). MethodsAn online anonymous survey was distributed to VIN members. The survey included questions pertaining to preanesthetic evaluation, premedication, induction, monitoring and maintenance protocols, and postoperative analgesia and sedation protocols when performing ovariohysterectomy in cats. ResultsA total of 1324 veterinarians completed the survey. Respondents (number; %) reported performing preanesthetic laboratory tests [packed cell volume (256; 19.3%), complete blood cell count (893; 67.4%) and biochemistry panels (1101; 83.2%)] and preanesthetic examinations (1186; 89.6%) on the morning of surgery. The most frequently administered drugs for premedication were dexmedetomidine (353; 26.7%) and buprenorphine (424; 32.0%). The most frequently administered induction agent was propofol (451; 61.3%), and isoflurane (668; 50.4%) was the most common agent for maintenance of anesthesia. The majority of respondents reported placing intravenous catheters (885; 66.8%), administering crystalloid fluids (689; 52.0%) and providing heat support (1142; 86.3%). Participants reported using perioperative and postoperative analgesia including opioids (791; 59.7%), non-steroidal anti-inflammatory drugs (NSAIDs; 697; 52.6%) and NSAIDs dispensed for home use (665; 50.2%). Cats were commonly released home on the day of surgery (1150; 86.9%), and most participants reported contacting owners for follow-up within 1–2 days (989; 74.7%). Conclusions and clinical relevanceAnesthetic protocols and management techniques for routine feline ovariohysterectomy differ widely among US veterinarians who are VIN members, and results from this study may be of use to evaluate anesthetic practices from this population of veterinarians.

Rate of Cesarean Delivery among Physicians Practicing in A Teaching Hospital in Tigray Region, Northern Ethiopia

Abstract Introduction: The Ethiopian national cesarean section rate is about 5%. Rates of cesarean delivery (CD) vary widely among population segments in Ethiopia suggesting unequal access. Within this context, this study aimed to assess the rate of CD among physicians practicing at Ayder Comprehensive Specialized Hospital (ACSH). Methods: This was cross-sectional study. All female physicians who are parous (n = 15) and all male physicians whose spouses are parous (n = 86) were interviewed to evaluate the mode of delivery among them. Indications for CD were also assessed. Results: The overall CD rate among participants was 81 (44.3%). Thirteen out of 18 (87%) female obstetrician/gynecologists and male obstetrician/gynecologists' spouses delivered via CD. Cesarean delivery for maternal request (CDMR) accounted for 22.6% of primary CDs. Nearly all (95%) potential candidates for Trial of Labor after Cesarean delivery (TOLAC) opted for repeat elective CD. The driving factors for CD were: lack of confidence in the process of intrapartum fetal monitoring, “uncertainty” of outcome of vaginal delivery, fear of labor pain (due to absence of labor analgesia), and managing obstetricians' fear of blame for poor outcome by their colleagues. Conclusion: This study revealed a disparity in CD rates in physician community vs the general Ethiopian population. More revealing are the reasons why they underwent CD. Rate of CD may be decreased by winning the confidence of the parturient mothers through instituting international-standard intrapartum fetal monitoring and labor analgesia protocols. Key Words Mode of delivery, Cesarean delivery, maternal request, physicians

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion.

Posterior cervical fusion (PCF) and anterior cervical diskectomy and fusion (ACDF) are two main surgical management options for the treatment of cervical spondylotic myelopathy. Although ACDF is less invasive than PCF which should theoretically reduce postoperative pain, it is still unknown whether this leads to reduced opioid use. Our objective was to evaluate whether PCF increases postoperative opioid use compared with ACDF. We retrospectively identified all patients undergoing 2-level to 4-level ACDF or PCF at a single center from 2017 to 2021. Our state's prescription drug-monitoring program was queried for filled opioid prescriptions using milligrams morphine equivalents (MMEs) up to 1 year postoperatively. In-hospital opioid use was collected from the electronic medical record. Bivariate statistics compared ACDF and PCF cohorts. Multivariate linear regression was done to assess independent predictors of in-hospital opioid use and short-term (0 to 30 days), subacute (30 to 90 days), and long-term (3 to 12 months) opioid prescriptions. We included 211 ACDF patients and 91 PCF patients. Patients undergoing PCF used more opioids during admission (126.7 vs. 51.0 MME, P < 0.001) and refilled more MMEs in the short-term (118.2 vs. 86.1, P = 0.001) but not subacute (33.6 vs. 19.7, P = 0.174) or long-term (85.6 vs. 47.8, P = 0.310) period. A similar percent of patients in both groups refilled at least one prescription after 90 days (39.6% vs. 33.2%, P = 0.287). PCF (β = 56.7, P = 0.001) and 30-day preoperative MMEs (β = 0.28, P = 0.041) were associated with greater in-hospital opioid requirements. PCF (β = 26.7, P = 0.039), C5 nerve root irritation (β = 51.4, P = 0.019), and a history of depression (β = 40.9, P < 0.001) were independently associated with 30-day postoperative MMEs. PCF is initially more painful than ACDF but does not lead to persistent opioid use. Surgeons should optimize multimodal analgesia protocols to reduce long-term narcotic usage rather than change the surgical approach.Level of Evidence:III.

Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy.

Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy.

PC52. Painless, Drainless Lipoabdominoplasty: A Retrospective Study of Pain following Lipoabdominoplasty Utilizing Liposomal Bupivacaine and a Modified Eras Protocol

PURPOSE: Propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve post-operative pain control. METHODS: A total of 80 patients operated on between 7/23/2020 - 12/15/2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized pre-, intra-, and post-operative pain regimen. Pain scores were measured across all patients in the immediate post-operative period, and post-operative days 1, 7, 28, 90. RESULTS: Mean pain scores in the PACU were 0.46/10 (+/- 0.18). Subsequent reassessment in the post-op recovery suite yielded mean pain scores of 0.34 (+/- 0.15). Mean pain scores on POD1 were 1.23 (+/- 0.15), and consistent through to POD7 at 1.24 (+/- 0.11) with patients taking an average of 6.65 total percocet 5mg during the week. After POD7, 95% (76/80) of patients were only taking NSAID medications. A total of 75/80 patients (93.75%) reported zero pain at 4-6 weeks after surgery (mean pain score 0.10 +/- 0.08). CONCLUSION: The multimodal analgesia protocol consisting of preoperative or immediate induction IV tylenol, precut local analgesia with marcaine and lidocaine, and intraoperative use of liposomal bupivacaine, can improve perioperative pain control in patients undergoing lipoabdominoplasty.

Validation of the Unesp-Botucatu pig composite acute pain scale (UPAPS) in piglets undergoing castration.

To accurately assess pain and support broadly-based analgesic protocols to mitigate swine pain, it is imperative to develop and validate a species-specific pain scale. The objective of this study was to investigate the clinical validity and reliability of an acute pain scale (UPAPS) adapted for newborn piglets undergoing castration. Thirty-nine male piglets (five days of age, 1.62 ± 0.23 kg BW) served as their own control, were enrolled in the study and underwent castration in conjunction with an injectable analgesic administered one-hour post-castration (flunixin meglumine 2.2 mg/kg IM). An additional 10, non-painful female piglets were included to account for the effect of natural behavioral variation by day on pain scale results. Behavior of each piglet was video recorded continuously at four recording periods (24 h pre-castration, 15 min post-castration, 3 and 24 h post-castration). Pre- and post-operative pain was assessed by using a 4-point scale (score 0-3) including the following six behavioral items: posture, interaction and interest in surroundings, activity, attention to the affected area, nursing, and miscellaneous behavior. Behavior was assessed by two trained blinded observers and statistical analysis was performed using R software. Inter-observer agreement was very good (ICC = 0.81). The scale was unidimensional based on the principal component analysis, all items except for nursing were representative (rs ≥ 0.74) and had excellent internal consistency (Cronbach's alpha ≥ 0.85). The sum of scores were higher in castrated piglets post-procedure compared to pre-procedure, and higher than in non-painful female piglets confirming responsiveness and construct validity, respectively. Scale sensitivity was good when piglets were awake (92.9%) and specificity was moderate (78.6%). The scale had excellent discriminatory ability (area under the curve > 0.92) and the optimal cut-off sum for analgesia was 4 out of 15. The UPAPS scale is a valid and reliable clinical tool to assess acute pain in castrated pre-weaned piglets.

Patient factors influencing the choice of opioid versus non-opioid postoperative analgesia following common sports procedures: a prospective survey study

PurposeDespite established opioid-free protocols for postoperative analgesia after common orthopaedic sports procedures, many patients continue to request opioids postoperatively. The purpose of this study was to elucidate patient factors influencing preferences for opioid versus nonopioid postoperative analgesia. MethodsPatients (age >/ = 15) without a history of a documented chronic pain disorder who were scheduled for one of ten sports procedure types from August 2020 to May 2021 were eligible for inclusion. Patients were excluded if undergoing revision surgery, had concomitant injuries, had opioids use >3 months preoperatively, or unable to read English. Recruitment ended after 100 patients enrolled. At the patients’ preoperative visit, patients were administered a written survey assessing pain medication preferences. Participants completed the Opioid Risk Tool survey, as well as Visual Analog Scale and Patient-Reported Outcome Measurement Information System surveys. ResultsOne hundred patients participated in the study. Forty-two patients preferred opioids versus 58 patients preferring nonopioid postoperative analgesia. Patients preferring opiates were more likely to have had previous surgery (90.2% vs. 69.6%, p = 0.023) with post-operative pain managed with opiates (87.5% vs 55.4%, p = 0.003), higher preoperative Visual Analog Scale score (6±3.5 vs. 3±2, p < 0.001), reported post-operative pain as a reason for opioids preference (88.1% vs 20.0%, p < 0.001), and were less concerned about addiction (4.8% vs. 45.5%, p < 0.001) and side effects (11.9% vs. 52.7%, p < 0.001). For every unit increase in Visual Analog Scale score, the odds of preferring opioid pain control increased 1.41 times. ConclusionsPatients with a history of prior surgery utilizing opioid pain control, higher Visual Analog Scale scores preoperatively, and concern for inadequately managed postoperative pain were more likely to prefer opioid pain control following common orthopaedic sports procedures. Patients may benefit from increased preoperative education about opioid risks and the role of multimodal pain management regimens.

Transversus abdominis plane block for anterior lumbar interbody fusion: a randomized controlled trial

BACKGROUND CONTEXTAnterior lumbar interbody fusion (ALIF) is a lumbar arthrodesis technique via an anterior approach that is less invasive than the posterior approaches. However, it is associated with specific pain in the abdominal wall. PURPOSEThe objective of this study was to determine whether performing a bilateral ultrasound-guided Transversus abdominis plane (TAP) block allows a reduction in morphine consumption in the first 24 hours after surgery. STUDY DESIGNThis study is a prospective single-center, randomized, double-blind study. PATIENT SAMPLEPatients undergoing ALIF surgery were included and randomized into two groups. Both groups received a TAP block performed at the end of surgery with either ropivacaine or placebo. OUTCOME MEASURESThe primary outcome measure was morphine consumption in the first 24 hours. The main secondary outcomes were immediate postoperative pain and opioid-related side effects. METHODSIntra- and postoperative anesthesia and analgesia protocols where standardized. A bilateral ultrasound-guided TAP block was performed with 75 mg (in 15 mL) of ropivacaine per side or isotonic saline serum depending on their assignment group. RESULTSForty-two patients were included in the study (21 per group). Morphine consumption at 24 hours (28 mg [18–35] in the ropivacaine group versus 25 mg [19–37] in the placebo group [p=.503]) were not significantly different between the two groups. CONCLUSIONTAP block with ropivacaine or placebo provided a similar postoperative analgesia when associated with a multimodal analgesia protocol for ALIF.

Anaesthetic management of three Maine Coon cats undergoing hybrid intervention for treatment of cor triatriatum sinister

AbstractThis report describes the anaesthetic management of three Maine Coon cats undergoing hybrid cutting balloon dilatation for treatment of cor triatriatum sinister. In cat 1, cor triatriatum sinister was an incidental finding during routine transthoracic echocardiographic screening. Cats 2 and 3 presented with tachypnoea and underwent preoperative therapy with diuretics and antithrombotics. All cats were premedicated with fentanyl. Anaesthesia was co‐induced with midazolam and either etomidate (cats 1 and 2) or alfaxalone (cat 3). Sevoflurane, a fentanyl continuous‐rate infusion and a dexmedetomidine continuous‐rate infusion were used for maintenance of anaesthesia. Intravenous methadone, epidural morphine and methadone, an intercostal block and a subcutaneous wound splash with local anaesthetics complemented the analgesic protocol. Intraoperative complications included arrhythmias, bleeding, hypotension and hypothermia. Postoperative emergence delirium and haemothorax developed in two and one cat, respectively. All three cats recovered well and were discharged home.