Analgesic Management Research Articles

Anesteziyoloji ve Reanimasyon Hekimleri Arasında Sezaryen Cerrahisi ve Doğum Sonrası Ağrı Yönetiminde; Prosedüre Özgü Ağrı Yönetimi (PROSPECT) Farkındalığı Anket Çalışması

Objective: Procedure-specific pain management (PROSPECT) provides clinicians with evidence-based recommendations for postoperative pain management. It was aimed to evaluate the preferences of Anesthesiology and Reanimation physicians for postpartum analgesia management. Methods: A questionnaire consisting of 19 questions was prepared, including demographic data, cesarean surgery and postpartum analgesia practices, and whether PROSPECT recommendations were followed. This questionnaire was sent to participants via e-mail. Results: The study included 247 participants. Thirtysix percent of participants reported following PROSPECT recommendations and 55.1% of participants reported prefering opioids routinely or in combination with other techniques for cesarean surgery and postpartum analgesia. Eightyfive percent of the participants think that inadequate postpartum analgesic treatment was performed. Conclusion: Inadequate postpartum analgesia appears to be a common problem. The potential of maternofetal interaction is reported to be the most important reason for this situation. We think that training on postoperative pain management following cesarean surgery will make a significant contribution to eliminating concerns about maternal-fetal interaction. Keywords: Cesarean section, postpartum analgesia, prospect, anesthesiology and reanimation, questionnaire study

PBIC in analgesia management: sensitivity vs. specificity

pBIC in analgesia management: sensitivity vs. specificity

Thoracic Epidural and Analgesic Options After Failed Transversus Abdominus Plane Block With Liposomal Bupivacaine.

A 39 year-old female with a history of Roux-en-Y gastric bypass underwent emergent partial colectomy. Her postoperative analgesic management of a transversus abdominus plane block administered with a combination of bupivacaine and liposomal bupivacaine was ineffective. A bupivacaine thoracic epidural was then placed, which provided significant pain relief. This use of a bupivacaine thoracic epidural infusion following liposomal bupivacaine regional anesthesia demonstrated a case of effective analgesia without the development of local anesthetic systemic toxicity symptoms in a remote hospital setting, where certain laboratory analyses were not readily available.

Comparison of combined deep and superficial serratus anterior block with thoracic paravertebral block for postoperative pain in patients undergoing video-assisted thoracoscopic surgery.

Thoracic paravertebral block (TPVB) is a well-established procedure for the management of postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). In recent years, there have been studies suggesting that fascial plane blocks may be an alternative to TPVB. The objective of our study was to determine the efficacy of combined deep and superficial serratus anterior block (C-SAPB) as an alternative to TPVB in the management of postoperative analgesia in VATS. The patients were divided into two groups: the TPVB group and the C-SAPB group. Both groups were administered the same dose of local anesthetics. Multimodal analgesia was achieved for the groups. The primary outcome measure was visual analog scale (VAS) pain scores recorded within the first 48 h of the postoperative period in each group. The secondary outcomes were analgesic requirement, rescue analgesics, complications rate, and postoperative patient satisfaction. Thirty patients with C-SAPB and 30 patients with TPVB were analysed. VAS rest and VAS coughing scores were similar between the groups (p > 0.05). Demographic and side effect conditions, total morphine use, additional analgesic needs, vital parameters, block procedure time, and patient satisfaction were also similar between the groups (p > 0.05). Additionally, although block application times were comparable, the time was slightly shorter in C-SAPB. Similar analgesic efficacy was observed between C-SAPB and TPVB. TPVB maintains its place among the first choices in VATS. The efficacy of C-SAPB is comparable to that of TPVB. While the duration of C-SAPB application is not a significant factor, the brief nature of the procedure and its straightforward administration suggest that it may be an effective method.

Efficacy of multimodal analgesia based on the concept of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer

Objective: To explore the effect of multimodal analgesia based on the concept of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic radical gastrectomy (LRG) for gastric cancer (GC). Methods: Clinical data of 128 patients undergoing LRG for GC, admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from March 2021 to March 2022, were retrospectively analyzed. Among them, 66 patients received a multimodal analgesic management based on ERAS (ERAS group), and 62 patients were treated with conventional mode of analgesia (control group). Pain levels, rehabilitation status, as well as inflammatory factors and stress response indicators before and after surgery were compared between the two groups. Results: There was no significant difference in baseline data between the two groups (P>0.05). The postoperative pain and recovery in the ERAS group were better than those in the control group (P<0.05). After the surgery, serum levels of tumor necrosis factor-alpha (TNF-α), Interleukin 6 (IL-6), and C-reactive protein (CRP) in both groups increased compared to before the surgery, but were significantly lower in the ERAS group compared to the control group (P<0.05). After the surgery, serum malondialdehyde (MDA) and xanthine oxidase (XOD) levels in both groups increased, while superoxide dismutase (SOD) levels decreased compared to preoperative levels. The observed postoperative levels of serum MDA and XOD were significantly lower in the ERAS group, while the postoperative SOD levels were higher compared to the control group (P<0.05). Conclusions: Patients undergoing LRG for GC can benefit from a multimodal pain management plan based on ERAS to reduce postoperative pain, alleviate inflammation, stress responses, and shorten the postoperative recovery process. doi: https://doi.org/10.12669/pjms.40.10.10088 How to cite this: Xu L, Yao L, Qin J, Xu H. Efficacy of multimodal analgesia based on the concept of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer. Pak J Med Sci. 2024;40(10):2190-2195. doi: https://doi.org/10.12669/pjms.40.10.10088 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

S746 Abdominal Pain in Gastroparesis: Comparing PAGI-SYM and SF-8 Survey Scores Among Opiate and Non-Opiate Analgesic Management

S746 Abdominal Pain in Gastroparesis: Comparing PAGI-SYM and SF-8 Survey Scores Among Opiate and Non-Opiate Analgesic Management

Clinical Effects of Topical Application of Compound Betamethasone in Total Knee Arthroplasty

Total knee replacement is the most effective treatment for end-stage knee osteoarthritis, and then postoperative pain becomes a major impediment to rapid patient recovery. Perioperative local infiltration analgesia has become an important part of multimodal analgesic management, but the combination of analgesic drugs among them is formulated with different standards. Many scholars have reported that glucocorticoids have favorable analgesic and anti-inflammatory effects in recent years. Compound betamethasone has been used as a potent, long-acting glucocorticoid in TKA. The purpose of this article is to review the efficacy of the localized application of compound betamethasone in total knee arthroplasty and to provide a reference for the clinical application of compound betamethasone.

The evaluation of the performance of ChatGPT in the management of labor analgesia

ChatGPT4 is a leading large language model (LLM) chatbot released by OpenAI in 2023. ChatGPT4 can respond to free-text queries, answer questions and make suggestions regarding virtually any topic. ChatGPT4 has successfully answered anesthesia and even obstetric anesthesia knowledge-based questions with reasonable accuracy. However, ChatGPT4 has yet to be challenged in obstetric anesthesia clinical decision-making. Study Objective: In this study, we evaluated the performance of ChatGPT4 in the management of clinical labor analgesia scenarios compared to expert obstetric anesthesiologists. Intervention: Eight clinical questions with progressively increasing medical complexity were posed to ChatGPT4. Measurements: The ChatGPT4 responses were rated by seven expert obstetric anesthesiologists based on safety, accuracy and completeness of each response using a five-point Likert rating scale. Main Results:ChatGPT4 was deemed safe in 73% of responses to the presented obstetric anesthesia clinical scenarios (27% of responses were deemed unsafe). None of the ChatGPT4 responses were unanimously deemed to be safe by all seven expert obstetric anesthesiologists. Moreover, ChatGPT4 responses were overall partly accurate (score 4 out of 5) and somewhat incomplete (score 3.5 out of 5). Conclusions: In summary, approximately one quarter of all responses by ChatGPT4 were deemed unsafe by expert obstetric anesthesiologists. These findings may suggest the need for more fine-tuning and training of LLMs such as ChatGPT4 specifically for clinical decision making in obstetric anesthesia or other specialized medical fields. These LLMs may come to play an important future role in assisting obstetric anesthesiologists in clinical decision making and enhancing overall patient care.

Refining pain management in mice by comparing multimodal analgesia and NSAID monotherapy for neurosurgical procedures

While neurosurgical interventions are frequently used in laboratory mice, refinement efforts to optimize analgesic management based on multimodal approaches appear to be rather limited. Therefore, we compared the efficacy and tolerability of combinations of the non-steroidal anti-inflammatory drug carprofen, a sustained-release formulation of the opioid buprenorphine, and the local anesthetic bupivacaine with carprofen monotherapy. Female and male C57BL/6J mice were subjected to isoflurane anesthesia and an intracranial electrode implant procedure. Given the multidimensional nature of postsurgical pain and distress, various physiological, behavioral, and biochemical parameters were applied for their assessment. The analysis revealed alterations in Neuro scores, home cage locomotion, body weight, nest building, mouse grimace scales, and fecal corticosterone metabolites. A composite measure scheme allowed the allocation of individual mice to severity classes. The comparison between groups failed to indicate the superiority of multimodal regimens over high-dose NSAID monotherapy. In conclusion, our findings confirmed the informative value of various parameters for assessment of pain and distress following neurosurgical procedures in mice. While all drug regimens were well tolerated in control mice, our data suggest that the total drug load should be carefully considered for perioperative management. Future studies would be of interest to assess potential synergies of drug combinations with lower doses of carprofen.

Advancements in Non-Addictive Analgesic Diterpenoid Alkaloid Lappaconitine: A Review.

The perennial herb Aconitum sinomontanum Nakai (Ranunculaceae) has been utilized as a traditional oriental medicine in China for numerous years. The principal pharmacological constituent of A. sinomontanum, lappaconitine (LA), exhibits analgesic, anti-inflammatory, anti-tumor, anti-arrhythmic, and anti-epileptic activities. Due to its potent efficacy and non-addictive nature, LA is widely utilized in the management of cancer pain and postoperative analgesia. This review encompasses the research advancements pertaining to LA including extraction methods, separation techniques, pharmacological properties, chemical modifications, and clinical applications. Additionally, it offers insights into the potential applications and current challenges associated with LA to facilitate future research endeavors.

Intravenous lidocaine for postoperative analgesia management in paediatrics: A systematic review with meta-analysis of published studies.

The administration of intravenous lidocaine during the peri-operative period may improve pain management after paediatric surgery. To explore the decrease in postoperative pain intensity and opioid consumption associated with peri-operative lidocaine administration in the paediatric population. A systematic review with meta-analysis of randomised controlled trials and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. Extensive literature review. This study includes clinical trials conducted during surgery that examined the effect of intravenous lidocaine compared with placebo on postoperative pain management. Lidocaine administration decreased pain intensity in PACU (standardised mean difference (SMD) = -1.89 [-3.75, -0.03], I2 = 97%, P of I2 < 0.001) and on postoperative day 1 (SMD = -2.02 [-3.37, -0.66], I2 = 96%, P of I2 < 0.001, number of studies = 5). Lidocaine was associated with a decrease in opioid consumption on postoperative day 1 (SMD = -1.2 [-2.19, -0.2], I2 = 93%, P of I2 < 0.001) but not on postoperative day 2 (SMD = -1.73 [-3.9, 0.44], I2 = 96%, P of I2 < 0.001). GRADE analyses resulted in low-quality results. Subgroup analyses revealed that pain intensity in PACU and opioid consumption on postoperative day 1 decreased when lidocaine was administered during both the intra-operative and postoperative periods. The use of lidocaine is associated with improved pain management. However, further studies are needed to increase the level of evidence and determine the optimal administration regimen for pain management.

Impact of early palliative care intervention in autologous bone marrow transplantation: feasibility of a multicentric study

IntroductionThis prospective multicentre study evaluates the impact of Palliative Care Unit (PCU) intervention (Experimental Group, EG), during autologous hematopoietic stem cell transplantation (AHSCT) on quality of life (QoL), symptom control and healthcare resource use compared to standard practice (Control Group, CG). We used validated scales on Days 0 (stem cell infusion), + 7 (bone marrow aplasia, acute symptoms) and + 21 (aplasia recovery).ResultsIn 40 patients (20 EG/ 20 CG: 45%/25% female, median age 57.5/59), QoL differed significantly at Day + 7 (EG: median 0.50; CG: -63.00; p < 0.001) and Day + 21 (EG: -2.00; CG: -129.00; p < 0.001). On Day 0, mean FACT-BMT scores were CG/EG: 131/ 89.35, reflecting the pre-transplant intervention of the PCU in EG patients. For pain (EG median 0.00, CG median 2.50; p = 0.01), 45% EG patients used opioids on day 0 (mean 38.5 mg morphine/day/patient). Reduced pain control impacted nutritional support (parenteral nutrition 45% CG, 5% EG; p = 0.08). Hospitalisation duration was longer in CG (median 18.5; EG median 13.00; p < 0.001). Despite the short follow-up and small sample size, PCU and HD collaboration improves QoL and symptom management during acute AHSCT, evident through pain control, analgesia management, reduced parenteral nutrition need and shorter hospital stays.

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

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

The effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain control in idiopathic scoliosis patients undergoing posterior spine fusion surgery: study protocol of a randomized controlled trial

BackgroundPosterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF.MethodsThis double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events.DiscussionAt present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery.Trial registrationChinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023.

Primary care-based interventions for secondary prevention of opioid dependence in chronic non-cancer pain patients on pharmaceutical opioids: systematic review.

Globally almost one third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority. Synthesise the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in CNCP patients on pharmaceutical opioids. Systematic review of randomised controlled trials (RCTs) and comparative non-randomised studies of interventions from high-income countries. We searched five databases for studies on non-tapering secondary prevention interventions such as tools for predicting dependence, screening tools for early recognition of dependence, prescribing/medication monitoring, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesised using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool. Of 7,102 identified reports, 18 studies were eligible (8 RCTs). Most used multiple interventions/components. Of the seven RCTs at low risk of bias or 'some concerns', five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimised analgesic management by a nurse care manager/physician pain specialist team, or of a mobile opioid management app. We identify a clear need for further adequately powered high quality studies. The conclusions that can be drawn on intervention effectiveness are limited by the sparsity and inconsistency of available data.

The efficacy of lumbar erector spinae plane block for postoperative analgesia management in patients undergoing lumbar unilateral bi-portal endoscopic surgery: a prospective randomized controlled trial

BackgroundThe efficacy and reliability of erector spinae plane block (ESPB) in posterior open lumbar spine surgery has been demonstrated; however, few randomized controlled trials of lumbar ESPB (L-ESPB) in lumbar unilateral bi-portal endoscopic (UBE) surgery have been reported.MethodsA total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores.ResultsCompared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference − 280 mcg, 95% confidence interval [CI] − 360 to − 200, p < 0.001, power = 100%); significantly reduced fentanyl consumption at 24 h postoperatively (estimated median difference − 80mcg, 95%[CI] − 128 to − 32, p = 0.001, power = 90%); and significantly enhanced the QoR-15 score at 24 h postoperatively (estimated median difference 11, 95%[CI] 8 to 14, p < 0.001, power = 100%). Compared to the control group, the ESPB group enhanced the resting numeric rating scale (NRS) score up to 8 h postoperatively, and the active movement NRS score up to 4 h postoperatively. The incidence of postoperative nausea and vomiting (PONV) (p = 0.015, power = 70%), abdominal distension (p = 0.024, power = 64%), and muscular calf vein thrombosis (MCVT) (p = 0.033, power = 58%) was lower in the ESPB group than in the control group. Moreover, the occurrence of L-ESPB related adverse reactions was not found herein.ConclusionUS-guided L-ESPB reduces intraoperative and 24 h postoperative opioid consumption and improves patients' QoR-15 scores at 24 h postoperatively. L-ESPB can be safely and effectively utilized in lumbar UBE surgery.Trial registrationChinese Clinical Trial Registry, ChiCTR2200061908, date of registration: 10/07/2022. Registry URL.

Do Regional Nerve Blocks During Bimaxillary Surgery Decrease Postoperative Pain and Vomiting Compared With Patient-Controlled Analgesia?

Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting. The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA). This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded. The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA. The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents. The study covariates included demographic, surgical, and anesthesia characteristics. Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher's exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P<.05. 354 participants were included in the study (262 in the nerve block group, mean age 22.5±4.0years; 92 in the PCA group, mean age 22.6±4.4years; P=.81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P=.18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio=0.67, 95% confidence interval: 0.22-2.01, P=.48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio=0.34, 95% confidence interval: 0.18-0.65, P=.001). For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

Effect of nociception level-directed analgesic management on opioid usage in robot-assisted laparoscopic radical prostatectomy: a single-center, single-blinded, randomized controlled trial.

To assess the importance of appropriate opioid administration methods according to nociceptive monitoring. We conducted a randomized controlled trial involving 54 patients who underwent robot-assisted laparoscopic radical prostatectomy at our hospital. Patients were randomly allocated to either receive nociception level (NOL)-directed intraoperative opioid management with a minimum flow of remifentanil (NOL group) or conventional intraoperative analgesic management (control group). The primary outcome was the mean intraoperative remifentanil infusion flow rate (intraoperative remifentanil usage [μg]/ideal body weight [kg]/operation time [min]). The main secondary outcomes were plasma concentrations of three perioperative inflammatory biomarkers (interleukin-6, C-reactive protein [CRP], and cortisol levels) and postoperative pain (Numeric Rating Scale [NRS]) scores 2h postoperatively and on postoperative days 1, 2, 3, and 7. Compared with standard analgesia management, NOL-directed analgesic management reduced remifentanil consumption by 20% ( - 0.038; 95% confidence interval, - 0.059 to - 0.017; p = 0.0007). NOL-directed management did not lead to an increase in IL-6, CRP, or cortisol levels compared with conventional analgesic management. Furthermore, this protocol led to improvements in the NRS scores at rest 2h postoperatively and upon movement up to postoperative day 3. NOL-directed analgesic management reduced remifentanil consumption by 20% and the NRS scores at rest 2h postoperatively and upon movement up to postoperative day 3 without an increase in inflammatory marker levels. Japan Registry of Clinical Trials, JRCTs052220034.

Fast-Track Anesthesia for Cito Craniotomy Evacuation Hematoma Due to Temporoparietal Subdural Hemorrhagic Hematoma in a Pediatric Patient: A Case Report

Introduction: Subdural hematoma (SDH) in early childhood is a serious condition that requires immediate surgical intervention. Fast-track anesthesia is an approach that aims to speed up the patient's recovery after surgery. This case report presents the experience of fast-track anesthesia in a 4-month-old pediatric patient with SDH who underwent a cito craniotomy. Case presentation: A 4-month-old child with a history of head trauma due to shaking experienced recurrent seizures. CT scan examination showed left temporoparietal SDH with intraparenchymal hemorrhage. The patient was classified as ASA IIIE and underwent a cito craniotomy. A fast-track anesthesia strategy was implemented using rapid induction, multimodal analgesia, and strict fluid management. Conclusion: Fast-track anesthesia was successfully applied to pediatric patients with SDH undergoing cito craniotomy. This approach allows for a quicker recovery, reduces postoperative complications, and shortens the length of hospital stay.

Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery.

Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).