Conventional Analgesia Research Articles

Efficacy of Local Anesthetic in Post-Operative Laparoscopic Cholecystectomy

Background: Pain management is medically pertinent for optimal care in surgical patients. Although development and advancement in understanding of the pathophysiology of pain, analgesic's pharmacology and the development of better effective techniques for postoperative pain control, patients still continue to experience considerable discomfort. Objectives: To compare the efficacy (in terms of pain) of local anesthetic in postoperative laparoscopic cholecystectomy compared to control group. Methods: A total of 60 patients undergoing laparoscopic cholecystectomy and of age 20-50 year were included. Group A included the cases in which at the end of laparoscopic surgery, prior to port withdrawal, a local anesthetic mixture, a short acting (Lidocaine 2%) plus a long acting (Bupivacaine 0.5%) was instilled through the port lumen between the abdominal wall layers while group B included the cases in which conventional analgesics (narcotics and NSAID) was given post - operatively. All the patients were assessed by the researcher himself up to 12 hours post-operatively and efficacy was noted by Visual Analogue Scale (VAS). This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Duration of study was 1 year from August, 2018 to August, 2019. Results: Efficacy in control of pain of Group A (local anesthetic) was seen in 22(73.33%) while in Group B (control group) was seen in07 (23.33%) patients as shown in Table VI (p- value = 0.0001). Conclusion: The study concluded that the efficacy of local anesthetic in postoperative laparoscopic cholecystectomy is better as compared to control group.

Prevalence and correlates of the use of complementary and alternative medicines among older adults with joint pain.

There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional medicines in osteoarthritis (OA) patients. This study aimed to describe the prevalence and correlates of the use of CAMs among community-dwelling older adults. Data from the Tasmania Older Adult Cohort Study (TASOAC, n = 1099) were used to describe the prevalence of CAM use. Correlates of CAM use were assessed by comparing CAM users and non-users. To further assess correlates of CAM use, participants with at least one joint with pain were classified into four categories: CAM-only, analgesics-only, co-therapy, and "neither CAMs nor analgesics" (NCNA). In all, 385 (35.0%) of our participants reported use of CAMs, among which vitamins/minerals were used most (22.6%, n = 232). Compared with CAM non-users, CAM users were more likely to be female, were less likely to be overweight, were better educated, had more joints with OA, had fewer WOMAC scores, and did more steps per day. Among participants with any joint pain, the CAM-only group were less likely to be overweight, consumed more alcohol, had higher quality of life, had more steps per day, and had fewer pain-related symptoms compared with the analgesic-only group. Complementary and alternative medicines were commonly used among Tasmanian older adults, with 35% of the population using CAMs either alone or in combination with conventional analgesics. CAM users were more likely to be female, be better educated, have more joints with OA, and had healthier lifestyles, including lower body mass index and higher number of steps per day.

Efficacy of regional analgesia in prevention of chronic postsurgical pain in children on the PEDSQL General Well-Being Scale and Pediatric Pain Questionnaire

Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health. Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires. Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block. Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia. Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p<0.001) on the scales of General Well-Being, General Health, Present Pain, and Worst Pain. This shows the need for using effective minimally invasive regional analgesia techniques in the perioperative period. Conclusions. Chronic pain syndrome reduces quality of life in children by reducing their general well-being and general health due to high indicators of present and worst pain. Regional analgesia techniques are a priority for the prevention of chronic pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Safety and efficacy of patient controlled epidural analgesia versus conventional epidural analgesia in lower limb orthopedic surgeries: a prospective randomized study

BackgroundOrthopedic surgeries lead to moderate to severe postoperative pain, treating which is a challenge to the anesthesiologist. The present prospective, randomized study was carried out to compare the efficacy of postoperative pain relief between patient controlled epidural analgesia (PCEA) and conventional intermittent bolus epidural analgesia (IBEA) \\with very low concentration of bupivacaine plus fentanyl in 60 ASA I and ASA II patients for orthopedic lower limb surgeries. Following variables like heart rate, mean arterial pressure, oxygen saturation, visual analogue scale (VAS) score, total analgesic consumption, patient satisfaction (Likert scale) and side effects were assessed for 24 h postoperatively.ResultsThe hemodynamic parameters were comparable in both the groups at various time intervals. There was a significant decrease in VAS score, less analgesic consumption, less rescue analgesia requirement and more patient satisfaction in PCEA group as compared to IBEA group.ConclusionsPatient controlled epidural analgesia (PCEA) with a combination of bupivacaine and fentanyl has more efficacy and safety than intermittent bolus epidural analgesia (IBEA) so it should be used more often.

Pre-operative erector spinae plane block should be considered a viable option for laparoscopic colectomies.

The Erector Spinae Plane (ESP) block is a recent development in the field of regional anaesthesia and has been increasingly explored for abdominal surgeries to reduce opioid use and improve pain control. Colorectal cancer is the commonest cancer in multi-ethnic Singapore and requires surgery for curative treatment. ESP is a promising alternative in colorectal surgeries, but few studies have evaluated its efficacy in such surgeries. Therefore, this study aims to evaluate the use of ESP blocks in laparoscopic colorectal surgeries to establish its safety and efficacy in this field. A prospective two-armed interventional cohort study comparing T8-T10 ESP blocks with conventional multimodal intravenous analgesia for laparoscopic colectomies was conducted in a single institution in Singapore. The decision for doing an ESP block versus conventional multimodal intravenous analgesia was made by a consensus between the attending surgeon and anesthesiologist. Outcomes measured were total intra-operative opioid consumption, post-operative pain control and patient outcome. Post-operative pain control was measured by pain score, analgesia use, and amount of opioids consumed. Patient outcome was determined by presence of ileus. A total of 146 patients were included, of which 30 patients received an ESP block. Overall, the ESP group had a significantly lower median opioid usage both intra-operatively and post-operatively (p = 0.031). Fewer patients required patient-controlled analgesia and rescue analgesia post-operatively for pain control (p < 0.001) amongst the ESP group. Pain scores were similar and post-operative ileus was absent in both groups. Multivariate analysis found that the ESP block had an independent effect on reducing intra-opioid consumption (p = 0.014). Multivariate analysis of post-operative opioid use and pain scores did not yield statistically significant results. The ESP block was an effective alternative regional anaesthesia for colorectal surgery that reduced intra-operative and post-operative opioid use while attaining satisfactory pain control.

COMPARATIVE STUDY TO ASSES ANALGESIC EFFICACY AND OPIOID SPARING EFFECT OF USG GUIDED SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN PATIENT UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY FOR POSTOPERATIVE PAIN RELIEF.

Background- Intensity of pain in early post-operative period after laparoscopic cholecystectomy is signicant. There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects. Objective- The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of bupivacaine in reducing postoperative pain, total analgesic consumptions after elective laparoscopic cholecystectomy. Materials and methods: 60 adult patients were randomly divided into 2 groups of 30 in each. The selected patients were randomly divided into two groups Group 1, patients received USG guided tap block before surgery. Group 2 patients received 40 ml of 0.25 % bupivacaine after surgery, instillation done by surgeon intraperitoneally at gall blabber bed and under the domes of diaphragm. Statistical analysis: In all Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. To nd the signicant difference between the bivariate samples in independent groups the Unpaired sample t-test and the Mann-Whitney U test was used. Above statistical tools the probability value &gt; .05 was considered as signicant level. Results: The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 from 1 hours to 24 hours and it was statistically signicant. Demand of rescue analgesia was higher in group 2 when compared to group 1 and it was statistically signicant. Conclusion: TAP block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy

Efficacy of Wound Instillation With Bupivacaine Through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison With Conventional Intravenous Analgesics.

Introduction A laparotomy can cause severe postoperative pain, which, if treated adequately, can result in reduced incidence of lung atelectasis and ileuspromoting early mobilization and faster recovery and in turn reducing the duration of hospital stays. Hence, effective postoperative analgesia is important to reduce postoperative stress and improve early surgical outcomes. Therefore, the hypothesis is based on the fact that following a midline laparotomy, instillation of local anaesthetic agent 0.25% bupivacaine through a wound catheter placed in the subcutaneous plane may provide better analgesia compared to the conventional intravenous analgesics and improve the early surgical outcomes. Methodology A prospective, comparative, quasi-experimental study was conducted on 80 patients planned for emergency or elective midline laparotomy procedures over a period of 18 months, who were randomly distributed into two groups of 40 each. The bupivacaine group consisted of 40 patients who received 10ml of 0.25% bupivacaine instilled through a wound catheter placed in the subcutaneous plane following a midline laparotomy. This was repeated every six hours for the first 24 hours followed by every 12 hours for the next 24 hours. The conventional intravenous (IV) analgesics group involved 40 patients who received conventional IV analgesics routinely used. Pain scores were recorded every four hours for 60 hours using the visual analogue scale (VAS) and dynamic visual analogue scale (DVAS). The parameters assessed were mean VAS and DVAS scores, number of rescue analgesic demands, cumulative rescue analgesic requirement, and early surgical outcomes. Wound complications were also assessed. Results Both groups shared similar demographic characteristics in terms of age, gender, comorbidities, and duration of operation. In comparison to patients who got standard IV analgesics, those who received 0.25% bupivacaine had improved postoperative analgesia. Between the two groups, there were statistically significant results in the number of rescue analgesic demands in the first 24 hours, but in the next 24 hours, it was statistically insignificant. The study also showed that bupivacaine instillation led to a significant decrease in postoperative lung complications and the length of hospital stays; however as hypothesised, it did not improve early surgical outcomes. Conclusion This modality, the instillation of bupivacaine through a wound catheter, is an efficient and technically simple method to provide optimal postoperative analgesia. It substantially reduces the need for systemic analgesics and can potentially avoid their related side effects. Hence, the armamentariumof multimodal analgesia can therefore include this method of delivering postoperative analgesia.

COMPARISON OF ERECTOR SPINAE PLANE BLOCK &amp; CONVENTIONAL ANALGESIC TECHNIQUE FOR POSTOPERATIVE PAIN RELIEF IN CAESAREAN SECTION – A PROSPECTIVE RANDOMISED STUDY

Background: Postoperative pain relief after caesarean delivery is challenging because it needs to provide maternal satisfaction while having no adverse effects on the baby. The study aimed to compare the analgesic efcacy of bilateral ESP block with that of conventional technique after elective LSCS under SAB. In this single blind randomized, prospective comparative Methods: study, 76 healthy parturient were randomly divided into two groups. Group1 received bilateral ESPB using 0.2% ropivacaine (0.2ml/kg) before spinal anaesthesia, Group 2 received conventional postoperative analgesics on patient's demand. The duration of postoperative analgesia and VAS pain score was recorded for 24hrs. Onset &amp; duration of sensory and motor block, hemodynamic parameters and adverse effects were assessed. Data analysis was done with statistical software SPSS Version. 24 with Unpaired T test and Chi-square test. The duration of anal Results: gesia (152.55 ± 64.46mins vs 96.68 ± 36.09mins) was signicantly prolonged in Group ESPB than Group Control (P&lt;0.0001) The mean VAS score was signicantly less in ESPB group at 2hr (P value =0.0243), 12hr (P value = 0.0250) and 24hrs (P value = 0.0408) postoperatively. ESPB group of patients require less analgesic dose of inj. Tramadol (P= 0.0389), inj. Diclofenac sodium (P &lt;0.0001) and inj. Paracetamol (P= 0.0423) as compared to that of Control group with signicant difference. Onset of sensory and motor block was signicantly faster in ESPB Group than Control Group. ESP block provides more effective Conclusion: pain relief, longer duration of analgesic action, prolongs time to rst analgesic requirement, associated with less consumption of conventional analgesics and also potentiates the onset of sensory and motor block.

Medyan Sternotomili Kardiyak Cerrahide Ultrason Kılavuzluğunda Yüzeysel Serratus Anterior Plan Bloğu: Retrospektif Çalışma

Objective: As part of multimodal analgesia regimen in cardiac surgery, the serratus anterior plane block (SAPB) is a technique regularly used in minimally invasive surgical interventions with thoracotomy. The aim of our study is to determine the analgesic efficacy of SAPB for cardiac surgery performed with sternotomy. Methods: A total of 99 patients who underwent SAPB (Group SAP, n=43) and conventional analgesia (Group C, n=56) for coronary artery bypass graft (CABG) surgery were compared retrospectively. Demographic data, postoperative opioid use, highest pain scores, nausea-vomiting, time to start oral intake, extubation time, lenght of intensive care unit and hospital stay were recorded. Results: Total opioid requirement, expressed in oral morphine equivalent within the first 24 hours after extubation, was found to be significantly lower in patients with SAPB (p=0.022). Similarly, both the highest reported pain scores at rest and during mobilization and also the nausea scores were found to be significantly lower in Group SAP during the same period (p=0.007, p=0.048, p=0.004). Extubation (p=0.025) and oral intake initiation time p=0.030) were shorter in Group SAP. Conclusion: By providing analgesia of the chest tube drain site, SAPB application was associated with lower opioid consumption, pain, and nausea-vomiting among patients who underwent CABG with median sternotomy. Because of this benefit, superficial SAPB may be part of opioid-reducing multimodal analgesia in cardiac surgery. Keywords: Serratus anterior plane block, fascial plane blocks, coronary artery bypass surgery, postoperative analgesia

Comparison of Analgesic Effect of Transversus Abdominis Plane (TAP) Block versus Conventional Analgesics in Patients Undergoing Different Obstetrics and Gynecological Surgeries

Comparison of Analgesic Effect of Transversus Abdominis Plane (TAP) Block versus Conventional Analgesics in Patients Undergoing Different Obstetrics and Gynecological Surgeries

Spirulina platensis Attenuates Cold Allodynia and Chemical Allodynia in Streptozotocin induced Diabetic Rats

Background: Diabetic neuropathic pain exerts strong as well as negative influence on both survival and quality of life of the patient. This pain is difficult to treat with conventional analgesics. Now a days, different medicinal herbs are highlighted due to their wide range of beneficial application with less side effects. In this regards Spirulina platensis is well known for its wide range of biological activities. Objective: To assess the effects of oral administration of Spirulina platensis on cold allodynia and chemical allodynia in diabetic neuropathic pain in Long Evans rats.Materials and Methods: This study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2017 to February 2019. Twenty four (24) Long Evans rats, having 150 to 200 grams body weight (on the basis of treatments), the rats were divided into Group I (normal saline 5 ml/kg body weight) and Group II (Spirulina platensis 400 mg/kg body weight). All the supplementations were given once daily for consecutive 21 days orally and last doses were given one hour before the pain evaluation tests. Further on the basis of experiments, previously grouped rats were divided into subgroup ‘a’(cold tail immersion test), and ‘b’ (formalin test). Data were expressed as mean±SEM and were statistically analyzed by SPSS (Version 16) using independent sample ‘t’ test to compare mean value between two groups. (p 0.05 was considered as the level of significance).Results: Spirulina platensis showed significantly higher tail flick latency (p 0.001) in cold tail immersion test. S. platensis demonstrated significantly lowered jerking frequency (p 0.001,p 0.01,p 0.001, respectively); the duration of licking (p 0.001,p 0.05,p 0.001, respectively) and the duration of flexing (p 0.001, non-significant 0.01, respectively) in early, inter and late phases of formalin test in compared to those of control. Conclusion: S. platensis attenuates cold allodynia and chemical allodynia diabetic neuropathic pain in rat model. KYAMC Journal Vol. 13, No. 04, January 2023: 208-213

Response to Arendt-Nielsen et al. (Methodology considerations for the paper by Hosted et al. 2023).

Response to Arendt-Nielsen et al. (Methodology considerations for the paper by Hosted et al. 2023).

Surgical pleth index monitoring in perioperative pain management: usefulness and limitations.

Surgical pleth index (SPI) monitoring is a representative, objective nociception-monitoring device that measures nociception using photoplethysmographic signals. It is easy to apply to patients and the numerical calculation formula is intuitively easy to understand; therefore, its clinical interpretation is simple. Several studies have demonstrated its efficacy and utility. Compared with hemodynamic parameters, the SPI can detect the degree of nociception during surgery under general anesthesia with greater accuracy, and therefore can provide better guidance for the administration of various opioids, including remifentanil, fentanyl, and sufentanil. Indeed, SPI-guided analgesia is associated with lower intraoperative opioid consumption, faster patient recovery, and comparable or lower levels of postoperative pain and rates of adverse events compared with conventional analgesia. In addition, SPI monitoring allows for the degree of postoperative pain and analgesic requirements to be predicted through the SPI values immediately before patient arousal. However, because patient age, effective circulating volume, position, concomitant medication and anesthetic regimen and level of consciousness may be confounding factors in SPI monitoring, clinicians must be careful when interpreting SPI values. In addition, as SPI values can differ depending on anesthetic and analgesic regimens and the underlying disease, an awareness of the effects of these variables with an understanding of the advantages and disadvantages of SPI monitoring compared to other nociception monitoring devices is essential. Therefore, this review aimed to help clinicians perform optimal SPI-guided analgesia and to assist with the establishment of future research designs through clarifying current usefulness and limitations of SPI monitoring in perioperative pain management.

COMPARISON BETWEEN PRE-EMPTIVE THORACIC EPIDURALANALGESIA VS CONVENTIONAL THORACIC EPIDURALANALGESIA IN PATIENTS UNDERGOING THORACOTOMY IN A TERTIARY CARE CENTRE

Background: Relative effects of timing of providing analgesia, type of surgery of local anaesthetics used for postoperative thoracic epidural analgesia and the possibility of establishment of pre-emptive analgesia as a superior mode for thoracic epidural analgesia are still in grey zone. In this observational study, we evaluated the idea of Pre-emptive thoracic epidural analgesia which can counter the post thoracotomy pain through pain scoring. Objective: To nd out whether pre-emptive thoracic epidural analgesia is superior to conventional postoperative epidural analgesia for post-thoracotomy pain. Study Design: Observational study. Place and Duration of Study: Department of Anesthesiology and Critical Care, Assam Medical College and Hospital, from Januray 2022 to January 2023. Methodology:After ethical committee approval and informed consent from patients, 22 patients undergoing thoracotomy were included in study. Preoperatively thoracic epidural catheter was inserted at T8-9 intervertebral space level. Group P was given 0.5ml/kg of 0.125% bupivacaine before induction of anesthesia; whereas group C was administered 0.5 ml 0.125% bupivacaine after closure of wound in supine position. All patients received thoracic epidural analgesia with a bolus dose of 0.1 ml/kg of 0.125% bupivacaine every 6 hourly post operatively .Visual analog scale (VAS) was used to assess pain severity at 1 and 24 hours postoperatively, both at rest and after cough (R1, R24, C1 and C24 respectively). Data were analyzed with SPSS and Microsoft Excel 2010. Results: There was no statistical difference in demographic prole of both groups in terms of age, gender, American Society of Anaesthesiologists (ASA) status or type of surgery, complications. Pain was signicantly less in group P at 1hour postoperatively (p=0.0001). However, there was no difference in pain severity at rest at 24 hours and with cough at 01 hour or 24 hours postoperatively. Conclusion: Pre-emptive thoracic epidural analgesia provides better pain control in immediate post operative period at rest. However, no such differences were observed in pain scores in immediate post operative period on coughing. No differences were observed at 24 hours at rest or coughing in both the groups

Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients.

With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques. A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups. A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05). Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Successful Management of Unilateral Post-traumatic Neuropathic Mastalgia: A Case Report.

Stellate ganglion block has been described in the management of postmastectomy neuropathic pain. However, its role in the treatment of posttraumatic neuropathic breast pain has not been reported in the literature. We present a case of a 40-year-old female with a chief complaint of severe debilitating pain in her right breast following trauma, refractory to oral medications including conventional analgesics, amitriptyline, pregabalin, and duloxetine. She was successfully managed after administration of ultrasound-guided stellate ganglion block and pulsed radiofrequency ablation of the stellate ganglion. It resulted in significant and prolonged pain relief leading to improved quality of life.

Dural Puncture Epidural for Labor Analgesia: Is It Really an Improvement Over Conventional Labor Epidural Analgesia?

(Anesthesiology. 2022;136:667–669) Continued innovations of the standard epidural technique have allowed for improvement of the quality of analgesia experienced by laboring women. The introduction of conventional neuraxial analgesia offered effective and safe pain relief to parturients, with relatively infrequent adverse outcomes, and is utilized in &gt;73% of contemporary births in the United States. Procedural refinements over time have offered improvement in analgesia quality, including continuous local anesthetic infusions, optimizations of volume and concentrations of medications delivered, the addition of opioids to the injectate, timed bolus injections, and patient-controlled epidural analgesia. As protocol variations, both combined spinal-epidural and dural puncture epidural utilize a smaller spinal needle that is passed through the epidural needle. In combined spinal-epidural, small doses of opioid and local anesthetic are injected into the intrathecal (IT) space. With dural puncture epidural, the spinal needle is used to intentionally puncture the dura, but no drugs are injected. Initial evidence suggested improved analgesia with this technique over standard epidural and combined spinal-epidural, but the literature has produced mixed results since. In the same issue of this journal, Tan et al deliver results from a randomized clinical trial of obese parturients receiving dural puncture epidural vs conventional epidural to determine if analgesia quality is enhanced by dural puncture in this population at higher risk for epidural failure.

Effect of surgical pleth index-guided remifentanil administration on perioperative outcomes in elderly patients: a prospective randomized controlled trial

BackgroundDuring general anesthesia, the surgical pleth index (SPI) monitors nociception. The evidence of SPI in the elderly remains scarce. We aimed to investigate whether there is a difference in perioperative outcomes following intraoperative opioid administration according to the surgical pleth index (SPI) value versus hemodynamic parameters (heart rate or blood pressure) in elderly patients.MethodsPatients aged 65–90 years who underwent laparoscopic colorectal cancer surgery under sevoflurane/remifentanil anesthesia were randomized to receive remifentanil guided by SPI (SPI group) or conventional clinical judgment based on hemodynamic parameters (conventional group). The primary endpoint was intraoperative remifentanil consumption. Secondary endpoints were intraoperative hemodynamic instability, pain score, fentanyl consumption and delirium in the post-anesthesia care unit (PACU), and perioperative changes in interleukin-6 and natural killer (NK) cell activity.ResultsSeventy-five patients (38, SPI; 37, conventional) were included in the study. The SPI group consumed significantly more remifentanil intraoperatively than the conventional group (mean ± SD, 0.13 ± 0.05 vs. 0.06 ± 0.04 μg/kg/min, P < 0.001). Intraoperative hypertension and tachycardia were more common in the conventional group than in the SPI group. Pain score in the PACU (P = 0.013) and the incidence of delirium in the PACU were significantly lower in the SPI group than the conventional group (5.2% vs. 24.3%, P = 0.02). There was no significant difference in NK cell activity and interleukin-6 level.ConclusionsIn the elderly patients, SPI-guided analgesia provided appropriate analgesia with sufficient intraoperative remifentanil consumption, lower incidence of hypertension/ tachycardia events, and a lower incidence of delirium in the PACU than the conventional analgesia. However, SPI-guided analgesia may not prevent perioperative immune system deterioration.Trial registrationThe randomized controlled trial was retrospectively registered in the UMIN Clinical Trials Registry (trial number: UMIN000048351; date of registration: 12/07/2022).

Postoperative Outcomes of Analgesic Management with Erector Spine Plane Block at T5 Level in Pediatric Patients Undergoing Cardiac Surgery with Sternotomy: A Cohort Study.

There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery. A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022. Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4-11)) compared to the CA group (median 10.5 days (IQR: 6-25)). Likewise, there was a higher probability of discharge from the ICU in the ESPB group (HR 1.71 (95% CI: 1.05-2.79)). The ESPB group had lower opioid consumption (p < 0.05). There were no differences in time to extubation, mortality, and postoperative complications. ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery is feasible and associated with shorter hospital length of stay, faster ICU discharge and lower opioid consumption.

Use of analgesics in Denmark: A national survey.

People suffering from pain constitute a sizeable and heterogeneous patient group. Conventional oral analgesics are considered a cheap and safe first-line treatment. These drugs are used on both a regular and 'as needed' basis and are often obtained over-the-counter (OTC). We explored patient-reported patterns of use and adverse effects of analgesics in a community pharmacy questionnaire. Eight pharmacies invited persons aged ≥18 years requesting analgesics via prescription or OTC to complete an electronic questionnaire. A total of 2410 participants completed the questionnaire (68% female; 50% ≥ 60 years). Most participants filled a prescription for paracetamol (61%; n= 842) and non-steroidal analgesics (n= 363; 26%). Among OTC users, most obtained paracetamol (61%). Among prescription users, 73% (n= 1114) had their analgesic prescribed for daily use; however, of these only 61% (n= 630) reported using it daily, while 35% (n= 363) reported 'as needed' use. Of all prescriptions, 80% (n= 898) were labelled with the standardized indication 'against pain'. Self-reported indications showed that back pain and muscle/joint pain were the most common indications. Among non-new users of OTC analgesics (n= 841), 17% (n= 141) used their medication daily. Finally, 90% (n= 1658) of all participants reported not experiencing adverse effects. Our findings suggest a need for continuous assessment of analgesic patterns of use after treatment initiation to inform counselling in community pharmacies and elsewhere.