Analgesic Dose Research Articles

The use of strong analgesics for prehospital pain management in children in the region of Southern Denmark: a register-based study

Abstract Background Acute pain in the prehospital setting is frequent and prehospital pain management presents multiple challenges, especially in children. There is a lack of high-level evidence regarding prehospital pain management in the paediatric population worldwide. In Denmark, this lack of evidence particularly concerns the frequency of the prehospital use of strong analgesics. Guidelines are sparse but there is evidence that prehospital fentanyl may be administered up to 5 µg/kg. Method This register-based study investigated the prehospital analgesic treatment in the population under 15 years from January 2017 to December 2022 in the Region of Southern Denmark. Data were extracted from electronic prehospital medical records. The analgesic treatment was characterised by the type of medication, dosage, administration method, and cause of ambulance dispatch. Lastly, response- and transport times were registered. Results A total of 28,933 prehospital paediatric medical records were examined. In one in seventeen of all prehospital contacts with children, fentanyl, alfentanil, morphine and/or s-ketamine was administered. Three-quarters of the doses of strong analgesics were administered to patients older than 10 years. Fentanyl was the most frequently administered medication (96.4%). The median fentanyl-equipotent doses of opioids were 1.7 µg/kg adjusted according to standardised patient weight. In 63.4% of cases, the analgesic treatment was administered intravenously. Conclusion The doses of opioids as administered by the EMS personnel seem safe as 97% of the doses were within the recommended range and even at the lower end of the recommended range. Although apparently safe, the utilisation of strong analgesics points to a risk of under-treating pain in children.

Nalfurafine is Aversive at Analgesic Doses - Non-Clinical Evidence to Indicate It is Not an Atypical Kappa Opioid Receptor Agonist

Nalfurafine is Aversive at Analgesic Doses - Non-Clinical Evidence to Indicate It is Not an Atypical Kappa Opioid Receptor Agonist

Effect of Different Doses of Intrathecal Nalbuphine as Adjuvant to Hyperbaric Bupivacaine on Characteristics of Subarachnoid Block in Pelvic and Lower Limb Orthopaedic Surgeries: A Randomised Clinical Study

Introduction: Hyperbaric bupivacaine 0.5% is most commonly used amide local anaesthetic drug in spinal anaesthesia. Various additives have been used as an adjuvant to hyperbaric bupivacaine 0.5% to modify its anaesthetic properties. Nalbuphine, a mix opioid with high efficacy kappa receptors agonism has also been used as an adjuvant to hyperbaric bupivacaine 0.5% at different doses. Aim: To compare and discover the effective dose of nalbuphine as adjuvant in subarachnoid block with hyperbaric bupivacaine in pelvic and lower limb orthopaedic surgeries in terms of onset and duration of sensory and motor block along with postoperative analgesia duration. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC), Piparia, Vadodara, Gujarat, India over a period of 18 months from February 2023 to August 2024 on 80 patients belonging to 20-60 years of age, American Soceity of Anaesthesiology (ASA) Grade I or II, of either gender undergoing elective pelvic and orthopaedic surgeries. Patients were randomly divided into two groups having 40 patients each. Group A received hyperbaric bupivacaine 12.5 mg+0.4 mg nalbuphine (total 3 mL) and Group B received hyperbaric bupivacaine 12.5 mg + 0.8 mg nalbuphine (total 3 mL). Sensory and motor block characteristics like their onset time, time to achieve highest sensory level, time to achieve bromage 3, time of two segment regression, duration of sensory and motor block, duration of postoperative analgesia and time for requirement of first rescue analgesia dose were observed and assessed. Haemodynamic parameters along with intraoperative and postoperative sideeffects were also observed. Results: Both the study groups had similar demographics and haemodynamic parameters. Time of two segment regression of sensory block was significantly longer in Group B (135.25±11.49 min) than A (120.95±16.98 min) with statistically significant prolonged duration of sensory block in Group B (228.25±21.91 min) than A (206.75±15.21 min) (p<0.0001). Postoperative analgesia was also prolonged in Group B (294.75±19.15 min) than A (226.19±14.78 min) without significant increase the incidence of side-effects (p≥0.05). Conclusion: Study concluded that 0.8 mg nalbuphine as an adjuvant to 0.5% hyperbaric bupivacaine in subarachnoid block is more effective dose as it provides prolonged duration of sensory block and postoperative analgesia with good haemodynamic stability and minimal side-effects.

Efficacy of Piroxicam as a Perioperative Analgesic for Patients Undergoing Maxillofacial Fracture Fixation: A Randomized Controlled Trial

Background: Fixation of maxillofacial fractures is a commonly performed surgical procedure and is often associated with moderate to severe pain. Postoperative pain management can be achieved using nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or a combination of both. This study aimed to assess the effectiveness and postoperative complications of intramuscular piroxicam.Methods: This randomized controlled study was conducted on 62 adult patients aged 16–25 years who had mandibular or maxillary fractures and received open reduction and internal fixation, were randomly divided into two groups, the piroxicam group (PG) (31 patients), received a dose of 0.4 mg/kg of intramuscular piroxicam, and the non-piroxicam group (NPG) (31 patients), did not. Our primary outcome included the total rescue analgesic dosage required. The secondary outcomes included visual analogue score, time to the first analgesic dose, and postoperative nausea and vomiting. Results: Similar demographic profiles, initial characteristics, and surgical techniques in both groups (p>0.05) were noticed. Visual analog scores at 6, 12, and 24 h, as well as the total dose of rescue analgesic, were significantly higher in the non-piroxicam group (NPG) than in the piroxicam group (PG) (p < 0.05). There were no statistically significant differences between the two groups in terms of visual analog scores three hours later or in the occurrence of postoperative nausea and vomiting (p>0.05). Conclusion: In patients undergoing maxillofacial fracture fixation, intramuscular administration of piroxicam has been found to be effective in providing perioperative analgesia and may also potentially reduce the requirement for postoperative rescue analgesia while maintaining a similar incidence of postoperative nausea and vomiting.

Efficacy and safety of perioperative analgesia in PENG block for children undergoing hip surgery with developmental dysplasia: study protocol for a randomized, double-blinded, non-inferiority trial

BackgroundSurgical intervention is critical in the treatment of hip developmental dysplasia in children. Perioperative analgesia, usually based on high opioid dosages, is frequently used in these patients. In some circumstances, regional anesthetic procedures such as caudal block and lumbar plexus block have also been used. Previous research has shown that pericapsular nerve group (PENG) block provides excellent anesthetic efficacy during open hip surgery in adults. PENG block is thought to provide a similar analgesia effect comparable to caudal block.MethodsThis study is a single-center, prospective, randomized, double-blinded, non-inferiority experiment that enrolled children aged 6 months to 7 years who were scheduled for developmental dysplasia hip surgery. Following general anesthesia and regional blocks (0.25% ropivacaine at a dose of 2.5 mg·kg−1 with epinephrine at a concentration of 1:200,000), 48 individuals will be randomly assigned to either the PENG or caudal groups. The primary outcome measure is the highest FLACC (face, legs, activity, crying, consolability) score achieved within 24 h of surgery. Secondary outcomes include intraoperative opioid consumption, analgesic dosage within 24 h of surgery, time to start rescue analgesia, number of PCA pump activations, time to remove SLIPA (streamlined liner of the pharynx airway), duration of regional block procedures, incidence of adverse events, plasma ropivacaine concentrations, and hospital stays and costs. All data will be collected by blinded investigators. The trial’s final results will be published in a peer-reviewed scientific journal.DiscussionWe expect this trial to provide some evidences that PENG block is safe and effective for perioperative analgesia in pediatric patients undergoing open hip surgery.Trial registrationChinese Clinical Trial Registry ChiCTR2100053128. Registered on November 12, 2021.

Efficacy of Acupuncture in Postoperative Pain-Relieving: A Systematic Review and Meta-Analysis.

This study aimed to assess the efficacy of acupuncture in relieving postoperative pain. Systematic review and meta-analysis. The search strategy was designed according to the PICOS principle (population, intervention, comparison, outcome, and study). PubMed, Web of Science, Cochrane Library, and Embase were searched from the inception of databases to August 25th, 2022 to collect studies on acupuncture in the management of postoperative pain. Two researchers independently screened the searched studies using the EndNote X9 software. Relevant data were extracted, and the risk of bias in included studies was assessed. RevMan 5.4 software was used for data analysis, and the Grading of Recommendations, Assessment, Development, and Evaluation was used to assess the quality of evidence. A total of 25 studies were included. This meta-analysis showed statistically significant differences in the pain scores (SMD=-0.38, 95 %CI [-0.69, -0.07], p = .02) and the dosage of analgesics (SMD = -0.53, 95% CI [-0.99, -0.06], I2 = 90 %, p < .00001] between the acupuncture group and the control group. Acupuncture is effective for alleviating postoperative pain and reducing the dosage of analgesics. More well-designed, and large-scale prospective studies are needed to further validate the efficacy of acupuncture in relieving postoperative pain. Acupuncture is an acceptable choice for relieving postoperative pain since it is convenient, effective, and acceptable. Nurses can provide tailored guidance for patients to enhance their recovery and satisfaction.

A survey on labor epidural test dose practices in India

Abstract There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labor epidurals among practicing obstetric anesthetists. A Google form based questionnaire was circulated to 300 members of the Association of Obstetric Anesthesiologists (AOA) of India of which 128 (42.7%) responded. According to our survey, labor analgesia is routinely practiced by only 40 (32%) responders. Sixty-eight (53.1%) responders reported placement of an epidural catheter at the patient’s request. Less than 50% reported the use of test dose for epidural catheter placement confirmation. Ninety-eight (76.6%) responders give the test dose at the time of catheter placement while 22 (17.1%) give it every time before injecting the local anesthetic as a top-up. The majority preferred using 3–4 mL of 2% lidocaine as test dose. Seventy-three (57%) responders relied on the use of conventional test dose of lidocaine with epinephrine. 8.5% of responders had experienced side effects with epidural test dose during labor analgesia. This survey highlights not just variations in the clinical practice regarding epidural test dose for labor analgesia but gross deviation from the current recommended standard of practice. The issue can be addressed by developing clear practice guidelines.

Efficacy and safety of SHR8554 on postoperative pain in subjects with moderate to severe acute pain following orthopedic surgery: A multicenter, randomized, double-blind, dose-explored, active-controlled, phase II/III clinical trial.

Biased µ-opioid receptor (MOR) agonists enhance pain relief by selectively activating G protein-coupled receptor signaling and minimizing β-arrestin-2 activation, resulting in fewer side effects. This multicenter Phase II/III trial evaluated the optimal dosage, efficacy, and safety of SHR8554, a biased MOR agonist, for postoperative pain management following orthopedic surgery. In Phase II, 121 patients were divided into four groups to receive varying patient-controlled analgesia (PCA) doses of SHR8554 or morphine. Phase III involved 320 patients with similar groupings, including a placebo group. The primary outcome was the resting summed pain intensity difference over 24 hours (rSPID24). Secondary outcomes included rSPID and active-SPID (aSPID) at other time points, rescue analgesia received, cumulative dose of analgesics, and satisfaction scores. Safety endpoints included treatment-emergent adverse events (TEAEs) and AE of special interest (AESIs). In both phases, SHR8554 demonstrated significant analgesic efficacy. In Phase II, the least squares (LS) mean differences in rSPID24 compared to morphine for the 0.05 mg,0.1 mg, and 0.2 mg SHR8554 groups were 16.8 (p = 0.01), 7.4 (p = 0.27), and 0.2 (p = 0.98), respectively. Phase III confirmed the efficacy of the 0.05 mg and 0.1 mg SHR8554 doses compared to placebo, with LS mean differences of 15.4 (p = 0.0001) and -19.8 (p < 0.0001), respectively. Trends in other secondary outcomes mirrored these findings. Safety analysis revealed that the 0.2 mg SHR8554 group had higher incidences of TEAEs (83.3 %) and AESIs (33.3 %) compared to other groups in Phase II. Similarly, in Phase III, the incidences of TEAEs were 81.0 %, 73.4 %, and 74.1 % in the 0.05 and 0.1 mg SHR8554 and morphine groups, respectively, compared with 61.3 % in the placebo group, while the AESIs were 29.1 %, 20.3 %, and 24.7 % compared with 12.5 % in the placebo group. In conclusion, SHR8554 exhibited efficacy compared to placebo and safety comparable to morphine for patients experiencing moderate-to-severe acute pain following unilateral total knee replacement or knee ligament reconstruction surgery. TRIAL REGISTRATION: Trial Name: Study on the Efficacy and Safety of SHR8554 Injection for Postoperative Analgesia in Orthopedics: Multicenter, Randomized, Double Blind, Dose Exploration, Placebo/Positive Control, Phase II/III Clinical Trial Registered on: chinadrugtrials.org.cn Identifier: CTR20220639.

Ultrasound-guided Bilevel Erector Spinae Plane Block for Oncoplastic Breast Reconstruction Involving Latissimus Dorsi Myocutaneous Flap

The incidence of chronic post-operative pain following breast surgery has been estimated to be ranging between 25% and 60%. The principal cause has been due to higher post-operative pain following breast surgery, which could be prevented by inclusive regional anaesthesia techniques. Erector spinae plane (ESP) block across various studies has demonstrated reduced post-operative pain and reduction in opioid consumption. We present a case series of 10 patients who underwent oncoplastic breast reconstructive surgeries involving latissimus dorsi myocutaneous flap. All patients received bi-level ESP block at T2 and T6 levels before induction of anaesthesia. Patients were followed up for 24 h post-surgery during which pain scores were elicited by Numeric Rating Scale (NRS) and total rescue analgesic dose noted. All patients had an NRS of &lt;3 at rest immediate and after 2 h following surgery in post-anaesthesia care unit. Further, patients had NRS &lt;3 both at rest and on movement induced by physiotherapy-assisted shoulder exercise up to 24 h post-surgery. None of them received any rescue analgesic and no side effects were noted.

Comparison of Analgesia Efficacy between Magnesium Sulfate and Dexamethasone as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgery: A Prospective Randomized Study

Background: Brachial plexus block, a widely used technique, offers effective regional anesthesia and analgesia for upper extremity surgeries. Compared to general anesthesia, its increasing popularity can be attributed to its safety, efficacy, patient satisfaction, and reduced hospital stay. The use of adjuvants with local anesthetics enhances the quality and duration of analgesia. The aim of this study was to compare the clinical efficacy of dexamethasone to magnesium sulfate (MgSO4) as adjuvants to ropivacaine in patients undergoing supraclavicular brachial plexus block for upper limb surgery. Methods: In this prospective randomized study, 100 American Society of Anesthesiologists physical status I/II patients undergoing elective upper limb surgery under peripheral nervous system-guided supraclavicular brachial plexus block were randomized into two groups. Group RD (n = 50) received 8 mg dexamethasone + 0.75% ropivacaine (total volume 30 ml) and Group RM (n = 50) 200 mg MgSO4 + 0.75% ropivacaine (total volume 30 ml). Duration and quality of analgesia, onset, and duration of sensory and motor blocks were assessed. Results: Onset of sensory and motor block was significantly faster in Group RD (13.20 ± 1.93 and 17.44 ± 2.54 min) as compared to Group RM (15.88 ± 2.50 and 19.26 ± 2.54 min). Duration of sensory and motor block was also significantly longer in Group RD (1184.40 ± 111.96 and 1093.80 ± 91.56 min) as compared to Group RM (468.60 ± 62.07 and 385.80 ± 45.36 min). Duration of analgesia was prolonged in group RD (1211.12 ± 111.22) as compared to group RM (498.18 ± 64.44 min) (P &lt; 0.001). Proportion of those using two or more rescue analgesic dosages was significantly higher in Group RM (100%) as compared to that in Group RD (16%) (P &lt; 0.001). Conclusion: Dexamethasone outperformed MgSO4 as an adjuvant to ropivacaine during supraclavicular brachial plexus block.

The effects of abdominal nerve block techniques as preventive analgesia on pediatric laparoscopic procedures: A randomized controlled trial

ABSTRACT Background The current study compared the effect of ultrasound-guided quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) on post-operative pain in children undergoing lower abdominal laparoscopy. Methods Ninety male and female patients (ASA I to II), ages (1–7), performing elective laparoscopic lower abdomen surgery randomly allocated into three equal groups of 30 patients each. Group (C) received conventional analgesics. In addition to conventional analgesics, 0.5 ml/kg of bupivacaine 0.25% was injected under US-guidance on both abdominal sides, into transversal plane at subcostal level in group (TAP) or into the facial plane between the PM and QL muscles in group (QL). Our primary outcome was the measuring FLACC scale immediately following surgery, every 30 minutes in the PACU, and then at 4, 6, 8, 10, 12, 18, and 24 hours after surgery. Our secondary outcomes were the first analgesic request, the dosage of analgesics, the postoperative complications, and parents’ satisfaction during the first 24 hours. Results When comparing the FLACC pain scores, the QL group showed a significant reduction in pain for the whole postoperative period in comparison to C group (p < 0.001) and up to 12 h in TAP group (p < 0.001). Patients in QL group got the longest time to the first analgesic requirement (p < 0.001). The C group required more analgesics overall than the other groups. Conclusions Ultrasound-guided QLB after induction of general anesthesia in comparison to TAP block provides better postoperative pain, prolonged analgesia, and less postoperative analgesic consumption after lower abdominal laparoscopic surgery in pediatrics.

Analgesic Efficacy Comparison Between Ultrasound-Guided Erector Spinae Plane Block and Retrolaminar Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial.

Breast cancer is the most common cancer in females. Surgery is the gold standard therapy, with modified radical mastectomy (MRM) being the most commonly performed procedure for breast cancer. Management of postoperative pain after MRM poses a clinical challenge and hence receives utmost priority. Ultrasound-guided regional nerve blocks are commonly administered to combat post-surgical pain after MRM. In this context, retrolaminar block (RLB) and erector spinae plane block (ESPB) are relatively newer techniques. Though these blocks are quicker, safer, and easier to administer, very few studies have been done to compare their postoperative analgesic efficacy. Henceforth, we conducted this trial to compare the postoperative analgesic efficacy of ESPB and RLB in patients scheduled for MRM. The procedures followed in this trial were according to the norms of the Declaration of Helsinki (2013). The study was started after obtaining approval from the Institutional Ethics Committee (IEC), written informed consent from the patients, and trial registration in the Clinical Trials Registry of India. Sixty female patients of the American Society of Anesthesiologists with physical statuses 1, 2, and 3, aged 18 years and above, planned for unilateral MRM under general anesthesia, were included, whereas patients not giving consent, allergic to study drugs, having contraindications to regional anesthesia, with a body mass index (BMI) of ≥ 35 kg/m2, deformity of the spine, psychiatric illness, lactating, or pregnant women were excluded. Computer-generated randomization was used to allocate the patients to groups E and R to receive ESPB or RLB, respectively, using 30 mL of ropivacaine (0.5%) with 2 mL of dexamethasone at the T4 spinous process level under ultrasound guidance. The primary outcome was to determinethe time to rescue analgesia based on a visual analog scale score ≥ 4. Secondary objectives were the intraoperative fentanyl consumption and side effects (if any). Sixty participants completed the study. Both groups were comparable in terms of demographic parameters, duration of surgery, time to the first dose of rescue analgesia, intraoperative fentanyl consumption, and side effects. The mean (SD) of duration of surgery (minutes) was 202.33 (14.55) and 197.00 (18.60) with P = 0.134, time to rescue analgesia (minutes) was 425.67 (134.33) and 468.50 (142.74) with P = 0.236, and intraoperative fentanyl consumption (mcg) was 4.00 (11.02) and 4.67 (8.60) with P = 0.410 in Group E and R, respectively. Both groups were similar in terms of the time to rescue analgesia, fentanyl consumption intraoperatively, and side effects. Thus, the ESPB is comparable to and not better than RLB for providing postoperative analgesia in patients with carcinoma breast undergoing MRM.

The impact of multidisciplinary collaborative bundled care on analgesia and sedation in ICU patients with endotracheal intubation.

Effective analgesia and sedation management play a crucial role in reducing the intensity of coughing in patients with endotracheal intubation and improving clinical outcomes. However, current approaches are predominantly singular and lack comprehensive management strategies based on multidisciplinary collaboration. This study aims to evaluate the impact of multidisciplinary collaborative bundled care on analgesia and sedation in intensive care unit (ICU) patients with endotracheal intubation, providing evidence to inform clinical practice. Seventy ICU patients were enrolled with endotracheal intubation, admitted between January and August 2024. They were divided into a control group (n = 35) receiving routine care (admitted from January to April) and an intervention group (n = 35) receiving multidisciplinary collaborative bundled care (admitted from May to August). Outcomes measured included physical restraint use, analgesic dosage, cough strength, delirium incidence, and duration of mechanical ventilation. The intervention group had significantly lower doses of remifentanil (8.37 ± 1.50 mg) and midazolam (21.43 ± 3.74 mg) compared to the control group (9.92 ± 1.58 and 31.12 ± 7.89 mg; P < .05). The incidence of delirium was also lower in the intervention group (11.4%) than in the control group (31.4%; P < .05). Delirium onset was delayed in the intervention group (3.02 ± 1.05 days) compared to the control group (2.58 ± 0.79 days), and its duration was shorter (3.43 ± 1.74 vs 5.12 ± 1.89 days; P < .05). Additionally, physical restraints were significantly lower in the intervention group (22.9% vs 45.7%; P < .05). Cough strength was notably higher in the intervention group (4.74 ± 0.82 vs 3.36 ± 0.76; P < .05), and the duration of mechanical ventilation was reduced (4.77 ± 1.42 vs 5.92 ± 1.66 days; P < .05). Multidisciplinary collaborative bundled care improves sedation and analgesia outcomes in ICU patients with endotracheal intubation, reducing medication dosage, incidence of delirium, physical restraint use, and duration of mechanical ventilation while enhancing cough strength.

A multimodal approach to the treatment of painful diabetic neuropathy. Case report

In painful diabetic polyneuropathy (DPN), an integrated approach is effective, including kinesiotherapy, sleep hygiene, an educational program, and pharmacological agents if indicated. A case of a patient with type 1 diabetes mellitus and a painful DPN is presented. The patient received metabolic therapy for a long time, an anticonvulsant at doses that are not the safest in diabetic nephropathy. At the neurological center, the patient's dosage of analgesics was adjusted, and a complex therapy was tailored to improve comorbidities. After 3 months, during therapy, the patient reported decreased neuropathic pain in the legs, decreased hypodynamia level, partial normalization of her emotional state, and normalization of sleep quality. Risk factors for developing neuropathic pain in DPN and effective methods for its treatment as part of a multidisciplinary approach are discussed.

Comparison of caudal bupivacaine and dexmedetomidine with caudal bupivacaine and intravenous dexmedetomidine for postoperative analgesia in children: A randomized controlled trial

Abstract Background and Aims: Caudal block is a part of multimodal analgesic regimen to alleviate pain in pediatric patients undergoing variety of surgeries. This study compares the effectiveness of caudal versus intravenous dexmedetomidine as an additive to caudal bupivacaine for prolonging analgesia in children posted for elective lower abdominal surgeries. The level of sedation and hemodynamic effects through both routes were also compared. Material and Methods: Ninety-six children (aged 1–8 years) of either gender scheduled for elective lower abdominal and pelvic surgeries were prospectively enrolled and randomized into two groups of 48 each: Group A (caudal bupivacaine + caudal dexmedetomidine) and Group B (caudal bupivacaine + intravenous dexmedetomidine). The postoperative pain was monitored using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, and sedation was assessed using the Ramsay sedation scale (RSS). Results: The degree of analgesia was comparable in both groups in the initial hours after surgery. Significantly higher FLACC scores were seen in Group B at 8 h (P- 0.016), 12 h (P &lt; 0.001), and 16 h (P &lt; 0.001), with 89.58% patients needing two rescue analgesic doses. RSS was higher in Gr=oup A till 12 h postsurgery. Conclusion: Caudal dexmedetomidine with bupivacaine provides improved analgesia after 8 h of surgery in comparison to caudal bupivacaine with intravenous dexmedetomidine in children undergoing lower abdominal surgeries.

Analgesic effects of pulsed magnetic therapy in idiopathic hip osteoarthrosis

BACKGROUND: Osteoarthrosis is the most frequently diagnosed disease of the musculoskeletal system. The grown number of patients awaiting surgical treatment and the possible negative consequences resulting from long-term pharmacological therapy lead to searching for non-pharmacological methods aimed at relieving pain and reducing doses of analgesics, including physiotherapy using magnetic fields. AIM: To evaluate the analgesic effects of the pulsed magnetic therapy in patients with idiopathic hip osteoarthrosis. MATERIALS AND METHODS: The randomized study enrolled 28 men aged 48 to 75 years (mean age: 62.8 years) with diagnosed idiopathic hip osteoarthrosis. The subjects were randomized into 2 groups (14 patients each): the first group included the patients who received pulsed magnetic therapy cycles, the second (comparison) group included the magnetic therapy-naïve ones. During the exposure cycle, both groups underwent multiple assessments of their mood, pain intensity, and dose of analgesics. RESULTS: No statistically significant differences were found in the assessment of respondents’ mood. The magnetic therapy group showed, on Day 14 and Day 21 of the procedures cycle, and in Week 1 after the therapy cycle, significantly decreased intensity of the perceived pain (p 0.05). In the group of the patients that received courses of magnetic therapy, the use of painkillers was by 14% (р 0.05) reliably lower than at the baseline; this was not reported in the comparison group. CONCLUSION: Using the pulsed magnetic therapy in the treatment of men with idiopathic hip osteoarthrosis results in a statistically significant improvement of the analgesic effect with a concomitantly decreased need for analgesic, without, however, any significant changes in the patient’s mood.

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.

Effect of remimazolam besylate versus propofol on haemodynamic profiles in patients undergoing thyroid surgery with recurrent laryngeal nerve monitoring: a protocol for a randomised controlled trial

IntroductionThyroid surgery with intraoperative nerve monitoring under total intravenous anaesthesia often requires deeper sedation due to limitations or lack of neuromuscular blocking agents, usually resulting in haemodynamic instability. Remimazolam, a...

Erector spinae plane block (ESPB) enhances hemodynamic stability decreasing analgesic requirements in surgical stabilization of rib fractures (SSRFs)

ObjectiveTo evaluate the efficacy of erector spinae plane block (ESPB) on intraoperative hemodynamic stability, opioid and inhalation anesthetic requirements and postoperative analgesic effects in patients undergoing surgical stabilization of rib fractures (SSRFs).MethodsWe retrospectively reviewed 173 patients who underwent surgical stabilization of rib fractures between May 2020 and December 2023. The patients were allocated into the ESPB group or the control group. Demographic data, intraoperative hemodynamic parameters, total intraoperative opioid consumption, the average minimum alveolar concentration (MAC) of inhalational anesthetics, postoperative simple analgesics and opioid consumption and the length of hospital stay were included in the analysis.ResultsCompared with the control group, the ESPB group had a lower heart rate (HR) in the first 90 min after surgical incision and lower systolic blood pressure (SBP) and mean arterial pressure (MAP) at the beginning of surgery. Intraoperatively, a notable reduction in fentanyl consumption was observed in the ESPB group (p = 0.004), whereas no significant difference was observed in the average MAC of inhalational agents (p = 0.073). Postoperatively, the ESPB group required fewer doses of simple analgesics in the first 24 h (p < 0.001) and 48 h (p = 0.029). No statistically significant difference in the length of hospital stay (p = 0.608) was observed between the groups.ConclusionESPB was shown to enhance intraoperative hemodynamic stability, reduce opioid consumption and decrease postoperative analgesic consumption in patients who underwent SSRF. These results suggest that ESPB may serve as a valuable component of multimodal analgesia protocols for SSRF. Larger prospective studies are warranted to confirm the results and evaluate long-term outcomes.

Efficacy of thumbtack needle acupuncture combined with PCIA on patients after laparoscopic myomectomy: a randomized controlled trial.

Pain and gastrointestinal dysfunction after laparoscopic myomectomy (LM) are significant issues that prevent this procedure from being classified as a "Day Surgery." This study aims to assess the effectiveness and safety of thumbtack needle acupuncture (TNA) combined with patient-controlled intravenous analgesia (PCIA) for promoting enhanced recovery after LM. A total of 52 patients were enrolled in the study, divided into a treatment group receiving TNA and a control group. Both groups were administered PCIA without background sufentanil. For rescue analgesia or antiemetic needs, a bolus infusion of flurbiprofen axetil (50 mg) or intravenous metoclopramide (10 mg) was provided. The primary outcomes measured were the Visual Analog Scale (VAS) scores at awakening, as well as at 36 h, 48 h, and 60 h after LM. Secondary outcomes included VAS scores at 6 h, 12 h, 24 h, and 72 h after LM, total sufentanil consumption, the number of PCIA analgesic requests (attempts), the number of doses of rescue flurbiprofen axel analgesia required, preoperative anxiety scores, gastrointestinal function recovery assessment, first ambulation time, length of hospital stay, and patient satisfaction. Adverse events were also recorded. Compared to the control group, the treatment group showed significantly lower VAS scores, fewer analgesia attempts, reduced total sufentanil consumption, and a smaller number of rescue analgesia doses after LM, along with lower preoperative anxiety scores and higher satisfaction with pain management (p < 0.05). Gastrointestinal function recovery was enhanced in the treatment group, as indicated by earlier flatus and defecation, a lower incidence of postoperative nausea and vomiting (PONV), and a smaller number of metoclopramide doses required (p < 0.05). Additionally, ambulation occurred earlier, and the length of hospital stay was shorter in the treatment group (p < 0.05). No adverse events were observed in patients receiving TNA. TNA is a safe intervention that effectively alleviates postoperative pain, decreases the total consumption of sufentanil, reduces preoperative anxiety, enhances the recovery of gastrointestinal function, and shortens the duration of hospitalization, making it an ideal adjunct treatment for postoperative recovery after LM. Further research is required to understand the mechanisms underlying this intervention. www.chictr.org.cn, ChiCTR2300069015.