Enhance Patient Recovery Research Articles

The role of tranexamic acid and cryotherapy on acute postoperative pain and blood loss: a randomized controlled study following total knee arthroplasty.

Blood loss and pain management are significant concerns in total knee arthroplasty (TKA). Tranexamic acid (TA) and cryotherapy have been used separately to address these issues, but their comparative effectiveness is not well studied. This study aimed to evaluate the efficacy of intravenous TA and cryotherapy in reducing blood loss and improving clinical outcomes after TKA. A randomized controlled trial with 76 patients assigned to three groups: Group 1 received pre- and postoperative cryotherapy, Group 2 received intravenous tranexamic acid (TA), and Group 3 (control) received a standard cold pack. Hemoglobin (Hb), hematocrit (Hct), prothrombin time, international normalized ratio (INR), knee flexion and extension angles, and visual analog scale (VAS) pain scores were monitored preoperatively and postoperatively at 6, 24, and 48h. The mean age of patients was 65 ± 7years. The tranexamic acid group showed significantly lower blood loss compared to the control group (p < 0.001). Knee flexion and extension angles were significantly better in the cryotherapy group compared to the control group (p < 0.001). VAS pain scores were significantly lower in the cryotherapy group at all time points compared to both the tranexamic acid and control groups (p < 0.001). Both tranexamic acid and cryotherapy are effective in reducing blood loss and improving clinical outcomes following TKA. Tranexamic acid significantly reduces blood loss, while cryotherapy effectively manages postoperative pain and range of motion. These methods can enhance patient recovery after TKA.

Research on Interactive Control Algorithms for Lower Limb Exoskeleton Rehabilitation Robots

Lower limb exoskeleton rehabilitation robots represent an important development direction in modern rehabilitation technology. By integrating various sensors and control algorithms, these robots effectively enhance the specificity and efficiency of rehabilitation training. This paper systematically analyzes several widely used control methods, including position-based, force feedback, bioelectrical signal, and intelligent control strategies. Each strategy has its unique features and addresses different issues in the interaction between the robot and the patient, thereby improving the effectiveness and efficiency of rehabilitation training. For instance, position control provides stability and repeatability, force control ensures compliance, bioelectrical signal control offers rapid responsiveness, and intelligent control exhibits adaptability. Future research will focus on combining the advantages of different strategies to develop composite control methods that enable more efficient and personalized rehabilitation training, enhancing patient recovery outcomes and experiences

Endoscopic surgery affects the gut microbiota and its metabolism in breast cancer patients.

Despite the advantages of endoscopic surgery in reducing trauma and enhancing recovery for breast cancer patients, its impact on gut microbiota, which is crucial for health and estrogen metabolism, remains unclear. Further investigation is necessary to fully understand this impact and its implications. Between June and December 2022, fecal samples were collected from 20 patients who underwent endoscopic surgery. The gut microbiota composition was determined using 16S rRNA sequencing, while the metabolites were analyzed through liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bioinformatics and statistical analyses were employed to identify significant alterations in microbial taxa abundance and to assess intergroup differences. These analyses included t-tests for pairwise comparisons, one-way ANOVA for multiple group comparisons, and chi-square tests for categorical data analysis. Endoscopic surgery in breast cancer patients subtly changed gut microbiota diversity and composition. Post-surgery, there was a reduction in Lachnospiraceae, Monoglobaceae and Firmicutes to Bacteroides ratios. Shifts in metabolites were also observed, the changed metabolites impacted pathways such as primary bile biosynthesis and Ascorbate and aldarate metabolism, with PE(PGD1/18:1(9Z)) identified as a key differential metabolite that increased post-surgery. Azasetron, tyramine glucuronide, DL-DOPA, phthalide, acetophenazine, aciclovir, creatinine bicarbonate, and 4-oxo-L-proline being associated with distinct bacterial taxa. Breast cancer patients undergoing endoscopic surgery experience a shift in their gut microbiota and metabolic profiles. Therefore, postoperative management, with a particular focus on the adjustment of the gut microbiota, is crucial for enhancing patient recovery and health outcomes.

Phase-specific changes in hip joint loading during gait following sacroiliac joint fusion: Findings from a finite element analysis.

Low back pain affects over 80% of adults, with sacroiliac joint dysfunction accounting for 15-30% of these cases. Sacroiliac fusion is a surgical procedure for refractory joint pain. While the biomechanics of the joint and its fusion relative to the spinal column are well-known, the hip-spine relationship post-fusion remains unclear. Understanding the biomechanical state following fusion can enhance patient recovery and optimize surgical outcomes. This study uses finite element analysis to assess hip joint biomechanics following sacroiliac joint fusion. CTs of a 55-year-old male were used to create a biomechanical model, validated against a cadaveric study. Three triangular titanium alloy implants were placed across the sacroiliac joint in a unilateral and bilateral configuration. The model, loaded with pelvis and hip joint kinematics during a gait cycle, calculated joint reaction forces, contact stress and area on the hip joint across various gait phases. Hip joint contact stresses varied with fixation configurations and gait phases. Unilateral right fusion reduced joint reaction forces by 2% but increased contact stress by 3.7%. Bilateral fusion increased joint reaction forces by 6.7% and contact stress by 3.25%, with higher stress during foot flat and heel off phases compared to unilateral fixation. Fusion alters hip loading patterns during specific gait phases, with bilateral fusion producing the highest stresses during foot flat and heel off. These findings may suggest the need for fusion-specific rehabilitation protocols and warrants further investigation of long-term joint health outcomes.

Prevalence, outcome and complications of Intertrochanteric Femur Fracture In Patients Admitted to AL Sammad General Hospital-from MAY 2020 to MAY 2022 Amran-Yemen

Background: Intertrochanteric fractures are common injuries, especially in elderly, and require effective management to minimize complications. This study aimed to evaluate the demographic characteristics, treatment modalities, and early postoperative complications of patients with intertrochanteric fractures admitted to the Al Sammad General Hospital, Amran, Yemen, from May 2020 to May 2022. Methods: A retrospective analysis was conducted on 90 patients diagnosed with intertrochanteric fractures during the study period. Data on age, sex, mechanism of injury, fracture type, treatment methods, and postoperative complications were collected and analyzed. Results: Among the 90 patients, 51% were male and 49% female, with the highest incidence in those aged &gt; 60 years (46.7%). The primary mechanism of injury was falling from a standing height (73.4%). Fracture classifications included 46.7% stable , 44.4% unstable , and 8.8% reverse oblique. Surgical treatment was performed in 96.7% of the cases, predominantly using dynamic hip screws (53.3%). Early postoperative complications were noted in 9.9% of the patients, with deep vein thrombosis (DVT) being the most common (3.3%). Conclusion: Intertrochanteric fractures are more common in males aged &gt; 60 years, with falls from standing height being the leading cause. Surgical treatment is preferred, and the complication rate is relatively low. Continued efforts to improve surgical outcomes and manage complications are vital to enhance patient recovery.

Ultrasound-Guided Percutaneous Puncture Combined With Continuous Pressure Dressing for Treating Subcutaneous Fluid Accumulation in the Bone Window Area After Decompressive Craniectomy.

Subcutaneous fluid accumulation in the bone window area is a common complication after decompressive craniectomy. If not promptly addressed, it may progress to serious complications such as intracranial infection and hydrocephalus, significantly affecting treatment outcomes and prognosis. However, there is currently no standardized approach for managing subcutaneous fluid accumulation. Ultrasound-guided percutaneous puncture in the bone window area can directly decrease the accumulated fluid; moreover, when combined with continuous pressure dressing, this approach can effectively eliminate subcutaneous fluid in a short period, prevent severe complications, and enhance patient recovery outcomes.

Nutritional support in critical care patients: Challenges, strategies, and recent advances

Nutritional support is a critical component of managing patients in intensive care units (ICUs). Critical illness triggers a hypermetabolic state, leading to significant nutritional demands and muscle wasting. Proper nutritional interventions can positively impact clinical outcomes, reduce the duration of mechanical ventilation, and improve overall recovery. However, delivering adequate nutrition to critically ill patients present several challenges, including the patient's unstable condition, varying metabolic needs, gastrointestinal dysfunction, and difficulties in achieving nutritional goals. Recent advances in understanding the nutritional requirements of ICU patients, the role of early enteral nutrition, and the development of specialized formulas have led to improved patient care. Strategies such as personalized nutrition, immunonutrition, and monitoring tools like indirect calorimetry have become essential components of ICU nutrition management. Additionally, managing critically ill patients with comorbidities, such as sepsis or multi-organ failure, requires tailored approaches to prevent malnutrition and overfeeding.This review highlights the key challenges associated with nutritional support in critical care, current strategies employed to optimize nutrition, and the recent advances in the field. Evidence-based practices with individualized care, nutritional support can enhance patient recovery, reduce ICU stay, and lower morbidity and mortality rates.

Effectiveness of contemporary surgical approaches and prosthetic rehabilitation in the management of ameloblastoma: a narrative review of functional and aesthetic outcomes

Ameloblastoma, a benign yet aggressive odontogenic tumour poses significant challenges in management due to its potential for recurrence and impact on oral functionality and aesthetics. Effective treatment necessitates a combination of surgical resection, bone reconstruction, and prosthetic rehabilitation. This review aims to evaluate contemporary surgical approaches and prosthetic rehabilitation strategies for managing ameloblastoma, focusing on functional and aesthetic outcomes to enhance patient recovery and quality of life. A narrative review was conducted using scholarly databases, incorporating articles published in English from 2013 to 2023. Studies were selected based on their focus on surgical approaches and prosthetic rehabilitation outcomes. A systematic framework categorized surgical techniques (radical, conservative) and prosthetic methods (fixed, removable, or implant-supported). Radical segmental resection with sufficient safety margins emerged as the preferred surgical approach to minimize recurrence. Immediate reconstruction using autogenous bone grafts, particularly vascularized fibula free-flaps, demonstrated high success rates and improved quality of life. Implant-supported prosthetics showed enhanced functional and aesthetic recovery, with immediate implants yielding better survival rates. Technological advancements such as CAD/CAM and 3D printing improved surgical precision and patient outcomes. Contemporary surgical and prosthetic advancements significantly enhance the management of ameloblastoma. Integrating innovative techniques with long-term follow-up ensures optimal functional and aesthetic results, contributing to improved patient satisfaction and recovery.

Efficacy of Oral Rehabilitation Techniques in Patients With Oral Cancer: A Systematic Review and Meta-Analysis.

Oral cancer commonly affects various parts of the oral cavity, including the lips, tongue, gums, palate, and inner cheeks. Oral rehabilitation involves multiple approaches aimed at restoring and improving oral function, esthetics, and overall well-being. This study assessed the functional outcomes and quality of life in patients who underwent rehabilitation following an oral cancer diagnosis. A comprehensive literature search was performed across PubMed, Cochrane Library, Dimensions, ScienceDirect, CINAHL, and Google Scholar databases. The study included patients diagnosed with oral cancer who had undergone oral rehabilitation. Functional outcomes and quality of life were key selection criteria. The methodological quality of the included studies was assessed, and data were systematically extracted and analyzed. A significant relationship was observed between the type of maxillectomy and quality of life, with obturator retention and stability being critical factors. Radiotherapy was found to adversely impact oral function and implant survival rates, with a strong correlation between radiation treatment and reduced implant survival (p < 0.00001). Additionally, dentition and the timing of implant placement were associated with recurrence rates and adverse effects. The findings highlight the crucial role of oral rehabilitation in improving both functional outcomes and quality of life in oral cancer patients. This study underscores the importance of incorporating oral rehabilitation into oral cancer treatment to enhance patient recovery and overall health.

Pursuing Better Outcomes in Obstructive Colorectal Cancer Surgery: A New Predictive Scoring System for Immediate Complications and Optimization of Hospital Stay.

Colorectal cancer (CRC) is one of themost common cancers occurring globally. Surgery for CRC often extends hospital stays due to complications, as patients must meet nutritional needs and regain mobility before discharge. Longer hospital stays, required for extended monitoring and care, can increase the risk of further complications, creating a cycle where extended stays lead to more issues. Predicting a patient's length of stay (LOS) is crucial for optimal resource management, financial control, and patient care. This study aimed to create a scoring system to predict postoperative complications and prolonged hospitalization in colorectal cancer surgery patients. Over 60 variables, including age, BMI, and tumor location, were analyzed for their correlation with complications. A complication score was developed based on six factors linked to postoperative complications: hemoglobin (Hb), serum albumin, tumor localization, EC (epidural catheter), opioid use, and NPO (nil per os) days. Patients with three or more identified risk factors had a 6.17-fold higher complication rate, with a highly significant p-value of 0.0008, demonstrating the score's strong potential for identifying high-risk patients. The factors significantly associated with length of stay (LOS) include admission hemoglobin levels, tumor localization (right versus left colon), intraoperative fluid intake, the presence or absence of regional anesthesia and analgesia (RAA), the number of drainage tubes, and postoperative hematocrit levels. The analysis shows that patients with at least three of the six identified risk factors are 5.17 times more likely to experience prolonged hospitalization (over eight days) compared to those with fewer than three points, with a statistically significant correlation (p-value of 0.003). Our findings indicate that patients with three or more risk factors are significantly more likely to experience complications and extended hospital stays. This scoring system can serve as an essential tool for healthcare providers to identify at-risk patients, optimize resource allocation, and ultimately enhance patient recovery and outcomes. Moreover, the integration of the complication and LOS scores into routine preoperative assessments can facilitate a more personalized care plan, enabling healthcare providers to identify patients who may benefit from closer monitoring and additional support during their recovery.Further validation in diverse populations and settings is needed to confirm the scoring system's generalizability and utility.

Could digital twins be the next revolution in healthcare?

A Digital Twin (DT) can be understood as a representation of a real asset, a virtual replica of a physical object, process, or even a system. They have been used in managing healthcare facilities, streamlining care processes, personalizing treatments, and enhancing patient recovery. The potential impact of this tool on our society and its well-being is quite significant. A quick review of the literature was carried out using the terms ('Digital Twins') and ('Digital Health'), and (Health Care) with a time interval of up to 5 years (2018-23). Using the PRISMA Method, the search was conducted in six academic databases: IEEE Xplore, Dimensions, Scopus, Web of Science, PubMed, and ACM. After applying the search strings and the exclusion criteria, a total of 13 publications were identified and listed to constitute and support the discussion of this article. The selected studies were categorized into 2 groups according to their application in healthcare: A group of clinical applications, subdivided into topics on personalized care and reproduction of biological structures and another group of operational applications, subdivided into topics such as optimization of operational processes, reproduction of physical structures, and development of devices and drugs. The use of DT in healthcare presents important challenges related to data integration, privacy, and interoperability. However, trends indicate exciting potential in personalizing treatment, prevention, remote monitoring, informed decision-making, and process management, which can result in significant improvements in quality and efficiency in healthcare.

Exploring the Potential of Stem Cells to Enhance Conventional Cancer Therapies

Abstract. Stem cell-based therapies are emerging as promising adjuncts to conventional cancer treatments, offering innovative strategies to target cancer cells and enhance patient recovery. This paper explores the potential of stem cells, particularly mesenchymal stem cells (MSCs) and human umbilical cord mesenchymal stem cells (HUCMCs), to improve cancer treatment outcomes through their regenerative and differentiation capabilities. MSCs exhibit significant promise due to their ability to inhibit tumor growth, support tissue regeneration, and modulate immune responses. Their unique features, including targeted homing to tumor sites and the secretion of bioactive molecules, present novel approaches to overcoming the limitations of traditional therapies. Despite these advancements, challenges such as immune rejection and tumorigenicity must be addressed. Current strategies to mitigate these issues involve immunosuppressive drugs, genetic engineering, and advanced technologies like CRISPR-Cas9. However, the reviewed studies often involve small sample sizes or remain in the laboratory phase, limiting the generalizability of findings. Future research should focus on larger-scale clinical trials to validate the effectiveness and safety of stem cell therapies, aiming to refine these treatments and integrate them into clinical practice.

The Effect of Preoperative Information and Education on the Clinical Outcome of Total Hip Arthroplasty: A Prospective, Randomized Trial.

Introduction Preoperative patient information and education is an essential aspect of modern surgical care, particularly for patients undergoing total hip arthroplasty (THA). This prospective, randomized trial aimed to assess the effects of structured preoperative education and information on clinical outcomes in patients undergoing THA. Materials and methods A total of 102 patients were randomized into two groups: the intervention group (n = 51) receiving standardized preoperative information and education, and the control group (n = 51) receiving standard preoperative care without a formal educational component. Postoperative outcomes, including functionality, mobility, length of hospital stay (LOS), patient satisfaction, health-related quality of life, anxiety, depression and fear for surgery, were compared between the two groups. Results Both groups were comparable in baseline characteristics, including age, sex, body mass index (BMI), smoking status and alcohol consumption. The mean age was 66.3 years, mean BMI was 29.05 and 70.6% of participants were female. Patients in the intervention group had a shorter mean hospital stay (mean 4.9 days vs. 6.2 days, p=0.031). Mean preoperative modified Harris Hip Score (mHHS) was similar between the two groups (p = 0.866). However, one month postoperatively, mHHS was significantly higher in the intervention group compared to controls (74.06 versus 67.81, p = 0.046). The absolute change in European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L) Index and EQ-5D-5L Visual Analogue Scale (VAS) score before and after THA was statistically significant (p = 0.021 and p = 0.042). Preoperative and postoperative depression was significantly lower in the intervention group, one day preoperatively, one day before discharge and one month postoperatively, as shown by the Hospital Anxiety and Depression Scale (HADS) (p = 0.026, p = 0.027 and p = 0.018 respectively). Conclusions This prospective, randomized trial demonstrated that preoperative education and information significantly improve clinical outcomes, duration of hospitalization, health-related quality of life and postoperative anxiety in patients undergoing THA. These findings underline the importance of incorporating structured educational programs into preoperative care protocols prior to THA for enhancing patient recovery and optimizing postoperative results.

Abstract 276: Evaluating the Frequency of Prestroke Cognitive Impairment Among Stroke Patients: Neurological and Functional Correlates

Introduction Prestroke cognitive impairment is a critical factor that can significantly impact stroke recovery, yet it is often underrecognized. This study aims to quantify the frequency of prestroke cognitive impairment among stroke patients and to explore its neurological and functional correlates. Methods We conducted a comprehensive assessment of 520 stroke patients, employing the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) to diagnose cognitive impairment prior to stroke. Neurological evaluations included the assessment of neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire (NPI‐Q), while functional abilities were measured through Activities of Daily Living (ADL) scales. Additionally, neuroimaging analyses were performed to identify structural brain abnormalities. Results Our study found that 32.5% of stroke patients exhibited cognitive impairment prior to their stroke. This impairment was strongly associated with more severe neuropsychiatric symptoms, as evidenced by higher NPI‐Q scores (5.5 ± 4.9 vs. 1.7 ± 2.3, p &lt; 0.001), and greater functional limitations, reflected in ADL scores (1.8 ± 1.9 vs. 0.3 ± 0.8, p &lt; 0.001). Regression analyses further identified older age, the presence of white matter lesions, and medial temporal lobe abnormalities as significant neurological correlates of cognitive impairment. Conclusion The study highlights a substantial prevalence of prestroke cognitive impairment in stroke patients and its strong association with both neuropsychiatric symptoms and functional limitations. These findings underscore the importance of early and proactive cognitive assessments in stroke populations. By identifying cognitive impairment before a stroke, healthcare providers can tailor rehabilitation strategies more effectively, potentially leading to improved outcomes for stroke survivors. Integrating routine cognitive evaluations into stroke care protocols may enhance patient recovery and overall quality of life.

Transient Implantable Electronics for Postsurgery Preventive Medicine

AbstractThe field of postoperative care has seen a remarkable shift toward the utilization of electronic implantable devices, including sensors, biosensors, stimulators, and drug delivery systems, all designed with a biodegradable form factor and wireless data/power transmission capability. These technologies hold immense potential for postsurgery out‐of‐hospital monitoring during the postdischarged period, where continuous monitoring of physiological signals is lacking. Furthermore, these devices eliminate the need for secondary surgeries required for device retrieval as they can safely degraded in the body, thus enhancing patient recovery. This review delves into the latest advancements in biodegradable implantable devices, examining their application in monitoring vital signs, the innovative wireless communication and powering technologies they employ, and the biodegradable materials that enable their function. The analysis extends to evaluating the efficacy and limitations of these devices across various medical applications. Moreover, it explores future research directions, emphasizing material advancements, device miniaturization, customization, and the integration of artificial intelligence to create closed‐loop therapeutic systems. This comprehensive review underscores the transformative potential of these technologies in enhancing postoperative care and outlines the pathway for future innovations in this dynamic field.

Identifying Clusters of Curatively-Treated Esophageal Cancer Patients Using Patient-Reported Outcome Measures at Three Months from Discharge: A Secondary Analysis from a Longitudinal Single Center Study.

This study aims to identify meaningful clusters based on Patient-Reported Outcome Measures (PROMs) in curatively-treated esophageal cancer patients at three months post-discharge. This secondary analysis of a longitudinal single-center study included 46 esophageal cancer patients who underwent curative surgery. Patients were selected based on their completion of PROMs surveys at three months post-discharge, were aged 18 years or older, and had undergone surgical resection (esophagectomy) with or without neoadjuvant chemotherapy and/or radiotherapy. The analysis utilized t-distributed Stochastic Neighbor Embedding (t-SNE) for dimensionality reduction and hierarchical clustering to analyze PROMs data collected three months post-discharge. Clustering was performed on physical, emotional, cognitive, and social functioning variables, symptom burden, and health literacy. Three distinct clusters were identified: Cluster 1 (n = 24) with higher functioning and moderate symptoms, Cluster 2 (n = 14) with moderate functioning, higher symptoms, and lower health literacy, and Cluster 3 (n = 8) with the highest functioning, lowest symptoms, and highest health literacy. Significant differences between squamous cell carcinoma and adenocarcinoma subtypes were observed across several PROMs domains, including critical health literacy, general health status/quality of life, nausea and vomiting, and insomnia. These clusters provide an exploratory framework for tailoring post-operative interventions to enhance patient recovery, which necessitates further confirmatory investigations, including outcomes such as complications and mortality, in the analysis. This study fills a research gap by demonstrating the utility of PROMs in identifying distinct recovery patterns in esophageal cancer patients post-surgery. The findings support the use of PROMs to guide personalized post-operative care, potentially improving patient outcomes and quality of life. Further research is needed to validate these findings in larger, diverse populations.

New Insights into the Assessment of Peri-Operative Risk in Women Undergoing Surgery for Gynecological Neoplasms: A Call for a New Tool

Existing tools for predicting postoperative complications in women undergoing surgery for gynecological neoplasms are evaluated in this narrative review. Although surgery is a very efficient therapy for gynecological tumors, it is not devoid of the possibility of negative postoperative outcomes. Widely used tools at present, such as the Surgical Apgar Score and the Modified Frailty Index, fail to consider the complex characteristics of gynecological malignancies and their related risk factors. A thorough search of the PubMed database was conducted for our review, specifically targeting studies that investigate several aspects impacting postoperative outcomes, including nutritional status, obesity, albumin levels, sodium levels, fluid management, and psychological well-being. Research has shown that both malnutrition and obesity have a substantial impact on postoperative mortality and morbidity. Diminished sodium and albumin levels together with compromised psychological well-being can serve as reliable indicators of negative consequences. The role of appropriate fluid management in enhancing patient recovery was also investigated. The evidence indicates that although current mechanisms are useful, they have limitations in terms of their range and do not thoroughly address these recently identified risk factors. Therefore, there is a need for a new, more comprehensive tool that combines these developing elements to more accurately forecast postoperative problems and enhance patient results in gynecological oncology. This paper highlights the need to create such a tool to improve clinical practice and the treatment of patients.

Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block vs. rectus sheath block for midline abdominal surgery in a low- and middle-income country: a randomised controlled trial.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and middle-income country. We allocated randomly 72 patients aged 18-65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13-17) h vs. 12 (11-13) h, respectively; p < 0.001). There were no block-related complications in either group. Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid-sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low-and middle-income countries.

Body image and quality of life undergoing totally robotic versus robotic-assisted distal gastrectomy: a retrospective propensity score matched cohort study

BackgroundWith the improvement of anastomotic techniques and the iteration of anastomotic instruments, robotic intracorporeal suturing has become increasingly proficient. The era of fully intracorporeal anastomosis in robotic gastric cancer resection is emerging. This study aims to explore the impact of totally robotic distal gastrectomy (TRDG) and robotic-assisted distal gastrectomy (RADG) on patients’ quality of life.Patients and methodsThis study is a comparative retrospective study of propensity score matching. This study included 306 patients who underwent robotic distal gastrectomy for gastric cancer between June 2016 and December 2023 at our center. Covariates used in the propensity score included sex, age, BMI, ASA score, maximum tumour diameter, degree of histological differentiation, Pathological TNM stage, Pathological T stage, Pathological N stage, and Lauren classification. Outcome measures included operative time, intraoperative bleeding, time to first venting, time to first fluid intake, postoperative hospital stay, total hospitalization cost, total length of abdominal incision, postoperative complications, inflammatory response, body image, and quality of life.ResultsAccording to the results of the study, compared with the RADG group, the TRDG group had a faster recovery time for gastrointestinal function (P = 0.025), shorter length of abdominal incision (P < 0.001), fewer days in the hospital (P = 0.006) less pain (P < 0.001), less need for additional analgesia (P = 0.013), and a postoperative white blood cell count (P < 0.001) and C-reactive protein content indexes were lower (P<0.001). In addition, the TRDG group had significantly better body imagery and cosmetic scores (P = 0.015), physical function (P = 0.039), role function (P = 0.046), and global function (P = 0.021) than the RARS group. Meanwhile, the TRDG group had milder symptoms of fatigue (P = 0.037) and pain (P < 0.001). The PASQ Total Subscale Score (P < 0.001) and Global Subscale Score (P < 0.001) were significantly lower in the TRDG group than in the RADG group at postoperative 3 months.ConclusionTotally robotic distal gastrectomy has a smaller incision, faster gastrointestinal recovery time, fewer days of postoperative hospitalization, and lower inflammatory markers than robotic-assisted distal gastrectomy. At the same time, postoperative cosmetic and quality of life outcomes were satisfactory. Clinically, these benefits translate to enhanced patient recovery, reduced surgical trauma, and better postoperative outcomes. These findings could guide surgeons in selecting more effective surgical approaches for patients undergoing gastrectomy, leading to better overall patient satisfaction and outcomes.

Efficacy and safety of multidrug cocktail injections in postoperative pain management for lumbar microendoscopic decompression surgery: a prospective randomized controlled trial.

This study aimed to evaluate the analgesic effects and safety of multidrug cocktail injections for postoperative pain management in patients undergoing lumbar microendoscopic decompression surgery. A prospective randomized controlled trial was conducted with 70 patients who underwent lumbar microendoscopic decompression surgery between December 2023 and May 2024. Patients were randomly assigned to receive either a multidrug cocktail injection (cocktail group, n = 35) or no cocktail injection (non-cocktail group, n = 35). Primary outcomes included scores of the numerical rating scale (NRS) for pain from postoperative days 1 to 7 and the number of analgesics used within the first 3 postoperative days. Secondary outcomes included sex, age, body mass index, preoperative diagnosis, surgical levels, duration of surgery, blood loss, C-reactive protein (CRP) levels on postoperative day 1, and drain output. The cocktail group experienced significantly lower pain levels from postoperative days 1 to 7 (p < 0.05) and used fewer analgesics within the first 3days (p = 0.01) compared with the non-cocktail group. Additionally, the cocktail group had significantly lower CRP levels (p < 0.001) and a shorter hospital stay (p = 0.01). No significant differences were observed in the duration of surgery, blood loss, or drain output between the groups. Multidrug cocktail injections are effective and safe for postoperative pain management in lumbar microendoscopic decompression surgery, significantly reducing pain, analgesic use, CRP levels, and hospital stay. These findings suggest that incorporating multidrug cocktail injections into postoperative care protocols can enhance patient recovery and outcomes.