GA Group Research Articles

PECS II block is associated with lower incidence of chronic pain after breast surgery.

BackgroundBreast cancer is complicated by a high incidence of chronic postoperative pain (25%–60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery.MethodsWe conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo).ResultsThe PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017).ConclusionsThe PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.

Associations among the opioid receptor gene (OPRM1) A118G polymorphism, psychiatric symptoms, and quantitative EEG in Korean males with gambling disorder: A pilot study.

Background and aimsA single nucleotide polymorphism of A118G (SNP; rs1799971) in the opioid receptor μ-1 (OPRM1) gene is a missense variant that influences the affinity of μ-opioid receptors. This study aimed to investigate the associations among the A118G polymorphism in the OPRM1 gene, psychiatric symptoms, and quantitative electroencephalography (qEEG) findings in patients with gambling disorder.MethodsFifty-five male patients with gambling disorder aged between 18 and 65 years old participated in the study. The A118G polymorphism was genotyped into the AA, GA, and GG groups by the polymerase chain reaction/restriction fragment length polymorphism method. Resting-state qEEG was recorded with the eyes closed, and the absolute power of the delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–30 Hz) frequency bands was analyzed. Psychiatric symptoms, including depression, anxiety, impulsivity and severity of gambling, were assessed by a self-rating scale.ResultsThere were no significant differences in psychiatric symptoms among the three genotype groups (AA, GA, and GG). However, the frequency band power of qEEG showed significant differences among the three genotype groups. The absolute power of the beta and theta bands in the frontal lobe was higher in G allele carriers.Discussion and conclusionBased on the findings of this study, the polymorphism in the OPRM1 gene might affect the neurophysiological process in patients with gambling disorder.

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial

IntroductionBilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methodsPatients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. ResultsThe intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01), 30 (p < 0.01) minutes, and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). ConclusionWe concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado

IntroductionBilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methodsPatients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 and 30 minutes and 1, 2, 6, 12, 24 and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. ResultsThe intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01) and 30 (p < 0.01) minutes and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). ConclusionWe concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

ObjectiveTo evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.SettingNationwide National Health Insurance Sharing Service database of Korea.ParticipantsAll patients aged ≥65 years old...

Caesarean section for placenta praevia: A retrospective study of anaesthetic technique and foeto-maternal

Introduction: Placenta praevia complicates approximately 0.3-0.8% of pregnancies in multiparous parturient and there is an increased risk in those with previous Caesarean section. The choice of anaesthetic technique usually poses dilemma to the attending anaesthetist. The aim of this study was to review the choice of anaesthetic technique for caesarean section complicated by placenta praevia and determine foeto-maternal outcome.Patients and Methods: This was a retrospective survey covering a period of four years (January 2013 - December 2016). After Ethics Committee approval, information was obtained from the anaesthetic and theatre records and the patients’ case notes. The information obtained were: patients’ characteristics, obstetric history, grade of placenta praevia, indications for surgery, choice of anaesthetic technique, PCV/haemoglobin level, haemodynamic changes, blood transfusion, maternal and foetal outcome. The data were analysed using IBM SPSS version 20.Results: A total of 4,388 Caesarean sections were carried out during the 4- year period of review. One hundred and forty-five cases (3.3%) with different degrees of placenta praevia progressing to Caesarean section were identified. The mean age (years) was 32.6+5.3 with a mean gestational age(weeks) of 36.7±1.11. Thirty-nine (26.9%) patients were offered general anaesthesia while 106 (73.1%) were done under spinal anaesthesia. The mean blood loss in the GA and spinal group was 1,080 + 970.53 and 753.77 + 568.19 ml respectively (P = 0.0135). 87.6% neonates were delivered alive. Seventy-nine (54.5%) were elective procedure with adequate preparation. There were two (1.4%) cases of maternal mortality and perinatal mortality of 12.4%.Conclusion: The anaesthetic technique for patients with placenta praevia should be determined by the patient’s haemodynamic status and the grade of the placenta praevia.

Intravoxel incoherent motion imaging of the kidney: The application in patients with hyperuricemia.

Hyperuricemia is an independent risk factor for onset and progression of kidney disease. However, there remains a lack of a reliable and noninvasive biomarker to identify and monitor the changes of renal function in patients with hyperuricemia. To assess the utility of intravoxel incoherent motion (IVIM) parameters in identifying the early changes of renal function in patients with hyperuricemia. Retrospective case-control study. Eighty-four male participants, including asymptomatic hyperuricemia (AH, 27 cases), gouty arthritis (GA, 31 cases), and 26 age-matched healthy controls. 3.0T; intravoxel incoherent motion (IVIM). Differences in the IVIM parameters among the three groups were assessed. Pure molecular diffusion (D value); perfusion-related diffusion (D* value); pseudodiffusion fraction (f value); apparent diffusion coefficient (ADC value); estimated glomerular filtration rate (eGFR). Also, they were correlated with eGFR. Bonferroni test, Tamhane's T2 method, and Pearson correlation analysis. The D values in renal cortex and medulla significantly decreased from the control, AH to GA groups (P < 0.05). The GA patients had a significantly lower cortical f value than the controls and AH patients (P < 0.05). The medullary f values in the AH and GA patients were significantly lower than that in the controls (P < 0.05). Also, the cortical and medullary ADC values had similar results across the three groups (P < 0.05), except for the comparison between the AH and GA groups (P = 0.668, P = 0.111, respectively). No significant correlation was found between any IVIM parameters with eGFR. IVIM imaging may be helpful for detecting the early changes of renal function induced by hyperuricemia. The D value could be the most sensitive IVIM-derived parameter in the assessment of renal function in patients with hyperuricemia in this study. 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:833-840.

Effect evaluation of blood component transfusion combined with recombinant activated factor VIIa in treatment of severe active hemorrhage after cardiac surgery

Objective To evaluate the efficacy and complications of component blood transfusion combined with recombinant activated factor Ⅶa(rFⅦa)in treatment of severe active hemorrhage after cardiac surgery. Methods Fifty patients who suffered from severe active hemorrhage after cardiac surgery were selected from the First Affiliated Hospital of Dalian Medical University from July 2015 to May 2017.All patients were divided into GR group(component blood transfusion combined with rFⅦa)and GA group(component blood transfusion combined with tranexamic acid)by random number table method, 25 cases in each group.The changes of disseminated intravascular coagulation (DIC) were screened on admission(D1), after cessation of cardiopulmonary bypass(D2), and 2 h (D3), 6 h (D4) and 12 h (D5) after medication.The difference of activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, hemoglobin and platelet of the two groups at each time point of D1, D2, D3, D4 and D5 were analyzed.Meanwhile, the postoperative drainage, postoperative blood transfusion, postoperative plasma transfusion volume, postoperative mechanical ventilation time, ICU retention time, the 30 d mortality and complications were compared between the two groups. Results There were significant differences in APTT, INR, fibrinogen, hemoglobin and platelet between the two groups (all P 0.05), but at D3 time point, APTT in GR group was significantly shorter than that in GA group((50.3±6.6)s vs.(60.1±6.5)s, P=0.027), and INR in GR group at D4 time point was also significantly lower ((1.3±0.3)vs.(1.5±0.3), P=0.041). In addition, the amount of red blood cells transfusion after treatment in GR group and GA group ((3.2±1.0)U vs.(4.1±1.0)U, P=0.005), the amount of fresh plasma transfusion ((303.2±98.5) ml vs.(469.6±190.5) ml, P=0.000), the amount of 24 h drainage after operation ((519.9±107.5) ml vs.(657.2±100.1) ml, P=0.000)were significantly decreased, the differences were statistically significant. Conclusion Blood component transfusion combined with rFⅦa can significantly improve APTT and INR of severe active hemorrhage after cardiac surgery, at the same time, it can reduce the amount of red blood cells transfusion and plasma transfusion. Key words: Cardiac Surgical Procedures; Postoperative Hemorrhage; Recombinant activated factor Ⅶa; Blood transfusion; Cardiac disease

The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

BackgroundEpidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression.MethodsForty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD)3+, CD4+, CD8+, CD4+/CD8+, interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7.ResultsVAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD3+, CD4+, and CD4+/CD8+ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD3+ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group.ConclusionsA combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection.Trial registrationThe study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939).

Hepatoprotective Effect of Gum Arabic in Non-Alcoholic Fatty Liver and Potential Modulation of Intestinal Microbiota (FS07-07-19)

ObjectivesTo study the hepatoprotective effect of gum Arabic in non-alcoholic fatty liver disease, and to test its ability to reverse the disturbance in intestinal microbiota associated with the disease. MethodsEighteen white male albino rats (150 g-170 g) were randomized into 3 groups (6 rats each). Animals of the normal control group were fed on a balanced diet. Non-alcoholic fatty liver was induced in the second group (HF group) by feeding the animals a high fructose-high fat diet (60% fructose,15% fat). Animals of the third group (GA group) were fed on a high fructose-high fat diet containing 10% gum Arabic. After 5 weeks, the animals were sacrificed, their livers were harvested, and feces samples were collected and stored at −80o C until analysis.Liver total fat was estimated using Folch’s extraction procedure. Liver sections were prepared and stained for histological examination. Genomic DNA was extracted from feces samples. Two intestinal phyla (Bacteroidetes and Firmicutes) were quantified by real-time PCR using specific primers. ResultsEstimation of the liver total fat showed a significant increase in the HF group compared to normal control. The GA group showed a significantly lower level of total fat compared to the HF group, which was comparable to the normal control group (P ≥ 0.05).Histological analysis of liver sections revealed severe fatty degeneration in most of the hepatocytes in the HF group. Hepatocytes of the GA group showed a marked improvement which was not far from the normal control.Real-time PCR showed slightly more copies of Bacteroidetes, and a slightly higher ratio of Bacteroidetes to Firmicutes in the GA group compared to the HF group. However, real-time PCR results were not statistically significant at P ≥ 0.05. ConclusionsGum Arabic is a promising functional food with a potential hepatoprotective effect in non-alcoholic fatty liver disease. Gum Arabic did not have a marked modulating effect on intestinal microbiota and more studies are needed in that area. Funding SourcesThis study was funded by the National Research Center in Egypt. Supporting Tables, Images and/or Graphs▪▪

141 Total bilirubin rate of rise of in moderate preterm neonates: impact of gestational age

Abstract Background As compared to term neonates, those &amp;lt; 35 weeks gestation (wks GA) are at greater risk for both acute and chronic bilirubin encephalopathy (ABE, CBE). Among these with postnatal total bilirubin rate of rise, (TB ROR) at age 0 to 72 hours has been observed because of either loss placental elimination system or increased postnatal production due to hemolysis. The ranges are known to vary &amp;gt; 8.5 umol/L/h in neonates with Rh disease to &amp;gt;3.4 umol/L/h at the 95th percentile track of the hour-specific nomogram. TB ROR in healthy term neonates is &amp;lt;3.4 umol/L/h. Objectives To determine the GA ranges on TB ROR to explore predictive TB ROR in preterm neonates who are more vulnerable with each &amp;lt;35 wks GA. Design/Methods A multi-site observational study to quantify TB ROR in preterm infants between 28 to 35 weeks. 1804 infants born between January 2013- March 2018 at 28–35 wks GA from three canadian perinatal centres were included and those with Rh disease were excluded. Analysis included infants &amp;gt;27 weeks with at least one TB prior to the initiation of treatment for severe hyperbilirubinemia treatment. Feeding patterns, birth history and maternal health conditions were documented. Results The TB ROR were compared by two prematurity GA groups (28–31 weeks and 32–35 weeks) then per individual gestational age in four time periods in hours, 0–24, 24–48, 48–96, and 96 -120 in 1049 preterm infants using 3065 TB samples. Infants &amp;lt;28 weeks GA were excluded since they represented a more diverse population. TB ROR by prematurity groups over all was higher in 32–35 weeks group at 0–12 hours (3.85 umol/L/h) and 25–36 hours (2.81umol/L/h) and decreased at 49–72 hours (0.24umol/L/h) time period as compared to the less mature group. Conclusion Though TB ROR were of similar patterns between prematurity groups (28–31 weeks and 32–35 weeks) it was at higher rate of rise between 13–36 hours and decreasing from 36–72 hours, with a plateau after 72 hours of age. There was a significant difference in the magnitude of TB ROR between prematurity groups at 0–24 hours. Additional research into the clinical care impact on the TB ROR should be conducted to study impact of production and elimination.

The first experience of using obturator nerve block to prevent spasm of adductor muscles of the thigh during transurethral resection of bladder

The objective is to study the possibility of using the obturator nerve block under the control of nerve stimulator to prevent the thigh adductor muscles spasm during transurethral resection of bladder tumor. Materials and methods . The prospective randomized study included data obtained during the surgical treatment of 50patients with lateral wall bladder tumor, which was subjected transurethral resection of the bladder. In the GA group (n = 25) was performed general anesthesia with use muscle relaxants, in the NS group (n = 25) spinal anesthesia was performed in combination with obturator nerve block by 10 ml of a 2 % solution of lidocaine under the control of nerve stimulation. Results. The thigh adductor muscles spasm was observed in 5 cases (25 %) in the GA group and in 3 cases (12 %) in the NS group (p = 0.702), this was the cause of bladder perforation in 1 (4 %) patient in the NS group. The incidence of arterial hypotension in the NS group was lower than in the GA group (0 % versus 32 %; p = 0.004), as well as the incidence of sinus bradycardia (12 % versus 48 %; p = 0.012). The time of being in operating room in the NS group was 45 minutes (40; 53) versus 60 minutes (50; 85) in the GA group (p = 0.006). Conclusion . The spinal anesthesia in combination with obturator nerve block under the control of nerve stimulation, as well as the general anesthesia with use muscle relaxants did not guarantee the absence of adductor muscles spasm during transurethral resection of the lateral wall bladder. The obturator nerve block under the control of nerve stimulation only can not be recommended to prevent perforation of the bladder wall in these interventions.

Neonatal arterial blood gases &amp; immediate outcome following perinatal asphyxia.

Background: Perinatal asphyxia (PNA) remains a significant cause of death and disability despite the important advances in perinatal care in the past decades. Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. Estimates of the incidence of perinatal asphyxia vary, in resource-rich countries is about 1/1000 live births and in resource-poor countries is probably much more common, an incidence of 5–10/1000 live births and represents the second most common cause of neonatal death (24%) after preterm birth related complications (35%). About one quarter of all neonatal deaths globally are caused by PNA &amp; an equal number of serious neurological consequences ranging from cerebral palsy &amp; mental retardation to epilepsy.&#x0D; Objective: To determine how well neonatal arterial blood pH and base deficit predict immediate outcome (survival to discharge) following perinatal asphyxia.&#x0D; Methods: This was a prospective study conducted in the delivery room and adjacent neonatal area (NICU) of Ad-din Medical College Hospital (AMCH), over 6 months from 1st June and 30th November, 2017. Research assistants were trained to observe and record events related to labor and neonatal resuscitation. Patient information was obtained which included patient characteristics (gender, birth weight &amp; gestational age) and APGAR scores at and beyond 5 minutes. Within one hour of delivery all admitted neonates were subjected to an arterial blood gas (ABG) analysis by GEM Premier 3000 blood gas analyzer and pH and base deficit were noted. All the neonates were classified according to GA, BW and Gender. After proper cleaning the collected data were analyzed thoroughly. Descriptive analyses were performed; differences in outcome by GA, BW, Gender, APGAR scores and ABG (pH and base deficit) status were determined using analysis of variance. Analyses were performed using the Statistical Package for Social Sciences (SPSS) version (Chi-Square test).&#x0D; Results: A total 50 neonates were studied in this period of which 72% survived &amp; 28 % expired. Death was mostly observed in neonate who had very high level of base deficit (&gt; 20mmol/L) &amp; very low pH (pH &lt;7.0) in 1st hour postnatal ABG. Survival rate was higher, 94.7% in &gt;35 - &lt;37 weeks GA group in comparison of &gt;37 weeks (58%) of GA (p = 0.0050). The neonates with birth weight (BW ) &gt;2000 - &lt;2500 gm were observed 77.78% survival and 68.75% in neonates with BW &gt;2500gm (p = 0.494). In this study most of the neonates were male (70%) &amp; recovery rate was relatively better among baby boys (74.3%) than baby girls (66.67%) (p = 0.582). High APGAR score neonates had better rate of recovery than poor APGAR score neonates. The neonates with APGAR score 4-6 beyond 5 minutes were observed 88.33% survival &amp; the neonates with APGAR score 0-3 beyond 5minutes were 55% survival (p= 0.028). High pH value neonates in 1st hour ABG were found higher rate of survival in comparison to low pH value neonates. It was 83.33% in pH 7.10- &lt;7.20 neonates, 72.73% in pH 7.0- &lt;7.10 neonates and 33.33% in pH &lt;7.0 neonates respectively (p=0.0136). The neonates with high level of base deficit in 1st hour ABG showed lower rate of survival than low level of base deficit neonates. It was 12.5% in base deficit &gt; 20mmol/L neonates, 33.33% in base deficit &gt; 15 - 20mmol/L neonates &amp; 87.18% in base deficit &gt; 12 -15mmol/L neonates respectively (p=0.00003).&#x0D; Conclusion: From this study it is concluded that initial pH and base deficit of 1st hour ABG of neonates along with APGAR score at or beyond 5 minutes is a good predictor of risk &amp; immediate outcome following perinatal asphyxia. A good percentage of neonates recover due to early diagnosis, meticulous nursing care and timely intervention.&#x0D; Bangladesh Journal of Medical Science Vol.18(2) 2019 p.238-243

Randomised controlled trial of dexmedetomidine sedation vs general anaesthesia for inguinal hernia surgery on perioperative outcomes in infants

BackgroundNeonates and infants undergoing general anaesthesia for hernia surgery are at risk of perioperative cardiorespiratory adverse events. The use of regional anaesthesia with dexmedetomidine preserves airway tone and may potentially avoid these complications. This study compares the perioperative conditions and adverse events between dexmedetomidine sedation with caudal block and general anaesthesia with caudal block for inguinal hernia surgery in infants. MethodsA randomised controlled trial was conducted in a tertiary hospital in Singapore involving 104 infants younger than 3 months, who were randomised to receive either dexmedetomidine sedation (DEX) with caudal block or general sevoflurane anaesthesia with tracheal intubation and caudal block (GA) for inguinal hernia surgery. Perioperative conditions, haemodynamics and adverse events were compared between groups. ResultsFifty-one infants received DEX and 48 infants received GA. In the DEX group, 46 infants (90.2%) had their operations completed solely under this technique, two (3.9%) were converted to general anaesthesia with intubation, and three (5.9%) required brief administration of nitrous oxide or low-dose sevoflurane. Overall, 96.1% of infants in the DEX group did not require intubation. Perioperative conditions were similar in both groups. The DEX group had significantly lower heart rates and higher mean arterial pressures intraoperatively. Two infants in the DEX group (3.9%) required postoperative intensive care admission compared with six infants (12.5%) in the GA group. ConclusionsDexmedetomidine sedation with caudal block provides a feasible alternative to general anaesthesia in infants undergoing hernia surgery. This technique avoids the need for tracheal intubation, which may be beneficial in neonates. Clinical trial registrationNCT02559102.

Association between COMT polymorphism, labor anxiety, and analgesia in pregnant women.

BackgroundCOMT gene polymorphism is associated with mental disorders and sensitivity to pain. In this study, we investigated the association between the COMT gene polymorphism and labor anxiety and analgesia in pregnant women.Subjects and methodsA total of 425 pregnant women undergoing labor analgesia were selected from May 2016 to February 2018. The COMT gene polymorphism was detected through the PCR with restriction fragment length polymorphism technique before childbirth. According to a COMT genotype, the enrolled pregnant women were subdivided into the Val/Val (allele GG) group, the Met/Met (allele AA) group, and the Val/Met (allele GA) group. Then, the intervertebral space of all pregnant women was injected with 3 mL of 2% lidocaine +6 mL of 0.08% ropivacaine and 6 µg of fentanyl. Labor analgesia was administered as follows: 80 mg of 0.08% ropivacaine +100 µg of fentanyl + normal saline to 100 mL. The general characteristics of the women were examined and recorded. In addition, the State Anxiety Inventory (SAI), VAS, Ramsay sedation score, and epinephrine and norepinephrine levels were compared and analyzed.ResultsA total of 391 pregnant women were enrolled in this study; among these pregnant women, there were 180 pregnant women in the GG group, 132 in the GA group, and 99 in the AA group. The minor allele frequency of COMT polymorphism among these pregnant women was 32.8%. Compared with the GG group, the SAI and VAS scores were higher, the Ramsay sedation score was lower, and the epinephrine and norepinephrine levels were higher in AA and GA groups (P<0.05). Nonetheless, there was no statistically significant difference in the SAI, VAS, Ramsay sedation score, and epinephrine and norepinephrine levels between the groups AA and GA (P>0.05).ConclusionThe COMT gene polymorphism was associated with labor anxiety and analgesia among pregnant women, and the Val158Met mutation in the COMT gene could lead to worse labor anxiety and less-effective labor analgesia in pregnant women.

Correlation of P2RX7 gene rs1718125 polymorphism with postoperative fentanyl analgesia in patients with lung cancer.

The aim of this study was to investigate the association between purinergic receptor P2X7 (P2RX7) gene rs1718125 polymorphism and analgesic effect of fentanyl after surgery among patients with lung cancer in a Chinese Han population.A total of 238 patients with lung cancer who received resection were enrolled in our study. The genotype distributions of P2RX7 rs1718125 polymorphism were detected by polymerase chain reaction and direct sequencing. Postoperative analgesia was performed by patient-controlled intravenous analgesia, and the consumption of fentanyl was recorded. The postoperative pain was measured by visual analog scale (VAS). Differences in postoperative VAS score and postoperative fentanyl consumption for analgesia in different genotype groups were analyzed by analysis of variance assay.The frequencies of GG, GA, and AA genotypes were 46.22%, 44.96%, and 8.82%, respectively. After surgery, the postoperative VAS score of GA group was significantly high in the period of analepsia after general anesthesia and at 6 hours after surgery (P = .041 and P = .030, respectively), while AA group exhibited obviously high in the period of analepsia after general anesthesia (P < .001), at postoperative 6 hours (P = .006) and 24 hours (P = .016). Moreover, the patients carrying GA and AA genotypes needed more fentanyl to control pain within 48 hours after surgery (P < .05 for all).P2RX7 gene rs1718125 polymorphism is significantly associated with postoperative pain and fentanyl consumption in patients with lung cancer.

Study on the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy

Objective To investigate the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy. Methods Sixty female patients who underwent unilateral radical mastectomy with general anesthesia in the Second Hospital of Shanxi Medical University from March 2016 to January 2018 were enrolled, and 58 cases were actually studied according to the inclusion and exclusion criteria. According to the random number table method, the patients were randomly divided into simple general anesthesia group (GA group, 30 cases) and paravertebral nerve block combined with general anesthesia group (PG group, 28 cases). In the PG group, 15 ml of 0.4% ropivacaine was injected into the T2-T6 paraspinal space on the surgical side with ultrasound. All patients received general anesthesia with intravenous propofol induction, and were given a self-controlled intravenous analgesia pump. When the visual analogue scale (VAS) score was ≥7 points, the patient was given intravenous morphine 5-10 mg. The t-test and χ2 test were used to compare the hemodynamic parameters at different time points, the VAS score at different time after operation, the postoperative analgesia pump use, and postoperative adverse reactions. Results There were no significant differences in hemodynamic parameters between the PG group and the GA group at different times (all P > 0.05). The static VAS scores of the PG group at different time points were lower than those of the GA group, but the difference was not statistically significant (all P > 0.05). The cough dynamic VAS scores of the patients in the PG group were lower than those in the GA group at 2, 6, 12, and 24 h after surgery, and the difference was statistically significant (all P < 0.05). The total amount of sufentanil [(35±10) μg vs. (50±8) μg, t = 6.308, P < 0.05], the number of remedial analgesia within 48 hours after operation [(550±105) mg vs. (680±128) mg, t = 4.240, P < 0.05], and the number of effective presses of analgesia pump (3.1±1.5 vs. 10.0±3.4, t = 10.117, P < 0.05) in the PG group were significantly lower than those in the GA group. The adverse reactions such as nausea, vomiting and lethargy in the PG group were significantly lower than those in the GA group, and the difference was statistically significant (χ2 values were 3.869 and 2.334, both P < 0.05). The postoperative analgesia comfort rate of the PG group was significantly higher than that of the GA group [96.4% (27/28) vs. 70.0% (21/30)], and the difference was statistically significant (χ2 = 7.089, P < 0.05). Conclusion The combined use of general anesthesia and ultrasound-guided paravertebral nerve block for postoperative analgesia in patients with radical mastectomy is superior to PCIA. Key words: Breast neoplasms; Surgical procedures, operative; Anesthesia; Ultrasound; Paravertebral nerve block; Analgesia

Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results

Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain (P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group (P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.

Relationship of common variants in Interleukin 33 gene with susceptibility and prognosis of osteosarcoma in Han Chinese population.

Osteosarcoma (OS) is one of the most common malignant bone tumors. Many previous studies have indicated that OS is a complex disease and that its development may be affected by multiple genetic factors, which may contribute to its carcinogenesis. The aim of the present study was to evaluate the relationship of IL-33 with susceptibility and prognosis of OS in Han Chinese individuals. A total of 1,605 study subjects including 507 OS patients and 1,098 controls were recruited. Eighteen SNPs mapped to IL-33 were selected for genotyping. Genetic associations between selected SNPs and OS disease status were evaluated. Survival analyses, including Kaplan-Meier analysis and Cox model fitting for significant SNPs, were performed. The functional consequences of significant SNPs were analyzed using a publicly available database. SNP rs1048274 was identified to be significantly associated with OS disease status (OR=0.75, P=1.53×10-4). Compared to the GA and GG groups, OS patients with the AA genotype of rs1048274 had better survival rate. The hazard ratio of SNP rs1048274 (AA group compared to GG+GA group) was 0.35 (95% confidence interval of 0.25-0.5) following adjustment for several clinical variables. In conclusion, our results suggested that IL-33 may play a key role in the etiology of OS, indicating IL-33 as a potential genetic risk factor of the development and prognosis of OS.

Effect of ultrasound-guided transverse abdominal plane block on postoperative analgesia in patients undergoing orthotopic liver transplantation under general anesthesia

Objective To evaluate the effect of ultrasound-guided transverse abdominal plane block(TAPB)on postoperative analgesia in patients undergoing orthotopic liver transplantation under general anesthesia. Methods Forty American Society of Anesthesiologists physical status Ⅲ-Ⅴ patients, with body mass index of 18-24 kg/m2, aged 18-64 yr, undergoing elective modified piggy-back orthotopic liver transplantation, were divided into 2 groups(n=20 each)by a random number table method: TAPB combined with general anesthesia group(TAPB-GA group)and general anesthesia group(GA group). In TAPB-GA group, two-point TAPB was performed below bilateral costal margins under ultrasound guidance after induction of general anesthesia, and a mixture of 0.33% ropivacaine 15 ml plus 0.5% dexamethasone 0.5 ml was injected into each point.The equal volume of normal saline was injected into each point instead in group GA.Patient-controlled intravenous analgesia was performed with sufentanil 2 μg/kg after operation in both groups.Sufentanil 5 μg was intravenously injected as rescue analgesic, and the visual analog scale score was maintained ≤3 within 48 h after operation.The intraoperative consumption of remifentanil and extubation time after operation were recorded.The requirement for sufentanil as rescue analgesic and development of nausea and vomiting, itching and respiratory depression were recorded within 48 h after surgery. Results Compared with group GA, the intraoperative consumption of remifentanil and requirement for sufentanil as rescue analgesic within 48 h after surgery were significantly reduced, the time of extubation was shortened, and the incidence of nausea and vomiting, itching and respiratory depression was decreased in group TAPB-GA(P<0.05). Conclusion Ultrasound-guided TAPB can provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation under general anesthesia. Key words: Nerve block; Abdominal muscles; Liver transplantation; Pain, postoperative