Incidence Of Postoperative Pain Research Articles

Diclofenac Transdermal Patch versus Oral Diclofenac on Post Endodontic Pain and Quality of Life- A Randomised Clinical Trial.

To compare the effect of pre-treatment transdermal and oral diclofenac on post-endodontic pain level and oral health-related quality of life (OHRQOL) in patients with symptomatic irreversible pulpitis with apical periodontitis in mandibular molars following single visit root canal treatment. This parallel-arm, randomised, double-blinded clinical trial is reported according to the Consoli-dated Standards of Reporting Trials (CONSORT) 2020 guidelines. The protocol was approved by the Institu-tional Ethical Committee on 30th March 2021 (MADC/IEC-I/029/2021) and registered at the clinical trial reg-istry of India (CTRI/2021/12/038696). Adult patients fulfilling the eligibility criteria were randomised into two groups. Group DTP received a diclofenac transdermal patch 100 mg, and Group DOT received a diclofenac oral tablet 100 mg one hour before root canal treatment. Pain scores were checked at baseline, 2, 4, 6, 8, 24, 48, and 72 hours after the treatment. OHRQOL was assessed at baseline and one week after the treatment. Both groups were associated with a significantly lower incidence of post-operative pain and im-proved OHRQOL. At 2 hours, the pain level was significantly lower with an oral diclofenac tablet, and at 24 hours, the pain level was significantly lower with a diclofenac transdermal patch. Regarding OHRQOL, there was no significant difference between the two groups. Within the limitations of this study, the diclofenac transdermal patch had lesser post-operative pain at 24 hours, whereas the oral diclofenac tablet had lesser pain at 2 hours.

Comparison of bolus dose administration of propofol and dexmedetomidine for incidence of emergence delirium in pediatric patients undergoing surgery with general anesthesia: A randomized, double-blind trial

Abstract Background and Aims: Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Material and Methods: Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. Results: The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. Conclusion: In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.

Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction.

Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD. A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group (n = 38) and malreduction group (n = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary's angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit. The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all P < .05). However, the calcaneal pitch angle, lateral Meary's angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all P > .05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, P < .05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain. Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain. Level III, retrospective comparative study.

Modified surgical incision suturing technique in uniportal video-assisted thoracoscopic pulmonary resection.

In recent years, single-hole thoracoscopic surgery technology is widely used in major medical centers and chest-specialized hospitals for the treatment of lung diseases. However, the single-hole minimally invasive surgery method focuses on one incision, and all surgical instruments need to pass through the same hole, resulting in repeated extrusion and tissue damage of the surgical incision. Therefore, we have improved the suture method of conventional surgical incision in order to reduce the probability of wound infection and dehiscence, promote early healing, and reduce the severity of postoperative wound scar, thereby enhancing the postoperative rapid recovery of patients. The purpose of this study is to explore the clinical efficacy of a modified surgical incision suture technique applied to uniportal thoracoscopic pulmonary resection. This study retrospectively analyzed 151 patients who were admitted to the Department of Thoracic Surgery and underwent pulmonary resection from January 2019 to October 2021 in the North District of Suzhou Municipal Hospital. The patients were divided into two groups according to the different surgical incision suture methods: a modified group and a conventional group. The postoperative general clinical indexes, incision infection rate, secondary suture rate, postoperative incision pain score, and the severity of postoperative incision scar were compared and analyzed between the two groups. There were no statistically significant differences between the two groups in terms of chest tube duration or postoperative drainage and postoperative incision pain scores; the incision infection rate (1.3% vs. 6.7%, P<0.05), secondary suture rate (2.6% vs. 9.4%, P<0.05), and postoperative scar score (4.853 vs. 5.543, P=0.03) were better in the modified group than in the conventional group, and the differences between the two groups were statistically significant. Our modified suture method reduces the chance of infection and splitting and the severity of postoperative incision scar formation, promoting early healing. It can be safely and effectively applied to the incision suture of uniportal thoracoscopic pulmonary resection, enhancing the rapid postoperative recovery of patients.

Chiral S-flurbiprofen axetil-loaded lipid microspheres for improved analgesic effects: Preparation, characterization, and preclinical evaluation

Flurbiprofen axetil (FPA) is a non-steroidal anti-inflammatory drug commonly used for managing post-surgical and cancer-related pain. However, FPA consists of two enantiomers, namely S-flurbiprofen axetil (S-FPA) and R-flurbiprofen axetil (R-FPA), with distinct inhibitory activities on cyclooxygenase (COX). This study focused on utilizing chiral S-FPA as the active pharmaceutical ingredient for the first time, and developed S-FPA-loaded lipid microspheres (S-FPA@LMs). The average particle size and zeta potential of S-FPA@LMs were 217.33 ± 6.66 nm and −36 ± 3.46 mV, respectively. S-FPA@LMs exhibited excellent stability for at least 6 months when stored at 5 ± 3 °C. COX activity inhibition assay revealed that S-FPA selectively inhibited COX-1, exhibiting a more potent inhibitory effect than the racemic form of FPA. In a rat model of postoperative incision pain, S-FPA@LMs demonstrated dose-dependent analgesic effects with superior efficacy compared to equimolar doses of FPA@LMs. Pharmacokinetic studies revealed comparable profiles for the metabolites, including S-flurbiprofen (S-FP) and R-flurbiprofen (R–FP), when S-FPA@LMs and FPA@LMs were administered in equimolar doses. Additionally, continuous administration for 7 days showed no significant accumulation of S-FP and R–FP. The inversion from S-FP to R–FP after S-FPA@LMs administration was also negligible. In terms of safety, S-FPA@LMs did not induce any signs of hemolysis or coagulation in rabbit erythrocytes. Moreover, no immediate allergic reactions were observed in the active systemic anaphylaxis test. The sub-acute toxicity study indicated dose-dependent adverse reactions primarily related to the gastrointestinal system, with recovery observed after a 2-week recovery period. Notably, S-FPA@LMs displayed a lower mortality rate and less severe pathological changes in the deceased rats compared to FPA@LMs. Overall, our findings highlight the potential of S-FPA@LMs as a promising candidate for acute pain management with satisfactory stability, enhanced analgesic efficacy, reduced dosage, and reduced toxicity compared to the racemic mixture. In summary, the introduction of S-FPA@LMs presents an innovative approach to managing acute pain, warranting further exploration and development in the field of pain therapeutics.

Comparison of Skin Staples versus Skin Sutures After Inguinal Hernioplasty in Terms of Surgical Site Infection

Background: Surgical site infection is a major concern following inguinal hernia repair, potentially leading to extended hospital stays, increased morbidity, patient discomfort, and higher healthcare costs. This study aimed to conduct a comparative analysis between skin staples and skin sutures in inguinal hernioplasty, explicitly focusing on their impact on surgical site infection rates. Methods: From September 2022 to June 2023, a randomized control trial study was carried out at the Surgery Department, Kulsoom Bai Valika Hospital Karachi. A total of 100 patients who underwent Lichtenstein tension-free mesh hernioplasty were allocated into two groups: the stapler group (n=50) and the polypropylene suture group (n=50). The patients were monitored for 3 to 6 hours post-surgery and safely discharged on the first postoperative day. Follow-up was scheduled 7 days after surgery to assess wound complications, specifically surgical site infections. Comparison between both groups was done using the Chi-square/Fisher exact test for surgical site infection and independent samples t-test for pain score. The level of significance was set at 5%. Results: The incidence of postoperative pain was slightly lower in the stapler group compared to the suture group (10% vs. 16%), this difference was not statistically significant (p=0.544). Moreover, the surgical site infection rate was significantly lower in the stapler group (3%) than in the suture group (12%) with p=0.012. Conclusion: When securing the mesh in inguinal hernia cases, the utilization of skin staples was considered a safe approach and was associated with lower surgical site infection as compared to skin sutures.

Clinical application of magnetic anchor technique in laparoscopic cholecystectomy: the first retrospective study in China.

Magnetic anchor technique (MAT) is frequently used in laparoscopic cholecystectomy. However, there are few reports on its clinical application in China. In this study, we retrospectively analyzed the clinical application of MAT in laparoscopic cholecystectomy in China. 25 patients (4 males, 21 females) who underwent laparoscopic cholecystectomy assisted by MAT at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled from November 2020 to March 2021. Their records were retrospectively analyzed. The magnetic anchor device was independently designed and developed by the authors and consisted of the anchor magnet and magnetic grasping apparatus. Surgical time, intraoperative blood loss, intraoperative accidents, operator experience, postoperative incision pain score, postoperative complications, and other indicators were evaluated and analyzed. All patients successfully underwent laparoscopic cholecystectomy, including 3 cases of MAT-assisted transumbilical single-port LC, 16 cases of MAT-assisted 2-port LC and 6 cases of conventional 3-port LC. The median operation time was 50 min (range 30-95 min); intraoperative bleeding was less than 30 ml. The median score of surgical incision on day 1 and 3 after the operation was 3 (range 1-4) and 1 (range 1-3), respectively. All patients had no intraoperative bile duct injury, vascular injury, postoperative bleeding, bile leakage, biliary stricture and other complications. No adverse events (such as injury to adjacent organs or failure of the magnetic anchor device) occurred either during or after the operation. The MAT-assisted laparoscopic cholecystectomy appears to be safe, feasible and effective and exhibits unique assistance in transumbilical single-port laparoscopic cholecystectomy.

Evaluation of the Application Effect of Rapid Rehabilitation Surgery Concept in Nursing

Objective: To analyze the clinical value of perioperative nursing for children with laparoscopic high ligation of hernia sac under the guidance of the concept of rapid rehabilitation surgery. Methods: A total of 74 children with laparoscopic high ligation of hernia sac were selected from March 2021 to March 2022 in our hospital. Random number table method was used to divide them into an average group of 37 children. the control group was given routine perioperative care, and the observation group was given rapid rehabilitation surgery perioperative care. the postoperative recovery, complication rate and nursing satisfaction of parents were compared between the two groups. Results: the time of wake up, exhaust time, out of bed activity time and hospital stay in the observation group were shorter than those in the control group (P &lt; 0.05). the incidence of postoperative pain was 32.42% in the observation group and 59.46% in the control group, P &lt; 0.05; Postoperative complications were 5.41% in the observation group and 18.92% in the control group, P &lt; 0.05; Parents' nursing satisfaction in the observation group and the control group was 100.00% and 89.19% respectively, P &lt; 0.05. Conclusion: Perioperative nursing of rapid rehabilitation surgery for children with laparoscopic high ligation of hernia sac can promote postoperative rehabilitation, reduce complication rate and harmonize nurse-patient relationship.

Comparison of Electrocautery and Scalpel Incision in Midline Abdominal Surgery

Background: With the advancement of surgical techniques, the comparison of electrocautery and scalpel incisions in midline abdominal surgeries has become an essential area of study. Traditional scalpel incisions have been known for their precision but carry risks of excessive blood loss and sharp injuries. Electrocautery, offering a potentially safer and more efficient alternative, has been gaining attention in surgical practices. Objective: The primary objective of this study was to compare the effectiveness, safety, and outcomes of electrocautery versus scalpel incisions in midline abdominal surgeries, with a focus on incision time, blood loss, wound infection, and postoperative pain. Methods: A randomized controlled trial was conducted at the Military Hospital, Rawalpindi, over 12 months from June 2021 to June 2022. A total of 150 patients, split evenly into electrocautery and scalpel groups, were evaluated. Patients aged 20-75 years, undergoing midline abdominal surgery, were included. The main parameters measured were incision time, blood loss, wound infection, and postoperative pain. Data were analyzed using SPSS version 25.0, employing independent samples t-tests and chi-square tests. Results: The electrocautery group exhibited a significantly shorter incision time (13.73 ± 2.45 seconds) compared to the scalpel group (18.67 ± 3.02 seconds, p &lt; 0.001). Blood loss was also lower in the electrocautery group (11.47 ± 2.49 ml) than in the scalpel group (27.27 ± 4.13 ml, p &lt; 0.001). Wound infection rates were 6.7% for electrocautery and 13.3% for scalpel, though this was not statistically significant (p = 0.174). Remarkably, 100% of the electrocautery group reported postoperative pain, in contrast to none in the scalpel group (p = 0.000). Conclusion: The study concluded that electrocautery is more effective than scalpel incision in terms of incision time and blood loss, making it a preferable method for midline abdominal surgeries. However, the higher incidence of postoperative pain in the electrocautery group warrants further investigation.

Passive ultrasonic irrigation on postoperative pain after endodontic treatment: a randomized clinical trial

Objective:This randomized clinical trial evaluated the effect of passive ultrasonic irrigation (PUI) protocol employed during endodontic treatment on the incidence of postoperative pain. Methods: Sixty adult patients with non-vital asymptomatic premolar and molars were included. The treatments were performed using ProTaper Universal instruments with working length set 1.0 mm short of the apical foramen. The patients were randomly divided to receive one of the following two final cleansing protocols (n = 30): PUI - the canals were rinsed with 2.5% NaOCl, 17% EDTA, and 1.0% NaOCl sequentially, with 3 cycles of 20 seconds in each irrigation solution, under ultrasonic agitation; Control (CON) - similar final irrigation protocol was employed without any agitation. To evaluate postoperative pain, a numerical rating scale was applied every 24 hours until the fifth day. Data were statically analyzed with Pearson's Chi-square, Friedman's and ANOVA tests with 5% of significance. Results: There were no significant differences in any of the periods (P=0.46). The great majority of patients in both groups showed no pain symptoms. No patient reported severe pain (≥ 7), with moderate pain occurring in only 2 patients in the CON group (7.4%) and 4 patients in the PUI group (16.7%), exclusively in the first 24 hours. Conclusions: The use of passive ultrasonic irrigation protocol did not influence the occurrence of postoperative pain in patients submitted to endodontic treatment.

Effect of Nefopam on Dysesthesia, Postoperative Pain, and Satisfaction in Patients with Lumbar Spinal Stenosis Undergoing Spine Surgery: A Double-Blind, Randomized Study

Postoperative residual pain and dysesthesia in patients with lumbar spinal stenosis (LSS) can reduce patient satisfaction. We investigated the effects of nefopam on dysesthesia, postoperative pain, and satisfaction in patients with LSS who underwent spine surgery. A total of 73 patients were randomly assigned to two groups: the nefopam group (n = 35), receiving a 20 mL normal saline-based solution containing nefopam 20 mg, and the control group (n = 38), which received 20 mL of normal saline 1 h before the end of the operation. Postoperative incisional pain, dysesthesia scores, and overall satisfaction with postoperative pain management were evaluated. The severity of dysesthesia within 12 and 24 h in the nefopam group was significantly lower than that in the control group (2.3 ± 1.9 and 1.7 ± 1.6 vs. 3.3 ± 2.1, and 2.6 ± 1.9, respectively; p = 0.029 and p = 0.048). Satisfaction scores for postoperative pain management were significantly higher in the nefopam group (3.7 ± 0.6 vs. 3.1 ± 1.0, respectively; p = 0.006). The administration of nefopam effectively reduced the severity of dysesthesia within 24 h of surgery in geriatric patients undergoing spine surgery and increased patient satisfaction with postoperative pain management.

Dehydrocorydaline alleviates sleep deprivation-induced persistent postoperative pain in adolescent mice through inhibiting microglial P2Y12 receptor expression in the spinal cord.

During adolescence, a second period of central nervous system (CNS) plasticity that follows the fetal period, which involves sleep deprivation (SD), becomes apparent. SD during adolescence may result in abnormal development of neural circuits, causing imbalance in neuronal excitation and inhibition, which not only results in pain, but increases the chances of developing emotion disorders in adulthood, such as anxiety and depression. The quantity of surgeries during adolescence is also consistently on the rise, yet the impact and underlying mechanism of preoperative SD on postoperative pain remain unexplored. This study demonstrates that preoperative SD induces upregulation of the P2Y12 receptor, which is exclusively expressed on spinal microglia, and phosphorylation of its downstream signaling pathway p38Mitogen-activated protein/Nuclear transcription factor-κB (p38MAPK/NF-κB)in spinal microglia, thereby promoting microglia activation and microglial transformation into the proinflammatory M1 phenotype, resulting in increased expression of proinflammatory cytokines that exacerbate persisting postoperative incisional pain in adolescent mice. Both intrathecal minocycline (a microglia activation inhibitor) and MRS2395 (a P2Y12 receptor blocker) effectively suppressed microglial activation and proinflammatory cytokine expression. Interestingly, supplementation with dehydrocorydaline (DHC), an extract of Rhizoma Corydalis, inhibited the P2Y12/p38MAPK/NF-κB signaling pathway, microglia activation, and expression of pro-inflammatory cytokines in the model mice. Taken together, the results indicate that the P2Y12 receptor and microglial activation are important factors in persistent postoperative pain caused by preoperative SD in adolescent mice and that DHC has analgesic effects by acting on these targets.

Intensity of Preoperative Pain is a Predictive Factor of Postoperative Pain Following Root Canal Treatment

The aim of this study was to determine whether the intensity of preoperative pain was a predictive factor for the prevalence and intensity of postoperative pain, considering demographic and clinical variables. The study involved́ 80 teeth with pulpal or periapical pathologies. Root canal treatment was performed in one or two sessions. Pain intensity was assessed using the visual analogue scale before treatment and then 6h, 12h, 24h, 48h, 72h and one week after root canal treatment. The sample consisted of 46 women and 34 men. This study showed́ that postoperative pain was statistically associated with female gender (p=0.05), tooth types (p=0.006), and its location on the mandibular arch (p=0.03). The main finding was that patients with a higher intensity of pre-operative pain had a higher incidence of post-operative pain (p&lt;0.05). In the group of patients who had no pre-operative pain, 63% (17/27) of patients remained asymptomatic after root canal treatment, while only 7.4% (2/27) had severe post-operative pain with a significant difference (p&lt;0.05). However, in the group with severe pre-operative pain, 100% of patients had post-operative pain, of which 75% (15/20) of patients had high levels of pain requiring analgesics.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients.

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS)ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 hand 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

Effect of two different laparoscopic techniques on post-operative wound complications in patients with benign gynaecological diseases: A meta-analysis.

Single-port laparoscopy (SPL) has existed for several years. This meta-analysis was conducted to evaluate the efficacy of SPL compared with conventional laparoscopy (CL) in the treatment of benign gynecologic adnexal lesions. The purpose of this meta-analysis is to evaluate the superiority of SPL versus CL in the treatment of post-operative wound pain. The study looked for English-language publications from PubMed, Embase, Cochrane Library and the Web of Science until June 2023. The main result was the visual analogue scale (VAS) after 2, 4, 6, 8, 12, 24 and 48 h after operation. The paper contains 10 related papers by means of e-search. Of these, 4 were randomized controlled trials (RCTs), while 6 were non-RCTs. The results indicated that SPL and CL were significantly different after 2, 24 and 48 h after operation. SPL had lower post-operative pain after 2 h compared with CL (MD, -0.6; 95% CI, -0.98, -0.21; p = 0.002). After the operation, SPL also had a lower incidence of post-operative pain after 24 h compared with CL (MD, -0.59; 95% CI, -1.12, -0.06; p = 0.03). And the difference in pain was at 48 h after the most significant (MD, -0.49; 95% CI, -0.75, -0.23; p = 0.0002). But after 6, 8 and 12 h after operation, there was no significant difference in the degree of pain. Thus, SPL operations may result in a lower degree of pain than CL in both the post-operative and far post-operative phase.

[Retrospective cohort study on application of acupuncture-aided anesthesia technique to patients undergoing thoracoscopic lobectomy].

To compare the clinical effect of "initial scheme" and "improved scheme" of acupuncture-aided anesthesia for patients undergoing thoracoscopic lobectomy. A retrospective analysis about 2 groups ("initial scheme" and "improved scheme") of patients (40 cases in each group) who underwent thoracoscopic lobectomy was conducted in the present paper. Patients of the "initial scheme" group received thoracoscopic operation with three incisions under acupuncture-aided anesthesia i.e., electroacupuncture (EA) stimulation of bilateral Hegu (LI4), Neiguan (PC6), Houxi (SI3) and Zhigou (SJ6), combined with Lidocaine and ropivacaine epidural anesthesia and propofol intravenous anesthesia from January of 2013 to December of 2017. Patients of the "improved scheme" group received thoracoscopic operation with single incision under acupuncture-aided anesthesia by EA, combined with ropivacaine paravertevinal block and lidocaine and remifentanil intravenous anesthesia from August 2018 to August 2021. The incidence of intraoperative deep breathing, resuscitation time, ambulatory rate on day after surgery and postoperative incision pain of the two schemes were compared. The incidence of intraoperative deep breathing and the degree of postoperative incision pain were significantly lower (P<0.05), the postoperative resuscitation time was obviously shorter (P<0.05), and the ambulatory rate on day after surgery was higher (P<0.05) in the "improved scheme" group than in the "initial scheme" group. The "improved scheme" is better than the "initial scheme" in stabilizing the patient's breathing during thoracoscopic lobectomy operation, shortening the resuscitation time, and ameliorating the postoperative recovery state and pain reaction, thus being a better technical solution in clinical practice.

Postoperative pain incidence and intensity following root canal obturation with bioceramic and other sealers: A systematic review with meta-analysis

Aims: To investigate whether bioceramic sealers induce a lower incidence and intensity of postoperative pain compared to other sealers.&#x0D; Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomized clinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.&#x0D; Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes.&#x0D; Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

Robotic Anterior Resection for Rectosigmoid Colon Cancer using Single Port Access.

Single-port laparoscopic surgery (SPLS) and a robotic surgical system have recently been included in contemporary colorectal surgical practice. 1-4 SPLS may result in better cosmetic outcomes, reduced postoperative incisional pain, fewer incisional hernias, minimal organ damage, and fewer wound complications. 2,5 However, SPLS for left-sided colorectal cancer is a challenging technique, even for experienced laparoscopic colorectal surgeons, owing to the difficulty of constructing instrument triangulation and using endo-staplers in the pelvic cavity from a single umbilical port with adequate distal margins. The Da Vinci Si Single-Site ® system (Intuitive Surgical, Sunnyvale, CA) was specifically developed to overcome SPLS limitations. Since the robotic instruments are crossed at the port site, but the software "reassigns" them to the surgeon's hand on the robotic console, the platform can easily create instrument triangulation while minimizing external robotic arm collisions. 6-8 Due to the lack of wrist articulation, the limited range of motion of the semi-rigid robotic instruments, and the limited choice of instruments, the Single-Site ® platform has not yet been widely utilized for colorectal diseases. A novel robotic technique, the da Vinci SP ® system (Intuitive Surgical, Sunnyvale, CA, USA), was designed for single-site surgery. This platform has a robotic arm with a high degree of freedom that is introduced directly into the peritoneal cavity through a single incision. The benefits of the single-port da Vinci robot platform include a holographic display of the instrument location, wristed articulation and flexible elbows, a console-controlled camera, and three-dimensional optics. This robotic system for single-port access can perform lymph node dissection around the inferior mesenteric artery using 4-arm wrist articulation while preserving the autonomic nerves during left-sided colorectal cancer surgery.

Effect of Oral Clonidine and Gabapentin as Premedication on Intraoperative Hemodynamic Responses and Postoperative Analgesia Requirement in Laparoscopic Cholecystectomy

Abstract Background: Laparoscopic cholecystectomy pain is a sensory and emotional experience connected with actual or potential tissue damage. Effective pain control is quite important, with around 70% of patients still complaining of moderate-to-severe pain postoperatively. Uncontrolled perioperative pain may raise patient morbidity and mortality rates. Both gabapentin and clonidine as premeditated can be easily administered have minimal side effects, are easily available at a low price, both them have a sedative effect that can decrease anxiety and they can blunt the stress response. Moreover, both drugs have anti-nociceptive effects that may be beneficial for controlling postoperating pain which is the basis of our current study. Aims: This study aims to compare the efficacy of oral clonidine with gabapentin before induction of anesthesia in attenuating hemodynamic stress response to laryngoscopy, intubation, and carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy and to compare the efficacy of oral clonidine with oral gabapentin for postoperative pain control. Materials and Methods: Hundred patients undergoing laparoscopic surgery and qualifying inclusion criteria were randomly allocated into two groups each containing 50 patients. Group I patients were given Tab. Clonidine (300 μg) and Group II patients were given tablet Gabapentin (600 mg) orally 60 min before induction of general anesthesia. Hemodynamic changes and the incidence of postoperative pain in both groups were measured and compared. Results: Hemodynamic blunting to pressor stress of laryngoscopy and intubation was seen in both groups with better results obtained in the group receiving clonidine in the form of lesser variations in heart rate, systolic blood pressure, and diastolic blood pressure. Postoperative analgesia was achieved in both groups but gabapentin showed a better analgesic profile in the form of lesser Visual Analog Scale scoring and decreased utilization of rescue analgesia. Conclusion: Clonidine (300 μg) cause a greater attenuation of intraoperative hemodynamic stress responses, whereas gabapentin (600 mg) provides superior postoperative analgesia.

Evaluation of the Impact of Different Instrumentation Techniques on the Incidence of Postoperative Pain in Patients Undergoing Root Canal Treatment.

Postoperative pain is a common concern in root canal treatment, and the choice of instrumentation technique can significantly impact patient comfort. This study aimed to evaluate the impact of different instrumentation techniques on the incidence of postoperative pain in patients undergoing root canal treatment. A randomized controlled trial was conducted on 208 patientsrandomly assigned to four groups: step-back preparation, crown-down preparation, hybrid technique, and conventional instrumentation. Pain intensity was assessed using a verbal rating scale (VRS) at six, 12, 24, 48, and 72 hours postoperatively. Data were analyzed using appropriate statistical methods. The mean pain scores and standard deviations (SDs) were calculated for each instrumentation technique at different time intervals. At six hours, the step-back preparation group reported a mean pain score of 2.3 (SD = 0.8), the crown-down preparation group had a score of 2.8 (SD = 0.9), the hybrid technique group had a score of 2.5 (SD = 0.7), and the conventional instrumentation group had a score of 3.1 (SD = 0.1). The differences in pain scores between the groups were statistically significant at all time intervals (p < 0.05). The choice of instrumentation technique significantly influenced the incidence of postoperative pain in root canal treatment. The step-back preparation technique was associated with lower pain intensity than the crown-down preparation, hybrid technique, and conventional instrumentation. These findings highlight the importance of considering the instrumentation technique to optimize patient comfort during and after root canal treatment.