Infiltration Anesthesia Research Articles

Sustained release of levobupivacaine from temperature-sensitive injectable hydrogel for long-term local anesthesia in postoperative pain management

Postoperative pain is a major concern for most of the surgical patients, and an inadequate postoperative pain control may cause a series of complications. With an effective pain control and lesser side effects, local anesthetics are preferred for use in postoperative pain management. However, the action duration of current local anesthetics is too short to meet the requirements of postoperative analgesia. In this study, an injectable levobupivacaine (LB)-loaded thermo-sensitive hydrogel system based on biodegradable poly(D,L-lactide)-poly(ethylene glycol)-poly(D,L-lactide) (PLEL) was developed for long-acting local anesthetic, in which the soluble charged cation form of LB (LB HCl) was partly alkalified to the poorly soluble base form (LB base). This hybrid LB loaded PLEL system (hLB/PLEL) is a free flowable liquid at room temperature and changes into a semi-solid hydrogel once injection in response to the physiological temperature. Then, the dissolved LB HCl could release firstly from the hydrogel contributing to a quick work, and the insoluble LB base dissolved and released gradually as the decrease of the pH during the biodegradation of PLEL hydrogel, resulting in a long-term LB release in local. The drug release behavior, pharmacokinetic, and biocompatibility of the thermo-sensitive hLB/PLEL were studied in vitro and in vivo. The anesthetic effects of hLB/PLEL system were evaluated in the rat models of sciatic nerve block, subcutaneous infiltration anesthesia and postoperative pain as well. This hLB/PLEL system generated a significantly prolonged analgesic effect in rat models, which produced approximately 7 times longer duration than 0.75% LB HCl and effectively relieved the spontaneous pain for 3 days. In general, the presented hLB/PLEL system can not only achieve a fast-acting but also sustainably release LB to block the nerve and significantly extend the effect of local analgesia, which means a promising candidate for long-acting postoperative pain management.

Differences in Analgesia Methods for Open Gastrointestinal Surgery Are Not Associated With Initial Postoperative Ambulation.

A characteristic of modern medical care is the reduction in the length of hospital stay, and several facilities across Japan are working towards this goal. The presence of postoperative pain is correlated with the number of days to hospital discharge. Therefore, this study investigated the relationship between the analgesic methods used in clinical practice and the initial ambulation of postoperative laparotomy patients with severe postoperative worked incisional pain to enable better analgesic management in the future. This retrospective study collected information from the medical records of 117 patients who underwent laparotomy between December 1, 2019, and October 13, 2020, at the Department of Gastroenterology of the International University of Health and Welfare Mita Hospital. Based on the failure or success of the ambulation process, the patients were divided into the delayed and successful groups, respectively. In the delayed group, patient-controlled epidural analgesia (PCEA) was used in 32 patients, intravenous patient-controlled analgesia (IV-PCA) was used in two patients, continuous worked incisional infiltration anesthesia was used in one patient, and transvenous acetaminophen was used in one patient for postoperative analgesia. In the successful group, PCEA was used in 66 patients, IV-PCA was used in 11 patients, continuous worked incisional infiltration anesthesia was used in three patients, and acetaminophen administered intravenously at patient's request was used in one patient (P = 0.094). No significant differences were observed between different postoperative analgesia methods, suggesting that there may be no association between postoperative ambulation and the postoperative analgesia method.

Comparison of Analgesia Treatment Methods After Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of 42 Randomized Controlled Trials

Background: The optimal method for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) is still unclear. Purpose: To compare the efficacy of postoperative analgesic methods after ARCR through network meta-analysis of randomized controlled trials and prospective controlled trials. Study Design: Systematic review; Level of evidence, 2. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Embase, and Web of Science from inception until April 12, 2022, for randomized controlled trials and prospective controlled trials evaluating neuraxial analgesia, peripheral nerve block, periarticular local anesthetic infiltration, intravenous patient-controlled analgesia, oral analgesia, or any combination of these methods for pain management after ARCR. Outcomes included pain scores at rest, morphine consumption, and complications (nausea and vomiting). Study quality was assessed using the Cochrane risk-of-bias tool. Network meta-analysis was used to assess the relative efficacy of the methods for postoperative analgesia. The best choice for postoperative analgesia was defined as the one with significant differences in pain scores and morphine consumption compared with placebo, with no significant difference in complications, during the initial 48 hours postoperatively. Results: Included were 42 studies with 3110 patients. Only suprascapular nerve block (SSNB) was significantly superior to placebo in pain scores (mean difference [MD], –0.93 [95% CI, –1.31 to –0.54] at 6 hours; MD, –2.34 [95% CI, –3.49 to –1.19] at 12 hours) and morphine consumption (MD, –17.70 [95% CI, –32.98 to –2.42] at 24 hours) ( P < .05 for all), with no difference in complications (odds ratio, 0.96 [95% CI, 0.21 to 4.32]; P > .05). Pain scores were significantly lower with interscalene nerve block compared with SSNB (MD, –0.69 [95% CI, –1.17 to –0.20] at 6 hours; MD, –1.44 [95% CI, –2.21 to –0.67] at 12 hours) and with SSNB + axillary nerve block compared with SSNB (MD, –3.09 [95% CI, –4.18 to –1.99] at 6 hours; MD, –0.87 [95% CI, –1.71 to –0.03] at 12 hours) ( P < .05 for all). Conclusion: Based on the current evidence, most analgesic methods lowered pain and morphine consumption compared with placebo. There were significant differences in pain scores between interscalene nerve block and SSNB during the first 12 hours postoperatively, and adding axillary nerve block to SSNB enhanced the analgesic effect.

Comparative study of attenuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Abstract Introduction: Needle prick pain is a distressing event for a patient receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally traumatizing for many patients. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the practice of giving injections of local anaesthetic or local application of EMLA cream or patch at the site of spinal puncture beforehand for anaesthetizing the skin and subcutaneous tissues. Methods: A prospective cohort study was done. Those enrolled patients were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed patients either EMLA cream or regular standard lignocaine infiltration anaesthesia and labelled them as Group E and Group L respectively. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 patients were enrolled in the study- 33 in Group E and 31 in Group L. Both groups had an almost similar number of patients who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E patients compared to that in Group L, p<0.001. The multivariate analysis had similar findings after controlling confounding factors in multiple regression analysis. Conclusion: Local 2% lignocaine injection achieved significantly more pain reduction during spinal needle insertion compared to the application of an EMLA patch before spinal anaesthesia.

Investigating 3D-printed disk compressing against skin for pain relief in intradermal infiltration anesthesia: a randomized controlled trial

BackgroundPain intensity may be varied during the needle advancing through different skin layers, injection into the intradermal layer may exclude mixed pain from deeper planes. This study aimed to investigate whether compressing a three-dimensional (3D)-printed disk against the skin may relieve pain associated with intradermal injection of local anesthetic which mimics the skin test procedure.MethodsAfter institutional review board approval, 3D-printed disks with projections were designed for this study. Enrolled patients were randomized to receive either a disk compressing against the axillary skin during the intradermal injection of local anesthesia (compressing disk group) or an intradermal injection of local anesthesia without any compression (no compressing disk group). The primary outcomes were pain intensity (100-mm visual analog scale) and satisfaction (5-point Likert scale) as assessed by patients.ResultsNinety patients with American Society of Anesthesiologists I–II physical status receiving intradermal local anesthesia prior to an ultrasound-guided axillary approach were included. Eighty-seven patients completed the study, with 44 and 43 patients in disk and no disk groups, respectively. Pain scores were significantly different (P < 0.001) in compressing disk (median, 10; IQR, 5–20) and no compressing disk (median, 30; IQR, 20–40) groups. The median satisfaction score was 5 in both groups. No complications occurred during follow-up.ConclusionCompressing a 3D-printed disk against the skin may reduce intradermal needle pain and offers an effective alternative for nerve block induction.

Prediction of Early Postoperative Pain in Infants Undergoing Primary Cleft Palate Repair.

Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management. A retrospective cohort study was performed in all infants who had undergone cleft palate repair. Tertiary Institutional. Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022. Requirement for analgesic intervention in the post operative care unit. Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission. Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04-3.18 and 1.49, 95%CI 0.96-2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01-5.16). Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates.

Erupted compound odontoma in patient with epileptic seizures - a case report

Erupted odontomas are rarely found in the oral cavity. To the best of our knowledge there are only a few cases reported of compound erupted odontoma. Also, different pathological conditions have been related to odontoma’s aetiology. This article describes a case report with review of a 17-year-old girl in investigation of Dravet syndrome, psychogenic nonepileptic seizures and psychotic disorder in whom it was identified an enamel-like tissue exposed in gingiva. The size of the lesion was around 2 mm and it was located between the right permanent mandibular lateral incisor and canine teeth. Periapical radiography revealed a radiopaque image of irregular tooth-like structures, suggesting the presence of an erupted compound odontoma. The lesion was surgically removed under infiltrative anesthesia and without the need for a flap. Four small tooth-like structures were removed, and the specimens were sent for histopathological analysis, confirming the hypothesis of compound odontoma. The procedure went without complications nor need of patient sedation. Twenty days after the surgery, there was satisfactory healing of the operated region’s tissue. Odontoma’s aetiology is not very well established yet, so it is unknown whether eventual epileptic seizures that occur during the period of dental formation and thus increase patient risk for accidental dental injuries could favor the development of these lesions.

Monitored care during anesthesia with remifentanil and lidocaine in pediatric strabismus surgery: A single center experience

Purpose: To evaluate the use of monitored anesthesia care (MAC) in pediatric strabismus surgery. Methods: A total of 17 cases undergoing strabismus surgery with MAC were included in this study. The protocol for sedation was standardized and data were collected prospectively for an ongoing quality assurance project. Intravenous channels were established in the ward for all the children, and penehyclidine 0.01 mg/kg and ondansetron 0.1 mg/kg were injected intravenously. After communicating with children the second time, 0.05 mg/kg midazolam, 0.1 μg/kg sufentanil, and 2 mg/kg propofol were injected intravenously. Continuous intravenous pumping of remifentanil 0.1 ~ 0.2 μg/kg/min while local infiltration anesthesia was performed with 1 % lidocaine after the loss of consciousness. Results: It took 7.0 ± 3.5 min to wake up successfully. There was no nausea, vomiting, or delirium after the operation. The children had good postoperative recovery and no bad memories, and they and their families were highly satisfied with the surgery.Conclusion: Local anesthesia and MAC produces satisfactory sedation in most patients without switching to general anesthesia. However, it has to be fully demonstrated that MAC local anesthesia is superior to general anesthesia in pediatric strabismus surgery via multi-centered studies.

The Use of Wound Infiltration for Postoperative Pain Management after Breast Cancer Surgery: A Randomized Clinical Study

(1) Background: The present study aims to evaluate the reduction of postoperative pain in breast surgery using a series of local analgesics, which were infiltrated into the wound; (2) Methods: Envelopes containing allocation were prepared prior to the study. The patients involved were randomly assigned to the groups of local anesthesia infiltration (Group A) or normal pain management with intravenous analgesics (Group B). The random allocation sequence was generated using computer-generated random numbers. The normally distributed continuous data were expressed as the means (SD) and were assessed using the analysis of variance (ANOVA), independent-sample t-test, or paired t-test; (3) Results: The development of the postoperative pain stages was recorded using the VAS score. Therefore, for Group A, the following results were obtained: the VAS at 6 h postoperatively showed an average value of 0.63 and a maximum value of 3. The results for Group B were the following: the VAS score at 6 h postoperatively showed an average value of 4.92, a maximum of 8, and a minimum of 2; (4) Conclusions: We can confirm that there are favorable statistical indicators regarding the postoperative pain management process during the first 24-38 h after a surgical intervention for breast cancer using local infiltration of anesthetics.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Blocks Vs. Local Infiltration Anesthesia on Post Anesthesia Care Unit (PACU) Pain Control

Abstract Goals/Purpose Ultrasound-guided regional field blocks are not widely used in outpatient plastic surgery.1 These blocks have been shown to significantly decrease the number of prescribed opioids in patients who underwent abdominoplasty, liposuction, and primary submuscular breast operations. 2,3 The goal of this study is to compare ultrasound-guided TAP blocks to local infiltration anesthesia with or without blind rectus sheath blocks in patients undergoing abdominoplasty. Methods/Technique A retrospective review was conducted of patients undergoing outpatient abdominoplasty performed by the senior surgeon. Group 1 (Local) received local infiltration anesthesia with or without blind rectus sheath blocks between April 2009 and December 2013. Group 2 (TAP) received surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks between January 2014 and December 2021. Outcomes measured included opioid utilization, morphine milligram equivalents (MME) and pain level at discharge (scale from 1 to 10). All abdominoplasties were performed using the same suture materials and techniques by the senior surgeon in the same accredited outpatient surgical facility. Abdominoplasty technique included supraumbilical undermining, umbilical transposition, rectus abdominis fascial plication, progressive tension sutures, and liposuction of the flanks. Patients were excluded if other procedures were performed at the time of abdominoplasty. Results/Complications 60 patients in each of the two study groups met the study criteria for a total of 120 patients. The study groups were similar except for a lower average age in group 1 (Table 1). Patients receiving TAP blocks (group 2) had significantly lower MME requirements in the PACU (3.48 v 2.21, p=0.005). There was no difference in pain level at discharge between the two groups (2.35 v 2.17, p=0.624), (Table 1). Conclusion Surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks statistically significantly reduced opioid utilization by 36.5% in the PACU while achieving comparable patient pain scores.

ROLE OF DEXMEDETOMIDINE AS AN ADJUVANT TO LIDOCAINE AND BUPIVACAINE COMBINATION AS LOCAL ANESTHETICS IN PATIENTS UNDERGOING EXTERNAL DACRYOCYSTORHINOSTOMY

Objective: The objective of the present study is to review the role of dexmedetomidine, its safety and efficacy when added to lidocaine and bupivacaine mixture to obtain local infiltration anesthesia (LA) in external dacryocystorhinostomy (DCR). Methods: A double-blind study was conducted to assess the role and efficacy of dexmedetomidine added to lidocaine and bupivacaine mixture to obtain local infiltration anaesthesia in External Dacryocystorhinostomy. In Group A of 32 patients 20 μg dexmedetomidine was added to 3.5 mL lidocaine 2% without epinephrine and bupivacaine 0.5% mixture as a local anesthetic. In Group B of 32 patients 3.5 mL of lidocaine 2% without epinephrine and bupivacaine 0.5% mixture alone was used as local anaesthetic. The onset and the duration of sensory blockade as well as intraoperative sedation were verified. Visual analog score was used to evaluate the post-operative pain during the 12 h postoperative period. Anesthesia-related intra-operative complications and patient satisfaction were observed. Results: Group B patients developed Anaesthesia in short duration; duration of the anesthetic effect was for long period than in the Group A (p-value was 0.015 and 0.0001, respectively). The Visual Analog Scale score of the analgesia during the post-operative period was much lower (0–3) in the study Group B than in the Group A patients (4 and 5). These values were recorded after 6th and 8th hours postoperatively with p-values at 0.002 and 0.031, respectively. Conclusion: Dexmedetomidine added to the local anesthetic agents acts as an adjuvant to produce an early sensory block, extended nerve block time, and post-operative analgesia without side effects and complications. Extended post-operative analgesia was associated with increased intraoperative sedation. Subjective satisfaction of the patients was achieved without side effects. Keywords: Lacrimal apparatus, Dacryocystorhinostomy, Local anesthetic, Sedation, Analgesia and Dacryocystorhinostomy.

Drill from Military to Operating Theater and Safe Reuse of Single-Use Items to Combat the Cost of Optical Fibers and Consumables in Endovenous Laser Ablation of Varicose Veins

Introduction: Can the tandem arrangement of operating theater setup to perform a surgical drill similar to military, together with safe reuse of single-use items combat the cost of consumables of endovenous laser ablation (EVLA)? Methods: Operation pathway of EVLA consisted of cleaning and draping of patient (step 1), access to the affected vein and infiltration of tumescent local anesthesia (step 2), endovenous ablation (step 3), ultrasound-guided microfoam sclerotherapy (step 4), and chemical sterilization of consumables (step 5). Dedicated theater lists for EVLA were arranged to treat several patients per session in a prearranged operating theater. When the step 5 is completed on the first patient, the step 1 on the next patient was performed using sterilized optical fiber (OF) as a cycle while minimizing patient changeover time. Number of patients treated with each session of OF and time taken for step 1 to step 4 was recorded and analyzed. Results: A total of 140 patients treated using eight OFs during December 2019 to December 2022. Average number of patients treated with a single OF and during a single session of fiber is 17.5 (9–23) and 4.2 (3–7), respectively. Average time taken for step 1 was 7.83 min, step 2 was 7.95 min, step 3 was 1.57 min, and step 4 was 6.36 min. All the procedures were performed using four chemically re-sterilized guidewires and introducer sheaths. Conclusion: Tandem arrangement of operating theater to perform EVLA procedure similar to military drill can optimize the utilization of OFs and consumables.

Evaluation of Healing Process and Blood Sugar Level Following Local Anesthetic Infiltration with and Without Vasoconstrictor for Extraction of Maxillary Teeth in Diabetic Patients: Double Blind Randomized Controlled Clinical Trial

Evaluation of Healing Process and Blood Sugar Level Following Local Anesthetic Infiltration with and Without Vasoconstrictor for Extraction of Maxillary Teeth in Diabetic Patients: Double Blind Randomized Controlled Clinical Trial

Assessment of local pain and analgesia in envenoming by wandering spiders (Phoneutria spp.)

Phoneutrism (bites by wandering spiders of the genus Phoneutria) frequently results in local pain. We describe a retrospective cohort study of a case series of phoneutrism admitted to our Emergency Department (ED), in which we used the Numeric Pain Rating Scale (NPRS 0-10) to assess the intensity of local pain upon admission, and recorded the analgesic measures used to control this pain. Other criteria for inclusion were: (1) An age ≥8 years, (2) Treatment exclusively at our ED, and (3) Visualization or photographing the spider at the time of the bite and/or bringing the spider for identification. The patients were classified into three groups based on the intensity of pain at admission: group 1 - mild or no pain (NPRS: 0-3), group 2 - moderate pain (NPRS: 4-6), and group 3 - intense or severe pain (NPRS: 7-10). Fifty-two patients fulfilled the inclusion criteria (n=11, 14 and 27 in groups 1, 2, and 3, respectively), with a median age of 37 years. The median NPRS upon admission was 7 (interquartile range: 5-8). In patients with an NPRS <7 (groups 1 and 2), only dipyrone was used to alleviate the pain, with six cases in group 1 requiring no analgesia. Most of the cases in group 3 (19/27) were treated with a local anesthetic infiltration (2% lidocaine), in association with analgesics given i.v. in 16 cases (dipyrone, 14; tramadol, 2); additional analgesic treatment was required in seven cases, six of which were treated with tramadol i.v. The median time spent in the ED was 18, 58 and 120min for groups 1, 2 and 3, respectively. These findings show that most cases of envenoming by Phoneturia spp. involved intense local pain (NPRS ≥7), with local anesthetics being used only in these cases, often in association with dipyrone i.v.

Rectus sheath block versus local anesthetic infiltration in pediatric laparoscopic inguinal hernia repair: a randomized controlled trial.

Rectus sheath block (RSB) and local anesthetic infiltration (LAI) are used for postoperative analgesia in pediatric laparoscopic inguinal hernia repair. However, whether the analgesic effect of RSB is superior to LAI remains unclear. We hypothesized that RSB would reduce opioid consumption in patients. Patients aged 3-14 years scheduled for laparoscopic inguinal hernia repair were randomly allocated to the RSB, local anesthetic infiltration high concentration (LAIHC), local anesthetic infiltration low concentration (LAILC), or control groups. Preoperatively, they received 0.4mL/kg of 0.25% ropivacaine (RSB), 0.4mL/kg of 0.25% ropivacaine( LAILC), or 0.2mL/kg of 0.5% ropivacaine(LAIHC), and 0.2mL/kg of normal saline(control). The primary outcome was equivalent morphine consumption. We analyzed 136 patients (RSB, 33; LAIHC, 34; LAILC, 35; control, 34). Intraoperative morphine equivalent consumption was lower in the RSB group (0.115 [0.107-0.123]) than in the LAIHC (0.144 [0.137-0.151]), LAILC (0.141 [0.134-0.149]), and control (0.160 [0.151-0.170]) groups (P<0.001). In the post-anesthesia care unit, morphine equivalent consumption differed between the RSB (0.018 [0.010-0.027]), LAIHC (0.038 [0.028-0.049]), LAILC (0.056 [0.044-0.067]), and control (0.074 [0.063-0.084]) groups (P<0.001). The rescue morphine equivalent consumption did not differ significantly between the RSB (0.015 [0.007-0.023]) and LAIHC (0.019 [0.010-0.029]) groups, which were lower than that in the control group (0.037 [0.029-0.045]) (P=0.001). RSB can provide effective analgesia for pediatric laparoscopic inguinal hernia repair, with better effectiveness than that of LAI at the same dose.

Effect of Vocal Anesthesia on Adult Dental Patients during Covid-19 pandemic period

BACKGROUND: Pain is as a major concern with dental patients. The dentist-patient interaction can reveal the presence of anxiety and fear, which may result in rise of pain. This study aimed to assess vocabulary communication as support to dental anesthesia on the adult dental patient.MATERIALS AND METHODS: This is a prospective, randomized clinical study, conducted from February 2020 through March 2021. Two hundred individuals (112 males, 88 females) of the age range (16 to 84 years) were separated into two groups for testing the level of pain during dental local anesthesia, with vocal communication and without vocal communication.RESULTS: While the control group showed no difference between males and females, there was a difference between the sexes in the experimental group with past dental visits, VAS and injection type having less anxiety (p=0.0001) while with education/VAS having (p£0.01) as appear in sex to age (p£0.05). There was no difference when data were compared by age, or type of anesthesia (inferior alveolar nerve block or infiltration technique).CONCLUSION: Dental anxiety can be alleviated by talking to the patients before the procedure, which could reduce the amount of pain.

The effect of simultaneous rhinoplasty and septoplasty on the development of postoperative pain syndrome

Introduction. One of the most difficult goals in facial reconstructive surgery is to eliminate defects in the external nose. Difficulties may arise with simultaneous septo- and rhinopalasty, as there is a need to restore and preserve the structures of the nasal cavity. To date, there are not many studies that would be aimed at assessing the pain syndrome after surgery on the structures of the nose, which was the impetus for studying this problem. The purpose of the study. The purpose of this study was to study the severity of acute pain syndrome after septoplasty, rhinoplasty and rhinoseptoplasty. Materials and methods. A total of 98 patients, 19 men and 79 women, aged from 18 to 45 years, were examined and operated on. The open rhinoplasty group (group 1) included 6 men and 27 women, the open rhinoseptoplasty group (group 2) – 7 men and 26 women, and the septoplasty group (group 3) included 6 men and 26 women. To ensure premedication, all patients were prescribed 2 ml of 0.4% dexamethasone solution, 4 ml of 0.2% ondacetron solution. Preoxygenation of 100% O2 5-6 l/min was carried out with the help of an anesthetic mask. Induction of anesthesia was carried out with 20 ml (200 mg) of 1% propofol emulsion. To achieve myoplegia, a solution of ridelate C (50 mg) was administered. For anesthesia purposes, 2 ml of 0.005% fentanyl solution (0.1 mg) was administered intravenously. Infiltration anesthesia during rhinoplasty was carried out using a 2% solution. Local anesthesia was performed by intramuscular administration of a 50 mg ketoprofen solution before surgery, 24 and 48 hours after manipulation, as well as for 3 days after it, taking into account the severity of the pain syndrome. After performing rhinoplasty, septoplasty and rhinoseptoplasty, the severity of the pain syndrome was assessed using a visual analog scale (VAS), a digital rating scale (DRS) and facial pain scale (FPS 3, 6, 24, 48 hours after the end of surgery. Results. According to the VAS pain syndrome assessment, the pain intensity in group 1 was maximal one hour after rhinoplasty and subsequently had negative dynamics: on the 3rd, 6th (p&lt;0.001), 24th (p&lt;0.05) and 48th (p&lt;0.001) hours after surgery. In groups 2 and 3, the highest pain intensity was recorded at the 3rd hour after surgery (p&lt;0.001), compared with the hour after surgery. According to the DRS, the intensity of pain 3 hours after rhinoplasty in group 1 decreased, compared with his assessment 1 hour after surgery, and continued to decrease on the 3rd, 6th (p&lt;0.001), 24th (p&lt;0.01) and 48th hours (p&lt;0.001). In group 2, 3 hours after surgical manipulation, the intensity of the pain syndrome increased significantly compared to the previous period of its assessment (p&lt;0.05), which was also found in the group of patients after rhinoseptoplasty (p&lt;0.05) at the same time. Assessing the severity of the pain syndrome according to FPS, in group 1, the pain syndrome was insignificant and did not cross the threshold. In patients of groups 2 and 3, compared with the 1st hour after the interventions, pain syndrome significantly increased after 3 hours (p&lt;0.001), but subsequently decreased. Conclusion. Based on the analysis of acute postoperative pain syndrome, this study confirms that septoplasty is a more traumatic intervention compared to rhinoplasty, and surgical operations in the area of the external nose and on the nasal septum in the early postoperative period entail excalation of stress reactions, relative to rhinoplasty and septoplasty.

Risk factors for incisional complications after lumbar internal fixation via posterior midline approach: A case-control study of 455 consecutive cases.

To analyse the clinical data of patients who developed incisional complications and those who did not develop incisional complications after lumbar internal fixation, and investigate the risk factors for incisional complications in patients after lumbar internal fixation with posterior midline incision. A standardised data collection form was used to collect the clinical data of patients who were admitted and underwent lumbar internal fixation in our hospital from July 2018 to July 2021. Patients who experienced any one of the incisional complications, such as incision exudates, swelling, blisters, bruising, superficial/deep incisional infections, poor healing and scarring, after surgery were included in the incisional complication group, and patients who did not develop the above-mentioned incisional complications were included in the control group. Univariate logistic regression analysis was first performed to identify potential risk factors, significant factors from univariate analysis were then included in multivariable logistic regression analysis to identify independent risk factors for incisional complications after lumbar spine surgery. Among 455 patients included in the study, postoperative incision complications occurred in 82 patients, with an incidence rate of 18.02%. Multivariate regression analysis identified seven independent risk factors for incisional complications: age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time and local anaesthetic infiltration at the incision site after surgery. Our findings documented that age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time, and postoperative local anaesthetic infiltration at the incision site were risk factors for incisional complications after lumbar internal fixation with posterior median incision. Awareness of these risk factors can enable surgeons to develop a more appropriate perioperative management plan for patients undergoing lumbar internal fixation, thus helping them recover faster.

Opioid-Sparing Multimodal Analgesia Use After Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study in 729 US Hospitals.

Optimizing analgesia after cesarean delivery is essential to quality of patient recovery. The American Society of Anesthesiologists and the Society for Obstetric Anesthesia and Perinatology recommend multimodal analgesia (MMA). However, little is known about clinical implementation of these guidelines after cesarean delivery under general anesthesia (GA). We performed this study to describe the use of MMA after cesarean delivery under GA in the United States and determine factors associated with use of MMA, variation in analgesia practice across hospitals, and trends in MMA use over time. A retrospective cohort study of women over 18 years who had a cesarean delivery under GA between 2008 and 2018 was conducted using the Premier Healthcare database (Premier Inc). The primary outcome was utilization of opioid-sparing MMA (osMMA), defined as receipt of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen with or without opioids and without the use of an opioid-combination drug. Any use of either agent within a combination preparation was not considered osMMA. The secondary outcome was use of optimal opioid-sparing MMA (OosMMA), defined as use of a local anesthetic technique such as truncal block or local anesthetic infiltration in addition to osMMA. Mixed-effects logistic regression models were used to examine factors associated with use of osMMA, as well as variation across hospitals. A total of 130,946 patients were included in analysis. osMMA regimens were used in 11,133 patients (8.5%). Use of osMMA increased from 2.0% in 2008 to 18.8% in 2018. Black race (7.9% vs 9.3%; odds ratio [OR] [95% confidence interval {CI}] 0.87 [0.81-0.94]) and Hispanic ethnicity (8.6% vs 10.0%; OR, 0.86 [0.79-0.950]) were associated with less receipt of osMMA compared to White and non-Hispanic counterparts. Medical comorbidities were generally not associated with receipt of osMMA, although patients with preeclampsia were less likely to receive osMMA (9.0%; OR, 0.91 [0.85-0.98]), while those with a history of drug abuse (12.5%; OR, 1.42 [1.27-1.58]) were more likely to receive osMMA. There was moderate interhospital variability in the use of osMMA (intraclass correlation coefficient = 38%). OosMMA was used in 2122 (1.6%) patients, and utilization increased from 0.8% in 2008 to 4.1% in 2018. Variation in osMMA utilization was observed after cesarean delivery under GA in this cohort of US hospitals. While increasing trends in utilization of osMMA and OosMMA are encouraging, there is need for increased attention to postoperative analgesia practices after GA for cesarean delivery given low percentage of patients receiving osMMA and OosMMA.

THE PROLIFERATIVE ACTIVITY OF FIBROBLASTS OF GINGIVA IN ADULTS AT CHRONIC PERIODONTITIS

Periodontitis is a disease that progresses with age and contributes to the biological aging of the dentition. One of the reasons for this phenomenon is the aging of human gum fibroblasts. Low-intensity laser therapy stimulates the release of growth factors from fibroblasts and their division. The aim of the study was to determine the number, proliferative activity and apoptosis of gingival fibroblasts in people without signs of periodontal inflammation, with chronic periodontitis and after laser therapy. We used biopsy material obtained for periodontal, surgical, orthopedic and orthodontic indications under infiltration anesthesia in two age groups of patients aged 20–40 and 41–60 years. Cell markers Ki-67 and p53 were detected by immunohistochemical methods, the total number of gingival fibroblasts was estimated by staining with hematoxylin and eosin. The results of the conducted studies showed that the number of fibroblasts in the connective tissue lamina of the gums has age-related features. In young people from 20 to 40 years, the number of fibroblasts in gum preparations is 1,12 times higher than in people aged 41–60 years. Among the reasons for the decrease in the number of gingival fibroblasts is a decrease in their proliferative activity and activation of the proapoptotic p53 protein with age. Chronic periodontal inflammation leads to a significant increase in the number of fibroblasts, regardless of the age of the subjects. Fibroblast proliferation and p53 protein expression were more sensitive to microbial inflammation in patients aged 41 to 60 years compared to younger patients. Three-fold laser exposure had a differentiated modulating effect on the state of the gingival fibroblast population, depending on the age of the patients, the number of gingival fibroblasts was restored to the levels characteristic of healthy people, and this was observed only in the group of young patients. Thus, the number of fibroblasts in the human gingival connective tissue lamina changes with age, under conditions of inflammation and under the influence of a diode laser, which must be taken into account in dental practice.