Patient-controlled Analgesia Research Articles

A randomized controlled trial to compare the effect of oxycodone and sufentanil on postoperative analgesia and immune function for laparoscopic resection of colorectal cancer

BackgroundThe purpose of this study is to evaluate the effect of oxycodone and sufentanil on postoperative analgesia and immune function in patients with laparoscopic resection of colorectal cancer (CRC), as well as the serum level of inflammatory cytokine.Methods40 patients from August 2023 to August 2024 in Shenzhen Nanshan Hospital undergoing laparoscopic resection of CRC were randomly divided into Group O (n = 20) and Group S (n = 20). The visual analog scale (VAS) score and serial blood samples were assessed during perioperative period. The primary outcomes were VAS scores and immune indicators (including IL-2, C3, C4, IgG, IgA, IgE, IgM, CD3+, CD4+, CD8+ and CD4+/CD8+) at 24 h and 72 h post-surgery at 24 h and 72 h after surgery. The secondary outcomes were inflammatory markers (including IL-4, IL-6, IL-10, TNF-a and INF-y) at 24 h and 72 h after surgery.ResultsThe VAS scores at cough in Group O at 24 h and 72 h postoperative were lower than those in Group S (p < 0.001). No significant difference was found in VAS scores at rest between the two groups (P > 0.05). The immune indicators did not show significant changes after using oxycodone or sufentanil for patient-controlled intravenous analgesia (PCIA), respectively. There was no significant difference in inflammatory factors at 24 h and 72 h after surgery between the Group O and Group S.ConclusionOxycodone is more effective than sufentanil in alleviating visceral pain, although it does not surpass sufentanil in managing cutting pain. In addition, there is no significant superiority in the effects of oxycodone on immune function and inflammatory cytokine release compared to sufentanil.Trial registrationChinese Clinical Trial Registry (ChiCTR2400089072).

Examining postoperative care: Predictors of perceived pain relief and satisfaction with pain management after orthopedic surgeries.

This study examines predictors of postoperative pain relief and patient satisfaction among orthopedic patients in Jordan, emphasizing demographic and clinical factors, patient involvement in pain management, Patient-Controlled Analgesia (PCA) utilization, and non-pharmacological pain relief techniques. This observational, predictive study included 300 orthopedic surgery patients. Pain intensity was measured 24h post-surgery, and patients completed the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). Demographic and clinical data were collected from medical records. Statistical analyses, including t-tests, ANOVA, and regression models, identified significant predictors of perceived pain relief and satisfaction with pain management. Patients reported high pain levels early post-surgery, with an average peak pain intensity of 8.52/10. Combined treatments provided an average pain relief score of 81.9%, and satisfaction with pain management averaged 7.86. Higher satisfaction was associated with PCA use, non-pharmacological methods, and information on pain management options. Key predictors of pain relief included surgery type, pain management information availability, the impact of opioid side effects, and pain's impact on activities, sleep, and emotional well-being. Satisfaction was also predicted by information on pain treatment, opioid side effects, and the total impact of pain. Enhanced patient education, active involvement in care, individualized non-pharmacological pain relief methods, and PCA use improve perceived pain relief and satisfaction with pain management. This study emphasizes the importance of personalized, multimodal pain management strategies to improve postoperative care and enhance recovery.

Dezocine versus esketamine as postoperative analgesia in women undergoing cesarean section.

The objective of this was to investigate the effect of esketamine as a postoperative analgesia in women undergoing caesarean section. A total of 134 patients were divided into two groups: 112 received esketamine and 22 received dezocine, based on their voluntary choice of analgesic drugs for patient-controlled intravenous analgesia (PCIA). The postoperative analgesic effects were compared between the two groups. The results showed that the visual analogue scale (VAS) scores at 12 and 24 hours post-operation were significantly lower in the esketamine group than in the dezocine group (P<0.05). Additionally, the time to first anal exhaust was earlier in the esketamine group (P<0.05), while there were no significant differences in the time to first ambulation or urination between the two groups (P>0.05). There was no significant difference in adverse reactions between the groups (P>0.05). The Edinburgh postnatal depression scale (EPDS) scores at 1 and 3 days after surgery were significantly higher than the preoperative scores in both groups (P<0.05); however, the EPDS scores were significantly lower in the esketamine group compared to the Dezocine group (P<0.05). We conclude that esketamine provides effective postoperative pain relief in women undergoing caesarean section patients without increasing adverse reactions, while it promotes recovery and reduces postpartum depression.

Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: A prospective study.

Enhanced Recovery After Surgery (ERAS) protocols have been shown to accelerate patient recovery across various surgical fields. There are growing reports of the benefits of ERAS for lumbar fusion, but the majority rely on retrospective analysis. This study aimed to prospectively assess the impact of an ERAS protocol on perioperative outcomes in patients undergoing lumbar spinal fusion. Prospective comparative cohort study conducted at a tertiary medical center in Taipei, Taiwan, between November 2020 and May 2023. The study included 242 patients undergoing lumbar spinal fusion for degenerative spinal conditions divided into ERAS and non-ERAS groups. Main outcomes measured included operative duration, estimated blood loss (EBL), postoperative nausea and vomiting (PONV), analgesic use, and visual analog scale (VAS) pain score. Propensity score matching (PSM) was used to minimize confounders between the 2 groups. Differences between the 2 groups were assessed using the 2-sample independent t-test or non-parametric Mann-Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. The ERAS group had significantly shorter operative time (202 ± 68 min vs. 255 ± 85 min) and EBL (480 ± 302 ml vs. 641 ± 387 ml) compared to the non-ERAS group. The ERAS group had significantly less total morphine-sulfate-equivalent (MSE) consumption (27 ± 24 mg vs. 42 ± 42 mg) and used patient-controlled analgesia (PCA) (97% vs. 41%) more frequently compared to the non-ERAS group. Notably, the ERAS group had a shorter time to ambulation and shorter time to removal of Foley catheters. These data suggest that the employed ERAS protocol significantly enhances recovery trajectories and the need for analgesics in patients undergoing lumbar spinal fusion.

The implementation of intrathecal morphine for caesarean delivery into clinical practice, and assessment of its impact on patient-reported quality of recovery using the ObsQoR-10-Dutch scale.

Optimising a mother's quality of recovery following caesarean delivery is of paramount importance as it facilitates maternal care of the newborn and affects physical, psychological and emotional well being. Intrathecal morphine (ITM) reduces postoperative pain and may improve quality of recovery: however its widespread use is limited. To assess the effects of implementing ITM for caesarean delivery on postoperative quality of recovery. Single-centre observational before-after study. Tertiary university hospital, the Netherlands, January 2023 until April 2024. Patients who underwent caesarean delivery under spinal anaesthesia. Patients recruited before implementation of ITM (n = 55) received patient-controlled intravenous analgesia with morphine or continuation of epidural analgesia previously used for labour ('pre-ITM group'). Patients recruited after implementation of ITM (n = 47) received ITM 100 μg and oral morphine tablets 10 mg as needed ('ITM group'). Primary outcome was the score on the Obstetric Quality of Recovery (ObsQoR-10-Dutch) questionnaire (0 to 100). Secondary outcomes included ObsQoR-10 subscores, length of stay, opioid consumption and self-reported general health score (0 to 100). Protocol adherence for ITM was 98%. Quality of recovery improved significantly [ObsQoR-10 scores pre-ITM 65 ± 16 vs. ITM 74 ± 13 points, mean difference 9.0 (95% CI, 3.1 to 15] points, P = 0.002], with improvement in pain scores, physical comfort, independence and psychological wellbeing. In multivariate analysis, the improvement was 6.3 (95% CI, 0.37 to 12.2] points, which was statistically significant but did not reach the predefined threshold for clinical relevance. There was, however, an improvement in self-reported general health score (57 ± 18 vs. 68 ± 17, P = 0.002), median [IQR] length of hospital stay (41 [36 to 51] vs. 37 [32 to 49] hours, P = 0.032) and median [IQR] opioid consumption (52 [35 to 73] vs. 0 [0 to 0] mg, P < 0.001). Implementing ITM for caesarean delivery resulted in moderate improvements in obstetric recovery and reduced opioid consumption. Cautious interpretation is warranted given the nonrandomised design of this implementation study. Our findings support the use of ITM in a multimodal analgesia strategy for patients undergoing caesarean delivery.

P-374. Bacterial Outbreak Investigations Associated with Drug Diversion by U.S. Healthcare Personnel, 1990-2023

Abstract Background Diversion of injectable medications by healthcare personnel (HCP) is widely recognized as a source of bloodborne pathogen transmission. Drug diversion can also cause bloodstream infections (BSIs) but may not be identified as a transmission source due to the myriad of potential etiologies of bacterial outbreaks in healthcare settings. Here, we describe characteristics of drug diversion-related bacterial outbreaks to inform identification and control. Methods We searched PubMed using the key terms “outbreak” or “cluster” and “diversion” to identify outbreaks reported from 1990-2023. Publication references were reviewed to identify additional reports. We excluded outbreaks outside the US and those caused by non-bacterial pathogens. We compiled patient- and outbreak-level data, including infection type, pathogen, length of stay, healthcare setting, diversion mechanism, and epidemiologic investigation strategies. Results We identified six drug diversion-related bacterial outbreaks published between 1991-2019, involving 80 patients. 93% (n=74) of patients presented with BSIs; 93% (n=74) were identified after surgery or procedure; 24% (n=18) of patients with a BSI had a polymicrobial infection. Median outbreak duration was 119 days (range: 38-288). All outbreaks involved water-associated bacteria (Table) and four outbreaks reported BSI onset within 48 hours of admission for at least one patient. Outbreaks necessitated multiple epidemiologic strategies, including routine approaches (e.g., case-control study [n=4]) and techniques specific to medication tampering (e.g., medication concentration testing [n=4]). At least three patients (range: 3-24) in each outbreak had related isolates by molecular typing or whole genome sequencing. Four outbreaks reported tampering with opioids administered by patient-controlled analgesia (PCA) pumps. Conclusion Certain features of healthcare BSI outbreaks, including involvement of water-associated bacteria, post-surgical populations, or rapid infection onset, should prompt consideration of drug diversion as a potential route of transmission. Multifaceted strategies, including evaluation for medication tampering, are needed to identify outbreaks from drug diversion. Disclosures All Authors: No reported disclosures

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Patient-centric innovations in pain management for postoperative care

Advancements in postoperative pain management have shifted toward patient-centric approaches, focusing on personalization, multimodal strategies, and the integration of technology. These innovations aim to enhance recovery outcomes, minimize opioid reliance, and address individual patient needs. Technological tools, such as patient-controlled analgesia (PCA) systems and artificial intelligence (AI)-driven predictive models, optimize pain control by enabling real-time monitoring and tailored interventions. Wearable devices and remote health applications further extend care beyond clinical settings, fostering better communication between patients and providers. Multimodal strategies have emerged as pivotal in postoperative recovery, combining pharmacological and non-pharmacological methods to achieve synergistic benefits. Regional anesthesia, prehabilitation programs, and the use of opioid-sparing medications demonstrate significant efficacy in reducing complications and promoting early mobility. The psychological dimensions of pain management, addressed through therapies like cognitive-behavioral interventions, play an integral role in holistic care, particularly for high-risk populations. Barriers such as socioeconomic inequities, educational limitations, and regulatory challenges hinder widespread adoption of these advancements. Disparities in access to innovative treatments exacerbate healthcare inequalities, while gaps in training impede the integration of interdisciplinary approaches. Stigma surrounding pain management, coupled with concerns over opioid misuse, further complicates implementation. Future directions include leveraging AI and machine learning for developing adaptive pain management frameworks, enhancing patient outcomes through precision medicine. Collaborative efforts among stakeholders, including policymakers, healthcare providers, and researchers, are essential for addressing these challenges. Bridging current gaps will require global harmonization of regulatory standards, equitable distribution of resources, and robust public health initiatives to reshape societal perceptions of pain management. As innovations continue to evolve, they hold the potential to revolutionize postoperative care by prioritizing personalization, equity, and patient empowerment.

Standardizing postoperative pain control for decompression of pediatric Chiari type I malformation by limiting narcotic usage.

The aim of this study was to assess the effectiveness of a postoperative multimodal pain control protocol on perioperative pain scores in children undergoing decompression for Chiari type I malformation (CM-I). This retrospective matched cohort study included patients < 21 years of age who underwent elective suboccipital craniectomy and C1 laminectomy for CM-I with or without duraplasty at a single center from January 2020 to July 2023. A standardized, multimodal postoperative pain protocol was implemented in August 2021 that did not use narcotic patient-controlled analgesia. Pre- and postprotocol cohorts were compared. The primary outcome was average perioperative pain score. Secondary outcomes included postoperative length of stay (LOS), narcotic usage, and antiemetic usage. Thirty-four children met the inclusion criteria (17 preprotocol, 17 postprotocol). Fifty-three percent were female (18/34). The mean patient age was 7.0 ± 5.0 years. After implementation of the pain protocol, noninferior average pain scores (p = 0.08) and less antiemetic administration (p = 0.048) were found across both surgery types. Equivalent inpatient LOS (p = 0.78), narcotic prescriptions at discharge (p = 0.73), and milliequivalents of morphine used (p = 0.55) were also found. Bone-only decompression was completed in 65% of patients (n = 22/34, 11 in each pre- and postprotocol group) with 12 of 34 undergoing duraplasty (6 in each pre- and postprotocol group). Patients who underwent posterior fossa decompression with duraplasty had a significantly longer LOS (p = 0.003), more overall narcotic usage (p = 0.015), and lower pain scores (p = 0.047) compared with those who underwent decompression without duraplasty. Patients undergoing a CM-I decompression had noninferior postoperative pain control and required less antiemetic dosing after implementation of a multimodal pain protocol. Neurosurgeons should consider a postoperative multimodal pain regimen for their patients with CM-I who undergo decompression with or without duraplasty.

The efficacy and safety of patient-controlled intravenous analgesia with esketamine after total hip arthroplasty: a randomized controlled trial

PurposeTo evaluate the efficacy and safety of esketamine-based patient-controlled intravenous analgesia following total hip arthroplasty.MethodsA total of 135 total hip arthroplasty patients were randomly assigned to one of the three treatment groups: esketamine, sufentanil or continuous fascia iliaca compartment block (FICB) group. The primary endpoint was the postoperative visual analogue scale (VAS) pain scores at rest and on movement. Secondary endpoints included preoperative 1-day and postoperative 7-day Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, the satisfaction of patients and surgeons, postoperative 1-month and 3-month Harris function scores, the incidence of adverse reactions.ResultsAt 48 h post-surgery, the VAS pain scores in the esketamine and FICB groups at rest and on movement were significantly lower than those in the sufentanil group (P < 0.05). The satisfaction of patients in the esketamine group was higher than that in the sufentanil and FICB groups (P = 0.014). The satisfaction of surgeons in the esketamine and FICB groups was higher than that in the sufentanil group (P = 0.002). At postoperative day 7, the SAS scores and SDS scores in the esketamine group were significantly lower than those in the sufentanil and FICB groups (P < 0.05). Compared with the sufentanil group, the postoperative nausea and vomiting, dizziness and total adverse reactions in the esketamine group and FICB group were lower (P < 0.05).ConclusionPatient-controlled intravenous analgesia with esketamine has the potential to provide good postoperative analgesia for total hip arthroplasty patients, reduce the incidence of adverse reactions after the operation, improve the satisfaction of patients and surgeons, and significantly improve patients’ postoperative mood.Trial registration: ChiCTR2300069632 (https://www.chictr.org.cn/) (March 22th, 2023).

Analgesic efficacy and safety of methylene blue combined with cocktail for periarticular infiltration following total knee arthroplasty: a prospective, randomized, controlled study

ObjectiveThis study aims to explore the analgesic effects and safety of periarticular injections of methylene blue (MB) combined with a cocktail formulation following total knee arthroplasty (TKA).MethodsA total of 70 patients undergoing total knee arthroplasty were selected and divided into two groups based on the cocktail formula used for periarticular infiltration, including the methylene blue group (M group, n = 35) and the control group (C group, n = 35). Both groups underwent spinal anesthesia. At the end of the surgery, the M group received a 0.05% methylene blue combined cocktail for periarticular infiltration block, while the C group received a conventional cocktail infiltration block. Postoperatively, both groups used intravenous patient-controlled analgesia. Then, the rest and movement Numeric Rating Scale (NRS) scores, postoperative sufentanil consumption, postoperative inflammatory markers, and the occurrence of adverse reactions such as wound infection and poor wound healing were compared after postoperative 24 h, 48 h, 72 h, and 7-day, 14-day, 28-day between the two groups.ResultsThe rest and during movement, NRS scores at postoperative 24 h, 48 h, 72 h, 7-day, 14-day, and 28-day were significantly lower in the C group compared with the M group (P < 0.05). The total sufentanil consumption at postoperative 72 h was less in the M group (98.9 ± 11.3 µg) compared to the C group (129.1 ± 12.3 µg) (P < 0.01). It also showed a lower IL-6 in the M group at postoperative 24 h and 72 h (P < 0.05). However, there were no significant differences in CRP levels between the two groups at 24 h and 72 h post-surgery (P > 0.05), and neither group experienced complications such as wound infection or poor wound healing.ConclusionMethylene blue combined with a cocktail can be safely used for local infiltration after knee arthroplasty, which reduces postoperative opioid consumption and suppresses the release of inflammatory factors. Moreover, it synergistically enhanced the local anesthetic analgesia and provided sustained pain relief for at least 4 weeks.

Enhanced recovery after surgery for adolescent idiopathic scoliosis: a revised systematic review and meta‑analysis.

Adolescent idiopathic scoliosis surgery (AIS) is often associated with high costs and significant recovery challenges. Enhanced recovery after surgery (ERAS) protocols aim to improve outcomes, reducing hospital stays and complications compared to traditional (TD) pathways. This study evaluates the impact of ERAS protocols on AIS treatment. Following PRISMA guidelines, a systematic review identified 30 studies (n = 15,954 patients). Search terms included "ERAS," "adolescent idiopathic scoliosis," and "posterior spinal fusion." Outcomes assessed included surgical metrics, recovery milestones, complications, and pain. A meta-analysis was performed, and the risk of bias was evaluated using the MINORS score. ERAS patients (n = 5582) had shorter surgical durations (-23min, p = 0.08) and reduced blood loss (-126mL, p = 0.033) compared to TD patients (n = 7916). Recovery milestones improved, including earlier ambulation (-37.4h, p < 0.0001), patient-controlled analgesia discontinuation (-1.1days, p < 0.0001), catheter removal (-0.75days, p < 0.001), and shorter hospital stays (-1.7days, p < 0.0001). Complications were lower in the ERAS group (4% vs. 8%, p = 0.0074), while wound-related complications and 30-day readmission rates were comparable. Pain scores were significantly reduced from surgery day to postoperative day 2 (p < 0.0181). ERAS protocols improve recovery and reduce complications in AIS surgery, with shorter hospital stays and enhanced patient outcomes. These findings support broader implementation and further randomized trials to evaluate long-term benefits and patient satisfaction.

Modified versus traditional subcostal anterior quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: a randomized-controlled study.

To examine the ramifications of both the modified and traditional subcostal anterior quadratus lumborum block (SQLB) on postoperative analgesia in individuals undergoing laparoscopic nephrectomy. Forty-six individuals slated for elective laparoscopic nephrectomy under general anesthesia were randomly assigned to acquire either traditional or modified SQLB using 20mL of 0.5% ropivacaine. The primary outcome was intravenous morphine-equivalent intake during the first 24h following surgery. Secondary outcomes included sensory block dermatomes, numerical rating scale (NRS) scores, the total number of patient-controlled analgesia (PCA) demands, rescue analgesic use, and complications related to opioids and nerve block. The modified SQLB group had significantly lower morphine-equivalent consumption compared to the traditional SQLB group within the initial 24h after surgery (23.1 ± 4.3 vs. 34.7 ± 6.8mg, P < 0.001). The modified SQLB also resulted in a greater number of dermatome segments of sensory block at 5, 10, and 15min after block (P < 0.05), lower NRS pain scores at rest and during coughing at 6, 24, and 48h (P < 0.001), and reduced usage of rescue analgesics as well as total PCA demands (P < 0.05). No significant differences were observed in the incidence of complications related to opioids or the nerve block procedure between the two groups. Ultrasound-guided modified SQLB confers significantly superior analgesic advantages over the traditional SQLB for patients undergoing laparoscopic nephrectomy, culminating in a marked reduction in postoperative opioid consumption and more efficacious pain management.

SCN10A gene polymorphism is associated with pain sensitivity and postoperative analgesic effects in patients undergoing gynecological laparoscopy

BackgroundPostoperative pain intensity is influenced by various factors, including genetic variations. The SCN10A gene encodes the Nav1.8 sodium channel protein, which is crucial for pain signal transmission in peripheral sensory neurons.ObjectivesThis study aims to investigate the relationship between genetic mutations in the SCN10A gene (rs6795970) and postoperative analgesic effects following gynecological laparoscopic surgery.MethodsTwo hundred female patients undergoing gynecological laparoscopic surgery under general anesthesia were included. pain sensitivity was evaluated using the catastrophizing scale and pain sensitivity questionnaire (PSQ). Patients received patient-controlled intravenous analgesia with sufentanil and dexmedetomidine for 48 h post-surgery. Postoperative pain indicators, such as visual analog scale (VAS) scores, Ramsay scores, and side effects were recorded. SCN10A rs6795970 mutations were identified using MassARRAY SNP typing technology, and patients were categoried into homozygous mutant (AA), wild type (GG), and heterozygous mutation (GA) groups for analysis.ResultsPatients in the AA group had higher scores on the pain Catastrophizing Scale, PSQ-total, PSQ-minor, and PSQ-moderate compared to GA and GG groups (P < 0.05). VAS scores at 4, 6, and 12 h post-operation were higher in the AA group than the GG group (P < 0.05). Ramsay scores were lower in AA patients at 2 and 4 h post-operation compared to GA and GG groups (P < 0.05). The AA group exhibited more self-control analgesic pump compressions within the first 24 h post-surgery, quicker depletion of analgesics in the pump, and lower patient satisfaction with pain relief compared to GA and GG groups (P < 0.05).ConclusionsFemale patients with homozygous SCN10A mutations may experience higher preoperative pain scores and increased sensitivity to postoperative pain following gynecological laparoscopic surgery with intravenous patient-controlled analgesia.Trial registration: www.chictr.org.cn, registration number: ChiCTR2200062425.

Pain control and analgesic requirements following laparoscopy-assisted transversus abdominus plane (TAP) block compared to port site infiltration post-paediatric laparoscopic appendicectomy. A Randomised controlled trial.

Appendicectomy is a common procedure in children. Regional anaesthesia helps reduce requirements for opioids and hospital stay and enhances recovery. Laparoscopic-assisted Transversus Abdominus Plane block (L-TAP) was shown to be efficient and potentially superior to port site infiltration (PSI); however, this was not previously studied in paediatric appendicitis. This study aimed to evaluate the effectiveness of L-TAP compared to PSI in children undergoing laparoscopic appendicectomy (LA). A single-blinded RCT was performed to compare L-TAP to PSI with 0.25% plain bupivacaine at the end of an LA. Patients aged 6-16 years diagnosed with uncomplicated acute appendicitis (AAST grade 1) were randomised to either group in a 1:1 fashion. Complicated appendicitis, open or Lap-converted to open appendicectomies, were excluded. Outcome measures included the total amount and number of doses of opiates and clonidine required, length of stay (LOS), and visual analogue score (VAS) of pain. 49 patients in the PSI group and 41 in the L-TAP group were included; the mean age was 11.3 ± 2.4 years. There was no significant difference in age and weight between the groups. One patient in each group required opioid-based patient-controlled analgesia (PCA) in the theatre recovery room; however, on retrospective review, this was not clinically warranted. Seven patients in each group required morphine while in recovery (p = 0.4). There was no significant difference in total morphine (PSI 0.12 vs L-TAP 0.04 mg/kg body weight, p = 0.1) and clonidine (PSI 0.57 vs L-TAP 0.59 micro gm/kg body weight, p = 0.5) requirement during the hospital stay. Patients in the L-TAP group had two hours shorter LOS than the PSI group (38.0 ± 3.9 vs 39.7 ± 4.1, p = 0.38). There was no significant difference in VAS scores. There was no difference between L-TAP and PSI. L-TAP was feasible, easy to earn, and safe. We recommend that it be considered in clinical protocols and local guidelines as part of the peri-operative analgesia regimen, especially when ultra-sound guided blocks are unavailable. Overall, patients with uncomplicated appendicitis who undergo LA have low VAS scores and require mostly simple analgesia.

Can erector spinae plane block replace intrathecal morphine in cesarean section? A prospective randomized controlled study on opioid consumption.

After cesarean, optimal analgesia is important for early mobilization, mitigating thromboembolic risks, and mother-infant communication. Our study aims to compare the postoperative analgesic effects of intrathecal morphine (ITM) and Erector Spinae Plane Block (ESPB) in elective cesarean section under spinal anesthesia. 82 patients were randomized into ESPB and ITM groups. Both groups received spinal anesthesia with 10mg of heavy bupivacaine. In the ITM group, intrathecal morphine (100mcg) was added. The ESPB group received bilateral T10 level ESPB with 20ml 0.25% bupivacaine postoperatively. Postoperative pain control included intravenous paracetamol 4x1gr, intravenous patient-controlled analgesia with tramadol, and diclofenac 75mg for rescue analgesia when NRS > 4. NRS, tramadol consumption, and side effects were recorded 24 hours postoperatively. The primary outcome of this study is to compare 24-hour postoperative opioid consumption after cesarean sections. Secondary outcomes include postoperative pain scores, rescue analgesia needs, and potential side effects. NRS scores ≤ 4 at all time intervals and were comparable among groups. The total 24-hour tramadol consumption was significantly higher in ESPB group (median: 75; Q1,Q3[40,140]) compared to ITM (50 [27.5,60], P = 0.008). Tramadol consumption was similar among groups during 0-6 and 6-12 hours. In the 12-24 hours, it was significantly higher in ESPB group (22.5 [15,57.5]) compared to ITM (15 [12.5,25],P = 0.005). In ITM group, nausea and vomiting were observed in 3 patients, itching in 1 patient; no adverse effects were observed in ESPB group. Patients undergoing cesarean section under spinal anesthesia, intrathecal morphine reduced opioid consumption more effectively than ESPB. ESPB is not recommended as a primary analgesic option for cesarean sections.

Factors Associated with Postoperative Pain Trajectory, Nausea and Vomiting After Total Knee Arthroplasty: A Retrospective Study.

Postoperative pain, nausea and vomiting adversely affect postoperative rehabilitation after total knee arthroplasty (TKA). We aimed to identify factors associated with postoperative pain trajectory and postoperative nausea and vomiting (PONV) and evaluated the effects of different analgesic modalities. We retrospectively reviewed patients undergoing unilateral primary TKA from 2017 to 2022. Patients received either general or spinal anesthesia. Patient -controlled analgesia (PCA) included patient-controlled epidural analgesia (PCEA) and intravenous analgesia (PCIA). Outcome variables included maximal pain intensity at certain times (before surgery, and 24h and 48h after surgery); and incidence of PONV. A Generalized estimating equation was used to determine the correlation between PCA usage and longitudinal pain score at 48 hours follow-up after surgery. Multivariable logistic regression analyses were used to evaluate PONV after adjusting for potential confounders. In total, 2,510 patients were identified. Patients without PCA intervention and with higher BMI reported greater acute postoperative pain. Furthermore, women and lower BMI were associated with higher rates of PONV. After adjusting for confounding factors, the PCEA group had a lower pain score than both the no PCA group (β estimate =-0.443, 95% CI= (-0.561 to -0.324), P<0.001) and the PCIA group (mean difference=-0.227, 95% CI = (-0.328 to -0.126), P <0.001). General anesthesia and PCA had no effect on the PONV incidence following TKA. Greater BMI correlated with higher pain scores but a lower likelihood of PONV. Epidural PCA provided superior acute postoperative analgesia without increasing the incidence of PONV.

Optimizing Intravenous Patient-Controlled Analgesia for Cancer Pain: A Randomized Controlled Trial on Adjusted Background Infusion Rates.

Patient-controlled analgesia (PCA) has been considered for managing cancer pain; however, limited research has been conducted on optimizing continuous infusion rates with PCA. This study aimed to evaluate the efficacy and safety of a method that optimizes background infusion (BI) alongside PCA for titrating intravenous (IV) morphine in managing cancer-related pain. Forty-four patients with solid tumors who could not manage pain with oral or transdermal opioid analgesics were randomly assigned in a 1:1 ratio to receive IV morphine through PCA or the conventional method. In the PCA group, the BI rate was automatically adjusted on the basis of the frequency and interval of bolus button presses; contrastingly, BI rate in the conventional group was adjusted at the discretion of the medical staff. The primary outcome was the daily number of patient complaints of breakthrough pain (numeric rating scale ≥4). The PCA group reported a significant decrease in breakthrough pain complaints at 24 hours (median, 0 v 3 times/d; P = .012) and a lower proportion of nonresponders at 24 hours (21% v 55%; P = .048) compared with the conventional group. The total daily IV dose of morphine increased in the PCA group and exhibited a significant difference between two groups within 48 hours (median, 76.80 v 44.42 mg/d; P = .036). No uncontrolled opioid-related adverse effects were observed in either group. PCA, with an optimized BI rate, facilitated faster titration of IV morphine than the conventional method, achieving tolerable and rapid pain relief.

Comparison of postoperative analgesia between dezocine plus flurbiprofen axetil and sufentanil in patients with CRC undergoing tumor resection: A prospective, observational study.

Flurbiprofen axetil is a nonsteroidal anti-inflammatory drug used for analgesia. Its combination with dezocine has previously shown a superior postoperative analgesic effect compared with that of opioids. The present study compared the analgesic effect between dezocine plus flurbiprofen axetil (DFA) and sufentanil in patients with colorectal cancer (CRC) following resection of the tumor. The study was performed as a prospective, observational study. It included 107 patients who were treated using a patient-controlled analgesia (PCA) pump following the resection of CRC. Patients in the DFA group were given a loading dose of 5 mg dezocine and 50 mg flurbiprofen axetil, followed by PCA with a combination comprising 30 mg dezocine, 200 mg flurbiprofen axetil and 8 mg ondansetron. Patients in the control group were treated with sufentanil at a loading dose of 5-10 µg followed by PCA with a combination of 100 µg sufentanil and 8 mg ondansetron. The DFA group reported lower pain numerical rating scale scores at 2 h (2.4±1.2 vs. 2.9±1.2) and 12 h (2.0±1.0 vs. 2.5±1.2) and reduced rates of moderate-to-severe pain at 12 h (6.7 vs. 21.0%) compared with those in the control group. In addition, the number of PCA boluses in the DFA group was lower than that in the control group [median (interquartile range), 6.0 (4.5-8.5) vs. 8.5 (5.0-11.0)]. The total satisfaction rate was increased, albeit not significantly, in the DFA group compared with that in the control group (80.0 vs. 62.9%). The levels of tumor necrosis factor-α at 24 and 48 h, and of interleukin-6 at 24 h were decreased in the DFA group compared with those in the control group. The incidences of adverse events did not differ between the groups. These findings indicate that DFA provides more effective analgesia, improves patient satisfaction and reduces the levels of pro-inflammatory cytokines with similar adverse effects compared with those of sufentanil in patients after CRC resection.