Local Anesthesia Group Research Articles

Impact of anesthesia type on surgical outcomes and medical complications in chronic subdural hematoma surgery

BackgroundsChronic Subdural Hematoma (CSDH) is common in elderly patients. Although general anesthesia (GA) has traditionally been used for CSDH surgeries, it may lead to postoperative complications, especially in older patients. We hypothesized that local anesthesia (LA) could reduce postoperative medical complications, including pneumonia, compared to GA. MethodsWe conducted a retrospective study from 2015 to 2019, of medical records of CSDH patients from two hospitals in addition to a comprehensive literature review. Inclusion criteria were a new CSDH diagnoses and treatment with burr-hole craniostomy (BHC) and drain insertion. Patients with recent ipsilateral craniotomies were excluded. Clinical variables included demographics, comorbidities, hematoma characteristics, and post-operative outcomes. ResultsOf 383 eligible patients, 63 underwent BHC under LA (LA group), and 320 under GA (GA group). Both groups exhibited similar baseline characteristics, hematoma characteristics, and surgical outcomes, including postoperative CT findings and ICU stay duration. There was also no significant difference in postoperative bleeding events between the groups. Although patients in the GA group experienced a higher incidence of postoperative pneumonia (3.8 % vs 1.6 %), multivariate analysis revealed that the occurrence of pneumonia was associated with a history of lung disease and preoperative neurological status (OR 7.28, p = 0.018, OR 3.40, p < 0.001, respectively) rather than with the type of anesthesia used. ConclusionOur study suggests that the type of anesthesia does not influence postoperative surgical and medical outcomes, including pneumonia, which is the most common medical complication of BHC for CSDH. Rather, preoperative neurological status and underlying morbidities appear to be more closely related to postoperative medical complications. Future large, prospective studies are needed to validate our findings.

Anesthésie locale comparée à l'anesthésie locorégionale dans les procédures TAVI par voie transfémorale

IntroductionTranscatheter aortic valve implantation (TAVI) has become the treatment of choice for the most fragile patients with severe aortic stenosis. The transfemoral route is preferred as the simplest and safest. The aim of our study was to compare the efficacy, tolerance and safety of local vs. locoregional anesthesia in trans-femoral TAVI procedures. Material and methodThis was a single-center retrospective study. Patients treated with femoral TAVI between February 25 and November 15, 2022 at the University Hospital of Reims were included, and two groups (local and locoregional anesthesia) were compared. ResultsTAVI success rate (92.9%), death rate (3.0%) and procedure duration (90.5 ± 13.5 minutes) did not differ between groups (p = 0.18, 0.15 and 0.55 respectively). For intra- and post-procedural treatments, the use of sedation, analgesics and benzodiazepines did not differ between groups. The cumulative dose of Remifentanil used per-procedure was lower in the local anesthesia group than in the locoregional anesthesia group (148.6 ± 71.9 mcg vs. 208.9 ± 110.0 mcg; p = 0.025). ConclusionsIn this non-randomized retrospective study, local and locoregional anesthesia had comparable safety and efficacy in transfemoral TAVI procedures. In a constrained context and with a view to simplification, these results encourage transfemoral TAVIs to be performed under local anaesthesia, and to consider a “PCI-like” approach, without the presence of an anaesthetist, for selected patients without respiratory, musculoskeletal or agitation disorders, or vascular approach difficulties.

Altieri modified Nesbit corporoplasty for the treatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes

Objective: To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia. Materials and methods: A total of 40 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (&lt; 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed. Results: The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria. Conclusions: Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia.

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade After Approval: General Versus Local Anesthesia for BotulinumtoxinA Detrusor Injection

Background: The onabotulinumtoxinA detrusor injection (OnabotA DI) was approved a decade ago for the treatment of patients with idiopathic overactive bladder (iOAB) or neurogenic detrusor overactivity (nDO) dysfunction who had not been treated successfully otherwise. The procedure is usually performed under local anesthesia (LA), and various approaches have been investigated to make the procedure as painless as possible. We examined the level of anxiety and pain experienced by patients who wanted to have the procedure performed under LA or general anesthesia (GA). Material and Methods: Patients scheduled for OnabotA DI were able to choose the anesthesia procedure (LA or GA). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to grade anxiety before anesthesia or before the procedure itself. Intra- and postoperative pain was determined using the Visual Analogue Scale (VAS). Various established questionnaires (including the Urinary Distress Inventory UDI-6), as well as a postoperative satisfaction questionnaire, were used to evaluate the success of the therapy. Results: In total, 104 patients (93 F, 11 M; age 64.0 (22–89) years; 80× iOAB, 24× nDO) were evaluated. OnabotA-DI was performed with LA in 72 patients and GA in 32. Stratified by first versus repeat injection in the LA group, there was a significant decrease in the Anxiety Score in the first vs. repeat injection group (p = 0.038). The LA group showed higher concerns in the anesthesia questions of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) than the GA group (OR: 0.29, 95%CI: 0.02–1.74). The VAS Pain Score during the procedure was significantly lower in the GA group compared to the LA group (LA: 3.3 ± 2.2, GA group 1.5 ± 1.5; p &lt; 0.001). There were no differences in the success of therapy. Despite the fear and pain, patients preferred LA to GA. Conclusions: This study shows that the anxiety and pain burden of patients undergoing OnabotA-DI under LA is significant in comparison to GA during the first injection, but insignificant for following injections. Overall, LA is favored over GA.

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.

Intra-articular Corticosteroid Injection for Adhesive Capsulitis: A Randomized Controlled Trial

Background Adhesive capsulitis is a common cause of glenohumeral joint pain and stiffness that significantly interferes with patients' lives and ability to work. Since no specific treatment options have been well established, this research examines arthrographic injection of the glenohumeral joint with steroid and local anesthetic versus local anesthetic alone for the treatment of adhesive capsulitis. Methods A double-blinded randomized controlled trial was conducted with patients diagnosed with idiopathic adhesive capsulitis. They were randomized to one of two groups: (1)local anesthetic plus steroid or (2)local anesthetic. A musculoskeletal radiologist performed all of the image-guided injections using a standardized patient-blinded technique. Outcome measures included shoulder range of motion, grip strength, and scores on the Shoulder Pain and Disability Index (SPADI), Constant Score, and Visual Analog Scale (VAS) for pain. Evaluations occurred at baseline and 3-, 6- and 12-weeks post-injection. Results Thirty-seven patients were enrolled in the study. There was no significant improvement in shoulder range of motion and grip strength with local anesthetic plus corticosteroid injection compared to local anesthetic alone. Shoulder range of motion was better at all time points for the group with local anesthetic alone. Both groups showed significant improvements in their VAS and SPADI pain scores at all post-injection follow-up appointments (p=.011). The SPADI results showed significantly better disability scores for the local anesthetic plus steroid group (p=.012) and improved pain scores from baseline at all follow-up times (p=.011), whereas the local anesthetic group had significant pain relief for only the first 3 weeks (p=.050). Conclusion Intra-articular injection with local anesthetic plus steroid was beneficial in improving pain but not range of motion when compared to injection with local anesthetic alone.

Liposomal Bupivacaine via an Adductor Canal Block Compared to a Peripheral Nerve Catheter and No Block After Total Knee Arthroplasty: A Retrospective Analysis.

Background As total knee arthroplasty is one of the most common surgeries in the United States, it is important to identify regional anesthesia methods that optimize patient recovery. This study evaluates the effectiveness of adductor canal (AC) blocks with liposomal bupivacaine (LB) compared to other regional anesthesia techniques. We hypothesized that patients receiving single-shot (SS) AC blocks with LB would have lower postoperative opioid consumption compared to other groups. Methods A retrospective cohort analysis was conducted on patients from a single institution between January 2014 and December 2021. The primary outcome assessed was postoperative opioid use, with secondary outcomes including postoperative pain scores and hospital length of stay. Results The final analysis included 280 patients: 41 received an SS AC block with plain local anesthetic, 76 received a peripheral nerve catheter (PNC) with continuous ropivacaine, 79 received an SS AC block with LB, and 84 received no block. In fully adjusted models, postoperative opioid consumption on day one was significantly lower in the SS AC block with LB group compared to the no block group (b = 23.2, SE = 5.7, p < 0.0001), the PNC group (b = 15.5, SE = 5.7, p = 0.01), and the SS AC block with plain local anesthetic group (b = 18.9, SE = 6.9, p = 0.01). Additionally, hospital length of stay was significantly reduced in the LB group compared to the no block group (b = 1.5, SE = 0.3, p < 0.0001), the PNC group (b = 1.1, SE = 0.3, p < 0.0001), and the SS AC block with plain local anesthetic group (b = 1.5, SE = 0.3, p < 0.0001). Conclusions Patients who received an AC block with LB had higher pain scores on postoperative day 0 (POD0) but required less opioid medication on postoperative day 1 (POD1) and had a shorter hospital stay compared to patients who received other types of AC blocks or no block.

Pipeline embolization device placement under local versus general anesthesia: a propensity score-matched study.

Pipeline embolization device (PED) placement for the treatment of intracranial aneurysms is safe and effective under general anesthesia (GA). However, GA is associated with certain risks, longer procedural time, and higher hospital cost. The authors aimed to compare clinical outcomes and hospital cost between GA and local anesthesia (LA) procedures in patients who underwent PED placement for intracranial aneurysm treatment. This retrospective study analyzed the charts of 216 patients with 223 intracranial aneurysms treated using the PED from June 2022 to March 2023. Cases were grouped according to type of anesthesia administered (LA or GA). Propensity score matching (PSM) was used to balance the groups to minimize confounding bias. Eighty-four patients with 88 aneurysms were treated under LA, and 132 patients with 135 aneurysms were treated under GA. The complication rate and modified Rankin Scale score at 6 months were similar in both groups. Procedural time was significantly shorter with LA both before (87.47 ± 22.68 minutes vs 118.90 ± 46.80 minutes, p < 0.001) and after (84.75 ± 16.77 minutes vs 110.02 ± 38.56 minutes, p < 0.001) PSM. LA eliminates the need for postanesthesia recovery. Hospital cost was significantly lower in the LA group both before ($30,820.74 ± $3216.93 vs $32,846.62 ± $4731.50, p = 0.001) and after ($30,127.83 ± $2763.12 vs $33,874.41 ± $3163.56, p = 0.002) PSM. PED placement under LA can achieve satisfactory outcomes similar to those of PED placement under GA; however, the use of LA reduces procedural time and hospital cost.

Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

PurposeTo determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). MethodsThis was a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014-2020. Patients who underwent preoperative intra-articular hip injection were classified based on injection type (local anesthetic, corticosteroid) and whether they experienced pain relief following injection (responders, non-responders). Responders were matched 2:1 by age, BMI, and sex with non-responders. Patient reported outcomes (PROs) including Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12-MCS) and physical component summary (SF-12-PCS) and visual analogue scale (VAS) pain were collected preoperatively and 2-years postoperatively. Mean score change and Minimal Clinically Important Difference (MCID) achievement were calculated and compared between groups. ResultsThe matched cohort included 126 total patients (42 non-responders, 84 responders; 74.6% female; mean ± SD age: 30.9 ± 9.9 years; BMI: 24.7 ± 3.7 kg/m2) with no differences in demographic or radiographic hip variables. Both groups demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12-MCS, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between corticosteroid injection responder and non-responder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except VAS pain which showed greater percentage of MCID achievement among local anesthetic non-responders relative responders (Responders: 55.0%, Non-responders: 89.5%; p = 0.03). Significant ceiling effects were most readily apparent among the injection responders group with greater percentages of patients achieving maximal 2-year postoperative survey scores (36.9% HOOS-ADL, 19.0% HOOS-Pain, 15.5% HOOS-QoL, 32.1% HOOS-Sport). ConclusionsResponse to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS. Level of EvidenceLevel III, retrospective matched cohort study.

A comparative study of the effect of port-site local anaesthetic application and standard analgesics on postoperative pain management in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incisions, reduces blood loss and is associated with fewer postoperative complications and decreased length of hospital stay. The study was done to evaluate the efficacy of the local anaesthetic infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain. Methods: In the period from July to December 2023, fifty patients who underwent laparoscopic cholecystectomy at Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad were included in this prospective comparative study. Cases were divided into two groups. Patients who received bupivacaine at the port site were put in the local anaesthetic group and patients who received postoperative analgesia with NSAIDs/Opioids were put into the Standard Analgesia Group. Pain was measured by the Visual Analog Scale in all patients at the 1st, 6th, 12th, and 24th hour postoperatively. Results: A Significant reduction in pain intensity was detected in the Bupivacaine Group compared to the patients in Standard Analgesia Group at 1st and 6th hour. On other hand, there was no difference in pain intensity at the 12th and 24th hour. There was delay in the time and total doses of rescue analgesia in the local anaesthetic group. Conclusion: Applying local anaesthetic to the port sites after laparoscopic cholecystectomy significantly reduces postoperative pain intensity in the first 6 hours and delays the need for rescue analgesia, suggesting potential decrease in analgesic drug usage for postoperative pain management.

Comparison of Pain With Ultrasound-Guided Intra-Articular Hip Injections With and Without Prior Subcutaneous Local Anesthesia.

To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection. Randomized prospective study. University-based musculoskeletal clinic. Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection. Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0-100) were collected before and after each injection. Visual analog scale pain score for the intra-articular hip injection. Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups (P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups (P = 0.232). Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.

Content Analysis of YouTube™ Videos Related to Anaesthesia Practices in Circumcision Surgery in Children

Aim:The aim of our study was to evaluate the accuracy and reliability of the information provided for patients by the videos on anaesthesia applications in circumcision surgeries in children on YouTube™ video platform,an internet information source. Materyal and Methods:The keywords ‘anaesthesia in circumcision surgery’ and ‘anaesthesia in circumcision surgery in children’ were typed into the search bar on YouTube™.A total of 220 videos were watched.The date of upload, number of views,duration,number of likes and dislikes,source of upload and number of comments were recorded.The reliability and quality of the video were assessed using the Global Quality Scale(GQS) and the modified DISCERN scale. Results:After exclusion criteria, a total of 38 videos were evaluated.The videos were divided into four groups according to the anaesthetic method mentioned/recommended in the content.When compared between the groups in terms of GQS score,modified DISCERN score and video content,it was observed that the mean scores of the videos in the local anaesthesia group were statistically significantly lower than those in both general and local anaesthesia groups, separated by age(p

Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tympanostomy Tubes Under Local Versus General Anesthesia for Children: A Prospective Long-Term Study.

Tympanostomy tube insertion (TTI) under local anesthesia (LA) is gaining popularity but literature comparing long-term outcomes for children undergoing TTI under LA versus general anesthesia (GA) is limited. This study compares the long-term quality of life (QoL) between LA and GA in children undergoing TTI. Secondary objectives included long-term behavioral changes, parental satisfaction, tube durability, and postoperative complications. We prospectively followed children aged under 6 who underwent TTI, under LA or GA, 2 years prior. We assessed QoL using validated scales (OM6, PedsQL), analyzed behavioral changes and parental satisfaction through qualitative scales, and retrieved data on tube durability and non-immediate complications. A total of 84 children (LA = 42; GA = 42) had complete data and a minimum of 1 year of follow-up. Demographic data were similar, except for younger patients in the LA group (1.4 vs. 1.9 years, p = 0.02). LA group exhibited increased fear of health care professionals following TTI (LA: Likert scale 2.1/5, GA: 1.5/5, p = 0.04). Tube retention rate was shorter in the LA group (at 15 months: GA:72%, LA:50%, p = 0.039). Two years post-TTI, there were no differences regarding QoL (OM-6 score; LA: 15.2/100, GA: 21.4/100, p = 0.18, and PedsQL score; LA: 84.3/100, GA: 83.8/100, p = 0.90), parental satisfaction with anesthesia (GA: 4.5/5, LA: 4.6/5, p = 0.56), and postoperative complications (GA: 3/42, LA: 7/42, p = 0.18). TTI under LA in children is associated with an increased fear of health care professionals and shorter functionality of tympanostomy tubes as compared to GA. No difference was observed in long-term QoL, parental satisfaction, and complications rate. Level 3 Laryngoscope, 2024.

Effectiveness and safety of multimodal analgesia in open gastrostomy in patients with end-stage head and neck cancer

Objective: To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. Methods: This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. Results: The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all P<0.001); The NRS score [M (Q1, Q3)] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (P<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all P<0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all P<0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (P<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (P=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Conclusion: Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.

Intrathecal Fentanyl versus Intrathecal Dexmedetomidine as an Adjuvant to Isobaric Levobupivacaine 0.5% in Elective Cesarean Sections: A Randomized Control Trial

Background: When a cesarean section is performed, it is crucial to have access to good postoperative analgesia. To achieve this, adjuvants are added along with local anesthetics as it has a synergistic action to improve its duration and quality. Alpha-2 adrenoceptor agonists and opioids such as dexmedetomidine and fentanyl, respectively, are used for their sedative, analgesic, and perioperative sympatholytic and cardiovascular stabilizing effects with reduced anesthetic requirements. The purpose of this research is to evaluate the effects of intrathecal fentanyl versus dexmedetomidine combined with levobupivacaine on postoperative analgesia and hemodynamic changes. Materials and Methods: This is a prospective randomized control trial, among 50 patients undergoing elective cesarean section. Group 1 will receive 0.5% levobupivacaine 2 ml + fentanyl 25 mcg and Group 2 will receive 0.5% levobupivacaine + dexmedetomidine 5 mcg. Duration of analgesia and onset and duration of sensory-motor block, perioperative analgesic requirements, sedation, and hemodynamic stability were compared. The data were entered into Microsoft Excel and analyzed using SPSS 16. Results: The baseline characteristics such as age and gender, weight, height, and body mass index were not statistically significant in both the groups. Duration of analgesia was significantly longer in the dexmedetomidine group than the fentanyl group. The mean time of onset of motor block in the group, for which dexmedetomidine was 14.23 ± 1.85 min and it was found to be much earlier than the local anesthetic group. All the patients in the dexmedetomidine group had a Visual Analog Scale (VAS) score of 0 (no pain) at the end of 4 h. In contrast, only 21 patients in the fentanyl group had a VAS score of 0, and four patients had a VAS score of 2, indicating mild pain requiring no treatment. Conclusion: The study showed that both fentanyl and dexmedetomidine as an adjuvant to levobupivacaine in cesarean section showed a longer duration of analgesia with increased sedation score and lesser pain score. When comparing the both, dexmedetomidine to the levobupivacaine has a more effective effect on postoperative pain management than fentanyl.

Pre-school children single inhalation anesthetic exposure and neuro-psychological development: a prospective study and Mendelian randomization analysis.

For children who are unable to cooperate due to severe dental anxiety (DA), dental treatment of childhood caries under Dental General Anesthesia (DGA) is a safe and high-quality treatment method. This study aims to evaluate the impact on neurocognitive functions and the growth and development of children 2 years after dental procedure based on previous research, and further establish a causal relationship between general anesthesia (GA) and changes in children's neurocognitive functions by incorporating Mendelian Randomization (MR) analysis. Data were collected and analyzed from 340 cases of S-ECC procedures of preschool children conducted in 2019. This involved comparing the neurocognitive outcomes 2 years post-operation of preschool children receiving dental procedures under general anesthesia or local anesthesia. Physical development indicators such as height, weight, and body mass index (BMI) of children were also compared at baseline, half a year post-operation, and 2 years post-operation. We performed a Mendelian randomization analysis on the causal relationship between children's cognitive development and general anesthesia, drawing on a large-scale meta-analysis of GWAS for anesthesia, including multiple general anesthesia datasets. Outcome data were obtained for 111 children in the general anesthesia group and 121 children in the local anesthesia group. The mean FSIQ score for the general anesthesia group was 106.77 (SD 6.96), while the mean score for the local anesthesia group was 106.36 (SD 5.88). FSIQ scores were equivalent between the two groups. The incidence of malnutrition in children in the general anesthesia group was 27.93% (p < 0.001) before surgery and decreased to 15.32% (p > 0.05) after 2 years, which was not different from the general population. The IVW method suggested that the causal estimate (p = 0.99 > 0.05, OR = 1.04, 95% CI = 5.98 × 10-4-1.82 × 103) was not statistically significant for disease prevalence. This indicates no genetic cause-and-effect relationship between anesthesia and childhood intelligence. There were no adverse outcomes in neurocognitive development in 2 years after severe early childhood caries (S-ECC) procedure under total sevoflurane-inhalation in preschool children. The malnutrition condition in children can be improved after S-ECC procedure under general anesthesia. Limited MR evidence does not support a correlation between genetic susceptibility to anesthesia and an increased risk for intelligence in children.

Exploring the rationale of performing vaginal hysterectomy under local anaesthesia: A single-centre experience

IntroductionVaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA. MethodsIn this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05. ResultsSeventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group. ConclusionsOur results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.

Comparison of postoperative results after hemorrhoidectomy under local and spinal anesthesia

BackgroundHemorrhoidectomy is commonly performed under general or regional anesthesia; nevertheless, the underutilization of local anesthesia is attributed to safety concerns. The aim of this study was to compare postoperative outcomes following hemorrhoidectomy using local anesthesia and spinal anesthesia. MethodsThis study was a retrospective cohort study, conducted at the General Surgery Department of the University Medical Center Ho Chi Minh City Branch 2 from January 2018 to September 2023, focused on Milligan-Morgan hemorrhoidectomies for third or fourth-degree hemorrhoids. ResultsA total of 114 patients with third or fourth-degree hemorrhoids were included in the study, with 59 patients in the local anesthesia group and 55 patients in the spinal anesthesia group. Throughout all three time points, average pain scores were consistently lower in the local anesthesia group. The average recovery time for the local anesthesia group was 8.34 ± 6.17 days, and for the spinal anesthesia group, it was 10.50 ± 7.01 days. However, these differences were not statistically significant (p > 0.05). Notably, the local anesthesia group exhibited a significantly lower rate of postoperative complications compared to the spinal anesthesia group (0 % versus 5.5 %, respectively). Additionally, the local anesthesia group had a significantly shorter length of stay (11.07 ± 15.81 h) and lower medical costs (7,793,187 ± 1,835,713 VND) compared to the spinal anesthesia group (32.87 ± 26.06 h and 9,468,098 ± 2,883,630 VND, respectively). ConclusionsHemorrhoidectomy under local anesthesia is feasible and safe, and local anesthesia may be considered as an alternative to spinal anesthesia in some cases.

Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting

Study ObjectiveTo assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an Enhanced Recovery After Surgery (ERAS) setting. DesignRandomized, controlled, double-blinded trial (Canadian Task Force level I) SettingUniversity affiliated tertiary medical center PatientsAll women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index (BMI) > 50 kg/m2 were excluded. InterventionPatients were randomized with a 1:1 allocation, to one of the following two arms, and stratified based on robotic versus laparoscopic approach.1. QLB: QLB (Bupivacaine) + Sham local trocar sites infiltration (normal saline). 2. Local Infiltration: Sham QLB (normal saline) + local infiltration (Bupivacaine) Measurements and Main ResultsThe primary outcome was defined as the quality of recovery score based on the validated questionnaire (QOR-40), completed 24-hours postoperatively. Secondary outcomes included: dynamic pain scores, accumulated opioid consumption up to 24-hours, post-operative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the post-anesthesia care unit (PACU) and adverse events. 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 (IQR 39-50) years, 47% of the participants were African American and mean BMI was 32.8 (SD 8.1) kg/m2. The mean QOR-40 score was 179.1 (+/- 10.3SD) in the QLB and 175.6 (+/- 9.7SD) for the local anesthesia group (p=0.072). All secondary outcomes were comparable between groups. ConclusionsQLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared to local anesthetic port site infiltration.