Lower Postoperative Pain Scores Research Articles

A comparison of robotic enhanced-view totally extraperitoneal approach versus trans-abdominal retro-muscular approach for midline ventral hernias.

The evolution of midline ventral hernia repair has progressed from the open Rives-Stoppa technique to minimally invasive robotic approaches, notably the trans-abdominal retromuscular (TARM) and enhanced-view Totally Extraperitoneal (eTEP) methods. This study compares these two robotic techniques in repairing medium-sized midline ventral hernias. A retrospective comparative study of electronic medical records from 2015 to 2021 was conducted on patients undergoing robotic TARM or eTEP at NYU Langone Hospital-Long Island. Data on demographics, comorbid conditions, surgical history, intraoperative details, hernia characteristics, and postoperative outcomes were analyzed. Both eTEP and TARM groups exhibited comparable outcomes regarding operative duration, hernia defect size, and overall complications. However, notable differences were observed in patients' BMI, implanted mesh area, mesh composition, and fixation techniques across the groups. The TARM group required a longer hospital stay (median: 1day) in contrast to the eTEP group (median: 0days). Additionally, eTEP patients indicated reduced postoperative pain scores (median: 2) compared to TARM (median: 3), with both differences being statistically significant (p < 0.001). The robotic eTEP approach is associated with lower post-operative pain scores, decreased hospital length of stay, and larger areas of mesh implantation as compared to the TARM approach. Other variables are largely comparable between the two techniques. Level III.

Comparison of three concentrations of ropivacaine in posterior quadratus lumborum block: A randomized clinical trial

BackgroundA conclusive evidence regarding the optimal concentration and volume of local anesthetic for quadratus lumborum block is lacking. MethodsIn this single-center, prospective, randomized, controlled study, 60 patients scheduled for laparoscopic colorectal surgery were randomly assigned to 3 different combinations of volume and concentration of ropivacaine (3 mg/kg) - Group 0.25%, Group 0.375% and Group 0.5%. All subjects received ultrasound-guided posterior quadratus lumborum block prior to the induction. The primary outcome was the complete sensory block rate of surgical site measured at 30 min after quadratus lumborum block, after extubation, at 12, 24, and 48 h after operation. Secondary outcomes were the changes in hemodynamic parameters before and after incision (ΔSBP, ΔDBP and ΔHR), postoperative pain score, the sufentanil consumption after surgery, length of stay and adverse reactions. ResultsThe sensory block rate of surgical site at 5 time points differed significantly among the three groups (P < 0.001). Both Group 0.375% (P < 0.001) and Group 0.5% (P < 0.001) had a higher sensory block rate than Group 0.25%, but no significant difference was observed between the former two. Group 0.375% and Group 0.5% had lower postoperative pain scores, lower sufentanil consumption after surgery and shorter length of stay. No statistical difference was observed in ΔSBP, ΔDBP, ΔHR and the incidence of adverse reactions. Conclusions0.375% and 0.5% ropivacaine in posterior quadratus lumborum block provide better sensory block of surgical site when compared to 0.25% in laparoscopic colorectal surgery. Trial registration numberChinese Clinical Trials Registry (ChiCTR2100043949).

Intraoperative Isoflurane End-Tidal Concentration during Infusion of Fentanyl, Tramadol, or Fentanyl-Tramadol Combination in Cats.

The aim of this study was to evaluate the end-tidal concentration of isoflurane required, clinical parameters, intraoperative antinociceptive effect, and postoperative analgesia in cats undergoing ovariohysterectomy, receiving fentanyl, tramadol, or fentanyl/tramadol. Sixty-six cats in three groups, were premedicated with dexmedetomidine and infused with one of the following treatments: fentanyl, tramadol, or fentanyl/tramadol combination. Anesthesia was induced with alfaxolone and maintained with isoflurane, titrated to keep heart rate, respiratory rate and systolic arterial pressure within target values recorded at endotracheal intubation. An intraoperative cumulative scale was performed. Postoperatively, a short form of the Glasgow Composite Measure Pain Scale Feline was used at 2, 12, and 24 h. The groups were similar for age, weight, dose of dexmedetomidine, and alfaxalone administered. A greater reduction in the end-tidal isoflurane fraction was observed with the combined fentanyl/tramadol infusion than with either fentanyl or tramadol alone. No differences in the end-tidal isoflurane fraction were found between fentanyl or tramadol alone. Hemodynamic stability associated with minimal cardiopulmonary changes, low response to noxious intraoperative stimulation, and low postoperative pain scores were also observed with the fentanyl/tramadol combination. The fentanyl/tramadol combination provided a reduction in the end-tidal isoflurane fraction compared with fentanyl or tramadol alone.

A comparative analysis of opioid-free and opioid-sparing anaesthesia techniques for laparoscopic ovariectomy in healthy dogs

ObjectiveTo compare the perioperative analgesic effects of an opioid-free (OFA) and an opioid-sparing (OSA) anaesthetic protocol in dogs undergoing laparoscopic ovariectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA group of 28 client-owned dogs. MethodsDogs were allocated to one of two groups. The OFA group was administered intramuscular (IM) dexmedetomidine 5 μg kg–1 and ketamine 1 mg kg–1, followed by two intraoperative constant rate infusions (CRIs) of dexmedetomidine (3 μg kg–1 hour–1) and lidocaine (1 mg kg–1 loading dose, 2 mg kg–1 hour–1). The OSA group was administered IM dexmedetomidine 5 μg kg–1, ketamine 1 mg kg–1 and methadone 0.2 mg kg–1, followed by two intraoperative saline CRIs. In both groups, anaesthesia was induced with intravenous (IV) propofol 2 mg kg–1 and diazepam 0.2 mg kg–1 and maintained with isoflurane. Rescue dexmedetomidine (0.5 μg kg–1) was administered IV if there was a 20% increase in cardiovascular variables compared with pre-stimulation values. Ketorolac (0.5 mg kg–1) was administered IV when the surgery ended. Postoperative analgesia was evaluated using the Short Form-Glasgow Composite Measure Pain Scale and methadone (0.2 mg kg–1) was administered IM if the pain score was ≥ 6/24. Statistical analysis included mixed analysis of variance, Chi-square test and Mann–Whitney U test. ResultsThere were no significant differences in the intraoperative monitored variables between groups. The OFA group showed a significantly lower intraoperative rescue analgesia requirement (p = 0.016) and lower postoperative pain scores at 3 (p =0.001) and 6 (p < 0.001) hours. No dogs were administered rescue methadone postoperatively. Conclusions and clinical relevanceAlthough both groups achieved acceptable postoperative pain scores with no need for further intervention, the analgesic efficacy of the OFA protocol was significantly superior to that of the OSA protocol presented and was associated with a lower intraoperative rescue analgesia requirement and early postoperative pain scores.

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial.

Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.

Postoperative analgesia and side effects of oral or injectable metamizole (dipyrone) in dogs and cats

PICO Question In dogs and cats after surgery, does the peri-operative administration of injectable or oral metamizole (dipyrone) as opposed to no intervention result in lower postoperative pain scores or higher incidence of side effects? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three prospective, randomised, blinded, clinical studies were critically reviewed. Strength of evidence Weak. Outcomes reported Variables assessed included: different pain assessment methods, metamizole dose required to reduce peri- and postoperative pain scores, changes in cardiovascular variables (heart rate, systolic, mean and diastolic blood pressure), changes in respiratory variables and variations in haematological and biochemical variables. Conclusion In healthy cats and dogs undergoing ovariohysterectomy, the use of metamizole in the peri- and postoperative period was associated with some reduction in pain levels (i.e., lower pain score or reduced need for rescue analgesia). In dogs, metamizole alone provided insufficient analgesia. No study evaluating metamizole after orthopaedic surgery was found. No evidence suggested that using metamizole peri-operatively resulted in higher incidence of side effects. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Laparoscopic vs open surgical insertion of peritoneal dialysis catheters: A propensity score-matched cohort study

BackgroudThe optimal peritoneal dialysis (PD) catheterization method remains under debated. To minimize catheter-related complications, we developed a novel modified low-position two-port laparoscopic technique, and evaluated the efficacy and safety of traditional open and advanced laparoscopic techniques. MethodsA total of 743 patients with uremia who underwent PD catheterization were retrospectively reviewed. For the placement of PD catheters, patients underwent low-position two-port laparoscopic surgery (Lap group) or traditional open surgery (open group). To minimize confounding bias, we performed a 1-to-2 propensity-score matching adjusted for the most clinically relevant potential confounders. The baseline characteristics, perioperative conditions, complications and outcomes were compared between the two groups. ResultsAfter propensity-score matching, a well-balanced cohort comprising 148 matched pairs were identified. In the matched analysis, patients in the Lap group showed significantly shorter operative time (43.0 ± 16.6 versus 81.6 ± 19.8 minutes, P < 0.001) and lower postoperative pain score within 24 hours (0.24 ± 0.62 versus 1.00 ± 1.41, P = 0.002). The incidence of catheter migration in the Lap group was significantly lower than those in the open group (0.7% versus 6.5%, P = 0.006), while other complications, such as catheter occlusion, omentum wrapping, dialysate leakage, bloody effluent, organ injury, hernia, hydrothorax, early tunnel infection and peritonitis, showed no difference (P > 0.05). The Lap group patients had a favorable catheter survival rate compared with group B (log rank, P = 0.032). ConclusionsOur low-position two-port laparoscopic technique is a safe, simple, and fast method that can minimize patient discomfort without additional cost and offers better catheter survival with minimal risk of migration.

Analysis of the Effectiveness of Laparoscopic Appendectomy Compared to Laparotomy in the Treatment of Acute Appendicitis

Objective: To analyze the clinical effects of laparoscopic appendectomy compared to traditional laparotomy in treating acute appendicitis. Methods: 90 patients with acute appendicitis were selected as research subjects. They were divided into a control group and an observation group, with 45 cases in each group. The control group underwent traditional laparotomy, while the observation group underwent laparoscopic appendectomy. The intraoperative indicators, postoperative recovery indicators, postoperative stress indicators, and postoperative omplications of the two groups were compared. Results: The operative time of the observation group was longer, but the incision length was shorter and the blood loss was lesser (P &lt; 0.05); the observation group had shorter postoperative first gas-passing time, recovery of gastrointestinal function, ambulation time, and lower postoperative pain score. The bservation group had lower postoperative stress index levels (P &lt; 0.05); the observation group had a lower postoperative complication rate (P &lt; 0.05). Conclusion: Aside from prolonging the operative time, laparoscopic appendectomy is more ideal than traditional laparotomy in all other indicators and has better therapeutic effects in treating acute ppendicitis.

Use of Perioperative Intravenous Lidocaine as Part of an Abdominal Surgery Enhanced Recovery Pathway Does Not Significantly Impact Postoperative Pain.

The utility of perioperative intravenous lidocaine in improving postoperative pain control remains unclear. We aimed to compare postoperative pain outcomes in ERP abdominal surgery patients who did vs did not receive intravenous lidocaine. We hypothesized that patients receiving lidocaine would have lower postoperative pain scores and consume fewer opioids. We performed a retrospective cohort study of patients undergoing elective abdominal surgery at a single institution via an ERP from 2017 to 2018. Patients who received lidocaine in the 6 months prior to a lidocaine shortage were compared to those who did not receive lidocaine for 6 months following the shortage. The primary outcome measures were pain scores as measured on the visual analogue scale and opioid consumption as measured by oral morphine equivalents (OME). We identified 1227 consecutive ERP abdominal surgery patients for inclusion (519 patients receiving lidocaine and 708 patients not receiving lidocaine). Demographics between the two cohorts were similar, with the following exceptions: more females, and more patients with a history of psychiatric diagnoses in the group that did not receive lidocaine. Adjusted, mixed linear models for both OME (P = .23) and pain scores (P = .51) found no difference between the lidocaine and no lidocaine groups. In our study of ERP abdominal surgery patients, perioperative intravenous lidocaine did not offer improvement in postoperative pain scores or OME consumed. We therefore do not recommend the use of intravenous lidocaine as part of an ERP multimodal pain management strategy in abdominal surgery patients.

Comparative analysis of standard, tubeless and total tubeless percutaneous nephrolithotomy: A prospective study.

This study was done to review and compare safety, effectiveness and advantages of total tubeless percutaneous nephrolithotomy (PCNL), tubeless PCNL with standard PCNL. This prospective comparative study involving 30 patients in each total tubeless PCNL, tubeless PCNL and standard PCNL group from Feb 2021 to June 2022. Significant difference was found in mean duration of surgery (p < 0.01), mean hospital stay (p < 0.01), mean VAS post op score (p < 0.01), mean time to return to normal activity (p < 0.01) in total and tubeless PCNL group as compared with standard PCNL. While no significant difference found in mean haemoglobin drop (p = 0.1417), blood transfusion (p = 3721), incidence of urine leak (p = 0.13), need of accessory secondary procedure (p = 0.1322) and associated complications (p = 0.5939) among three groups. Study observed that total tubeless, tubeless PCNL is a safe and efficient technique. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores. Total tubeless PCNL obviates need of second procedure of removing DJ stent. Standard, tubeless and total tubeless PCNL have similar post op complication rate. Study thus concludes that total tubeless, tubeless PCNL can be used as a substitute for traditional standard PCNL.

Outcome of Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) with Doppler Guidance for Symptomatic Grade-II, III and IV Internal Haemorrhoids

Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy .&#x0D; Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids.&#x0D; Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. &#x0D; Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. &#x0D; Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates.&#x0D;

A Propensity Score-Matching Analysis: Robotic Thymectomy Through the Subxiphoid Has Advantages Over Video-Assisted Thymectomy Surgery.

Objective: The purpose of this article is to evaluate the security and effectiveness of subxiphoid and subcostal robot-assisted thoracoscopic thymectomy (S-RATT) and compare it with subxiphoid and subcostal video-assisted thoracoscopic thymectomy (S-VATT) in terms of short-term perioperative results and costs. Methods: A retrospective study was carried out on 62 individuals who had undergone successful complete thymectomy for anterior mediastinal disease using subxiphoid and subcostal arch approaches. Propensity score-matching analysis was utilized between the two groups, and the perioperative outcomes were compared. Results: The S-RATT group exhibited less intraoperative blood loss (20 ± 15.35 versus 69.55 ± 69.54, P < .001), lower levels of C-reactive protein (112.38 ± 68.08 versus 72.58 ± 42.62, P = .027), and lower postoperative pain scores (2.09 ± 1.54 versus 4.27 ± 1.28, P < .001). However, the hospitalization costs of patients in the S-VATT group were found to be lower than those in the S-RATT group (33,802.41 ± 8785.05 versus 49,977.53 ± 20,221.79, P < .001). Conclusions: S-RATT appears to be a viable and secure method for managing anterior mediastinal tumors.

Mesh Fixation Versus Nonfixation in Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6months. A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24hours and 6months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4cm in size. The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24hours and at 6months; however, the rate of recurrence was comparable to that of the fixation method.

Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients.

Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

A Comparative Analysis Between Spinal and General Anesthesia for Orthopedic Surgery

Background: Many surgeries can be performed with spinal anesthesia (SA) or general anesthesia (GA). However, there are only limited and confounding data available regarding costs and anesthesia-related times. Hip or knee replacement are common orthopedic surgeries that can be performed using SA or GA without differences regarding mortality or morbidity. Observational studies have suggested that spinal anesthesia may be associated with lower risks of death, delirium and major medical complications and with shorter lengths of stay in the hospital than general anesthesia. The aim of this study was to assess and compare the effects of spinal versus general anesthesia on postoperative outcomes in patients undergoing orthopedic surgery. Material &amp; Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from March,2021 to March,2023. In this study we included 200 patients undergoing orthopedic surgery. The patients were randomly divided into two groups – Group A (Patients who were given general anesthesia) &amp; Group B (Patients who were given spinal anesthesia). Results: In total 200 patients from both the groups completed the study. In our study we found majority (44.5%) of our patients were aged 60-69 years and most of our patients were female (56%) compared to male (44%).The mean age of our patients was 61.73 ± 7.92 years. The mean BMI was 31.67±3.24 kg/m.2Among all patients ,48% had mild systemic disease and followed by 31.5% had severe systemic disease. Majority (43.5%) of our patients had hypertension, 31% had diabetes. Vomiting was found 47% in group A on contrary only 23% had vomiting in spinal group. We found the mean anesthesia induction time was significantly higher in spinal group. Anesthesia time was lower in spinal group while PACU time was higher in group B. Time duration of surgery was significantly lower in spinal group. After 24 hours, spinal group showed less pain score than general anesthesia group. Conclusion: In our study, we found that SA is associated with less fixed and variable costs and lower postoperative pain scores during the stay in the PACU. Therefore, SA is a more reasonable alternative to GA in the immediate postoperative period for patients undergoing hip or knee replacement. When compared to general anaesthesia, spinal anaesthesia provides better operating circumstances, better postoperative pain control, and faster postoperative recovery.

Efficacy of the Enhanced Recovery After Surgery program for thoracic surgery in a developing country

PurposeEnhanced Recovery After Surgery (ERAS) is a strategy used to improve perioperative outcomes and reduce complications. However, data on the efficacy of ERAS in thoracic surgery in developing countries are limited. The current study aimed to validate the benefits of ERAS among patients at a single institution.MethodsThis was a retrospective study of patients who underwent pulmonary resection at Vajira Hospital, Bangkok, Thailand, between 2016 and 2020. To compare outcomes, patients were divided into the pre-ERAS group (2016–2018) and the post-ERAS group (2019–2020) using propensity score matching (1:2) with the year 2019 as the cutoff for introducing ERAS protocols at our institution.ResultsIn total, 321 patients were included in the analysis (pre-ERAS group, n = 74; post-ERAS group, n = 247). After propensity score matching, 56 and 112 patients were classified under the pre- and post-ERAS groups, respectively. The post-ERAS group had significantly lower pain scores than the pre-ERAS group on postoperative days 1, 2, and 3, and a lower volume of intraoperative blood loss. In the multivariable analysis, the post-ERAS group had a shorter chest tube duration (mean difference = −1.62 days, 95% confidence interval = −2.65 to −0.31) and length of hospital stay (mean difference = −2.40 days, 95% confidence interval = −4.45 to −0.65) than the pre-ERAS group.ConclusionThe use of ERAS guidelines in pulmonary resection is beneficial. Although no significant differences were observed in postoperative complication rate, intensive care unit stay, and additional cost burden between the two groups, patients in the post-ERAS group had a shorter postoperative chest tube duration, shorter hospital stays, shorter operative time, lower postoperative pain score, and lower volume of intraoperative blood loss.

The Lateral Femoral Cutaneous and Over the Hip (LOH) Block for the Surgical Management of Hip Fractures: A Safe and Effective Anesthetic Strategy.

To examine the efficacy of regional anesthesia with sedation only for a variety of hip fractures using the newly described lateral femoral cutaneous with over the hip (LOH) block. Retrospective. Orthopedic specialty hospital. 40 patients who presented between November 2021 and February 2022 for fixation of OTA/AO 31.A1-3 and 31.B1-3 fractures. Matched cohorts of 40 patients who received general anesthesia and 40 patients who received spinal anesthesia for hip fracture fixation were also used. Operative fixation under LOH block and sedation only. The LOH block is a regional hip analgesic that targets the lateral femoral cutaneous nerve, articular branches of femoral nerve, and accessory obturator nerve. Demographics, intraoperative characteristics, anesthesia-related complications, hospital quality metrics, and short-term mortality and reoperation rates. A total of 120 patients (40 each: general, spinal, and LOH block) were compared. The cohorts were similar in age, race, body mass index, sex, Charlson comorbidity index, trauma risk score, ambulatory status at baseline, fracture type, and surgical fixation technique performed. Physiologic parameters during surgery were more stable in the LOH block cohort ( P < 0.05). Total OR time and anesthesia time were the shortest for the LOH block cohort ( P < 0.05). Patients in the LOH block cohort also had lower postoperative pain scores ( P < 0.05). Length of hospital stay was the shortest for patients in the LOH block cohort ( P < 0.05), and during discharge, patients in the LOH block cohort ambulated the furthest ( P < 0.05). No differences were found for anesthesia-related complications, palliative care consults, major and minor hospital complications, discharge disposition, reoperation and readmission rates, and mortality rates. The LOH block is safe and effective anesthesia for the treatment of all types of hip fractures in the elderly patients requiring surgery. In addition, this block may decrease postoperative pain and length of hospital stay, and allow for greater ambulation in the early postoperative period for patients with hip fracture. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials.

This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. A meta-analysis of randomised controlled trials was performed. This was a meta-analysis involving no people or animals. The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. PROSPERO CRD42022330223. Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p=.13) and gastric fluid volume (p=.25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p=.02), lower incidence of postoperative nausea (p=.0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p=.02). Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.

Comparison of Different Carbon Dioxide Insufflation Rates on Hemodynamic Changes in Laparoscopic Surgeries: A Randomized Controlled Trial.

Introduction The injury and detrimental effects of carbon dioxide (CO2) insufflation during laparoscopic surgeries may be due to the higher flow rates used during insufflation. The aim of our study was to study the effects of different CO2 insufflation flow rates on hemodynamic parameters in laparoscopic surgeries. The secondary objectives were to compare the patient and surgeon satisfaction scores, postoperative shoulder scores, and surgical site pain scores. Methods This prospective, randomized, double-blinded trial was commenced after institutional ethical committee approval and The Clinical TrialsRegistry- India (CTRI) registration (CTRI 2021/10/037595). Ninety patients scheduled for laparoscopic cholecystectomy were randomly divided into three groups based on CO2 insufflation flow rate by computer-generated random numbers and the sealed envelope method: Group-A: 5 L/min; Group-B: 10 L/min; and Group-C: 15 L/min. General anesthesia was standardized in all three groups. Mean arterial pressure (MAP) and heart rate were recorded at different timelines, which included the arrival in the operating room (T0), just before the induction of anesthesia (T1), at the beginning of pneumoperitoneum (T2), 10 minutes (T3), 20 minutes (T4), 30 minutes (T5), and 60 minutes (T6) after the pneumoperitoneum, at the end of the operation (T7), five minutes (T8), and 15 minutes (T9) after arriving at the recovery room. The patient and surgeon satisfaction scores were assessed on a 5-point Likert scale. The visual analog score (VAS) was used to assess the surgical site pain and shoulder pain every four hours for 24 hours. The continuous data were assessed by one-way analysis of variance (ANOVA), and the categorical data were assessed by the Chi-square test. The sample size was estimated based on a pilot study and using the G Power 3.1.9.2 Program (Universitat Kiel, Germany) calculator. Results There was an increase in the mean arterial pressure (MAP) between the groups 60 min after pneumoperitoneum creation with higher flow rates. The baseline MAP was 85.76± 10.11 in group A, 86.03± 9.79 in group B, and 88.13± 8.46 in group C. At 60 min from the creation of the pneumoperitoneum, the MAP increased significantly from 99.17 ± 9.35 in group A, 102.43 ± 8.24 in group B, to 106.83 ± 8.31 in group C. This was statistically significant with a p-value of 0.004. There was a statistically significant difference in heart rate between the groups 10 minutes after pneumoperitoneum creation. No complications were reported in any of the groups. The postoperative shoulder pain was more severe when higher flows were used at 20 and 24 hours. The surgical site pain was also significantly more for up to 12 hours following surgery with higher flows. Conclusion We conclude that low-flow CO2 insufflation during laparoscopic surgeries is associated with fewer hemodynamic changes, better patient satisfaction scores, and lower postoperative pain scores.

Short-term outcomes of enhanced recovery after surgery protocol in robotic-assisted McKeown esophagectomy for esophageal cancer: a single-center retrospective cohort study.

This study aimed to evaluate the short-term outcomes of enhanced recovery after surgery (ERAS) protocol in perioperative robotic-assisted McKeown esophagectomy (RAME) among esophageal cancer patients. For this retrospective study, all patients who had undergone RAME with esophageal cancer using ERAS protocol and conventional management strategy at the surgery center of our hospital from February 2019 to March 2022 were performed for analysis. A total of 211 patients were included. Compared to the conventional group, the ERAS group has shorter median operative time [207 (147.5-267.5) vs. 244 (183-305), P<0.001], time to first flatus (P<0.001), time to out-of-bed activity (P=0.045), and time to liquid diet (P<0.001). In addition, the ERAS group has lower postoperative pain scores (3.62 ± 0.87 vs. 4.54 ± 0.91), shorter duration of analgesia pump [2 (1-3) vs. 3 (2.5-5.5)], shorter postoperative hospital stay [(9 (6-47) vs. 11 (6-79)], shorter postoperative hospital stay within neoadjuvant treated patients [8 (7-43) vs. 13 (8-67], shorter postoperative ICU stay [1 (0-7) vs. 2 (0-15)], and less reoperation rate (7.6% vs. 16.8%). Furthermore, the overall complication rate was significantly lower in the ERAS group (26.1%) than in the conventional group (50.4%). Notably, the ERAS group had lower thoracic fluid drainage volume than the conventional group on postoperative 2-7 days (P<0.05). The application of ERAS protocol in esophageal cancer patients treated with RAME showed advantages of quick postoperative recovery in contrast to the conventional management strategy.