Lower Pain Scores Research Articles

Machine learning insights into patient satisfaction following lateral lumbar interbody fusion.

Lateral Lumbar Interbody Fusion (LLIF) has become a minimally invasive procedure for treating degenerative lumbar conditions. While it offers reduced blood loss and faster recovery, patient satisfaction following LLIF surgery shows significant variability. Identifying the factors influencing satisfaction is crucial for optimizing surgical outcomes and improving patient care. This study aims to determine key factors affecting patient satisfaction after LLIF surgery using machine learning (ML) models, including Random Forest, Logistic Regression, Support Vector Machine (SVM), and k-Nearest Neighbors (k-NN). Additionally, the study evaluates the predictive performance of these models to identify the most influential factors contributing to postoperative satisfaction. A retrospective analysis was conducted on 149 patients who underwent LLIF surgery. Preoperative, intraoperative, and postoperative variables were collected, including patient demographics, clinical measures, surgical details, and functional outcomes. Based on these variables, ML models were used to predict patient satisfaction vs. not satisfied) satisfaction (s. Model performance was evaluated using fivefold cross-validation, with metrics including accuracy, precision, recall, and F1 score. Of the 149 patients, 85.2% reported satisfaction with the surgical outcome. Random Forest achieved the highest predictive performance, with an average accuracy of 82.6%, precision of 83.6%, recall of 99.2%, and an F1 score of 90.7%. Key factors influencing patient satisfaction included the preoperative low back pain score, social life function, and postoperative improvements in walking ability and mental health. Surgical factors, such as the number of fused segments and endplate injury, had less influence on satisfaction. Functional outcomes, particularly improvements in low back pain, walking ability, and mental health, are the primary determinants of patient satisfaction following LLIF surgery. In contrast, surgical factors play a less significant role. Mental health emerged as a critical factor, underscoring the importance of addressing psychological recovery through preoperative counseling and personalized postoperative care. The analysis demonstrated that ML models, especially Random Forest, are effective tools for identifying the factors most predictive of postoperative satisfaction. These findings highlight the potential of ML techniques to enhance personalized treatment planning and improve outcomes by focusing on both physical and mental recovery. Further research, including multi-center studies and the integration of psychological variables, is needed to provide a more comprehensive understanding of patient satisfaction after LLIF surgery.

Modified thoracoabdominal nerves block through perichondrial approach is effective in reducing postoperative opioids requirements in patients undergoing laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis.

The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC. We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements. This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05). M-TAPA block provides superior analgesia when compared with control group in LC.

The outcomes of the 5 mm versus 11 mm primary trocar in gynecologic surgery - randomised study.

To compare the effects of using 11 mm trocar and 5 mm trocar as primary ports on postoperative pain in benign gynecological laparoscopic surgeries. The patients were divided into two groups as the primary port, group I (5 mm trocar) and group II (11 mm trocar) by block randomization. In the 5 mm trocar group, postoperative pain score and need for analgesia were less in level I and level II operations. Patient satisfaction was significantly higher in the 5 mm trocar group. The postoperative pain score was higher in patients who had trocar insertion attempts 3 times with the direct trocar method compared to patients with 1 or 2 trocar entry attempts. The use of a 5 mm laparoscope in benign gynecological operations is an advantageous method due to low postoperative pain score, analgesic requirement, and high patient satisfaction.

Application of enhanced recovery after surgery in pediatric patients with obstructive sleep apnea-hypopnea syndrome

Background Enhanced Recovery After Surgery (ERAS) has demonstrated effectiveness in accelerating recovery and reducing complications across surgical fields, with limited application in Ear-Nose-Throat surgeries. Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), a prevalent condition affecting pediatric patients, calls for innovative management due to its impact on health and the need for surgical interventions like tonsillectomy. Objective The present study aimed to investigate the efficacy of ERAS in pediatric patients with OSAHS. Methods Review and analyze 1100 cases of pediatric patients with OSAHS who underwent plasma-coblation tonsillectomy and adenoidectomy using nasal endoscopy from June 2016 to June 2022 in our hospital. Among these cases, a total of 564 patients were managed according to ERAS theory, while 536 patients were treated with classical theory. The incidence of preoperative discomfort, postoperative pain, bleeding, and other complications between the two groups were compared. Results ERAS group showed comparable preoperative-discomfort rates to the control ( P = 0.799). However, ERAS patients exhibited significantly lower pain scores at 24-, 48-, and 72-h post-operation ( P < 0.05). Mental state scores were similar between ERAS and control 4 h pre-surgery ( P > 0.05), but notably lower in ERAS at 30 min pre-op and 6-, 12-, and 24-h post-operation ( P < 0.05). ERAS had lower complication rates and intra/postoperative bleeding, quicker ambulation/oral intake, and shorter hospital stays than control ( P < 0.05). Conclusion ERAS management in patients with OSAHS resulted in notable reductions in postoperative pain and incidence of complications, along with improved postoperative recovery and shorter hospital stays.

Establishing the first ever pediatric procedural sedation clinic in a low-income country: Assessment of the safety and efficacy.

Pediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5years since its establishment. A multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital. In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures. One hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality. Based on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.

Regional Anesthesia and Pain Outcomes After Anterior Cruciate Ligament Reconstruction Surgery in Pediatric Patients: Society of Pediatric Anesthesia Improvement Network.

Optimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms. We performed a multisite, prospective observational study of adolescent patients undergoing ACLR. Perioperative data included demographics, block details, anesthetic, and surgical techniques. Self-reported surveys documented pain scores, medication use, and neurological symptoms at various time points after the surgery (postoperative day [POD] 1, POD 3, week 6, and month 6). Associations between different groups of peripheral nerve blocks (PNBs) and the absence of a block were analyzed for their effects on acute postoperative pain outcomes. In addition, factors influencing self-reported neurological outcomes were determined using both univariate and multivariate regression. Data from 519 subjects (aged 15 years, 55.7% female) showed that 23.9% of patients with anterior plus posterior nerve blocks (A+P PNB) reported severe postanesthesia care unit (PACU) pain scores, compared to 40% with no PNB and 38.3% with anterior PNB (A-PNB). Patients receiving A-PNB or A+P PNB had significantly lower intraoperative morphine equivalents (MEs) (0.49 mg/kg and 0.46 mg/kg, respectively) vs no block patients (0.61 mg/kg). Total PACU MEs were lower for any patient who received a PNB. Multivariable logistic regression analysis showed that patients who received A+P PNB or a hamstring autograft had lower POD 1 severe pain scores (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.15-0.84 and OR = 0.35; 95% CI, 0.15-0.83, respectively). Patients with PNBs with local anesthesia concentration (LAC) greater than 0.25% reported higher POD1 pain scores (OR = 2.14; 95% CI, 1.1-4.16) compared to those with lower LAC. Patients with PNB catheters had reduced POD 1 pain. Multivariable logistic regression analysis for numbness at week 6 revealed a greater odds of numbness for A-PNB with LAC >0.25% (OR = 5.13; 95% CI, 1.27-20.8). At month 6, patients receiving PNB with perineural steroid adjuvant were more likely to report numbness (dexamethasone OR = 5.93; 95% CI, 1.61-21.9, methylprednisolone OR = 11.3; 95% CI, 2.16-58.6). Patients who received A+P PNB had lower postoperative pain scores than those who received no block. Additional studies are necessary to discern how PNB type, graft harvest site, LAC, and adjuvants influence pain control, persistent numbness, and weakness.

Effect of perioperative esketamine use on emergency delirium in children undergoing tonsillectomy and adenoidectomy: a systematic review and meta-analysis of randomized controlled trials

BackgroundEmergence delirium(ED) is a common postoperative complication in children undergoing tonsillectomy and adenoidectomy under general anesthesia. There is no high-quality evidence on the relationship between esketamine and ED. The systematic review and meta-analysis was performed to investigate the effect of perioperative esketamine use on ED in children undergoing tonsillectomy and adenoidectomy.MethodWe searched Embase, The Cochrane Library, PubMed, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, VIP, and SinoMed from inception to 1 September, 2024. Two evaluators identified randomized controlled trials comparing perioperative use of esketamine with placebo or other drugs in children undergoing tonsillectomy and adenoidectomy. Incidence of ED was the primary outcome of the study. Data synthesis was performed by using Review Manager 5.4 software.ResultsTwenty-three relevant studies involving a total of 1,996 children were identified. Perioperative use of esketamine reduced the incidence of ED in children undergoing tonsillectomy and adenoidectomy (RR = 0.33, 95% CI: [0.25, 0.44], p &amp;lt; 0.00001, I2 = 0%). Scores of ED were lower in the esketamine group than in the control group (SMD = -1.20, 95% CI: [−1.56,-0.84], p &amp;lt; 0.00001, I2 = 88%). Children in the esketamine group have lower postoperative pain scores (SMD = -0.51, 95% CI: [−0.80,-0.39], p &amp;lt; 0.00001, I2 = 74%). Esketamine was also associated with a lower incidence of adverse events (RR = 0.75, 95% CI: [0.57, 0.99], p = 0.04, I2 = 62%). We also found that the use of esketamine reduced the length of stay in the post-anesthetic care unit (PACU) but had no effect on the time to extubation.ConclusionPerioperative use of esketamine could significantly reduce the incidence of ED in children undergoing tonsillectomy and adenoidectomy. However, the optimal dose and timing of esketamine administration for preventing ED remains to be explored.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=558560, PROSPERO: CRD42024558560.

Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial.

The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference,-0.889; 95% CI,-1.464 to -0.314; P < 0.001), 2 (mean difference,-0.631; 95% CI,-1.211 to -0.051; P =0.014), and 3 (mean difference,-0.798; 95% CI,-1.345 to -0.251; P < 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.

Improvement in Central Sensitization Following Total Knee Arthroplasty Is Associated With Severe Preoperative Pain and Affects Postoperative Quality ofLife:A Retrospective Study.

Central sensitization (CS) is associated with quality of life (QOL) after total knee arthroplasty (TKA). However, how CS changes after TKA and whether these changes have clinical relevance remain unclear. Therefore, this study was conducted to identify changes in CS after TKA and to assess the clinical significance of these changes. This retrospective study was conducted on 92 patients between January 2021 and May 2023. CS severity was quantified using the Central Sensitization Inventory (CSI). One year after TKA, the patients were divided into groups based on whether CS severity improved by ≥ 1 level (improved group) or did not improve (non-improved group). The differences in preoperative and postoperative characteristics of patients in the two groups were analyzed. These characteristics included demographics, underlying diseases, physical examinations, and the Hospital for Special Surgery (HSS) knee score. QOL improvement was compared based on two different minimal clinically important changes (MIC) in the Short-Form Health Survey (SF-36). Continuous variables were compared using Student's t-test or the Mann-Whitney U-test. The chi-squared test was used to compare categorical variables. The postoperative CS severity in patients was significantly lower compared to preoperative levels (p < 0.001). The improved group exhibited a lower HSS knee pain score (p < 0.001). Out of the eight SF-36 scales, five showed significantly greater improvement in the improved group compared to the non-improved group. The mean postoperative increases in scores for all eight SF-36 scales exceeded the MIC in the improved group, whereas half of the scales fell below the MIC in the non-improved group. CS showed improvement after TKA, particularly in patients with more severe preoperative pain. This improvement appears to be correlated with the improvement in QOL after TKA.

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.

Efficiency of immersive virtual reality game technology on pain management in children with limb fractures: A randomized controlled trial.

Children with fractured limbs usually have moderate to high pain, and distraction can help reduce their pain and anxiety. Virtual reality technology is an emerging method of distraction. We investigated whether the use of immersive virtual reality gaming technology to treat perioperative pain in children with school-age limb fractures effectively. Ninty-nine patients who had limb fracture surgery between October 2021 and September 2022 were randomly assigned to receive immersive virtual reality game therapy (Group A), non-immersive virtual reality game therapy (Group B), or conventional treatment group (Group C). Changes in pain, anxiety, fear, and biochemical markers were assessed at various time points in the three groups using subjective and objective rating scales. Both Group A and Group B consistently showed lower pain scores, fear levels, and anxiety levels compared to Group C after surgery, statistical analysis revealed significant differences among the three groups (p<0.001). Additionally,serum levels in group A were significantly lower than those in other groups, showing a notable statistical discrepancy (p<0.001). Both immersive and non-immersive virtual reality gaming significantly reduce perioperative pain, fear, and anxiety in children with limb fractures, and have practical significance for pain management of pediatric orthopedic patients. Immersive virtual reality, however, appears to have a more pronounced effect. The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry(ChiCTR210004583).

CD34hi subset of synovial fibroblasts contributes to fibrotic phenotype of human knee osteoarthritis.

Osteoarthritis (OA) shows various clinical manifestations depending on the status of its joint components. We aimed to identify the synovial cell subsets responsible for OA pathophysiology by comprehensive analyses of human synovium samples in single-cell resolution. Two distinct OA synovial tissue groups were classified by gene expression profiles in RNA-Seq: inflammatory and fibrotic. The inflammatory group exhibited high expression of inflammatory cytokines, histologically inflammatory infiltrate, and a more severe pain score. The fibrotic group showed higher expression of fibroblast growth factor (FGFs) and bone morphogenetic proteins (BMPs), showed histologically perivascular fibrosis, and showed a lower pain score. In single-cell RNA-Seq (scRNA-Seq) of synovial cells, MERTKloCD206lo macrophages and CD34hi fibroblasts were associated with the inflammatory and fibrotic groups, respectively. Among the 3 fibroblast subsets, CD34loTHY1lo and CD34loTHY1hi fibroblasts were influenced by synovial immune cells, whereas CD34hi fibroblasts were influenced by mural and endothelial cells. Particularly, in CD34hi fibroblast subsets, CD34hiCD70hi fibroblasts promoted proliferation of Tregs, potentially suppressing synovitis and protecting articular cartilage. Elucidation of the mechanisms underlying the regulation of these synovial cell subsets may lead to novel strategies for OA therapeutics.

P1112 Pharmacokinetic comparability and safety between original and citrate-free mirikizumab formulations for subcutaneous injections: Results from three clinical trials in healthy participants

Abstract Background Mirikizumab (miri), a humanized IgG4 monoclonal antibody which selectively binds to the p19 subunit of human IL-23, is administered via subcutaneous (SC) injection. Since injection site pain (ISP) may be negatively affected by formulation buffer excipients such as citrate1, a citrate-free (CF) formulation of miri has been developed. We assessed the bioequivalence, ISP, and overall safety of the CF formulation of miri. Methods Three phase 1, two-arm, randomised, single-dose, subject-blind, parallel design studies were conducted in healthy subjects: one pilot relative bioavailability (RBA) study A (NCT04548219), and two bioequivalence (BE) studies B (NCT05515601) and C (NCT05644353). Subjects were randomised 1:1 to CF or original miri in all studies. The primary endpoint in all studies was to assess the comparability between CF and original formulations via Cmax, area under the concentration versus time curve (AUC) (0-∞), and AUC(0-tlast). Study A assessed the RBA of a single 200 mg SC dose, Study B assessed the BE of a single 200 mg SC dose, and Study C assessed the BE of a single 300 mg SC dose. The 200 mg and 300 mg doses are proposed for ulcerative colitis and Crohn’s disease, respectively. The secondary endpoint was safety assessment by spontaneous treatment-emergent adverse events and serious adverse events. In addition, in Study A, ISP was also quantified prospectively using the 100-mm validated visual analogue scale (VAS) assessment form2. Injection site reactions (ISRs) were prospectively assessed in Study A. Results The number of subjects who received miri were 60 in Study A, 396 in Study B, and 450 in Study C. Baseline characteristics were similar across studies and treatment groups. There was no statistically significant difference in exposure between the formulations in Study A. Figure 1 shows that the CF formulation demonstrated BE in Studies B and C, with the 90% confidence intervals (CIs) of the ratios of geometric least squares means (LSM) within the pre-specified equivalence limits. Figure 2 shows a statistically significant difference of 13.43 in the VAS Pain Score LSM at 1-minute post-dose for Study A, which is also considered clinically relevant3. Overall, CF and original miri demonstrated an acceptable safety profile consistent with previous work in healthy participants. Conclusion The CF formulation of mirikizumab is bioequivalent to the original formulation and is associated with a lower VAS pain score which may positively affect treatment experience.

What is the most effective method for reducing pain during debonding procedures? A systematic review.

This study aimed to investigate the most effective methods in controlling pain during debonding procedures. Electronic searches in published and unpublished studies were performed. Restricted to the English language and publication date up to 23/3/2024, the searches in published literature covered the following databases: MEDLINE, PubMed, EMBASE, Tripe, Web of Science, Scopus and PubMed Central. However, unpublished literature was searched at ClinicalTrials.gov, National Research Register, and ProQuest Dissertations and Theses. Lists of all eligible studies were checked for further scrutiny. Risk of bias for randomized and non-randomized control trials was assessed using ROB2 and ROBINS Cochrane tools. Thirteen RCTs and two non-RCTs were included. All the reviewed articles studied the pain during debonding events and included 886 patients aged between 12-65. They used different scales such as VAS, NRS, Wong-Baker faces, and others scales. Two studies have shown that the lift-off plier causes less pain than other pliers when comparing different types of dental instruments. However, when comparing different adjunctive techniques, two studies have found that using a wafer causes less pain, while two studies have reported no significant difference between methods and one study has found that using finger pressure causes less pain. In addition, three separate studies have found that utilizing an ultrasonic device, as well as a thermal device and laser radiation, can lead to lower pain scores. Furthermore, two studies have demonstrated that using medication has a positive impact on reducing pain. According to reported evidence, applying finger pressure is more effective in relieving pain in the anterior teeth, while wafer biting is more effective in the posterior teeth. Pain-relieving medications like paracetamol or ibuprofen can also effectively reduce debonding pain. Promising procedures, such as using diode or Er-YAG lasers, and thermal devices, may also be effective, but further studies are needed to confirm their efficacy. The protocol of this systematic review was registered with the PROSPERO International Database under ID number CRD42024529190. This review follows the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the instructions provided in the Cochrane Handbook.

Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial.

Laparoscopic sleeve gastrectomy (LSG) causes significant postoperative pain, necessitating effective multimodal analgesia strategies. This study evaluated the efficacy of the external oblique intercostal block (EOIB) in this context. This prospective, randomized, controlled, single-blind study conducted between April and December 2023 included 60 patients who underwent LSG. Patients were divided into the EOIB (30 ml 0.25% bupivacaine/side) and control (no block) groups. The primary outcome was the cumulative intravenous (IV) morphine milligram equivalent (MME) consumption in the first 24 h postoperatively. Secondary outcomes included 12-h MME consumption, pain scores, intraoperative remifentanil use, rescue analgesia requirements, time to first analgesic request, nausea/vomiting scores, antiemetic use, and American Pain Society Patient Outcome Questionnaire-Revised Turkish Version (APS-POQ-R-TR) scores. The control group had significantly higher median opioid consumption than the EOIB group at 12 (14.4 vs. 5.8 mg; P < 0.001) and 24 h (25.9 vs. 10.6 mg; P < 0.001) postoperatively. The need for rescue analgesics did not differ significantly (43.3 vs. 23.3%: P = 0.1). The EOIB group exhibited significantly higher patient satisfaction (APS-POQ-R-TR score 2.91 vs. 4.42; P < 0.001) and consistently lower pain scores across all time points (P < 0.001) The EOIB group had lower nausea/vomiting scores (P < 0.001), fewer patients requiring antiemetics (16.7% vs. 40%; P = 0.045), longer time to first morphine request (57.5 vs. 25 min; P < 0.001), and lower remifentanil use (850 vs. 1050 μg; P < 0.001). The preoperative EOIB, as a part of multimodal analgesia, provides effective analgesia for acute pain in patients undergoing LSG.

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.

Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study.

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.

Utilizing vaginal natural orifice to facilitate bowel manipulation during totally intracorporeal ileal conduit construction: a retrospective cohort study

Objective To explore the feasibility and efficacy of the modified technique of totally intracorporeal ileal conduit (IC) construction via vaginal approach following robot-assisted radical cystectomy (RARC) in females. Methods By comparing the perioperative outcomes of the modified technique with extracorporeal urinary diversion (ECUD), 31 females treated for bladder cancer with RARC and IC from May 2020 to December 2023 were retrospectively analyzed and divided into two groups: the ECUD group (10 patients) and the modified intracorporeal urinary diversion (MICUD group) (21 patients). The modified technique involved performing transvaginal natural orifice specimen extraction surgery (TV-NOSES) after RARC; followed by the transvaginal placement of an Endo-GIA stapler to manipulate the bowel for intracorporeal IC construction. Results Both groups’ surgeries were successfully completed by the same surgeon and team. Patients in the MICUD group had shorter total operative time, lower postoperative pain scores, quicker recovery, and shorter hospital stays. The learning curve of the MICUD showed two phases: a learning phase (cases 1-7) and a proficiency phase (cases 8-21). The incidence of postoperative complications between the two groups was similar. The mean follow-up times were 29.3 months (ECUD group) and 22.6 months (MICUD group). In the MICUD group, there was one case of local tumor recurrence, two cases of distant metastasis, including one death from progression; in the ECUD group, one patient had distant metastasis and died from progression. Conclusion RARC with MICUD represents a safe, feasible and easy-to-learn minimally invasive surgical approach. Patients experience less trauma and faster recoveries.

Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study

BackgroundThere are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure.MethodsAll patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected.ResultsThe final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR −11.7; 95% CI −22.35 to −1.04; P = 0.031), KOOS symptoms score (OR −17.11; 95% CI −28.85 to −5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR −11.15; 95% CI −21.71 to −0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR −9.99; 95% CI −15.77 to −4.22; P = 0.001).ConclusionsThe clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.Study designRetrospective cohort study; level of evidence, 3

Efficacy and safety of preoperative duloxetine in reducing post-laparoscopic surgery pain: a meta-analysis of randomized placebo-controlled trials.

Recent studies suggest that duloxetine administration before non-laparoscopic surgery may reduce postoperative pain and analgesic requirement without increasing adverse event occurrence. To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on preoperative administration of duloxetine versus placebo for postoperative pain relief in adults undergoing laparoscopic surgery, assessing efficacy- and safety-related outcomes. We systematically searched MEDLINE, Embase, and Cochrane Library, covering all records up to July 19, 2024. Inclusion criteria consisted of RCTs comparing preoperative administration of duloxetine versus placebo in adults undergoing laparoscopic surgery and reporting at least one outcome of interest. The random-effects model was used to estimate the mean difference (MD) and risk ratio (RR), along with their respective 95% confidence intervals (95%CIs). We included four RCTs (227 patients). Compared with placebo, duloxetine provided a statistically lower pain scores at 2 (MD -1.04; 95%CI -1.75, -0.33), 4 (MD -1.28; 95%CI -1.77, -0.79), 8 (MD -1.22; 95%CI -1.72, -0.72), 12 (MD -1.64; 95%CI -2.88, -0.41), and 24h (MD -1.05; 95%CI -1.72, -0.39) after surgery. Duloxetine also granted a statistically longer time to first analgesic requirement (MD 128.38min; 95%CI 41.31, 215.46), compared with placebo. Additionally, the duloxetine group had a significantly lower risk of nausea/vomiting (RR 0.48; 95%CI 0.25, 0.90), while there were no significant differences between both groups for the risk of dizziness, headache, and somnolence. Compared with placebo, duloxetine administration before laparoscopic surgery significantly minimized postoperative pain intensity, delayed analgesic requirement, and reduced nausea/vomiting risk.