Method Of Postoperative Analgesia Research Articles

Feasibility study on local infiltration anesthesia for postoperative analgesia in patients with hallux valgus

To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus. From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded. All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group(P<0.05). There was no significant difference in VAS between the two groups 72 hours after operation (P>0.05). There was no significant difference in the number of adverse drug reactions between the two groups at 0 to 12 hours after operation (P>0.05);there was significant difference in the number of adverse drug reactions 12 to 24 hours after operation (P<0.05). No adverse drug reactions occurred in both groups 24 to 48 hours after operation. There was no significant difference in the grade of knife edge healing between the two groups after suture removal (P>0.05). Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.

APPLICATION OF THE MODIFIED PECS BLOCKADE DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE MAMMARY GLANDS

Existing methods of anesthesia, drugs used in the field of breast plastic surgery have a number of features compared to anesthesia in the practice of general surgery. In particular, techniques of regional blockades, such as interfascial blocks PECS 1 and PECS 2 are taken into account. Their effectiveness in comparison with standard methods of anesthesia for different types of interventions on the breast is subject to further discussion.&#x0D; Thus, the article presents the results of efficiency in the implementation of the author's development - a modified PECS-block during reconstructive and aesthetic surgery on the mammary glands.&#x0D; Material and methods. During 2018-2020, 58 women (average age 36,8 ± 10,8 years) were included in the prospective study, who underwent low-flow inhalation anesthesia with sevoflurane during surgery, and in the postoperative period were divided into two subgroups: 1) subgroup 1, in whom regional anesthesia according to the author's method used; 2) subgroup 2 with nalbuphine analgesia. At the first visit, clinical and laboratory, instrumental ultrasound examination, completed informed consent cards of patients, as well as long-term observation cards were filled in.&#x0D; The method of postoperative analgesia developed by the author's method is, in essence, a combination of PECS 1 and PECS 2 blockades. The anesthetic solution was administered so as to effectively block the intercostal nerves that run along the posterior surface of the chest and extend outward into the parasternal region.&#x0D; For statistical analysis of the obtained results we used a package of general statistic data “Statistica for Windows” version 6.0 (Stat Soft inc., USA). At p&lt;0, 05, the difference was considered statistically significant.&#x0D; Results. It was found that the use of modified PECS-block was characterized by a shortening of the verticalization time by 58,8%, compared with the introduction of nalbuphine and 2,16 times in the absence of postoperative anesthesia. The absolute efficiency (AE,%) of the modified PECS-block relative to the verticalization time was 68,0% higher compared to the use of nalbuphine, with a probable relative efficiency (RR, p&lt;0,05) and the odds ratio (OR, p&lt;0,05). 3 hours after the intervention of AE modified PECS-block relative to the intensity of pain less than 1 point was 89,0%, with a clinical efficiency of 60,0% relative to the use of nalbuphine, probable RR (p&lt;0,05) and OR (p&lt;0,05). The majority of patients who underwent modified PECS-block rated their physical and motor activity by more than 2 points (86,0%), while using nalbuphine the part was only 43.0% (p&lt;0,05). The reversal, moderate regression relationship between pain self-esteem and physical activity (r=-0.46, p&lt;0.05) persisted for 3 hours after the intervention.&#x0D; Against the background of the modified PECS block, there was no cases of postoperative nausea, in contrast to nalbuphine (AE – 18,0%, RR – 0,02 [0,003-0,97], p&lt;0,05; HS – 0,02 [0,004-0,87], p&lt;0,05). Regarding the parameters of cardio hemodynamics, it was found that against the background of nalbuphine there was an increase in heart rate to 29,3% after 1 hour, by 48,6 and 39,7% after 3 and 8 hours, compared with the modified PECS-block. The tendency to high (greater than 140 mm Hg) and high normal (greater than 130 mm Hg) blood pressure on the background of nalbuphine, in contrast to the modified PECS-block, where the CAT values during the 1st day stayed in the range of optimal pressure (110-130 mm Hg).

Влияние уровня противовоспалительного гормона кортизола в сыворотке крови на частоту возникновения хронического болевого синдрома у больных после торакотомии в зависимости от использованных методов послеоперационного обезболивания

Актуальность. При торакотомии повреждение тканей сопровождается повышением в крови маркеров воспаления, которые влияют на развитие хронического болевого синдрома. Цель исследования: изучить влияние различных методов послеоперационного обезболивания на состояние гормонов гипофизарно-надпочечниковой системы (гормонов стресса) и иммуноцитокиновый статус у больных после торакотомии. Материалы и методы. 85 больных после торакотомии были распределены на три группы. Обезболивание проводили с помощью пролонгированной паравертебральной аналгезии (ПВА) (n = 19) и пролонгированной эпидуральной аналгезии (ЭДА) (n = 36) 0,2% раствором ропивакаина, в контрольной группе (n = 30) — внутривенной контролируемой пациентом аналгезией (КПА) раствором морфина. В течение трех суток после операции исследовали уровни глюкозы крови, инсулина, интерлейкина (IL)-6, кортизола, фибриногена и С-реактивного протеина. Для оценки влияния различных методов обезболивания на формирование хронической боли проводили опрос больных через 6 месяцев после торакотомии. Результаты. У больных всех исследуемых групп в течение 72 часов послеоперационного периода сохранялась нормогликемия. Максимальный рост уровня инсулина наблюдался в контрольной группе на третьи сутки послеоперационного периода и составлял 62,54 ± ± 5,56 мкМЕ/мл. В опытных группах уровень инсулина также повысился, но был значительно ниже контрольной группы. Максимальный подъем уровня IL-6 наблюдался в первые сутки послеоперационного периода во всех трех группах и был следующим: в контрольной группе — 81,63 ± 38,40 пг/мл, в группе ЭДА — 70,69 ± 27,29 пг/мл, в группе ПВА — 80,12 ± 25,14 пг/мл. На третьи сутки уровень IL-6 снижался и был примерно одинаковым во всех группах. Максимальное увеличение С-реактивного протеина наблюдалось в контрольной группе — с 0,05 ± 0,02 мг/дл до 1,53 ± 0,60 мг/дл. В группе ЭДА — с 0,38 ± ± 0,23 мг/дл до 2,34 ± 0,84 мг/дл, в группе ПВА — с 0,32 ± ± 0,16 мг/дл до 2,14 ± 0,95 мг/дл. Уровень кортизола в группе ПВА через 24 часа после операции увеличился с 16,80 ± 2,33 мкг/дл до 27,78 ± 7,92 мкг/дл. В других исследуемых группах уровень кортизола оставался практически неизменным. Через 72 часа послеоперационного периода наиболее выраженная противовоспалительная реакция сохранялась в группе ПВА, где уровень кортизола составил 25,95 ± 7,87 мкг/дл (в контрольной группе — 23,64 ± 3,01 мкг/дл; в группе ЭДА — 23,26 ± 3,06 мкг/дл). В контрольной группе хроническая боль развилась через 6 мес. у 8 больных (53 %); в группе ЭДА — у 5 больных (33,3 %); в группе ПВА — у 3 больных (20 %). Выводы. Во всех группах наблюдались стабильные показатели гликемии. Уровень инсулина в контрольной группе был значительно выше. Применение ПВА и ЭДА обеспечивало лучшее стресс-протективное действие, но приоритет оставался за ЭДА. Динамика уровня кортизола показала, что наиболее выраженная системная противовоспалительная реакция наблюдалась в группе ПВА. Отмечена заметная связь между частотой возникновения хронического болевого синдрома, качеством обезболивания и уровнем кортизола плазмы крови в раннем послеоперационном периоде.

Влияние методов послеоперационного обезболивания на моторную функцию желудочно-кишечного тракта у детей с перитонитом, осложненным интраабдоминальной гипертензией

Актуальность. Метод послеоперационного обез­боливания может влиять на скорость восстановления моторной функции желудочно-кишечного тракта, уровень интраабдоминального давления (ИАД) и способствовать развитию интраабдоминальной гипертензии (ИАГ). Цель: исследовать влияние методов послеоперационного обезболивания на моторную функцию кишечника у детей с перитонитом, осложненным ИАГ. Материалы и методы. 115 детей, которым были проведены оперативные вмешательства по поводу аппендикулярного перитонита, рандомизированы на группы в зависимости от метода послеоперационного обезболивания: «Опиоиды» (n = 36, инфузия морфина), «Лидокаин» (n = 40, инфузия лидокаина), «ЭДА» (n = 39, эпидуральная аналгезия). В зависимости от уровня ИАД и наличия органной дисфункции дети каждой группы были разделены на подгруппы: «без ИАГ» (ИАД &lt; 10 мм рт.ст.), «ИАГ» (ИАД &gt; 10 мм рт.ст.) и «АКС» (абдоминальный компартмент-синдром, ИАГ с органной дисфункцией). Всем детям в послеоперационном периоде проводилось измерение уровня ИАД и оценка скорости восстановления моторной функции желудочно-кишечного тракта. Результаты. Во всех подгруппах группы «ЕДА» время до восстановления перистальтики и первых испражнений и объем остатка по назогастральному зонду были статистически значимо меньшими по сравнению с аналогичными показателями в подгруппах группы «Опиоиды» (Р &lt; 0,05). В подгруппах «ИАГ» и «АКС» группы «ЭДА» также было статистически значимо меньшим время до первых испражнений по сравнению с аналогичными показателями в подгруппах группы «Лидокаин» (Р &lt; 0,05). Статистически значимо меньшими были время до восстановления перистальтики и объем остатка по НГЗ во всех подгруппах группы «Лидокаин» по сравнению с аналогичными показателями группы «Опиоиды» (Р &lt; 0,05). Эпизоды повышения ИАД &gt;10 мм рт.ст. значительно чаще встречались у детей в группе «Опиоиды», чем в группах «Лидокаин» и «ЭДА» (Р &lt; 0,05). Количество эпизодов ИАД &gt; 10 мм рт.ст. имело прямую корреляцию с длительностью времени восстановления перистальтики, но сила такой корреляции была выше в группах «Опиоиды» (rs = 0,78; p = 0,001 и rs = 0,76; p = 0,01) и «Лидокаин» (rs = 0,58; p = 0,008 и rs = 0,95; p = 0,01), чем в группе «ЭДА» (rs = 0,39; p = 0,16 и rs = 0,46, p = 0,43). Выводы. ЭДА является оптимальным методом послеоперационного обезболивания у детей с перитонитом, осложненным ИАГ, который приводит к раннему восстановлению моторной функции ЖКТ и предотвращает дальнейший рост ИАД. Инфузия лидокаина может быть использована как альтернативный метод обезболивания. Системная опиоидная аналгезия оказывает негативное влияние на моторику желудочно-кишечного тракта.

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

Pain management after cesarean section surgery- medicaments and methods: literature review

Eglė Žukauskaitė1, Lina Raišytė1 1Faculty of Medicine of the Medical Academy of the Lithuanian University of Health Sciences Abstract Background. Adequate postoperative analgesia after caesarean section surgery is very essential. It determines maternal healing process, recovery and the emotional state on which mother‘s and newborn‘s health depend. Opioid analgesics still remain the main choice for reducing postoperative pain but due to their side effects and possible addiction syndrome it is recommended to assess the situation individually and, if necessary, to use several drugs with different mechanisms – multimodal analgesia. The aim of this article is to analyse the possibilities and methods of postoperative analgesia after caesarean section, medications, their effects on the mother and the newborn. Materials and methods: a search of scientific articles was performed in PubMed, ScienceDirect, Cochrane, UpToDate databases. The search was performed using the selected keywords. The literature review includes 40 scientific publications describing the post-CPO analgesia, medications used, their side effects and complications. Results. It is currently recommended that multimodal analgesia be considered as the first-line treatment, starting with acetaminophen with NSAIDs during surgery and adding a weaker opioid after surgery. However, it is important to weigh the benefits and risks of breastfeeding when giving opioid analgesics to the newborn and to assess the side effects on the mother. Conclusions: 1. For women after CPO, the method of analgesia is selected individually according to the state of health and the woman’s wishes. 2. Multimodal analgesia is recommended for post-CPO pain relief in women. 3. It is advisable to use acetaminophen and NSAIDs during breast-feeding, if necessary, opioid analgesics may be given. 4. Side effects of analgesics depend on the dose administered. Keywords: caesarean section surgery, analgesia, multimodal analgesia.

Comparative study between ultrasound-guided pudendal nerve block and caudal epidural block anesthesia in children undergoing hypospadias surgery

BackgroundThe aim of the study is to compare the effectiveness and safety of ultrasound-guided pudendal nerve block versus caudal epidural block as a part of multimodal analgesia in children undergoing hypospadias surgery.In this prospective, single-blinded study, 50 patients were randomized into 2 groups (25 each group) either receiving ultrasound-guided pudendal nerve block group A or caudal epidural block group B. In the pudendal nerve block group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the caudal epidural group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. Consumption of paracetamol was assessed during the first 24 h postoperatively. The “objective pain scale” done by Hannalah and Broadman was used to assess postoperative pain.ResultsThis prospective randomized controlled single-blind clinical study was performed on total (50) ASA status I or II patients, of age 3 to 6 years scheduled for hypospadias surgery.For the primary outcome, there was no statistically significant difference found between the two studied groups regarding objective pain score at arrival to PACU with p value = 1.000 while there was a statistically significant increase in pain score in group B than group A at 6 h and 12 h with p value = 0.017 and 0.003, respectively. Also, no statistically significant difference found between the two groups after 18 h with p value = 0.238 may be due to receiving acetaminophen dose in group B. Finally there was a statistically significant increase found in objective pain score in group B at 24 h than group A with p value = 0.015. And there was a statistically significant increase in time to first analgesia in group A than group B with p value < 0.001 while there was a statistically significant increase in total dose of acetaminophen in group B than group A with p value < 0.001.ConclusionBoth ultrasound-guided pudendal block and caudal epidural block are effective and safe methods for postoperative analgesia for children undergoing hypospadias surgery but ultrasound-guided pudendal block gives more postoperative pain control.

An evaluation of regional anesthesia complications and patient satisfaction after cesarean section

Background/Aim: In obstetric anesthesia, regional techniques are considered advantageous for maternal mortality and morbidity. Nevertheless, serious or less severe complications related to regional anesthesia may occur. This study aimed to determine the postoperative early complications and assess postoperative pain and satisfaction of the patients by conducting a postoperative survey among those operated with regional anesthesia on the day after cesarean section. Methods: All patients who underwent a cesarean section with regional anesthesia during the day within six months at our institution were considered for eligibility to participate in this cross-sectional study. On the day after the surgery, an anesthesiologist visited the patients and collected postoperative data, including demographic data and previous anesthesia experience, presence and intensity of the pain (current and from the operation until the postoperative visit), postoperative analgesia method, postoperative nausea, and vomiting (PONV), urinary catheterization, gas discharge, presence of backache, headache, shoulder pain, and initiation and the difficulties of breastfeeding. The patients were also questioned about their comfort during the operation, and their satisfaction with the anesthetic technique used. Results: A total of 729 patients participated in the survey. Postoperative pain was managed with paracetamol and non-steroidal anti-inflammatory drugs in 696 (95.5%) patients, PCEA in 25 (3.4%) patients and intravenous PCA in 8 (1.1%) patients. Six hundred and ninety-three (87.7%) patients had pain at the time of the visit and the mean VAS score of current pain intensity was 4.2 (1.7). Seven hundred and twenty-two (99.0%) patients had pain between the end of the operation until the postoperative visit and the mean VAS score of maximum pain intensity was 6.4 (2.0). The mean time until postoperative pain began was 3.7 (2.4) hours. Among all, 48.7% of the patients experienced backache, 36.9% had shoulder pain, 17.8% had postoperative nausea, 6.6% had postoperative vomiting, and 20.2% had a postpartum headache. Breastfeeding was not initiated until the first postoperative day in 87.5% of the patients and the mean time until the onset of breastfeeding was 1.9 (2.8) hours. The intraoperative comfort and satisfaction with the anesthesia method were rated as good/very good by 74.7% and 84.4% of our patients, respectively. Conclusion: Backache and shoulder pain are the most frequent minor complications in patients operated with regional anesthesia on the day after cesarean section. Determining and overcoming postoperative early complications is important for the satisfaction of patients after cesarean section.

Is wound catheter needed for local high-volume infiltration anesthesia in total knee replacement?

BACKGROUND: The use of local high-volume infiltration anesthesia (LHVIA) is becoming increasingly popular for postoperative analgesia in total knee arthroplasty (TKA). However, one of the elements of the technique is the use of an intraarticular or wound catheter to prolong the analgesic effect.&#x0D; AIM: Therefore, the investigation aimed to estimate wound catheter use as a component of LHVIA in TKA.&#x0D; MATERIALS AND METHODS: The study included 102 patients who underwent primary TKA for stage 3 gonarthrosis under spinal anesthesia with intravenous sedation. Two groups were formed by envelope randomization: the LHVIAc group (n=51) in which the wound catheter was placed at the end of the operation and followed by the infusion of the local anesthetic solution for 24 h; and the LHVIA group (n=51) in which the patients were treated without a catheter.&#x0D; RESULTS: The groups were comparable in terms of sex, age, and the nature of the pathology. The LHVIAc group showed a significantly decreased severity of pain in 46 h after surgery, both at rest and during flexion of the knee (p=0.001 and p=0.003). On postoperative day 1, the use of the wound catheter contributed to a significantly decreased severity of pain syndrome when flexing the knee (p=0.002). No infectious complications or significant adverse reactions were recorded in the groups.&#x0D; CONCLUSION: 1) LHVIA is an effective method of postoperative analgesia in TKA; 2) the use of the catheter in the early postoperative period increased the analgesic effect of LHVIA without increasing the frequency of infectious and other complications; 3) the use of the wound catheter reduced the severity of pain syndrome in postoperative day 1 during activation, which facilitates postoperative rehabilitation of patients with TKA.

A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty.

BackgroundPostoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions.MethodsWe performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsWe included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices.ConclusionsOur findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

Sacral erector spinae plane block for analgesia after hip surgery

Erector spinae plane block (ESPB) is an interfascial plane block used for providing analgesia in acute or chronic perioperative/postoperative pain for various indications. The case reports presented here describe the use of sacral ESPB for postoperative pain control in two patients who were operated on for a femur fracture. One underwent spinal anesthesia and the other underwent general anesthesia. The sacral ESPB technique has been described and the pain scores and the analgesia requirements of the patients during postoperative 48 hours have been reported. We observed that sacral ESPB is an effective method for postoperative analgesia in patients undergoing surgery for the treatment of a femoral fracture through a posterolateral approach.

Comparison of transversus abdominis plane catheters with thoracic epidurals for cost and length of stay in open colorectal surgeries: a cohort study

BackgroundThoracic epidural analgesia has long been a common method of postoperative analgesia for major open abdominal surgeries and is frequently used within enhanced recovery after surgery programs. An alternative postoperative analgesia method is the single shot transversus abdominis plane block, which has shown promising outcomes with respect to total length of stay, cost, pain scores, and decreased opioid usage. However, far less is known regarding continuous transversus abdominis plane analgesia using catheters. We evaluated the total cost-effectiveness of transversus abdominis plane catheter analgesia compared to thoracic epidural analgesia for patients undergoing open colorectal surgeries within the enhanced recovery after surgery program at our institution.MethodsThis cohort study included patients booked under the colorectal surgery enhanced recovery after surgery program from November 2016 through March 2018 who received either bilateral transversus abdominis plane catheters (n = 52) or thoracic epidural analgesia (n = 24).ResultsThere was no difference in total direct cost (p = 0.660) and indirect cost (p = 0.220), and median length of stay (p = 0.664) in the transversus abdominis plane catheter group compared to the thoracic epidural group. Additionally, the transversus abdominis plane catheter group received significantly less morphine equivalents compared to the thoracic epidural group (p = 0.008) and had a lower mean body mass index (p = 0.019). There was no significant difference between the two groups for age (p = 0.820), or sex (p = 0.330).ConclusionsTransversus abdominis plane catheter analgesia is not associated with increased cost or longer hospital stays when compared to thoracic epidural analgesia in patients undergoing open colorectal surgery within an enhanced recovery after surgery program. Furthermore, transversus abdominis plane catheter analgesia led to decreased opioid consumption while maintaining similar pain scores, suggesting similar pain control between the two modalities.

Effect of quadratus lumborum block on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial

BackgroundQuadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries. However, whether QLB can affect early postoperative cognitive function by inhibiting surgical traumatic stress and the inflammatory response remains unclear. This study aimed to explore the effect of QLB on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy.MethodsSixty-four elderly patients who underwent laparoscopic radical gastrectomy were randomly divided into the QLB group (Q group, n = 32) and control group (C group, n = 32). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure cognitive function 1 day before and 7 days after surgery. Postoperative cognitive dysfunction (POCD) was defined as a decline of ≥ 1 SD in both tests. The visual analog scale (VAS) scores 6 h (T1), 24 h (T2), and 48 h (T3) after surgery were measured. The serum levels of high mobility group box protein 1 (HMGB1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were evaluated 1 day before surgery (baseline), and 1 day (day 1) and 3 days after surgery (day 3). The intraoperative remifentanil dosage, sufentanil consumption 24 h after surgery, recovery time from anesthesia, and adverse effects were also compared.ResultsPOCD was present in two patients in the QLB group and eight patients in the C group 7 days after surgery (6.7 % vs. 27.6 %, P = 0.032). The MMSE and MoCA scores were similar in both groups preoperatively, and the two scores were higher in the QLB group than in the C group 7 days after surgery (P < 0.05). The VAS scores were significantly lower in the Q group at all times after surgery (P < 0.05). Compared with the C group, the levels of HMGB1, TNF-α, and IL-6 were significantly decreased 1 and 3 days after surgery in the QLB group (P < 0.05). The remifentanil consumption intraoperatively and sufentanil 24 h postoperatively were significantly lower in the QLB group (P < 0.05). The recovery time from anesthesia was shorter in the QLB group (P < 0.05). No severe adverse effects occurred in either group.ConclusionsQLB could improve postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. This may be related to the suppression of the inflammatory response after surgery.Trial registrationChictr.org.cn identifier ChiCTR1900027574 (Date of registry: 19/11/2019, prospectively registered).

THE INFLUENCE OF POSTOPERATIVE ANALGESIA TECHNIQUES ON SPLANCHIC BLOOD FLOW IN CHILDREN WITH INTRAABDOMINAL HYPERTENSION

Introduction. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) often develop in critically ill patients and can lead to affected splanchnic blood flow, intestinal mucosal ischemia, bacterial translocation, sepsis, and multiorgan dys-function. There is limited literature data on the effect of analgesic methods on splanchnic blood flow in IAG / AСS. The aim of the study was to define the effect of different postoperative analgesia techniques on splanchnic blood flow in children with appendicular peritonitis with IAH. Materials and methods. The study included 115 children who underwent surgery for appendicular peritonitis. Children were randomized into three groups depending on the method of postoperative analgesia: “Opioids” (n = 36; intravenous infusion of morphine 10 μg/kg/h); “Lidocaine” (n = 40; intravenous infusion of lidocaine 1.5 mg/kg/h); “EDA” (n = 39; epidural infusion 0.25% bupivacaine 0.4 mg/kg/h). Postoperatively intraabdominal pressure (IAP) was measured 4 times a day using the standard in-direct method through a Foley catheter in the bladder. According to the IAP level and presence of organ dysfunction patients in each group were divided in subgroups: “Without IAH”, “IAH” and “ACS”. The diameters and linear velocities of blood flow in the superior mesenteric artery (SMA) and portal vein (PV) were detected using US. The blood flow indices in SMA and PV (BFISMA, BFIPV, ml/min/m2) were calculated. Results. BFISMA and BFIPV were significantly higher in children without IAH than in children with IAH (p &lt;0.0001) and ACS (p &lt;0.0001). Among patients in all subgroups, BFISMA was significantly higher in the groups “Lidocaine” (p &lt;0.05) and “EDA” (p &lt;0.0001) compared with the group “Opioids”. BFIPV was higher in the group “EDA” (p &lt;0.05) in children with IAH and in the groups “Lidocaine” (p &lt;0.0001) and “EDA” (p &lt;0.0001) in children with ACS compared with children of all subgroups in the group “Opioids”. Among the children without IAH a statistically significant negative correlation between IAP and BFISMA was observed only in the group “Opioids” (rs = -0.5; p &lt;0.001). Among the children with IAH and ACS, a statistically significant negative correlation between IAP and BFISMA was observed in all analgesia groups, but it was weakest in the group “EDA” (rs = -0.24; p &lt;0.04 and rs = -0.39; p &lt;0.05, respectively). In the group “Opioids” a statistically significant negative correlation between IAP and BFIPV was observed only in the children with IAH (rs=-0.31; p&lt;0.01) and ACS (rs=-0.4; p&lt;0.0001). Conclusions. Epidural analgesia is the most optimal method of analgesia for the effect on impaired splanchnic blood flow in children with peritonitis complicated with intra-abdominal hypertension. Intravenous analgesia with lidocaine may be an alternative to epidural anesthesia.

Prospective, Single-Center Comparison of Transcranial Direct Current Stimulation Plus Electroacupuncture and Standard Analgesia in Patients After Total Knee Arthroplasty: Effect on Rehabilitation and Functional Recovery.

BackgroundThe aim of this prospective study was to compare transcranial direct current stimulation (tDCS) plus electroacupuncture with standard analgesia in patients after total knee arthroplasty (TKA) to determine the effects on rehabilitation and functional recovery.Material/MethodsEighty patients with osteoarthritis of the knee who underwent TKA were included in the study. They were divided into experimental (n=40) and control groups (n=40) according to postoperative analgesia method. The control group received multimodal analgesia after TKA and the experimental group received additional tDCS plus electroacupuncture. Postoperative pain, knee function, and quality of life were compared between the 2 groups.ResultsCompared with the control group, the experimental group had significantly lower visual analog scale scores at 3 and 7 days and 3 and 6 weeks after TKA (P<0.05). At 6 weeks after TKA, knee injury and osteoarthritis outcome and Hospital for Special Surgery scores and maximum knee flexion in the experimental group were significantly better than those in the control group (P<0.05). In the experimental group compared with the control group, the Short Form-36 Health Survey score also was significantly increased (P<0.05).ConclusionsThe findings from this study showed that tDCS plus electroacupuncture effectively reduced pain after TKA and improved rehabilitation and functional recovery.

Postoperative anesthesia for vitreoretinal surgery in children

Vitreoretinal surgery for retinal detachments in children is an effective, sometimes the only method to restore vision. As practice shows, the use of minimally invasive regional techniques is increasingly used for combined anesthesia in ophthalmic surgery in children. In the postoperative period, the use of blockades can provide prolonged analgesia, thereby improving the childs comfort level after the surgery. All types of blockades in ophthalmology have certain risks, but the pterygopalatine blockade has not any, since it is performed outside the eye structures. The research of the use of the pterygopalatine blockade after surgery in children is important not only for creating prolonged analgesia, but also for reducing vegetative reactions that can complicate the recovery period.&#x0D; Purposeof the study isto increase the pain management efficacy in the postoperative period in children who have undergone extensive surgery for retinal detachment.&#x0D; Materials and methods. 1st group (n= 32) received postoperative analgesia pterygopalatine blockage with ropivacaine 0.5%, 2nd group (n= 28) systemic analgesia. Changes in hemodynamics and stress index in the postoperative period were evaluated. Cortisol levels in the intensive care unit was evaluated in 2 hours later. The time and frequency use of antiemetics in the occurrence of PONV were recorded. The level of patients comfort after surgery and the pain intensity were evaluated on an integral scale and on the Verbal Rating Scale (VRS) in points.&#x0D; Results.The children of 1st group did not have significant changes in heart rate and SBP in the intensive care unit. In group 1, the TI decreased by 13.2% in the intensive care unit, and in group 2, the TI increased by 28.5% after 2 hours and by 88.6% after 8 hours. 2 hours after the surgery pain was 2 points in 12.5% of the patients (1st group) and 39.2% of patients (2nd group). After 8 hours, 35.7% of patients (2nd group) reported moderate pain that required medication. There were no PONV in group 1, and it occured in 28.5% of patients in group 2. In group 1, 75% of children rated the postoperative period as comfortable, and in group 2 21.4% (p 0,05).&#x0D; Conclusion. Pterygopalatine blockade as the main method of postoperative analgesia in the early postoperative period has got a long-term analgesic effect, reducing the frequency of nausea and vomiting, improving the quality of the postoperative period in children.

The effectiveness of Bilateral Erector Spinae Plane Block in reducing perioperative opioid administration in patients undergoing Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC), is one of the most common surgeries performed in general surgery. Most of the times, LC is accompanied by moderate to severe postoperative pain. Erector Spinae Plane Block (ESPB) is an innovative trunk block which has been used as a method of postoperative analgesia in various clinical procedures. In this study we evaluated its effectiveness as a method of perioperative analgesia, seeking to investigate whether it is effective in reducing perioperative opioid administration in patients undergoing LC. Methods: This is a double-blind, randomized, controlled, prospective study. 60 patients were randomized into Group C (ESPB with N/S 0.9%), Group D (ESPB with ropivacaine 0.375%, dexmedetomidine 1 γ/kg) and Group R (ESPB with ropivacaine 0.375%). ESPB was performed bilaterally before induction of general anesthesia, with ultrasound guidance. Statistical analysis included ANOVA, two-way ANOVA for repeated measures, Kruskal-Wallis and Spearman tests. Results: All patients remained hemodynamically stable during their hospitalization, without major complications. Statistical significance was found to exist regarding total perioperative remifentanil consumption between all three Groups. Median morphine consumption, NRS pain scores and mobilization time of the patients was found to be significantly less in patients of Group D compared with patients of Group C and in patients of Group R compared with patients of Group C. However, there was no statistically important difference between Groups D and R. Satisfaction scores were found to be statistically higher in patients of Group D when compared with patients of Group C. Conclusion: ESPB performance with administration of ropivacaine or a combination of ropivacaine and dexmedetomidine in patients undergoing LC, is an innovative, safe and simple method which contributes to the amelioration of the quality of perioperative analgesia, avoiding the complications arising from opioid administration and thus, achieving multimodal analgesia.

A comparative evaluation of epidural clonidine vs. dexmedetomidine as adjuvants in post-operative analgesia

Background: Requirement of anesthetic agents is reduced due to addition of adjuvants in epidural anaesthesia as they augment the local anesthetic action and have analgesic properties as well. Effective epidural analgesia ensures stable hemodynamics and satisfactory perioperative period. Objective: To evaluate efficacy of epidural clonidine compared to dexmedetomidine as adjuvants in postoperative analgesia Materials and Methods: Comparative, randomized clinical study was carried out among 100 subjects undergoing abdominal and vaginal hysterectomies of age 44-65 years with ASA grade I and II. They were divided randomly into two group of 50 each. Group A received 17ml of 0.5% of bupivacaine with 2mcg per kg clonidine. Group B received 17ml of 0.5% of bupivacaine with 1.5mcg per kg dexmedetomidine. Various parameters related to sensory and motor blockade, Ramsay sedation scale for sedation score, Hemodynamic parameters were monitored continuously and recordings were made at regular intervals. Results: Both groups were comparable in terms of age, weight, duration of surgery, ASA grades and type of surgery. Parameters pertaining to time for onset of sensory and motor block were significantly higher in clonidine group compared to the dexmedetomidine group (p0.05) between two groups except for heart rate which was significantly less in dexmedetomidine group at 120min compared to clonidine group (p Conclusion: Dexmedetomidine added to bupivacaine epidurally prolonged postoperative analgesia longer than clonidine. Keywords: Dexmedetomidine, Clonidine, Bupivacaine, Epidural.

Epidural Versus Transabdominal Wall Catheters: A Comparative Study of Outcomes After Pancreatic Resection

BackgroundThis study compared epidural analgesia with local anesthetic administration via transabdominal wall catheters (TAWC), to determine the effect on perioperative outcomes in pancreatic surgery. Materials and methodsA retrospective review of patients undergoing open pancreatic surgery at Auckland City Hospital from 2015 to 2018 was undertaken. Data collected included patient demographics, type of perioperative analgesia, intravenous fluid and vasopressor use, length of high dependency unit stay, postoperative complications, and length of hospital stay. ResultsSeventy-two patients underwent pancreatic surgery, of which 47 had epidural analgesia and 25 TAWC. The median age was 64 y (range 29-85). Failure of analgesia method occurred in 45% of epidural patients and 28% of TAWC patients (P = 0.209). There was no significant difference in volume of intravenous fluid given or need for vasopressors in the first 3 postoperative days, length of high dependency unit stay (median 1 d, P = 0.2836), rates of postoperative pancreatic fistula (32% versus 40%, P = 0.6046), postoperative complications (38% versus 20%, P = 0.183), or mortality (0.04% versus 0.04%, P = 1.0). ConclusionsEpidural analgesia and TAWC may have comparable perioperative outcomes in patients undergoing pancreatic surgery. Further randomized studies with a larger cohort of patients are warranted to identify the best postoperative analgesic method in patients undergoing pancreatic resection.

Comparison of Premixed with Sequential Administration of Intrathecal Morphine and Hyperbaric Bupivacaine for Lower Segment Caesarean Section

Background: Adequate pain relief is considered as a basic human right .In obstetrics patients, using low dose opioids (Morphine, Fentanyl, sufentanil) in neuraxial blockade is effective method for anaesthesia and postoperative analgesia in LSCS and nearly no danger to parturient or unborn. Subjects and Methods: Keeping in mind the difference in the baricties of commonly used hyperbaric bupivacaine and morphine, we conducted a single blind randomized controlled trial on 156 full term parturient scheduled for elective and emergency LSCS under SAB and on the technique of intrathecal administration of drug parturients were divided into 3 groups. GROUP 1 (n=52) - Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + morphine 200mcg (0.2ml) as a mixture GROUP 2 (n=52)-Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + Morphine 200mcg (0.2ml) administered after bupivacaine GROUP 3 (n=52)-Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + Morphine 200mcg (0.2ml) administered before bupivacaine. We observed for block characteristics, maternal hemodynamics and neonatal outcome. Results: In our study, duration of analgesia was clinically prolonged in all the groups. The block characteristics were comparable between the groups.These beneficial effects were not accompanied by any major hemodynamic instability or adverse effects and no untoward effect on the newborn. Conclusion: Premixed and sequential administration of IT morphine with hyperbaric bupivacaine were comparable in terms of quality of subarachnoid block maternal hemodynamic and neonatal outcome.