Multimodal Management Approach Research Articles

The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial.

Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.

Dietary Management of Obesity

Obesity is defined as a condition characterized by the abnormal accumulation of fat cells, which results in increased body weight. Worldwide, obesity is progressively on the rise, leading to an increased prevalence of chronic conditions such as cardiovascular disease, type 2 diabetes, and hyperlipidemia. Obesity is a result of the interplay between genetic, metabolic, social, behavioral, and cultural factors, necessitating an interdisciplinary and multimodal management approach. Diet therapy, which includes dietary modifications and nutritional interventions, is a fundamental component of the multifaceted approach to managing obesity. The principle of diet therapy is based on achieving weight loss through a negative energy balance and maintaining weight through an equilibrium of energy intake and expenditure. Strategies for weight loss and control rely on caloric restriction, macronutrient distribution, and dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. Recently, studies have been conducted on weight control using information and communication technology-based interventions, as well as interventions based on intestinal microorganisms which consider inter-individual variability and long-term adherence. In conclusion, diet therapy stands as a pivotal element in the management of obesity, providing a personalized and comprehensive approach to weight control. By combining evidence-based dietary strategies with behavioral modifications and consistent support, healthcare professionals can enable individuals to attain and sustain a healthier weight, thereby reducing related health risks.

Canine Atopic Dermatitis: Prevalence, Impact, and Management Strategies.

Atopic dermatitis (AD) is a common inflammatory and pruritic allergic skin disease in humans and dogs worldwide. The pathogenesis of AD is multifactorial, immunologically complex, and may involve genetic factors, epidermal barrier dysfunction, microbiome changes, immune dysregulation, and allergic sensitization. Across species, prevalence of AD is on the rise. At present, there is no cure for canine AD (CAD). The treatment for CAD is multifaceted and aimed at controlling the pruritus, associated inflammation, and infections, repairing the skin barrier function, and dietary management. This review presents data on prevalence, impact, and complex immunological interactions in AD with a focus on subsequent management of the disease in the canine population. A multimodal approach for management of CAD to address varying clinical signs and responses to therapies is discussed.

The Practice of Multimodal Analgesia Technique for Patients Undergoing Surgery under General Anaesthesia in Debre Markos Compersive Specialized Hospital Debre Markos, East Gojjam, Ethiopia, 2022. A Cross-Sectional Study

Background: Practice guidelines for preoperative pain management recommend that multimodal analgesic therapy should be used for postsurgical patients. This method uses different analgesic agents, which may target different components of pain transmission to improve post-operative analgesia and decrease reliance on opiate-based medication. The practice of Multimodal analgesia includes the combined use of neuraxial blockage regional anesthesia and systemic medications and has been shown to reduce opioid use and side effects in surgical patients. However, the proportion of patients who receive this evidence-based approach is unknown. To assess the practice of multimodal analgesia among patients undergoing surgery under general anesthesia at Debere Markos Compressive Specialized Hospital, Northwest Ethiopia, 2022. Methods: After obtaining ethical approval a hospital-based cross-sectional study was conducted from February 22 to May 10, 2022, in Debere Markos Compressive specialized hospital. Data was collected, prospectively using questionnaires from anesthetists, nurses in the recovery room, and anesthesia record sheets. Patients were considered to have multimodal analgesia if they received two or more analgesics. Descriptive statistics were performed to identify the practice of multimodal analgesia. Results: A total of 200 participated in our study. We observed the practice of multimodal analgesia in patients who had undergone surgery under general anesthesia in the study period was 47%. Opiod is the most widely administered analgesia. It was given to 81.5% of patients. The practice of multimodal analgesia in emergency surgery was found to be 61.7%. During the study period, multimodal analgesia was more practiced among Bsc anesthetists and it was found to be 42.5%. The practice of multimodal analgesia in PACU was found to be 9%. Conclusion and Recommendation: The practice of multimodal analgesia for surgical patients in Debre Markos Specialized Compressive Hospital is underutilized. Anesthesia professionals should use a multimodal approach for preoperative pain management for all surgical patients. The Department of Anesthesia should develop a guideline for the treatment of perioperative pain.

Narrative Review on Osteoporosis: A Silent Killer

Osteoporosis is a common condition affecting the elderly population. Most of the time, it is diagnosed only after an individual suffers from a fracture. In addition to the fracture and its complications, the patients and their families must also bear the psychological and financial consequences of the disease. There are multiple risk factors associated with osteoporosis, hence it requires a multimodal approach in management as well. This narrative review aims to provide a comprehensive insight into the classification, prevalence, pathophysiology, signs and symptoms, risk factors, screening tools, management, differential diagnosis, prognosis, complications, and recent advances in osteoporosis.

Functional Outcomes and Successful Predictors of Lumbar Transforaminal Epidural Steroid Injections (LTFESIs) for Lumbar Radiculopathy Under Fluoroscopic Guidance: A Prospective Study.

Lumbar radiculopathy, a common and debilitating condition, often necessitates a multimodal approach for effective management. Lumbar transforaminal epidural steroid injection (LTFESI) has emerged as a valuable therapeutic option when conservative measures fall short. Recent interest in long-acting and non-particulate steroids prompts a critical examination of their impact on LTFESI outcomes. This prospective study aims to evaluate the efficacy of LTFESI in improving pain and functional outcomes in patients with lumbar radiculopathy, focusing on long-acting and non-particulate steroids, and analyse the associated economic burden. The study, conducted from October 2017 to April 2019, involved 52 patients with lumbar radiculopathy meeting specific criteria. LTFESI was administered using a hospital-based prospective design. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores at various intervals. Statistical analyses were performed to identify predictors of successful outcomes. Participants (average age 43.22 years, 27 (51.92%) male) exhibited diverse Michigan State University (MSU) grade profiles and predominantly had pathology at the L4-5 level. The study demonstrated a significant and lasting functional improvement in 43 (82.69%) of patients after LTFESI. Patients with 2AB-type intervertebral disc prolapse (IVDP) showed lower response rates, emphasizing subtype influence. The efficacy of LTFESI was sustained for up to six months in almost 82.69% of patients, highlighting its potential for long-lasting benefits. The difference in the mean ODI score pre-injection and six months post-injection is statistically significant (p<0.0001). A total of four patients (7.69%) underwent surgical treatment for lumbar radiculopathy as their symptoms did not improve after injection. For all four patients (7.69%), surgery was done one month after injection. Five patients (9.61%) had ODI scores of more than 40, indicating severe disability at the end of six months. So, in nine patients (17.3%), the injection given was not effective at the end of six months, four (7.69%) of whom were operated on and five (9.61%) patients received conservative treatment. Thus, 43 (82.69%) of patients had a good outcome. The study reinforces LTFESI as an effective and safe intervention, providing substantial and lasting benefits for lumbar radiculopathy. The majority experienced immediate relief, supporting its role as an intermediate option between conservative management and surgery. Identified predictors of decreased success underscore the importance of early intervention and tailored treatment plans. The study emphasizes LTFESI's diagnostic and therapeutic potential, with economic benefits and safety highlighted. LTFESI emerges as a safe and effective intervention for lumbar radiculopathy, offering substantial and enduring pain relief. The study contributes valuable insights into the nuanced outcomes of LTFESI, including the impact of IVDP subtypes, factors influencing success, and the procedure's cost-effectiveness. While acknowledging limitations, this work adds to the growing evidence supporting LTFESI as a crucial component in the management of lumbar radiculopathy.

A CRITICAL APPRAISAL OF AUTISM SPECTRUM DISORDER IN TERMS OF AYURVEDA

Introduction: Autism spectrum disorders are conditions characterised by impaired social interaction communication skills and associated stereotypic, restrictive and repetitive behavioural patterns. According to a WHO report, it is estimated that worldwide, about one in 100 children has ASD. In India, according to the calculation of the Rehabilitation Council of India, the prevalence rate is 1 in 500 or 0.2%. Multimodal management approach of Ayurveda comprising herbal supplements, Ayurveda compounds, and panchakarma therapies. In Ayurvedic literature, Acharyas mention three types of chikitsa for the whole body and mind level- daivavyapashraya, yuksivyapashraya and satvavjaya chikitsa. These treatments benefit autistic children by a different mechanism of action and improve their quality of life. It concluded that Ayurveda provides safe, effective, cheap and untoward effect-free management along with enhancing the quality of life for people living with ASD and bringing back smiles on parents' faces.

Evaluation and Medical Management of Chronic Pelvic Pain.

Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical management of CPP with a comprehensive approach.

Effects of ultrasound-guided erector spinae plane block in radical prostatectomy surgery on pain and surgical stress response

BackgroundErector spina plane block, as a part of a multimodal approach in perioperative pain management, is effective in many surgical procedures on pain management. The aim of this prospective, randomized, controlled study was to investigate the effects of erector spinae plane block on pain, analgesic consumption, and surgical stress in radical prostatectomy operations.ResultsForty-six patients operated for elective open radical prostatectomy surgery were randomly allocated to Group B (n = 23) and Group K (n = 23). Ultrasound-guided erector spinae plane block was performed bilaterally on patients in Group B, while group K was the control group. Remifentanil and tramadol consumption, rescue analgesic need, pain scores, and nausea-vomiting scores were less in Group B. While there was no difference in glucose, cortisol, insulin, and C-reactive protein values at all times between groups, postoperative 24-h prolactin values were higher in Group B. Shapiro–Wilk test, Student t-test, and Mann–Whitney U-test were used for statistical analysis.ConclusionsUltrasound-guided erector spinae plane block is an effective analgesic method in radical retropubic prostatectomy surgeries providing a reduction in intraoperative and postoperative opioid consumption but has limited effect on the surgical stress response.Trial registrationClinicalTrials NCT05170373, Registered 11/03/2021 — retrospectively registered.

Future therapies for obesity

Obesity is a chronic disease associated with increased morbidity and mortality. Bariatric surgery can lead to sustained long-term weight loss (WL) and improvement in multiple obesity-related complications, but it is not scalable at the population level. Over the past few years, gut hormone-based pharmacotherapies for obesity and type 2 diabetes mellitus (T2DM) have rapidly evolved, and combinations of glucagon-like peptide 1 (GLP1) with other gut hormones (glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) as dual or triple agonists are under investigation to enhance and complement the effects of GLP1 on WL and obesity-related complications. Tirzepatide, a dual agonist of GLP1 and GIP receptors, marks a new era in obesity pharmacotherapy in which a combination of gut hormones could approach the WL achieved with bariatric surgery. In this review, we discuss emerging obesity treatments with a focus on gut hormone combinations and the concept of a multimodal approach for obesity management.

One of Jehovah’s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report

There are an increasing number of patients who are refusing blood transfusions for several reasons, the most widespread among them being Jehovah’s Witnesses. We present a case of a 66-year-old woman admited to the hospital with gangrene as a complication of the diabetic foot. The hemoglobin level was 4.8g/dl, hematocrit was 15.8% and mean corpuscular volume was 77.1 fL. She needed urgent surgery to amputate her foot. Being one of Jehovah’s Witnesses, she refused blood transfusions. A multimodal blood management approach was applied, and the patient underwent leg amputation without transfusion of any blood product. The treatment strategy is discussed.

Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study.

Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations. A consensus study using the nominal group technique. Four trauma systems in Canada. Participants included expert clinicians and decision makers, and people with lived experience. Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a 7-point Likert scale. Implementation considerations were identified through a synthesis of discussions. A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients, 7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them. This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.

Ambulatory palliative care among patients with hidradenitis suppurativa: A qualitative study

Patients with hidradenitis suppurativa (HS) experience high physical and emotional symptom burden and may benefit from palliative care interventions, though no studies have explored the unmet palliative care needs in this population. This case series aimed to qualitatively evaluate unmet needs and palliative care interventions among patients with HS who were referred to palliative care. We reviewed medical records of patients with HS who were referred from an HS specialty clinic and seen in an interprofessional palliative care ambulatory clinic. Palliative care notes were qualitatively analyzed inductively and deductively to identify themes characterizing unmet needs and palliative care interventions. Thirteen patients with HS (median [IQR] age, 38 [31-45] years; 11 [85%] women; 11 [85%] Black) were referred and seen in a palliative care specialty clinic. Topics discussed included uncontrolled HS pain, housing insecurity, and emotional distress. Palliative care interventions included a thorough assessment of pain, multimodal pain management approaches, social worker weekly check-ins, and management of psychotropic medications. Small study at a single tertiary center. Care models integrating palliative care approaches with multidisciplinary support services may reduce disease burden in a subset of patients with HS.

Pediatric Project ECHO® for Pain: implementation and mixed methods evaluation of a virtual medical education program to support interprofessional pain management in children and youth

BackgroundPediatric pain is a complex health challenge requiring a multi-modal management approach. It is critical that healthcare providers (HCPs) have access to ongoing, flexible education and mentorship specific to pediatric pain. However, there are significant gaps in available pain education and a need for more opportunities to support interprofessional training. Project Extension for Community Healthcare Outcomes (Project ECHO®) is a model for delivering online HCP education and cultivating a virtual community of practice. Within the pediatric pain setting, ECHO® has potential to improve local access to specialized pain knowledge, particularly among the physicians, nurses, and allied health providers who primarily manage these cases in community and hospital settings across rural and urban environments. The purpose of this study was three-fold. First, to evaluate the feasibility (participation levels, acceptability) of implementing Project ECHO® in the context of pediatric pain. Second, to measure preliminary program impacts on HCP knowledge, self-efficacy, and clinical practice. Third, to characterize HCP program engagement levels before and after onset of the COVID-19 pandemic.MethodsA needs assessment was conducted to identify interprofessional education gaps and inform the program curriculum. The no-cost Pediatric ECHO® for Pain program offered TeleECHO sessions (didactic and case-based learning) as well as foundational education. Surveys were distributed at baseline and 6 months to assess outcomes using 7-point Likert scales. Participant engagement was assessed for periods prior to and during the COVID-19 pandemic. Descriptive and inferential statistical analyses were conducted.ResultsEighty-five TeleECHO sessions were hosted, with a mean attendance of 34.1 ± 23.4 HCPs. Acceptability scores at 6 months (n = 33) ranged from 5.0 ± 1.4 to 6.5 ± 0.5. Participants reported statistically significant (p < 0.05) improvements in knowledge (7 out of 7 topics) and self-efficacy (8 out of 9 skills). Most participants reported positive practice impacts, including improved satisfaction with managing children with pain. Exploratory analyses showed a trend of greater engagement from ECHO® learners after onset of the COVID-19 pandemic.ConclusionsProject ECHO® is a feasible and impactful model for virtual education of interprofessional HCPs in managing pediatric pain.

Multi-modal approach in management of vulvo-vaginal gingival syndrome − a rare variant of oral lichen planus

Lichen planus (LP) is a chronic autoimmune relapsing mucocutaneous disease that significantly affects the patient's quality of life (QoL) and is associated with several etiological factors. Vulvo-vaginal gingival syndrome (VVGS) is characterized as a clinical triad of gingival, vaginal and vulval LP. In previous literature, it has been described as a distinctive pattern of erosive plurimucosal LP. This condition if progressed can lead to multiple complications such as urethral and vaginal stenosis. This case report highlights the management of VVGS using a multidisciplinary strategy that includes dermatological consultation, oral hygiene maintenance, topical steroid application using custom-made trays and photodynamic therapy.

HEMODYNAMICS EFFECT OF BUPIVACAINE AND LEVOBUPIVACAINE IN PAEDIATRIC ABDOMINAL SURGERIES

Regional analgesia features a prime role within the multimodal analgesia approach for surgical pain management. currently each day it's common apply of using transverses abdominis plane block (TAP Block) with numerous sorts of native anaesthetics and adjuvants, as a multimodal pain relieving remedy used worldwide for intra and postoperative pain management in several surgeries. However, only a few studies are done wherever hemodyanamics effects when bupivacaine versus levobupivacaine have compared. Aim of this study to examine the consequences of bupivacaine vs levobupivacaine in patients undergoing lower abdominal surgeries and their effects on hemodynamics ( the blood pressure, HR, and SpO2). Method: A randomised double-blind management study conducted when approval from IEC Ref. code-92nd IIB Thesis / P4 . The study has fifty patients, with ASA I – II physical status, as well as each sex and 2-10 years cluster age and who set up for abdominal surgery notably lower abdominal . 25 patients set in every group and every which way allotted: cluster Bupiva and Levobupiva . All patients were well well-read regarding the procedure, drugs, and effects of drugs, and untoward complications. well-read written consent was taken from each patient before involving them within the study. primary objective is to examine the impact of those medicine on Blood pressure, HR, and SPO2 &amp; Secondary objective was to check rescue physiological condition reduction within the surgical period. After the comparison between these 2 clusters, The mean SBP of group Bupiva was found below that of group Levobupiva . and located to be important at fifteen min, one hour, a pair of hr, and four hr and insignificant at baseline zero min, thirty min, half dozen hr (p=0.092), twelve hr, eighteen hr, and twenty four h.differences is insignificant in comparison the DBP at any purpose of your time from baseline to 24 hr. On comparing the center rate, variations were found insignificant from baseline (p = 0.897), 0 min (p = 0.651), 30 min (p = 0.096), 1hr (p = 0.192), 2 hr (p=0.390), four hour (p=0.525), half dozen hr (p=0.469), twelve hr (p=0.443), eighteen hr (p=0.288) to twenty four hr (p=0. 390) except at fifteen min (p=0.010) that was the mean pulse rate of cluster Bupiva is over that of group Levobupiva at one,5 min. On comparison the SPO2differences were insignificant at baseline (p = 0.620), 15 min (p = 0.108), thirty min (p=0.353), 1 hr (p = 0.789), 2 hr (p = 0.364), 4 hr (p = 0.292) and 6 hr (p = 0. 198) however important at 0 min (p = 0.002), 12hr (p = 0.012), 18hr (p = 0.002) and24 hr (p = 0.028) wherever the mean SPO2 of cluster Bupiva was abundant below the group Levobupiva. Stable hemodynamics for a extended period were provided by Levobupivacaine as compared to Bupivacaine.

CPD article: Diet in canine dermatology part 1: nutrition for skin health and support

Nutrition has a very important role to play in supporting skin and coat health, both in healthy dogs and in those with skin conditions. Key nutrients include protein — which composes 95% of each hair within the coat — omega 3 and 6 fatty acids, zinc, and different vitamins. These nutrients play different roles within the skin, and dietary intake of some or all of them may need to be considered in an individual patient. The role of each of these nutrients will be explored, along with the potential benefits of nutritional modification as part of a multimodal management approach in the support of patients with skin conditions. The article will also look at the role of supplements, and review the latest knowledge about how manipulation of the microbiome may play a role in patients with atopy.

Abstract 356: Pre-clinical investigations utilizing Bcl2 inhibitors in glioblastoma

Abstract Glioblastoma (GBM) is a lethal malignant cancer of the central nervous system. The multimodal management approach does not extend survival beyond 2 years. Due to diverse variability in subpopulations of patients with glioma, treatment benefits are not uniform with apoptosis evasion being a key attribute of treatment resistance in GBM. Antiapoptotic protein, Bcl-2, Bcl-xL, and Mcl-1, are frequently upregulated in acquired chemo resistant cancer cells. Here in, we investigated the anti-proliferative effects of disrupting “Bcl-2-regulated pathways” in GBM. Of note, accessibility of FDA approved Bcl-2 inhibitors with known safety profile, makes it a biologically relevant target where intra- and inter-patient heterogeneity can be overcome successfully. Western Blot (WB) analysis was performed to compare the Bcl-2 family expression in human GBM cell lines (LN229, T98G, DI321, SA21). RT-PCR data was obtained for Bcl-2 family mRNA expression profile in present GBM cell lines. IC50s were determined for afore mentioned cell lines using MTS assay for Temozolomide (TMZ, alkylating agent), Bcl-2 inhibitor ABT199, Bcl-xL inhibitor A1331852, Mcl-1 inhibitor AZD5991, and BTK inhibitor Ibrutinib. Further, synergistic activity of TMZ, ABT199, A1331852, AZD5991 and Ibrutinib in several permutations. All experiments were performed with an n of 3/5. Our data suggests upregulation of antiapoptotic Bcl-2 family proteins in GBM cells including GSCs (DI321) and patient derived cells (SA21). There was significant decrease in viability of these cells when treated with ABT199 and A-1331852 (p&amp;lt; 0.0001) as compared to TMZ as a single agent. Other combinations ABT199+AZD5991 (p&amp;lt; 0.0001), AZD5991+A-1331852 (p&amp;lt; 0.0001) and TMZ+ABT (p&amp;lt;0.0002) also shows anti-tumor activity. Alternatively, we observed increased sensitivity in TMZ-resistant GBM cells against these drugs using MTS assay. GBM is an aggressive malignancy with 100% recurrence over time. Our preclinical data suggests synergism of Bcl-2 protein inhibitors in GBM cells, both TMZ-naïve and TMZ-resistant. Our ongoing research is investigating the biological relevance of Bcl-2 in conjugation with other tumor suppressor proteins, in vitro and in vivo. Citation Format: Srishti Kala, Leland Earp, Sonikpreet Aulakh. Pre-clinical investigations utilizing Bcl2 inhibitors in glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 356.

Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials.

Objective This meta-analysis aims to evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in treating post-operative pain. Methods This meta-analysis was registered in PROSPERO (CRD42021286753). We searched PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs) about TEAS in treating postoperative pain that were published before November 2021. The primary outcome was visual analogue scale (VAS) within 24 h after surgery. The secondary outcomes included postoperative opioid analgesic drug consumption and the occurrence of adverse reactions within the postoperative 24–72 h. Adverse reactions included dizziness, nausea, and vomiting. Continuous variables were analyzed using mean difference (MDs) or standardized mean difference (SMDs) and 95% CIs. Relative risk (RR) and 95% CI were used for dichotomous data. The data were pooled and analyzed by RevMan 5.4 and STATA15.0 software. Results Seventeen trials with 1375 participants were included. The current results suggested that application of TEAS showed obvious superiority in reducing VAS scores (SMD = −1.51, 95% CI = −2.20∼−0.82, I2 = 96%). Subgroup analysis was performed according to open surgery and minimally invasive surgery. VAS scores were decreased after surgery at 24 h (SMD = −0.84, 95% CI = −1.07∼−0.6, I2 = 96%; SMD = −0.88, 95% CI = −1.02∼−0.75, I2 = 96%). The incidence of postoperative dizziness and nausea and vomiting was significantly lower in the TEAS group within postoperative 24–72 h (RR = 0.48, 95% CI = 0.34∼0.68, I2 = 0%; RR = 0.66, 95% CI = 0.44∼1.01, I2 = 69%; and RR = 0.49, 95% CI = 0.24∼1.00, I2 = 51%). Postoperative opioid analgesics were also reduced in the TEAS group within 72 h after surgery (SMD = −2.10, 95% CI = −3.37∼−0.82, I2 = 96%). Conclusions TEAS can reduce postoperative pain as well as the incidence of dizziness, nausea, and vomiting and the number of analgesics used after surgery. TEAS is a reasonable modality to incorporate into a multimodal management approach for postoperative pain.

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review.

Purpose of ReviewSickle cell disease (SCD) is an inherited hemoglobinopathy with potential life-threatening complications that affect millions of people worldwide. Severe and disabling acute pain, referred to as a vaso-occlusive crisis (VOC), is a fundamental symptom of the disease and the primary driver for acute care visits and hospitalizations. Despite the publication of guidelines for VOC management over the past decade, management of VOCs remains unsatisfactory for patients and providers.Recent FindingsAcute SCD pain includes pain secondary to VOCs and other forms of acute pain. Distinguishing VOC from non-VOC pain may be challenging for both patients and clinicians. Further, although opioids have been the gold-standard for VOC pain management for decades, the current highest standard of care for all acute pain is a multimodal approach that is less dependent on opioids, and, instead incorporates analgesics and adjuvants from different mechanistic pathways. In this narrative review, we focus on a multimodal pharmacologic approach for acute SCD pain management and explore the evidence for existing non-opioid pharmacological adjuncts. Moreover, we present an explanatory model of pain, which is not only novel in its application to SCD pain but also captures the multidimensional nature of the SCD pain experience and supports the need for such a multimodal approach. This model also highlights opportunities for new investigative and therapeutic targets – both pharmacological and non-pharmacological.SummaryMultimodal pain regimens that are less dependent on opioids are urgently needed to improve acute pain outcomes for individuals with SCD. The proposed explanatory model for SCD pain offers novel opportunities to improve acute pain management for SCD patients.