Component Of Multimodal Analgesia Research Articles

Nonopioid Drugs for Postoperative Pain: A Selection Governed by Choices of the Authors of Academic Articles

The opioid crisis has profoundly changed the interest in using nonopioid analgesics. This review identified nonopioid drugs receiving the most interest in the treatment of postoperative pain. Publication-based interest, which reflects the authors’ choices of subjects for academic articles, was used to show the shifts in their interest. The authors’ choices of a particular drug for an article’s subject were regarded as reflective of the collective opinion of experts most knowledgeable on the subject. The frequency with which a drug was the topic of an article was measured with the use of specific bibliometric indices. They were employed to select nonopioid drugs for this review. These included acetaminophen, dexmedetomidine, dexamethasone, ketamine, gabapentin, ibuprofen, ketorolac, diclofenac, magnesium sulfate, clonidine, intravenous lidocaine, and meloxicam (in order of most to least bibliometric interest). Individual reviews on these agents described how the bibliometric indices characterized a drug. They also addressed the question of whether a nonopioid analgesic produced a marked opioid-sparing effect. Information relative to this question was presented via the results of meta-analyses with emphasis on the possible reduction of opioid-related side effects. Overall, nonopioid drugs demonstrating the largest popularity among authors and continuous interest growth in 2018-2022 include acetaminophen, dexmedetomidine, dexamethasone, and ibuprofen. The relevant meta-analyses show that nonopioids, administered as components of multimodal analgesia, provided the opioid-sparing effect; they also show that the most common change in the opioid-related side effects was a lower incidence of postoperative nausea and vomiting.

Analgesic Efficacy of Single-Shot Erector Spinae Block in Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Retrospective Cohort Study.

Introduction Video-assisted thoracic surgery (VATS) is a minimally invasive surgical technique though effective analgesia remains a challenge. Erector spinae plane block (ESPB) has gained popularity due to its ease and safety of placement. In this study, we evaluated the analgesic efficacy of ESPB in patients undergoing VATS through a propensity score-matched retrospective cohort study. The primary outcome is the total opioid use in the first 12 postoperative hours. Methods We used binomial logistic regression to model whether patients received ESPB as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, and surgery type to generate a propensity score for each patient for matching. Results After screening 286 patients, 55 patients each in the ESPB and no-block groups were matched. ESPB was associated with a 1.2 mg (95% CI: -2.2 to -0.2) reduction in opioid use in IV hydromorphone equivalents when compared to no block. However, there was no reduction in the 12-hour pain score area under the curve or incidence of complications between the two groups. Conclusions ESPB was associated with a modest reduction in total opioid consumption although not a difference in pain score. While its analgesic efficacy may be limited, ESPB could be considered a component of multi-modal analgesia in VATS.

Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: A randomized controlled factorial trial.

Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection. This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20mL. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0. The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI, 4.0-8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI, 0.2-4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0). For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.

Внутрішньовенна інфузія лідокаїну для попередження хронічного післяопераційного болю в дітей після різних видів оперативних втручань

Chronic postoperative pain is a serious postoperative complication. Inadequate pain management in the early postoperative period can contribute to the development of hyperalgesia. Aim - to evaluate the effectiveness of intravenous infusion of lidocaine in the prevention of chronic postoperative pain after various types of surgical intervention in children and adolescents. Materials and methods. 150 children who underwent under general multicomponent anesthesia surgical interventions due to traumatic pathology (I group, n=40), abdominal (II group, n=48) and urological (III group, n=62) surgical interventions were examined. Each of these groups was divided into two subgroups: in the subgroups Ib (n=17), IIb (n=19) and IIIb (n=24) children received intravenous lidocaine (according to the instructions) as a component of multimodal analgesia in the perioperative period, in the control subgroups Ia (n=23), IIa (n=29) and IIIa (n=38) children did not receive lidocaine. The presence of chronic postoperative pain 6 and 12 months after the operation, its frequency, localization, intensity according, the impact on the child’s daily activity were analyzed. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0. Results. Perioperative use of intravenous lidocaine infusion inpediatric patients was associated with a lower incidence of chronic pain 6 and 12 months after trauma surgery (odds ratio (OR): 5.13; 95% confidence interval (95% CI): 1.13-23.3 and OR: 4.24; 95% CI: 1.01-93.48, respectively) and after abdominal surgery (OR: 5.19; 95% CI: 1.02-26.94), as well as a higher level of functional activity after trauma (OR: 5.52; 95% CI: 1.08-28.2; p=0.028) and abdominal surgery (OR: 8.1; 95% CI: 1.01-70.36; p=0.032), but not after urological operations. Conclusions. This study demonstrated the efficacy of intravenous infusion of lidocaine to prevent of chronic pain after trauma and abdominal surgery in pediatric patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Analgesic Efficacy of Thoracolumbar Interfascial Plane Block versus Standard Care in Patients Undergoing Lumbar Spinal Surgeries—A Randomized Controlled Trial

Abstract Background Patients who undergo spine surgery often experience severe pain postoperatively. Multimodal analgesia inclusive of a regional block provides optimal pain relief. Thoracolumbar interfascial plane (TLIP) block may provide promising analgesia in these patients. Materials Fifty consenting adults aged between 18 and 60 years undergoing elective lumbar spinal surgeries under balanced general anesthesia were divided into two equal groups (group T: received bilateral TLIP block, and group C: received conventional opioid analgesia). All the patients were taken care of by an independent anesthesiologist unaware of the study protocol in the postanesthesia care unit. The postoperative pain was assessed by visual analog scale (VAS). Time to first rescue analgesia, total morphine consumption, complications, and patient satisfaction were also recorded. Results Postoperative mean VAS scores till 12 hours were significantly higher in the control group. The mean time to the first analgesic requirement among group T and group C patients was 404.4 ± 25.1 and 150.2 ± 12.4 minutes, respectively (p &lt; 0.001). Morphine consumptions in 24 hours were also significantly higher in group C (3.36 ± 1.04 vs. 7.84 ± 1.43; p &lt; 0.001). Mean intraoperative fentanyl consumption was significantly more in group C (122.4 ± 16.4 µg and 140.4 ± 21.7 µg; p = 0.001). Complications were similar in both groups. However, patient satisfaction was significantly higher in group T (p &lt; 0.001). Conclusion TLIP block provided superior analgesia, decreased opioid consumption, and improved patient satisfaction as compared with patients receiving standard general anesthesia with opioid analgesics. Hence, TLIP block could be a component of multimodal analgesia in patients undergoing lumbar spine surgeries.CTRI No.: CTRI/2021/03/031682

Efficacy of Trans Abdominis Plane (TAP) Block for Post-caesarean Delivery Analgesia: A Prospective Randomized Controlled Study

Background: Caesarean delivery is a major surgical procedure after which substantial post-operative pain and discomfort can be anticipated. A substantial component of pain experienced by patients is derived from abdominal wall incision. Currently multimodal analgesia technique involving abdominal field block with parenteral analgesia are becoming popular for these patients. Transversus abdominal plane (TAP) blockcan relieve pain associated with abdominal incision. We carried out this study to evaluate the efficacy of TAP block in providing post operativepain relief and the cumulative requirement of analgesic over first 48 hour in patients who underwent LSCS under spinal anaesthesia.Methods: This prospective randomized controlled study was carried out with 60 patients posted for electivecaesarean section, two groups with 30 patients each. Both groups were compared to see the effectiveness of Trans Abdominis Plane (TAP) Block as a method for post-operative multimodal analgesia technique using VAS score. Total number of rescue analgesia required upto 48hrs and total dose of rescue analgesia given in both the groups was also compared.Results: The mean VAS score at rest andon movement was decreased significantly after Trans Abdominis Plane (TAP) Block. The total dose and number of rescue analgesia was also decreased significantly.Conclusions: TAP block as a component of multimodal analgesia after caesarean section was effective in providing analgesia with delayed time for 1st rescue analgesia and reduction in total analgesic requirement in 1st 48 hr.

The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study

The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study

Comparison of Ultrasound-Guided Anterior, Posterior and Combination of Quadratus Lumborum Block in Laparoscopic Abdominal Surgeries: A Pilot Study.

The quadratus lumborum block (QLB) is an effective technique to provide analgesia for upper and lower abdominal surgeries. There are various approaches described in the literature, but the best approach is still to be explored. This study aims to compare the analgesic efficacy of three different approaches of QLBs. Sixty-five patients, aged 18-70 years posted for elective laparoscopic abdominal surgery under general anesthesia were enrolled after taking written informed consent. QLB was given using bupivacaine 0.25% 40 mL with injection dexmedetomidine 1 mcg/kg in all the groups. In Group 1 and Group 2, the drug was injected into the anterior and posterior aspects of the muscle respectively. In Group 3, a combination of the anterior-posterior approach was used. Pain scores at various intervals along with analgesic consumption and complications were observed. The demographic variables, hemodynamic parameters, and complications were comparable among the three groups. There were statistically significant differences between treatment groups in fentanyl requirement as assessed using the Kruskal-Wallis test (P = 0.012). Pairwise post-hoc analysis between block groups showed that the differences between Group 1 & Group 2 and Group 2 & Group 3 were significant (P = 0.0098 and P = 0.013). The tramadol requirement was comparable in all the groups (P = 0.75). Patient satisfaction was significantly higher in Group 3 compared to other groups (P = 0.024). Further studies can be planned to evaluate the best approach for QLB in terms of perioperative analgesia, which remains a dilemma in this pilot study. The anterior, posterior, and combined anterior-posterior QLB approaches appear equally efficacious as a component of multimodal analgesia in laparoscopic abdominal surgeries.

Ultrasound-guided erector spinae plane blocks for pain management after open lumbar laminectomy.

Lumbar spine surgery is associated with significant postoperative pain. The benefits of erector spinae plane blocks (ESPBs) combined with multimodal analgesia has not been adequately studied. We evaluated the analgesic effects of bilateral ESPBs as a component of multimodal analgesia after open lumbar laminectomy. Analgesic effects of preoperative, bilateral, ultrasound-guided ESPBs combined with standardized multimodal analgesia (n = 25) was compared with multimodal analgesia alone (n = 25) in patients undergoing one or two level open lumbar laminectomy. Other aspects of perioperative care were similar. The primary outcome measure was cumulative opioid consumption at 24h. Secondary outcomes included opioid consumption, pain scores, and nausea and vomiting requiring antiemetics on arrival to the post-anesthesia care unit (PACU), at 24h, 48h, and 72h after surgery, as well as duration of the PACU and hospital stay. Opioid requirements at 24h were significantly lower with ESPBs (31.9 ± 12.3mg vs. 61.2 ± 29.9mg, oral morphine equivalents). Pain scores were significantly lower with ESPBs in the PACU and through postoperative day two. Patients who received ESPBs required fewer postoperative antiemetic therapy (n = 3, 12%) compared to those without ESPBs (n = 12, 48%). Furthermore, PACU duration was significantly shorter with ESPBs (49.7 ± 9.5 vs. 79.9 ± 24.6min). Ultrasound-guided, bilateral ESPBs, when added to an optimal multimodal analgesia technique, reduce opioid consumption and pain scores, the need for antiemetic therapy, and the duration of stay in the PACU after one or two level open lumbar laminectomy.

Transverse abdominis plane block as a method of anesthesia after caesarean section

Although we have various methods of analgesia, the prevalence of severe pain after caesarean section remains high. Therefore, it is necessary to look for new reliable technologies for optimal postoperative anesthesia.The objective was to compare the efficiency of postoperative wound infiltration with a local anesthetic and transverse abdominis plane block (TAP-block) as a component of multimodal analgesia in the postoperative period after cesarean section.Materials and methods. A prospective randomized study was conducted. It included 91 patients after elective caesarean section under spinal anesthesia. Patients were divided into 3 groups depending on the method of postoperative analgesia. In group 1 (n = 30), we used wound analgesia. In group 2 (n = 32), transverse abdominis plane block was performed. In group 3 (n = 29), intravenous infusion of paracetamol in combination with intramuscular injection of tramadol 0.5 mg/kg were used for postoperative analgesia.Results. Pain syndrome was less severe after wound analgesia and TAP-block for 24 hours compared to analgesia with systemic analgesics. Moreover, during wound analgesia, lower points of the visual analogue scale (VAS) were traced for three days. The minimum consumption of paracetamol was on the background of wound analgesia, while no patient required the introduction of narcotic analgesics. Women in the wound analgesia group were able to earlier activating: they could walk after 5.6±0.2 hours, compared to 6.1± 0.2 hours with TAP-block and 8.8± 0.4 hours with analgesia with systemic analgesics.Conclusion. Continuous analgesia of postoperative wound is a safe and effective method that allows achieving adequate postoperative analgesia, avoiding using narcotic analgesics and reducing the consumption of non-narcotic systemic analgesics.

Intrathecal opioids for the management of post-operative pain.

Intrathecal opioids are highly effective in the management of post-operative pain. The technique is simple with a very low risk of technical failure or complications, and it does not require additional training or expensive equipment such as ultrasound machines and, therefore, is widely practised around the world. The high-quality pain relief is not associated with sensory, motor or autonomic deficits. This study focuses on intrathecal morphine (ITM) which is the only US Food and Drug Administration-approved opioid for intrathecal administration and remains the most commonly used as well as extensively studied. The use of ITM is associated with prolonged analgesia lasting 20-48h after a variety of surgical procedures. ITM has a well-established role in thoracic, abdominal, spinal, urological and orthopaedic surgeries. It is considered the 'gold standard' analgesia technique for caesarean delivery which is generally performed under spinal anaesthesia. As the role of epidural technique in post-operative pain management continues to decrease, ITM has emerged as the neuraxial technique of choice for pain management after a major surgery as a component of multimodal analgesia in Enhanced Recovery After Surgery (ERAS) protocols. ITM is recommended by many scientific groups and societies such as ERAS, PROSPECT, the National Institute for Health and Care Excellence and the Society of Obstetric Anesthesiology and Perinatology. The doses of ITM have decreased successively; today they are a fraction of those used in the early 1980s. With these dose reductions, the risks have decreased; current evidence shows that the risk of the much-feared respiratory depression with low-dose ITM (up to 150 mcg) is no greater than that with systemic opioids used in routine clinical practice. Patients receiving low-dose ITM can be nursed in regular surgical wards. The monitoring recommendations from societies such as the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the American Society of Regional Anesthesia and Pain Medicine and the American Society of Anesthesiologists need to be updated so that the requirements for extended or continuous monitoring at postoperative care units (PACUs), step-down units, high-dependency units, and intensive care units can be eliminated, thereby reducing additional costs and inconvenience and making this simple, versatile and highly effective analgesia technique available to a wider patient population in resource-limited settings.

Comparison of the effects of intravenous lignocaine and ketamine on postoperative pain after lower abdominal surgeries under general anaesthesia.

As a component of multimodal analgesia, the administration of systemic lignocaine and ketamine is a well-known technique. This study was designed to compare the effect of intravenous lignocaine and ketamine on postoperative pain in the patients undergoing lower abdominal surgeries under general anaesthesia. Total 126 patients, aged between18 to 60 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomly allocated into lignocaine (Group L), ketamine (Group K), or control (Group C). We assessed the mean fentanyl consumption 24 hours postoperatively, visual analogue score (VAS), time to first rescue analgesia, haemodynamic parameters, postoperative complications patient satisfaction score, and duration of hospital stay among three groups. The mean fentanyl consumption in first 24 hours postoperatively was higher in group C (194.65 ± 48.48 μg) compared to group L (139.69 ± 46.96 μg) and group K (161.37 ± 46.31 μg) (P < 0.05). The VAS pain scores were lower in group L and group K compared to group C (P < 0.05). The time to first rescue analgesia was prolonged in group L and group K as compared to group C (P < 0.05). The patients were more satisfied in group L and group K as compared to group C (P < 0.05). The mean fentanyl consumption in 24 hours postoperatively and pain intensity were less with intraoperative lignocaine and ketamine infusion with improved patient satisfaction in patients undergoing lower abdominal surgery under general anaesthesia.

Sacral Multifidus Plane Block – A Way Forward to Provide Perioperative Analgesia for Spinopelvic Fixation Surgery

Sacral Multifidus Plane Block – A Way Forward to Provide Perioperative Analgesia for Spinopelvic Fixation Surgery

Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children

BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively.&#x0D; AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged 1 year after cardiac surgery.&#x0D; MATERIALS AND METHODS: A prospective single-center study included 122 children aged 1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery.&#x0D; RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine.&#x0D; CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.

Ефективність та безпечність пролонгованої внутрішньовенної інфузії лідокаїну для післяопераційного знеболювання та відновлення після оперативних втручань у дітей віком 8-17 років

Postoperative pain control in pediatric practice is an important issue not only for patients but also for the health care system overall. The results of meta-analyses and a large number of studies have shown that intravenous infusions of lidocaine significantly improve the quality of postoperative analgesia and help reduce the consumption of narcotic analgesics after various surgical procedures in adult patients. This technique is rarely reported in the pediatric population due to insufficient data on its efficacy and safety. The purpose - to evaluate the efficacy and safety of perioperative continuous intravenous infusion of lidocaine as a component of multimodal analgesia in children aged 8 years and older to improve pain control and quick recovery after surgery. Materials and methods. The prospective controlled study included 74 (50 boys, 24 girls) children who underwent surgical procedures under general anesthesia. The age of the patients was from eight to 18 years. Patients were divided into two groups: the (study) Group 1 (n=28) included children who received intravenous lidocaine as a component of multimodal analgesia in the perioperative period, and the second (control) group (n=46) included children who were not administered lidocaine. Pain intensity, duration of the postoperative narcotic analgesics administration and their dosage, the time for recovery of intestinal motility, the transition period to full enteral nutrition, the length of hospital stay, and the nature of postoperative complications were evaluated. Data analysis was performed using the statistical package “SPSS 20” (SPSS Inc.) version 21.0.0 for Windows. Results. The results of our study demonstrated that pain intensity, as well as total postoperative morphine requirement, were significantly lower in the lidocaine group compared to the control group during the 48-hour follow-up period (p&lt;0.05). Additional morphine analgesia on postoperative day 1 was documented in 5 (17.9%) patients in the lidocaine group and 19 (41.3%) patients in the control group. Intestinal motility was restored within 3.79±1.81 hours postoperatively in the study group and was significantly shorter compared to the control group. In the postoperative period, there was a significantly lower frequency of postoperative nausea in patients in the study group. Side effects of lidocaine infusion were not registered. Conclusions. Prolonged perioperative infusion of lidocaine as a component of multimodal analgesia helps to reduce the consumption of narcotic analgesics and significantly improves the quality of pain syndrome treatment in the postoperative period in children. Due to the earlier restoration of bowel motility, lidocaine infusion may be useful for rapid postoperative rehabilitation programs. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Intravenous infusion of lidocaine as a component of multimodal analgesia in children under one year of age after cardiac surgery

BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology.&#x0D; AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects.&#x0D; MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine.&#x0D; RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups.&#x0D; CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.

Effect of Bilateral Superficial Cervical Plexus Block on Postoperative Analgesic Consumption in Patients Undergoing Thyroid Surgery.

PurposePatients complain of moderate-intensity pain following thyroid surgery. Superficial cervical plexus block (SCPB) can be employed as a component of multimodal analgesia after thyroid surgery. This double-blind, randomized study aimed to compare the effects of bilateral SCPB (BSCPB) on postoperative analgesic requirements following thyroid surgery.MethodsA total of 60 American Society of Anesthesiologists (ASA) I-II patients who underwent elective total thyroidectomy under general anesthesia were randomly assigned to Group 1 and Group 2. After inducing general anesthesia, BSCPB was not administered to Group 1, whereas BSCPB was administered using a three-point injection technique with 0.5% levobupivacaine in Group 2. Patient-controlled analgesia (PCA) was applied by using tramadol in both groups for postoperative analgesia. Tenoxicam was administered as rescue analgesic to patients in case of numeric rating scale (NRS) >4. The postoperative consumption of tramadol, rescue analgesic requirement, and hoarseness, hematoma, signs of local anesthetic toxicity were recorded.ResultsThe consumption of tramadol for PCA at two, six, 12, and 24 hours postoperatively, NRS scores in the recovery room, and the number of patients who used tenoxicam as rescue analgesic were significantly lower in Group 2 than in Group 1. The hemodynamic values were similar between the groups.ConclusionsOur study demonstrates that BSCPB, when applied as a component of multimodal analgesia, is an effective method for reducing the analgesic requirements following thyroid surgery.

Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial

BackgroundPostoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy.MethodsA total of 338 elderly patients, aged 65–80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits.ResultsDelirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05).ConclusionThoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects.Trial registrationThe study was registered on the Chinese Clinical Trial Registry Center (www.chictr.org.cn; registration number: ChiCTR 2,000,033,238) on 25/05/2018.

Періопераційна аналгезія абдомінальних гістеректомій: ретроспективне дослідження

Актуальність. Ефективність та універсальність регіонарних методів знеболювання в поєднанні з мультимодальним підходом до періопераційної аналгезії дозволяють використовувати їх для дедалі більшої кількості пацієнтів, зокрема при проведенні операцій в гінекології. Мета: оцінити анальгетичну ефективність TAP-блоку як компонента мультимодальної аналгезії порівняно з відсутністю застосування регіонарних методів аналгезії при проведенні абдомінальних тотальних гістеректомій. Матеріали та методи. Нами проведено ретроспективне одноцентрове дослідження у відділеннях анестезіології, інтенсивної терапії та гінекології КП «Рівненська обласна клінічна лікарня імені Юрія Семенюка». У дослідження було включено пацієнтів із симптомними фіброміомами, ускладненими кровотечами зі статевих шляхів, які потребували проведення тотальної абдомінальної гістеректомії (надпіхвової ампутації матки з придатками), віком 40–65 років. Критеріями виключення з дослідження були: відмова пацієнта від участі у дослідженні на будь-якому з його етапів, клас за ASA &gt; IV, індекс маси тіла &gt; 40 кг/м2, застосування агоністів/агоністів-антагоністів опіатних рецепторів до операції, неконтрольована артеріальна гіпертензія, порушення ритму серця. До аналізу даних включені 43 пацієнти. Результати. Встановлено, що рівень болю за візуальною аналоговою шкалою у І групі досягав максимальних значень на етапах дослідження h12 та h24 і становив 4,8 [3,3; 5,8] бала та 5,3 [3,9; 6,4] бала, тоді як у пацієнтів ІІ групи на аналогічних етапах дослідження біль було оцінено в 2,7 [2,3; 3,5] бала та 2,1 [1,6; 4,1] бала відповідно (p &lt; 0,05). Виявлено вірогідні відмінності рівня частоти серцевих скорочень між І та ІІ групами пацієнтів на етапі дослідження h24 (93 [87; 98] уд/хв у І групі порівняно з 72 [63; 79] уд/хв у ІІ групі, p = 0,05). Не встановлено вірогідних відмінностей середнього артеріального тиску між І та ІІ групами пацієнтів на всіх етапах дослідження, проте була тенденція до зниження цього показника впродовж усього дослідження в І групі пацієнтів. Середня добова потреба в налбуфіні на етапі дослідження h24 мала тенденцію (p = 0,07) до нижчих показників серед пацієнтів ІІ групи (40,9 ± 1,1 мг/добу) порівняно з показниками пацієнтів І групи (51,4 ± 2,9 мг/добу). На етапі дослідження h72 потреба в налбуфіні була вірогідно нижчою (p &lt; 0,05) в ІІ групі та становила 5,8 ± 0,8 мг/добу порівняно з 22,5 ± 4,1 мг/добу в І групі. Середня тривалість госпіталізації серед пацієнтів І групи становила 6,8 ± 0,5 дня, серед пацієнтів ІІ групи — 4,2 ± 0,2 дня (p &lt; 0,05). Висновки. Застосування двостороннього TAP-блоку із 0,25% бупівакаїном та ад’ювантом дексаметазоном продемонструвало тенденцію до зниження потреби в налбуфіні в першу післяопераційну добу на 25,7 %, на третю післяопераційну добу — в 3,9 раза (p &lt; 0,05). Тривалість госпіталізації у пацієнтів ІІ групи зменшувалася на 2,6 дня (p &lt; 0,05).

Association Between Local Anesthetic Dosing, Postoperative Opioid Requirement, and Pain Scores After Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia.

Multimodal analgesia (MMA) during breast surgery reduces postoperative pain and opioid requirements, but the relative contribution of local anesthetic dosing as a component of MMA is not well defined among patients undergoing lumpectomy and sentinel lymph node biopsy (SLNB). We identified consecutive patients who underwent lumpectomy and SLNB with MMA from 1/2019 to 4/2020. Univariable and multivariable linear and logistic regression were used to examine associations between local anesthetics, opioid requirements in the post-anesthesia care unit (PACU), and pain scores in the PACU and on postoperative day (POD) 1. In total, 1603 patients [median tumor size, 14 mm (interquartile range 8-20 mm)] were included. The median PACU opioid requirement was 0 morphine milligram equivalents (interquartile range 0-5). PACU maximum pain was none or mild in 58% of patients and moderate to severe in 42%; among 420 survey respondents, 56% reported no or mild pain and 44% reported moderate to severe pain on POD 1. On multivariable analysis that adjusted for routine components of MMA, increasing doses of 0.5% bupivacaine were associated with reduced PACU opioid requirements (β -0.04, 95% confidence interval -0.07 to -0.01, p = 0.011) and lower odds of moderate to severe pain (odds ratio 0.98, 95% confidence interval 0.97-0.99, p < 0.001). Local anesthetics were not associated with pain scores on POD 1. Higher amounts of local anesthetics reduce acute postoperative pain and opioid requirement after lumpectomy and SLNB. Maximizing dosing within weight-based limits is a low-risk, cost-effective pain control strategy that can be used in diverse practice settings.