Need For Additional Analgesia Research Articles

Advancing mid-rectal cancer surgery: Unveiling the potential of natural orifice specimen extraction surgery in comparison to conventional laparoscopic-assisted resection.

Mid-rectal cancer treatment traditionally involves conventional laparoscopic-assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR. To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long-term prognosis between NOSES and CLAR groups. A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases. The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications. While long-term outcomes (overall survival, disease-free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid-rectal cancer treatment, while maintaining similar long-term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long-term results.

Effect of Preemptive Systemic Patient-controlled Analgesia in Evisceration

Purpose: To investigate the effect of preemptive systemic analgesia using patient-controlled analgesia (PCA) on postoperative pain after evisceration.Methods: Of the patients who underwent evisceration under general anesthesia in our hospital, 55 who were able to evaluate pain using a numeral rating scale (NRS) were included. The patients were divided into two groups: group 1 used PCA after surgery, and group 2 used PCA preemptively before surgery. We compared the two groups in terms of the NRS pain scores on the day of surgery and 1, 2, and 3 days after surgery, and according to whether additional analgesics were used.Results: The 55 patients included 17 in group 1 and 38 in group 2. The NRS at 3, 5, and 7 hours on the day of surgery tended to be lower in group 2, but not significantly (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The NRS on days 1 and 2 after surgery was significantly lower in group 2 (&lt;i&gt;p&lt;/i&gt; = 0.014 and &lt;i&gt;p&lt;/i&gt; = 0.027, respectively), and the NRS on day 3 after surgery was also lower, although not significantly (&lt;i&gt;p&lt;/i&gt; = 0.059). Significantly fewer cases required additional analgesics in group 2 compared to group 1 on the day of surgery and 1, 2, and 3 days after surgery (&lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, and &lt;i&gt;p&lt;/i&gt; = 0.008, respectively).Conclusions: Using preemptive systemic PCA in evisceration significantly reduced the postoperative pain, and PCA itself was an effective administration method due to the high rate of pain control without the need for additional analgesics.

Impact of intra-operative ketamine on postoperative outcomes in abdominal surgery: a narrative review.

Ketamine offers a promising solution to common postoperative issues in abdominal surgery, including pain, nausea, opioid use, and opioid-related side effects. The purpose of this literature review is to analyze the benefits and potential adverse effects associated with the intraoperative utilization of ketamine during abdominal surgeries. A comprehensive search of PubMed and Ovid MEDLINE was conducted by two independent reviewers. Studies were included if they targeted adult patients and evaluated intra-operative use of ketamine for abdominal operations. We identified 13 studies of intraoperative use of ketamine in abdominal surgery. The results of these studies showed improved pain management as demonstrated by lower pain scores, decreased hyperalgesia, and a decreased need for additional analgesics. The results also demonstrated a decrease in opioid consumption during the critical 24-hour postoperative period. However, a few studies reported undesirable side effects such as hallucinations and delirium. The intraoperative use of ketamine holds promise as a valuable adjunct to anesthesia during abdominal surgeries. Studies support its use in improving post-operative pain and decreasing opioid consumption. Due to risks of adverse effects, further studies in larger patient populations may help identify which patients will benefit the most. This review offers a succinct selection of the pertinent literature.

Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy

ObjectiveTo compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA total of 29 female dogs with mammary tumors. MethodsPremedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 μg kg–1 loading dose (LD) and 1 μg kg–1 hour–1; lidocaine 2 mg kg–1 LD and 3 mg kg–1 hour–1; ketamine 1 mg kg–1 LD and 0.6 mg kg–1 hour–1; n = 14] or FLK (fentanyl 5 μg kg–1 LD and 9 μg kg–1 hour–1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe′Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann–Whitney test. ResultsMore dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe′Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. Conclusions and clinical relevanceBased on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus.

Ventral hernia repairs, particularly laparoscopic ventral hernia repair (LVHR), have become common procedures among general surgeons worldwide. Despite the benefits of LVHR, acute postoperative pain remains a significant concern. Transversus abdominis plane (TAP) blocks have been employed to alleviate postoperative pain in various laparoscopic procedures. This study aimed to assess the effectiveness of laparoscopic-guided TAP block in laparoscopic IPOM plus and its impact on postoperative pain and analgesic requirements. A randomized controlled trial was conducted at a tertiary care center in India involving 72 patients undergoing laparoscopic IPOM plus. Patients were randomized into two groups: Group I received laparoscopic-guided TAP block, while Group II received standard general anesthesia without TAP block. Pain scores were assessed at 6, 12, and 24h postoperatively using the numerical rating scale. Postoperative analgesic requirements were also recorded. Group I demonstrated significantly lower pain scores at 6 and 24h postoperatively compared to Group II. The need for additional analgesics was significantly lower in Group I (13.8%) compared to Group II (72.2%). There were no significant differences in age, BMI, duration of surgery, or other demographic characteristics between the two groups. The findings of this randomized controlled trial demonstrate the effectiveness of laparoscopic-guided TAP blocks in reducing postoperative pain and analgesic requirements after laparoscopic IPOM plus.

Spinal Anestezi Altında Sezaryen Doğumda Postoperatif Analjezi için Transversalis Fasya Plan Bloğunun Transversus Abdominis Plan Bloğuyla Karşılaştırılması: Retrospektif Bir Çalışma

Objective: Transversalis fascia plane (TFP) and transversus abdominis plane (TAP) blocks are used for postoperative analgesia in many lower abdominal procedures such as cesarean section. This study aimed to retrospectively compare the postoperative effects of TFP and TAP blocks for postoperative multimodal analgesia in patients who underwent cesarean section under spinal anesthesia. Methods: We retrospectively searched electronic medical records to identify patients who underwent cesarean section under spinal anesthesia between November 2021 and June 2022. A total of 497 patients were identified, and 120 patients were included that meet our criteria in our analysis. The patients were divided into three groups: TFP, TAP, and control. Data were obtained from the files of the patients. Results: The block groups had significantly lower numeric rating scale (NRS) scores, less non-steroidal anti-inflammatory drug consumption, and lower complications than the control group. No opioid consumption was observed in the block groups. Although no non-steroidal anti-inflammatory drug consumption until the 4th hour and no opioid consumption until the 8th hour were observed in the control group, the need for additional analgesics increased as time passed. While the TFP group needed analgesics later than the TAP group, the NRS scores and total analgesic consumption were lower (p&lt;0.001). Patient satisfaction was higher in the block groups than in the control group (p&lt;0.001). Conclusion: Transversalis fascia plane and TAP blocks are effective as part of multimodal analgesia in cesarean section. The TFP block is superior to the TAP block in terms of pain scores, additional analgesic requirements, and patient satisfaction. Keywords: Cesarean section, postoperative pain, ultrasound-guided regional anesthesia, transversus abdominis plane block, transversalis fascia plane block

Analgesic efficacy and safety of regional anesthesia methods in the perioperative period of surgical treatment of unstable spinal fractures: a randomized study

INTRODUCTION: Perioperative anesthesia in spinal surgery is important areas of anesthesiology. Comparison of spine-straightening muscle block (Erector spinae plane block, ESP block) and epidural anesthesia (EA) during spinal surgery may access its effectiveness and safety. OBJECTIVE: To evaluate the efficacy and safety of a single and extended ESP block compared with epidural analgesia in the perioperative period of treatment of unstable vertebral fractures. MATERIALS AND METHODS: A prospective trial involved 110 patients. Three groups of patients were identified: group 1 (n = 35) — with bonuses P block; group 2 (n = 30) — with prolonged ESP block, group 3 (n = 45) — with prolonged epidural analgesia. Systemic hemodynamics, total opioid consumption, pain intensity, complications, the need for additional analgesia were evaluated. RESULTS: There were no differences in hemodynamics and opioid consumption in the intraoperative period. Six hours after surgery the groups with prolonged ESP block (group 2) and prolonged epidural analgesia (group 3) had lower pain indicators on the VAS scale than for group 1. The need for anesthesia (tramadol) for group 1 was significantly higher than for other groups, and amounted to 78 %. The need of opioid was 3 % for group 1, in other groups it was not required. PTR was present in a small percentage in each of the groups, but no statistical differences were found (p = 0.45). In the group with EA, there were 3 cases of urinary retention, 1 case of hip paresthesia. CONCLUSIONS: The use of ESP block allows to achieve effective and safe analgesia during spinal surgery for unstable vertebral fractures. Longer analgesia is provided by prolonged use of the ESP block than by its single use. When compared with prolonged EA, no significant differences were found in the effectiveness of analgesia, the consumption of opioids and the frequency of PTR.

Does Local Infiltration of Anesthesia Reduce Port-site Pain in Gynecological Laparoscopic Surgeries? A Pilot Study

Objectives: The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery. Materials and Methods: A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute’s Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from “no pain” to “worst possible pain” was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia. Results: Comparison of both groups with the VAS score shows P &gt; 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period. Conclusion: The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.

Evaluation of paravertebral blocks in improving post-procedural pain and decreasing hospital admission after microwave ablation of liver tumors

Although ablations are performed with conscious sedation or general anesthesia, microwave ablations can be painful post procedure. Newer analgesic modalities, including regional blocks, have promoted the proliferation of less invasive anesthesia care for ablative procedures. This study evaluates whether bilateral paravertebral blocks reduce the need for additional analgesics in comparison to unilateral blocks in microwave ablations. In this retrospective study, individuals undergoing microwave ablation who underwent unilateral versus bilateral nerve blocks at a single institution from 2017 to 2019 were compared. Categorical variables were analyzed using Pearson’s chi-squared tests. Comparisons of means were completed using multiple T-tests corrected using the Holm-Sidak method with alpha = 0.05. Regression modeling was used to identify factors related to increased MME (milligram morphine equivalent) usage and post-procedure admission rates. A total of 106 patients undergoing 112 liver MWA procedures were included in this analysis, with patients receiving either a bilateral or unilateral block. Pre-procedural characteristics demonstrated no significant differences in age or gender. Bilateral blocks were associated with decreased usage of gabapentin (14% vs. 0%, p = 0.01) and a lower rate of post-procedure admissions (OR 0.23, p = 0.003). Therefore, when using paravertebral blocks, bilateral blocks are superior to unilateral blocks, as demonstrated by decreased rates of hospital admission and reduced use of systemic neuropathic pain medication. Additionally, reducing post-procedural MME may reduce the rate of admission to the hospital.

Intraperitoneal Bupivacaine in Laparoscopic Cholecystectomy, Efficacy and Feasibility

Abstract Background Laparoscopic Cholecystectomy among the most frequently performed elective daycare surgeries. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress, to determine the efficacy of intraperitoneal bupivacaine instillation on management of early postoperative pain in patient undergoing laparoscopic cholecystectomy. Aim of the Work To determined the efficacy of intraperitoneal bupivacaine instillation on management early postoperative pain in patient with laparoscopic cholecystectomy. Patients and Methods This is a prospective randomized study with sample size of 50 patients underwent elective laparoscopic cholecystectomy. We recruited patients from surgery department at Agouza Hospital. We randomly assigned patients to undergo laparoscopic cholecystectomy with bupivacaine and 25 ml of physiological saline (0.9% normal saline) on liver bed or without bupivacaine. Results Fifty patients finally met our inclusion criteria. In bupivacaine group, mean age was 35 (± 6.6), 64% were females and 36% were males. While in non-bupivacaine group mean age was 37.6 (± 6.6), 68% were females and 32% were males with no statistically significant difference between both groups; age (P value=0.22) and age (P value=0.77), In bupivacaine group there was significant pain reduction compared to non-bupivacaine group in terms of VAS at 2 h (p value=0.04), 12 h (p value=0.02), 24 h (, p value=0.01) and VRS at 2 h (p value&amp;lt;0.01), 12 h (p value&amp;lt;0.01), 24 h (p value&amp;lt;0.01). Hospital stay was lower hospital stay in bupivacaine group 0.94 (± 0.16) than nonbupivacaine group 1.21 (± 0.41) (p value&amp;lt;0.01). Need for additional analgesia was lower in bupivacaine group (P value &amp;lt;0.01). Conclusion Intraperitoneal route for administration of local anaesthetic is a safe and effective approach. Bupivacaine is an effective treatment option to achieve postoperative analgesic, limit the duration of hospital stay and the need for additional analgesia. But it did not significantly lower the incidence of nausea and vomiting.

Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery.

The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications. From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH. Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support. Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors. Clinicaltrials.gov identifier: NCT05671783.

Comparison of the effects of one-level and bi-level pre-incisional erector spinae plane block on postoperative acute pain in video-assisted thoracoscopic surgery; a prospective, randomized, double-blind trial

BackgroundThis prospective, randomized, double-blind trial aimed to compare the postoperative analgesic efficacy of One-Level pre-incisional erector spinae plane block (ESPB) and Bi-Level pre-incisional ESPB in patients undergoing video-assisted thoracic surgery (VATS).MethodsThis pilot trial was conducted between April 2022 and February 2023 with sixty patients. The patients were randomly divided into two groups. In One-Level ESPB Group (n = 30) block was performed at the thoracal(T)5 level with the 30 ml 0.25% bupivacaine. In the Bi-Level ESPB Group (n = 30) block was performed at T4 and T6 levels by using 15 ml of 0.25% bupivacaine for each level. In the postoperative period, 50 mg dexketoprofen every 12 h and 1 g paracetamol every 8 h were given intravenously (IV). Patient-controlled analgesia (PCA) prepared with morphine was applied to the patients. 0.5 mg/kg of tramadol was administered via IV for rescue analgesia. Visual analog scale (VAS) scores were recorded in the postoperative 1st, 2nd, 4th, 12th, 24th, and 48th -hours. The need for additional analgesics and side effects were recorded. In two groups, patients’ demographics and postoperative hemodynamic data were recorded.ResultsVAS scores at resting were statistically significantly higher at the 1st (p: 0.002) and 4th -hour (p: 0.001) in the One-Level ESPB. When the groups were evaluated in terms of VAS coughing scores, the 4th -hour (p: 0.001) VAS coughing scores results were found to be statistically significantly higher in the One-Level ESPB group. In terms of VAS values evaluated during follow-up, the rates of VAS coughing score > 3 values were found to be statistically significantly lower in the Bi-Level ESPB group (p: 0.011). There was no statistically significant difference between the groups in terms of side effects, morphine consumption, and additional analgesic use (p > 0.05).ConclusionsAdequate analgesia was achieved in the early postoperative period in the group treated with Bi-Level ESPB with similar morphine consumption and side effects. This may be an advantage, especially in the early postoperative period when the pain is quite intense.

Bilateral transversus abdominis plane (TAP) block reduces pain and the need for additional analgesics after elective cesarean section under opioid-free spinal anesthesia: findings from a randomized clinical trial

BackgroundCesarean section (CS) is the most frequently performed obstetric procedure globally, and postoperative pain remains a prominent concern. This study aimed to evaluate the effectiveness of the bilateral transversus abdominis plane (TAP) block in addressing this issue.MethodsWe performed a randomized trial in women with term pregnancies who underwent elective CS with spinal anesthesia. The women were randomized (1:1) to receive bilateral TAP or postoperative systemic analgesics (control group). The primary outcome was the effect on postoperative pain assessed using the numeric rating score (NRS) at 2, 6, 12, and 24 h in the postoperative period.ResultsAt 2 and 6 h after the surgical procedure, there was a significant reduction in both resting (rNRS p = 0.004) and movement-related pain (dNRS p = 0.0001, p = 0.001 respectively). However, at 12 h, a reduction of dNRS was demonstrated (p = 0.0001), while no benefit was observed at rest. The percentage of women with NRS ≤ 4 was higher after the block at 2 h for both resting and movement-related pain (rNRS p = 0.010; dNRS p = 0.0001); at 6 and 12 h, it was only significant for dNRS (p = 0.002). Rescue doses of analgesics were significantly higher in the control group at 2, 6, and 12 h (p = 0.01, p = 0.0383, p = 0.0003 respectively). No complications with the procedure were recorded.ConclusionBilateral TAP block has the potential to alleviate postoperative pain and reduce the need for additional analgesics after CS.Trial registrationThis study is registered with ClinicalTrials.gov, number (NCT02801968), registered 28 May 2016, https://clinicaltrials.gov/ct2/show/NCT02801968?term=NCT02801968&draw=2&rank=1

#5576 SYSTEMATIC REVIEW AND META-ANALYSIS OF THE SAFETY AND EFFICACY OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS FOR THE MANAGEMENT OF POSTPARTUM PAIN

Abstract Background and Aims Effective pain management is critical for postpartum recovery. While commonly prescribed, systematically-reviewed data regarding efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) are limited. Moreover, guidelines suggest avoiding NSAIDs in women with hypertensive disorders of pregnancy (HDP) due to risks of hypertension and adverse events (AE). However, these AE have not been consistently observed in cohort studies and randomised controlled trials (RCTs) following postpartum NSAID use. This systematic review aims to provide further insight into the postpartum safety and efficacy of NSAIDs. Method A systematic review of eight databases and four clinical trial registries was conducted in July 2020 (PROSPERO Protocol CRD42020196054). RCTs which assessed the safety and/or efficacy of NSAIDs in postpartum women after the year 2000 were included. The primary outcome was incidence of hypertension, with secondary outcomes categorised into three groups: hypertension, secondary safety and efficacy. Data were tabulated and analysed using R (version 4.0.2). Due to heterogeneity in study design, NSAIDs were analysed in a single group and compared with other medications (including paracetamol, opioids, and local anaesthetics) grouped based on mechanism to facilitate meta-analysis. Risk of bias was assessed using the RoB 2 tool with a plan to assess quality of evidence for the primary outcome. Results 12,172 records were identified with the inclusion of 92 RCTs. Eight studies, with four that included women with HDP, reported hypertension-related data (Table 1). The primary outcome was included in one RCT. Secondary safety outcomes such as acute kidney injury or eclampsia were not reported. The odds of nausea, vomiting and sedation were similar between groups. NSAIDs were effective when compared with placebo, as assessed by mean differences (MD) in visual assessment scores (VAS) at 12 hours (MD -1.57, 95% confidence intervals (CI) -2.47 to -0.66), 24 hours (MD -0.82, 95% CI -1.42 to -0.22) and need for additional analgesia (odds ratio 0.17, 95% CI 0.05 to 0.61). There were no significant differences in VAS between NSAIDs and other comparators at 12 and 24 hours. Further interpretation of results is limited due to heterogeneity in intervention and comparator groups, inclusion criteria and reported outcomes. Conclusion Our study confirms the efficacy of NSAIDs for postpartum pain, but current data are inconclusive regarding the risk of developing hypertension. Available data do not demonstrate trends toward AE although further research is required to determine long term, clinically-relevant outcomes to guide decision making.

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p&gt;0.05).

The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications.

To assess the safety and effectiveness of the 4.5/6.5Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA). A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications. The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0-1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005). TIUA had an equal surgical success rate and controlled patients' intraoperative pain as SA. It was superior in terms of TIUA's patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.

Serratus anterior plane block for postoperative analgesia in modified radical mastectomy

Introduction: Serratus Anterior Plane (SAP) block can be used as part of multimodal analgesia, reducing the need for additional analgesia for 24 h postoperatively. The SAP block (SAPB) is easy to apply with a safe technique and low side effects. This study analyzes serratus anterior plane block as postoperative analgesia in Modified Radical Mastectomy (MRM) surgery by assessing the level of pain, side effects, and complications.&#x0D; Methods: This study was a double-blind randomized control trial (RCT) conducted on patients scheduled to undergo MRM, at Dr. Kariadi Hospital Semarang during August-October 2022. A total of 44 patients were enrolled, and divided into two groups; 22 patients in each group. The treatment group received SAPB and was compared with the control group of morphine 0.1 mg/kg, in terms of the numeric pain rating scale, at 4, 8, 12, and 24 h postoperatively, time and number of analgesic rescue doses, the incidence of PONV and pruritus within 24 h postoperatively. Independent T-test, Mann-Whitney, Chi-square, and Fischer tests were performed to analyze the data. P &lt; 0.05 was considered significant.&#x0D; Results: The mean NRS at 4, 12, and 24 h postoperatively was lower in the SAPB group than in the control group (2.73 ± 0.77 vs. 3.23 ± 0.53; 1.77 ± 0.61 vs. 2.32 ± 0.48, and 1.45 ± 0.59 vs. 2.09 ± 0.61). The difference was statistically significant, e.g., P = 0.017, P = 0.003, and P = 0.001, respectively. Time to the first request of rescue analgesia was prolonged in the SAPB group than in the control group (398.86 ± 140.6 vs. 100.91 ± 10.3; P = 0.000). The mean rescue analgesic dose in the SAPB group was lower than in the control group (3.59 ± 1.56 vs. 8.55 ± 2.4; P = 0.000). The control group showed a higher incidence of PONV (68.2% vs. 18.2%, P = 0.01). There was no significant difference in the groups regarding the frequency of pruritus (P = 0.073).&#x0D; Conclusion: Serratus anterior plane block reduced pain significantly up to 24 h postoperatively compared to the control group. The patients in this group needed rescue analgesia after longer duration and needed lower doses of rescue analgesia. There was lower frequency of PONV than the control group.&#x0D; Abbreviations: MRM - Modified Radical Mastectomy; PONV – Postoperative Nausea and Vomiting; PMPS - Post-Mastectomy Pain Syndrome; PVB – Para Vertebral Block; SAP - Serratus Anterior Plane; VAS - Visual Analog Scale&#x0D; Key words: Serratus Anterior Plane Block; Breast Cancer; Modified Radical Mastectomy&#x0D; Citation: Mochamat, Arifin J, Pramadika T, ManapaCH, Istanto W, Wicaksono SA, Nugroho TE. Serratus anterior plane block for postoperative analgesia in modified radical mastectomy. Anaesth. pain intensive care 2023;27(5):486−490; DOI: 10.35975/apic.v27i5.2297&#x0D; Received: January 05, 2023; Reviewed: January 18, 2023; Accepted: March 31, 2023

In-bag abdominal manual morcellation versus contained power morcellation in laparoscopic myomectomy: a comparison of surgical outcomes and costs

BackgroundTo compare the surgical outcomes and costs of in-bag abdominal manual morcellation (AMM) and contained power morcellation (PM) in laparoscopic myomectomy.MethodsA total of 61 patients were divided into two groups based on their myomectomy specimen extraction methods: AMM group (n = 33) and electromechanical contained PM group (n = 28). The surgical outcomes and cost were compared between groups. During AMM, a glove bag (in 27 patients) and an endo bag were used (in 6 patients) according to the myoma size.ResultsMorcellation time (18 ± 9.2 min vs. 37.4 ± 14.1 min) and total operation time (100 ± 24.3 min vs. 127 ± 33.1 min) were significantly lower in the AMM group compared to those in the PM group. Other surgical outcomes, which were similar between groups, included delta hemoglobin, length of hospital stay and VAS score at 12 and 24 h postoperatively. There were no per- or postoperative complications in both group with no conversion to laparotomy. One patient was transfused with two units of erythrocyte suspension postoperatively in the PM group. Sarcoma was not diagnosed in any of the cases in both group.ConclusionThe in-bag AMM or contained PM for specimen extraction resulted in similar outcomes in terms of delta hemoglobin, postoperative pain intensity (VAS score at 12 and 24 h postoperatively), the need for additional analgesia, and the length of hospital stay; however, total operation time and morcellation time were significantly shorter in the AMM group, indicating a prominent advantage. Significant cost-effectiveness is also a critical advantage of in-bag AMM compared to containing PM.

Lidocaine 10% sprays versus oral diclofenac sodium for pain relief in women undergoing hysterosalpingography for infertility workup: A randomized clinical trial

ABSTRACT Background Tubal disease is the leading cause of female infertility in the West African sub-region and hysterosalpingography (HSG) is the first-line imaging technique in its assessment. HSG is an acutely painful procedure. Various studies on analgesia for HSG were inconclusive. We compared the efficacy of 10 mg lidocaine 10% spray and 50 mg oral diclofenac sodium for pain relief during HSG. Methods This randomized clinical trial was carried out at the Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria between December 2019 and December 2021, among one hundred and eight eligible women undergoing HSG as part of their infertility workup. Ethical clearance was obtained from the ethics committee of the hospital with Protocol number ERC/2019/01/14. They were randomized into two groups. One group of 54 patients received 10 mg of 10% lidocaine spray and an oral placebo, while the second group of 54 women had 50 mg of oral diclofenac sodium and normal saline spray. Pain scores were assessed using a 10 cm visual analog scale at cervical traction, instillation of contrast media, and thirty minutes after HSG. The mean pain scores, the need for additional analgesia, and the occurrence of adverse drug reactions were compared between the two groups. Result Those in the oral diclofenac group had significantly lower pain scores than the 10% Lidocaine group 30 minutes after HSG; 1.13 ± 1.06 Vs. 2.04 ± 1.26 (p < 0.001). The additional analgesic requirement also showed no statistically significant difference between the two groups. Conclusion This study showed that oral diclofenac sodium is comparable to lidocaine spray for pain relief during HSG. It also has the additional benefit of improved quality of life 30 mins after HSG as evidenced by effective pain relief. Consideration should be given to the use of oral diclofenac sodium for pain relief during and after HSG in well-selected patients.

Efficacy and tolerability of oral morphine versus oxycodone/acetaminophen for analgesia in the emergency department.

Oxycodone/acetaminophen is one of the most commonly prescribed medications for pain management in the emergency department (ED) despite its high abuse liability. Our objective was to determine whether oral immediate-release morphine is as effective and well tolerated as oral oxycodone/acetaminophen for pain relief in stable ED patients. This is a prospective comparative study in which stable adult patients with acute painful conditions who had either oral morphine (15 or 30 mg) or oxycodone/acetaminophen (5/325 mg or 10/650 mg) ordered for them at the discretion of a triage physician were recruited. This study took place in an urban, academic ED from 2016 to 2019. Seventy-three percent of the subjects were between the ages of 18 and 59, 57 percent were female, and 85 percent were African American. Most presented with abdominal, extremity, or back pain. Patient characteristics were similar between treatment groups. Of the 364 enrolled patients, 182 were given oral morphine and 182 were given oxycodone/acetaminophen at the discretion of the triage provider. They were asked to rate their pain score prior to receiving analgesia and at 60 and 90 minutes after administration. We examined pain scores, adverse effects, overall satisfaction, willingness to accept the same treatment again, and the need for additional analgesia. There was no difference in satisfaction reported by patients who received morphine versus oxycodone/acetaminophen: 15.9 percent vs 16.5 percent were very satisfied, 31.9 percent vs 26.4 percent were somewhat satisfied, and 23.6 percent vs 22.5 percent were not satisfied, p = 0.56. Secondary outcomes also showed no significant difference: net change in pain score -2 vs -2 at 60 and 90 minutes, p = 0.91 and p = 0.72, respectively; adverse effects 20.9 percent vs 19.2 percent, p = 0.69; need for further analgesia 9.3 percent vs 7.1 percent, p = 0.44; willingness to accept analgesic again 73.1 percent vs 78.6 percent, p = 0.22. Oral morphine is a feasible alternative to oxycodone/acetaminophen for analgesia in the ED.