NSAID Consumption Research Articles

Comparison of Intercostal Nerve Block and Serratus Anterior Plane Block for Perioperative Pain Management and Impact on Chronic Pain in Thoracoscopic Surgery: A Randomized Controlled Trial.

This study compares the analgesic efficacy of Intercostal Nerve Block (ICNB) under direct thoracoscopic visualization and Serratus Anterior Plane Block (SAPB) with ultrasound guidance during thoracoscopic surgery's perioperative period. Furthermore, it examines their impact on chronic pain and identifies potential risk factors associated with its development. In this prospective randomized controlled study, 74 thoracoscopic surgery patients were randomly assigned to ICNB or SAPB groups. Attending surgeons administered ICNB, while anesthesiologists performed SAPB, both using 20mL of 0.5% ropivacaine. Primary outcomes included Visual Analog Scale (VAS) scores for resting and coughing pain at 6, 12, 24, and 48 hours postoperatively, perioperative opioid and NSAID consumption, and chronic pain incidence at 3 months postoperatively. Secondary outcomes aimed to identify independent risk factors for chronic pain. The primary results reveal that SAPB group exhibited significantly lower VAS scores than ICNB group for postoperative coughing at 24 hours (P<0.001, 95% CI=[0.5, 1]) and for resting pain at 48 hours (P=0.001, 95% CI=[0.2, 1]). Conversely, ICNB group demonstrated reduced VAS score for resting pain at 6 hours compared to SAPB group (P=0.014, 95% CI=[-0.5, 0.5]). SAPB group required significantly less intraoperative sulfentanil (P<0.001, 95% CI=[2.5, 5]), remifentanil (P=0.005, 95% CI=[-0.4, -0.1]), and flurbiprofen ester (P=0.003, 95% CI=[0, 50]) than ICNB group. Chronic pain incidence was similar (P=0.572, 95% CI=[0.412, 1.279]), with mild pain in both ICNB and SAPB groups. Secondary findings indicate that resting VAS score at 12 hours (OR=7.59, P=0.048, 95% CI=[1.02, 56.46]), chest tube duration (OR=3.35, P=0.029, 95% CI=[1.13, 9.97]), and surgical duration (OR=1.02, P=0.049, 95% CI=[1.00, 1.03]) were significant predictors of chronic pain occurrence. ICNB and SAPB demonstrated comparable analgesic effects, with similar rates of chronic pain occurrence. Chronic pain independent risk factors included resting VAS score at 12 hours, chest tube duration, and surgical duration.

NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database

IntroductionWe aim to explore the association between NSAIDs consumption, Symptomatic Slow Action Drugs for Osteoarthritis (SYSADOA), analgesics, and antiplatelet drugs, and decline in renal function by estimated Glomerular Filtration Rate (eGFR).MethodsWe performed a case-control study using the SIDIAP database in Catalonia. We considered defined cases, patients with an eGFR value ≤ 45 ml/min/1.73 m2 in the period 2010–2015 with a previous eGFR value ≥ 60, and no eGFR ≥ 60 after this period. Controls had an eGFR ≥ 60 with no previous eGFR < 60. Five controls were selected for each case, matched by sex, age, index date, Diabetes Mellitus and Hypertension. We estimated Odds Ratios (OR, 95% Confidence Intervals) of decline in renal function for drugs group adjusting with logistic regression models, by consumption measured in DDD. There were n = 18,905 cases and n = 94,456 controls. The mean age was 77 years, 59% were women. The multivariate adjusted model showed a low risk for eGFR decline for NSAIDs (0.92;0.88–0.97), SYSADOA (0.87;0.83–0.91) and acetaminophen (0.84;0.79–0.89), and an high risk for metamizole (1.07;1.03–1.12), and antiplatelet drugs (1.07;1.03–1.11). The low risk in NSAIDs was limited to propionic acid derivatives (0.92;0.88–0.96), whereas an high risk was observed for high doses in both acetic acid derivatives (1.09;1.03–1.15) and Coxibs (1.19;1.08–1.30). Medium and high use of major opioids shows a high risk (1.15;1.03–1.29). Triflusal showed high risk at medium (1.23;1.02–1.48) and high use (1.68;1.40–2.01).ConclusionWe observed a decline in renal function associated with metamizole and antiplatelet agent, especially triflusal, and with high use of acetic acid derivates, Coxibs, and major opioids. Further studies are necessary to confirm these results.

Rehabilitation Using Implants with Sloped Platform Edge vs. Standard Platform with Guided Bone Regeneration: A Randomized Control Clinical Trial.

The purpose of this study was to evaluate the vertical bone loss after using different techniques: sloped implants or standard implants with guided bone regeneration. Patients with tooth gap and horizontal bone deficiency were randomly allocated to the test group (implants with sloped platform-SLP) and control group (standard design implants with guided bone regeneration-GBR). The primary outcome was bone loss (6 months after finishing the prosthetic treatment). Secondary outcomes included the following: patient-reported outcome measures (PROMs), post-operative edema, keratinized mucosa width, and pink aesthetic score (PES). The average bone loss at 6 months was 0.23 ± 0.15 mm and 1.03 ± 0.37 mm in the SLP and GBR groups, respectively. The SLP group was characterized by lower pain intensity the first 7 days (p < 0.001), lower post-operative edema (p < 0.001), lower consumption of NSAIDs on days 1, 3, 5, and 7 (p = 0.002, <0.001, <0.001, and 0.008), and lower total OHIP-14 (p = 0.047) on day 7. The keratinized mucosa width was 3.7 (3.4-4.0) mm and 2 (1.4-2.0) mm in the SLP and GBR groups, respectively. The preservation of the mesial, distal papillae, and the level of soft tissue correspondence were significantly higher in the SLP group (p = 0.003, 0.038, <0.001). In the SLP group, more natural color and better texture of soft tissues were found (p = 0.048, p = 0.041). The use of implants with a sloped platform resulted in superior outcomes compared to the standard-design implants with GBR.

Dual effects of dulaglutide on glycemic control and knee osteoarthritis pain in elderly patients with Type 2 diabetes.

Aim: This study aims to evaluate the dual benefits of dulaglutide in improving glycemic control and reducing knee OA pain.Patients & methods: Elderly T2DM patients diagnosed with bilateral knee OA on conventional OA treatment for at least 3 months were studied for their glycemic metrics, OA pain scores and NSAID consumption at baseline, 3 months and 6 months.Results: Significant improvements in glycemic control were observed, HbA1c decreased from 8.7% to 6.5% over 6 months. Pain scores, NSAID, body weight and BMI showed substantial reductions over time. Positive correlation (r=0.73, p<0.001) was found between glycemic control and pain reduction.Conclusion: Dulaglutide improves glycemic control, knee joint OA pain and weight management in elderly patients with T2DM.

A Questionnaire to Evaluate Undergraduate Students' Consumption and Awareness of Non-Steroidal Anti-Inflammatory Drugs in Syria

This study aims to evaluate the level of awareness and consumption of NSAIDs among college undergraduate students in Syria. 60.1% of 309 participants were between 20 and 25 years old. 64.1% were females. 27.6% were medical college students. NSAID consumption was very high among participating students. 94.9% have used these drugs. 65.9% admit taking these medications between 2 to 10 times per month. Most participants prefer to take tablets and capsules (93.8%), especially for relieving pain (84.6%). The first choice of NSAIDs among students was ibuprofen 36.6%, then diclofenac 25.3%. 69.1% have not experienced any side effects as a result of taking NSAIDs. The study findings showed that the level of awareness among participants about NSAIDs was good since about 76% of participants have taken NSAIDs after food. However, most participants used NSAIDs without consulting a doctor or a pharmacist every 8 hours. In addition, some of them mentioned antibiotics as an example of NSAIDs. The college students who participated in this survey have a general knowledge of NSAIDs. Medical college students are more aware of the side effects, safety, and dosage of NSAIDs.

ОПЫТ ПРИМЕНЕНИЯ ИМПЛАНТАТОВ СО СКОШЕННЫМ КРАЕМ ПЛАТФОРМЫ

Purpose: Comparative analysis of the use of implants with modified neck configuration and standard implants with additional bone grafting.&#x0D; Materials and methods: 34 patients with partial tooth loss combined with a horizontal defect of the alveolar bone were included in the study. In group 1 (n = 15) implants with sloped platform edge were placed, in group 2 (n = 19) implants of standard design with directed bone regeneration (GBR) were placed. The primary end point of the study was the level of vertical bone resorption in the implant neck area 6 months after the operation. Secondary endpoints were: pain (VAS) and oedema scores, width of attached gingiva, number of analgesics taken, quality of life and health (OHIP-14).&#x0D; Results: The level of vertical resorption after 6 months in patients in group 1 was 0.04 ± 0.04mm mesially and 0.06 ± 0.05mm distally, in patients in group 2 mesially 1.06 ± 0.35mm and distally 1.00 ± 0.39mm. The use of implants with sloped edge of the platform was characterized by lower pain intensity the first 7 days after surgery (p &lt; 0,001), lower severity of collateral edema (p &lt; 0,001), lower consumption of NSAIDs on 1, 3, 5, 7 days (p = 0,002, &lt;0,001, &lt;0,001 and 0,008, respectively), lower total OHIP-14 score (p = 0,047) on 7 days. After 4 months, the width of attached keratinized gingiva was 3.6 (3–3.8) mm in patients in group 1 and 2 (1.5–2.1) mm in group 2.&#x0D; Conclusion: The use of implants with a sloped platform edge is characterized by a lower level of vertical resorption and allows for a more comfortable postoperative period.

Outcomes of hip fracture treatment with intravenous morphine and with other analgesics: postoperative analgesic medical expense, severity of pain and hospitalisation—a retrospective study

AimsThis study compares the postoperative medical costs and outcomes of hip fracture patients treated with intravenous (IV) versus other analgesics (weak opioids, NSAIDs or acetaminophen).MethodsWe performed a retrospective study at a tertiary hospital in Thailand, examining 1,531 patients who underwent hip fracture surgery between 2009 and 2020. We analyzed data on analgesic usage, costs, pain scores, and adverse effects.ResultsIn the study of 1531 patients, 63% of patients received as-needed analgesics, and 37% received preemptive prescriptions. In both groups, IV morphine was the predominant choice. The mean cost for the IV group was marginally higher than the other analgesics group ($2277 vs $2174). The other analgesics group had a significantly higher consumption of acetaminophen and selective NSAIDs (p = 0.004). Pain scores were similar across both groups, but the IV group had a significantly higher incidence of gastrointestinal side effects (24% vs 10.5%, p < 0.01).ConclusionThe choice of IV or other analgesics in treating hip fractures affects analgesic usage, side effects, medical costs, and patient outcomes. Further studies across different regions are recommended.

Factors Associated with Functional Dyspepsia in Junior College Students of the Faculty of Nursing, University of Riau

Functional dyspepsia is a collection of symptoms in the form of an uncomfortable feeling in the upper abdomen, pain, bloating, early fullness, frequent belching, nausea and vomiting. This study used a correlation descriptive research design with a cross sectional approach. The research sample was 147 respondents who were taken based on inclusion criteria using a total sampling technique. The analysis used univariate analysis to see the distribution of frequencies and bivariate using the Chi-Square test. The data collection tool used was the Perceived Stress Scale (PSS) questionnaire, eating habits, irritative diets, and functional dyspepsia which had been tested for validity and reliability. The results of this study indicate that most students experience functional dyspepsia. The results of this study indicate the factors associated with functional dyspepsia in college students, namely eating regularity (0.021). Meanwhile, factors that were not related to functional dyspepsia included stress level (p = 0.162), history of NSAID consumption (p = 0.112), and irritative diet (p = 0.380) There is a relationship between eating regularity and functional dyspepsia. The results of this study are expected so that students can manage their diet and maintain stomach health properly, so that the incidence of functional dyspepsia in students can decrease.

Pain management following septorhinoplasty surgery: evidence from a systematic review.

We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery. Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022. Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies. This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques.

Analgesic Efficacy of Intraoperative Superior Hypogastric Plexus (SHP) Block during Abdominal Hysterectomy: A Systematic Review and Meta-Analysis of Controlled Trials.

Background and Objectives: Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. The objective of this research is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and nonrandomized comparative trials (NCTs) that have surveyed the analgesic benefits and morbidity of intraoperative superior hypogastric plexus (SHP) block (intervention) compared with no SHP block (control) during abdominal hysterectomy. Materials and Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Web of Science, PubMed, Scopus, and Embase were searched from inception until 8 May 2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias of RCTs and NCTs, respectively. In a random effects mode, the data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Five studies (four RCTs and one NCT) comprising 210 patients (SHP block = 107 and control = 103) were analyzed. The overall postsurgical pain score (n = 5 studies, MD = -1.08, 95% CI [-1.41, -0.75], p < 0.001), postsurgical opioid consumption (n = 4 studies, MD = -18.90 morphine milligram equivalent, 95% CI, [-22.19, -15.61], p < 0.001), and mean time to mobilization (n = 2 studies, MD = -1.33 h, 95% CI [-1.98, -0.68], p < 0.001) were significantly decreased in the SHP block group contrasted with the control arm. Nevertheless, there was no significant variance between both arms regarding operation time, intraoperative blood loss, postsurgical NSAID consumption, and hospital stay. There were no major side effects or sympathetic block-related aftermaths in both groups. Conclusions: During abdominal hysterectomy and receiving perioperative multimodal analgesia, the administration of intraoperative SHP block is largely safe and exhibits better analgesic effects compared to cases without administration of SHP block.

Prevalence and etiology of Helicobacter pylori infection in dyspepsia patients: a hospital-based cross-sectional study.

A cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC) from January to June 2022 to find out the prevalence and risk factors of H. pylori in dyspepsia patients. A prevalidated questionnaire was used to collect the data from 180 patients. This study adheres to the principles outlined in the Helsinki Declaration. The χ 2-test was applied, and the odds ratio and 95% CI were calculated to find the association of H. pylori with the risk factors. A total of 180 patients were enrolled in this study, of whom, 73 (40.6%) patients were male and 107 (59.4%) were female. In seropositive H. pylori patients, 80 (60.6%) patients had nausea or vomiting, 110 (83.3%) patients were found to have flatulence, 128 (97.7%) patients were experiencing frequent burping, and 114 (86.4%) patients were having epigastric pain. The household member greater than 4, smoking, rural area residence, NSAIDs consumption, BMI greater than 25, O+ blood group, and Rhesus positive status were significantly associated with H. pylori with a P value of less than 0.05. This study concludes that the prevalence of H. pylori in our population is high, and the risk factors identified are lower class, BMI greater than 25, smoking, O+ blood group, NSAID consumption, rural area residence, household member greater than 4, Rhesus positive status, and the symptoms of nausea or vomiting, frequent burping, epigastric pain, and flatulence. Patients with an increased number of risk factors should be taken into consideration for an appropriate checkup.

PATHOLOGICAL PROFILE AND RECOVERY RATE IN PATIENTS WITH DRUG-INDUCED ACUTE KIDNEY INJURY: A RETROSPECTIVE STUDY FROM NORTH-EAST INDIA

Introduction : Drug-induced acute kidney injury (DI-AKI) is a common renal event with long-term sequelae. However, pathological profile and recovery rate are scarcely reported from north-east India. Thus, we evaluated the commonly implicated nephrotoxic drugs, pathological findings on renal biopsy, and recovery following treatment in patients with DI-AKI. Materials and MethodsThis retrospective, observational study involved the review of Nephrology AKI registry of a tertiary care institute. The review involved data of the adult patients diagnosed with DI-AKI over a period of 24 months (August 2020 to July 2022). Results : During the study period, a total of 182 patients developed DI-AKI. AKI was predominantly caused by antimicrobials (33.52%), alternative medicine (15.38%), and NSAIDs (11.54%).The younger and elderly patients were involved in significantly higher consumption of NSAIDs and alternative medicine, respectively (p-values&lt;0.05). Biopsy was performed in 79 (43.41%) patients, and findings included mainly acute interstitial nephritis (AIN, 37.97%), allergic interstitial nephritis (ALIN, 18.99%), and acute tubular nephropathy (ATN, 12.66%). Steroid therapy and hemodialysis were required in 66 (36.26%) and 105 (57.69%) patients, respectively. At a mean follow-up of 124.78 ± 30.15 days, complete and partial recovery was observed in 136 (74.73%) and 12 (6.59%) patients, respectively. Recovery rate did not differ significant according to class of drugs (p-value=0.194). Conclusion : Antimicrobials, alternative medicine, and NSAIDs were predominantly implicated in DI-AKI. AIN, ALIN, and ATN were the most common biopsy findings with absence of any correlation with the offending agents. Around three quarters of the patients recovered completely.

Risk Factors and Indirect Costs in Chronic Kidney Failure Patients with Hemodialysis in dr. Drajat Prawiranegara Hospital Serang

Increased prevalence of chronic kidney failure from time to time will increase, causing significant economic pressure, both for patients and their families and other stakeholders. This study aims to determine the main factors and several advanced CRF risk factors and indirect costs incurred from a household perspective in CRF patients with hemodialysis at Dr. Drajat Prawiranegara Serang Regional Hospital. This type of research is Case Control Study. Data analysis is carried out using three stages, namely univariate, bivariate, and multivariate. The results of bivariate statistical analysis show that of the 21 CRF risk factors there are 15 factors that are statistically significant with P-value 00 0.005. These factors consist of sociodemography, biophysiology, lifestyle. The results of multivariate analysis, the most dominant causing chronic kidney failure (GGK) is kidney stone disease with a risk of 9.6 times compared to without a history of this disease. Then, NSAID consumption history is 7.8 times, herbal consumption. Indirect costs from the household perspective are seen from the transportation costs of each arrival, the cost of eating during hemodialysis therapy and the purchase of multivitamins or medicines that are not borne by insurance/BPJS, other costs such as lodging and personal care. The total minimum cost for each arrival is Rp. 47,250 Maximum Rp. 1,970,000. The monthly fee is 8 times the minimum total expenditure, which is Rp. 96,000 and maximum spending Rp. 9,120,000.

A digital application and augmented physician rounds reduce postoperative pain and opioid consumption after primary total knee replacement (TKR): a randomized clinical trial

BackgroundSevere postoperative pain not only is a considerable burden for patients but also leads to overprescription of opioids, resulting in considerable health concerns. The remarkable development of new technologies in the health care system provides novel treatment opportunities in this area and could exploit the additional placebo effect, provide added value for patients, and at the same time support hospital staff. We aimed to test the pain- and opioid intake-reducing effects of enhanced postoperative pain management by boosting pain medication by using a technical application and/or augmented physician rounds.MethodsIn a four-arm, randomized clinical trial, 96 patients (24 patients per group) scheduled for a total knee replacement (TKR) were randomized into four groups for four postoperative days: an “application” group (APP) with information via an iPad-based application; a “doctor” group (DOC) with augmented physician rounds; a combination group (APP+DOC), which received both interventions; and a “treatment as usual” group (TAU) as a baseline with no additional intervention besides the standard care which consists of standardized medication, regular physician rounds, and physiotherapy. Postoperative pain and opioid requirements pre- and postoperatively until hospital discharge were recorded.ResultsThe difference between post- and preoperative pain was significantly different between the groups (P=.02, partial η2=.10). APP+DOC experienced greater postoperative pain relief than DOC (mean: 2.3 vs. 0.7, 95% CI: 0.08–3.09; P=.04) and TAU (mean 2.3 vs. 0.1; 95% CI: 0.69–3.71; P=.005), respectively, the difference compared to APP (mean 2.3 vs. 1.7; 95% CI −1.98–1.76) was not significant. Opioid consumption differed significantly between groups (P=.01, partial η2=.12). APP+DOC (72.9 mg) and DOC (75.4 mg) consumed less oxycodone than APP (83.3 mg) and TAU (87.9 mg; 95% CI: 2.9–22.1; P=.003). APP+DOC consumed significantly less oxycodone than DOC (d=0.2–0.4). There were no significant group differences in NSAID and Morphine sulfate consumption. Patients in APP+DOC were more satisfied with their treatment than patients in TAU (P=.03, partial η2=.09).ConclusionsThe combination of an innovative digital app, which implements open drug administration and augmented physician rounds that support the doctor–patient relationship can significantly improve postoperative pain management.Trial registrationThe protocol was approved by the local ethics committee of the ethical commission of the German Psychological Society (Deutsche Gesellschaft für Psychologie; DGPs). The study was registered at DRKS.de (identifier: DRKS00009554).

Clinical profile and management of perforation peritonitis in Bharatpur hospital, Nepal: A prospective study

IntroductionThe most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss clinical profile and management of perforation peritonitis in a hospital in central Nepal. MethodsThis prospective study was done for one year at Bharatpur Hospital, Chitwan Nepal. In our study, only patient above 15 years were included and those who were not fit for anesthesia and surgery were excluded. Most of the patient were diagnosed clinically supported by lab investigations and imaging like X-ray and ultrasonography of abdomen. The variables analyzed were the risk factors of the patient like smoking, alcohol, liver disease and previous abdominal surgeries. ResultsThe majority of the patients were in the age group 50–59 years in male and 40–49 years in female. Among sixty cases, 31 were female and 29 were male with Female: Male ratio of 1.06:1. The most common cause of perforation found was peptic ulcer compromising 88.3% (53 cases) followed by appendicular perforation accounting 8.3% (5 cases). Similarly, Tubercular perforation was found in 3.3%. Smoking was most common risk factor accounting 88.3%, followed by alcohol consumption (48.33%) while, 15% of patients had positive history of NSAIDs consumption. On imaging, 38.33% patient had air fluid level on X-ray and 78.33% had gas under diaphragm. On blood investigation, leukocytosis was found in 53.33% of patients, hyponatremia in 10% of patients and hypokalemia in 18.33% of patients. While on urine examination, albumin was found in 5% of patients. The repair of perforation along with omentopexy was done in 73.3% of patients while only repair was done in 15% of patients. Only 8.3% opted for appendectomy while a very few patients (3.3%) went for resection with anastomosis. The Postoperative complications found were wound infection (43.3%), paralytic ileus (18.33%), sepsis (15%), followed by electrolyte imbalance (11.6%), postoperative bowel obstruction (6.6%) and burst abdomen (1.6%). While, there were only 3 cases of mortality. ConclusionsPerforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study.

ABSTRACTAims:Chest wall blocks are effective alternatives for postoperative pain control in mitral valve surgery in right mini-thoracotomy (mini-MVS). We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief after mini-MVS.Settings and Design:It is a prospective, observational study.Material and Methods:A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini-MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator-free days).Results:The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups (P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group (P = 0.002 and P = 0.048, respectively).Conclusions:ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.

496 Stereotactic Electroencephalography is Associated with Reduced Opioid and NSAID Use When Compared to Subdural Grids: A Pediatric Case Series

INTRODUCTION: Opioid administration and consumption along with length of hospital stay can be decreased using minimally invasive surgery (MIS). METHODS: A retrospective chart review was conducted on pediatric patients that underwent surgery for epilepsy mapping using either SEEG or ECoG between 2015-2019. The hospital stay was divided into four distinct time periods and the total amount of opioids, NSAIDs, and pain scores were calculated for each time interval. The total amount of opioids were calculated by converting each type into their morphine equivalents (ME). Pain scores were calculated by using a modified version of the Clinically Aligned Pain Assessment (CAPA) scale. The two groups were then compared using appropriate statistical tests. RESULTS: The study included 40 patients including 31 in the SEEG group and 9 in the ECoG group. The SEEG group consumed significantly less opioids during the hospital stay when compared to the ECoG group (23.6 vs 61.7 MMEs; p=0.041). There were also significant differences in the length of stay (6.9 vs 12.2 days; p=0.002), complications (0% vs 20%; p=0.006), and total NSAIDs consumed (3264.8 vs 12730.2 mg; p=0.002). CONCLUSION: Opioid and NSAID consumption are significantly lower in pediatric patients who undergo epilepsy mapping via SEEG compared to ECoG. These patients also have a significantly shorter length of stay. MIS options should be considered by patients and physicians in order to decrease the overall use of pain medications and expedite patient discharge.

Hyaluronic Acid Therapy in Hip OA Does Not Perform Equally in Osteoarthritis Secondary to Juvenile Idiopathic Arthritis When Compared to Primary Osteoarthritis: A 2-Year Preliminary Evaluation.

Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain and disability. Total hip arthroplasty (THA) is considered the standard when medical approaches fail to relieve pain. However, THA is problematic for many reasons. As current literature lacks studies valuating medical management of osteoarthritis (OA) secondary to JIA, we assessed the long-term pain relief effect of US-guided intra-articular viscosupplementation in hip osteoarthritis secondary to JIA versus primary OA under different etiological conditions. Patients in both groups received intra-articular Hylan G-F 20 2ml once a month for 3 consecutive months and every 6 months for 2years as maintenance. Effectiveness (VAS and WOMAC), NSAID/analgesic consumption, tolerability, withdrawals and reason for discontinuation were collected at each time point. An inverse probability weighting was used to balance the two groups. We retrospectively retrieved data of 14 JIA patients and 26 primary OA. Weighting successfully accounted for differences between the disease groups supporting the results. Viscosupplementation led to an early and significant improvement of pain and function and concomitant decrease in NSAIDs consumption, while the response diverged over 1 year with loss of benefits in JIA. The worst outcome was observed in active JIA. Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of arthritis. Multiple courses of viscosupplementation are required to maintain low-dose NSAIDs consumption in patients responsive to treatment while shortening the time between consecutive injections might provide persistent positive results in patients suffering from JIA.

The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung.

Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block. All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded. There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038). Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.

Gastrointestinal Bleeding Associated With Warfarin and Rivaroxaban Therapy in Atrial Fibrillation Cases with Concomitant Coagulopathy.

There is inadequate information on the risk of gastrointestinal (GI) bleeding in patients who are under rivaroxaban and warfarin therapy in Iran. Determining the risk of GI bleeding in patients receiving these two drugs can help to select a more appropriate anti-coagulation prophylaxis in high-risk patients. The aim of this study was to compare the incidence of GI bleeding in patients with atrial fibrillation (AF) and concomitant bleeding risk factors receiving either warfarin or rivaroxaban. In this observational study, 200 patients with AF and bleeding risk factors who referred to Imam Hossein Hospital (Tehran, Iran) were included. The patients were under treatment with either warfarin or rivaroxaban. The incidence of GI bleeding was compared between the two groups monthly for one year. GI bleedings were observed in 61% and 34% of patients treated with warfarin and rivaroxaban, respectively (P = 0.001).Melena was the most common type of GI bleeding in both groups. History of hypertension, history of stroke, consumption of anti-platelet drugs, NSAID consumption, and history of alcohol consumption were associated with more frequent GI bleeding only in warfarin group. The incidence of GI bleeding was lower in AF patients who received rivaroxaban compared to those treated with warfarin. Also, GI bleeding risk does not change according to the consumption of other anti-coagulant drugs and underlying history of hypertension or stroke in patients received rivaroxaban. Therefore, rivaroxaban is suggested as the choice of prophylaxisin patients with AF and concomitant coagulopathy.