Pain Control Research Articles

The ASRA Pain Medicine Mentor Match Program: nationally awarded and locally realized

The ASRA Pain Medicine Mentor Match Program: nationally awarded and locally realized

Editor's corner: the people of ASRA Pain Medicine

Editor's corner: the people of ASRA Pain Medicine

ASRA Pain Medicine excellence in education award statement

ASRA Pain Medicine excellence in education award statement

Postoperative Pain Control After ACL Reconstruction With Semitendinosus Tendon Graft: A Randomized Controlled Trial Comparing Adductor Canal Block to Local Infiltration Analgesia

Background: Both adductor canal block (ACB) and local infiltration (LI) are effective for postoperative pain management after arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction (ACLR). While LI is a more straightforward procedure, its effectiveness remains debated. Purpose: To evaluate morphine consumption within 48 hours after ACLR with a semitendinosus tendon graft, comparing ACB and LI; secondary objectives: to evaluate pain levels, patient satisfaction, quadriceps strength, range of knee motion, and complications. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients undergoing primary ACLR with a semitendinosus tendon graft were randomized to receive either ACB (0.25% bupivacaine; 20 mL) or LI at the surgical wound, graft harvest area, and intra-articular injection. The LI group received morphine (3 mg), ketorolac (30 mg), and tranexamic acid (1 g). Morphine consumption within 48 hours was monitored using an intravenous patient-controlled analgesia device. Results: A total of 48 patients were analyzed (n = 24 in each group); baseline characteristics were similar between groups. The LI group consumed significantly less morphine than the ACB group at 6 hours (median [interquartile range, IQR], 3 mg [0-4.8 mg] for the LI group vs 5.5 mg [2-9] for the ACB group; P = .003). However, no significant differences were observed in morphine consumption at other time points. Additionally, no significant difference was found in cumulative morphine consumption at 48 hours between the groups (median [IQR], 21.5 mg [11-34.5 mg] for the ACB group vs 16.5 mg [8.5-21.8 mg] for the LI group; P = .137). Postoperative pain scores, quadriceps strength, and patient satisfaction were similar between the 2 groups. Conclusion: Morphine consumption at 48 hours postoperatively was comparable between the LI and ACB groups, and no significant group differences were found in postoperative pain, quadriceps strength, or patient satisfaction. Registration: TCTR20190320003 (Thai Clinical Trial Registry).

Pain control post total knee replacement in patients given local infiltrative analgesia combined with adductor canal block compared to either modality alone: a systematic review and meta-analysis

ObjectivesOptimising postoperative pain following knee replacement is important for patients, healthcare professionals and healthcare funders. Adductor canal blocks (ACB) are widely used but there is uncertainty about their efficacy when...

Evaluation of cats treated with robenacoxib after gastrointestinal surgery.

The aim of the study was to determine if cats administered robenacoxib immediately after gastrointestinal surgery have a similar complication rate to cats that were not administered robenacoxib. Medical records were reviewed for 154 cats that underwent gastrointestinal surgery between December 2015 and September 2021 in this retrospective study. Data collected included patient signalment, presenting complaint, surgical procedure(s) performed, robenacoxib administration and major postoperative complications. Cats were excluded if they did not have a 2-week postoperative follow-up examination. Two groups were analyzed: group R (postoperative robenacoxib administration) consisted of 43 cats; and group C (no postoperative robenacoxib administration) consisted of 111 cats. Complications occurred in 10/43 (23.2%) cats in group R and 34/111 (30.6%) cats in group C. Major complications occurred in 1/43 (2.3%) in group R and 14/111 (12.6%) in group C. Minor complications occurred in 9/43 (20.9%) cats in group R and 20/111 (18.0%) cats in group C. One of 43 cats (2.3%) in group R and 10/111 (9.0%) cats in group C were euthanized or died within 0-16 days after gastrointestinal surgery. Cats that were administered robenacoxib postoperatively did not have an increase in major postoperative complications after gastrointestinal surgery compared with cats that were administered an alternative analgesic medication. The use of robenacoxib in cats after gastrointestinal surgery may be a safe analgesic option for postoperative pain control.

A Non-Opioid Multimodal Pain Protocol Achieves Equivalent Pain Control After Total Shoulder Arthroplasty: A Randomized-Controlled Trial

A Non-Opioid Multimodal Pain Protocol Achieves Equivalent Pain Control After Total Shoulder Arthroplasty: A Randomized-Controlled Trial

Preoperative Acetaminophen For Microsuspension Laryngoscopy Reduces Postoperative Opioid Use.

The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of preoperative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a previous study of pain and opioid use following MSL (Tsang et al.). A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were administered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and present pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statistical analysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. RESULTS: Eighty-nine patients were included (mean age 52.8 ± 17.3 years, 40 males). All patients received preoperative 1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scores were 5 [2-11], 21 [12.3-56.8], and 3 [2-3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioid requirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043-1.548), p = 0.017) and total laryngoscope suspension time (OR (95%CI) = 0.791 (0.651-0.962, p = 0.019)). This cohort demonstrated reduced opioid usage on POD1 compared with Tsang et al (23%). Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use following MSL. Anesthesia time correlated with need for postoperative opioids. 4 Laryngoscope, 134:4625-4635, 2024.

Pain in palliative cancer patients – Analysis of the German National Palliative Care Registry

Palliative care aims to improve the quality of life in patients with progressive diseases such as cancer. Effective cancer pain management is a major challenge of palliative treatment. Empirical data on the prevalence of cancer pain, the efficiency of pain treatment and influencing factors are scarce. Here, we investigated pain in cancer patients treated on inpatient palliative care wards in Germany. N = 4779 data sets provided by the German Palliative Care Registry from yearly evaluation periods between 2015 and 2020 were included. Pain ratings were assessed by professionals through a checklist of symptoms and problems (HOPE-SP-CL). More than half of the included patients suffered from moderate/severe pain at the beginning of inpatient palliative care and in 71% of these patients, pain relief was achieved at the end of inpatient treatment. Pain intensity, depression and ECOG performance status at admission were weak predictors of later pain relief. The highest pain intensity at the beginning and least pain relief were found in patients with bone and cartilage cancer. The highest percentage of adequate pain control (81%) was seen in 2020. Data from the German Palliative Care Registry confirmed that although increasingly better addressed over the years, insufficiently controlled cancer pain remains a challenge for palliative care units. Patient-specific (e.g. psychological comorbidity) and cancer-related (e.g. bone or cartilage cancer) risk factors for poor pain treatment underline the need for individualized multimodal pain management including psychological support.

Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial.

Pain intensity after temporomandibular joint (TMJ) surgery is often underestimated, and inadequate pain control may relate to poor recovery quality, increased opioid consumption, and longer hospital stay. This trial aims to evaluate whether non-opiate anesthesia provides a promising option of pain management for patients undergoing TMJ surgery. Sixty patients receiving TMJ surgery were randomly assigned to either the control group or the non-opiate group. Non-opiate anesthesia used lidocaine, dexmedetomidine, and ketamine infusion therapy for pain management. The primary outcome was the highest documented pain score while in the post-anesthesia care unit (PACU). Secondary outcomes included perioperative opioid consumption, utilization, dosage, and timing of rescue analgesia in the PACU, incidence of postoperative nausea and vomiting in the PACU and at home, pain satisfaction levels, occurrence of opioid-related adverse effects, duration of PACU and hospital stays, and total consumption of oxycodone-acetaminophen tablets at 24 and 48hours post-surgery. Patients were predominantly female (88.3%) and had a median age of 37.5 [IQR 26.0, 52.5] years. There were no significant differences observed in the highest documented pain scores (mean difference [MD] -0.36 points, 95% CI: -1.84, 1.12, p = 0.63), postoperative oxycodone-acetaminophen consumption (MD 6.68 mg, 95% CI: -2.48, 15.84, p = 0.15), pain satisfaction (odds ratio [OR] 0.81, 95% CI: 0.23, 2.81, p = 0.74), time to PACU discharge (hazard ratio [HR] 1.24, 95% CI: 0.67, 2.30, p = 0.49) or time to hospital discharge (HR 1.48, 95% CI: 0.80, 2.75, p = 0.21) between the two groups. Similarly, no significant difference was observed in time to rescue analgesia, calculated in minutes from the end of surgery (HR 1.69, 95% CI: 0.79, 3.61, p = 0.18). Non-opiate anesthesia for pain management shows a similar postoperative analgesia effect, compared to opioid-based anesthesia, in patients undergoing arthroscopic TMJ surgery.

Effectiveness of implementing a Best Practice Guideline recommendations to manage pain in oncological hospitalized patients

ObjectiveTo evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) “Assessment and Management of Pain” recommendations for pain control in oncological/oncohaematological hospitalized patients. MethodsAmbispective cohort study. Sample and Setting: Adults admitted to oncological unit in Hospital of Albacete. InterventionImplementation of GBP recommendations. Variables: 1) Demographic data. 2)On implementation of GBP recommendations. 3) Outcome in patients: pain intensity in the first 24 h after admission and maximum intensity during admission Tools: Numeric and Visual Scales. Data collection: indicators exported from clinical history for evaluation of the BPSO® program. Ethical aspects: anonymous data. Data analysis (SPSS®): Descriptive during periods: baseline (T0 = December 2015); initial (T1 = 2017); consolidation (T2 = 2018–2019); sustainability (T3 = 2021–2022). Measurements of central tendency and dispersion, absolute and relative frequencies. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). Statistical significance: p < 0.05. ResultsIncluded 572 patients, 61.5% (352) men. Daily intervention of pain detection was performed in 94.6% (538) of patients (20%–T0; 98.3%–T1; 98.4%–T2; 91.2%–T3; p < 0.001), pain assessment using an appropriate scale in 97.6% (558) (0%–T0; 98.3%–T1; 99.2%–T2; 100%–T3; p < 0.001); 93.7% (535) had a care plan for assessment and management of pain (0%–T0; 98.3%–T1; 96.3%–T2; 92.3%–T3; p < 0.001). The percentage of patients who had severe pain (6–10) during the first 24 hours was reduced from T1 to T3 (5.1%–T1; 6.6%–T2; 2.1%–T3; p = 0.145), but throughout hospitalization increased from T1 to T3 (19.2%–T1; 17%–T2; 22.5%–T3; p = 0.21). ConclusionsImplementation of recommendations has led to a statistically significant improvement over the periods in the study; however, no effectiveness has been shown to reduce pain intensity.

Chronic Pain Influences Lower Extremity Energetics During Landing Cutting in Patients with Chronic Ankle Instability.

Chronic ankle instability (CAI) patients exhibit altered movement patterns during jump landing/cutting movements. Persistent pain is one of the residual symptoms that may affect movements. Calculating joint energetics affected by chronic pain offers a novel method to understand how chronic pain influences energetics of lower extremity joints in CAI patients. To identify the effects of chronic pain on lower extremity energy dissipation and generation during jump landing and cutting in CAI patients. Cross-sectional Study. Laboratory. Fifteen CAI patients with higher pain (6 males, 9 females; age=22.1±2.1year; height=1.74±0.09m; mass=71.3±10.6kg, pain=66.9±9.4), 15 CAI patients with lower pain (6 males, 9 females; age=22.3±2.1year; height=1.74±0.08m; mass=70.1±10.7kg, pain=89.3±2.6), and 15 healthy controls (6 males, 9 females; age=21.3±1.7year; height=1.73±0.08m; mass=70±10.3kg, pain=100±0). Ground reaction force data were collected during 5 trials of maximal jump landing/cutting tasks. Joint power was defined as the product of angular velocity and joint moment. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve. CAI patients with higher pain displayed less ankle energy dissipation (p=.013 and p=.018) and generation in the ankle (p=.002 and p=.028) than CAI patients with lower pain and healthy controls during the jump landing/cutting phase. CAI patients with higher pain showed more hip energy generation than CAI patients with lower pain (P=.038) and healthy controls (P=.013) during the cutting phase. CAI patients with higher pain changed both energy dissipation and generation in the lower extremities, reducing the burden of the ankle joint during jump landing/cutting and having a hip dominant compensatory strategy during the cutting phase. Our results suggest that chronic pain could be one of the factors that affect motor strategies in the CAI population.

Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy

BackgroundAdequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. MethodsPatients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). ResultsOf 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. ConclusionRegional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

Reduction of Preoperative Anxiety Using Virtual Reality vs Midazolam: A Randomized Controlled Trial

More than 50% of pediatric patients experience significant stress and anxiety prior to surgery.1 High anxiety can result in increased postoperative pain, analgesic consumption, and delayed recovery.2 To reduce this preoperative anxiety, multiple therapeutic modalities have been developed, including the use of distraction, such as playing video games, watching movies, and listening to music. In severe cases of anxiety, anxiolytic and sedative medications like midazolam are used. However, given the acknowledged drawbacks of medications, including the risk of paradoxical reactions to the drug, alternatives to medication for reducing preoperative anxiety in patients may be useful. We aim to compare the use of virtual reality (VR) to midazolam in reducing preoperative anxiety in surgical patients and assess differences in induction compliance, emergence delirium, pain scores, and opioid use in VR vs. midazolam-treated patients. Methods This study was approved by the Phoenix Children’s Hospital Institutional Review Board. First-time surgical patients (N = 36) between the ages of 5 and 11 years undergoing tonsillectomy or tonsillectomy/adenoidectomy procedures were randomly assigned to either receive midazolam (0.5 mg/kg up to 25 mg) or play an interactive underwater-themed game using VR. The Modified Yale Preoperative Anxiety Scale (mYPAS) was administered by a single child life specialist preoperatively, and only patients who reached a threshold of &gt;40 on mYPAS scoring were enrolled (scale range: 23 - 100). Additional anxiety measurement was tested using the adult and child State-Trait Anxiety Inventory (STAI). Midazolam or VR was administered prior to transport to the OR, and mYPAS was scored again at the time of separation from the family. The Induction Compliance Checklist (ICC) was utilized for assessment at the time of anesthesia induction. The VR-treated patients continued use of the VR headset through mask induction. A standardized anesthesia induction protocol was used for all patients. The Pediatric Anesthesia Emergence Delirium (PAED) scale was administered at emergence, postoperatively. Postoperative nurses scored pain and administered IV pain medication as needed. Group means and standard deviations were reported and compared with two-sided t tests. Results Interim results show the mYPAS anxiety scores dropped 20.1 ± 11.7 points following midazolam treatment (p&lt;0.001) and dropped 28.3 ± 7.3 points following VR treatment (p &lt; 0.001). There was a significant difference in mYPAS scores between groups following treatment (midazolam = 32.0 ± 4.9; VR = 25.4 ± 4.7; p = 0.04). There were no significant differences between midazolam- and VR-treated groups in the Induction Compliance Checklist, PAED scale, peak postoperative pain scores, and medication use for pain control postoperatively. This study is currently ongoing. Conclusion VR appears to reduce preoperative anxiety similarly to midazolam in anxious first-time surgical pediatric patients. Limitations include patient population. Further studies should be conducted for greater generalizability.

COMPARISON OF TWO DIFFERENT DOSES OF ORAL GABAPENTIN FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY UNDER SPINAL ANAESTHESIA

Background: Pre-emptive analgesia is a technique of pain control where treatment is initiated before intervention and operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure. Gabapentin has demonstrated analgesic effects in clinical trials as a preemptive analgesic in acute postoperative pain management with very few side effects. Owing to the protective effect of gabapentin on the nociceptive pathways, preemptive analgesia has the potential to be more effective and hence reduce postoperative pain and development of chronic pain. Objective: We therefore designed this study to compare two different doses of Oral Gabapentin (300mg and 600mg) given as pre-emptive analgesic for post-operative pain relief in lower limb surgeries under spinal anaesthesia. Method: After the approval from ethical committee this prospective randomized double blinded clinical study was conducted over a period of two years in department of anaesthesia in M.G.M.s medical college, Aurangabad. Randomly allocated two groups were given Oral Gabapentin 300mg and 600mg respectively, one hour prior to giving spinal anaesthesia for post operative analgesia in lower limb surgeries. Conclusion: There is no statistically significant difference between group G300 (gabapentin 300mg) and group G600 (gabapentin 600mg) regarding age, gender, duration of analgesia (i.e. demand for first rescue analgesic), total dose of analgesics in first twenty four hours after surgery, duration of sensory block (i.e. L1 regression), highest ramsay sedation score and VAS scores. No significant difference was seen in cases hemodynamic stability and incidence of side effects.

The complex pathophysiology and clinical management of epidermolysis bullosa: a comprehensive review

Epidermolysis bullosa (EB) represents a group of rare, genetically heterogeneous disorders characterized by the formation of blisters and erosions of the skin and mucous membranes in response to minor mechanical trauma. EB is classified into four major types-EB simplex, junctional EB, dystrophic EB, and Kindler syndrome, each associated with mutations in specific genes that encode structural proteins essential for skin integrity. The clinical spectrum of EB ranges from mild forms, presenting with localized skin involvement, to severe variants that lead to widespread blistering, mutilating scarring, and significant morbidity. The pathophysiology of EB is complex, involving disruptions in the adhesion between the dermis and epidermis, leading to compromised structural stability of the skin. Current therapeutic strategies focus on symptom management, including wound care, infection prevention, and pain control, as no definitive cure exists. Advances in gene therapy, stem cell therapy, and protein replacement therapy hold promise for future treatment paradigms. This review aims to elucidate the molecular underpinnings, clinical manifestations, and emerging therapeutic approaches for EB, providing a comprehensive overview for clinicians and researchers engaged in the management and study of this challenging condition.

Assessing Tramadol Hydrochloride as an Alternative to Lignocaine Hydrochloride in Dental Implant Procedures: A Randomized Trial.

To evaluate tramadol hydrochloride, an atypical opioid with potential analgesic properties, as a viable alternative to lignocaine hydrochloride in supraperiosteal anesthesia for dental implants. A split-mouth, double-blind, randomized controlled trial was conducted in patients requiring maxillary dental implants. Patients meeting inclusion criteria received either 5% tramadol hydrochloride with adrenaline or 2% lignocaine hydrochloride with adrenaline via supraperiosteal infiltration. Onset, duration of anesthesia, visual analog scale (VAS) pain scores, and adverse effects were recorded. Forty patients were included, with a mean age of 39.35 years, 62.5% male. No significant differences were observed in VAS pain scores between tramadol (2.08 ± 1.328) and lignocaine (2.05 ± 1.260) groups (p = 0.931). Onset of anesthesia showed no significant difference between the tramadol (128.00 ± 18.207 seconds) and lignocaine (128.30 ± 18.287 seconds) groups (p = 0.736). The duration of anesthesia was comparable between tramadol (59 ± 12.092 minutes) and lignocaine (59.90 ± 11.705 minutes) groups (p = 0.0736). Adverse effects included nausea in two tramadol and one lignocaine patient. Tramadol hydrochloride demonstrated comparable local anesthetic efficacy to lignocaine hydrochloride in dental implant surgery Clinical significance: Both drugs provided effective pain control with similar onset and duration of anesthesia. Tramadol may offer an alternative for patients with lignocaine contraindications, although further studies are warranted to validate its safety and efficacy in dental procedures. How to cite this article: Parlawar AN, Mundada BP. Assessing Tramadol Hydrochloride as an Alternative to Lignocaine Hydrochloride in Dental Implant Procedures: A Randomized Trial. J Contemp Dent Pract 2024;25(7):639-644.

The QSP-31: a multidimensional questionnaire for assessing psychosocial / psychodynamic aspects in patients with somatoform pain

ABSTRACT Somatoform pain poses major challenges in medicine. There is a lack of quantitative instruments that systematically assess psychosocial aspects of somatoform pain. A better knowledge of such aspects could contribute (1) to gaining further insight into the relationship between psychodynamic and psychosocial components of pain, and (2) to facilitating the development and monitoring of improved interventions targeting psychodynamic and psychosocial mechanisms of pain. An item pool on biopsychosocial aspects of pain was developed and completed by 200 patients with somatoform pain disorder. In addition, anxiety (STAI), depression (BDI II), somatization (SOMS-2), and quality of life (SF-36) were assessed. As compared to norm data, patients reported higher scores for anxiety (STAI), depression (BDI-II) somatization (SMOS-2), and lower quality of life (SF-36). Applying item and factor analyses, a new questionnaire (QSP-31) was developed to identify psychodynamic and psychosocial aspects of pain. There was evidence for the construct validity of the six scales through confirmatory factor analysis: Relationships between pain and negative emotions, Negative attitudes towards help-seeking, Negative pain-related childhood experiences, Negative attitudes towards own body, Negative aspects of the doctor-patient relationship, and Perceived pain control. Cronbach's alpha coefficients for these scales lay within the range of .81-.92. Regarding criterion validity, moderate correlations in expected directions were found between all scales and anxiety, depression, somatic symptom severity, and quality of life, except for the scale Perceived pain control. The QSP-31 appears promising for the identification of relevant psychosocial aspects associated with the experience of pain and might be a useful instrument.

Subtotal vaginal hysterectomy with cervical ring preservation and cervical stump suspension to the sacrospinous ligament in women with pelvic organ prolapse: An exposed cohort study

To evaluate the short-term safety and efficacy of vaginal hysterectomy with cervical preservation in patients with genital prolapse stages II to IV. This is a descriptive case series study. It included women with genital prolapse stages II to IV, indicated for vaginal hysterectomy, with negative cervicovaginal cytology for malignancy, who underwent subtotal vaginal hysterectomy with suspension of the cervical stump to the sacrospinous ligament between June 1 and December 31, 2023, at a high-complexity general clinic. Sociodemographic variables and complications six months postoperatively were analyzed. The surgical technique is presented, and descriptive analysis, along with a detailed surgical technique exposition of cervical stump suspension to the sacrospinous ligament, was conducted. During the described period, 10 patients consulted, of whom eight met the inclusion criteria. The mean duration of the surgical procedure was 133 minutes. Average blood loss was 200 cc. One patient required analgesic use of pregabalin for peripheral neuropathic pain, achieving adequate postoperative pain control. No other intraoperative or postoperative complications were reported. No prolapse recurrence was observed six months postevaluation. Subtotal vaginal hysterectomy with cervical stump suspension to the sacrospinous ligament is a surgical repair technique that could be considered for the management of uterine prolapse. Randomized studies comparing this technique with other management alternatives are needed to evaluate its long-term efficacy and safety.

Efficacy of Quadratus Lumborum Block Compared to Paravertebral Block on Pediatric Patients Undergoing Abdominal Surgery

Background: Abdominal surgery is a major procedure associated with severe postoperative pain in pediatric patients. Quadratus lumborum block (QLB) is considered an effective pain control in such cases. Paraverterbral block (PVB) is another option for postoperative pain management. The aim of this study was to compare the effectiveness of quadratus lumborum block with paravertebral block. Methods: This single-blind randomized controlled trial included 22 pediatric patients who underwent abdominal surgery at Sanglah Hospital, Denpasar between August – October 2022. Research subjects were divided into 2 treatment groups; group A consisted of general anesthesia combined with quadratus lumborum block and group B consisted of general anesthesia combined with paravertebral block. Duration of analgesia was recorded based on the time to analgesic rescue, FLACC pain scale at 0, 2, 4, 6, 12 and 24 hours and total opioid consumption 24 hours after surgery. Statistical analyses were performed using SPSS. Results: Eleven patients received QLB and PVB respectively. There was a significant difference in mean analgesia duration of 1287 ± 129.69 minutes compared to 750 ± 122.22 minutes (p &lt; 0.001) (CI 95%: 425.18 – 649.36), median FLACC pain scale at 12 (1 (IQR 2) vs 4 (IQR 1)) and 24 hours postoperative (1 (IQR 2) vs 3 (IQR 1)) between QLB and PVB (p &lt; 0.001 and p &lt; 0.007). Mean 24-hour postoperative opioid consumption was significantly lower in the QLB compared to the PVB. Conclusion: QLB has better effectiveness than PVB in pediatrics undergoing abdominal surgery.