Pain In Postanesthesia Care Unit Research Articles

Improved Pain and Perioperative Outcomes After Hip Arthroscopy With the Pericapsular Nerve Group Block

To compare early postoperative pain in patients undergoing hip arthroscopy with versus without the pericapsular nerve group (PENG) block. A retrospective chart review of prospectively collected data was performed to identify patients who underwent hip arthroscopy at a single institution between May 2019 and October 2021. Patients were included if they received general anesthesia and were opioid naive. Patients who received the PENG block were compared with patients who did not. Opioid, benzodiazepine, and antiemetic medication administration was recorded both intraoperatively and for the duration of the patient's stay in the postanesthesia care unit (PACU). Opioids administered were converted to morphine milligram equivalents (MMEs). Pain was assessed with a visual analog scale. Time to discharge (in minutes) and complications were recorded. A total of 53 patients were identified for inclusion, of whom 28 received the PENG block and 25 did not. Opioid consumption was significantly lower in the PENG block group both intraoperatively (16.9 ± 14.1 MMEs vs 40.6 ± 18.3 MMEs, P < .001) and in the PACU (14.4 ± 11.4 MMEs vs 31.2 ± 20.1 MMEs, P < .001). The highest recorded PACU pain score was significantly greater in the no-PENG block group (7.0 ± 1.9 vs 5.3 ± 2.1, P= .004). Within the PENG block group, fewer patients required antiemetics (0 vs 4, P= .043). There was a greater time to discharge in the no-PENG block group (161 ± 50 minutes vs 129 ± 34 minutes, P= .008). No complications, including postoperative falls, were noted in either group. The PENG block improves perioperative outcomes by decreasing pain, opioid consumption, time to discharge, antiemetic requirements, and benzodiazepine requirements after hip arthroscopy. Level III, retrospective comparative therapeutic trial.

Virtual reality immersion compared to monitored anesthesia care for hand surgery: A randomized controlled trial.

IntroductionCommon anesthesia practice for hand surgery combines a preoperative regional anesthetic and intraoperative monitored anesthesia care (MAC). Despite adequate regional anesthesia, patients may receive doses of intraoperative sedatives which can result in oversedation and potentially avoidable complications. VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction. Our hypothesis was that intraoperative VR use reduces sedative dosing during elective hand surgery without detracting from patient satisfaction as compared to a usual care control.MethodsForty adults undergoing hand surgery were randomized to receive either intraoperative VR in addition to MAC, or usual MAC. Patients in both groups received preoperative regional anesthesia at provider discretion. Intraoperatively, the VR group viewed programming of their choice via a head-mounted display. The primary outcome was intraoperative propofol dose per hour (mg · hr-1). Secondary outcomes included patient reported pain and anxiety, overall satisfaction, functional outcome, and post anesthesia care unit (PACU) length of stay (LOS).ResultsOf the 40 enrolled patients, 34 completed the perioperative portion of the trial. VR group patients received significantly less propofol per hour than the control group (Mean (±SD): 125.3 (±296.0) vs 750.6 (±334.6) mg · hr-1, p<0.001). There were no significant differences between groups in patient reported overall satisfaction, (0–100 scale, Median (IQR) 92 (77–100) vs 100 (100–100), VR vs control, p = 0.087). There were no significant differences between groups in PACU pain scores, perioperative opioid analgesic dose, or in postoperative functional outcome. PACU LOS was significantly decreased in the VR group (53.0 (43.0–72.0) vs 75.0 (57.5–89.0) min, p = 0.018).ConclusionVR immersion during hand surgery led to significant reductions in intraoperative propofol dose and PACU LOS without negatively impacting key patient reported outcomes.

The association of Serratus Anterior Plane blocks with postoperative opioid use and analgesia following simple lumpectomy: a retrospective cohort analysis

BackgroundThe potential benefit of regional interventions for simple lumpectomy breast cancer surgeries has not been well investigated. Understanding which patients to not offer a regional intervention to can be just as important as knowing which would benefit. It is unclear whether fascial plane blocks, such as serratus anterior plane (SAP) block, should be routinely performed for less extensive breast surgeries. Therefore, our goal in this retrospective cohort study was to evaluate the association of integrating SAP blocks into a standard perioperative multimodal analgesia plan in patients undergoing simple lumpectomies (without node biopsies) with perioperative opioid consumption. As secondary outcomes, we also analyzed postoperative pain scores and post-anesthesia care unit (PACU) length of stay.MethodsThis was a single institution retrospective cohort study (surgical site infiltration only versus SAP block cohorts) assessing the association of SAP blocks to our outcomes of interest. In the adjusted analysis, we created matched cohorts using 1:1 (surgical site infiltration only: SAP block) propensity-score matching using nearest neighbor-matching without replacement. To compare the primary and secondary outcomes in the matched cohorts, we used the Wilcoxon signed rank test. A P-value of < 0.05 was considered statistically significant.ResultsThere were 419 patients included in the analysis, in which 116 (27.7%) received a SAP block preoperatively in addition to our standard perioperative analgesia plan. In an unadjusted analysis, no differences were seen in perioperative opioid consumption, PACU pain scores, and PACU length of stay. Among the matched cohorts, the median [quartile] perioperative opioid consumption in the surgical site infiltration only versus SAP block cohorts were 10 mg [10, 13.25 mg] and 10 mg [7, 15 mg], respectively (P = 0.16). No differences were seen in the other outcomes.ConclusionsIn this study, we evaluated the impact of SAP blocks on patients undergoing simple lumpectomies, which are relatively less involved breast surgeries. We concluded that routine use of preoperative regional anesthesia is not beneficial for these specific patients. Future studies should focus on identifying patients that would directly benefit from regional interventions.

Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial

Study objectiveThe quality of recovery (QoR) of remimazolam-based and propofol-based total intravenous anesthesia was compared as measured by QoR-15 scores. DesignA prospective, double-blind, randomized controlled, non-inferiority trial. SettingAn operating room, a post-anesthesia care unit (PACU), and a hospital ward. PatientsFemale patients (n = 140; 20–65 years) scheduled for open thyroidectomy were enrolled and randomly assigned to the remimazolam or propofol group. InterventionsThe remimazolam group received continuous remimazolam infusions and effect-site target-controlled remifentanil infusions. The propofol group received effect-site target-controlled infusions of propofol and remifentanil. MeasurementsThe primary outcome was QoR-15 on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of −8. Secondary outcomes were QoR-15 on POD2, hemodynamic data, time to lose and recover consciousness, sedation score upon PACU admission, pain, and postoperative nausea and vomiting profiles at the PACU and ward. Group-time interaction effects in hemodynamic data and QoR-15 were analyzed using a linear mixed model. Main resultsThe total QoR-15 score on POD1 in the remimazolam group was non-inferior to that in the propofol group (mean [SD] 111.2 [18.8] vs. 109.1 [18.9]; mean difference [95% CI] 2.1 [−4.2, 8.5]; p = 0.002 for non-inferiority). The QoR-15 score on POD2 was comparable between the groups, and no group-time interaction was observed. At the end of anesthesia, after extubation, and upon arrival at the PACU, mean arterial pressure was significantly higher in the remimazolam group. Remimazolam group was more sedated at the time of admission to PACU. Pain intensity and the requirement for analgesics were lower in the remimazolam group than in the propofol group. ConclusionsRemimazolam-based total intravenous anesthesia provided a similar QoR to propofol. Remimazolam and propofol can be used interchangeably for general anesthesia in female patients undergoing thyroid surgery.

Randomized controlled trial of NSAID prior to cystoscopic ureteral stent removal in a pediatric population

Ureteral spasm, common with ureteral stents, is partially mediated by prostaglandins and may be suppressed by cyclooxygenase inhibitors like non-steroidal anti-inflammatory (NSAIDs). Practices currently vary widely for pain management in patients with ureteral stents, sometimes including opioids. We aimed to determine if NSAID given prior to stent removal would reduce postoperative pain. We hypothesized there would be at least a 75% reduction in postoperative severe pain (pain score ≥7) in patients receiving ibuprofen compared to placebo. We performed a double-blind, placebo-controlled randomized controlled trial on pediatric urology patients with an indwelling ureteral stent undergoing removal in the operating room from 2014 to 2019. 20 patients in each arm were needed to achieve 80% power to detect a 75% reduction in the estimated 55% incidence of severe postoperative pain (α=0.05). Patients ≥4 years old who had a unilateral stent placed after treatment of urolithiasis or ureteropelvic junction obstruction were randomized to NSAID or placebo in a 1:1 ratio at least 15min prior to scheduled stent removal. Patients estimated pain using Faces Pain Scale-Revised (FPS-R) or visual analogue scale (VAS) prior to and 24h after stent removal. 254 patients undergoing stent removal were assessed for eligibility, and 44 randomized patients were analyzed using intention to treat analysis. The cohorts were demographically similar and received similar anesthesia treatment. There was no significant difference in maximum post anesthesia care unit pain score (p=0.269) or use of in-hospital opioids (p=0.626) between the two groups. No difference was seen in the incidence of severe postoperative pain (p=1.0), thus rejecting the hypothesis. Significant worsened postoperative pain (pain score increases of ≥2 between time points) decreased from 22.7% to 13.6% between placebo and NSAID, but this did not reach significance (p=0.410). There was no difference in postoperative pain for patients undergoing ureteral stent removal given preoperative NSAID versus placebo. The incidence of severe pain before and after stent removal was low, ranging from 4.5 to 9.1%. Research to understand the etiology of pain after stent removal and techniques to minimize or prevent discomfort should continue in order to optimize patient outcomes.

An EBP Project: What Is the Best Music Listening Intervention for Patients Recovering in the Post Anesthesia Care Unit (PACU)

<h3>Introduction</h3> In the Weinberg PACU, Patients who were having laparoscopic radical prostatectomies experience severe pain which caused them to have an increase length of stay. Additionally, these patients who suffered from prostate cancer also have high levels of anxiety that required them to have large doses of opioids administered for their pain management. The Perianesthesia nurses questioned what complementary evidence could support a non-pharmacologic approach to reducing this patient population's post-operative pain. <h3>Identification of the problem</h3> What is the best music listening intervention for patients recovering in the post anesthesia care unit? <h3>EBP Question/Purpose</h3> <b>PICO question. Databases utilized</b>. P - Post Anesthesia patients recovering in the PACU I - Best method of music listening C - Preferred music listening compared to relaxation breathing narrative O - Listening to best method will reduce anxiety and PACU pain score <h3>Methods/Evidence</h3> Literature search yielded 1006 articles and only 20 were appropriate articles that met our PICO criteria. The evidence search strategy range from year 2012-2020. The data base searches were PUBMED, CINAHL, ERIC, Jonna Briggs Institute, and Cochrane Review data bases were searched. The key mesh terms used were: music, music listening, music therapy, intervention, surgery, PACU, post- operative, randomized controlled trials, anxiety, pain and pain management. <h3>Synthesis /Recommendations</h3> Appraisal results were six level 1A's, three level 2A's, three level 1B's, two level 2B's, one level 4A's, one level 5A's and one level 5B's. Synthesis recommended two evidence-based music listening interventions: Preferred music listening method and relaxation breathing over minimalistic music for therapeutic interventions to reduce anxiety and pain. <h3>Future Perianesthesia Research</h3> Translation of EBP project to practice implemented the "Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Randomized Comparative Clinical Trial. The results of this study revealed that both preferred selected music listening method and guided relaxation breathing over a minimalistic hypnotic track can meaningfully reduced patient's anxiety and PACU pain scores.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Mixed Method Randomized Comparative Clinical Trial

<h3>Introduction/Background</h3> Laparoscopic radical prostatectomy surgery patients have reported severe pain post operatively and experienced psychological distress for potential urinary incontinence and sexual dysfunction. Over this past year, PACU nurses identified anxiety and pain management as the primary cause of these patients' increased length of stay in PACU. <h3>Identification of the problem</h3> Patients undergoing major cancer surgery frequently express increased anxiety about how severe their pain will be as well as their oncology surgical outcomes. Mid-Atlantic academic teaching hospital's postanesthesia care unit (PACU) Standards of Care Committee met to discuss investigating complementary music listening methods to enhance pharmacologic pain management to address concerns in this surgical population. <h3>Purpose of the Study</h3> To compare two methods of music listening interventions on anxiety, pain, heart rate, blood pressure, and oxygen saturation among post anesthesia care unit (PACU) patients who are recovering from laparoscopic radical prostatectomy surgeries: a) patient-preferred music listening via Spotify selections; and b) relaxation breathing narrative over minimalistic hypnotic music. <h3>Methodology</h3> Randomization of participants by computer-generated table of random numbers for effective balance between the two groups. A power analysis was calculated to have 77 male participants: Group I (n=37) and Group II (n=40). Inclusion criteria/exclusion criteria established. Nurses blinded to study interventions. The study started in December 2019 and concluded in December 2020. Data collection began in PreOP and continued through discharge. <h3>Results</h3> Both Groups I and II had reduced pain scores at discharge as compared to PACU admission; both groups had significant reduction (p=0.046 Group I, and Group II (p=0.002), but changes for comparative groups (I and II) were not significant between the two groups (p=0.53). <h3>Discussion</h3> Both interventions reduced State Trait Anxiety Inventory scores and pain scores to a similar degree; this reduction was clinically and statistically significant. Pain medication use did not differ between the two groups. Notably, three study participants did not require any pain medication throughout their entire PACU stay. Qualitative inquiry question on discharge revealed significant relaxation, distraction, pain relief, and comfort when listening to music. <h3>Conclusion</h3> Study revealed both relaxation/breathing track and personally selected music can meaningfully improve patients' anxiety and PACU pain scores. <h3>Implications for perianesthesia nurses and future research</h3> Future multicenter studies of music listening methods should be studied in other surgical/procedural patients recovering in PACU.

Dexmedetomidine reduces postoperative pain and speeds recovery after bariatric surgery: a meta-analysis of randomized controlled trials.

Dexmedetomidine in opioid-sparing analgesia promotes enhanced recovery and improves postoperative outcomes. This study aimed to explore the safety and efficacy of dexmedetomidine in bariatric surgery. Meta-analysis. We selected studies from Pubmed, Embase, Web of Science, and the Cochrane Central Registry of Controlled Trials before 20 April, 2021. The primary outcomes were pain scores and intravenous morphine equivalents (IVME) in the post anesthesia care unit (PACU) and postoperative day 1 (POD1). The secondary outcomes included postoperative nausea and vomiting (PONV), the length of hospital stay (LOS), intraoperative mean arterial pressure (MAP) and heart rate (HR). We extracted 697 participants from 10 randomized controlled trials. Dexmedetomidine reduced PACU pain scores (MD = -1.51, 95% confidence interval [CI]: -2.60 to -.42) after bariatric surgery, especially laparoscopic Roux-en-Y gastric bypass (MD = -3.05, 95%CI: -3.77 to -2.33), but it did not affect POD1 pain scores (MD = .20, 95%CI: -.85 to 1.26). Dexmedetomidine can reduce PACU IVME (MD = -4.29, 95%CI: -6.59 to -1.99), but does not reduce POD1 IVME (MD = -.36, 95%CI: -2.41 to 1.68). In addition, dexmedetomidine significantly reduced PONV both in PACU (OR = .28, 95%CI: .14-.54) and POD1 (OR = .24, 95%CI: .14-.4), shortened LOS (MD = -.29, 95%CI: -.49 to -.10), and had little effect on intraoperative MAP (MD = -6.64, 95%CI: -9.52 to -3.76) and HR (MD = -4.8, 95%CI: -11.55 to 1.94). In conclusion, the use of dexmedetomidine in opioid-sparing analgesia contributes to postoperative analgesia after bariatric surgery, but the heterogeneity was high. In addition, dexmedetomidine is beneficial for enhanced recovery.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Randomized Comparative Clinical Trial

PurposeRandomized comparative mixed method approach with qualitative inquiry study's aim sought to determine if there was a difference in pre/post-intervention State-Trait Anxiety Inventory (STAI) scores and postanesthesia pain scores between two music listening groups of laparoscopic radical prostatectomy patients. DesignProspective randomized comparative mixed method approach with a qualitative inquiry. MethodsSample size of 77 male participants assigned by a table of random numbers to Spotify patient-preferred music selection Group I (n = 37) or minimalist hypnotic music with guided relaxation breathing (MHMGRB) instructional narrative Group II (n = 40). Outcome measures used patients’ STAI questionnaire and reported PACU admission and discharge pain scores. ResultsBoth Groups I and II had reduced pain scores at discharge as compared to admission; both groups had a significant reduction (P = .046 Group I, and Group II (P = .002), but changes for comparative groups (I and II) were not significant between the two groups (P = .53). ConclusionsStudy revealed that both patient-preferred selected music and MHMGRB can meaningfully reduce patients’ anxiety and PACU pain scores.

Pain after Interventional Radiology in Oncology: A Case-Control Study from a 5-Year Cohort.

Simple SummaryFew reports address post-procedural pain after interventional radiology in oncology. All patients treated from 2015 to 2019 in interventional radiology were included in a retrospective cohort study. In an additional case-control study, patients reporting strong or intolerable pain were compared to those with no pain. From 4411 procedures, severe pain was more frequent in women (6% vs. 4%) and the youngest patients, after general anesthesia, arterial embolization, limb cementoplasty, osteosynthesis, and abdominal tumor ablation. In the case-control study, long-term opioid use, duration >160 min, and high-dose remifentanil were risk factors for a high pain level. Intraoperative ketoprofen was associated with a decreased high pain level incidence. Immediate severe post-procedural pain was a risk factor for severe pain in wards until discharge. Severe post-procedural pain was observed, particularly after specific interventional radiology procedures, and may be prevented by injecting intraoperative analgesics.Background: Interventional radiology plays a major role in oncology both for curative and palliative treatment, but few reports address post-procedural pain. The purpose of this study was to quantify postoperative pain after interventional radiology procedures in oncology and to identify major pain-associated pre and intraoperative factors. Methods: From 2015 to 2019, all patients treated with interventional radiology were included retrospectively in a cohort study. Anesthetic protocols were standardized by the type of radiological procedure. Demographic data, preoperative treatments, analgesic agents, pain score levels, and morphine consumption from the post-anesthesia care unit (PACU) to hospital discharge were collected from databases. In an additional case-control study, patients reporting strong or intolerable pain in PACU were compared to those with no pain. Matching to control cases was based on the type of intervention, sex, and age. Results: From 4411 procedures, severe pain in PACU was more frequent in women (p < 0.04) and the youngest patients (p < 0.0001), after general anesthesia (p < 0.0001). Higher pain levels were associated with certain procedures, such as arterial embolization, limb cementoplasty, osteosynthesis, and abdominal tumor ablation, and when the intervention duration exceeded 160 min (p = 0.038). In the cohort study, high-dose remifentanil (≥0.055 µg/kg/min) was a risk factor for post-procedural high pain levels (p < 0.001). Intraoperative ketoprofen was associated with a decrease in high pain level incidence (p < 0.0001). Severe pain in PACU was a risk factor for severe pain in wards from day 0 until discharge. Conclusion: Severe pain depends on the type and duration of interventional radiology, type of anesthesia, and preoperative use of opiates. Limiting doses of remifentanil and injecting intraoperative analgesics, especially ketoprofen, may reduce the incidence of post-intervention severe pain.

Liposomal compared to 0.25% bupivacaine in patients undergoing hemorrhoidectomy: A pre- and post-implementation quality improvement evaluation

Study objectiveThe efficacy of infiltration of liposomal bupivacaine against an active comparator, such as bupivacaine, remains debated on acute postoperative pain control. We evaluated the analgesic efficacy, patient satisfaction, and side effects of liposomal bupivacaine compared to bupivacaine during hemorrhoidectomy procedures. DesignA pre- and post-implementation quality improvement evaluation. SettingOperating room and post-anesthesia care unit. PatientsNinety-four consecutive adult patients with hemorrhoid surgery between October 2019 and November 2020. InterventionsA preintervention control group of 0.25% bupivacaine (50 ml, 125 mg, n = 47) and a postintervention group of liposomal bupivacaine (30 ml, 266 mg, n = 47) for perianal local anesthetic administration. MeasurementsThe primary endpoint was analgesic efficacy of liposomal bupivacaine compared to bupivacaine based on a reduction in the number of patients administered opioids and patient-reported pain scores in the postanesthesia care unit (PACU). Secondary endpoints included constipation, post-discharge patient-reported pain management satisfaction, and opioid prescription refill requests in telephonic interviews three days after surgery. Main resultsPACU peak pain scores were significantly higher in the bupivacaine compared to the liposomal bupivacaine group (median 3 [IQR 0–6] vs. 0 [IQR 0–4], p = 0.03), respectively with no differences in PACU discharge pain scores. There was no difference in the frequency of rescue opioid use (38.2% vs. 25.5%, p = 0.18) or the morphine milligram equivalents administered to each of those patients (median 15 [IQR 10–23] vs. 15 [IQR 15–25], p = 0.39) in the PACU comparing the bupivacaine and liposomal bupivacaine groups respectively. Secondary endpoints were similar in each group with respect to requests for opioid refills (10.6 vs. 12.8%, p = 0.75), >75% satisfied with their pain management (p = 0.94), and constipation reported on day 3 after surgery (p = 0.07). ConclusionsLiposomal bupivacaine compared to a bupivacaine perianal block reduces early PACU pain scores without affecting opioid refill requests, has a similarly low incidence of complications, and high satisfaction in both groups.

An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project.

Introduction:Using plan-do-study-act (PDSA) cycles, this quality improvement (QI) project aimed to standardize an anesthetic protocol to optimize multimodal pain management for pediatric open inguinal hernia repair (OIHR).Methods:PDSA cycle 1: in December 2017, we standardized the intraoperative OIHR anesthesia protocol by replacing transversus abdominis plane (TAP) or ilioinguinal-iliohypogastric (II) blocks and fentanyl with exclusively II blocks and fentanyl. PDSA cycle 2: in January 2019, we used an opioid sparing strategy, replacing II blocks and fentanyl with II blocks and dexmedetomidine. We used statistical process control (SPC) charts to analyze data from the medical record. Outcome measures included the percent of patients requiring rescue morphine in the postanesthesia care unit (PACU), maximum PACU pain score, PACU length of stay (LOS), and anesthesia preparation duration.Results:The team performed a total of 641 pediatric OIHRs between July 2015 and June 2021. The three groups included 203 patients in our baseline group, 127 patients in the PDSA cycle 1 group, and 311 patients in the PDSA cycle 2 group. Special cause variation (SCV) occurred for the percent of patients requiring rescue morphine, anesthesia preparation duration, and PACU LOS. The percent of patients requiring rescue morphine showed improvement. Anesthesia preparation duration improved compared to baseline. There was no SCV detected in the SPC chart for maximum PACU pain score.Conclusion:We implemented an opioid sparing anesthetic protocol for pediatric OIHR utilizing II blocks and dexmedetomidine without adversely affecting postoperative pain score or morphine rescue rate over 6 years.

The impact of fascia iliaca nerve blockade on early postoperative pain and recovery after hip arthroscopy for femoroacetabular impingement syndrome.

ABSTRACTFascia iliaca nerve blockade (FIB) has been previously described as an effective technique for reducing postoperative pain and opioid consumption after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesize that an FIB will significantly reduce opioid consumption, pain scores and recovery time in our population. A retrospective observational study of 326 consecutive patients undergoing hip arthroscopy for FAIS at a single institution was performed. Patients were classified based on whether or not they received an FIB. Patient demographics, surgical details, medication details and 6-month postoperative outcomes were collected. The primary endpoint was the amount of narcotics required intraoperatively and in the postanesthesia care unit (PACU). Of the 326 patients included in the study, 37 received an FIB. No differences in sex, age or other surgical details were observed between groups. Patients receiving an FIB were more likely to receive celecoxib (P < 0.001), pregabalin (P = 0.001) and methocarbamol (P = 0.002). The FIB group received lower doses of narcotics intraoperatively (P = 0.001), postoperatively (P < 0.001) and in total (P < 0.001). The FIB group also self-reported lower first pain scores upon arrival to PACU (P = 0.001) and experienced shorter PACU recovery times (P < 0.001). After controlling for differences between groups, patients who received an FIB required significantly lower amounts of narcotics, had shorter PACU times and lower first PACU pain score than those who did not (P < 0.001). No differences in complication rates were noted between groups. The use of FIB resulted in lower pain scores, reduced recovery time and decreased early postoperative narcotic requirements for patients undergoing hip arthroscopy for femoroacetabular impingement. Further study is required to validate these findings and determine the optimal approach to regional analgesia in this patient population.

The use of CONOX as a guide to the general anesthesia on laparotomy patients compared with standard clinical care – A pilot study

Background: Avoiding excessive doses of anesthesia was fundamental, mainly to reduce the adverse effect of anesthesia. Electroencephalography (EEG)-based monitors can be used to measure the depth level of anesthesia and guide intraoperative hypnosis drug and opioid administration. This study aims to evaluate the benefit of using CONOX monitor when administering anesthesia drugs in laparotomy procedures.&#x0D; Method: Twenty patients aged 18-65 years with physical status ASA I-III who underwent major laparotomy surgery with general anesthesia total intravenous anesthesia (TIVA) were divided into two groups. Group A received general anesthesia guided with the CONOX monitor, while group B using standard clinical care. We later evaluate the total use of propofol and fentanyl, intraoperative hemodynamic profile, postoperative cognitive disorder (POCD), intraoperative awareness, postoperative nausea and vomiting (PONV), and moderate to severe pain in the post-anesthesia care unit (PACU).&#x0D; Results: The mean total propofol used is lower in CONOX group (63.6 ± 11.7 mcg/kg/min vs. 74 ± 17.87 mcg/kg/min). A similar result was obtained with fentanyl. The CONOX group use a lower total of fentanyl (212.5 ± 32.3 mcg vs. 249 ± 54.6 mcg) than the control group. POCD was found to be more prevalent in the control group (5 vs 2 patients). While there is no report of intraoperative awareness.&#x0D; Conclusion: The incidence of PONV and moderate to severe pain in PACU was similar between the two groups. This pilot study is a preliminary study to evaluate the benefit of using EEG-based monitors to adjust anesthesia drugs.

Factors Associated with Moderate to Severe Pain in Post- Anesthesia Care Unit after Tonsillectomy: A Retrospective Study

Background: Tonsillectomy can cause high intensity of pain and inadequate pain control might lead to eating problems. However, usage of opioids and non-steroidal anti-inflammatory drugs for postoperative analgesia is limited due to patients’ comorbidities such as obstructive sleep apnea and risk of postoperative bleeding. Objective: To define the incidence of moderate to severe pain after tonsillectomy and associated factors. Materials and Methods: Electronic medical records of patients age 17 or older undergoing tonsillectomy between March 2014 and December 2018 were retrospectively reviewed. The collected data included patient data, surgical data, pain scores in the post-anesthesia care unit (PACU), and perioperative pain management. Results: Three hundred twenty-three patients were included. The mean age was 34.9±12.9 years, mean body mass index was 24.8±5.7 kg/m², and 65% were female. The incidence of moderate (numeric rating scale [NRS], (0 to 10) of 4 to 6) to severe pain (NRS of 7 or more) in the PACU was 63.8%. Multivariate analysis revealed that not receiving intraoperative dexamethasone was the only factor associated with moderate to severe pain (adjusted OR 2.21, 95% CI 1.34 to 3.65) in the PACU. Conclusion: Moderate to severe pain after tonsillectomy was found in 63.8% of patients in the PACU and not giving intraoperative dexamethasone was a significant risk factor. Keywords: Risk factor, Post-anesthesia care unit, Tonsillectomy, Dexamethasone, Postoperative pain

Clinical effect of normal saline injectate into interscalene nerve block catheters given within one hour of local anesthetic bolus on analgesia and hemidiaphragmatic paralysis

BackgroundPrevious case reports describe the reversal of phrenic nerve blockade from the interscalene nerve block using normal saline injectate washout. This randomized clinical trial aimed to evaluate whether using normal...

Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study.

IntroductionAn opioid-sparing anesthetic involves a multi-modal technique with non-opioid medications targeting different analgesic pathways. Such techniques may decrease adverse effects related to opioids. These techniques may be considered in patients at higher risk for opioid-related adverse effects including obstructive sleep apnea or sleep disordered breathing.MethodsA prospective, pilot study was performed in 10 patients (3–8 years of age), presenting for adenoidectomy. The perioperative regimen included oral dextromethorphan (1 mg/kg) and acetaminophen (15 mg/kg) plus single boluses of intraoperative dexmedetomidine (0.5 μg/kg) and ketamine (0.5 mg/kg). Pain scores were assessed in the post anesthesia care unit (PACU) using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Patients with a pain score >4 received fentanyl as needed. PACU time, pain scores, and parent satisfaction were recorded. Postoperatively, patients were instructed to use oral acetaminophen or ibuprofen every 6 hours as needed for pain.ResultsThe study cohort included 10 patients, 3–8 years of age. All patients had opioid-free anesthetic care. PACU time ranged from 24 to 102 minutes (median: 56 minutes). FLACC pain scores were 0 for all PACU assessments. Nine patients were discharged home and 1 patient had a planned overnight admission. Following hospital discharge, the pain scores were satisfactory during the 72-hour study period and 90% of the patients’ guardians were satisfied or highly satisfied with their child’s pain control.ConclusionThis opioid-sparing approach provided safe and effective pain control as well as parental satisfaction following adenoidectomy in children. Additional prospective studies are needed to determine whether this regimen is effective in a larger cohort of patients with and for other otolaryngology procedures.

Ropivacaine infiltration analgesia of the drainage exit site enhanced analgesic effects after breast Cancer surgery: a randomized controlled trial

BackgroundPostoperative pain after breast cancer surgery remains a major challenge in patient care. Local infiltration analgesia is a standard analgesic technique used for pain relief after surgery. Its application in patients who underwent mastectomy requires more clear elucidation. This study aimed to investigate the effect of ropivacaine infiltration of drainage exit site in ameliorating the postoperative pain after mastectomy.MethodsA prospective randomized controlled study was conducted in 74 patients who were scheduled for unilateral mastectomy by standardized general anesthesia. Both intervention group and control group were given infiltration of the two entry points of drainage catheters with 10 ml 0.5% ropivacaine (Group A) (n = 37) or 10 ml normal saline (Group B) (n = 37). Pain scores were recorded in post-anesthesia care unit (PACU), at 6 h, 12 h, 24 h and 36 h after operation by using a visual analogue scale (VAS). Postoperative nausea and vomiting (PONV) incidence, postoperative analgesic and antiemetic requirements, the incidence of chronic pain, as well as the quality of recovery were recorded.ResultsThe patients in Group A showed a significant reduction in postoperative pain in PACU (p < 0.0005), at 6 h (p < 0.0005), 12 h (p < 0.0005), and 24 h after surgery (p < 0.05) when compared to those in Group B. There were more postoperative analgesic requirements in Group B (p < 0.05). With regard to the quality of recovery, Group A was shown to be much superior over Group B (p < 0.05).ConclusionsRopivacaine infiltration of the two drainage exit sites decreased the degree of postoperative acute pain after mastectomy, and this approach improved patients’ quality of recovery.Trial registrationretrospectively registered in Chictr.org.cn registry system on 24 February 2020 (ChiCTR2000030139).

Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy

Background: Hip arthroscopy has become the standard for the operative treatment of symptomatic femoroacetabular impingement. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge. Purpose/Hypothesis: Our purpose was to perform a single-blinded randomized controlled trial comparing the use of pericapsular injection versus lumbar plexus blockade for postoperative pain control after arthroscopic surgery on the hip. We hypothesized that pericapsular injection would provide equivalent pain relief to that of lumbar plexus blockade while minimizing adverse effects and alleviating the dependence on a qualified individual to administer. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 64 consecutive patients undergoing hip arthroscopy were prospectively assessed over a 6-month period between 2017 and 2018. Patients were randomly allocated to 1 of 2 groups: 32 patients received a lumbar plexus blockade by a single anesthesiologist, while 32 patients received a pericapsular injection of 30 mL of ropivacaine and 12 mg of morphine. Postoperative pain in the postanesthesia care unit (PACU) as measured using the numeric rating scale, time to discharge, PACU morphine equivalents, and adverse effects were collected by PACU staff. Postoperative day 1 and 2 narcotic use was obtained through a telephone call with the patient on postoperative day 3. Results: We found no statistically significant difference in PACU pain scores at all time points, although there was a trend toward lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not vary across the 2 arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention. Conclusion: Pericapsular injection provides equivalent analgesia when compared with lumbar plexus blockade. It is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy. Registration: ClinicalTrials.gov ID: NCT03244631.

Lumbar Plexus Block versus Peri-capsular Injection for Hip Arthroscopy: A Single-Blinded Randomized Controlled Trial

Objectives:To perform a single-blinded, randomized controlled trial comparing pericapsular injection versus lumbar plexus blockade for post-operative pain control following arthroscopic surgery on the hip.Methods:70 consecutive patients undergoing hip arthroscopy were prospectively assessed over a six-month period from 2017 to 2018. Patients were randomly allocated to 1 of 2 groups. 35 patients received a lumbar plexus blockade by a single anesthesiologist, while 35 patients received a pericapsular injection of 30cc of ropivacaine and 12mg of morphine. Post-operative pain in the post-anesthesia care unit (PACU) as measured by the numeric rating scale (NRS), time to discharge, PACU morphine equivalents and adverse effects were collected by PACU staff. Post-operative day (POD) 1 and POD 2 narcotic use was obtained through a phone call with the patient on post-operative day 2.Results:We found no statistically significant difference in PACU pain scores at all time-points, although there was a trend towards lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not differ significantly between the two arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention.Conclusion:Pericapsular injection provides equivalent analgesia when compared to lumbar plexus injection. It is a safe, time-saving intervention that allows for efficient post-operative analgesia for patients undergoing hip arthroscopy.