Patient-controlled Analgesia Device Research Articles

Erector spinae block for postoperative pain management in lumbar disc hernia repair.

Lumbar disc herniation is the most common spinal disorder and various less invasive techniques such as microdiscectomy have been described. However, postoperative pain management in patients undergoing discectomy is still commonly inadequate. Erector spinae plane (ESP) block is a relatively easier technique with lower risks of complications, and can be performed to provide postoperative analgesia for various procedures. The current study aimed to determine the effect of ESP block on postoperative analgesia in patients who underwent elective lumbar disc herniation repair surgeries. Fifty-four ASA I-II patients aged 18-65years scheduled for elective discectomy surgery were included in the study. Patients were randomized either to the ESP or control group. Ultrasound-guided ESP block with 20mL of 0.25% bupivacaine was performed preoperatively in the ESP group patients and a sham block was performed with 20mL normal saline in the control group patients. All the patients were provided with intravenous patient-controlled analgesia devices containing morphine. Morphine consumption and numeric rating scale (NRS) scores for pain were recorded 1, 6, 12, and 24h after surgery. A significantly lower morphine consumption was observed at 6, 12, and 24h timepoints in the ESP group (p < 0.05 for each timepoint). Total morphine consumption at 24h after surgery decreased by 57% compared to that of the control group (11.3 ± 9.5mg in the ESP group and 27 ± 16.7mg in the control group). NRS scores were similar between the two groups. This study showed that ESP block provided effective analgesia in patients who underwent lumbar disc herniation surgery. NCT03744689.

Comparison of ultrasonography-guided pectoral nerve block with patient-controlled analgesia for breast surgery patients

Objectives: Pectoral nerve block is an effective method that can be applied for analgesic purposes in breast surgery. In this prospective study we aimed to compare the postoperative analgesic efficacy of pectoral nerve block for postoperative analgesia and patient-controlled analgesia (PCA) for patients undergoing breast surgery in terms of the incidence of nausea and vomiting. Methods: The study included 93 patients who underwent ASA I-II anesthesia and breast surgery. Group 1 was PCA group, group 2 was PECS (Pectoral Nerves) block group. PECS block was administered as PECS-1 and PECS-2 block under the guidance of ultrasonography. Patients investigated in the study had postoperative monitoring forms examined for vital signs and visual analog scale (VAS) scores in the 1st, 6th and 24th hours. Results: When the pectoral nerve block with bupivacaine under ultrasound guidance was compared with PCA device, there were significant reductions in VAS score at 24 hours.(1.53 vs 4.27, 1.10 vs 3.27 and 0.90 vs 1.93, respectively; p = 0.0001). Although there was no significant difference in terms of vomiting, there was a difference in favor of pectoral nerve block especially at the postoperative 6th hour in terms of nausea. Conclusions: Pectoral nerve block can be used in the patients undergoing breast surgery due to the lower visual analog score and nausea incidence in the postoperative period.

The effect of opioid receptor gene polymorphism (A118G) on postoperative tramadol consumption after gynecological surgery performed with a pfannenstiel incision

Introduction: The analgesic efficacy and side effects of opioid medications show great inter-individual differences. Genetic studies have indicated that this difference is considerably associated with the relationship between opioid and receptor. Therefore, in this study it was aimed to investigate the effect of A118G polymorphism on postoperative tramadol consumption and opioid-related side-effects after gynecological surgery performed. Material and Methods: Evaluation was made of 80 patients with I-II ASA status, scheduled for gynecological surgery performed with a pfannenstiel incision under general anesthesia. Genomic DNA was extracted from the blood samples. After surgery, all of the patients were equipped with an intravenous Tramadol patient-controlled analgesia device and tramadol consumption was measured. Pain scores were measured with a numerical rating scale. All assessments were performed prior to gene analysis. In order to detect the genotype for A118G single point mutation, Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism(RFLP) methods were used. Results: The study included 80 patients were included. Of these, 60(75%) patients were detected to have homozygous 118AA(AA) genotype and 20(25%) patients to have heterozygous 118AG(AG). No patients with homozygous 118GG(GG mutant) genotype were detected. Patients were divided into 2 separate groups based on their genotypes. The postoperative total tramadol consumption and pain score in the group carrying the AG heterozygous allele were significantly higher than in the group carrying the AA homozygous allele. No statistically significant difference was detected between the groups in respect of side-effects. Conclusions: A118G polymorphism detected in the µ-opioid receptor gene has an effect on postoperative tramadol consumption.

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study.

Background and objectives: The fixed-rate continuous background infusion mode with bolus dosing is a common modality for intravenous patient-controlled analgesia (PCA). However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM) where the background injection rate varies depending on the patient’s bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated to either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data on bolus demand count, total infused volume, and background infusion rate were downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (p = 0.621), decreasing with time in both groups (p < 0.001). The bolus demand count was not significantly different between groups throughout (p = 0.756). The mean total cumulative infused PCA volume was lower in group OBIM (84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM (102 (97.8−106.0) mL; p < 0.001). The total cumulative opioid dose in fentanyl equivalents, after converting sufentanil to fentanyl using an equipotential dose ratio, was lower in group OBIM (714.1 (647.4−780.9) μg) than in group TBIM (963.7 (870.5−1056.9) μg); p < 0.001). The background infusion rate was significantly different between groups throughout the study period (p < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour and lower from the 18th to the 48th postoperative hour. Conclusions: The OBIM combined with bolus dosing reduces the cumulative PCA volume and opioid consumption compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.

Laparoskopik Kolesistektomi Geçiren Hastalarda Ultrasonografi Eşliğinde Uygulanan Transversus Abdominis Plan Bloğun Perioperatif Analjezi ve Hasta Konforuna Katkısı

Objective: Inadequate pain management after laparoscopic cholecystectomy is an important problem that can lead to complications and negatively affect the patient’s recovery. Transversus abdominis plane block can contribute to postoperative analgesia in abdominal surgeries. The aim of this study is to investigate the effects of preoperative unilateral or bilateral transversus abdominis plane block on perioperative analgesia in patients underwent laparoscopic cholecystectomy and its contribution to patient comfort. Methods: A total of 75 patients were randomized into 3 groups as Group-1 (n=25) without unblocking, Group-2 (n=25) with unilateral block and Group-3 (n=25) with bilateral block. Block was applied to Group 2 and Group 3 under general anesthesia before surgery. Demographic characteristics of patients, intraoperative opioid consumption, postoperative 30 min, 2, 4, 8, 12 and 24 hours VAS rest-VAS cough scores, analgesic consumption in patient controlled analgesia, postoperative additional analgesic requirement, side effects, mobilization times and patient satisfaction were recorded. Results: The dose of remifentanil consumed intraoperatively was significantly lower in Group-3. VAS values were significantly different among the groups until the 12th hour postoperatively. The VAS rest and VAS cough values were lower in the Group 3. There was a significant difference among the groups in the patient-controlled analgesia devices when the bolus dose demand/given amounts and the total amount of drugs requested/consumed were compared. Total drug consumption was determined in the highest Group-1 and the lowest in Group-3. The satisfaction scores of the patients in group-3 were higher than the other groups. Conclusion: Our study showed that transversus abdominis plane block application in laparoscopic cholecystectomy surgeries contributed to decreased perioperative analgesic consumption and lower VAS scores up to 12 hours. Transversus abdominis plane block, which was performed with laparoscopic cholecystectomy in the preoperative period, has been shown to be an effective analgesic method.

Femoral Blokta Farklı İki Doz Bupivakain Protokolünün Postoperatif Analjezi Üzerine Etkisi: Tek Merkez Verilerinin Retrospektif Analizi

INTRODUCTION: In our study, we aimed to compare the analgesic efficacy, side effect profile and its effect on opioid consumption of the femoral nerve block applied with different concentrations of local anesthetic agents (%0.5 bupivacaine and %0.25 bupivacaine) in the same volume (20 mL) after total knee replacement (TKR) operation. METHODS: The files of patients who underwent unilateral TKR surgery under spinal anesthesia between August 2018 and June 2019 were retrospectively reviewed. A total of 163 patients were included in the study, 81 patients in group 1 who received %0.25 bupivacaine, and 82 patients in group 2 who received %0.50 bupivacaine for femoral block. The highest visual analogue pain scale (VAS) scores in the postoperative 24 hours, the amount of tramadol requested and consumed with intravenous patient-controlled analgesia (PCA) devices, and whether there was a significant difference in terms of side effects (nausea, vomiting, motor and sensory deficit) were analyzed. RESULTS: The highest VAS score in group 1 was 2.95 ± 1.31, in group 2 it was 2.84 ± 1.06, and there was no significant difference between them. The mean consumption of tramadol was 197.04 ± 92.03 mg in group 1 and 208.05 ± 85.06 mg in group 2. There was no difference between the demand and consumption of tramadol and side effects. DISCUSSION AND CONCLUSION: 20 mL %0.25 bupivacaine for the femoral block provided the equivalent analgesic efficacy to the same volume of %0.50 bupivacaine. We think that the use of % 0.25 bupivacaine is a more reliable option to reduce systemic side effects, motor block risk and complications.

Anesthetic and analgesic approach in total knee arthroplasty: A national survey study

Aim: Although the optimum anesthetics and analgesic choice for total knee arthroplasty is a heavily debated topic in recent years, the failure to reach any ideal consensus on this topic leads clinicians to adopt different approaches. This study was conducted to assess differences in general anesthetic and analgesic approaches toward the total knee arthroplasty across Turkey. Materials and Methods: Our 28-item survey was presented online to physicians who work as Anesthesiology and Reanimation specialists in Turkey and agreed to participate in the study. The survey includes questions about the techniques preferred by the clinicians in the management of anesthesia and postoperative analgesia in TKA and the main reasons underlying their preferences. Results: 255 anesthesiologists, i.e. 72 (28.1%) faculty members and 183 (71.9%) specialists, completed the study in full. According to our survey, spinal anesthesia (61.3%) comes first in the selection of an anesthetic method in TKA, followed by the Combined Spinal-Epidural Anesthesia (32.4%). The spinal anesthesia is the most frequently preferred method in training and state hospitals and Combined Spinal-Epidural Anesthesia is the most frequently preferred method in private hospitals. The use of peripheral nerve blocks is 49.8% (127). Femoral nerve block is preferred with 79.7%, followed by adductor canal block with 36.1%. The rate of use of intravenous patient-controlled analgesia is 38.1% and the most commonly preferred analgesia is Tramadol (69.1%). 63.1% of those using epidural anesthesia do not use any epidural patient-controlled analgesia device. The physicians reported that the lack of a team to follow up epidural patient-controlled analgesia device (50.9%) as the most common reason for not choosing epidural patient-controlled analgesia. Conclusion: Regional anesthesia is the first preference in the anesthesia management of total knee arthroplasty in our country. In postoperative analgesia practice, peripheral nerve blocks are preferred at a higher rate than epidural and intravenous patient-controlled analgesia.

Comparison between periarticular injection and intraarticular infusion for pain control following total knee arthroplasty

Objectives: To compare periarticular infiltration and intraarticular continuous infusion methods in pain management following total knee arthroplasty (TKA). Methods: Patients who underwent TKA from May 2015 through September 2015 according to their postoperative pain protocol were compared. The patients who received bupivacaine by periarticular infiltration (PAI group) and intraarticular infusion (IAI group) were included in the study. Patients also received a treatment through intravenous patient-controlled analgesia (PCA) device. The frequency of patients’ bolus need and the tramadol dose used via PCA device, Visual Analogue Scale (VAS) scores and clinical evaluation as active knee flexion at the postoperative 3th day were obtained from the patient follow - up forms and records. Side effects related to narcotic analgesic medications were also obtained. Results: The study included 90 patients, of whom 46 were in the PAI group (median age, 65.5 years; females, 82.6%) and 44 were in the IAI group (median age: 65.5 years; females, 81.8%). The VAS pain scores assessed at various postoperative time points and tramadol consumption were usually lower in the IAI group than in the PAI group. No difference was determined between the groups regarding the 3th-day VAS scores in flexion and in terms of analgesia-associated side effects. Conclusions: Bupivacaine administration by IAI for postoperative pain management following TKA is associated with lower pain and lower tramadol consumption as compared with bupivacaine administration by PAI. The groups were comparable in terms of side effects. Accordingly, IAI seems to be an effective and safe analgesic technique for patients undergoing TKA.

Intravenous patient-controlled analgesia vs nurse administered oral oxycodone after total knee arthroplasty: a retrospective cohort study.

Severe post-operative pain is common after total knee arthroplasty. Patient-controlled analgesia is an alternative method of pain management, whereby a patient administers his or her own pain medication. Patients seem to prefer this method over nurse-administered analgesia. However, it remains unclear whether patients using patient-controlled analgesia devices use higher or lower doses of opioids compared to patients treated with oral opioids. This retrospective study examined 164 patients undergoing total knee arthroplasty. Post-operatively, 82 patients received oxycodone via intravenous patient-controlled analgesia devices, while the pain medication for 82 patients in the control group was administered by nurses. The main outcome measure was the consumption of intravenous opioid equivalents within 24h after surgery. Secondary outcome measures were the use of anti-emetic drugs and the length of stay. Furthermore, we evaluated opioid-related adverse event reports. The consumption of opioids during the first 24h after surgery and the use of anti-emetic drugs were similar in both groups. The median opioid dose of intravenous morphine equivalents was 41.1mg (interquartile range (IQR): 29.5-69.1mg) in the patient-controlled analgesia group and 40.5mg (IQR: 32.4-48.6mg) in the control group, respectively. The median length of stay was 2days (IQR: 2-3days) in the patient-controlled analgesia group and 3days (IQR: 2-3days) in the control group (p=0.02). The use of anti-emetic drugs was similar in both groups. The administration of oxycodone via intravenous patient-controlled analgesia devices does not lead to increased opioid or anti-emetic consumptions compared to nurse-administered pain medication after total knee arthroplasty. Patient-controlled analgesia might lead to shortened length of stay.

A118G polymorphism of OPRM1 gene caused different morphine consumption in female patients after total knee replacement

BackgroundWe intended to clarify the effect of gender and A118G polymorphism of Opioid Receptor μ1 (OPRM1) on the required morphine for patients to maintain Visual Analogue Scale ≦ 3 for post-operative pain control after total knee replacement (TKR). MethodsWith approval from Institutional Review Board (IRB) and obtainment of informed consents, 111 patients undergoing primary TKR were enrolled without violating the exclusion criteria, including previous history of allergy to morphine, alcohol or substance abuse, use of psychotropic medications, morbid obesity of body mass index (BMI) > 40 kg/m2, chronic pain with evidence of central sensitization, and uncooperative use of patient controlled analgesia (PCA) device. The amount of PCA-delivered morphine for pain control and the ‘demand’ (the count of button pushing for requiring pain medication from PCA) were recorded at 3, 6, 12, 24, 36, 48 and 72 h after the operation. One-way ANOVA with post-hoc test by Scheffe's method was adopted for statistical analysis of each variant (AA, AG, GG). The side-effects (nausea, vomiting and sedation) from morphine were recorded. P < 0.05 was considered to be statistically significant. ResultsWith sequencing by ABI PRISM 310 Genetic Analyser, we disclosed that the allele frequency was 75.5% for the A allele (female: 77.5%, male: 69.6%) and 24.5% for the G allele (female: 22.5%, male: 30.4%). The frequency of genotype occurrence was 61.3% for AA, 24.3% for AG and 14.4% for GG. Female patients of homozygous G118G of OPRMI required more morphine from PCA device for post-operative pain control than patients of AA and AG genotypes. No significant difference in morphine consumption for post-operative pain control was disclosed among three genotypes for male patients. ConclusionsThe impact caused by G118G polymorphism of OPRM1 on requirement of morphine consumption for post-operative pain control is potentially gender-linked.

An up-to-date overview of sublingual sufentanil for the treatment of moderate to severe pain

ABSTRACT Introduction Sufentanil is a selective µ-opioid agonist, used intravenously and intrathecally for moderate to severe acute pain. Sublingual sufentanil nanotablets have been developed; 15 mcg tablet for a patient-controlled analgesia device and 30-mcg tablet for a single-dose device administered by a healthcare professional. Dosing interval is a minimum of 20 min for a 15 mcg tablet and a treatment duration of up to 72 hours. The single 30-mcg nanotablet dosing interval is 1 hour. Mean plasma elimination half-life is 13 hours and bioavailability 47–57% after the first sublingual sufentanil tablet. Areas covered This review focuses on the effectiveness, safety, and feasibility of sublingual sufentanil 30-mcg single dose suspended by a healthcare professional for the management of moderate to severe acute pain. A few Phase 4 studies concerning the sublingual sufentanil tablet system containing 15-mcg nanotablets are also reviewed. Expert opinion Sufentanil sublingual 30-mcg nanotablets provide effective pain relief in various acute moderate to severe pain states. The safety profile of sublingual sufentanil 30 mcg is typical to opioids nausea, vomiting, and sedation being the most common ones. Sublingual sufentanil 30-mcg nanotablet has the potential for efficient moderate to severe pain management in supervised healthcare facilities.

Authorized Agent-Controlled Analgesia for Pain Management in Critically Ill Adult Patients.

Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent-controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults. To evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients. A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent-controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent-controlled analgesia. Authorized agent-controlled analgesia was administered by nurses only. The mean (SD) change in pain score was -3.4 (2.0) (95% CI, -4.0 to -2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent-controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent-controlled analgesia initiation on pain scores remained significant (P < .001). Use of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.

Gastrointestinal Complications After Pancreatoduodenectomy With Epidural vs Patient-Controlled Intravenous Analgesia

Morbidity is still high in pancreatic surgery, driven mainly by gastrointestinal complications such as pancreatic fistula. Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are frequently used for pain control after pancreatic surgery. Evidence from a post hoc analysis suggests that PCIA is associated with fewer gastrointestinal complications. To determine whether postoperative PCIA decreases the occurrence of gastrointestinal complications after pancreatic surgery compared with EDA. In this adaptive, pragmatic, international, multicenter, superiority randomized clinical trial conducted from June 30, 2015, to October 1, 2017, 371 patients at 9 European pancreatic surgery centers who were scheduled for elective pancreatoduodenectomy were randomized to receive PCIA (n = 185) or EDA (n = 186); 248 patients (124 in each group) were analyzed. Data were analyzed from February 22 to April 25, 2019, using modified intention to treat and per protocol. Patients in the PCIA group received general anesthesia and postoperative PCIA with intravenous opioids with the help of a patient-controlled analgesia device. In the EDA group, patients received general anesthesia and intraoperative and postoperative EDA. The primary end point was a composite of pancreatic fistula, bile leakage, delayed gastric emptying, gastrointestinal bleeding, or postoperative ileus within 30 days after surgery. Secondary end points included 30-day mortality, other complications, postoperative pain levels, intraoperative or postoperative use of vasopressor therapy, and fluid substitution. Among the 248 patients analyzed (147 men; mean [SD] age, 64.9 [10.7] years), the primary composite end point did not differ between the PCIA group (61 [49.2%]) and EDA group (57 [46.0%]) (odds ratio, 1.17; 95% CI, 0.71-1.95 P = .54). Neither individual components of the primary end point nor 30-day mortality, postoperative pain levels, or intraoperative and postoperative substitution of fluids differed significantly between groups. Patients receiving EDA gained more weight by postoperative day 4 than patients receiving PCIA (mean [SD], 4.6 [3.8] vs 3.4 [3.6] kg; P = .03) and received more vasopressors (46 [37.1%] vs 31 [25.0%]; P = .04). Failure of EDA occurred in 23 patients (18.5%). This study found that the choice between PCIA and EDA for pain control after pancreatic surgery should not be based on concerns regarding gastrointestinal complications because the 2 procedures are comparable with regard to effectiveness and safety. However, EDA was associated with several shortcomings. German Clinical Trials Register: DRKS00007784.

The effect of thoracic paravertebral block on seroma reduction in breast surgery – a randomized controlled trial

BackgroundIncreasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. ObjectiveWith this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. MethodsForty ASA I–II female patients aged 18–65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusionsMean seroma formation at postoperative 24th hour was 112.5±53.3mL in the control group and 74.5±47.4mL in the TPVB group (p=0.022). NRS scores were similar between two groups (p=0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6±4mg in the TPBV group, and 16.6±6.9mg in the control group (p<0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

A comparison of peri-articular injection and femoral block for pain management after total knee arthroplasty: A prospective cohort study

Aim: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insufficient postoperative pain control negatively affects patients’ satisfaction and functional results. The aim of this study is to compare the effects of intraoperative peri-articular injection and postoperative single-dose femoral nerve block on functional results, the need for analgesia, and pain in the short-term following total knee arthroplasty (TKA).Methods: Thirty-one patients who received peri-articular injection (PAI) during TKA and 38 who were administered a single dose of femoral nerve block (FNB) postoperatively were evaluated. In both groups, an intravenous patient-controlled analgesia (PCA) device was utilized for postoperative analgesia. Analgesia demand and the amount administered from the PCA in the first 24 hours were recorded. For the evaluation of the level of postoperative pain, a visual analog scale (VAS) was used at rest at 2nd, 4th, 8th, 12th, and 24th hours, and dynamic VAS was used at the 24th hour to assess pain with mobilization. Range of movement (ROM) was recorded with the measurements of active flexion and extension angles at the first, second and third postoperative days.Results: The resting VAS scores at the 2nd, 4th, 8th, and 24th hours were significantly lower in the PAI group than in the FNB group (P=0.032, P=0.037, P=0.014, P=0.004, respectively). The number of patients’ demands on the PCA for pain relief and the number of doses administered were higher in the FNB group. The ROM values measured on postoperative days 1, 2, and 3 were insignificantly greater in the PAI patients (P=0.956, P=0.103, P=0.162, respectively).Conclusion: The peri-articular injection technique, when used appropriately, is easy to apply with a low-side effect profile. Therefore, it can be considered a safe and effective analgesia method providing a higher level of patient comfort and greater range of movement.

Efficacy and Safety of Continuous Paravertebral Block after Minimally Invasive Radical Esophagectomy for Esophageal Cancer.

Objective To compare the effects of continuous paravertebral block analgesia and patient-controlled intravenous analgesia after minimally invasive radical esophagectomy for esophageal cancer and their effects on postoperative recovery. Methods A retrospective analysis was performed among 233 patients who underwent minimally invasive esophageal cancer radical operation and met the requirements, including 87 patients (group C) who were successfully placed with a continuous paravertebral block device under direct vision and 146 patients (group P) who used a patient-controlled intravenous analgesia device. Visual analogue pain score (VAS) at rest and in motion for 1, 3, 6, 12, 24, 36, and 48 hours after awakening, incidence of adverse reactions of the two analgesic methods, occurrence of pulmonary complications after operation, use of emergency analgesics, and hospital stay after operation was recorded. Results The VAS scores of group C in resting and active state at 1, 3, 6, 12, 24, 36, and 48 hours after operation were significantly lower than those of group P (P < 0.001). The incidence of adverse reactions, pulmonary complications, and the use of emergency analgesics in group C were lower than those in group P (P < 0.05). The hospitalization time of group C was significantly shortened, and the satisfaction degree of group C was significantly higher than that of group P (P < 0.05). Conclusion Paravertebral block is safe and effective for patients undergoing minimally invasive radical esophagectomy. The incidence of adverse reactions and complications is lower, and the satisfaction of postoperative analgesia is higher, which is beneficial to the rapid recovery of patients after operation.

A micro-costing study: comparing a standard intravenous patient-controlled analgesia system with a novel sublingual patient-controlled analgesia system.

Judicious spending in healthcare is of paramount importance, particularly when introducing new devices or interventions. These products or interventions need to be economically efficient both directly and indirectly. An accepted method of cost estimation is micro-costing. Micro-costing involves direct enumeration and costing of every input consumed in the treatment of a particular patient when using new device, medicine or intervention. In our study, we investigated the cost of using a novel sublingual (SL) patient-controlled analgesia (PCA) device and compared it with our conventional intravenous (IV) PCA device. A previous study performed in our institution produced a cost per use of IV PCA device at €97. This compared with a previous European study published in this journal in 2010 which showed a similar figure of €96 per use of IV PCA device. In our comparative study, we used a case record form (CRF) to incorporate a cost to all consumables used, staff time and equipment used to both the SL PCA and the IV PCA. A total of 60 patients of similar demographic were included in our study. The cost of an IV PCA episode was €97.89 and €182.32 for an SL PCA episode. Standl et al. (2010) showed that the average cost of an IV PCA episode was €96.40 with 78% of this being made up of staff time. SL PCA was more efficacious in certain patient groups and in certain surgical groups. After performance of a micro-costing study, the less costly IV PCA episode was statistically significant compared with a SL PCA episode. However, the associated staff costs were less with a SL PCA episode. We performed a micro-costing study on a novel sublingual PCA device and compared it with a conventional intravenous PCA device. All resources were included and compared.

Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: A randomized controlled trial

Background:The erector spinae plane block is a newer technique of analgesia to the chest wall.Objective:The study was carried out to establish the efficacy and safety of this block in patients undergoing total mastectomy and axillary clearance.Design:Prospective randomized controlled study.Setting:Single tertiary care center, the study was conducted over a period of 1 year.Patients:65 patients were included; final analysis was done for 60 female patients undergoing total mastectomy and axillary clearance under general anesthesia were randomly allocated to two groups.Intervention:Group B (block group) received ultrasound-guided erector spinae plane block at T5 level with ropivacaine (0.5%, 0.4 mL/kg) while the control group did not receive any intervention. Postoperatively, patients in both groups received morphine via intravenous patient-controlled analgesia device. Patients were followed up for 24 h postoperatively.Main Outcome Measures:The 24-hour morphine consumption was considered as the primary outcome and secondary outcomes included time to first rescue analgesia, pain scores at 0, ½, 1, 2, 4, 6, 8, 12, and 24 h and characteristics and complications associated with block procedure.Results:The 24-hour morphine consumption was 42% lower in block group compared to control group [mean (SD), 2.9 (2.5) mg vs 5.0 (2.1) mg in group B and group C, respectively, P = 0.01]. The postoperative pain score was lower in group B vs group C at 0, 1/2, 1, 2, 4, 6, 12, and 24 h (P < 0.05). 26 patients in group C against 14 in group B used rescue analgesia within 1 h of surgery (P = 0.01).Conclusion:Erector spinae block may prove to be a safe and reliable technique of analgesia for breast surgery. Further studies comparing this technique with other regional techniques are required to identify the most appropriate technique.

A Prospective Randomized Trial of an Oral Patient-Controlled Analgesia Device Versus Usual Care Following Total Hip Arthroplasty.

Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management. Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff. Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys. Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN. Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.

Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial

BackgroundThe pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns. ObjectivesIn this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn. MethodsAdult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded. ResultsWe included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study. ConclusionAn intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.