Patient-controlled Analgesia Morphine Research Articles

The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial.

Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.

Erector spinae plane block for post-operative analgesia in thoracolumbar spine surgery: A randomised controlled trial

Background and Aims: Thoracolumbar spine surgery is one of the most painful surgical procedures. This study's primary objective was to evaluate the effect of erector spinae plane (ESP) block on post-operative cumulative morphine consumption at 24 h in patients undergoing thoracolumbar spine surgery. Methods: Seventy adults posted for thoracolumbar spine surgery were randomised into the control group [Number of patients (n)=35], who received general anaesthesia without any nerve block, and the intervention group (n = 35), who received bilateral ultrasound (US)-guided ESP block at the level of spine surgery with 0.25% bupivacaine 20 mL after standard general anaesthesia. Along with intravenous patient-controlled analgesia morphine, post-operative analgesia was standardised for both groups. Total morphine consumption, visual analogue scale (VAS) score to evaluate pain, overall patient satisfaction, and any side effects were compared at 24 h. The statistical analysis was done using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL). Results: Post-operative total morphine consumption at 24 h was significantly decreased in the intervention group compared to the control group [5.69 (1.549) versus 9.51 (1.634) mg; P < 0.001]. Post-operative VAS scores were also significantly decreased in the intervention group at rest (P < 0.001) and on movement (P < 0.001). Patient satisfaction scores were more favourable in the intervention group [3.8 (0.4) versus 3.2 (0.6); P < 0.001]. Post-operative nausea and vomiting were found more in the control group but were not significant (n = 14 versus 8; P = 0.127). Conclusion: US-guided ESP block significantly reduces post-operative morphine consumption and improves analgesia and patient satisfaction without adverse effects in patients undergoing thoracolumbar spine surgery.

Stigma and patient-controlled analgesia: Trust is the essential ingredient of successful patient education in the patient-doctor relationship

A clinical decision report using: Van Beers EJ, Van Tuijn CFJ, Nieuwkerk PT, et al. Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. Am J Hematol. 2007;82(11):955-960. https://doi.org/10.1002/ajh.20944 for a patient with recurrent vaso-occlusive crisis secondary to Sickle Cell Disease.

Sufentanil Sublingual Tablet System vs. Intravenous Patient-Controlled Analgesia with Morphine: Postoperative Pain Control and Its Impact in Quality of Recovery.

Patient-controlled analgesia (PCA) is commonly used for postoperative pain control. Although widely used, intravenous (IV) morphine PCA may not be suitable for all patients. Sufentanil sublingual tablet system (SSTS) PCA is a recent technique that has had success as a safe and effective alternative for acute pain management. This study aims to compare both the efficacy and safety of SSTS PCA versus IV morphine PCA in postoperative pain control and the quality of recovery in adult patients following scheduled gynecological or orthopedic surgery. Open-label, parallel-group, randomized controlled trial with 54 patients. The primary outcome was postoperative pain control, while the secondary outcomes included adverse effects associated with two analgesic modalities, total opioid dose required, patient satisfaction, and impact on the quality of postoperative recovery. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was used in categorical variables. When distribution was normal, T-student (mean ± standard deviation) was used in continuous variables. In contrast, when distribution was not normal, the Mann-Whitney test (median (minimal-maximal)) was used. The results showed that there was a statistically significant difference in the total dose of opioid used by patients at 24 hours postoperatively, with patients receiving SSTS PCA requiring a higher total dose when compared to those receiving IV morphine PCA. However, there were no statistically significant differences in pain scores, adverse events, or patient satisfaction. The study suggests that both IV morphine and sublingual sufentanil are safe and effective for postoperative pain management.

Effects of intraoperative liposomal bupivacaine on postoperative opioid usage in kidney transplant recipients.

This study retrospectively evaluated the use of intraoperative locally infiltrated peri-incisional liposomal bupivacaine in kidney transplant recipients with the primary outcome of oral morphine equivalent reduction during the transplant admission. Secondary outcomes included pain scores, time to first bowel movement and length of stay. Postoperative morphine equivalents were significantly lower in the liposomal bupivacaine group <24 hours (50% reduction, p < 0.05) and 24-48 hours (56.5% reduction, p < 0.05). When accounting for analgesic medication choices, liposomal bupivacaine did not result in a significant reduction in opioid use within 48 hours postoperatively with the exception of a 51% (p = 0.02) median reduction in fentanyl patient-controlled analgesia morphine equivalents <24 hours postoperatively. Morphine equivalence reductions >48 hours, differences in pain scores, time to first bowel movement or length of stay did not reach significance. Intraoperative liposomal bupivacaine reduced kidney transplant recipient's postoperative opioid requirements, but this benefit did not reliably extend past 24 hours postoperatively.

Single-bolus injection of local anesthetic, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomized controlled unblinded trial

IntroductionPrevious trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled...

Comparative Study Between Intravenous Patient-Controlled Analgesia Morphine and Computerized Ambulatory Delivery Device Epidural Morphine for Post Operative Analgesia for Nuss Procedure in Pectus Excavatum: A Retrospective Analysis.

Pectus deformities are commonly seen in chest wall deformities among the pediatric age group. Pectus deformities occur due to defective growth of the sternum and its surrounding cartilage. The Nuss procedure is the technique of choice for correcting the deformity surgically which includes placing a convex bar under the sternum without resection or injury to costal cartilages. Adequate pain control is utmost to improve wound healing, patient satisfaction, short hospital stays, and decrease the financial burden on attendants. Therefore, it is necessary to investigate which analgesic method is more advantageous for the Nuss procedure. To compare the analgesic effects of intravenous patient-controlled analgesia (IVPCA) morphine versus computerized ambulatory delivery device (CADD) epidural morphine on acute post-operative pain management in Nuss procedures. A retrospective study was done at Rajiv Gandhi Cancer and Research Hospital, New Delhi from 2015 to 2020 to assess the efficacy and safety between IVPCA morphine and CADD epidural for post-operative analgesia following pectus excavatum repair. A total of 34 cases of Nuss procedures were taken with 17 cases in each group. Group 1 (intravenous PCA morphine) was given 39 ml normal saline + 6 ml morphine (total 45 ml, 2 mg/ml morphine), set at demand dose 0.5 ml, i.e. 1 mg, lockout interval 7 minutes, doses per hour was six and Group 2 (CADD epidural morphine) was given 42 ml normal saline + 3 ml morphine (1 mg/ml morphine) with continuous infusion at the rate of 0.5 ml/hr. Demand dose 0, lockout interval nil. Visual analog pain scores using a scale of 0-10 and Ramsay Sedation Score (RSS) scores were obtained on arrival at the post-anesthesia care unit, at 12, 24, 48, and 72 hours throughout the subsequent hospital stay. This study yielded positive information about our experience with the pectus post-operative pain management. The mean visual analogscale (VAS) score was lower in Group 1 compared to Group 2 but significantly different at 12 and 72 hours only. The mean RSS score was comparable between groups. The mean hospital stay (days) and requirement of rescue analgesia doses were 3.47±0.51 and 0.12±0.33 in Group 1 and 4.76±0.44, 0.59±1.12 in Group 2. Both IVPCA morphine and CADD morphine were effective in controlling post-surgical pain in the Nuss procedure, but IVPCA morphine was better as compared to CADD morphine in this regard because it was noninvasive, safe, and cost-effectivewith non-significant complications.

The Efficacy of Patient Controlled Analgesia for Acute Non Traumatic Abdominal Pain in Emergency Department

INTRODUCTION: Patient-Controlled Analgesia (PCA) is an intravenous selfadministration of small doses of opioids (such as morphine) using a programmable pump, The goal of PCA is to efficiently reduce patients’ pain at patient's preferred dose and schedule. Thus, we conducted a study to compare patient PCA morphine with intravenous bolus morphine for acute abdominal pain of non-traumatic origin in the emergency department (ED). MATERIALS AND METHODS: A randomised, non-blinded clinical trial was conducted in patients presented with severe acute non traumatic abdominal pain of less than 24 hours requiring opioid analgesic based on numerical pain score of more than seven at triage. The primary outcome was visual analogue pain score (VAS) recorded at 0, 30th, 60th and 120th minutes during the management in the ED and after admission to wards, and the secondary outcomes were total dosage of morphine used and degree of patient satisfaction. RESULTS: A total of 62 participants who fulfilled study criteria were randomized into PCA morphine group or bolus morphine group. The average amount of analgesic used for bolus morphine group was lower compared to PCA morphine (4.23 mg)(s.d 1.89 vs 5.29 mg)(s.d 2.16) (p=0.027). Despite of significant VAS score changes within group analysis, between group repeated measure ANOVA (RMA) VAS score analysis was not statistically significant. [Bolus group (6.7+2.03) compared to PCA group (5.83 + 2.38)](p=0.089). Patient satisfaction was statistically significant for the PCA group [PCA (1.65+0.709) compared to bolus group (2.23+0.920)](p=0.007). CONCLUSIONS: There was no significant difference in pain score reduction between PCA and intravenous bolus of morphine for the management of severe acute non traumatic abdominal pain in ED. However, PCA provided more patient satisfaction and should be considered as an alternative modality of acute pain management in ED.

Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study

BackgroundThe liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores.MethodsNinety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group.ResultsThere were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively.ConclusionIntraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia.

Ultrasound -guided erector spinae plane block (ESPB) versus intravenous opioids based analgesia in patients with rib fractures

ABSTRACT Background There has been a great interest in the erector spinae plane block (ESPB) to control pain in patients who are presented with rib fractures. ESPB has been shown to achieve adequate analgesia with little adverse effects, although its effectiveness in comparison to other analgesic alternatives has not been sufficiently studied. Aim of the study Our target was to compare the effectiveness of ESPB and opioid based analgesia in relieving pain in rib fractures patients. Methodology Fifty-two patients between 21 and 60 years old, divided into 2 equal groups, received either Ultrasound-guided (US) ESPB with 20 ml of bupivacaine 0.25% or intravenous (IV) morphine 0.1 mg/kg then IV Patient-controlled analgesia (PCA) containing morphine. Assessment of visual analogue scale (VAS) score before and after spirometer exercise at baseline, then at 30 minutes, 6 hours, and 12 hours after the intervention was done. Also Peak Inspiratory Flow Rate (PIFR) was measured by an incentive spirometer, first 12-hour morphine consumption as rescue analgesia was calculated, the incidence of complications was noted, and patients satisfaction was assessed. Results The VAS score was higher in morphine group compared to ESPB group before and after spirometry. PIFR was higher in ESPB group. Less opioid consumption and side effects, along with better patient satisfaction, were recorded in the ESPB group. Conclusion Erector spinae plane block provided superior analgesia and improved respiratory function for IV PCA morphine. Furthermore, ESPB was linked to fewer side effects, less opioid use, and better patient satisfaction.

Comparison between pericapsular nerve group block and morphine infusion in reducing pain of proximal femur fracture in the emergency department: A randomized controlled study

ABSTRACT Background This study aimed to assess the safety and efficacy of analgesia with pericapsular nerve group (PENG) block as an adjuvant to morphine infusion for the management of preoperative pain in patients with proximal femur fractures. Methods This single-blinded, parallel-group, randomized trial enrolled 36 adult patients with proximal femur fractures who were prepared for surgery. The patients were randomly allocated to two groups. In the PENG group, 18 patients received a US-guided PENG block as an adjuvant to patient-controlled morphine analgesia (PCA), while in the PCA group, 18 patients received PCA only. The primary outcome was the total morphine consumption in 24 hours before the surgery. The secondary outcomes included the visual analogue scale (VAS), need for rescue analgesia, total sleep hours, incidence of respiratory depression, hemodynamic stability, and incidence of nausea and vomiting during the first 24 hours post-procedure. Results The PENG block significantly decreased the total dose of morphine, VAS score at one-hour post-procedure, need for rescue analgesia, incidence of respiratory depression and nausea but increased the sleeping hours. Vomiting was comparable in the two groups (p = 0.121). Significantly higher mean arterial pressures from 8 to 20 hours after the block as well as heart rates immediately after the block were observed in the PENG group compared to the PCA group. Conclusion In patients with proximal femur fractures, preoperative PENG block can be used as an adjuvant to morphine infusion for controlling the pain and the total dose of morphine usage.

Salivary cortisol as a biomarker of stress in surgical patients.

Surgical stress and pain result in activation of hypothalamus-pituitary-adrenal axis. The aim of this study was to establish the effects of postoperative pain and various modalities of analgesic administration on salivary and serum cortisol levels, as well as to establish the validity of salivary cortisol as a stress indicator in surgical patients. A randomized controlled trial involved 60 patients scheduled for elective abdominal aortic aneurysm surgery. Patients were randomly divided into two groups depending on the model of postoperative analgesia. The first group (MI - morphine intermittently) included patients given morphine doses 0.1 mg/kg/6h s.c. intermittently. The second group (MPCA - morphine patient-controlled analgesia) included patients who received morphine via the PCA system - intravenous administration of morphine adjusted to a dose of 1 mg per shot and a lockout interval of 6 minutes.

ROBOTIC ASSISTED MINIMALLY INVASIVE CARDIAC SURGERY DA VINCI ROBOTIC SYSTEM. ANALYSIS OF PERIOPERATIVE CONSIDERATIONS

<h3>Introduction</h3> Robotic assisted minimally invasive cardiac surgery is a complex procedure where the anesthesiologist works in situations that require management skills. <h3>Method</h3> The study design is a retrospective observational model, which was performed with chart review. Data were collected from 104 patients who underwent minimally invasive cardiac surgery and were repaired using the Da Vinci robot-assisted minimally invasive approach from November 2019 to March 2022. The variables collected were assigned into three groups: preoperative variables, intraoperative variables and postoperative variables. The preparatory variables were age, sex, personal history of interest, Anesthetic Risk Scale (ASA), European System for Cardiac Operation Risk Evaluation II (EUROESCORE II), preoperative echocardiography, preoperative laboratory tests and diagnosis. Intraoperative variables were type of anesthesia, airway device used, invasive monitor, intraoperative transesophageal echocardiography data, complications, vasoactive drug use, blood product transfusion, extracorporeal circulation times and aortic clamping times, analgesic technique, extubation and surgical outcome. Finally, the postoperative variables were length of stay in the intensive care unit, length of hospital stay and postoperative complications. <h3>Results</h3> On the ASA 101 patients (97.1%) were in the ASA IV group and only 3 patients were in the ASA V group (2.9%). In the Euroescore II 103 patients scored less than 3 (99.03 %) and only one patient scored above 3 (0.9 %). Regarding anesthesia, 71 patients received total intravenous general anesthesia (68,3%) and 32 patients received balanced general anesthesia (30,7%) and in 1 patient this information could not be collected (0,9%)).. For airway management, a left double-lumen tube was used in 21 patients (20.8%), a Vivasight-type camera tube in 47 patients (46.6%) and a bronchial blocker through a conventional tube under fibrobronchoscopic vision in 33 patients (32.6%). In 3 patients this information could not be collected. Only 1 patient suffered serious complications during surgery (0.96 %). Vasoactive drugs were used in 81 patients (78%). Blood products were transfused in 7 patients (6.7%). The analgesic technique used consisted of locoregional blocks in 59 patients (56%), Locoregional block + patient-controlled morphine analgesia (PCA) in 14 patients (13,4%), PCA only in 29 patients (27,8%) and in 4 patients we do not know this information (3,8%). With regard to postoperative complications, 26 patients (25 %) were recorded. One patient died (0.96%). <h3>Conclusions</h3> In minimally invasive robotic-assisted cardiac surgery there are fundamental details to consider before, during and post-intervention such as the selection of the right patient, preoperative assessment, anesthetic technique, airway management, performing a good transesophageal echocardiographic study, hemodynamic behavior of the patient during the intervention, measures to take in case of complications and postoperative management, among others. Little literature exists so far and more studies are needed. ANALYSIS OF ANAESTHETIC CONSIDERATIONS

Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study

BackgroundPostoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilitate recovery after knee arthroplasty in an enhanced recovery program.Case presentationIn a prospective observational single-center study, thirty patients operated on for primary knee arthroplasty in the enhanced recovery pathway were included. Patients who received the SSTS (n=15) were compared with those who received an intravenous morphine patient-controlled analgesia (PCA) (n=15). Our recovery program included in particular the use of an adductor canal block, periarticular infiltration of local anesthetic by the surgeon, removal of the venous cannula from the recovery room if possible, the use of an SSTS when available or an IV morphine PCA otherwise, and early physiotherapy. Recovery parameters including the Timed-Up and Go test, pain scores at rest and on exertion, knee flexions, complications, and lengths of hospital stay were not significantly different between the two groups. However, the postoperative opioid consumption in morphine equivalents was significantly greater in the SL-sufentanil group and these patients had their venous cannula removed earlier than in IV-morphine group.ConclusionIn our center, the use of a SSTS was suitable for treating postoperative pain after knee arthroplasty, but it did not improve early recovery in comparison with a morphine PCA.

Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial.

Background:The serratus plane block is an effective technique for providing analgesia to patients undergoing breast surgery.Methods:This prospective, double-blind, randomized study enrolled 60 female patients scheduled for unilateral mastectomy and axillary clearance. The patients received either a superficial serratus plane block or deep serratus plane block. Dermatomal spread was recorded 30 minutes after block administration. Postoperatively, pain visual analog scale (VAS) scores were documented at recovery (time 0), at 30 minutes; and in the ward hourly for 4 hours, and 4-hourly until 24 hours postoperatively. The time to first analgesic rescue and cumulative morphine consumption using patient-controlled analgesia morphine (PCAM) were recorded.Results:The results showed lower VAS scores at rest (at 1, 2, 3, and 4 hours postoperatively), and during movement (at 1, 2, 3, 4, 8, and 24 hours postoperatively) in the superficial serratus plane block group, P < .005. Similarly, cumulative morphine usage was lower in the superficial serratus plane group, P < .005. The time to the first rescue analgesic was also significantly longer in the superficial group, P < .001. More patients in the superficial serratus plane group achieved greater dermatomal spread at T2 and T7 than those in the deep group.Conclusions:Superficial serratus plane block provides better analgesic efficacy than deep serratus plane block in mastectomy and axillary clearance.

Ultrasound Guided Continuous Erector Spinae Plane Block versus Patient Controlled Analgesia in Open Nephrectomy for Renal Malignancies: A Randomized Controlled Study.

BackgroundIt is critical to manage acute postoperative pain for patient satisfaction and better outcome. Erector spinae plane block (ESPB) can produce sensory blocking on both visceral and somatic levels. This study aimed to evaluate the ESPB efficacy in controlling acute postoperative pain in open nephrectomy for renal malignancies.MethodsThis prospective randomized, controlled, open-label trial included 60 cases scheduled for open nephrectomy for renal malignancy under general anesthesia. Cases were assigned randomly into two equal groups. Group E administered continuous preoperative unilateral ESPB (20mL bupivacaine 0.25% bolus then 6 mL/h 0.1% for 48 hours). Group C administered intravenous (IV) patient-controlled analgesia (PCA) morphine (0.01 mg/kg/h). Postoperative analgesia was managed by morphine (3 mg IV in group E or 0.01 mg/kg bolus with a 15-min lockout in group C) to keep the visual analog scale (VAS) scores <4.ResultsIntraoperative fentanyl consumption and total morphine consumption in 1st 48 hours postoperatively were significantly lower in group E than group C (P= 0.001 and <0.001, respectively). The time to first analgesic request was significantly longer in group E than group C (P <0.001). VAS scores at movement and rest were significantly lower in group E than group C (P <0.001).ConclusionIn renal malignancies, ESPB provided better analgesia with prolonged time and lower pain scores at both rest and movement compared to IV PCA following open nephrectomy.

424 High Volume vs. Low Volume Transversus Abdominis Plane (TAP) Blocks and Post-Operative Pain in Elective Colorectal Surgery- the More the Merrier?

Abstract Introduction Transversus abdominis plane (TAP) regional anaesthetic blocks are often performed by surgeons and provide effective anaglesia in the immediate postoperative period. It is not known whether the volume and concentration of local anaesthetic used for TAP blocks influences the quality of analgesia when the total drug dose is similar. Aim This pilot aimed to compare low volume versus high-volume TAP block and post-operative pain in patients undergoing elective colorectal surgery, using analgesic consumption as a proxy for pain. Method Single centre cohort study. Data were collected for patients undergoing elective colorectal resections from April – December 2021. Patients were cohorted into those receiving low-volume, high-concentration TAP block (40–50ml 0.25% levobupivacaine) and those receiving high-volume, low-concentration TAP block (100ml 0.125% levobupivacaine). Data including PCA (patient-controlled analgesia) type (morphine/ oxycodone) and post-operative consumption were collected. Results 107 patients undergoing elective colorectal resections were identified. Data regarding TAP block usage was available for 55 patients. 23 (41.8%) patients were given high volume TAP blocks. 78.3% (p=0.56) of patients in the high-volume group were prescribed a PCA postoperatively, compared to 84.3% in the low-volume group. Median morphine PCA consumption was 11mg in the high-volume cohort, compared to 18mg in the low volume cohort (p=0.23). Conclusions High volume TAP block was associated with reduced requirement for a post-operative PCA and a reduced consumption of morphine PCA. Although not statistically significant in our small sample size, our results may be of interest to surgeons and suggest that the use of high-volume TAP blocks warrants further study.

Comparison of the Effect of Ketamine and Dexmedetomidine Combined with Total Intravenous Anesthesia in Laparoscopic Cholecystectomy Procedures: A Prospective Randomized Controlled Study.

This randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 μg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 μg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.

Patient-controlled analgesia and oral mucositis pain in hematological malignancies.

Oral mucositis (OM) pain is an anticipated complication of immunosuppressive therapies for hematological malignancies. Opioids are effective for OM-associated pain and dysfunction that is refractory to simple measures. At the study institution, parenteral opioids are preferentially prescribed for the treatment of complicated OM. This audit explores the efficacy of opioids for the management of OM pain using morphine, oxycodone, and fentanyl patient-controlled analgesia (PCA). Pain scores, opioid consumption, resumption of oral intake, and the duration of admission were retrospectively analyzed from patient records over an 18-month period. Two-thirds of included patients had ceased PCA therapy by day 6, by which time there was a meaningful 35.4 percent reduction in pain scores, with very few side effects reported. Interagent comparison demonstrated no significant differences in mean daily pain scores; however, a larger sample size would facilitate an investigation of clinically significant nuances in treatment differences, if they exist.

28-Year-Old Man With Joint Pain

28-Year-Old Man With Joint Pain