Patient-controlled Intravenous Analgesia Pump Research Articles

Evaluating the Efficacy of Wrist-Ankle Acupuncture Combined With Patient-Controlled Intravenous Analgesia for Managing Post Uvulopalatopharyngoplasty.

The aim of this study is to investigate the impact of combining wrist-ankle acupuncture with patient-controlled intravenous analgesia (PCIA) on active pain and food intake in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) after undergoing uvulopalatopharyngoplasty (UPPP). Sixty patients with OSAHS who underwent UPPP at our hospital's Department of Otorhinolaryngology from January 2020 to October 2023 were selected and randomly divided into 2 groups of 30 each: an observation group and a control group. The control group received general anesthesia administered by an anesthesiologist and used a PCIA pump. In addition to this treatment, the observation group received the combined intervention of wrist-ankle acupuncture. Active pain levels were monitored at 0, 6, 12, 24, 36, and 48 hours after UPPP, and food intake was observed at 24, 36, and 48 hours postoperation. The results were compared and recorded for both groups. The analgesic effect on active pain in the observation group was significantly greater than in the control group at 6, 12, 24, 36, and 48 hours postoperation, and the differences were statistically significant (P<0.05). In addition, when comparing food intake scores at 24, 36, and 48 hours postoperation, the observation group had significantly higher food intake than the control group, and the differences were statistically significant (P<0.05). The combined intervention of wrist-ankle acupuncture and PCIA provides effective pain relief for OSAHS patients after UPPP, enhances their food intake, improves their quality of life, and supports early recovery.

Application of multimodal standardized analgesia under the concept of enhanced recovery after surgery in laparoscopic radical colorectal cancer surgery.

To observe the efficacy and safety of multimodal standardized analgesia in patients undergoing laparoscopic radical colorectal cancer surgery. A prospective, double-blind, randomized study of patients who were admitted to our hospital between December 2020 and March 2022 with a diagnosis of colorectal cancer and who intended to undergo elective laparoscopic radical colorectal cancer surgery was conducted. The participants were randomly divided into two intervention groups, namely, a multimodal standardized analgesia group and a routine analgesia group. In both groups, the visual analogue scale (VAS) pain scores while resting at 6h, 24h, 48h and 72h and during movement at 24h, 48h and 72h; the number of patient controlled intravenous analgesia (PCIA) pump button presses and postoperative recovery indicators within 3 days after surgery; the interleukin-6 (IL-6) and C-reactive protein (CRP) levels on the 1st and 4th days after surgery; and the incidence of postoperative adverse reactions and complications were recorded. Compared with the control group, the multimodal standardized analgesia group had significantly lower VAS pain scores at different time points while resting and during movement (P<0.05), significantly fewer PCIA pump button presses during the first 3 postoperative days (P<0.05), and significantly lower IL-6 and CRP levels on the 1st postoperative day (P<0.05). There was no statistically significant difference in the time to out-of-bed activity, the time to first flatus, the IL-6 and CRP levels on the 4th postoperative day or the incidence of postoperative adverse reactions and complications between the two groups (P >0.05). For patients undergoing laparoscopic radical colorectal cancer surgery, multimodal standardized analgesia with ropivacaine combined with parecoxib sodium and a PCIA pump had a better analgesic effect, as it effectively inhibited early postoperative inflammatory reactions and promoted postoperative recovery and did not increase the incidence of adverse reactions and complications. Therefore, it is worthy of widespread clinical practice.

Safety and effectiveness of opioid-free anaesthesia in thoracoscopic surgery: a preliminary retrospective cohort study

BackgroundThis study aimed to observe the effect of opioid-free anaesthesia (OFA) on intraoperative haemodynamic,postoperative analgesia and postoperative nausea and vomiting (PONV) in thoracoscopic surgery in order to provide more evidence for evaluating the safety and effectiveness of OFA technology.MethodsThis was a single-centre retrospective observational study.Adult patients who underwent thoracoscopic surgery with the preoperative thoracic paravertebral block between January 2017 and June 2020 were included.A cohort of 101 thoracoscopic surgery patients who received the OFA technique were matched with 101 thoracoscopic surgery patients who received standard opioid-containing anaesthesia(SOA). Heart rate (HR) and mean arterial blood pressure (MAP) were measured before anaesthesia induction, immediately after endotracheal intubation, at the beginning of surgery, and 10, 20, and 30 min after surgery began.The total amount of intraoperative infusion, frequency of vasoactive drugs use, morphine ingested via the patient-controlled intravenous analgesia (PCIA) 24 h post-surgery,visual analogue scale (VAS) scores at rest and activity on the first day post-surgery, and frequency of nausea and vomiting within 24 h post-surgery were analysed.ResultsThere was no significant difference in intraoperative HR between the two groups (F = 0.889, P = 0.347); however, there was significant difference in intraoperative MAP (F = 16.709, P < 0.001), which was lower in SOA patients than in OFA patients. The frequency of vasoactive drug use and amount of infusion was less in OFA patients (P = 0.001). The consumption of morphine used by the PCIA 24 h post-surgery was significantly lower in OFA patients (OFA, 1.8 [0, 4.8] mg vs. SOA, 3.6 [0.6, 23] mg, P < 0.001). There was no significant difference in VAS scores at rest (P = 0.745) or during activity (P = 0.792) on the first day post-surgery. There was also no statistically significant difference in nausea and vomiting within 24 h post-surgery (P = 0.651).ConclusionsThis case-control study demonstrated that compared with SOA, OFA can effectively maintain the stability of intraoperative MAP, reduce the incidence of hypotension. Although OFA reduced morphine consumption via the PCIA pump 24 h post-surgery, postoperative pain scores and nausea and vomiting within 24 h post-surgery were similar between the groups.But this study was only a preliminary study and needed to confirm in a larger, more robust trial.

Effects of sufentanil in combination with dexmedetomidine for patient-controlled intravenous analgesia after renal transplantation

Background/Aim. Nowadays, the most convenient analgesic method is patient-controlled intravenous injection of one or more adjuvant drugs. The aim of our study was to evaluate the effects of sufentanil plus dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after renal transplantation. Methods. Seventy-eight patients receiving living-related renal transplantation under general anesthesia were selected. Radioisotope scanning was performed, and the single glomerular filtration rate of the unilateral kidney was ? 40 mL/min/1.73 m2. The control group (CG) and observation group (OG) (39 patients in each group) were analgesic with sufentanil and sufentanil plus dexmedetomidine, respectively. When the Visual Analogue Scale (VAS) score exceeded 4 points, 0.05 mg/kg oxycodone was intravenously injected for remedial analgesia. Plasma levels of endothelin, urea nitrogen, and creatinine were measured by radioimmunoassay. Heart rate (HR), mean arterial pressure, oxygen saturation, VAS score, and sedation score were recorded before anesthesia and after surgery. Analgesic remediation rate, number of effectively pressing the PCIA pump, and incidence rate of adverse reactions within 48 hrs after surgery were recorded. Results. HR of OG was significantly lower than that of CG 6 and 12 hrs after surgery (p &lt; 0.05). VAS score of OG was lower than that of CG 6, 12, and 24 hrs after surgery (p &lt; 0.05). OG had a lower postoperative remedial rate, number of effectively pressing the PCIA pump, and incidence rates of nausea and vomiting (p &lt; 0.05) compared to CG. Endothelin, urea nitrogen, and creatinine levels significantly decreased after surgery compared with those before anesthesia (p &lt; 0.05). The levels of OG were lower than those of CG at each time point after surgery (p &lt; 0.05). Conclusion. Sufentanil plus dexmedetomidine can be safely and effectively used for PCIA after renal transplantation, with superior outcomes to those of sufentanil alone.

Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study.

To investigate the effect of different analgesic methods on lungs in elderly patients with hip fractures. A prospective study was conducted on 78 elderly hip fracture patients undergoing spinal anesthesia for surgery, where 3 analgesic methods were used: postoperative Patient-controlled intravenous analgesia pump (PCIA) (group I), pre and postoperative PCIA (group II), and preoperative fascia iliaca compartment block (FICB) + postoperative PCIA (group III). The following indicators were monitored at admission (T1), on the day of surgery before anesthesia (T2), and 7 days after surgery (T3): heart rate (HR), respiratory rate (RR), forced expiratory volume during the first second, arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), C-reactive protein (CRP), and interleukin 6 (IL-6). Pulmonary complications such as pulmonary atelectasis and respiratory insufficiency were analyzed. The HR, RR, forced expiratory volume during the first second, PaO2, PaCO2, IL-6, and CRP levels at T1 after fracture did not significantly differ among the 3 groups (P > .05). After different analgesic treatments post-admission, all indicators at T2 were significantly higher in group I than in groups II and III (P < .05), while there was no significant difference between groups II and III (P > .05). At T3, there were no significant differences in RR, HR, PaO2, PaCO2, and CRP levels among the groups (P > .05), but IL-6 levels at T3 were significantly higher in group I than in groups II and III (P < .05). The use of effective pain relief during surgery can help protect the lung function of elderly patients with hip fractures. When using PCIA with FICB before surgery, respiratory performance may be better protected compared to using unsustained analgesia. This could be due to a decrease in the levels of inflammatory markers such as CRP and interleukin-6.

Effect of transcutaneous electrical acupoint stimulation on postoperative pain in pediatric orthopedic surgery with the enhanced recovery after surgery protocol: a prospective, randomized controlled trial

Study objectiveTo evaluate the safety and effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in postoperative analgesia following pediatric orthopedic surgery with the enhanced recovery after surgery (ERAS) protocol. DesignProspective randomized controlled trial. SettingThe Seventh Medical Center of the Chinese People’s Liberation Army General Hospital. ParticipantsEligible participants were children aged 3–15 years who were scheduled to undergo orthopedic surgery of the lower extremities under general anesthesia. InterventionsA total of 58 children were randomly allocated into two groups: TEAS (n = 29) and sham-TEAS (n = 29). The ERAS protocol was used in both groups. In the TEAS group, the bilateral Hegu (LI4) and Neiguan (PC6) acupoints were stimulated starting from 10 min before anesthetic induction until the completion of surgery. In the sham-TEAS group, the electric stimulator was also connected to the participants; however, electrical stimulation was not applied. MeasuresThe primary outcome was the severity of pain before leaving the post-anesthesia care unit (PACU) and at postoperative 2 h, 24 h, and 48 h. Pain intensity was measured with the Faces Pain Scale-Revised (FPS-R). ResultsNone of the participants had any TEAS-related adverse reactions. In comparison with the sham-TEAS group, FPS-R scores in the TEAS group were significantly decreased before leaving the PACU and at postoperative 2 h and 24 h (p < 0.05). The incidence of emergence agitation, intraoperative consumption of remifentanil, and time to extubation were significantly reduced in the TEAS group. Furthermore, the time to first press of the patient-controlled intravenous analgesia (PCIA) pump was significantly longer, the pressing times of the PCIA pump in 48 h after surgery was significantly decreased, and parental satisfaction was significantly improved (all p < 0.05). ConclusionTEAS may safely and effectively relieve postoperative pain and reduce the consumption of perioperative analgesia in children following orthopedic surgery with the ERAS protocol. Trial registrationChinese Clinical Trial Registry (ChiCTR2200059577), registered on May 4, 2022.

The efficiency of ultrasound-guided erector spinae plane block in early cervical cancer patients undergoing laparotomic radical hysterectomy: A double-blind randomized controlled trial.

We aim to compare the efficiency of erector spinae plane block (ESPB) with transversus abdominis plane block (TAPB) in patients undergoing laparotomic radical hysterectomy because only a few studies are reported exploring this matter. In this randomized controlled trail, 154 eligible patients were randomly allocated into ESPB group [ESPB + patient-controlled intravenous analgesia (PCIA)] and TAPB group (TAPB + PCIA) at 1:1 ratio. The primary outcome was visual analog scale (VAS) score at rest state at 12 h. We found that ESPB group was associated with the lower VAS scores at rest and cough state than TAPB group at 2, 4, 6, 12, and 24 h postoperatively (P < 0.05). Less analgesic consumption and sufentanil consumption in PCIA pump were found in the ESPB group (P < 0.05). Moreover, ESPB group was followed by fewer rescue analgesia requirements, less rescue analgesic consumption, less adverse reactions, and higher analgesia satisfaction (P < 0.05). Our study found that ESPB had advantages on analgesic effect and opioids consumption. In the future, more studies were needed to confirm our findings. Systematic Review Registration: https://www.chictr.org.cn/index.aspx, identifier: ChiCTR2100044240.

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial

PurposeTo compare the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) and PCIA alone on analgesia after laparoscopic cholecystectomy (LC). MethodsIn this double-blind, randomized controlled trial, 160 patients undergoing LC were randomized into the TAPB group (n = 80) and PCIA group (n = 80). Bilateral ultrasound-guided TAPB was performed with 20 mL 0.5% ropivacaine and the PCIA pump was given after LC in the TAPB group. The PCIA group received the PCIA pump alone as a control group. The primary outcome was postoperative pain, assessed by the visual analog scale (VAS). ResultsVAS pain (including abdominal wall pain or visceral pain) scores at rest and coughing were significantly lower in the TAPB group at 1, 4, 12, 24, 36, and 48 h after LC (P < 0.05). Postoperative additional analgesic needs, analgesic pump compressions, and PCIA analgesic dosages, and total morphine equivalents were significantly reduced in the TAPB group, and postoperative hospital stay, total hospitalization expenses, expenses within 24 h or 48 h (from analgesia and adverse reactions), and patient satisfaction were significantly higher in the TAPB group than the PCIA group (all P < 0.05). No significant between-group differences were observed in operation time, intraoperative blood loss, unplugging the analgesic pump due to adverse reactions, first exhaust time, and postoperative adverse events between the two groups. ConclusionsUltrasound-guided TAPB combined with PCIA was an effective and safe perioperative analgesic technique for patients undergoing LC compared to PCIA only.

Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy

BackgroundThoracoscopic radical pneumonectomy is associated with a high incidence of postoperative chronic pain. Studies on the benefits of lidocaine intravenous infusion during the perioperative period were still controversial in thoracoscopic surgery.MethodsSixty-four lung cancer patients scheduled for thoracoscopic radical pneumonectomy were randomly divided into two groups: normal saline group (control group) or lidocaine group. In the lidocaine group, 1.5 mg/kg lidocaine was administered during the anesthesia induction, and 2 mg·kg−1·h−1 lidocaine was continuously intravenous infused until the end of the surgery. After the surgery, a mixture of 2 μg/kg sufentanil and 10 mg/kg lidocaine was continuously intravenous infused by postoperative patient-controlled intravenous analgesia pump (100 ml). In the control group, the same volume of normal saline was administered according to the calculation of lidocaine during anesthesia induction, maintenance and postoperative patient-controlled intravenous analgesia. The primary outcome was the incidence of chronic postoperative pain at 3 months after the surgery. The secondary outcomes include the incidence of chronic postoperative pain at 6 months after the surgery; the effect of lidocaine on postoperative pain within the first 24 and 48 h; total amount of sufentanil administered during entire procedure and the number of PCA triggers within 48 h after surgery.ResultsCompared with the control group, the incidence of chronic pain at 3 months after the surgery was significantly lower (13 cases, 46.4% vs. 6 cases, 20.7%, p < 0.05), but no significant difference at 6 months between two group. The cumulative dosage of sufentanil in perioperative period was significantly lower (149.64 ± 18.20 μg vs. 139.47 ± 16.75 μg) (p < 0.05), and the number of PCA triggers (8.21 ± 4.37 vs. 5.83 ± 4.12, p < 0.05) was significantly greater in the control group. The NRS pain scores at 24 h (1.68 ± 0.72 vs. 1.90 ± 0.86) and 48 h (1.21 ± 0.42 vs. 1.20 ± 0.41) after the operation were no significant difference.ConclusionPerioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy.Trial registrationhttp://www.chictr.org.cn: ChiCTR1900024759, frist registration date 26/07/2019.

Ultrasound-guided superficial cervical plexus block reduces opioid consumption in patients undergoing craniotomy via suboccipital retrosigmoid approach: a randomized controlled trial

IntroductionThe effectiveness of superficial cervical plexus block (SCPB) at decreasing opioid use and improving hemodynamic stability during suboccipital retrosigmoid craniotomy has not been established. The aim of this study is...

Analgesic Effects and Safety of Dexmedetomidine Added to Nalbuphine or Sufentanil Patient-Controlled Intravenous Analgesia for Children After Tonsillectomy Adenoidectomy.

Tonsillectomy is a frequently performed surgical procedure in children, requiring post-operative analgesia. This study evaluated the efficacy and safety of nalbuphine or sufentanil combined with dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after pediatric tonsillectomy adenoidectomy. A total of 400 patients undergoing tonsillectomy with and without adenoidectomy were included in the study. Patients received a PCIA pump (0.5 mg/kg nalbuphine, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group ND (n = 200). Patients received a PCIA pump (2 μg/kg sufentanil, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group SD (n = 200). More stable hemodynamic changes were noted in Group ND than Group SD from 1 h to 48 h after operation. At 6, 12, 24, and 48 h after operation, the children in Group ND had higher Ramsay sedation scores than those in Group SD. The times to push the PCIA button in Group ND and Group SD were 2.44 ± 0.74 and 2.62 ± 1.00, showing significant differences (p = 0.041). The VASR scores of children in Group ND were significantly lower within 6, 12, and 24 h than those in Group SD (p < 0.05). The VASC scores of children in Group ND were significantly lower within four time points (2, 6, 12, and 24 h) than those in Group SD (p < 0.05). At 1st day after surgery, the children in Group ND had lower levels of serum ACTH, IL-6, and COR levels than those in Group SD (p < 0.001). The incidence rates of nausea and vomiting, and pruritus were significantly higher in Group SD than Group ND (5.00% vs. 11.00%, p = 0.028; 1.00% vs. 4.50%, p = 0.032). The total incidence rate of adverse reactions was significantly higher in Group SD than Group ND (15.00% vs. 31.00%, p = 0.0001). The study demonstrated that dexmedetomidine added to nalbuphine PCIA enhanced the analgesic effects, attenuated the postoperative pain, and reduced the stress response after pediatric tonsillectomy adenoidectomy.

Effectiveness of Patient-Controlled Intravenous Analgesia (PCIA) with Sufentanil Background Infusion for Post-Cesarean Analgesia: A Randomized Controlled Trial.

PurposeTo investigate the effectiveness of sufentanil patient-controlled intravenous analgesia pump (PCIA) and background infusion in patients of post-cesarean analgesia.Patients and MethodsThis trial compared two groups of women undergoing cesarean section and receiving PCIA: no background infusion group (n=30), 6-min lockout time, and background infusion group (n=30), 2 mL/h infusion, 10-min lockout time. Both groups with 2 μg/kg sufentanil was diluted to 100 mL with normal saline. VAS scores at rest at 36 h was the primary endpoint. The secondary endpoints were the VAS scores at rest at 6, 12, and 24 h, the total amount of sufentanil consumed, the Ramsay sedation score (RSS) assessed at the same time points, postpartum bleeding within 24 h, the injection/attempt (I/A) ratio, BP and HR, PONV, side effects of sufentanil.ResultsCompared with the no background infusion group, the background infusion group showed lower VAS pain scores at 6, 12, and 24 h (P<0.01), but no differences at 36 h (95% CI = −0.5–0.8. P>0.05). Attempts, injections, and total sufentanil consumption were significantly different between the two groups (P<0.001), but without difference in I/A. Bleeding was less in the background infusion group at 1 h (P=0.03). The minimal respiration rates were not significantly different between groups.ConclusionBackground infusion increased the total consumption of sufentanil within 36 h after cesarean section. Although it did not reduce uterine contraction pain and wound pain at 36 h, it significantly reduced the pain at 6, 12, and 24 h after cesarean section. It improved patient satisfaction and reduced the amount of bleeding after 1 h. Importantly, it did not increase the incidence of hypertension, PONV and respiratory depression.

Comparison of erector spinae plane and paravertebral nerve blocks for postoperative analgesia in children after the Nuss procedure: study protocol for a randomized controlled non-inferiority clinical trial

BackgroundThoracic paravertebral block (TPVB) is a widely advocated regional technique for alleviating postoperative pain in children undergoing elective pectus excavatum repair. However, this technique is associated with some undesirable adverse events. Recently, the erector spinae plane block (ESPB) has been introduced as a practical alternative to the TPVB in thoracic surgery. This interfascial regional anesthesia technique interrupts pain sensation by injecting local anesthetics between the muscular layers of the thoracic wall. Several case series described it as an effective pain management technique following pectus excavatum repair. Therefore, this trial is designed to test the hypothesis that ESPB is non-inferior to TPVB in postoperative pain control after pectus excavatum repair.MethodsThis is a prospective randomized double-blind non-inferiority trial. A total of 40 patients aged 4 to 18 years undergoing Nuss surgery will be randomly assigned to receive pain treatment with either ESPB or TPVB. All patients will receive additional systemic multimodal analgesia with an intravenous patient-controlled analgesia pump and acetaminophen. The primary outcome is the pain intensity at rest, 24 h postoperatively. Secondary outcomes include accumulated morphine-equivalent consumption, postoperative pain scores, emergence agitation incidence, time of the first mobilization, time to first rescue analgesia, complications related to pain treatment, and morphine-related adverse events.DiscussionThis will the first randomized controlled trial to compare ESPB with TPVB for analgesia after pectus excavatum repair. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of ESPB in children.Trial registrationClinicalTrials.govNCT05034601. This trial was prospectively registered.

External Application of Traditional Chinese Medicines on Acupoint Shenque to Treat Gastrointestinal Reactions Caused by Intravenous Patient-Controlled Analgesia Pump in Patients After Surgery for Limb Fractures

To explore the clinical effect of external application of Ban Xia Gan Jiang San (Powder of Pinellia tuber and dried ginger root) on acupoint Shenque for the treatment of gastrointestinal reactions caused by intravenous patient-controlled analgesia pump. A total of 240 patients who underwent surgery in our hospital from January 2019 to September 2020 were selected and randomly divided into a control group and a research group, 120 patients in each group. The control group received conventional treatment. The research group received external application of Ban Xia Gan Jiang San on acupoint Shenque. The clinical data of the two groups had no statistically significant differences (p>0.05) and the two groups were comparable. In terms of treatment effect, the research group had significantly better results than the control group and the difference was statistically significant (p<0.05). The external application of Ban Xia Gan Jiang San on acupoint Shenque can effectively reduce the incidence of gastrointestinal reactions caused by intravenous patient-controlled analgesia pump and it is worthy of application and promotion in clinical practice.

Does adding ketamine to morphine in a patient-controlled intravenous analgesia pump after orthopedic surgeries help better management of postoperative pain in obese patients? A double-blinded clinical trial

Introduction: Low doses of ketamine can cause an antagonistic effect on NMDA-receptors by blocking the magnesium-gated channels. Several studies demonstrated the effect of ketamine in improving the analgesia using opioids, however, obese people reported different reactions to this problem. Objectives: This study seeks to answer the following question: Does adding ketamine to morphine in a patient-controlled intravenous analgesia pump (PCIA) after orthopedic surgeries help better management of postoperative pain in obese patients? Patient and Methods: This double-blinded clinical trial involved 60 obese (body mass of higher than 30 kg/m²) lower limb orthopedic surgery candidates at Shohada hospital (Tabriz, Iran). The participants were randomly categorized into three groups. In group M, 20 mg morphine sulfate, in group MK1 100 mg ketamine + 20 mg morphine sulfate, and in group MK2 200 mg ketamine+10 mg morphine sulfate was added to the analgesia pump. Pain intensity (VAS), sedation score (Ramsay Scale), as well as nausea and vomiting (N&amp;V score) were compared among different groups at 12, 24, 36, and 48 hours after the operation. Results: Group M manifested a significantly higher pain intensity than two other groups during all examined times, and group MK2 demonstrated a significantly lower pain intensity than other groups. In the course of the research, the amount of opioid consumption in group MK2 was significantly lower than in the other groups. Conclusion: The addition of a low dose of ketamine to morphine in the PCIA pump after orthopedic surgeries in obese patients results in proper postoperative pain management. Trial Registration: The trial protocol was approved in the Iranian registry of clinical trial (identifier: IRCT2017101636822N1, https://www. irct.ir/trial/27429, ethical code; IR.TBZMED.REC.1400.820).

Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic Surgery.

Objective To evaluate whether a low-dose perioperative infusion of Dex reduces early POCD. Design This study was a double-blind, randomized, placebo-controlled trial that randomly assigned patients to Dex or saline placebo infused during surgery and patient-controlled intravenous analgesia (PCIA) infusion. Patients were assessed for postoperative cognitive decline. Interventions. Dex was infused at a loading dose of 0.5 μg/kg intravenously (15 min after entering the operation room) followed by a continuous infusion at a rate of 0.5 μg/kg/h until one-lung ventilation or artificial pneumothorax ended. Patients in the Dex group received regular PCIA pump with additional dose of Dex (200 μg). Results In total, 126 patients were randomized, and 102 patients were involved in the result analysis. The incidence of POCD was 36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline (NS) group, with no statistic difference. No significant difference was observed between the two groups in terms of Telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times. However, the TICS-m score at 7 days after surgery was significantly lower than that at 30 days in 102 patients (32.93 ± 0.42 vs. 33.92 ± 0.47, P = 0.03). The visual analogue scale scores in the Dex group were significantly lower than those in the NS group 1 day postoperation at rest and activity (2.00 [1.00–3.00] vs. 3.00 [2.00–4.00], P < 0.01; 4.00 [3.00–5.00] vs. 5.00 [4.00–6.00], P < 0.05, respectively). Patients receiving Dex or NS had no statistical difference in activities of daily living (ADLs) scores at 7 and 30 days after surgery, but the ADL score at 30 days after surgery showed a significant reduction compared with that at 7 days (P < 0.01). Patients in the Dex group had a shorter hospital length of stay (15.26 ± 3.77 vs. 17.69 ± 5.09, P = 0.02) and less expenses (52458.71 ± 10649.30 vs. 57269.03 ± 9269.98, P = 0.04) than those in the NS group. Conclusions Low-dose Dex in the perioperative period did not reduce the incidence of early POCD in thoracic surgery. However, it relieved postoperative pain, decreased the hospitalization expenses, and shortened the length of stay.

A Randomized, Double-blind, Comparative Study of the Analgesic Efficacy of Perineural Dexmedetomidine as Adjuvant to Ropivacaine versus Ropivacaine Alone in Ultrasound Guided Saphenous Nerve Block after Anterior Cruciate Ligament Reconstruction Surgery

Background: The saphenous nerve block has been effectively used for pain treatment after knee surgeries, however, a single-shot saphenous nerve block with a long-acting local anesthetic usually provides a relatively short duration of postoperative analgesia. Dexmedetomidine is a highly selective alpha-2 adrenoceptors agonist and its perineural injection as an additive to local anesthetics has been shown to improve postoperative analgesia. The aim of this prospective, randomized double-blind study was to evaluate the effects of adding dexmedetomidine to ropivacaine on the quality of postoperative analgesia with ultrasound-guided saphenous nerve block after anterior cruciate ligament reconstruction surgery of the knee. Methods: 40 ASA class I–II patients undergoing arthroscopic anterior cruciate ligament reconstruction surgery under general anesthesia were randomly divided into 2 groups of 20 patients each. At the end of surgery, ultrasound-guided saphenous nerve block was performed with either 10 ml ropivacaine 0.5% alone, or 1 µg/kg dexmedetomidine added to 10 ml of ropivacaine 0.5%. The total volume of injected solutions was increased to 12 ml by adding normal saline. The postoperative pain scores as well as fentanyl consumption through intravenous patient-controlled analgesia pump, hemodynamic parameters, sedation scores, and adverse effects were assessed every 1 hour to 6 hours and then every 2 hours to 24 hours. Results: There were significantly lower postoperative pain scores in the ropivacaine plus dexmedetomidine group compared to ropivacaine alone group at all postoperative measured time points. The total amount of fentanyl consumption and sedation scores after surgery was significantly higher in group ropivacaine alone than in group ropivacaine plus dexmedetomidine. Systolic blood pressure and heart rate within 24 hours after surgery were significantly lower in the dexmedetomidine+ ropivacaine group than in the ropivacaine alone group. However, no bradycardia and hypotension were detected in any of the patients. Conclusion: Perineural administration of 1 µg/kg of dexmedetomidine as an adjuvant to ropivacaine 0.5% for ultrasound guided saphenous nerve block significantly reduced pain scores and opioid requirements in the first 24 h after ACLR surgery compared to ropivacaine alone without any significant side effects.

Different Doses of Nalbuphine Combined with Dexmedetomidine in Laparoscopic Oophorocystectomy.

BackgroundThe goal of this study was to investigate different doses of nalbuphine combined with dexmedetomidine in the postoperative treatment of laparoscopic oophorocystectomy.Material/MethodsThis prospective single-blinded randomized controlled study included 219 patients with benign ovarian cysts who received laparoscopic oophorocystectomy from March 2017 to October 2019. Patients were randomized into 4 groups: low (0.5 mg/kg), middle (1.0 mg/kg), and high (1.5 mg/kg) doses of nalbuphine combined with dexmedetomidine (4 μg/kg) (LND, MND, and HND groups, respectively) and a control group with sufentanil (2.5 μg/kg), with different patient-controlled intravenous analgesia pump (PCIA) strategies. Rest and active visual analog scale (VAS) scores measured postoperative pain, and Ramsay scores were used to measure sedation.ResultsThe HND group showed the lowest rest and cough VAS scores at 2 h, 8 h, 12 h, and 24 h after surgery, the lowest PCIA pressing time within 48 h after surgery, and the highest Ramsay scores at 2 h, 8 h, 24 h and 48 h after surgery. Rest and cough VAS scores decreased with higher nalbuphine doses in a dose-dependent manner. One day after surgery, IL-1β and IL-6 levels increased in all groups, with the lowest levels of IL-1β and IL-6 in the HND group. Hospitalization time was significantly shorter in the HND group compared with the LND and MND groups. There were no significant differences in complications among groups.ConclusionsCombined nalbuphine and dexmedetomidine improved postoperative pain and sedative conditions, reduced inflammation in a nalbuphine dose-dependent manner, and might facilitate patient recovery.

Adjunctive dexmedetomidine infusion in open living donor hepatectomy: A way to enhance postoperative analgesia and recovery.

Open living donor hepatectomy (OLDH) is a highly painful procedure. Advanced strategies for enhancing perioperative analgesia and accelerating recovery are needed for patients undergoing OLDH. This study evaluated the effects of intravenous infusion of dexmedetomidine (DEX) during OLDH on postoperative analgesia and recovery. This prospective, randomised, double-blinded, and placebo-controlled study included 34 patients randomised to a control group (group C) and a DEX group (group D). Utilisation of intravenous patient-controlled analgesia (IV-PCA) pump, pain intensity, and postoperative recovery variables were recorded. Moreover, intraoperative anaesthetic consumption, hemodynamic parameters, and fluid status were also recorded. During the first 24hours after surgery, patients in group D had a lower pain intensity. The cumulative numbers of IV-PCA pump presses and fentanyl consumption within 24 and 48hours postoperatively in group C were significantly higher than in group D. The time to first IV-PCA attempt was prolonged in group D. In addition, faster flatus passage was observed in group D. Intraoperatively, fewer anaesthetic agents were required in group D. Less fluctuation in hemodynamics and reduced bleeding were also found in group D. The present study revealed that the addition of intravenous infusion of DEX during OLDH provided several benefits in relieving postoperative pain and promoting recovery. Therefore, we concluded that intraoperative DEX infusion may play an important role in enhancing the recovery of patients undergoing OLDH.

The Effect of Balanced Analgesia with Sufentanil and Flurbiprofen Axetil in Patients with Cervical Cancer after Open Surgery

Objective:&nbsp;To study the effect of balanced analgesia with sufentanil and flurbiprefen axetil in patients with cervical cancer after open surgery. Methods:&nbsp;92 patients with cervical cancer treated in our hospital from October 2018 to December 2020 were selected. All patients were treated with open surgery for cervical cancer. According to the odd even grouping method, the patients were divided into observation group and control group, with 46 cases in each group. Sufentanil was used for postoperative analgesia in the control group, and sufentanil combined with flurbiprofen axetil was used for postoperative analgesia in the observation group. Serum prostaglandin E2 (PGE2), β Endorphins（β- EP), cortisol (COR), 5-hydroxytryptamine (5-HT), VAS score at different time points after operation and the number of presses of patient-controlled intravenous analgesia pump (PCIA) were compared. Results:&nbsp;Before operation, serum PGE2, β- Comparison of EP, Cor and 5-HT levels were compareed, P &gt; 0.05; 24 hours after operation, the above indexes in the observation group were significantly lower than those in the control group (P &lt; 0.05); The VAS scores of the observation group at different time points were lower than those of the control group (P &lt; 0.05); The incidence of adverse reactions in the observation group was 6.52%, lower than 23.91% in the control group (P &lt; 0.05). Conclusion:&nbsp;In the postoperative analgesia of patients with cervical cancer after open surgery, the application of sufentanil combined with flurbiprofen axetil balanced analgesia can not only reduce the secretion of related factors, but also improve the analgesic effect with less adverse reactions, which is worthy of clinical reference.