Postoperative Analgesic Regimen Research Articles

Anesthesia and Postoperative Analgesia for Cesarean Section: A Retrospective Observational Study

Objectives: The current state of the art for c-section anesthesia includes the use of regional anesthesia techniques because of their effectiveness, safety, and extended postoperative analgesia. This study aimed to analyze the anesthetic techniques employed for c-section and postoperative analgesic regimens and to identify predictive factors for postoperative pain, postoperative complications, and hospitalization time. Study Design: A retrospective, observational study was conducted on pregnant women who underwent c-section between January and December 2021. Demographic data, medical comorbidities, indications for c-section, anesthetic techniques, and postoperative outcomes (pain, complications, and hospitalization time) were registered. Linear and logistic regression were applied for data analysis. Results: Data from 925 women who underwent c-sections were analyzed. Combined spinal–epidural anesthesia was the most used technique for elective c-sections (423 out of 430 women), while general anesthesia was commonly used in emergent procedures (29 out of 39 women). Epidural analgesia was the most commonly used technique for postoperative pain management (83%), and pruritus (8.9%) and headaches (4.1%) were the most frequently registered complications. Risk factors for moderate/severe pain included lower body mass index, conversion to general anesthesia, and the use of systemic analgesia. Preeclampsia and intrathecal morphine increased postoperative complications. General anesthesia and some postoperative complications were predictors for longer hospitalization times. Conclusions: This study suggests that a multimodal analgesic approach with neuraxial morphine and/or local anesthetics, nonsteroidal anti-inflammatory drugs, and acetaminophen is central to achieve an effective postoperative analgesia after a c-section. However, further studies should investigate the optimal neuraxial analgesic combination to minimize side effects.

A Systematic Review of Multimodal Analgesic Effectiveness on Acute Postoperative Pain After Adult Cardiac Surgery.

To synthesise the best available empirical evidence about the effectiveness of multimodal analgesics on pain after adult cardiac surgery. A systematic review with meta-analysis. Indexed full-text papers or abstracts, in any language, of randomised controlled trials of adult patients undergoing cardiac surgery investigating multimodal postoperative analgesic regimen effect on mean level of patient-reported pain intensity at rest. Eight databases, via two platforms and three trial registries were searched from 1 January 1995 to 1 June 2024 returning 3823 citations. Of the 123 full-text papers assessed, 29 were eligible for inclusion. Data were independently extracted by a minimum of two reviewers in Covidence. There were 2195 participants, aged 60.4 ± 6.6 (range 40-79) years, who were primarily male (n = 1522, 76.1%), randomised in the included studies. Risk of bias was high and reporting quality was poor. Patient-reported pain was measured at rest in 28 (96.6%) trials. Data were suitable for pooled analysis from 10 (34.5%) of these trials with an average rest pain intensity of 3.3 (SD 1.5) in the control and 2.7 (SD 1.9) in the intervention groups, respectively. No trials compared combinations of nonopioid, opioid-agonist-antagonist, partial opioid agonists or full opioid agonists. Most trials (n = 11, 37.9%) compared two different full opioid options for less than 72 h (n = 24, 82.7%). Robust trials are needed to determine which multimodal analgesic combination will optimise patient recovery after adult cardiac surgery. There is an urgent need to test and refine high-quality end-point measures. Adequate assessment precedes ideal pain treatment. The findings from this review reveal neither are sufficient, and the impact of suboptimal pain management on postoperative recovery is grossly underinvestigated. The optimal combination of multimodal analgesics is unknown despite being recommended in best practice guidelines for enhanced recovery after cardiac surgery. Almost 30% of adults continue to experience ongoing pain up to a year after cardiac surgery, and findings from this review reveal a dearth of robust empirical evidence for optimal pain management, and heterogeneity in the way pain is assessed, measured and managed. This review provides a premise for robust trials focused on acute postoperative recovery in cardiac surgery and beyond. This review was conducted in accordance with the PRISMA-P statement. There was no patient or public contribution. PROSPERO: CRD42022355834.

Deep Serratus Anterior Plane Block for Multimodal Analgesia in Minimally Invasive Mitral Valve Surgery Performed via Right Anterior Mini-Thoracotomy.

This study investigated if the serratus anterior plane block (SAPB) within a multimodal analgesia scheme would reduce acute post-operative pain and intravenous opioid consumption in patients admitted to the intensive care unit after isolated minimally invasive mitral valve surgery. Retrospective study. Patients were admitted to the intensive care unit (ICU) of the University Hospital of Siena (Italy). Patients treated with intravenous opioids (OP-G) as a postoperative analgesic regimen were compared to those managed with an opioid-sparing protocol consisting of a single-shot SAPB with 0.5% ropivacaine plus 4 mg dexamethasone administered 1 hour before the extubation (SAPB-G). The behavioral pain scale (BPS) for intubated (I) or non-intubated patients (NI) and the Richmond Agitation Sedation Scale (RASS) scores were collected at ICU admission and every 8 hours during the initial 24 postoperative hours. One hundred five patients (50 SAPB-G; 55 OP-G) were enrolled (median age 67 [60-70]; male 67 [64%]). RASS score at 8 hours after ICU admission was higher in the SAPB-G (0 [0, 0] v OP-G -2 [-3, 0], p < 0.001). At 24 hours after ICU admission, the number of patients with a BPS/BPS-NI score >4 was lower in the SAPB-G (4.0% v 18.2% OP-G, p = 0.048). SAPB-G received a lower number of opioid rescue doses during the first 24 hours (20% v 84% OP-G, p < 0.001). The SAPB may be effective in reducing the postoperative use of opioids in patients undergoing minimally invasive mitral valve surgery. Prospective randomized studies are warranted.

Pharmacogenetic features of tramadol metabolism affecting the quality of postoperative analgesia in vascular surgery

BACKGROUND: The issue of the efficacy and safety of medications employed for postoperative analgesia has not been resolved to date. Insufficient analgesia constitutes one of the primary risk factors for developing cardiovascular complications postoperatively. Tramadol is a medication that is frequently used for postoperative pain relief following minor and moderately traumatic operations. The biotransformation of this drug is considerably slowed by the presence of CYP2D6 gene polymorphisms G1846A and C100T, which play a significant role in its metabolism. In such patients, a decrease in the quality of postoperative analgesia can be anticipated, which will consequently lead to an increase in cardiac complications. AIM: To assess the efficacy of a postoperative analgesia regimen based on tramadol and the incidence of cardiac complications during vascular operations depending on the presence/absence of polymorphisms of the CYP2D6 gene polymorphisms, an isoenzyme of cytochrome P-450. MATERIALS AND METHODS: An examination of 109 patients undergoing planned vascular surgery was conducted. The frequency of occurrence of polymorphisms G1846A and C100T of the CYP2D6 gene was determined. All patients were assessed for the severity of postoperative pain syndrome during activity and at rest using a visual analog scale on the first day following surgery. Cardiovascular complications that arose while the patients were in the hospital were documented. To assess the autonomic nervous system, patients underwent cardiointervalography. RESULTS: Polymorphism G1846A was detected in 28 (25.7%), while C100T was detected in four (3.7%) patients. Patients without polymorphisms were included in group 1 (n=77). Patients with polymorphisms were assigned to group 2 (n=32). Pain syndrome at rest and during activity was higher in group 2 patients (p 0.05). The tension index before surgery did not differ between the groups; however, it was greater in group 2 patients after surgery (p 0.001). Cardiac complications were identified in 9.1% of group 1 and 18.8% of group 2 patients (p=0.20). CONCLUSION: The frequency of polymorphisms G1846A and C100T of the CYP2D6 gene in patients who underwent vascular surgery was 29.4%. Such patients experienced pain syndrome of greater severity. The patient groups did not exhibit any significant differences in the frequency of cardiac complications.

Multimodal analgesics after adult cardiac surgery; a systematic review

Abstract Background Moderate to severe pain is frequently reported during the acute recovery phase following adult cardiac surgery. Multimodal analgesics are recommended for adult patients post cardiac surgery, but the optimal combination of multimodal analgesics is unknown. Purpose To synthesise the best available evidence about the effectiveness of multimodal analgesics on pain after adult cardiac surgery. Methods A systematic review was conducted according to the PRISMA-P statement and the published review protocol. Inclusion criteria were full-text papers or abstracts with adequate reporting, in any language, of randomised controlled trials (RCTs) in adult patients undergoing cardiac surgery that investigated the effect of multimodal postoperative analgesic regimens, compared to a control group. The highest mean level of patient self-reported pain intensity at rest, captured using a validated pain assessment tool, was the primary outcome measure. Results Of 3754 citations identified in the initial search to the 12th of December 2022, there were 1605 duplicates leaving 2149 citations for title and abstract screening, of which 2027 were irrelevant. There were 122 full-text papers assessed and 29 included in the review. Data were independently extracted by 2 reviewers in Covidence®. Participants (N = 2360), aged 59.5 + 8.2 years, were primarily male (N = 1561, 66.1%), weighing 78.1 +9.2 kilograms. Risk of bias was high and reporting quality was poor. Pain at rest reported in 18 (62%) studies was 3.5 (SD 1.2) in the control and 2.7 (SD 0.9) in the intervention groups respectively. Nurse-led versus patient-controlled analgesic administration was tested in 14 (48.3%) trials. All trials tested different analgesic combinations, none of which compared a combination of non-opioids, opioid agonist-antagonist agents, or full opioid agonists. Conclusions Poorly managed pain is associated with postoperative complications, unplanned readmissions, and the development of chronic pain. Robust RCTs are urgently needed to inform optimal combinations of multimodal analgesics to optimise patient recovery after adult cardiac surgery.Risk of Bias

Postoperative Analgesic Regimens and Their Satisfaction Rates-Data from the Swedish Quality Register for Tonsil Surgery.

To describe postoperative analgesic regimens and patient-reported pain-related outcomes after tonsil surgery. Cohort study including perioperative data (n = 9274) and patient-reported outcome measures (n = 5080) registered in the Swedish Quality Register for Tonsil Surgery during 2023. After tonsil surgery, 92.7% received at least paracetamol and a NSAID/COX inhibitor, while 6.8% received no NSAID/COX inhibitor. Opioids were prescribed after tonsillectomy to 62.9% of adults and less often to adolescents and children (13-17-year-olds: 48.2%, 6-12-year-olds: 8.8%, 0-5-year-olds: 4.0%). Clonidine was frequently prescribed to 0-5-year-olds after tonsillectomy (54.4%). Overall, 11.7% reported dissatisfaction with the pain treatment, with the highest dissatisfaction rate after tonsillectomy in adolescents (20.6%) and adults (20.0%), and the lowest after tonsillotomy in children (4.9-6.8%). The most common complaint among dissatisfied patients was analgesics not being sufficiently helpful. Adult patients who received addition of opioids were less dissatisfied with the pain treatment (15.9% vs. 25.9%, p < 0.001), but also reported more side effects (5.7% vs. 2.7%, p = 0.039), compared with patients who received only paracetamol and NSAID/COX inhibitors. Tonsil surgery patients in Sweden receive various analgesic regimens. Although most are satisfied with pain treatment, there is room for improvement, particularly among adolescents and adults undergoing tonsillectomy. Paracetamol and a NSAID/COX inhibitor seem advisable as basic treatment. However, many patients need more effective treatment. The addition of opioids in adults results in greater satisfaction with pain treatment, but safety issues with opioid prescriptions must be taken into consideration. 4 Laryngoscope, 135:140-147, 2025.

Effect of preoperative oral ibuprofen on postoperative pain after dental implantation: a randomized controlled trial

Objective: To evaluate the effect of preemptive analgesia with ibuprofen on postoperative pain following single posterior tooth implantation, aiming to provide a clinical reference for its application. Methods: A multicenter, randomized, double-blind, placebo-controlled parallel-group trial was conducted. A total of 82 participants were included in the trial, meeting the eligibility criteria from April 2022 to April 2024 at the Capital Medical University School of Stomatology (40 cases), Beijing TianTan Hospital, Capital Medical University (22 cases), Beijing Chao-Yang Hospital, Capital Medical University (20 cases). Participants were randomly assigned in a 1∶1 ratio to either the ibuprofen group or the control group, with each group comprising 41 individuals. Participants in the ibuprofen group received 300 mg of sustained-release ibuprofen capsules orally 15 min before surgery, while the control group received a placebo. Both groups received the same postoperative analgesic regimen for 3 days. Pain scores were assessed using the Numerical rating scale (NRS) at 30 min, 4 h, 6 h, 8 h, 24 h, 48 h, and 72 h postoperatively, and the additional use of analgesic medication was recorded from days 4 to 6 postoperatively. Results: A total of 82 participants were initially enrolled in the study, with 7 dropouts (4 from the control group and 3 from the ibuprofen group), resulting in 75 participants (37 in the control group and 38 in the ibuprofen group) completing the trial. There were no reports of adverse events such as nausea or vomiting among the participants. The ibuprofen group exhibited significantly lower pain scores at 4 h, 6 h and 8 h [1.0 (0.0, 2.0), 1.0 (0.0, 2.0), 1.5 (0.0, 3.0) ] postoperatively compared to the control group 4 h, 6 h and 8 h [2.0 (1.0, 3.0), 3.0 (1.5, 4.0), 2.0 (1.0, 4.0)] (Z=-1.99, P=0.047; Z=-3.01, P=0.003; Z=2.10, P=0.036). The proportions of patients requiring additional analgesic medication between days 4 and 6 post-surgery were 18.4% (7/38) in the ibuprofen group and 27.0% (10/37) in the control group, with no significant difference (χ2=0.79, P=0.373). The median additional medication usage postoperatively was [0.0 (0.0, 0.0) pills] in the ibuprofen group and [0.0 (0.0, 1.0) pills] in the control group, with no significant difference (Z=-0.78, P=0.439). Conclusions: Preemptive analgesia with ibuprofen effectively reduces postoperative pain following tooth implantation, representing a safe and effective perioperative pain management strategy.

Limitations of Patient-Controlled Epidural Analgesia Following Abdominoplasty.

Effective postoperative pain management is essential for patient satisfaction and an uneventful postoperative course, particularly in body contouring procedures. Systemic analgesic regimens can be supported by regional procedures, such as the transverse abdominis plane (TAP) block, but these have a limited duration of action. In contrast, thoracic epidural analgesia offers the possibility of a longer-lasting, individualized regional anesthesia administered by a patient-controlled analgesia pump. The aim of this study was to investigate the effects of a patient-controlled epidural analgesia to better classify the clinical value of this procedure in abdominoplasties. This work reviewed the digital medical charts of patients who underwent selective abdominoplasty without combined surgical procedures between September 2018 and August 2022. Evaluated data comprise the postoperative analgesia regimen, including on-demand medication, mobilization time, inpatient length of stay, and clinical outcome. The patients were grouped by the presence of a thoracic epidural catheter. This catheter was placed before anesthetic induction and a saturation dose was preoperatively applied. Postoperative PCEA patients received a basal rate and could independently administer boluses. Basal rate was individually adjusted during daily additional pain visits. The study cohort included 112 patients. Significant differences in the demand for supportive nonepidural opiate medication were shown between the patient-controlled epidural analgesia (PCEA) group (n = 57) and the non-PCEA group (n = 55), depending on the time after surgery. PCEA patients demanded less medication during the early postoperative days (POD 0: PCEA 0.13 (±0.99) mg vs non-PCEA 2.59 (±4.55) mg, P = 0.001; POD 1: PCEA 0.79 mg (±3.06) vs non-PCEA 2.73 (±3.98) mg, P = 0.005), but they required more during the later postoperative phase (POD 3: PCEA 2.76 (±5.60) mg vs non-PCEA 0.61 (±2.01) mg, P = 0.008; POD 4: PCEA 1.64 (±3.82) mg vs non-PCEA 0.07 (±2.01) mg, P = 0.003). In addition, PCEA patients achieved full mobilization later (PCEA 2.67 (±0.82) days vs non-PCEA 1.78 (±1.09) days, P = 0.001) and were discharged later (PCEA 4.84 (±1.23) days vs non-PCEA 4.31 (±1.37) days, P = 0.005). Because the postoperative benefits of PCEA are limited to potent analgesia immediately after abdominoplasty, less cumbersome, time-limited regional anesthesia procedures (such as TAP block) appear not only adequate but also more effective.

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

Abstract Background Morbid obesity may cause a restrictive condition. general anesthesia (GA) and supine posture both result in a decrease in lung capacity and Functional residual capacity (FRC), encouraging the development of atelectasis, altering the ventilation/perfusion ratio and raising the pulmonary shunt. This study evaluated the impact of recruitment maneuver (RM) and Transversus Abdominis Plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, hemodynamic variables, opioid requirements and pain score assessed after surgery. Methods This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients had received standardized postoperative analgesia regimen, group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal exsufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results Forced Vital Capacity “FVC”, Forced Expiratory Volume “FEV1” were found to be significantly higher after operation in group IV compared to other groups. FEV1/FVC was insignificantly different among the four groups before and after operation. Intraoperative PaO2, PaO2/FiO2 were significantly higher in group III and IV compared to other groups. Numerical rating scale (NRS) at 1, 2, 4, 6 and 12hr had significantly decreased in group II and IV compared to other groups. Heart rate (HR) and mean arterial blood pressure (MAP) were insignificantly different among the four groups. Morphine consumption was significantly lower in group II and IV compared to other groups. Conclusions TAP block combined with RM group exhibited better postoperative pulmonary function tests (PFTs). Intraoperative oxygenation was higher in RM groups. NRS and opioid consumption were lower in TAP groups in postoperative period.

Comparison of analgesic effectiveness between nefopam and propacetamol in living kidney donors following rectus sheath block after hand-assisted living donor nephrectomy: a prospective, randomized controlled trial

BackgroundNefopam and propacetamol are the most commonly used analgesics in postoperative multimodal analgesic regimens. Distinct mechanisms are involved in each drug’s anti-nociceptive effects. No studies have compared pain relief efficacy between the two drugs in patients undergoing transplantation surgery. Here, we investigated whether the administration of nefopam or propacetamol to healthy living kidney donors who underwent rectus sheath block (RSB) for parietal pain could reduce the subsequent opioid dose necessary to produce adequate analgesia.MethodsThis prospective, randomized controlled trial included 72 donors undergoing elective hand-assisted living donor nephrectomy into two groups: propacetamol (n = 36) and nefopam (n = 36). Intraoperative RSB was performed in all enrolled donors. The primary outcome was the total volume of intravenous opioid-based patient-controlled analgesia (PCA) used on postoperative day 1 (POD 1). Additionally, the Numeric Rating Scale scores for flank (visceral) and umbilicus (parietal) pain at rest and during coughing were compared, and the Korean adaptation of the Quality of Recovery-15 Questionnaire (QoR-15 K) was evaluated on POD 1.ResultsBoth groups had similar preoperative and intraoperative characteristics. On POD 1, the total amount of PCA infusion was significantly lower in the nefopam group than in the propacetamol group (44.5 ± 19.3 mL vs. 70.2 ± 29.0 mL; p < 0.001). This group also reported lower pain scores at the flank and umbilical sites and required fewer rescue doses of fentanyl in the post-anesthesia care unit. However, pain scores and fentanyl consumption in the ward were comparable between groups. The QoR-15 K scores were similar between groups; there were substantial improvements in breathing, pain severity, and anxiety/depression levels in the nefopam group. The incidences of postoperative complications, including sweating and tachycardia, were similar between groups.ConclusionCompared with propacetamol, nefopam provides a greater analgesic effect for visceral pain and enhances the effects of blocks that reduce the opioid requirement in living kidney donors with parietal pain managed by RSB.Trial registrationThe trial was registered prior to patient enrollment in the clinical trial database using the Clinical Research Information Service (registration no. KCT0007351, Date of registration 03/06/2022).

Pericapsular nerve group (PENG) block combined with local infiltration analgesia is not superior to local infiltration analgesia for the management of postoperative pain after primary elective total hip arthroplasty: A prospective, randomized, controlled, single-blind trial

BackgroundLocal infiltration analgesia (LIA) has been advocated for the pain management after total hip arthroplasty (THA). The analgesic benefits of an added pericapsular nerve group (PENG) block remain questionable. MethodsThis randomized, single-blind trial enrolled patients undergoing elective THA under general anaesthesia and standardized postoperative analgesia. Patients were allocated to receive either a PENG block (20 mL of ropivacaine 0.475 %) combined with intraoperative LIA (PENG + LIA group, n = 32), or intraoperative LIA alone (LIA group, n = 32). The primary outcome was oral morphine equivalent (OME) consumption at day 1. Secondary outcomes were: pain scores at post anaesthesia care unit (PACU) discharge and on day 2, times for the Timed to Up and Go (TUG) test and measurement of adductor strength on day 1, and patients’ satisfaction using the EVAN-G questionnaire. ResultsCompared with LIA alone, PENG + LIA resulted in similar OME consumption on day 1 (78 [51–91.5] mg vs 58 [30–80] mg respectively, median difference (95%CI) of −17 (−34 to 1) mg, p = 0.09). Pain scores and morphine consumption were not different between groups at any time point. TUG and thigh adduction tests were similar between LIA and PENG + LIA groups (respectively 35 [25–48.5] vs 31.5 [19.5–46.5] sec, p = 0.39; and 105 [85–150] vs 100 [80–125] mmHg, p = 0.61). No difference in the patients’ satisfaction was found. ConclusionThe addition of a PENG block to large-volume LIA did not significantly improve the analgesia for elective THA in the setting of an adequate basic postoperative analgesia regimen. The results of the lower limb functional tests confirmed the PENG block to be motor-sparing.

Topical lyophilized thrombin application improves wound healing for posterior spinal surgery

BackgroundThe erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application. Materials and methodsWe performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups. ResultsOur study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %). ConclusionsESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.

Effect of liposomal bupivacaine for preoperative erector spinae plane block on postoperative pain following video-assisted thoracoscopic lung surgery: a protocol for a multicenter, randomized, double-blind, clinical trial.

There is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery. This multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis. We hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.

Postoperative pain relief quality after cesarean section using a stress monitor (Neon FSC system): prospective single-center randomized clinical comparative study

BACKGROUND: The objective assessment of pain levels during labor, postpartum period, and effectiveness of analgesic response remains difficult. We suppose that the dynamics of the activity of the sympathetic nervous system by measuring the galvanic skin response may become a promising method for solving this problem.&#x0D; OBJECTIVE: To evaluate the effectiveness of various multimodal analgesia regimens after cesarean section using the NeonFSC stress monitoring system.&#x0D; MATERIALS AND METHODS: A prospective single-center clinical comparative study was conducted to evaluate the effectiveness of various postoperative multimodal analgesia regimens in 48 postpartum women who underwent elective cesarean section under spinal anesthesia. For postoperative analgesia, group 1 (n=24) underwent a TAP block, and ketorolac and tramadol were prescribed, and group 2 (n=24) received only ketorolac and tramadol. Randomization was made using the envelope method. The visual analog scale (VAS) and NeonFSC system were used to assess the effectiveness of postoperative pain relief. The observation time was 19–22 h.&#x0D; RESULTS: The patients were comparable in age, gestational age, physical status, method of pain management and delivery. At baseline and during the 2-h postoperative period, the median and distribution of visual analogue scale pain scores did not show a statistically significant difference between groups. During the study period, the highest level of spectral power of skin conductance (SC) was recorded in group 2. Baseline skin conductance variability (SCV) values were comparable between groups (p 0.001). Lower SCV values were noted in patients of group 1, compared to group 2, at night (p=0.003 vs p 0.001). The median values of the level of total spectral power of skin conductivity (DASS) in patients of group 1 were 1.5–2 times lower, starting from the second hour until the end of observation.&#x0D; CONCLUSION: The NeonFSC system can be a component of an objective assessment of the effectiveness of analgesia after cesarean section.

GAMBARAN MANAJEMEN NYERI AKUT PASKA OPERASI PADA PASIEN YANG MENJALANI TINDAKAN OPERASI ELEKTIF DI RSU HAJI MEDAN

Profile of nutritional status and eating behavior of doctors in their work To determine the description of acute post-operative pain management in patients undergoing elective surgery at RSU Haji Medan. This research is a descriptive study with a cross-sectional research design on elective post-operative patients. In this study, the number of respondents who participated was 66 people, with the largest gender being 37 people (56.1%), the average age was 40 years, and the majority of respondents were Javanese, namely 25 people (37.9%) . The highest preoperative pain intensity was moderate pain, amounting to 41 people (62.1%). The majority of pain intensity in the first 8 hours after surgery was moderate pain, in the second 8 hours the majority was mild pain and in the third 8 hours the majority was no pain. The majority of post-operative analgesic regimens use a combination of intravenous injection of ketorolac 30 mg and paracetamol 1 gram per 8 hours. The majority of the side effects felt by respondents after surgery were nausea.

Transdermal buprenorphine patch as an adjunct to multimodal analgesia after total joint arthroplasty: a retrospective cohort study.

Total hip arthroplasty or total knee arthroplasty (THA/TKA) is often associated with varying degrees of pain. In recent years, transdermal buprenorphine (TDB) patch has shown encouraging results for acute postoperative pain control in orthopedic surgery. The aim of our study was to investigate the efficacy and safety of the combination of TDB patch and nonsteroidal anti-inflammatory drugs (NSAIDs) as a multimodal analgesic regimen after THA/TKA. Patients who underwent THA and TKA between January 2022 and January 2023 were reviewed. Three postoperative analgesic regimens were selected: Group A (flurbiprofen 50mg and tramadol 37.5mg/acetaminophen 325mg), Group B (flurbiprofen 50mg and TDB 5mg), and Group C (Parecoxib 40mg and TDB 5mg). The primary outcomes were the Wong-Baker face pain scale revision (FPS-R) scores and the rate of sleep disturbances. Secondary outcomes of the study included the proportion of patients with postoperative pain relief rates categorized as 0%, <50%, ≥50%, and 100%. The dynamic FPS-R pain scores on day 3 after surgery in Group B were significantly lower than those in Group A for THA (P < 0.017). The dynamic FPS-R pain scores were lowest in Group C on day 2 and 3 after THA and TKA (P < 0.017). Rate of sleep disturbances was significantly lower in Group B for THA and in Group C for TKA, respectively, compared with that in Group A (P < 0.017). The proportion of dynamic pain relief rate ≥50% in Group C was statistically higher than that in Group A for THA (P < 0.017). Rate of adverse reactions among three groups for THA and TKA was not statistically different (P > 0.05). This study suggests that the combination of TDB patch and NSAIDs is safe and effective for postoperative analgesia after THA/TKA.

The Efficacy of Low-Dose Esketamine and Butorphanol in Treating Depression and Pain After Cesarean Section

Objective: To explore the efficacy of combining low-dose esketamine with butorphanol in treating depression and pain following cesarean section. Methods: 100 cases of elective cesarean section were selected and randomly assigned into two groups in a 1:1 ratio. All parturients who fulfilled the inclusion criteria received spinal anesthesia, maintaining the anesthesia level at T6. In the esketamine group, the dosage regimen comprised esketamine 0.5 mg/kg and butorphanol 10 mg, diluted with 0.9% sodium chloride injection to 100 mL. The control group received butorphanol 10 mg, diluted similarly. Analgesia in both groups commenced after cutting the umbilical cord, with a loading volume of 2 mL, a background infusion dose set to 2 mL/h, and patient-controlled analgesia at 2 mL with an effective interval time of 30 minutes. The main indicators included the maternal burnout scale (MBS) and numerical rating scale (NRS) for pain to assess postpartum depression and pain after surgery. Results: No significant differences were observed in MBS scores between the two groups on postoperative days 1 to 9 (P &gt; 0.05). Postpartum depression was not detected in either group. Pain NRS scores at 24 and 48 hours after surgery, including incision and uterine contraction pain, showed no significant differences between the two groups (P &gt; 0.05). Tramadol rescue was not administered to any patients in either group. Additionally, no adverse reactions requiring drug intervention occurred in either group. Conclusion: This study concluded that the combination of low-dose esketamine with butorphanol did not further optimize the analgesic effect of butorphanol but significantly improved postpartum depression after cesarean section. Further research is needed to investigate the impact of the ketamine postoperative analgesia regimen on postpartum analgesia and depression.

Comparison of continuous pericapsular nerve group (PENG) block versus continuous fascia iliaca compartment block on pain management and quadriceps muscle strength after total hip arthroplasty: a prospective, randomized controlled study

BackgroundThis investigation aimed to evaluate the impact of continuous pericapsular nerve group (PENG) block and continuous fascia iliac compartment block (FICB) on postoperative pain following total hip arthroplasty (THA).MethodsThis prospective, randomized, and controlled trial recruited a cohort of fifty-seven patients with unilateral femoral neck fractures from Xi’an Aerospace General Hospital in northwest China between July 2020 and November 2021. These patients were randomly assigned to two groups: the continuous PENG block group (PENG group, n = 29) and the continuous FICB group (FICB group, n = 28). Under ultrasound guidance, PENG block and FICB procedures were performed prior to spinal anesthesia, utilizing 20 ml of 0.25% ropivacaine for PENG block and 30 ml of 0.25% ropivacaine for FICB. Subsequently, a catheter was inserted. All study participants received a standardized postoperative multimodal analgesic regimen, including intravenous administration of 30 mg Ketorolac tromethamine every eight hours and patient-controlled neural analgesia (PCNA) after surgery. Numerical rating scale (NRS) scores at rest and during exercise were recorded at various time points: prior to block (T0), 30 min post-blockade (T1), and 6 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) postoperatively. Additional data collected encompassed postoperative quadriceps muscle strength, the time of initial ambulation after surgery, the number of effective PCNA activations, rescue analgesia requirements, and occurrences of adverse events (such as nausea and vomiting, hematoma, infection, catheter detachment, or displacement) within 48 h following surgery.ResultsIn the PENG group, the resting NRS pain scores exhibited lower values at T1, T4, and T5 than those at T0. Furthermore, exercise NRS pain scores at T1-T5 were lower in the PENG group than in the FICB group. Similarly, during the same postoperative period, the PENG group demonstrated enhanced quadriceps strength on the affected side compared to the FICB group. Additionally, the PENG group displayed earlier postoperative ambulation and reduced occurrences of effective PCNA activations and rescue analgesia requirements compared to the FICB group.ConclusionContinuous PENG block exhibited superior analgesic efficacy after THA compared to continuous FICB, promoting recovery of quadriceps strength on the affected side and facilitating early postoperative ambulation.Trial RegistrationThis clinical trial was registered in the China Clinical Trials Center (http://www.chictr.org.cn) on 20/07/2020, with the registration number ChiCTR2000034821.

Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions

Introduction Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain. ERAS components ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast. Conclusion ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.

MP39-15 IMPLEMENTATION OF AN OPIOID FREE PAIN PATHWAY IN MINIMALLY INVASIVE UROLOGICAL ONCOLOGIC SURGERIES

You have accessJournal of UrologyCME1 Apr 2023MP39-15 IMPLEMENTATION OF AN OPIOID FREE PAIN PATHWAY IN MINIMALLY INVASIVE UROLOGICAL ONCOLOGIC SURGERIES Abdulla Alameeri, Omar Almidani, Ammar Al Homsi, Rashed Rowaiee, Heather Brown, and Waleed Hassen Abdulla AlameeriAbdulla Alameeri More articles by this author , Omar AlmidaniOmar Almidani More articles by this author , Ammar Al HomsiAmmar Al Homsi More articles by this author , Rashed RowaieeRashed Rowaiee More articles by this author , Heather BrownHeather Brown More articles by this author , and Waleed HassenWaleed Hassen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An optimal pain management is essential to establish an effective fast-track surgery model. In patients undergoing minimally invasive oncological surgeries including radical prostatectomy (RP) and Radical Nephrectomy (RN), multiple studies have assessed the efficacy of various analgesic medications. Therefore, we aim in our study to compare the efficacy of post-operative analgesic regimen after the implementation of an opioid-free regimen at a large tertiary care center. METHODS: Mixed retrospective and prospective, non-randomized, pre and post interventional trial was performed at our institution between November 2015 and October 2022. Sample included patients undergoing RP and RN during that time frame. An opioid-free pain regimen was developed and instituted in April 2019, which included preoperative education and counseling regarding opioids and pain expectation management, round-the-clock intravenous acetaminophen as inpatient and prescriptions of oral acetaminophen as outpatients. Comparison was made between patients in the opioid-regimen group (pre-implementation) vs. the opioid-free regimen group (post-implementation) in terms of pain score and the need for additional analgesics. RESULTS: A total of 226 (44.66%) patients were in the pre-implementation group, with both RP and RN included in the total, and 280(55.33%) patients were in the post-implementation group. The intervention significantly reduced postoperative opioid administration from [Pre: 78.3% vs Post: 14.6%, p <0.001]. The post-implementation group had a significantly lower maximum pain score [Pre: 6.3± 2.1 vs Post: 4.5 ± 2.6, p= 0.04] and lower average pain score [Pre: 3.1 ± 1.4 vs Post: 2.0 ± 1.8, p < 0.001]. However, the post-implementation group had higher rates of return visits for postoperative pain management [Pre:1.2% vs Post: 5.1%, p = 0.274].Pre implementation patients followed up for uncontrolled pain were 1(0.44%) and 7 (2.5%) post implementation presented to the ER for uncontrolled pain. CONCLUSIONS: The results support the efficacy of opioid-free pain management regimen in patients undergoing minimally invasive upper tract and pelvic urologic surgery. To Date, this study is considered one of the largest highlighting the efficacy of opioid free regimen post op. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e541 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdulla Alameeri More articles by this author Omar Almidani More articles by this author Ammar Al Homsi More articles by this author Rashed Rowaiee More articles by this author Heather Brown More articles by this author Waleed Hassen More articles by this author Expand All Advertisement PDF downloadLoading ...