Postoperative Pain Control Research Articles

Comparison Between Oxycodone and Pregabalin as Preemptive Analgesia for Postoperative Pain Control: A Randomized Controlled Trial

Comparison Between Oxycodone and Pregabalin as Preemptive Analgesia for Postoperative Pain Control: A Randomized Controlled Trial

Comparison of intranasal versus intravenous dexmedetomidine in postoperative pain control in traumatic mandibular fractures surgery: a randomized clinical trial

Objective: Effective pain management in mandibular fractures is crucial due to the complications associated with opioids, such as respiratory depression and re-intubation. Non-opioid methods are therefore important. This study aims to compare the effectiveness, safety, and efficiency of intranasal (IN) versus intravenous (IV) dexmedetomidine (Dex) for reducing acute pain following mandibular surgery. Methods: This study was a randomized, double-blind clinical trial. All patients underwent general anesthesia, laryngoscopy, and intubation in a standardized manner. For the IN administration group, Dex was prescribed at a dose of 0.2 µ/kg (in the form of drops) half an hour before the start of anesthesia. For the IV administration group, Dex was administered at a dose of 0.5 µ/kg intravenously over ten minutes, half an hour before anesthesia. During the first 24 hours after surgery, pain intensity and the total amount of opioid medication (measured in mg of pethidine) were recorded for each patient. Results: There was no significant difference in pain intensity between the two groups in the post-anesthesia care unit (P=0.898), one hour (P=0.052) and 24 hours post-surgery (P=0.898). However, pain intensity was significantly lower in the IN Dex group at the second (P=0.044), fourth (P=0.041), sixth (P=0.048), and twelfth (P=0.025) hours. Total pethidine injected in the IN Dex group was significantly lower than in the IV Dex group (P=0.041). Conclusion: This study underscores the efficacy of IN Dex as a viable alternative for postoperative pain management in traumatic mandibular fracture surgeries

A Retrospective Review of Ambulatory Oral and Maxillofacial Surgery in a Suburban Tertiary Hospital in Nigeria

Background Ambulatory surgical procedures are integral aspects of oral and maxillofacial surgical (OMS) practice. Objective The aim of this study is to report the scope of ambulatory OMS procedures in a Nigerian suburban teaching hospital. Method A retrospective review of ambulatory OMS procedures performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between March 2021 and February 2022 was conducted. Sociodemographic data, diagnoses, procedures, type of anesthesia, and immediate postoperative complications were retrieved from patients' records. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 22. Results Two hundred and fifty-two ambulatory OMS procedures were performed during the 12-month study period. This accounted for 80.3% (252/314) of elective surgeries. The patients' mean (standard deviation [SD]) age was 32.2 (10.4) years, while a slight male preponderance (51.6%) was recorded. Third molar surgery was the commonest (48.0%) procedure undertaken in ambulatory setting. Most (90.9%) of them were performed under local anesthesia. Satisfactory postoperative pain control was achieved with the use of oral nonsteroidal anti-inflammatory analgesics in most patients (81.7%). However, owing to a failed ambulatory session, there was an eventual admission rate of 0.4% (1/252). Conclusion Ambulatory surgical procedures constitute the majority of the OMS elective cases, with third molar surgery being the commonest procedure. Judicious prescription and administration of oral analgesics were effective in managing postoperative pain in our day case OMS patients. We recommend a prospective study to determine an intermediate/long-term outcome of care in ambulatory settings.

Advancements in Respiratory Surgery Anesthesia: A Collaborative Approach to Perioperative Management and Recovery

Thoracic surgery is a highly complex field requiring collaboration between surgeons, anesthesiologists, pulmonologists, and other specialists. Successful outcomes depend on thorough preoperative evaluations that consider the patient’s overall health, lifestyle habits, and surgical risks. Key elements include proper intraoperative anesthesia management, postoperative pain control, and the integration of enhanced recovery after surgery (ERAS) protocols to optimize recovery. Double-lumen tubes (DLTs) are essential for one-lung ventilation during thoracic procedures, although they can be invasive. Recent advancements, such as video-assisted laryngoscopes, have improved the success of DLTs and reduced the invasiveness of DLT intubation and extubation. Postoperative pain management is crucial for minimizing complications and enhancing recovery. Techniques like epidural analgesia, nerve blocks, and patient-controlled analgesia improve patient outcomes by allowing early mobility and deep breathing. Dexmedetomidine (DEX), a sedative with minimal respiratory impact, has shown promise in reducing delirium and aiding recovery. This review highlights the importance of teamwork, pain management, and emerging technologies in improving thoracic surgery outcomes. Advances in these areas, particularly within ERAS protocols, continue to enhance patient care and overall surgical success.

Exploring the relationship between pain intensity, self-management of pain and pain self-efficacy on post-operative pain on day 5 after cesarean section: A cross-sectional study in Mie prefecture in Japan.

Pain self-management among women who begin child-rearing after a cesarean section (CS) has not been ascertained. This study aimed to explore the relationship among pain intensity, self-management, and self-efficacy on post-operative day (POD) 5 after CS in postpartum women. A cross-sectional online survey was conducted on POD5 after CS. Participants were recruited through convenience sampling in Mie Prefecture, Japan, from August 2023 to April 2024. Pain was assessed using a numerical rating scale (NRS), both during activity and at rest, with higher scores indicating greater pain. Pain self-efficacy was assessed using the Japanese version of the Pain Self-Efficacy Questionnaire (PSEQ-J), and pain self-management was investigated. SPSS version 29.0 was used for data analysis, and p<0.05 was set as the significance level. Data from 124 participants (valid response rate: 73.8%) were analyzed. The median (IQR) of the NRS was 4.5 (3-6) during activity and 2.0 (1-4) at rest. There were significant differences according to method of oral analgesia during activity (p<0.049) and at rest (p<0.015). Multiple regression analysis revealed that NRS scores at maximum pain after CS significantly influenced pain on POD5. However, the number of oral analgesics and PSEQ-J scores were not influenced (during activity: R2=0.21, p<0.001, at rest: R2=0.12, p<0.001). Pain intensity during activity on POD5 was moderate and required pain-management. Acute post-operative pain-management was related to pain intensity on POD5, suggesting the importance of early post-operative pain control. Future studies are needed to examine the association between pain self-efficacy and other psychological factors.

Surgical Sensation During Cesarean Section: A Qualitative Analysis

(Int J Obstet Anesth. 2024:57:103935. https://doi.org/10.1016/j.ijoa.2023.103935) Cesarean section (CS) is a significant surgical procedure for young and generally healthy patients, marking a crucial emotional milestone. Neuraxial anesthesia (NA) is preferred for CS due to its safety advantages over general anesthesia, including reduced blood loss, improved postoperative pain control, and decreased neonatal exposure to drugs. While it allows patients and their partners to experience childbirth intimately, NA carries known risks such as hypotension, headache, and inadequate pain relief. Sedation is minimal during CS to ensure neonatal safety and preserve parental bonding. Preoperative anxiety affects postoperative outcomes and patient satisfaction, emphasizing the need for comprehensive patient education and counseling. However, there is limited recent data on patients’ perceptions of surgical sensations during CS under NA, highlighting the importance of this study’s detailed assessment to improve patient care and inform future research.

Identifying factors associated with persistent opioid use after total joint arthroplasty: A retrospective review.

To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty. Retrospective cohort study. Maine Health System. Opioid-naïve patients who underwent at least one total joint arthroplasty (knee, hip, or shoulder) between 2015 and 2020. Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to create a predictive model for persistent opioid use after surgery from a US Electronic Health Record dataset in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) format. 75% of the data was used to build the LASSO model using 10-fold cross-validation and 25% of the data was used to determine the optimal probability threshold for predicting the binary outcome. Out of 6432 patients, 12.3% (792) were identified as having persistent opioid use across combined total joint arthroplasties defined as at least one opioid prescription between 90 days and one year after surgery. Patients with persistent opioid use were more likely to be current smokers (OR 1.65), use antidepressants (OR 1.76), or have a diagnosis of post-traumatic stress disorder (OR 2.07), or a substance related disorder (OR 1.69). Other factors associated with persistent opioid use included back pain (OR 1.43), dementia (OR 1.65), and BMI over 40 (OR 2.50). The probability of persistent opioid use was not associated with age, sex, or ethnicity. This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for post-operative pain control.

Naproxen Sodium: The Superior Choice Over Dexketoprofen for Dental Pain and Inflammation Management

The management of postoperative pain and inflammation following dental procedures, such as dental implants and root canal therapies, is essential to ensure patient comfort and optimal recovery. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Naproxen Sodium and Dexketoprofen are widely utilized due to their effectiveness in controlling pain and inflammation by inhibiting cyclooxygenase (COX) enzymes. This review compares the pharmacological characteristics, onset of action, duration of analgesic effects, and safety profiles of Naproxen Sodium and Dexketoprofen in managing pain associated with dental treatments. Naproxen Sodium’s rapid onset of action (within 15 minutes) and prolonged duration (up to 13 hours) make it a superior choice for postoperative pain control, minimizing the need for frequent dosing. Dexketoprofen, while providing pain relief within 30 minutes, has a shorter duration of effect, requiring more frequent administration. Naproxen Sodium also demonstrates superior anti-inflammatory properties and safety profile make it the preferred first-line option over Dexketoprofen for managing pain and inflammation following dental procedures as evidenced by FDA recommendations. The review concludes that Naproxen Sodium offers a more balanced efficacy, safety, and sustained analgesia, making it a preferred NSAID for managing postoperative dental pain and inflammation over Dexketoprofen. Keywords: Naproxen Sodium, Dexketoprofen, Dental Pain, cyclooxygenase (COX) enzymes

VS 02 - HPB Inter-fascial Catheter with Local Anaesthetic Infusion in Hepato-biliary Surgery (HILA) – A Video Guide to Catheter Placement

Abstract Background Thoracic epidural analgesia (TEA) offers effective pain control after open hepato-biliary surgery, however it is associated with several limitations that delay post-operative recovery. Inter-fascial catheter with local anaesthetic infusion (IF) is an effective, safe and cost-saving alternative to thoracic epidural analgesia (TEA) following open liver and biliary surgery, with significant decrease in post-operative vasopressor requirements, and length of critical care and hospital stay. Method This video presentation outlines current clinical evidence with local data from Nottingham University Hospital, relevant clinical anatomy of the inter-fascial plane, intra-operative placement techniques, tips and tricks as well as troubleshooting in the event of a catheter related complication. Results The inter-fascial catheters can be placed in the transversus abdominis or posterior rectus plane based on the type of skin incision to achieve optimal post-operative pain control. It is associated with a low technical failure rate. Conclusion Inter-fascial catheter with local anaesthetic infusion is an effective, safe and cost-saving technique associated with significant decrease in post-operative vasopressor requirement, and length of critical care and hospital stay.

Liposomal Bupivacaine Versus Plain Bupivacaine for Pain Control Following Congenital Cardiac Surgery.

Pain control following cardiac surgery can be challenging, and inadequate pain control is associated with postoperative complications. Liposomal bupivacaine can improve postoperative pain control due to its prolonged duration compared with plain bupivacaine. However, there is a paucity of data regarding its efficacy in congenital cardiac surgery. The primary outcome was to compare opioid requirements between liposomal bupivacaine and plain bupivacaine for local infiltration in pediatric patients undergoing cardiac surgical procedures via a median sternotomy approach. Secondary outcomes included antiemetic use, adjunct pain medication use, length of stay, and pain scores. This single center retrospective study analyzed data from 2017 to 2022 involving patients who underwent congenital cardiac surgery via median sternotomy. Sixty-three patients who received liposomal bupivacaine were matched with 33 patients who received plain bupivacaine. Patient data were extracted from the electronic medical record and underwent statistical analysis using Wilcoxon, χ2, and Fisher exact tests. There were no demographic differences between the two groups. Postoperative opioid use did not differ significantly between the liposomal bupivacaine and plain bupivacaine groups. The liposomal bupivacaine group had increased acetaminophen and antiemetic use, while the plain bupivacaine group had increased ketorolac use. Otherwise, there were no significant differences in secondary outcomes, including length of stay. Liposomal bupivacaine may not offer any advantage over plain bupivacaine in congenital cardiac postoperative pain control.

Adequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception.

Background/Objectives: Hemodynamic instability and inappropriate postoperative pain perception (IPPP) with their consequences constitute an anesthesiological challenge in patients undergoing primary elective open lumbar infrarenal aortic aneurysm repair (OLIAAR) under general anesthesia (GA), as suboptimal administration of intravenous rescue opioid analgesics (IROAs), whose titration is optimized by Adequacy of Anaesthesia (AoA) guidance, constitutes a risk of adverse events. Intravenous or thoracic epidural anesthesia (TEA) techniques of preventive analgesia have been added to GA to minimize these adverse events. Methods: Seventy-five patients undergoing OLIAAR were randomly assigned to receive TEA with 0.2% ropivacaine (RPV) with fentanyl (FNT) 2.5 μg/mL (RPV group) or 0.2% bupivacaine (BPV) with FNT 2.5 μg/mL (BPV group) or intravenous metamizole/tramadol (MT group). IROA using FNT during GA was administered under AoA guidance. Systemic morphine was administered as a rescue agent in all groups postoperatively in the case of IPPP, assessed using the Numeric Pain Rating Score > 3. The maximum score at admission and the minimum at discharge from the postoperative care unit to the Department of Vascular Surgery, perioperative hemodynamic stability, and demand for rescue opioid analgesia were analyzed. Results: Ultimately, 57 patients were analyzed. In 49% of patients undergoing OLIAAR, preventive analgesia did not prevent the incidence of IPPP, which was not statistically significant between groups. No case of acute postoperative pain perception was noted in the RPV group, but at the cost of statistically significant minimum mean arterial pressure values, reflecting hemodynamic instability, with clinical significance < 65mmHg. Demand for postoperative morphine was not statistically significantly different between groups, contrary to significantly lower doses of IROA using FNT in patients receiving TEA. Conclusions: AoA guidance for IROA administration with FNT blunted the preventive analgesia effect of TEA compared with intravenous MT that ensured proper perioperative hemodynamic stability along with adequate postoperative pain control with acceptable demand for postoperative morphine.

Comparison of Ropivacaine and Bupivacaine in Intraperitoneal Instillation for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Introduction Laparoscopic cholecystectomy, despite its several advantages, is sometimes associated with discomfort due to pain in the immediate postoperative period. Effective management of this pain is critical for enhancing recovery, minimizing complications, and facilitating early discharge. The use of local anesthetics for intra-abdominal analgesia, specifically bupivacaine and ropivacaine, has been investigated as a means to improve postoperative pain control. This study aims to compare the analgesic efficacy of intra-peritoneal ropivacaine versus bupivacaine following laparoscopic cholecystectomy. Methods This prospective, randomized, comparative study was conducted after obtaining institutional ethics committee clearance. Sixty ASA grade I/II patients, aged 18 to 65 years, undergoing elective laparoscopic cholecystectomy were enrolled. Patients were randomly assigned to receive either 35 ml of 0.375% ropivacaine (Group R) or 35 ml of 0.25% bupivacaine (Group B) administered intra-peritoneally. Analgesic efficacy was assessed using Visual Analogue Scale (VAS) scores, heart rate monitoring, and the requirement for rescue analgesia. Data were collected at various time intervals and analyzed using statistical methods. Results Mean heart rate values were significantly lower in Group R compared to Group B from the 2nd to 8th hour and at the 18th hour postoperatively (p < 0.05). The mean VAS scores for pain at rest were significantly lower in Group R compared to Group B from the 8th to 24th hour (p < 0.001). A substantially higher proportion of patients in Group B required rescue analgesia compared to Group R (p < 0.05). Specifically, 16.7% of patients in Group R required rescue analgesia versus 43.3% in Group B. The time to the first dose of rescue analgesia was longer in Group R (8.4±3.6 hours) compared to Group B (6.8±11.3 hours), though this difference was not statistically significant (p > 0.05). Total analgesic consumption was significantly higher in Group B (20.5±3.2 mg) compared to Group R (14.6±2.8 mg) (p < 0.001). Conclusion Ropivacaine provides superior postoperative analgesia compared to bupivacaine when used for intra-peritoneal instillation in laparoscopic cholecystectomy. The findings support the use of ropivacaine for effective pain management in this surgical context, potentially leading to improved patient outcomes and reduced opioid consumption.

The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention. Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO2, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications. US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.

Successful cutaneous sensory blockade following single-injection and double-injection techniques of ultrasound-guided superficial parasternal intercostal plane block: a randomized clinical trial.

While superficial parasternal intercostal plane blocks can improve analgesia after cardiac surgery, the optimal site and the number of injections remain uncertain. This study aimed to compare the efficacy of single versus double injections of superficial parasternal blocks, hypothesizing that double injections would achieve superior cutaneous sensory blockade. 70 cardiac patients undergoing median sternotomy were randomly assigned to receive either single or double injections of superficial parasternal blocks bilaterally. Each patient received 40 mL of 0.25% bupivacaine with epinephrine 5 µg/mL and dexamethasone 10 mg. The single-injection group received 20 mL/side at the third costal cartilage, while the double-injection group received 10 mL/injection at the second and fourth costal cartilages. The primary outcome was a successful block, defined as sensory loss in the T2-T6 dermatomes. Secondary outcomes included sensory block of T1, T7, and T8 dermatomes, block-related complications, intraoperative hemodynamics, postoperative pain intensity, opioid consumption, and recovery quality. Double injections achieved an overall higher success rate compared with the single-injection technique (81% vs 51%, relative risk 1.6; 95% CI 1.2, 2.0; p<0.001). Additionally, higher blockade percentages were observed in dermatomes T1 (83% vs 59%, p=0.003), T7 (67% vs 46%, p=0.017), and T8 (61% vs 39%, p=0.011) with double injections. Other secondary outcomes did not differ significantly between groups. Compared with single injection, double injections of superficial parasternal blocks provided more reliable coverage of the T2-T6 dermatomes, crucial for median sternotomy. However, no differences were observed in intraoperative hemodynamic effects or postoperative pain control after cardiac surgery. TCTR20230408004.

Postoperative Pain Control After ACL Reconstruction With Semitendinosus Tendon Graft: A Randomized Controlled Trial Comparing Adductor Canal Block to Local Infiltration Analgesia.

Both adductor canal block (ACB) and local infiltration (LI) are effective for postoperative pain management after arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction (ACLR). While LI is a more straightforward procedure, its effectiveness remains debated. To evaluate morphine consumption within 48 hours after ACLR with a semitendinosus tendon graft, comparing ACB and LI; secondary objectives: to evaluate pain levels, patient satisfaction, quadriceps strength, range of knee motion, and complications. Randomized controlled trial; Level of evidence, 1. Patients undergoing primary ACLR with a semitendinosus tendon graft were randomized to receive either ACB (0.25% bupivacaine; 20 mL) or LI at the surgical wound, graft harvest area, and intra-articular injection. The LI group received morphine (3 mg), ketorolac (30 mg), and tranexamic acid (1 g). Morphine consumption within 48 hours was monitored using an intravenous patient-controlled analgesia device. A total of 48 patients were analyzed (n = 24 in each group); baseline characteristics were similar between groups. The LI group consumed significantly less morphine than the ACB group at 6 hours (median [interquartile range, IQR], 3 mg [0-4.8 mg] for the LI group vs 5.5 mg [2-9] for the ACB group; P = .003). However, no significant differences were observed in morphine consumption at other time points. Additionally, no significant difference was found in cumulative morphine consumption at 48 hours between the groups (median [IQR], 21.5 mg [11-34.5 mg] for the ACB group vs 16.5 mg [8.5-21.8 mg] for the LI group; P = .137). Postoperative pain scores, quadriceps strength, and patient satisfaction were similar between the 2 groups. Morphine consumption at 48 hours postoperatively was comparable between the LI and ACB groups, and no significant group differences were found in postoperative pain, quadriceps strength, or patient satisfaction. TCTR20190320003 (Thai Clinical Trial Registry).

Evaluation of cats treated with robenacoxib after gastrointestinal surgery.

The aim of the study was to determine if cats administered robenacoxib immediately after gastrointestinal surgery have a similar complication rate to cats that were not administered robenacoxib. Medical records were reviewed for 154 cats that underwent gastrointestinal surgery between December 2015 and September 2021 in this retrospective study. Data collected included patient signalment, presenting complaint, surgical procedure(s) performed, robenacoxib administration and major postoperative complications. Cats were excluded if they did not have a 2-week postoperative follow-up examination. Two groups were analyzed: group R (postoperative robenacoxib administration) consisted of 43 cats; and group C (no postoperative robenacoxib administration) consisted of 111 cats. Complications occurred in 10/43 (23.2%) cats in group R and 34/111 (30.6%) cats in group C. Major complications occurred in 1/43 (2.3%) in group R and 14/111 (12.6%) in group C. Minor complications occurred in 9/43 (20.9%) cats in group R and 20/111 (18.0%) cats in group C. One of 43 cats (2.3%) in group R and 10/111 (9.0%) cats in group C were euthanized or died within 0-16 days after gastrointestinal surgery. Cats that were administered robenacoxib postoperatively did not have an increase in major postoperative complications after gastrointestinal surgery compared with cats that were administered an alternative analgesic medication. The use of robenacoxib in cats after gastrointestinal surgery may be a safe analgesic option for postoperative pain control.

Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy

BackgroundAdequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. MethodsPatients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). ResultsOf 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. ConclusionRegional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

Subtotal vaginal hysterectomy with cervical ring preservation and cervical stump suspension to the sacrospinous ligament in women with pelvic organ prolapse: An exposed cohort study

To evaluate the short-term safety and efficacy of vaginal hysterectomy with cervical preservation in patients with genital prolapse stages II to IV. This is a descriptive case series study. It included women with genital prolapse stages II to IV, indicated for vaginal hysterectomy, with negative cervicovaginal cytology for malignancy, who underwent subtotal vaginal hysterectomy with suspension of the cervical stump to the sacrospinous ligament between June 1 and December 31, 2023, at a high-complexity general clinic. Sociodemographic variables and complications six months postoperatively were analyzed. The surgical technique is presented, and descriptive analysis, along with a detailed surgical technique exposition of cervical stump suspension to the sacrospinous ligament, was conducted. During the described period, 10 patients consulted, of whom eight met the inclusion criteria. The mean duration of the surgical procedure was 133 minutes. Average blood loss was 200 cc. One patient required analgesic use of pregabalin for peripheral neuropathic pain, achieving adequate postoperative pain control. No other intraoperative or postoperative complications were reported. No prolapse recurrence was observed six months postevaluation. Subtotal vaginal hysterectomy with cervical stump suspension to the sacrospinous ligament is a surgical repair technique that could be considered for the management of uterine prolapse. Randomized studies comparing this technique with other management alternatives are needed to evaluate its long-term efficacy and safety.

Virtual Reality for Postoperative Pain Management: A Review of Current Evidence.

With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures. Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting.

Epidural Catheter Bacterial Colonization and Infection in a Secondary Portuguese Hospital Setting.

Background and study goal Epidural analgesia is effective for postoperative pain control but carries risks of infection, including bacterial colonization. This study aimed to determine the incidence of epidural catheter colonization and infection in a Portuguese hospital, identify common microorganisms and antibiotic resistance profiles, and assess potential risk factors. Materials and methods We conducted a prospective observational study from November 2022 to March 2023 in a Portuguese secondary care center. Adult patients undergoing surgery with epidural analgesia were included. Data related to patient demographics, surgical details, and the epidural technique were collected. Incidence rates were calculated, and risk factors for colonization were analyzed. Results and discussion Overall, 215 patients were included (mean age: 52.12 years; 76.7% women). The average catheter duration was 2.66 days. The incidence of bacterial colonization was 16.3% (95% CI=11.3-21.2%), with 74.3% showing antibiotic resistance. Staphylococcus epidermidis was the most frequent isolate (37.1%). No cases of epidural space infection were observed. Exploratory analyses indicated a potential higher risk of colonization when multiple punctures were needed (adjusted odds ratio (aOR): 4.52, p=0.33). Conclusion Epidural catheter colonization occurred in 16.3% of cases, with Staphylococcus epidermidis being the predominant agent. Despite colonization, clinical infections were rare. The high rate of antibiotic resistance underscores the need for improved stewardship and aseptic practices.