Postoperative Opioids Research Articles

Surgical Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery

Importance Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures. Objective The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery. Study Design From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively. Results Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work. Conclusions Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.

Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge.

The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI95% 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.

Comparative study between effect of preoperative multimodal analgesia and pregabalin as unimodal analgesia in reduction of postoperative opioids consumption and postoperative pain in laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy is a popular abdominal surgery and the most common problem for patients undergoing laparoscopic cholecystectomy is the postoperative pain, and associated side effects due to opioids use for pain management and multimodal analgesia is suggested to reduce postoperative pain and need for postoperative opioids. This controlled clinical trial compares the effects of multimodal analgesia and pregabalin as unimodal analgesia on postoperative pain management, postoperative opioids consumption, and reduction of opioids accompanied adverse effects in patients undergoing laparoscopic cholecystectomy where large multicenter studies evaluating specific analgesic combinations are lacking.MethodThis comparison randomized controlled trial between multimodal analgesia approach and pregabalin as unimodal analgesia included 95 laparoscopic cholecystectomy patients that were randomly allocated to three groups using a simple randomization method where multimodal and pregabalin groups included 30 patients in each and the drugs was administered orally one hour before the incision and control group included 35 patients that did not receive any preoperative analgesia. Multimodal analgesic therapy included acetaminophen 1 g, pregabalin 150 mg and celecoxib 400 mg while pregabalin group received pregabalin 150 mg only.ResultsMultimodal group showed a significantly lower need for total opioid analgesics mean ± SD (1.33 ± 1.918) as compared to the control group mean ± SD (3.31 ± 2.784) with p-value 0.014. Pregabalin and multimodal groups showed significantly lower postoperative visual analogue scale used for pain assessment mean ± SD (3.50 ± 2.543) and mean ± SD (3.70 ± 2.231), respectively, compared to the control group mean ± SD (5.89 ± 2.857) with p-value 0.001.ConclusionMultimodal analgesia reduced postoperative opioids consumption more than pregabalin alone when used preoperatively in laparoscopic cholecystectomy and consequently reduced opioids associated adverse effects, but they have the same efficacy in reducing postoperative pain, so pregabalin can be used alone preoperatively in patients with contraindications for using some analgesics included in multimodal analgesia protocol. The study was registered retrospectively in clinical trials; Trial registration ID: NCT05547659.

Preoperative Acetaminophen For Microsuspension Laryngoscopy Reduces Postoperative Opioid Use.

The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of preoperative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a previous study of pain and opioid use following MSL (Tsang et al.). A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were administered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and present pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statistical analysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. RESULTS: Eighty-nine patients were included (mean age 52.8 ± 17.3 years, 40 males). All patients received preoperative 1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scores were 5 [2-11], 21 [12.3-56.8], and 3 [2-3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioid requirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043-1.548), p = 0.017) and total laryngoscope suspension time (OR (95%CI) = 0.791 (0.651-0.962, p = 0.019)). This cohort demonstrated reduced opioid usage on POD1 compared with Tsang et al (23%). Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use following MSL. Anesthesia time correlated with need for postoperative opioids. 4 Laryngoscope, 134:4625-4635, 2024.

Liposomal bupivacaine plus intrathecal hydromorphone associated with shortened length of stay and decreased opioid use in pediatric patients following posterior spinal fusion surgery.

We aimed to determine if the use of intrathecal (IT) hydromorphone and/or liposomal bupivacaine (LB) decreased the amount of postoperative and post-discharge opioids for pediatric patients undergoing fusion (PSF) surgery to treat adolescent idiopathic scoliosis (AIS). A retrospective review of AIS patients undergoing PSF surgery was conducted. Hospital LOS, and inpatient and post-discharge opioid use were compared. Opioid use was reported as oral morphine equivalents (OMEs). Three groups were formed from 186 patients: the control (CG) (n = 39), the IT hydromorphone only (IT) (n = 58), and the liposomal bupivacaine with intrathecal hydromorphone (LB + IT) group (n = 89). The mean LOS were 4.8, 4.2, and 3.5 days for the CG, IT, and LB + IT groups, respectively, with the LB + IT group being shorter than both the CG (p < 0.001) and IT groups (p < 0.001). The mean inpatient OMEs were 106.3/day, 69.2/day, and 30.0/day for the CG, IT, and LB + IT groups, respectively, with each group being significantly different than each other (all pairwise comparisons, p < 0.001). The mean total OMEs that patients were prescribed post-discharge were 693.6 in the CG, 581.1 in the IT, and 359.4 in the LB + IT group (F(2,183) = 14.5, p < 0.001), with the LB + IT group being prescribed significantly less than both the IT (p = 0.003) and CG groups (p < 0.001). Both the use of IT hydromorphone and LB were associated with shortened LOS and fewer total and per day in-hospital OMEs; however, the group who received both IT and LB (LB + IT) had the greatest decrease in LOS, and both inpatient and post-discharge OME usage. Level III (retrospective comparative study).

Perioperative Use of Intravenous Lidocaine Infusion to Decrease Postoperative Opioids in Colorectal Surgery: A Randomized Prospective Study

Pain is defined as an unpleasant sensory and emotional sensation provoked by real tissue damage and manifested by autonomic, psychological, and behavioral reactions. Improvement of postoperative pain control remains a significant challenge among clinicians. 40 patients aged 30-60 years, ASA 1-2 scheduled for colorectal surgery, were divided into two groups 20 patients each. Lidocaine group: (n= 20) received bolus intravenous lidocaine 20 min before incision with a dose of 1.5mg/kg followed by lidocaine infusion with a dose of 1.5mg/kg/h. Control group: (n= 20) receive intravenous lidocaine only. After premedication with a bolus dose of lidocaine at induction, the heart rate was lower in the interventional group compared with the control one until 12 hours post-operatively, then returned to be equal by 24 hours. Between recovery and one hour postoperative, intraoperative serial differences were significant only for the intervention group. After premedication and during the operation until 24 hours, postoperative mean blood pressure was significantly higher among controls. This returns to be equal by 48 hours and beyond. The postoperative VAS score and analgesic requirements were significantly lower in the lidocaine infusion group. Perioperative lidocaine infusion provides analgesia, low pain score, and decreases postoperative opioid consumption in laparoscopic colorectal surgery.

Opioid free versus opioid sparing strategies for multimodal antinociception during laparoscopic colectomy: a randomised controlled trial

BackgroundIt remains unclear whether opioid-free anesthesia (OFA), when compared to opioid-sparing anesthesia (OSA), reduces postoperative opioid consumption while still providing adequate pain control. We thus tested the hypothesis that patients having an OFA strategy during laparoscopic colectomy would require less postoperative opioids when compared to an OSA strategy. MethodsThis single-center, prospective randomized controlled superiority trial, randomly allocated consecutive patients undergoing laparoscopic colectomy to receive either sevoflurane-dexmedetomidine anesthesia with a continuous infusion of lidocaine and ketamine (OFA group) or sevoflurane-sufentanil boluses anesthesia with a continuous infusion of lidocaine (OSA group). Both groups received multimodal antinociception with boluses of dexamethasone, lidocaine, and ketamine during anesthesia induction, as well as acetaminophen, ketoprofen, and nefopam before the end of the surgery. OFA patients also received a dose of magnesium sulfate during induction. The primary outcome was cumulative opioid consumption at 48 h after surgery, expressed in oral morphine equivalents (OME). Secondary exploratory outcomes were pain scores, opioid-related adverse events, and patient quality of life (WHODAS score). ResultsOf the 160 randomized patients, 155 were included in a modified intention-to-treat analysis. Median [Q1-Q3] OME consumption at 48 hours after surgery did not differ between groups (9 [0-30] mg for OFAvs. 14 [0-30] mg for OSA; p = 0.861). Key secondary outcomes were not different between groups except a three time higher incidence of bradycardia in the OFA group. ConclusionsIn patients undergoing laparoscopic colectomy with a multimodal antinociception protocol, OFA, when compared to OSA, did not decrease postoperative opioid consumption. Clinical Trial Registry and NumberNCT05031234.

Is Opioid Consumption Impacted by Study Participation? Maintenance of Fewer Opioid Refills With Reduced Prescription Quantity After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis.

Opioid overprescribing can lead to nonmedical opioid use. In a previous prospective study (STUDY), we showed that a standardized protocol involving preoperative education and reduced opioid prescription quantity decreased opioid use in idiopathic scoliosis patients following posterior spinal fusion (PSF). A potential limitation was the Hawthorne effect, where participant behavior changes due to observation. At STUDY conclusion, we continued the reduced opioid prescriptions but discontinued the formal preoperative education. This retrospective study (post-STUDY) assessed if opioid refill requests increased outside of a study setting. Post-STUDY included patients aged 10 to 17 years who underwent PSF for idiopathic scoliosis between January 2022 and December 2023 and were discharged with a prescription of ≤30 oxycodone doses. Patients were excluded if they had previous spine surgery or were discharged with an opioid other than oxycodone. Demographics, perioperative variables, and opioid refill requests were compared with the data from STUDY, in which patients were aware their opioid use would be tracked. Patient-reported outcomes were collected via Scoliosis Research Society-22r (SRS-22r) surveys. The post-STUDY cohort included 67 patients (69% female). The average age at the time of PSF was 13.9 years (range, 11 to 17y). The mean number of levels fused was slightly higher (10.9 vs. 10.0, P=0.04), and intraoperative estimated blood loss was lower (211 vs. 303mL, P<0.01) compared with the STUDY cohort. Demographics, preoperative major curve magnitude, surgery duration, and length of hospital stay were similar. The percentage of patients who requested and received opioid refills between the post-STUDY and STUDY cohorts was also similar [6/67 (9%) vs. 3/49 (6%), P=0.30]. SRS-22r showed improvements in self-image, satisfaction, and mean total score from preoperative to postoperative. Reduced opioid prescriptions did not result in increased opioid refill requests in adolescents undergoing PSF for idiopathic scoliosis outside of a study setting. While formal preoperative discussions about postoperative pain control are important, other factors likely influence opioid use. Further research should explore characteristics that predispose patients to require higher amounts of postoperative opioids. Level III-therapeutic.

Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery.

To consider the clinical anatomy, safety and effectiveness of the suprazygomatic maxillary nerve block in cleft palate surgery. Observational case series. Single cleft centre in the United Kingdom. Patients born with a cleft palate (with or without a cleft lip) undergoing palatal surgery between the ages of 9 months and 18 years. Introduction of suprazygomatic maxillary nerve (SZMN) block using ropivacaine 0.2% into clinical protocol in February 2023. Peri-procedure complications and post-operative opioid administration. The clinical anatomy of the SZMN block is described in a stepwise and pictorial approach from superficial to deep structures. 43 patients underwent surgical interventions involving the palate (either intravelar veloplasty, Furlow palatoplasty or bilateral myomucosal buccinator flaps for palatal lengthening). 22 patients had a general anaesthetic and local anaesthetic infiltration and 21 had an additional SZMN block. There were no local or systemic complications associated with the SZMN block. There was no difference in the total dosing of post-operative (P = .79) opioids between the groups. We demonstrate the feasibility and safety of this procedure without the use of ultrasound guidance in a heterogenous group of paediatric patients undergoing palatal surgery. Regional anaesthesia should be considered as part of the multi-modal analgesic strategy, although it may be difficult to demonstrate a change in opioid use in clinical settings where enhanced recovery techniques are established, and opioid use is already low.

Immunological effects of post-operative epidural analgesia versus oral opioids in VATS.

Anaesthetic choices in cancer surgery, including the use of epidural analgesia, may affect immune function during the perioperative period and might play an important role in subsequent cancer spread and recurrence. This was a prospective, randomised, controlled, double-blinded, single-centre study allocating patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy to post-operative pain management using either thoracic epidural analgesia or oral morphine. We compared pre-, per-, and post-operative plasma levels of interleukin (IL)-6, IL-10, IL-12, and interferon (IFN)-γ using regression analysis, and conducted a two-year survival follow-up. A total of 66 patients were randomised. Fifty-six received the allocated treatment and were analysed. None of the investigated cytokines exhibited significant between-group differences in plasma concentrations when adjusted for the chosen covariates (p ≥ 0.204). A two-year follow-up showed no difference in survival between the two groups (p = 0.5). Our study found no differences in the impact on the innate, non-specific immune system related to epidural analgesia for pain management in VATS. The Danish Cancer Society (R150-A10139). Oberstinde Kirsten Jensa la Cours Mindelegat (JSP-25076). University of Southern Denmark, Region of Southern Denmark and Department of Anaesthesia and Intensive Care, Odense University Hospital. NCT02359175 (ClinicalTrials.gov).

Continuing the Quest to Decrease the Need for Postoperative Opioids

Continuing the Quest to Decrease the Need for Postoperative Opioids

Reducing Post-operative Opioids in Pediatric Orthopedics: An Updated Tiered Prescription Guideline with a “Tier 0”

BackgroundThere is growing data on strategies to reduce opioid prescriptions in pediatric orthopedics. Our institution implemented tiered guidelines for opioid discharge prescriptions in 2018 to standardize prescribing patterns across our entire pediatric orthopedics practice. In 2022, we updated the tiered system with a goal to further minimize the quantity of opioids prescribed and eliminate opioids altogether for certain procedures. The aim of this project was to evaluate the effects of the updated tiered guidelines for discharge opioid prescribing following common pediatric orthopedic procedures. MethodsA quality improvement project was conducted at a single academic institution. Guidelines for discharge opioid prescriptions were updated in January 2022 and established 5 tiers of increasing invasiveness for 28 procedures. The updated guidelines included a “Tier 0” which provided no opioids, reorganized surgical tiers based on prior data, and decreased the doses recommended for tiers. Opioid prescriptions were reported as oral morphine equivalents (OMEs). Univariate tests were performed to assess statistically significant differences before and after implementation of updated guideline eras, comparing 2020-2021 and 2022. ResultsOverall, 747 patients (2020-2021, N=500; 2022, N=247) were included. The proportion of patients receiving discharge opioid prescriptions decreased from 89.8% to 80.6% (p<0.05), between 2020-2021 and 2022. This resulted in decreased overall OME prescribed (median 75 vs. 45, p<0.05) and OME prescribed in those >10 years (135 vs. 113, p<0.05) while 30-day refill rates (9.4% vs. 6.1%), and OME per kilogram in those <11 years of age (median 0.9 vs. 0.8) remained unchanged (both p>0.05). Discharge prescriptions falling within overall guidelines increased after guideline implementation (83.3% vs 85.4%), though this was not statistically significant and guideline adherence was low among Tier 0 at 31%. ConclusionsIncluding a “Tier 0” of procedures receiving no opioid prescriptions, reorganizing procedures within tiers, and decreasing the recommended doses to an already strict tiered guideline for discharge opioid prescriptions significantly decreased the quantity of opioids prescribed. We noted continued excellent overall adherence and, importantly, no overall increase in refills, with areas for improvement in Tier 0. Quality improvement projects can continue to reduce the amount of opioids prescribed following pediatric orthopedic procedures. Level of EvidenceIII

A Case Control Study of vNOTES versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy

While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy. Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m3), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia. Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.

Opioid prescription following radical orchiectomy associated with new persistent opioid use

IntroductionOpioid dependence represents a public health crisis and can be observed after outpatient urologic procedures. The purpose of this study was to evaluate the risk of persistent opioid usage after radical orchiectomy for testicular cancer. Materials and methodsThe TriNetX Research network database was queried for men between 15 and 45 years undergoing radical orchiectomy for a diagnosis of testicular cancer. All patients with N+ or M+ disease, prior opioid use, and patients who underwent chemotherapy, radiotherapy, or retroperitoneal lymph node dissection were excluded. Patients were stratified whether they were prescribed opioids or not at time of orchiectomy. The incidence of new, persistent opioid use, defined as a prescription for opioids between 3 and 15 months after orchiectomy, was evaluated. ResultsA total of 2,911 men underwent radical orchiectomy for testicular cancer, of which 89.8% were prescribed opioids at time of orchiectomy. After propensity score matching for age, race, and history of psychiatric diagnosis, 592 patients were included (296 received opioids, 296 did not). Overall, 0% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 10.5% of patients who received postoperative opioids developed new persistent opioid use. Patients prescribed postoperative opioids for orchiectomy had statistically higher risk difference of developing new persistent opioid use (Risk Difference: 10.5%; 95% CI: 7.0-14.0; Z: 5.7; P < 0.01). ConclusionsPostoperative opioid prescription following radical orchiectomy is significantly associated with developing new persistent opioid use, with 1 in 10 young men who received postoperative opioids obtaining a new prescription for opioids well beyond the postoperative period. Future efforts should emphasize nonopioid pathways for pain control following this generally minor procedure.

Opioid-free general anesthesia: considerations, techniques, and limitations.

To discuss the role of opioids during general anesthesia and examine their advantages and risks in the context of clinical practice. We define opioid-free anesthesia (OFA) as the absolute avoidance of intraoperative opioids. In most minimally invasive and short-duration procedures, nonopioid analgesics, analgesic adjuvants, and local/regional analgesia can significantly spare the amount of intraoperative opioid needed. OFA should be considered in the context of tailoring to a specific patient and procedure, not as a universal approach. Strategies considered for OFA involve several adjuncts with low therapeutic range, requiring continuous infusions and resources, with potential for delayed recovery or other side effects, including increased short-term and long-term pain. No evidence indicates that OFA leads to decreased long-term opioid-related harms. Complete avoidance of intraoperative opioids remains questionable, as it does not necessarily ensure avoidance of postoperative opioids. Multimodal analgesia including local/regional anesthesia may allow OFA for selected, minimally invasive surgeries, but further research is necessary in surgeries with high postoperative opioid requirements. Until there is definitive evidence regarding procedure and patient-specific combinations as well as the dose and duration of administration of adjunct agents, it is imperative to practice opioid-sparing approach in the intraoperative period.

Pharmacological Insights of Ropivacaine and Clinical Applications: A Narrative Review.

This review focuses on ropivacaine, a long-acting amide local anaesthetic, detailing its pharmacology and clinical applications. The article highlights its applications in providing analgesia, prolonging pain relief, and improving recovery outcomes in surgical settings. Ropivacaine is particularly effective for epidural labor analgesia in obstetrics, promoting stable hemodynamics and rapid onset when used with adjuvants. Its prolonged anesthetic effects reduce the need for postoperative opioids in peripheral nerve blocks. Intrathecal administration may enhance functional recovery and postoperative analgesia in various surgical procedures. While effective in treating acute pain, its role in chronic pain management remains unclear, indicating a need for further research. The review underscores the versatility and efficacy of ropivacaine in acute pain management and the importance of exploring its potential in chronic pain treatment.

ADVANTAGES OF USING DEXMEDETOMIDINE AS AN ADJUVANT IN LAPAROSCOPIC BARIATRIC SURGERIES

The global rise in obesity rates has necessitated an increased frequency of bariatric surgeries, posing intricate challenges in anesthesia management. Dexmedetomidine, an α2-adrenergic receptor agonist, has emerged as a potential adjunct to general anesthesia in this context. This study aimed to evaluate the efficacy and safety of dexmedetomidine in 1306 adult patients undergoing elective bariatric surgery between January 2017 and September 2023, comparing outcomes with a placebo group.Dexmedetomidine was administered during both the maintenance phase of anesthesia. Key parameters including intraoperative and postoperative complications, analgesic requirements, hemodynamics, and recovery profiles were meticulously monitored and analyzed. Dexmedetomidine demonstrated sedative and analgesic-sparing effects, coupled with cardiovascular stabilization and preservation of respiratory function. Notably, it significantly reduced the utilization of anesthetic drugs, postoperative opioids, and propofol during the surgical procedure. Furthermore, dexmedetomidine exhibited efficacy in attenuating propofol injection pain, mitigating stress responses during the critical phase of extubation, and diminishing postoperative pain along with associated analgesic requirements. However, a nuanced approach to dosage was imperative, as higher doses correlated with delayed respiratory recovery and an increased incidence of bradycardia.To summarize, dexmedetomidine as an adjuvant to general anesthesia in bariatric surgery presents notable advantages in enhancing recovery profiles, mitigating complications, and improving patient comfort. Optimal dosing strategies are paramount to harnessing its benefits while mitigating potential adverse effects, thereby optimizing perioperative care in this patient population.

Use of Baclofen Premedication as an Analgesic Adjuvant in Patients Undergoing Percutaneous Nephrolithotripsy: A Placebo-Controlled, Double-Blind Randomized Trial.

Baclofen, a clinically available GABAB receptor agonist, produces nonopioid analgesia in multiple models of pain but has had limited studies related to perioperative pain control.The present study seeks to study effects of baclofen on postoperative pain measures and opioid use in adult patients subjected to percutaneous nephrolithotomy (PCNL). Using a placebo-controlled, double-blind methodology, a single 10 mg oral dose of baclofen or placebo was given prior to a surgery in 34 patients undergoing PCNL.Standardized intraoperative and postoperative protocols related to opioid use were followed.Use of postoperative opioids in the post-anesthesia care unitand for the first 24 hours following surgery were recorded as were pain scores and other medication use. There was a significant positive correlation in the use of postoperative opioids in patients who had a preceding history of opioid use.However, there were no significant differences in opioid use which could be attributed to baclofen.There were also no differences in postoperative vital signs, side effects or other medication use. Analgesic benefits of preoperative baclofen were not observed at the dose employed.Safety of the drug was observed.

Comparative Study between Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. Aim of the Work The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB). Results The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group II from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs. Conclusion Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.

Single-shot interscalene block with liposomal bupivacaine vs. non-liposomal bupivacaine in shoulder arthroplasty

Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including nonliposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of this study was to compare pain control and opioid consumption within 48 hours postoperation in those undergoing TSA with either LIB or NLIB. This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or an NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day emergency department (ED) visits or readmissions. The primary outcome was postoperative pain and opioid use. Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (P>.05 for all). However, the LIB group had improved pain scores at 24 and 36 hours postoperation (P<.05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 numeric rating scale-11 score, between the 2 anesthesia groups after adjusting for preoperative pain and baseline opioid use (odds ratio 1.25, 95% confidence interval 0.57-2.74; P=.57). Overall, 99 of 316 patients receiving LIB (31.3%) did not require any postoperative opioids compared with 38 of 173 receiving NLIB (22.0%); however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (P=.33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (P>.05 for both). Finally, no significant differences were found in 30- and 90-day ED visits or readmission rates (all P>.05). LIB and NLIB demonstrated differences in patient-reported pain scores at 24 and 36 hours postoperation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents, and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates.