Postoperative Analgesia Group Research Articles

The efficacy of preemptive multimodal analgesia in elderly patients undergoing laparoscopic colorectal surgery: a randomized controlled trial

Objective To evaluate the effectiveness of preemptive multimodal analgesiain elderly patients undergoing laparoscopic colorectal surgery. Methods A prospective randomized controlled study was conducted in the Department of Gastrointestinal Surgery of the Second Hospital of Hebei Medical University from January 2022 to December 2022. A total of 133 patients were included according to the criteria and randomly divided into preemptive analgesia (PRA) group (test group, 67patients) and postoperative analgesia (POA) group (control group, 66patients). Results The Visual Analog Scale (VAS)scores of PRA group 24 h, 48 h, and 72 h after operation were lower than those of POA group, and the difference was statistically significant, P < 0.001.The incidences of postoperative gastrointestinal dysfunction (POGD) and postoperative delirium (POD)in PRA group were 13.43% and 8.98%, respectively, which were significantly lower than those in POA group (31.82% and 24.24%), P < 0.05. The levels of IL-6 and IL-10 in PRA group after the operation were 17.54 ± 2.13 ng/L and 15.57 ± 1.71 ng/L respectively, which were lower than those in POA group (25.45 ± 2.95 ng/L and 23.45 ± 1.88 ng/L), P < 0.05. The level of acetylcholinesterase(AchE) was 56.34 ± 5.62 nmol/L in the POA group, which was significantly higher than that in the POA group (49.59 ± 5.52 nmol/L), P < 0.001. Conclusion Preemptive multimodal analgesia can reduce the incidence of POGD and POD in elderly patients undergoing laparoscopic gastrocolic surgery, improve the recovery process of postoperative gastrointestinal function, increase the concentrations of propionic acid and butyric acid in short chain fatty acids (SCFAs) and the number of beneficial intestinal bacteria.

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial.

The optimal strategy for the management of postoperative pain after total knee arthroplasty (TKA) remains challenging, while its treatment is crucial to increase patients' outcomes. This study aimed to investigate the effects of parecoxib as add-on therapy, in a standard postoperative pain management protocol, represented by the continuous femoral nervous block. We studied its influence on rehabilitation indices and pain scoresin patients undergoing TKA. This is a single-center, prospective, double-blind, randomized, placebo-controlled trial. All patients were operated with the use of subarachnoid anesthesia, and divided into two groups for postoperative analgesia. Both groups received a continuous femoral nerve block. One of the groups received intravenous parecoxib, while the other received a placebo. The primary investigated outcome was the range of motion (ROM). Recordings were noted at different times postoperatively. Bromage score (BS), visual analogscale (VAS), and the State-Trait Anxiety Inventory (STAI) were also studied. A total of 90 patients were included and analyzed. ROM was significantly better (p<0.001) and pain scores were significantly lower (p=0.007) in the parecoxib group. No statistically significant difference was found with regardto BS between the two groups. A significant correlation was found between ROM and VAS pain scores at 12 hours (p=0.02), while ROM was inversely correlated with STAI postoperatively. The use of intravenous parecoxib is effective in improving rehabilitation indices and provides decreased postoperative pain scores after TKA.

The analgesic effect and safety of preoperative versus postoperative administration of celecoxib in patients who underwent arthroscopic rotator cuff repair: a randomized, controlled study.

Celecoxib presents a good analgesic effect in patients who undergo arthroscopic rotator cuff repair (ARCR) surgery, while few studies investigate the optimal timing of celecoxib administration. This study aimed to explore the analgesic effect of preoperative versus postoperative administration of celecoxib in ARCR-treated patients. A total of 106 ARCR-treated patients were enrolled and randomized at a 1:1 ratio into preoperative analgesia group (N = 53) and postoperative analgesia group (N = 53). The pain visual analog scale (VAS) score at rest or flexion, salvage consumption of pethidine, patient's satisfaction score, modified University of California at Los Angeles (UCLA) score and adverse events were evaluated. Pain VAS scores at rest at 12h and D1 (but not D2, D3 or D7) and pain VAS scores at flexion at 12h, D1 and D2 (but not D3 or D7) were decreased in preoperative analgesia group compared to postoperative analgesia group. Meanwhile, rescue analgesia rate and 7-day pethidine consumption in preoperative analgesia group were lower than that in postoperative analgesia group. Besides, the overall satisfaction scores at D1 and D3 (but not at D7 or M3) were elevated in preoperative analgesia group compared to postoperative analgesia group. However, no difference of modified UCLA scores at D7 or M3, or the occurrences of adverse events were found between the two groups. Celecoxib preoperative administration remits acute pain and facilitates satisfaction but does not improve long-term shoulder joint function recovery compared to its postoperative administration in patients who undergo ARCR surgery.

Effect of Bilateral Superficial Cervical Plexus Block on Postoperative Analgesic Consumption in Patients Undergoing Thyroid Surgery.

PurposePatients complain of moderate-intensity pain following thyroid surgery. Superficial cervical plexus block (SCPB) can be employed as a component of multimodal analgesia after thyroid surgery. This double-blind, randomized study aimed to compare the effects of bilateral SCPB (BSCPB) on postoperative analgesic requirements following thyroid surgery.MethodsA total of 60 American Society of Anesthesiologists (ASA) I-II patients who underwent elective total thyroidectomy under general anesthesia were randomly assigned to Group 1 and Group 2. After inducing general anesthesia, BSCPB was not administered to Group 1, whereas BSCPB was administered using a three-point injection technique with 0.5% levobupivacaine in Group 2. Patient-controlled analgesia (PCA) was applied by using tramadol in both groups for postoperative analgesia. Tenoxicam was administered as rescue analgesic to patients in case of numeric rating scale (NRS) >4. The postoperative consumption of tramadol, rescue analgesic requirement, and hoarseness, hematoma, signs of local anesthetic toxicity were recorded.ResultsThe consumption of tramadol for PCA at two, six, 12, and 24 hours postoperatively, NRS scores in the recovery room, and the number of patients who used tenoxicam as rescue analgesic were significantly lower in Group 2 than in Group 1. The hemodynamic values were similar between the groups.ConclusionsOur study demonstrates that BSCPB, when applied as a component of multimodal analgesia, is an effective method for reducing the analgesic requirements following thyroid surgery.

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

BackgroundBreast cancer is currently the leading cause of women’s death. It is crucial to further improve the approach to treatment and the long-term survival rate of breast cancer patients, and to reduce the rates of recurrence and metastasis. It has been reported that the possibility of tumor metastasis depends on the metastatic potential of the tumor and the host defense against tumor metastasis, in which cellular immunity and the function of natural killer (NK) cells are critical to maintaining this balance. Surgical stress response and postoperative pain inhibit perioperative immune function in patients and increase the likelihood of dissemination and metastasis of cancer cells after cancer surgery. The study aims to investigate the effect of anesthetic factors and pain treatment on the long-term prognosis of patients with early stage lymph node negative breast preservation surgery.MethodsA total of 337 patients with early-stage lymph node negative breast cancer (ASA I-II) who had undergone successful breast-conserving surgery in our hospital were included in this retrospective analysis. Cases were divided into general anesthesia with postoperative analgesia group (GA + PCA), general anesthesia without postoperative analgesia group (GA), epidural anesthesia with postoperative analgesia group (EA + PCA), and epidural anesthesia without postoperative analgesia group (EA). The 5-year survival rate and 5-year disease-free survival were recorded in the 4 groups.ResultsThe general condition and length of hospital stay of the patients were not statistically different between the 4 groups. However, the 5-year survival rate and 5-year disease-free survival rate of the 4 groups were statistically different. The 5-year survival rate and 5-year disease-free survival rate were the lowest in the GA group, while the EA + PCA group had the highest 5-year disease-free survival rate. The 5-year survival rate and 5-year disease-free survival rate in the GA + PCA group were significantly higher than those in the GA group. The 5-year disease-free survival rate in EA group was significantly higher than GA group.ConclusionsEpidural anesthesia and postoperative pain treatment maybe beneficial to the long-term prognosis of patients with early-stage lymph node-negative breast cancer.

Ultrasound-guided adductor canal block combined with lateral femoral cutaneous nerve block for post-operative analgesia following total knee arthroplasty: a prospective, double-blind, randomized controlled study.

The purpose of this study was to investigate whether adductor canal block (ACB) combined with lateral femoral cutaneous nerve block (LFCNB) could improve the efficacy of post-operative analgesia in a comparison with a standard peri-articular infiltration analgesia (PIA) after a total knee arthroplasty (TKA). One hundred and sixty patients of scheduled unilateral primary TKA were randomly allocated into two groups for post-operative analgesia. Eighty cases were treated with ACB combined with LFCNB and the other eighty treated with PIA. The primary outcomes were pain visual analogue scale (VAS) and rescue pain killer consumption, and the secondary outcomes were knee active range of motion (ROM), quadriceps strength, patients' ambulation ability, Knee Society Score (KSS), length of hospital stay, and adverse events. We found that ACB combined with LFCNB was better on decreasing the post-operative pain score within 12hours at rest and 8h with activity (p < 0.05) and provided longer duration of analgesia (19.91 ± 5.09 VS 12.06 ± 3.67h, p < 0.01) and less rescue morphine consumption (13.63 ± 9.84 vs 18.00 ± 11.52mg, p = 0.011) than the PIA. There was no significant difference between the two groups (p > 0.05) in terms of knee ROM, quadriceps strength, daily mobilization distance, KSS, and complication occurrence. ACB combined with LFCNB provides a significantly better pain control, less opioid consumption, and longer duration of analgesia than peri-articular infiltration while preserving muscle function without affecting knee functional recovery nor the length of stay or side effects occurrence.

Efficacy of preemptive analgesia versus postoperative analgesia of celecoxib on postoperative pain, patients\u2019 global assessment and hip function recovery in femoroacetabular impingement patients underwent hip arthroscopy surgery

We aimed to investigate the efficacy of preemptive analgesia of celecoxib on postoperative pain, patients’ global assessment (PGA) and hip function recovery compared to postoperative analgesia of celecoxib in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy surgery (HAS). The 100 FAI patients underwent HAS were randomly allocated to preemptive analgesia group (N = 50) or postoperative analgesia group (N = 50) as a 1:1 ratio for 3 months. Pain visual analog scale (VAS) score, PGA score, rescue-use pethidine consumption and Harris hip score were assessed. Compared to postoperative analgesia group, pain VAS score decreased on day 1 (P = 0.036), day 2 (P = 0.046) and day 3 (P = 0.046), while was similar prior to operation (P = 0.587), on day 7 (P = 0.398), at month 1 (P = 0.461) and month 3 (P = 0.805) in preemptive analgesia group. Besides, rescue-use pethidine consumption was decreased in preemptive analgesia group than postoperative analgesia group within 3 days (P = 0.016) and within 7 days (P = 0.033) post-operation. For PGA score, it reduced on day 2 (P = 0.030) and day 3 (P = 0.048), while was similar prior to operation (P = 0.699), on day 1 (P = 0.699), day 7 (P = 0.224), at month 1 (P = 0.640) and month 3 (P = 0.400) in preemptive analgesia group than postoperative analgesia group. For Harris hip score, it was similar prior to operation (P = 0.372), on day 7 (P = 0.366), at month 1 (P = 0.466) and month 3 (P = 0.658) between the two groups. In conclusion, preemptive analgesia of celecoxib decreases short-term postoperative pain and PGA, but without effect on long-term hip function recovery than postoperative analgesia of celecoxib in FAI patients who underwent HAS.

Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery.

This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.

Preemptive meloxicam achieves a better effect on postoperative pain control and similar tolerance compared with postoperative meloxicam in patients receiving arthroscopic knee surgery

This study aimed to compare the efficacy and safety of very early preemptive meloxicam, early preemptive meloxicam, and postoperative meloxicam administration for postoperative pain relief in patients undergoing arthroscopic knee surgery (AKS). Three hundred and six patients about to receive AKS were consecutively enrolled in this randomized, controlled study and randomly allocated into three groups: very early analgesia (VEA) group, early analgesia (EA) group, and postoperative analgesia (PA) group. Pain visual analog scale (VAS) score at rest and at flexion, patient global assessment (PGA) score, consumption of rescue pethidine, and adverse events (AEs) were assessed. Pain VAS score and severity at rest/flexion were all decreased in the VEA group compared with EA group and PA group at 4h post-operation and were also reduced in the VEA and EA groups compared with the PA group at 8h and 12h post-operation. PGA score was lower in the VEA group compared with the EA group and PA group at 4h post-operation, and was attenuated in the VEA group and the EA group compared with the PA group at 8h, 12h, and 24h post-operation as well. Consumption of rescue pethidine was less in the VEA group than that in the PA group. In addition, no difference in the incidence of AEs was found among the VEA, EA, and PA groups. In conclusion, preemptive meloxicam is more effective in postoperative pain control and equally tolerated compared with postoperative meloxicam in patients receiving AKS.

Prospective, randomized comparative study of ultrasound-guided blocking of the lateral cutaneous branches of the intercostal nerves versus conventional analgesia in non-reconstructive breast surgery

Abstract Objective The objective of this study is to determine whether the accomplishment of an interfascial blockade, the blocking of the cutaneous branches of the intercostals nerves in the axillary line (BRILMA) associated with a multimodal analgesic regimen improves post-operative analgesia and allows saving opioids after non-reconstructive surgery of breast. Material and methods A prospective, randomized and simple blind study was conducted on patients that underwent non-reconstructive breast surgery. The patients were randomly assigned to the blocking group, or to the standard post-operative analgesia group (paracetamol and dexketoprofen). The main variables analysed were the pain intensity assessed by the verbal numerical scale and the analgesic rescue needs with tramadol. Results Statistically significant differences were observed in the consumption of tramadol during the study period (10.5 mg in the BRILMA group, compared to 34.3 in the control group, p = .0001). There were also differences in the pain assessment, with lower values found in the BRILMA group. Conclusions In non-reconstructive breast surgery, performing a BRILMA block allows obtaining lower pain scores, which implies less need for rescue analgesics and a significant saving of tramadol in the study period.

Estudio prospectivo, aleatorizado comparativo entre el bloqueo guiado por ultrasonidos de las ramas cutáneas laterales de los nervios intercostales frente a analgesia convencional en cirugía no reconstructiva de mama

ObjectiveThe objective of this study is to determine whether the accomplishment of an interfascial blockade, the blocking of the cutaneous branches of the intercostal nerves in the axillary line (BRILMA) associated with a multimodal analgesic regimen improves post-operative analgesia and allows saving opioids after non-reconstructive surgery of breast. Material and methodsA prospective, randomised and simple blind study was conducted on patients that underwent non-reconstructive breast surgery. The patients were randomly assigned to the blocking group, or to the standard post-operative analgesia group (paracetamol and dexketoprofen). The main variables analysed were the pain intensity assessed by the verbal numerical scale and the analgesic rescue needs with tramadol. ResultsStatistically significant differences were observed in the consumption of tramadol during the study period (10.5mg in the BRILMA group, compared to 34.3 in the control group, P=.0001). There were also differences in the pain assessment, with lower values found in the BRILMA group. ConclusionsIn non-reconstructive breast surgery, performing a BRILMA block allows obtaining lower pain scores, which implies less need for rescue analgesics and a significant saving of tramadol in the study period.

The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery: A randomized, controlled study.

This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90o flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90o VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90o flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.

Comparação de bloqueio do plexo braquial por via interescalênica e administração de anestésico local intra‐articular no manejo da dor no pós‐operatório de cirurgia artroscópica do ombro

Background and objectivesIn this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound‐guided interscalene brachial plexus block and intra‐articular bupivacaine carried out with bupivacaine. MethodsIn the first group of patients 20mL 0.25% bupivacaine and ultrasound‐guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given via intra‐articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient‐controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. ResultsIn the ISPB group, morphine consumption in the periods between 0‐4, 6‐12 and 12‐24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6th hours (p<0.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p<0.05). ConclusionInterscalene brachial plexus block was found to be more effective than intra‐articular local anesthetic injection for postoperative analgesia.

Comparación de bloqueo del plexo braquial por vía interescalénica y administración de anestésico local intraarticular en el manejo del dolor en el postoperatorio de cirugía artroscópica del hombro

Background and objectivesIn this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intraarticular bupivacaine carried out with bupivacaine. MethodsIn the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given vía intraarticular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia with morphine was used in all three groups for postoperative analgesia. ResultsIn the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24h was lower than in the other 2 groups. Morphine consumption in the IA group was lower than in the control group in the period from 0-6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6thh (P<.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6thh were lower than in the control group (P<.05). ConclusionISPBl plexus block was found to be more effective than intraarticular local anesthetic injection for postoperative analgesia.

Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

Background and objectivesIn this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. MethodsIn the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. ResultsIn the ISPB group, morphine consumption in the periods between 0–4, 6–12 and 12–24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6th hours (p<0.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p<0.05). ConclusionInterscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection.

BackgroundCoagulation changes can complicate liver resection, particularly in patients with cirrhosis. The aim of this prospective hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia (IVPCA) with and without transversus abdominis plane (TAP) block.MethodsFifty patients with Child’s A cirrhosis undergoing liver resection were randomly divided into two groups for postoperative analgesia, ie, an IVPCA group receiving a 10 μg/mL fentanyl bolus of 15 μg with a 10-minute lockout and a maximum hourly dose of 90 μg, and an IVPCA + TAP group that additionally received TAP block (15 mL of 0.375% bupivacaine) on both sides via a posterior approach with ultrasound guidance before skin incision. Postoperatively, bolus injections of bupivacaine 0.375% were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension (subcostal approach) guided by the visual analog scale score (<3, 5 mL; 3 to <6, 10 mL; 6–10, 15–20 mL) according to weight (maximum 2 mg/kg). The top-up dosage of local anesthetic could be omitted if the patient was not in pain. Coagulation was monitored using standard coagulation tests.ResultsAge, weight, and sex were comparable between the groups (P>0.05). The visual analog scale score was significantly lower at 12, 18, 24, 48, and 72 hours (P<0.01) in IVPCA + TAP group. The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group (1.57±0.74 versus 2.2±0.41, respectively, P<0.01). Heart rate, systolic blood pressure, and fentanyl consumption were lower in the IVPCA + TAP group at 24, 48, and 72 hours (P<0.05). Intensive care unit stays were significantly shorter with TAP (2.61±0.74 days versus 4.35±0.79 days, P<0.01). Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups.ConclusionCombining TAP with IVPCA improved postoperative pain management and reduced fentanyl consumption, with a shorter stay in intensive care. TAP block can be included as part of a balanced multimodal postoperative pain regimen.

Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting (OPCABG). Upon the approval of institutional Ethics Committee and informed consent, forty patients ASAII or III aged 52-77 yr with BMI (body mass index) < 30 kg/m(2), undergoing OPCABG, were randomly divided by random numbers into two groups(n = 20 each):thoracic paravertebral block for postoperative analgesia group (group P) and patient-controlled intravenous analgesia (PCIA) group (group I). Bilateral thoracic paravertebral block and insertion epidural catheter were performed at T3, 4 interspace prior to induction of anesthesia in group P. At the end of the operation , an infusion of 0.375% ropivacaine was injected at the rate of 5 ml/h up to 48 h.Group I received PCIA with morphine. Dermatomes of hypoalgesia in group P were recorded. The following indexes were recorded at 12, 24, 36 and 48 hours after postoperative analgesia beginning: VAS scores of rest pain, cough pain and sedation score. To evaluate stability of circulation. Cycle time, complications and side effects after operation were recorded. Dermatomes of hypoalgesia was 5.1 ± 1.0 segments in group P. VAS scores of rest pain (2.4 ± 0.4, 2.6 ± 0.5, 2.4 ± 0.4, 2.2 ± 0.3 vs 3.7 ± 0.7, 3.6 ± 0.8, 3.4 ± 0.6, 3.1 ± 0.6, all P < 0.01), cough pain (3.7 ± 0.8, 3.9 ± 1.0, 3.8 ± 1.1, 3.8 ± 0.9 vs 4.4 ± 1.1, 4.9 ± 1.3, 4.8 ± 1.3, 4.3 ± 1.2, P < 0.05, <0.01) and sedation scores (2.2 ± 0.4, 2.0 ± 0.4, 1.9 ± 0.3, 1.8 ± 0.3, 2.6 ± 0.5, 2.5 ± 0.4, 2.4 ± 0.5, 2.2 ± 0.4, P < 0.05) in group P were significantly lower than in group I at the four points. The incidences of sinus tachycardia (5% vs 25%) and hypertension (0 vs 30%) in group P were significantly reduced than in group I (P < 0.05), and there were no significant difference in the incidences of sinus brachycardia (30% vs 15%) and hypotension (20% vs 10%) (P > 0.05) . Compared with group I, extubation time (5.5 ± 1.4 vs 7.1 ± 1.7) and residence time in ICU (17.3 ± 4.2 vs 21.4 ± 5.8) were shortened significantly in group P (P < 0.05), and there were no significant difference in length of stay after operation (10.5 ± 2.6 vs 11.7 ± 2.8, P > 0.05). The incidence rate of nausea in group P was significantly lower than in group I (5% vs 25%, P < 0.05), and there were no significant difference in the other complications and side effects after operation (P > 0.05). Bilateral thoracic paravertebral block for postoperative analgesia could be used safely and efficiently and accelerate the cycle time in patients after OPCABG.

Effect of preemptive analgesia with parecoxib sodium on interleukin-6 and C-reactive protein level in patients undergoing radical excision of breast cancer

Objective To investigate the preemptive analgesia of parecoxib sodium on interleukin-6 (IL-6) and C-reactive protein (CRP)level in patients undergoing radical excision of breast cancer,and to evaluate its analgesic effect.Methods Sixty ASA Ⅰ-Ⅱ patients undergoing radical excision of breast cancer were randomly divided into three groups(n=20):preemptive analgesia group(group A),blank control group(group B) and postoperative analgesia group(group C).Patients received intravenous parecoxib sodium 40 mg before 10 min(group A) or at the end of surgery(group C) or normal saline(group B).Blood samples were collected from all patients before anesthesia(T1) and at 1 h (T2),6 h (T3),24 h (T4) after surgery for assaying the plasma levels of interleukin-6 and C-reactive protein.Postoperative analgesic efficacy was assessed with visual analog scales (VAS).Results Compared with T1,the plasma levels of IL-6 and CRP were significantly higher at T2,T3 and T4 in all the three groups (P＜0.01).In group B,IL-6 and CRP levels were increased along with time progress,and were higher at T4 than at T2 (P＜0.01).The plasma levels of interleukin-6 in preemptive analgesia group at T2,T3,T4 time points were [(16.6±2.4),(27.0±3.7),(24.5 ±3.6) ng/L],lower than control group [(24.2±2.6),(32.9±4.2),(36.2±5.1) ng/L] and postoperative analgesia group [(20.8±2.7),(29.4±3.9),(31.9±4.4) ng/L] (P＜0.05).The plasma levels of C-reactive protein in preemptive analgesia group at T2,T3,T4 time points were [(10.6±2.4),(18.4±3.5),(40.7±4.3) mg/L],lower than control group [(14.9±3.2),(24.3±4.4),(54.6±5.4) mg/L] and postoperative analgesia group [12.3±2.6),(21.7±4.2),(45.6±4.8) mg/L] (P＜0.05).The VAS scores at both group A and C at 1,2,4,6 h,were [(2.1±1.0),(2.4±1.2),(2.9±1.3),(3.3±1.2)points],[(2.9±1.2),(3.2±1.2),(3.4±1.3),(3.6±1.2)points] lower than at the same time point of group B (P＜0.05).Pethidine consumption at 24 h after operation were higher in group B than in group A and group C (P＜0.05).The VAS scores were no significant differences at 12,24 h in three groups.Conclusions Preemptive analgesia with parecoxib can be achieved good analgesic effect and can effectively inhibit the postoperative of IL-6 and C-reactive protein level increased,regulate the body's inflammatory and stress response,possess immunization protection.,promote postoperative recovery. Key words: Parecoxib; Breast cancer; Preemptive analgesia; Interleukin-6; C-reactive protein

The Effects of Pregabaline on Postoperative Pain and Opioid Consumption Used Perioperatively in Patients Undergoing Modified Radical Mastectomy

In this study, effects of pregabaline on postoperative pain and opioid consumption used perioperatively in patients undergoing modified radical mastectomy(MRM) were investigated. Sixty ASA 1-2 patients scheduled for MRM were included. Patients were randomly divided into two and 30 patients were allocated into each group. Group Pregabaline was given pregabaline 150 mg 1 hr before operation and Group Placebo empty capsule. In both groups, anesthesia induction was obtained by penthotal, fentanyl and rocuronium and maintainence by sevoflurane, N2O and O2. Twelve hr after operation, Group Pregabaline was administered pregabaline 75 mg while Placebo group received empty capsule again. All patients received lornoxicam 8 mg iv 1 hr before end of surgery and ondansetrone 4 mg 30 min before. Patient-controlled analgesia device prepared with morphine was connected to both groups for postoperative analgesia. Postoperative VAS pain scores, hemodynamic parameters, morphine consumption, side-effects like nausea-vomiting, sedation and dizziness were followed and recorded. Demographic parameters were similar. VAS scores were significantly lower in Group Pregabaline at 1, 30 min, 1,4,8 and 12 hr (p<0.05). There was no significant difference in postoperative morphine consumption and need for additional dose, although they were higher in Placebo group. The patients in Placebo group had higher bothersome scores for side-effects. Hemodynamic parameters and other side-effects were similar. In our study, we showed that pregabalin administered perioperatively increased postoperative analgesic efficacy in MRM operations without making significant side effect, but did not change opioid consumption. We think that further studies about this topic must be held with different dose and patient groups.

The effect of postoperative analgesia of flurbiprofen for percutaneous vertebral angioplasty in preemptive analgesia

Objective To observe the effect of postoperative analgesia of flurbiprofen for percutaneous vertebral angioplasty in preemptive analgesia. Methods 40 paifients with ASA Ⅰ - Ⅱ level elective through skin vertebral angioplasty resection patients were seleted and randomly divided into 40 cases, flurbiprofen preemptive analgesia group(group A), and flurbiprofen postoperative analgesia group (group B). Group A was administrated with 50mg flurbiprofen before operation through intravenous, and Group B was administrated with it in the end of operation. By visual analog scale(VAS) ,the score of postoperative 0,1,4,8 and 12h level of pain and postoperative analgesia 24h overall evaluation was assessed. And the additional analgesics and deelop aderse reactions of patients were recorded.Results After operation 24h overall VAS score of group B (1.8 + 0.6) points was above that of group A (3.2 +0. 8) points (P ＜ 0.05). Both groups had no obvious adverse reactions. Conclusion Postoperative analgesia of flurbiprofen for pereutaneous vertebral angioplasty in preemptive analgesia had exact effect,convenience and less adverse reactions. Key words: Flurbiprofen; Diskectomy, Percutaneous; Analgesia