Postoperative Analgesic Requirements Research Articles

Effect of Preoperative Anxiety Level on Postoperative Analgesia Requirement in Patients Undergoing Laparoscopic Cholecystectomy

Effect of Preoperative Anxiety Level on Postoperative Analgesia Requirement in Patients Undergoing Laparoscopic Cholecystectomy

Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial

Background & Objective: Preemptive analgesia aims at minimizing the development of central sensitization thereby decreasing postoperative pain and analgesic requirements. Various drugs have been used for this purpose. Tapentadol, is a newer centrally acting analgesic which is effective in moderate to severe pain. The aim of this study was to analyze the effect of preoperative oral tapentadol upon postoperative analgesia and analgesic requirements in patients undergoing inguinal hernia surgeries. Methodology: One hundred adult patients undergoing elective unilateral inguinal hernia repair were randomized into two groups of fifty each. Group P received placebo tablets and Group T received tapentadol (100 mg) tablets orally 30 min before anesthesia. All patients received spinal anesthesia and the duration of postoperative analgesia and analgesic consumption in the first postoperative day was recorded. Diclofenac was administered when the patients demanded analgesia. Results: Time for first analgesic demand was significantly delayed in Group T as compared to Group P (328.00 ± 129.71 vs. 252.00 ± 101.38 min, P = 0.017) and the total analgesic consumption of diclofenac was also less than in the placebo group (73.33 ± 28.57 mg vs. 95.00 ± 31.30 mg; P = 0.006). No adverse events were observed in either group. Conclusion: Preemptive oral tapentadol is effective for minimizing postoperative pain and analgesic requirement in patients undergoing inguinal hernia surgeries under spinal anesthesia. Key words: Anesthesia, Spinal; Tapentadol; Hernia surgery; Analgesia, Postoperative Citation: Vadhanan P, Rajendran I, Kumar V. Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial. Anaesth. pain intensive care 2023;27(3):356−359; DOI: 10.35975/apic.v27i3.2230 Received: April 15, 2023; Reviewed: April 29, 2023; Accepted: May 10, 2023

Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery – a prospective observational study

BACKGROUND CONTENTThe goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSEThe primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries. STUDY DESIGNProspective, observational study. PATIENT SAMPLESixty patients requiring a single-level lumbar fusion surgery. OUTCOME MEASURESPostoperative pain intensity and the amount of postoperative analgesics consumption. METHODSIn our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3. RESULTSThe average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics. CONCLUSIONPreoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.

(350) Narcotic Requirements and Operative Outcomes of a Pudendal Nerve Block Prior to Primary Inflatable Penile Prosthesis Implantation in a Multiethnic Population

Abstract Introduction There are various analgesic regimens for post-operative pain control following inflatable penile prosthesis (IPP) implantation. Specifically, post-operative pain control with opioids is a common practice, but efforts to minimize narcotic usage are vital given the current opioid epidemic in the United States. Pudendal nerve block (PNB) provides regional perineal and penile anesthesia and represents an attractive option to maximize pain control while minimizing post-operative narcotic use. However, there is a paucity of studies describing whether utilization of PNBs decreases intra- and post-operative narcotic requirements following IPP implantation. Objective To determine whether PNB utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. Secondary objectives were to assess PNB utilization on intra-operative and 30-day safety outcomes. Methods A single institution retrospective study was conducted of patients who underwent primary IPP implantation between December 2015 and February 2022. Demographic data, intra-operative characteristics, and outcome measures were extracted from electronic medical records. Baseline characteristics of PNB (yes or no) were summarized and analyzed using a Student’s t-test, Chi-square test, or Mann-Whitney U for non-normally distributed variables. PNB usage and PACU opioid administration (yes or no) were analyzed using binary logistic regression for univariate and multivariate analysis. Results A total of 363 patients were included, 294 (81.0%) in the PNB group and 69 (19.0%) in the non-PNB group. The majority of patients were of Hispanic race (62.3%). History of chronic pain (17.7% vs. 7.2%, p=0.03) and hyperlipidemia (52.0% vs. 34.8%, p=0.01) were more prevalent in the PNB group. Significantly more IPPs in the PNB group had cylinders measuring 20 centimeters or greater (57.1% vs 41.2, p=0.017). Estimated blood loss of 50ml or greater (43.1% vs. 20.0%, p&amp;lt;0.001), PACU narcotic usage (61.6% vs. 75.4%, p=0.040) and time (minutes) spent in the PACU (144 [111-185] vs. 238 [162-307], p&amp;lt;0.001) were all significantly lower in the PNB group. There were no significant differences in postoperative and 30-day safety outcomes. On univariate analysis, both PNB (OR=0.52, p=0.043) and age above 65 (OR=0.53, p=0.004) were associated with a lower likelihood of receiving opiates in the PACU, while only age remained significant (OR=0.53, p=0.006) on multivariate analysis. Conclusions Pre-operative PNB decreases intra-operative estimated blood loss, post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation. Thus, PBN represents a potentially attractive, non-opioid means of analgesia in patients undergoing primary IPP surgery. Disclosure No

Correlation between FLACC scale score and analgesic requirement in children undergoing Minimally Invasive Surgery.

Postoperative pain presents several challenges in pediatric Minimally Invasive Surgery. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is a valid scale for pediatric postoperative pain. The aim of our study was to assess postoperative pain using FLACC scale and to analyze the correlation between FLACC scale score and analgesic requirement in children underwent Minimally Invasive Surgery. We retrospectively analyzed data of 153 children aged 2 months-3 years who underwent Minimally Invasive Surgery in our unit from January 2019 and December 2019. Postoperative pain assessment was established using FLACC scale. In each patient were analyzed the correlation between FLACC score and analgesic requirement. Pain evaluation was assigned immediately after surgery and at 15 and 60 minutes. 36.6% of patients (56 children) were asleep so considered pain free; 21.6% of patients (33 children) had a FLACC score more than 7 so they required analgesics and the pain assessment 15 and 60 minutes after was significantly lower. 41.8% of patients (64 children) had a postoperative FLACC score less than 3, so they didn't require any analgesic treatment. On the basis of our results, we recommend FLACC scale for postoperative pain assessment in children underwent MIS aged 2 months-3 years. FLACC scale is an effective and precise scale in detection of postoperative analgesic requirement in children and it could be extended in different age groups with further research.

Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study.

In the present study,the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeriesby observing intra- and postoperative requirements of the total doseof the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed. Sample size was calculated using referenceby taking the parameter pain score at 12 hoursusing MedCalc software v. 19.5.1 (MedCalc Software,Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted. Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min)with a p-value <0.0001. No significant complications were noted in any patient. SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.

A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed.

Perioperative opioid analgesia has been extensively reexamined during the opioid epidemic. Multiple studies have demonstrated over prescription of opioids, demonstrating the need for change in prescribing practices. A standard opioid prescribing protocol was implemented to evaluate opioid prescribing trends and practices. To evaluate opioid use after primary ventral, inguinal, and incisional hernia repair and to assess clinical factors that may impact opioid prescribing and consumption. Secondary outcomes include the number of refills, patients without opioid requirement, difference in opioid use based on patient characteristics and adherence to prescribing protocol. This is a prospective observational study examining patients undergoing inguinal, primary ventral and incisional hernias between February and November 2019. A standardized prescribing protocol was implemented and utilized for postoperative prescribing. All data was captured in the abdominal core health quality collaborative (ACHQC) and opioid use was standardized via morphine milligram equivalents (MME). 389 patients underwent primary ventral, incisional, and inguinal hernia repair, with a total of 285 included in the final analysis. 170 (59.6%) of patients reported zero opioid use postoperatively. Total opioid MME prescribed and high MME consumption were significantly higher after incisional hernia repair with a greater number of refills were required. Compliance with prescribing protocol resulted in lower MME prescription, but not actual lower MME consumption. Implementation of a standardized protocol for opioid prescribing after surgery decreases the total MME prescribed. Compliance with our protocol significantly reduced this disparity, which has the potential for decreasing abuse, misuse, and diversion of opioids by better estimating actual postoperative analgesic requirements.

A Comprehensive Review on the Efficacy of Nerve Blocks in Reducing Postoperative Anesthetic and Analgesic Requirements.

The purpose of this article review is to investigate whether or not nerve blocks are beneficial in minimizing the amount of postoperative anesthetic and analgesic medication required, hence improving patient outcomes and reducing healthcare costs. This review investigates several different kinds of nerve blocks, their administration techniques, and the anatomical and physiological aspects that influence nerve block effectiveness. It analyzes the impact of nerve blocks on opioid use, postoperative pain scores, and the incidence of opioid-related adverse effects by compiling the findings of numerous large-scale, randomized, controlled trials. Infection, hematoma, nerve injury, and systemic toxicity are some potential complications of nerve blocks discussed in the article. It concludes with recommendations for optimizing nerve block techniques in clinical practice and identifies areas that require further research, such as the development of new anesthetics and the identification of patient subgroups that would benefit the most from nerve blocks. In addition, it provides recommendations for optimizing nerve block techniques in clinical practice.

A Randomized Control Trial to Compare Hemodynamic Parameters of Patients Undergoing Percutaneous Nephrolithotomy Under Combined Spinal-Epidural and General Anesthesia in a Tertiary Hospital.

Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA). A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed. There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general anesthesia. Combined spinal epidural analgesia can be used as an alternative to general anesthesia for patients undergoing PCNL in the supine position in view of less MAP and reduced postoperative analgesic and blood transfusion requirement.

PROSPECTIVE OBSERVATIONAL STUDY COMPARING OUTCOMES AND COMPLICATIONS OF OPEN VS LAPAROSCOPIC NEPHRECTOMY

Introduction: Nephrectomy refers to surgical removal of the kidney and is further divided into simple, radical, partial and donor nephrectomy. Simple nephrectomy is conducted in irreversible kidney damage; radical nephrectomy in malignant or benign renal tumours while partial nephrectomy involves removal of part of kidney. Nephrectomy may be performed via open or laparoscopic approaches; although there is evidence favouring laparoscopy, supplementary evidence is necessary to establish it.2 This study aims to compare outcomes, complications and other parameters for laparoscopic and open surgical nephrectomy at a tertiary care centre in western India. To compare outcomes and Aim: complications for laparoscopic and open nephrectomy. Objectives: To compare: 1. Immediate and late complications. 2. A] Requirement of analgesia. B] Return of bowel functions. 3. Mean length of hospitalization and return to regular normal activity. Materials And Methods: A prospective observational single centre study was conducted at a tertiary care centre in western India. Total sample size was 49 of which 25 patients underwent laparoscopic nephrectomy while 24 patients underwent open nephrectomy. Intraoperative anaesthesia, trocar access, duration of surgery, blood loss, repeat haemoglobin and haematocrit value at post operative day 1, requirement of blood transfusion, duration of analgesics requirement, post-operative stay; histopathology report and time to resume normal activity at immediate follow up, follow up at 3 months and further follow up after surgery were noted down. Current study found statist Results: ically signicant relationship of higher intra-operative blood transfusion requirement and higher post-op requirement of Analgesia in case of open surgery. Moreover, among laparoscopy group there was signicantly lower blood loss during surgery, early time to oral diet, low pain VAS score, lower doses of Tramadol and early return to normal activity was found as compared to Open surgery group (p&lt;0.05). Laparoscopic nephrectom Conclusion: y results in less blood loss, less requirement of post operative analgesia and more rapid post operative recovery in comparison to open surgery

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

The postoperative analgesic efficacy of Transversus abdominis plane block after caesarean section: A randomized trial

: The present study was conducted to evaluate the postoperative analgesic efficacy of Transversus abdominis plane block after caesarean section and to compare it with patients who were managed conventionally without the TAP Block. The present study was conducted as a comparative study at Department of Anaesthesiology, Hamidia Hospital for a period of 1 year among 100 females undergoing caesarean section. All the selected women were randomly divided into two groups of 50 patients each. Hemodynamic parameters, pain and postoperative analgesic requirement was observed and compared between two groups. : Pain at various interval of time was significantly lower in TAP block group as compared to control group (p&amp;#60;0.01). Mean time to rescue analgesia was 356.44±91.63 min and 95.12± 24.14 min in groups TAP and control groups respectively and the observed difference was statistically highly significant (p&amp;#60;0.001). : TAP block is effective in providing postoperative analgesia among women undergoing LSCS. It is one of the excellent multimodal analgesia technique and significantly reduces the opioid requirements during postoperative period. TAP block was easy to perform, and provided reliable and effective analgesia in this study, and no complications due to the TAP block were detected.

Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position

A sore throat is an adverse postoperative consequence of tracheal intubation under general anesthesia. Recently, dexmedetomidine, an anesthetic adjuvant, has shown beneficial effects in postoperative sore throat (POST). Herein, we compared the effects of dexmedetomidine and remifentanil on POST after spinal surgery in the prone position, which is a risk factor for developing POST. Ninety-eight patients were enrolled in the dexmedetomidine and remifentanil groups. Each drug was continuously infused using the following protocol: 1 μg/kg over 10 minutes followed by 0.2 to 0.8 μg/kg/h of dexmedetomidine, 3 to 4 ng/mL during induction followed by 1 to 3 ng/mL of remifentanil intraoperatively. The incidence and severity of POST were assessed serially at 24 hours postoperatively. Postoperative hoarseness, nausea, and pain scores were measured. The incidence and severity of POST were significantly lower in the dexmedetomidine group than that in the remifentanil group. However, the incidence of hoarseness was comparable between the 2 groups. Postoperative nausea was lower in the dexmedetomidine group at 1 hour postoperatively; however, the postoperative pain score and analgesic requirements did not differ significantly. Dexmedetomidine infusion as an adjuvant during sevoflurane anesthesia significantly reduced the incidence and severity of POST in patients who underwent lumbar surgery 24 hours postoperatively.

Comparison of a blind and an ultrasound-guided technique for Retrobulbar anesthesia in dogs undergoing unilateral subconjunctival enucleation.

This study compared the quality of retrobulbar anesthesia using a blind inferior-temporal palpebral approach (ITP) with an ultrasound-guided supratemporal (ST) technique in dogs undergoing unilateral enucleation. Twenty-one client-owned dogs were undergoing enucleation. Dogs were randomly assigned to receive ITP (n = 10) or ST (n = 11) with 0.5% ropivacaine at 0.1 mL/cm of neurocranial length. The anesthetist was blinded to the technique. Intraoperative data included cardiopulmonary variables, inhalant anesthetics requirement, and requirement for rescue analgesia (intravenous fentanyl 2.5 mcg/kg). Postoperative data included pain scores, sedation scores, and need for intravenous hydromorphone (0.05 mg/kg). Treatments were compared using Wilcoxon's rank sum test or Fisher's exact test as appropriate. Comparison of variables over time were tested using a mixed effect linear model on rank. Significance was set at p = 0.05. Intraoperative cardiopulmonary variables and inhalant requirements were not different between groups. Dogs receiving ITP required median (interquartile range, IQR) 1.25 (0, 2.5) mcg/kg intraoperative fentanyl while those receiving ST required none (p < 0.01). Intraoperative fentanyl was required in 5/10 and 0/11 of dogs in the ITP and ST groups, respectively (p = 0.01). Postoperative analgesia requirements were not significantly different between groups; 2/10 and 1/10 dogs in the ITP and ST groups, respectively. Sedation score negatively affected pain score (p < 0.01). The ultrasound-guided ST technique was more effective at decreasing intraoperative opioid requirements than the blind ITP approach in dogs undergoing unilateral enucleation.

Enhanced recovery after spinal surgery protocol versus conventional care in non- insulin diabetic patients: A prospective randomized trial

ABSTRACT Background Enhanced Recovery After Surgery (ERAS) approach was proven in many surgical specialties. This prospective, randomized, single-blinded trial was designed to assess the effectiveness of ERAS on quality of recovery (QOR) after surgery in non-insulin-dependent diabetic patients. Patients and methods 72 patients undergoing elective lumbar decompressive surgery were randomly allocated to one of two equal groups receiving either ERAS protocol in group E or conventional care in group C. QOR after surgery using QOR-40 score, pain score, perioperative opioid consumption, time to early ambulation, serum markers of stress response, length of stay and possible perioperative complications were recorded. Results QOR-40 scores were significantly greater in group E at PACU, first postoperative day and second postoperative day (P = 0.015, 0.041 and 0.048, respectively). VAS was significantly lower in group E in the first eight hours postoperative. Time to first postoperative analgesic requirement was significantly longer in group E (P = 0.0001). Intraoperative fentanyl and postoperative nalbuphine requirements were significantly less in group E (P = 0.001, and 0.0001, respectively). Time to early ambulation was significantly less in group E (P = 0.006). Both CRP and interleukin-6 were significantly less at the second postoperative day in group E (P = 0.001, and 0.017, respectively). There was insignificant difference among groups in length of hospital stay and intraoperative insulin requirements (P = 0.251, and 0.347, respectively). Conclusion In non-insulin diabetic patients, enhanced recovery after spinal surgery improved quality of recovery, lowered pain scores, reduced perioperative opioid consumption, allowed early ambulation and decreased stress response but not length of hospital stay.

A Comparison of Femoropopliteal Block versus Spinal Anesthesia for Malleolar Surgeries

Background and Aim Surgery for malleolar fractures is associated with severe pain. Ultrasonography-guided nerve blocks have quality, precision, and drug dose reduction but are not preferred over spinal anesthesia. We have conducted a study to compare the effectiveness of femoropopliteal block with spinal anesthesia. Objective The aim of this study was to compare onset, duration, and hemodynamic variability and total analgesic requirement of femoropopliteal block with spinal anesthesia. Methods Preoperatively patients were divided into two groups (30 in each): Group 1—patients receiving spinal anesthesia with 0.5% hyperbaric bupivacaine; Group 2—patients receiving 15 mL in popliteal block and 5 mL in femoral block of 20 mL 0.5% bupivacaine with 8 mg dexamethasone. Onset, duration, hemodynamic changes, and postoperative analgesia requirements were monitored. Results Mean onset of sensory blockade in group 1 and 2 was 3.83 ± 0.92 and 12.68 ± 3.03 minutes (p-value &lt;0.001.) and motor blockade in group 1 and 2 was 5.36 ± 1.7 and 12.68 ± 3.03 minutes (p-value &lt;0.01), respectively. Mean duration of analgesia in group 1 and 2 was 3 ± 1.31 and 20.2 ± 4.7 hours, respectively. None of the patients in group 2 and 3% in group 1 had hypotension and bradycardia (p-value &gt; 0.05). The mean dose of morphine required in group 1 and 2 was 20.3 ± 2.1 and 3.56 ± 0.02 mg in 24 hours (p-value &lt; 0.001), respectively. Conclusion Femoropopliteal block was slower in onset but produced longer postoperative analgesia with markedly reduced opioid consumption.

Efficacy of erector spina plane blocks and paravertebral blocks in kyphoplasty surgery

Aims: Kyphoplasty (KP) surgeries are commonly performed under local, general and regional anesthesia. The purpose of our study was to compare the perioperative and postoperative effects of ultrasound (USG) guided erector spinae plane blocks (ESPB) and paravertebral blocks (PVB) in patients with KP. Methods: Forty patients who underwent kyphoplasty were evaluated retrospective as Group 1 (ESPB, n=20) and Group 2 (PVB,n=20). Perioperative additional opioid, hemodynamic parameters, complications, postoperative analgesia requirement, pain with visual analog scale (VAS) at specified times, amount of analgesic used within 24 hours, first mobilization and discharge time, and complications were compared. Results: There was no difference between the study groups regarding demographic data, ASA, preoperative analgesic use, mean arterial pressure (MAP), heart rate (HR), SpO2, additional opioid requirement, perioperative complication rates, VAS and surgical level. A significant difference was observed between Group 1 and Group 2 regarding the VAS score and paracetamol dose at 6 hours postoperatively (p:0.023 and p:0.006, respectively). There was no statistical difference between the groups first mobilization and discharge time, postoperative complications, postoperative intensive care needs (PICU), and tramadol dose rates used (p&gt;0.05). Conclusion: The USG-guided ESPB and PVB did not appear superior to one another in kyphoplasty procedures regarding 12 and 24-hour VAS scores, first mobilization and discharge time, postoperative complications, PICU needs and tramadol dose. The analgesic effect of ESPB in KP surgery was superior to that of PVB, 6hours postoperatively. Therefore, it is possible to consider them a safe and alternative method of anesthesia and analgesia.

Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3-4, 6-8, 12-16 and 24h. Opioid consumption in the first postoperative 24h was significantly lower in the NB group (MD=- 9.02, 95% CI - 14.29 to - 3.75, P<0.05), I2=95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD=43.15, 95% CI 4.74-81.56, P<0.05, I2=96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07-0.28, P<0.05, I2=0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22-0.48; P<0.05; I2=0%). There was no significant difference in operation duration between the two groups. Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical pleth index monitoring in perioperative pain management: usefulness and limitations.

Surgical pleth index (SPI) monitoring is a representative, objective nociception-monitoring device that measures nociception using photoplethysmographic signals. It is easy to apply to patients and the numerical calculation formula is intuitively easy to understand; therefore, its clinical interpretation is simple. Several studies have demonstrated its efficacy and utility. Compared with hemodynamic parameters, the SPI can detect the degree of nociception during surgery under general anesthesia with greater accuracy, and therefore can provide better guidance for the administration of various opioids, including remifentanil, fentanyl, and sufentanil. Indeed, SPI-guided analgesia is associated with lower intraoperative opioid consumption, faster patient recovery, and comparable or lower levels of postoperative pain and rates of adverse events compared with conventional analgesia. In addition, SPI monitoring allows for the degree of postoperative pain and analgesic requirements to be predicted through the SPI values immediately before patient arousal. However, because patient age, effective circulating volume, position, concomitant medication and anesthetic regimen and level of consciousness may be confounding factors in SPI monitoring, clinicians must be careful when interpreting SPI values. In addition, as SPI values can differ depending on anesthetic and analgesic regimens and the underlying disease, an awareness of the effects of these variables with an understanding of the advantages and disadvantages of SPI monitoring compared to other nociception monitoring devices is essential. Therefore, this review aimed to help clinicians perform optimal SPI-guided analgesia and to assist with the establishment of future research designs through clarifying current usefulness and limitations of SPI monitoring in perioperative pain management.

General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized &gt;20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials (RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien–Dindo grade II (OR: 0.68; 95% CI: 0.49 – 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 – 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 – 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 – -5.41; p&lt;0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 – -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 – 0.20; p&lt;0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 – 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.