Postoperative Analgesic Requirements Research Articles

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>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.

Analgesic efficacy and safety of epidural and paravertebral blocks in thoracotomy surgery

Objectives: Epidural anesthesia, once considered a gold standard, has significant complications: hypotension, urinary retention, and catastrophic neurological damage in rare cases. While paravertebral analgesia can provide similar analgesic effectiveness to epidural analgesia, it is associated with fewer side effects. To compare the perioperative and postoperative effects of epidural (ED) and ultrasound-guided paravertebral block (PVB) applications in thoracotomy surgeries. Methods: Fifty-two patients underwent elective thoracotomy; Group 1 (ED, n = 23) and Group 2 (PVB, n = 29) were evaluated. A comparison of hemodynamic parameters and complications preoperatively and postoperatively, postoperative analgesia requirements, visual analog scale (VAS) pain scores within 24 hours at specified times, the amount of analgesic used, the time to mobilize, the time to discharge, and the VAS values measured at three months was made. Results: There was no difference between the study groups regarding demographic and ASA values, most comorbid chronic diseases, obesity, and smoking. The number of attempts, the postoperative 2nd hour VAS score, and the doses of paracetamol and tramadol used was significantly higher in Group 1 than in Group 2 (p = 0.002, p = 0.002, p = 0.012, and p = 0.022, respectively). There was no statistical difference between the groups in terms of postoperative 6, 12, 24 hours, and 3 months VAS scores, first mobilization and discharge, time to remove the thorax tube, intensive care (PACU) need, and perioperative and postoperative complications (p &amp;gt; 0.05). Conclusions: Ultrasound-guided PVB can be considered a safe and effective alternative to ED in thoracotomy surgery.

Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study.

This study aimed to investigate the analgesic effect of ultrasound-guided transversus thoracis plane block (TTPB) combined with intermediate cervical plexus block (ICPB) in the early postoperative period after trans-areolar endoscopic thyroidectomy. A total of 62 female patients undergoing trans-areolar endoscopic thyroidectomy were randomly classified to the TTPB combined with ICPB group with ropivacaine (block group) or superficial cervical plexus block group (control group). The primary outcome measures were resting visual analogue scale (VAS) in the chest area at 6 h after surgery. The secondary outcome measures included chest resting and movement VAS score, neck resting and movement VAS score within 24 h after surgery, intraoperative remifentanil consumption, postoperative analgesia rate and analgesic requirements and patient satisfaction score for pain management at discharge. Compared with the control group, the block group at rest showed consistently lower VAS scores in the chest area at 6 and 12 h after operation; the block group at rest showed lower VAS scores in the neck at 6, 12 and 24 h after operation. Regarding movement, the VAS scores of the chest and neck area at 2, 6, 12 and 24 h after the operation were lower in the block group than in the control group. The consumption of remifentanil, rate of postoperative analgesic requirements, and consumption of postoperative rescue analgesia in the block group were lower than those in the control group. Satisfaction with pain treatment at discharge was higher in the block group than in the control group. Ultrasound-guided TTPB combined with ICPB provides good analgesic effect in the early postoperative period after trans-areola endoscopic thyroidectomy.

ANALGESIC EFFICACY OF ULTRASOUND GUIDED BILATERAL SUBCOSTAL TRANSVERSUS ABDOMINIS MUSCLE PLANE BLOCK AND PORT SITE INFILTRATION WITH BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane block in comparison to port-site local anesthetic infiltration in patients undergoing elective lapa­roscopic cholecystectomy. Methodology: It was a Quasi experimental study, conducted in Combined Military Hospital Rawalpindi, over 6 months, from 13/4/21 till 13/10/2021. Patients numbering 92 of both genders fulfilling inclusion criteria were incorporated and placed into 2 groups equally. Group O (n=46) underwent ultrasound guided bilateral subcostal transversus abdominis plane block using 0.25% bupivacaine with volume dosage of 0.4ml/kg divided by 2, one part for each side. In Group-P (n=46) total dose of bupivacaine (0.25%, volume dose of 0.4ml/kg) was divided by total number of ports used and one portion was infiltrated at each port-site at the completion stage of surgery. Post-operative pain score, quantity of post-operative analgesia and patient satisfaction scores were calculated. Results: Mean tramadol usage in Group-O was 109.56 ± 15.04 mg compared with 155.21 ± 22.18 mg of Group-P (p value &lt;0.001 for both). Visual Analog pain scores were lesser in Group-O all the times. Patient satis­faction scores were 3.30 ± 0.66 and 2.71 ± 0.98 for Group-O and Group-P respectively. Conclusion: Ultrasound guided subcostal Transversus abdominis plane block is effective in contributing to post-operative analgesia following laparoscopic cholecystectomy and is superior to port site infiltration. It decreas­es pain scores, post-operative analgesia requirement and increments patient satisfaction compared with port-site infiltration.

A descriptive study of day care stapled hemorrhoidopexy surgery in grade-4 hemorrhoids under pudendal block

Background: Hemorrhoids are one of the most common afflictions of human beings from times immemorial. It is said that 40% of population have symptoms due to hemorrhoids at some time in their lives. Stapled hemorrhoidopexy under local anesthesia has been emerging as the procedure of choice for symptomatic hemorrhoids. Aims and Objectives: The objectives of the study are as follows: (1) To assess the advantage of performing stapled hemorrhoidopexy under local pudendal block. (2) To study the post-operative complications after stapled hemorrhoidopexy. (3) To assess the feasibility of stapled hemorrhoidopexy in grade IV hemorrhoids. (4) To assess the advantages of stapled hemorrhoidopexy in anal skin regression after surgery. Materials and Methods: 50 patients of grade 4 hemorrhoids were operated by hemorrhoid stapler under local anesthesia. Results: Stapled hemorrhoidopexy under local anesthesia can be safely performed as a day care procedure in grade IV hemorrhoids. Patients following stapled hemorrhoidopexy under local anesthesia have reduced post-operative pain, hospital stay, analgesic requirements, and earlier return to work, early mobility out of bed, less operative time, short learning curve, less operative complications, cost effectiveness, and good patient satisfaction. Conclusion: Stapled hemorrhoidopexy under local anesthesia is feasible to be used in those patients who are unwilling and unfit for other modes of anesthesia with better results with lesser complication rate and as a day care procedure.

Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?

To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer. Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response. Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%) underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra- and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis. Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer.

Comparison of lateral transperitoneal versus retroperitoneal laparoscopic adrenalectomy for pheochromocytoma: a single-centre retrospective study.

Laparoscopic adrenalectomy (LA) has became the standardized treatment for pheochromocytoma. The aim of this study was to evaluate outcomes of lateral transperitoneal and retroperitoneal LA for pheochromocytoma. Between January 2011 and December 2021, 142 patients with pheochromocytoma underwent LA via lateral transperitoneal (123 patients) or retroperitoneal (19 patients) approaches. Data of these patients were assessed to investigate the differences in perioperative outcomes and intraoperative haemodynamic parameters between the two procedures. Clinical parameters at presentation were comparable between the two groups, except for tumour size, which was larger in the transperitoneal group (50 [10-115] mm vs 35 [7-110] mm, P = 0.012). There were no significant differences between the two groups in terms of operation time, estimated blood loss, intraoperative transfusion rate, incidence of complications, conversion to open surgery, postoperative analgesic requirement, time to first oral intake, or mean hospital stay. Intraoperative haemodynamic parameters of the two groups were similar. After adjusting for tumour size using propensity score matching, both perioperative outcomes and haemodynamic parameters were still comparable. Lateral transperitoneal and retroperitoneal laparoscopic adrenalectomies provide similar perioperative and haemodynamic outcomes for surgical resection of pheochromocytoma.

Ketamine infiltration decreases the need for opioids after thyroid surgery

Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.

Opioid versus Nonopioid Analgesia for Craniotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Despite the use of intraoperative opioid analgesia, postoperative pain is often reported by patients undergoing craniotomies. Opioids also cause undesirable side effects in neurosurgical patients. Hence, the role of nonopioid analgesia has been explored for craniotomies in recent years. This systematic review evaluated evidence from randomized controlled trials (RCTs) comparing opioid and nonopioid analgesia during craniotomies regarding postoperative pain, recovery, and adverse events. Of the 10,459 records obtained by searching MEDLINE, Embase, and Web of Science databases, 6 RCTs were included. No difference was observed in pain scores between opioid and nonopioid analgesia at 1 and 24 hours after surgery: mean difference (MD), 1.11 units; 95% confidence interval [CI],-0.16 to 2.38, P= 0.09 and MD,-0.06 units; 95% CI,-1.14 to 1.01, P= 0.91, respectively. The time for first postoperative analgesic requirement was shorter with opioids but was not statistically significant (MD,-84.77 minutes; 95% CI,-254.65 to 85.11; P= 0.33). Postoperative nausea and vomiting (relative risk= 1.60; 95% CI, 0.96-2.66; P= 0.07) was similar but shivering (relative risk= 2.01; 95% CI, 1.09-3.71; P= 0.03) was greater in the opioid group than nonopioid group. There were no important differences in clinical outcomes between the groups in our review. The GRADE certainty of evidence was rated low for most outcomes. Available evidence does not suggest superiority of intraoperative nonopioid over opioid analgesia for postoperative pain in patients undergoing craniotomy. More studies are needed to firmly establish the role of nonopioid intraoperative analgesics as an alternative to opioids in this population.

Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Study Comparing Ropivacaine and Ropivacaine With Dexamethasone.

Patients with hip fractures will be experiencingexcruciating pain, which would preventthe ideal positioning of the patient for the neuraxial blockade. There is growing interest in using regional nerve blocks for pain in the elderly associated with a fractured hip. Pericapsular Nerve Group (PENG) block is gaining popularity as a provider of adequate analgesia in patients suffering from a hip fracture. The present study aimed to assess the effectiveness of PENG block using ropivacaine alone or ropivacaine with dexamethasone in reducing pain scores during patient positioning for the central neuraxial blockade and to compare the duration of postoperative analgesia. This randomized double-blinded study was conducted on patients posted for hip surgery under spinal anesthesia at a tertiary care referral hospital between January 2021 and May 2022. Twenty-eight patients (14 in each group) were randomly allocated to receive either group A (20 ml of 0.5% ropivacaine for PENG block) or Group B (20ml of 0.5% ropivacaine with 8mg Dexamethasone for PENG block) before patient positioning for subarachnoid block. Intra-operative hemodynamic variables, pain scores on a visual analog scale (VAS), at rest and with movement, before block, at the time of positioning for spinal anesthesia, time for first rescue analgesic request, and the total dosage of rescue analgesia in the first 24 hours after PENG block were measured. Pain scores at rest and with movement at baseline and at the time of positioning for spinal anesthesia were significant within the groups (p< 0.01). The time for the first rescue analgesic requirement was significantly longer in group B (445.0 ±17.4 minutes) than in group A (388.9±19.0 minutes) (p<0.05). The mean average number of doses of rescue analgesia (Tramadol in milligrams) was significantly lower in group B (190 ± 60) than in group A patients (250 ± 70) (p<0.05). The present study documented the effectiveness of PENG for patient positioning during the neuraxial blockade. Further, the addition of dexamethasone as an adjunct to ropivacaine yields a significantly longer duration of postoperative analgesia with a lowerpostoperative analgesic requirement.

Opioid Reduced Anesthesia in Major Oncologic Cervicofacial Surgery: A Retrospective Study.

This is a retrospective case-controlled study of 172 patients with major cervicofacial oncologic surgery. Group ORA (dexmedetomidine and lidocaine), n = 86, was compared to patients treated with standard opioid based anesthesia, Group control, n = 86. The main endpoint was to study perioperative opioid consumption and postoperative pain scores, and the secondary endpoint was to observe opioid related side effects. The ORA group received 6.2 ± 3.1 mg morphine titration at the end of surgery, while the control group received 10.1 ± 3.7 mg p < 0.0001; there was no significant difference in post-operative analgesia requirements and pain scores between the groups. Intraoperatively, the ORA protocol yielded bradycardia in 4 persons, while in the control group, only 2 persons had bradycardia necessitating intervention, p < 0.05. Postoperatively, episodes of hypoxemia (50%) and the need for additional pressure-assisted ventilation (6%), was significantly different in the ORA group than in the control group (70% and 19%), p < 0.05. There was no difference between the two groups for the incidence of nausea and vomiting, ileus, or postoperative delirium. ORA was not associated with a decrease in postoperative pain and opioid requirement, but possibly reduced the incidence of hypoxemia and the use of additional pressure-assisted ventilation, although we cannot rule out confounding factors. The possible benefits of ORA remain to be demonstrated by prospective studies.

Can Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, or Systemic Immune Inflammation Index Be an Indicator of Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy?

Through this study, we aim to investigate whether biomarkers like the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) might predict the postoperative first 24 hours analgesic requirement and pain scores of patients undergoing laparoscopic cholecystectomy. Material & Method: After receiving the local ethical board approval, records of 67 patients, aged between 18 and 75 years, with ASA classifications I-III who underwent elective laparoscopic cholecystectomy were retrospectively evaluated to record postoperative analgesic requirements and numerical pain scale (NRS) scores. NLR, PLR, and SII scores were calculated from preoperative hemograms and compared with analgesic requirements and NRS scores. The data of 67 patients were evaluated. There was no correlation between postoperative tramadol use and NRS scores, PLR, or SII values (p>0.05). NRS scores and the cumulative 24-hour postoperative tramadol use were correlated (p=0.0001), as it was observed that patients with high NRS scores used higher amounts of tramadol.Additionally, a poor statistically significantcorrelation was found between PDW (Platelet distribution width) value and tramadol dose (AUC = 0.611). No significant association between NLR, PLR, SII, pain scores, and tramadol use wasdetected.

Intraoperative administration of methadone reduced postoperative pain and opioid consumption following cadaveric renal transplantation: a randomized controlled trial

Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed.&#x0D; Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications.&#x0D; Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P &lt; 0.001).&#x0D; Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery.

Evaluation of a constant rate intravenous infusion of dexmedetomidine on the duration of a femoral and sciatic nerve block using lidocaine in dogs.

This study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Client-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005-0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t-test and a Kaplan-Meier test (p < 0.05). Twenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer (p < 0.001) for group D [168 (146-191, 95% CI), 161 (143-179, 95% CI) min] than in group C [120 (96.1-144, 95% CI), 116 (90.9-142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different (p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C. Dexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours.

Is laparoscopic pyelolithotomy an alternative to percutaneous nephrolithotomy for treatment of kidney stones larger than 2.5cm in pediatric patients?

The aim was to compare laparoscopic pyelolithotomy and percutaneous nephrolithotomy in terms of efficacy and safety for the treatment of renal pelvis stones larger than 2.5cm in pediatric patients. Our study consisted of two groups. Group 1 included 33 patients who underwent laparoscopic pyelolithotomy (LPL) between January 2013 and March 2022, and group 2 included 39 patients who underwent percutaneous nephrolithotomy (PCNL). The basic clinical parameters of the patients were recorded. Mean operation time, stone size, estimated blood loss, blood transfusion rate, postoperative hospital stay, stone-free rate, postoperative analgesia requirements, intraoperative complications, and early and late postoperative complications were compared between the two groups. In our study, the mean age of the patients in groups 1 and 2 was 8.89 ± 1.58years and 9.1 ± 1.85years, respectively (p = 0.657). The mean stone size was 2.37 ± 0.38cm in group 1 and 2.55 ± 0.45cm in group 2 (p = 0.64). The mean operation time was 85.65 ± 20.55min in group 1, while it was 76.11 ± 13.12min in group 2 (p = 0.08). The stone-free rate was 100% in both groups. Intraoperative mean blood loss, need for postoperative analgesia, blood transfusion and intraoperative complication rates were significantly higher in the PCNL group (p < 0.01, p = 0.02, p < 0.01, p < 0.01, respectively). Our results show that laparoscopic pyelolithotomy is a safe and effective method for pediatric patients with large kidney stones.

An Observational Study Comparing Hybrid Transvaginal Notes and Four-Port Laparoscopic Cholecystectomy.

Recently, a great interest has arisen in hybrid natural orifice transluminal endoscopic surgery-cholecystectomy (NOTES-C). It has the potential to causeless postoperative pain and may offer better cosmesis over conventional laparoscopic cholecystectomy (CLC). A total of 112 females who underwent conventional cholecystectomy were compared with 108 patients of hybrid transvaginal NOTES-cholecystectomy (TV NOTES-C). We compared intraoperative factors, postoperative pain, the analgesic requirement at different intervals, duration of hospital stay, and time to return to normal activities. In addition, cosmesis and patient satisfaction were assessed at four weeks. Postoperative pain and analgesic requirement were less in the hybrid TV NOTES-C group (p<0.001 at 95% CI). Hybrid TV NOTES-C patients were discharged more frequently within 12 hours (27.5% versus 1.8%; p<0.001) and returned faster (2.22 versus 4.62 days; p<0.001) to normal activities.Cosmetic results and short-term quality of life as assessed by the patient and observer scar assessment scale (POSAS) and short form-36 (SF-36) scores, respectively, were better in the hybrid TV NOTES-C group (p<0.001 at 95% CI). Hybrid TV NOTES-C is associated with reduced postoperative analgesic requirements, faster return to normal activities, better cosmesis, and patient satisfaction compared to conventional four-port cholecystectomy.

Dexamethasone as an adjuvant to local anesthetic mixture in brachial plexus block: A prospective randomized double-blind controlled trial

Introduction: Peripheral neural blockade is now a well-accepted component of comprehensive anesthetic care. Many adjuvants such as dexmedetomidine, clonidine, opioids, ketamine, and midazolam and corticosteroids have been used; however, still the search for ideal adjuvant is in process. The purpose of this study was to investigate whether addition of 8 mg dexamethasone to local anesthetic solution for brachial plexus block would prolong the period of postoperative analgesia. Materials and Methods: This was a prospective double-blind randomized controlled trial. Forty patients between the age of 20 and 65 years, of either sex of the American Society of Anesthesiologists Grade I-III, who were undergoing upper limb surgery, were selected to study the quality of brachial plexus block and duration of postoperative analgesia produced by addition of dexamethasone to local anesthetic solution versus plain local anesthetic solution in the infraclavicular brachial plexus block. Results: Demographic parameters such as age, weight, height, and body mass index were comparable between two groups with P > 0.05. We also observed that onset of sensory and motor block was earlier in Group I, and duration of motor and sensory block was more in Group I. There was a less requirement of postoperative analgesics. Furthermore, the incidence of postoperative complications was less in Group I compared to Group II. Conclusion: We conclude that addition of dexamethasone to local anesthetic solution for brachial plexus block sets the sensory block early, increases the duration of sensory block without any side effect, provides improved patient comfort, effective pain relief, and decreases the requirement of postoperative supplementary analgesic.