Postoperative Analgesic Usage Research Articles

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

Charting Proficiency: The Learning Curve in Robotic Hysterectomy for Large Uteri Exceeding 1000 g.

Background/Objectives: This study evaluates the safety and surgical outcomes of performing robotic hysterectomy on uteri weighing over 1000 g, with a focus on the surgeon's learning curve. Methods: A retrospective analysis was conducted on 44 patients who underwent hysterectomy by a single surgeon from January 2020 to February 2024 using the DaVinci Xi System. Surgical procedures included total hysterectomy with bilateral salpingectomy, and specimens were removed via transvaginal manual morcellation. Operative times were segmented into docking, console, morcellation, and conversion times. Results: Results indicated an inflection point in the 20th case, suggesting proficiency after 20 surgeries. Comparison between early (Group A, cases 1-20) and later cases (Group B, cases 21-44) showed significant reductions in console time (CT) and morcellation time (MT) in Group B, leading to a shorter overall operative time (OT). Although estimated blood loss was higher in Group A, it was not statistically significant. Hemoglobin differences were significantly higher in Group B. No significant differences were observed in transfusion rates, postoperative analgesic usage, or complications between the groups. Conclusions: The study concludes that robotic hysterectomy for large uteri is safe and that surgical proficiency improves significantly after 20 cases, enhancing overall outcomes.

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 μg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Assessment of Discomfort and Analgesic Usage Following Pediatric Dental Procedures in India: A Cross-Sectional Study.

Pain management in pediatric dentistry is crucial for ensuring positive treatment outcomes and reducing patient suffering. This study aimed to evaluate postoperative discomfort and analgesic usage among pediatric dental patients undergoing various procedures in India. A cross-sectional study was conducted at a tertiary care dental hospital in India from June 2023 to December 2023. A total of 150 pediatric patients aged 2-18 years who underwent different dental procedures were included. Data on postoperative discomfort and analgesic usage were collected immediately following the procedure and during follow-up phone calls. Significant differences were found in immediate postoperative discomfort following pulpotomy (P = 0.03). Patients receiving primary stainless steel crowns (SSCs) alone or in combination with pulpotomy were significantly more likely to report discomfort (P < 0.001 and P < 0.05, respectively). No significant associations were observed between discomfort and sealants, preventive resin restorations, 1- or 2-surface restorations, or extractions. Over-the-counter analgesic usage was prevalent, particularly following SSC placement. This study highlights the variability in postoperative discomfort among pediatric dental patients undergoing different procedures in India. Tailored pain management strategies based on specific procedures are essential to minimize discomfort and improve patient outcomes in pediatric dentistry.

Effect of Oxycodone-Based Multimodal Analgesia on Visceral Pain After Major Laparoscopic Gastrointestinal Surgery: A Randomised, Double-Blind, Controlled Trial.

Oxycodone is a potent μ- and κ-opioid receptor agonist that can relieve both somatic and visceral pain. We assessed oxycodone- vs sufentanil-based multimodal analgesia on postoperative pain following major laparoscopic gastrointestinal surgery. In this randomised double-blind controlled trial, 40 adult patients were randomised (1:1, stratified by type of surgery) to receive oxycodone- or sufentanil-based multimodal analgesia, comprising bilateral transverse abdominis plane blocks, intraoperative dexmedetomidine infusion, flurbiprofen axetil, and oxycodone- or sufentanil-based patient-controlled analgesia. The co-primary outcomes were time-weighted average (TWA) of visceral pain (defined as intra-abdominal deep and dull pain) at rest and on coughing during 0-24 h postoperatively, assessed using the numerical rating scale (0-10) with a minimal clinically important difference of 1. All patients completed the study (median age, 64 years; 65% male) and had adequate postoperative pain control. The mean (SD) 24-h TWA of visceral pain at rest was 1.40 (0.77) in the oxycodone group vs 2.00 (0.98) in the sufentanil group (mean difference=-0.60, 95% CI, -1.16 to -0.03; P=0.039). Patients in the oxycodone group had a significantly lower 24-h TWA of visceral pain on coughing (2.00 [0.83] vs 2.98 [1.26]; mean difference=-0.98, 95% CI, -1.66 to -0.30; P=0.006). In the subgroup analyses, the treatment effect of oxycodone vs sufentanil on the co-primary outcomes did not differ in terms of age (18-65 years or >65 years), sex (female or male), or type of surgery (colorectal or gastric). Secondary outcomes (24-h TWA of incisional and shoulder pain, postoperative analgesic usage, rescue analgesia, adverse events, and patient satisfaction) were comparable between groups. For patients undergoing major laparoscopic gastrointestinal surgery, oxycodone-based multimodal analgesia reduced postoperative visceral pain in a statistically significant but not clinically important manner. Chinese Clinical Trial Registry (ChiCTR2100052085).

Investigating the clinical outcomes of bulking agent injection in comparison with modified Gil-Vernet anti-vesicoureteral reflux surgery in children with high-grade reflux (4 or 5)

BackgroundVesicoureteral reflux (VUR) is a common condition associated with childhood urinary tract infection (UTI) that can lead to chronic renal failure and hypertension. Various anti-reflux treatments were advocated, with various degrees of morbidity and success. The purpose of this study is to analyze and compare the results of modified Gil-Vernet anti-reflux surgery and bulking agent injection in children with unilateral high-grade reflux.MethodsThe study involved 179 patients who underwent surgical interventions for primary VUR from February 2013 to September 2019. Data on baseline demographics, preoperative symptoms, radiological imaging studies, and postoperative outcomes were analyzed. Treatment goal was defined as when no VUR or downgrading was detected 6 months or later after the intervention.ResultsA total of 128 patients underwent modified Gil-Vernet anti-reflux surgery and 51 patients underwent dextranomer/hyaluronic acid (Dx/HA) injection with mean VUR grading of 4.3 in both groups (P = 0.687). The overall VUR resolution rates were significantly higher in modified anti-reflux surgery rather than Dx/HA injection (86% vs. 68%, P = 0.021). Dx/HA injection was associated with shorter operation time (21 ± 8 min vs. 57 ± 11 min, P = 0.01), and shorter hospital stay (0.34 ± 0.22 days vs. 3.50 ± 0.50 days, P < 0.001). No major complications were identified in both groups.ConclusionsDx/HA injection has a significantly shorter operation time, lower postoperative analgesic usage, and shorter hospital stay, modified Gil-Vernet anti-reflux surgery is associated with significantly higher VUR downgrading and resolution rates than Dx/HA injection, particularly in the higher grade VUR.

A randomised controlled trial to study the analgesic efficacy of transversus abdominis plane block for adult undergoing elective laparoscopic appendectomy

Background: Laparoscopic appendectomy has evolved over the years as a minimally invasive approach for appendicitis. Routinely opioids are used for pain control postoperatively, however, its widespread use has numerous side effects and delays postoperative recovery. More recent studies have shown that transversus abdominis plane block reduces postoperative pain and analgesic drug usage. This study aims to evaluate the impact of transversus abdominis plane block in managing postoperative pain following elective laparoscopic appendectomy. Methods: A prospective, randomized, double-blind trial was performed on patients undergoing elective laparoscopic appendectomy. Patients were randomized to receive a TAP block with 0.25% bupivacaine and a control group receiving a TAP block with normal saline infusion. Laparoscopic port sites were infiltrated with bupivacaine in the control group and normal saline in the TAP block intervention group before starting the surgery. Postoperative pain scores were recorded using the visual analog scale scores at dedicated time points. Results: A total of 20 patients were included in the control group and 19 in the TAP block group. Visual analog scale scores were significantly reduced in the TAP block group at 6 hours, 12 hours, and 18 hours (p&lt;0.001 in each). However, there was no significant reduction in the visual analog scale score at 24 hours (p=0.015). There was no significant difference between postoperative nausea (p=0.18), and length of postoperative hospital stay (p=0.93) between the two groups. Consumption of rescue analgesics and antiemetics in the first 24 hours postoperatively between both groups was statistically significant (p=0.005). Conclusions: Bilateral TAP block is safe and effective in reducing the need for analgesics and antiemetics in patients undergoing laparoscopic appendectomy in the postoperative period. In addition, there is a significant improvement in visual analog scale scores in patients after TAP block.

7829 Ultrasound Guided Quadratus Lumborum Block for Improved Postoperative Analgesia in Minimally Invasive Gynecologic Surgery

<h3>Study Objective</h3> To determine whether the quadratus lumborum block (QLB) is an effective analgesic adjunct in the control of postoperative pain in the first 24 hours after minimally invasive hysterectomy. <h3>Design</h3> Prospective cohort observational study of women who underwent laparoscopic or robotic hysterectomy for benign indication. Patients either received a QLB or did not receive a QLB and postoperative pain scores were recorded, using the numeric rating scale. The primary outcome was the 3-hour pain score. The secondary analysis evaluated postoperative use of analgesic medication in the first 24 hours. <h3>Setting</h3> 1 and 3-hour postoperative pain scores were recorded in the post anesthesia recovery area. Patients were called to collect 24-hour pain scores and postoperative analgesic medication usage. <h3>Patients or Participants</h3> 50 patients were included in the study; 25 received a preoperative QLB and 25 patients did not receive a QLB. <h3>Interventions</h3> During QLB, a local anesthetic is injected under ultrasound guidance between the quadratus lumborum muscle and the thoracolumbar fascia to provide analgesia to T4 to L1 dermatomes. <h3>Measurements and Main Results</h3> The median postoperative pain score at 1-hour was 4/10 and 5/10 (p=0.541), 3-hour was 2/10 and 3/10 (p=0.418), and 24-hour was 6/10 and 6/10 (p=0.358) in the non-QLB and QLB groups respectively. 11 of 25 patient's vs 11 of 25 patients at 1-hour (p=1.0), 8 of 25 patients vs 18 of 25 patients at 3-hour (p=0.005), and 21 of 25 patients vs 23 of 25 patients at 24-hour (p=0.384) used any analgesia postoperatively in the non-QLB vs QLB group respectively. Evaluation of differences in the amount of postoperative pain medication used between the two groups is still pending. <h3>Conclusion</h3> There was no statistically significant difference between the QLB and non-QLB groups at 1, 3, and 24-hour postoperative pain scores. However, patients who received a QLB were more likely to receive pain medication 3 hours after surgery.

Intra-operative Methadone Decreases Post-operative Pain and Opioid Use in DIEP Flap Breast Patients: A New ERAS Protocol

BACKGROUND: Post-operative pain relief is a significant problem for many patients, increasing the risk of surgical complications and chronic post-operative pain. Patients undergoing surgery can achieve better analgesia with just one dose of methadone (long acting μ-opioid) then with multiple doses of a short acting opioid, however this has never been evaluated in the plastic surgery literature. This purpose of this study is to evaluate the effectiveness of methadone for pain control following DIEP flap breast reconstruction in the setting of a newly instituted ERAS protocol. METHODS: This is a prospective study of an ERAS protocol for all patients undergoing DIEP flap breast reconstruction at a single institution, which centered around the standardization of a single weight based intra-operative dose of methadone. Patients who were operated on after institution of the ERAS protocol were compared to those immediately prior to protocol implementation. Charts were reviewed for patient demographics, intra-operative analgesics, and postoperative medication, both during hospitalization and after discharge. RESULTS: 83 women who underwent DIEP flap Breast reconstruction were identified, 54 patients in the ERAS cohort and 29 in our non-ERAS cohort. The two cohorts had comparable age, weight, BMI, and other medical co-morbidities (p>0.05). The ERAS cohort had significant reduction in opioid usage overall. During the first 12 hours following surgery, the morphine milligram equivalents (MME) was 11.18 versus 27.28 (p<0.001) in the ERAS versus the non-ERAS group, 24 hours following surgery it was 38.69 vs 77.40 MME (p<0.001), and in total during hospital admission it was 79.98 vs 146.7 MME,(p=0.002). The ERAS cohort also had a significant reduction in their overall daily patient rated pain score (P<0.05) and significantly lower heart rate throughout admission. Importantly, those in the ERAS cohort were less likely to be tachycardic throughout admission, defined as a heart rate greater than 100 bpm for at least 12 consecutive hours. There was no difference in length of stay (p>0.05) between the two cohorts. On average during the first week after discharge, patients in the ERAS cohort required 13.9 MME of narcotic pain medications per day. 25% of patients did not require any narcotics at home and after 1 week, more then 75% of patients did not require any narcotics at home. CONCLUSION: In conclusion, after instituting our ERAS protocol with a single dose of intra-operative methadone, post-operative opioid analgesic usage and pain was significantly reduced. Methadone has the potential to be used for patients undergoing plastic surgery procedures, both inpatient and ambulatory, to decrease post-operative pain, opioid use, and increase overall patient comfort and satisfaction. Further work is ongoing to study the impact of our ERAS protocol on DIEP flap patients’ post-operative course.

Efficacy Of Systemic Or Perineural Dexamethasone As An Adjunct To Ultrasound Guided Supraclavicular Block

Background: Regional anaesthesia (RA) techniques have traditionally been utilized for surgical anaesthesia and post-operative pain control. Post-operative analgesia from an epidural or a peripheral nerve block can benefit the patients with better recovery and more satisfaction. Innumerable additives have been tried in nerve blocks with variable results. We wished to evaluate the use of addition of dexamethasone with local anaesthetics and compare the efficacy with simultaneous administration of systemic dexamethasone in brachial plexus blocks. Methods: Ninety-seven patients posted for upper limb surgeries were divided randomly into three groups to receive ultrasound guided supraclavicular brachial plexus block with bupivacaine saline combination(A) or dexamethasone bupivacaine combination(B) or a systemic dexamethasone(C) with bupivacaine alone in the plexus site. The onset and duration of sensory and motor blocks were noted.ANOVA, Chi square tests and intent to analyses were done according to the need and a p value of less than 0.05 was considered significant. Results: The variables like mean age, weight, duration of surgery were similar between the groups. The onset and duration of sensory and motor blocks were similar with addition of dexamethasone either in plexus(perineural) or systemic. Onset (A, B, C -17 vs 12 vs 12 in minutes) duration of sensory anaesthesia (414 vs 857 vs 838 minutes) But patients in both the dexamethasone groups showed significant shortening of action in onset and prolonged duration than saline group. (p &lt;0.001), There were no significant side effects.Conclusion: Systemic dexamethasone had a similar effect on the onset and duration of both the sensory and motor actions in supraclavicular brachial plexus blocks as perineural dexamethasone. Dexamethasone usage, both systemic and perineural, reduces cumulative postoperative analgesic usage in the first 24 hours. Either of the two techniques outperformed the control group, which received only normal saline. There were no significant negative side effects.

Comparison of Analgesic Outcomes of Bilateral Transversus Abdominis Plane Block with Intravenous Tramadol Following Cesarean Delivery Under Spinal Anesthesia

Objective: To compare the effect of bilateral transversus abdominis plane (TAP) block analgesia and intravenous tramadol in post-operative period following cesarean delivery under spinal anesthesia. Patients and Methods: In this randomized controlled trial we included 100 patients who underwent elective cesarean delivery from 1-June-2021 to 01-January-2022 in Nishtar Hospital Multan. All patients were given spinal anaesthesia using standard technique. In group A, patients were given TAP block at the end of the procedure. Group B, was given spinal anaesthesia alone with intravenous tramadol 50 mg and analgesia requirement were noticed at 12 hours postoperatively. Results: Mean age was 28.28±4.61 years. Mean BMI was 23.60±2.33 kg/m2. Mean gestational age of patients was 39.96±1.26 weeks. Mean duration of procedure was 48.10±5.39 minutes. Mean duration in TAP block was 48.53±5.30 minutes and in IV analgesia group was 47.67±5.50 minutes (p-value 0.42). Mean VAS for pain was 4.27±1.50. Mean VAS for pain in TAP block was 3.46±0.93 and in IV analgesia group was 5.07±1.56 with p-value of &lt;0.001. The mean VAS score after 24 hours was 0.7±0.5 in TAP group versus 3.1±0.7 in IV analgesia only (p-value &lt;0.0001). Time of first rescue analgesia was 212±60 minutes in TAP group versus 77±23 minutes in IV analgesia only group (p-value &lt;0.001) [Table 1]. Conclusion: The use of the bilateral TAP block in patients undergoing elective cesarean delivery can reduce postoperative pain and analgesic usage for up to 24 hours after the procedure. Key Words: Transversus abdominis plane (TAP), block analgesia, intravenous tramadol, cesarean delivery, spinal anesthesia.

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study.

PurposeThe aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management.MethodsTotally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E1 and Group E2 were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured.ResultsGroup E1 and Group E2 had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E2 was significantly lower than Group S (P = 0.007). The opioid consumption in Group E1 and Group E2 was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772).ConclusionEsmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions.Trial RegistrationChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn.

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

BackgroundWell-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS.MethodsIn this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay.ResultsNo technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days.ConclusionsIncorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

Different Doses of Oxycodone for Endoscopic Injection Sclerotherapy of Esophageal Varices.

BackgroundThe aim of the present study was to evaluate the effects of different doses of oxycodone during endoscopic injection sclerotherapy (EIS) for esophageal varices with painless sclerosing agents.Material/MethodsA total of 119 patients were randomly divided into 3 groups: Group A, midazolam and 0.075 mg/kg oxycodone (n=40); Group B, midazolam and 0.1 mg/kg oxycodone (n=40); and Group C, midazolam and 0.125 mg/kg oxycodone (n=39). The main observation index was the incidence of body movement during the perioperative period. The secondary indices were additional propofol usage; postoperative analgesic usage; other adverse effects, such as hypoxia, myoclonus, and cough; and satisfaction scores for surgeons and patients.ResultsThe incidence rates for body movement during the perioperative period in groups A, B, and C were 33%, 13%, and 0, respectively (P<0.001). The satisfaction scores for surgeons and patients were highest in Group C (0.125 mg/kg oxycodone). The incidence rates for hypoxia before EIS were 15%, 8%, and 33% (P=0.026) and during EIS were 23%, 3%, and 0% (P<0.001), respectively. There were no significant between-group differences with respect to other adverse effects.ConclusionsThe ideal dose of oxycodone for perioperative analgesia during EIS for esophageal varices is 0.125 mg/kg.

Laparoscopic Completion Total Gastrectomy as a Standardized Procedure for Gastric Stump Cancer: A Case Control Study

Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into 2 groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 versus 182.5 min; P = 0.026), lower blood loss (14 versus 105 mL; P &amp;lt; 0.001), and shorter period to the first flatus passage (2 versus 3 days; P &amp;lt; 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the 2 groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathologic findings revealed that the laparoscopic group had a smaller tumor size (not pathologic T category) and fewer metastatic lymph nodes than the open group, leading to an earlier distribution of the pathologic stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.

Ultrasound guided lateral quadratus lumborum block enhanced recovery in patients undergoing laparoscopic colorectal surgery

PurposeThis study aimed to evaluate the effects of lateral quadratus lumborum block (QLB) on postoperative pain and recovery in patients undergoing laparoscopic colorectal surgery. Materials and methodsPatients between 18 and 70 years old, diagnosed with colon or rectal cancer, with American Society of Anesthesiologists (ASA) physical status I or II, and scheduled for laparoscopic colorectal surgery were recruited. Patients were excluded if they were allergic to local anesthetics and unable to complete the procedure of puncture or follow-up evaluation. All included patients were randomly allocated to either QLB or Sham group. The primary outcome was perioperative cumulative sufentanil consumption. ResultsThere were no significant differences between the groups in anesthetic time, operation time, dosage of propofol, and remifentanil (P ​> ​0.05). Patients in the QLB group had significantly less sufentanil consumption both intraoperatively and postoperatively, compared with the Sham group (P ​< ​0.05). Postoperative VAS pain scores on coughing in the QLB group at 2 ​h, 6 ​h, 12 ​h, 24 ​h time points and VAS pain score at rest 2 ​h, 6 ​h after surgery were significantly lower than in the Sham group (P ​< ​0.05). Compared with the Sham group, time to first ambulation and anal flatus after surgery in the QLB group were significantly shorter (P ​< ​0.05). Significant differences of postoperative rescue analgesic usage and QoR-15 score at 48 ​h were found between the two groups (P ​< ​0.05). ConclusionsUltrasound-guided lateral QLB significantly reduced perioperative opioid consumption, alleviated postoperative pain, shortened the time to first ambulation and anal flatus, and enhanced postoperative recovery of the patients undergoing laparoscopic colorectal surgery.

Risk Factors for Increased Postoperative Pain and Recommended Orderset for Postoperative Analgesic Usage.

Objective:An interdisciplinary pain team was established at our institution to explore options for improving pain control in patients undergoing orthopedic surgery by identifying traits that put a patient at increased risk for inadequate pain control postoperatively.Materials and Methods:The interdisciplinary pain team identified 7 potential risk factors that may lead to inadequate pain control postoperatively including (1) history of physical, emotional, or sexual abuse; (2) history of anxiety; (3) history of drug or alcohol abuse; (4) preoperative nonsteroidal anti-inflammatory drug, or disease-modifying antirheumatic drug use; (5) current opioid use; (6) psychological conditions other than anxiety; and (7) current smoker. Statistical analysis determined which risk factors were associated with increased preoperative and postoperative pain scores.Results:A total of 1923 patients undergoing elective orthopedic surgery were retrospectively identified. Hip, knee, and shoulder replacements accounted for 76.0% of the procedures. 78.5% of patients had 3 or fewer risk factors and 17.1% had no risk factors. Anxiety, other psychological conditions, current opioid use, and current smoking were significantly associated with higher preoperative and postoperative pain scores.Discussion:We found a significant association between anxiety, current smoking, psychological conditions, and current opioid use with increased preoperative and postoperative reported pain score. We propose that identification of these risk factors should prompt more attention to postoperative pain control plans and will improve communication with patients and providers. We recommend a multimodal approach to postoperative pain control, and developed a pain orderset to help guide providers.

Enhanced recovery after surgery (ERAS) pathway for microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion

ObjectivesEnhanced recovery after surgery (ERAS) principle and minimally invasive surgery allow patients to recover faster and better postoperatively. Due to a paucity of their integration, this retrospective study aims to assess clinical outcomes of ERAS pathway in microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Patients and methodsA total of 72 consecutive cases were enrolled. According to their inclusion order, the former 21 cases received microendoscopy-assisted MIS-TLIF without any ERAS approach (control group), while the latter 51 participants underwent the same surgery with ERAS protocol (observation group). Perioperative parameters, including operative duration, intraoperative estimated blood loss (EBL), length of stay, postoperative analgesic usage and ambulatory time, were recorded. Visual analogue scale (VAS, back and leg), Barthel index were obtained before and at three days, one month, six months postoperatively. Modified MacNab criteria and Bridwell grading were used to assess surgical outcome and interbody fusion at one week and two years after surgery, respectively. ResultsObservation group had statistically improved perioperative parameters (operative duration, intraoperative EBL, length of stay, postoperative analgesic usage and ambulatory time) in comparison with control group. Remarkable decreases in VAS (back and leg) were observed continuously at three days, one month and six months post-surgery in both groups when compared with scores prior to the surgery. More significant improvement of VAS (back and leg) was found in observation group at both three days and one month postoperatively. Regarding Barthel index, despite its transient decrease at three days after surgery in control group, it showed statistical increase at postoperative one month when compared with preoperative values in both groups; moreover, its inter-groups comparison revealed much more improvement in patients receiving ERAS recommendations; while at final follow-up, it continued further increase in either group. Marginally higher proportion of patients in observation group showed perfect or good clinical outcome, as well as solid interbody fusion. ConclusionsERAS pathway in microendoscopy-assisted MIS-TLIF has advantages of decreased operative time, reduced intraoperative haemorrhage, increased initial back pain relief, decreased length of stay, lowered analgesic usage and earlier daily activity recovery and thus, benefit postoperative rehabilitation further.

Comparison between preoperative and post-operative administration of paracetamol, ibuprofen and mefenamic acid for post-extraction pain control

Pain is a common aftereffect following a dental treatment, especially extractions. Hence, the main aim of the study was to compare the effect of pre-operative and post-operative analgesic usage on post-operative pain management following dental treatment. Moreover, the efficacies of three types of painkillers (Paracetamol, Ibuprofen and Mefenamic Acid) in pain relief were also evaluated. Volunteers (n = 120) who were undergoing extraction participated in this study and were randomly divided into two groups. One group consisting of 60 participants were given pre- and post-operative analgesics while another group (n = 60) received post-operative analgesics only. A visual scale was used to record pain from zero to 56 hours post-operatively at 8-hour intervals. The results showed that patients who were taking analgesics pre-operatively experienced significantly (p = 0.0045) less pain compared to those who had taken post-operative analgesics only However, a lower cumulative number of moderate and severe experiences of post-extraction pain was recorded for the pre- and post-operative analgesic treatment groups as compared to the postoperative only analgesic treatment group; no significant differences were observed. Moreover, no significant differences were observed among the analgesics used in this study as well. On the basis of these results, we conclude that preoperative analgesic usage has a positive impact on postextraction acute pain management.

The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal.

The aim of this study was to evaluate the quality of spinal anesthesia and hemodynamic parameters of intravenous versus intrathecal dexmedetomidine in patients undergoing inguinal hernia repair surgery under spinal anesthesia. Fifty male patients aged 18-70years with ASA I and II were randomly divided into two groups of 25 patients receiving either intravenous (1μg/kg infused during 10min before blockade) or intrathecal (5μg, added to local anesthetics) dexmedetomidine. The duration of analgesia, sensory and motor blockade levels, the score of pain intensity, post-operative analgesic usage and the level of sedation as well as hemodynamic changes, and complications were recorded. The duration of analgesia in the intrathecal group was significantly longer than intravenous group (403.588 ± 93.706 vs. 274.048 ± 47.266min; P < 0.001). Duration of the sensory and motor blockade were significantly longer in intrathecal than intravenous group (230.440 ± 26.494 vs. 181.400 ± 28.850min; P < 0.001 for sensory block, and 253.800 ± 32.637 vs. 205.400 ± 30.921min; P < 0.001 for motor block). The score of pain intensity was lower in the intrathecal group in the post-operative period (3.680 ± 1.680 vs. 5.520 ± 1.901; P = 0.001 and 2.360 ± 1.320 vs. 3.24 ± 1.69; P = 0.041, respectively, for the time 6 and 12). Ramsay sedation score was higher in the intravenous group during surgery but it was higher in intrathecal group during recovery room period (P < 0.05). Moreover, the incidence of bradycardia was significantly lower in the intrathecal group (0% vs. 36% respectively; P = 0.002). Administration of intrathecal dexmedetomidine along with local anesthetics can be recommended to increase the quality of spinal anesthesia with minimal complications.