Postoperative Nausea Research Articles

Dexmedetomidine-propofol versus ketamine-propofol for sedation of cancer patients undergoing computerized tomography guided bone biopsy: a randomized double-blind trial

Background & Objective: Patients suffering from malignancy, often need to undergo computed tomography (CT) for evaluation or for CT-guided bone biopsy. They are shifted to the radio-diagnostic suite and require sedation and analgesia during this procedure. We compared the efficacy and safety of combining dexmedetomidine (DEX) or ketamine with propofol for better sedation among these patients undergoing CT-guided bone biopsy. Methodology: This randomized, double-blind study was done on 60 adult cancer patients undergoing CT-guided bone biopsy. Patients were randomized into two equal groups. Group D received DEX 1 µg/kg (over 10 min) + propofol 2.5 mg/kg intravenous (IV). It was followed by DEX 0.5 µg/kg/h + propofol 2.5 mg/kg/h infusion. Group K received ketamine 1 mg/kg + propofol 2.5 mg/kg IV, followed by ketamine 0.25 mg/kg/h + propofol 2.5 mg/kg/h infusion. Results: The total intra-procedure propofol consumption was significantly decreased in Group D than in Group K (P < 0.05). The visual analog scale score at 15 min and 30 min post-procedure, number of patients requiring morphine and paracetamol within one hour of procedure and the recovery times were significantly decreased in Group D than in Group K (P < 0.05). Mean arterial pressure (MAP) and heart rate (HR) measurements at 10 min, 20 min, end of the procedure, and 15 min, 30 min post-procedure was significantly decreased in Group D than in Group K (P < 0.05). Adverse events, e.g., postoperative nausea and vomiting, hypotension, and bradycardia, were comparable. Conclusion: DEX-propofol combination had superior sedation efficacy as noted through lower pain scores, intraprocedural propofol or postprocedural morphine and paracetamol consumption, and the shorter recovery time during CT-guided bone biopsy compared to ketamine-propofol combination. However, ketamine-propofol combination exhibited superior hemodynamic stability, as shown by more consistent HR and MAP. Keywords: Dexmedetomidine; Ketamine; Propofol; Computed tomography; Bone biopsy; Morphine Citation: Abdelgalil AS, Mohammed AM, Abdelrahman AS, Zayed NOA. Dexmedetomidine-propofol versus ketamine-propofol for sedation of cancer patients undergoing computerized tomography guided bone biopsy: a randomized double-blind trial. Anaesth. pain intensive care 2024;28(5):809−815; DOI: 10.35975/apic.v28i5.2554 Received: Jun 17, 2024; Reviewed: Jul 31, 2024; Accepted: Aug 19, 2024

Ultrasound-guided erector spinae plane block in radical cystectomy: a randomized controlled study

Background & Objectives: Radical cystectomy (RC) is usually performed under general anesthesia, with the management of postoperative pain being a big challenge. Various approaches have been tried, including epidural analgesia, or regional nerve blocks in addition to the intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of bilateral single-injection erector spinae plane block (ESPB) with IV-PCA administered morphine to manage postoperative pain following RC. Methodology: This prospective randomized controlled clinical study was performed on 60 participants ranging in age from 21 to 65 years, both sexes, BMI 20-40 kg/m2, ASA physical status II-III, planned for elective RC. Participants were randomized into two equal groups. Group ESPB received ultrasound-guided single shot ESPB at T10 with 20 mL bupivacaine 0.25% bilaterally; IV morphine 3 mg bolus was used as rescue analgesia when the Numeric Rating Scale (NRS) pain score was ≥ 4. Group C (control group) received IV-PCA by morphine 3 mg IV when NRS pain score was ≥ 4 and repeated 1/2 mg if still pain score was recorded ≥ 4 for 15 min. Pain was measured on NRS at 2 , 4 , 8, and 12 h as well as the postoperative heart rate (HR) and mean arterial blood pressure (MAP). Complications were noted, Results: Time to first analgesic request was substantially prolonged in Group ESPB compared to Group C (P < 0.001). Total postoperative consumption of morphine in 1st 48 h and postoperative nausea and vomiting were substantially reduced in Group ESPB compared to Group C (P < 0.05). NRS pain scores, postoperative HR and MAP measurements were substantially reduced at 2, 4, 8, and 12 h in Group ESPB than Group C (P < 0.05). Bradycardia and hypotension varied insignificantly different between both groups. Respiratory depression and urinary retention did not occur in any patient in both groups. Conclusions: Compared with IV-PCA administered morphine, bilateral single-injection ESPB was associated with better hemodynamics and analgesic properties, as observed by lower pain scores, less postoperative opioid consumption, and longer time to first analgesic request with good safety profile after radical cystectomy. Keywords: Ultrasound; Erector Spinae Plane Block; Radical Cystectomy; Patient-Controlled Analgesia Citation: Ahmed AM, Tantawy AM, Mahran E, Abd El Galil TE, Abd El Galil AS. Ultrasound-guided erector spinae plane block in radical cystectomy: a randomized controlled study. Anaesth. pain intensive care 2024;28(5):939−944; DOI: 10.35975/apic.v28i5.2568 Received: July 16, 2024; Reviewed: August 05, 2024; Accepted: August 29, 2024

Effectiveness of newborn infant parasympathetic evaluation (NIPE) index for guiding intraoperative fentanyl administration in children under 2 years: a randomized controlled trial.

Assessing pain in infants and neonates is challenging due to their inability to communicate verbally. While validated subjective tools exist, they rely on interpreting the child's behavior, leading to potential inconsistencies and underestimation of pain. Based on heart rate variability, the newborn infant parasympathetic evaluation (NIPE) index offers a more objective approach to pain assessment in children under 2 years. Although promising, research on its effectiveness during surgery under general anesthesia remains limited and inconclusive. This study compared the effectiveness of NIPE-guided fentanyl administration to traditional vital signs (heart rate and mean arterial pressure) in managing pain during surgery in children under 2 years. Seventy children undergoing head, neck, or upper extremity surgery were randomized into group N (NIPE) or group C (Control) with 35 participants in each group. Both groups received standardized anesthesia and monitoring, including NIPE. Group N received fentanyl when NIPE scores fell below 50, while group C received fentanyl upon a 20% increase in heart rate or mean arterial pressure (MAP). Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scores, alongside fentanyl consumption, sedation levels, and potential side effects. Both groups exhibited similar outcomes in terms of postoperative pain scores, fentanyl consumption, sedation levels, and absence of side effects (postoperative respiratory depression or nausea and vomiting). Additionally, intraoperative NIPE scores, heart rate, and MAP were comparable between the groups. There are strong correlations between both groups in terms of NIPE scores (r = 0.735, p < 0.0001), heart rate (r = 0.630, p < 0.0001), and MAP (r = 0.846, p < 0.0001). In both group C and group N, the NIPE scores reveal strong negative correlations with heart rate (r = -0.610, p < 0.0001, and r = -0.674, p < 0.0001) and MAP (r = -0.860, p < 0.0001, and r = -0.756, p < 0.0001). NIPE-guided intraoperative fentanyl administration was not superior to heart rate/MAP-guided administration, as both achieved similar pain management outcomes in this study. However, NIPE may offer a more practical and precise approach, as it is an objective tool with a defined threshold. These findings suggest NIPE's promise as a valuable tool for managing pain in children under 2 years undergoing surgery. However, confirmation of its widespread effectiveness requires further research with larger, multicenter studies encompassing procedures with a broader spectrum of pain severity.

Low-pressure Pulmonary Recruitment Maneuver to Decrease Post-laparoscopic Shoulder Pain in Gynecologic Surgery: A Double-blind Randomized Placebo Controlled Trial

Objective: To evaluate the efficacy of minimum optimal pressure (30 and 40 cmH2 O) of pulmonary recruitment maneuver (PRM) for reducing post-laparoscopic shoulder pain (PLSP). Methods: Women who were scheduled for laparoscopic gynecologic surgery during October 2020 to June 2021 were enrolled and randomly assigned to three groups: PRM 30 cmH2 O (30-PRM) group, PRM 40 cmH2 O (40-PRM) group and control group. All participants were placed in the Trendelenburg position and compressed abdomen to eradicate gas. PLSP scores were assessed by using a visual analog scale (VAS). Results: Total of 80 women were included and randomized to 30-PRM group (N = 28), 40-PRM group (N = 26) and control group (N = 26).The PLSP scores at 12-hour after surgery in 40-PRM group were significantly lower than the control group (VAS 0 = 57.7%, VAS 1-3 = 19.2% and VAS ≥ 4 = 23.1% in 40-PRM group vs VAS 0 =19.2%, VAS 1-3 = 26.9% and VAS ≥ 4 = 53.9% in control group, P = 0.018), while no significant difference of PLSP between 30-PRM and control groups (P = 0.256). Other variables, such as PLSP at 24 and 48 hrs., post-operative surgical pain, nausea and vomiting, vital signs and residual gas in abdominal cavity at 24-hour were similar among three groups. Conclusions: PRM with pressure 40 cmH2 O significantly decreases PLSP at 12 hours. This procedure is feasible and safe. Using the PRM with pressure 40 cmH2 O may be applied at the end of laparoscopic procedure

Is pericapsular nerve group block superior to other regional analgesia techniques following total hip arthroplasty? a systematic review and network meta-analysis

BackgroundA systematic review and network meta-analysis (NMA) to compare the safety and efficacy of pericapsular nerve group block (PENGB) with other regional analgesia techniques in patients undergoing total hip arthroplasty (THA).MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant research from inception to May, 2024. Randomized controlled trials (RCTs) comparing PENGB with other regional analgesia techniques in patients undergoing THA were included. The primary outcome was resting pain scores at 6 h after surgery. The NMA was made by using Stata 15.1 software. Potential risk of bias was assessed by using CINeMA. Sensitivity and subgroup analyses were performed on the primary outcome.ResultsA total of 11 RCTs including 766 patients were eligible for inclusion. For postoperative resting and movement pain scores within 24 h analysis, PENGB + periarticular local anesthetic infiltration (PLAI) was found to be significantly more effective than other treatments and its Surface under the cumulative ranking curve (SUCRA) was the lowest. Moreover, PENGB + PLAI was ranked the best in reducing opioid consumption within 24 h and the length of hospital stay. PENGB was found to have significantly lower incidence of quadriceps motor block and postoperative nausea and vomiting (PONV).ConclusionsPENGB is more likely to reduce the incidence of quadriceps motor block and PONV in patients undergoing THA, but PENGB + PLAI is superior to other regional analgesia techniques (PLAI, PENGB, fascia iliaca compartment block, and quadratus lumborum block) in improving postoperative pain and shortening the length of hospital stay.Trial registration numberCRD42024538421.

The effectiveness of combined anesthesia in comparison with general anesthesia in thyroid and parathyroid surgery: a single-center prospective randomized study

BACKGROUND. Operations on the organs of the anterior surface of the neck (thyroidectomy, carotidectomy, plastic surgery, etc.) are widespread in the Russian Federation. The development of adequate anesthesiological support for these interventions is an urgent task of modern anesthesiology. The introduction of combined regional anesthesia techniques into surgical practice makes it possible to minimize postoperative complications, manifested in the form of severe pain syndrome, postoperative nausea and vomiting. AIM. To conduct a comparative assessment of the effectiveness of combined (general + regional) and only general anesthesia during operations on the thyroid and parathyroid glands. MATERIALS AND METHODS. In a prospective randomized study, 60 patients operated on for thyroid and parathyroid gland diseases were divided into 2 groups: in group 1, general anesthesia was performed in combination with blockade of the internal fascia of the neck and bilateral blockade of the superficial branches of the cervical plexus, as well as the Berry ligament area under ultrasound navigation; patients of group 2 were operated on in conditions of combined general anesthesia. The hemodynamic profile during surgery, plasma cortisol concentration, required doses of fentanyl, intensity of postoperative pain syndrome, need for anesthesia, and recovery time were evaluated. RESULTS. Combined (general + regional) anesthesia was characterized by a decrease in fentanyl consumption compared with the group receiving only general anesthesia (p 0.0001), a decrease in cortisol content in blood plasma 12 hours after extubation (p=0.0439), a reduction in median pain after tracheal extubation 3 and 12 hours after surgery (p=0.0190, p 0.0001), as well as a twofold reduction in the time interval from the end of the operation to the moment of extubation (p=0.0001). The assessment of patients on the Aldreth awakening scale in the group of people who underwent combined anesthesia indicates a higher willingness of patients to be transferred from the operating room to the awakening ward (p=0.0114). CONCLUSION. The study demonstrated the effectiveness and safety of the combined anesthesia technique in thyroid and parathyroid surgery, which provides adequate anesthetic protection for patients.

Anesthesia for thyroid surgery and the possibility of regional blocks as its component

The number of thyroid surgeries is increasing annually. The choice of anesthetic approach influences the speed and quality of postoperative recovery and determines the risk of complications. This review presents data from clinical studies and meta-analyses regarding the impact of various anesthesia methods in thyroid surgery on surgical stress response, hormonal status, and complication risk. The results of the review indicate that the use of regional anesthesia techniques contributes to a reduction in the intensity of postoperative pain, nausea and vomiting, and the incidence of chronic postoperative pain syndrome. Incorporating regional anesthesia techniques into enhanced recovery after surgery protocols for thyroid surgery helps reduce hospital stay duration and treatment costs. A well-studied, simple, and safe technique is the superficial cervical plexus block, while the intermediate cervical plexus block is less studied but considered safe. The deep cervical plexus block is associated with a higher risk of serious complications. Advancements in ultrasound technology in anesthesia have enabled the use of previously inaccessible regional techniques. Potentially beneficial methods for thyroid surgery include pericapsular block and Berry's ligament block. Further research is required to evaluate the efficacy and safety of these methods.

Effect of remimazolam for general anesthesia on postoperative nausea and vomiting : Asystematic review and meta-analysis.

Benzodiazepines reduce postoperative nausea and vomiting (PONV); however, conflicting results have been reported regarding the use of remimazolam, anovel benzodiazepine. This meta-analysis examines whether remimazolam reduces PONV incidence compared with propofol or volatile agents used in general anesthesia. Electronic databases, including PubMed, EMBASE, CENTRAL, and Web of Science, were searched on 31 July 2023. The primary outcome was the incidence of PONV. Secondary outcomes included PONV severity, rescue antiemetic use, amounts of remifentanil used, and participant satisfaction scores. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using arandom-effects model. The risk of bias (RoB) was assessed using the Cochrane RoB2 tool. Atotal of 1514 adult patients from11 randomized controlled trials were included. The incidences of PONV in the remimazolam and control groups were 16.1% and 16.5%, respectively. Remimazolam did not increase the incidence of PONV (OR 0.62; 95% CI, 0.37-1.04; p = 0.0676; I2 = 48%). Subgroup analysis showed asignificant reduction in PONV with remimazolam vs. volatile agents (OR 0.25; 95% CI, 0.13-0.47; P = 0.0000; I2 = 0%) but not vs. propofol (OR 1.04; 95% CI, 0.70-1.56; p = 0.8332; I2 = 0%). More remifentanil was used in the remimazolam group vs. the volatile group, with no significant difference between remimazolam and propofol groups. Participant satisfaction scores were higher with remimazolam. Remimazolam did not increase PONV risk compared to propofol and reduced PONV incidence compared to volatile agents, with higher participant satisfaction. To validate the present findings, further well-planned large clinical trials are required.

Older age is associated with postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia containing droperidol: A retrospective observational analysis

BackgroundThis study investigated the associations of age and other factors with postoperative nausea and vomiting (PONV) in patients receiving fentanyl and droperidol intravenous patient-controlled analgesia (IVPCA) after laparoscopic gynecological surgery. A younger age is generally considered a higher risk factor for PONV. However, in our clinical experience, older age represents a higher risk factor for patients receiving IVPCA containing fentanyl and droperidol. Thus, we hypothesized that older age was a higher risk factor, and we explored factors associated with PONV in those patients. MethodsThe incidence of PONV was investigated in 5401 patients who received fentanyl–droperidol IVPCA after laparoscopic gynecological surgery under general anesthesia. Patient characteristics, operative/anesthetic factors, and intraoperative prophylactic antiemetics were investigated by multiple logistic regression analysis to determine the relationships of these factors with PONV. ResultsAmong the 5401 patients, 4929 (91.3 %) received propofol-based anesthesia, and 5187 (96.0 %) received a prophylactic antiemetic. The overall incidences of nausea, vomiting, and postoperative antiemetic use were 36.6 %, 17.6 %, and 17.7 %, respectively. Older age was associated with a significantly higher risk (adjusted odds ratio 1.18 per 10 years, 95 % confidence interval [1.11–1.25], p < 0.001) for PONV. No PONV after previous anesthesia, entry time into the operating room, and maximum duration of IVPCA were factors that influenced the risk of PONV, together with previously identified risk factors. ConclusionsOlder age was a higher risk factor for PONV in patients receiving fentanyl–droperidol IVPCA after laparoscopic gynecological surgery.

The Relationship Between Fasting Duration and The Incidence of Post Operative Nausea and Vomiting in Spinal Anesthesia Patients

Background: Anesthesia, a critical pain management tool during surgeries and procedures, necessitates pre-operative fasting to mitigate the risk of post-operative nausea and vomiting (PONV). The fasting period restricts both solid and liquid intake. Purpose: This study aims to explore the correlation between fasting duration and the incidence of PONV in patients undergoing spinal anesthesia at Dr. Soedirman Regional Hospital, Kebumen. Method: Employing an analytical observational design with quantitative methods, this research included 70 participants selected through cross-sectional sampling. Data collection utilized the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scale for observation. Findings: The study revealed that the majority of respondents (54.3%) adhered to an adequate fasting duration of 6-8 hours. Among these, 89.5% (34 respondents) did not experience PONV. Conversely, an inadequate fasting period (&gt;8 hours) was associated with a higher incidence of PONV, observed in 38.6% (27 respondents), while only 3.7% (1 respondent) did not experience PONV. The correlation analysis yielded a significant relationship with a coefficient of 0.502. Conclusion: There is a significant correlation between fasting duration and the incidence of PONV in patients receiving spinal anesthesia at Dr. Soedirman Regional Hospital, Kebumen. Adequate pre-operative fasting (6-8 hours) is associated with a lower incidence of PONV, emphasizing the importance of adherence to recommended fasting guidelines to minimize post-operative complications

Effects of adding intravenous midazolam to a dual postoperative nausea and vomiting regimen in patients undergoing breast surgery: A pragmatic randomized controlled trial

Background: For high-risk patients, adding a third antiemetic drug to dual postoperative nausea and vomiting (PONV) prophylaxis is controversial. Given the established antiemetic properties of midazolam, this study compared the combination of low-dose dexamethasone-ondansetron and midazolam with high-dose dexamethasone-ondansetron. Methods: A total of 300 female patients scheduled for breast surgery were recruited and randomly assigned to two groups. The DO group received dexamethasone 8 mg and ondansetron 4 mg, whereas the DOM group received dexamethasone 4 mg, ondansetron 4 mg, and midazolam 0.04 mg/kg. The primary outcome was the incidence of PONV within 24 h. Secondary outcomes were PONV severity, antiemetic requirement, blood glucose levels, satisfaction and sedation scores, time to eye opening and extubation, pain outcome, and sore throat. Results: Primary outcome analysis included 298 patients. Incidence of PONV within the first 24 h after surgery occurred in 52 of 150 (35%) patients in the DO group and 33 of 148 (22%) patients in the DOM group (adjusted risk ratio, 0.63; 95% confidence interval, 0.45–0.88; P = 0.007). The antiemetic requirement was significantly greater in the DO group compared with the DOM group (P = 0.034). However, a significantly higher sedation level and longer time for eye-opening and extubation were observed in the DOM group (P &lt; 0.05). Conclusion: Compared to high-dose dexamethasone and ondansetron alone, midazolam combined with low-dose dexamethasone and ondansetron decreased the incidence of PONV in patients undergoing breast surgery; however, it increased the sedation level in the early postoperative period.

Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study.

There is no uniformity on the safety profile of ultra-fast-track cardiac anesthesia (UFTCA), and there is a lack of research on the postoperative lung function status of patients with UFTCA. This retrospective study was to examine the benefits of UFTCA on the postoperative recovery and pulmonary function of patients undergoing minimally invasive cardiac surgery (MICS). This retrospective study was performed on patients who underwent MICS at Zhejiang Provincial People's Hospital between January 2022 and July 2023. Patients were retrospectively segregated into two groups: UFTCA group and conventional general anesthesia (CGA group). Primary endpoints encompassed differences in the duration of postoperative intensive care unit (ICU) stay and overall hospital stay. Secondary observations included in-hospital mortality rate, 3-month post-discharge survival rate, oxygenation indexes of preoperative (T0), immediately after extubation (T1), 6 hours after extubation (T2), and 12 hours after extubation (T3), use of high-flow nasal cannula oxygen therapy in the ICU, postoperative total chest drainage volume, and the rate of complications. Group comparisons were performed using grouped t-tests and repeated measures analysis of variance (ANOVA). The UFTCA group (n=327) demonstrated shorter ICU and hospital stays when compared with the CGA group (n=216) (P=0.001). At the immediately after extubation, the UFTCA group exhibited a decrease in oxygenation index [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)] accompanied by elevated alveolar-arterial oxygen tension difference [P(A-a)O2] and respiratory index [P(A-a)O2/PaO2] values compared to the CGA group (P=0.001). However, by 12 hours after extubation, the UFTCA group manifested an improved PaO2/FiO2 and diminished P(A-a)O2/PaO2 values compared to the CGA group. The UFTCA group required high-flow oxygen therapy after extubation with greater frequency than the CGA group (P=0.001). However, neither the UFTCA nor CGA group had patients who needed reintubation (P>0.05). No significant differences were observed in postoperative atelectasis and pulmonary edema rates between the groups (P>0.05), the UFTCA group recorded a diminished total chest drainage volume postoperatively (P=0.001). Incidence of postoperative nausea and vomiting (PONV) was heightened in the UFTCA group (P=0.01), while the incidence of delirium was less frequent when compared with the CGA group (P=0.001). UFTCA demonstrates potential benefits in minimizing ICU and postoperative hospital stay in patients undergoing MICS. This approach also contributes to a reduction in postoperative chest drainage volume and a decreased likelihood of postoperative delirium. Despite the initial decline in lung oxygenation immediately following early post-extubation, subsequent lung function proves to be superior, with no differences in postoperative atelectasis or pulmonary edema rates. However, the implementation of UFTCA requires additional strategies to prevent the occurrence of PONV.

Comparative Study Of Standard Drug Dose Mixture Versus Fentanyl In Attenuating Stress Response During Laryngoscopy And Tracheal Intubation In Neurosurgery: A Prospective Observational Study

Background: Opioid-free anesthesia (OFA) is gaining prominence, particularly in neurosurgery, due to its potential to minimize opioid-related complications such as postoperative nausea and vomiting (PONV) and shivering. This Prospective observational study aims to compare the efficacy of a standard drug dose mixture comprising intravenous magnesium sulphate, lignocaine, paracetamol, and tramadol with fentanyl in attenuating the hemodynamic stress response during laryngoscopy and tracheal intubation. Methods: Sixty neurosurgical patients, aged 18 to 60 years, undergoing cervical or lumbar discectomies under general anesthesia in our institute were divided into two groups. One group received the standard drug dose mixture, and the other received fentanyl. Hemodynamic parameters, including pulse rate, blood pressure, oxygen saturation (SpO2), and electrocardiogram (ECG) changes, were recorded at baseline, during intubation, and at one- minute intervals for five minutes post-intubation. Results: Both groups demonstrated stable hemodynamics with no significant differences in pulse rate or blood pressure. No ECG abnormalities were observed, and SpO2 remained above 96% in all patients. Additionally, the standard drug dose mixture group showed a reduced incidence of PONV and shivering compared to the fentanyl group. Conclusion: The standard drug dose mixture provides a safe and effective alternative to fentanyl for attenuating the hemodynamic stress response during laryngoscopy and tracheal intubation, with fewer side effects. Further randomized controlled trials are recommended to confirm these findings and explore the benefits of opioid-free anesthesia in various surgical procedures.

High-Dose Compound Betamethasone Used in Local Infiltration Analgesia Does Not Increase Reinfection Rates Following Periprosthetic Joint Infection Treatment

BackgroundThe administration of cocktails that contain glucocorticoids for local infiltration analgesia (LIA) is highly advocated and has been shown to be effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA. MethodsA comprehensive retrospective study was carried out on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of reinfection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared. ResultsDuring minimum 2-year follow-up, there was no significant difference in the reinfection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the initial 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). Notably, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery for knee PJIs (P < 0.001). Furthermore, within the first 72 hours post-surgery, the necessity for additional opioid analgesics in the CB group was significantly reduced compared to the non-CB group (P < 0.05). ConclusionA LIA with a high-dose compound betamethasone reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.

Ramosetron 3.0μg/mL Combining with Dexamethasone (0.05, 0.1, 0.2mg/mL) in Infusion Solutions: A Physicochemical Stability Study.

Dexamethasone in conjunction with type 3 serotonin receptor antagonists are being used to the prevention and treatment of chemotherapy-induced nausea and vomiting and postoperative nausea and vomiting in clinic. The present study aimed to investigates the stability of ramosetron with dexamethasone in infusions, with the goal of enhancing the safety and clinical applicability of their combined use. Ramosetron hydrochloride (3.0μg/mL) combining with dexamethasone (0.05, 0.1, 0.2mg/mL) were prepared with 0.9% sodium chloride injection and then packaged in polyolefin bags or glass bottles. The stability were investigated kept in the dark at refrigeration for 14days and at room temperature for 48h. The concentration of both drugs maintained at least 97% in the various solutions for both storage conditions with light protection. In the light exposure conditions, as the extension of storage time, the concentration of both drugs had declined. All antiemetic mixture solutions remained clear and no changes in color, turbidity, precipitation, and the pH remained stable. The insoluble particles were in line with Chinese Pharmacopoeia. Our findings suggest that combinations of ramosetron hydrochloride with dexamethasone sodium phosphate in 0.9% sodium chloride injection remain stable for 14days at 4°C and 48h at 25°C when protected from light.

Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery: protocol for a multicentre randomised factorial trial.

Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery. This prospective, multicentre, randomised, controlled, factorial trial will be conducted at three tertiary hospitals in Jiangsu, China. We will recruit a total of 420 patients who are at least 60 years old and undergoing major non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine surgery) under general anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine will be infused at 0.5 µg/kg/h throughout surgery, and intraoperative bispectral index target will be 55 for light anaesthesia and 40 for deep anaesthesia. The primary outcome is the occurrence of POD during the first 7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method two times per day. The secondary outcomes include days with POD, type of POD, pain scores at rest and on movement at 24 and 48 hours postoperatively, patient-controlled intravenous fentanyl consumption during 0-24 and 24-48 hours postoperatively, hypotension, bradycardia, postoperative nausea and vomiting, non-delirium complications, length of postoperative hospital stay, 30-day cognitive function and 30-day mortality. Data will be analysed on a modified intention-to-treat basis. This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University and each participating centre. The trial results will be published in a peer-reviewed journal. Chinese Clinical Trial Registry (ChiCTR2300073271).

Study of The Results of Routine Preoperative Blood Tests on Complications in Sectio Caesarea Patients

Background: Pre-operative evaluations, including laboratory assessments, are critical components of surgical preparation, with cesarean sections being no exception. Despite their importance, prior research suggests that 70-90% of routine pre-operative blood tests are unnecessary and frequently exhibit abnormal findings. Purpose: This study aims to evaluate the outcomes of routine pre-operative blood tests in patients undergoing cesarean sections at Banjarnegara Islamic Hospital. Methods: A descriptive quantitative study with a cross-sectional design was conducted in June 2024. The sample comprised 44 patients selected through convenience sampling. Data were collected by observing and recording the results of routine pre-operative blood tests, including erythrocytes, hemoglobin, hematocrit, leukocytes, and platelets. Findings: The analysis revealed average erythrocyte levels of 3.95 × 10^6/uL, hemoglobin levels of 11.27 g/dL, hematocrit values of 33.06%, leukocyte counts of 12.62 × 10^3/uL, and platelet counts of 250.77 × 10^3/uL. Intra-anesthesia complications were predominantly hypotension (81.8%), while the most common post-anesthesia complication was postoperative nausea and vomiting (54.5%). Conclusions: The findings indicate a significant proportion of routine blood tests fall outside standard reference ranges, though anesthetic complications remain relatively low. These results underscore the need to reassess the necessity of routine blood tests in pre-operative evaluations and highlight potential areas for improving patient outcomes. Recommendations: Future research should explore the clinical implications of these findings and contribute to establishing guidelines for routine pre-operative testing and management of anesthetic complications

Use of liposomal bupivacaine in cats undergoing gastrointestinal surgery is associated with lower doses of full µ-opioid agonists postoperatively

Objectives The aim of the study was to analyze the association of the administration of liposomal bupivacaine (Nocita) with postoperative opioid use in cats undergoing gastrointestinal surgery, as well as to analyze the administration of antiemetics postoperatively in this study population to qualify the degree of nausea related to opioid administration. Methods Records of 187 cats undergoing gastrointestinal surgery across two institutions, the Matthew J Ryan Veterinary Hospital at the University of Pennsylvania and the University of Florida Small Animal Hospital, were analyzed for multilayer liposomal bupivacaine infiltration at the time of abdominal closure, postoperative injectable opioid use and postoperative injectable antiemetic use. Results Cats that were administered liposomal bupivacaine at the time of abdominal closure received significantly lower doses of full µ-opioid agonists postoperatively. Significantly more cats that received liposomal bupivacaine were managed with full µ + partial µ-opioid agonists postoperatively than any other opioid profile. Cats that received liposomal bupivacaine received lower doses of ondansetron in hospital compared with cats that did not receive liposomal bupivacaine. Conclusions and relevance This study suggests that in cats requiring analgesia postoperatively, the use of liposomal bupivacaine at closure reduces the use of full µ-opioid agonists postoperatively. In addition, more patients that received liposomal bupivacaine were de-escalated from full µ-opioid agonists to partial µ-opioid agonists during their hospital stay, suggesting that less analgesia was required throughout their hospitalization. Lastly, lower doses of ondansetron, a typical second-line antinausea medication after gastrointestinal surgery, were used in cats that received liposomal bupivacaine, which may suggest less postoperative nausea.

Gender differences in postoperative pain, sleep quality, and recovery outcomes in patients undergoing visual thoracoscopic surgery

ObjectiveThe purpose of our study was to investigate the effect of gender on postoperative pain, sleep quality, and recovery outcomes in patients undergoing VATS surgery under general anesthesia. MethodPerioperative peripheral blood inflammatory markers system inflammation Index (SII) was recorded for perioperative inflammatory response. The visual analog scale (VAS) was used to evaluate pain level. And the Athens Insomnia Scale (AIS) was evaluated on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3) for postoperative sleep. ResultIn this prospective cohort study, 79 males and 79 females were consecutively included. Females had significantly higher pain score (both rest and cough pain) compared to the males at 3 h after the surgery (3.85 ± 1.2 vs. 3.16 ± 1.1) (rest) (p < 0.001) and 5.10 ± 1.3 vs. 4.46 ± 1.6 (coughing) (p = 0.006)). Patients in the male group had significantly lower AIS scores than those in the female group at Sleep POD 1 and Sleep POD 3 (p = 0.024 and p = 0.045). And in both groups, postoperative SII was increased and statistically significant compared to preoperative SII (p < 0.001, respectively). Women presented higher levels of SII on the first day after surgery, and the increase of postoperative SII in females groups was significantly higher than that in male group when compared to preoperative SII (1806.33 ± 1314.8 vs 1430.55 ± 958.4) (p = 0.042). ConclusionThese findings highlight the complex multidimensional nature of postoperative pain, nausea and vomiting, sleep quality and the potential contributory role of sex in shaping these outcomes. Women had worse sleep quality, higher postoperative inflammatory response level and pain level than men.

Comparison of the postoperative analgesic efficacy of serratus anterior plane block with different types of blocks for video-assisted thoracoscopic surgery: A systematic review and meta-analysis of randomized controlled trials

Background: The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques. Methods: In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed. Results: Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; I2 =97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p&lt;0.001; I2 =0%; fixed effects model) and lower than in LIA (SMD=–1.77; 95% CI, –2.24 to –1.30; Z=7.41; p&lt;0.001; I2 =0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=–2.90; 95% CI, –5.29 to –0.50; Z=2.37; p=0.02; I2 =93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; I2 =0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p&lt;0.001; I2 =0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting. Conclusion: After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.