Postoperative Pain Management Research Articles

Limitations of Patient-Controlled Epidural Analgesia Following Abdominoplasty.

Effective postoperative pain management is essential for patient satisfaction and an uneventful postoperative course, particularly in body contouring procedures. Systemic analgesic regimens can be supported by regional procedures, such as the transverse abdominis plane (TAP) block, but these have a limited duration of action. In contrast, thoracic epidural analgesia offers the possibility of a longer-lasting, individualized regional anesthesia administered by a patient-controlled analgesia pump. The aim of this study was to investigate the effects of a patient-controlled epidural analgesia to better classify the clinical value of this procedure in abdominoplasties. This work reviewed the digital medical charts of patients who underwent selective abdominoplasty without combined surgical procedures between September 2018 and August 2022. Evaluated data comprise the postoperative analgesia regimen, including on-demand medication, mobilization time, inpatient length of stay, and clinical outcome. The patients were grouped by the presence of a thoracic epidural catheter. This catheter was placed before anesthetic induction and a saturation dose was preoperatively applied. Postoperative PCEA patients received a basal rate and could independently administer boluses. Basal rate was individually adjusted during daily additional pain visits. The study cohort included 112 patients. Significant differences in the demand for supportive nonepidural opiate medication were shown between the patient-controlled epidural analgesia (PCEA) group (n = 57) and the non-PCEA group (n = 55), depending on the time after surgery. PCEA patients demanded less medication during the early postoperative days (POD 0: PCEA 0.13 (±0.99) mg vs non-PCEA 2.59 (±4.55) mg, P = 0.001; POD 1: PCEA 0.79 mg (±3.06) vs non-PCEA 2.73 (±3.98) mg, P = 0.005), but they required more during the later postoperative phase (POD 3: PCEA 2.76 (±5.60) mg vs non-PCEA 0.61 (±2.01) mg, P = 0.008; POD 4: PCEA 1.64 (±3.82) mg vs non-PCEA 0.07 (±2.01) mg, P = 0.003). In addition, PCEA patients achieved full mobilization later (PCEA 2.67 (±0.82) days vs non-PCEA 1.78 (±1.09) days, P = 0.001) and were discharged later (PCEA 4.84 (±1.23) days vs non-PCEA 4.31 (±1.37) days, P = 0.005). Because the postoperative benefits of PCEA are limited to potent analgesia immediately after abdominoplasty, less cumbersome, time-limited regional anesthesia procedures (such as TAP block) appear not only adequate but also more effective.

Comparative Study between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural as Postoperative Pain Management in Modified Radical Mastectomy

Abstract Background Surgery is one of the mainstays of treatment of breast cancer, and modified radical mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy. Aim of the Work to compare between Serratus Anterior plane block and thoracic epidural as efficacy of postoperative analgesia in Modified Radical Mastectomy. Patients and Methods This study was prospective controlled single blinded randomized clinical study, carried out in Ain Shams University hospitals, Cairo, Egypt over a period of 6 months. The study included adult female patients undergoing modified radical mastectomy was randomly assigned into two equal groups by computer generated: Group A: Included 15 patients received general anaesthesia preceded by Thoracic Epidural 9 ml of 0.25% Bupivacaine at T4-T5 level. Group B: Included 15patients received general anaesthesia followed by SAP block using only bupivacaine 0.25% (safety dose 3 mg /kg). Results The haemodynamic data including heart rate and mean arterial blood pressure show a significant decrease in SAP group less than the TE group. The pain scale (VAS) showed a significant decrease in SAP group less than the TE group. The total opioids consumption was significantly less in SAP than TE group. The first rescue morphine analgesia (min.) was significantly higher in SAP group more than TE group. Conclusion The SAP was effective and safe technique which provides better pain relief compared with the TE and reduced post-operative opioid consumption. Also, SAP was effective analgesic technique showing greater hemodynamics stability and less stress response to surgery compared with TE.

I Pack Block versus Adductor Canal Block for Post-Operative Pain Management in Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) is a highly distressful major surgery, with a significant potential for complications, not only because of the surgical and anesthetic impact of the procedure, but also because of the demographic and clinical characteristics of the target population. Careful pain management is necessary post-operative to achieve early post-operative mobilization while ensuring patient comfort throughout and preventing post-operative complications. Objective we aim to compare postoperative pain management and post- operative analgesic consumption between IPACK block and Adductor canal block in total knee arthroplasty cases. Methods After obtaining approval from the medical ethical committee in Ain Shams University, this Prospective randomized controlled double-blind clinical trial study was conducted in the operating theatres of Ain shams University Hospitals. Study period March 2022 to August 2022. Physical status: ASA 1 or 2 and candidates for spinal anaesthesia undergoing total knee arthroplasty. Age group: 40-65 years. Sample sizes of 30 patients in total; 15 in group I (group I) and 15 in group II (group A). Results As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. Conclusion The comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.

A Comparative Study between Continuous Epidural Analgesia versus Ultrasound Guided Continuous Femoral Nerve Block (CFNB) versus Ultrasound Guided Continuous Adductor Canal Block (ACB) for Post-Operative Pain Management after Total Knee Replacement (TKR)

Abstract Background Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2μg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded. Results Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications. Conclusions Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects.

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section

Abstract Background Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. Objective to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine. Results In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value < 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.). Conclusion Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.

Ultra-Sound Guided Quadratus Lamborum Block Using Dexamethasone and Bupivacaine versus Dexmedetomidine and Bupivacaine for Post-Operative Analgesia after Labaroscopic Cholecystectomy

Abstract Background The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using regional anethesia. Transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after lower abdominal surgeries. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution. Objective To assess the analgesic effect of addition dexamethasone or Dexmedetomidine with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing laparscopic abdominal surgeries in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients undergoing laparscopic abdominal surgeries were included in the study, and were divided into two groups (n = 10; each); group A and B . Where in group A patients(n = 10) received 20 ml bupivacaine 0.5% plus 100 μg Dexmedetomidine diluted in 5ml 0.9% NaCl (the total volume injected in all patients is 25 ml), and group B patients (n = 10) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl . Results The thesis proved that the addition of either Dexmedetomidine or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for laparscopic abdominal (cholecystectomy) surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexmedetomidine showing better results. Conclusion The addition of either 100 μg Dexmedetomidine diluted in 5 ml 0.9% NaCl or 8 mg dexamethasone to 20 ml bupivacaine 0.25% in ultrasound guided quadratus lumborum block for laparscopic abdominal surgery prolonged the duration of analgesia significantly and decreased the postoperative analgesic requirement. Hence, our study suggests that either Dexmedetomidine or dexamethasone may be a useful alternative as an adjuvant to long-acting local anesthetics for quadratus lumborum nerve block with Dexmedetomidine showing better results.

Effects of ultrasound-guided serratus plane block combined with general anesthesia on postoperative early quality of recovery and analgesia in patients undergoing transapical transcatheter aortic valve implantation surgery: study protocol for a randomized controlled trial

BackgroundCompared to traditional thoracotomy, transapical transcatheter aortic valve implantation (TAVI) surgery offers reduced trauma and faster recovery, fostering the adoption of enhanced recovery after surgery (ERAS) protocols in cardiac surgery. Despite these advancements, postoperative pain management has received insufficient attention. The potential effects of multi-mode analgesia, including ultrasound-guided serratus anterior plane block (SAPB), on postoperative pain and early quality of recovery have not been widely studied, lacking comprehensive prospective evidence. Therefore, this study aims to investigate the impact of SAPB combined with general anesthesia on early recovery quality and analgesic efficacy in transapical TAVI patients.MethodsThis prospective, randomized controlled study will enroll 70 patients undergoing transapical TAVI, randomly allocated to either the SAPB group or the control group. The primary outcome, assessed using Quality of Recovery-40 (QOR-40) scale, focuses on the quality of recovery at 24 h and 48 h postoperatively. Secondary outcomes include the visual analog scale (VAS) pain scores at rest and during coughing at 6 h, 12 h, 24 h, and 48 h after surgery, frequency of patient-controlled analgesia (PCA) utilization at 24 h and 48 h, opioid consumption at 24 h and 48 h, time and frequency of rescue analgesia and severe pain at 24 h and 48 h, incidence of nausea and vomiting at 48 h after surgery, and dosage of antiemetic drugs.DiscussionThe purpose of our study is to evaluate the effects of ultrasound-guided SAPB combined with general anesthesia on postoperative early quality of recovery and analgesia in transapical TAVI patients. The results obtained may provide valuable insight for the implementation of multi-mode analgesia and enhanced ERAS in this specific patient population.Trial registrationChina Clinical Trial Register ChiCTR2300068584. Registered on 24 February 2023.

Utilization and Evaluation of Analgesics in Post Gynecologic Operations: A Cross- Sectional Study

Background: This study evaluated the current practices of opioid and non-opioid analgesic administration for postoperative pain management in gynecological surgeries, aiming to optimize pain relief while minimizing side effects. Methods: A cross-sectional, prospective Drug Utilization Evaluation (DUE) study was conducted at Al-Zahra Hospital, Tabriz, Iran. Medical records of 100 patients undergoing gynecological surgery were reviewed over five months. Data on prescribed analgesics, pain scores, and adherence to APS2016 and ERAS2016 guidelines were collected and analyzed statistically. Results: Meperidine (pethidine) and diclofenac were the most frequently prescribed analgesics. The average patient pain score was 2.48 units. A combination of meperidine, diclofenac, and acetaminophen was identified as the most effective regimen for pain control. Prescribed regimens demonstrated 41.4±27.3% theoretical and 60.60 ± 28.77% practical compliance with APS2016 and ERAS2016 guidelines. While achieving the primary objective of pain relief with minimal side effects, compliance with established guidelines could be further improved through educational interventions. Conclusion: Optimizing analgesic regimens for postoperative pain management requires careful consideration of individual patient needs, including the benefits of opioid analgesics in achieving greater pain reduction. Adherence to evidence-based guidelines and ongoing educational programs for healthcare professionals are crucial for ensuring optimal pain relief with minimal side effects.

Strategy for the management of acute postoperative pain in day surgery centres in Spain. DUCMA 2.0. project

IntroductionAdequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain. MethodsA cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country. ResultsWe recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs. ConclusionsThe DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.

Postoperative Pain Management in Patients Undergoing Hip Surgeries with Spinal Anesthesia: Review Article

Postoperative Pain Management in Patients Undergoing Hip Surgeries with Spinal Anesthesia: Review Article

Predictive factors for critical care dependency after posterior spinal fusion for adolescent idiopathic scoliosis

AimsHistorically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with posterior spinal fusion (PSF).MethodsWe retrospectively reviewed all AIS patients who had undergone PSF between January 2018 and January 2020 in a specialist tertiary spinal referral centre. All patients were assessed preoperatively in an anaesthetic clinic. Postoperative care was defined as ward-based (WB) or critical care (CC), based on the preoperative FEV1, FVC, major curve Cobb angle, and the planned number of instrumented levels.ResultsOverall, 105 patients were enrolled. Their mean age was 15.5 years (11 to 25) with a mean weight of 55 kg (35 to 103). The mean Cobb angle was 68° (38° to 122°). Of these, 38 patients were preoperatively scored to receive postoperative CC. However, only 19% of the cohort (20/105) actually needed CC-level support. Based on these figures, and an average paediatric intensive care unit stay of one day before stepdown to ward-based care, the potential cost-saving on the first postoperative night for this cohort was over £20,000. There was no statistically significant difference between the Total Pathway Score (TPS), the numerical representation of the four factors being assessed, and the actual level of care received (p = 0.052) or the American Society of Anesthesiologists grade (p = 0.187). Binary logistic regression analysis of the TPS variables showed that the preoperative Cobb angle was the only variable which significantly predicted the need for critical care.ConclusionMost patients undergoing posterior fusion surgery for AIS do not need critical care. Of the readily available preoperative measures, the Cobb angle is the only predictor of the need for higher levels of care, and has a threshold value of 74.5°.Cite this article: Bone Joint J 2024;106-B(7):713–719.

Evaluation of Post-Operative Pain Management Techniques in Oral Surgery

ABSTRACT Objective: This prospective research directed to estimate the efficacy and safety of different post-operative pain management techniques in oral surgery subjects. Methods: Patients scheduled for various oral surgical procedures were recruited from a single oral surgery clinic between January 2022 and December 2023. Inclusion criteria encompassed adult subjects undergoing elective oral surgery under local or general anesthesia. Subjects were randomly assigned to one of three post-operative pain management protocols: Group A received standard analgesics, Group B received combination analgesics, and Group C received non-pharmacological interventions. Pain intensity scores, analgesic consumption, adverse events, and patient satisfaction were assessed at specified intervals post-operatively. Results: Non-pharmacological interventions demonstrated lower pain intensity scores and analgesic consumption compared to standard and combination analgesics. Additionally, the incidence of adverse events was lower in the non-pharmacological intervention group. Statistical analysis revealed significant differences in pain outcomes among the three groups. Conclusion: This prospective research suggests that non-pharmacological interventions may provide effective pain relief with fewer adverse events compared to traditional analgesics in post-operative oral surgery subjects. Implementation of multi-modal pain management approaches tailored to individual patient needs may improve overall pain control and enhance patient outcomes.

Intrathecal Fentanyl versus Intrathecal Dexmedetomidine as an Adjuvant to Isobaric Levobupivacaine 0.5% in Elective Cesarean Sections: A Randomized Control Trial

Background: When a cesarean section is performed, it is crucial to have access to good postoperative analgesia. To achieve this, adjuvants are added along with local anesthetics as it has a synergistic action to improve its duration and quality. Alpha-2 adrenoceptor agonists and opioids such as dexmedetomidine and fentanyl, respectively, are used for their sedative, analgesic, and perioperative sympatholytic and cardiovascular stabilizing effects with reduced anesthetic requirements. The purpose of this research is to evaluate the effects of intrathecal fentanyl versus dexmedetomidine combined with levobupivacaine on postoperative analgesia and hemodynamic changes. Materials and Methods: This is a prospective randomized control trial, among 50 patients undergoing elective cesarean section. Group 1 will receive 0.5% levobupivacaine 2 ml + fentanyl 25 mcg and Group 2 will receive 0.5% levobupivacaine + dexmedetomidine 5 mcg. Duration of analgesia and onset and duration of sensory-motor block, perioperative analgesic requirements, sedation, and hemodynamic stability were compared. The data were entered into Microsoft Excel and analyzed using SPSS 16. Results: The baseline characteristics such as age and gender, weight, height, and body mass index were not statistically significant in both the groups. Duration of analgesia was significantly longer in the dexmedetomidine group than the fentanyl group. The mean time of onset of motor block in the group, for which dexmedetomidine was 14.23 ± 1.85 min and it was found to be much earlier than the local anesthetic group. All the patients in the dexmedetomidine group had a Visual Analog Scale (VAS) score of 0 (no pain) at the end of 4 h. In contrast, only 21 patients in the fentanyl group had a VAS score of 0, and four patients had a VAS score of 2, indicating mild pain requiring no treatment. Conclusion: The study showed that both fentanyl and dexmedetomidine as an adjuvant to levobupivacaine in cesarean section showed a longer duration of analgesia with increased sedation score and lesser pain score. When comparing the both, dexmedetomidine to the levobupivacaine has a more effective effect on postoperative pain management than fentanyl.

Comparative analysis of intraperitoneal ropivacaine with and without tramadol for post-operative pain management in laparoscopic cholecystectomy

Comparative analysis of intraperitoneal ropivacaine with and without tramadol for post-operative pain management in laparoscopic cholecystectomy

Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy: Randomized Controlled Trial

Background: Laparoscopic hysterectomy patients report high levels of postoperative pain and inadequate pain relief. This minimally invasive procedure is difficult to manage and leads to increased opioid use, limited mobility, and higher risks of complications, delayed rehabilitation and prolonged hospital stay. Objective: To determine the analgesic efficacy of bupivacaine’s intraperitoneal instillation (IP) with dexmedetomidine as an adjuvant for postoperative pain management in laparoscopic hysterectomy. Methods: This study is a randomized control clinical trial done at the Obstetrics and Gynecology Department, Ain Shams University Hospital, within 11 months (from September 2021 to August 2022). This study’s target population was all patients enrolled in laparoscopic hysterectomy. A total of 30 patients participated in this study, and we randomly divided it into two groups equally (15 patients per group). Results: There was no significant difference between groups regarding body mass index, age, parity, obstetric history, medical history, surgical history, indication of hysterectomy, type of hysterectomy, duration of surgery, and uterus size. Visual analog scores for patients at 1-, 6-, 12-, and 24-hours post-operatively increased significantly in Group B than in Group A. Furthermore, the time required for first rescue analgesia increased significantly more in Group A than in Group B. Group A required substantially less analgesic amount than Group B. Group A had significantly shorter hospital stays than Group B. There was no statistically significant difference between groups A and B in terms of adverse effects like nausea and vomiting (p>0.05) although they were less frequent in group A. Conclusion: Intraperitoneal instillation of bupivacaine combined with dexmedetomidine during laparoscopic hysterectomy substantially reduces postoperative pain and the requirement for analgesics in the postoperative period, compared to the control group, with no adverse side effects.

Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.

Surgeons have come under increased scrutiny for postoperative pain management, particularly for opioid prescribing. To decrease opioid use but still provide pain control, nonopioid medications such as muscle relaxants are being used, which can be harmful in older adults. However, the prevalence of muscle relaxant prescribing, trends in use over time, and risk of prolonged use are unknown. Using a 20% representative Medicare sample, we conducted a retrospective analysis of muscle relaxant prescribing to patients ≥ 65 years of age. We merged patient data from Medicare Carrier, MedPAR, and Outpatient Files with Medicare Part D for the years 2013-2018. A total of 14 surgical procedures were included to represent a wide range of anatomic regions and specialties. The study cohort included 543,929 patients. Of the cohort, 8111 (1.5%) received a new muscle relaxant prescription at discharge. Spine procedures accounted for 12% of all procedures but 56% of postoperative prescribing. Overall, the rate of prescribing increased over the time period (1.4-2.0%, p < 0.001), with increases in prescribing primarily in the spine (7-9.6%, p < 0.0001) and orthopedic procedure groups (0.9-1.4%, p < 0.0001). Of patients discharged with a new muscle relaxant prescription, 10.7% had prolonged use. The use of muscle relaxants in the postoperative period for older adults is low, but increasing over time, especially in ortho and spine procedures. While pain control after surgery is crucial, surgeons should carefully consider the risks of muscle relaxant use, especially for older adults who are at higher risk for medication-related problems.

Ultrasound-Guided Percutaneous Cryoneurolysis of the Antebrachial Cutaneous Nerves for the Management of Prolonged Acute Post-Surgical Forearm Pain: A Report of Two Cases.

Prolonged acute postsurgical pain (PAPSP) contributes to the development of chronic postsurgical pain, impaired rehabilitation, longer hospital stays, and decreased quality of life. For upper extremity analgesia, the duration of postoperative pain management with continuous brachial plexus peripheral nerve blocks is limited due to the risk of infection. Ultrasound-guided percutaneous cryoneurolysis provides extended analgesia and avoids the risks and inconveniences of indwelling catheters. We present 2 cases of PAPSP of the forearm effectively managed by the use of ultrasound-guided percutaneous cryoneurolysis to treat the medial, lateral, and posterior antebrachial cutaneous nerves.

A Randomized, Controlled Trial to Assess the Efficacy and Safety of PF-72 Mixed with 0.75% Ropivacaine Hydrochloride in the Management of Postoperative Pain in Patients Undergoing Elective Arthroscopic Shoulder Surgery

A Randomized, Controlled Trial to Assess the Efficacy and Safety of PF-72 Mixed with 0.75% Ropivacaine Hydrochloride in the Management of Postoperative Pain in Patients Undergoing Elective Arthroscopic Shoulder Surgery

The Analgesic Efficacy of Erector Spinae Plane Block in Ankle and Foot Surgery: A Randomized Controlled Study

Background: During ankle and foot surgeries, we often use different regional analgesic modalities to reduce patient pain during and after orthopaedic and surgical operations. The purpose of this research was to examine the effectiveness of erector spinae plane (ESP) block for postoperative pain management after ankle and foot surgeries. Methods: Sixty patients, aged 18 to 65, with ASA physical status I, participated in a randomized controlled clinical experiment. Patients were divided into two groups (E and C) at random, with group (E) receiving ESP block and group (C) receiving a placebo. The patients' medical histories were evaluated, and they were all examined and tested. Results: Observations At 2, 4, 12 &amp; 24 hours postoperatively, the ESP group had substantially lower visual analogue scale (VAS) ratings in contrast to the control group. The total quantity of fentanyl and pethidine given during, and after surgeries were both considerably lower in the Erector group in comparison with the control group. Total nonsteroidal anti-inflammatory medication usage did not vary significantly among the 2 groups, however. Conclusions: ESP is safe &amp; effective technique in decreasing pain and providing adequate analgesic effect in ankle and foot ssurgeries. Trial Registration: This study was prospectively registered on https://clinicaltrials.gov/ under the NCT05708742 number (principal investigator: Mohamed Ahmed Hamed), registration date: 24/01/ 2023.

Comparison of grapiprant and meloxicam for management of postoperative joint pain in dogs: A randomized, double-blinded, prospective clinical trial.

Grapiprant is a novel anti-inflammatory drug approved for the treatment of pain associated with osteoarthritis in dogs. Compare the efficacy of grapiprant vs meloxicam for the management of postoperative joint pain in dogs. Forty-eight dogs presented with cranial cruciate ligament disease and treated by tibial plateau leveling osteotomy (TPLO) between May 2020 and May 2022. In this randomized, double blinded, prospective clinical trial, client-owned dogs with naturally occurring unilateral cruciate ligament rupture were enrolled on the day of surgery. The day after surgery, all animals received a subcutaneous injection of 0.2 mg/kg of meloxicam and were randomly assigned to receive either oral grapiprant (2 mg/kg) or meloxicam (0.1 mg/kg), once a day for 14 days, in a blinded manner. The primary endpoint of the study was the pain severity (PSS) and interference (PIS) scores, assessed by the Canine Brief Pain Inventory (CBPI) at day 3, 7, 10 and 15 after the surgery. Three days after surgery, grapiprant treated dogs had lower PSS compared to meloxicam treated dogs with a mean ± SD of 2.76 ± 0.18 vs 3.25 ± 0.23, respectively (difference of -0.49 [95% CI -0.94 to -0.04], P = .032). Pain Interference Score was also lower in grapiprant group at day 3 (4.11 ± 0.18 vs 4.69 ± 0.16 in meloxicam group [difference of -0.58 {95% CI -1.03 to -0.13}, P = .013]) and at day 10 (2.23 ± 0.13 vs 2.72 ± 0.28 [difference of -0.49 {95% CI -0.92 to -0.01}, P = .049]). Our study supports the use of grapiprant as an alternative analgesic to meloxicam for management of postoperative joint pain in dogs.