Postoperative Pain Management In Patients Research Articles

Effectiveness of the Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for Postoperative Pain Management in Patients Undergoing Major Surgical Operations at Manokwari Hospital

Postoperative pain is a common complication in patients undergoing major surgical operations, interfering with comfort and recovery and increasing the risk of further complications. This study aimed to evaluate the effectiveness of NSAIDs in managing postoperative pain at Manokwari Regional Hospital. Utilizing qualitative research methods, data was collected through observation and literature study and analyzed via data reduction, data presentation, and conclusion drawing. The findings indicate that NSAIDs effectively alleviate postoperative pain by inhibiting cyclooxygenase (COX) enzymes responsible for prostaglandin production. However, their use is limited by potential systemic side effects, including gastrointestinal disorders, kidney impairment, increased blood pressure, heart attack, and heart failure. Consequently, topical NSAID formulations are recommended to mitigate these risks. The study suggests that while NSAIDs are effective, clinicians should consider their side effects and prefer topical alternatives. Future research should explore the efficacy and safety of topical NSAIDs and alternative pain management strategies to enhance clinical practice.

To Compare the Efficacy of Sub-Pecto-Interfascial Block with Erector Spinae Plane Block in Postoperative Pain Management in Patients Undergoing Cardiac Surgery

Objectives: Pain following sternotomy has always been an issue of major concern for anesthesiologists. The incidence of pain is as high as 49% at rest following coronary artery bypass grafting. We planned to utilize the sub-pecto-interfascial plane (SIP) block and erector spinae plane (ESP) block to determine its efficacy and quality of analgesia as compared to conventional intravenous analgesia. Material and Methods: After the Institutional Ethics Committee’s approval, we recruited 105 patients and randomized them into three groups. Group 1 received conventional analgesia, group 2 SIP, and group 3 ESP block. Group 2 and Group 3 received allocated blocks after induction of balanced general anesthesia under ultrasound guidance. With high-frequency linear probe (13 MHz) planes identified, a mixture of injection ropivacaine (0.375%) and dexmedetomidine (1.1 mcg/mL) was deposited. In group 2, six injections of 6 mL each at the 2nd, 4th, and 6th intercostal spaces in the bilateral parasternal region. In group 3, two injections of 20 mL of the above-mentioned mixture on each side above the transverse process of the T5 vertebra under the erector spinae muscle plane were injected. All patients were monitored throughout the procedures, and their vitals were recorded. Heart rate, systolic blood pressure, and diastolic blood pressure were noted at baseline, at skin incision, at sternotomy, and 30 min post-extubation. Patients were followed for total fentanyl consumption, pain score (numerical rating scale [NRS] score), and peak inspiratory flow rate, which were noted at extubation and 2, 4, 6, 8, 12, and 24 hours post-extubation. Levels of C-reactive protein (CRP), cortisol, and prolactin were done at baseline and 24 h after surgery. Extubation time, time of first oral intake, and total length of intensive care unit (ICU) stay were also compared between the groups. Results: Total fentanyl consumption was significantly lower (P < 0.005) in group 2 and group 3 compared to group 1. Patient receiving blocks were significantly lower NRS score compared to the control group. Spirometry has shown improved results in block groups catering to early discharge from ICU. Rise in levels of CRP, cortisol, and prolactin were much higher in group 1 as compared to group 2 and group 3. Conclusion: The application of ESP and SIP blocks is far superior than conventional parenteral analgesics in terms of pain score, total opioid’s consumption, hemodynamic maintenance, spirometry efforts, and length of ICU stays.

Comparison of genicular nerve block with adductor canal block for postoperative pain management in patients undergoing arthroscopic knee ligament reconstruction: A randomised controlled trial.

Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann-Whitney U test was used to compare continuous variables. NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31-1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000). US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR.

Analyzing the application of dezocine combined with psychological care in the postoperative pain management of patients with hemifacial spasm

Objective To analyze the application of Dezocine combined with psychological care in the postoperative pain management. Methods This is a retrospective study. A total of 186 HFS patients who underwent Microvascular Decompression (MVD) at First People’s Hospital of Zunyi between January 2020 and January 2022 were selected as the study subjects. Patients were divided into two groups based on different treatment interventions. The control group (n = 93) received routine perioperative care without preemptive analgesia, while the observation group (n = 93) received preemptive analgesia and combined psychological care on the basis of the control group’s intervention. Results At 30 min post-laryngeal mask removal (T3), no significant difference in Ramsay Sedation Scale scores existed between control and observation groups (p > 0.05). The observation group showed significantly lower RSS scores at immediate mask removal (T2) and VAS scores at T3 compared to controls (p < 0.05). Following intervention, the observation group had notably lower SAS and SDS scores than controls (p < 0.05). Baseline (T0) and 5 min pre-removal (T1) exhibited no significant differences in mean arterial pressure (MAP) and heart rate (HR) values between groups (p > 0.05). However, at T2 and T3, the observation group displayed significantly lower MAP and HR values than controls (p < 0.05). No significant differences in pulse oxygen saturation (SpO2) values existed between groups at any time point (p > 0.05). Conclusion Compared to standard perioperative care alone, Dezocine combined with preemptive analgesia and psychological care effectively reduces postoperative pain during the awakening period, lowers the risk of immediate extubation-related agitation, and maintains stable hemodynamics in the postoperative period.

Online Learning to Improve Nurses’ Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults

BackgroundOlder adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses’ knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management. AimTo determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty. DesignA quasi-experimental pre-test–post-test design with intervention and control groups. MethodSix inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses’ knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired t-tests, and independent t-tests. ResultsThe knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group. ConclusionsAn online learning program improves nurses’ understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.

Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials.

The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods. We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model. The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups. For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.

GAMBARAN MANAJEMEN NYERI AKUT PASKA OPERASI PADA PASIEN YANG MENJALANI TINDAKAN OPERASI ELEKTIF DI RSU HAJI MEDAN

Profile of nutritional status and eating behavior of doctors in their work To determine the description of acute post-operative pain management in patients undergoing elective surgery at RSU Haji Medan. This research is a descriptive study with a cross-sectional research design on elective post-operative patients. In this study, the number of respondents who participated was 66 people, with the largest gender being 37 people (56.1%), the average age was 40 years, and the majority of respondents were Javanese, namely 25 people (37.9%) . The highest preoperative pain intensity was moderate pain, amounting to 41 people (62.1%). The majority of pain intensity in the first 8 hours after surgery was moderate pain, in the second 8 hours the majority was mild pain and in the third 8 hours the majority was no pain. The majority of post-operative analgesic regimens use a combination of intravenous injection of ketorolac 30 mg and paracetamol 1 gram per 8 hours. The majority of the side effects felt by respondents after surgery were nausea.

Role of the NeuroCuple™ Device for the Postoperative Pain Management of Patients Undergoing Unilateral Primary Total Knee and Hip Arthroplasty: A Pilot Prospective, Randomized, Open-Label Study

Background: The potential effectiveness of the non-pharmacological and nanotechnology-based NeuroCuple™ device in reducing postoperative surgical pain and opioid consumption remains unknown. Methods: This randomized controlled open-label study was conducted in patients undergoing a primary unilateral total knee or total hip arthroplasty. In the recovery room, patients were randomized to receive either standard of care (control group) or standard of care plus two NeuroCuple™ devices. The outcome variables included pain and opioid consumption (oral morphine equivalent, OME in milligrams). Results: A total of 69 patients were randomized to either the NeuroCuple™ group (n = 38) or the control group (n = 31). Use of the NeuroCuple™ devices was associated with a significant 34% reduction in pain at rest (means of area under the curve: 6.3 vs. 9.5; p = 0.018) during postoperative days 1–3. Opioid consumption was reduced by 9%. More importantly, use of the NeuroCuple™ devices reduced the number of patients requesting an opioid prescription following discharge from the hospital by 52% (26% vs. 55%, p = 0.016). Conclusions: Our data suggest that the NeuroCuple™ device may be an effective non-pharmacological alternative to opioids to manage postoperative pain following unilateral arthroplasty due to its ability to reduce postoperative opioid use.

Comparison of the effectiveness of bilateral parasternal plane block as an adjunct for postoperative pain management in patients undergoing median sternotomy for cardiac surgery

Comparison of the effectiveness of bilateral parasternal plane block as an adjunct for postoperative pain management in patients undergoing median sternotomy for cardiac surgery

Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy

Abstract Study Objective Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves. Design Prospective randomized, double blinded study. Setting After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals. Patients Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis Interventions Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group. Measurements Postoperative nalbuphine consumption and pain scores between groups were compared. Main Results Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p &amp;lt; 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis. Conclusion Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia

Paravertebral vs Epidural Anesthesia for Video-assisted Thoracoscopic Surgery: A Randomized Trial

BackgroundThe choice of postoperative pain management for patients who experience moderate to severe acute pain after thoracoscopic surgery is debatable. This study aimed to determine whether paravertebral block (PVB) provides more benefits than thoracic epidural analgesia (TEA) for thoracoscopic surgery. MethodsFrom February 2020 to April 2022, patients without chronic pain who were scheduled to undergo thoracoscopic surgery were randomly assigned to the PVB group or the TEA group. The visual analogue scale score was used to measure the degree of pain when the patients were at rest or coughing. ResultsIn total, 176 eligible patients were enrolled in this study. No significant difference in the visual analogue scale score was found between the 2 groups at rest (P = .395) or with coughing (P = .157). Additionally, there was no significant difference in the average pain score between these 2 states (P = .221). The median time for catheter placement in the PVB group was 5 minutes, which was shorter than that (14 minutes) in the TEA group (P < .001). Moreover, the catheter placement failure rate in the PVB group was lower than that in the TEA group (P = .038). The incidence of hypotension (P = .016) and urinary retention (P = .006) in the PVB group was lower than that in the TEA group. ConclusionsPVB can provide pain relief that is similar to that of TEA but with no additional puncture pain, a shorter catheter placement time, and fewer side effects in patients undergoing video-assisted thoracoscopic surgery.

Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials

BackgroundSerratus anterior plane block (SAPB) is a promising regional technique for analgesia in thoracic surgery. Till now, several randomized controlled trials (RCTs) have explored the effectiveness of SAPB for postoperative pain control in patients undergoing video-assisted thoracoscopic surgery (VATS), but the sample sizes were small and conclusions remained in controversy. Therefore, we conducted the present systematic review and meta-analysis.MethodsRCTs evaluating the analgesic performance of SAPB, comparing to control methods (no block, placebo or local infiltration anesthesia), in patients undergoing VATS were searched in PubMed, EMBASE, Web of Science and Cochrane Library from inception to December 31, 2022. Mean difference (MD) and corresponding 95% confidence interval (95%CI) were calculated for postoperative pain scores at various time points, postoperative opioid consumption and length of hospital stay. Pooled relative risk (RR) with 95%CI were calculated for the risk of postoperative nausea and vomiting (PONV) and dizziness. A random-effect model was applied.ResultsA total of 12 RCTs (837 participants) were finally included. Compared to control group, SAPB had significant reductions of postoperative pain scores at 2 h (MD = -1.58, 95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38, P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h (MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover, SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There was no difference between both groups regarding length of hospital stay and risk of dizziness.ConclusionSAPB shows an excellent performance in postoperative pain management in patients undergoing VATS by reducing pains scores, postoperative opioid consumption and incidence of PONV. However, due to huge heterogeneity, more well-designed, large-scale RCTs are needed to verify these findings in the future.

Efficacy of different local anaesthetic volumes during erector spinae block for postoperative pain management in patients undergoing open nephrectomy operations. A randomized controlled study

ABSTRACT Background Pain control after surgery is of highest priority. Erector spinae plane block [ESPB] was reported to be a successful method to reduce pain scores and consumption of postoperative opioids. However, hardly any investigation has looked at the ideal volume of bupivacaine for ESPB. So, this work tried to fill this gap of literature in patients undergoing simple nephrectomy. Methods In this randomized double blinded control study, 100 cases undergoing simple nephrectomy were randomized into 4 groups with 25 patients per group. Group E1, 2, and 3 received ESPB with 2.5, 3.4, and 6.6 ml/segment of 0.25% bupivacaine, respectively, whereas there was no block given to the control group. Intraoperative fentanyl consumption, heart rate [HR] and the blood pressure [BP], Postoperative morphine consumption, time passed to first analgesic request, numerical rating score [NRS] of pain, the complications, HR and BP were documented for 24 hours after the operation. Results The reduction in intraoperative fentanyl consumption, postoperative morphine consumption and NRS were a significantly different between the block groups and control. Group E3 had significant difference from other groups with the longest time to first analgesia request. A lower HR was shown in block groups but within normal range. BP showed insignificant difference between groups. There were no reported complications in all study groups. Conclusions The volume of 6.6 ml/level was associated with the best pain control, without significant hemodynamic changes or adverse events as compared to other groups. This suggests that this volume may be the optimal for ESPB in patients undergoing simple nephrectomy.

Pectus arcuatum: Description of a hybrid surgical technique

ObjetivesPectus Arcuatum (PA) is a very rare anterior chest wall deformity resulting from premature obliteration of the sternomanubrial junction. Unlike other chest wall deformities, surgical correction continues to be the only treatment option. We report our initial experience using the hybrid technique and evaluate the results. MethodsWe reviewed all the cases of PA that underwent a hybrid procedure between January 2020 and June 2022.We combined the Nuss procedure and the modified-Ravitch procedure. All patients underwent either percutaneous or thoracoscopic cryoanalgesia to improve postoperative pain management. The Nuss procedure was performed first. A single bar was inserted under thoracoscopic vision.Sternochondroplasty was performed through a 3-4-centimeter-long mid-sternal skin incision. After dissecting the sternal insertions of both pectoralis major muscles, bilateral subperichondrial chondrectomies were carried out and a wedge-shaped transverse sternal osteotomy was performed using an oscillating saw, preserving the posterior lamina. Sternal realignment was achieved by securing opposite sides of the osteotomy with two vertical titanium plates. ResultsThree patients with PA were subjected to the hybrid procedure between January 2019 and June 2022. The mean age was 15 years (14-16). No intraoperative complications were encountered. The mean operative time was 200 minutes. Postoperative radiography showed optimal sternal realignment and stabilization. Excellent esthetic results were obtained with high patient satisfaction in all cases. The overall hospital stay ranged from four to five days in all cases with optimal pain control. The mean follow-up was 26.6 months (6-38), recurrence was not noted after bar removal. ConclusionsThe simultaneous correction of the sternal depression, with the insertion of a single pectus bar, during the hybrid procedure enables surgeons to perform a less invasive sternochondroplasty and a single sternal wedge-osteotomy through a smaller and more esthetic mid-sternal skin incision, whilst maintaining chest-wall stability. The hybrid technique is a novel procedure that has been carried out successfully in the 3 cases reported in our study, with excellent esthetic results. To our knowledge cryoanalgesia has not been previously employed to better the postoperative pain management of patients undergoing surgical correction for PA.

Oxidative Stress and Inflammation Biomarkers in Postoperative Pain Modulation in Surgically Treated Patients with Laryngeal Cancer—Pilot Study

(1) Background: Surgical treatment of laryngeal carcinoma includes different types of laryngectomies with neck dissection. Surgical tissue damage triggers an inflammatory response, leading to the release of pro-inflammatory molecules. This increases reactive oxygen species production and decreases antioxidant defense mechanisms, leading to postoperative oxidative stress. The aim of this study was to assess the correlation between oxidative stress (malondialdehyde, MDA; glutathione peroxidase, GPX; superoxide dismutase, SOD) and inflammation (interleukin 1, IL-1; interleukin-6, IL-6; C–reactive protein, CRP) parameters and postoperative pain management in patients surgically treated with laryngeal cancer. (2) Methods: This prospective study included 28 patients with surgically treated laryngeal cancer. Blood samples were taken for the analysis of oxidative stress and inflammation parameters before the operative treatment and after the operative treatment (1st postoperative day and 7th postoperative day). The concentrations of MDA, SOD, GPX, IL-1, IL-6, and CRP in the serum were determined by coated enzyme-linked immunosorbent assay (ELISA). The visual analog scale (VAS) was used for pain assessment. (3) Results and conclusion: There was a correlation between oxidative stress and inflammation biomarkers and postoperative pain modulation in surgically treated patients with laryngeal cancer. Age, more extensive surgery, CRP values, and use of tramadol were predictors for oxidative stress parameters.

The Effect of Dexamethasone on Postoperative Pain Management in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

Objective The objective of this study was to evaluate the effectiveness ofdexamethasonein treating postoperative pain in patients undergoing total knee arthroplasty (TKA). Methodology This randomized controlled trial (RCT) was completed over the course of two years (September 7, 2015, to September 6, 2017). In the course of their treatment for osteoarthritis of the knee, all of the patients who had primary unilateral total knee replacement (TKR) participated in the research. Under spinal anesthesia, each patient had medial para-patellar approach medial orthopedic surgery. Patients were assigned to group A or group B based on a random selection. Each of the groups consisted of 79 individuals. Group A was given dexamethasone through intravenous administration at a dose of 0.1 mg/kg before the operation. During the subsequent period of 24 hours, no more treatment was administered (control group). On a predesigned questionnaire, postoperative pain was measured using the visual analog scale (VAS) for pain. Functional results, duration of hospital stay, and complications were all recorded on the questionnaire (VAS). Analysis of data was carried out using the Statistical Package for the Social Sciences (SPSS) version 23 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 158 patients in total in the study, out of which 98 were females and 60 were males in the group. The patients' average body mass index (BMI) was 26.94 ± 3.14 kg/m2. Patients in group A had lower postoperative analgesic and antiemetic needs and higher VAS scores and spent less time in the hospital than patients in group B. There were no postoperative problems in either group. Conclusion In patients undergoing TKA, the use of dexamethasone during and after surgery decreases pain, the need for analgesics, and the duration of hospital stay.

The Impact of the Need for Language Assistance Services on the Use of Regional Anesthesia, Postoperative Pain Scores and Opioid Administration in Surgical Oncology Patients

Language barriers can negatively impact the quality of healthcare. In surgical patients, limited English proficiency (LEP) can lead to disparities in acute postoperative pain management. Interpreters are often used for communication with LEP patients to help alleviate these disparities. We aimed to investigate the impact of the need for language assistance services (LAS) in acute postoperative pain management in patients undergoing oncologic surgery. We retrospectively collected data on adult patients undergoing open abdominal oncologic surgery between March 2016 and August 2021. The need for LAS, patient demographics, treatment and clinical outcomes were obtained from the patient's electronic medical record. The primary endpoint was pain intensity, while secondary endpoints included opioid use in PACU and regional anesthesia. Post-matching analysis (n = 590) demonstrated no significant difference in preoperative variables between patients needing LAS and those not needing LAS. The rate of regional use was slightly lower but not statistically significant in patients needing LAS. Patients needing LAS had significantly lower opioid consumption and reported lower pain intensity in PACU than subjects not requiring translation. In this study, LAS may have aided in the patient decision process regarding the acceptance of regional anesthesia. Although the need for LAS was associated with statistically significant lower pain intensity scores and a corresponding lesser opioid use than no LAS, the margin of differences, especially in pain intensity scores, may not be clinically significant. This may suggest that LAS allowed for better patient-provider communication and appropriate pain management.

Comparison of Postoperative Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block and Local Anaesthetic Infiltration with 0.375% Ropivacaine in Percutaneous Nephrolithotomy Patients: A Randomised Clinical Study

Introduction: The Erector Spinae Plane Block (ESPB) is a novel procedure that has shown benefits in postoperative pain management for various surgeries. It involves the systemic infiltration of anaesthesia into the surrounding tissues, which helps to suppress local pain responses. Aim: To compare the efficacy of Ultrasound-guided (USG) ESPB with local anaesthetic infiltration in postoperative pain management for patients undergoing Percutaneous Nephrolithotomy (PCNL). The comparison was based on the Numeric Rating Scale (NRS) score and the time taken for the first rescue analgesic requirement, along with its total consumption within 24 hours. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at Velammal Medical College and Hospital, Madurai, Tamil Nadu, India. The duration of the study was two months, from September 2022 to October 2022. A total of 70 patients were randomly assigned to either group L (n=35) (local anaesthetic infiltration) or group E (n=35) (USG-guided ESPB). Demographic details, NRS pain scores, time taken for the first rescue analgaesia, and total consumption within 24 hours were noted and analysed. Descriptive analysis was performed, and a comparison between the groups was made using the Mann-Whitney U test or Chisquare test. Analysis was conducted using coGuide V1.0.3. Results: The mean age (mean±SD) of the study participants in group L and group E was found to be 49.31±13.96 years and 46.37±13.72 years, respectively. A total of 35 patients were included in each group, consisting of 16 (45.71%) females and 19 (54.29%) males in both groups. The difference in NRS scores was significant at 30 minutes, one hour (p-value &lt;0.001), and six hours (p-value &lt;0.011). The median time required for the first rescue analgesic was found to be 480 and 30 minutes in group E and group L, respectively (p-value &lt;0.001). The median total consumption within 24 hours was 50 mg in both groups. Conclusion: The USG-guided ESPB provided a longer-lasting analgesic effect in postoperative pain management for PCNL patients, as evidenced by the NRS pain scale, postoperative opioid consumption, and time for the first rescue analgesia

Evaluation of Supraclavicular Brachial Plexus Nerve Block with Patient Controlled Intravenous Analgesia for Post-Operative Pain Management in Patients with Forearm Surgery

Objective: To compare the efficacy of supraclavicular brachial plexus block with patient-controlled intravenous analgesia (PCIA) for post-operative pain management in forearm surgery.&#x0D; Study Design: Comparative Cross-Sectional Study.&#x0D; Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Kharian Pakistan, from Sep 2018 to Nov 2019.&#x0D; Methodology: Eighty-two adult patients, of ASA Class I and II, were enrolled and were randomly divided into two equal groups using computer-generated random numbers. General anaesthesia was administered to both groups. Additionally, Group-A (n=41) received supraclavicular brachial plexus block while Group-B (n=41) received patients-controlled analgesia. Post-operative pain was assessed using a 10 cm visual analogue scale (VAS). The pain scores were noted after complete recovery from general anaesthesia at 5 minutes, 6, 12 and 24 hours.&#x0D; Results: The pain score was found to be significantly lower in Group-A (supraclavicular brachial plexus block) as compared to Group-B (patients-controlled analgesia) at 6, 12 and 24 hours (p&lt;0.05) while the non-significant difference was noted at 5 minutes (p &gt;0.05).&#x0D; Conclusion: Significantly, better pain control was noted in supraclavicular brachial plexus block compared to patients’- controlled analgesia in post-operative pain management.

An Assessment of Postoperative Pain Management Undergoing Cesarean Section

Postoperative pain management of cesarean patients has become a major medical and nursing challenge in all over the world. Due to the various constraints postoperative pain management of cesarean patient in Bangladesh got greater attention from the scientific community and policy makers. An observational study was conducted to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing cesarean section in the obstetric unit in a district hospital, Hobigonj, Bangladesh during the period from February 2022 to August 2022. We recorded patient’s demographics, postoperative pain orders, and analgesia regime on the day of surgery. Anesthesia team, which included one of the investigators, assessed the overall pain since the time of surgery by visual analogue scale (VAS) and also recorded any complications since the time of surgery and patients’ satisfaction with the pain management. A total of 150 patients were reviewed during the study period. The common modality of pain management was intravenous opioid infusion (94%) and co-analgesia was used in 99% of patients. The analysis of pain at rest by VAS was between 1 and 3 in 89.7%, 4 and 6 in 9.5%, and 7 and 10 in 0.8% of patients. The VAS on movement was 1–3 in 60.1%, 4–6 in 33.1%, and 7–10 in 6.8% of patients. Patients’ opinion regarding postoperative pain management was satisfactory in 76.60% of patients and unsatisfactory in 23.40% of patients. In the conclusion, we can say, the regime for postoperative pain management was mostly started and followed by both the teams at the hospital and was not adequately satisfied.