Postoperative Pain Management In Patients Research Articles

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 < 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.

Post-C-Section Pain Management with the Enhanced Recovery after Surgery and Multimodal Analgesia Methods: A Case Series

Introduction: This study aims to present the management of postoperative c-section pain using multimodal analgesia.&#x0D; Case presentation: There were two patients who received multimodal analgesia as a treatment for postoperative C-section pain. The first patient, a woman 15 years old, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and cephalopelvic disproportion (CPD). The second patient, a 23-year-old woman, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and 1x umbilical cord. Physical examination of both patients showed vital signs within normal limits. Laboratory evaluation within normal limits. Both patients were included in the ASA II category. The anesthetic method used intraoperatively was subarachnoid block with hyperbaric bupivacaine 0.5% 10 mg and morphine 50 mcg. Lidocaine infiltration injection is performed intraoperatively in combination with the following; lidocaine 2% (3 ampoules), dexamethasone 4 mg, ketorolac 60 mg, and morphine 4000 mcg dissolved in aquabides into 20 ml subcutaneously.&#x0D; Conclusion: A multimodal analgesia is an appropriate approach for postoperative pain management in patients undergoing cesarean section.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Arthroscopic therapy of rotator cuff diseases: A bibliometric study of the past 2 decades (2002-2021).

PurposeRotator cuff diseases, as a common cause of shoulder pain and disability, have seriously affected the patients' daily life. Rotator cuff repair techniques have been a hot topic in the arthroscopic therapy field. Our study was to use bibliometrics analysis to clarify the current status and research trends in the field of arthroscopic therapy of rotator cuff diseases.MethodsThe publications relating to arthroscopic therapy of rotator cuff diseases published from 2001 to 2021 were obtained from the Web of Science Core Collection (WoSCC) database. The R software and VOSviewer software were used for the cross-sectional bibliometric and scientometric analysis.ResultsA total of 4,567 publications about arthroscopic therapy of rotator cuff diseases published between 2002 and 2021 retrieved from the WoSCC database were analyzed in our study. The results showed that the United States made the largest contribution to this field. The most relevant institutions were Seoul National University, Rush University, and Hospital for Special Surgery. Stephen S Burkhart was the most relevant researcher in this field with the largest number of publications, as well as the highest H-index and G-index. The journal ARTHROSCOPY contributed the largest number of publications in the past 2 decades. Considering the H-index and G-index, ARTHROSCOPY was also the journal with the largest impact in this field.ConclusionsArthroscopic Therapy of Rotator Cuff Diseases Related research presented a rising trend in the past 2 decades. The United States can be regarded as the leader because of its huge contributions to this field. The journal ARTHROSCOPY published the largest number of publications in this field. It can be predicted that research about advanced arthroscopic techniques and postoperative pain management of patients with rotator cuff diseases will be the next research hotspots in the following years.

Efficacy and safety of 5% lidocaine patches for postoperative pain management in patients undergoing unilateral inguinal hernia repair: study protocol for a prospective, double-blind, randomized, controlled clinical trial

BackgroundAcute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units.Methods/designThis is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow up at our outpatient clinic on the first postoperative day and at 1 week after surgery. The primary outcome is pain intensity, which will be measured using the visual analog scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 h and 1 week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height).DiscussionThis trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management.Trial registrationClinicalTrials.gov NCT04754451. Registered on February 10, 2021.

Addition of lumbar intrathecal morphine along with standard thoracic epidural anesthesia for abdomino thoracic esophagectomy

Introduction: Thoracic epidural anaesthesia (TEA) has been the standard of care for postoperative pain management for patients undergoing abdomino-thoracic esophagectomy. The study aims to observe whether addition of lumbar intrathecal morphine along with TEA reduces the post operative pain scores, post operative opioid consumption and total epidural drug requirement. Materials and methods:50 patients divided into two groups, one group was given standard TEA at level T5-T7, other group was receiving intrathecal morphine along with TEA. General anaesthesia will be provided as per standard protocol and one lung isolation will be achieved using Robertsons double lumen tube of proper size. Pain scores will be monitored using Numerical rating Scale. Total requirement of epidural drug in both the groups , requirement of rescue analgesia, complications in both the groups will be observed. Results and observations: In our study we found that VAS score were better in the combined intrathecal morphine plus thoracic intrathecal morphine plus thoracic epidural approach group and there were less need of rescue analgesia and good recovery compared to conventional thoracic epidural approach. Haemodynamic parameters and complications were almost comparable in both the groups except for heart rate.

Opioid-Sparing Effects of the Bupivacaine Pleural Catheter in Surgical Decompression of the Thoracic Outlet

Rib resection in thoracic outlet decompression can result in significant postoperative pain requiring high levels of opioid medications. We evaluated the impact of a bupivacaine infusing pleural catheter on postoperative pain and opioid usage in patients undergoing rib resection for thoracic outlet syndrome. We hypothesized that delivery of local anesthetic via the pleural catheter would improve postoperative pain control compared to standard multimodal analgesia, and that the use of the catheter would decrease opioid use during the index hospitalization and prescriptions for opioid pain medications at discharge. We conducted a single-center retrospective cohort study of 26 patients who underwent rib resection for thoracic outlet decompression. Primary outcome was opioid consumption during the index hospitalization, measured in morphine milligram equivalents (MME). Secondary outcomes were MME prescribed at discharge and pain scores during the index hospitalization before and after the pleural drain and pleural catheter were removed. Patients in the bupivacaine infusion pleural catheter group (n=11) had significantly lower MME usage during the index hospitalization (22.5 [1.9, 65.6] vs. 119.8 [76.5, 167.4]), and significantly lower MME prescribed at discharge (0 [0, 37.5] vs. 225 [183, 315]), compared to standard multimodal analgesia in controls (n=15). Only 3 patients in the bupivacaine pleural catheter group were discharged with any opioid prescriptions (27%), compared to 14 patients in the control group (93%). There was no difference in postoperative pain scores between groups before or after removal of the pleural drain, which was placed in all cases (P=0.31 and P=0.76, respectively). Intraoperative placement of a bupivacaine infusion pleural catheter significantly reduced opioid use during the index hospitalization and opioid prescribing at discharge. Anesthetic infusion pleural catheters should be the treatment modality of choice for postoperative pain management in patients undergoing thoracic outlet decompression.

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study.

BackgroundPectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption.MethodsWe conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups.ResultsTwo hundred and twenty-eight subjects (n = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups (p = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% (N = 5), being wound infection, the only complication observed in the PECS groups (N = 2), and hematoma (N = 2) and wound dehiscence (N = 1) in the control group.ConclusionPECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.