Postoperative Pain Scores Research Articles

Efficacy and Safety of Different Preemptive Analgesia Measures in Pain Management after Laparoscopic Cholecystectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients. We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24h), opioid consumption within 24h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness. Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300mg, 150mg) and gabapentin (600mg, 300mg, and 20mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300mg having a lower adverse drug reaction (ADR) incidence. Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC. PROSPERO CRD42024522185.

Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Postoperative Pain Scores?

Study ObjectiveVaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in post-operative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale (VAS) at 2 hours, 6 hours, and 1 day post-operatively. Secondary outcomes include change in hemoglobin, urinary retention and length of stay (LOS) in hospital. DesignProspective cohort study SettingTertiary care academic teaching hospital. All PFRS performed by fellowship-trained urogynecologists. ParticipantsConsenting patients undergoing PFRS. InterventionsAt the completion of surgery, gauze packing soaked with either estrogen cream 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on post-operative day 1. ResultsWe included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean post-operative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66±2.25, 2.30±2.17, 2.24±2.07; p=.4656), 6 hours (2.99±2.38, 2.52±2.30, 2.36±2.01; p=.2181) or on post operative day 1 (1.89±2.01 vs. 2.08±2.15 vs. 2.44±2.19; p=.2832) as measured by VAS scores (0-10). There was no difference in the secondary outcomes of change in pre-/post-operative hemoglobin (21.8±10.73g/L, 20.09±11.55g/L, 21.7±9.62g/L, p=.68), urinary retention (37%, 45% and 48%, p=.45), LOS (1.05±0.46 days, 1.02±0.12, 1.03±0.24, p=.97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents (median (IQR1, IQR3), Kruskal-Wallis test): 11.25mg (0,33), 7.5mg (0, 22.5) and 15mg (0, 33.88) p =0.41. ConclusionThere was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to post-operative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing. Clinical Trial RegistrationNCT03266926. Registered February 1, 2017. https://clinicaltrials.gov/study/NCT03266926

Pectoral Nerve Block II for Cardiac Implantable Electronic Devices.

This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.

Efficacy of locoregional analgesic techniques after laparotomy for gynecologic cancer: a systematic review

ObjectiveTo determine which locoregional techniques are effective in managing post-operative pain in major open oncologic gynecologic surgery in terms of pain scores and opioid consumption when epidural analgesia is not...

Biological sex differences in pain response and functional outcomes after orthopedic surgery procedures: a scoping review

Background/Objective: Post-operative pain is frequently experienced by patients following orthopedic surgery procedures despite improved surgical technology and anesthesia techniques. The intensity of postoperative pain is multifactorial and biological sex is a key component of pain analysis. In this review article, the authors examine the impact of biological sex on post-operative pain scores and surgical outcomes following orthopedic surgery procedures. Methods: A keyword-based search of the National Library of Medicine and the National Center for Biotechnology Information was utilized for this review. Through our literature search we identified 56 articles related to the impact of sex on post-operative pain. These studies were then tabulated and analyzed in detail to provide data for this review article. Results: There are a variety of factors that influence surgical outcomes in orthopedics including age, comorbidities, and biological sex. The reviewed studies found that women report higher pain scores in the initial 6 wk post-operative period after total joint arthroplasty, upper extremity surgery, spine surgery, and general orthopedic surgery. Female sex was also associated with higher opioid consumption following surgery. In addition, men tend to have better surgical outcomes following total joint arthroplasty, upper extremity procedures, and spine surgery. Discussion/Conclusion: Biological differences including hormones, anatomy, and psychosocial factors influence post-operative pain differences between sexes. Little data is available on orthopedic surgery post-operative pain scores between the sexes and therefore further research is needed. Biological sex must be considered when evaluating patient wellness following orthopedic surgery procedures.

Interpersonal differences in postoperative pain scores after bariatric surgery: a systematic review

Background: Despite intensive and better multimodal pain management schemes during bariatric surgery, many obese patients still experience severe early postoperative pain. Furthermore, postoperative pain varies considerably between patients who undergo the same kind of surgery. The main purpose of this study is to investigate psychological and demographic predictors for interpersonal differences of acute postoperative pain after laparoscopic bariatric surgery. Methods: A search of Pubmed, Web of Science, Cochrane database, PsycARTICLES, Google Scholar from 2008 to 2023 was conducted with the following search criteria: psychological, psychometric, catastrophizing, anxiety, pain, fear, stress, depression, vulnerability, self-efficacy, somatization, perception, bariatric surgery and postoperative pain. Results: Younger age, higher ASA physical status, higher educational level, pre-existing anxiety, pre-existing depression and pre-existing alexithymia may contribute to interpersonal differences in acute postoperative pain scores after bariatric surgery. Conclusion: Limited evidence exists on demographic and psychological factors. Further research is warranted to clarify these demographic and psychological predictors of acute postoperative pain in bariatric surgery to provide a more effective intervention and perioperative care.

Comparison Of Ketorolac Versus Ibuprofen For Postoperative Pain Management In Total Abdominal Hystrectomy Surgeries

Background - Postoperative pain management is crucial for ensuring patient comfort and promoting faster recovery. Pharmacological interventions, such as NSAIDs, play an essential role in reducing pain intensity while minimizing opioid-related side effects. Ketorolac, a potent NSAID, and ibuprofen are both commonly used for pain relief. This study focuses on comparing the efficacy of these two drugs for pain management in total abdominal hysterectomy surgeries. Aim -To assess and compare the effects of intravenous ketorolac and intravenous ibuprofen on postoperative pain management in total abdominal hysterectomy patients. Materials and Methods: A randomized single-blind study was conducted on 30 patients, divided into two groups (Group K: ketorolac, Group I: ibuprofen). Various parameters, including VAS pain scores, sedation, time for rescue analgesia, and the number of rescue analgesics, were compared. Participants: 30 patients undergoing total abdominal hysterectomy, randomized into two groups (Group K: ketorolac, Group I: ibuprofen). Inclusion Criteria: Patients between 18 and 65 years of age undergoing elective surgery, ASA grade I or II. Exclusion Criteria: Patients with NSAID hypersensitivity, coagulation disorders, bronchial asthma, hepatic or renal failure, and peptic ulcers. Methodology: Patients received lumbar subarachnoid block, followed by either 30 mg of ketorolac or 800 mg of ibuprofen postoperatively. Rescue analgesics were provided if needed. Results: The postoperative pain scores were significantly lower in the ibuprofen group. Time for first rescue analgesia and the total number of rescue analgesics required were also lower in the ibuprofen group

Sphenopalatine ganglion block for pain control after septoplasty: a systematic review and meta-analysis with trial sequential analysis.

Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is still lacking. This systematic review and meta-analysis aim to comprehensively evaluate the analgesic efficacy of SPGB in septoplasty patients. We systematically searched PubMed/Medline, Scopus, Web of Science, Embase, and CENTRAL from inception to April 10th, 2024. Randomized controlled trials (RCTs) were assessed using the RoB-2 tool. The primary outcomes were postoperative pain scores, analgesic consumption, surgery duration, postoperative nausea and vomiting (PONV), and patient satisfaction. Continuous data were pooled as mean difference (MD), and dichotomous data as risk ratio (RR) with a 95% confidence interval (CI) using STATA software. Additionally, trial sequential analysis (TSA) was conducted. Three RCTs with 180 patients were included. Two RCTs had a 'low risk' of bias, while one RCT had 'some concerns'. The SPGB group had significantly lower postoperative pain within 24 hours compared to controls, particularly after particularly after 1-2 hours (MD = -1.85), 4-6 hours (MD = -2.02), 12 hours (MD = -2.14), and 24 hours (MD = -2.36) TSA confirmed the conclusive evidence. Analgesic use was significantly reduced in the SPGB group. No significant differences were observed in surgery duration or PONV rates between groups. Patient satisfaction was significantly higher in the SPGB group. SPGB demonstrates efficacy and safety in managing postoperative pain in patients undergoing septoplasty for DNS.

More efficient endoscopic submucosal dissection with deep endotracheal intubation for superficial cervical esophageal carcinoma: a dual-center, prospective, randomized controlled study

Deep endotracheal intubation (DET) has been proposed to improve cervical esophageal endoscopic submucosal dissection (ESD) because of the limited space and visibility. We aimed to evaluate the efficacy and safety of DET. In the current dual-center trial, patients were randomized into DET or conventional endotracheal intubation (CET) groups. Complete resection rate, operation time, and adverse events were measured and compared. Fifty-nine patients (60 lesions) were assigned to the groups, showing comparable baseline characteristics. The complete resection rates were similarly high in both groups. However, DET significantly reduced ESD operation time (52.2 minutes vs 71.1 minutes, P< .001) and postoperative pain scores (3.1 vs 4.7, P< .01). Severe stenosis occurred more frequently in the CET patients (20% vs 0%, P= .035). No significant differences were observed in other adverse events. DET can overcome technical challenges to improve therapeutic efficiency and safety. (Clinical trial registration number: NCT06420258.).

The comparison of erector spinae plane block and caudal block for postoperative analgesia in paediatric surgery - meta-analysis.

To assess the efficacy of Erector Spinae Plane Block (ESPB) compared to caudal block in reducing postoperative pain in paediatric surgery. An electronic literature search was conducted using the Cochrane Library, PubMed, and Google Scholar databases, with data collected from January 2018 until September 2023. This meta-analysis includes English-language randomized controlled trials (RCTs) studies contrasting ESPB with caudal block in paediatric patients. The primary outcome was the 24-hour post-operative pain scores. The secondary outcome included the time to rescue analgesia, the number of patients requiring rescue analgesia, and the occurrence of post-operative nausea and vomiting (PONV) and urinary retention. Five RCTs with 295 samples were included. The results showed no significant difference between ESPB and caudal block in postoperative pain scores at 1st hour SMD (standardized mean difference) of -0.17 (95% CI -0.70, 0.36; I2=76%; p= 0.53), 2nd hour of SMD: -0.50 (95% CI -1.21, 0.21; I2=88%; p=0.17), 6th hour SMD -1.09 (95% CI -2.21, 0.03; I2=95%; p = 0.06), 12th hour SMD -0.77 (95% CI -1.75, 0.21; I2=93%; p=0.12), and the 24th hour SMD -0.13 (95% CI -0.39, 0.12;, I2=2%; p=0.30) were found. Furthermore, there was no significant difference in the time first to rescue analgesia, the number of patients requiring analgesia rescue, PONV occurrence, and urinary retention. ESPB and caudal block showed equivalent analgesia efficacy and safety in paediatric surgery.

Evolving Strategies of Acute Post-operative Pain Management Service across Three Time Periods – A Single-centre Retrospective Analysis

Background and Aims: Pain alleviation is essential to enhanced recovery after surgery. In India, the acute pain service (APS) is still not well organised, and there is a wide variation in practices. In this retrospective cohort study, we have aimed to analyse how introducing a structured APS and its subsequent evolution with time has affected the pain scores of our post-operative patients undergoing major abdominal oncosurgeries. Methods: All adult patients who underwent elective major open abdominal oncosurgeries in our institution during the three time periods based on different levels of APS development: Timeline-1 (April 2021–September 2021), Timeline-2 (April 2022–September 2022) and Timeline-3 (January 2023–June 2023) were included, and data on post-operative dynamic pain scores were collected. The pain service delivery was reorganised, and from January 2021 onwards, there was an evolution from once-daily pain rounds to twice-daily pain rounds, facilitated by including a designated pain nurse and further refinement to include pre-operative patient education and staff training. The data were collected and analysed for change in various outcomes related to APS and its outcomes. Results: A total of 936 patients were included in the study. A statistically significant decline in dynamic pain scores was observed over time. Subgroup analysis conducted according to the extent of surgical incision revealed significant declines in dynamic pain scores over time. Conclusion: The study underscores the significance of a structured APS in optimising post-operative outcomes and highlights the need for continued efforts to enhance acute surgical pain management practices in healthcare settings.

A Retrospective Study Establishing a Nomogram Predictive Model for Postoperative High-Activity Delirium After Non-Cardiac Surgery.

Postoperative high-activity delirium (PDHA) manifests as a high alertness, restlessness, hallucinations, and delusions. Occurrence of PDHA represents an increased risk of poor prognosis for patients. To establish and validate a nomogram prediction model for high-activity delirium after non-cardiac surgery in a post-anesthesia care unit (PACU). This study retrospectively enrolled adult patients who underwent non-cardiac surgery and were observed in the PACU as training data. Patients were divided into PDHA (199 patients) and non-PDHA (396 patients) groups. Patients' general data, preoperative indicators, intraoperative conditions, and postoperative PACU conditions were collected. The risk factors for PDHA were identified using univariate and multivariate logistic regression analyses. A predictive column chart was created using R language. Adult patients who underwent non-cardiac surgery and entered the PACU for observation were randomly selected as the validation set data (198 cases) for model performance validation. The incidence rate of adult PDHA in the PACU was 0.275%. Sex, age, smoking history, low preoperative albumin level, Society of Anesthesiologists (ASA) classification, anesthesia duration, and postoperative PACU pain score were independent risk factors for hyperactive delirium in PACU adults. In this study, an adult PACU PDHA nomogram prediction model was developed. The training dataset verified that the ROC curve (area under the curve) and 95% confidence interval (95% CI) were 0.936 (0.917-0.955). The ROC curve of the validation data row showed that the area under the curve and 95% CI were 0.926 (0.885-0.967). The nomogram predictive model for PACU adult high-activity delirium constructed in this study showed good predictive performance. This model could enable the visualization and graphical prediction of adult high-activity delirium occurrence after PACU, which has clinical value.

Analysis of Patients Who Undergo Index Arthroscopy With Biopsy but Not Implantation for Staged Chondrocyte Cell Transplantation.

Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are 2-stage procedures requiring an index full-thickness cartilage biopsy. Only a portion of patients ultimately undergo second-stage ACI/MACI. To identify patients with articular cartilage defects who underwent arthroscopic debridement with biopsy for ACI/MACI and compare those who did with those who did not proceed with implantation within 2 years after biopsy. Additionally, the authors sought to identify why patients did not proceed with implantation. Case-control study; Level of evidence, 3. Patients who underwent arthroscopy and autologous chondrocyte biopsy from January 1, 2015, to December 31, 2019, and who had minimum 2-year follow-up data were grouped into those who proceeded with second-stage ACI/MACI (implant group; n = 97) and those who did not (biopsy group; n = 63). Demographic factors, cartilage defect characteristics, and preoperative International Knee Documentation Committee (IKDC) scores were analyzed. Patients in both groups were evaluated postoperatively using the IKDC, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, and patients who did not undergo implantation were asked for their reasoning. Body mass index (BMI) (P < .001) and Outerbridge grades at index arthroscopy (P = .047) were significantly higher for the implant group than the biopsy group. Both groups had significantly improved IKDC scores from their initial presentation to final follow-up (implant group: 46.4 ± 16.2 preoperative vs 69.6 ± 20.6 postoperative [P < .001]; biopsy group: 47.2 ± 15.9 preoperative vs 70.7 ± 19.1 postoperative [P < .001]); however, the level of improvement did not differ significantly between groups. Postoperative WOMAC, SANE, and VAS pain scores were also similar between groups. In the biopsy group, 23 patients (37%) cited symptom resolution or activity level improvement after initial arthroscopy as the reason for not proceeding with implantation. Patients who proceeded to the second stage of chondrocyte implantation via either ACI or MACI had higher-grade articular defects and higher BMI compared with those who underwent biopsy with concomitant debridement chondroplasty alone. Postoperative outcomes were similar between the groups.

Minimally invasive surgery, precise anesthesia and effective analgesia are crucial for walking within 1 hour after lung surgery.

The clinical effectiveness of enhanced recovery after surgery (ERAS) strategy, which emphasizes a comprehensive intervention without highlighting key points, seems to have reached a bottleneck. This study focuses on surgery, anesthesia and postoperative analgesia as the three key factors, to observe the related manifestations of ERAS in patients undergoing lung surgery with minimal intervention throughout the perioperative period. All patients who underwent lung surgery by micro-invasive video-assisted thoracoscopic surgery (VATS) at Taizhou Municipal Hospital from August 2018 to August 2019 were consecutively enrolled in the study. The clinical data of patients were collected to observe the results of ERAS. The patients were divided into intravenous analgesia group and intercostal nerve block group according to different analgesic methods, and the ERAS results of the two analgesic methods were compared. A total of 242 patients were included in the study. The time from cessation of anesthesia to extubation was 10 [interquartile range (IQR), 9, 12] minutes (min), the time from extubation to limb activity according to instructions was 18 (IQR, 14, 23) min, time to sit up was 18 (IQR, 14, 23) min, time to stand up was 40 (IQR, 35, 46) min, and time to walk was 48 (IQR, 45, 55) min. No patient had any anesthesia complications. Compared with the intravenous analgesia group, the intercostal nerve block group had shorter time to limb activity according to instructions, time to sit up and time to walk after extubation, and lower postoperative pain scores (P<0.05). For patients undergoing thoracic surgery, focusing on surgery, anesthesia and analgesia the three key factors, using micro-invasive VATS to reduce surgical trauma and shorten operation time, precise individualized anesthesia program and effective postoperative analgesia can achieve early autonomous activity of patients after surgery.

Transoral robotic thyroidectomy: Lessons learned from consecutive series of 1,000 patients

BackgroundTransoral robotic thyroidectomy has gained popularity as a promising approach for thyroid surgery owing to its improved cosmetic outcomes. The objective of this retrospective study was to describe the surgical and safety outcomes of 1,000 consecutive transoral robotic thyroidectomy cases. Methods1,000 consecutive patients who underwent transoral robotic thyroidectomy for thyroid disease were reviewed at a large metropolitan tertiary hospital (Seoul, Korea) between September 2012 and March 2022. ResultsThe study comprised 1,000 patients (815 women), with 891 cancer cases. Lobectomy was the most common procedure (89.4%), followed by total thyroidectomy (9.8%) and isthmusectomy (0.8%), and their respective mean total operative times were 173.8 ± 36.2, 236.8 ± 50.5, and 107.5 ± 19.8 minutes. An obvious learning curve was noted. The respective postoperative pain scores on postoperative days 0, 1, and 2 were 4.6 ± 1.3, 3.1 ± 0.8, and 2.5 ± 0.8. The mean postoperative hospital stay duration was 2.6 ± 0.9 days. Complications occurred in 3.6% of cases, including oral wound infection, skin flap burn, bleeding, chyle leakage, transient and permanent mental nerve injury, and transient and permanent recurrent laryngeal nerve injury. Transient hypoparathyroidism occurred in 4.1% of total thyroidectomy cases. Thirty-seven patients (4.2%) underwent additional radioactive iodine therapy. The median follow-up period was 39 months, and there were no cases of recurrence. ConclusionsUnder the expertise of an experienced surgeon, transoral robotic thyroidectomy results in favorable cosmetic outcomes, tolerable postoperative pain, and acceptable complication rates in carefully selected patients.

Umbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of giant inguinal hernias in infants and young children

ObjectiveExploration of the efficacy of treating large indirect inguinal hernias in infants and young children using umbilical double-port laparoscopy combined with extraperitoneal water injection.MethodsA retrospective analysis was conducted on 165 cases of primary unilateral large indirect inguinal hernias in infants and young children treated at our hospital from May 2018 to May 2023. Among them, 90 cases underwent umbilical double-port laparoscopic surgery combined with extraperitoneal water injection and high ligation of the hernia sac (Double-Port Group), and another 75 cases underwent conventional three-port laparoscopic high ligation of the hernia sac (Three-Port Group). The two groups were compared in terms of operation time, postoperative pain scores at 24 hours, hospital stay, incision complications, and recurrence within one year after surgery.ResultsBoth groups successfully completed the surgery without any intraoperative complications. The pain score at 24 hours postoperatively was lower in the Double-Port Group compared to the Three-Port Group, and there was no statistically significant difference in operation time, hospital stay, and incision complications between the two groups (P > 0.05). Both groups were followed up for one year postoperatively; the Three-Port Group had one recurrence that was cured after further treatment, while there were no recurrences in the Double-Port Group.ConclusionUmbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of large indirect inguinal hernias in infants and young children has the advantages of being safe and reliable, with concealed and aesthetic incisions, and rapid recovery.

Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country

BackgroundLaparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic techniques like modified perichondral approach to thoracoabdominal nerve block (M-TAPA) show promise. Our retrospective study evaluates M-TAPA’s efficacy in postoperative pain control for laparoscopic cholecystectomy in a middle-income country.MethodsThis was a retrospective case-control study of laparoscopic cholecystectomy patients at Hospital General de Mexico in which patients were allocated to the M-TAPA or control group. The data included demographic information, intraoperative variables, and postoperative pain scores. M-TAPA blocks were administered presurgery. Outcomes: opioid consumption, pain intensity, adverse effects, and time to rescue analgesia. Analysis of variance (ANOVA) compared total opioid consumption between groups, while Student’s t test compared pain intensity and time until the first request for rescue analgesia.ResultsAmong the 56 patients, those in the M-TAPA group had longer surgical and anesthetic times (p < 0.001), higher ASA 3 scores (25% vs. 3.12%, p = 0.010), and reduced opioid consumption (p < 0.001). The M-TAPA group exhibited lower postoperative pain scores (p < 0.001), a lower need for rescue analgesia (p = 0.010), and a lower incidence of nausea/vomiting (p = 0.010).ConclusionBilateral M-TAPA offers effective postoperative pain control after laparoscopic cholecystectomy, especially in middle-income countries, by reducing opioid use and enhancing recovery.

Mini transabdominal preperitoneal repair (mTAPP) of inguinal hernia: Better to use three 5 mm trocars

BackgroundTransitioning to less invasive inguinal hernia repair techniques, the use of smaller trocars in transabdominal preperitoneal (TAPP) procedures, has been hypothesized to improve patient outcomes by reducing postoperative pain and facilitating quicker recovery periods. This study compared the mini-TAPP (mTAPP) approach, which uses three 5 mm trocars, with the conventional laparoscopic transabdominal preperitoneal (cTAPP) technique. MethodsThis retrospective cohort study included patients who underwent laparoscopic TAPP surgery between December 2019 and December 2023. The key metrics compared included operation time, postoperative pain scores measured via the visual analog scale (VAS), length of hospital stay, and hernia recurrence rates at the one-year follow-up. ResultsA total of 96 patients were analyzed, 46 of whom underwent mTAPP and 50 of whom underwent cTAPP. Notably, the mTAPP group had significantly shorter hospital stays (p<0.001) and lower VAS scores at 6 hours postsurgery (p=0.02), without a significant difference in hernia recurrence (p=0.521). No significant difference was found in the operation time between the groups (p=0.761). The percentage of patients discharged on the same day after surgery was 71.7% in the mTAPP group and 6% in the cTAPP group, with a statistically significant difference between the two groups (p < 0.001). ConclusionsThe outcomes of this study revealed that laparoscopic mini-transabdominal preperitoneal hernia repair performed with routinely used instruments can increase the rate of same-day surgery. Therefore, mTAPP may lead to reduced costs and increased patient satisfaction. Further studies on a larger scale and with a prospective design are warranted to validate these outcomes.

Effect of Early Removal of Urinary Catheter in Patients Undergoing Abdominal and Thoracic Surgeries with Continuous Thoracic Epidural Analgesia on Postoperative Urinary Retention

Background: Postoperative continuous thoracic epidural analgesia (TEA) is an integral aspect of pain management after major abdominal and thoracic surgery. Under TEA, postoperative urinary retention (POUR) is frequently noted, prompting a common practice of maintaining the transurethral catheter (UC) until the cessation of TEA to avoid the necessity for reinsertion of the UC. This study analyzes the effect of an early bladder catheter removal during TEA on POUR incidence. Methods: The retrospective study was conducted on 71 patients undergoing elective abdominal and thoracic operations with TEA for postoperative pain control. Patients were divided into two groups based on the UC removal time in relation to the epidural catheter removal. In the early removal group (ERG), the UC was removed within 3 days of surgery, while in the standard group (SG), it was removed after completion of TEA. All patients in the ERG were still receiving TEA at the time of the UC removal. The primary outcome assessed was the incidence of POUR, while secondary outcomes included urinary tract infections (UTI), hospital length of stay (LOS), and patient’s comfort. Results: The overall prevalence of POUR was 7%, with five POUR cases – two (4.9%) of 41 patients in SG and three (10%) of 30 in ERG (p = 0.644). No significant difference was found in POUR occurrence between ERG and SG (p = 0.644). Additionally, no UTIs were observed in the study. The postoperative pain scores (visual analog scale [VAS]) 72 h and 96 h and the LOS (SG: 16.74 [±8.39] days; ERG: 14.53 [±6.99] days; p = 0.3) were similar between both study groups. Conclusion: Based on our results, it can be concluded that the removal of UC in the early postoperative period, even during TEA, can be performed safely without significantly increasing the risk of recatheterization.

TO ASSESS THE ROLE OF NASAL TAPENTADOL AS PRE-EMPTIVE ANALGESIA, IN BREAST SURGERY PATIENTS

Patients undergoes moderate to severe postoperative pain after surgery, which is troublesome during the postoperative period. Inadequately treated acute post operative pain causes prolonged morbidity to patients. Pre-emptive analgesic minimises the pain in perioperative period by central neuro sensitization. We assessed the role of Nasal Tapentadol in breast surgery patients, as a pre-emptive analgesic, in the reduction of post-operative analgesic requirement. In a double blinded prospective randomized control study, sixty breast surgery patients, received nasal spray of tapentadol (Group A) or saline Spray (Group B), 30 minutes prior to general anaesthesia. Perioperative analgesic requirement, time taken for first analgesic requirement in post operative period, post operative pain and sedation scores, we compared the following parameters in the first 24h during the postoperative period in all patients: Analgesic requirement during perioperative period, time taken for first post operative analgesic dose, pain score and sedation score in postoperative period.Data Of all sixty patients were analysed. Patients in Tapentadol Group A had significantly lower requirement of analgesics and lower Visual analog scale (VAS) than Saline group in the post operative period. However, Ramsay sedation score was more in Tapentadol group, immediately after shifting the patient to the postanaesthetic care unit. Single Pre-emptive nasal spray of tapentadol (45mg) is an effective intervention to, reduce the surgical pain and lesser requirement of analgesics, in post operative period, without added side effects.