Preventive Analgesia Research Articles

Analgesic Effects of Methanol Leaf Extracts from Datura alba ness in Male Wistar Rats through Reduction of C-reactive Protein Levels

Introduction: The increasing interest in utilizing natural products from medicinal plants for pain management stems from their wide availability and minimal side effects. This study aims to evaluate the toxicity profile of Datura alba ness (DAN) extracts and assess their potential analgesic activity through preventive and therapeutic analgesia models in Wistar rats, as well as to investigate the possible mechanisms of action using molecular docking. Materials and Methods: Fresh leaves of DAN were collected from a garden in the Abua/Odua Local Government Area of Rivers State, Nigeria. The leaves were extracted using cold maceration to obtain ethanolic extracts of Datura alba ness (MEDAN). Twelve mice (19-30g) were used for toxicity study, while sixty Wistar rats (140-180g) were used for analgesic studies. Serum C-reactive protein levels were determined using ELISA methods, and molecular docking simulations were conducted using AutoDock and Discovery Studio Visualizer. Results: The results indicated that MEDAN was very safe, with an LD50 of 5000 mg/kg. The findings demonstrate that MEDAN significantly increased the pain threshold in male Wistar rats after three weeks of administration in a dose-dependent manner during the preemptive analgesia study, while pain thresholds increased within one hour but decreased over time in the therapeutic analgesia study. The combination of MEDAN with a standard drug (Flexicam) resulted in improved analgesic effects at the 500 mg/kg dose. Additionally, the study revealed that MEDAN significantly reduced serum C-reactive protein levels after three weeks of oral administration. Molecular docking studies indicated that stigmasterol, gamma-sitosterol, and cholest-5-en-3-ol, 24-propylidene-(3β) from MEDAN demonstrated binding affinity to C-reactive protein receptors, mimicking the effects of the reference drug, celecoxib. Conclusion: This study concludes that ethanolic extracts of Datura alba ness exhibited significant efficacy in pain reduction by lowering C-reactive protein levels. This effect was especially enhanced when the 500 mg/kg dose of MEDAN was combined with the standard drug, Flexicam. The findings provide a scientific basis supporting the traditional medicinal use of Datura alba ness for pain management.

Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report.

Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (p = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (p = 0.002; p < 0.05) with no influence on the dose of IROA (p = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects.

Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using a life cycle analysis.

The combination of acetaminophen with a nonsteroidal anti-inflammatory drug is the cornerstone of perioperative multimodal analgesia. These drugs can be administered intravenously or orally as premedication, consistent with the concept of pre-emptive and preventive analgesia. We aimed to assess the environmental impact of their intravenous and oral administration in a French university hospital. We carried out a life cycle assessment to determine the amount of greenhouse gas emissions and depletion of water resources resulting from the oral vs intravenous administration of 1g acetaminophen and 50mg ketoprofen. We assessed two schemes of intravenous administration, depending on the use of the same or a different infusion set for each drug. At our centre, the intravenous administration of both drugs was associated with the emission of 444-556g CO2 equivalent (CO2e), and with 9.8-12.2 L of water waste. The oral administration of both drugs generated 8.36g of CO2e emissions and consumed 1.16 L of water. At a national level, the switch from intravenous to oral premedication of the drugs could avoid the emission of 2,900-3,700 tons of CO2e and the waste of 58,000-74,000 m3 of water each year. This eco-audit indicates that oral administration of acetaminophen and ketoprofen results in significantly lower carbon emissions and water consumption than intravenous administration. These findings highlight the importance of using the oral route for most patients, limiting intravenous administration for those with specific needs because of higher environmental impact and cost.

238 - Preventive analgesia in postoperative pain management following transvaginal pelvic reconstructive surgeries: A systematic review and Bayesian meta-analysis

238 - Preventive analgesia in postoperative pain management following transvaginal pelvic reconstructive surgeries: A systematic review and Bayesian meta-analysis

Current concepts and targets for preventing the transition of acute to chronic postsurgical pain.

It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain. A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.

Updating Clinical Practice: Improving Perioperative Pain Management for Adeno-Tonsillectomy in Children.

Perioperative acute pain management in pediatric patients is essential to reduce complications. Adenoidectomy-Tonsillectomy are surgical procedures requiring pain control, and risk minimization for postoperative bleeding, nausea, and vomiting. Despite their known secondary effects, the use of opioid analgesics is still preponderant in pediatric perioperative management. We performed a comprehensive review on adeno-tonsillectomy perioperative pain management in children. We developed and implemented a multimodal analgesia protocol aimed to improve patients' pain management while consistently reducing opioids use. relevant Information was summarized, then compared to our clinical needs. Learnings were used to create and implement a multimodal analgesia protocol that we use in patients 3-9 years-old undergoing adenoidectomy/tonsillectomy. The full protocol is presented. Analgesic strategies have emerged to reduce or avoid the use of opioids. Among these strategies, combining different non-opioid analgesics (Ibuprofen, Paracetamol, Metamizole) has been shown to be an effective and safe pharmacological strategy when implemented as part of perioperative multimodal analgesia protocols. Considerable evidence associating the use of NSAIDs with a bigger risk of postoperative bleeding does not exist. Perioperative management of adenotonsillectomy pain should include preventive and multimodal analgesia, which have shown to provide significantly more effective analgesia than some opioid regimens. Ibuprofen offers highly effective analgesia for postoperative pain, particularly when combined with acetaminophen.

The impact of erector spinae plane (ESP) block on neurophysiological monitoring in patients undergoing scoliosis repair

ABSTRACT Background Preventive analgesia is designed to ensure perioperative pain control. The erector spinae plane (ESP) block may abolish the neuroendocrine stress response and augments controlled hypotensive anesthesia. But to what extent does it interfere with spinal cord function. Methods The patient’s population is divided into Group N (control) and Group E (ESP Group). A baseline for the amplitude and/or latency of either somatosensory evoked potentials (SSEPs) or motor evoked potentials (MEPs) were collected (30 min after induction of anesthesia and after full reverse of muscle relaxant before performing ESP block) in group E, the change from the baseline was recorded as a percent decrease. The total dose of anesthetics, the adjuvant analgesics and the postoperative complications were recorded. Results The change in the latency and the amplitude of SSEPs and MEPs among the two groups showed a non-significant change from the baseline. The intra-operative fentanyl consumption was significantly lower in group E than in C. The mean was 21.5 ± 25 vs 178.2 ± 46 mg respectively. The total doses of propofol and dexmedetomidine were lower in group E than in C. 18% of the patients in group E requested a rescue analgesic at a median of 70 (65) min postoperatively vs 55% of those in group C that requested analgesics earlier at a median 16(6) min. Conclusion The ESP block can be safely used without interfering with the monitoring of the somatosensory and MEPs during complex spinal surgery.

Successful Management of Opioid-refractory Pelvic Cancer Pain Using Continuous Local Anesthetic Infusion via a Tunneled Epidural

Opioid refractory pelvic cancer pain is common and difficult to manage, which often results in analgesic polypharmacy and escalating opioid doses, alongside the use of interventional techniques. However, up-titration of opioids often results in systemic side effects, and interventional procedures have limitations in their duration of action, efficacy, and risk of nerve damage. Therefore, intrathecal pumps have been utilized as a more permanent option for pain management. Their ability to deliver localized therapy using a variety of pharmacological agents makes it an attractive option for cancer pain management. However, they are limited by a need for careful titration, pump volume constraints, and risks of severe side effects. These limitations can be mitigated by targeting the epidural space instead, and we propose the use of a tunneled epidural catheter technique for continuous local anesthetic infusion in opioid-refractory pelvic and abdominal cancer pain. In this case report, we describe a patient with pelvic and abdominal cancer pain due to stage IV sigmoid adenocarcinoma with widespread metastases, who received adequate pain management from a continuous local anesthetic infusion through a tunneled lumbar epidural catheter. Throughout this patient’s hospital admission, their opioid requirements remained the same, and their pain remained well controlled on review in the community one month after discharge. This case demonstrated that epidural catheters with local anesthetic as the sole neuraxial analgesic agent over a short duration could potentially provide preventive analgesia. This case highlights that a local anesthetic tunneled epidural, without addition of neuraxial opioids, is an effective alternative to intrathecal pumps in managing complex cancer pain and has potential for preventive analgesia.

Mouse Anesthesia and Analgesia

AbstractProviding anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. This practice is necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging, for instance), and providing intra‐ and post‐procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical guidance for the investigator, covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, considerations for administering preventative analgesia, and considerations for post‐operative care. © 2024 Wiley Periodicals LLC.Basic Protocol 1: Injectable anesthesiaBasic Protocol 2: Inhalant anesthesiaBasic Protocol 3: Assessing pain

Preoperative Intrathecal Morphine is Associated With Reduced Postoperative Pain, Agitation, and Delirium In Living Donor Kidney Transplantation Recipients

BackgroundPostoperative delirium after organ transplantation can lead to increased length of hospital stay and mortality. Since pain is an important risk factor for delirium, perioperative analgesia with intrathecal morphine (ITM) may mitigate postoperative delirium development. We evaluated if ITM reduces postoperative delirium incidence in living donor kidney transplant (LDKT) recipients. Methods296 patients who received LDKT between 2014 and 2018 at our hospital were retrospectively analyzed. Recipients who received preoperative ITM (ITM group) were compared to those who did not (control group). Primary outcome was postoperative delirium based on Confusion Assessment Method for Intensive Care Unit results during the first four postoperative days. ResultsDelirium occurred in 2.6% (4/154) and 7.0% (10/142) of ITM and control groups, respectively. Multivariable analysis showed age (OR: 1.07, 95% CI: 1.01-1.14; P = 0.031), recent smoking (OR: 7.87, 95% CI: 1.43-43.31; P = 0.018), preoperative psychotropics (OR: 23.01, 95% CI: 3.22-164.66; P = 0.002) were risk factors while ITM was a protective factor (OR: 0.23, 95% CI: 0.06-0.89; P = 0.033). ConclusionPreoperative ITM showed an independent association with reduced post-LDKT delirium. Further studies and development of regional analgesia for delirium prevention may enhance postoperative recovery of transplant recipients.

Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients

Background &amp; objective: Preventive analgesia is implied before the actual surgical insult occurs and it is aimed to reduce the neuro-humoral changes associated with surgical induced pain. Different methods have been used by the anesthesiologists for this purpose. We studied the effect of pre-emptive oral tramadol 50 mg and pregabalin 100 mg on post-operative pain, the requirement of rescue analgesics and the stay in post-anesthesia care unit (PACU) in breast cancer surgery patients. Methodology: A randomized double blinded, placebo-controlled trial, was conducted in the Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan) after ethical approval by the hospital Scientific Review Committee and Institutional Review Board. Atotal of 30 patients, undergoing breast cancer surgery, were enrolled and randomly divided into two groups. Group A (study group) patients were given tramadol 50 mg and pregabalin 100 mg orally, and Group B (control group) received two soda mint tablets orally 30 min prior to induction of anesthesia. Standard monitoring was done and routine general anesthesia was administered with intubation. After recovery, Visual Analog Scale (VAS) scores and time to rescue analgesia, total morphine consumption, were recorded. Data was analyzed using SPSS v.20. P &lt; 0.05 was considered significant. Results: The mean ages in Group A and B were 36.67 ± 9.50 y and 41.80 ± 12.43 y (P = 0.236). The differences in intra-operative morphine and rescue morphine use in both groups were not significant (P = 0.139 and 0.293, The rescue analgesic use and VAS scores in PACU were significantly different in both groups (P = 0.005 and P = 0.022, respectively). Total PACU stay in Group A was 79.33 ± 26.31 min and in Group B was 96.67 ± 34.98 min (P = 0.281). Tramadol use in the ward was not statistically equivalent (P = 0.300). Mean post-operative rescue morphine was 0.2 ± 0.775 mg/kg in control group as compared to placebo group was 1.4 ± 1.682 mg/kg, which was statistically significant (P = 0.02). VAS scores in PACU in both groups showed statistically differences, e.g., 1.33 ± 1.1 vs 2.70 ± 1.60 (P = 0.01). PACU stay time was also higher in the control group. Conclusion: The use of pre-emptive analgesia with oral tramadol 50 mg and pregabalin 100 mg 30 min before the surgery can reduce the requirement of peri operative opioid use, achieve better pain control and early recovery. Abbreviations: BMI- Basal Metabolic Rate; PACU- Post-Anesthesia Care Unit; PONV- Postoperative Nausea and Vomiting; VAS- Visual Analog Scale Key words: Analgesia, Preventive; Cancer Surgery; Opioids; Post-Anesthesia Care Unit; Pregabalin; Tramadol Citation: Usman A, Mehdi SR, Khan AA. Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients. Anaesth. pain intensive care 2024;28(1):81−84; DOI: 10.35975/apic.v28i1.2374 Received: November 17, 2021; Reviewed: September 24, 2022; Accepted: July 06, 2023

Improving the effectiveness of local anesthesia in patients with arterial hypertension in the provision of emergency dental care

Was to evaluate the use of Ketorol Express as a preventive analgesia to increase the effectiveness of local anesthesia in providing emergency dental care to patients with arterial hypertension. The study was conducted on the basis of the state autonomous healthcare institution of the Moscow region «Royal Dental Clinic» with the participation of 83 people. The patients were divided into two groups. In group 1, Ketorol Express was prescribed as a preventive analgesia in a dosage of 20 mg before local anesthesia. Patients of group 2 underwent dental interventions without the use of preventive analgesia. A 3% solution of mepivacaine was used as a local analgesic solution. For a subjective assessment of the effectiveness of anesthesia, use a visual analog scale. All patients had their blood pressure and heart rate measured before and after the interventions and hemodynamic parameters were continuously monitored during emergency dental care. In group 1, the effectiveness of combined anesthesia with the infiltration method of local anesthetic administration was 93±1.17%, according to the patient, 94±1.47%, according to the doctor, with the conductive method of anesthesia at the mandibular orifice - according to the patient it was 91±1.01%, according to the doctor 92± 1.36%. In group 2, when providing emergency dental care with the infiltration method of administration of 3% mepivacaine the anesthesia was effective in 80±1.97% of cases according to the patient and in 80±1.17% of cases according to the doctor, with the conductive method of anesthesia at the mandibular orifice, the effectiveness of anesthesia according to the patient was 82±1.11%, according to the doctor 85±1.23%. The results of the study demonstrated a statistically significant increase in the effectiveness of local anesthesia performed with a 3% solution of mepivacaine in patients with arterial hypertension due to the use of preventive analgesia with Ketorol Express at a dosage of 20 mg (2 tablets of 10 mg) in emergency dental care with registration and analysis of changes in hemodynamic parameters.

Postoperative Nausea and Vomiting following Endoscopic Sinus Surgery under the Guidance of Adequacy of Anesthesia or Pupillometry with Intravenous Propofol/Remifentanil.

Postoperative nausea and vomiting (PONV) constitutes an adverse event after endoscopic sinus surgery (ESS) under general anesthesia (GA) with intravenous opioids, such as remifentanil (RMF). Monitoring the nociception/antinociception balance using the surgical pleth index (SPI) or pupillary dilatation reflex (PRD) helps guide intravenous RMF infusion. We aimed to investigate whether their employment could help reduce the incidence of PONV in patients undergoing ESS. The data of 30 patients from the GA group, 31 from the SPI group, and 28 from the PRD group were analyzed. The initial RMF infusion rate of 0.25 µg/kg body weight/minute was increased by 50% when the SPI, PRD, or Boezaart Bleeding Scale (BBS) were elevated by >15, >5%, or >2 points, respectively, until they normalized. PONV was present in 7/89 patients (7.9%): 2/31 patients (6.5%) of the SPI group, 1/30 patients (3.3%) of the GA group, and 4/28 patients (14.3%) of the PRD group. Neither PRD nor SPI guidance for RMF administration reduced the incidence of PONV compared to standard practice. Further studies are required in order to investigate the possibility of PONV eradication in patients undergoing ESS under GA when it is possibly combined with paracetamol/metamizole preventive analgesia, as well as those using antiemetic prophylaxis based on the Apfel Score and premedication with midazolam.

Comparative effect of preoperative oral pregabalin 50 mg vs. 75 mg on nerve growth factor (NGF) levels in parturients undergoing cesarean section

Background &amp; objectives: Postoperative pain after cesarean section (CS) is a crucial problem faced by the parturients. Pregabalin is a choice of preventive analgesia to reduce neuropathic pain, inflammation, tissue irritation, and post-cesarean section pain. The purpose of this study was to compare the effect of giving pregabalin 50 mg or 75 mg in combination with paracetamol 1 g on nerve growth factor (NGF) levels after cesarean section. &#x0D; Methodology: A prospective, comparative model was used in this study. The study took place at Mother and Children Hospital of Sitti Khadijah I, Makassar, Indonesia. A total of 30 patients who underwent CS were randomly divided into two groups; group P1 who received pregabalin 50 mg orally and 1 g paracetamol intravenously, 1 h before surgery (n = 15), and group P2 who received pregabalin 75 mg orally and 1 g paracetamol intravenously, 1 h before surgery (n = 15). Nerve Growth Factor (NGF) levels were measured 2 h before surgery, and at 4 and 6 h post-surgery. Data were analyzed by the Mann-Whitney test using SPSS 26.0.&#x0D; Results: There was a decrease in NGF levels in the pregabalin 75 mg group at 6 h post-surgery, while in the pregabalin 50 mg group it tended to increase at 4 and 6 h post-surgery. In the pregabalin 50 mg group, there was a significant increase in NGF levels from measurements of NGF1 to NGF2 and NGF0 to NGF2 (P &lt; 0.05), whereas, in the pregabalin 75 mg group, there was a significant decrease in NGF levels from measurements of NGF1 to NGF2 and NGF0 to NGF2 (P &lt; 0.05). &#x0D; Conclusion: The combination of pregabalin 75 mg orally with paracetamol 1 g intravenously is effective as perioperative multimodal analgesia by reducing nerve growth factor levels after cesarean section surgery.&#x0D; Abbreviations: BDNF- brain-derived neurotrophic factor; CS- Cesarean section; GABA- Gamma Amino Butyric Acid; NGF- Nerve Growth Factor&#x0D; Keywords: Cesarean section; Nerve Growth Factor (NGF); Postoperative; Pregabalin&#x0D; Citation: Ahmad MR, Harahap MW, Wirawan NS. Comparison between pregabalin 50 mg and 75 mg on nerve growth factor (NGF) levels after cesarean section. Anaesth. pain intensive care 2022;27(6):721−725; DOI: 10.35975/apic.v27i6.2159&#x0D; Received: February 20, 2923; Revised: July 11,2023; Accepted: October 29, 2023

The rationale for the choice of preventive intraoperative anesthesia for uterine curettage in patients with individual intolerance to amide anesthetics

Background. Uterine curettage (UC) is widely used in global clinical practice owing to its great diagnostic and therapeutic value. At the same time, UC leads to a damage to the integrity of soft tissues, causing development of postoperative pain syndrome. Some patients have an individual intolerance to amide anesthetics, which limits their use in this cohort. Purpose: to improve the quality of providing anesthetic care in the early postoperative period after UC to women who have a history of individual intolerance to amide anesthetics through selection of a comprehensive method of preventive intraoperative anesthesia for this category of patients. Materials and methods. Ninety females took part in the study. Clinical, laboratory, and mathematical and statistical research methods were used to study the preventive analgesic effectiveness of the compared methods of anesthesia. Five samples of biological material, called the control points, were taken: before surgery, immediately after it, then 1, 3 and 6 hours after intervention. In this way, an idea was got about the initial level of the studied indicators and their changes during the postoperative stay in the hospital. Properties of various combinations of propofol, ketamine, fentanyl, and dexketoprofen were studied. Results. It was revealed that a combination of propofol (2 mg/kg), fentanyl (0.1 µg/kg), ketamine (0.1 mg/kg), as well as additional intravenous administration of dexketoprofen (50 mg) at the stage of premedication has the advantages in terms of preventive intraoperative analgesia. Effectiveness of the proposed method of anesthesia was proved by significantly better indicators of vital functions (heart rate, mean arterial pressure) and serum levels of some laboratory markers of stress (glucose, cortisol, insulin, cortisol-insulin index). Differences in the studied parameters were recorded both when comparing them between the groups at the same control time points and conside-ring the development and regression of the postoperative pain syndrome severity within the groups. Conclusions. The proposed method of anesthesia has a reliable advantage in terms of preventive reduction of the postoperative pain syndrome of UC in patients who cannot have application anesthesia due to individual intolerance to amide drugs. The specified method has a positive effect on vital functions and serum levels of some laboratory markers of stress, and the fastest recovery of patients is caused by a lower suppressive action of the anesthetic drugs used.

Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis.

To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.

The Efficacy of Intercostal Nerve Block in the Management of Postoperative Pain After Costal Cartilage Harvest for Craniofacial Reconstruction Systematic Review and Meta-analysis.

Autologous costal cartilage harvest is a common procedure in craniofacial reconstruction due to its stability, dependability, and diversity. However, such a procedure is associated with severe donor-site pain postoperatively. Therefore, we aim through this study to compare the efficacy of intercostal nerve block in the management of postoperative pain in patients undergoing costal cartilage harvest for craniofacial reconstruction. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time-limitation. As a result of reviewing the literature, 33 articles were screened by full-text resulting in 14 articles which met our inclusion/exclusion criteria. However, only four high-quality RCT articles were included in the quantitative synthesis (meta-analysis). The findings of this study suggest that there is no significant difference in pain scores between ICNB and control groups at 12, 24, and 48h postoperatively, both at rest and with coughing. Therefore, both techniques are considered safe and effective. Our results show evidence of favorable outcome of preventive donor-site analgesia with ICNB for harvesting autologous costal cartilage in multiple studies. However, the overall outcomes were insignificant between the two arms. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Postoperative infusion of dexmedetomidine via intravenous patient-controlled analgesia for prevention of postoperative delirium in elderly patients undergoing surgery

BackgroundPostoperative delirium (POD) is a common clinical complication in elderly patients after surgery and predicts poor outcomes.AimWe researched whether postoperative infusion of dexmedetomidine (DEX) had prophylactic effect on POD in elderly patients.MethodsA total of 236 patients over the age of 60 years undergoing thoracoabdominal tumor surgery were enrolled in Zhejiang Cancer Hospital from November 2016 to October 2020. The patients were randomly assigned into DEX group (group D) and control group (Group C). DEX was provided via PCIA pump 1–3 days after surgery, which consisted of 3 ug/kg sufentanil and 3 ug/kg DEX in group D, and 3 ug/kg sufentanil without DEX in group C. The PCIA parameters were programmed as follows: total amount 150 ml, 2 ml bolus dose with a lock-out of 10 min and background infusion rate 2 ml/h. The primary endpoint was the incidence of POD, assessed twice daily within 7 days after surgery by Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method–Intensive Care Unit (CAM-ICU). The secondary endpoint was postoperative hospitalization days, ICU stay time, adverse events and non-delirium complications.ResultsThe incidence of POD in all patients was 7%. The incidence of POD in group C was significantly higher than that in group D (10.1% vs 3.4%, P = 0.042). There were no significant differences in length of hospital stay after operation, ICU stay time, the percentage of patients discharged within 7 days after surgery, non-delirium complications, and 30-day all-cause deaths between the two groups. The incidence of hypertension in group D was lower than that in group C (P = 0.003), and there were no differences in other adverse events.ConclusionPatients aged over 60 years received DEX in addition to intravenous patient-controlled analgesia (PCIA) for major thoracoabdominal surgery experienced less delirium.

Efficacy of regional analgesia in prevention of chronic postsurgical pain in children on the PEDSQL General Well-Being Scale and Pediatric Pain Questionnaire

Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health. Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires. Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block. Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia. Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p&lt;0.001) on the scales of General Well-Being, General Health, Present Pain, and Worst Pain. This shows the need for using effective minimally invasive regional analgesia techniques in the perioperative period. Conclusions. Chronic pain syndrome reduces quality of life in children by reducing their general well-being and general health due to high indicators of present and worst pain. Regional analgesia techniques are a priority for the prevention of chronic pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Pre-emptive versus preventive analgesia for postoperative pain: a systematic review and meta-analysis

BackgroundPostoperative pain is a type of nociceptive pain that originates from tissue damage due to trauma caused by surgery. Pre-emptive analgesia is treatment that starts before surgery, to prevent or reduce the establishment of sensitization of dorsal horn neurons caused by tissue injury, the sensitized neurons being supposed to amplify postoperative pain. Pre-emptive analgesia consists of administering analgesic medication before tissue injury, that is, before the reception, transmission, modulation, and nociception of the aggressive stimulus, aiming to prevent hyperalgesia. This review aims to compare the efficacy of pre-emptive analgesia and preventive analgesia in postoperative pain. MethodsArticle searching was done on five databases (PubMed, ProQuest, Scopus, ScienceDirect, ClinicalKey). Hand-searching was also done to find additional articles. We have only included double-blind, randomized, controlled trials (RCT). A total of fifteen articles were included and all were RCT studies comparing pre-emptive analgesia with preventive analgesia. The quality of the included studies was evaluated with Cochrane risk-of-bias assessment tools. Quantitative analysis was performed by Review Manager 5.4. ResultsFifteen studies comprising 830 subjects were included in this study. Our analysis revealed that pre-emptive analgesia significantly improved visual analog scale (VAS)/numeric rating scale (NRS)/verbal rating scale (VRS) 4 hours postoperatively [mean difference (MD) = -0.25, 95% CI: [- 0.49, -0.02]; I2 = 94%]. Unfortunately, pain scoring at 6, 12 and 24 hours after surgery did not differ significantly between pre-emptive and preventive analgesia. Duration of analgesia was comparable between the two groups. Time to rescue analgesics was similar between the two groups, but the pre-emptive group was associated with less analgesic consumption postoperatively than the preventive group. ConclusionPre-emptive analgesia provided better pain relief than preventive analgesia during the short term. Time to rescue analgesics is comparable between both groups, but pre-emptive analgesia is associated with lower amounts of rescue analgesics postoperatively.