Significant Postoperative Pain Research Articles

Intraperitoneal Bupivacaine 0.25% versus intravenous Diclofenac on post-operative analgesia in the cesarean section under spinal anesthesia: A prospective randomized comparative study in a tertiary care hospital of India

Background: Cesarean section (CS) is a common surgical procedure, often accompanied by significant post-operative pain, which can hinder recovery, bonding with the baby, and breastfeeding. Effective pain management is crucial to prevent complications such as chronic pain and depression. Intraperitoneal (IP) instillation of local anesthetics, such as Bupivacaine has shown promise in providing analgesia, while intravenous (IV) Diclofenac is a common alternative. Aims and Objectives: This study aimed to compare the post-operative analgesic efficacy of IP Bupivacaine with IV Diclofenac in parturients undergoing lower segment CS (LSCS). Materials and Methods: A randomized, double-blind, prospective study was conducted in Deen Dayal Upadhyay Hospital, New Delhi, with 60 patients divided into two groups: Group B received IP Bupivacaine (30 mL, 0.25%) and Group D received IV Diclofenac (1 mg/kg). Post-operative pain was assessed using the Visual Analog Scale (VAS) at various time points up to 24 h. The time to first rescue analgesia and total analgesic requirement were also measured. Results: Group B had significantly lower VAS scores at 6, 8, 10, 12, and 24 h post-operatively (P<0.05). Time to first rescue analgesia was longer in Group B (7.26±1.04 h) compared to Group D (5.01±0.49 h) (P=0.001), and the total analgesic requirement was lower in Group B (P=0.01). Early breastfeeding was more feasible in Group B. Conclusion: IP Bupivacaine provided superior analgesia compared to IV Diclofenac, promoting earlier mobilization, bonding, and breastfeeding. It is a simpler and more effective method for post-operative pain management in LSCS.

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Machine learning approach to predict postoperative pain after spinal morphine administration during caesarean delivery

BackgroundA major barrier to optimal pain management is the difficulty in predicting and assessing patients at high risk for significant pain across multiple locations within the institution in a timely manner. This is compounded by the fragmented display of clinical information on enterprise clinical platform, which further hinders delay the reviews and hence the increased risk of untreated pain. We evaluated and compared the predictive performance of six modelling techniques in predicting significant pain, defined as the maximum pain score of 3 or more on movement at the 13th to 24th hour after spinal morphine administration during caesarean delivery. MethodsWe retrieved medical records from women who underwent caesarean delivery and received postoperative spinal morphine in a single specialist maternity hospital in Singapore between Aug 2019 and Aug 2022. We extracted 120 clinical variables from the medical records of eligible patients and further selected 23 to improve algorithm accuracies. The dataset was split randomly, with 80 % of patients (n = 5248) used for training the models, and 20 % (n = 1313) reserved for validation. ResultsThe study cohort comprised 6561 patients with an incidence of significant postoperative pain of 7.9 %. Ridge regression demonstrated the best performance with both the full (AUC: 0.649) and selected (AUC: 0.719) feature sets. By reducing the number of features, Ridge regression, LASSO, Elastic net, and XGBoost showed similar in AUC (0.704–0.719), sensitivity (0.644–0.695), specificity (0.644–0.705), positive predictive value (0.155–0.179), and negative predictive value (0.949–0.955) in predicting significant postoperative pain. These were attributed to the top three variables, mainly the last recorded postoperative pain score (on movement) before the prediction point, mean and standard deviation of the hourly maximum postoperative pain score (at rest) at 0th to 12th hour. ConclusionsFuture research will aim to refine these models and explore their implementation in clinical settings to enhance real-time pain management and risk stratification for women after caesarean delivery.

LigaSure versus conventional Milligan MORGAN hemorrhoidectomy in Nigerian patients with symptomatic hemorrhoids.

Hemorrhoidectomy is considered as the most effective approach for patients with grade III and grade IV hemorrhoids; the operative procedure may be associated with significant postoperative pain and other complications. Several surgical techniques and devices have been developed to overcome these postoperative problems. To compare perioperative and postoperative outcomes of hemorrhoidectomy performed with the LigaSure and the conventional Milligan-Morgan hemorrhoidectomy among Nigerian patients with symptomatic hemorrhoids. All consenting adult patients who fulfilled the inclusion criteria were randomized to either conventional Milligan-Morgan or LigaSure hemorrhoidectomy. Outcome measures were the duration of the procedure, estimated blood loss, and resolution of symptoms, which were assessed using the Sodergren hemorrhoids severity score (SHSS). Postoperative pain was evaluated using the visual analog scale (VAS), and the short-term recurrence rate was also checked at 3months. Data were analyzed using the computer software IBM SPSS version 23. Fifty-two patients were randomized equally into the two arms. The median blood loss in the LigaSure group was 10.0mL, whereas the median blood loss in the Milligan-Morgan group was 26.5mL, (p=0.0001). The median postoperative pain at 2weeks using the VAS was 5.5 in the LigaSure group, and in the Milligan-Morgan group, it was 6.0 (p=0.002). The mean duration of surgery in the LigaSure group was 18.04min and 34.19min in the Milligan-Morgan group (p=0.0001). LigaSure hemorrhoidectomy is faster and associated with less blood loss compared to conventional Milligan-Morgan hemorrhoidectomy.

Opioid Use after Transforaminal Lumbar Interbody Fusion: A Comparison between Open and Minimally Invasive Surgery.

Opioids are medications frequently used in patients with moderate and severe chronic pain. Their pharmacologic profile allows their use in acute severe postoperative pain. However, due to their highly addictive profile, opioid misuse is considered a public health issue. Vertebral spine fusion, decompression, and instrumentation are often associated with acute, severe postoperative pain. The present study aims to compare postoperative opioid consumption in a group of patients who underwent open transforaminal lumbar interbody fusion (OTLIF) against a similar group of patients who underwent minimally invasive transforaminal lumbar interbody fusion (MTLIF). We present a quantitative, observational, analytical, and historical cohort study. After convenience sampling, we identified 45 patients, 34 of whom underwent OTLIF and 11 underwent MTLIF. The analysis was made after measuring the following variables: demographics, type of surgery, length of stay, pain control, opioid type, and opioid dose. Statistical methods were implemented according to the origin and behavior of the variable. We found a difference between significant and nonsignificant pain among the groups with less opioid consumption in the MTILF group. This difference was seen in the frequency and dosage during all observation periods. However, in the postoperative observation, the frequencies and dosages were equal between groups. According to linear regression, the type of surgery, radiculopathy, and radiculitis explain the significant postoperative pain in up to 50% of cases. Our study reveals a significant difference in opioid consumption between patients undergoing different surgical techniques. While these findings are valid for the studied population, the limitation in sample size highlights the need for further research. The implications of our findings on postoperative pain management and opioid use in spinal surgeries are significant and warrant continued investigation.

Designing an all-laser processing and operating microheater conceptual device for medical applications

Obstructive sleep apnea (OSA) is a prevalent condition affecting a significant portion of the population, with a reported prevalence of 33% and 19% in males and females, respectively. OSA is associated with an increased risk of sudden death, with studies suggesting nearly double the risk compared to individuals without OSA. The condition is characterized by frequent sleep disruptions due to airway collapse, often at the level of the tongue or soft palate. Current treatment approaches primarily rely on radiofrequency (RF) ablation for tissue volume reduction. While effective, this technique can cause significant collateral damage and postoperative pain due to extensive burning of surrounding tissues. To avoid such drawbacks, in this work it is proposed and discussed the features of a possible conceptual all-laser-processing and operating device that can produce localized heat affected zones, with the possibility to monitor the local temperature during the procedure. The device is based on the eutectic composition of the system Al2O3-YAG, with double doping Nd3+ and Cr3+ crystalline fiber tip, which is prepared by the Laser-Heated Pedestal Growth technique on a sapphire single crystal fiber end. The results showed that the tip, although highly Nd3+-doped, follows the Jackson-Hunt relation for binary eutectic compounds. The lifetime of the luminescence produced by the Cr3+ doping, emitted by the eutectic tip, can act as a temperature sensor for the device in the range of 30 to 100 °C.

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain

Abstract Background Total knee replacement (TKR) is a well-known popular surgical procedure for knee diseases, including end-stage knee osteoarthritis that causes severe postoperative pain and prolonged immobility. TKR is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. Aim of the Work The current study aims to assess the IPACK block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared with femoral nerve block following TKR. Patients and Methods This study is a randomized controlled clinical trial was conducted on 40 random patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: Group A: Patients in group A (n = 20) received spinal anesthesia followed by FNB block at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions, Group B: Patients in group B (n = 20) received spinal anesthesia followed by IPACK at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions. Results As for the comparison between effect of the IPACK block and FNB regarding ambulation and postoperative pain in TKR, it showed that there is significance regarding ambulation that was delayed in FNB than IPACK using TUG test and 10-min walk test, but regarding VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative. Conclusion Our study showed that there was delayed ambulation in FNB than in IPACK using the TUG test and 10-min walk test, but regarding the VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative.

Comparison between Ultrasound Guided IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) and Adductor Canal Block in Patients Undergoing Total Knee Replacement in Postoperative Pain

Abstract Background Total knee replacement (TKR) is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. Aim of the Work The aim of the study is to compare postoperative pain management and post-operative analgesia between IPACK block and Adductor canal block in total knee replacement cases. Patients and Methods The study was conducted on 60 patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: group 1: Patients in group 1 (n = 30) will receive IPACK block at the beginning of operation with 20 ml bupivacaine (0.25%) under complete aseptic conditions, group 2: patients in group 2 (n = 30) will receive Adductor canal block at the beginning of the operation with 20 ml bupivacaine (0.25%) under complete aseptic conditions. Results The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding analgesic outcome by recording time for first for analgesic need, total consumption of opioid and pain score during walking and climbing stairs. Side effects were also monitored and compared. Conclusion The comparison between effect of IPACK block and adductor canal block as regard post- operative pain in total knee replacement showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for adductor canal block and 2-4 for IPACK block.

Comparative Study between the Analgesic Efficacy of Bupivacaine versus Bupivacaine and Nalbuphine in Ultrasound Guided Adductor Canal Block Post Knee Arthroscopy

Abstract Background Knee arthroscopy (KA) is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. However, despite the effectiveness of this approach, the rehabilitation of limbs after a KA operation still faces critical challenges. Pain is the most difficult factor to control following KA; however, the development of an ultrasound- guided nerve block and multi- modal analgesia and motor- sparing regional anesthetic blocks has helped to reduce postoperative pain to a certain extent to help achieve early limb autonomous movement and facilitates early knee range of motion (ROM), speed up the rehabilitation process, reduces overall narcotic consumption, shorten hospital stays, and improve patient satisfaction. Aim of the Work to compare the analgesic effect of Bupivacaine and Bupivacaine/nalbuphine in adductor canal block in patients undergoing knee arthroscopy as regard post operative pain management. Patients and Methods This study is a Prospective, Randomized, Controlled study. After obtaining approval from Research Ethics Committee of Ain Shams University, the study was conducted on 50 patients in the operating theatres of Ain Shams University. Results The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding NRS postoperative, by recording time for first for analgesic need and total consumption of opioid. Side effects were also monitored and compared. As for the comparison between effect of Adductor canal block with Bupivacaine alone and Bupivacaine with Nalbuphine as regard post-operative pain in knee arthroscopy, it showed that there is significance regarding the numeric rating score (NRS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block with Bupivacaine and Nalbuphine and 2-4 for Adductor Canal block with Bupivacaine alone. These findings with our study primary and secondary outcomes showed that Adductor canal block with Nalbuphine has more analgesic effect regarding pain assessment and also with significant difference regarding the time of first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative, but there was no significant difference regarding post operative complications such as hypotension, nausea and vomiting. Conclusion the comparison between effect of Adductor canal block with Bupivacaine alone and Bupivacaine with Nalbuphine as regard post-operative pain in knee arthroscopy, it showed that there is significance regarding the numeric rating score (NRS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block with Bupivacaine and Nalbuphine and 2-4 for Adductor Canal block with Bupivacaine alone.

Ultrasound Guided Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Adults Patients after Laparoscopic Colorectal Surgery

Abstract Background Major abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold- standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided oblique subcostal TAP block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients. Group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia. Group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia. Results As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in Group E (ESP) block when compared with that of Group T (OSTAP) block and showed significant difference between both groups at 4, 6, 8 and 10 hrs postoperatively. Time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68+1.50 hours compared to that of group T (OSTAP) block was 9.56+2.41 hours. These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total meperidine consumption with the mean total consumption in each group was 75+0.37 mg in the ESP block group compared with 125+0.87 mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E. Conclusion Erector spinae plane block under ultrasound guidance for laparoscopic colorectal surgery provides a longer duration and better quality of postoperative analgesia, as well as reducing the postoperative analgesic consumption when compared to oblique subcostal transversus abdominis plane block for laparoscopic colorectal surgery. Both blocks are mostly devoid of complications, and they provide reliable and effective postoperative analgesia in patients undergoing laparoscopic colorectal surgery.

Effectiveness of Ultrasound Guided Quadratus Lumborum Block versus Intravenous Analgesia for Postoperative Pain Management in Patients Undergoing Hip Surgeries

Abstract Background Orthopedic operations such as hip and femur fractures can lead to significant postoperative pain. In these patients, nonopioid analgesia techniques are especially important in aging populations when comorbidities are considered. Aim of the Work to compare the analgesic efficacy of ultrasound guided Quadratus Lumborum (QL) block versus intravenous analgesia for postoperative pain management in patients undergoing hip surgeries under spinal anesthesia. Patients and Methods This prospective interventional study was conducted at Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from January until August 2023. During this study, 40 patients scheduled for hip surgery under spinal anaesthesia were enrolled and divided into two equal groups; quadratus lumborum and control groups, with the same inclusion and exclusion criteria. Total amount of opioid analgesics needed by patients in both groups, pain scores according to the Visual Analog Scale (VAS), first time the patient needed postoperative rescue analgesia, vital data, postoperative length of hospital stay and side effects of drugs were recorded and compared between both groups. Results In our study, no differences were noted between groups regarding demographic data “age, sex, ASA and type of operation”. Regarding hemodynamics, our study revealed that at 10, 20, 40 min, PACU at 30 and 1hr, mean arterial pressures and heart rate were statistically significant higher among control cases compared with quadratus lumborum group. Regarding analgesic efficacy, our study revealed that VAS score was statistically significant higher after 4, 6 and 12hrs, need of 1st rescue analgesic was statistically significant faster 3.60 ± 1.06 vs. 18.00 ± 8.49 hours and total narcotics “mg” was statistically significant higher 60.00 ± 16.16 vs. 40.00 ± 13.69 among control cases compared with quadratus lumborum group. Also, our study revealed that hospital stay “days” was statistically significant longer 2.75 ± 0.44 vs. 1.75 ± 0.64 and side effect respiratory depression and vomiting were statistically significant higher among control cases compared with quadratus lumborum group. Conclusion QL block is effective for analgesia in patients after hip surgery compared with placebo or no block. QLB as a part of multimodal analgesia protocol reduces opioid consumption and pain scores in patients undergoing hip surgeries. The certainty of evidence based on GRADE was moderate.

Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Trans-Muscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery

Abstract Background Orthopedic operations for hip and femur fractures can lead to significant postoperative pain. In these patients, different regional anaesthesia techniques play an important role in multimodal analgesia plans. Nonopioid analgesia techniques are especially important in aging populations when comorbidities are considered. Aim of the Work to evaluate the effectiveness of ultrasound-guided lumbar Erector Spinae Plane block versus Trans-muscular Quadratus Lumborum block for postoperative analgesia in hip and proximal femur surgery. Patients and Methods This study is a double-blind, Prospective, Randomized, Study. This study is conducted at Ain Shams University hospitals, Cairo, Egypt. The study period 6 months. Results The current study results revealed three distinct groups were examined: the L-ESB Group, QLB-T Group, and Control Group, each comprising 20 participants. The study aimed to compare the effects of two different interventions, namely L-ESB and QLB-T, against a Control Group. The evaluation was based on a range of parameters, and the outcome measures were assessed using both demographic and clinical variables. In terms of participants' ages, the mean ages and standard deviations were provided for each group. The calculated mean ages were 51.7 years for the L-ESB Group, 52.95 years for the QLB-T Group, and 52.28 years for the Control Group. The slight differences in mean ages, as indicated by a p-value of 0.790 and a similarity measure (§=0.237), suggest that the age distribution across these groups is statistically comparable. Consequently, potential impacts of age-related variations on observed outcomes are likely to be minimal. Conclusion The results demonstrated that the interventions exhibited statistically significant influences on various aspects of post-operative recovery, including pain perception, mean arterial blood pressure, heart rate, time to request analgesia, and medication dosages. Notably, the interventions showcased potential benefits in terms of improved pain management and reduced analgesic requirements. These findings underscore the importance of considering individualized interventions for optimal patient care in hip and proximal femur surgery, while acknowledging the potential impact of confounding factors and the need for further studies to establish precise dosage and concentration protocols for local anesthesia.

Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial.

Patients undergoing laparoscopic renal surgery often experience significant postoperative pain. Quadratus lumborum block (QLB) provides effective postoperative pain control after laparoscopic procedures, while lidocaine administered intravenously also exerts analgesic effects for surgical patients. We design this trial to compare the effects of i.v. lidocaine infusion with QLB on postoperative analgesia in patients undergoing laparoscopic renal surgery. In this randomized noninferiority trial, a total of 120 adult patients undergoing laparoscopic renal surgery will be randomized to receive either i.v. lidocaine or unilateral QLB for postoperative pain management. Lidocaine will be i.v. administered at 1.5 mg/kg (ideal body weight) over 10min during anesthesia induction, followed by an infusion of 1.5 mg/kg/h intraoperatively and in a post-anesthesia care unit. Ultrasound-guided anterior QLB with 0.375% ropivacaine 30 mL will be conducted before the start of surgery. Patient-controlled i.v. sufentanil will be used for pain relief during the first 48h after surgery. The primary outcome is the cumulative sufentanil consumption during 0-24h postoperatively, with a noninferiority margin of 5μg. Secondary outcomes include pain intensity at rest and on coughing at 1, 6, 24, and 48h postoperatively; sufentanil consumption within 24-48h after surgery; rescue analgesic use within 0-48h after surgery; nausea and vomiting within 0-48h postoperatively; and quality of recovery at 24 and 48h after surgery. The results of this trial will add to the clinical evidence for improving postoperative pain management in patients who undergo laparoscopic renal surgery. Chinese Clinical Trial Registry (ChiCTR2400082974).

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial

BackgroundObesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block.MethodsWe propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups—group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient’s overall postoperative recovery.DiscussionRegional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery.Trial registrationThis trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding.

Hemorrhoids are a common and painful condition, with conventional treatments such as endoscopic rubber band ligation (ERBL) and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain. A clinical trial by Qu et al introduces a novel approach called endoscopic poli-docanol foam sclerobanding (EFSB). This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL. The study's strengths include its robust design, comprehensive outcome evaluation, and patient-centered approach. Despite limitations such as the single-blind design and relatively short follow-up period, the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option. Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.

Comparing modalities of opioid education in patients undergoing total knee arthroplasty: a randomized pilot trial

BackgroundPatients undergoing total knee arthroplasty (TKA) experience significant postoperative pain and routinely require opioids, yet they often lack knowledge regarding appropriate use and handling of these medications. Evidence suggests that...

Effectiveness of Lignocaine Tramadol Hydrochloride Combination in Bier’s Block on Post-Operative Analgesia

Background: Bier’s block has been most commonly used for hand and wrist surgery. Though it reduces the potential complication of general anaesthesia, significant post-operative pain is very common just after tourniquet release. Many adjuvants have been used so far with local anaesthetic to produce a dense block and to provide adequate post–operative analgesia. Of them, Tramadol Hydrochloride was used very successfully as it has got less potential side effects. This study was done to see the effect of Tramadol Hydrochloride in Bier’s block for post-operative analgesia after tourniquet release. Methods: This study was carried out in the Department of Anaesthesiology, Bangladesh Medical College Hospital, Dhaka, during the period of July ’2011 to march ’2012. A total sixty patients aged 20-60 years of ASA-1 and ASA-2 undergoing hand and wrist surgery of less than 40-minute duration were enrolled for the study. The effectiveness of combination of Lignocaine and Tramadol Hydrochloride as an anaesthetic solution in Bier’s block was assessed in terms of reduction of tourniquet pain, quality of anaesthesia, the time of first analgesic demand, and the amount of total analgesic needed in post-operative 24-hours period. Patients in control group (Gr-L) received 40 ml of 0.5% Lignocaine and patients in trial group (Gr-LT) received 38 ml of Lignocaine with 2ml (100mg) of Tramadol Hydrochloride as an anaesthetic solution. Patients were observed post-operatively for 24 hours. Pain was assessed in terms of VAS. Results: Tourniquet pain was significantly less in Gr-LT (p&lt;0.000). Post-operative analgesia was also significantly prolonged in Gr-LT (109.61±12.32 min) than in Gr-L (75.8±9.30 min). The number of total analgesic demand in post-operative 24 hours period was also significantly reduced in Gr-LT (P&lt;0.000).Conclusion: The Lignocaine and Tramadol Hydrochloride mixture in Bier’s block provides adequate post-operative analgesia and causes less analgesic demand in post-operative period.

Unveiling the impact of opioid-free postoperative regimens in ureteroscopy: a comprehensive systematic review and meta-analysis.

Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are minimally invasive urologic procedures that are commonly used to treat kidney stones. However, they often result in significant postoperative pain. Historically, patients undergoing these surgeries have predominantly been managed with opioids, which has contributed to the escalating global complications associated with these drugs, including abuse and addiction. As a result, over the recent years, many healthcare centers have made efforts to minimize opioid use, opting instead for safer alternative medications. In this study, we aim to compare the efficacy of both opioid and opioid-free pain management regimens following URS or RIRS procedures. A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies that compared opioid-based and opioid-free postoperative care for managing pain in patients who underwent URS or RIRS for lithotripsy. Our primary outcome of interest was the frequency of postoperative emergency department (ED) visits. Secondary outcomes included pain-related phone calls, postoperative unexpected encounters, need for opioids at discharge, and patients with opioid refills. We retrieved 10 articles, encompassing 6786 patients in the opioid group and 5276 patients in the opioid-free group. Overall, our findings lean towards favoring the opioid-free regimen, revealing notable differences between the groups. Opioid-free regimen was associated with less ED visits (OR=0.67; 95% CI: 0.58, 0.77; P=0.00001; I2=0%) and required less opioids at discharge (OR=0.11; 95% CI 0.02, 0.64; P=0.01; I2=89%). Through statistically superior results, our meta-analysis suggests that an opioid-free regimen outperforms the use of opioids after URS or RIRS, particularly in terms of pain management.

Ultrasound-guided subcostal transversus abdominis plane block versus erector spinae plane block for post-operative pain after percutaneous nephrolithotomy: A comparative observational study

In India, about 12% of the population has kidney stones, and out of these about 50% may end up with some kidney function loss or renal damage percutaneous nephrolithotomy (PCNL) is accepted as the procedure of choice for large or complex renal stones. Significant post-operative pain can occur after PCNL in first 24 hours due to distension in the renal capsule and pelvicalyceal system. The study aim was to compare the efficacy of ultrasonography guided subcostal transversus abdominis plane block with erector spinae plane block in PCNL. This observational study included 67 consecutive cases (16-65 years, ASA grade I-II) divided into 2 groups. Group A (n=33) received subcostal transversus abdominis plane (SCTAP) block and Group B (n=34) received erector spinae plane block (ESPB). Post operative pain in terms of pain scores, opioid consumption, requirement of rescue analgesic in first 24 hours was noted. Quality of recovery and any adverse events were also noted. Post-operative opioid consumption was significantly less in ESPB group (34.41 ± 27.32 mcg), compared to SCTAP Group (270.91 ± 121.41 mcg). Group B patients had better post operative quality of recovery compared to Group A patients. VAS pain scores at almost all time-points were lower in the ESPB group. ESPB provided effective postoperative analgesia and reduced fentanyl consumption postoperatively compared to SCTAP block.