Surgical Site Pain Research Articles

Marijuana and Its Implications in Breast Reduction Surgery Outcomes and Quality of Life: A Matched Analysis.

With marijuana use on the rise, its influence on surgical outcomes, particularly for breast reduction, warrants investigation. This study aims to clarify marijuana's effects on breast reduction surgery outcomes, given its limited research focus despite potential perioperative implications. A retrospective review was conducted from 2016 to 2022 of patients with/without marijuana use undergoing breast reduction. Propensity score-matching considered age, body mass index, ptosis, and breast tissue mass. Patient demographics, clinical attributes, and postoperative details were analyzed. Quality-of-life (QoL) changes were gauged using pre- and postoperative BREAST-Q. Of 415 patients who underwent breast reduction, 140 patients documented marijuana use. After propensity matching, a total of 108 patients (54 marijuana users versus 54 nonusers) were analyzed. The average age was 39 years ± 12 and body mass index 30.1 kg/m2 ± 5.3. There were no differences between the 2 groups in comorbidities, breast symmetry, excision patterns, pedicle use, or drain count (P > 0.05). Furthermore, surgical outcomes including surgical site occurrences, scarring, pain levels, hypersensitivity, or sensation loss were comparable between the groups (P > 0.05). There were also no differences in number of readmissions, reoperations, or emergency department visits (P > 0.05). Both groups showed enhanced postoperative QoL, regardless of marijuana usage. This study indicates that marijuana use does not significantly impact breast reduction surgery outcomes. Comparable surgical results and postoperative QoL improvements were observed in both marijuana users and nonusers. This study provides surgeons with the knowledge to offer more informed patient counseling regarding the implications of marijuana use in relation to breast reduction procedures.

Impact of general anesthesia type on chronic postsurgical pain following video-assisted thoracoscopic surgery for lung cancer: a retrospective propensity-matched cohort study.

Anesthetic agents are potential modifiable factors that can mitigate chronic postsurgical pain (CPSP) development. This study aimed to investigate the association between propofol-based total intravenous anesthesia (TIVA) and the occurrence of CPSP following video-assisted thoracoscopic surgery (VATS) for lung cancer resection. This single-center retrospective cohort study included adult patients with lung cancer who underwent elective VATS between January 2018 and December 2022. Patients were divided based on the maintenance anesthetic used (propofol vs. sevoflurane). The primary outcome was the presence of CPSP, defined as any level of surgical site pain recorded within 3-6 months postoperatively. The authors investigated the association between anesthetic agents and CPSP using propensity score matching with stabilized inverse probability of treatment weighting (sIPTW) to adjust for confounders. Additionally, multivariable logistic regression was used to further adjust for intraoperative opioid use that sIPTW could not account for. The robustness of these associations was evaluated using the E-value. Of the 833 patients analyzed, 461 received propofol and 372 sevoflurane. The overall incidence of CPSP was 43.3%. After sIPTW, the use of TIVA was significantly associated with a lower incidence of CPSP (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.57-0.99, P = 0.041), and remained significant after adjusting for intraoperative remifentanil equivalent dose (OR: 0.73, 95% CI: 0.55-0.96, P = 0.026). The E-values were 1.08 and 1.17, respectively. Propofol-based TIVA is associated with reduced CPSP occurrence in VATS for lung cancer. Further prospective studies are needed to confirm the results.

Minimally invasive exoscope-assisted coccygectomy: A novel approach for chronic refractory coccydynia

BackgroundThis technical note presents a novel minimally invasive exoscope assisted coccygectomy to treat chronic refractory coccydynia. Traditional treatments often fail to provide adequate relief for this debilitating condition, prompting the need to explore surgical approaches. Case DescriptionA 40-year-old female patient with persistent pain unresponsive to conservative treatments underwent this advanced procedure. Utilizing the Synaptive exoscope-microscope system, the surgery allowed for precise dissection and removal of affected coccygeal segments, with a focus on minimizing skin and soft tissue disruption to optimize wound healing and surgical site pain. ConclusionPostoperative recovery showcased significant pain reduction and improved quality of life, emphasizing the method's potential for better outcomes and fewer complications. Despite the promising results, the limitations of a single-case study necessitate further research to establish long-term effectiveness across a broader patient population.

Retraction: Effects of rapid rehabilitation nursing model on surgical site wound infection and pain of patients with ovarian cancer: A meta-analysis.

Fan E, Zhang K, Wan Y, Hu S. Effects of rapid rehabilitation nursing model on surgical site wound infection and pain of patients with ovarian cancer: a meta-analysi. Int Wound J. 2023; 21(3):e14464. 10.1111/iwj.14464 The above article, published online on 12 November 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. It came to the publisher's attention from a third party that a number of articles shared concerning similarities in format and structure. Following an investigation by the publisher, the retraction of this article has been agreed on because the peer review and publishing process for this article were found to have been manipulated. The authors did not respond to our notice of retraction.

Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial.

Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain. The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery. The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05. The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups. The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain.

Surgical options in thoracic disc herniation: Evaluating long-term outcomes of 21 cases based on a single-center 10-year experience.

Symptomatic thoracic disc herniation (TDH) is a rare pathology that is addressed with relatively challenging surgical approaches, the choice and technical execution of which have been well described in the literature. Interestingly, long-term outcomes, including surgical site pain-related disability, the need for instrumentation, and commonly occurring complications such as cerebrospinal fluid (CSF)-pleural fistula have not been widely addressed. Here, we address the complication profiles and long-term outcomes of different surgical approaches for TDH. We conducted a retrospective review of 21 consecutive patients who underwent surgery for TDH between 2000 and 2010. We assessed post-operative complications such as CSF-pleural fistulas, as well as long-term outcomes using Frankel grades, the EQ-5D-3L, and the Visual Analog Scale. We also looked at the need for instrumentation postoperatively. 21 consecutive patients (13 females, 8 males) with a mean age of 55.3 years (Standard deviation 8.1) underwent thoracic discectomy for symptomatic TDH. Surgical approaches included posterolateral thoracotomy (52%, n = 11), costotransversectomy (43%, n = 9), and transpedicular (5%, n = 1). Herniations were classified as soft (38%, n = 8), calcified (38%, n = 8), or calcified-transdural (24%, n = 5). Postoperatively, all patients with calcifiedtransdural herniations undergoing posterolateral thoracotomy (100%, n = 5) developed CSF-pleural fistulas, which resolved spontaneously without the need for surgical re-exploration. 89% (n = 16) of patients exhibited sustained improvement in Frankel scores. Persistent wound site pain was reported by 50% (n = 7) of patients. Despite favorable neurological outcomes, patients with symptomatic TDHs can experience long-term surgical site pain, and therefore, a move toward minimally invasive exposure in such cases should be considered. Postoperative complications such as CSF-pleural fistulas are unlikely to require surgical intervention and thus can be managed conservatively.

Comparison of Analgesic Efficacy of Continuous Adductor Canal Block versus Single-shot Adductor Canal Block Using Ropivacaine for Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract Context: Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. Aims: The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. Settings and Design: It was a prospective randomized controlled trial carried out in a tertiary care hospital. Materials and Methods: Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Statistical Analysis: Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant. Results: In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. Conclusions: ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.

The impact of laparoscopic surgery on postoperative pain: A prospective study

Introduction: The reduction of postoperative pain intensity is recognized as one of the major advantages of laparoscopic surgery. However, even though this pain is of low intensity, it is not completely abolished after laparoscopic surgery, and may even be multifactorial in origin. The objective of our study is to evaluate pain after laparoscopic surgery and to highlight the various causes of pain. Materials and Methods: This is a descriptive and prospective study involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies between February 2018 and October 2021. Pain was assessed using the visual analog scale (VAS). Results: Postoperative pain was present in 335 patients (99.4%) on postoperative day 0 and in 283 patients (83.98%) on postoperative day 1. This pain was of low intensity in the majority of cases (73%, n=246 patients) on postoperative day 0 and (68.5%, n=231 patients) on postoperative day 1. Surgical site pain was present in 134 cases (39.77%), pain related to delayed intestinal transit in 52 cases (15.43%), shoulder pain related to CO2 in 40 cases (11.87%), and a combination of different types of pain was found in 16.7% of patients. Conclusion: Post-laparoscopic surgery pain is multifactorial, of low intensity, and easily managed with first-tier analgesics.

Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection.

Hypothalamic hamartomas (HH) are rare developmental anomalies of the inferior hypothalamus that often cause refractory epilepsy, including gelastic seizures. Surgical resection is an effective method to treat drug-resistant epilepsy and endocrinopathy in a suitable patient group. Open surgery, endoscopic surgery, ablative procedures, and stereotactic radiosurgery can be utilized. In this study, we aimed to describe the full-endoscopic approach for HH resection. The technique involves the use of an intraoperative ultrasonography (USG) system, a 30° rigid endoscope system that has an outside diameter of 2.7 mm with two working channels, a stylet that has an outer diameter of 3.8 mm, a monopolar coagulation electrode, a fiberoptic light guide, and the endovision system. Microforceps and monopolar electrocautery are the two main surgical instruments for HH removal. The protocol is easy to apply after a particular learning curve has been passed and shorter than open surgical approaches. It leads to less blood loss. Full-endoscopic surgery for HH is a minimally invasive technique that can be applied safely and effectively with good seizure and endocrinological outcomes. It provides low surgical site pain and early mobilization.

Effects of high tibial osteotomy compared with unicondylar knee arthroplasty on the surgical site wound infection and pain in patients with medial knee osteoarthritis.

This study aims to comprehensively compare the effects of unicondylar knee arthroplasty (UKA) and high tibial osteotomy (HTO) on wound infection and pain in patients with medial knee osteoarthritis. A computerized search was conducted in Embase, PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Library and Wanfang databases, from database inception to October 2023, for studies comparing UKA and HTO for medial knee osteoarthritis. Studies selection, data extraction and study quality evaluation were independently conducted by two researchers. Stata 17.0 software was employed for data analysis. Overall, 10 studies involving 870 patients with medial knee osteoarthritis were included. It was found that the UKA group had significantly lower wound visual analogue scale scores compared to the HTO group (SMD = -0.53, 95%CI: -0.87 to -0.20, p < 0.001). The incidence of wound infection in the UKA group was higher than in the HTO group (OR = 1.92, 95%CI: 0.65-5.69, p = 0.240), and the incidence of complications was lower (OR = 0.89, 95%CI: 0.52-1.54, p = 0.684), though these differences were not statistically significant. This study indicates that UKA is effective in alleviating postoperative wound pain in medial knee osteoarthritis. However, the rates of postoperative wound infection and complications are comparable to those of HTO. Clinicians should consider factors such as patient age and disease severity in making individualized treatment decisions.

Results of Early Manipulation Under General Anesthesia in Intra-Articular Distal Femur Fractures

Abstract Background: Postoperative knee stiffness after intra-articular distal femur fracture causes significant disability affecting daily activities of the patient and causing concern for the surgeon. Although the importance of early postoperative mobilization is emphasized to all patients, many patients, especially those from rural areas, have no access to specialized physiotherapy and do not understand the importance of the same. These patients also do not visit the hospital on scheduled days of follow-up due to various socio-economic reasons. Hence, such patients can have restrictions on knee movements (flexion as well as extension) very early during the postoperative period. We present our study protocol for early manipulation under general anesthesia (MUGA) and suture removal at 3 weeks after surgery for these fractures. At 3 weeks, the soft tissue healing of the trauma as well as the surgery have occurred to a great extent. The surgical site pain and inflammation have also reduced. All patients who are operated on will always come to hospital for suture removal. We planned to do a MUGA for the knee along with suture removal at 3 weeks for these patients. Materials and Methods: A prospective study was carried out at our institution for patients admitted and operated on for an intra-articular distal femur fracture. These patients were evaluated for knee range of motion at 3 weeks and posted for manipulation under anesthesia (MUA) and suture removal. Results: The 15 patients who were operated on for an intra-articular distal femur fracture underwent early MUA at 3 weeks. The mean pre-manipulation mean knee flexion was 60°. On manipulation, mean knee flexion of 110° was achieved. At the time of follow-up at 3 months, mean knee flexion was 123°. The average time for MUA was 15 min. No complications occurred during manipulation procedures. Conclusion: Early MUA is a suitable and effective noninvasive treatment modality for postoperative stiffness in cases of intra-articular distal femur fractures.

Influences of ultrasound osteotome on wound infection and wound complications following removal of mandibular wisdom teeth.

We conducted this study to assess the effect of ultrasound osteotome on surgical site wound infection and pain following removal of mandibular wisdom teeth. A computerised search of Embase, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for publicly available randomised controlled trials (RCTs) on the clinical effects of applying ultrasound osteotome to extract mandibular wisdom teeth was conducted from the inception of the databasesto September 2023. Two researchers independently screened the retrieved results for literature screening, quality assessment and data extraction. RevMan 5.4 software was applied for data analysis. A total of 17 RCTs were included in this study, including 848 cases in the ultrasound osteotome group and 842 cases in the control group. The analysis revealed, compared with the control group, the ultrasound osteotome group showed a significantly lower incidence of postoperative wound infection (1.42% vs. 5.46%, odds ratio [OR]: 0.30, 95% confidence intervals [CI]: 0.17-0.53, p < 0.0001), fewer postoperative complications (6.35% vs. 22.12%, OR: 0.23, 95% CI: 0.17-0.32, p < 0.00001), shorter operative time (standardised mean differences [SMD]: -1.30, 95% CI: -1.97 to -0.64, p = 0.0001) and lower wound pain scores (SMD: -2.26 95% CI -2.80 to -1.73, p < 0.00001). Strong evidence suggests that ultrasound osteotome applied to extract mandibular wisdom teeth is more advantageous in terms of lower postoperative wound infection, less wound pain, fewer postoperative complications and shorter operative time compared with conventional treatment methods, but large-scale, multicentre RCTs are still needed to obtain more accurate results.

Effect of rapid rehabilitation care on surgical site wound infection and pain in patients with intertrochanteric femoral fractures: A meta-analysis.

This study examines the effects of rapid rehabilitation on surgical site wound infections and pain in patients with intertrochanteric femoral fractures. A computerised search was conducted for randomised controlled trials (RCTs) on rapid rehabilitation care in patients undergoing surgery for intertrochanteric femoral fractures published in the China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Embase, Cochrane Library and Web of Science. The search was conducted from the time of the database construction to August 2023. Two investigators independently performed literature screening, data extraction and quality assessment based on predefined inclusion and exclusion criteria. Meta-analysis was performed via RevMan 5.4 software. Encompassing 21 studies involving 2004 patients, with 1007 patients receiving rapid rehabilitation care and 997 receiving routine care, our analysis revealed that rapid rehabilitation care significantly reduced postoperative complications (odds ratio [OR] = 0.24, 95% confidence interval [CI]: 0.17-0.33, p < 0.001), wound infections (OR = 0.30, 95% CI: 0.14-0.65, p = 0.002) and hospital stay (mean difference [MD] = -5.23, 95% CI: -6.03 to -4.43, p < 0.001). Moreover, compared with routine care, it notably improved wound pain (MD = -1.51, 95% CI: -1.98 to -1.05, p < 0.001) in patients undergoing surgery for intertrochanteric femoral fractures. Our findings underscore the effectiveness of rapid rehabilitation care in reducing wound pain, postoperative complications and wound infections among patients with intertrochanteric femoral fractures.

Effects of rapid rehabilitation nursing model on surgical site wound infection and pain of patients with ovarian cancer: A meta-analysis.

To explore the effect of rapid rehabilitation nursing model on surgical site wound infection and pain of patients with ovarian cancer. Computer searches were performed on randomised controlled trials (RCTs) of rapid rehabilitation nursing model applied to ovarian cancer patients in PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (SinoMed), VIP and Wanfang Database from the time each database was constructed to May 2023. Two researchers independently screened the literature, extracted data and completed an assessment of the quality of the literature based on the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. The database was searched to obtain 255 articles, and 22 articles were finally included, containing 966 patients in the experimental group and 954 patients in the control group, for a total of 1920 patients. The results of the meta-analysis showed that, compared with other nursing models, the use of the rapid rehabilitation nursing model significantly reduced surgical site wound infections in patients with ovarian cancer (OR = 0.30, 95% CI: 0.15-0.61, p < 0.001) and the rate of post-operative complications (OR = 0.27, 95% CI: 0.19-0.38, p < 0.001) also reduced the patients' post-operative wound pain (MD = -0.70, 95% CI: -0.85 to -0.55, p < 0.001). The rapid rehabilitation nursing model applied to patients with ovarian cancer surgery can effectively reduce the rate of post-operative complications and wound infections, and it can also reduce the post-operative wound pain.

Effects of parasternal intercostal block on surgical site wound infection and pain in patients undergoing cardiac surgery: A meta-analysis.

This study aimed to assess the effect of parasternal intercostal block on postoperative wound infection, pain, and length of hospital stay in patients undergoing cardiac surgery. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases were extensively queried using a computer, and randomised controlled studies (RCTs) from the inception of each database to July 2023 were sought using keywords in English and Chinese language. Literature quality was assessed using Cochrane-recommended tools, and the included data were collated and analysed using Stata 17.0 software for meta-analysis. Ultimately, eight RCTs were included. Meta-analysis revealed that utilising parasternal intercostal block during cardiac surgery significantly reduced postoperative wound pain (standardised mean difference [SMD] = -1.01, 95% confidence intervals [CI]: -1.70 to -0.31, p = 0.005) and significantly shortened hospital stay (SMD = -0.40, 95% CI: -0.77 to -0.04, p = 0.029), though it may increase the risk of wound infection (OR = 5.03, 95% CI:0.58-44.02, p = 0.144); however, the difference was not statistically significant. The application of parasternal intercostal block during cardiac surgery can significantly reduce postoperative pain and shorten hospital stay. This approach is worth considering for clinical implementation. Decisions regarding its adoption should be made in conjunction with the relevant clinical indices and surgeon's experience.

Effects of tourniquet on surgical site wound infection and pain after total knee arthroplasty: A meta-analysis.

The application of a tourniquet (TNQ) for haemostasis in total knee arthroplasty (TKA) is controversial and lacking systematic evaluation. This meta-analysis assessed relevant international data to quantitatively evaluate the implications of using TNQ in TKA, further guide clinical diagnosis and treatment, and improve postoperative outcomes. A comprehensive computerised search of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases was conducted to retrieve randomised controlled trials on the application of TNQ in TKA published from database inception to August 2023. The included data, ultimately comprising 1482 patients in 16 studies, were collated and subjected to meta-analysis using Stata 17.0 software. The results showed that the use of TNQ during TKA led to significantly higher rates of postoperative surgical site wound infection (3.96% vs. 1.79%, odds ratio: 2.15, 95% confidence intervals [CIs]: 1.11-4.16, p = 0.023) and wound pain scores on the first (standardised mean difference [SMD]: 0.65, 95% CI: 0.35-0.94, p < 0.001), second (SMD: 0.66, 95% CI: 0.01-1.31, p = 0.045), and third (SMD: 0.68, 95% CI: 0.31-1.05, pP < 0.001) day after the procedure. In conclusion, the application of TNQ in TKA increases the risk of postoperative surgical site wound infection and worsens short-term postoperative wound pain; therefore, TNQ should be used sparingly during TKA, or its use should be decided in conjunction with the relevant clinical indications and the surgeon's experience.

Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study.

Prospective, randomized controlled double-blinded study. To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia. 81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded. The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; P < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29mg; P < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03mL, 380.74 ± 77.80mL) than the control group (498.89 ± 71.22mL) (P < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief. Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.

Full-Endoscopic Transforaminal Approach for Lumbar Discectomy.

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.

The Association of Cannabis Use After Discharge From Surgery With Opioid Consumption and Patient-reported Outcomes.

To compare outcomes of patients using versus not using cannabis as a treatment for pain after discharge from surgery. Cannabis is increasingly available and is often taken by patients to relieve pain. However, it is unclear whether cannabis use for pain after surgery impacts opioid consumption and postoperative outcomes. Using Michigan Surgical Quality Collaborative registry data at 69 hospitals, we analyzed a cohort of patients undergoing 16 procedure types between January 1, 2021, and October 31, 2021. The key exposure was cannabis use for pain after surgery. Outcomes included postdischarge opioid consumption (primary) and patient-reported outcomes of pain, satisfaction, quality of life, and regret to undergo surgery (secondary). Of 11,314 included patients (58% females, mean age: 55.1 years), 581 (5.1%) reported using cannabis to treat pain after surgery. In adjusted models, patients who used cannabis consumed an additional 1.0 (95% CI: 0.4-1.5) opioid pills after surgery. Patients who used cannabis were more likely to report moderate-to-severe surgical site pain at 1 week (adjusted odds ratio: 1.7, 95% CIL 1.4-2.1) and 1 month (adjusted odds ratio: 2.1, 95% CI: 1.7-2.7) after surgery. Patients who used cannabis were less likely to endorse high satisfaction (72.1% vs 82.6%), best quality of life (46.7% vs 63.0%), and no regret (87.6% vs 92.7%) (all P < 0.001). Patient-reported cannabis use, to treat postoperative pain, was associated with increased opioid consumption after discharge from surgery that was of clinically insignificant amounts, but worse pain and other postoperative patient-reported outcomes.

A Retrospective Study of Transaxillary Endoscopic Breast Augmentation Using Ultrasonic Scalpel or Conventional Electrocautery for Implant Pocket Dissection.

Ultrasonic scalpel has been reported to be superior to conventional electrocautery in many studies. However, with respect to transaxillary endoscopic breast augmentation, few studies on the effect of ultrasonic scalpel are available in the literature. The medical records of 173 female patients who underwent breast augmentation via endoscopic transaxillary approach from January 2018 to December 2020 were reviewed retrospectively. The patients were divided into two groups according to the implant pocket dissection instruments. In group A, the implant pockets were dissected with conventional electrocautery (EC group) on 81 patients, and in group B, ultrasonic scalpel (US group) was used for implant pockets on 92 patients. All operations were performed by the same senior plastic surgeon and the same surgical team. The operation time, intraoperative blood loss, postoperative total drainage volume, days of drainage, postoperative surgical site pain and hospital stay time of the two groups were compared and analyzed statistically. The average operation time of the US group (83.82 ± 11.57min) was significantly shorter than that of the EC group (101.40 ± 14.36min), intraoperative blood loss in the US group was significantly less than that of the EC group (18.67 ± 6.20ml vs. 21.59 ± 6.44ml), the mean hospital stay days (2.96 ± 0.69 vs. 4.30 ± 1.11), total drainage volume (122.24 ± 43.81 vs. 232.37 ± 99.15), and duration of drain (2.52 ± 0.54 vs. 3.77 ± 1.10), mean VAS score for surgical site pain on 3 postoperative days (5.08 ± 1.35 vs. 6.51 ± 1.36, 4.08 ± 1.16 vs. 5.40 ± 1.32, 3.04 ± 0.91 vs. 4.06 ± 1.11) were significantly lower in the US group compared to the EC group. The ultrasonic scalpel reduces operative time, intraoperative blood loss, postoperative drainage, postoperative pain, hospital stay time, and incidence of complications. The ultrasonic scalpel is safe and reliable for transaxillary endoscopic breast augmentation. This journal requires that authors assign a level of evidence to each article. 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 .