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Fan GQ, Zhang XD, He YK, Lu XG, Zhong JY, Pang ZY, Gan XY. Safety and feasibility of enhanced recovery after surgery-based management model for ambulatory pediatric surgical procedures. World J Clin Cases 2024; 12:4965-4972. [DOI: 10.12998/wjcc.v12.i22.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND There is still some room for optimizing ambulatory pediatric surgical procedures, and the preoperative and postoperative management quality for pediatric patients needs to be improved.
AIM To discuss the safety and feasibility of the enhanced recovery after surgery (ERAS)-based management model for ambulatory pediatric surgical procedures.
METHODS We selected 320 pediatric patients undergoing ambulatory surgery from June 2023 to January 2024 at The First People’s Hospital of Liangshan Yi Autonomous Prefecture. Of these, 220 received ERAS-based management (research group) and 100 received routine management (control group). General information, postoperative ambulation activities, surgical outcomes (operation time, postoperative gastrointestinal ventilation time, and hospital stay), postoperative pain visual analogue scale, postoperative complications (incision infection, abdominal distension, fever, nausea, and vomiting), and family satisfaction were compared.
RESULTS The general information of the research group (sex, age, disease type, single parent, family history, etc.) was comparable to that of the control group (P > 0.05), but the rate of postoperative (2 h, 4 h, and 6 h after surgery) ambulation activities was statistically higher (P < 0.01), and operation time, postoperative gastrointestinal ventilation time, and hospital stay were markedly shorter (P < 0.05). The research group had lower visual analogue scale scores (P < 0.01) at 12 h and 24 h after surgery and a lower incidence of total postoperative complications than the control group (P = 0.001). The research group had higher family satisfaction than the control group (P = 0.007).
CONCLUSION The ERAS-based management model was safe and feasible in ambulatory pediatric surgical procedures and worthy of clinical promotion.
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Affiliation(s)
- Gui-Quan Fan
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Xin-Dan Zhang
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Yong-Ke He
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Xiao-Gang Lu
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Ji-Yong Zhong
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Zong-Yang Pang
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
| | - Xi-Yang Gan
- Pediatric Surgery, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang 615000, Sichuan Province, China
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Gao T, Wang Y, Zheng Y, Yu Y, Li Q, Zhang L. Quadratus lumborum block vs. transversus abdominis plane block for postoperative pain control in patients with nephrectomy: A systematic review and network meta-analysis. J Clin Anesth 2024; 95:111453. [PMID: 38531283 DOI: 10.1016/j.jclinane.2024.111453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/04/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
STUDY OBJECTIVE This systematic review and network meta-analysis aimed to compare the analgesic efficacy of transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) on nephrectomy. DESIGN Systematic review and network meta-analysis. PATIENTS Patients undergoing nephrectomy. INTERVENTIONS TAPB and QLB for postoperative analgesia. MEASUREMENTS The primary outcome was 24 h morphine-equivalent consumptions after surgery. Secondary outcomes included postoperative pain scores, postoperative opioid consumption, postoperative rescue analgesia, postoperative nausea and vomiting (PONV), length of hospital stay after surgery, and patient satisfaction. MAIN RESULTS Fourteen studies involving 883 patients were included. Seven studies compared TAPB to control, six studies compared QLB to control, and one study compared TAPB to QLB. For direct meta-analysis of the post-surgical 24 h morphine-equivalent consumption, QLB was lower than control (mean difference [95%CI]: -18.16 [-28.96, -7.37]; I2 = 88%; p = 0.001), while there was no difference between TAPB and control (mean difference [95%CI]: -8.34 [-17.84, 1.17]; I2 = 88%; p = 0.09). Network meta-analysis showed similar findings that QLB was ranked as the best anesthetic technique for reducing postoperative 24 h opioid consumption (p-score = 0.854). Moreover, in direct meta-analysis, as compared to control, the time of first postoperative rescue analgesia was prolonged after QLB (mean difference [95%CI]: 165.00 [128.99, 201.01]; p < 0.00001), but not TAPB (mean difference [95%CI]: 296.82 [-91.92, 685.55]; p = 0.13). Meanwhile, QLB can effectively reduce opioid usages at intraoperative period, as well as at postoperative 6 h and 48 h, while TAPB can only reduce opioid consumption at 6 h after surgery. As compared to control, both TAPB and QLB exhibited the reduction in PONV and pain scores at post-surgical some timepoints. Also, QLB (mean difference [95%CI]: -0.29 [-0.49, -0.08]; p = 0.006) but not TAPB (mean difference [95%CI]: 0.60 [-0.25, 1.45]; p = 0.17) exhibited the shorter postoperative length of hospital stay than control. CONCLUSIONS QLB is more likely to be effective in reducing postoperative opioid use than TAPB, whereas both of them are superior to control with regard to the reduction in postoperative pain intensity and PONV. TRIAL REGISTRATION PROSPERO identifier: CRD42022358464.
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Affiliation(s)
- Tianyu Gao
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yigang Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yuxin Zheng
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Qing Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China.
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China.
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Xu HT, Zimmerman J, Bertoch T, Chen L, Chen PJ, Onel E. CPL-01, an investigational long-acting ropivacaine, demonstrates safety and efficacy in open inguinal hernia repair. Hernia 2024; 28:1345-1354. [PMID: 38713429 PMCID: PMC11297089 DOI: 10.1007/s10029-024-03047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND There is an unmet medical need for effective nonopioid analgesics that can decrease pain while reducing systemic opioid use. CPL-01, an extended-release injectable formulation of ropivacaine, is designed to safely provide analgesia and reduce or eliminate opioid use in the postoperative period. METHODS Subjects undergoing open inguinal hernia with mesh were prospectively randomized to 1 of 3 doses of CPL-01 (10, 20, or 30 ml of 2% CPL-01, n = 14, 12, and 14, respectively), Naropin (150 mg, n = 40), or saline placebo (n = 13) infiltrated into the surgical site prior to closure. Pain and rescue medication usage was assessed, and Numeric Rating Scale (NRS) pain scores were adjusted for opioid usage using windowed worst observation carried forward (wWOCF) imputation. The primary efficacy endpoint was the mean area under the curve (AUC) of the NRS pain intensity scores with activity. RESULTS Ninety-three subjects were treated, and 91 subjects completed 72 h of post-operative monitoring. Subjects who received the highest dose of CPL-01 in Cohort 3 showed a clinically meaningful reduction in postoperative pain intensity scores, which was the lowest value for any treatment in all cohorts, showing a trend towards statistical significance as compared to the pooled placebo group (p = 0.08), and numerically better than the 40 subjects who received Naropin. Opioid use through 72 h in subjects who received CPL-01 in Cohort 3 was approximately half of that shown in the placebo and Naropin groups; approximately 2/3 of the CPL-01 subjects (9/14) required no opioids at all through the first 72 h after the operation. More CPL-01 subjects avoided severe pain and were ready for discharge earlier than other groups. CPL-01 was safe and well-tolerated, with no clinically meaningful safety signals, and showed predictable and consistent extended-release pharmacokinetics. CONCLUSION Results suggest that CPL-01 may be the first long-acting ropivacaine to address postoperative pain while reducing the need for opioids.
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Affiliation(s)
- H T Xu
- Cali (SZ) Biosciences Co., Ltd. Shanghai Branch, Building 7, 690 Bibo Road, Shanghai, R715S, China.
| | - J Zimmerman
- Trovare Clinical Research, 3838 San Dimas St Ste A280, Bakersfield, CA, 93301, USA
| | - T Bertoch
- CeneExel JBR, 650 East 4500 South, Suite 100, Salt Lake City, UT, 84107, USA
| | - L Chen
- Cali Biosciences US, LLC, 9675 Businesspark Avenue, San Diego, CA, 92131, USA
| | - P J Chen
- Cali (SZ) Biosciences Co., Ltd. Shanghai Branch, Building 7, 690 Bibo Road, Shanghai, R715S, China
- Cali Biosciences US, LLC, 9675 Businesspark Avenue, San Diego, CA, 92131, USA
| | - E Onel
- Cali Biosciences US, LLC, 9675 Businesspark Avenue, San Diego, CA, 92131, USA
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Maselli R, Massimi D, Ferrari C, Mondovì AN, Hassan C, Repici A. Enhanced recovery after surgery (ERAS) in advanced therapeutic flexible endoscopy: Introducing the concept of enhanced recovery after therapeutic endoscopy (ERATE). Dig Liver Dis 2024; 56:1253-1256. [PMID: 38161088 DOI: 10.1016/j.dld.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Enhanced recovery after surgery (ERAS) guidelines are evidence-based recommendations designed to improve patient outcomes and reduce complications after surgery. Although the ERAS guidelines focus primarily on surgical procedures, many of the principles could be applied also to therapeutic endoscopy as well. An extensive literature research on Embase and PubMed was thus made to reviewed articles regarding ERAS protocols applied to therapeutic endoscopy, organized by specific endoscopic field. Out of 214 papers, only 6 were relevant to the topic. Few studies explored in real life and in trial setting the hypothesized significance of ERAS principles applied to endoscopic procedures, mostly retrospective, not even covering the entire field of therapeutic endoscopy. This field of knowledge appears neglected so far by scientific community and endoscopic organizations. We believe that endoscopy units could benefit anyway from developing and implementing structured enhanced recovery pathways for their patients, therefore we subsequently created and suggested a simply and easily applicable, Enhanced Recovery protocol After Therapeutic Endoscopy which include preoperative preparation, anesthesia and sedation, nausea and vomiting (PONV) prophylaxis, and postoperative care.
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Affiliation(s)
- Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Davide Massimi
- IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy.
| | - Chiara Ferrari
- IRCCS Humanitas Research Hospital, Department of Anestesiology, Rozzano, Italy
| | | | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
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Görges M, Sujan J, West NC, Sreepada RS, Wood MD, Payne BA, Shetty S, Gelinas JP, Sutherland AM. Postsurgical Pain Risk Stratification to Enhance Pain Management Workflow in Adult Patients: Design, Implementation, and Pilot Evaluation. JMIR Perioper Med 2024; 7:e54926. [PMID: 38954808 PMCID: PMC11252618 DOI: 10.2196/54926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Exposure to opioids after surgery is the initial contact for some people who develop chronic opioid use disorder. Hence, effective postoperative pain management, with less reliance on opioids, is critical. The Perioperative Opioid Quality Improvement (POQI) program developed (1) a digital health platform leveraging patient-survey-reported risk factors and (2) a postsurgical pain risk stratification algorithm to personalize perioperative care by integrating several commercially available digital health solutions into a combined platform. Development was reduced in scope by the COVID-19 pandemic. OBJECTIVE This pilot study aims to assess the screening performance of the risk algorithm, quantify the use of the POQI platform, and evaluate clinicians' and patients' perceptions of its utility and benefit. METHODS A POQI platform prototype was implemented in a quality improvement initiative at a Canadian tertiary care center and evaluated from January to September 2022. After surgical booking, a preliminary risk stratification algorithm was applied to health history questionnaire responses. The estimated risk guided the patient assignment to a care pathway based on low or high risk for persistent pain and opioid use. Demographic, procedural, and medication administration data were extracted retrospectively from the electronic medical record. Postoperative inpatient opioid use of >90 morphine milligram equivalents per day was the outcome used to assess algorithm performance. Data were summarized and compared between the low- and high-risk groups. POQI use was assessed by completed surveys on postoperative days 7, 14, 30, 60, 90, and 120. Semistructured patient and clinician interviews provided qualitative feedback on the platform. RESULTS Overall, 276 eligible patients were admitted for colorectal procedures. The risk algorithm stratified 203 (73.6%) as the low-risk group and 73 (26.4%) as the high-risk group. Among the 214 (77.5%) patients with available data, high-risk patients were younger than low-risk patients (age: median 53, IQR 40-65 years, vs median 59, IQR 49-69 years, median difference five years, 95% CI 1-9; P=.02) and were more often female patients (45/73, 62% vs 80/203, 39.4%; odds ratio 2.5, 95% CI 1.4-4.5; P=.002). The risk stratification was reasonably specific (true negative rate=144/200, 72%) but not sensitive (true positive rate=10/31, 32%). Only 39.7% (85/214) patients completed any postoperative quality of recovery questionnaires (only 14, 6.5% patients beyond 60 days after surgery), and 22.9% (49/214) completed a postdischarge medication survey. Interviewed participants welcomed the initiative but noted usability issues and poor platform education. CONCLUSIONS An initial POQI platform prototype was deployed operationally; the risk algorithm had reasonable specificity but poor sensitivity. There was a significant loss to follow-up in postdischarge survey completion. Clinicians and patients appreciated the potential impact of preemptively addressing opioid exposure but expressed shortcomings in the platform's design and implementation. Iterative platform redesign with additional features and reevaluation are required before broader implementation.
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Affiliation(s)
- Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Jonath Sujan
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Rama Syamala Sreepada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Michael D Wood
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Beth A Payne
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Swati Shetty
- MD Undergraduate Program, The University of British Columbia, Vancouver, BC, Canada
| | - Jean P Gelinas
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Anesthesiology, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Ainsley M Sutherland
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, St. Paul's Hospital, Vancouver, BC, Canada
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Saks J, Yoon U, Neiswinter N, Schwenk ES, Goldberg S, Nguyen L, Torjman MC, Elia E, Shah A. Randomized Controlled Trial of Enhanced Recovery After Surgery Protocols in Live Kidney Donors: ERASKT Study. Transplant Direct 2024; 10:e1663. [PMID: 38953038 PMCID: PMC11216682 DOI: 10.1097/txd.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 07/03/2024] Open
Abstract
Background Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function. Methods In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis plane block. Our primary outcome measure was postoperative opioid consumption. The secondary outcome measures were postoperative pain scores, first oral intake, and hospital length of stay. Results There were no significant differences in demographics between the 2 groups. The ERAS group had a statistically significant reduction in total postoperative opioid consumption calculated in intravenous morphine equivalents (24.2 ± 20.2 versus 71 ± 39.5 mg, P < 0.01). Postoperative pain scores were significantly lower (P < 0.001) from 1 h postoperatively to 48 h. Surgical time was 45 min shorter (P = 0.037). Intraoperative PlasmaLyte administration was lower (PlasmaLyte: 1444 ± 907 versus 2168 ± 1347 mL, P = 0.049). Time to tolerating regular diet was shorter by 2 h (P < 0.008), and length of hospital stay was decreased by 10.1 h. Conclusions The ERAS group experienced superior postoperative analgesia and a shorter length of hospital stay compared with controls.
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Affiliation(s)
- Jacob Saks
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Uzung Yoon
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Natalie Neiswinter
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Eric S. Schwenk
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Stephen Goldberg
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Linh Nguyen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Marc C. Torjman
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Elia Elia
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ashesh Shah
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
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7
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Jackson CB, Desai J, Lee WA, Renfro LA. Utility of Continuous Paravertebral Block After Retroperitoneal Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2024; 104:124-131. [PMID: 37454895 DOI: 10.1016/j.avsg.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Open abdominal aortic aneurysm (AAA) repairs can be associated with significant pain and morbidity. Previous studies have demonstrated utility of adjunctive epidural analgesia (EA) in addition to general anesthesia (GA) to reduce pain and blunt the maladaptive surgical stress response. However, EA may be complicated by epidural hematomas and severe hypotension. Recently, we started using continuous paravertebral block (PVB) for perioperative analgesia after retroperitoneal AAA repair. PVB has some distinct advantages over EA such as unilateral localization, reduced risk of hypotension, and minimal risk of epidural hematoma in the setting of systemic heparinization. This study aimed to examine the utility of PVB by comparing total opioid consumption in the postoperative period among patients who received GA + PVB and those who received GA alone. METHODS This retrospective matched cohort study included 62 patients who underwent elective retroperitoneal AAA repair between January 2019 and August 2022. Thirty-one subjects managed with GA + PVB were compared with 31 control subjects treated with GA alone, matched on following criteria: age, sex, and cross-clamp location. Outcome measures included total opioid analgesics administered during their inhospital postoperative course, time to extubation, time to return to baseline activity, time to normal bowel function, and length of stay. Opioid doses were converted to morphine milligram equivalents (MMEs). RESULTS The GA + PVB group required significantly less opioid analgesics (81 ± 53 MME) than the GA group (171 ± 121 MME) (P < 0.001). Compared to GA alone, GA + PVB was superior in every clinical metric examined: time to extubation (3 vs. 1 hr, P < 0.001), recovery of bowel function (3 vs. 2 days, P = 0.002), recovery of baseline physical activity (4 vs. 2 days, P = 0.019), and length of stay (5 vs. 3 days, P < 0.001). CONCLUSIONS Continuous paravertebral block provides better pain management with significantly decreased opioid requirements in the postoperative period compared to GA-alone for patients undergoing elective retroperitoneal AAA repair.
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Affiliation(s)
- Cody B Jackson
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Jamshed Desai
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - W Anthony Lee
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL; Baptist Health Medical Group-Vascular Surgery, Boca Raton Regional Hospital, Boca Raton, FL
| | - Leslie A Renfro
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL; Department of Anesthesiology, Boca Raton Regional Hospital, Boca Raton, FL.
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Sia CJY, Wee S, Au-Yong APS, Lie SA, Tan WJ, Foo FJ, Kam JH, Lee DJK, Koh FH. Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis. Int J Surg 2024; 110:4393-4401. [PMID: 38912972 PMCID: PMC11254305 DOI: 10.1097/js9.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting. METHODS The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study. RESULTS ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95 mg (95% CI: -8.86 to -3.04; P <0.0001); I2 =89%], intraoperative opioid consumption MD of -102.4 mcg (95% CI: -145.58 to -59.21; P <0.00001); I2 =39%, and incidence of nausea [RR 0.38 (95% CI: 0.25-0.60; P <0.0001); I2 =0%] and vomiting [RR 0.32 (95% CI: 0.17-0.63; P =0.0009); I2 =0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of -0.68 (95% CI: -0.94 to -0.41); P <0.00001; I2 =0%]. CONCLUSIONS This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements.
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Affiliation(s)
| | - Sheila Wee
- Department of Anaesthesiology, Khoo Teck Phuat Hospital
| | | | - Sui-An Lie
- Department of Anaesthesiology and Perioperative Science, Singapore General Hospital
| | - Winson J. Tan
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Fung-Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Juinn-Huar Kam
- Department of General Surgery, Sengkang General Hospital
| | - Daniel JK Lee
- Department of Colorectal Surgery, Khoo Teck Puat Hospital, Singapore
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Huh J, Lee N, Kim M, Choi H, Oh DY, Choi J, Hwang W. Comparison of Nefopam-Based Patient-Controlled Analgesia with Opioid-Based Patient-Controlled Analgesia for Postoperative Pain Management in Immediate Breast Reconstruction Surgery: A Randomized Controlled Trial. J Clin Med 2024; 13:3490. [PMID: 38930019 PMCID: PMC11204651 DOI: 10.3390/jcm13123490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Immediate breast reconstruction surgery (BRS) often leads to significant postoperative pain, necessitating effective analgesia. This study aimed to compare the analgesic efficacy of patient-controlled analgesia (PCA) containing nefopam with that of PCA containing opioids alone in patients undergoing BRS. Methods: A prospective, double-blind, randomized controlled trial was conducted on 120 patients undergoing immediate BRS after mastectomy. Patients were randomly allocated to receive PCA with fentanyl alone (Group F: fentanyl 10 mcg/kg), fentanyl and nefopam (Group FN: fentanyl 5 mcg/kg + nefopam 1 mg/kg), or nefopam alone (Group N: nefopam 2 mg/kg). Pain intensity (expressed in VASr and VASm), opioid consumption, and opioid-related complications were assessed. Results: PCA with nefopam, either alone or in combination with opioids, demonstrated non-inferior analgesic efficacy compared to PCA with fentanyl alone. At 24 h postoperatively, the VASr scores were 2.9 ± 1.0 in Group F, 3.1 ± 1.2 in Group FN, and 2.8 ± 0.9 in Group N (p = 0.501). At the same timepoint, the VASm scores were 4.1 ± 1.2 in Group F, 4.5 ± 1.5 in Group FN, and 3.8 ± 1.4 in Group N (p = 0.129). Significant differences among the three groups were observed at all timepoints except for PACU in terms of the total opioid consumption (p < 0.0001). However, there were no significant differences in opioid-related complications among the three groups. Conclusions: PCA with nefopam, whether alone or in combination with opioids, offers non-inferior analgesic efficacy compared to PCA with fentanyl alone in patients undergoing immediate BRS.
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Affiliation(s)
- Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (N.L.); (M.K.); (H.C.)
| | - Noori Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (N.L.); (M.K.); (H.C.)
| | - Minju Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (N.L.); (M.K.); (H.C.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (N.L.); (M.K.); (H.C.)
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.Y.O.); (J.C.)
| | - Jangyoun Choi
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.Y.O.); (J.C.)
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (N.L.); (M.K.); (H.C.)
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10
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Jenny JY, Godet J, de Ladoucette A. Complication Rates Are Not Higher After Outpatient Versus Inpatient Fast-Track Total Knee Arthroplasty: A Propensity-Matched Prospective Comparative Study. J Arthroplasty 2024:S0883-5403(24)00583-7. [PMID: 38866346 DOI: 10.1016/j.arth.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND This prospective study aimed to compare the complication rates and clinical outcomes of propensity-matched patients who received fast-track total knee arthroplasty (FT TKA) in outpatient versus inpatient settings. METHODS Patients (n = 629) who received FT TKA at various outpatient (n = 176) and inpatient (n = 462) surgery rates were prospectively followed until 90 days after surgery. The decision between inpatient versus outpatient FT TKA was made on a case-by-case basis, depending on consultation between the surgeon and patient. Complications were collected to distinguish between intraoperative complications, complications with no readmission, complications with readmission, and complications with reoperation. Propensity scores based on age, sex, body mass index, and the American Society of Anesthesiologists score were used to match outpatient to inpatient FT TKA. A cumulative incidence function was computed by taking the time to diagnose any postoperative complication in the first 90 days as the end point. RESULTS Propensity score matching (1:2 ratio) for comparison resulted in 173 outpatient FT TKAs and 316 inpatient FT TKAs. No significant differences were observed between outpatient versus inpatient FT TKA for intraoperative complication rates (2% in both groups). At 90-day follow-up, no significant differences were observed between outpatient versus inpatient FT TKA for total complications with no readmission (8.0 versus 7.9%), complications with readmission but no reoperation (1.1 versus 0.6%), and complications with reoperation (4.0 versus 4.4%). A comparison of postoperative complication diagnosis time using the cumulative incidence function revealed no significant differences between outpatient versus inpatient FT TKA. CONCLUSIONS The present study revealed that there were no differences in 90-day postoperative complication rates between outpatient and inpatient FT TKA and that there were also no differences in rates of intraoperative complications, readmissions, or reoperations. These findings may encourage hesitant surgeons to move toward outpatient TKA pathways, as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Jean-Yves Jenny
- Hôpitaux Universitaires de Strasbourg, Pôle Locomax, Strasbourg, France; Sainte Odile Clinic, ELSAN, Haguenau, France
| | - Julien Godet
- Hôpitaux Universitaires de Strasbourg, Pôle Locomax, Strasbourg, France
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11
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Kuo CC, McCall JG. Neural circuit-selective, multiplexed pharmacological targeting of prefrontal cortex-projecting locus coeruleus neurons drives antinociception. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.08.598059. [PMID: 38895281 PMCID: PMC11185789 DOI: 10.1101/2024.06.08.598059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Selective manipulation of neural circuits using optogenetics and chemogenetics holds great translational potential but requires genetic access to neurons. Here, we demonstrate a general framework for identifying genetic tool-independent, pharmacological strategies for neural circuit-selective modulation. We developed an economically accessible calcium imaging-based approach for large-scale pharmacological scans of endogenous receptor-mediated neural activity. As a testbed for this approach, we used the mouse locus coeruleus due to the combination of its widespread, modular efferent neural circuitry and its wide variety of endogenously expressed GPCRs. Using machine learning-based action potential deconvolution and retrograde tracing, we identified an agonist cocktail that selectively inhibits medial prefrontal cortex-projecting locus coeruleus neurons. In vivo, this cocktail produces synergistic antinociception, consistent with selective pharmacological blunting of this neural circuit. This framework has broad utility for selective targeting of other neural circuits under different physiological and pathological states, facilitating non-genetic translational applications arising from cell type-selective discoveries.
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Affiliation(s)
- Chao-Cheng Kuo
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA; Center for Clinical Pharmacology, University of Health Sciences and Pharmacy in St. Louis and Washington University School of Medicine, St. Louis, MO, USA; Washington University Pain Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Jordan G. McCall
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA; Center for Clinical Pharmacology, University of Health Sciences and Pharmacy in St. Louis and Washington University School of Medicine, St. Louis, MO, USA; Washington University Pain Center, Washington University in St. Louis, St. Louis, MO, USA
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12
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Weber M, Chao M, Kaur S, Tran B, Dizdarevic A. A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery. Anesthesiol Clin 2024; 42:345-356. [PMID: 38705681 DOI: 10.1016/j.anclin.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.
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Affiliation(s)
- Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Melissa Chao
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Simrat Kaur
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Bryant Tran
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Anis Dizdarevic
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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13
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Taylor JM, Moman PD, Chevalier JM, Tseng CY, Festekjian JH, Delong MR. Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Tissue Expander-based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5879. [PMID: 38855130 PMCID: PMC11161298 DOI: 10.1097/gox.0000000000005879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 06/11/2024]
Abstract
Background Enhanced recovery after surgery (ERAS) protocols have demonstrated success in reducing hospital stay and opioid consumption, but are less well studied in patients undergoing tissue expander-based breast reconstruction (TEBR). This study evaluates the effectiveness of an ERAS postoperative protocol for TEBR at a high-volume center. Methods All patients undergoing immediate tissue expander reconstruction after the introduction of ERAS were prospectively included from April 2019 to June 2023. An equivalent number of similar patients were retrospectively reviewed before this date as the non-ERAS control. Data included demographics, operative details, postoperative length of stay, inpatient and discharge narcotic quantities, inpatient pain assessments, postoperative radiation, and complications within 90 days. Results There were 201 patients in each cohort with statistically similar demographics. Patients in the ERAS cohort were more likely to undergo prepectoral reconstruction (83.1% versus 4.5%, P < 0.001), be discharged by day 1 (96.5% versus 70.2%, P < 0.001) and consume lower inpatient milligram morphine equivalent (MME) median (79.8 versus 151.8, P < 0.001). Seroma rates (17.4% versus 3.5%, P < 0.001) and hematoma incidence (4.5% versus 0%, P = 0.004) were higher in the ERAS cohort. Adjusting for implant location, ERAS was associated with a 60.7 MME reduction (β=-60.7, P < 0.001) and a shorter inpatient duration by 0.4 days (β =-0.4, P < 0.001). Additionally, prepectoral reconstruction significantly decreased MME (β=-30.9, P = 0.015) and was the sole predictor of seroma development (odds ratio = 5.2, P = 0.009). Conclusions ERAS protocols significantly reduce opioid use and hospital stay after TEBR.
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Affiliation(s)
- Jeremiah M. Taylor
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Precious D. Moman
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Jose M. Chevalier
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Charles Y. Tseng
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Jaco H. Festekjian
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Michael R. Delong
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
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14
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Chaves Junior ADJ, Avelino PS, Lopes JB. Comparison of the Effects of Full Median Sternotomy vs. Mini-Incision on Postoperative Pain in Cardiac Surgery: A Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20230154. [PMID: 38748974 PMCID: PMC11095119 DOI: 10.21470/1678-9741-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/12/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION It is not yet clear whether cardiac surgery by mini-incision (minimally invasive cardiac surgery [MICS]) is overall less painful than the conventional approach by full sternotomy (FS). A meta-analysis is necessary to investigate polled results on this topic. METHODS PubMed®/MEDLINE, Cochrane CENTRAL, Latin American and Caribbean Health Sciences Literature (or LILACS), and Scientific Electronic Library Online (or SciELO) were searched for all clinical trials, reported until 2022, comparing FS with MICS in coronary artery bypass grafting (CABG), mitral valve surgery (MVS), and aortic valve replacement (AVR), and postoperative pain outcome was analyzed. Main summary measures were the method of standardized mean differences (SMD) with a 95% confidence interval (CI) and P-values (considered statistically significant when < 0.05). RESULTS In AVR, the general estimate of postoperative pain effect favored MICS (SMD 0.87 [95% CI 0.04 to 1.71], P=0.04). However, in the sensitivity analysis, there was no difference between the groups (SMD 0.70 [95% CI -0.69 to 2.09], P=0.32). For MVS, it was not possible to perform a meta-analysis with the included studies, because they had different methodologies. In CABG, the general estimate of the effect of postoperative pain did not favor any of the approaches (SMD -0.40 [95% CI -1.07 to 0.26], P=0.23), which was confirmed by sensitivity analysis (SMD -0.02 [95% CI -0.71 to 0.67], P=0.95). CONCLUSION MICS was not globally less painful than the FS approach. It seems that postoperative pain is more related to the degree of tissue retraction than to the size of the incision.
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Affiliation(s)
| | | | - Jackson Brandão Lopes
- Department of Anesthesiology and Surgery, Faculdade de Medicina da
Bahia, Universidade Federal da Bahia (FMB/UFBA), Salvador, Bahia, Brazil
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15
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Ramjit S, Davey MG, Loo C, Moran B, Ryan EJ, Arumugasamy M, Robb WB, Donlon NE. Evaluating analgesia strategies in patients who have undergone oesophagectomy-a systematic review and network meta-analysis of randomised clinical trials. Dis Esophagus 2024; 37:doad074. [PMID: 38221857 DOI: 10.1093/dote/doad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
Optimal pain control following esophagectomy remains a topic of contention. The aim was to perform a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating the analgesia strategies post-esophagectomy. A NMA was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using Shiny and R. Fourteen RCTs which included 565 patients and assessed nine analgesia techniques were included. Relative to systemic opioids, thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): -13.73, 95% Confidence Interval (CI): -27.01-0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: -36.2, 95% CI: -61.44-10.96) (n = 569, 15 RCTs) and dynamic (MD: -42.90, 95% CI: -68.42-17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: -13.05, 95% CI: -22.74-3.36) and dynamic (MD: -18.08, 95% CI: -31.70-4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: -33.20, 95% CI: -60.57-5.83) and 48 hours (MD: -42.66, 95% CI: -59.45-25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: -5.00, 95% CI: -6.82-3.18) and time to extubation (MD: -4.40, 95% CI: -5.91-2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91-18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87-26.87). TEA provides optimal pain control and improved post-operative respiratory function in patients post-esophagectomy, reducing ICU stays, one of the benchmarks of improved post-operative recovery. IPA demonstrates promising results for potential implementation in the future following esophagectomy.
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Affiliation(s)
- Sinead Ramjit
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitlyn Loo
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Moran
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eanna J Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - William B Robb
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel E Donlon
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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16
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Haskes K, Donado C, Carbajal R, Berde CB, Kossowsky J. Rescue designs in analgesic trials from 0 to 2 years of age: scoping review. Pediatr Res 2024; 95:1237-1245. [PMID: 38114607 DOI: 10.1038/s41390-023-02897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Abstract
Pediatric analgesic trials are challenging, especially in newborns and infants. Following an FDA-academic consensus meeting, we analyzed pragmatic rescue designs in postoperative trials of local anesthetics, acetaminophen, opioids, and NSAIDs involving children ages 0-2 years and assessed surgical volumes to provide trial design recommendations. Searches of PubMed, Embase, CINAHL, The Cochrane Library, and Web of Science were conducted. A scoping approach identified trends in analgesic trials with an emphasis on randomized controlled trials (RCTs) utilizing immediate rescue designs. Age-specific surgical volumes were estimated from French national databases. Of 3563 studies identified, 23 RCTs used study medication(s) of interest and immediate rescue paradigms in children ages 0-2 years. A total of 270 studies met at least one of these criteria. Add-on and head-to-head designs were common and often used sparing of non-opioid or opioid rescue medication as a primary outcome measure. According to French national data, inguinal and penile surgeries were most frequent in ages 1 month to 2 years; abdominal and thoracic surgeries comprise approximately 75% of newborn surgeries. Analgesic trials with rescue sparing paradigm are currently sparse among children ages 0-2 years. Future trials could consider age-specific surgical procedures and use of add-on or head-to-head designs. IMPACT: Clinical trials of analgesic medications have been challenging in pediatrics, especially in the group from newborns to 2 years of age. Following an FDA-academic workshop, we analyzed features of completed analgesic trials in this age group. Studies using immediate rescue in placebo control, add-on, and head-to-head trial designs are pragmatic approaches that can provide important information regarding clinical effectiveness, side effects, and safety. Using a French national dataset with a granular profile of inpatient, outpatient, and short-stay surgeries, we provide information to future investigators on relative frequencies of different operations in neonates and through the first 2 years of life.
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Affiliation(s)
- Kyra Haskes
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Carolina Donado
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Ricardo Carbajal
- Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau-Sorbonne Université, Paris, France
- Institut National de La Santé et de La Recherche Médicale, UMR1153, Paris, France
| | - Charles B Berde
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Li ZL, Ma HC, Yang Y, Chen JJ, Wang ZJ. Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendicitis. World J Gastrointest Surg 2024; 16:816-822. [PMID: 38577072 PMCID: PMC10989332 DOI: 10.4240/wjgs.v16.i3.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocol is a comprehensive management modality that promotes patient recovery, especially in the patients undergoing digestive tumor surgeries. However, it is less commonly used in the appendectomy. AIM To study the application value of ERAS in laparoscopic surgery for acute appendicitis. METHODS A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method, including 63 patients in the experimental group and 57 patients in the control group. Patients in the experimental group were managed with the ERAS protocol, and those in the control group were received the traditional treatment. The exhaust time, the hospitalization duration, the hospitalization expense and the pain score between the two groups were compared. RESULTS There was no significant difference in age, gender, body mass index and Sunshine Appendicitis Grading System score between the experimental group and the control group (P > 0.05). Compared to the control group, the patients in the experimental group had earlier exhaust time, shorter hospitalization time, less hospitalization cost and lower degree of pain sensation. The differences were statistically significant (P < 0.01). CONCLUSION ERAS could significantly accelerate the recovery of patients who underwent laparoscopic appendectomy for acute appendicitis, shorten the hospitalization time and reduce hospitalization costs. It is a safe and effective approach.
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Affiliation(s)
- Zhu-Lin Li
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Hua-Chong Ma
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yong Yang
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jian-Jun Chen
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhen-Jun Wang
- Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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19
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Hao Y, Zhao Q, Jiang K, Feng X, Ma Y, Zhang J, Han X, Ji G, Dong H, Nie H. Association of adherence to the enhanced recovery after surgery pathway and outcomes after laparoscopic total gastrectomy. BMC Anesthesiol 2024; 24:110. [PMID: 38519945 PMCID: PMC10958831 DOI: 10.1186/s12871-024-02433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/26/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The current study used a composite outcome to investigate whether applying the ERAS protocol would enhance the recovery of patients undergoing laparoscopic total gastrectomy (LTG). EXPOSURES Laparoscopic total gastrectomy and perioperative interventions were the exposure. An ERAS clinical pathway consisting of 14 items was implemented and assessed. Patients were divided into either ERAS-compliant or non-ERAS-compliant group according the adherence above 9/14 or not. MAIN OUTCOMES AND MEASURES The primary study outcome was a composite outcome called 'optimal postoperative recovery' with the definition as below: discharge within 6 days with no sever complications and no unplanned re-operation or readmission within 30 days postoperatively. Univariate logistic regression analysis and multivariate logistic regression analysis were used to model optimal postoperative recovery and compliance, adjusting for patient-related and disease-related characteristics. RESULTS A total of 252 patients were included in this retrospective study, 129 in the ERAS compliant group and 123 in the non-ERAS-compliant group. Of these, 79.07% of the patients in ERAS compliant group achieved optimal postoperative recovery, whereas 61.79% of patients in non-ERAS-compliant group did (P = 0.0026). The incidence of sever complications was lower in the ERAS-compliant group (1.55% vs. 6.5%, P = 0.0441). No patients in ERAS compliant group had unplanned re-operation, whereas 5.69% (7/123) of patients in non-ERAS-compliant group had (p = 0.006). The median length of the postoperative hospital stay was shorter in the in the ERAS compliant group (5.51 vs. 5.68 days, P = 0.01). Both logistic (OR 2.01, 95% CI 1.21-3.34) and stepwise regression (OR 2.07, 95% CI 1.25-3.41) analysis showed that high overall compliance with the ERAS protocol facilitated optimal recovery in such patients. In bivariate analysis of compliance for patients who had an optimal postoperative recovery, carbohydrate drinks (p = 0.0196), early oral feeding (P = 0.0043), early mobilization (P = 0.0340), and restrictive intravenous fluid administration (P < 0.0001) were significantly associated with optimal postoperative recovery. CONCLUSIONS AND RELEVANCE Patients with higher ERAS compliance (almost 70% of the accomplishment) suffered less severe postoperative complications and were more likely to achieve optimal postoperative recovery.
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Affiliation(s)
- Yiming Hao
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qingchuan Zhao
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kun Jiang
- Department of Digital Center, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiangying Feng
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yumei Ma
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | - Xi'an Han
- The Unimed Scientific Inc, Wu Xi, China
| | - Gang Ji
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Hailong Dong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Huang Nie
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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20
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Wang C, Wang Y, Zhao P, Li T, Li F, Li Z, Qi Y, Wang X, Shi W, Liu L, Li G, Wang Y. Application of enhanced recovery after surgery during the perioperative period in children with Meckel's diverticulum-a single-center prospective clinical trial. Front Pediatr 2024; 12:1378786. [PMID: 38590767 PMCID: PMC11000669 DOI: 10.3389/fped.2024.1378786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Enhanced recovery after surgery (ERAS) has been widely used in adult surgery. However, few studies have reported the efficacy of ERAS in paediatric patients with Meckel's diverticulum (MD), the aim of the study was to prospectively evaluate the safety and efficacy of ERAS in treating MD. Methods A prospective randomised controlled study of children with MD admitted to our hospital from Jan 1, 2021 to Dec 31, 2023 were conducted, we developed and implemented an ERAS program for this patients. All cases were strictly selected according to the inclusion and exclusion criteria. Among these patients, they were randomly assigned to the ERAS group or the traditional (TRAD) group with random number table row randomization. The main observational indicators were operation time, intraoperative hemorrhage, FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery, length of postoperative stay (LOPS), time to first defecation, time to first eating after surgery, time to discontinuation of intravenous infusion, total treatment cost, incidence of postoperative complications, 30-day readmission rate and parental satisfaction rate. Results A total of 50 patients underwent Meckel's diverticulectomy during this period, 7 patients were excluded, 23 patients were assigned to the ERAS group and 20 patients were assigned to the TRAD group. There were no significant differences in demographic data and operation time, intraoperative hemorrhage. The FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery were significantly lower in the ERAS group. The LOPS was 6.17 ± 0.89 days in the ERAS group and 8.30 ± 1.26 days in the TRAD group, resulting in a significantly shorter LOPS in ERAS group. ERAS could also reduce the first postoperative defecation time, the time to first eating after surgery and the time to discontinuation of intravenous infusion. The treatment cost was decreased in the ERAS group. The rate of complications and 30-day readmission were not significantly different between the two groups. Conclusions In this single-center study, the ERAS protocol for patients with MD requiring surgery was safe and effective.
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Affiliation(s)
- Cuicui Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Youliang Wang
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Ping Zhao
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Ting Li
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Fan Li
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Zhi Li
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Yingwen Qi
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Xuewu Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Weidong Shi
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Lina Liu
- Department of Obstetrics, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Gamei Li
- Department of Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Yong Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
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21
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Xiao Y, Zhang S, Ren Q. The New Orientation of Postoperative Analgesia: Remote Ischemic Preconditioning. J Pain Res 2024; 17:1145-1152. [PMID: 38524690 PMCID: PMC10959302 DOI: 10.2147/jpr.s455127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose of Review Postoperative analgesia is currently a significant topic in anesthesiology. Currently, the predominant approach for achieving multimodal analgesia involves the utilization of pharmacotherapy and regional anesthesia procedures. The primary objectives of this approach are to mitigate postoperative pain, enhance patient satisfaction, and diminish overall opioid usage. Nevertheless, there is a scarcity of research on the use of remote ischemia preconditioning aimed at mitigating postoperative pain. Recent Findings Transient stoppage of blood flow to an organ has been found to elicit remote ischemia preconditioning (RIPC), which serves as a potent intrinsic mechanism for protecting numerous organs. In addition to its established role in protecting against reperfusion injury, RIPC has recently been identified as having potential benefits in the context of postoperative analgesia. Summary In addition to traditional perioperative analgesia, RIPC provides perioperative analgesia and organ protection.
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Affiliation(s)
- Yunyu Xiao
- Department of Anesthesiology, Hangzhou Ninth People’s Hospital, Hangzhou, Zhejiang, 311225, People’s Republic of China
| | - Shaofeng Zhang
- Department of Anesthesiology, Hangzhou Ninth People’s Hospital, Hangzhou, Zhejiang, 311225, People’s Republic of China
| | - Qiusheng Ren
- Department of Anesthesiology, Hangzhou Ninth People’s Hospital, Hangzhou, Zhejiang, 311225, People’s Republic of China
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22
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Kościuczuk U, Tarnowska K, Rynkiewicz-Szczepanska E. Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study. J Pain Res 2024; 17:941-951. [PMID: 38476874 PMCID: PMC10929647 DOI: 10.2147/jpr.s449563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA (low opioid anaesthesia) and OFA (opioid-free anaesthesia). The aim was to describe the effects of LOA on nausea, vomiting, and pain control during general anaesthesia and postoperative period after laparoscopic cholecystectomy. Patients and Methods The protocol included the study group-40 patients received low-opioid anaesthesia (LOA), and the control group-40 patients received general anaesthesia with opioid analgesia (OA). The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole. The OA was based on standard opioid (fentanyl) administration in induction and maintenance phase due to clinical observation. Postoperative analgesia included 1g of paracetamol and 1g of metamizol intravenously, with a 6-hour interval between doses. Results Significant differences in the pain score in the periods of 2-6, 6-12, and 12-24 hours after anaesthesia between the groups were noticed (p < 0.001). Moreover, a significant difference in the frequency of nausea (p = 0.005) and vomiting (p = 0.04) between groups were presented. Nausea occurred in 54.05% of OA group, while in the LOA group, it occurred in a 23.08%. Vomiting occurred in 32.43% of control group, while in the study group, it occurred in 12.82% of patients. Conclusion The LOA protocol was more beneficial in reducing nausea and vomiting than the opioid-based method of anaesthesia. The LOA protocol of general anaesthesia during laparoscopic cholecystectomy and non-opioid postoperative analgesia have better outcomes in pain control, as well as nausea and vomiting, and improve postoperative patient comfort. The LOA protocol during anaesthesia and non-opioid postoperative analgesia should be considered in routine practice.
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Affiliation(s)
- Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
| | - Katarzyna Tarnowska
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
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23
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Langford R, Pogatzki-Zahn EM, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, López-Cedrún JL, Bescós S, Gascón N, Plata-Salamán C. Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1). Adv Ther 2024; 41:1025-1045. [PMID: 38183526 PMCID: PMC10879371 DOI: 10.1007/s12325-023-02744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. METHODS Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0-4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. RESULTS All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0-4 (analysis of covariance least squares mean differences [95% confidence interval]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. CONCLUSIONS CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.
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Affiliation(s)
| | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals, Barcelona, Spain
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24
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Dunworth S, Barbeito A, Nagavelli H, Higgins D, Edward S, Williams M, Pyati S. Transitional Pain Service: Optimizing Complex Surgical Patients. Curr Pain Headache Rep 2024; 28:141-147. [PMID: 38117461 DOI: 10.1007/s11916-023-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The care of patients with complex postsurgical pain can be challenging and burdensome for the healthcare system. Transitional pain service (TPS) is a relatively new concept and has not been widely adopted in the USA. This article explores the benefits and barriers of transitional pain services and describes the development of a TPS at our institution. RECENT FINDINGS Evidence from a few institutions that have adopted TPS has shown decreased postsurgical opioid consumption for patients on chronic opioids and decreased incidence of chronic postsurgical opioid use for opioid-naïve patients. The development of a transitional pain service may improve outcomes for these complex patients by providing longitudinal and multidisciplinary perioperative pain care. In this article, we describe the implementation of a TPS at a tertiary medical center. Our TPS model involves a multidisciplinary team of anesthesiologists, pain psychologists, surgeons, and advanced practice providers. We provide longitudinal care, including preoperative education and optimization; perioperative multimodal analgesic care; and longitudinal follow-up for 90 days post-procedure. With our TPS service, we aim to reduce long-term opioid use and improve functional outcomes for our patients.
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Affiliation(s)
- Sophia Dunworth
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Atilio Barbeito
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Harika Nagavelli
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Diana Higgins
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Shibu Edward
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Melvania Williams
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA.
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA.
- Present address: Department of Anesthesiology, Duke University School of Medicine, Durham Veterans Affairs Healthcare System, PO Box 3094, Durham, NC, 27701, USA.
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25
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Langford R, Margarit C, Morte A, Cebrecos J, Sust M, Ortiz E, Giménez-Arnau JM, de Leon-Casasola O. Co-crystal of tramadol-celecoxib (CTC) for acute moderate-to-severe pain. Curr Med Res Opin 2024; 40:455-468. [PMID: 38205948 DOI: 10.1080/03007995.2023.2276118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE This narrative review aims to provide a clinical perspective on the potential role of co-crystal of tramadol-celecoxib (CTC) in the management of acute moderate-to-severe pain by synthesizing the available preclinical and clinical data, with emphasis on phase 3 trials. METHODS A non-systematic literature review was performed using a targeted PubMed search for articles published between January 1, 2000, and May 2, 2023; all publication types were permitted, and selected articles were limited to those published in English. Search results were manually reviewed to identify references based on their preclinical and clinical relevance to CTC and management of acute moderate-to-severe pain. RESULTS The crystalline structure of CTC alters the physicochemical properties of tramadol and celecoxib, modifying their pharmacokinetics. If taken in a free combination, tramadol reduces absorption of celecoxib. Conversely, administration of CTC slows tramadol absorption and lowers its maximum plasma concentration, while increasing celecoxib plasma concentration through its enhanced release. In clinical studies across models of acute moderate-to-severe pain, CTC demonstrated an early onset of analgesia, with improved efficacy and lower rescue medication use, compared with either agent alone. CTC's safety profile was in line with that expected for the individual components; no additive effects were observed. CTC exhibited tramadol-sparing effects, with efficacy seen at lower daily/cumulative opioid doses vs. tramadol alone. CONCLUSIONS Results from phase 3 trials suggest that the modified physicochemical properties of tramadol and celecoxib in CTC translate into an improved clinical benefit-risk profile, including fewer opioid-related adverse effects due to lower overall opioid dosing.
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Affiliation(s)
| | - Cesar Margarit
- Hospital General Universitario de Alicante, Alicante, Spain
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26
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Liu J, Yin J, Yin J, Zhou M, Chen L, Dong X, Li Y. Effect of esketamine-based opioid-sparing anesthesia strategy on postoperative pain and recovery quality in patients undergoing total laparoscopic hysterectomy: A randomized controlled trail. Heliyon 2024; 10:e24941. [PMID: 38317936 PMCID: PMC10839621 DOI: 10.1016/j.heliyon.2024.e24941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Opioid-sparing anesthesia reduces intraoperative use of opioids and postoperative adverse reactions. The current study investigated the effect of esketamine-based opioid-sparing anesthesia on total laparoscopic hysterectomy patients' recovery. Methods Ninety patients undergoing total laparoscopic hysterectomy were randomly assigned to esketamine-based group (group K) or opioid-based group (group C). The allocation to groups was unknown to patients, surgeons, and postoperative medical staff. The inability to implement blinding for anesthesiologists was due to the distinct procedures followed by the various groups while administering drugs. The QoR-40 and VAS were used to measure recovery quality. Postoperative adverse events, perioperative opioid consumption, and intraoperative hemodynamics were secondary endpoints. Results There was an absence of notable discrepancy in the baseline data observed between the two groups. The QoR-40 scores exhibited greater values in group K when compared to group C on the first day following the surgical procedure (160.91 ± 9.11 vs 151.47 ± 8.35, respectively; mean difference 9.44 [95 %CI: 5.78-13.11]; P < 0.01). Within 24 h of surgery, the VAS score of group K was lower at rest and during movement. (P < 0.05 for each). Group K had much lower rates of nausea and vomiting within 24 h of surgery. (P < 0.05 for each). Group K received significantly lower total doses of sufentanil and remifentanil than group C. (17.28 ± 2.59 vs 43.43 ± 3.52; 0.51 ± 0.15 vs 1.24 ± 0.24). The proportion of patients who used ephedrine in surgery was higher in group C than in group K (P < 0.05). Conclusions Esketamine-based opioid-sparing anesthesia strategy is feasible and enhanced recuperation following surgery by decreasing adverse effects associated with opioids and pain scores compared to an opioid-based anesthetic regimen.
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Affiliation(s)
- Jialei Liu
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
- Department of Anesthesiology, Suzhou First People's Hospital, Suzhou, China
| | - Jiangwen Yin
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jieting Yin
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Menghan Zhou
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Long Chen
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Xiwei Dong
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Yan Li
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
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27
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Meyer JA, Alton S, Seung H, Pahlavan A, Trilling AR, Coghlan M, Goetzinger KR, Cojocaru L. Enhanced recovery after cesarean from the patient perspective: a prospective study of the ERAC Questionnaire (ERAC-Q). J Perinat Med 2024; 52:14-21. [PMID: 37609844 DOI: 10.1515/jpm-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To evaluate the impact of an Enhanced Recovery After Cesarean (ERAC) protocol on the post-cesarean recovery experience using a validated ten-item questionnaire (ERAC-Q). METHODS This is a prospective cohort study of patients completing ERAC quality-of-life questionnaires (ERAC-Q) during inpatient recovery after cesarean delivery (CD) between October 2019 and September 2020, before and after the implementation of our ERAC protocol. Patients with non-Pfannenstiel incision, ICU admission, massive transfusion, bowel injury, existing chronic pain disorders, acute postpartum depression, or neonatal demise were excluded. The ERAC-Q was administered on postoperative day one and day of discharge to the pre- and post-ERAC implementation cohorts, rating aspects of their recovery experience on a scale of 0 (best) to 10 (worst). The primary outcome was ERAC-Q scores. Statistical analysis was performed with SAS software. RESULTS There were 196 and 112 patients in the pre- and post-ERAC cohorts, respectively. The post-ERAC group reported significantly lower total ERAC-Q scores compared to the pre-ERAC group, reflecting fewer adverse symptoms and greater perceived recovery on postoperative day one (1.6 [0.7, 2.8] vs. 2.7 [1.6, 4.3]) and day of discharge (0.8 [0.3, 1.5] vs. 1.4 [0.7, 2.2]) (p<0.001). ERAC-Q responses did not predict the time to achieve objective postoperative milestones. However, worse ERAC-Q pain and total scores were associated with higher inpatient opiate use. CONCLUSIONS ERAC implementation positively impacts patient recovery experience. The administration of ERAC-Q can provide real-time feedback on patient-perceived recovery quality and how healthcare protocol changes may impact their experience.
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Affiliation(s)
- Jessica A Meyer
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Suzanne Alton
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice & Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Autusa Pahlavan
- Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Ariel R Trilling
- Department of Obstetrics, Gynecology & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martha Coghlan
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Anesthesia Critical Care, Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Staten Island University Hospital of Northwell Health, New York, NY, USA
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Stojanović M, Marinković M, Miličić B, Stojičić M, Jović M, Jovanović M, Isaković Subotić J, Jurišić M, Karamarković M, Đekić A, Radenović K, Mihaljević J, Radosavljević I, Suđecki B, Savić M, Kostić M, Garabinović Ž, Jeremić J. The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study. J Clin Med 2024; 13:764. [PMID: 38337458 PMCID: PMC10856234 DOI: 10.3390/jcm13030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia-typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management.
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Affiliation(s)
- Marina Stojanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Biljana Miličić
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marko Jović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Isaković Subotić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Đekić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Savić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marko Kostić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Željko Garabinović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Lersch F, Correia PC, Hight D, Kaiser HA, Berger-Estilita J. The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians. Curr Opin Anaesthesiol 2023; 36:666-675. [PMID: 37724595 PMCID: PMC10621648 DOI: 10.1097/aco.0000000000001308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes. RECENT FINDINGS Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain. SUMMARY The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96 ).
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Affiliation(s)
- Friedrich Lersch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Paula Cruz Correia
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Darren Hight
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Heiko A. Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
- Centre for Anaesthesiology and Intensive Care, Hirslanden Klink Aarau, Hirslanden Medical Group, Schaenisweg, Aarau
| | - Joana Berger-Estilita
- Institute of Anesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS@RISE, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
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Kim DH, Lee H, Pawar A, Lee SB, Park CM, Levin R, Metzger E, Bateman BT, Ely EW, Pandharipande PP, Pisani MA, Hohmann SF, Marcantonio ER, Inouye SK. Trends in use of antipsychotics and psychoactive drugs in older patients after major surgery. J Am Geriatr Soc 2023; 71:3755-3767. [PMID: 37676699 PMCID: PMC10841351 DOI: 10.1111/jgs.18580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Professional society guidelines recommend limiting the use of antipsychotics in older patients with postoperative delirium. How these recommendations affected the use of antipsychotics and other psychoactive drugs in the postoperative period has not been studied. METHODS This retrospective cohort study included patients 65 years or older without psychiatric diagnoses who underwent major surgery in community hospitals (CHs) and academic medical centers (AMCs) in the United States. The outcome was the rate of hospital days exposed to antipsychotics, antidepressants, antiepileptics, benzodiazepines, hypnotics, and selective alpha-2 receptor agonist dexmedetomidine in the postoperative period by hospital type. RESULTS The study included 4,098,431 surgical admissions from CHs (mean age 75.0 [standard deviation, 7.1] years; 50.8% female) during 2008-2018 and 2,310,529 surgical admissions from AMCs (75.0 [7.4] years; 49.4% female) during 2009-2018. In the intensive care unit (ICU) setting, the number of exposed days per 1000 hospital-days declined for haloperidol (CHs: 33-21 days [p < 0.01]; AMCs: 24-15 days [p < 0.01]) and benzodiazepines (CHs: 261-136 days [p < 0.01]; AMCs: 150-77 days [p < 0.01]). The use of atypical antipsychotics, antidepressants, antiepileptics, and dexmedetomidine increased, while hypnotic use varied by the hospital type. In the non-ICU setting, the rate declined for haloperidol in CHs but not in AMCs (CHs: 10-6 days [p < 0.01]; AMCs: 4-3 days [p = 0.52]) and for benzodiazepines in both settings (CHs: 126-56 days [p < 0.01]; AMCs: 30-27 days [p < 0.01]). The use of antiepileptics and antidepressants increased, while the use of atypical antipsychotics and hypnotics varied by the hospital type. CONCLUSIONS The use of haloperidol and benzodiazepines in the postoperative period declined at both CHs and AMCs. These trends coincided with the increasing use of other psychoactive drugs.
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Affiliation(s)
- Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - E. Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Pratik P. Pandharipande
- Departments of Anesthesiology and Surgery, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Samuel F. Hohmann
- Vizient, Inc. and Department of Health Systems Management, Rush University, Chicago, IL
| | - Edward R. Marcantonio
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sharon K. Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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Liu D, Li X, Nie X, Hu Q, Wang J, Hai L, Yang L, Wang L, Guo P. Artificial intelligent patient-controlled intravenous analgesia improves the outcomes of older patients with laparoscopic radical resection for colorectal cancer. Eur Geriatr Med 2023; 14:1403-1410. [PMID: 37847474 PMCID: PMC10754746 DOI: 10.1007/s41999-023-00873-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
METHODS Patients undergoing elective laparoscopic radical resection of colorectal cancer from July 2019 to May 2021 were selected. The patients were assigned to Ai-PCIA group and control group. Ai-PCIA group received postoperative analgesia management and effect evaluation through intelligent wireless analgesia system + postoperative follow-up twice a day, while control group received analgesia management and effect evaluation through ward physician feedback + postoperative follow-up twice a day. The pain numerical score (NRS), Richards-Campbell Sleep Scale (RCSQ), and adverse outcomes were collected and compared. RESULTS A total of 60 patients (20 females and 40 males with average (78.26 ± 6.42) years old) were included. The NRS scores at rest and during activity of the Ai-PCA group at 8, 12, and 24 h after the operation were significantly lower than that of the control group (all P < 0.05). The RCSQ score of Ai-PCA group was significantly higher than that of control group on the 1st and 2nd days after operation (all P < 0.05). There were no significant differences in the incidence of dizziness and nausea, vomiting, and myocardial ischemia (all P > 0.05). CONCLUSIONS Ai-PCIA can improve the analgesic effect and sleep quality of older patients after laparoscopic radical resection, which may be promoted in clinical analgesia practice.
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Affiliation(s)
- Dandan Liu
- Department of Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaopei Li
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Xiaohong Nie
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Qiangfu Hu
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China.
| | - Jiandong Wang
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Longzhu Hai
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Lingwei Yang
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Lin Wang
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
| | - Peilei Guo
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfuqian Street, Erqi District, Zhengzhou, Henan, China
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Muetterties CE, Taylor JM, Kaeding DE, Morales RR, Nguyen AV, Kwan L, Tseng CY, Delong MR, Festekjian JH. Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Microvascular Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5444. [PMID: 38098953 PMCID: PMC10721129 DOI: 10.1097/gox.0000000000005444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023]
Abstract
Background Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center. Methods The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls. Results The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age: traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 (P < 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME: 154.2 versus 70.4, P < 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME: 337.5 versus 150.0, P < 0.0001). ERAS had a lower pain average on POD 0-3; however, this finding was not statistically significant. Conclusion Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.
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Affiliation(s)
- Corbin E. Muetterties
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Jeremiah M. Taylor
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Diana E. Kaeding
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Ricardo R. Morales
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Anissa V. Nguyen
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
- Department of Urology, University of California Los Angeles, Los Angeles, Calif
| | - Lorna Kwan
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
- Department of Urology, University of California Los Angeles, Los Angeles, Calif
| | - Charles Y. Tseng
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Michael R. Delong
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Jaco H. Festekjian
- From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif
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Ebara G, Sakuramoto S, Matsui K, Nishibeppu K, Fujita S, Fujihata S, Oya S, Lee S, Miyawaki Y, Sugita H, Sato H, Yamashita K. Efficacy and safety of patient-controlled thoracic epidural analgesia alone versus patient-controlled intravenous analgesia with acetaminophen after laparoscopic distal gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023; 37:8245-8253. [PMID: 37653160 DOI: 10.1007/s00464-023-10370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy is a common procedure for early gastric cancer treatment. Improving postoperative pain control enhances patient recovery after surgery. The use of multimodal analgesia can potentially enhance the analgesic effect, minimize side effects, and change the postoperative management. The purpose of this study was to evaluate and compare the efficacies of the use of patient-controlled intravenous analgesia with regular acetaminophen (PCIA + Ace) and patient-controlled thoracic epidural analgesia (PCEA) for postoperative pain control. METHODS We retrospectively collected the data of 226 patients who underwent laparoscopic distal gastrectomy (LDG) with delta-shaped anastomosis between 2016 and 2019. After 1:1 propensity-score matching, we compared 83 patients who used PCEA alone (PCEA group) with 83 patients who used PCIA + Ace (PCIA + Ace group). Postoperative pain was assessed using a numeric rating scale (NRS) with scores ranging from 0 to 10. An NRS score ≥ 4 was considered the threshold for additional intravenous rescue medication administration. RESULTS Although NRS scores at rest were comparable between the PCEA and PCIA + Ace groups, NRS scores of patients in the PCIA + Ace group during coughing or movement were significantly better than those of patients in the PCEA group on postoperative days 2 and 3. The frequency of additional rescue analgesic use was significantly lower in the PCIA + Ace group than in the PCEA group (1.1 vs. 2.7, respectively, p < 0.001). The rate of reduction or interruption of the patient-controlled analgesic dose was higher in the PCEA group than in the PCIA + Ace group (74.6% vs. 95.1%, respectively, p = 0.0002), mainly due to hypotension occurrence in the PCEA group. Physical recovery time, postoperative complication occurrence, and liver enzyme elevation incidence were not significantly different between groups. CONCLUSIONS PCIA + Ace can be safely applied without an increase in complications or deterioration in gastrointestinal function; moreover, PCIA + Ace use may provide better pain control than PCEA use in patients following LDG.
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Affiliation(s)
- Gen Ebara
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keiji Nishibeppu
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shouhei Fujita
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shiro Fujihata
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Seigi Lee
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
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Cavallaro G, Gazzanelli S, Iossa A, De Angelis F, Fassari A, Micalizzi A, Petramala L, Crocetti D, Circosta F, Concistrè A, Letizia C, De Toma G, Polistena A. Ultrasound-guided Transversus Abdominis Plane Block is Effective as Laparoscopic Trocar site infiltration in Postoperative Pain Management in Patients Undergoing Adrenal Surgery. Am Surg 2023; 89:4401-4405. [PMID: 35797715 DOI: 10.1177/00031348221114035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain management in patients undergoing laparoscopy is still a matter of debate as several techniques have been proposed to reduce postoperative analgesic consumption and improve recovery. Among these, transversus abdominis plane (TAP) block is considered as safe, effective, and easy to perform under ultrasound guidance; even so, recently laparoscopically guided trocar site anesthetic infiltration has been proposed as a "surgeon-dependent alternative to TAP block." The aim of this evaluation is to compare these analgesic techniques in the setting of laparoscopic adrenalectomy. METHODS This is a retrospective evaluation of a prospectively maintained database. Patients were divided into two groups: Group A patients received laparoscopic-assisted trocar site infiltration of ropivacaine; Group B patients received bilateral ultrasound-guided TAP block with ropivacaine. All patients received 24 h infusion of 20 mg morphine postoperatively; pain was checked at 6, 24 and 48 h after surgery. A rescue analgesia was given if numerical rating scale (NRS) score was > 4 or on patient request. RESULTS One hundred and three patients were enrolled in the evaluation (57 in group A and 46 in group B). There were no differences in operative time, complications and postoperative stay, and no complications related to trocar site infiltration. There were no differences in NRS at 6, 24, and 48 hours as well as in patients requiring further analgesic administration. CONCLUSIONS Laparoscopic-guided trocar site ropivacaine infiltration has similar pain outcomes compared to ultrasound-guided TAP block in the management of postoperative pain in patients undergoing laparoscopic adrenalectomy. Since there is no difference among these techniques, the decision can be based on surgeon or anesthesiologist preference.
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Affiliation(s)
| | - Sergio Gazzanelli
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessia Fassari
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Francesco Circosta
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Claudio Letizia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Andrea Polistena
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Ye S, Chen M, Luo Y, Zhao C, Li Q, Kang P. Comparative study of carbazochrome sodium sulfonate and tranexamic acid in reducing blood loss and inflammatory response following direct anterior total hip arthroplasty: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2023; 47:2553-2561. [PMID: 37338547 DOI: 10.1007/s00264-023-05853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Carbazochrome sodium sulfonate (CSS) is a haemostatic agent. However, its hemostatic and anti-inflammatory effects in patients undergoing total hip arthroplasty (THA) via a direct anterior approach (DAA) are unknown. We investigated the efficacy and safety of CSS combined with tranexamic acid (TXA) in THA using DAA. METHODS This study enrolled 100 patients who underwent primary, unilateral THA through a direct anterior approach. Patients were randomly divided into two groups: Group A used a combination of TXA and CSS, while Group B used TXA only. The primary outcome was total perioperative blood loss. The secondary outcomes were hidden blood loss, postoperative blood transfusion rate, inflammatory reactant levels, hip function, pain score, venous thromboembolism (VTE), and incidence of associated adverse reactions. RESULTS The total blood loss (TBL) in group A was significantly lower than in group B. The levels of inflammatory reactants and the rate of blood transfusion were also significantly lower. However, the two groups had no significant differences in intraoperative blood loss, postoperative pain score, or joint function. There were no significant differences in VTE or postoperative complications between the groups. CONCLUSION As a haemostatic agent, CSS combined with TXA can reduce postoperative blood loss in patients undergoing THA via DAA and seems to have an anti-inflammatory effect. Moreover, it did not increase the incidence of VTE or its related complications.
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Affiliation(s)
- Shuwei Ye
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China
| | - Maojia Chen
- Animal Experimental Center, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China
| | - Yue Luo
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China
| | - Chengcheng Zhao
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China
| | - Qianhao Li
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China
| | - Pengde Kang
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, China.
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Nakai A, Nakada J, Takahashi Y, Sakakura N, Masago K, Okamoto S, Kuroda H. Divided method of intercostal nerve block reduces ropivacaine dose by half in thoracoscopic pulmonary resection while maintaining the postoperative pain score and 4-h mobilization: a retrospective study. J Anesth 2023; 37:749-754. [PMID: 37561173 PMCID: PMC10543147 DOI: 10.1007/s00540-023-03229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE This study investigated whether the divided method of multi-level intercostal nerve block (ML-ICB) could reduce the ropivacaine dose required during thoracoscopic pulmonary resection, while maintaining the resting postoperative pain scores. METHODS This retrospective, single-cohort study enrolled 241 patients who underwent thoracoscopic pulmonary resection for malignant tumors between October 2020 and March 2022 at a cancer hospital in Japan. ML-ICB was performed by surgeons under direct vision. The differences in intraoperative anesthetic use and postoperative pain-related variables at the beginning and end of surgery between group A (single-shot ML-ICB; 0.75% ropivacaine, 20 mL at the end of the surgery) and group B (divided ML-ICB, performed at the beginning and end of surgery; 0.25% ropivacaine, 30 mL total) were assessed. The numerical rating scale (NRS) was used to evaluate pain 1 h and 24 h postoperatively. RESULTS Intraoperative remifentanil use was significantly lower in group B (14.4 ± 6.4 μg/kg/h) than in group A (16.7 ± 8.4 μg/kg/h) (P = 0.02). The proportion of patients with NRS scores of 0 to 3 at 24 h was significantly higher in group B (85.4%, 106/124) than in group A (73.5%, 86/117) (P = 0.02). The proportion of patients not requiring postoperative intravenous rescue drugs was significantly higher in group B (78.2%, 97/124) than in group A (61.5%, 72/117) (P < 0.01). CONCLUSION The divided method of ML-ICB could reduce the intraoperative remifentanil dose, decrease the postoperative pain score at 24 h, and curtail postoperative intravenous rescue drug use, despite using half the total ropivacaine dose intraoperatively.
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Affiliation(s)
- Aiko Nakai
- Department of Anesthesiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan.
| | - Jyunya Nakada
- Department of Anesthesiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Katuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Sakura Okamoto
- Department of Anesthesiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Liu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100822. [PMID: 37927993 PMCID: PMC10625022 DOI: 10.1016/j.lanwpc.2023.100822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 11/07/2023]
Abstract
Background Postoperative pain poses a significant challenge to the healthcare system and patient satisfaction and is associated with chronic pain and long-term narcotic use. However, systemic assessment of the quality of postoperative pain management in China remains unavailable. Methods In this cross-sectional study, we analyzed data collected from a nationwide registry, China Acute Postoperative Pain Study (CAPOPS), between September 2019 and August 2021. Patients aged 18 years or above were required to complete a self-reported pain outcome questionnaire on the first postoperative day (POD1). Perioperative pain management and pain-related outcomes, including the severity of pain, adverse events caused by pain or pain management, and perception of care and satisfaction with pain management were analyzed. Findings A total of 26,193 adult patients were enrolled. There were 48.7% of patients who had moderate-to-severe pain on the first day after surgery, and pain severity was associated with poor recovery and patient satisfaction. The systemic opioid use was 68% on the first day after surgery, and 89% of them were used with intravenous patient-controlled analgesia, while the rate of postoperative nerve blocks was low. Interpretation Currently, almost half of patients still suffer from moderate-to-severe pain after surgery in China. The relatively high rate of systemic opioid use and low rate of nerve blocks used after surgery suggests that more effort is needed to improve the management of acute postoperative pain in China. Funding National Key Research and Development Program of China (No. 2018YFC2001905).
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Affiliation(s)
- Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
| | - Saisong Xiao
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- Department of Anesthesia, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Huikai Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xuecai Lv
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Aisheng Hou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yandong Jiang
- Department of Anesthesiology, McGovern Medical School, University of Texas, Houston Health Science Center, Houston, TX, 77030, USA
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
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Wang P, Kong C, Teng Z, Zhang S, Cui P, Wang S, Zhao G, Lu S. Enhanced Recovery After Surgery (ERAS) Program for Anterior Cervical Discectomy and Fusion (ACDF) in Patients Over 60 Years Old. Clin Interv Aging 2023; 18:1619-1627. [PMID: 37790741 PMCID: PMC10543997 DOI: 10.2147/cia.s422418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
Background Enhanced recovery after surgery (ERAS) is currently widely used in many surgical specialties, but there is still a lack of concern about the cervical ERAS program for old patients (>60 years old). We aimed to determine whether our ERAS program significantly improved satisfaction and outcomes in old patients (>60 years old) with anterior cervical discectomy and fusion (ACDF). Methods This is a retrospective cohort study. The study enrolled patients if they were over the age of 60 years old underwent ACDF from July 2019 and June 2021 (ERAS group) and from January 2018 and June 2019 (non-ERAS group). Data including demographic, comorbidity, and surgical information were collected. We also evaluated ERAS process compliance, primary outcome, surgical complication, and length of stay (LOS). Results There were 135 patients in the ERAS group, and 122 patients in the non-ERAS group were included. A comparison of the demographic data revealed that there were no statistically significant intergroup differences observed between the group. Overall, ERAS pathway compliance was 91.9%. There were no significant differences in the fusion levels, operative time, intraoperative blood loss, postoperative VAS score, and complications between the ERAS and non-ERAS groups. In addition, there was no significant difference in readmission and mortality at 30-day follow-up between the two groups. However, we observed a statistically significant decrease in the LOS in the ERAS group (8.68±2.34 of ERAS group versus 10.43±4.05 in non-ERAS group, p=0.013). Conclusion This report describes the first ERAS protocol used in old patients with ACDF. Our ERAS program is safe and associated with incremental benefits with respect to LOS in old patients with ACDF.
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Affiliation(s)
- Peng Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Ze Teng
- Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, People’s Republic of China
| | - Sitao Zhang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Shuaikang Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Guoguang Zhao
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China
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Mu Er Ti Zha MEALM, Sun ZJ, Li T, Ai Mai Ti RZY, Fu G, Yao DC, Yu X. Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study. J Orthop Surg Res 2023; 18:702. [PMID: 37726824 PMCID: PMC10510143 DOI: 10.1186/s13018-023-04178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully to improve clinical outcomes in multiple surgical disciplines; however, no study has investigated the effect of different degrees of compliance with ERAS protocol on short-term outcomes following distal radius surgery. We aimed to analyze whether different degrees of compliance with the ERAS pathway are associated with clinical improvement following surgery for DRF. METHODS We retrospectively analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups, including patient complications, total length of hospitalization, discharge time after surgery, hospital costs, time taken to return to preinjury level performance level, number of visual analogue scale (VAS) pain scores > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores. We performed multiple linear regression analyses to assess the impact of ERAS compliance on the postoperative function level (DASH scores). RESULTS No significant differences were detected between the high- and low-compliance groups with respect to demographics, including sex, age, body mass index (BMI), and comorbidities (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and number of times when the VAS pain score was > 3 points during hospitalization (0.88, [0.44, 1.31], p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of patients postoperatively (DASH scores) when adjusted for age, comorbidity, sex, and BMI. CONCLUSIONS This study provided a realistic evaluation and comparison of the ERAS protocol among patients with DRF and can guide clinical decision making. The ERAS protocol may improve outcomes after surgery, with high postoperative function levels and reduced pain and discharge time after surgery, without increased complication rates or hospital costs.
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Affiliation(s)
- Mi Er A Li Mu Mu Er Ti Zha
- Department of Orthopedic, People's Hospital of Xinjiang Uygur Autonomous Region China, Urumqi, 830001, Xinjiang, China
| | - Zhi Jian Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Re Zi Ya Ai Mai Ti
- College of Traditional Uyghur Medicine, Xinjiang Medical University, Urumqi, 830017, Xinjiang, China
| | - Gang Fu
- Department of Orthopedic, Fuzhou Second Hospital, Fuzhou, 350007, China
| | - Dong Chen Yao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xiang Yu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
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Franco-de la Torre L, Gómez-Sánchez E, Aragon-Martinez OH, Hernández-Gómez A, Franco-González DL, Guzmán-Flores JM, Alonso-Castro AJ, Granados-Soto V, Isiordia-Espinoza MA. Analgesic Efficacy and Safety of Tapentadol Immediate Release in Bunionectomy: A Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:1287. [PMID: 37765095 PMCID: PMC10536393 DOI: 10.3390/ph16091287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of different doses of tapentadol immediate release (IR) and its adverse effects after a bunionectomy. Pubmed, Cochrane, Lilacs, Medline, and Imbiomed were used to identify abstracts of scientific publications related to the keywords of this systematic review (PROSPERO ID CRD42023437295). Moreover, the risk of bias in all included articles was assessed using the Cochrane Collaboration risk of bias tool. Data on the sum of pain intensity, total pain relief, global assessment, and adverse effects were extracted. The statistical method of inverse variance with means difference was used to evaluate the numerical data and the Mantel-Haenszel and Odd Ratio test to analyze the dichotomous data. In addition, the number needed to treat, the number needed to harm, and the 95% confidence intervals were calculated. A qualitative evaluation (n = 2381) was carried out according to the conclusions of the authors. Tapentadol (n = 1772) was more effective in relieving postoperative pain than the placebo (n = 609) after a bunionectomy. In addition, the analgesic efficacy of IR tapentadol (n = 1323) versus the placebo (n = 390) was evaluated in a total of 1713 patients using a global evaluation of the treatments. All three doses of IR tapentadol showed better results compared to the placebo after a bunionectomy. Finally, the adverse effects have a direct relationship with the dose, and the greatest number of adverse effects are most observed with tapentadol IR 100 mg (n = 2381). It is concluded that tapentadol IR (100 mg) leads to the best satisfaction score in this meta-analysis.
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Affiliation(s)
- Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
| | - Eduardo Gómez-Sánchez
- División de Disciplinas Clínicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Othoniel Hugo Aragon-Martinez
- Laboratorio de Productos Naturales, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí 78210, Mexico;
| | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Diana Laura Franco-González
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
| | - Juan Manuel Guzmán-Flores
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato 36040, Mexico;
| | - Vinicio Granados-Soto
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, South Campus, Mexico City 14330, Mexico;
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
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Hootsmans N, Parmiter S, Connors K, Badve SB, Snyder E, Turcotte JJ, Jayaraman SS, Zahiri HR. Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries. Surg Endosc 2023; 37:7192-7198. [PMID: 37353653 DOI: 10.1007/s00464-023-10217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. METHODS We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. RESULTS A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). CONCLUSIONS We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.
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Affiliation(s)
- Norbert Hootsmans
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA.
| | - Sara Parmiter
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Kevin Connors
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Shivani B Badve
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Elise Snyder
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | - Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
| | | | - H Reza Zahiri
- Luminis Health Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD, USA
- Luminis Health Doctors Community Medical Center, Lanham, MD, USA
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Hirano K, Igarashi T, Murotani K, Tanaka N, Sakurai T, Miwa T, Watanabe T, Shibuya K, Yoshioka I, Fujii T. Efficacy and feasibility of scheduled intravenous acetaminophen administration after pancreatoduodenectomy: a propensity score-matched study. Surg Today 2023; 53:1047-1056. [PMID: 36746797 DOI: 10.1007/s00595-023-02647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/31/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE The efficiency and safety of routine intravenous administration of acetaminophen after highly invasive hepatobiliary pancreatic surgery remain unclear. In particular, there have been no studies focusing on pancreatoduodenectomy. The present study clarified its clinical utility for patients undergoing pancreatoduodenectomy. METHODS We retrospectively collected 179 patients who underwent open pancreatoduodenectomy from 2015 to 2020. The analgesic effects and adverse events in patients with scheduled intravenous administration of acetaminophen were evaluated using propensity score matching. RESULTS After 40 patients from each group were selected by propensity score matching, the postoperative liver function tests were not significantly different between the control and acetaminophen groups. No significant differences were found in the self-reported pain intensity score or postoperative nausea and vomiting; however, the rate of pentazocine use and the total number of additional analgesics were significantly lower in the acetaminophen group than in the control group (p = 0.003 and 0.002, respectively). CONCLUSION The scheduled intravenous administration of acetaminophen did not affect the postoperative liver function and had a good analgesic effect after pancreatoduodenectomy.
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Affiliation(s)
- Katsuhisa Hirano
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takamichi Igarashi
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi-Machi, Kurume, Fukuoka, Japan
| | - Nobutake Tanaka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Taro Sakurai
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takeshi Miwa
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Isaku Yoshioka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Lersch F, Zingg TJG, Knapp J, Stüber F, Hight D, Kaiser HA. [Processed EEG for personalized dosing of anesthetics during general anesthesia]. DIE ANAESTHESIOLOGIE 2023; 72:662-676. [PMID: 37552241 PMCID: PMC10457248 DOI: 10.1007/s00101-023-01313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/09/2023]
Abstract
Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations.
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Affiliation(s)
- F Lersch
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - T J G Zingg
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - J Knapp
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - F Stüber
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - D Hight
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - H A Kaiser
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz.
- Zentrum für Anästhesiologie und Intensivmedizin, Hirslanden Klinik Aarau, Hirslanden AG, Schänisweg, 5001, Aarau, Schweiz.
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Khambaty M, Devalapalli AP, Silbert RE, Kashiwagi DT, Regan DW, Sundsted KK, Mauck KF. Practice Changing Updates in Perioperative Medicine Literature 2022. A Systematic Review. Am J Med 2023; 136:753-762.e1. [PMID: 37148994 DOI: 10.1016/j.amjmed.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
Perioperative medicine is a rapidly growing multidisciplinary field with significant advances published each year. In this review, we highlight important perioperative publications in 2022. A multi-database literature search from January to December of 2022 was undertaken. Original research articles, systematic reviews, meta-analyses, and guidelines were included. Abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature were excluded. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi technique was used to identify 8 practice-changing articles. We identified another 10 articles for tabular summaries. We highlight why these articles have the potential to change clinical perioperative practice and areas where more information is needed.
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Affiliation(s)
- Maleka Khambaty
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Aditya P Devalapalli
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Richard E Silbert
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Deanne T Kashiwagi
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Sheikh Shakhbout Medical City in partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Dennis W Regan
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karna K Sundsted
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
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Yang G, Zuo S, Wang P, Yin Y, Zhang X, Ma Y, Quan G, Zhang Y, Zhao X, Qu H, Zhou P, Zhang X, Zhang H, Lian H, Chu Q. Virtual Pain Unit Is Associated with Improvement of Postoperative Analgesia Quality: A Retrospective Single-Center Clinical Study. Pain Ther 2023; 12:1005-1015. [PMID: 37199861 PMCID: PMC10290007 DOI: 10.1007/s40122-023-00518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Acute postoperative pain is a major concern among surgical patients. Thus, this study established a new acute pain management model and compared the effects of the acute pain service (APS) model in 2020 and the virtual pain unit (VPU) model in 2021 on postoperative analgesia quality. METHODS This retrospective, single-center clinical study involved 21,281 patients from 2020 to 2021. First, the patients were grouped on the basis of their pain management model (APS and VPU). The incidence of moderate to severe postoperative pain (MSPP) [numeric rating scale (NRS) score ≥ 5], postoperative nausea and vomiting (PONV), and postoperative dizziness were recorded. RESULTS The VPU group recorded significantly lower MSPP incidence (1-12 months), PONV, and postoperative dizziness (1-10 months and 12 months) compared with the APS group. In addition, the annual average incidence of MSPP, PONV, and postoperative dizziness in the VPU group was significantly lower than in the APS group. CONCLUSIONS The VPU model reduces the incidence of moderate to severe postoperative pain, nausea, vomiting, and dizziness; hence, it is a promising acute pain management model.
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Affiliation(s)
- Guanyu Yang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Shanshan Zuo
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Pengfei Wang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Yue Yin
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Xiaowei Zhang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Yanling Ma
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Gang Quan
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Yueli Zhang
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Department of Pharmacy, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Huan Qu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Piao Zhou
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Xiaofei Zhang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Huaibin Zhang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Hongkai Lian
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China.
- Trauma Research Center, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China.
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China.
- Virtual Pain Unit, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China.
- Trauma Research Center, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China.
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Spisak K, Thomas MD, Sirois ZJ, Jones A, Brown L, Froehle AW, Albert M. Novel Enhanced Recovery After Surgery Pathway Reduces Length of Stay and Postoperative Opioid Usage in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion. Cureus 2023; 15:e43079. [PMID: 37680415 PMCID: PMC10482126 DOI: 10.7759/cureus.43079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE The goal of this study was to compare our institution's recently implemented enhanced recovery after surgery (ERAS) protocol to previous post-operative management for adolescent idiopathic scoliosis patients undergoing posterior spinal fusion, specifically assessing length of stay, opioid consumption, and pain scores. METHODS This is a retrospective analysis that compares the length of stay, opioid consumption, and pain scores of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Patients were analyzed prior to the implementation of our ERAS protocol, deemed the traditional pain pathway (TPP), to those who underwent the ERAS pathway. All patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis were included. Patients were excluded if they weighed less than 40kg, had significant comorbidities, or had non-idiopathic causes of scoliosis. RESULTS We examined 22 patients in the TPP cohort and 20 in the ERAS cohort. Length of stay in the ERAS cohort was significantly reduced compared to the TPP by 1.7 days (P<0.01). Overall opioid consumption was also significantly reduced in the ERAS with 1.4 ± 0.7 morphine equivalents (ME)/kg compared to the TPP 2.4 ± 1.1 ME/kg (P < 0.01). We found no difference in pain scores between the two groups. CONCLUSION Implementation of an ERAS pathway at our institution significantly reduced length of stay and opioid consumption in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion. These outcomes reduce morbidity and costs associated with posterior spinal fusion and provide an overall improvement in the quality of care for our patients.
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Affiliation(s)
| | | | | | - Alvin Jones
- Orthopedic Surgery, Dayton Children's Hospital, Dayton, USA
| | | | | | - Michael Albert
- Orthopedic Surgery, Dayton Children's Hospital, Dayton, USA
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Orbay Yaşli S, Günay Canpolat D, Doğruel F, Demirbaş AE. Efficacy of Tenoxicam, Paracetamol, and Their Combination in Postoperative Pain After Double-Jaw Surgery. Cureus 2023; 15:e44195. [PMID: 37641729 PMCID: PMC10460537 DOI: 10.7759/cureus.44195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Orthognathic surgical procedures include a series of surgical operations in which interventions are applied to the maxilla, mandible, or both for occlusal or aesthetic concerns due to facial skeletal development deformities. Double-jaw surgeries have the highest pain scores, in which both maxilla and mandible bones are intervened. This study aimed to compare the efficacy of individual applications of paracetamol and tenoxicam with their combined application on postoperative pain and opioid consumption in patients undergoing double-jaw surgery. Methods In this randomized, double-blind study, 60 patients undergoing double-jaw surgery were allocated into three groups, with each having 20 patients: the paracetamol group, the tenoxicam group, and the paracetamol-tenoxicam combination group. Pain intensity was evaluated using the visual analogue scale (VAS) at intervals of 30 minutes, 60 minutes, 120 minutes, and again at the 24th postoperative hour. Additionally, the consumption of opioids and other rescue analgesics was documented over the 24-hour postoperative period. Results The VAS values at 30 minutes, 60 minutes, and 24 hours were lower in the paracetamol-tenoxicam group compared to the other groups (p<0.001). The need for a rescue analgesic drug in the first 24 hours was not observed in the tenoxicam and paracetamol-tenoxicam groups. Conclusion It was concluded that both tenoxicam and paracetamol-tenoxicam combinations, especially the tenoxicam-paracetamol combination, were good options for postoperative analgesia in patients with double-jaw surgery.
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Affiliation(s)
- Seher Orbay Yaşli
- Anesthesiology in Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, TUR
| | - Dilek Günay Canpolat
- Anesthesiology in Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, TUR
| | - Fatma Doğruel
- Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, TUR
| | - Ahmet E Demirbaş
- Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, TUR
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Silva F, Costa G, Veiga F, Cardoso C, Paiva-Santos AC. Parenteral Ready-to-Use Fixed-Dose Combinations Including NSAIDs with Paracetamol or Metamizole for Multimodal Analgesia-Approved Products and Challenges. Pharmaceuticals (Basel) 2023; 16:1084. [PMID: 37630999 PMCID: PMC10459253 DOI: 10.3390/ph16081084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The combination of non-steroidal anti-inflammatory drugs (NSAIDs) with non-opioid analgesics is common in clinical practice for the treatment of acute painful conditions like post-operative and post-traumatic pain. Despite the satisfactory results achieved by oral analgesics, parenteral analgesia remains a key tool in the treatment of painful conditions when the enteral routes of administration are inconvenient. Parenteral ready-to-use fixed-dose combinations of non-opioid analgesics combinations, including NSAIDs and paracetamol or metamizole, could play a central role in the treatment of painful conditions by combining the advantages of multimodal and parenteral analgesia in a single formulation. Surprisingly, only in 2020, a parenteral ready-to-use fixed-dose combination of ibuprofen/paracetamol was launched to the market. This review aims to investigate the current availability of combinations of NSAIDs with paracetamol or metamizole in both European and American markets, and how the combination of such drugs could play a central role in a multimodal analgesia strategy. Also, we explored how the parenteral formulations of NSAIDs, paracetamol, and metamizole could serve as starting elements for the development of new parenteral ready-to-use fixed-dose combinations. We concluded that, despite the well-recognized utility of combining NSAIDs with paracetamol or metamizole, several randomized clinical trial studies demonstrate no clear advantages concerning their efficacy and safety. Future clinical trials specifically designed to assess the efficacy and safety of pre-formulated fixed-dose combinations are required to generate solid evidence about their clinical advantages.
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Affiliation(s)
- Fernando Silva
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Gustavo Costa
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Laboratory of Pharmacognosy, Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, Pólo das Ciências da Saúde, 3000-548 Coimbra, Portugal
| | - Francisco Veiga
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Catarina Cardoso
- Laboratórios Basi, Parque Industrial Manuel Lourenço Ferreira, Lote 15, 3450-232 Mortágua, Portugal
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
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Cubeddu F, Masala G, Sotgiu G, Mollica A, Versace S, Careddu GM. Cardiorespiratory Effects and Desflurane Requirement in Dogs Undergoing Ovariectomy after Administration Maropitant or Methadone. Animals (Basel) 2023; 13:2388. [PMID: 37508165 PMCID: PMC10376119 DOI: 10.3390/ani13142388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
General anesthesia for ovariectomy in dogs is based on a balanced anesthesia protocol such as using analgesics along with an inhalant agent. While opioids such as fentanyl and methadone are commonly used for their analgesic potency, other drugs can also have analgesic effects. Maropitant, an antiemetic for dogs and cats, has also been shown to exert analgesic effects, especially on visceral pain. The aim of this study was to compare the cardiorespiratory effects and analgesic properties of maropitant and methadone combined with desflurane in dogs undergoing ovariectomy. Two groups of 20 healthy mixed-breeds bitches undergoing elective ovariectomy received intravenous either maropitant at antiemetic dose of 1 mg kg-1 or methadone at the dose of 0.3 mg kg-1. Cardiorespiratory variables were collected before premedication, 10 min after sedation and during surgery. Recovery quality and postoperative pain were evaluated 15, 30, 60, 120, 240 and 360 min postoperatively. Results showed that maropitant produced analgesia and reduced the requirement of desflurane in amounts similar to those determined by methadone (5.39 ± 0.20% and 4.91 ± 0.26%, respectively) without significant difference, while maintaining heart rate, arterial blood pressure, respiratory rate and carbon dioxide end-tidal partial pressure even at a more satisfactory level. Therefore, maropitant may be recommended as an analgesic drug for abdominal surgery not only in healthy dogs but also in those with reduced cardiorespiratory compensatory capacities or at risk of hypotension, especially when combined with a sedative such as dexmedetomidine.
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Affiliation(s)
- Francesca Cubeddu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Gerolamo Masala
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Department of Surgical and Experimental Medical Sciences Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Alessandra Mollica
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Sylvia Versace
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni Mario Careddu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
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Wu J, Gao L, Shi Q, Qin C, Xu K, Jiang Z, Zhang X, Li M, Qiu J, Gu W. Accuracy Evaluation Trial of Mixed Reality-Guided Spinal Puncture Technology. Ther Clin Risk Manag 2023; 19:599-609. [PMID: 37484696 PMCID: PMC10361284 DOI: 10.2147/tcrm.s416918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To evaluate the accuracy of mixed reality (MR)-guided visualization technology for spinal puncture (MRsp). Methods MRsp involved the following three steps: 1. Lumbar spine computed tomography (CT) data were obtained to reconstruct virtual 3D images, which were imported into a HoloLens (2nd gen). 2. The patented MR system quickly recognized the spatial orientation and superimposed the virtual image over the real spine in the HoloLens. 3. The operator performed the spinal puncture with structural information provided by the virtual image. A posture fixation cushion was used to keep the subjects' lateral decubitus position consistent. 12 subjects were recruited to verify the setup error and the registration error. The setup error was calculated using the first two CT scans and measuring the displacement of two location markers. The projection points of the upper edge of the L3 spinous process (L3↑), the lower edge of the L3 spinous process (L3↓), and the lower edge of the L4 spinous process (L4↓) in the virtual image were positioned and marked on the skin as the registration markers. A third CT scan was performed to determine the registration error by measuring the displacement between the three registration markers and the corresponding real spinous process edges. Results The setup errors in the position of the cranial location marker between CT scans along the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) axes of the CT bed measured 0.09 ± 0.06 cm, 0.30 ± 0.28 cm, and 0.22 ± 0.12 cm, respectively, while those of the position of the caudal location marker measured 0.08 ± 0.06 cm, 0.29 ± 0.18 cm, and 0.18 ± 0.10 cm, respectively. The registration errors between the three registration markers and the subject's real L3↑, L3↓, and L4↓ were 0.11 ± 0.09 cm, 0.15 ± 0.13 cm, and 0.13 ± 0.10 cm, respectively, in the SI direction. Conclusion This MR-guided visualization technology for spinal puncture can accurately and quickly superimpose the reconstructed 3D CT images over a real human spine.
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Affiliation(s)
- Jiajun Wu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
| | - Lei Gao
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
| | - Qiao Shi
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital of China, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China
| | - Chunhui Qin
- Department of Pain Management, Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of China
| | - Kai Xu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
| | - Zhaoshun Jiang
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
| | - Xixue Zhang
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
| | - Ming Li
- Department of Radiology, Huadong Hospital affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
| | - Jianjian Qiu
- Department of Radiation Oncology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
| | - Weidong Gu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People’s Republic of China
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