Parecoxib's effects on anastomotic and abdominal wound healing: a randomized Controlled trial

Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy

BACKGROUND

 Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population.

METHODS

 Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds.

RESULTS

 Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001).

CONCLUSION

 This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.

Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome

Nonsteroidal anti-inflammatory drugs are among the most commonly administered drugs in the perioperative period due to their prominent role in pain management. However, they potentially have perioperative consequences due to immune-modulating effects through the inhibition of prostanoid synthesis, thereby affecting the levels of various cytokines. These effects may have a direct impact on the postoperative outcome of patients since the immune system aims to restore homeostasis and plays an indispensable role in regeneration and repair. By affecting the immune response, consequences can be expected on various organ systems. This narrative review aims to highlight these potential immune system-related consequences, which include systemic inflammatory response syndrome, acute respiratory distress syndrome, immediate and persistent postoperative pain, effects on oncological and neurologic outcome, and wound, anastomotic, and bone healing.

Nonopioid analgesics for analgesia in critically ill patients: Friends, enemies, or collaborators

Patients in intensive care units (ICUs) experience pain, which they describe as a significant cause of stress during treatment. It can progress to chronic pain and significantly affect the quality of life. Opioids have long been the backbone of ICU pain therapy. The consequences of their long-term use are known today, such as prolonged ICU stay and mechanical ventilation, resulting in increased treatment costs. Additionally, abstinence syndrome is a consequence of abrupt opioid withdrawal. Also, there is a risk of tolerance and hyperalgesia after prolonged opioid use. Globally, opioid dependence after hospital opioid treatment is alarming, although there is still a lack of data on its incidence after ICU. Multimodal analgesia enables comfort to the patient, opioid-sparing, and avoidance of side effects of non-opioid analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad group of drugs recommended with paracetamol to treat mild to moderate acute postoperative pain. Although often prescribed by intensivists, their use in treating painful conditions in ICU is controversial due to the possible consequences on the organs of critically ill patients. Due to the inhibition of cyclooxygenases, NSAIDs indirectly cause vasoconstriction of the renal arteries and arterioles, leading to kidney damage. NSAIDs inhibit platelet aggregation and may predispose to bleeding. Analgesia of a critically ill patient is a important part of their treatment, however it can be challenging in certain patients. Numerous combinations of pharmacological and non-pharmacological approaches can be adapted to the patient's current characteristics.

Combination of Epidural Blockade and Parecoxib in Enhanced Recovery After Gastrointestinal Surgery

OBJECTIVE

To investigation effects of the combination use of epidural blockade and parecoxib in postoperative recovery of colorectal cancer (CRC) patients.

METHODS

The present prospective single-blinded study included 186 CRC patients who received radical resection during April 2016 to December 2017. All patients were randomized into 3 different groups, the epidural blockade group, the combined-group with both epidural blockade and pre-intravenous injection of parecoxib, and the control group. The mean operative time, bleeding volume, the first out of bed activity time and hospital stay time were recorded. The mini-mental state examination (MMSE) score and Ramsay score were measured for cognitive function and the Visual Analog Score (VAS) was determined for the pain condition.

RESULTS

The surgery time for the control group was significantly shorter than the other 2 groups (P < 0.05). The VAS scores were significantly lower in both the combined group and the epidural blockade group when compared with the control group and were dramatically lower in the combined group than the others 2 groups (all P < 0.05). The first out of bed activity time and hospital stay time were the shortest in the combined group, and the control group had the longest time (all P < 0.05). Both the Ramsay and MMSE scores were the highest in the combination group than other groups (all P < 0.05) and no significant difference was observed between the epidural blockade group and the control.

CONCLUSION

The combination of epidural blockade and parecoxib could enhance the recovery process, as well as reduce the pain for the CRC patients.

Pressure algometry for assessment of abdominal wall sensitivity in horses after ventral midline coeliotomy

OBJECTIVE

To assess the clinical course of abdominal wall sensitivity after ventral midline coeliotomy in horses by determining mechanical nociceptive thresholds (MNTs) during hospitalization, and to determine the inter-observer reliability of pressure algometry on the abdominal wall.

STUDY DESIGN

Observational, cohort study.

SAMPLE POPULATION

A total of 13 horses presenting with signs of abdominal pain/colic undergoing ventral midline coeliotomy and 10 healthy horses without an abdominal incision.

METHODS

Measurements were performed on days 1, 3, 5, 7 and 9 postoperatively using a pressure algometer. Measurement sites were marked left and right, abaxial to the abdominal incision. Cranial to the incision, two control points were marked. Measurements were made by one observer, blinded to the recorded MNT values. To determine inter-observer reliability, five horses (surgical group n = 2; nonsurgical group n = 3) were measured by two observers in a randomized order.

RESULTS

Mean MNT values on days 5 and 7 were 9.61 Ncm^-2 and 10.14 Ncm^-2 in the operated group (p = 0.009 ; p = 0.005) respectively versus 13.00 Ncm^-2 on day 1. Wound-associated points showed lower values than control points (p = 0.002). The nonsurgical group did not show a difference between control points and wound-associated points (p = 0.06). No significant differences were found between the surgical and the nonsurgical groups at the wound-associated points on any days measured. The inter-observer reliability was low (intraclass correlation coefficient of 0.26; Cronbach's alpha of 0.27).

CONCLUSION

Operated animals showed a reduction in MNT values on days 5 and 7 when compared with day 1 and lower values for the wound-associated points when compared with the control points. Inter-observer reliability was low. Pressure algometry could be a useful tool for assessing wound sensitivity after ventral midline coeliotomy in horses, which may improve pain management postoperatively.

Effect of Autologous Platelet-Rich Plasma Gel on Skin Flap Survival

BACKGROUND Skin flap grafting is one of the most common tissue transplantations for wound repair and organ reconstruction. Thus, improving the survival rate of the transplanted skin flap is important. Platelet-rich plasma (PRP) is an autologous platelet concentrate obtained from whole blood. It has been widely used in repairing tissue defects. Considering that the PRP gel has similar biological characteristics, this study used PRP gel for skin flap transplantation. MATERIAL AND METHODS PRP gel from Sprague-Dawley (SD) rats was prepared and the growth factor concentration was determined. A rat skin flap model was established to evaluate the survival rate of skin flap. Morphologic evaluation was also done. RESULTS We found that the PRP gel increased the survival rate of the skin flap. In addition, it reduces the inflammation response in skin flap transplantation and has better effects in terms of generating new soft tissue. CONCLUSIONS The effectiveness PRP gel in skin flap transplantation is satisfactory. The possible mechanisms by which PRP gel promotes the survival of the skin flap includes platelets, growth factors, immune activity factor, and fibrin. PRP could be a new clinical method for promoting skin flap survival.

Parecoxib, a selective blocker of cyclooxygenase-2, directly inhibits neuronal delayed-rectifier K+ current, M-type K+ current and Na+ current

Parecoxib, a prodrug of valdecoxib, is a selective inhibitor of cyclooxygenase-2 and widely used for traumatic and postoperative patients to avoid opioid-induced side effects. It is a potent analgesic and has a role in multimodal analgesic and enhanced recovery after surgery. Whether parecoxib exerts any actions on these types of ionic currents remains unclear. In this study, we investigated whether it exerts any effects on ion currents in differentiated NG108-15 neuronal cells. Cell exposure to parecoxib (1-30 μM) caused a reversible reduction in the amplitude of I_K(DR) with an IC₅₀ value of 9.7 μM. The time course for the I_K(DR) inactivation in response to a long-lasting pulse was changed to the biexponential process during cell exposure to 3 μM parecoxib. Other agents known to inhibit the cyclooxygenase activity have minimal effects on I_K(DR). Parecoxib enhanced the degree of excessive accumulative inhibition of I_K(DR) inactivation evoked by a train of brief repetitive stimuli. This compound suppressed the amplitude of M-type K⁺ current. It depressed the peak amplitude of voltage-gated Na⁺ current with no change in the current-voltage relationship of this current. However, it did not have any effect on hyperpolarization-activated cation current. No change in the expression level of K_V3.1 mRNA was detected in the presence of parecoxib. The effects of parecoxib on ion currents are direct and unrelated to its inhibition of the enzymatic activity of cyclooxygenase-2. The inhibition of these ion channels by parecoxib may partly contribute to the underlying mechanisms by which it affects neuronal function in vivo.