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Hemdanieh M, Mzeihem M, Ei Zouhbi A, Tamim H, Nassereddine M. Derivation and validation of a risk calculator for the prediction of incidence of complications following repair of Achilles Tendon Rupture. J Orthop Surg Res 2024; 19:498. [PMID: 39175049 PMCID: PMC11340080 DOI: 10.1186/s13018-024-04921-7] [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: 03/24/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The Achilles tendon is the body's strongest and largest tendon. It is commonly injured, particularly among athletes, accounting for a significant portion of serious tendon injuries. Several factors play a precipitating role in increasing the risk of these injuries. OBJECTIVE Our objective is to derive and validate a risk calculator for the prediction of incidence of any complication following Achilles tendon repair. METHODS We used de-identified data from the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2021. It comprises 7010 individuals who had undergone Achilles tendon rupture repair. Demographic and risk factors information was collected. To develop the calculator, the sample was divided into a derivation cohort (40%) and a validation cohort (60%). Multivariate logistic regression was used for statistical analysis, and a risk calculator for incidence of any complication was derived from the derivation cohort and validated on the remaining 60% of the sample. Patients with missing data were excluded, and the significance level was set at p < 0.05. RESULTS We analyzed the derivation cohort of 2245 individuals who underwent Achilles tendon repair surgery between 2005 and 2021, with a 5.5% overall complication. Multivariate logistic regression identified anesthesia type, ASA classification, certain co-morbidities (pre-operative dialysis and medication-requiring hypertension), and wound classification as significant predictors of complications. The developed risk calculator model had an area under the curve (AUC) of 0.685 in the derivation cohort and 0.655 in the validation cohort, surpassing the widely used and validated modified frailty index. A cut-off score threshold of 0.06 was established using Youden's index to dichotomize individuals into low and high risk for developing any postoperative complications. CONCLUSION Our risk calculator includes factors that most significantly affect the incidence of any complication following Achilles tendon repair.
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Affiliation(s)
- Maya Hemdanieh
- Department of Orthopedics Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Mzeihem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anas Ei Zouhbi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamad Nassereddine
- Department of Orthopedics Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Fuertes-Recuero M, de Segura IAG, López AS, Suárez-Redondo M, Arrabé SC, Hidalgo SP, Fontanillas-Pérez JC, Ortiz-Diez G. Postoperative pain in dogs undergoing either laparoscopic or open ovariectomy. Vet J 2024; 306:106156. [PMID: 38834104 DOI: 10.1016/j.tvjl.2024.106156] [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: 11/30/2023] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024]
Abstract
A prospective, quasi-experimental, clinical trial was performed to assess acute postoperative pain in healthy female dogs following elective ovariectomy by either laparoscopy (n=13) or laparotomy (n=14). Pain was assessed by both a veterinarian at the hospital, and by the owner once the patient was discharged. The Spanish version of the short form of the Glasgow Composite Measuring Pain Scale (CMPS-SF) was used. Pain scores were assessed by the veterinarian preoperatively and at 1, 2, 4, and 6 h after extubation, whilst owner-assessed scores were performed preoperatively and at postoperative days 0, 1, 2, 3, 5 and 7. Data were compared with Mann-Whitney-U test. Veterinarian-assessed CMPS-SF scores were different between both groups at all postoperative times but not at baseline, being below 6/24 in all dogs in the laparoscopy group, but equal to or greater than 6/24 in the laparotomy group at 1 h (n=12), and 4 h (n=4) (P<0.001 and P=0.029, respectively). There were also differences in pain scores between both groups at 2 h (P=0.012) and 6 h (P=0.007), being below 6/24 in all of them. However, there were no differences in owner assessments between groups. In conclusion, ovariectomy performed by laparoscopy induced lower pain scores that were below the pain threshold set by the CMPS-SF during the first 6 h postoperatively. After discharge, and up to one week later, ongoing owner-assessed scores suggest no pain was induced with neither of the techniques. Owners were proactive allowing real-time pain assessment to be reported. The development and validation of instruments for acute pain assessment by owners is warranted, as these tools are currently lacking.
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Affiliation(s)
- M Fuertes-Recuero
- Department of Physiology, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain; Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain.
| | - I A Gómez de Segura
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain; Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
| | - A Sánchez López
- Puchol Veterinary Hospital, C/Sauceda 8, Madrid 28050, Spain
| | - M Suárez-Redondo
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
| | - S Canfrán Arrabé
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain; Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
| | - S Penelo Hidalgo
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
| | - J C Fontanillas-Pérez
- Department of Physiology, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
| | - G Ortiz-Diez
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain; Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid 28040, Spain
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Suárez-Redondo M, Fuertes-Recuero M, Guzmán-Soltero A, Aguado D, Del Carmen Martín-Espada M, Espinel-Rupérez J, Ortiz-Diez G. Description of postoperative complications and bacterial contamination of wound soaker catheters used to administer postoperative local analgesia after mastectomy in 11 dogs: case series. Vet Res Commun 2024; 48:2707-2712. [PMID: 38656657 PMCID: PMC11315717 DOI: 10.1007/s11259-024-10377-1] [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: 12/17/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Mastectomy is a common and painful procedure in dogs. Wound soaker catheters (WSC) are frequently used to reduce postoperative pain, including pain after mastectomy. The objectives of this case series were to describe the use of WSC for owner administration of postoperative local analgesia in dogs with mammary tumors treated surgically, to identify complications associated with WSC and to determine the frequency of bacterial colonization of the catheters. Twelve WSC were placed in 11 dogs during mastectomy surgery, left in place for three days, protected by a dressing and successfully managed by owners at home. No postoperative antibiotics were administered. No complications were identified in any cases. No bacterial growth was identified on bacteriological analysis of the twelve WSC. These results suggest that the use of WSC is a safe alternative for postoperative analgesia administration following mastectomy in dogs. Future studies comparing dogs with or without WSC with a larger number of dogs are needed to further evaluate efficacy and complications.
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Affiliation(s)
- María Suárez-Redondo
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
| | - Manuel Fuertes-Recuero
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain.
- Department of Physiology, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain.
| | - Alba Guzmán-Soltero
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
| | - María Del Carmen Martín-Espada
- Department of Animal Health, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
| | | | - Gustavo Ortiz-Diez
- Complutense Veterinary Teaching Hospital, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
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Sakthivel M, Bapna T, Ivanic S, Lang C, Nataraja RM, Pacilli M. An Objective Evaluation of Intraoperative and Postoperative Pain in Infants Undergoing Open Inguinal Herniotomy and Laparoscopic Inguinal Hernia Repair Using the Newborn Infant Parasympathetic Evaluation (NIPE™) Monitor. J Pediatr Surg 2024:161651. [PMID: 39164127 DOI: 10.1016/j.jpedsurg.2024.07.036] [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: 03/10/2024] [Revised: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor is an objective, non-invasive tool for the assessment of pain in children under 2 years of age. The aim of this study was to objectively compare pain in infants undergoing open and laparoscopic inguinal hernia surgery using the NIPE monitor. METHOD This prospective observational study included neonates and infants (<2 years of age) undergoing elective open inguinal herniotomy and laparoscopic inguinal hernia repair under general anaesthesia with a caudal block. The NIPE monitor was connected to the electrocardiogram monitor with continuous monitoring performed intraoperatively, and postoperatively in the Post Anaesthesia Care Unit. The NIPE index was recorded at different intraoperative steps. The median NIPE index (NIPEm) was calculated for the entire procedure and postoperative period. The NIPE index ranges from 0 to 100; lower values indicate greater levels of pain, values < 50 indicate severe pain. P values < 0.05 were considered significant. RESULTS There were 40 infants recruited: 27 underwent open herniotomy and 13 underwent laparoscopic repair. Intraoperatively, NIPEm was found to be significantly lower in the laparoscopic group (59.00 vs. 77.00, p = 0.0018). Postoperatively, NIPEm was also found to be significantly lower in the laparoscopic group (49.00 vs. 57.50, p = 0.0001). CONCLUSION This is the first study to objectively demonstrate that laparoscopic inguinal hernia repair is more painful intraoperatively and leads to greater levels of pain in the early postoperative period compared to open inguinal herniotomy. This difference might explained by painful stimuli in anatomical areas not covered by the caudal block. TYPE OF STUDY Treatment Study/Prospective Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Mahesh Sakthivel
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tanay Bapna
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Svetlana Ivanic
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Cassandra Lang
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia.
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Sakamoto N, Matsuo M, Takazawa T. Relationship between epidural catheter migration beneath the skin and subcutaneous fat thickness assessed using postoperative CT imaging: a retrospective cross-sectional study. J Anesth 2024:10.1007/s00540-024-03374-w. [PMID: 38990343 DOI: 10.1007/s00540-024-03374-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: 02/15/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin. METHODS We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length. RESULTS We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71 years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: - 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient - 0.40, 95% CI: - 0.65, - 0.14). CONCLUSION We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.
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Affiliation(s)
- Natsumi Sakamoto
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Mitsuhiro Matsuo
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Tomonori Takazawa
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Park S, Park JH, Park S, Jang JN, Kim C, Choi YS. Ultrasound-guided subcostal approach of transversus abdominis plane block compared with wound infiltration for postoperative analgesia following laparoscopic cholecystectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38044. [PMID: 38701299 PMCID: PMC11062739 DOI: 10.1097/md.0000000000038044] [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: 11/16/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The ultrasound-guided subcostal approach of transversus abdominis plane (sTAP) blocks and wound infiltration (WI) are both widely practiced techniques to reduce postoperative pain in patients undergoing LC. Although these methods have been shown to relieve postoperative pain effectively, the relative analgesic efficacy between ultrasound-guided sTAP blocks and WI is not well known. METHODS We searched PubMed, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) comparing ultrasound-guided sTAP block versus WI for postoperative pain control in adult patients undergone LC. The search was performed until May 2023. Primary outcome was defined as 24-hour cumulative opioid consumption. Secondary outcomes were postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). RESULTS Finally, 6 RCTs were included, and data from 314 participants were retrieved. Postoperative 24-hour opioid consumption was significantly lower in ultrasound-guided sTAP group than in the WI group with a mean difference of -6.67 (95% confidence interval: -9.39 to - 3.95). The ultrasound-guided sTAP group also showed significantly lower pain scores. Incidence of PONV did not significantly differ between the 2 groups. CONCLUSIONS We conclude that there is low to moderate evidence to advocate that ultrasound-guided sTAP block has better analgesic effects than WI in patients undergoing LC. Further trials are needed with robust methodology and clearly defined outcomes.
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Affiliation(s)
- Sukhee Park
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Soyoon Park
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Chaeeun Kim
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
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Cheema MRS. Unveiling the interplay: Diabetes and lumbar stenosis surgery outcomes. Clin Neurol Neurosurg 2024; 239:108207. [PMID: 38458056 DOI: 10.1016/j.clineuro.2024.108207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
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Sakthivel M, Su V, Nataraja RM, Pacilli M. Newborn and Infant Parasympathetic Evaluation (NIPE™) Monitor for Assessing Pain During Surgery and Interventional Procedures: A Systematic Review. J Pediatr Surg 2024; 59:672-677. [PMID: 38158253 DOI: 10.1016/j.jpedsurg.2023.12.008] [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: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor has been designed to be an objective, non-invasive tool for the assessment of pain and discomfort in children under 2 years of age. The aim of this systematic review was to evaluate the ability of NIPE to assess pain in neonates and infants during surgical and/or painful procedures. METHODS A systematic review (2010-2023) was conducted using PRISMA guidelines. Studies containing children above 2-years-old were excluded. The ROBINS-I (Risk of Bias in Non-randomised Studies of Interventions) tool was used to assess the quality of included studies. RESULTS 9 databases were searched identifying 470 articles, 460 did not meet the inclusion criteria and were excluded; therefore, 10 studies with 548 participants were included. NIPE was used to assess intraoperative and postoperative pain for surgery under general anaesthesia (5 studies), as well as acute and prolonged pain from other interventional procedures (5 studies). For surgery under general anaesthesia: NIPE has shown to detect nociceptive events (e.g., skin incision, intubation), insufficient analgesia intraoperatively and to predict early postoperative pain. For painful interventional procedures: NIPE has shown to detect acute pain with a high sensitivity and negative predictive value. CONCLUSION NIPE has been used to assess pain in surgery and for various painful procedures. NIPE can detect intraoperative pain and reflect early postoperative pain. NIPE may be useful in evaluating procedural pain, however with heterogenous outcomes, more studies are required to confirm its efficacy. TYPE OF STUDY Systematic Review. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Mahesh Sakthivel
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Virginia Su
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia.
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Stefansdottir AB, Vieira L, Johnsen A, Isacson D, Rodriguez A, Mani M. Comparison of Pain Management Strategies to Reduce Opioid Use Postoperatively in Free Flap Breast Reconstruction: Pain Catheter versus Nerve Block in Addition to Refinements in the Oral Pain Management Regime. Arch Plast Surg 2024; 51:156-162. [PMID: 38596158 PMCID: PMC11001454 DOI: 10.1055/s-0043-1777673] [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] [Received: 05/24/2023] [Accepted: 10/23/2023] [Indexed: 04/11/2024] Open
Abstract
Background Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group ( n = 63) had lower opioid consumption compared to the PP group ( n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay ( p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.
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Affiliation(s)
- Andrea B. Stefansdottir
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Luis Vieira
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Plastic Surgery, Central University Hospital Center, Lisbon, Portugal
| | - Arni Johnsen
- Department of Otorhinolaryngology, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Daniel Isacson
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andres Rodriguez
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Mani
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Bharadwaj S, Gopalakrishna KN, Akash VS, Konar S, Srinivasaiah B, Kamath S. Perioperative care practices and outcomes of intracranial neurosurgery: Experience at a dedicated neurosciences hospital in a developing country. J Anaesthesiol Clin Pharmacol 2023; 39:622-627. [PMID: 38269186 PMCID: PMC10805212 DOI: 10.4103/joacp.joacp_305_22] [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: 08/18/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aims Understanding of perioperative care practices and early postoperative outcomes helps minimize potentially preventable perioperative complications while supporting systemic and neurological well-being. The objective of this prospective study was to evaluate the perioperative care practices and early postoperative outcomes of cranial neurosurgery at a high-volume tertiary care neurosciences hospital in India. We also aimed to see if the care elements differed depending on the surgical approach. We hypothesized that care elements and outcomes are likely to be different between major surgical approaches. Material and Methods This was a prospective observational study of consecutive adult neurosurgical patients who underwent elective surgeries for intracranial pathologies over a period of six months from October 2020 to March 2021 at a tertiary care neurosciences center in India. Perioperative data about intraoperative care elements and early postoperative outcomes till the third day after surgery were collected. Results Incidence of blood loss >1 L was significantly (P = 0.07) higher after infratentorial surgery (26%, N = 17). Incidence of intraoperative and postoperative desaturation was more after transnasal surgery (6%, N = 2, P = 0.002, and 9%, N = 3, P = 0.01, respectively). Conclusion This study informs the early perioperative care practices of neurosurgical patients from a dedicated neurosciences hospital in a developing world. We observed that transnasal surgery was associated with more perioperative adverse events and slower convalescence compared to supra- and infratentorial surgeries despite being a considerably less invasive surgery.
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Affiliation(s)
- Suparna Bharadwaj
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - VS Akash
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Bharath Srinivasaiah
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Sriganesh Kamath
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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La Regina D, Popeskou SG, Saporito A, Gaffuri P, Tasciotti E, Dossi R, Christoforidis D, Mongelli F. Laparoscopic versus ultrasound-guided transversus abdominis plane block in colorectal surgery: a non-inferiority, multicentric randomized double-blinded clinical trial. Colorectal Dis 2023; 25:1921-1928. [PMID: 37525414 DOI: 10.1111/codi.16689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/03/2023] [Accepted: 04/25/2023] [Indexed: 08/02/2023]
Abstract
AIM The aim of this study was to assess if laparoscopic-assisted transversus abdominis plane (TAP) block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control. METHOD In all, 112 patients scheduled for elective laparoscopic colon resection from February 2018 to December 2021 at two Swiss hospitals were included and randomized in a 1:1 ratio before surgery with either L-TAPB or U-TAPB. The primary end-point was the non-inferiority of the L-TAPB compared to U-TAPB with regard to the total opioid consumption within the first 24 h after surgery. Data regarding patients' characteristics, opioid consumption, pain on the visual analogue scale, operative and anaesthesia induction time, complications and length of stay were collected and analysed. RESULTS Fifty-five patients were allocated to the L-TAPB and fifty-seven to the U-TAPB. No significant difference was found in the overall dose of opioids within 24 h, and the non-inferiority of the L-TAPB was confirmed. There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, P = 0.008). The anaesthesia induction time was significantly longer in the U-TAPB group (17 ± 11 min vs. 23 ± 12 min, P = 0.014). For all other variables (pain on the visual analogue scale, opioid consumption, need of epidural analgesia, operating time, postoperative complications and hospital stay) no statistically significant difference between the L-TAPB and the U-TAPB groups was noted. CONCLUSION Our results showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration of the TAP block, with the advantage of not affecting anaesthesia times. STUDY REGISTRATION NUMBER 2017-02017 CE 3294, ClinicalTrials.gov identifier NCT04575233.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sotirios Georgios Popeskou
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Edoardo Tasciotti
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Roberto Dossi
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Dimitri Christoforidis
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
- Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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12
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Deshler BJ, Rockenbach E, Patel T, Monahan BV, Poggio JL. Current update on multimodal analgesia and nonopiate surgical pain management. Curr Probl Surg 2023; 60:101332. [PMID: 37302814 DOI: 10.1016/j.cpsurg.2023.101332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Bailee J Deshler
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Emily Rockenbach
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Takshaka Patel
- Department of Surgery, General Surgery Resident Physician, Temple University Hospital, Philadelphia, PA
| | - Brian V Monahan
- Department of Surgery, General Surgery Resident Physician, Temple University Hospital, Philadelphia, PA
| | - Juan Lucas Poggio
- Division and System Chief, Colorectal Surgery, Department of Surgery, Professor of Surgery, Temple University Health System, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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13
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Ivanic S, Tong LS, Laird A, Malhotra A, Nataraja RM, Lang C, Pacilli M. The Newborn Infant Parasympathetic Evaluation (NIPE™) monitor predicts post-operative pain in children undergoing day-procedures: A prospective observational study. J Pediatr Surg 2023; 58:684-688. [PMID: 36646541 DOI: 10.1016/j.jpedsurg.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pain assessment is essential for the administration of appropriate analgesia. Currently, clinicians use surrogate methods, such as heart rate or behavioural pain scales, to estimate pain in neonates and infants. The Newborn and Infant Parasympathetic Evaluation (NIPE™) monitor aims to provide an objective numeric value (NIPE index) of pain through a continuous assessment of the patient's parasympathetic activity. The aim of this study was to determine if the intraoperative NIPE index monitoring could predict postoperative pain in neonates and infants. METHODS This prospective observational pilot study included neonates and infants undergoing elective day-surgical procedures (n = 50). Intraoperatively, NIPE indices at 0 (NIPE0), 10 (NIPE10), 20 (NIPE20), 30 (NIPE30) minutes and at completion of surgery (NIPEe), were recorded; the median NIPE index (NIPEm) was calculated for the entire procedure. Postoperative Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were calculated by the nursing staff blinded to the intraoperative NIPE indices. RESULTS Linear regression documented an association between the NIPEm and postoperative FLACC score at 0 (r = 0.31, p = 0.03) and 10 min (r = 0.36, p = 0.01). No significant associations were observed for FLACC scores at 20 (r = 0.21, p = 0.2) and 30 min (r = 0.36, p > 0.9). Multiple regression analysis revealed that intraoperative NIPE10, NIPE20, NIPE30 and NIPEe also predicted the FLACC score at 0 min (p = 0.003). CONCLUSION The intraoperative NIPE index is predictive of pain in the immediate postoperative period. This association was lost at 20 min likely due to nursing intervention to administer analgesia. NIPE monitoring could be useful in facilitating postoperative pain management in infants. LEVEL OF EVIDENCE II. TYPE OF STUDY Study of Diagnostic Test.
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Affiliation(s)
- Svetlana Ivanic
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lauren S Tong
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ashleigh Laird
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia
| | - Cassandra Lang
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences., Monash University, Melbourne, Australia.
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14
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Uchida R, Hombu A, Ishida Y, Nagasawa M, Chosa E. Investigation of cryotherapy for pain relief after arthroscopic shoulder surgery. J Orthop Surg Res 2022; 17:553. [PMID: 36536379 PMCID: PMC9764510 DOI: 10.1186/s13018-022-03404-x] [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: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, cryotherapy has become a common practice for postoperative pain management. The current accepted practice in Japan is the use of cryotherapy at 5 °C after arthroscopic shoulder surgery. However, this therapy has been reported to be highly intense because the sustained low temperature causes discomfort for patients. The optimum temperature and duration of cooling required for comfortable and effective cryotherapy after arthroscopic shoulder surgery were investigated. METHODS Because pain levels might differ depending on the condition, we selected 52 patients with rotator cuff injuries, which were the most common disorders indicated for arthroscopic shoulder surgery. Patients were treated with cryotherapy at 5 °C or 10 °C for 16 h or 24 h. The pain level was determined using the visual analogue scale, and deep shoulder joint temperatures were recorded at different time points for analysis. RESULTS Pain after arthroscopic shoulder surgery was found to be related to the presence of a brachial plexus block using the interscalene approach during surgical anesthesia. To obtain effective analgesia with cryotherapy, the cooling temperature and duration of cryotherapy had to be changed based on the presence or absence of the brachial plexus block. Patients who received brachial plexus blocks had the lowest recorded pain scores after receiving cryotherapy at 5 °C for 24 h after surgery. Patients who did not receive the block had the lowest recorded pain scores when receiving cryotherapy at either 5 °C for 16 h or 10 °C for 24 h. CONCLUSIONS Using universal cryotherapy intensity and duration settings regardless of the use of other interventions is likely to unintentionally increase postoperative pain levels. This study revealed that cryotherapy at 5 °C for 24 h was optimal for patients who received an anesthesia block and at 5 °C for 16 h or at 10 °C for 24 h for those who did not receive the anesthesia block. These results can be used as a reference for setting the temperature and duration of cryotherapy after arthroscopic shoulder surgery.
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Affiliation(s)
- Rinko Uchida
- grid.410849.00000 0001 0657 3887School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake-Cho, Miyazaki-City, Miyazaki 889-1692 Japan
| | - Amy Hombu
- grid.410849.00000 0001 0657 3887Center for Language and Cultural Studies, University of Miyazaki, Miyazaki, Japan
| | | | - Makoto Nagasawa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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15
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Wang C, Liu LD, Bai X. Bibliometric and Visual Analysis of the Current Status and Trends of Postoperative Pain in Children from 1950-2021. J Pain Res 2022; 15:3209-3222. [PMID: 36267350 PMCID: PMC9578501 DOI: 10.2147/jpr.s380842] [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: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Postoperative pain in children has been overlooked for a long time. The knowledge structure, research hotspots and trends related to postoperative pain in children are unclear and have not been systematically summarized. Purpose We aimed to analyze the current state of research on postoperative pain in children and to conduct in-depth mining of the knowledge structure. Methods The PubMed database for publications on postoperative pain in children between 1950 and 2021 was searched. Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) was performed to obtain the co-word matrix and co-occurrence matrix. The H-index method was used to extract high-frequency main Medical Subject Headings (MeSH) terms/subheadings. Results The high-frequency MeSH terms were analyzed by biclustering, strategic diagram and social network analyses. Totally, 4022 publications were retrieved. The analysis showed that 60 countries or regions published relevant documents, with the United States publishing the most significant number of papers. Totally, 811 journals published relevant papers, with Pediatric Anesthesia ranking first. Moreover, we extracted 43 high-frequency main MeSH terms/subheadings and clustered them into five categories: overview, aetiology and epidemiology, pharmacotherapy, opioid administration and dosing, and prevention and control of postoperative pain in children. Conclusion Pharmacological treatments, pain prevention and control are the focus of research and are becoming increasingly mature. Opioid stewardship and regional anesthesia is the trend and focus of future research. Our study offers a better understanding of the current status and knowledge structure of postoperative pain in children and provides a reference for improving postoperative pain management in children in the future.
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Affiliation(s)
- Cong Wang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Li-Dan Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xue Bai
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China,Correspondence: Xue Bai, Department of Health Management, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, People’s Republic of China, Email
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16
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Perera E, Flood B, Madden K, Goel DP, Leroux T, Khan M. A systematic review of clinical outcomes for outpatient vs. inpatient shoulder arthroplasty. Shoulder Elbow 2022; 14:523-533. [PMID: 36199506 PMCID: PMC9527489 DOI: 10.1177/17585732211007443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Outpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. The aim of this study was to investigate literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty. METHODS We conducted a systematic review of Medline, Embase and Cochrane Library databases from inception to 6 April 2020. Methodological quality was assessed using MINORS and GRADE criteria. RESULTS We included 17 studies, with 11 included in meta-analyses and 6 in narrative review. A meta-analysis of hospital readmissions demonstrated no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, p = 0.49). Pooled post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70, p = 0.02). Considerable cost saving of between $3614 and $53,202 (19.7-69.9%) per patient were present in the outpatient setting. Overall study quality was low and presented a serious risk of bias. DISCUSSION Shoulder arthroplasty in the outpatient setting appears to be as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. However, this is based on low quality evidence and high risk of bias suggests further research is needed to substantiate these findings.
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Affiliation(s)
- Edward Perera
- Epsom & St. Helier University NHS Hospital, London, UK
| | - Breanne Flood
- Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, Canada
| | - Kim Madden
- Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, Canada,Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Danny P Goel
- Department of Orthopedic Surgery, University of British Columbia, Vancouver, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Moin Khan
- Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, Canada,Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada,Moin Khan, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6.
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17
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Nnadozie UU, Sunday-Nweke NA, Maduba CC, Madu CI, Nnamonu MI, Akunekwe MI, Igboanugo AA, Okeke VU. Anesthesia for inguinal hernia repair: Experience with a tertiary hospital-based surgical outreach in a developing world. Ann Afr Med 2022; 21:140-145. [PMID: 35848646 PMCID: PMC9383021 DOI: 10.4103/aam.aam_95_20] [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] [Indexed: 11/04/2022] Open
Abstract
Background The dearth of adequate facilities and anesthetists limits the number and extent of surgical cases that can be attended to in surgical outreach programs. Inguinal hernia remains a common health burden in the developing world. Tertiary hospitals provide good anesthetic complements to safe surgeries and will be a veritable tool in surgical outreaches. Objectives The objective of the study is to assess the types/techniques of anesthesia used in uncomplicated open inguinal hernia repair in a tertiary hospital-based surgical outreach program. Materials and Methods This study was a prospective analysis of anesthetic techniques used in all uncomplicated inguinal hernia repairs performed in outreach program over 1 week in May 2018. Data were collected with a pro forma, analyzed with SPSS, and presented in tables and figures. Results One hundred and ninety-five patients with uncomplicated inguinal hernias were recruited for the study. The patients' age ranged from 0 to 89 years, with a mean age of 33.62 ± 22.75 years. Most cases occurred in children. The male-to-female ratio was 7:1, and the majority were primary hernia repairs. Eighty-seven (44.6%) patients had local anesthesia (LA), 65 (33.3%) had general anesthesia (GA), while 43 (22.1%) had spinal anesthesia (SA). One hundred and sixty-two (83.1%) patients needed intraoperative analgesic augmentation. One hundred and sixty-nine (86.7%) patients were operated as day-case surgeries, while 26 (13.3%) patients were discharged the day after surgery. The failure rate of LA and SA put together was 74.6%, but there was no conversion to GA. Anesthetic complication was observed in 3.4% of cases. Conclusion Organizing inguinal hernia repair outreach in a tertiary hospital offers the benefit of a full complement of anesthesia, which ensures safe and smooth surgery with low anesthetic complications. Most cases were done as daycare surgeries despite the high failure rate of LA and SA. Résumé Contexte Le manque d'installations adéquates et d'anesthésistes limite le nombre et l'étendue des cas chirurgicaux qui peuvent être traités dans les programmes de proximité chirurgicale. La hernie inguinale reste un fardeau de santé courant dans les pays en développement. Les hôpitaux tertiaires fournissent de bons compléments anesthésiques aux chirurgies sûres et seront un véritable outil dans les interventions chirurgicales. Objectifs Évaluer les types / techniques d'anesthésie utilisés dans la réparation de hernie inguinale ouverte non compliquée dans un programme de proximité chirurgicale en milieu hospitalier tertiaire. Méthode Une analyse prospective des techniques d'anesthésie utilisées dans toutes les réparations de hernie inguinale non compliquées effectuées dans le cadre d'un programme de sensibilisation sur une semaine en mai 2018. Les données ont été recueillies à l'aide d'un formulaire, analysées avec SPSS et présentées sous forme de tableaux et de figures. Résultats Cent quatre-vingt-quinze patients atteints de hernies inguinales non compliquées ont été recrutés pour l'étude. L'âge des patients variait de 0 à 89 ans avec un âge moyen de 33,62 + 22,75 ans. La plupart des cas sont survenus chez des enfants. Le ratio homme / femme était de 7: 1 et la majorité était des réparations primaires de hernie. Quatre-vingt-sept (44,6%) des patients ont eu une anesthésie locale (LA), 65 (33,3%) une anesthésie générale (AG), tandis que 43 (22,1%) une anesthésie rachidienne (SA). Cent soixante-deux (83,1%) patients ont eu besoin d'une augmentation analgésique peropératoire. Cent soixante-neuf (86,7%) patients ont été opérés en garderie tandis que 26 (13,3%) patients ont obtenu leur congé le lendemain de la chirurgie. Le taux d'échec de LA et SA réunis était de 74,6%, mais il n'y a pas eu de conversion en GA. Une complication anesthésique a été observée dans 3,4% des cas. Conclusion l'organisation de soins de proximité pour la réparation de la hernie inguinale dans un hôpital tertiaire offre l'avantage d'un complément complet d'anesthésie qui garantit une chirurgie sûre et en douceur avec de faibles complications anesthésiques. La plupart des cas ont été pratiqués en garderie malgré le taux d'échec élevé de l'anesthésie locale et rachidienne. Mots-clés Réparation de hernie inguinale, chirurgie de jour, anesthésie générale, anesthésie locale, anesthésie rachidienne.
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Affiliation(s)
- Ugochukwu Uzodimma Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Nneka Alice Sunday-Nweke
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, India
| | - Charles Chidiebele Maduba
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chinedu Ignatius Madu
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, India
| | | | | | - Arinze Aetelbert Igboanugo
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, India
| | - Valentine Uche Okeke
- Department of Morbid Anatomy, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, India
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18
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Viderman D, Aubakirova M, Abdildin YG. Transversus Abdominis Plane Block in Colorectal Surgery: A Meta-Analysis. Front Med (Lausanne) 2022; 8:802039. [PMID: 35295183 PMCID: PMC8920556 DOI: 10.3389/fmed.2021.802039] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Acute postoperative pain is one of the most common concerns during the early postoperative period in colorectal surgery. Opioids still represent the cornerstone of postoperative pain management, yet they often result in significant side effects such as nausea and/or vomiting, sedation, urinary retention, delayed recovery of colonic motility, respiratory depression, and postoperative ileus. Transversus abdominis plane (TAP) block has been widely used for postoperative analgesia in various abdominal surgeries. The primary aim of this meta-analysis was to compare the postoperative opioid requirements of patients in the TAP block group and the control group (placebo). The secondary aims included evaluation of the efficacy of TAP blocks in postoperative pain management, the measurement of time to first request for opioids, the measurement of length of hospital stay (LoS), and the documentation of postoperative nausea and/or vomiting. We searched for articles reporting the results of randomized controlled trials (RCTs) on the application of TAP block in colorectal surgery published before September 2021. Eight RCTs involving 615 patients were included in the meta-analysis. Seven articles reported the results of TAP blocks in laparoscopic surgery and eight in both laparoscopic and open surgery. The need for opioids and the intensity of pain at rest within 24 h after laparoscopic and combined (laparoscopic and open) surgeries were significantly lower in the TAP block group compared with the “no block” group. The intensity of pain during coughing within 24 hours after laparoscopic surgery was significantly lower in the TAP block groups compared to the groups without block. There were no statistically significant differences between the TAP block and “no block” groups in overall (over the entire hospital stay) postoperative opioid consumption and length of hospital stay after laparoscopic surgery, as well as in postoperative nausea and vomiting after laparoscopic and combined surgeries.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
| | - Mina Aubakirova
- Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
| | - Yerkin G Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
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19
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Erten O, Isiktas G, Avci SN, Berber E. The efficacy of laparoscopic transversus abdominis plane block on reducing postoperative narcotic usage in patients undergoing minimally invasive adrenalectomy. Surg Endosc 2022; 36:7204-7209. [PMID: 35112141 DOI: 10.1007/s00464-022-09076-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-operative pain relief after abdominal operations is critical for patient satisfaction and rapid recovery. Narcotics have been a traditional part of postoperative analgesia, with transversus abdominis plane (TAP) block introduced recently. The aim of this study is to assess the efficacy of laparoscopic TAP block on postoperative pain control in patients undergoing minimally invasive adrenalectomy. METHODS This was an institutional review board-approved retrospective study. Parameters related to postoperative pain control were compared between patients who underwent robotic transabdominal lateral adrenalectomy with (after December 2018) or without laparoscopic TAP block (control group) (before December 2018) by one surgeon. Statistics were performed using Mann Whitney U and Chi-square tests. RESULTS There were 86 patients in the TAP and 83 patients in the control group. Groups were similar regarding demographic and clinical parameters. Despite the availability of intravenous acetaminophen to a higher percentage of patients in the control (31.3%) versus the TAP group (8.1%), 0-24 h lowest postoperative pain scores were significantly lower in the TAP group (P < 0.0001). In TAP versus control group, percentage of patients requiring narcotics and amount of narcotics used was lower (P = 0.04 vs P = 0.0004, respectively). Mainly due to less pain-related over-stay, percentage of patients requiring more than a day of hospital stay was less in the TAP (12%) versus control group (18%) (P = 0.01). CONCLUSION To our knowledge, the utility of TAP block in patients undergoing minimally invasive adrenalectomy has not been reported in the past. This study shows that there may be benefits of laparoscopic TAP block in reducing post-operative narcotic usage while improving pain control in these patients.
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Affiliation(s)
- Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Gizem Isiktas
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Seyma N Avci
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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20
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Kappenschneider T, Meyer M, Maderbacher G, Parik L, Leiss F, Quintana LP, Grifka J. [Delirium-an interdisciplinary challenge]. DER ORTHOPADE 2022; 51:106-115. [PMID: 35037987 DOI: 10.1007/s00132-021-04209-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Delirium is a common and potentially life-threatening disease that often poses major problems for hospitals in terms of care. It mainly affects older patients and is multifactorial, especially in older people. Permanent functional and cognitive impairments after delirium are not uncommon in geriatric patients. DIAGNOSTIC Often, delirious syndromes are not recognized or are misinterpreted. This is especially the case with the hypoactive form of delirium. Various screening and test procedures are available for the detection of delirium, the routine use of which is essential. TREATMENT In many cases, delirium can be avoided with suitable preventive measures. Above all, nondrug prevention strategies and multidimensional approaches play an important role here. For the drug treatment of delirium in geriatric patients, low-potency, classic and atypical neuroleptics, as well as dexmedetomidine for severe courses are recommended.
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Affiliation(s)
- Tobias Kappenschneider
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Matthias Meyer
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Günther Maderbacher
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Lukas Parik
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Franziska Leiss
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Loreto Pulido Quintana
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Joachim Grifka
- Klinik und Poliklinik für Orthopädie, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Tejedor A, Deiros C, García M, Vendrell M, Gómez N, Gómez E, Masdeu J. Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial. Braz J Anesthesiol 2021; 72:253-260. [PMID: 33915192 PMCID: PMC9373262 DOI: 10.1016/j.bjane.2021.03.021] [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: 01/30/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our goal was to evaluate whether TAP block offers the same analgesic pain control compared to epidural technique in laparoscopic radical prostatectomy surgery through the morphine consumption in the first 48 hours. METHODS In this study, 45 patients were recruited and assigned to either TAP or epidural. The main study outcome was morphine consumption during the first 48 hours after surgery. Other data recorded were pain at rest and upon movement, technique-related complications and adverse effects, surgical and postoperative complications, length of surgery, need for rescue analgesia, postoperative nausea and vomiting, start of intake, sitting and perambulation, first flatus, and length of in-hospital stay. RESULTS From a total of 45 patients, two were excluded due to reconversion to open surgery (TAP group = 20; epidural group = 23). There were no differences in morphine consumption (0.96 vs. 0.8 mg; p = 0.78); mean postoperative VAS pain scores at rest (0.7 vs. 0.5; p = 0.72); or upon movement (1.6 vs. 1.6; p = 0.32); in the TAP vs. epidural group, respectively. Sitting and perambulation began sooner in TAP group (19 vs. 22 hours, p = 0.03; 23 vs. 32 hours, p = 0.01; respectively). The epidural group had more technique-related adverse effects. CONCLUSION TAP blocks provide the same analgesic quality with optimal pain control than epidural technique, with less adverse effects.
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Affiliation(s)
- Ana Tejedor
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain.
| | - Carme Deiros
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
| | - Marta García
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
| | - Marina Vendrell
- Hospital Clínic de Barcelona, Departamento de Anestesiología, Barcelona, Spain
| | - Nuria Gómez
- Hospital Sant Joan Despí Moisès Broggi, Servicio de Enfermería, Barcelona, Spain
| | - Esther Gómez
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Urología, Barcelona, Spain
| | - Josep Masdeu
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
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Lee SU, Lee HJ, Kim YS. The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial. J Orthop Surg Res 2020; 15:523. [PMID: 33176845 PMCID: PMC7659046 DOI: 10.1186/s13018-020-02060-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair. Methods In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale. Results The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. Conclusions Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence Level I, randomized controlled trials, treatment study
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Affiliation(s)
- Sang-Uk Lee
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
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Luo M, Song B, Zhu J. Sleep Disturbances After General Anesthesia: Current Perspectives. Front Neurol 2020; 11:629. [PMID: 32733363 PMCID: PMC7360680 DOI: 10.3389/fneur.2020.00629] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this article is to review (1) sleep mechanism under general anesthesia, harmful effects of postoperative sleep disturbances; (2) risk factors associated with postoperative sleep disturbances; (3) measures to prevent and improve postoperative sleep disturbances. General anesthesia changes the postoperative sleep structure especially in elderly patients after major surgery and results in a high incidence rate of sleep disturbances. Sleep disturbances produce harmful effects on postoperative patients and lead to a higher risk of delirium, more cardiovascular events, and poorer recovery. Some researchers do propose non-pharmacological treatments such as attention to environmental and psychological factors, application of electroacupuncture (EA) technology and pharmacological treatments are helpful, but larger high-quality clinical trials with longer following-up are needed to further investigate the efficacy and safety.
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Affiliation(s)
- Man Luo
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Benato L, Murrell JC, Blackwell EJ, Saunders R, Rooney N. Analgesia in pet rabbits: a survey study on how pain is assessed and ameliorated by veterinary surgeons. Vet Rec 2020; 186:603. [PMID: 32303663 DOI: 10.1136/vr.105071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/29/2020] [Accepted: 03/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the last 20 years, two studies on the veterinary use of perioperative analgesia in small mammals reported a limited use of analgesics in rabbits but suggested an increasing use over the years. The aim of this study was to better understand how pain is treated and ameliorated in rabbits while under veterinary care. METHODS An online survey of 60 questions was developed and advertised at national and international veterinary conferences, in veterinary publications and on social media. RESULTS In total 94.3 per cent of the respondents routinely administered nonsteroidal anti-inflammatory drugs (NSAIDs) to rabbits undergoing surgical procedures such as neutering, 71.4 per cent administered an opioid and 70.3 per cent routinely administered multimodal analgesia, although dosages do not always match current consensus opinion. Buprenorphine and meloxicam were the most common analgesic drugs prescribed by the respondents. The dosage of meloxicam administered both parenterally and orally varied widely. CONCLUSION Rabbit analgesia has improved over recent years similarly to the trend seen in other companion animals. However, overall it seems that pain assessment is still limited in rabbits. The lack of multimodal composite pain scales specific for rabbits makes this task even more challenging.
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Affiliation(s)
- Livia Benato
- Animal Welfare and Behaviour, School of Veterinary Sciences, University of Bristol, Langford, UK
| | - Joanna C Murrell
- School of Veterinary Sciences, University of Bristol, Langford, UK
| | - Emily Jayne Blackwell
- Animal Welfare and Behaviour, School of Veterinary Sciences, University of Bristol, Langford, UK
| | - Richard Saunders
- Rabbit Welfare Association and Fund, Enigma House, Culmhead Business Centre, Taunton, UK
| | - Nicola Rooney
- Animal Welfare and Behaviour, School of Veterinary Sciences, University of Bristol, Langford, UK
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Peltrini R, Cantoni V, Green R, Greco PA, Calabria M, Bucci L, Corcione F. Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:787-802. [PMID: 32253612 DOI: 10.1007/s10151-020-02206-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multimodal opioid-sparing analgesia is a key component of the enhanced recovery after surgery (ERAS) protocol for postoperative pain management. Transversus abdominis plane (TAP) block has contributed to the implementation of this approach in different kinds of surgical procedures. The aim of this study was to evaluate the efficacy of TAP block and its impact on recovery in colorectal surgery. METHODS A comprehensive literature search of the PubMed, Embase, and Scopus databases was conducted. Studies that compared TAP block to a control group (no TAP block or placebo) after colorectal resections were included. The effects of TAP block in patients undergoing colorectal surgery were assessed, including the technical aspects of the procedure. Two measures were used to evaluate the effectiveness of postoperative pain control: a numeric pain rating score at rest and on coughing or movement at 24 h following surgery and the opioid requirement at 24 h. Clinical aspects of recovery were postoperative ileus, surgical site infection, postoperative nausea and vomiting, and length of hospital stay. RESULTS Sixteen studies were included in the analysis. Data showed that TAP block is a safe procedure associated with a significant reduction in the pain score at rest [WMD - 0.91 (95% CI - 1.56; - 0.27); p < 0.05] and on coughing or movement [WMD - 0.36 (95% CI - 0.72; - 0.01); p < 0.05] at 24 h after surgery and a significant decrease in morphine consumption in the TAP block group the day after surgery [WMD - 2.07 (95% CI - 2.63; - 1.51); p < 0.001]. CONCLUSIONS TAP block appears to provide both an effective analgesia and a significant reduction in opioid use on the first postoperative day after colorectal surgery. Its use does not seem to lead to increased postoperative complications.
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Affiliation(s)
- R Peltrini
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - V Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - R Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - P A Greco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - L Bucci
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - F Corcione
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Melesse DY, Chekol WB, Tawuye HY, Denu ZA, Agegnehu AF. Assessment of the analgesic effectiveness of rectus sheath block in patients who had emergency midline laparotomy: Prospective observational cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lee J, Kim S. The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study. Medicine (Baltimore) 2019; 98:e15385. [PMID: 31045789 PMCID: PMC6504301 DOI: 10.1097/md.0000000000015385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/02/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. METHODS We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. RESULTS Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 μg vs 1047.7 μg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups. CONCLUSIONS Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS.
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Affiliation(s)
- Jungwon Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Benato L, Rooney NJ, Murrell JC. Pain and analgesia in pet rabbits within the veterinary environment: a review. Vet Anaesth Analg 2018; 46:151-162. [PMID: 30737017 DOI: 10.1016/j.vaa.2018.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/11/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide an overview of pain and analgesia in rabbits with the aim of developing a more accurate understanding of these topics. To illustrate and discuss the areas that have advanced in recent years and those that still require further research. DATABASES USED Three key subject resources were used: Web of Science, Medline and CAB Abstracts. Search terms were rabbits, lagomorphs, laboratory animals, pet, pain, surgical procedures, ovariohysterectomy, orchiectomy, castration, analgesia, opioids, and non-steroidal anti-inflammatory drugs. References from books and articles relevant to the topics were also included. CONCLUSIONS Rabbit medicine has improved over the last 20 years, but the literature suggests that pain management in this species is still inadequate and veterinary professionals believe their knowledge of pain and analgesia in this species is limited. Assessment and quantification of pain in rabbits can be challenging in a clinical environment not only because, as a prey species, rabbits tend to hide signs of pain but also because there are no validated methods to assess pain, except the Rabbit Grimace Scale, which is based on only one rabbit breed. Current consensus is that perioperative multimodal analgesia is the best practice. However, it is not widely used in rabbits. In rabbits, analgesia protocols and dosages reported in the literature are often poorly researched and do not result in complete pain amelioration with the return of normal. The present literature on rabbit pain and analgesia presents gaps either due to unexplored areas or insufficient findings. Further research should focus on these areas with the aim of improving the welfare of rabbits within a veterinary clinic.
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Affiliation(s)
- Livia Benato
- Animal Welfare and Behaviour, School of Veterinary Sciences, University of Bristol, Langford, UK.
| | - Nicola J Rooney
- Animal Welfare and Behaviour, School of Veterinary Sciences, University of Bristol, Langford, UK
| | - Jo C Murrell
- School of Veterinary Sciences, University of Bristol, Langford, UK
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Babazade R, Saasouh W, Naylor AJ, Makarova N, Udeh CI, Turan A, Udeh BL. The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management. J Clin Anesth 2018; 53:56-63. [PMID: 30326379 DOI: 10.1016/j.jclinane.2018.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/29/2018] [Accepted: 10/07/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE Intravenous patient-controlled opioid analgesia (IVPCA), epidural analgesia and transversus abdominis plane (TAP) infiltrations are frequently used postoperative pain management modalities. The aim of this study was to conduct a cost-effectiveness analysis comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively in patients undergoing major lower abdominal surgery. DESIGN Retrospective cost effectiveness analysis. SETTING Operating room. PATIENTS We obtained data on major lower-abdominal surgeries performed under general anesthesia on adult patients between January 2012 and July 2014. INTERVENTIONS A cost-effectiveness analysis was comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively. MEASUREMENTS A decision analytic model was used to estimate the health outcomes for patients undergoing major lower abdominal surgery. The primary outcome was time-weighted pain from 0 to 72 h after surgery, as measured by numerical rating scale pain scores. The analysis was conducted from the perspective of the hospital as the party responsible for most costs related to surgery. MAIN RESULTS From the base case analysis, IVPCA was the optimal strategy regarding cost and effect. TAP with LB, however, was only narrowly dominated, while epidural was clearly dominated. From the sensitivity analysis at willingness-to-pay (WTP) of $150, IV PCA and TAP infiltration were each the optimal strategy for approximately 50% of the iterations. At WTP of $10,000, epidural was only the optimal strategy in 10% of the iterations. CONCLUSIONS This is the first study in the literature to compare the cost-effectiveness of epidural, IVPCA, and TAP infiltrations with LB. Within reasonable WTP values, there is little differentiation in cost-effectiveness between IVPCA and TAP infiltration with LB. Epidural does not become a cost-effective strategy even at much higher WTP values.
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Affiliation(s)
- Rovnat Babazade
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Outcomes Research Consortium, Cleveland Clinic, OH, USA
| | - Wael Saasouh
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Amanda J Naylor
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Natalya Makarova
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Chiedozie I Udeh
- Department of Cardiothoracic Anesthesiology and the Center for Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Belinda L Udeh
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Quality Institute, and Neurology Institute Center for Outcomes Research (NICORe), USA
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Lau LLN, Li CY, Lee A, Chan SKC. The use of 5% lidocaine medicated plaster for acute postoperative pain after gynecological surgery: A pilot randomized controlled feasibility trial. Medicine (Baltimore) 2018; 97:e12582. [PMID: 30278568 PMCID: PMC6181576 DOI: 10.1097/md.0000000000012582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine the feasibility and potential efficacy of 5% lidocaine medicated plaster for acute postoperative pain in a parallel, blinded, randomized controlled pilot trial. METHODS Twenty-eight women undergoing elective gynecological surgery with midline incisions were randomly allocated 5% lidocaine medicated patch (Lignopad) or placebo plasters. Postoperative pain at rest and on movement at 24 hours were the primary study endpoints, with secondary endpoints of postoperative pain within the first 48 hours, cumulative morphine consumption (mg), predicted peak flow rate (PFR) (%) and adverse effects. We assessed pain scores at rest and on movement using the visual analogue scale (0-100). RESULTS The lidocaine patch group had lower postoperative pain scores at rest at 24 hours (mean difference [MD] -15.1, 95% confidence interval [95% CI] -28.3 to -2.0; P = .024) but not on movement at 24 hours (MD -6.4, 95% CI -22.7 to 9.9; P = .445). Compared to placebo, lidocaine may slightly lower cumulative morphine consumption (mg) over time (MD -3.4, 95% CI -6.9 to 0.2; group*time interaction P = .065). The difference in improvement in the PFR over time after surgery between groups appeared small (group*time P = .0980). No adverse effects occurred. CONCLUSIONS Lidocaine patch may provide a clinically important reduction in postoperative pain intensity. A larger trial to confirm the efficacy and safety of lidocaine patch is feasible after modifying the inclusion criteria and collecting patient-centered outcomes, such as quality of recovery and patient satisfaction.
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Affiliation(s)
- Lydia LN Lau
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
| | - Cheuk Yin Li
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Simon KC Chan
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
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Gutiérrez-Bautista ÁJ, Morgaz J, Granados MDM, Gómez-Villamandos RJ, Dominguez JM, Fernandez-Sarmiento JA, Aguilar-García D, Navarrete-Calvo R. Evaluation and comparison of postoperative analgesic effects of dexketoprofen and methadone in dogs. Vet Anaesth Analg 2018; 45:820-830. [PMID: 30316696 DOI: 10.1016/j.vaa.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 04/03/2018] [Accepted: 06/08/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate and compare the analgesic efficacy and adverse effects of dexketoprofen and methadone using a noninferiority trial, during the first 24 postoperative hours in dogs undergoing orthopaedic surgery. STUDY DESIGN Randomized, blinded clinical study. ANIMALS A total of 38 healthy dogs undergoing orthopaedic surgery. METHODS Dogs were premedicated with dexmedetomidine [1 μg kg-1 intravenously (IV)] followed by dexketoprofen (1 mg kg-1 IV; group DK) or methadone (0.2 mg kg-1 IV; group M). Anaesthesia was induced with propofol and maintained with isoflurane in 60% oxygen. Postoperatively, dexketoprofen was administered every 8 hours (group DK) and methadone every 4 hours (group M). Analgesia was assessed at baseline and at 1, 2, 4, 6, 18 and 24 hours after extubation using a dynamic and interactive visual analogue scale (DIVAS), the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF), mechanical wound thresholds (MWTs) and plasma cortisol levels. If CMPS-SF score was ≥5, rescue analgesia was administered. Data were analysed using a general linear mixed model, Mann-Whitney U test and chi-squared test as appropriate; a p value <0.05 was considered significant. RESULTS The CMPS-SF and DIVAS scores were significantly higher in group M compared with group DK and remained higher for a longer period in group M, although the differences were not clinically significant. No significant differences were found in MWT assessment between groups. Plasma cortisol level significantly increased 2 hours after extubation, without significant differences between treatments. Rescue analgesia was administered to three animals (one in group DK; two in group M). CONCLUSION AND CLINICAL RELEVANCE We conclude that 1 mg kg-1 IV dexketoprofen administered every 8 hours during the first 24 hours postoperatively is noninferior to methadone in controlling pain after orthopaedic surgery in dog, although frequent pain assessments are recommended to adjust the analgesia plan.
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Affiliation(s)
- Álvaro J Gutiérrez-Bautista
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Juan Morgaz
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain.
| | - María Del Mar Granados
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Rafael J Gómez-Villamandos
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Juan M Dominguez
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - José A Fernandez-Sarmiento
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Daniel Aguilar-García
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Rocío Navarrete-Calvo
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
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Interfascial intercostal nerves block. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND Pelvic exenterations are extensive surgical procedures for locally advanced or recurrent malignancies of the pelvis. However, this is often at the cost of significant morbidity due to perioperative pain, which has been poorly studied. OBJECTIVE This study aims to review perioperative pain management in patients undergoing pelvic exenteration. DESIGN This is a retrospective review of patients undergoing pelvic exenteration between January 2013 and December 2014. Data were gathered from medical records and a prospectively maintained database. SETTING This study was conducted at a single quaternary referral center for pelvic exenteration. PATIENTS Consecutive patients underwent pelvic exenteration at a single center. INTERVENTIONS Pelvic exenteration was performed in consecutive patients. MAIN OUTCOMES MEASURES Primary outcomes were the prevalence of preoperative pain, preoperative opiate use (type, dosage), and postoperative pain (verbal numerical rating scale). Secondary outcomes included the number of pain consultations and correlations between preoperative opiate use, length of stay, and extent of resection (en bloc sacrectomy and nerve excision). RESULTS Ninety-nine patients underwent pelvic exenteration. Sixty-one patients (61.6%) underwent major nerve resection and/or sacrectomy. Thirty patients (30%) required opiates preoperatively, with a mean daily morphine equivalent of 72.9 mg (SD 65.0 mg). Patients on preoperative opiates were more likely to have worse pain postoperatively and to require higher opiate doses and more pain consultations (9.3 vs 4.8; p < 0.001). Major nerve excision and sacrectomy were not associated with worse postoperative pain. By discharge, 60% still required opiate analgesia. LIMITATIONS Retrospective study design, the subjective nature of pain assessment because of a lack of valid methods to objectively quantify pain, and the lack of long-term follow-up were limitations of this study. CONCLUSIONS Perioperative pain is a significant issue among patients undergoing pelvic exenteration. One in three patients require high-dose opiates preoperatively that is associated with worse pain outcomes. Potential areas to improve pain outcomes in these complex patients could include increased use of regional anesthesia, antineuropathic agents, and opiate-sparing techniques. See Video Abstract at http://links.lww.com/DCR/A572.
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Bustamante R, Daza MA, Canfrán S, García P, Suárez M, Trobo I, Gómez de Segura IA. Comparison of the postoperative analgesic effects of cimicoxib, buprenorphine and their combination in healthy dogs undergoing ovariohysterectomy. Vet Anaesth Analg 2018; 45:545-556. [PMID: 29716837 DOI: 10.1016/j.vaa.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the noninferior postoperative analgesic efficacy of cimicoxib compared to buprenorphine following elective ovariohysterectomy in healthy bitches. STUDY DESIGN Prospective, randomized, blinded, controlled clinical trial. ANIMALS A total of 63 healthy dogs. METHODS To provide perioperative analgesia, cimicoxib 2 mg kg-1 (orally), buprenorphine 0.02 mg kg-1 (two doses, intramuscularly), or both drugs combined, were administered. Dogs were sedated with acepromazine and anaesthetized with propofol and isoflurane. Pain was assessed with the short form of the Glasgow Composite Pain Scale (GCPS), a pain numerical rating scale (NRS) and mechanical nociceptive thresholds (MNT), preoperatively and at 1, 2, 4, 6, 20 and 23 hours after extubation. Sedation was also scored at the same time points. A noninferiority approach was employed to determine the efficacy of cimicoxib compared to buprenorphine. Treatment groups were compared with parametric [analysis of variance (anova), t test] and nonparametric test as appropriate (Kruskal-Wallis, chi-square). RESULTS The GCPS, pain NRS and MNT tests demonstrated noninferiority of cimicoxib compared to buprenorphine (rejection of inferiority: p < 0.001, all). Furthermore, cimicoxib provided better analgesia compared to buprenorphine alone according to the GCPS (p < 0.01) and NRS (p < 0.05), but not the MNT. Conversely, an increase in the analgesic effect when cimicoxib was combined with buprenorphine was only observed with the MNT (p < 0.01). There were no differences in rescue analgesia requirements both intra- and postoperatively between treatments. Gastrointestinal side effects were increased in dogs administered cimicoxib, whereas dogs treated with buprenorphine had higher sedation scores 1-hour postoperatively and required lower doses of propofol for the induction of anaesthesia. CONCLUSIONS AND CLINICAL RELEVANCE Cimicoxib has noninferior postoperative analgesic efficacy compared to buprenorphine, and both drugs have comparable analgesic effects for the control of postoperative pain in bitches undergoing ovariohysterectomy.
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Affiliation(s)
- Rocío Bustamante
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - María A Daza
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Susana Canfrán
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Paloma García
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - María Suárez
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Trobo
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Ignacio A Gómez de Segura
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.
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Holmes R, Smith SR, Carroll R, Holz P, Mehrotra R, Pockney P. Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks. ANZ J Surg 2017; 88:786-791. [DOI: 10.1111/ans.14317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Ryan Holmes
- The University of Newcastle; Newcastle New South Wales Australia
| | - Stephen R. Smith
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Colorectal Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rosemary Carroll
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Phillip Holz
- Department of Anaesthesia and Intensive Care; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rahul Mehrotra
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Peter Pockney
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
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Intraoperative Techniques for the Plastic Surgeon to Improve Pain Control in Breast Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1522. [PMID: 29263948 PMCID: PMC5732654 DOI: 10.1097/gox.0000000000001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. In recent years, there has been a growing emphasis placed on reducing length of hospital stay and health costs associated with breast surgery. Adequate pain control is an essential component of enhanced recovery after surgery. Postoperative pain management strategies include use of narcotic analgesia, non-narcotic analgesia, and local anesthetics. However, these forms of pain control have relatively brief durations of action and multiple-associated side effects. Intraoperative regional blocks have been effectively utilized in other areas of surgery but have been understudied in breast surgery. The aim of this article was to review various intraoperative techniques for regional anesthesia and local pain control in breast surgery and to highlight areas of future technique development.
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Abstract
BACKGROUND Hip hemiarthroplasty and dynamic hip screw (DHS) fixation are common procedures performed in trauma units, but there is little information regarding perioperative pain experience with respect to these treatment modalities. PURPOSE To evaluate the relationship between pain, analgesia requirements, and type of procedure for hip fracture surgery. METHODS An analysis was performed on consecutive patients presenting with a hip fracture in 2 hospitals over 2 years. Patients with a diagnosis of dementia were excluded because of the limitations of pain assessment. Postoperative pain scores were taken from standardized patient observation charts. Perioperative opiate consumption was calculated from inpatient drug charts. RESULTS A total of 357 patients were studied; 205 patients (53%) underwent a cemented hemiarthroplasty and 152 (47%) had fixation with a DHS. Patients who underwent a DHS fixation had more pain than those who had a hemiarthroplasty and required almost double the amount of opiates. CONCLUSION The reason for the elevated pain scores and higher morphine requirement in the DHS group (DG) remains unclear. It could be related to highly sensitive periosteum reaction in the DG. It is important to recognize the difference in pain experienced between the groups, and analgesia should be tailored toward the individual based upon clinical assessment and knowledge of the surgery performed. A comprehensive understanding of this principle will allow for improved perioperative surgical care and patient experience.
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Qazi N, Bhat WM, Iqbal MZ, Wani AR, Gurcoo SA, Rasool S. Postoperative Analgesic Efficacy of Bilateral Transversus Abdominis Plane Block in Patients Undergoing Midline Colorectal Surgeries Using Ropivacaine: A Randomized, Double-blind, Placebo-controlled Trial. Anesth Essays Res 2017; 11:767-772. [PMID: 28928585 PMCID: PMC5594804 DOI: 10.4103/0259-1162.194577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. Materials and Methods: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. Results: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). Conclusion: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.
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Affiliation(s)
- Nahida Qazi
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Wasim Mohammad Bhat
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Malik Zaffar Iqbal
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Anisur Rehman Wani
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Showkat A Gurcoo
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sahir Rasool
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Effective Target Concentration of Sufentanil Combined With Sevoflurane Anesthesia for Abdominal Surgery: A Dose-Response Study. Int Surg 2017. [DOI: 10.9738/intsurg-d-14-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was designed to investigate the effects of target-controlled infusion (TCI) of sufentanil with sevoflurane anesthesia on hemodynamics and postoperative recovery of abdominal surgery. Target-controlled infusion of opioid analgesics provides efficient drug use, allowing an accurate achievement of the desired analgesia level and fewer overdose-induced adverse effects. A total of 80 patients receiving abdominal surgery (surgery for gastric cancer or colorectal cancer) were divided into 4 groups to receive anesthesia with sevoflurane accompanied with different doses of sufentanil (0.4, 0.6, 0.8, or 1.0 ng/mL). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, times to recovery of spontaneous respiration, eye opening, extubation, and orientation were recorded. Hemodynamic measurements were compared among groups. Comparison between the 2 groups of subjects was made with one-way analysis of variance (ANOVA), LSD-t test, or χ2 test. Although sufentanil at 0.8 and 1.0 ng/mL maintained stable perioperative hemodynamics, the higher dose was associated with increased incidence of bradycardia following intubation (10/19 cases, 52.6%; P < 0.05). Additionally, no differences were observed in the incidence of hypotension, hypertension, or tachycardia between groups (P > 0.05). Increased dose of sufentanil was associated with delayed postoperative recovery. These results demonstrate that TCI at 0.8 ng/mL sufentanil accompanied with sevoflurane anesthesia is a suitable anesthetic regimen for abdominal surgery.
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Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study. Sci Rep 2016; 6:30354. [PMID: 27578313 PMCID: PMC5005994 DOI: 10.1038/srep30354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function.
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Kim H, Ku SY, Kim HC, Suh CS, Kim SH, Choi YM. Effects of Anesthetic Agent Propofol on Postoperative Sex Hormone Levels. Geburtshilfe Frauenheilkd 2016; 76:408-412. [PMID: 27134297 DOI: 10.1055/s-0041-111571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction: Several studies have found anesthetic agents including propofol in ovarian follicular fluid. However, little is known about the effect of anesthetic agents on ovarian function. We aimed to investigate whether there were differences in the postoperative levels of sex hormones when propofol was used as the anesthetic agent. Methods: A retrospective review was done of 80 patients who underwent ovarian surgery, with 72 infertile women serving as controls. Patients were included in the study if their serum estradiol (E2) and follicle stimulating hormone (FSH) levels were measured during their first postoperative menstrual cycle. Results: Patients were grouped according to the use or non-use of propofol as follows: propofol group (n = 39) and non-propofol group (n = 41). The control group did not undergo surgery. Postoperative E2 levels did not differ between the three groups, but FSH levels were significantly higher in the patients who had undergone surgery compared to controls (p < 0.05). Post-hoc analysis of E2 and FSH levels in the propofol and non-propofol groups did not show any significant differences. Conclusions: The use of propofol did not result in any differences compared to other anesthetic agents in terms of postoperative sex hormone levels after gynecologic surgery. The type of anesthetic agent does not seem to affect the postoperative levels of female sex hormones.
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Affiliation(s)
- H Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-Y Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H C Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - C S Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S H Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Y M Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2016; 3:CD005563. [PMID: 26967259 PMCID: PMC10431752 DOI: 10.1002/14651858.cd005563.pub3] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Delirium is a common mental disorder, which is distressing and has serious adverse outcomes in hospitalised patients. Prevention of delirium is desirable from the perspective of patients and carers, and healthcare providers. It is currently unclear, however, whether interventions for preventing delirium are effective. OBJECTIVES To assess the effectiveness of interventions for preventing delirium in hospitalised non-Intensive Care Unit (ICU) patients. SEARCH METHODS We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 4 December 2015 for all randomised studies on preventing delirium. We also searched MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Central (The Cochrane Library), CINAHL (EBSCOhost), LILACS (BIREME), Web of Science core collection (ISI Web of Science), ClinicalTrials.gov and the WHO meta register of trials, ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) of single and multi- component non-pharmacological and pharmacological interventions for preventing delirium in hospitalised non-ICU patients. DATA COLLECTION AND ANALYSIS Two review authors examined titles and abstracts of citations identified by the search for eligibility and extracted data independently, with any disagreements settled by consensus. The primary outcome was incidence of delirium; secondary outcomes included duration and severity of delirium, institutional care at discharge, quality of life and healthcare costs. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes; and between group mean differences and standard deviations for continuous outcomes. MAIN RESULTS We included 39 trials that recruited 16,082 participants, assessing 22 different interventions or comparisons. Fourteen trials were placebo-controlled, 15 evaluated a delirium prevention intervention against usual care, and 10 compared two different interventions. Thirty-two studies were conducted in patients undergoing surgery, the majority in orthopaedic settings. Seven studies were conducted in general medical or geriatric medicine settings.We found multi-component interventions reduced the incidence of delirium compared to usual care (RR 0.69, 95% CI 0.59 to 0.81; seven studies; 1950 participants; moderate-quality evidence). Effect sizes were similar in medical (RR 0.63, 95% CI 0.43 to 0.92; four studies; 1365 participants) and surgical settings (RR 0.71, 95% CI 0.59 to 0.85; three studies; 585 participants). In the subgroup of patients with pre-existing dementia, the effect of multi-component interventions remains uncertain (RR 0.90, 95% CI 0.59 to 1.36; one study, 50 participants; low-quality evidence).There is no clear evidence that cholinesterase inhibitors are effective in preventing delirium compared to placebo (RR 0.68, 95% CI, 0.17 to 2.62; two studies, 113 participants; very low-quality evidence).Three trials provide no clear evidence of an effect of antipsychotic medications as a group on the incidence of delirium (RR 0.73, 95% CI, 0.33 to 1.59; 916 participants; very low-quality evidence). In a pre-planned subgroup analysis there was no evidence for effectiveness of a typical antipsychotic (haloperidol) (RR 1.05, 95% CI 0.69 to 1.60; two studies; 516 participants, low-quality evidence). However, delirium incidence was lower (RR 0.36, 95% CI 0.24 to 0.52; one study; 400 participants, moderate-quality evidence) for patients treated with an atypical antipsychotic (olanzapine) compared to placebo (moderate-quality evidence).There is no clear evidence that melatonin or melatonin agonists reduce delirium incidence compared to placebo (RR 0.41, 95% CI 0.09 to 1.89; three studies, 529 participants; low-quality evidence).There is moderate-quality evidence that Bispectral Index (BIS)-guided anaesthesia reduces the incidence of delirium compared to BIS-blinded anaesthesia or clinical judgement (RR 0.71, 95% CI 0.60 to 0.85; two studies; 2057 participants).It is not possible to generate robust evidence statements for a range of additional pharmacological and anaesthetic interventions due to small numbers of trials, of variable methodological quality. AUTHORS' CONCLUSIONS There is strong evidence supporting multi-component interventions to prevent delirium in hospitalised patients. There is no clear evidence that cholinesterase inhibitors, antipsychotic medication or melatonin reduce the incidence of delirium. Using the Bispectral Index to monitor and control depth of anaesthesia reduces the incidence of postoperative delirium. The role of drugs and other anaesthetic techniques to prevent delirium remains uncertain.
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Affiliation(s)
- Najma Siddiqi
- University of YorkDepartment of Health SciencesHeslingtonYorkNorth YorkshireUKY010 5DD
| | - Jennifer K Harrison
- University of EdinburghCentre for Cognitive Ageing and Cognitive Epidemiology and the Alzheimer Scotland Dementia Research CentreDepartment of Geriatric Medicine, The Royal Infirmary of Edinburgh, Room S164251 Little France CrescentEdinburghUKEH16 4SB
| | - Andrew Clegg
- University of LeedsAcademic Unit of Elderly Care and RehabilitationBradford Institute for Health ResearchBradfordUKBD9 6RJ
| | - Elizabeth A Teale
- University of LeedsAcademic Unit of Elderly Care and RehabilitationBradford Institute for Health ResearchBradfordUKBD9 6RJ
| | - John Young
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationBradfordUK
| | - James Taylor
- Bradford Teaching Hospitals NHS Foundation TrustDepartment of AnaesthesiaBradfordUKBD9 6RJ
| | - Samantha A Simpkins
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationBradfordUK
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Abstract
SUMMARY To improve postoperative pain management, several concepts have been developed, including preemptive analgesia, preventive analgesia, and multimodal analgesia. This article will discuss the role of these concepts in improving perioperative pain management. Preemptive analgesia refers to the administration of an analgesic treatment before the surgical insult or tissue injury. Several randomized clinical trials have, however, provided equivocal evidence regarding the benefits of preincisional compared with postincisional analgesic administration. Current general consensus, therefore, indicates that use of preemptive analgesia does not translate into consistent clinical benefits after surgery. Preventive analgesia is a wider concept where the timing of analgesic administration in relation to the surgical incision is not critical. The aim of preventive analgesia is to minimize sensitization induced by noxious stimuli arising throughout the perioperative period. Multimodal analgesia consists of the administration of 2 or more drugs that act by different mechanisms for providing analgesia. These drugs may be administered via the same route or by different routes. Thus, the aim of multimodal analgesia is to improve pain relief while reducing opioid requirements and opioid-related adverse effects. Analgesic modalities currently available for postoperative pain control include opioids, local anesthetic techniques [local anesthetic infiltration, peripheral nerve blocks, and neuraxial blocks (epidural and paravertebral)], acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2-specific inhibitors as well as analgesic adjuncts such as steroids, ketamine, α-2 agonists, and anticonvulsants.
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Gassman AA, Yoon AP, Festekjian J, Da Lio AL, Tseng CY, Crisera C. Comparison of immediate postoperative pain in implant-based breast reconstructions. J Plast Reconstr Aesthet Surg 2016; 69:604-16. [PMID: 26947947 DOI: 10.1016/j.bjps.2015.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implant-based techniques represent the most common form of breast reconstruction. However, substantial postoperative pain has been associated with implant-based breast reconstruction. OBJECTIVE The objective of this study is to evaluate immediate postoperative pain in implant-based breast reconstruction. METHODS We reviewed 378 patients who underwent implant-based reconstruction between January 2004 and December 2012. Each patient's visual analog scale (VAS) score, pain medication, and patient-controlled analgesia (PCA) attempts were used to assess in-hospital postoperative pain. We evaluated timing of reconstruction post mastectomy, tissue expander (TE) designed fill volume, TE initial fill volume, and single-stage immediate implant (II) versus TE reconstruction. RESULTS No significant differences in pain parameters were noted between the immediate and delayed postmastectomy reconstruction cohorts. TEs with larger (>300 cc) designed volumes required significantly more narcotic use (p = 0.02) and PCA attempts (p < 0.01). Narcotic use was higher in the larger (>250-cc) TE initial fill group starting on postoperative day 2, but overall differences in VAS score and PCA attempts were not significant. Morphine equivalence (p < 0.01) and non-opioid oral analgesic use (average p = 0.03) of the TE cohort were significantly higher than those of the II cohort. CONCLUSION Patients undergoing TE-based implant reconstruction show greater analgesic use than those with single-stage II-based reconstruction. This may indicate a higher immediate postoperative pain in TE procedures than in II procedures. Furthermore, higher initial fill and designed volume of TE require more morphine equivalence postoperatively. These findings may warrant further preoperative discussion for better pain management and patient satisfaction.
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Affiliation(s)
- Andrew A Gassman
- UT Southwestern, Department of Plastic Surgery, Dallas, TX Dallas, TX 75390, USA.
| | - Alfred P Yoon
- University of California Los Angeles, Division of Plastic & Reconstructive Surgery, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jaco Festekjian
- University of California Los Angeles, Division of Plastic & Reconstructive Surgery, Los Angeles, CA, USA
| | - Andrew L Da Lio
- University of California Los Angeles, Division of Plastic & Reconstructive Surgery, Los Angeles, CA, USA
| | - Charles Y Tseng
- University of California Los Angeles, Division of Plastic & Reconstructive Surgery, Los Angeles, CA, USA
| | - Chris Crisera
- University of California Los Angeles, Division of Plastic & Reconstructive Surgery, Los Angeles, CA, USA
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Jin F, Li XQ, Tan WF, Ma H, Lu HW. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels of patients with open midline incisions undergoing transabdominal gynaecological operation: study protocol for a randomised controlled trial. Trials 2015; 16:568. [PMID: 26652009 PMCID: PMC4676186 DOI: 10.1186/s13063-015-1096-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/01/2015] [Indexed: 12/15/2022] Open
Abstract
Background Rectus sheath block (RSB) is used for postoperative pain relief in patients undergoing abdominal surgery with midline incision. Preoperative RSB has been shown to be effective, but it has not been compared with postoperative RSB. The aim of the present study is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively versus postoperatively. Methods/Design This study is a prospective, randomised, controlled (randomised, parallel group, concealed allocation), single-blinded trial. All patients undergoing transabdominal gynaecological surgery will be randomised 1:1 to the treatment intervention with general anaesthesia as an adjunct to preoperative or postoperative RSB. The objective of the trial is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively (n = 32) versus postoperatively (n = 32). All of the patients, irrespective of group allocation, will receive patient-controlled intravenous analgesia (PCIA) with oxycodone. The primary objective is to compare the interval between leaving the post-anaesthesia care unit and receiving the first PCIA bolus injection on the first postoperative night between patients who receive preoperative versus postoperative RSB. The secondary objectives will be to compare (1) cumulative oxycodone consumption at 24 hours after surgery; (2) postoperative sleep quality, as measured using a BIS-Vista monitor during the first night after surgery; and (3) cytokine levels (interleukin-1, interleukin-6, tumour necrosis factor-α and interferon-γ) during surgery and at 24 and 48 hours postoperatively. Discussion Clinical experience has suggested that RSB is a very effective postoperative analgesic technique, and we will answer the following questions with this trial. Do preoperative block and postoperative block have the same duration of analgesic effects? Can postoperative block extend the analgesic time? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. Trial registration Current Controlled Trials NCT02477098 15 June 2015.
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Affiliation(s)
- Feng Jin
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Xiao-Qian Li
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Wen-Fei Tan
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Hong Ma
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Huang-Wei Lu
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
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Efficacy of multimodal analgesia injection combined with corticosteroids after arthroscopic rotator cuff repair. Orthop Traumatol Surg Res 2015; 101:S337-45. [PMID: 26563923 DOI: 10.1016/j.otsr.2015.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although arthroscopic rotator cuff repair is minimally invasive, there is still considerable postoperative pain, especially during the first 48 hours. The present study assessed the short-term efficacy and safety of multimodal analgesic (MMA) injection associated to corticosteroids in arthroscopic rotator cuff tear surgery. MATERIAL AND METHOD A single-center prospective randomized study included 50 patients undergoing arthroscopic rotator cuff tear surgery. The study group received subacromial injection of a mixture of morphine, ropivacaine and methylprednisolone associated to intra-articular injection of morphine plus methylprednisolone; the control group received only isotonic saline. All patients had had 24 hours self-administered morphine associated to standard analgesia. Postoperative data were recorded at 30 minutes and 1, 2, 4, 6, 12, 18 and 24 hours: pain intensity, morphine intake and side effects, and also time to first morphine bolus and additional analgesic intake. Constant, ASES and SST functional scores were recorded at 3 months. RESULTS Postoperative pain was significantly less intense in the MMA group than in controls at 30 min, H1, H4, H6, H12, H18 and H24 (P<0.05). A rebound at D10 occurred in both groups. During the first 24 hours, MMA significantly reduced cumulative resort to morphine (P<0.05 at H1/2, P<0.001 at H1-24). Mean time to first bolus was significantly longer in the MMA group (71.6 vs. 33 min; P<0.05). The rate of opioid-related side effects was similar between groups. At last follow-up, functional scores were similar between groups. There were no cases of infection or delayed skin healing. CONCLUSION MMA associated to corticosteroids after arthroscopic rotator cuff tear surgery provided immediate benefit in terms of analgesia and morphine sparing, without apparent risk of infection. The practice is presently little known in France and deserves longer-term assessment, especially as regards functional rehabilitation and tendon healing. LEVEL OF EVIDENCE 2.
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Smith SR, Draganic B, Pockney P, Holz P, Holmes R, Mcmanus B, Carroll R. Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial. Int J Colorectal Dis 2015; 30:1237-45. [PMID: 26099316 DOI: 10.1007/s00384-015-2286-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adequate postoperative analgesia is essential for recovery following colorectal surgery. Transversus abdominis plane (TAP) blocks have been found to be beneficial in improving pain following a variety of abdominal operations. The objective of this study was to determine if TAP blocks are useful in improving postoperative recovery following laparoscopic colorectal surgery. MATERIALS AND METHODS A prospective double-blind randomized clinical trial, involving 226 consecutive patients having laparoscopic colorectal surgery, was performed by a university colorectal surgical department. Patients were randomized to either TAP blockade using ultrasound guidance, or control, with the primary outcome being postoperative pain, as measured by analgesic consumption. Secondary outcomes assessed were pain visual analogue score (VAS), respiratory function, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. RESULTS A total of 142 patients were followed up to trial completion (74 controls, 68 interventions). Patients were well matched with regard to demographics. No complications occurred as a result of the intervention of TAP blockade. There was no difference between groups with regards to analgesic consumption (161 mEq morphine control vs 175 mEq morphine TAP; p = 0.596). There was no difference between the two groups with regards to the secondary outcomes of daily VAS, respiratory outcome, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. CONCLUSION We conclude that TAP blockade appears to be a safe intervention but confers no specific advantage following laparoscopic colorectal surgery.
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Affiliation(s)
- Stephen Ridley Smith
- Division of Surgery, John Hunter Hospital, University of Newcastle, Locked Bag 1, Hunter Regional Mail Centre, Newcastle, NSW, 2310, Australia,
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Tighe P, Buckenmaier CC, Boezaart AP, Carr DB, Clark LL, Herring AA, Kent M, Mackey S, Mariano ER, Polomano RC, Reisfield GM. Acute Pain Medicine in the United States: A Status Report. PAIN MEDICINE 2015; 16:1806-26. [PMID: 26535424 DOI: 10.1111/pme.12760] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Consensus indicates that a comprehensive,multimodal, holistic approach is foundational to the practice of acute pain medicine (APM),but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service,which is often unavailable or inconsistently applied.This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. METHODS A multidisciplinary panel was nominated through the APM Shared Interest Group of the American Academy of Pain Medicine. The panel met in Chicago, IL, in July 2014, to identify gaps and set priorities in APM research and education. RESULTS The panel identified three areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers,hospital administrators, and other key stake holders to convey the importance of APM. CONCLUSION This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain.
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Affiliation(s)
- Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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Review of the analgesia options for patients undergoing TRAM and DIEP flap breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1098-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee HJ, Kim YS, Park I, Ha DH, Lee JH. Administration of analgesics after rotator cuff repair: a prospective clinical trial comparing glenohumeral, subacromial, and a combination of glenohumeral and subacromial injections. J Shoulder Elbow Surg 2015; 24:663-8. [PMID: 25648969 DOI: 10.1016/j.jse.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/25/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Local analgesic injections are commonly used for pain relief after shoulder surgery. The aim of this study was to compare the efficacy of local injections administered in the glenohumeral joint, the subacromial space, or both locations after arthroscopic rotator cuff repair. METHODS Between March 2011 and December 2011, 121 consecutive patients who had undergone arthroscopic rotator cuff repair surgery were enrolled in the study and all patients were randomly allocated to 3 groups. In group 1, 40 patients received a postoperative glenohumeral injection of bupivacaine (20 mL) and lidocaine (10 mL). In group 2, 42 patients received the same postoperative injection, but it was administered in the subacromial space. In group 3, 39 patients received the same amount of local anesthesia but with half injected in the glenohumeral joint and half in the subacromial space. The visual analog scale was used to assess pain intensity before surgery and at postoperative hours 1, 2, 6, 12, and 24. Demerol was used as a postinjection rescue analgesic, and the total number of administrations was recorded at each time point. RESULTS There were no significant differences between groups in patient age, sex, or rotator cuff tear size (P > .05). The visual analog scale scores for pain between each group were not significantly different at any time point, including before surgery (P > .05). In addition, the amount of supplementary analgesic administered was not significantly different between the groups (P > .05). CONCLUSION Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Yang-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - In Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Ho Ha
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Jun-Hyung Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
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