Effect of General Anesthesia Combined with Transversus Abdominis Plane Block on Postoperative Sleep Disorders in Elderly Patients Undergoing Gastrointestinal Tumor Surgery: A Prospective, Randomized Controlled Trial

Purpose

The aim of this study was to investigate the effect of general anesthesia combined with transversus abdominis plane block on postoperative sleep disorders in elderly patients undergoing gastrointestinal tumor surgery.

Methods

For elderly patients with gastrointestinal malignant tumors, we recruited 94 patients, aged 65-80, who were scheduled for radical laparoscopic surgery. Using the random number table method, the patients were randomly divided into two groups, the general anesthesia group (group GA) and the general anesthesia combined with transversus abdominis plane block group (group GT). The group GA received the sedation-aspiration complex general anesthesia regimen, while the group GT underwent bilateral transversus abdominis plane blocks (TAPB) after the same induction of anesthesia. Group GA was injected bilaterally with equal amounts of saline in the same way. Sleep was monitored using wearable devices on the first day before surgery (P1) and the first and third day after surgery (D1 and D3). The Pittsburgh Sleep Quality Index(PSQI) scale was used to assess sleepiness and the occurrence of postoperative sleep disorders (POSD) on P1, D1 and D3 nights, respectively.

Results

Compared to the group GA, the group GT showed a significant decrease in remifentanil use during surgery (P<0.05). At D1, the group GT showed an increase in the ratio of deep sleep to rapid eye movement sleep (REM), along with a significant decrease in the number of wakefulness (P<0.05). At D3, the proportion of REM continued to increase and PSQI scores were significantly lower at both D1 and D3 (P<0.05). In addition, the incidence of POSD and the visual analog scores (VAS) at 0.5h and 6h postoperative activity in D1 showed a decreasing trend (P<0.05). However, no significant differences were observed between the two groups in general condition, intraoperative condition, remedial analgesia and number of analgesic pump presses (P>0.05).

Conclusion

General anesthesia combined with transversus abdominis plane block reduces the dosage of opioids in abdominal surgery, especially gastrointestinal surgery, alleviates postoperative pain in elderly gastrointestinal oncology patients, improves sleep quality, and reduces the incidence of sleep disorders.

Effect of desflurane maintenance on postoperative sleep quality in patients undergoing elective breast surgery: A non-inferiority randomized controlled trial

BACKGROUND

Postoperative sleep disturbance (PSD) is prevalent in perioperative patients，and has significant impact on postoperative recovery and prognosis. The aim of this study was to investigate the effect of desflurane maintenance on postoperative sleep quality, in order to optimize patients' perioperative sleep management.

METHOD

A total of 118 patients undergoing elective breast surgery were randomized to receive either desflurane-based volatile anesthesia (desflurane group) or propofol-based total intravenous anesthesia (propofol group) for anesthesia maintenance. The primary outcome was the quality of sleep, which was assessed by the Pittsburgh Sleep Quality Index (PSQI) on 3 days after operation (POD3). Secondary outcomes were PSQI on postoperative day 7 (POD7) and 30 (POD30), and postoperative anxiety, depression, and pain score, as well as objective sleep parameters including total sleep time (TST), WASO (Wakefulness after sleep onset), REM (Rapid eye movement) and NREM (Non-rapid Eye Movement) measured by Fitbit Charge 2TM during the initial 3 postoperative days.

RESULTS

The global PSQI scores on POD3 in the desflurane group was non-inferior to that in the propofol group [mean (SD) 8.47 (3.46) vs. 7.65 (3.16); mean difference (95 % CI) 0.82 (-0.43, 2.07); p < 0.001 for non-inferiority]. There were no significant differences in PSQI scores on POD3 and POD7. In addition, the score of anxiety, depression, and pain on the 3rd, 7th, and 30th day after surgery have no significant differences between the propofol and the desflurane group, respectively. The postoperative NREM was higher in the desflurane group than that in the propofol group.

CONCLUSION

The effects of desflurane-based volatile anesthesia maintenance on postoperative sleep quality is not inferior to that of propofol-based total intravenous anesthesia, and these two drugs may have different effects on the sleep structure.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04805775.

Effect of dexmedetomidine infusion on postoperative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial

BACKGROUND

Most women with breast cancer are prone to postoperative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep structures.

METHODS

A monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg-1 infusion 15 min before induction, then infused at 0.4 μg kg-1 h-1 until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of postoperative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA).

RESULTS

There were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (p = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on postoperative first day (p = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on postoperative first (p < 0.001) and third (p < 0.001) days.

CONCLUSION

Intra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group.

TRIAL REGISTRATION

Registered at www.chictr.org.cn (ChiCTR2300070136).

Postoperative Sleep Quality of Insomnia Patients After TIVA Anesthesia: A Prospective Study

PURPOSE

The purpose of this study is to observe the postoperative sleep quality of insomnia patients undergoing laparoscopic gynecologic oncology surgery after total intravenous anesthesia.

DESIGN

Prospective study.

METHODS

We conducted a prospective, observational study in our hospital. All patients underwent propofol-remifentanil anesthesia without other sedative medications before or during the operation. Pittsburgh Sleep Quality Index (PSQI) scores of the baseline value, night-1 (the first night after surgery), night-3, night-5, and night-30 were observed.

FINDINGS

Sixty-nine female insomnia patients were allocated based on the results of the PSQI and the diagnostic criteria of insomnia. The PSQI global scores were respectively 6 (5-8), 5 (4-6), 5 (3-6), and 6 (5-7) on night-1, night-3, night-5, and night-30, significantly lower than the baseline 7 (6-8) (P < 0.05). The 5 components (subjective sleep quality, sleep latency, sleep duration, sleep efficiency and daytime dysfunction) had significant changes at different postoperative time points (P < 0.05). The daytime dysfunction could also be improved 1 month after the surgery (P < 0.05). In contrast, the variations of sleep disturbance and use of sleep medication had no statistical differences.

CONCLUSIONS

The sleep quality of female patients with insomnia was improved on the first night after surgery in the sides of sleep latency and daytime dysfunction, and the improvement could also be obtained 1 month after propofol-remifentanil general anesthesia.

Association between sleep quality and general anesthesia in teenager under elective surgery: a prospective study

OBJECTIVE

Anesthesia was reported to be associated with lowered postoperative sleep quality in adults, but its effect on teenager was less understood. This study was conducted to explore the association between postoperative sleep quality and general anesthesia in teenagers.

METHODS

A prospective study was conducted. Teenagers aged from 12 to 16 years who were treated with general anesthesia and under urologic or otolaryngologic surgery were recruited. Healthy teenagers matched by sex and age (± 3 years) with the specific case were recruited as the controls. The Sleep Habits Questionnaire was applied to assess the sleep quality of the teenagers. We applied a logistic regression analysis to evaluate the association between general anesthesia in teenagers under elective surgery and poor sleep quality. Risk ratio (RR) and its corresponding 95% confidence interval (CI) were computed.

RESULTS

A total of 212 teenagers were included comprising 106 patients with general anesthesia who underwent urologic or otolaryngologic surgery and 106 healthy controls. The male participants were accounting for 47.2% (100/212). Anesthesia duration and surgery duration in the patients were 103.7 ± 14.4 min and 162.1 ± 17.0 min, respectively. Positive associations between general anesthesia and poor sleep quality in the 1st, 3rd, and 7th postoperative days were found, and RRs and their corresponding 95%CIs were 4.87 (1.72-13.79), 3.33 (1.22-9.1), and 3.26 (1.07-9.93), respectively. However, there was a lack of statistical associations before surgery and after 14 postoperative days.

CONCLUSIONS

Teenagers who were treated with general anesthesia and under urologic or otolaryngologic surgery might have poor sleep quality within 7 postoperative days.

Clinical Effect of Different Drugs and Infusion Techniques for Patient-Controlled Analgesia After Spinal Tumor Surgery: A Prospective, Randomized, Controlled Clinical Trial

PURPOSE

To evaluate the outcomes of the different drug combination and infusion techniques for patient-controlled analgesia (PCA).

METHODS

Ninety-seven patients who had undergone spinal tumor surgery were randomized to 4 groups with different PCA drugs and infusion techniques: subcutaneous sufentanil (SS) group; (n=25), subcutaneous sufentanil and dexmedetomidine (SDS) group (n=24), intravenous sufentanil (SI) group (n=23), and intravenous sufentanil and dexmedetomidine (SDI) group (n=25). The primary outcome measured the cumulative amount of sufentanil delivered to the patients through PCA 24 and 48 hours after the surgery. Secondary outcomes measured the visual analog scale pain scores 24 and 48 hours after the surgery, Pittsburgh Sleep Quality Index before and 1 month after surgery, Athens Insomnia Score before and the first 2 nights after surgery, and the rate of adverse events within 48 hours after surgery.

FINDINGS

At 24 and 48 hours after surgery, the cumulative amount of sufentanil in the SDS group (mean [SD], 76.44 [10.75] at 24 hours and 151.96 [20.92] at 48 hours) and the SDI group (mean [SD], 75.08 [9.00] at 24 hours and 149.56 [18.22] at 48 hours) were significantly lower than in SS group (mean [SD] 95.52 [12.40] at 24 hours and 183.23 [23.06] at 48 hours) and the SI group (mean [SD], 97.25 [10.80] at 24 hours and 186.67 [20.14] at 48 hours; P < 0.001). The visual analog scale pain scores and Athens Insomnia Scale scores were also lower in the SDS and SDI groups than in the SS and SI groups 24 and 48 hours after surgery (P < 0.05). The Pittsburgh Sleep Quality Index was lower in the SDS and SDI groups 1 month after surgery. Lastly, the rate of nausea and vomiting was higher in the SI group than in the SS, SDS, and SDI groups (P = 0.018).

IMPLICATIONS

Dexmedetomidine in PCA could decrease sufentanil intake and improve analgesic effect and sleep quality. Subcutaneous PCA can provide the same benefit with a lower rate of nausea and vomiting. ClinicalTrials.gov identifier: NCT04111328. (Clin Ther. 2021;XX:XXX-XXX) © 2021 Elsevier HS Journals, Inc.

Propofol and sufentanil may affect the patients' sleep quality independently of the surgical stress response: a prospective nonrandomized controlled trial in 1033 patients' undergone diagnostic upper gastrointestinal endoscopy

Background

It is unknown whether sedative per se contributes to the postoperative sleep disturbance. Diagnostic upper gastrointestinal endoscopy (UGE) is a minimally invasive procedure which is not likely to cause tissue trauma and pain. The purpose of this study was to evaluate the sleep quality of patients undergoing routine (without sedative) diagnostic UGE or UGE with sedative, before, 1 week, and 1 month after the procedure.

Methods

One thousand and thirty-three patients undergoing UGE were enrolled. Patients chose sedative or without sedative. Propofol and sufentanil were administered to the sedative group, not allowed for the routine group. The Pittsburgh Sleep Quality Index (PSQI) was measured before, 1 week and 1 month after the procedure.

Results

Five hundred and ten patients were enrolled in the sedative group and 523 in the routine group. One week after the procedure, patients in the sedative group showed significantly higher PSQI scores (worse sleep quality) than the baseline PSQI scores (p < 0.001), but there was no significant change for the routine group in the same period (p = 0.096). One month after the procedure, there was no significant difference in PSQI scores between the two groups compared with the baseline values (p = 0.358 for sedative group, p = 0.161 for routine group). There were also no significant difference in the PSQI scores between the two groups in the entire 1 month follow-up period (p = 0.885).

Conclusions

The sedative group showed impaired sleep quality 1 week after diagnostic UGE. Propofol and sufentanil may independently affect the sleep quality of patients after sedative of diagnostic UGE for only one week.

Trial registration

This study is registered on Chinese Clinical Trial Registry (IDChiCTR-OCH-13003128). Registered 2 April 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-017-0341-3) contains supplementary material, which is available to authorized users.

Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

OBJECTIVE

Opioid analgesics are commonly and increasingly prescribed by physicians for the management of chronic pain. However, strong evidence supports the need for strategies that reduce opioid use. The objective of this review is to outline limitations associated with opioid use and discuss therapeutic techniques that can be adopted to optimize the use of opioids in the management of chronic nonmalignant pain.

SCOPE

Literature searches through MEDLINE and Cochrane databases were used to identify relevant journal articles. The search was limited to articles published from January 1980 to January 2014. Additional references were obtained from articles extracted during the database search. Relevant search terms included opioid, opioid abuse, chronic pain management, written care agreements, urine drug testing, and multimodal therapy.

FINDINGS

Opioids exhibit a well established abuse potential and evidence supporting the efficacy of opioids in chronic pain management is limited. In addition, opioid exposure is associated with adverse effects on multiple organ systems. Effective strategies designed to mitigate opioid abuse and diversion and optimize clinical outcomes should be employed.

CONCLUSIONS

Appropriate patient selection through identification of risk factors, urine drug testing, and access to prescription monitoring programs has been shown to effectively improve care. Structured opioid therapy in a multimodal platform, including use of a low initial dose, prescription of alternative non-opioid analgesics including non-steroidal anti-inflammatory drugs and acetaminophen, as well as development of written care agreements to individualize and guide therapy has also been shown to improve patient outcomes. Implementation of opioid allocation strategies has the potential to encourage appropriate opioid use and improve patient care.