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Zhang W, Li C, Zhao C, Ji N, Luo F. Opioid-Sparing Effects of Flurbiprofen Axetil as an Adjuvant to Ropivacaine in Pre-Emptive Scalp Infiltration for Post-Craniotomy Pain: Study Protocol for a Multicenter, Randomized Controlled Trial. J Pain Res 2023; 16:1415-1427. [PMID: 37131532 PMCID: PMC10149076 DOI: 10.2147/jpr.s399454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
Background Pain after craniotomy remains a poorly controlled problem that is mainly caused by the inflammatory reaction at the incision site. Nowadays, systemic opioids use, as first-line analgesics, is often limited because of adverse effects. Flurbiprofen axetil (FA) is a non-steroidal anti-inflammatory drug merged into emulsified lipid microspheres, which represent a strong affinity to inflammatory lesions. Local administration of flurbiprofen into a surgical wound has induced enhanced analgesic efficacy and few systemic or local adverse effects after oral surgery. However, the impact of local FA, as a non-opioid pharmacologic alternative, remains elusive on postoperative pain in craniotomy. In this study, we presume that pre-emptive infiltration of scalp with FA as an adjuvant to ropivacaine can lead to less sufentanil consumption postoperatively in patient controlled intravenous analgesia (PCIA) compared with ropivacaine alone. Methods/Design We design a multicenter, randomized controlled study that will enroll 216 subjects who are planned to receive supratentorial craniotomy. Patients will receive pre-emptive infiltration of scalp either with 50 mg FA and 0.5% ropivacaine, or with 0.5% ropivacaine alone. Primary outcome is total consumption of sufentanil with PCIA device at 48 h postoperatively. Discussion This is the first study attempting to explore the analgesic and safety profile of local FA as an adjuvant to ropivacaine for incisional pain in patients undergoing craniotomy. It will provide additional insights into the opioid-sparing analgesia pathways by local administration of NSAIDs for neurosurgery.
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Affiliation(s)
- Wei Zhang
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Chunzhao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Chunmei Zhao
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
- Nan Ji, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 West Road, South 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Email
| | - Fang Luo
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
- Correspondence: Fang Luo, Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, No. 119 West Road, South 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86 10 59976664, Fax +86 10 67050177, Email
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Wu Y, Cai Z, Li Y, Kang Y, Fu B, Wang J. Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair. Medicine (Baltimore) 2022; 101:e29320. [PMID: 35608433 PMCID: PMC9276157 DOI: 10.1097/md.0000000000029320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To observe the effect of Ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative sedation in patients undergoing laparoscopic hernia repair. METHODS 100 male patients aged 60 to 80 years old, a line to elective laparoscopic inguinal hernia repair, were randomly divided into four groups: control group (Group A) and dezocine group (Group B), ketorolac tromethamine group (Group C), ketorolac tromethamine combined with dezocine group (Group D). Patients were administrated with 0.1 mg/kg dezocine in Group B, 0.5 mg/kg ketorolac in Group C, 0.1 mg/kg dezocine, and 0.5 mg/kg ketorolac in Group D, and with an equal dose of normal saline in group A. The heart rate (HR) and mean arterial pressure (MAP) of patients in 4 groups were recorded at each time point as follows, T0 (enter the operating room), T1 (before skin resection), 10 min after pneumoperitoneum (T2), mesh placement (T3), and laryngeal mask extraction (T4). Operation time, awakening time (time from drug withdrawal to consciousness recovery), the dosage of propofol, sufentanil, remifentanil, and intraoperative vasoactive drug dosage were recorded to compare. Visual analog scale score and sedation Ramsay score were evaluated 1, 6, 12, and 24 hours after extubation. RESULTS There was no significant difference in operation time, anesthesia recovery time, sufentanil dosage, and vasoactive drugs among all groups. The amount of propofol in Group B and D was less than that in Group A and C (P < .05), and there was no difference between Group B and D, A and C (P > .05). The amount of remifentanil in Group B, C, and D was less than that in Group A (P < .05), and Group D was less than B and C (P < .05). After extubation, HR and MAP were significantly higher than before (P < .05). Compared with T0, HR and MAP increased in each group at T4, but MAP and HR in Group D increased the least (P < .05). There were significant differences between Group B, C, D, and A, MAP and HR fluctuated little during extubation (P < .05), but there was a significant difference between Group D and B, C (P < .05). Visual analog scale scores of Group B, C, and D were lower than those of A at 1, 6, and 12 hours after surgery (P < .05), and there was a significant difference between Group D, and B, C (P < .05). Ramsay scores in Group B and D were higher than those in A and C at 1 and 6 hours after the operation (P < .05). There was no difference in the incidence of adverse reactions among groups. CONCLUSION The prophylactic use of ketorolac tromethamine and dezocine before laparoscopic inguinal hernia repair can reduce hemodynamic disorder during anesthesia recovery, increase postoperative sedative and analgesic effects.
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Schreiber N, Gebauer D, Schittek G, Sandner-Kiesling A. [Role of Dexamethasone for Pain Management in Intervertebral Disc Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:138-141. [PMID: 35172344 DOI: 10.1055/a-1483-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intervertebral disc operations are already among the most common and their frequency is increasing. The pain associated with these operations is one of the most common postoperative discomforts, has a significant impact on psychosocial aspects, and should therefore be treated effectively. Therefore, we present the importance of dexamethasone for multimodal pain management after intervertebral disc surgery.
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Umari M, Paluzzano G, Stella M, Carpanese V, Gallas G, Peratoner C, Colussi G, Baldo GM, Moro E, Lucangelo U, Berlot G. Dexamethasone and postoperative analgesia in minimally invasive thoracic surgery: a retrospective cohort study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:23. [PMID: 37386655 DOI: 10.1186/s44158-021-00023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/21/2021] [Indexed: 07/01/2023]
Abstract
BACKGROUND Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV), and recent reviews suggest a role for dexamethasone in postoperative analgesia. The aim of this study is to evaluate the efficacy of dexamethasone as an analgesic adjuvant in minimally invasive thoracic surgery. Primary outcome was morphine consumption 24 h after surgery; secondary outcomes were pain control, measured as numeric rating scale (NRS), glycemic changes, PONV, and surgical wound infection. RESULTS We performed a retrospective cohort study considering 70 patients who underwent elective lobectomy, segmentectomy, or wedge resection surgery with a mini-thoracotomy approach or video-assisted thoracoscopic surgery (VATS). All patients received the same locoregional techniques and short-acting opioids during surgery; 46 patients received dexamethasone at induction. There were no significant differences in morphine consumption at 24 h (p = 0.09) and in postoperative pain scores. Nevertheless, a higher frequency of rescue therapy (p = 0.01) and a tendency for a higher attempted-PCA pushes count were observed in patients who did not receive dexamethasone. No cases of surgical wound infections were detected, and the incidence of PONV was similar in the two groups. Postoperative glycemia was transiently higher in the dexamethasone group (p = 0.004), but the need of hypoglycemic therapy was not significantly different. CONCLUSIONS Preoperative administration of dexamethasone did not cause a significant reduction in morphine consumption, but appears to be safe and plays a role in a multimodal anesthesia approach for patients undergoing elective minimally invasive thoracic surgery.
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Affiliation(s)
- Marzia Umari
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy.
| | - Giacomo Paluzzano
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Matteo Stella
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Valentina Carpanese
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Giovanna Gallas
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Caterina Peratoner
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Giulia Colussi
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Gaia Maria Baldo
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Edoardo Moro
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
| | - Giorgio Berlot
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara University Hospital, Trieste, Italy
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Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, Lund JN, Williams JP. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev 2021; 6:CD012978. [PMID: 34125958 PMCID: PMC8203105 DOI: 10.1002/14651858.cd012978.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postoperative pain is a common consequence of surgery and can have many negative perioperative effects. It has been suggested that the administration of analgesia before a painful stimulus may improve pain control. We defined pre-emptive nonsteroidal anti-inflammatories (NSAIDs) as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. OBJECTIVES To assess the efficacy of preventive and pre-emptive NSAIDs for reducing postoperative pain in adults undergoing all types of surgery. SEARCH METHODS We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED and CINAHL (up to June 2020). In addition, we searched for unpublished studies in three clinical trial databases, conference proceedings, grey literature databases, and reference lists of retrieved articles. We did not apply any restrictions on language or date of publication. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs) only. We included adult participants undergoing any type of surgery. We defined pre-emptive NSAIDs as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. We included studies that gave the medication by any route but not given on the skin. DATA COLLECTION AND ANALYSIS We used the standard methods expected by Cochrane, as well as a novel publication bias test developed by our research group. We used GRADE to assess the certainty of the evidence for each outcome. Outcomes included acute postoperative pain (minimal clinically important difference (MCID): 1.5 on a 0-10 scale), adverse events of NSAIDs, nausea and vomiting, 24-hour morphine consumption (MCID: 10 mg reduction), time to analgesic request (MCID: one hour), pruritus, sedation, patient satisfaction, chronic pain and time to first bowel movement (MCID: 12 hours). MAIN RESULTS We included 71 RCTs. Seven studies are awaiting classification. We included 45 studies that evaluated pre-emptive NSAIDs and 26 studies that evaluated preventive NSAIDs. We considered only four studies to be at low risk of bias for most domains. The operations and NSAIDs used varied, although most studies were conducted in abdominal, orthopaedic and dental surgery. Most studies were conducted in secondary care and in low-risk participants. Common exclusions were participants on analgesic medications prior to surgery and those with chronic pain. Pre-emptive NSAIDs compared to post-incision NSAIDs For pre-emptive NSAIDs, there is probably a decrease in early acute postoperative pain (MD -0.69, 95% CI -0.97 to -0.41; studies = 36; participants = 2032; I2 = 96%; moderate-certainty evidence). None of the included studies that reported on acute postoperative pain reported adverse events as an outcome. There may be little or no difference between the groups in short-term (RR 1.00, 95% CI 0.34 to 2.94; studies = 2; participants = 100; I2 = 0%; low-certainty evidence) or long-term nausea and vomiting (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 228; I2 = 29%; low-certainty evidence). There may be a reduction in late acute postoperative pain (MD -0.22, 95% CI -0.44 to 0.00; studies = 28; participants = 1645; I2 = 97%; low-certainty evidence). There may be a reduction in 24-hour morphine consumption with pre-emptive NSAIDs (MD -5.62 mg, 95% CI -9.00 mg to -2.24 mg; studies = 16; participants = 854; I2 = 99%; low-certainty evidence) and an increase in the time to analgesic request (MD 17.04 minutes, 95% CI 3.77 minutes to 30.31 minutes; studies = 18; participants = 975; I2 = 95%; low-certainty evidence). There may be little or no difference in opioid adverse events such as pruritus (RR 0.40, 95% CI 0.09 to 1.76; studies = 4; participants = 254; I2 = 0%; low-certainty evidence) or sedation (RR 0.51, 95% CI 0.16 to 1.68; studies = 4; participants = 281; I2 = 0%; low-certainty evidence), although the number of included studies for these outcomes was small. No study reported patient satisfaction, chronic pain or time to first bowel movement for pre-emptive NSAIDs. Preventive NSAIDs compared to post-incision NSAIDs For preventive NSAIDs, there may be little or no difference in early acute postoperative pain (MD -0.14, 95% CI -0.39 to 0.12; studies = 18; participants = 1140; I2 = 75%; low-certainty evidence). One study reported adverse events from NSAIDs (reoperation for bleeding) although the events were low which did not allow any meaningful conclusions to be drawn (RR 1.95; 95% CI 0.18 to 20.68). There may be little or no difference in rates of short-term (RR 1.26, 95% CI 0.49 to 3.30; studies = 1; participants = 76; low-certainty evidence) or long-term (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 456; I2 = 29%; low-certainty evidence) nausea and vomiting. There may be a reduction in late acute postoperative pain (MD -0.33, 95% CI -0.59 to -0.07; studies = 21; participants = 1441; I2 = 81%; low-certainty evidence). There is probably a reduction in 24-hour morphine consumption (MD -1.93 mg, 95% CI -3.55 mg to -0.32 mg; studies = 16; participants = 1323; I2 = 49%; moderate-certainty evidence). It is uncertain if there is any difference in time to analgesic request (MD 8.51 minutes, 95% CI -31.24 minutes to 48.27 minutes; studies = 8; participants = 410; I2 = 98%; very low-certainty evidence). As with pre-emptive NSAIDs, there may be little or no difference in other opioid adverse events such as pruritus (RR 0.56, 95% CI 0.09 to 3.35; studies = 3; participants = 211; I2 = 0%; low-certainty evidence) and sedation (RR 0.84, 95% CI 0.44 to 1.63; studies = 5; participants = 497; I2 = 0%; low-certainty evidence). There is probably little or no difference in patient satisfaction (MD -0.42; 95% CI -1.09 to 0.25; studies = 1; participants = 72; moderate-certainty evidence). No study reported on chronic pain. There is probably little or no difference in time to first bowel movement (MD 0.00; 95% CI -15.99 to 15.99; studies = 1; participants = 76; moderate-certainty evidence). AUTHORS' CONCLUSIONS There was some evidence that pre-emptive and preventive NSAIDs reduce both pain and morphine consumption, although this was not universal for all pain and morphine consumption outcomes. Any differences found were not clinically significant, although we cannot exclude this in more painful operations. Moreover, without any evidence of reductions in opioid adverse effects, the clinical significance of these results is questionable although few studies reported these outcomes. Only one study reported clinically significant adverse events from NSAIDs administered before surgery and, therefore, we have very few data to assess the safety of either pre-emptive or preventive NSAIDs. Therefore, future research should aim to adhere to the highest methodology and be adequately powered to assess serious adverse events of NSAIDs and reductions in opioid adverse events.
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Affiliation(s)
- Brett Doleman
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Thomas P Heinink
- Department of Anaesthesia, Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK
| | - Hannah Boyd-Carson
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Laura Carrick
- Department of Anaesthesia and Intensive care, Royal Derby Hospital, Derby, UK
| | - Rahil Mandalia
- Department of Anaesthesia, University Hospitals of Leicester, Leicester, UK
| | - Jon N Lund
- Division of Health Sciences, School of Medicine, University of Nottingham, Derby, UK
| | - John P Williams
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
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Early postoperative pain after laparoscopic donor nephrectomy predicts 30-day postoperative infectious complications: a pooled analysis of randomized controlled trials. Pain 2021; 161:1565-1570. [PMID: 32107359 DOI: 10.1097/j.pain.0000000000001842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our research group recently published a positive association between early postoperative pain and 30-day postoperative complications in a broad surgical population. To investigate whether heterogeneity of the population and surgical procedures influenced these results, we explored this association in a homogenous surgical population. A secondary analysis of the LEOPARD-2 (clinicaltrials.gov NCT02146417) and RELAX-1 study (NCT02838134) in laparoscopic donor nephrectomy patients (n = 160) was performed. Pain scores on the postanesthesia care unit and postoperative day (POD) 1 and 2 were compared between patients with infectious, noninfectious, and no complications 30 days after surgery. Patients who developed infectious complications had significantly higher pain scores on POD1 and 2 (6.7 ± 2.1 and 6.4 ± 2.8) than patients without complications (4.9 ± 2.2 and 4.1 ± 1.9), respectively (P = 0.006 and P = 0.000). Unacceptable pain (numeric rating scale [NRS] ≥ 6) on POD1 was reported by 72% of patients who developed infectious complications, compared to 38% with noninfectious complications and 30% without complications (P = 0.018). This difference was still present on POD2 at 67% with infectious complications, 21% with noninfectious, and 40% without complications (P = 0.000). Multiple regression analysis identified unacceptable pain (numeric rating scale ≥6) on POD2 as a significant predictor for 30-day infectious complications (odds ratio 6.09, P = 0.001). Results confirm the association between early postoperative pain and 30-day infectious complications in a separate, homogenous surgical population. Further clinical trials should focus on finetuning of postoperative analgesia to elucidate the effects on the endocrine and immune response, preserve immune homeostasis, and prevent postoperative infectious complications.
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Baek W, Jang Y, Park CG, Moon M. Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:73-81. [PMID: 32165329 DOI: 10.1016/j.anr.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression. METHODS The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction. RESULTS Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6 hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24 hours after surgery was significantly greater in the group with lower satisfaction. CONCLUSION Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mir Moon
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
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Jovanovic D, Milovanovic DR, Jeremic N, Nikolic T, Stojic I, Jakovljevic V, Vukovic N. Oxidative Stress Parameters after Abdominal Hysterectomy and Their Relationships with Quality of Recovery. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.1515/sjecr-2017-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study aimed to investigate relationship between oxidative stress markers and postoperative recovery in woman after abdominal hysterectomy, as well as to test the hypothesis that different analgesics differently influence redox status.
The quality of recovery was evaluated with a QoR-40 questionnaire in fifty-one patients who underwent abdominal hysterectomy, preoperatively and on the 1st, 2nd, 3rd postoperative days (POD1,2,3). Blood samples were collected at baseline (T0), 3 (T1), 24 (T2), 48 (T3) and 72 (T4) hours after surgery. Oxidative stress markers concentrations (TBARS, NO2
−, H2O2, O2
− ) as well as antioxidative enzymes (SOD, CAT, and GSH) were analyzed.
QoR-40 total score significantly declined on POD1 and POD2 and returned to baseline levels on POD3 (p<0.001). H2O2 levels significantly decreased from T0 to T3 and then, increased at T4 (p=0,011). Changes of TBARS and H2O2 from T0 to T3 showed significant and negative correlation (r=−0.303, p=0.046). There was no significant correlation between QoR-40 total score and any parameter of oxidative stress response (p>0.05). Changes in TBARS levels from T0 to T3 were statistically significant between the study subgroups primarily due to increase of the concentrations in patients receiving paracetamol (p=0.031). Patients age, duration of surgery and cigarette smoking status showed significant influcences on and association with some oxidative stress response markers (TBARS, O2
−, CAT) (p<0.05).
Women who underwent hysterectomy had significant changes of H2O2 and TBARS activity however, those changes were not associated with changes of QoR-40 total scores during recovery.
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Affiliation(s)
- Danijela Jovanovic
- Department of Anesthesiology and Reanimatology , Clinical Centre “Kragujevac” , Kragujevac , Serbia
| | - Dragan R. Milovanovic
- Department of Clinical Pharmacology, Clinical Centre “Kragujevac”, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Nevena Jeremic
- Department of Physiology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Tamara Nikolic
- Department of Physiology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Isidora Stojic
- Department of Physiology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
- Department of Human Pathology , 1st Moscow State Medical University IM Sechenov , Moscow , Russia
| | - Natalija Vukovic
- Departement of Anesthesiology and Reanimatology , Clinical Centre „Nis “ , Nis , Serbia
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Vicente D, Patino M, Marcus R, Lillmoe H, Limani P, Newhook T, Lee A, Tzeng CW, Segraves-Chun Y, Tweardy D, Gottumukkala V, Vauthey JN, Aloia T, Cata JP. Impact of epidural analgesia on the systemic biomarker response after hepatic resection. Oncotarget 2019; 10:584-594. [PMID: 30728909 PMCID: PMC6355178 DOI: 10.18632/oncotarget.26549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/22/2018] [Indexed: 12/30/2022] Open
Abstract
Background Perioperative inflammation is associated with poor oncologic outcomes. Regional analgesia has been shown mitigate some of these inflammatory changes and be associated with better oncologic outcomes in patients with hepatic malignancies. The mechanism for this effect, however, remains unclear. The authors sought to compare systemic biomarker concentrations in a comprehensive and oncologically relevant panel in the perioperative setting between patients undergoing thoracic epidural analgesia (TEA) and intra-venous patient- controlled analgesia (IV-PCA) for resection of hepatic metastatic disease. Results Clinicopathologic variables and baseline biomarkers were similar between TEA (n = 46) and IV-PCA (n = 16) groups. Of the biomarkers which were significantly changed from baseline, there was a lower fold change from baseline in the TEA patients compared to IV-PCA including IL-6 (13.5vs19.1), MCP-1 (1.9vs3.0), IL-8 (2.4vs3.0), and Pentraxin-3 (10.8vs15.6). Overall decreased systemic concentrations of TGFb signaling were noted in TEA patients on POD1 TGFb3 (243.2 vs. 86.0, p = 0.005), POD3 TGFb1 (6558.0 vs. 2063.3, p = 0.004), POD3 TGFb2 (468.3 vs. 368.9, p = 0.036), POD3 TGFb3 (132.2 vs. 77.8, p = 0.028), and POD5 TGFb3 (306.5 vs. 92.2, p = 0.032). POD1 IL-12p70 concentrations were significantly higher in TEA patients (8.3 vs. 1.6, p = 0.024). Conclusion Epidural analgesia damped the postoperative inflammatory response and systemic immunosuppressive signaling, as well as promoted Th1 systemic signaling early in the post-operative period after hepatic resection for metastatic disease. These differences elaborate on known mechanisms for improved oncologic outcomes with regional anesthesia, and may be considered for biomarker monitoring of effective regional anesthesia in oncologic surgery. Materials and Methods Patient data, including clinicopathologic variables were collected for this study from the database of a randomized controlled trial comparing perioperative outcomes in patients undergoing hepatic resection with TEA vs. IV-PCA. Patients undergoing resection for metastatic disease were selected for this study. Plasma concentrations (pg/mL) of well-studied biomarkers (IL-1b/2/4/5/6/7/8/10/12p70/13/17, MCP-1 IFNγ, TNFα, MIP-1b, GM-CSF, G-CSF, VEGF, Resistin, TGFb1, TGFb2, and TGFb3), as well as novel perioperative markers (CXCL12, CXCL10, Omentin-1, sLeptin R, Vaspin, Pentraxin-3, Galactin-3, FGF-23, PON-1, FGF-21) were measured preoperatively, and on postoperative day (POD)1, POD3, and POD5 using multiplex bead assays. Clinicopathologic variables and perioperative variations in these biomarkers were compared between TEA vs IV-PCA groups.
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Affiliation(s)
- Diego Vicente
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Miguel Patino
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Marcus
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lillmoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preparim Limani
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andy Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Segraves-Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Tweardy
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Kamali A, Zarepour Z, Shokrpour M, Pazuki S. Comparison of intradermal Dexmedmotidine and subcutaneous Ketamine for post-surgical pain management in patients with abdominal hysterectomy. Eur J Transl Myol 2019; 29:7873. [PMID: 31019659 PMCID: PMC6460212 DOI: 10.4081/ejtm.2019.7873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022] Open
Abstract
Hysterectomy after cesarean section is the second most commonly used surgery for women in the United States. One of the most common problem after hysterectomy is pain. We decided to compare the effects of dexmedmotidine or ketamine on pain in patients by a double blind randomized clinical trial on 126 female candidates for abdominal hysterectomy in three groups of 42 persons referred to Taleghani hospital in Arak. For the first group, 50 micrograms of intradermal dexmedmotidine were injected, while in the second group, patients were injected with 100 mg of subcutaneous ketamine and the third group received 5 cc normal saline. Data were next analyzed by SPSS version 19. The mean age and body mass index of the patients were not significantly different in the three groups. The mean scores of pain during recovery of patients in ketamine, dexmedmotidine and placebo groups were 4.2±0.77, 2.6±0.89 and 1.3±0.87, respectively (p = 0.001). Scores of pain in patients at 4 and 8 hours after surgery showed also significant differences. In conclusion, ketamine and dexmedmotidine significantly reduce the severity of pain, but ketamine has a lower effect.
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Affiliation(s)
- Alireza Kamali
- Department of Anesthesiology, Arak University of Medical Sciences, Arak Iran
| | - Zahra Zarepour
- Department of Anesthesiology, Arak University of Medical Sciences, Arak Iran
| | - Maryam Shokrpour
- Department of Gynecology, Arak University of Medical Sciences, Arak, Iran
| | - Shirin Pazuki
- Department of Anesthesiology, Arak University of Medical Sciences, Arak Iran
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11
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Smith HJ, Leath CA, Straughn JM. Enhanced Recovery After Surgery in Surgical Specialties. Surg Clin North Am 2018; 98:1275-1285. [DOI: 10.1016/j.suc.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Hozumi J, Sumitani M, Nishizawa D, Nagashima M, Ikeda K, Abe H, Kato R, Kusakabe Y, Yamada Y. Resistin Is a Novel Marker for Postoperative Pain Intensity. Anesth Analg 2018; 128:563-568. [PMID: 29649030 DOI: 10.1213/ane.0000000000003363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pro- and anti-inflammatory cytokines (adipokines) associated with adipose tissue can modulate inflammatory processes and lead to systemic inflammatory conditions such as metabolic syndrome. In the present pilot study, we investigated 3 major adipokines (leptin, adiponectin, and resistin) and 2 nonspecific proinflammatory cytokines (tumor necrosis factor α and interleukin-6) with regard to their association with postoperative pain intensity. METHODS We analyzed a total of 45 single-nucleotide polymorphisms of the adipokines in 57 patients with postlaparotomy pain. We adjusted for multiple testing to reduce the chance of false-positive results by controlling the false discovery rate. Serum levels of the adipokines and proinflammatory cytokines were measured in another 36 patients undergoing laparotomy. A stepwise multiple linear regression analysis using these measurements and opioid dosages as independent variables was performed to explore the factors associated with postoperative pain. RESULTS Only 1 variant of the resistin gene (rs3745367) demonstrated a significant association with postoperative pain (P < .002). Patients exhibiting homozygosity for the minor alleles (n = 7; numerical rating scale [NRS], 2.3 ± 1.3) demonstrated lower pain intensity compared with those exhibiting homozygosity for the major alleles (n = 29; NRS, 3.8 ± 1.0; P = .004) and heterozygosity for the minor alleles (n = 21; NRS, 4.2 ± 0.8; P < .001). Only serum resistin levels showed a positive association with postoperative pain. CONCLUSIONS A genetic variant of resistin and serum resistin levels were associated with postoperative pain intensity, while other adipokines and cytokines exhibit no such association. Resistin can alter the inflammatory responses in postoperative wounds, although it could be a determinant factor that is independent of inflammatory processes. Resistin may be a novel marker for postoperative pain intensity.
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Affiliation(s)
- Jun Hozumi
- From the Departments of Anesthesiology and Pain Relief Center
| | - Masahiko Sumitani
- Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Medical Center, Sakura Hospital, Chiba, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hiroaki Abe
- From the Departments of Anesthesiology and Pain Relief Center
| | - Ryoji Kato
- Department of Surgery, Toho University Medical Center, Sakura Hospital, Chiba, Japan
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13
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Zhou F, Du Y, Huang W, Shan J, Xu G. The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery: A randomized, controlled study. Medicine (Baltimore) 2017; 96:e8234. [PMID: 29049211 PMCID: PMC5662377 DOI: 10.1097/md.0000000000008234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90 flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90 VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90 flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.
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14
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Wang K, Luo J, Zheng L, Luo T. Preoperative flurbiprofen axetil administration for acute postoperative pain: a meta-analysis of randomized controlled trials. J Anesth 2017; 31:852-860. [PMID: 28936554 DOI: 10.1007/s00540-017-2409-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Non-steroidal anti-inflammatory drugs have been shown to effectively decrease postoperative pain and reduce opioid requirements. Flurbiprofen axetil is an injectable non-selective cyclooxygenase inhibitor that has a high affinity for inflammatory tissues to achieve targeted drug therapy and prolonged duration of action. This meta-analysis examined the use of preoperative flurbiprofen axetil and its impact on postoperative analgesia. METHODS An electronic literature search of the Library of PubMed, Cochrane CENTRAL, and EMBASE databases was conducted in Feb 2016. Searches were limited to randomized controlled trials. The primary outcome was pain scores. The secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects. RESULTS A total of nine RCT studies involving 457 patients were included in this study. Compared to patients without perioperative flurbiprofen axetil, patients treated with preoperative flurbiprofen axetil had lower pain scores at 2 h (SMD -1.00; 95% CI -1.57 to -0.43, P = 0.0006), 6 h (SMD -1.22; 95% CI -2.01 to -0.43; P = 0.002), 12 h (SMD -1.19; 95% CI -2.10 to -0.28; P = 0.01), and 24 h (SMD -0.79; 95% CI -1.31 to -0.27; P = 0.003) following surgery. Preoperative flurbiprofen axetil had no significant effect on postoperative opioid consumption (SMD -13.11; 95% CI -34.56 to 8.33; P = 0.23). There was no significant difference between the groups with regard to adverse effects. Compared to patients with postoperative flurbiprofen axetil, however, preoperative flurbiprofen axetil resulted in decreased pain score only at 2 h after operation. CONCLUSIONS Preoperative use of flurbiprofen axetil will result in significantly lower postoperative pain scores, but no difference in nausea, vomiting, and opioid consumption compared to those who did not receive flurbiprofen axetil. However, more homogeneous and well-designed clinical studies are necessary to determine whether preoperative flurbiprofen axetil administration has more efficacy than that given at the end of surgery.
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Affiliation(s)
- Ke Wang
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Jun Luo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Limin Zheng
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
| | - Tao Luo
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
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15
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Soliz JM, Ifeanyi IC, Katz MH, Wilks J, Cata JP, McHugh T, Fleming JB, Feng L, Rahlfs T, Bruno M, Gottumukkala V. Comparing Postoperative Complications and Inflammatory Markers Using Total Intravenous Anesthesia Versus Volatile Gas Anesthesia for Pancreatic Cancer Surgery. Anesth Pain Med 2017; 7:e13879. [PMID: 29344445 PMCID: PMC5750426 DOI: 10.5812/aapm.13879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/23/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The objective of this study is to evaluate postoperative complications and inflammatory profiles when using a total intravenous anesthesia (TIVA) or volatile gas-opioid (VO) based anesthesia in patients undergoing pancreatic cancer surgery. Methods Design, retrospective propensity score matched cohort; Setting, major academic cancer hospital; Patients, all patients who had pancreatic surgery between November 2011 and August 2014 were retrospectively reviewed. Propensity score matched patient pairs were formed. A total of 134 patients were included for analysis with 67 matched pairs; Interventions, Patients were categorized according to type of anesthetic used (TIVA or VO). Patients in the TIVA group received preoperative celecoxib, tramadol, and pregabalin in addition to intraoperative TIVA with propofol, lidocaine, ketamine, and dexmedetomidine. The VO-group received a volatile-opioid based anesthetic; Measurements, demographic, perioperative clinical data, platelet lymphocyte ratios, and neutrophil lymphocyte ratios were collected. Complications were graded and collected prospectively and later reviewed retrospectively. Results Patients receiving TIVA were more likely to have no complication or a lower grade complication than the VO-group (P = 0.014). There were no differences in LOS or postoperative inflammatory profiles noted between the TIVA and VO groups. Conclusions In this retrospective matched analysis of patients undergoing pancreatic cancer surgery, TIVA was associated with lower grade postoperative complications. Length of hospital stay (LOS) and postoperative inflammatory profiles were not significantly different.
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Affiliation(s)
- Jose M Soliz
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
- Corresponding author: Jose M Soliz, MD, Department of Anesthesiology and Perioperative Medicine University of Texas M.D., Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX 77030, E-mail:
| | - Ifeyinwa C Ifeanyi
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Jonathan Wilks
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Thomas McHugh
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Lei Feng
- Department of Biostatistics, Houston, TX, USA
| | - Thomas Rahlfs
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Morgan Bruno
- Department of Surgical Oncology, Houston, TX, USA
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16
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Sun J, Lin H, Feng X, Dong J, Ansong E, Xu X. A comparison of intrathecal magnesium and ketamine in attenuating remifentanil-induced hyperalgesia in rats. BMC Anesthesiol 2016; 16:74. [PMID: 27599837 PMCID: PMC5013621 DOI: 10.1186/s12871-016-0235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Activation of NMDA receptors play an important role in the development of remifentanil-induced hyperalgesia. We hypothesized that in addition to ketamine, intrathecal MgSO4 could also relieve thermal and mechanical hyperalgesia in rats. Methods Initially, 24 Sprague–Dawley rats were divided into control group, remifentanil group, surgical incision group and remifentanil combined with surgical incision group to create an experimental model. Subsequently, 40 rats were divided into control group, model group, model group plus 100 μg MgSO4, 300 μg MgSO4 and 10 μg ketamine respectively. Paw withdrawal mechanical thresholds and paw withdrawal thermal latency tests were performed at −24 h, 2 h, 6 h, 24 h, 48 h, 72 h and 7 day after the surgical procedure. After behavior assessment on the 7th day, remifentanil was given again to ascertain whether or not NMDA antagonists could suppress the re-exposure of remifentanil-induced hyperalgesia. Results Remifentanil administration plus surgical incision induced significant postoperative hyperalgesia, as indicated by decreased paw withdrawal mechanical thresholds and paw withdrawal thermal latency to mechanical and thermal stimulation. In addition to ketamine, intrathecal MgSO4 (100, 300 μg) dose-dependently reduced remifentanil-induced mechanical and thermal hyperalgesia. Ketamine had less mechanical hyperalgesia in 6 h (p = 0.018), 24 h (p = 0.014) and 48 h (p = 0.011) than 300 μg MgSO4. There was no difference in inhibiting thermal hyperalgesia between the group ketamine and group MgSO4 (300 μg). The rats were given remifentanil again 7 days later after the first exposure of remifentanil. The hyperalgesic effect induced by re-exposure of remifentanil was not reversed in any groups of MgSO4 or ketamine. Conclusions In addition to ketamine, intrathecal administration of MgSO4 dose-dependently reduced remifentanil-induced hyperalgesia in a surgical incision mode. Re-exposure to remifentanil 1 week later again produced hyperalgesia, and this was not altered by the prior intrathecal treatments in any 4 groups treated with MgSO4 or ketamine. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0235-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiehao Sun
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Hai Lin
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China.,Department of Anesthesiology and Pain medicine, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaona Feng
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Jiaojiao Dong
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Emmanuel Ansong
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Xuzhong Xu
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China.
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