Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

Effects of Mangifera indica fruit extract on cognitive deficits in mice.

Mangos are a source of bioactive compounds with potential health-promoting activity. The present work was undertaken to evaluate the ethanolic extract of Mangifera indica L. fruit on cognitive performances. The models used to study the effect on cognitive performances are step down passive avoidance task and elevated plus maze task in mice. Chronic treatment (7 days) of extract and vitamin C significantly (p < 0.05) reversed the aging and scopolamine induced memory deficits in both paradigms. Preliminary phytochemical screening revealed the presence of free sugars, saponins, tannins, and flavonoids. The results suggest the extract contained pharmacologically active principles that are memory-enhancing in nature.

Central nervous system activity of acute administration of ethanol extract of Punica granatum L. seeds in mice.

Role of ethanolic extract of P. granatum seeds on central nervous system (CNS) in animal models of elevated plus maze test, barbiturate-induced sleeping time, tail suspension test, hot-plate and tail-flick test was studied. P. granatum (PG) extract was administered to young and aged mice at single doses of 100, 250 and 500 mg/kg, perorally while diazepam (1 mg/kg), morphine (5 mg/kg) and imipramine (30 mg/kg) were used intraperitoneally as standard drugs. The results showed that PG extract at all dose levels significantly exhibited the anxiolytic activity. In another study PG extract (250 and 500 mg/kg) significantly increased the sleeping latency and reduced the sleeping time. Tail suspension test showed that PG extract (250 and 500 mg/kg) was able to induce a significant decrease in the immobility time, similar to imipramine, a recognized antidepressant drug. Tail-flick and hot-plate tests exhibited antinociceptive property of PG extract, similar to morphine, a recognized antinociceptive agent. Phytochemical investigation of ethanol extract for the presence of phenolic compounds, flavonoids, tannins, anthocyanins, sugars and saponins was also carried out. Phytochemical screening and measurement of reducing power revealed the CNS activity of ethanol extract of PG seeds may be due to its antioxidative profile.