Ultrasound-guided continuous fascia iliaca compartment block for perioperative pain management in elderly patients undergoing hip fracture surgery / 中国骨伤

OBJECTIVE@#To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures.@*METHODS@#A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F, including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old, involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group, including 18 males and 47 females, with an average age of (81.4±8.7) years old ranging from 65 to 94 years old, involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS), minimental state examination (MMSE), observer's assessment of alertness/sedation(OAA/S) scale, modified Bromage score, postoperative complications and general conditions during hospitalization in two groups were observed.@*RESULTS@#The resting and exercise VAS at 30 min after block, anesthesia placement and 6, 24 and 48 h after surgery were lower than those in group C(P<0.05). In group F, MMSE scores at 12 h before surgery, and 1, 3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(P<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(P<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(P<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(P>0.05).@*CONCLUSION@#Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture, and could significantly reduce perioperative pain, improve postoperative cognitive function, and reduce postoperative complications, thereby shortening hospital stay and improving the quality of life during hospitalization.

Comparison of three intraoperative analgesic strategies in laparoscopic bariatric surgery: a retrospective study of immediate postoperative outcomes

Abstract Introduction and objectives Multimodal Analgesia (MMA) has shown promising results in postoperative outcomes across a broad spectrum of surgeries, including bariatric surgery. We compared the analgesic effect immediately after Laparoscopic Bariatric Surgery (LBS) of the combined effect of MMA and methadone against two techniques that were based mainly on the use of high-potency medium-acting opioids. Methods Two hundred seventy-one patients were retrospectively reviewed. The primary outcome was postoperative pain score > 3/10 measured by the Verbal Numeric Scale (VNS) during the Postanesthetic Care Unit (PACU) stay. The three protocols of intraoperative analgesia were: (P1) sufentanil at anesthetic induction followed by remifentanil infusion; (P2) sufentanil at induction followed by dexmedetomidine infusion; and (P3) remifentanil at induction followed by MMA including dexmedetomidine, magnesium, lidocaine, and methadone. Only P1 and P2 patients received morphine toward the end of surgery. Poisson regression was used to adjust confounding factors and calculate Prevalence Ratio (PR). Results Postoperative VNS > 3 was recorded in 135 (49.81%) patients, of which 93 (68.89%) were subjected to P1, 25 (18.56%) to P2, and 17 (12.59%) to P3. In the final adjusted model, both anesthetic techniques (P3) (PR = 0.10; 95% CI [0.03-0.28]), and (P2) (PR = 0.42%; 95% CI [0.20-0.90]) were associated with lower occurrence of VNS > 3, whereas age range 20-29 was associated to higher occurrence of VNS > 3 (PR = 3.21; 95% CI [1.22-8.44]) in PACU. Postoperative Nausea and Vomiting (PONV) was distributed as follows: (P1) 20.3%, (P2) 31.25% and (P3) 6.77%; (P3 < P1, P2; p< 0.05). Intraoperative hypotension occurred more often in P3 (39%) compared to P2 (20.31%) and P1 (17.46%) (p< 0.05). Conclusion MMA + methadone was associated with higher incidence of intraoperative hypotension and lower incidence of moderate/severe pain in PACU after LBS.

Revisión de metadona intraoperatoria para el manejo de dolor posquirúrgico / Intraoperative methadone for the management of postsurgical pain a review

Pain management associated with surgery is a constant concern of the health team as well as the patient. Multiple proposals for analgesia have been made in the perioperative context. The use of opioids with rapid effect and easy titration in the intraoperative period are currently frequent; to then perform a postoperative analgesic control with drugs with a longer half-life, usually achieving adequate pain management. However, sometimes the standard analgesic scheme is not enough. The problems associated with this situation have led to the need for high doses of opioids in the postoperative period, with the requirement for monitoring, health personnel, and the adverse effects that these involve. Methadone is a long-acting, rapid-onset opioid, the latter secondary to its long elimination half-life. It is presumed that these characteristics have led patients to report adequate pain management, which has been related to a decrease in the need and dose of rescue opioids, in addition to delaying the requirement of these if necessary during the postoperative. These properties allow methadone to be a potential solution to perioperative pain management.

El manejo del dolor asociado a la cirugía es una preocupación constante del equipo de salud al igual que del paciente. Se han planteado múltiples propuestas de analgesia en el contexto perioperatorio, siendo actualmente frecuente el uso de opioides de rápido efecto y fácil titulación en el intraoperatorio; para luego realizar un control analgésico postoperatorio con fármacos de mayor vida media, logrando habitualmente un manejo adecuado del dolor. Sin embargo, a veces el esquema analgésico estándar no es suficiente. La problemática asociada a esta situación ha llevado a la necesidad de altas dosis de opioides en el posoperatorio, con el requerimiento de monitorización, personal de salud y efectos adversos que estos involucran. La metadona es un opioide de inicio de acción rápido y larga duración, este último secundario a su vida media de eliminación prolongada. Se presume que estas características han logrado que los pacientes reporten un adecuado manejo de su dolor, lo que se ha relacionado a una disminución en la necesidad y dosis de opioides de rescate, además de retrasar el requerimiento de éstos en el caso de ser necesarios durante el postoperatorio. Estas propiedades permiten que la metadona pueda ser una potencial solución al manejo del dolor perioperatorio.

Recomendaciones analgésicas en el perioperatorio del adulto mayor / Analgesic recommendations in the perioperative of the elderly adult

Resumen: El envejecimiento acelerado de la población representa un reto importante para el sector salud. En México, la pirámide poblacional tiene la proyección de modificarse hacia el año 2050 y el cambio ya ha comenzado. Las estimaciones del Consejo Nacional de Población indican que, para el año 2040, una de cada cuatro personas que vivan en nuestro país será mayor de 60 años. Además de la longevidad, los servicios quirúrgicos también se van incrementando y, en consecuencia, es necesario implementar esquemas de analgesia ajustados a este grupo etario que envejece. El siguiente escrito pretende resumir los cambios que ocurren con la edad y presenta los diversos grupos analgésicos y su indicación acordes a los niveles de evidencia de la National Health and Medical Research Council designation (NHMRC, 1999).

Abstract: The accelerated ageing of the population represents an important challenge for the health sector. In Mexico, the population pyramid has the projection to be modified by the year 2050 and the change has already begun. Estimates from the National Population Council indicate that by the year 2040, one in four people living in our country will be over 60 years. In addition to longevity, surgical services are also increasing therefore, it is necessary to implement analgesia schemes according to this age aging group. The following writing aims to summarize changes occurring with age and presents the analgesic groups with their indication according to the levels of evidence of the National Health and Medical Research Council designation (NHMRC, 1999).

Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?: a case report / 대한마취과학회지

Cryoneurolysis entails using low temperatures to reversibly ablate nerves, with a subsequent analgesia duration measured in weeks or months. Previously, clinical applications for acute pain were limited because treatment originally required exposing the target nerve surgically. However, three developments have now made it possible to provide prolonged postoperative analgesia by cryoneurolysis: 1) new portable, hand-held cryoneurolysis devices, 2) ultrasound machine proliferation, and, 3) anesthesiologists trained in ultrasound-guided peripheral nerve block administration. This report is the first to describe the use of a single preoperative administration of ultrasound-guided percutaneous cryoneurolysis to provide multiple weeks of analgesia following shoulder rotator cuff repair and total knee arthroplasty. Considering the significant benefits of cryoanalgesia relative to continuous peripheral nerve blocks (e.g., lack of catheter/pump care, extremely long duration), this analgesic modality may be a practical alternative for the treatment of prolonged post-surgical pain in a select group of surgical patients.

Progress of Perioperative Analgesia of Total Knee Arthroplasty in Fast Track Surgery Protocol / 中国微创外科杂志

In total knee arthroplasty, perioperative analgesia is transforming into multimodal analgesia.As a significantly important part of fast track surgery ( FTS ) protocol, perioperative analgesia does affect the recovery of patients.We reviewed the advantages and disadvantages of perioperative ( pre-operative, intra-operative and post-operative ) analgesia in FTS protocols in total knee arthroplasty, including the latest progress of the field.

Comparison of intravenous flurbiprofen axetil and epidural tramadol for postoperative pain after cesarean section / 复旦学报（医学版）

Objective To assess the effect and safety of mono and combination of intravenous flurbiprofen axetil (FP) and epidural tramadol on postoperative pain after cesarean section. Methods Eighty parturients undergoing selected cesarean section with combined epidural spinal anesthesia were randomly allocated into 4 groups (n=20 in each): Group FT treated with intravenous FP 50 mg immediately after the umbilical cord was clamped (T1) and epidural tramadol at the time of suturing peritonaeum (T2);Group FF treated with intravenous FP 50 mg at T1 and T2;Group T treated with epidural tramadol 100 mg at T2, and Group F treated with FP 50 mg at T2. Postoperative pain was assessed by parturients using visual analog scales (VAS) at 2, 4, 8, 12, 24 h after surgery. The cases that patients required rescued analgesia were recorded as well as the times of analgesics administration. The events of nausea and vomiting within 24 hours as well as the time of first breast-feeding were observed. Results All groups were similar in VAS at 2 hours after surgery, but were statistically significant different at 4, 8, 12 and 24 hours. Group FF showed significant lower VAS than the other 3 groups. However, no significant difference of VAS was observed among the other 3 groups. Rescued analgesia was administered once after surgery to 7 cases in Group F, 4 in Group T, and 2 in Group FT. No patient in Group FF required rescued analgesia. There was significant difference in the rate of rescued analgesia post surgery among the 4 groups (P=0.0149). No significance in the incidence of nausea and vomiting was observed in 4 groups. There was no significant difference in the time of first breast-feeding after surgery in the 4 groups (F=0.54,P=0.657). Conclusions Intravenous flurbiprofen axetil administration immediately after the umbilical cord is clamped and at the time of closing peritonaeum in cesarean section could relieve postoperative pain and reduce postoperative rescue analgesic requirement without increasing the incidence of nausea and vomiting.

Recent advances in perioperative pain management in orthopaedic surgery / 中国矫形外科杂志

It is generally known that postoperative pain can cause many adverse clinical effects on the patients of orthopaedic surgery such as lack of exercises of the involved limb,atrophy of the related muscles,anchylosis,osteoparosis,et al,which will ultimately affect the patient's final recovery and living quality.This paper introduces some recent advanced theories about the orthopaedic postoperative pain diagnosis,evaluation and various kinds of treatments hoping to achieve more effective perioperative analgesia in orthopaedic surgery.