Postoperative pain management in the elderly. Literature review

Timely post-operative pain management in elderly patients is critically important. Given their physiological changes and comorbidities, management in this group of patients is different from the rest of the population. Knowledge of potentially inappropriate medications (Beers criteria) is relevant because of the presence of comorbidities in this population. Although acetaminophen continues to be safe, non-steroidal anti-inflammatory agents produce several adverse effects which need to be considered before they are used. On the other hand, opioids continue to be one of the pillars in analgesia, with due consideration of their adverse affects and interactions, and the need for dose adjustments. Adequate postoperative pain management prevents adverse effects and the risk of developing chronic pain.

El manejo oportuno del dolor en la población anciana durante el periodo posoperatorio es de vital importancia. Este grupo de pacientes, dado sus cambios fisiológicos y comorbilidades, requieren un manejo diferente al resto de la población. Es relevante conocer cuáles medicamentos son potencialmente inapropiados para su uso (criterios de Beers) ante las comorbilidades de esta población. Si bien el acetaminofén continúa siendo seguro, los antiinflamatorios no esteroideos causan varios efectos adversos que ameritan consideración antes de su uso; por su parte, los opioides siguen siendo uno de los pilares analgésicos, teniendo en cuenta sus efectos adversos y valorando la necesidad de ajuste de dosis e interacciones. El adecuado manejo del dolor posoperatorio previene desenlaces adversos y el riesgo de cronificación.

Eficácia da realidade virtual no manejo da dor pediátrica: contribuições da inovação tecnológica em saúde / Effectiveness of virtual reality in pediatric pain management: contributions of health technological innovation / Eficacia de la realidad virtual en el manejo del dolor pediátrico: aportes de la innovación tecnológica em salud

Avaliar e manejar a dor no período pós-operatório é fundamental, pois a dor aguda, se não ratada, é capaz de alterar diversos sistemas orgânicos. A realidade virtual constitui instrumento promissor de baixo custo para o alívio da dor. Este trabalho objetivou determinar a eficácia da realidade virtual no manejo da dor aguda leve a moderada em pacientes no pós-operatório mediato. Trata-se de um estudo clínico randomizado, realizado em um hospital pediátrico de Curitiba. Os participantes da pesquisa foram randomizados e alocados em dois grupos, submetidos a um vídeo temático relaxante e à realidade virtual. Os dados foram submetidos à análise estatística descritiva e inferencial. A redução da dor proporcionada pela realidade virtual é estatisticamente significativa e superior quando comparada à redução induzida pelo vídeo temático relaxante, podendo otimizar a experiência de hospitalização, com atenção centrada na experiência do paciente, mitigando os efeitos colaterais relacionados ao uso de opioides.

Assessing and managing pain in the post-operative period is essential, as acute pain, if left untreated, can alter several organic systems. Virtual reality is a promising low-cost tool for pain relief. This study aimed to determine the effectiveness of virtual reality in the management of mild to moderate acute pain in patients in the immediate postoperative period. This is a randomized clinical study, carried out in a pediatric hospital in Curitiba. Research participants were randomized and allocated into two groups, and shown a relaxing thematic video and virtual reality. Data were subjected to descriptive and inferential statistical analysis. Pain reduction provided by virtual reality is statistically significant and superior when compared to the reduction induced by the relaxing thematic video, and can optimize the hospitalization experience, with attention focused on the patient's experience, mitigating side effects related to the use of opioids

La evaluación y manejo del dolor en postoperatorio es fundamental. Ya que el dolor agudo, si no se trata, es capaz de alterar varios sistemas. La realidad virtual es un instrumento prometedor de bajo costo para alivio del dolor. Este estudio tuvo como objetivo determinar la efectividad de la realidad virtual en el manejo del dolor agudo en pacientes en postoperatorio inmediato. Se trata de un estudio clínico aleatorizado realizado en un hospital pediátrico de Curitiba. Los sujetos de la investigación fueron aleatorizados y distribuidos en dos grupos, sometidos a un video temático relajante y a la realidad virtual. Los datos fueron sometidos al análisis estadístico descriptivo e inferencial. La reducción del dolor proporcionada por la realidad virtual es estadísticamente significativa y superior en comparación con la reducción inducida por el video temático relajante, que puede optimizar la experiencia de hospitalización, con atención contrada en la experiencia del paciente, mitigando efectos secundarios relacionados con opioides.

Effect of esketamine for acute and chronic pain after cesarean section / 中国医师杂志

Objective:To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods:One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups ( n=75) using a random number table: esketamine group (group E) and control group (group C). Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration. After the delivery of the fetus, 0.15 mg/kg (1 mg/ml) esketamine was pumped intravenously for 30 min in the group E, while the same dosage of normal saline was administered in the group C. Furthermore, patients received an intravenous patient controlled intravenous analgesia (PCIA) pump after surgery (100 μg sufentanil + 1.25 mg/kg esketamine + 8 mg ondansetron for the group E, 100 μg sufentanil + 8 mg ondansetron for the group C). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in the initial time of esketamine administration, and 5, 15 min, and 30 min after administration. The pain Numerical Rating Scale (NRS) score at rest and during coughing were recorded at 2, 6, 12, 24 h and 48 h after surgery. The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h, 12-24 h, 24-48 h, 0-24 h and 0-48 h after surgery. Moreover, we recorded the incidence of chronic pain at 3 and 6 months after surgery. Results:There were no significant differences in HR, SBP and DBP between the two groups immediately after administration of esketamine and 5, 15 min and 30 min after administration (all P>0.05). At rest or during coughing, the pain NRS score were significantly lower at 2, 6 h, and 12 h postoperatively in group E compared to group C (all P<0.05). The time to first analgesia in group E was significantly longer than the group C [(176.8±18.3)min vs (148.5±16.9)min, P<0.05]. The cumulative sufentanil consumption was significantly lower in group E during 0-12 h, 12-24 h, 0-24 h and 0-48 h postoperatively than in group C (all P<0.05), but there was no statistical significance between the two groups at 24-48 h ( P>0.05). There were no significant difference between the two groups in the incidence of chronic pain at 3 months and 6 months after surgery ( all P>0.05). The incidence of chronic pain in group E was lower than that in group C at 3 months [13.4%(9/67) vs 18.8%(13/69), P=0.392] and 6 months [10.7%(6/56) vs 16.1%(10/62), P=0.391], but the difference was not statistically significant. Conclusions:Perioperative administration of esketamine provided superior short-term analgesia after cesarean section and did not increase the psychotomimetic adverse event rate. However, the development of chronic pain was not restrained.

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.

Effects of deep deltoid ligament injury on postoperative ankle function in patients with pronation-external rotation ankle fractures / 中国基层医药

Objective:To investigate the effects of a deep deltoid ligament injury on postoperative ankle function and pain in patients with pronation-external rotation ankle fractures.Methods:Thirty patients with pronation-external rotation ankle fractures without deep deltoid ligament injury admitted to Weihai Municipal Hospital from March 2019 to March 2020 were included in the control group. Thirty patients with pronation-external rotation ankle fractures with deep deltoid ligament injury admitted to the same hospital from April 2020 to June 2021 were included in the observation group. Both groups received reduction and internal fixation of pronation-external rotation ankle fractures. American Orthopaedic Foot and Ankle Society score, pain, and quality of life were compared between the two groups.Results:At 1 and 3 months after surgery, American Orthopaedic Foot and Ankle Society scores in the observation group were (69.87 ± 2.89) points and (75.66 ± 4.27) points, which were significantly lower than (81.45 ± 4.78) points, and (93.62 ± 3.54) points in the control group ( t = 11.35, 17.37, both P < 0.01). At 1 and 3 months after surgery, Visual Analogue Scale (VAS) scores in the observation group were (7.16 ± 1.15) points and (5.84 ± 0.52) points, respectively, which were significantly higher than (6.42 ± 0.54) points and (4.28 ± 0.16) points in the control group ( t = 3.19, 15.70, both P < 0.05). At 3 months after surgery, the scores of physical health, mental health, social relationship, and surrounding environment in the observation group were (19.18 ± 1.96) points, (18.67 ± 1.82) points, (17.42 ± 2.54) points, (19.65 ± 2.43) points, respectively, which were significantly lower than (21.65 ± 3.58) points, (23.57 ± 3.56) points, (20.09 ± 3.95) points, (22.38 ± 3.67) points in the control group ( t = 3.31, 6.71, 3.11, 3.39, all P < 0.05). Conclusion:Deep deltoid ligament injury affects the recovery of pronation-external rotation ankle fracture and affects the quality of life. Therefore, it is necessary to repair deep deltoid ligament injury in time in patients with pronation-external rotation ankle fractures.

Risk factors of moderate to severe pain in patients with non-small cell lung cancer within 3 days after lobectomy / 中国基层医药

Objective:To investigate the risk factors of moderate to severe pain in patients with non-small cell lung cancer within 3 days after lobectomy.Methods:The clinical data of 297 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center from December 2020 to June 2021 were retrospectively analyzed. A numerical rating scale was used to score the most severe pain within 3 days after surgery. Pain score ≥ 4 was defined as moderate to severe pain. The risk factors for moderate to severe pain were analyzed by binary Logistic regression. General linear model repeated measures and linear mixed models were used to analyze the trend of risk factors influencing postoperative pain with time.Results:The incidence of moderate to severe pain was 34.2% (102/297), 59.8% (178/297), 66.4% (198/297), and 28.2% (84/297) on days 0, 1, 2, and 3 after surgery respectively. The risk for moderate to severe pain was significantly higher in patients undergoing thoracotomy than patients undergoing thoracoscopic surgery on days 1 ( OR = 1.99, P = 0.009), 2 ( OR = 3.08, P < 0.001), and 3 ( OR = 3.88, P < 0.001) after surgery. However, the risk for moderate to severe pain in patients undergoing thoracotomy was slightly, but not significantly, higher than that in patients undergoing thoracoscopic surgery ( OR = 1.53, P = 0.087). The risk for moderate to severe pain was higher in female patients than male patients on day 2 ( OR = 1.62, P = 0.077), and in particular on day 3 after surgery ( OR = 2.39, P = 0.002). Prophylactic use of parecoxib significantly reduced the risk of moderate to severe pain on day 0 ( OR = 0.32, P = 0.004), 1 ( OR = 0.20, P < 0.001), 2 ( OR = 0.36, P < 0.001) and 3 ( OR = 0.56, P = 0.047). Conclusion:The incidence of moderate to severe pain on days 1 and 2 after lobectomy was relatively high in patients with non-small cell lung cancer. Patients undergoing thoracotomy have a higher risk of moderate to severe pain than those who underwent thoracoscopic surgery. Female patients have a higher risk for moderate to severe pain on days 2 and 3 after surgery than male patients. Prophylactic use of parecoxib can decrease the risk for moderate to severe pain in patients with non-small cell lung cancer.

Effects of transversus abdominis plane block on pain, rehabilitation indexes and immune function in patients undergoing laparoscopic colorectal cancer surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.

Effects of Compound Huangbai Liquid coating combined with Xiaochuang Mixture on postoperative wound healing, clinical symptoms and inflammatory response in patients with perianal abscess surgery / 国际中医中药杂志

Objective:To explore the effects of Compound Huangbai Liquid coating combined with Xiaochuang Mixture on wound healing, clinical symptoms and inflammatory response in patients with perianal abscess surgery; To evaluate the clinical efficacy.Methods:Randomized controlled trial. 120 patients after perianal abscess surgery in the hospital from August 2021 to August 2022 were selected as the observation subjects, and they were divided into three groups by the random number table method, with 40 cases in each group. On the basis of routine anti-infection therapy, external TCM application group was given Compound Huangbai Liquid coating, oral TCM administration group was given oral Xiaochuang Mixture, and combined treatment group was treated with Compound Huangbai Liquid coating + Xiaochuang Mixture. The three groups were continuously treated for 15 days. TCM symptoms scores and VAS score were performed on the 2nd day, 7th day and 15th day after surgery, and the levels of IL-6 and TNF-α were detected by ELISA. The wound healing time and carrion shedding time of patients were observed and recorded, and the clinical efficacy was evaluated.Results:The scores of perianal secretions, granulation morphology and surrounding tissue edema and score of VAS decreased in the three groups at 7 days and 15 days after surgery compared with those at 2 days after surgery ( P<0.01), and with the extension of time, the scores of perianal secretions, granulation morphology and surrounding tissue edema and VAS score from the aspects of time-point effect ( F=21.69, 134.65, 19.27, 73.15) and between-group effect ( F=7.99, 98.79, 8.68, 10.71) were declined ( P<0.01), and there was an interaction effect between the decline degree and the treatment method ( F=9.78, 59.52, 11.29, 22.48, P<0.01). The carrion shedding time [(4.63±1.31) d vs. (6.22±2.14) d, (6.17±2.09) d, F=9.16] and healing time [(27.76±3.46) d vs. (30.27±4.11) d, (31.48±4.23) d, F=9.24] were earlier in combined treatment group than those in the external TCM application group and oral TCM administration group ( P<0.01). Serum levels of IL-6 and TNF-α in the three groups at 7 and 15 days after surgery were reduced compared with those at 2 days after surgery ( P<0.01), and with the extension of time, the levels of serum IL-6 and TNF-α in the three groups decreased from the aspects of time-point effect ( F=69.36, 38.76) and between-group effect ( F=21.81, 13.50) ( P<0.01), and there was an interaction effect between the decrease degree and treatment method ( F=28.46, 23.34, P<0.01). The total effective rate was 100.0% (40/40) in combined treatment group, 80.0% (32/40) in external TCM application group and 87.2% (34/39) in oral TCM administration group ( H=8.44, P=0.015). Conclusion:The combination of Compound Huangbai Liquid coating and Xiaochuang Mixture can reduce perianal secretions, improve granulation morphology, alleviate surrounding tissue edema and wound pain, promote wound healing, and reduce inflammatory response of patients with perianal abscess surgery.

Acupoint selection rule of acupuncture therapy for relieving postoperative pain based on data mining / 国际中医中药杂志

Objective:To analyze the rule of acupoint selection for acupuncture in relieving postoperative pain based on data mining technology.Methods:Articles about acupuncture for postoperative pain were retrieved from CNKI, SinoMed, VIP, Wanfang, PubMed, Embase and Web of Science databases from establishment to June 6, 2022. Excel 2019 and SPSS Modeler 18.0 software were used to establish acupoints database and conduct the data analysis.Results:Totally 308 articles were obtained, involving 317 acupuncture prescriptions and 173 acupoints. Acupoints of bladder meridian, stomach meridian, large intestine meridian and spleen meridian were used frequently. Zusanli (ST 36), Hegu (LI 4) and Neiguan (PC 6) were high-frequency acupoints with a frequency of ≥50 times. Five-shu acupoint was often selected in specific acupoints. The common sites for acupuncture to relieve postoperative pain were abdomen, perianal, lumbar back and knee. Zusanli (ST 36), Neiguan (PC 6) and other acupoints were commonly used for abdominal postoperative pain, and the most commonly used combination was "Zusanli (ST 36)-Neiguan (PC 6)"; Chengshan (BL 57), Changqiang (GV 1) and other acupoints were often used for perianal postoperative pain, and "Chengshan (BL 57)-Changqiang (GV 1)" was highly correlated combination; Shenshu (BL 23) and Huantiao (GB 30) were commonly used for postoperative pain in the lumbar and back region, and acupoints with high correlation were "Ashi acupoint-Huantiao (GB 30)" and "Shenshu (BL 23)-Huantiao (GB 30)"; Xuehai (SP10) and Liangqiu (ST 34) were commonly used for postoperative pain of knee, and their compatibility had a high correlation.Conclusion:Acupuncture therapy for relieving postoperative pain often selects Yang meridians acupoints, and follows the principle of distal-proximal points combination and acupoint selection along meridians, and pays attention to the use of specific acupoints.

Anesthetic block of the intertransverse septum, a prospective observational study / Bloqueio anestésico do septo intertransverso, estudo prospectivo observacional / Bloqueo anestésico del septo intertransverso, estudio prospectivo observacional

ABSTRACT Objective: To evaluate the influence of intertransverse septal anesthetic block (BASIT) on postoperative pain in lumbar spine surgery. Methods: The study was carried out prospectively and observationally. Were included 105 patients who underwent posterior lumbar spine surgery, divided into two groups: 35 patients in the experimental group, who received BASIT at the end of the procedure, and 70 patients in the control group, without BASIT. Patients were assessed for low back pain (visual pain scale), opioid consumption on the 1st postoperative day, complications related to the procedure, and length of stay after surgery. Results: The sample consisted of 46 men and 59 women, with a mean age of 57.7 years (21 to 90 years). Mean postoperative pain in the experimental group was 1.88, and in the control group 2.11 (p<0.05). There was a trend towards less morphine use in the experimental group with p = 0.053. There was a statistical difference in morphine consumption between patients who did not previously use opioids and those who already used them (p 0.04). There was no difference between the groups regarding length of stay. Conclusion: Anesthetic blockade of the intertransverse septum reduced the consumption of opioids and the levels of low back pain after surgery (p<0.05), with no statistical difference in length of hospital stay or complications related to the technique. Level of Evidence II; Clinical Prospective Study.

RESUMO: Objetivo: Avaliar a influência do bloqueio anestésico do septo intertransverso (BASIT) sobre a dor pós-operatória em cirurgia de coluna lombar. Metodologia: O estudo foi realizado de modo prospectivo e observacional. Foram incluídos no estudo 105 pacientes submetidos à cirurgia da coluna lombar por via posterior e divididos em dois grupos: 35 pacientes no grupo experimental, que recebeu o BASIT ao final do procedimento e 70 pacientes no grupo controle, sem o BASIT. Os pacientes foram avaliados quanto à dor lombar (escala visual de dor), consumo de opioide no 1º dia pós-operatório, complicações referentes ao procedimento e tempo de internamento após a cirurgia. Resultados: A amostra consistiu em 46 homens e 59 mulheres, com média de idade de 57,7 anos (21 a 90 anos). A média de dor pós-operatória do grupo experimento foi 1,88 e no grupo controle 2,11 (p<0,05). Houve uma tendência a menor uso de morfina no grupo experimento com p = 0,053. Houve diferença estatística no consumo de morfina entre os pacientes que não utilizavam opioides previamente quanto comparados aos que já faziam uso (p 0,04). Não houve diferença entre os grupos quanto ao tempo de internamento nem eventos adversos relacionados à técnica. Conclusão: O bloqueio anestésico do septo intertransverso reduziu o consumo de opioides e os níveis de dor lombar após cirurgia (p<0,05), não havendo diferença estatística no tempo de internamento, nem intercorrências relacionadas a técnica. Nível de Evidência II; Estudo Prospectivo Clínico.

RESUMEN: Objetivo: Evaluar la influencia del bloqueo anestésico del septo intertransverso (BASIT) sobre el dolor posoperatorio en cirugía de columna lumbar. Método: El estudio se realizó de forma prospectiva observacional. Fueron incluidos en el estudio 105 pacientes sometidos a cirugía de columna lumbar posterior y se dividieron en dos grupos: 35 pacientes en el grupo experimental, recibieron BASIT al final del procedimiento, y 70 pacientes en el grupo control, sin BASIT. Los pacientes fueron evaluados por dolor lumbar (escala visual de dolor), consumo de opioides en el primer día postoperatorio, complicaciones relacionadas con el procedimiento y tiempo de estancia hospitalaria después de la cirugía. Resultado: La muestra consistió en 46 hombres y 59 mujeres, con una edad media de 57,7 años (21 a 90 años). El dolor postoperatorio medio en el grupo experimental fue de 1,88 y en el grupo control de 2,11 (p<0,05). Hubo una tendencia hacia un menor uso de morfina en el grupo experimental con p = 0,053. Hubo una diferencia estadística en el consumo de morfina entre los pacientes que no usaban previamente opioides en comparación con los que ya los usaban (p 0,04). No hubo diferencia entre los grupos con respecto a la duración de la estancia. Conclusión: El bloqueo anestésico del septo intertransverso redujo el consumo de opioides y los niveles de dolor lumbar posoperatorio (p<0,05), sin diferencia estadística en la estancia hospitalaria ni en las complicaciones relacionadas con la técnica. Nivel de Evidencia II; Estudio Clínico Prospectivo.

Fixed and on-demand regimens of acetaminophen in periodontal surgery: randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized". Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen "as needed," at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

Abstract Background This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I2= 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I2= 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I2= 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p= 0.05; I2= 97%; GRADE: very low). Conclusions Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

Role of S1PR1 in dorsal root ganglion in remifentanil-induced hyperalgesia in rats with incisional pain / 中华麻醉学杂志

Objective:To evaluate the role of sphingosine-1-phospho-1 receptor(S1PR1)in the dorsal root ganglion in remifentanil-induced hyperalgesia in rats with incisional pain.Methods:Forty-eight male Sprague-Dawley rats with successful intrathecal and caudal vein catheterization, weighing 260-280 g, aged 2-3 months, were divided into 6 groups ( n= 8 each) using a random number table method: control group (group C), S1PR1 antagonist (FTY720) group (group F), remifentanil group (group R), remifentanil + S1PR1 antagonist (FTY720) group (group R+ F), remifentanil + incisional pain group (group R+ I), and remifentanil + incisional pain + S1PR1 antagonist (FTY720) group (group R+ I+ F). In C group, normal saline 0.1 μg·kg -1·min -1 was intravenously infused for 60 min. In R group, remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In F group, FTY720 3 nmol was intrathecally injected, and 10 min later normal saline 1.0 μg· kg -1·min -1 was infused for 60 min via the caudal vein. In R+ F group, FTY720 3 nmol was intrathecally injected, and 10 min later remifentanil 1.0 μg· kg -1·min -1 was infused for 60 min through the caudal vein. In R+ I group, remifentanil 1.0 μg·kg -1·min -1 was infused for 60 min through the caudal vein while the model of incisional pain was developed. In R+ I+ F group, FTY720 3 nmol was intrathecally injected, 10 min later the incisional pain model was prepared, and remifentanil 1.0 μg·kg -1·min -1 was injected for 60 min through the caudal vein at the same time. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before remifentanil or normal saline infusion (T 0) and 2, 6, 24 and 48 h after stopping remifentanil or normal saline infusion (T 1-4). Rats were sacrificed after the last measurement of pain threshold, and the L 4-6 segments of dorsal root ganglion were taken for determination of the expression of S1PR1, NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), interleukin-1β (IL-1β) and glutamate transporter-1 (GLT-1) protein and mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with C group, the MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and the expression of GLT-1 protein and mRNA in dorsal root ganglion was down-regulated in R group ( P<0.05), and no significant change was found in the parameters mentioned above in group F ( P>0.05). Compared with R group, MWT was significantly decreased and TWL was shortened at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in dorsal root ganglion was up-regulated, and GLT-1 protein and mRNA expression in dorsal root ganglion was down-regulated in R+ I group, and MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and GLT-1 protein and mRNA expression in the dorsal root ganglion was up-regulated in R+ F group ( P<0.05). Compared with R+ I group, MWT was significantly increased and TWL was prolonged at T 1-4, the expression of S1PR1, NLRP3 and IL-1β protein and mRNA in the dorsal root ganglion was down-regulated, and the expression of GLT-1 protein and mRNA in the dorsal root ganglion was up-regulated in R+ I+ F group( P<0.05). Conclusions:The mechanism by which remifentanil induces hyperalgesia is associated with up-regulation of S1PR1 expression, activation of inflammatory factors, and down-regulation of GLT-1 expression in the rats with incisional pain.

Effect of low-dose esketamine on remifentanil-induced postoperative hyperalgesia / 中华麻醉学杂志

Objective:To evaluate the effects of low-dose esketamine on remifentanil-induced postoperative hyperalgesia in the patients.Methods:Ninety-six American Society of Anesthesiologist Physical Status classificationⅠ or Ⅱ patients, aged 18-60 yr, with body mass index of 18-30 kg/m 2, scheduled for elective thyroidectomy under general anesthesia, were divided into 3 groups ( n=32 each) using a random number table method: control group (group C), esketamine administered before anesthesia induction group (group K1), and esketamine administered immediately after the end of surgery group (group K2). Esketamine 0.4 mg/kg was intravenously injected in group K1, and the equal volume of normal saline was given instead in C and K2 groups at 5 min before anesthesia induction. Anesthesia was induced by intravenous injection of propofol, remifentanil and rocuronium. Remifentanil was intravenously infused at a rate of 0.3 μg · kg -1·min -1 and 1.5%-2.5% sevoflurane was inhaled for anesthesia maintenance. Esketamine 0.4 mg/kg was intravenously injected in group K2 and the equal volume of normal saline was given instead in C and K1 groups immediately after the end of surgery. The mechanical pain thresholds of surgical incision and forearm of non-dominant hand were measured at 1 day before surgery and 30 min, 6 h, 24 h and 48 h after surgery, and flurbiprofen axetil was intravenously injected for rescue analgesia when the NRS score≥4 or the patient needed sedation. The intensity of pain was estimated using numeric rating scale at 30 min, 6 h, 24 h and 48 h after surgery. The intraoperative consumption of remifentanil, use of vasoactive drugs, recovery time, tracheal extubation time, duration of PACU stay, postoperative rescue analgesia and adverse reactions were recorded. Results:Compared with C group, the mechanical pain threshold around surgical incision and of the forearm of non-dominant hand was significantly increased at 30 min and 6 h after surgery in K1 and K2 groups ( P<0.05). Compared with C and K1 groups, the emergence time, tracheal extubation time, and duration of PACU stay were significantly prolonged, and the incidence of hallucinations and increased glandular secretion was increased in group K2 ( P<0.05). There were no significant differences in the consumption of remifentanil, intraoperative utilization rate of atropine and ephedrine, numeric rating scale scores at each time point after surgery, incidence of postoperative nausea and vomiting, and rate of rescue analgesia among the three groups ( P>0.05). Conclusions:Intravenous injection of small dose of esketamine (0.4 mg/kg) before anesthesia induction and immediately after the end of surgery can reduce postoperative hyperalgesia induced by remifentanil, and administration before anesthesia induction provides better efficacy in the patients.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches / Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

Abstract Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p< 0.001), as well as lower hematimetric loss (p< 0.001), shorter operative time (p< 0.001), and improvement in immediate postoperative active mobility tests (p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Resumo Objetivo Comparar as técnicas de osteossíntese de fraturas intertrocantéricas com o parafuso dinâmico de quadril (dynamic hip screw, DHS, em inglês) pelas vias de acesso de Hardinge e minimamente invasiva do quadril, avaliando o tempo cirúrgico, o grau de dor no pós-operatório imediato, a perda hematimétrica, e os aspectos funcionais de mobilidade ativa. Métodos Estudo clínico randomizado e duplo-cego, em que 66 pacientes com fratura intertrocantérica foram submetidos a osteossíntese com DHS. Os pacientes foram divididos em um grupo teste, submetidos ao acesso minimamente invasivo, e um controle, em que a cirurgia foi realizada pela via de Hardinge. Resultados Os pacientes submetidos ao tratamento pela via minimamente invasiva apresentaram um grau de dor pós-operatória inferior em comparação ao grupo tratado pela via lateral de Hardinge (p< 0,001), assim como menor perda hematimétrica (p< 0,001), menor tempo operatório (p< 0,001), e melhora nos testes de mobilidade ativa pós-operatória imediata (p< 0,05). Conclusão O estudo demonstrou a superioridade clínica nos parâmetros analisados da via de acesso minimamente invasiva em relação ao acesso de Hardinge para a fixação de fraturas intertrocantéricas, quando o DHS for a opção de osteossíntese escolhida. Nível de evidência I.

Effect of local infiltration of ropivacaine in gallbladder triangle on agitation and postoperative pain in patients undergoing laparoscopic cholecystectomy / 中国医师杂志

Objective:To study the effect of local infiltration of ropivacaine in gallbladder triangle on agitation and postoperative pain in patients undergoing laparoscopic cholecystectomy (LC).Methods:108 patients with LC who met the requirements of this study treated in Yunnan Cancer Hospital from March 2018 to March 2021 were randomly divided into two groups, 54 cases in each group. Both groups received routine LC under general anesthesia. The observation group received ropivacaine for local infiltration in the gallbladder triangle, and the control group received the same amount of normal saline for local infiltration in the gallbladder triangle. The anesthesia indexes, agitation during awakening and postoperative pain were compared between the two groups.Results:There was no significant difference in extubation, anesthesia and recovery time between the observation group and the control group (all P>0.05); The scores of static and dynamic visual analogue scale (VAS) in the two groups reached the highest value at 6 h after operation, and then decreased gradually, with significant differences between the two groups ( F=15.28, 4.26, 11.06, 3.21, all P<0.05). The dynamic and static VAS scores of the observation group were lower than those of the control group at the time of awakening, 6 h, 12 h and 24 h after operation, with statistically significant difference (all P<0.05). Compared with the control group, the Riker sedation agitation score (SAS) and the incidence of agitation in the observation group were significantly lower (all P<0.05), and the effective times of analgesic pump pressing 24 hours after operation were significantly less ( P<0.05); There was no significant difference in SpO 2 level between the observation group and the control group ( P>0.05); The levels of heart rate (HR) and mean arterial pressure (MAP) in the two groups were significantly higher than those before anesthesia, and the rising degree in the observation group was significantly lower than that in the control group (all P<0.05); The levels of norepinephrine (NE), C-reactive protein (CRP) and cortisol in the two groups were significantly higher than those before anesthesia, and the rising degree in the observation group was significantly lower than that in the control group (all P<0.05). Conclusions:Local infiltration of gallbladder triangle with ropivacaine during LC can reduce the degree of postoperative pain, the use of PCIA pump and the occurrence of agitation during awakening, so as to maintain hemodynamic stability.

Preliminary application of the subxiphoid video-assisted thoracoscopic extended thymectomy / 中国基层医药

Objective:To analyze the preliminary effects of subxiphoid video-assisted thoracoscopic extended thymectomy.Methods:We retrospectively analyzed the clinical data of six patients who underwent subxiphoid video-assisted thoracoscopic extended thymectomy in Peking University International Hospital from August 2018 to June 2020.Results:All six patients underwent successful subxiphoid video-assisted thoracoscopic extended thymectomy without conversion to thoracotomy. The rate of R0 resection was 100%. Operative time was (175.50 ± 67.78) minutes, intraoperative blood loss was (40.83 ± 31.37) mL, and postoperative drainage time was (7.17 ± 3.55) days. The total amount of postoperative drainage was (1781.67 ± 1293.53) mL. Postoperative hospital stay was (10.67 ± 6.35) days. The length of hospital stay was (19.67 ± 5.65) days. The Visual Analog Scale score measured after surgery was (2.12 ± 0.48) points. Three patients had grade 1 complications, with an incidence of complications of 50.00%. Grade 3-5 compilations did not occur in any patient. No patient died during the perioperative period.Conclusion:Subxiphoid video-assisted thoracoscopic extended thymectomy is safe and effective and provides a good visual field. The surgical method allows bilateral thoracic surgery, reduces surgical trauma, and has a broad application prospect.

The effect of dexmedetomidine combined with thoracic paravertebral block on sleep quality, serum interleukin -6 and high mobility group protein-1 in patients undergoing thoracoscopic pulmonary surgery / 中国医师进修杂志

Objective:To analyze the effect of dexmedetomidine combined with thoracic paravertebral block (TPVB) on sleep quality, serum interleukin-6 (IL-6) and high mobility group protein (HMGB-1) levels in patients undergoing thoracoscopic pulmonary surgery.Methods:The clinical data of 90 patients who received thoracoscopic pulmonary surgery from January 2020 to January 2021 in Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 45 patients were given dexmedetomidine combined with TPVB before operation (experiment group), and 45 patients were given TPVB before operation (control group). The indexes of sleep quality were recorded, including Pittsburgh sleep quality index (PSQI) and total sleep time 24 and 48 h after operation. The visual analogue score (VAS) during quiet and cough 1, 6, 12, 24 and 48 h after operation were recorded. The serum substance P (SP), 5-hydroxytryptamine (5-HT), C-reactive protein (CRP), IL-6 and HMGB-1 before operation and 1 d after operation were detected. The adverse reactions were compared between 2 groups.Results:The PSQI 24 and 48 h after operation in experiment group was significantly lower than that in control group: (11.38±4.61) scores vs. (13.65±2.72) scores and (8.78±3.79) scores vs. (10.95±2.81) scores, the total sleep time was significantly longer than that in control group: (7.71±2.64) h vs. (5.49±2.10) h and (9.75±3.14) h vs. (7.82±2.67) h, and there were statistical differences ( P<0.01). The VAS during quiet and cough 1, 6 and 12 h after operation in experiment group was significantly lower than that in control group, and there was statistical difference ( P<0.01); there was no statistical difference in the VAS during quiet and cough 24 and 48 h after operation between 2 groups ( P>0.05). There were no statistical differences in serum SP, 5-HT, CRP, IL-6 and HMGB-1 before operation between 2 groups ( P>0.05); the SP, 5-HT, CRP, IL-6 and HMGB-1 1 d after operation in experiment group were significantly lower than those in control group: (132.59±10.34) ng/L vs. (141.57±12.26) ng/L, (0.73±0.11) μmol/L vs. (0.95±0.09) μmol/L, (32.46±3.54) mg/L vs. (38.53±4.12) mg/L, (145.67±24.68) ng/L vs. (162.79±23.51) ng/L and (70.35±6.81) ng/L vs. (92.36±7.08) ng/L, and there were statistical differences ( P<0.01). The incidence of adverse reactions in experiment group was significantly lower than that in control group: 20.00% (9/45) vs. 48.89% (22/45), and there was statistical difference ( χ2 = 8.32, P = 0.004). Conclusions:Dexmedetomidine combined with TPVB can effectively improve postoperative sleep quality of patients undergoing thoracoscopic pulmonary surgery, relieve pain, and reduce postoperative serum pain mediators and inflammatory factors, with fewer adverse reactions.

Application value of Manchester Pain Management Model of patients undergoing rotator cuff repair surgery / 中国实用护理杂志

Objective:To investigate the effects of Manchester Pain Management Model (MPMM) on postoperative pain and joint function for patients undergoing rotator cuff repair surgery.Methods:A total of 66 patients undergoing rotator cuff repair surgery from February 2017 to October 2020 in the First People′s Hospital of Hefei were divided into experimental group and control group by random digits table method, with 33 cases in each group. The control group received routine nursing; based on the routine care, the experimental group implemented MPMM-based intervention. The degree of pain and shoulder function of the two groups were assessed by Visual Analogue Scale (VAS) and Constant-Murley Scale (CMS).Results:During the study period, 1 case in the experimental group was lost, 32 cases in the final experimental group and 33 cases in the control group. There was no significant difference in the score of VAS and CMS before surgery between the two groups ( P>0.05). At 1 day, 3 days, 3 weeks and 6 weeks after surgery, VAS scores in the experimental group were 5.47 ± 1.72, 4.63 ± 1.16, 3.25 ± 0.78, 1.81 ± 0.52, lower than those scores in the control group 6.42 ± 1.03, 5.45 ± 1.54, 4.30 ± 0.64, 2.39 ± 0.47, the differences were statistically significant ( t values were 2.36-3.11, all P<0.05). At 3, 6, 12 weeks after surgery, CMS scores in the experimental group were 57.09 ± 4.32, 67.75 ± 4.60, 81.94 ± 4.18, higher than those scores in the control group 52.27 ± 5.39, 64.24 ± 3.76, 78.91 ± 4.36, the differences were statistically significant ( t=3.97, 3.37, 2.89, all P<0.01). Conclusions:MPMM can effectively alleviate the postoperative pain and promote the recovery of joint function in patients undergoing rotator cuff repair surgery.