Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract Background: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. Methods: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. Conclusion: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO registration: CRD42022339628 PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID=339628

Actualización en analgesia preventiva y analgesia multimodal / Update on preventive analgesia and multimodal analgesia

Una deficiente calidad del manejo del dolor post operatorio agudo genera aumento en la morbilidad perioperatoria, disminuye la calidad de vida del paciente, aumenta los reingresos hospitalarios y, finalmente, los costes en salud. La analgesia preventiva y multimodal son dos estrategias que han sido implementadas para tratar de optimizar el manejo del dolor. Si bien en la primera, la evidencia es favorable a su empleo, aún no existe un total consenso en esto. A su vez, la analgesia multimodal, al emplear diferentes fármacos y/o técnicas, ha logrado evidenciar de mejor manera su utilidad y los beneficios al implementarla como terapia. En este artículo, revisamos la evidencia que certifica y avala el uso de éstas. Finalmente, a nuestro parecer, lo más importante en el quehacer del clínico, es lograr individualizar la estrategia que usaremos en el manejo del dolor postoperatorio, adaptándonos a las necesidades y el contexto propio de cada uno de nuestros pacientes.

A poor quality of acute postoperative pain management generates an increase in perioperative morbidity, decreases the quality of life of the patient, increases hospital readmissions and finally, increases health costs. Preventive and multimodal analgesia are two strategies that are implemented to try to optimize pain management. Although in the first, the evidence is favorable to its use, there is still no total consensus. At the same time, multimodal analgesia, by using different drugs and/or techniques, has demonstrated, in a better way, its usefulness and benefits when implemented as a therapy. In this article, we review the evidence that certifies and supports the use of these techniques. Finally, in our opinion, the most important thing in the clinician's task is to be able to individualize the strategy that we will use in postoperative pain management, adapting to the needs and context of each one of our patients.

Ultrasound-guided continuous costoclavicular block through retrograde stimulating catheter technique for postoperative analgesia in shoulder surgery: a case series

Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study

Abstract Backgraund: This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. Methods: Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values obtained from the final model. Results: There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. Conclusion: In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.

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.

Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

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.

Medidas para optimizar cuidados post rinoplastia. Revisión sistemática de la literatura / Measures to optimize rhinoplasty post operative care, systematic review of the literature

Introducción: El cuidado postoperatorio de la rinoplastia ha evolucionado, paralelamente, al desarrollo de la técnica quirúrgica. Existen varias recomendaciones, sin embargo, hay una gran variabilidad interprofesional de las indicaciones post quirúrgicas. Objetivo: Realizar una revisión sistemática de la literatura científica sobre los cuidados post operatorios de la rinoplastia. Material y Método: Para la realización de este estudio se llevaron a cabo búsquedas en PubMed y en Cochrane Database of Systematic Reviews con los perfiles: ([rhinoplasty] AND [post operative care]) y ([rhinoplasty] AND [post surgical care]). Se seleccionaron los artículos publicados en los últimos 10 años, desde 2013 hasta 2023, ambos inclusive. Resultados: Los documentos analizados recogen la evidencia de los diferentes métodos de cuidados post quirúrgicos en rinoplastia. Estos confirman la utilización de corticoides en el período postoperatorio, así como el reposo en 90° y exponen la variabilidad interprofesional que existe en el protocolo postquirúrgico de esta cirugía. Conclusión: El uso de corticoides y el reposo en 90° disminuyen las complicaciones postquirúrgicas de la rinoplastia. Debe existir una clara información sobre lo que el paciente debe esperar post cirugía. El uso de opioides debe ser restringido y la analgesia debe ser multimodal. Es preciso realizar estudios futuros con mayor nivel de evidencia y tener protocolos uniformes para la práctica clínica.

Introduction: The postoperative care of rhinoplasty has evolved along with the development of the surgical technique. There are several recommendations, however there is enormous interprofessional variability of post-surgical indications. Aim: To carry out a systematic review of the scientific literature on rhinoplasty postoperative care. Material and Method: To carry out this study, searches were carried out in PubMed and in the Cochrane Database of Systematic Reviews with the profiles: ([rhinoplasty] AND [post operative care]) and ([rhinoplasty] AND [post surgical care]). Articles published in the last 10 years were selected, from 2013 to 2023, both inclusive. Results: The documents analyzed collect the evidence of the different methods of post-surgical care in rhinoplasty, they confirm the use of corticosteroids in the postoperative period as well as rest at 90° and expose the interprofessional variability that exists in the post-surgical protocol of this surgery. Conclusion: The use of corticosteroids and rest at 90° reduce the post-surgical complications of rhinoplasty. There must be clear information about what the patient should expect post surgery. The use of opioids must be restricted and analgesia must be multimodal. It is necessary to carry out future studies with a higher level of evidence and have uniform protocols for clinical practice.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

Abstract Background: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). Methods: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). Conclusion: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register Number: NCT05199922.

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

BACKGROUND@#Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.@*METHODS@#We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects.@*RESULTS@#Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%).@*CONCLUSION@#Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

Manejo del dolor posoperatorio en pacientes beneficiarios de una artroplastia total de rodilla: comparación de tres técnicas analgésica / Postoperative pail management in patients underfgoing total knee arthroplaty: comparison of three analgesic techniques

Introducción: La artroplastia total de rodilla (ATR) es un procedimiento quirúrgico muy doloroso en cirugía ortopédica, siendo muy difícil su tratamiento. El objetivo del presente estudio fue comparar 3 estrategias de analgesia post operatoria en el manejo del dolor post ATR. Pacientes y Método: se estudiaron 60 pacientes, divididos en 3 grupos. Grupo 1: Bloqueo iliofascial (BIFC), Grupo 2: Analgesia epidural continua (AEPIC) y Grupo 3: Morfina intratecal (MIT). Se evaluó el dolor post operatorio (DPO) en reposo y movimiento con escala visual análoga en las primeras 24 hrs., consumo de morfina endovenosa (MEV), incidencia de efectos adversos: prurito, náuseas y vómitos (NVPO), retención urinaria (RU). Al término del tratamiento se evaluó la satisfacción del paciente. Resultados: El DPO fue significativamente menor entre las 6 y 24 hrs. en los pacientes del Grupo 3 versus los de los Grupos 1 y 2 (p<0,01). El consumo de MEV fue menor en los pacientes del grupo 3 (p< 0,01). La incidencia de prurito post operatorio y RU fue significativamente mayor en el grupo 3 versus los grupos 1 y 2 (p< 0, 001 y p< 0,008). La hipotensión arterial fue mayor en los grupos 2 y 3 versus el grupo 1 (p< 0,05), siendo más frecuente la hipotensión moderada en el grupo 3 versus a los grupos 1 y 2 (p< 0.01). La calidad de la analgesia fue considerada superior en los pacientes del grupo 3. Conclusión: Las 3 técnicas analgésicas son útiles para el manejo del DPO de una ATR. La MIT presenta menor índice de dolor, mejor calidad de la analgesia percibida por el paciente, pero una mayor incidencia de efectos adversos en relación con el BIFC y AEPIC.

Introduction: Total knee arthroplasty (TKA) is a very painful surgical procedure in orthopedic surgery, making its treatmentvery difficult. The objective of the present study was to compare 3 postoperative analgesia strategies in the management of post TKA pain. Patients and Method: 60 patients, divided into 3 groups, were studied. Group 1: Iliofascial blockade (BIFC), Group 2: Continuous epidural analgesia (AEPIC) and Group 3: Intrathecal morphine (MIT). Postoperative pain (POD) at rest and movement was evaluated with a visual analog scale (EVA) in the first 24 hours, intravenous morphine consumption (VEM), incidence of adverse effects: pruritus, nausea and vomiting (PONV), urinary retention (UR). At the end of treatment, patient satisfaction was evaluated. Results: The DPO was significantly lower between 6 and 24 hours in the patients of Group 3 versus those of Groups 1 and 2 (p<0.01). MEV consumption was lower in patients of group 3 (p<0.01). The incidence of postoperative pruritus and UR was significantly higher in group 3 versus groups 1 and 2 (p<0.001 and p<0.008). Arterial hypotension was greater in groups 2 and 3 versus group 1 (p<0.05), with moderate hypotension being more frequent in group 3 versus groups 1 and 2 (p<0.01). The quality of analgesia was considered superior in patients in group 3. Conclusion: The three analgesic techniques are useful for managing the DPO of a TKA. MIT presents a lower pain index, better quality of analgesia perceived by the patient, but a higher incidence of adverse effects in relation to BIFC and AEPIC.

Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery - a randomized trial

Abstract Background Breast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. Methods A total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded. Results The time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p< 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p< 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p< 0.05). The incidence of PONV was also less in the SAPB group (p= 0.028). No block-related adverse effects were reported. Conclusion We found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.

Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block

Abstract Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

Associations between postoperative analgesic consumption and distress tolerance, anxiety, depression, and pain catastrophizing: a prospective observational study

Abstract Background Patients' postoperative treatment might be affected by their psychological state. The study aimed to evaluate the effects of anxiety, coping ability (stress tolerance), depression, and pain catastrophizing on analgesic consumption in patients scheduled for sleeve gastrectomy. Methods This prospective observational study consisted of 72 patients. The Distress Tolerance Scale (DTS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) were completed in the preoperative period. In the postoperative period, pain intensity, as measured with the Visual Analogue Scale (VAS), and morphine consumption (mg) were evaluated after 2, 6, 8, and 24 hours. Total morphine consumption was recorded. Results The results revealed a strong negative correlation between distress tolerance and postoperative total morphine consumption (r = -0.702, p< 0.001). There was a strong positive correlation between total morphine consumption and pain catastrophizing (r = 0.801, p< 0.001). A moderate positive correlation was observed between total morphine consumption and anxiety and between total morphine consumption and depression (r = 0.511, p< 0.001; r = 0.556, p< 0.001, respectively). Linear regression revealed that distress tolerance, anxiety, depression, and pain catastrophizing are predictors of postoperative morphine consumption (β = 0.597, p< 0.001; β = 0.207, p= 0.036; β = 0.140, p= 0.208; β = 0.624, p< 0.001, respectively). Conclusions Distress tolerance, anxiety, depression, and pain catastrophizing can be predictive of postoperative analgesic consumption. In the estimation of postoperative analgesic consumption, distress tolerance, as well as anxiety, depression, and pain catastrophizing, were found to be important predictors.