Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial.

Background: The type of anaesthesia and choice of anaesthetic drugs may affect the quality of recovery after surgery. Remimazolam is a new benzodiazepine with rapid onset and offset, specifically antagonised by flumazenil. This study aimed to compare remimazolam with propofol on the quality of recovery in patients undergoing ambulatory arthroscopic surgery. Methods: Patients aged 18-65 yr and scheduled for ambulatory arthroscopic meniscus repair were recruited and randomly assigned to receive either continuous i.v. infusion of remimazolam or plasma target-controlled infusion of propofol. The quality of recovery-15 (QoR-15) scale was administered on postoperative day 1 (POD1) as the primary outcome. Secondary outcomes included the Athens Insomnia Scale (AIS) scores and cardiovascular variables. Results: In total, 120 patients were randomly assigned to the remimazolam or propofol groups and 114 patients were included in the analysis. The remimazolam group had higher total QoR-15 scores on POD1 (125 [120-127.5] vs 121.5 [119-124], with a median difference of 3 (95% confidence interval: 1-5; P=0.002). Physical independence and psychological support were higher in the remimazolam group (8.5 [8-10] vs 8 [7-9], P=0.043; 17 [13-17] vs 12.5 [12-14], P<0.001). Remimazolam lowered the number of awakenings during the first postoperative night (P=0.042) and the incidence of hypotension (P=0.04). Conclusions: Remimazolam-based total i.v. anaesthesia was associated with small improvements in the quality of recovery; however, the improvement was less than the minimally clinically important difference. Clinical trial registration: ChiCTR2100053014.

Effects of Dexmedetomidine on Postoperative Nausea and Vomiting in Adult Patients Undergoing Ambulatory Thyroidectomy: A Randomized Clinical Trial.

Background: Postoperative nausea and vomiting (PONV) is a common and disturbing problem in patients undergoing ambulatory thyroidectomy. This prospective trial aimed to explore whether dexmedetomidine (DEX) combined with azasetron (AZA) can further drop the incidence of PONV in patients undergoing ambulatory thyroidectomy compared with AZA. Methods: This single-center, randomized, double-blind trial involved 172 adult patients undergoing ambulatory thyroidectomy. The individuals were randomized to DEX + AZA group and AZA group. In the DEX + AZA group, patients received dexmedetomidine 0.5 µg kg-1 for 10 min and then the infusion rate was held at 0.1 µg kg-1 h-1 until the completion of the operation, while the same amount of 0.9% saline in the AZA group. At the completion of the surgery, 10 mg azasetron was administered to every patient in both groups. The primary outcome was the incidence of 24 h PONV after ambulatory thyroidectomy. The secondary outcomes included residence time in recovery room, pain scores, severity of nausea, and adverse events. Results: No significant difference was found in the incidence of 24-h PONV between the DEX + AZA group and the AZA group [36% (30 of 84) vs. 38% (32 of 84); relative risk, 0.94; 95% confidence interval (CI), 0.63-1.40; P = 0.749]. The incidence of severe nausea was similar between the DEX + AZA group and the AZA group [57% (12 of 21) vs. 43% (9 of 21); relative risk, 1.33; 95% CI, 0.72-2.50; P = 0.355]. Conclusions: Intraoperative dexmedetomidine combined with azasetron failed to drop the incidence of 24-h PONV compared with azasetron alone in patients undergoing ambulatory thyroidectomy.

Local Anesthetic Lidocaine and Cancer: Insight Into Tumor Progression and Recurrence.

Cancer is a leading contributor to deaths worldwide. Surgery is the primary treatment for resectable cancers. Nonetheless, it also results in inflammatory response, angiogenesis, and stimulated metastasis. Local anesthetic lidocaine can directly and indirectly effect different cancers. The direct mechanisms are inhibiting proliferation and inducing apoptosis via regulating PI3K/AKT/mTOR and caspase-dependent Bax/Bcl2 signaling pathways or repressing cytoskeleton formation. Repression invasion, migration, and angiogenesis through influencing the activation of TNFα-dependent, Src-induced AKT/NO/ICAM and VEGF/PI3K/AKT signaling pathways. Moreover, the indirect influences are immune regulation, anti-inflammation, and postoperative pain relief. This review summarizes the latest evidence that revealed potential clinical benefits of lidocaine in cancer treatment to explore the probable molecular mechanisms and the appropriate dose.

The Effect of Ultrasound-Guided Erector Spinae Plane Block Combined with Dexmedetomidine on Postoperative Analgesia in Patients Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial.

INTRODUCTION: One of the most common malignancies in women worldwide is breast cancer. Erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy for breast cancer. The duration of nerve block analgesia is limited if local anesthetic agents are used alone. The purpose of this study was to evaluate the effect of dexmedetomidine on postoperative analgesia during a single injection of local anesthetics. METHODS: In this double-blind, randomized study, 60 female American Society of Anesthesiologists (ASA) I-II patients undergoing modified radical mastectomy were randomized into two groups: ultrasound (US)-guided ESPB with 30 mL of 0.33% ropivacaine (group R) and US-guided ESPB with 30 mL of dexmedetomidine plus 0.33% ropivacaine (group DR). US-guided ESPB at the T3 vertebral level was performed preoperatively in all patients. The indicators were 1-, 6-, 12-, 24-, and 48-h visual analog scale (VAS) pain scores after surgery in the resting state and at 90-degree shoulder abduction. Other measures were a comparison of intraoperative sufentanil and remifentanil, postoperative nausea and vomiting (PONV), flurbiprofen consumption, the lengths of post-anesthesia care unit (PACU) stay and hospital stay, postoperative bradycardia, and hypotension. RESULTS: The VAS pain score was lower in group DR than group R at any time in the resting state, except at 1 h after surgery. The VAS pain score was lower in group DR than group R at 12 and 24 h in an active state after surgery (P < 0.05 for each time interval). The intraoperative dosages of remifentanil and sufentanil in group DR were lower than that in group R. The postoperative dosage of flurbiprofen in group DR was lower than that in group R (P = 0.038). The lengths of PACU stay were longer in group DR than in group R. No significant difference was found in PONV and hospital stay between the two groups. No sinus bradycardia or hypotension after surgery occurred in the two groups. CONCLUSIONS: Dexmedetomidine as an adjunctive to ESPB can effectively relieve pain and significantly reduce the need for opioids during modified radical mastectomy for breast cancer. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2000031134, principal investigator: Yao Lu, date of registration: 2020-3-22).

A narrative review of ultrasound-guided serratus anterior plane block.

Ultrasound-guided serratus anterior plane block (SAPB) is located using ultrasound at the level of the midaxillary line and the fifth rib, and a certain amount of local anesthetics is injected either superficially or deeply into the serratus anterior muscle, blocking the third to sixth intercostal nerves, the long thoracic and thoracodorsal nerves. It is mainly used in breast surgeries, rib fractures and thoracotomy to manage the pain of the anterolateral chest wall. The surgery of anterolateral chest wall is often accompanied by severe postoperative pain, leading to postoperative infection, atelectasis and other complications, and prolonged hospitalization. However, effective pain management can reduce the occurrence of postoperative pulmonary complications, promote patients to get out of bed as soon as possible, and accelerate the recovery of patients. Recently, with the development of ultrasonic technology and equipment, SAPB has entered the era of visualization, further improving the safety and success rate of operations. SAPB, as a new technology of regional block, has a higher positioning accuracy, a higher success rate, lesser complications, and simpler and more effective postoperative analgesia effect. Compared with thoracic epidural analgesia and thoracic paravertebral block, SAPB has a good ultrasonic anatomical basis; thus, has a broad application prospect in clinics. In this paper, the SAPB in clinical application was reviewed.

Comparison Between Intravenous Nalbuphine and Lidocaine in Reducing Propofol-Induced Injection Pain During Gastroscopy: A Randomized Controlled Trial.

INTRODUCTION: Intravenous propofol anesthesia is widely used in painless endoscopy. However, propofol injection pain is a common adverse effect. This study investigated the effects of nalbuphine and lidocaine in reducing propofol-induced injection pain. METHODS: In this double-blind, randomized study, 330 patients were randomly divided into three groups by using a random number table: the nalbuphine group (N), lidocaine group (L), and control group (C). The N, L, and C groups received either 0.1 mg/kg nalbuphine, 0.5 mg/kg lidocaine, or an equivalent volume of normal saline, respectively, as pretreatment drug. Then propofol was manually injected. The primary outcome of this study was the incidence of propofol-induced injection pain, and secondary outcomes included the severity of propofol-induced injection pain, vital signs, and adverse events, including hypotension, bradycardia (< 50 beats/min), hypoxemia (SpO2 < 90%), drowsiness, physical movement, and cough. RESULTS: The percentages of patients with propofol injection pain were higher in group C than in group N and group L (64, 34, and 27%, respectively, p < 0.05). The percentage of patients with severe pain after propofol injection was significantly higher in group C than in group N and group L (12, 1, and 0%, respectively, p < 0.05). The doses of propofol in group C and group L were significantly higher than that in group N. More patients suffered hypoxemia in group N than in group C and group L. Then, less patients got physical movement and cough in group N. CONCLUSIONS: Pretreatment with nalbuphine 0.1 mg/kg was effective in reducing propofol-induced injection pain and propofol consumption. Propofol combined with nalbuphine can be safely and effectively used during gastroscopy. TRIAL REGISTRATION: Chinese Clinical Trial Registry; ChiCTR1900025438.