Evaluation of Pectoral Nerve Block in Modified Radical Mastectomy: Comparison of Three Concentrations of Ropivacaine.

BACKGROUND: Pectoral nerve block type I (PECS I Block) and type II (PECS II Block) with ropivacaine are relatively new analgesic methods for breast-cancer surgery. We evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for the PECS II Block in patients undergoing modified radical mastectomy (MRM). PATIENTS AND METHODS: One hundred and twenty women undergoing elective MRM who met inclusion criteria were divided randomly into four groups of 30: control group without PECS II Block and R0.2%, R0.3%, and R0.4% groups, who received general anesthesia plus the PECS II Block with ropivacaine at 0.2%, 0.3%, and 0.4%, respectively, in a volume of 40 mL. RESULTS: The postoperative numerical rating scale (NRS) pain score at rest and active was significantly higher in the control group than that in the three ropivacaine groups (P<0.05 for all), and the postoperative NRS score in the R0.3% group and R0.4% group at 12, 24, and 48 h postoperatively were significantly lower than that in the R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. The time when pain was first felt after MRM, the total number of complaints during 3, 6, 12, 24, and 48 h after MRM, and the total analgesic requirement (tramadol consumption) during the first 24 h postoperatively in the R0.3% group and R0.4% group were significantly lower than those in the control group and R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. CONCLUSION: A dose of 0.3% ropivacaine was the optimal concentration for a PECS II Block for patients undergoing MRM because it provided efficacious analgesia during and >48 h after MRM. Increasing the ropivacaine concentration did not improve the analgesia of the PECS II Block significantly.

The effects of vitamin-rich carbohydrate pretreatment on the surgical stress response and S-100ß after splenectomy in elderly rats.

BACKGROUND: Preoperative oral carbohydrates has been suggested to attenuate insulin resistance and decrease postoperative complications. In this study, a vitamin-rich carbohydrate beverage was administered before surgery in an animal model to investigate its effects on the surgical stress response and S-100ß levels. METHODS: Thirty aged male Sprague-Dawley rats were randomly assigned to three groups: control group (n = 6), fasting group (n = 12), and carbohydrate-treated group (CHO group, n = 12). Rats in the control group were not given any treatment. Rats in the fasting group received splenectomy after 12 h of fasting. In the CHO group, rats were given 5 ml of vitamin-rich carbohydrate by gavage 2 h before surgery. Fasting plasma glucose, insulin, insulin resistance (HOMA-IR index, IRI), the S-100ß protein level, and the inflammatory mediators IL-1ß, IL-6 and TNF-α were assessed after surgery (postoperative day (POD) 1 and 3). RESULTS: Postoperative insulin resistance was significantly greater in the fasting group than in the control and CHO group. The median plasma S-100ß level was significantly higher in the fasting group than in the control and CHO groups on POD 1. The median plasma IL-1ß level was significantly lower in the CHO group than in the fasting group on POD 1; however, no other differences in the concentrations of immunological biomarkers of stress were found between the fasting group and the CHO group. CONCLUSIONS: Vitamin-rich carbohydrate pretreatment attenuated the metabolic aspect of the surgical stress response and decreased the level of plasma S-100ß, which may decrease the risk of postoperative complications in elderly rats.

Post-operative pain in mice is prolonged by diet-induced obesity and rescued by dietary intervention.

The prevalence of obesity has increased at an alarming rate during past decades. Obesity is associated with pathophysiological disorders that can evolve and increase the risk of heart disease, diabetes and hypertension. While the impact of diabetes on post-operative recovery is now known, the consequences of obesity on post-operative pain remain much less explored. Here, we show that obesity affects post-operative pain resolution and leads to a chronic pain state in mice. Several mechanisms were identified as implicated in the prolonged post-operative pain. Indeed, we found that following a hind paw incision, high fat diet prolonged glial cell activation in the spinal cord. It also altered the expression of neurotrophins and increased inflammatory and endoplasmic reticulum stress markers in both central and peripheral nervous systems. Moreover, we show that a dietary intervention, leading to weight reduction and decreased inflammation, was able to restore normal pain sensitivity in mice suffering from chronic pain for more than 10 weeks. In conclusion, our data demonstrate that obesity is responsible for pain chronicization. This is clearly of importance in a clinical post-operative setting.

Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding.

Objective Tonsillectomy is a common operation; however, there are controversial opinions regarding the posttonsillectomy diet. The aim of this study was to compare the effects of cold/liquid diet vs regular diet on posttonsillectomy pain and bleeding. Study Design Prospective randomized controlled trial. Setting Tertiary referral center. Subjects and Methods In total, 194 children who underwent tonsillectomy (with or without adenoidectomy) were randomly allocated into 2 groups. A total of 100 patients were allocated in the cold/liquid diet, and 94 patients were allocated in the regular diet group. Pain score was recorded for the first 7 days, and rate of hemorrhage was recorded for 10 days after surgery. Results The participants' age range was 3 to 17 years. The mean pain score level in the regular diet group after breakfast, lunch, and dinner was not statistically significant in comparison with the cold/liquid diet group. One patient in the regular diet group was admitted to the hospital due to secondary bleeding, but it stopped without any intervention. Conclusion Most otolaryngologists believe in dietary restrictions following tonsillectomy. However, there is much controversy regarding posttonsillectomy dietary advice in the literature. In addition, only a few randomized clinical trials have focused on this subject. We found that there was no difference between regular diet and cold/liquid diet in terms of posttonsillectomy pain and bleeding. Hence, we do not recommend a limited posttonsillectomy diet.

Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial.

OBJECTIVE: To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy. DESIGN: Randomized comparative trial. SETTING: University hospital. PATIENT(S): Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV (r-AFS). INTERVENTION(S): Six months of placebo (n = 110) versus GnRH-a (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n = 39) or continuous estroprogestin (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n = 38) versus dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n = 35). MAIN OUTCOME MEASURE(S): Painful symptoms (visual analogue scale score) and quality-of-life endometriosis-related symptoms (SF-36 score) at 12 months' follow-up. RESULT(S): Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo. CONCLUSION(S): Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life.

Electrophysiological and in vivo characterization of A-317567, a novel blocker of acid sensing ion channels.

Acid Sensing Ion Channels (ASICs) are a group of sodium-selective ion channels that are activated by low extracellular pH. The role of ASIC in disease states remains unclear partly due to the lack of selective pharmacological agents. In this report, we describe the effects of A-317567, a novel non-amiloride blocker, on three distinct types of native ASIC currents evoked in acutely dissociated adult rat dorsal root ganglion (DRG) neurons. A-317567 produced concentration-dependent inhibition of all pH 4.5-evoked ASIC currents with an IC50 ranging between 2 and 30muM, depending upon the type of ASIC current activated. Unlike amiloride, A-317567 equipotently blocked the sustained phase of ASIC3-like current, a biphasic current akin to cloned ASIC3, which is predominant in DRG. When evaluated in the rat Complete Freud's Adjuvant (CFA)-induced inflammatory thermal hyperalgesia model, A-317567 was fully efficacious at a dose 10-fold lower than amiloride. A-317567 was also potent and fully efficacious when tested in the skin incision model of post-operative pain. A-317567 was entirely devoid of any diuresis or natriuresis activity and showed minimal brain penetration. In summary, A-317567 is the first reported small molecule non-amiloride blocker of ASIC that is peripherally active and is more potent than amiloride in vitro and in vivo pain models. The discovery of A-317567 will greatly help to enhance our understanding of the physiological and pathophysiological role of ASICs.

Dietoterapia: o equilíbrio entre ômega 6 e ômega 3 no controle da inflamação e da dor bucofacial / Therapeutic diet: the balance between omega 6 and omega 3 on inflammation and oralfacial pain

As diferentes atividades dos eicosanóides derivados do ácido araquidônico (ômega 6) e do ácido eicosapentaenóico (ômega 3) explicaram a ação antiinflamatória dos ácidos graxos da dieta. Nos ensaios clínicos, pacientes submetidos à exodontia dos terceiros molares foram pré e pós-tratados com a dieta, vitamina C e vitamina E por 15 dias. Na quantificação da dor foi utilizada uma tabela do nível de dor (0-3). A dietoterapia na razão de 3 (ômega 3): 1 (ômega 6) reduziu de modo significativo a dor e a inflamação pós-operatória, assim como a utilização de fármacos em 51% para analgésicos e 100% para antibióticos.

Dietary and supplementary intake of nutrients by patients with gastrointestinal diseases.

The dietary and supplementary intake of food, energy, and nutrients were examined in 54 patients after various gastrointestinal operations and in 33 patients with gastritis, peptic ulcer, or undefined abdominal pain. Forty-six of the operated and 21 of the nonoperated patients had to avoid certain foods (p less than 0.001, chi 2-test), mainly milk, beans, cabbage and other vegetables, bread, and fried foods. Only a few patients got discomfort from coffee, fatty foods, and meat. The intake of energy was at the level of light physical work. The dietary intake of iron, vitamin A, and niacin did not reach the level of the recommended daily allowance (RDA). One-half of the patients used vitamins and supplements, which increased their intake over the level of RDA. It is important to inform patients before operations about the possibility of persistent abdominal symptoms after the operation.