• Pain Management
• Pain Measurement
• Pain, Postoperative

• Humans
• Evidence-Based Medicine
• Pain Management/methods
• Pain, Postoperative/drug therapy
• Pain, Postoperative/prevention & control
• Pain, Postoperative/diagnosis
• Perioperative Care/methods
• Analgesics/therapeutic use
• Analgesics/administration & dosage
• Perioperative Medicine/methods

• OUTCOMES
• Outcome Assessment, Health Care
• Pain, Postoperative
• Postoperative Complications
• REGIONAL ANESTHESIA

• Humans
• Acute Pain/therapy
• Acute Pain/drug therapy
• Anesthesia, Conduction/trends
• Anesthesia, Conduction/methods
• Awards and Prizes
• Outcome Assessment, Health Care
• Pain Management/methods
• Pain Management/trends

• anesthesia
• enhanced recovery
• enhanced recovery after surgery
• gynecologic surgery
• patient-reported outcomes
• perioperative medicine

• Anti-thrombotic therapy
• Biomarkers
• Guidelines
• Non-cardiac surgery
• Peri-operative beta-blockers
• Peri-operative cardiac management
• Peri-operative myocardial injury/infarction
• Peri-operative treatment of arrhythmias
• Post-operative cardiac surveillance
• Pre-operative cardiac risk assessment
• Pre-operative cardiac testing
• Pre-operative coronary artery revascularization
• Pre-operative treatment of valvular disease

• Humans
• Intraoperative Complications
• Postoperative Complications
• Risk Assessment

Severe stenotic aortic valve poses serious anesthetic challenges because of the fixed cardiac output and complex hemodynamics. The challenges magnify in the presence of a difficult airway which not only puts the airway at risk but also disturbs the hemodynamics, which can negatively impact the patient outcome. Moreover, prone positioning, intraoperative hemodynamics, recovery, and extubation are equally challenging for management. This case report highlights the perioperative management of a child with severe uncorrected aortic stenosis and Klippel–Feil syndrome posted for cervical spinal stabilization under anesthesia.

Background

Although video-assisted thoracoscopic surgery (VATS) is a less invasive technique compared to thoracotomy, patients often experience postoperative pain. Hence, intravenous patient-controlled analgesia (PCA) is frequently used. The geriatric age group constitutes a significant portion of patients undergoing thoracic surgery. However, pain management can often be difficult in elderly patients. In this study, we aimed to examine the pain management techniques applied in geriatric patients who underwent VATS and to compare the efficacy and side effects of PCA with morphine and tramadol.

Methodology

The following patients were included in this study: aged 65 years and older, those who underwent elective VATS under general anesthesia, and those who underwent thoracic paravertebral block in the operating room for postoperative pain. We recorded diagnoses, demographic data, American Society of Anesthesiologists status, complications developed during the intraoperative or postoperative 24 hours, postoperative rest and cough Visual Analog Scale (VAS), and need for additional analgesics. The patients were divided into the following two groups: those treated with tramadol PCA (tramadol group) and those treated with morphine PCA (morphine group).

Results

A total of 65 patients were included in this study. Overall, 22 patients were administered tramadol PCA while 43 were administered morphine PCA. There was no statistically significant difference between the groups concerning complications. The 24-hour VAS resting score was statistically significantly lower in patients administered morphine than those administered tramadol (p < 0.05). There was no statistically significant difference between the groups concerning zero-minute, thirty-minute, one-hour, two-hour, six-hour, and twelve-hour VAS resting and cough scores at all times (p > 0.05).

Conclusions

There was no significant difference in the tramadol and morphine groups concerning analgesic efficacy, patient satisfaction, and side effects among geriatric patients who underwent VATS and were administered intravenous PCA. In our view, both tramadol and morphine can be used safely in geriatric patients requiring intravenous PCA. Moreover, because the 24-hour analgesic efficacy was observed to be better in the morphine group in our study, morphine can be preferred in geriatric patients.

• Auricular acupuncture
• Gastric cancer
• Intradermal needle
• Movement-evoked pain
• Randomized controlled trial

• Acupuncture, Ear/methods
• Feasibility Studies
• Gastrectomy
• Humans
• Pain, Postoperative/therapy
• Pilot Projects
• Single-Blind Method

• anesthesia adjuvants
• dexamethasone
• dexmedetomidine
• meta-analysis
• nerve block
• postoperative pain
• systematic review

• Adjuvants, Anesthesia
• Adrenergic alpha-2 Receptor Agonists/administration & dosage
• Adrenergic alpha-2 Receptor Agonists/therapeutic use
• Anesthesia, Local/methods
• Dexamethasone/administration & dosage
• Dexamethasone/therapeutic use
• Dexmedetomidine/administration & dosage
• Dexmedetomidine/therapeutic use
• Glucocorticoids/administration & dosage
• Glucocorticoids/therapeutic use
• Humans
• Nerve Block/methods
• Peripheral Nerves
• Randomized Controlled Trials as Topic

• anesthesia
• autonomic nerve block
• local
• nerve block
• pain perception
• regional anesthesia

• Administration, Oral
• Analgesics/administration & dosage
• Anesthetics, Local/administration & dosage
• Female
• Head and Neck Neoplasms/surgery
• Humans
• Infusions, Intralesional
• Longitudinal Studies
• Male
• Middle Aged
• Pain Management/methods
• Pain Measurement
• Pain, Postoperative/drug therapy
• Prospective Studies
• Quality of Life

• analgesia
• anesthesia
• opioid epidemic
• regional anesthesia
• surgery

One of the most complex medical problems is pain, that due to inappropriate management of patients after surgery could cause various side effects on the psychological, physiological, and metabolic state of the patients. The natural duration of analgesia can be increased by adding new efficient adjuvant. The present study is mainly aimed to investigate the differences between the epidural dexmedetomidine and ketamine effectiveness when administered as an adjuvant to epidural 0.25% bupivacaine for improving the postoperative analgesia duration.

In the present double-blind clinical study, 105 patients of the age range of 40–85 years were selected for elective femoral surgery and then was divided into three of ketamine, dexmedetomidine, and control randomly. The scores of postoperative pain were evaluated in accordance with the visual Analogue Scale (VAS) criteria and the duration of analgesia and the amount of analgesics consumption were recorded.

The mean pain VAS score during the first day after the surgery and recovery of patients in the dexmedetomidine group was significantly lower in comparison with two other groups (p = 0.01). However, no significant difference was found in the mean VAS score of Paine during 12 and 24 hours after the operation (P ≥ 0.05). Comparisons among these groups demonstrated that the mean on opioid administration during the operation and 24 hours after that was significantly higher in both groups of ketamine and control in comparison with the dexmedetomidine group (P = 0.001 and P = 0.01). Besides, analgesia duration among patients belonged to the dexmedetomidine group was notably lower in comparison with two other groups (P = 0.001).

In epidural anesthesia cases adding ketamine and dexmedetomidine as adjuvants to the solution of bupivacaine 0.25%, could increase the duration of analgesia and reduce the consumption of analgesics, which is more in the dexmedetomidine group when compared with ketamine.

• Dexmedetomidine
• epidural anesthesia
• femoral fracture
• ketamine
• postoperative pain

• Abdominal Injuries/drug therapy
• Abdominal Injuries/physiopathology
• Abdominal Injuries/surgery
• Analgesia, Epidural/adverse effects
• Analgesia, Epidural/methods
• Anesthesia, Local/adverse effects
• Anesthesia, Local/methods
• Anesthetics, Local/administration & dosage
• Elective Surgical Procedures/standards
• Female
• Humans
• Laparotomy/standards
• Male
• Middle Aged
• Pain Management/methods
• Pain Measurement/methods
• Pain, Postoperative/physiopathology
• Pain, Postoperative/prevention & control
• Pilot Projects
• Postoperative Complications/physiopathology
• Postoperative Complications/prevention & control
• Postoperative Period

• Adult
• Aged
• Analgesia, Patient-Controlled
• Chronic Pain/etiology
• Female
• Humans
• Interpersonal Relations
• Male
• Middle Aged
• Pain, Postoperative/etiology
• Prospective Studies
• Quality of Life
• Surgical Procedures, Operative/psychology

Optimising the management of peri-operative pain and recovery following knee replacement has been identified as a patient priority. Current pain relief strategies use opiate-based analgesia; however, up to 50% of patients experience significant side effects. Local anaesthetic incisional infiltration is one alternative. The length of the duration of action is a major limiting factor of current local anaesthetic techniques. Liposomal bupivacaine has been reported to be effective for up to 72 h. This randomised controlled trial will evaluate the clinical and cost effectiveness of liposomal bupivacaine.

SPAARK is a patient-blinded, multi-centre, active comparator, superiority, two-arm, parallel-group randomised controlled trial. Five hundred patients undergoing knee replacement will be recruited and randomised to liposomal bupivacaine plus bupivacaine hydrochloride or bupivacaine hydrochloride alone. The co-primary outcomes are the Quality of Recovery 40 measured at 72 h post-surgery and also cumulative pain measured daily using a 0–10 visual analogue scale for the first 3 days following surgery. Secondary outcomes include cumulative opioid consumption, fitness for discharge, functional outcomes assessed using the Oxford Knee Score and American Knee Society Score, the EuroQol five dimensions instrument and complications. A cost utility analysis is also planned.

The clinical effectiveness and cost effectiveness of liposomal bupivacaine have yet to be evaluated in the National Health Service, making this trial appropriate and timely.

ISRCTN registry, ISRCTN54191675. Registered on 14 November 2017.

• Anaesthetic
• Analgesia
• Knee replacement
• Liposomal bupivacaine
• Peri-operative pain
• Randomised controlled trial

To compare the effect of metamizole versus etoricoxib as baseline analgesic for treating postoperative pain after tonsillectomy.

Single centre prospective cohort study.

Two consecutive cohorts of tonsillectomy patients.

124 patients (n = 55 treated with etoricoxib, n = 69 with metamizole); median age 30.5 years; 50% women.

Patients rated their pain on first postoperative day using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0–10) for pain determination. The influence of preoperative and postoperative parameters on patients' pain was estimated by univariate and multivariate statistical analysis.

The demographic parameters showed no differences between the patients in the metamizole group and the etoricoxib group (all p>0.05) with one exception: Patients in the metamizole group had significantly more preoperative pain than patients in the etoricoxib group (p = 0.001). The metamizole group had a mean postoperative pain in activity of 4.4 ± 2.1 and the etoricoxib group of 4.5 ± 2.2. Maximal pain for the metamizole group and the etoricoxib group were 5.6 ± 2.2 and 6.1 ± 1.9, respectively. Pain in activity, maximal pain and minimal pain were not different between both groups (p = 0.652, p = 0.113, p = 0.276, respectively). Patients of the etoricoxib group received more frequently piritramide in recovery room as demand medication (p = 0.046). In the whole cohort, patients with peritonsillar abscess had more preoperative pain in comparison to chronic tonsillitis (p<0.001). Patients under 30.5 years reported higher maximal pain than older patients (p = 0.049). On the other hand, a significant influence of patients’ age on the pain in activity and minimal pain could not be demonstrated (p = 0.368, p = 0.508, respectively). Men reported lower minimal pain than women (p = 0.041). Also, patients with ASA status I had lower minimal pain than patients with higher ASA status (p = 0.019). The multivariate analysis did not show an association between postoperative pain in activity and preoperative counseling on postoperative pain management (p = 0.588, p = 0.174, respectively). Special preoperative counseling on postoperative pain management resulted in lower levels of maximal pain (p = 0.024). Linear regression demonstrated an independent association of higher pain in activity with higher mobility impairment (p = 0.034) and respiratory impairment (p = 0.002). The linear regression of minimal pain identified female gender (p = 0.005) as an independent influencing factor with higher pain levels. In terms of satisfaction, no preoperative pain therapy (p = 0.016) could be found as an independently significant influencing factor with higher satisfaction.

Etoricoxib does not have an advantage as baseline analgesic for post tonsillectomy pain in comparison to metamizole.

• Adult
• Dipyrone/administration & dosage
• Etoricoxib/administration & dosage
• Female
• Humans
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative/drug therapy
• Pain, Postoperative/physiopathology
• Postoperative Period
• Prospective Studies
• Registries
• Surveys and Questionnaires
• Tonsillectomy/adverse effects
• Tonsillitis/surgery

• Nuss procedure
• Pain management
• Pectus excavatum
• Serratus anterior plane block
• analgesia

The beneficial effects of epidural analgesia (EDA) in terms of pain control and postoperative convalescence are widely known and led to a frequent use for patients who underwent living donor kidney nephrectomy. The objective of this study was to determine whether general anesthesia (GA) plus EDA compared to GA only, administered for living donor nephrectomy has effects on postoperative graft function in recipients.

In this monocentric, retrospective cohort analysis we analyzed the closed files of all consecutive donor- recipient pairs who underwent living donor kidney transplantations from 2008 to 2017. The outcome variable was delayed graft function (DGF), defined as at least one hemodialysis within seven days postoperatively, once hyperacute rejection, vascular or urinary tract complications were ruled out. Statistical analyses of continuous variables were calculated using the two-tail Student’s t test and Fisher exact test for categorical variables with a significance level of p < 0.05, respectively.

The study enclosed 291 consecutive living donor kidney transplantations. 99 kidney donors received epidural analgesia whereas 192 had no epidural analgesia. The groups showed balanced pretransplantational characteristics and comparable donors´ and recipients’ risk factors. 9 out of all 291 recipients needed renal replacement therapy (RRT) during the first 7 days due to delayed graft function; none of these donors received EDA. The observed rate of DGF in recipients whose kidney donors received epidural analgesia was significantly lower (0% vs. 4.6%; p = 0.031).

In our cohort we observed a significantly lower rate of DGF when epidural analgesia for donor nephrectomy was administered. Due to restrictions of the study design this observation needs further confirmation by prospective studies.

• Delayed graft function
• Donor nephrectomy
• Epidural analgesia
• Kidney transplantation

• Anesthesia quality improvement
• Patient satisfaction
• Performance feedback and improvement

• Anesthesia/methods
• Anesthesia/psychology
• Anesthesia/standards
• Humans
• Patient Satisfaction
• Physician-Patient Relations
• Surveys and Questionnaires/standards

Perioperative regional anaesthesia may protect from persistent postsurgical pain (PPSP) and improve outcome after total knee arthroplasty (TKA).

Aim of this study was to evaluate the impact of regional anaesthesia on PPSP and long-term functional outcome after TKA.

A web-based prospective observational registry.

Five Italian Private and University Hospitals from 2012 to 2015.

Undergoing primary unilateral TKA, aged more than 18 years, informed consent, American Society of Anesthesiologists (ASA) physical status classes 1 to 3, no previous knee surgery.

Personal data (age, sex, BMI and ASA class), preoperative pain assessed by numerical rating scale (NRS) score, and risk factors for PPSP were registered preoperatively. Data on anaesthetic and analgesic techniques were collected. Postoperative pain (NRS), analgesic consumption, major complications and patient satisfaction were registered up to the time of discharge. PPSP was assessed by a blinded investigator during a phone call after 1, 3 and 6 months, together with patient satisfaction, quality of life (QOL) and walking ability.

Experience of PPSP according to the type of peri-operative analgesia.

Five hundred sixty-three patients completed the follow-up. At 6 months, 21.6% of patients experienced PPSP, whereas autonomy was improved only in 56.3%; QOL was worsened or unchanged in 30.7% of patients and improved in 69.3%. Patients receiving continuous regional anaesthesia (epidural or peripheral nerve block) showed a lower NRS through the whole peri-operative period up to 1 month compared with both single shot peripheral nerve block and those who did not receive any type of regional anaesthesia. No difference was found between these latter two groups. Differences in PPSP at 3 or 6 months were not significantly affected by the type of anaesthesia or postoperative analgesia. A higher NRS score at 1 month, younger age, history of anxiety or depression, pro-inflammatory status, higher BMI and a lower ASA physical status were associated with a higher incidence of PPSP and worsened QOL at 6 months.

Continuous regional anaesthesia provides analgesic benefit for up to 1 month after surgery, but did not influence PPSP at 6 months. Better pain control at 1 month was associated with reduced PPSP. Patients with higher expectations from surgery, enhanced basal inflammation and a pessimistic outlook are more prone to develop PPSP.

Clinicaltrials.gov identifier: NCT02147730

• knee
• local infiltration analgesia
• multimodal analgesia
• pain syndrome
• total knee arthroplasty

• Ambulatory care
• Outpatient surgery
• Patient reported outcome measures
• Patient satisfaction

• nerve stimulation
• peripheral nerve block
• ultrasound guidance

• Anaesthesia
• Anestesia
• Auto-assessment
• Autoevaluación
• Dolor postoperatorio inmediato
• Escala visual analógica
• Hetero-assessment
• Heteroevaluación
• Immediate postoperative pain
• Post-Anaesthesia Recovery Unit
• Unidad de Recuperación Postanestésica
• Visual analogue scale

Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance.

This was a prospective, randomized, double-blind study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t-test with SPSS 16.0 software.

In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000), shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000).

Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA.

• Bupivacaine
• nalbuphine
• postoperative analgesia
• supraclavicular block

The incidence of ischaemic heart disease (IHD) is increasing. The patients with IHD with or without interventions coming for non-cardiac surgical procedures are also increasing. These patients have increased risk of myocardial ischaemia, myocardial infarction (MI), conduction disturbances, morbidity and mortality during the peri-operative period. The risks of these events are even higher in patients with recent MI. An anaesthesiologist should be aware of the pathophysiology and the need to thoroughly evaluate the patient for peri-operative management. We searched Pubmed using combinations of terms like “ischemic heart disease” and “anaesthesia”, “perioperative”, and “anaesthetic implications”. We reviewed the current practices and guidelines regarding evaluation, risk stratification and management.

• Evaluation
• myocardial infarction
• revascularisation
• risk stratification

• EEG
• brain source localization
• evoked potentials
• nociceptive withdrawal reflexes
• opioid
• serotonin and norepinephrine reuptake

• Continuous regional anesthesia
• Foot surgery
• Outpatient management

• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care/economics
• Ambulatory Care/methods
• Amides/administration & dosage
• Amides/economics
• Anesthesia
• Anesthesia, Conduction/economics
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/economics
• Case-Control Studies
• Cost-Benefit Analysis
• Female
• Foot/surgery
• Health Care Costs/statistics & numerical data
• Hospitalization/economics
• Humans
• Inpatients
• Male
• Middle Aged
• Orthopedic Procedures/economics
• Orthopedic Procedures/methods
• Outpatients
• Quality of Health Care
• Regression Analysis
• Ropivacaine
• Switzerland
• Treatment Outcome

The advent of ultrasonographic-guided techniques has led to increased interest in femoro-sciatic nerve block (FSNB) for lower limb surgeries. α₂-agonists have been used recently as adjuvants to local anaesthetics in nerve blocks. We aimed to compare equal doses of clonidine or dexmedetomidine as an adjuvant to levobupivacaine in FSNB for post-operative analgesia.

Ninety patients scheduled to undergo below knee orthopaedic surgeries under subarachnoid block were divided into three groups: Group LL (n = 30) patients received 38 mL of 0.125% levobupivacaine with 2 mL normal saline, Group LD (n = 30) patients received 38 mL of 0.125% levobupivacaine with 0.5 μg/kg dexmedetomidine and Group LC (n = 30) received 38 mL of 0.125% levobupivacaine with 0.5 μg/kg clonidine in saline to make total drug volume of 40 mL. The primary and secondary outcome variables were duration of analgesia and rescue analgesic requirement, verbal rating score respectively. Continuous variables were analysed with analysis of variance or the Kruskal–Wallis test on the basis of data distribution. Categorical variables were analysed with the contingency table analysis and the Fisher's exact test.

Duration of analgesia was prolonged with dexmedetomidine (10.17 ± 2.40 h) and clonidine (7.31 ± 1.76 h) as compared to control (4.16 ± 1.04 h, P = 0.00). Significantly lower pain scores were observed in dexmedetomidine group as compared to clonidine up to 8 h post-operatively.

Equal doses of clonidine or dexmedetomidine added to levobupivacaine prolonged the duration of analgesia, decreased requirement of rescue analgesia. Dexmedetomidine delays the requirement of rescue analgesics with better pain scores as compared to clonidine.

• Adjuvants
• anaesthesia analgesia
• dexmedetomidine hydrochloride
• levobupivacaine
• pain post-operative

• Anaesthesia
• Anestesia
• Anestesia regional
• Bloqueo de nervio periférico
• Encuesta
• Peripheral nerve block
• Regional anaesthesia
• Survey

• Continuous wound infiltration
• Lliac lymphadenectomy
• Local pain catheter
• Melanoma
• Postoperative pain