Anesthesiology and Pain Medicine最新文献

Background: Numerous medical interventions have been utilized to prevent postoperative shivering. Due to the potential complications associated with the use of pethidine, such as respiratory failure, the exploration of alternative drugs for the prevention and treatment of postoperative shivering has been a key consideration.

Objectives: The aim of this study was to assess the preventive effects of ketamine and dexmedetomidine on shivering in patients undergoing inguinal herniorrhaphy under spinal anesthesia.

Methods: This triple-blind randomized clinical trial involved patients who were candidates for inguinal herniorrhaphy with spinal anesthesia. Patient, investigator/administering, and outcome assessor were blinded. The necessary sample size was 150, estimated based on statistical formula at a 95% confidence interval and 80% power. Patients were randomly assigned using a computer-generated random sequence allocation and a randomized block sampling design with block sizes of six to ensure balanced allocation across the three groups: Ketamine, dexmedetomidine, and control. Randomization was performed using random sequence allocation software and randomized block sampling with 6 blocks for all 3 treatment groups. The severity of shivering was assessed using the Bedside Shivering Assessment Scale (BSAS) at multiple time points: Immediately, 5, 15, and 30 minutes after spinal anesthesia, and upon entering the recovery room, 15 minutes later, and at discharge from recovery. Data were analyzed using IBM SPSS Statistics version 21 software. Quantitative data were expressed as mean ± standard deviation, while qualitative data were presented as percentages. The mean of the variables was compared using Student's t-test, and the chi-square test was employed to compare qualitative data.

Results: The severity of shivering was notably lower in the dexmedetomidine group at 5, 15, and 30 minutes after spinal anesthesia induction, during recovery, and 15 minutes after recovery. The intensity of shivering upon exiting recovery was similar in the ketamine and dexmedetomidine groups and significantly lower than in the control group. Systolic blood pressure was significantly lower in the dexmedetomidine group upon entry into recovery and 15 minutes after recovery. Throughout all time periods, patients in the dexmedetomidine group exhibited significantly lower heart rates.

Conclusions: Both ketamine and dexmedetomidine proved effective in reducing post-herniorrhaphy shivering compared to the control group, with the effect being notably greater in the dexmedetomidine group.

Background: Interscalene brachial plexus block (ISB) remains the gold standard for analgesia in arthroscopic shoulder surgery (ASS). However, ISB is associated with a higher incidence of hemidiaphragmatic paralysis (DP).

Objectives: This study compares ultrasound-guided interscalene brachial plexus block (USG-ISB) with a combination of ultrasound-guided pericapsular nerve block (USG-PENB) and superficial cervical plexus block (SCPB) to evaluate analgesic efficacy and the incidence of DP.

Methods: In this prospective, triple-blinded randomized trial, 42 American Society of Anesthesiologists (ASA) I - II patients undergoing elective ASS were randomized into two groups after induction of general anesthesia (GA): Group A (ISB, 10 mL 0.25% bupivacaine) or group B [pericapsular nerve block (PENB) 10 mL + SCPB 5 mL 0.25% bupivacaine]. Blocks were performed under ultrasound guidance. The primary outcome was the incidence of DP; secondary outcomes included pain scores, opioid consumption, pulmonary function, and patient satisfaction.

Results: Compared with group A, group B demonstrated a delayed time to first request for rescue analgesia (13.24 vs. 8.38 hours; P < 0.001) and reduced 24-hour fentanyl consumption (135.71 vs. 192.86 mcg; P = 0.012). Pulmonary function was significantly better preserved in group B (P < 0.05). The incidence of DP was lower in group B (4.76% vs. 38.1%; P = 0.02). Pain scores at 6, 12, and 18 hours were also lower in group B (P < 0.05). Both groups showed no differences in hypotension, bradycardia, or patient satisfaction.

Conclusions: The combination of PENB and SCPB provides analgesia non-inferior to ISB, while significantly reducing the incidence of DP and opioid requirements. For individuals at risk of respiratory impairment, this approach presents a lower-risk alternative without compromising pain control efficacy.

Background: Shoulder pain is widely recognized as one of the most prevalent complications following cholecystectomy procedures. The management of postoperative shoulder discomfort primarily relies on pharmacological interventions. Pregabalin, a commonly prescribed medication, is valued for its efficacy in modulating neuropathic pain.

Objectives: This study aimed to evaluate the impact of preoperative pregabalin, in combination with paracetamol, on the control of shoulder pain after cholecystectomy.

Methods: This randomized, double-blind clinical trial enrolled 90 patients aged 20 - 60 years, scheduled for cholecystectomy at Imam Ali Hospital in Bojnourd in 2023. Patients were selected by convenience sampling and randomly assigned to one of three groups. The first group received 300 mg of oral pregabalin one hour before surgery, as well as 1 g of intravenous paracetamol 30 minutes before the end of the operation, followed by dosing every 6 hours for 24 hours. The second group received only oral pregabalin as premedication one hour prior to surgery. The third group received standard care (standard multimodal analgesia with diclofenac as needed), without pregabalin or paracetamol. The primary outcome was the severity of shoulder pain during recovery and at 6, 12, 18, and 24 hours postoperatively, measured using the Visual Analog Scale (VAS).

Results: Significant differences were observed in the severity of postoperative shoulder pain among the three groups at all-time intervals (P < 0.05). Inter-group comparisons revealed that the severity of shoulder pain in the first group was significantly lower than in the third group at all-time points (P < 0.05). Additionally, the second group exhibited significantly lower shoulder pain severity compared to the third group at all-time points except at 18 and 24 hours postoperatively (P < 0.05). There was a notable reduction in pain severity over time in the first and second groups (P < 0.001).

Conclusions: According to the study findings, premedication with oral pregabalin and intravenous paracetamol effectively alleviated postoperative shoulder pain across all time intervals without adverse effects. Pregabalin premedication alone also demonstrated analgesic effects, though with a shorter duration compared to the combination regimen.

Background: Failed back surgery syndrome (FBSS) is a challenging chronic pain condition following spinal surgery, often resistant to conventional therapies. Caudal epidural injection is a mainstay for managing FBSS, yet its effects on intracranial pressure (ICP), particularly in adults with post-surgical anatomical changes, remain poorly understood. Optic nerve sheath diameter (ONSD) measured by ultrasound offers a non-invasive surrogate marker for detecting alterations in ICP.

Methods: This prospective single-center clinical trial enrolled 46 adult FBSS patients scheduled for therapeutic caudal epidural injection at Imam Hussein Hospital, Tehran, Iran. Each participant received a standardized two-stage, 30 mL caudal epidural injection. The ONSD and hemodynamic parameters [systolic, diastolic and mean arterial blood pressure (SBP), (DBP), (MAP), heart rate (HR)] were assessed at baseline, immediately, and then at 10, 20, and 40 minutes post-injection. All measurements were performed by blinded, trained personnel using validated protocols.

Results: Caudal epidural injection produced a significant, transient increase in mean ONSD (baseline: 4.8 ± 0.49 mm; immediate post-injection: 5.1 ± 0.50 mm; P < 0.001), which normalized within the observation period. No patient exhibited symptoms or clinical signs of raised ICP. While serial monitoring indicated statistically significant reductions in SBP, DBP, MAP, and HR at 40 minutes, all values remained within physiologically acceptable ranges. No major procedural complications or adverse neurological outcomes occurred.

Conclusions: Standard-volume caudal epidural injection in adults with FBSS causes a temporary, asymptomatic elevation in ONSD, reflecting a reversible change in ICP. The procedure was well tolerated, with minimal and clinically insignificant hemodynamic effects, supporting its safety and utility in this patient population.

Background: Patient-controlled analgesia (PCA) is a widely used method for managing postoperative pain. However, its impact on hospital length of stay (LOS) is unclear due to patient population variation. Currently, there is limited data directly comparing LOS in limb fracture patients receiving PCA versus those exclusively receiving nurse-administered analgesia (NAA).

Objectives: To assess the impact of PCA in combination with NAA on hospital LOS and postoperative pain scores in limb fracture surgery patients compared to NAA alone.

Methods: A retrospective chart review was conducted to examine the LOS between all postoperative Northeast Georgia Health System (NGHS) patients between 18 and 75 years of age who underwent surgical limb fracture repairs between 2019 and 2024, specifically evaluating those who exclusively received NAA versus those who received a combination of PCA and NAA. The PCA and NAA groups each consisted of 49 patients. The PCA group self-administered intravenous (IV), epidural, or peripheral nerve analgesics via PCA pumps in addition to receiving nurse-administered transdermal or intramuscular analgesics. The NAA group received transdermal, intramuscular, or IV analgesics exclusively via manual administration by nursing staff. Medications included in this study were morphine, oxycodone, hydromorphone, fentanyl, and acetaminophen. Measured outcome variables include hospital LOS and pre- and postoperative pain scores, which were directly taken from NGHS's electronic medical record.

Results: The two groups studied included patients who received IV PCA in addition to NAA (termed as PCA) and patients who exclusively received transdermal, intramuscular, and/or IV NAA (termed as non-PCA). A total of n = 49 patients underwent limb fracture repair and received PCA, and 49 patients from the non-PCA group were matched accordingly. After propensity matching, average preoperative pain scores between the non-PCA and PCA groups were similar at 5.64 and 5.60, respectively. Patients in the PCA group had higher mean postoperative pain scores (μ = 4.92) compared to the NAA group (μ = 4.41), with a mean difference of 0.51 points (P = 0.046).

Conclusions: This retrospective analysis suggests that the use of PCA in conjunction with NAA is associated with increased LOS and higher postoperative pain scores when compared to NAA alone in patients undergoing surgical repair of limb fractures.

Background: Propofol is one of the most commonly used drugs in anesthesia, but administering it to patients often causes significant pain and discomfort. Numerous studies have been conducted on various methods to mitigate this adverse effect due to its prevalence.

Methods: This study was conducted in 2025 at Kashani Hospital in Isfahan, Iran, involving 150 patients undergoing elective surgery who received propofol for anesthesia induction. They were randomly assigned to five groups: Normal saline (control), transcutaneous electrical nerve stimulation (TENS), acetaminophen, intravenous lidocaine, or intravenous fentanyl. Additionally, this randomized, double-blind, controlled clinical trial (allocation ratio 1:1) employed block randomization. Patients, along with the assessor and the data analyst, were blinded. Statistical analyses were performed using ANOVA, chi-square, and repeated-measures ANOVA. Pain during injection was rated using a 0 - 10 numerical scale.

Results: There was no statistically significant difference in pain intensity between the intervention groups when comparing their mean pain scores (P > 0.05). However, in most comparisons, the normal saline group had the highest average pain scores.

Conclusions: All interventions except saline reduced propofol injection pain. Secondary outcomes, including patient satisfaction, recovery time, and hemodynamic stability, were also evaluated, and no significant adverse effects were observed among the interventions. These findings support the use of multiple safe strategies to minimize discomfort during anesthesia induction.

Background: Chronic pain is a complex condition affecting a significant portion of the population, and various approaches are being explored for its management.

Objectives: This study aims to design and evaluate a telemedicine system for chronic pain management.

Methods: A developmental cross-sectional study was conducted in three phases: Identifying a minimum dataset through literature review and expert opinion, developing and testing a prototype using Nielsen's Ten Heuristics, and finalizing and evaluating the system with the Questionnaire for User Interface Satisfaction (QUIS).

Results: The minimum dataset included 56 elements across eight categories. The system was developed as a web-based platform. Usability evaluation based on Nielsen's ten principles showed that the highest number of issues (n = 9) and the greatest severity (mean score 2.37) were related to the system-real world consistency. User satisfaction with the interface was favorable, with mean scores of 8.07 ± 0.41 for specialists and 7.73 ± 0.55 for patients.

Conclusions: The designed telemedicine system for chronic pain management, considering its features, provides specialized services to patients with chronic pain who are unable to visit a pain specialist in person. Additionally, by eliminating unnecessary visits to medical centers, this system can be beneficial in reducing related costs.

Background: Intravenous regional anesthesia (IVRA) is a widely used technique for hand and wrist surgeries. However, conventional upper arm IVRA requires higher anesthetic doses, which increases the risk of systemic toxicity. Forearm IVRA offers potential advantages, including lower anesthetic requirements and improved tourniquet tolerance.

Objectives: The study aims to compare the efficacy, analgesic effectiveness, and safety of forearm versus upper arm IVRA in elective hand and wrist surgeries.

Methods: In this prospective, randomized, open-label clinical trial, 140 adult patients, classified as American Society of Anesthesiologists (ASA) physical status I - II and aged 21 - 65 years, scheduled for elective hand or wrist surgery at Ain Shams University Hospitals, were randomized into two equal groups: Upper arm IVRA and forearm IVRA. The outcomes measured included block success, onset of analgesia, tourniquet pain-free duration, pain scores, rescue analgesia requirements, and patient and surgeon satisfaction.

Results: Block success rates were similar between the forearm and upper arm IVRA groups (94.3% vs. 91.4%, P = 0.512). Forearm IVRA demonstrated a significantly longer tourniquet pain-free duration (45.7 ± 4.6 vs. 43.2 ± 4.7 minutes, P = 0.002) and a longer time to the first postoperative analgesic request (8.9 ± 0.9 vs. 5.8 ± 1.0 hours, P < 0.001), with lower 24-hour nalbuphine consumption (11.4 ± 4.2 vs. 28.7 ± 3.4 mg, P < 0.001). Patient satisfaction was higher in the forearm group (P < 0.001), while surgeon satisfaction did not differ significantly (P = 0.145).

Conclusions: Forearm IVRA is an effective and safe alternative to upper arm IVRA for hand and wrist surgeries, offering superior tourniquet tolerance, prolonged analgesia, reduced opioid requirements, and higher patient satisfaction.

Context: Cesarean section (CS) represents a prevalent surgical intervention necessitating meticulous and efficacious anesthetic administration to optimize maternal and neonatal well-being. This narrative review aims to comprehensively examine the pharmacological properties, clinical applications, and safety considerations associated with the utilization of ketamine and dexmedetomidine as anesthetic agents within the context of CS.

Evidence acquisition: A structured literature search was performed across PubMed, Scopus, and Web of Science databases using key terms including 'Ketamine', 'dexmedetomidine', 'cesarean section', 'anesthesia', and 'pharmacogenetics'. Inclusion criteria were applied to guide the selection of relevant studies for a narrative synthesis. Data collection involved identifying information pertinent to anesthesia types (neuraxial/general), administration routes [intravenous (IV)/intrathecal], dosages, and maternal and neonatal outcomes for a qualitative summary. This narrative review did not include a formal risk of bias assessment or quantitative meta-analysis.

Results: A narrative synthesis of the identified literature indicates that ketamine, recognized for its dissociative anesthetic characteristics and significant analgesic potency, contrasts with dexmedetomidine, which offers distinct sedative and analgesic actions while exhibiting limited respiratory depressant effects. The concurrent administration of these two pharmacological agents holds the potential for synergistic interactions, potentially leading to improved patient outcomes through mechanisms such as reduced opioid requirements, enhanced hemodynamic stability, and minimized postoperative adverse events.

Conclusions: This review underscores the potential for synergistic effects between ketamine and dexmedetomidine in enhancing both analgesic efficacy and hemodynamic stability during CS. Furthermore, it examines the safety profiles associated with this combination and considers relevant pharmacogenetic factors.

Background: Inflammatory cytokines negatively impact postoperative reactions and outcomes in abdominal surgeries.

Objectives: This study investigates the effect of general and spinal anesthesia (SA) on the serum levels of leptin, adiponectin, and interleukin-6 (IL-6) 24 hours after cesarean sections (CS) conducted with spinal or general anesthesia (GA).

Methods: This cross-sectional study was conducted at Sayad Shirazi Hospital in Gorgan, IR. Iran, in 2024. Eighty pregnant women who were scheduled for CS were enrolled in the study. All participants satisfied the criteria for both general and SA, and the method of anesthesia was randomly assigned to each participant. Exclusion criteria included autoimmune diseases, preeclampsia, hypertension, gestational diabetes, a gestational age < 37 weeks, those who received blood transfusions and/or intubation. Participants were divided into two groups based on the anesthesia method after the CS: GA and SA. General anesthesia was administered using propofol and sodium thiopentone combined with atracurium and cis-atracurium. Bupivacaine and ropivacaine were used for SA. Peripheral blood samples were collected 24 hours post-operation to measure IL-6, leptin, and adiponectin levels.

Results: A comparison of serum cytokine levels revealed that 24 hours after CS, IL-6, adiponectin, and leptin were significantly higher in the GA than in the SA group (P < 0.001 for all). In the SA group, there were positive and significant correlations among the following variables: IL-6 and leptin (r = 0.641, P < 0.001), IL-6 and adiponectin (r = 0.617, P < 0.001), as well as between leptin and adiponectin (r = 0.742, P < 0.001). In the GA group, a positive and significant correlation was found between the pro-inflammatory cytokines leptin and IL-6 (r = 0.316, P = 0.047).

Conclusions: The present research found elevated leptin, IL-6, and adiponectin levels in CS cases that underwent GA.