Anesthesiology and Pain Medicine最新文献

Background: Regarding post-adenotonsillectomy pain management, pediatric patients with severe obstructive sleep apnea (OSA) are often treated with lower total opioid doses, and with more short-acting opioid types, relative to their non-severe OSA counterparts. It is unclear whether this practice undermines these patients' pain management and exposes them to a traumatic experience due to under-managed surgical pain. Pain sensitivity differs between adult males and females. Whether the difference exists in the pediatric population, especially related to surgical pain sensitivity, is unclear.

Objectives: We explored the differences in pain sensitivity between sexes using a pediatric adenotonsillectomy population and studied the effects of sleep apnea on acute pain responses.

Methods: We retrospectively analyzed perioperative pain management approaches in a pediatric adenotonsillectomy surgical population at our medical center. Patients aged 3 to 12 years were grouped into those with less severe OSA or severe OSA. Perioperative pain medications and post-anesthesia care unit (PACU) pain assessments were compared between two groups.

Results: Of a total 3,586 patients we analyzed, a higher percentage of severe OSA patients received non-opioid type analgesic medications, as well as fewer and shorter-acting opioids. The use of rescue opioids in the post-operative period did not significantly increase in patients with severe OSA. Post-operative pain scores did not differ between patients with and without severe OSA status. Female patients had significantly higher post-operative pain scores than males in the less severe OSA group, but sex differences in the severe OSA group were not significant.

Conclusions: Despite receiving less perioperative opioid, pediatric patients with severe OSA did not demonstrate worse pain scores in post-surgical recovery. Overall, we did not under-manage their post-operative pain with reduced dosages of opioids. We did find that a sex difference in acute pain perception exists even in pre-puberty pediatric population. However, severe OSA reduces pain sensitivity in both sexes, and blunts sex differences in acute pain perception.

Introduction: Superior hypogastric plexus block (SHPB) is an established treatment for chronic pelvic pain (CPP). Anatomical variations can significantly complicate interventional pain procedures.

Case presentation: We present a case of a 44-year-old woman with CPP secondary to endometriosis and unique lumbosacral (L-S) anatomy, including enlarged and bifid transverse processes, which posed a challenge to standard SHPB techniques. This necessitated a tailored approach to ensure success and patient safety. Successful bilateral blockade was achieved using a combination of posterolateral and trans-discal approaches under fluoroscopic guidance. The patient reported substantial pain relief and improved quality of life.

Conclusions: This case underscores the clinical relevance of recognizing and adapting to anatomical variations during SHPB to optimize procedural success and patient outcomes. Despite the limitations inherent in its retrospective design and reliance on existing clinical data, this study reinforces the need for individualized approaches in similar interventions.

Background: The adductor canal block (ACB) is a widely recognized intervention for post-surgical pain management following total knee arthroplasty (TKA).

Objectives: In this study, we evaluated the analgesic efficacy and functional outcomes of ACB between bupivacaine at concentrations of 0.5% and 0.25% in participants who underwent primary unilateral TKA.

Methods: In this randomized controlled trial, we monitored participants who had undergone TKA surgery. They were randomly assigned to receive postoperative ACB with either 0.5% bupivacaine (22 patients) or 0.25% bupivacaine (22 patients). Data were collected at various time points following the intervention, including quadriceps muscle tone assessed by the Manual Muscle Contraction Test (MMT), pain levels measured using the Visual Analog Scale (VAS) pain scores, analgesic consumption, and patient satisfaction with pain control.

Results: There was no significant difference in pain intensity between the two groups three hours after surgery (P = 0.55). However, the group receiving 0.5% bupivacaine showed a statistically significant trend toward lower VAS scores at 6, 12, and 24 hours post-operation compared to the 0.25% bupivacaine group (P = 0.02, P < 0.005, and P = 0.002, respectively). Patients' satisfaction with postoperative pain management and quadriceps muscle strength did not differ significantly between the two groups. Similarly, opioid consumption at 3, 6, and 24 hours post-surgery showed no significant difference (P = 0.052, P = 0.43). However, opioid consumption was notably higher in the 0.25% bupivacaine group 12 hours after surgery compared to the 0.5% bupivacaine group (P = 0.002).

Conclusions: This study demonstrates that a higher dose of bupivacaine plays a crucial role in effectively reducing postoperative pain and minimizing the need for narcotic consumption.

Background: Fentanyl is often used during general anesthesia and can cause reflex cough.

Objectives: We assessed the effectiveness of administering intravenous ketorolac in reducing the incidence and severity of cough caused by fentanyl, aiming to find an alternative to lidocaine in cases where it is contraindicated.

Methods: In a prospective randomized controlled trial, a total of 210 patients, classified as American Society of Anesthesiologists (ASA) I or II, undergoing elective surgery, were randomly allocated to three groups: The Ketorolac group (K), the Lidocaine group (L), and the normal saline group (N). Three minutes before the injection of 3 mcg/kg intravenous fentanyl, patients received 0.5 mg/kg ketorolac, 1 mg/kg lidocaine, and 2 cc of 0.9% normal saline, respectively. The onset and severity of cough were documented within 3 minutes after the administration of fentanyl.

Results: There was a significant difference in the onset time of cough between the groups (P = 0.001). Three individuals (4.3%) in group L and nine individuals (12.9%) in group N experienced severe coughs, with a significant difference in cough intensity among the groups (P = 0.001). There was no significant difference in heart rate (HR) and arterial oxygen saturation (SpO₂) at different time points (P > 0.05) among the three groups. However, there was a significant difference among the groups regarding arterial blood pressure (BP) 3 minutes after fentanyl injection and 1 minute after intubation (P = 0.003, 0.001, respectively), with the mean arterial BP being higher in group N than in group L, and higher in group L than in group K.

Conclusions: The administration of ketorolac and lidocaine decreases both the frequency and severity of cough induced by fentanyl, especially in individuals who received ketorolac, as no cases of severe cough were observed. Therefore, ketorolac can be used in cases where lidocaine is contraindicated to prevent coughing due to fentanyl.

Background: Groin strains are common in soccer and often lead to prolonged recovery and high recurrence. Traditional rehabilitation may overlook the role of integrated trunk-limb coordination, which is essential in multidirectional sports. The anterior oblique sling (AOS) system, involving the obliques, adductors, and abdominal fascia, is key in dynamic stability and force transfer.

Objectives: Evaluate the effects of AOS training on pain, hip mobility, adductor strength, and performance in soccer players with groin strain.

Methods: In this quasi-experimental study, 30 male semi-professional footballers (18 - 30 years, with ≥ 5 years' experience and confirmed groin strain) were allocated to either an 8-week supervised AOS training program (3x/week, 40 - 60 min/session; n = 15) or a control group (n = 15). Outcomes assessed pre- and post-intervention included pain [Visual Analog Scale (VAS)], hip mobility, isometric adductor strength (dynamometer), and change-of-direction and acceleration test (CODAT). The data were analyzed via repeated-measures ANOVA and nonparametric tests.

Results: The AOS group experienced a 35.6% reduction in pain (VAS: 4.66 ± 0.61 to 3.00 ± 0.92; P = 0.001), unlike the control group. Hip mobility significantly improved in the AOS group (abduction: +4.47°, flexion: +8.87°, extension: +2.54°, internal rotation: +5.73°, external rotation: +3.93°; all P ≤ 0.04, η² = 0.14 - 0.36), with no similar gains in the control group. Adductor strength increased by 19.8% in the AOS group (P = 0.001, η² = 0.32) compared to 4.6% in the control group (P = 0.17). Performance improved by 8.0% in the AOS group (CODAT time: 7.03 ± 0.46 to 6.47 ± 0.41 s; P = 0.001, η² = 0.51), with no change in the control group.

Conclusions: The AOS training effectively reduces groin pain and enhances functional outcomes in soccer players. It offers a promising, chain-based rehabilitation approach for dynamic sports.

Background: Tissue injury resulting from surgical procedures leads to the release of various inflammatory agents, such as mitochondrial DNA (mt-DNA). This can trigger inflammatory mechanisms that may harm different organs.

Objectives: In this study, we investigated the effects of isoflurane and propofol on mt-DNA levels during posterior spinal fusion (PSF) surgery.

Methods: After meeting the inclusion criteria, 40 patients scheduled for PSF surgery were enrolled in a prospective randomized controlled clinical trial and randomly divided into groups receiving propofol or isoflurane for maintenance of anesthesia. Mitochondrial DNA levels were measured before surgery, one hour after induction of anesthesia, in the recovery unit, and 24 hours post-surgery.

Results: There was no statistically significant difference between groups regarding age, gender, and mt-DNA levels prior to surgery (P-value > 0.05). However, mt-DNA levels were significantly higher in the isoflurane group one hour after induction of anesthesia (P-value = 0.001), in the recovery unit (P-value = 0.042), and 24 hours after surgery (P-value = 0.018).

Conclusions: Propofol was superior to isoflurane, as demonstrated by a lesser elevation in plasma levels of mt-DNA in PSF patients.

Background: Postoperative pain following laparoscopic surgeries, such as laparoscopic cholecystectomy, can be severe. Despite various analgesic methods, high doses of narcotics are often required, leading to complications such as dizziness, respiratory disorders, and postoperative nausea and vomiting (PONV).

Objectives: The present study aimed to evaluate the efficacy of two novel analgesic methods, the erector spinae plane block (ESPB) and the retrolaminar block (RLB), performed under ultrasound guidance, in managing pain after upper abdominal laparoscopic surgeries.

Methods: In this clinical trial, candidates for elective upper abdominal laparoscopic surgeries were randomly assigned to two groups (40 patients in the ESPB group and 40 in the RLB group). To manage preoperative pain, one group received an ESPB block under ultrasound guidance on the surgical side, while the other group received a RLB. Both groups were equipped with a patient-controlled intravenous analgesia (PCIA) pump containing fentanyl. The analgesic used in both blocks was 0.1% ropivacaine (20 cc) on the surgical side. Patients' pain intensity [based on the Numeric Rating Scale (NRS)], need for additional narcotics, satisfaction, and sedation scores were recorded and analyzed at various time points post-surgery.

Results: There was no statistically significant difference in the demographic and baseline characteristics between the two groups. However, the average NRS score was significantly lower in the RLB group at all time points post-surgery, except immediately after surgery (P < 0.001). Patient satisfaction was higher in the RLB group at 20 minutes, 2 hours, 4 hours, and 6 hours post-surgery (P < 0.05). The RLB group also required fewer narcotics, indicating that the RLB is more effective in managing acute postoperative pain.

Conclusions: The RLB is more effective than the ESPB in reducing post-laparoscopic cholecystectomy pain. It also decreases narcotic consumption and associated complications. Therefore, it is recommended as a cost-effective method for managing acute pain after laparoscopic cholecystectomy.

Background: Spinal anesthesia (SA) is preferred over general anesthesia for lower extremity surgeries, but the optimal method of needle placement is debated. Although the paramedian approach reduces the risks of dural puncture, it presents technical difficulties. The modified paramedian technique may increase safety and patient satisfaction by facilitating subarachnoid access and overcoming anatomical challenges, particularly in obese or elderly patients.

Objectives: This study aimed to compare the paramedian and modified paramedian techniques from the perspective of anesthesiologists and their impact on postoperative patient satisfaction.

Methods: This triple-blind randomized clinical trial investigated the effects of two SA techniques - paramedian and modified paramedian - on patient satisfaction and procedural ease. A total of 112 patients meeting inclusion and exclusion criteria were enrolled. Data were collected using the Iowa Satisfaction with Anesthesia Care Questionnaire. Demographic information was recorded in coded form, and data analysis was performed using SPSS version 19. Statistical methods included the independent t-test for comparing continuous means between groups, the chi-square test for categorical variables, and logistic regression analysis to assess the impact of individual characteristics (age, gender, weight) on the ease of performing spinal anesthesia.

Results: The results indicated that the modified paramedian group demonstrated superior performance in terms of success on the first attempt (P = 0.006), reduced need for repositioning (P = 0.038), and fewer repeated attempts (P = 0.017). Additionally, patient satisfaction scores were significantly higher in the modified paramedian group (P = 0.001). Multivariate regression confirmed age and Body Mass Index (BMI) as independent predictors of procedural difficulty (P < 0.05).

Conclusions: The modified paramedian technique significantly enhanced the ease of SA administration and patient satisfaction compared to the traditional approach. These findings indicate its potential to improve the anesthesia process, reduce side effects, and elevate patient experience. This study supports broader adoption of the technique in surgical and healthcare settings, advancing anesthesia care quality.

Background: Functional endoscopic sinus surgery (FESS) is the cornerstone of treatment for nasal pathology.

Objectives: This randomized study compares the ability of preoperative and intraoperative esmolol and dexmedetomidine to induce postoperative analgesia and sedation.

Methods: Seventy ASA I and II patients, of either sex, scheduled for FESS, were divided into two groups: The esmolol group (group E) received an intravenous bolus dose of 0.5 mg/kg prior to the induction of anesthesia, followed by 0.05 mg/kg/min and stopped immediately upon extubation, while the dexmedetomidine group (group D) received 1 µg/kg of dexmedetomidine over 10 minutes, immediately before the induction of anesthesia, followed by a 0.5 µg/kg/hour infusion after induction and stopped immediately upon extubation. Mean arterial pressure and heart rate were monitored before induction, before and after intubation, and then every 5 to 30 minutes, as well as every 10 minutes until 90 minutes following the commencement of the IV medication infusion. The sedation level was assessed using the Ramsay sedation scale at 15, 30, and 60 minutes postoperatively. Pain scores were evaluated in the recovery room (on arrival and then 15 minutes, 30 minutes, and 1 hour later) and at 2 hours, 6 hours, 12 hours, and 24 hours. The length of the procedure, the degree of bleeding during the intervention, and the occurrence of any adverse effects were documented. Categorical data were summarized as counts and percentages and compared by the chi-square test. Continuous data were assessed for normality using the Shapiro-Wilk test. The Student's t-test was used for quantitative variables that are normally distributed, whereas the Mann-Whitney test was used for quantitative variables that are not.

Results: According to our findings, both esmolol and dexmedetomidine were safe and beneficial in reducing blood loss during FESS, promoting optimal surgical field quality, and improving surgical field visibility. Dexmedetomidine was far more effective in providing postoperative sedation, reducing the need for opioids, and delaying the initial need for postoperative analgesia.

Conclusions: It was discovered that esmolol and dexmedetomidine both provided superior surgical field, less nasal hemorrhage, and more successful results. Dexmedetomidine caused effective sedation and a reduced need for analgesics.

Background: Antihypertensive medications taken before surgery are associated with increased intraoperative hypotension, and patient positioning can further influence hemodynamics during surgery. However, the combined effects of antihypertensive medication use and patient positioning on intraoperative hypotension during spine surgery have not been clearly established.

Objectives: This study aimed to investigate the incidence of hypotension in patients undergoing spine surgery according to surgical position, antihypertensive drug use, and patient characteristics through a retrospective analysis of medical records.

Methods: This retrospective study analyzed 4,973 patients who had undergone spine surgery. Demographic data, medical history, antihypertensive medication use before surgery, and anesthetic information, including blood pressure during surgery, were collected from electronic medical records (EMRs). The incidence of hypotension according to surgical positioning (supine vs. prone) and antihypertensive medication use was investigated.

Results: The incidence of intraoperative hypotension was higher in patients positioned prone (supine: 19.06% vs. prone: 24.91%) and among those taking more antihypertensive medications (no medication: 19.49%; one medication: 25.18%; two or more medications: 32.97%). Logistic regression indicated that patients with a history of hypertension undergoing surgery in the prone position had a significantly greater risk of hypotension [odds ratio (OR) = 1.407] and severe hypotension (OR = 1.940) compared with those with no history of hypertension undergoing surgery in the supine position. Older age, longer anesthesia duration, cervical surgical site, and the use of multiple antihypertensive agents were associated with an increased risk of intraoperative hypotension. In particular, taking two or more antihypertensive drugs (OR = 1.601) and undergoing surgery in the prone position (OR = 1.505) were independent predictors of hypotension and severe hypotension during spine surgery.

Conclusions: Preoperative use of two or more antihypertensive medications increases the risk of intraoperative hypotension, and spine surgery in the prone position increases the risk of severe hypotension.