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Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WAH, Schraag S, Pradelli L, Repping S, Sperna Weiland NH. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine 2024; 72:102636. [PMID: 38774674 PMCID: PMC11106536 DOI: 10.1016/j.eclinm.2024.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Background General anaesthesia is provided to more than 300 million surgical patients worldwide, every year. It is administered either through total intravenous anaesthesia, using only intravenous agents, or through inhalational anaesthesia, using volatile anaesthetic agents. The debate on how this affects postoperative patient outcome is ongoing, despite an abundance of published trials. The relevance of this topic has grown by the increasing concern about the contribution of anaesthetic gases to the environmental impact of surgery. We aimed to summarise all available evidence on relevant patient outcomes with total intravenous anaesthesia versus inhalational anaesthesia. Methods In this systematic review and meta-analysis, we searched PubMed/Medline, Embase and Cochrane Central Register of Controlled trials for works published from January 1, 1985 to August 1, 2023 for randomised controlled trials comparing total intravenous anaesthesia using propofol versus inhalational anaesthesia using the volatile anaesthetics sevoflurane, desflurane or isoflurane. Two reviewers independently screened titles, abstracts and full text articles, and assessed risk of bias using the Cochrane Collaboration tool. Outcomes were derived from a recent series of publications on consensus definitions for Standardised Endpoints for Perioperative trials (StEP). Primary outcomes covered mortality and organ-related morbidity. Secondary outcomes were related to anaesthetic and surgical morbidity. This study is registered with PROSPERO (CRD42023430492). Findings We included 317 randomised controlled trials, comprising 51,107 patients. No difference between total intravenous and inhalational anaesthesia was seen in the primary outcomes of in-hospital mortality (RR 1.05, 95% CI 0.67-1.66, 27 trials, 3846 patients), 30-day mortality (RR 0.97, 95% CI 0.70-1.36, 23 trials, 9667 patients) and one-year mortality (RR 1.14, 95% CI 0.88-1.48, 13 trials, 9317 patients). Organ-related morbidity was similar between groups except for the subgroup of elderly patients, in which total intravenous anaesthesia was associated with a lower incidence of postoperative cognitive dysfunction (RR 0.62, 95% CI 0.40-0.97, 11 trials, 3834 patients) and a better score on postoperative cognitive dysfunction tests (standardised mean difference 1.68, 95% CI 0.47-2.88, 9 trials, 4917 patients). In the secondary outcomes, total intravenous anaesthesia resulted in a lower incidence of postoperative nausea and vomiting (RR 0.61, 95% CI 0.56-0.67, 145 trials, 23,172 patients), less emergence delirium (RR 0.40, 95% CI 0.29-0.56, 32 trials, 4203 patients) and a higher quality of recovery score (QoR-40 mean difference 6.45, 95% CI 3.64-9.25, 17 trials, 1835 patients). Interpretation The results indicate that postoperative mortality and organ-related morbidity was similar for intravenous and inhalational anaesthesia. Total intravenous anaesthesia offered advantages in postoperative recovery. Funding Dutch Society for Anaesthesiology (NVA).
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Affiliation(s)
- Jasper M. Kampman
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Healthcare Evaluation and Appropriate Use, National Healthcare Institute, Diemen, the Netherlands
| | - Nicolaas H. Sperna Weiland
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, the Netherlands
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Hung KC, Kao CL, Ho CN, Hsing CH, Chang YJ, Wang LK, Liao SW, Chen IW. The impact of perioperative ketamine or esketamine on the subjective quality of recovery after surgery: a meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:1293-1303. [PMID: 38614917 DOI: 10.1016/j.bja.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to evaluate the impact of ketamine/esketamine on postoperative subjective quality of recovery (QoR). METHODS MEDLINE, Embase, Cochrane library, and Google Scholar were searched for randomised controlled trials (RCTs) that examined the impacts of perioperative ketamine/esketamine use and postoperative QoR. The primary outcome was subjective QoR (QoR-9, QoR-15, QoR-40) on postoperative day (POD) 1-3, whereas the secondary outcomes included pain severity, anxiety scores, depression scores, risk of adverse events (i.e. nausea, vomiting, dizziness, drowsiness), and length of stay. RESULTS The analysis included 18 RCTs (1554 participants; ketamine: seven trials, esketamine: 11 trials), of which 15 were conducted in China. Ketamine/esketamine improved the QoR scores on PODs 1 and 2 compared with the control (standardised mean difference [SMD]: 0.63, P<0.0001 for POD 1; SMD: 0.56, P=0.04 for POD 2), without beneficial effect on POD 3. Subgroup analyses revealed significant differences in QoR scores on POD 1 by regimen (SMD: esketamine 1.14, ketamine 0.01) and country (SMD: China 0.82, other countries -0.21). The emotional domain of QoR was improved from PODs 1 to 3, whereas the other domains were only improved on POD 1. Lower postoperative anxiety (SMD: -0.48, P=0.003) and depression (SMD: -0.72, P=0.001) scores were also observed with ketamine/esketamine use. Furthermore, pain severity was reduced on PODs 1 and 2, with no difference in the risk of adverse events or length of stay. CONCLUSIONS This meta-analysis demonstrated that ketamine/esketamine use in the perioperative period is associated with improved early subjective QoR, pain severity, and psychological symptoms without an increase in the likelihood of adverse events. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42023477580).
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Shu-Wei Liao
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
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Kulturoglu G, Altinsoy S, Ergil J, Ozkan D, Ozguner Y. Investigation of the analgesic effects of rhomboid intercostal and pectoral nerve blocks in breast surgery. J Anesth 2024:10.1007/s00540-024-03351-3. [PMID: 38777932 DOI: 10.1007/s00540-024-03351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The objective of this study was to examine the hypothesis that the opioid consumption of patients who receive a rhomboid intercostal block (RIB) or a pectoral nerve (PECS) block after unilateral modified radical mastectomy (MRM) surgery is less than that of patients who receive local anesthetic infiltration. METHODS Eighty-one female patients aged 18-70 years who underwent unilateral MRM surgery with general anesthesia were randomly allocated to three groups. The first group received an RIB with 30 ml of 0.25% bupivacaine on completion of the surgery, and the second received a PECS block with the same volume and concentration of local anesthetic. In the third (control) group, local infiltration was applied to the wound site with 30 ml of 0.25% bupivacaine at the end of the surgery. The patients' total tramadol consumption, quality of recovery (QoR), postoperative pain scores, and sleep quality were evaluated in the first 24 h postoperatively. RESULTS Both the RIB (58.3 ± 22.8 mg) and PECS (68.3 ± 21.2 mg) groups had significantly lower tramadol consumption compared to the control group (92.5 ± 25.6 mg) (p < 0.001 and p = 0.002, respectively). Higher QoR scores were observed in the RIB and PECS groups than the control group at 6 h post-surgery. The lowest pain values were observed in the RIB group. The sleep quality of the patients in the RIB and PECS groups was better than that of the control group (p < 0.001). CONCLUSION Compared to local anesthetic infiltration, the RIB and PECS blocks applied as part of multimodal analgesia in MRM surgery reduced opioid consumption in the first 24 h and improved the quality of recovery in the early period.
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Affiliation(s)
- Gokcen Kulturoglu
- Department of Anesthesiology and Reanimation, Etlik City Hospital, Ankara, Turkey.
| | - Savas Altinsoy
- Department of Anesthesiology and Reanimation, Etlik City Hospital, Ankara, Turkey
| | - Julide Ergil
- Department of Anesthesiology and Reanimation, Etlik City Hospital, Ankara, Turkey
| | - Derya Ozkan
- Department of Anesthesiology and Reanimation, Etlik City Hospital, Ankara, Turkey
| | - Yusuf Ozguner
- Department of Anesthesiology and Reanimation, Etlik City Hospital, Ankara, Turkey
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Ding Q, Yue S. A study of hemodynamic effects, postoperative recovery, and safety of esketamine (right handed) during flexible bronchoscopy under general anesthesia. Curr Med Res Opin 2024:1-8. [PMID: 38713585 DOI: 10.1080/03007995.2024.2331167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/12/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Flexible bronchoscopy during general anesthesia has become an indispensable tool. Anesthetics are widely utilized in flexible bronchoscopy (FB). This study delved into the application value of a subanesthetic dose of esketamine (ES) (right handed) in flexible bronchoscopy during general anesthesia. METHODS A sample of 160 patients who underwent flexible bronchoscopy during general anesthesia were selected as study subjects and were equally divided into the control and ES groups, with clinical baseline data (age, sex, body mass index, American Society of Anesthesiologists grading) collected. Hemodynamic parameters (mean artery pressure, heart rate, pulse blood oxygen saturation) at different time points, the onset time of anesthesia, surgery time, analgesia maintenance time, anesthesia awakening time, and perioperative adverse reactions were recorded. Visual analogue scale (VAS), Mini-Mental State Examination (MMSE), and quality of recovery-40 (QoR-40) scales were utilized for assessing post-surgery satisfaction, cognitive function, and post-surgery early recovery quality. RESULTS The hemodynamics were stable at each time point, but patients in the ES group were more stable than those in the control group. Patients in the ES group exhibited faster onset and awakening time of anesthesia, longer duration of analgesia, and lower total incidence of adverse reactions versus the control group. The patients' QoR-40 total scores in the ES group were improved versus the control group at 1 day after surgery. CONCLUSION Compared with fentanyl, the use of ES (right handed) in flexible bronchoscopy during general anesthesia produces more stable hemodynamics, faster onset and recovery time of anesthesia, longer duration of analgesia, lower incidence of adverse reactions, and improved early postoperative recovery quality in patients.
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Affiliation(s)
- Qin Ding
- Department of Anesthesiology, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huaian, China
| | - Suyang Yue
- Department of Gastroenterology, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huaian, China
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Matsuda Y, Nagamine Y, Irie T, Goto T. Effects of pain management using nonsteroidal anti-inflammatory drug suppositories during brachytherapy for cervical cancer: A single-center prospective observational study. Brachytherapy 2024; 23:257-265. [PMID: 38462384 DOI: 10.1016/j.brachy.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION No standardized pain management protocol exists for intracavitary brachytherapy, and various methods of analgesia have been used in different countries and institutions. This study aimed to investigate the effects of pain management during intracavitary brachytherapy using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen suppositories. METHODS In this single-center, prospective, observational study, patients undergoing intracavitary brachytherapy for cervical cancer completed a questionnaire survey after each brachytherapy session, which comprised questions regarding pain intensity, satisfaction with analgesia, and desire for effective anesthesia. RESULTS Data analysis was performed using data from 100 brachytherapy sessions of 27 patients. The median numerical rating scale (NRS; 0-10) score for each intracavitary brachytherapy session was 3-4. The median satisfaction scale score for analgesia (5-point scale, 1-5) for each session was approximately 4. Eight patients (29.6%) answered that they desired anesthesia more effective than suppositories at any session of brachytherapy. A comparison of the high (NRS ≥4) and low (NRS ≤3) NRS groups during the first session revealed that the high NRS group tended to have higher NRS scores and lower satisfaction with analgesia during all sessions. A positive correlation was observed between tumor size and the NRS score during the first brachytherapy session. CONCLUSIONS The NRS score was approximately 3-4, and satisfaction with analgesia was approximately 4 out of 5 when NSAIDs or acetaminophen suppositories were used as analgesics during intracavitary brachytherapy for cervical cancer. Although the current pain management protocol is clinically acceptable, inadequate analgesia is indicated in approximately 30% of patients.
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Affiliation(s)
- Yuko Matsuda
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Nagamine
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan.
| | - Tomoya Irie
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
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Jones H, Robson K, Maddox T, Alderson B. Incidence of and risk factors for poor recovery quality in dogs recovering from general anaesthesia-a prospective case control study. Vet Anaesth Analg 2024; 51:227-234. [PMID: 38350794 DOI: 10.1016/j.vaa.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the incidence of and identify risk factors associated with poor quality of recovery in dogs recovering from general anaesthesia. STUDY DESIGN Case controlled study. METHODS All dogs undergoing general anaesthesia at the University of Liverpool Small Animal Teaching Hospital between January 2020 and January 2021 were eligible for recruitment. Signalment, anaesthetic case management and a recovery score were recorded. Univariable and multivariable logistic and ordinal logistic regression analysis were used to identify factors which impact incidence of poor quality of recovery. RESULTS A total of 247 dogs undergoing general anaesthesia were included. Overall, 72 [29.1%; 95% confidence interval (CI) 23.8%-35.1%] dogs experienced a poor quality recovery. Of these, 40 (55.5%) required sedation to manage behaviours associated with poor recovery. Multivariable logistic regression revealed American Society of Anesthesiologists (ASA) physical status classification of III or higher was associated with a decreased incidence of poor quality recovery [odds ratio (OR) = 0.34, 95% CI 0.12-0.93, p = 0.037] and the use of multiple inhalational anaesthetics during one procedure was associated with an increased incidence of poor quality of recovery (OR = 42.5, 95% CI 3.0-598.3, p = 0.005). CONCLUSIONS AND CLINICAL RELEVANCE Poor quality recovery is common in dogs recovering from general anaesthesia and sedation is often required for resolution. It is more likely to occur in healthy veterinary patients (ASA I and II). The use of multiple inhalational anaesthetic agents during one procedure should be discouraged as this may increase the likelihood of poor quality of recovery.
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Affiliation(s)
- Heather Jones
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK.
| | - Katherine Robson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Thomas Maddox
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Briony Alderson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
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Miao L, Chen Q, Wang Y, Wang D, Zhou M. Effect of intraperitoneal infusion of ropivacaine combined with dexmedetomidine in patients undergoing total laparoscopic hysterectomy: a single-center randomized double-blinded controlled trial. Arch Gynecol Obstet 2024; 309:1387-1393. [PMID: 37004537 PMCID: PMC10894115 DOI: 10.1007/s00404-023-07020-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate the effect of intraperitoneal infusion of ropivacaine combined with dexmedetomidine and ropivacaine alone on the quality of postoperative recovery of patients undergoing total laparoscopic hysterectomy (TLH). METHODS Female patients scheduled to undergo a TLH under general anesthesia at Fujian Maternity and Child Health Hospital were included. Before the end of pneumoperitoneum, patients were laparoscopically administered an intraperitoneal infusion of 0.25% ropivacaine 40 ml (R group) or 0.25% ropivacaine combined with 1 µg/kg dexmedetomidine 40 ml (RD group). The primary outcome was QoR-40, which was assessed before surgery and 24 h after surgery. Secondary outcomes included postoperative NRS scores, postoperative anesthetic dosage, the time to ambulation, urinary catheter removal, and anal exhaust. The incidence of dizziness, nausea, and vomiting was also analyzed. RESULTS A total of 109 women were recruited. The RD group had higher QoR scores than the R group at 24 h after surgery (p < 0.05). Compared with the R group, NRS scores in the RD group decreased at 2, 6, 12, and 24 h after surgery (all p < 0.05). In the RD group, the time to the first dosage of postoperative opioid was longer and the cumulative and effective times of PCA compression were less than those in the R group (all p < 0.05). Simultaneously, the time to ambulation (p = 0.033), anal exhaust (p = 0.002), and urethral catheter removal (p = 0.018) was shortened in the RD group. The RD group had a lower incidence of dizziness, nausea, and vomiting (p < 0.05). CONCLUSION Intraperitoneal infusion of ropivacaine combined with dexmedetomidine improved the quality of recovery in patients undergoing TLH. TRIAL REGISTRATION ChiCTR2000033209, Registration Date: May 24, 2020.
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Affiliation(s)
- Liyan Miao
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, China
| | - Qiuchun Chen
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuping Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, China
| | - Denggui Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, China.
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, China.
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Wu W, Wang D, Liu Y, Zhu T, He W, Shi H. Comparison of ultrasound-guided subtransverse process interligamentary plane block with paravertebral block for postoperative analgesia in thoracic surgery: protocol for a randomised non-inferiority trial. BMJ Open 2024; 14:e082135. [PMID: 38485177 PMCID: PMC10941127 DOI: 10.1136/bmjopen-2023-082135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The subtransverse process interligamentary (STIL) plane block is an emerging interfascial plane block that has garnered attention for its potential to provide effective postoperative analgesia for breast and thoracic surgeries. However, a direct comparative assessment between the STIL plane block and the paravertebral block is currently lacking. Consequently, our study aims to assess the analgesic efficacy of the STIL block in comparison to paravertebral block for patients undergoing video-assisted thoracoscopic surgery (VATS). METHODS AND ANALYSIS This study is a randomised, parallel-controlled, double-blind, non-inferiority trial, with the goal of enrolling 114 participants scheduled for uniportal VATS at Shanghai Pulmonary Hospital. Participants will be randomly assigned in a 1:1 ratio through block randomisation to receive either the STIL plane block (n=57) or the paravertebral block (n=57). The primary outcome of the study is the area under the curve of Numerical Rating Scale(NRS) scores recorded over a 48-hour period following the surgical procedure. Secondary outcomes encompass the evaluation of Quality of Recovery-40, cumulative sufentanil consumption, serum inflammatory factors, rescue medication usage, the incidence of adverse events and the patient satisfaction scores. ETHICS AND DISSEMINATION This study has received approval from the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval no. L22-329). Written informed consent will be obtained from all participants. The findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200066909.
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Affiliation(s)
- Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Danyang Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianyi Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Wenxin He
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Kovač R, Juginović I, Delić N, Velat I, Vučemilović H, Vuković I, Kozomara V, Lekić A, Duplančić B. The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial. J Pers Med 2024; 14:190. [PMID: 38392623 PMCID: PMC10890626 DOI: 10.3390/jpm14020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85-0.92) and 0.73 (0.64-0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability.
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Affiliation(s)
- Ruben Kovač
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivo Juginović
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Nikola Delić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Velat
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Hrvoje Vučemilović
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Vuković
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Verica Kozomara
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Angela Lekić
- Surgery Department, University Hospital Split, 21000 Split, Croatia
| | - Božidar Duplančić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
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Imai T, Asada Y, Matsuura K. Enhanced recovery pathways for head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx 2024; 51:38-50. [PMID: 37558602 DOI: 10.1016/j.anl.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The enhanced recovery after surgery (ERAS) pathway is designed to facilitate recovery after surgery by packaging evidence-based protocols specific to each aspect of the perioperative period, including the preoperative, intraoperative, postoperative, and post-discharge periods. The ERAS pathway, which was originally developed for use with colonic resection, is now being expanded to include a variety of surgical procedures, and the ERAS Society has published a consensus review of the ERAS pathway for head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). The ERAS pathway for HNS-FTTR consists of various important protocols, including early postoperative mobilization, early postoperative enteral nutrition, abolition of preoperative fasting, preoperative enteral fluid loading, multimodal pain management, and prevention of postoperative nausea and vomiting. In recent years, meta-analyses investigating the utility of the ERAS pathway in head and neck cancer surgery have also been presented, and all reports showed that the length of the postoperative hospital stay was reduced by the implementation of the ERAS pathway. The ERAS pathway is now gaining traction in the field of head and neck surgery; however, the details of its efficacy remain uncertain. We believe the future direction will require research focused on improving the quality of postoperative patient recovery and patient satisfaction. It will be important to use patient-reported outcomes to determine whether the ERAS pathway is actually beneficial.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Chen Y, Liu S, Li B, Lin R, Lai W, Liu D, Wang Z, Liu J, Qin X, Wu X, Li J, Jia K, Chen J. Application of the quality of recovery-40 questionnaire to evaluate the effectiveness of enhanced recovery after surgery protocols in gastric cancer. Updates Surg 2024:10.1007/s13304-023-01719-w. [PMID: 38245892 DOI: 10.1007/s13304-023-01719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
Patient reported outcomes is currently considered to be an important supplement to evaluate the effectiveness of enhanced recovery after surgery (ERAS) clinical practice. The Quality of Recovery-40 Questionnaire (QoR-40) is one of the most frequently used and validation tool to assess the subjective feelings of quality of life after surgery. The present study aimed to use the QoR-40 to evaluate the effectiveness of ERAS protocols in gastric cancer from the perspective of patient-reported quality of recovery. The study was designed as a prospective, non-randomized clinical trial, conducted in a single center. Patients in our hospital who were scheduled to undergo radical surgery for gastric cancer were divided into ERAS group and control group (Contr group). The QoR-40 were administered one day before surgery (Baseline) and on postoperative day 1, 3, 6, and 30. The difference in QoR-40 scores between the ERAS and Contr groups was compared by repeated-measures ANOVA. A total of 200 patients completed the study, including 100 patients in the ERAS group and 100 patients in the Contr group. The Baseline time point QoR-40 scores of the ERAS and Contr groups were 179.68 ± 14.46 and 180.12 ± 17.12, respectively, and no significant difference was noted between the two groups (p = 0.845). The postoperative QoR-40 score of the ERAS group was significantly higher than that of the Contr group, and the difference was statistically significant (p = 0.006). This study demonstrated that, in terms of patient-reported quality of recovery, the postoperative recovery effect of ERAS protocols in gastric cancer is significantly better than that of the traditional treatment model.
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Affiliation(s)
- Yeyang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
- Department of Thyroid and Breast surgery, The First People's Hospital of Yulin, Yulin, China
| | - Siyu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Bopei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Rujing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Weikun Lai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Dejun Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Zhen Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Jinlu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Xingan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Xianghua Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Jiehua Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Kui Jia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China.
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Wu J, Zhang Y, Shen L. Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol. BMJ Open 2024; 14:e075999. [PMID: 38238052 PMCID: PMC10806907 DOI: 10.1136/bmjopen-2023-075999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Early oral intake (EOI) is supposed to be safe and beneficial to patients' recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid surgery. On the other hand, a modified electromyography (EMG) endotracheal intubation protocol with real-time EMG monitoring during video laryngoscope/fibrescope-guided intubation was presented in 2022, which was regarded as an effective way to shorten the intubation time. We aimed to use Quality of Recovery-15 (QoR-15) questionnaire to compare the efficacy and safety of different EMG endotracheal intubation protocols combined with different postoperative oral intake strategy in thyroid and parathyroid surgery. METHODS AND ANALYSIS This prospective, single-centre, 2×2 factorial, randomised controlled trial will be conducted in the Peking Union Medical College Hospital (PUMCH), China. We plan to recruit 200 adult patients who will receive thyroid or parathyroid surgery under intraoperative nerve monitoring. Eligible patients will be randomly divided into two groups, which will receive either the modified intubation protocol (M group) or conventional intubation process (C group). After patients enter postanaesthesia care unit and Steward scores ≥4, they will be randomly divided into two groups again, which will receive early resumption of oral intake (E group) or delayed resumption of oral intake (D group). Patients will be followed up during hospitalisation and the QoR-15 questionnaire will be administered to compare the quality of recovery on the day before surgery (T0), the first day after surgery (T1) and the day of discharge (T2). The primary outcome is the QoR-15 scores at T1. ETHICS AND DISSEMINATION The study protocol has been approved by the Research Ethics Committee of Peking Union Medical College Hospital (IRB K-2501). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals. TRIAL REGISTRATION NUMBER NCT05624463.
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Affiliation(s)
- Juelun Wu
- Anesthesiology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Le Shen
- Anesthesiology, Peking Union Medical College Hospital, Beijing, People's Republic of China
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Cheng M, Ding R, Xu W, Wang S. Analyzing robotic surgery impact on recovery quality & emotions. Heliyon 2024; 10:e23905. [PMID: 38226242 PMCID: PMC10788283 DOI: 10.1016/j.heliyon.2023.e23905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background The objective of this study is to investigate the postoperative recovery quality and emotional status of patients with non-small cell lung cancer (NSCLC) who underwent robot-assisted and video-assisted thoracoscopic surgery using the 15-item Quality of Recovery (QoR-15) scale and to analyze the correlation. Methods We collected clinical data from 320 patients with NSCLC who underwent lobectomy using either robot-assisted thoracoscopic surgery (RATS) or video-assisted thoracoscopic surgery (VATS) at our center from January 2021 to December 2022. We compared perioperative parameters and followed up after the operation using the QoR-15 scale to objectively assess the quality of postoperative recovery and physical and emotional status. Results Apart from a notable distinction in anesthesia time, no significant differences were observed in other general data. Notably, the overall recovery rate for patients in the RATS group surpassed that of the VATS group (P < 0.05). Specifically, the recovery rates in the RATS group were significantly superior to those in the VATS group across nociceptive factors, emotional factors, activities of daily living, physiological factors, and cognitive ability (P < 0.05). Spearman correlation analysis between surgical methods and various indicators of the QoR-15 scale showed significant correlations between surgical methods (P < 0.05). Conclusion The QoR-15 scale is a valuable tool for assessing the postoperative recovery quality in lung cancer patients. The RATS plays a significant role in promoting the swift postoperative recovery of patients and demonstrates excellent efficacy, safety, and reliability.
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Affiliation(s)
- Ming Cheng
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Renquan Ding
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Wei Xu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, China
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14
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van Beek S, Nieboer D, Klimek M, Stolker RJ, Mijderwijk HJ. Development and external validation of a clinical prediction model for predicting quality of recovery up to 1 week after surgery. Sci Rep 2024; 14:387. [PMID: 38172591 PMCID: PMC10764891 DOI: 10.1038/s41598-023-50518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance (R2)) and calibration (calibration plot and slope). The full model consisted of age, sex, previous surgery, BMI, ASA classification, duration of surgery, HADS and preoperative QoR-40 score. At model development, the R2 of the full model was 0.24. At external validation the R2 dropped as expected. The calibration analysis showed that the QoR-40 predictions provided by the developed prediction models are reliable. The presented models can be used as a starting point for future updating in prediction studies. When the predictive performance is improved it could be implemented clinically in the future.
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Affiliation(s)
- Stefan van Beek
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Hendrik-Jan Mijderwijk
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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15
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Bilge A, Başaran B. Postoperative quality of recovery with erector spinae plane block or thoracolumbar interfascial plane block after major spinal surgery: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:68-76. [PMID: 37889327 DOI: 10.1007/s00586-023-07998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Major spinal surgery causes severe postoperative pain. The present randomized, controlled, prospective study tested the short- and long-term effects of thoracolumbar interfascial and erector spinae plane blocks on patient-centered outcomes for major lumbar spinal surgery. METHODS Sixty adult patients were randomly assigned to receive either bilateral thoracolumbar interfascial plane or erector spinae plane block after anesthesia induction using bupivacaine 0.25%, 20 mL. The primary outcome of this study was the Quality of Recovery-40 score in the postoperative 24th hour. Secondary outcomes were Comprehensive Complication Index scores, postoperative pain scores, opioid consumption, first rescue analgesic administration time, and complication incidence. RESULTS The recovery scores of both blocks at the postoperative 24th hour were similar, with a median thoracolumbar interfascial plane block of 178 (IQR 173-180) and an erector spinae plane block of 175 (IQR 168.7-182) (p = 0.717). Thoracolumbar interfascial plane block reduced area under the curve pain with movement over 24 h compared with erector spinae plane block (p = 0.024). The pain scores between the groups were similar at all time points (p > 0.05), except the 24th hour with movement in the thoracolumbar interfascial plane block compared with the erector spinae plane block [median 3 (IQR 2-4)] vs. 4 (IQR 3-5), respectively] (p = 0.019). No differences were recorded between the block groups regarding postoperative 24th-h oxycodone consumption, time to first opioid intake, and complication incidence (p > 0.05). CONCLUSIONS Both blocks resulted in similar quality of recovery in the postoperative 24-h period in major spinal surgery and were effective in terms of analgesia.
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey
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16
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Wang S, Shi J, Dai Y, Zhang J, Liu Q, Yang P, Zhu N. The effect of different nerve block strategies on the quality of post-operative recovery in breast cancer patients: A randomized controlled study. Eur J Pain 2024; 28:166-173. [PMID: 37655864 DOI: 10.1002/ejp.2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To compare the effects of three types of ultrasound-guided nerve blocks on post-operative recovery quality in patients undergoing modified radical mastectomy for unilateral breast cancer. METHODS In this randomized double-blinded trial (chictr.org.cn, ChiCTR2200059428), 150 female patients were equally assigned to S group (serratus anterior plane block, SAPB) group, P group (paravertebral block, PVB) or ST group (serratus anterior combined with transverse thoracic muscle plane blocks, SA-TTMPB). The primary outcome was QoR-15 at five time points after surgery. Secondary outcomes were pain scores, time of first rescue analgesic and chronic pain incidence at 3 months. RESULTS The QoR-15 total score of S group at 24 h, 48 h, 72 h and 7 days post-surgery was significantly lower in groups P and ST, while there was no significant difference between groups P and ST (S vs. P vs. ST, 100.29 ± 6.20 vs. 108.51 ± 7.46 vs. 106.46 ± 6.95; 105.59 ± 6.18 vs. 113.06 ± 7.44 vs. 111.22 ± 6.56; 112.51 ± 6.32 vs. 119.88 ± 6.44 vs. 117.62 ± 6.09; 123.00 ± 5.78 vs. 128.86 ± 5.96 vs. 126.92 ± 5.72, p < 0.05). The dynamic and rest NRS scores at 6 and 12 h post-surgery were significantly higher in group S than in groups P and ST. CONCLUSION Serratus anterior plane block combined with transverse thoracic muscle plane block and paravertebral block both have better effects than serratus anterior plane block alone in improving patients' early post-operative recovery quality, and also have an advantage in improving early post-operative pain. CLINICAL TRIAL REGISTRATION chictr.org.cn (ChiCTR2200059428). DATE OF REGISTRATION 29 April 2022. SIGNIFICANCE Serratus anterior combined with transverse thoracic muscle plane block may be a safer, easier, and equally effective nerve block strategy than paravertebral block in patients undergoing modified radical mastectomy for unilateral breast cancer.
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Affiliation(s)
- Shun Wang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jinghong Shi
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yunke Dai
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jie Zhang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Qiaoli Liu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Pingliang Yang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Zhu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Huang Y, Yan T, Lu G, Luo H, Lai Z, Zhang L. Efficacy and safety of remimazolam compared with propofol in hypertensive patients undergoing breast cancer surgery: a single-center, randomized, controlled study. BMC Anesthesiol 2023; 23:409. [PMID: 38087245 PMCID: PMC10714447 DOI: 10.1186/s12871-023-02364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Remimazolam, as a novel anesthetic, has recently been shown to improve hemodynamic stability during anesthesia induction and maintenance; however, it has not been reported in the hypertensive population. This study aimed to compare the effects of remimazolam and propofol on hemodynamic stability in hypertensive patients undergoing breast cancer surgery. METHODS We enrolled 120 hypertensive patients undergoing breast cancer surgery in this prospective study and randomly allocated them to remimazolam (n = 60) or propofol (n = 60) groups. Anesthesia regimens were consistent between groups, except for the administration of remimazolam and propofol. Our primary outcome was the incidence of post-induction hypotension, which was either an absolute mean arterial pressure (MAP) < 60 mmHg or a > 30% relative drop in MAP compared to baseline within 20 min of induction or from induction to the start of surgery. Secondary outcomes included minimum MAP and MAP at different time points during anesthesia, the application of vasoactive drugs, adverse events, and the patient's self-reported Quality of Recovery-40 scale for the day after surgery. RESULTS The incidence of post-induction hypotension was lower and the minimum MAP during induction was higher in the remimazolam group than those in the propofol group. There were no significant differences between the two groups in the remaining outcomes. CONCLUSION Remimazolam is safe and effective in hypertensive patients undergoing breast cancer surgery. Induction with remimazolam in hypertensive patients may result in more stable hemodynamics than propofol. TRIAL REGISTRATION This study was registered at the Chinese Clinical Trials Registry ( http://www.chictr.org.cn ) on 03/12/2020, with registration number ChiCTR2000040579.
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Affiliation(s)
- Yaqi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Ting Yan
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Guiting Lu
- Department of Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Huirong Luo
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Zhongmeng Lai
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China.
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18
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Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth 2023; 37:914-922. [PMID: 37740124 PMCID: PMC10654206 DOI: 10.1007/s00540-023-03254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE In the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery. METHODS In this study, 75 patients scheduled for thyroid surgery under general anesthesia were randomly allocated into two groups. The primary outcome included the incidence of nausea within 24 h after surgery. The main secondary outcomes included the incidence of vomiting and the visual analog score (VAS) scores within 24 h after surgery as well as the quality of recovery 40 questionnaires (QoR-40) scores 24 h after surgery. RESULTS In the OFA group, the incidence of postoperative nausea was 6.1%, compared to 39.4% in the control group (p = 0.001). No patient presented with postoperative vomiting in the OFA group, while 15.2% of patients suffered from postoperative vomiting in the control group (p = 0.063). The VAS scores of patients in the postanesthetic care unit (PACU) and 2 h, 4 h, and 6 h after surgery were lower in the OFA group, and the difference is statistically significant. Besides, the VAS scores of patients at rest (p = 1.000) and during swallowing (p = 1.000) 24 h after surgery were comparable. CONCLUSION Compared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores. TRIAL REGISTRATION Chinese Clinical Trial Regisrty, ChiCTR2200056344, https://www.chictr.org.cn.
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Affiliation(s)
- Zhi Liu
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- China Medical University, Shenyang, China
| | - Congjie Bi
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China.
| | - Xingguo Li
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Ruonan Song
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
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Choi S, Choi YH, Lee HS, Shin KW, Kim YJ, Park HP, Cho WS, Oh H. Effects of Scalp Nerve Block on the Quality of Recovery after Minicraniotomy for Clipping of Unruptured Intracranial Aneurysms : A Randomized Controlled Trial. J Korean Neurosurg Soc 2023; 66:652-663. [PMID: 37042173 PMCID: PMC10641417 DOI: 10.3340/jkns.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE This study compared the quality of recovery (QoR) after minicraniotomy for clipping of unruptured intracranial aneurysms (UIAs) between patients with and without scalp nerve block (SNB). METHODS Patients were randomly assigned to the SNB (SNB using ropivacaine with epinephrine, n=27) and control (SNB using normal saline, n=25) groups. SNB was performed at the end of surgery. To assess postoperative QoR, the QoR-40, a patient-reported questionnaire, was used. The QoR-40 scores were measured preoperatively, 1-3 days postoperatively, at hospital discharge, and 1 month postoperatively. Pain and intravenous patient-controlled analgesia (IV-PCA) consumption were evaluated 3, 6, 9, and 12 hours and 1-3 days postoperatively. RESULTS All QoR-40 scores, including those measured 1 day postoperatively (primary outcome measure; 155.0 [141.0-176.0] vs. 161.0 [140.5-179.5], p=0.464), did not significantly differ between the SNB and control groups. The SNB group had significantly less severe pain 3 (numeric rating scale [NRS]; 3.0 [2.0-4.0] vs. 5.0 [3.5-5.5], p=0.029), 9 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.048), and 12 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.035) hours postoperatively. The total amount of IV-PCA consumed was significantly less 3 hours postoperatively in the SNB group (2.0 [1.0-4.0] vs. 4.0 [2.0-5.0] mL, p=0.044). CONCLUSION After minicraniotomy for clipping of UIAs, SNB reduced pain and IV-PCA consumption in the early postoperative period but did not improve the QoR-40 scores.
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Affiliation(s)
- Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Choi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hoo Seung Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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20
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van Hoorn BT, Tromp DJ, van Rees RCM, van Rossenberg LX, Cazemier HK, van Heijl M, Tromp Meesters RC. Effectiveness of a digital vs face-to-face preoperative assessment: A randomized, noninferiority clinical trial. J Clin Anesth 2023; 90:111192. [PMID: 37467628 DOI: 10.1016/j.jclinane.2023.111192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
STUDY OBJECTIVE Digitalizing the preoperative assessment clinic can be a solution to keep up with the growing demand for surgery. It remains unclear if a digital preoperative assessment clinic is as safe, and effective in terms of patient health outcomes and experience compared to face-to-face consultations. This study aimed to compare quality of recovery and mental state in patients undergoing a digital preoperative assessment versus regular face-to-face consultations. DESIGN This was a single centre, randomized (1:1), parallel, open-label, noninferiority trial. SETTING The preoperative clinic and preoperative unit of an urban secondary care hospital. PATIENTS All adult, Dutch speaking, ASA I-IV patients with access to an online computer who required surgery. INTERVENTIONS Digital preoperative screening, consisting of an electronic screening questionnaire and web-based platform with personalized information and recommendations related to the procedure, or face-to-face screening, consisting of two 20-min in-hospital consultations. MEASUREMENTS The primary endpoint was quality of recovery, measured 48 h after surgery. The analysis followed a per-protocol principle, and only patients who underwent the intended screening were included in the analysis. The noninferiority margin was set at -6. The trial was registered at ClinicalTrials.gov, NCT05535205, during the study on 09/08/2022, before analysing results. MAIN RESULTS Between March 1, 2021 and 30 august 2021, 480 patients were assessed for eligibility. 400 patients were randomly assigned to the digital group (n = 200) or face-to-face group (n = 201), of which respectively 117 and 124 patients were eventually included in the primary analysis. The mean quality of recovery score of patients undergoing digital screening (158) was non-inferior to that of patients undergoing face-to-face screening (155), with a mean difference of 3·2 points and a 97.5% lower confidence limit of -2.1 points. There were no adverse events. CONCLUSIONS A digital preoperative screening is not inferior to face-to-face consultations in patients undergoing predominantly low to moderate risk surgery. Given its potential to reduce physician workload, reallocate healthcare resources, and lower healthcare costs, a digital preoperative screening may be a better choice for preoperative assessments.
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Affiliation(s)
| | - Daniel J Tromp
- Department of General Surgery, University of Utrecht, Utrecht, the Netherlands
| | | | | | - Hanna K Cazemier
- Department of Anaesthesia, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of General Surgery, University of Utrecht, Utrecht, the Netherlands
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21
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Kilic K, Sakat MS, Sahin A, Ahiskalioglu EO, Altunok H. Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study. Acta Otolaryngol 2023; 143:979-983. [PMID: 38108626 DOI: 10.1080/00016489.2023.2289584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. OBJECTIVES To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery. MATERIAL AND METHODS One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status. RESULTS The postoperative 30 min, 1st, 2nd, 4th (p < .001) and 24th hour (p < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort (p < .001), emotional state (p < .05), psychological support, pain and total score values (p < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group. CONCLUSION Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.
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Affiliation(s)
- Korhan Kilic
- Department of Otorhinolaryngology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Muhammed Sedat Sakat
- Department of Otorhinolaryngology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Abdulkadir Sahin
- Department of Otorhinolaryngology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | | | - Hazal Altunok
- Department of Otorhinolaryngology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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22
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Rashad AE, El Hefnawy E, Elmorshedi M, Abuyousif YA, Salem A, Attia M, El Nakeeb A, Zaid A, Aldossary HM, Mohammed MN. Prevalence, Risk Factors, and Management of Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy (a Retrospective Multicentric Study). Obes Surg 2023; 33:3237-3245. [PMID: 37624489 DOI: 10.1007/s11695-023-06803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) is a frequent unappealing laparoscopic sleeve gastrectomy (LSG) sequel. The study's purpose was to determine the prevalence, risk factors of PONV, and management of PONV after LSG. PATIENTS AND METHODS This multicenter retrospective study included patients with morbid obesity who had LSG between January 2022 and April 2023. The age range for LSG was 16 to 65 years, and the eligibility requirements included morbid obesity according to international guidelines. RESULTS PONV was experienced by 74.6% of patients who underwent LSG at 6 h postoperative. Multivariate analysis revealed that female gender, smokers, preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were found to be independent protective variables against the development of PONV. Combined intravenous ondansetron and metoclopramide improved 92.6% of patients who developed PONV. Dexamethasone and antihistamines drugs are given for 42 cases with persistent PONV after using intravenous ondansetron and metoclopramide. Pain management postoperatively by opioid-free analgesia managed PONV. Helicobacter pylori status has no role in the development of PONV after LSG. CONCLUSION Female gender, smoking, presence of preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were observed to be independent protective factors against the occurrence of PONV. Combined intravenous ondansetron and metoclopramide improved PONV. Dexamethasone and antihistamines drugs are given for persistent PONV.
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Affiliation(s)
- Aly E Rashad
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
- Wadi Aldawaser Armed Forces Hospital, Wadi Aldawaser, Kingdom of Saudi Arabia, 18511
| | - Emad El Hefnawy
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Elmorshedi
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
| | | | - Ali Salem
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Attia
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
| | - Ayman El Nakeeb
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt.
- Wadi Aldawaser Armed Forces Hospital, Wadi Aldawaser, Kingdom of Saudi Arabia, 18511.
| | - Ahmed Zaid
- Wadi Aldawaser Armed Forces Hospital, Wadi Aldawaser, Kingdom of Saudi Arabia, 18511
| | | | - Mohammed N Mohammed
- Gastroenterology Surgical Center, Mansoura University, Mansoura, 35516, Egypt
- Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
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23
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Torosis M, Fullerton M, Kaefer D, Nitti V, Ackerman AL, Grisales T. Pudendal Nerve Block Analgesia at the Time of Vaginal Surgery: A Randomized, Double-Blinded, Sham-Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:827-835. [PMID: 37093572 PMCID: PMC10919352 DOI: 10.1097/spv.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Effective opioid-sparing postoperative analgesia requires a multimodal approach. Regional nerve blocks augment pain control in many surgical fields and may be applied to pelvic floor reconstruction. OBJECTIVE This study aimed to evaluate the impact of pudendal nerve block on postoperative pain control and opioid consumption after vaginal surgery. STUDY DESIGN In this randomized, double-blind, sham-controlled trial, we enrolled women undergoing pelvic reconstruction, excluding patients with chronic pelvic pain or contraindications to nonnarcotic analgesia. Patients were randomized to transvaginal pudendal nerve block (9 mL 0.25% bupivacaine and 1 mL 40 mg/mL triamcinolone) or sham injection (10 mL normal saline). Primary outcomes were pain scores and opioid requirements. Sixty patients were required to show a 20-mm difference on a 100-mm visual analog scale (VAS). RESULTS We randomized 71 patients: 36 pudendal block and 35 sham. Groups were well matched in baseline characteristics and surgery type. Prolapse repairs were most common (n = 63 [87.5%]), and there was no difference in anesthetic dose or operative time. Pain scores were equivalent in the postanesthesia care unit (mean VAS, 53.1 [block] vs 56.4 [sham]; P = 0.517) and on postoperative day 4 (mean VAS, 26.7 [block] vs 35.5 [sham]; P = 0.131). On postoperative day 1, the intervention group reported less pain, but this did not meet our 20 mm goal for clinical significance (mean VAS, 29.2 vs 42.5; P = 0.047). A pudendal block was associated with lower opioid consumption at all time points, but this was not statistically significant. CONCLUSIONS Surgeon-administered pudendal nerve block at the time of vaginal surgery may not significantly improve postoperative pain control or decrease opioid use.
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Affiliation(s)
- Michele Torosis
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
| | - Morgan Fullerton
- Department of Obstetrics and Gynecology, Kaiser Permanente, Panorama City, CA
| | | | | | | | - Tamara Grisales
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
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Gao W, Li H, Li T, Zhang L, Zhang T, Lin W, Wen Z, Cao L, Tan H. Effects of S-ketamine on Postoperative Recovery Quality and Inflammatory Response in Patients Undergoing Modified Radical Mastectomy. Pain Ther 2023; 12:1165-1178. [PMID: 37354266 PMCID: PMC10444913 DOI: 10.1007/s40122-023-00533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION S-ketamine plays an important role in reducing postoperative pain, but its impact on the quality of recovery in breast cancer has not been clarified. We designed this trial to explore the effects of s-ketamine on the quality of postoperative recovery and inflammatory response in modified radical mastectomy. METHODS A total of 138 patients were randomly assigned to group C (group control), group K1 (group of s-ketamine dose 1) and group K2 (group of s-ketamine dose 2). Groups K1 and K2 were given 0.1 mg/kg, 0.2 mg/kg s-ketamine intravenous (IV) after induction, followed by 0.1 mg/kg/h or 0.2 mg/kg/h continuous intravenous infusion, respectively. Group C received the same volume of saline. A 40-item Quality of Recovery Questionnaire (QoR-40) was used to assess the quality of recovery at 24 h postoperatively. Changes in inflammatory markers, nociceptive thresholds, and the occurrence of adverse events were recorded at 24 h postoperatively. RESULTS The QoR-40 scores at 24 h postoperatively were higher in group K2 [182.00 (179.00-185.00)] compared to group K1 [174.00 (169.50-180.50)] and group C [169.00 (163.75-174.25)] (group K2 vs. group K1, P < 0.001; group K2 vs. group C, P < 0.001). At 24 h postoperatively, the neutrophil count, NLR (neutrophil-lymphocyte ratio), and CRP (C-creative protein) were all significantly lower in group K2 than group C(P < 0.05), no differences were observed between group K1 and C(P > 0.05), group K1 and K2(P > 0.05), respectively. There was no significant difference in the incidence of adverse effects among the three groups (P > 0.05). CONCLUSIONS A high dose of s-ketamine improved the quality of recovery at 24 h after surgery, as well as alleviated the inflammatory response without increasing the incidence of adverse effects.
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Affiliation(s)
- Wuyou Gao
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Huiting Li
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ting Li
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Lili Zhang
- Department of Anaesthesiology, Hubei Cancer Hospital, Hubei, 430000, China
| | - Tianhua Zhang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Wenqian Lin
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Zhesheng Wen
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Longhui Cao
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Hongying Tan
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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25
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Sagalow ES, Estephan LE, Kumar AT, Hwang M, Krein H, Heffelfinger R. Recovery Benefit With Total Intravenous Anesthesia in Patients Receiving Rhinoplasty. Otolaryngol Head Neck Surg 2023; 169:489-495. [PMID: 36906818 DOI: 10.1002/ohn.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE The aim was to evaluate the difference in recovery when comparing total intravenous anesthesia (TIVA) to inhalational gas anesthesia in patients receiving rhinoplasty. STUDY DESIGN Retrospective review. SETTING Postoperative anesthesia care unit (PACU). METHODS Patients who received a functional or cosmetic rhinoplasty at a single academic institution between April 2017 and November 2020 were included. Inhalational gas anesthesia was in the form of sevoflurane. Phase I recovery time, which was defined as the time it took a patient to reach ≥9/10 on the Aldrete scoring system was recorded, as well as the usage of pain medication in the PACU. The postoperative course and incidence of postoperative nausea and vomiting (PONV) were also collected. RESULTS Two hundred and two patients were identified with 149 (73.76%) who received TIVA and 53 (26.24%) who received sevoflurane. For the patients who received TIVA, the average recovery time was 101.44 minutes (standard deviation [SD]: 34.64) compared to an average recovery time of 121.09 minutes (SD: 50.19) for patients who received sevoflurane leading to a difference of 19.65 minutes (p = 0.002). Patients who received TIVA experienced less PONV (p = 0.001). There were no differences in the postoperative course including surgical or anesthesia complications, postoperative complications, hospital or Emergency Department admissions, or administration of pain medication (p > 0.05 for all). CONCLUSION When utilizing TIVA over inhalational anesthesia, patients undergoing rhinoplasty had significantly increased benefits in terms of reduced phase I recovery times and decreased incidence of PONV. TIVA was demonstrated to be a safe and efficacious method of anesthesia for this patient population.
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Affiliation(s)
- Emily S Sagalow
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Leonard E Estephan
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ayan T Kumar
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michelle Hwang
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Howard Krein
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ryan Heffelfinger
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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26
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Alver S, Ciftci B, Güngör H, Gölboyu BE, Ozdenkaya Y, Alici HA, Tulgar S. Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:595-602. [PMID: 37201747 PMCID: PMC10533976 DOI: 10.1016/j.bjane.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). METHODS Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. RESULTS The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). CONCLUSION In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. REGISTER NUMBER NCT05199922.
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Affiliation(s)
- Selcuk Alver
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Bahadir Ciftci
- Istanbul Medipol University, School of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Hande Güngör
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | | | - Yasar Ozdenkaya
- Istanbul Medipol University, Department of General Surgery, Istanbul, Turkey
| | - Haci Ahmet Alici
- Istanbul Medipol University, Department of Algology, Istanbul, Turkey
| | - Serkan Tulgar
- Samsun University, Faculty of Medicine, Samsun Training and Research Hospital, Department of Anesthesiology and Reanimation, Samsun, Turkey
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27
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Wang X, Jia X, Li Z, Zhou Q. Rhomboid intercostal block or thoracic paravertebral block for postoperative recovery quality after video-assisted thoracic surgery: A prospective, non-inferiority, randomised controlled trial. Eur J Anaesthesiol 2023; 40:652-659. [PMID: 37377368 DOI: 10.1097/eja.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The analgesic characteristics of rhomboid intercostal block (RIB) remain unclear. Before it can be fully recommended, we compared the recovery quality and analgesic effects of RIB and thoracic paravertebral block (TPVB) for video-assisted thoracoscopic surgery (VATS). OBJECTIVE The current study aimed to investigate whether there is a difference in postoperative recovery quality between TPVB and RIB. DESIGN A prospective, non-inferiority, randomised controlled trial. SETTING Affiliated Hospital of Jiaxing University in China from March 2021 to August 2022. PATIENTS Eighty patients aged 18 to 80 years, with ASA physical status I to III, and scheduled for elective VATS were enrolled in the trial. INTERVENTION Ultrasound-guided TPVB or RIB was performed with 20 ml 0.375% ropivacaine. MAIN OUTCOME MEASURES The primary outcome of the study was the mean difference of quality of recovery-40 scores 24 h postoperatively. The non-inferiority margin was defined as 6.3. Numeric rating scores (NRS) for pain at 0.5, 1, 3, 6, 12, 24 and 48 h postoperatively in all patients were also recorded. RESULTS A total of 75 participants completed the study. The mean difference of quality of recovery-40 scores 24 h postoperatively was -1.6 (95% CI, -4.5 to 1.3), demonstrating the non-inferiority of RIB to TPVB. There was no significant difference between the two groups in the area under the curve for pain NRS over time, at rest and on movement, at 6, 12, 24 and 48 h postoperatively (all P > 0.05), except for the area under the curve pain NRS over time on movement at 48 h postoperatively ( P = 0.046). There were no statistical differences between the two groups in the postoperative sufentanil use at 0 to 24 h or 24 to 48 h (all P > 0.05). CONCLUSION Our study suggests that RIB was non-inferior to TPVB for the quality of recovery, with almost the same postoperative analgesic effect as TPVB after VATS. CLINICAL TRIAL REGISTRATION chictr.org.cn: ChiCTR2100043841.
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Affiliation(s)
- Xuru Wang
- From the Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China (XW, XJ, ZL, QZ)
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28
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Xu M, Zhang G, Tang Y, Wang R, Yang J. Impact of Regional Anesthesia on Subjective Quality of Recovery in Patients Undergoing Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2023; 37:1744-1750. [PMID: 37301699 DOI: 10.1053/j.jvca.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Regional anesthesia can be effective for managing pain after thoracic surgery. This study evaluated whether it can also improve patient-reported quality of recovery (QoR) after such surgery. DESIGN Meta-analysis of randomized controlled trials. SETTING Postoperative care. INTERVENTION Perioperative regional anesthesia. PATIENTS Adults undergoing thoracic surgery. MEASUREMENTS AND MAIN RESULTS The primary outcome was total QoR scores 24 hours after surgery. Secondary outcomes were postoperative opioid consumption, pain scores, pulmonary function, respiratory complications, and other adverse effects. Eight studies were identified, of which 6 involving 532 patients receiving video-assisted thoracic surgery were included in the quantitative analysis of QoR. Regional anesthesia significantly improved QoR-40 score (mean difference 9.48; 95% CI 3.53-15.44; I2 = 89%; 4 trials involving 296 patients) and QoR-15 score (mean difference 6.7; 95% CI 2.58-10.82; I2 = 0%; 2 trials involving 236 patients). Regional anesthesia also significantly reduced postoperative opioid consumption and the incidence of nausea and vomiting. Insufficient data were available to meta-analyze the effects of regional anesthesia on postoperative pulmonary function or respiratory complications. CONCLUSIONS The available evidence suggests that regional anesthesia can enhance QoR after video-assisted thoracic surgery. Future studies should confirm and extend these findings.
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Affiliation(s)
- Min Xu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Guangchao Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yidan Tang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
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29
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Ramirez MF, Gan TJ. Total intravenous anesthesia versus inhalation anesthesia: how do outcomes compare? Curr Opin Anaesthesiol 2023; 36:399-406. [PMID: 37338939 DOI: 10.1097/aco.0000000000001274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
RECENT FINDINGS Surgical procedures that involve general anesthesia are performed with either volatile anesthetics or propofol-based total intravenous anesthesia. Both techniques are safe and provide appropriate conditions for surgery. Despite being a well established anesthetic, the use of propofol-based total intravenous anesthesia (TIVA) remains low. Possible explanations include the perceived increase risk of awareness, lack of target controlled infusion devices, increased turnover time for device set up and individual preference. SUMMARY There are some scenarios where patients could potentially benefit from propofol-based TIVA rather than a volatile anesthetic (e.g. postoperative nausea and vomiting) and some other clinical scenarios where the use of propofol-based anesthesia remains controversial since the strength of the evidence remains low. PURPOSE In this review we will summarize the clinical evidence comparing the effect of propofol-based TIVA and volatile anesthetic on postoperative outcomes such as postoperative nausea and vomiting, postoperative pain, quality of recovery, postoperative cognitive dysfunction and cancer outcomes.
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Affiliation(s)
- Maria F Ramirez
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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30
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Devakumar H, Ossin D, Martin L, Frank L, Hurtado E, Davila GW. Dexamethasone administration to improve patient recovery in ambulatory vaginal reconstructive surgery: a randomized prospective trial. Int Urogynecol J 2023; 34:1781-1788. [PMID: 36729165 DOI: 10.1007/s00192-023-05461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/28/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Dexamethasone is a potent glucocorticoid that may improve quality of recovery (QoR). We hypothesized that standard administration of dexamethasone at induction may improve QoR compared to placebo in subjects undergoing ambulatory vaginal reconstructive surgeries. METHODS This was a randomized prospective clinical trial on subjects scheduled for ambulatory vaginal reconstructive surgery for prolapse and/or urinary incontinence. Intervention arm subjects were administered dexamethasone and the control group, a placebo (normal saline). Timing of administration, anesthesia medications, postoperative pain medications, and antiemetics were standardized. Primary outcome was difference in QoR (QoR-40) scores 24-48 h after surgery. Power analysis estimated that 27 subjects were required in each group to detect a difference in QoR-40 scores with 80% power and an alpha of 0.05. RESULTS Fifty-one subjects were enrolled and randomized. 4 withdrew, 1 was excluded, and 46 were analyzed. For the primary outcome, there was no difference in the QoR-40 between the dexamethasone and placebo group (--13.5 vs -19.6, p=0.24). Postoperative nausea vomiting intensity scores were not different (8.33 vs 9.09, p=1). Pain scores were similar in the two groups (6.0 vs 4.7, p=0.12). Although not statistically significant, surgical satisfaction at 6 weeks was better with dexamethasone (23.5 vs 26.9, p=0.09). CONCLUSION Based on this study, a single dose of dexamethasone at the time of induction prior to ambulatory vaginal reconstructive surgery was not associated with improved QoR. Standardized anesthesia protocols may play a role in postoperative nausea, pain control, and thereby QoR in patients undergoing ambulatory vaginal reconstructive surgeries.
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Affiliation(s)
- Hemikaa Devakumar
- Academic Urology and Urogynecology, 14044 West Camelback Road, Phoenix, AZ, 85340, USA.
- Cleveland Clinic Florida, Department of Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Weston, FL, USA.
| | - David Ossin
- Cleveland Clinic Florida, Department of Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Weston, FL, USA
| | - Laura Martin
- Cleveland Clinic Florida, Department of Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Weston, FL, USA
| | - Lawrence Frank
- Cleveland Clinic Florida, Department of Anesthesiology, Weston, FL, USA
| | - Eric Hurtado
- Cleveland Clinic Florida, Department of Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Weston, FL, USA
| | - G Willy Davila
- Holy Cross Medical Group, Department of Obstetrics and Gynecology, Weston, FL, USA
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Alsharkh WS, Aljuaid M, Huda AU, Bawazir A, Alharbi A, Alharbi N. Effect of total fasting hours on the overall quality of recovery after surgery: An observational study. Saudi J Anaesth 2023; 17:373-377. [PMID: 37601496 PMCID: PMC10435811 DOI: 10.4103/sja.sja_71_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 08/22/2023] Open
Abstract
Context Preoperative fasting is one of the pre-requisite for patients undergoing a surgery. Despite clear instructions, patients frequently fast for extended periods before elective surgeries. Longer periods of fasting may cause discomfort, thirst, hunger, and other physiological problems. Aims To assess the quality of postoperative recovery among adult patients having different preoperative fasting hours by using the postoperative Quality of Recovery40 (QoR40) score. Settings and Design This was an observational study that was conducted for adult patients undergoing elective surgery during four weeks between 19th September and 13th October 2022 at Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. Methods and Material We excluded pediatric patients, patients undergoing spine or neurosurgery, emergency cases, or local anesthesia cases. Non-probability convenient sampling technique was used in this study. The postoperative quality of recovery-40 (QoR-40) questionnaire was distributed among 200 patients. Statistical Analysis Used All analyses were performed with Statistical Package for the Social Sciences software (SPSS) v25. Descriptive statistics (frequency, percentage, median, and IQR) were used for the questionnaire's variables. The difference between the variables was analyzed using Kruskal-Wallis, and a P value <0.05 was considered statistically significant. Results Out of 200 patients, 172 patients responded but 16 responses were excluded. A total of 156 adult patients' responses were included in this study. The majority were female (53%), 31% were older than 45 years. More than 50% of patients reported fasting for more than 6 hours for drinking and more than 8 hours for eating. On the positive scale, the comfort score was significantly affected by the fasting hours for drinking (P value = 0.045). On the negative scale of the questionnaire, the emotions were significantly affected by fasting hours for both drinking (P value = 0.027) and eating (P value = 0.043). Conclusions The study results showed better comfort for patients with lesser fasting hours for drinking. Moreover, the results strongly suggest the need of following the fasting guidelines without prolonging the fasting duration. However, further studies with larger sample sizes are recommended.
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Affiliation(s)
- Wejdan S. Alsharkh
- Department of Anesthesia, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Mohammad Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Anwar U. Huda
- Department of Anesthesia, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Atheer Bawazir
- Department of Anesthesia, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alharbi
- Department of Anesthesia, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Nouf Alharbi
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
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Zhou F, Cui Y, Cao L. The effect of opioid-free anaesthesia on the quality of recovery after endoscopic sinus surgery: A multicentre randomised controlled trial. Eur J Anaesthesiol 2023; Publish Ahead of Print:00003643-990000000-00107. [PMID: 37377372 DOI: 10.1097/eja.0000000000001784] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND It remains to be determined whether opioid-free anaesthesia (OFA) is consistently effective for different types of surgery. OBJECTIVES The current study hypothesised that OFA could effectively inhibit intraoperative nociceptive responses, reduce side effects associated with opioid use, and improve the quality of recovery (QoR) in endoscopic sinus surgery (ESS). DESIGN A multicentre randomised controlled study. SETTING Seven hospitals participated in this multicentre trial from May 2021 to December 2021. PATIENTS Of the 978 screened patients who were scheduled for elective ESS, 800 patients underwent randomisation, and 773 patients were included in the analysis; 388 patients in the OFA group and 385 patients in the opioid anaesthesia group. INTERVENTIONS The OFA group received balanced anaesthesia with dexmedetomidine, lidocaine, propofol and sevoflurane; the opioid anaesthesia group received opioid-based balanced anaesthesia using sufentanil, remifentanil, propofol and sevoflurane. OUTCOME MEASURES The primary outcome was 24-h postoperative QoR as evaluated by the Quality of Recovery-40 questionnaire. The key secondary outcomes were episodes of postoperative pain and postoperative nausea and vomiting (PONV). RESULTS A significant difference (P = 0.0014) in the total score of 24-h postoperative Quality of Recovery-40 was found between the OFA group, median [interquartile range], 191 [185 to 196] and the opioid anaesthesia group (194 [187 to 197]). There were significant differences between the opioid anaesthesia group and the OFA group in the numerical rating scale score for pain after surgery at 30 min (P = 0.0017), 1 h (P = 0.0052), 2 h (P = 0.0079) and 24 h (P = 0.0303). The difference in the area under the curve of pain scale scores between the OFA group (24.2 [3.0 to 47.5]) and the opioid anaesthesia group (11.5 [1.0 to 39.0]) was significant (P = 0.0042). PONV occurred in 58 of 385 patients (15.1%) in the opioid anaesthesia group compared with 27 of 388 patients (7.0%) in the OFA group, suggesting the incidence of PONV in the OFA group was significantly lower than in the opioid anaesthesia group (P = 0.0021). CONCLUSION OFA can provide good intraoperative analgesia and postoperative recovery quality as effectively as conventional opioid anaesthesia in patients undergoing ESS. OFA can be an alternative option in the pain management of ESS. TRIAL REGISTRATION The study was registered at the Chinese Clinical Trial Registry (ChiCTR2100046158; registry URL: http://www.chictr.org.cn/enIndex.aspx.).
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Affiliation(s)
- Fengzhi Zhou
- From the Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, Hunan (FZ, YC, LC), Department of Anesthesia, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang (FZ) and Department of Anesthesia, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, Guangxi, China (LC)
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Balakrishnan A, Chhabra A, Kumar A, Talawar P, Bhoi D, Garg H. Comparison of continuous transmuscular quadratus lumborum block and continuous psoas compartment block for posterior total hip arthroplasty: A randomised controlled trial. Indian J Anaesth 2023; 67:530-536. [PMID: 37476434 PMCID: PMC10355350 DOI: 10.4103/ija.ija_863_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023] Open
Abstract
Background and Aims Analgesia for hip surgery involves cutaneous anaesthesia at the site of the skin incision and the anterior hip capsule. This study aimed to compare continuous ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) with psoas compartment block (PCB) for analgesia in patients undergoing total hip arthroplasty (THA) under general anaesthesia (GA). Methods This randomised, observer-blinded trial included 18-70-year-old American Society of Anesthesiologists physical status I-III patients undergoing THA under GA with either US-guided continuous TQLB or PCB. Primary objectives included a visual analogue scale (VAS; 0-100 mm) at rest and mobilisation at 6 h postoperatively (analysed by intention to treat and per protocol) using a non-inferiority margin of 20 mm. Secondary objectives included VAS at other time points, 24-h fentanyl consumption (analysed using the Wilcoxon rank-sum test), sensory dermatomes anaesthetised, motor weakness 30 min after block, and haemodynamic response to skin incision (analysed using the Chi-squared or Fisher's exact test). A P value less than 0.05 was considered statistically significant. Results VAS (0-100 mm) score at 6 h on rest was 25.34 ± 14.25 and 27.3 ± 9.6, mean difference (MD) was 1.9 [-3.3, 7.1] and at movement was 35.1 ± 23.0 and 38.6 ± 17.0, MD was 3.5 [-5.2, 12.2], in the PCB (n = 29) and QLB (n = 30) groups, respectively (i.e. less than the non-inferiority margin). However, VAS (rest) at 1, 12, and 24 h postoperatively and median (IQR) 24-h fentanyl consumption was significantly higher in the QLB group (1212.5 [300-2345] μg] when compared to the PCB group (635 [100-1645] μg; P = 0.0004). Conclusion Though statistically, continuous QLB was non-inferior to continuous PCB for pain at rest and mobilisation at 6-hours postoperatively, a higher 24-hour perioperative fentanyl consumption and VAS show that QLB was clinically inferior to PCB.
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Affiliation(s)
- Arjun Balakrishnan
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Anjolie Chhabra
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Praveen Talawar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Heena Garg
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
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Pillai AK, Guzzi J, Treggiari MM, Yanez ND, Hyman JB. Comparison of electronic versus phone-based administration of the Quality of Recovery-40 survey after ambulatory surgery. J Clin Anesth 2023; 86:111054. [PMID: 36641953 DOI: 10.1016/j.jclinane.2023.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE Studies that track patient-centered outcomes are better suited to evaluate the relative benefits and harms of an intervention in ambulatory surgery as severe morbidity and mortality have become increasingly rare. This pilot study aimed to assess for differences in response rate and survey scores for phone-based and electronic administration of the Quality of Recovery-40 (QoR-40) survey in patients undergoing general anesthesia for ambulatory surgery. DESIGN A single-center prospective observational study. SETTING Yale New Haven Hospital (September 22-November 2, 2021). PATIENTS 100 consecutive patients undergoing ambulatory surgery under general anesthesia. INTERVENTIONS Patients were randomized to receive QoR-40 surveys via email or phone. MEASUREMENTS The QoR-40 survey is a 40-item questionnaire that provides a global score across five dimensions: patient support, comfort, emotions, physical independence, and pain. The primary outcome was the response rate following the administration of the QoR-40 survey on postoperative days 1, 2, and 7. The secondary outcome was the mean QoR-40 score during the study period. MAIN RESULTS A total of 109 patients consented to participate and 100 patients were randomized in this study. A total of 76%, 72%, and 68% of patients completed the survey on POD 1, 2, and 7, respectively. There were no differences in the response rate of patients who completed the survey between phone (78%) versus electronic (74%) administration (difference 4%, 95% confidence interval (CI): -13%, 21%, respectively) on POD 1, 2 (74% vs 70%, difference 4%, 95% CI -14%, 22%, respectively) or 7 (68% vs 68%, difference 0%, 95% CI -18%, 18%, respectively). The mean (standard deviation) QoR-40 score was 176.2 (18.1), 179.8 (19.4), 187.7 (13.1) on POD 1, 2, and 7, respectively. There were no significant differences in the mean QoR-40 scores between groups at any of the time points. CONCLUSION The response rate following the electronic administration of the QoR-40 survey did not differ from the phone-based administration during the postoperative period following ambulatory surgery. The use of an electronic version of the survey may allow for larger sample sizes with fewer resources utilized in future interventional studies.
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Affiliation(s)
| | - John Guzzi
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Miriam M Treggiari
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - N David Yanez
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Jaime B Hyman
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA.
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Shinozaki T, Imai T, Kobayashi K, Yoshimoto S, Zenda S, Yamaguchi T, Eguchi K, Okano T, Mashiko T, Kurosaki M, Miyaji T, Matsuura K. Preoperative steroid for enhancing patients' recovery after head and neck cancer surgery with free tissue transfer reconstruction: protocol for a phase III, placebo-controlled, randomised, double-blind study (J-SUPPORT 2022, PreSte-HN Study). BMJ Open 2023; 13:e069303. [PMID: 37258074 DOI: 10.1136/bmjopen-2022-069303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION There is no established methodology for the perioperative management of head and neck cancer surgery and free tissue transfer reconstruction (HNS-FTR). A single dose of corticosteroid administered immediately before surgery has been shown to reduce postoperative pain and nausea/vomiting after some types of surgery. However, the efficacy of this strategy has not been demonstrated in HNS-FTR, and the increased risk of infectious complications associated with its use cannot be ruled out. This phase III, placebo-controlled, randomised, double-blind, comparative, multicentre study seeks to determine if preoperative administration of corticosteroid hormone has an adjunctive effect in terms of reducing pain and nausea/vomiting after surgery and improving the quality of postoperative recovery. METHODS AND ANALYSIS Using the minimisation method, patients undergoing HNS-FTR are currently being recruited and randomly assigned to a study arm at a 1:1 allocation rate. The study treatment arm consists of 8.0 mg of dexamethasone phosphate dissolved in 100 mL of saline administered as a single dose by intravenous infusion. These treatments will be administered in a double-blind fashion. All patients will receive perioperative care according to the common multicentre enhanced recovery after surgery programme. The primary endpoint is the quality of postoperative recovery, as determined by the area under the curve (AUC) for total score on the Japanese version of the Quality of Recovery Score (QOR-40J) on postoperative days 2 and 4. The point estimate and CI for the difference in the AUC between the groups on postoperative days 2 and 4 will be calculated. ETHICS AND DISSEMINATION The study will be performed in accordance with the Declaration of Helsinki and Japan's Clinical Trials Act. The study protocol was approved by the Certified Review Board of National Cancer Center Hospital East (Reference K2021004). TRIAL REGISTRATION NUMBER The study was registered in the Japan Registry of Clinical Trials (jRCTs031210593; V.3.0, November 2021, available at https://jrct.niph.go.jp/en-latest-detail/jRCTs031210593).
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Affiliation(s)
- Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoka Okano
- Department of Pharmacy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Tomoe Mashiko
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Miyuki Kurosaki
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Tempei Miyaji
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Fuad Hetta D, Abdelfatah Mohamed M, Elmorabaa HA, Ahmed MI, Elgalaly NA, Kamal SM. Efficacy of perioperative duloxetine as a part of multimodal analgesia in laparoscopic colorectal cancer surgeries. BMC Anesthesiol 2023; 23:166. [PMID: 37194004 DOI: 10.1186/s12871-023-02119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Although laparoscopic surgery provides earlier recovery, less morbidity and hospital stay, however, severe pain is still a problem after it. Duloxetine has been recently used in postoperative pain management. We tested perioperative duloxetine to evaluate its effect on patients undergoing laparoscopic colorectal cancer surgery. METHODS Sixty patients were enrolled in this study divided into two equal groups; duloxetine group each patient received an oral duloxetine capsule (60 mg) 1st dose at night before surgery, the 2nd dose 1 h preoperative, and the 3rd dose 24 h postoperative. Placebo group received placebo capsules at the same times. The cumulative morphine consumption in 48 h, postoperative VAS score, quality of recovery (QoR-40 score), sedation, and adverse effects were evaluated. RESULTS Duloxetine group had lower VAS scores compared to placebo group, (3 ± 0.69) VS. (4.17 ± 0.83), (2.5 ± 0.6) VS. (4.3 ± 0.9), (2.2 ± 0.7) VS. (3.9 ± 0.6), (1.6 ± 0.7) VS. (3.6 ± 0.8), (1.1 ± 0.8) VS. (3.7 ± 0.7), (0.7 ± 0.7) VS. (3.5 ± 0.8), (0.6 ± 0.7) VS. (3.5 ± 0.8) respectively, P ˂0.01. The cumulative morphine consumption was significantly reduced in the Duloxetine group compared to the placebo group (4.6 ± 2.9 vs. 11.3 ± 1.7 mg), P < 0.01. The total QoR-40 score for duloxetine group was (180.8 ± 4.5) vs. (156 ± 5.9) in placebo group (P < 0.01). Patients in Duloxetine group were more sedated in all the 48 h postoperatively in comparison to placebo group. CONCLUSIONS Perioperative duloxetine had reduced postoperative pain, decreased opioid consumption, and improved the quality of recovery in patients undergoing laparoscopic colorectal surgery.
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Affiliation(s)
- Diab Fuad Hetta
- Anesthesia and intensive care and pain management department, South Egypt Cancer Institiue, Assiut University, Assiut, Egypt
| | - Montaser Abdelfatah Mohamed
- Anesthesia and intensive care and pain management department, South Egypt Cancer Institiue, Assiut University, Assiut, Egypt
| | - Hany Ahmed Elmorabaa
- Anaesthesia, Intensive care and pain management department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mirna Ismail Ahmed
- Anesthesia and intensive care and pain management department, South Egypt Cancer Institiue, Assiut University, Assiut, Egypt
| | - Nourhan Alaa Elgalaly
- Anesthesia and intensive care and pain management department, South Egypt Cancer Institiue, Assiut University, Assiut, Egypt
| | - Shereen Mamdouh Kamal
- Anesthesia and intensive care and pain management department, South Egypt Cancer Institiue, Assiut University, Assiut, Egypt.
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van Samkar G, Ru Tan Y, Hermanns H, Preckel B, Jamaludin FS, Hollmann MW, Stevens MF. Comparison of Patient-Controlled versus Continuous Epidural Analgesia in Adult Surgical Patients: A Systematic Review. J Clin Med 2023; 12:jcm12093164. [PMID: 37176605 PMCID: PMC10179281 DOI: 10.3390/jcm12093164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The advantages of PCEA over CEA have been demonstrated in obstetric patients. Whether a similar benefit applies to surgical patients is unclear. METHODS Embase, PubMed, and Cochrane Library were searched, enabling a systematic review of studies comparing PCEA and CEA in adult surgical patients (PROSPERO: CRD42018106644). The study quality was assessed using the Cochrane risk-of-bias tool (RoB2). The primary outcome was pain scores on postoperative day one (POD1). Secondary outcomes were 24 or 48 h epidural or intravenous total analgesic dose, systemic analgesics, manual top-ups, side effects, and patient satisfaction. RESULTS Six randomized controlled trials with high heterogeneity of study characteristics were identified with a moderate risk of bias. Two studies showed significantly reduced resting pain scores on POD1 in PCEA compared with CEA patients (36-44%, p < 0.05). Four studies found comparable pain scores between these groups. PCEA use reduced epidural medication (28% to 40% reduction, p < 0.01) in four studies. One study found a 23% reduction (p < 0.001) of top-ups in PCEA; intravenous morphine use by PCEA patients was reduced (0.16 vs. 3.45 mg per patient, p < 0.05) in one study. PCEA patients were more satisfied with analgesia (p < 0.001) in two studies. Nausea and vomiting were reduced in PCEA (p = 0.01). CONCLUSIONS Regarding the reduction in pain scores, the effects of PCEA were not significant or clinically not relevant. However, regarding the amount of epidural drug use, the amount of required rescue systemic analgesics, patient satisfaction, and the number of required top-ups, PCEA had advantages over CEA in surgical patients.
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Affiliation(s)
- Ganapathy van Samkar
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Yan Ru Tan
- Department of Anesthesiology, Singapore General Hospital, Outram Road, Singapore 169856, Singapore
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Faridi S Jamaludin
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Markus F Stevens
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Morales-Ariza V, Loaiza-Aldeán Y, de Miguel M, Peña-Navarro M, Martínez-Silva O, González-Tallada A, Manrique-Muñoz S, de Nadal M. Validation and cross-cultural adaptation of the postoperative quality of recovery 15 (QoR-15) questionnaire for Spanish-speaking patients: A prospective cohort study. Am J Surg 2023; 225:740-747. [PMID: 36414472 DOI: 10.1016/j.amjsurg.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postoperative QoR-15 questionnaire may improve the detection of postoperative complications on an early basis and contribute to optimize treatment and recovery. No validated Spanish QoR-15 questionnaire has been available to date. METHODS The Spanish QoR-15 questionnaire (QoR-15E), carried out by official bilingual translators, was administered to 242 adult patients undergoing elective surgery before and 24 h after surgery. Patients were asked about their perceived quality of general recovery using a visual analogue scale (VAS). A random subgroup of 36 patients completed a third questionnaire 30-60 min after having completed the first one, and under the same conditions. RESULTS The Pearson correlation coefficient between QoR-15E and the VAS score was 0.759. Cronbach's alpha was 0.856 in the postoperative period. Reliability by the split-half method was 0.781. Test-retest correlation coefficient was 0.998. Cohen's d was 0.94. The mean time to complete the preoperative questionnaire was 2.9 ± 0.5 min. CONCLUSIONS The QoR-15E is valid and reliable for assessing postoperative quality of recovery in Spanish-speaking patients, with psychometric and interpretative features similar to those of the original instrument.
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Affiliation(s)
- Victor Morales-Ariza
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Yuri Loaiza-Aldeán
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Marcos de Miguel
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mireia Peña-Navarro
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Olga Martínez-Silva
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anna González-Tallada
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Susana Manrique-Muñoz
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Maternal and foetal medicine Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Miriam de Nadal
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Neurotraumatology and neurosurgery Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:168-175. [PMID: 36841749 DOI: 10.1016/j.joim.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/10/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief. OBJECTIVE This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room. OUTCOMES AND MEASURES Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy. RESULTS The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy. CONCLUSION Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; Epub ahead of print.
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Affiliation(s)
- Xin-Rui Han
- Department of Nursing, Chengdu Integrated TCM & Western Medicine Hospital, Sichuan 610041, Sichuan Province, China
| | - Wei Yue
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Hui-Chao Chen
- Department of Nursing, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Wei He
- Department of General Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Jiang-He Luo
- Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China
| | - Shan-Xia Chen
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Na Liu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China.
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Kang D, Kim M, Bae HB, Moon S, Kim J. Comparison of Postoperative Recovery between Balanced and Total Intravenous Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass (OPCAB) Surgery: A Prospective, Single-Blind Randomized Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2310. [PMID: 36767677 PMCID: PMC9915931 DOI: 10.3390/ijerph20032310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Recovery after anesthesia has a significant impact on a patient's return to daily life. This study was performed to compare the postoperative quality of recovery according to the method of anesthesia administered among patients undergoing OPCAB using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire. This single-blind, prospective study (trial number: KCT0004726) was performed using a population of 102 patients undergoing OPCAB under general anesthesia. The patients were randomly assigned to one of two groups using a computer-generated list: a total intravenous anesthesia group (Group T) and a balanced anesthesia group (Group B). The QoR-40K score was measured preoperatively and at 24 and 48 h after extubation. There was no significant difference in the QoR-40K scores between the groups at 24 and 48 h after extubation. In addition, there were no significant differences between groups with respect to any of the five dimensions of QoR-40K at 24 and 48 h after extubation. Finally, there were no differences in the postoperative opioid consumption, time to extubation, or length of hospital stay. In this study, there was no difference in the QoR-40K score at 24 h after extubation between Groups T and B. Therefore, both methods of anesthesia are suitable for use when performing OPCAB.
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Affiliation(s)
- Dongho Kang
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Hwasun Hospital, Hwasun 58128, Chonnam, Republic of Korea
| | - Minji Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Hwasun Hospital, Hwasun 58128, Chonnam, Republic of Korea
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Seonho Moon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
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Wang XR, Jia XY, Jiang YY, Li ZP, Zhou QH. Opioid-free anesthesia for postoperative recovery after video-assisted thoracic surgery: A prospective, randomized controlled trial. Front Surg 2023; 9:1035972. [PMID: 36684254 PMCID: PMC9852053 DOI: 10.3389/fsurg.2022.1035972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/02/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose Opioid-based anesthesia is a traditional form of anesthesia that has a significant analgesic effect; however, it can cause nausea, vomiting, delirium, and other side effects. Opioid-free anesthesia with dexmedetomidine and lidocaine has attracted widespread attention. This study aimed to compare the effects of opioid-free and opioid-based anesthesia (OFA and OBA, respectively) on postoperative recovery in patients who had undergone video-assisted thoracic surgery. Methods Eighty patients undergoing video-assisted thoracic surgery were assigned to receive either opioid-free anesthesia (OFA group) or opioid-based anesthesia (OBA group) according to random grouping. The primary outcome of the study was the quality of recovery-40 scores (QoR-40) 24 h postoperatively. The secondary outcome measure was numerical rating scale (NRS) scores at different times 48 h postoperatively. In addition to these measurements, other related parameters were recorded. Results Patients who received opioid-free anesthesia had higher QoR-40 scores (169.1 ± 5.1 vs. 166.8 ± 4.4, p = 0.034), and the differences were mainly reflected in their comfort and emotional state; however, the difference between the two groups was less than the minimal clinically important difference of 6.3. We also found that the NRS scores were lower in the OFA group than in the OBA group at 0.5 h (both p < 0.05) and 1 h (both p < 0.05) postoperatively and the cumulative 0-24 h postoperative dosage of sufentanil in the OBA group was higher than that in the OFA group (p = 0.030). There were no significant differences in postoperative nausea and vomiting (PONV) (p = 0.159). No surgical or block complications were observed between the groups. Conclusion Opioid-free analgesia potentially increased the postoperative recovery in patients who underwent video-assisted thoracic surgery. Trial registration The study protocol was registered in the Chinese Clinical Trial Register under the number ChiCTR2100045344 (http://www.chictr.org.cn/showproj.aspx?proj=125033) on April 13, 2021.
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Affiliation(s)
- Xu-ru Wang
- Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, China,Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiao-yu Jia
- Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, China,Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yan-yu Jiang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China,Anesthesia Medicine, Bengbu Medical College, Bengbu, China
| | - Zhen-ping Li
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China,Correspondence: Zhen-ping Li Qing-he Zhou
| | - Qing-he Zhou
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China,Correspondence: Zhen-ping Li Qing-he Zhou
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Muacevic A, Adler JR, Balasubramanian N, Mirunalini G. Patient Comfort During Postop Period in Breast Cancer Surgeries: A Randomized Controlled Trial Comparing Opioid and Opioid-Free Anesthesia. Cureus 2023; 15:e33871. [PMID: 36819361 PMCID: PMC9934931 DOI: 10.7759/cureus.33871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anesthetic management practices have advanced to opioid-free anesthesia (OFA) often replacing opioids in oncologic surgeries. The study was conducted to find the quality of recovery (QoR) of patients undergoing breast cancer surgeries receiving OFA. METHODS A double-blinded, randomized controlled study was conducted with 60 patients randomized to group OFA and group OA (opioid anesthesia). Group OFA received one-time dosing of ketamine 0.3 mg/kg, lignocaine 1.5 mg/kg, and dexmedetomidine 1 mcg/kg. Group OA received fentanyl 2mcg/kg. Intraoperatively, Group OFA received dexmedetomidine 0.4 mcg/kg/h and the OA group received fentanyl 0.5 mcg/kg/h infusion. Bispectral index (BIS), hemodynamics, muscle relaxant administration, and sevoflurane concentration were noted. A modified QoR-40 score was used to assess the quality of recovery in the postoperative period. RESULTS A higher QoR-40 score was found in the OA group (median 182, IQR 178-186) compared to the OFA group (median 180, IQR 178-184). Out of the five components, the patient's emotional state was better in the group OA (39.9±2.77) than in the OFA group (37.9±2.77). The patient's physical comfort was found to be better in the group OFA (52.52±3.23) compared to group OA (50.93±3.23). Physical independence, psychological support, and pain were comparable between the two groups. Patients in group OFA received less sevoflurane, a muscle relaxant, and showed a mild reduction in heart rate and mean arterial pressure (MAP) when compared to group OA. The time taken to reach a Modified Aldrete score of 9 was high in OFA (11.47±2.16) and (9.17±1.09) when compared to group OA. No significant differences were noted with the visual analog score (VAS) score, Ramsay sedation score, and modified post-anesthesia discharge scoring system (PADSS) score. CONCLUSION We conclude that the quality of recovery of patients receiving opioid-free methods of anesthesia was not inferior to OA in patients undergoing breast cancer surgeries.
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Pan Y, Shao Y, Chi Z, Jin S, Wang J. Transcutaneous Electrical Acupoint Stimulation Accelerates the Recovery of Patients Undergoing Laparoscopic Myomectomy: A Randomized Controlled Trial. J Pain Res 2023; 16:809-819. [PMID: 36925621 PMCID: PMC10013582 DOI: 10.2147/jpr.s399249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose To evaluate transcutaneous electrical acupoint stimulation (TEAS) on the perioperative rehabilitation of patients undergoing laparoscopic myomectomy. Patients and Methods One hundred and five women undergoing laparoscopic hysteromyomectomy were randomly divided into TEAS group (Group T) and control group (Group C). Propofol and remifentanil were used to stabilize patient blood pressure and keep BIS between 40 and 60. Group T patients received TEAS at LI4/PC6 30 minutes before the operation and lasting until the end of anesthesia, followed by TEAS at ST36/SP6 for 30 minutes in PACU. All required indicators were recorded. Results Group T patients required lower dosages of remifentanil and vasoactive drugs, and had a reduced incidence of propofol injection pain and intraoperative hypotension compared to Group C. Group T also had a lower maximum NRS score in PACU, lower NRS scores at 1 hour and 24 hours, and a lower incidence of vomiting within 24 hours. In addition, the QoR-40 score for Group T at 24 hours after operation was higher in terms of physical comfort, emotional state, pain and total score. Conclusion TEAS can reduce the amount of anesthetic, maintain hemodynamic stability, reduce postoperative pain, reduce postoperative vomiting, enhance the recovery of gastrointestinal function, increase the quality of postoperative recovery and thus accelerate overall patient recovery.
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Affiliation(s)
- Yuanyuan Pan
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yifan Shao
- Department of Anesthesia, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhanghuan Chi
- Department of Anesthesia, Wenzhou People's Hospital, Wenzhou, People's Republic of China
| | - Shenhui Jin
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Junlu Wang
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Kovač R, Juginović I, Delić N, Velat I, Vučemilović H, Vuković I, Kozomara V, Duplančić B. The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Radical Prostatectomy. J Pers Med 2022; 13:jpm13010051. [PMID: 36675712 PMCID: PMC9862137 DOI: 10.3390/jpm13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
No studies are currently regarding the quality of recovery (QoR) after open radical prostatectomy (ORP) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored QoR on the first postoperative day after ORP. Sixty-one men were randomized into two groups. The first (epidural) group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second (control) group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. Secondary outcome measures were: QoR-15, QoR-VAS and the visual analogue scale (VAS) for pain, anxiety and nausea. The median difference in the total QoR-40 score after 24 postoperative hours between the two groups of patients was 2 (95% CI: −3 to 8), p = 0.35. The global multivariate inference test for secondary outcomes between groups was not significant p > 0.05). QoR-VAS was correlated with QoR-40 (r = 0.69, p ≤ 0.001) and with QoR-15 (r = 0.65, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficient with 95% CI was 0.88 (0.83-0.92) and 0.83 (0.77−0.89), respectively. There was no difference in the QoR between the epidural and the control group after ORP. The QoR-40 and QoR-15 showed good convergent validity and adequate reliability.
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Affiliation(s)
- Ruben Kovač
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
- Correspondence: (R.K.); (B.D.)
| | - Ivo Juginović
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Nikola Delić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Velat
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Hrvoje Vučemilović
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Vuković
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Verica Kozomara
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Božidar Duplančić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
- Correspondence: (R.K.); (B.D.)
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He M, Chen M, Yu F. Comparison of total intravenous anesthesia and inhalation anesthesia on postoperative quality of recovery after laparoscopic hysterectomy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32365. [PMID: 36595812 PMCID: PMC9794279 DOI: 10.1097/md.0000000000032365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postoperative recovery is a complex process and affected mainly by factors from patients, surgery and anesthesia. Although we have all kinds of sedatives and hypnotics now, the selection of an ideal medication for general anesthesia is still challenging. In this study, we perform a protocol for systematic review and meta-analysis to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based inhalation anesthesia on postoperative quality of recovery in patients undergoing laparoscopic hysterectomy. METHODS The protocol of this review was registered in PROSPERO (CRD42022379485). Meanwhile, it will be reported follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. We will search 3 foreign electronic databases (Cochrane Library, Embase, Pubmed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database and Chinese Scientific Journal Database) to collect potential studies from their inceptions to December 2022. Only randomized controlled trials will be included. Two reviewers will independently perform study selection, data extraction and risk of bias assessment. Data synthesis and statistical analysis will be performed using the RevMan 5.4 (The Cochrane Collaboration, Copenhagen, Denmark) software. RESULTS The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal. CONCLUSION This study may provide the evidence regarding the efficacy and safety of total intravenous anesthesia and inhalation anesthesia on postoperative quality of recovery after laparoscopic hysterectomy.
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Affiliation(s)
- Menglin He
- Department of Anesthesiology, Shifang People’s Hospital, Sichuan, China
| | - Mingxue Chen
- Department of Anesthesiology, Shifang People’s Hospital, Sichuan, China
| | - Feng Yu
- Department of Anesthesiology and Pain, Nantong Haimen District People’s Hospital, Jiangsu, China
- *Correspondence: Feng Yu, Department of Anesthesiology and Pain, Nantong Haimen District People’s Hospital, Jiangsu 226100, China (e-mail: )
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Johnson JPJ, Arumugam R, Karuppusami R, Mariappan R. Intraoperative administration of systemic/epidural/intrathecal morphine on the quality of recovery following substitutional urethroplasty with buccal mucosal graft: A randomized control trial. J Anaesthesiol Clin Pharmacol 2022; 38:537-543. [PMID: 36778804 PMCID: PMC9912865 DOI: 10.4103/joacp.joacp_589_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Aims Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting. Material and Methods This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared. Results Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185-191), 189 (187-191), and 185 (183-189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group. Conclusion All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.
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Affiliation(s)
| | - Rajasekar Arumugam
- Senior Fellow in Cardiothoracic Transplant Anaesthesia, Critical Care and ECMO, North-West Heart Centre, Manchester University, NHS Foundation Trust, Manchester, United Kingdom
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramamani Mariappan
- Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
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Spaans LN, Dijkgraaf MGW, Meijer P, Mourisse J, Bouwman RA, Verhagen AFTM, van den Broek FJC. Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia, continuous paravertebral block or single-shot intercostal nerve block (OPtriAL): study protocol of a three-arm multicentre randomised controlled trial. BMC Surg 2022; 22:330. [PMID: 36058900 PMCID: PMC9441091 DOI: 10.1186/s12893-022-01765-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate pain control after video-assisted thoracoscopic surgery (VATS) for lung resection is important to improve postoperative mobilisation, recovery, and to prevent pulmonary complications. So far, no consensus exists on optimal postoperative pain management after VATS anatomic lung resection. Thoracic epidural analgesia (TEA) is the reference standard for postoperative pain management following VATS. Although the analgesic effect of TEA is clear, it is associated with patient immobilisation, bladder dysfunction and hypotension which may result in delayed recovery and longer hospitalisation. These disadvantages of TEA initiated the development of unilateral regional techniques for pain management. The most frequently used techniques are continuous paravertebral block (PVB) and single-shot intercostal nerve block (ICNB). We hypothesize that using either PVB or ICNB is non-inferior to TEA regarding postoperative pain and superior regarding quality of recovery (QoR). Signifying faster postoperative mobilisation, reduced morbidity and shorter hospitalisation, these techniques may therefore reduce health care costs and improve patient satisfaction. METHODS This multi-centre randomised study is a three-arm clinical trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and QoR (superiority) in 450 adult patients undergoing VATS anatomic lung resection. Patients will not be eligible for inclusion in case of contraindications for TEA, PVB or ICNB, chronic opioid use or if the lung surgeon estimates a high probability that the operation will be performed by thoracotomy. PRIMARY OUTCOMES (1) the proportion of pain scores ≥ 4 as assessed by the numerical rating scale (NRS) measured during postoperative days (POD) 0-2; and (2) the QoR measured with the QoR-15 questionnaire on POD 1 and 2. Secondary outcome measures are cumulative use of opioids and analgesics, postoperative complications, hospitalisation, patient satisfaction and degree of mobility. DISCUSSION The results of this trial will impact international guidelines with respect to perioperative care optimization after anatomic lung resection performed through VATS, and will determine the most cost-effective pain strategy and may reduce variability in postoperative pain management. Trial registration The trial is registered at the Netherlands Trial Register (NTR) on February 1st, 2021 (NL9243). The NTR is no longer available since June 24th, 2022 and therefore a revised protocol has been registered at ClinicalTrials.gov on August 5th, 2022 (NCT05491239). PROTOCOL VERSION version 3 (date 06-05-2022), ethical approval through an amendment (see ethical proof in the Study protocol proof).
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Affiliation(s)
- L N Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- University of Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - J Mourisse
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R A Bouwman
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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A comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. J Cardiothorac Surg 2022; 17:211. [PMID: 36028870 PMCID: PMC9419309 DOI: 10.1186/s13019-022-01936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Methods Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected. Results Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups. Conclusions General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Trial registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020.
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Effects of Ultrasound-Guided Stellate Ganglion Block on Postoperative Quality of Recovery in Patients Undergoing Breast Cancer Surgery: A Randomized Controlled Clinical Trial. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7628183. [PMID: 36046011 PMCID: PMC9424037 DOI: 10.1155/2022/7628183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022]
Abstract
Surgery has been the primary treatment for breast cancer. However, instant postoperative complications, such as sleep disorder and pain, dramatically impair early postoperative quality of recovery, resulting in more extended hospital stays and higher costs. Recent clinical trials indicated that stellate ganglion block (SGB) could prolong sleep time and improve sleep quality in breast cancer survivors. Moreover, during the perioperative period, SGB enhanced the recovery of gastrointestinal functions in patients with laparoscopic colorectal cancer surgery and thoracolumbar spinal surgery. Furthermore, perioperative SGB decreased intraoperative requirements for anesthetics and analgesics in patients with complex regional pain syndrome. However, information is scarce regarding the effects of SGB on postoperative quality recovery in patients with breast cancer surgery. Therefore, we investigated the effects of SGB on the postoperative quality of recovery of patients undergoing breast cancer surgery. Sixty patients who underwent an elective unilateral modified radical mastectomy were randomized into two 30-patient groups that received either an ultrasound-guided right-sided SGB with 6 ml 0.25% ropivacaine (SGB group) or no block (control group). The primary outcome was the quality of postoperative recovery 24 hours after surgery, assessed with a Chinese version of the 40-item Quality of Recovery (QoR-40) questionnaire. Secondary outcomes were intraoperative requirements of propofol and opioids, rest pain at two, four, eight, and 24 hours after surgery, patient satisfaction score, and the incidence of postoperative abdominal distension. At 24 hours after surgery, global QoR-40 scores were higher in the SGB group than in the control group. Besides, in the SGB group, patients needed less propofol, had a lower incidence of postoperative abdominal bloating, and had higher satisfaction scores. Ultrasound-guided SGB could improve the quality of postoperative recovery in patients undergoing breast cancer surgery by less intraoperatively need for propofol and better postoperative recovery of sleep and gastrointestinal function.
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Spinal Anesthesia in Laparoscopic Cholecystectomy: A Cohort Study of 1762 Cases in Southeastern Mexico. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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