Patients with gastroenteric tumor after upper abdominal surgery were more likely to require rescue analgesia than lower abdominal surgery

The efficacy of Sijunzi on immune function in patients with gastrointestinal cancers after surgery: Integrating systematic review and network pharmacology

BACKGROUND

Patients with gastrointestinal cancer often have impaired immune function after surgery. This study aimed to assess the efficacy of Sijunzi decoction (SJZD) on immune function in patients with gastrointestinal cancers after surgery.

METHODS

The electronic databases, including CNKI, Wanfang, SinoMed, Weipu, PubMed, Web of Science, EMBASE, and Cochrane databases were retrieved (March 1, 2024), and the randomized controlled trials (RCTs) that met the criteria were included. Methodologic quality assessment of RCTs was performed using the Cochrane risk of bias tool. The data of RCTs were acquired and analyzed by meta-analysis by Review Manager 5.3, and the quality of the evidence followed the Grading of Recommendations, Assessment, Development and Evaluations approach. This research was registered in the International Platform of Registered Systematic Review and Meta-analysis, 202440001. Based on the network pharmacology, relationships between key genes of SJZD and tumor-infiltrating immune cells in gastrointestinal cancers were explored.

RESULTS

Thirteen articles (RCTs) were included, containing 1010 patients with gastrointestinal cancers after surgery. The results of meta-analysis revealed that SJZD with conventional therapies could improve CD3+ T lymphocyte (mean difference [MD] = 5.73, 95% confidence interval [CI]: 2.07-9.39, P = .002), CD4+ T lymphocyte (MD = 5.86, 95% CI: 3.90-7.82, P < .00001), CD4+/CD8+ (MD = 0.29, 95% CI: 0.15-0.43, P < .0001), and reduce CD8+ T lymphocyte (MD = -2.44, 95% CI: -4.03 to -0.85, P = .003) compared with conventional therapies alone. In addition, the funnel plot showed the included RCTs might have publication bias. The Grading of Recommendations, Assessment, Development and Evaluations classification showed low-quality evidence for CD4+, CD8+, and CD4+/CD8+, and very low-quality evidence for other indicators. The network pharmacology results suggested that SJZD may exert effects by regulating the immune cells in the microenvironment of gastrointestinal cancers.

CONCLUSION

SJZD could enhance the immune function of patients with gastrointestinal cancers after surgery. Due to the low quality of articles, more high-quality RCTs are needed to improve the level of evidence.

Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study

Objective

The aim of this study was to assess the impact of the external oblique intercostal block (EOIB) on early postoperative pain in patients who underwent laparoscopic cholecystectomy.

Methods

120 patients were divided into two groups: the EOIB group (Group E) and the control group (Group C). The assessed variables were mainly intraoperative remifentanil usage, numerical rating scale (NRS) pain scores at 0, 1, 2, 4, 6, 12, and 24 h postoperatively, cumulative fentanyl consumption within 24 h postoperatively and within the first-hour post-anesthesia care unit.

Results

Remifentanil consumption during surgery was significantly reduced in Group E compared to Group C. Postoperative fentanyl requirements were also lower in Group E at 1 and 24 h after surgery. Furthermore, Group E demonstrated significantly lower NRS scores at 0, 1, 2, 4, and 6 h postoperatively and a reduced need for rescue analgesia compared to Group C. However, at 12 h post-surgery, Group E's NRS scores were slightly higher than Group C's.

Conclusion

The EOIB is associated with reduced pain within the first 24 postoperative hours following laparoscopic cholecystectomy.

Comparison of analgesic efficacy of ultrasound-guided external oblique intercostal plane block and subcostal transversus abdominis plane block in patients undergoing upper abdominal surgery: A randomised clinical study

Background and Aims

Upper abdominal surgeries are associated with severe postoperative pain. External oblique intercostal (EOI) block blocks both anterior and lateral cutaneous branches of intercostal nerves. We compared the postoperative analgesic efficacy of unilateral EOI block with conventional unilateral subcostal transversus abdominis plane (TAP) block.

Methods

Fifty American Society of Anesthesiologists (ASA) I/II patients scheduled for upper abdominal surgery via subcostal incision were randomly assigned to receive either EOI block (Group E) or subcostal TAP block (Group T) with 25 mL of 0.2% ropivacaine. Postoperatively, these patients received intravenous (IV) fentanyl through a patient-controlled analgesia (PCA) pump with settings of demand-only mode. The primary outcome was the time to activation of PCA postoperatively. Secondary outcomes were 24-hour opioid consumption, pain scores (at 30 minutes and at 1, 2, 4, 6, 12, and 24 hours), patient satisfaction scores (48 hours), and block-related complications. Unpaired t-test and Mann-Whitney U test were used for analysis. A P value less than 0.05 was considered to be statistically significant.

Results

Patients in Group E had an increased mean time of activation of PCA [610.28 [standard deviation (SD): 118.95)] minutes vs 409.68 (SD: 101.36) minutes] (P = 0.001). The 24-hour postoperative mean fentanyl consumption was 102.40 (SD: 25.70) μg in Group E versus 123.20 (SD: 34.38) μg in Group T (P = 0.019). Patients in Group E had better satisfaction scores (P < 0.001). Pain scores were better at 30 minutes and 6 hours.

Conclusion

EOI block provides effective postoperative analgesia in upper abdominal surgeries as it prolongs the duration of PCA activation with a better patient satisfaction score.

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study

BACKGROUND

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery.

MATERIAL AND METHODS

After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20 mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25 mg pethidine as a rescue analgesic to patients with VAS ≥4.

RESULTS

Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05).

CONCLUSION

It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

Comparison of analgesic efficacy of combined external oblique intercostal and rectus sheath block with local infiltration analgesia at port site in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

BACKGROUND

Conventional fascial plane block approaches for upper abdominal surgeries spare the lateral cutaneous nerve. An external oblique intercostal block (EOIB) may be suitable for upper abdominal incisions as it blocks the lateral and anterior branches of the intercostal nerves T6-T10. However, there is a paucity of studies evaluating this block in clinical settings. The study aimed to compare the analgesic efficacy of combined EOIB and rectus sheath block with local infiltration analgesia (LIA) in laparoscopic cholecystectomy (LC).

METHODS

After obtaining written informed consent, 70 patients were randomly allocated to undergo right-sided EOIB with 20 ml and left-sided RSB with 10 ml of 0.25% bupivacaine at the end of surgery (group ER, n = 35). Patients in the LIA group (n = 35) underwent local infiltration at the port site using 20 ml of the same solution (group LIA, n=35).

RESULTS

The visual analog scale scores with combined EOI and RSB were significantly lower than those with LIA at 1, 2, 4, 8, and 12 h (P < 0.001). Rescue analgesics were required by 65.7% and 14.3% of the patients in the LIA and block groups, respectively (P < 0.001). The time to first rescue analgesic was significantly greater in the ER group than that in the LIA group (2.8 ± 1.10 vs. 1.6 ± 0.50 h; P = 0.012). The number of times rescue analgesia was required was significantly lower in the ER group than that in the LIA group (1.00 ± 0.00 vs. 1.83 ± 0.72; P = 0.015). Nausea and vomiting scores were higher in the LIA group than those in the ER group (P < 0.001). Patient satisfaction scores were higher in the ER group than those in the LIA group.

CONCLUSIONS

EOIB combined with RSB provides superior analgesia compared with LIA and should be considered for LC.

The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects

INTRODUCTION

Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries.

PATIENT CONCERNS, DIAGNOSIS AND INTERVENTIONS

Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes).

OUTCOMES

All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia.

CONCLUSION

We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.