Bowel Surgery and Multimodal Analgesia: Same Game, New Team?

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

Download Full-text

Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy

BMC Urology ◽

10.1186/s12894-021-00785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

K. Sisa ◽

S. Huoponen ◽

O. Ettala ◽

H. Antila ◽

T. I. Saari ◽

...

Keyword(s):

Postoperative Nausea And Vomiting ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Robot Assisted ◽

Ctrl Group ◽

Laparoscopic Prostatectomy ◽

The Impact

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

Download Full-text

Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis

SAGE Open Medicine ◽

10.1177/2050312120986733 ◽

2021 ◽

Vol 9 ◽

pp. 205031212098673

Author(s):

Paul Feuerstadt ◽

Mena Boules ◽

Laura Stong ◽

David N Dahdal ◽

Naomi C Sacks ◽

...

Keyword(s):

Loop Ileostomy ◽

Charlson Comorbidity Index Score ◽

Real World Data ◽

Infection Group ◽

Bowel Surgery ◽

Clinical Complications ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Infection Episode

Objective: Clostridioides difficile infection and recurrent C. difficile infection result in substantial economic burden and healthcare resource use. Sepsis and bowel surgery are known to be serious complications of C. difficile infection. This study evaluated clinical complications in patients with C. difficile infection and recurrent C. difficile infection during a 12-month period following the primary C. difficile infection. Methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus™ database was conducted for patients aged 18–64 years with an index C. difficile infection episode requiring inpatient stay or an outpatient visit for C. difficile infection followed by a C. difficile infection treatment. Each C. difficile infection episode ended after a 14-day C. difficile infection-claim-free period was observed. Recurrent C. difficile infection was defined as a further C. difficile infection episode within an 8-week window following the claim-free period. Clinical complications were documented over 12 months of follow-up and stratified by the number of recurrent C. difficile infection episodes (0 rCDI, 1 rCDI, 2 rCDI, and 3+ rCDI). Results: In total, 46,571 patients with index C. difficile infection episode were included. During the 6-month pre-index, the mean (standard deviation) baseline Charlson comorbidity index score, by increasing the recurrent C. difficile infection group, was 1.2 (1.9), 1.5 (2.2), 1.8 (2.3), and 2.3 (2.5). During the 12-month follow-up, sepsis occurred in 16.5%, 27.3%, 33.1%, and 43.3% of patients, and subtotal colectomy or diverting loop ileostomy was performed in 4.6%, 7.3%, 8.9%, and 10.5% of patients, respectively, by increasing the recurrent C. difficile infection group. Conclusions: Reduction in recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.

Download Full-text

Opioid-free anaesthesia for the surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome in five dogs

Companion Animal ◽

10.12968/coan.2020.0082 ◽

2021 ◽

Vol 26 (3) ◽

pp. 57-61

Author(s):

María Isabel Gómez Martínez ◽

Miguel Ángel Martínez Fernández

Keyword(s):

Side Effects ◽

Nerve Block ◽

Opioid Analgesic ◽

Multimodal Analgesia ◽

Human Medicine ◽

Surgical Correction ◽

Analgesic Drugs ◽

Maxillary Nerve ◽

Nociceptive Pathways ◽

Maxillary Nerve Block

Opioid-free anaesthesia is currently becoming more popular in human medicine, as it provides multimodal analgesia, affecting multiple nociceptive pathways without the use of opioids, in order to minimise opioid-related side effects. This article presents the cases of five dogs undergoing surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome, all of whom received opioid-free anaesthesia for surgery. All dogs received a bilateral maxillary nerve block with bupivacaine 0.5% and a combination of non-opioid analgesic drugs. Buprenorphine was allowed during the postoperative period, based on pain assessment. Three out of five dogs received buprenorphine 6–7 hours after the nerve block was performed. Opioid-free anaesthesia provided adequate conditions for surgery and no adverse effects were reported. Prospective controlled studies comparing opioid-free anaesthesia with opioid-based techniques are required to elucidate whether or not opioid-free anaesthesia confers objective advantages.

Download Full-text