Analgesic Outcomes of Tramadol Alone and in Combination with Butorphanol or Flurbiprofen Axetil after Caesarean Section: A Retrospective Study with Propensity Score Matching Analysis

Abstract Background: To our knowledge, the Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesic regimen for caesarean delivery analgesia. Therefore, this study aimed to compare the analgesic effects of tramadol alone and in combination with butorphanol or flurbiprofen axetil after caesarean section.Methods: We retrospectively analysed 2323 women with puerperas who had undergone caesarean section based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, perioperative complications, surgical factors, and anaesthesia. We also recorded the postoperative analgesic solution, pain intensity (assessed by the numeric rating scale [NRS]) during the first 48 hours after surgery. Postoperative inadequate analgesia during the postoperative 48 hours was defined as an NRS score ≥4. We also collected data regarding off-bed activity and intestinal function recovery. Analgesic outcomes of three groups were compared using propensity score matching analysis.Results: Compared to the tramadol mixed with butorphanol group (group B), the incidence of inadequate analgesia at rest and while moving was lower in the tramadol combined with flurbiprofen axetil group (group F), and the relative risks (RRs) for women with puerperas suffering from inadequate analgesia at rest and while moving in group F were 0.34 (95% confidence interval [CI]: 0.21–0.54; P<0.001) and 0.24 (95% CI: 0.19–0.31, P<0.001), respectively. The percentage of intestinal function recovery and off-bed activity at 2 days postoperatively was higher in group B than in group F (74.1 versus [vs.] 66.4, P=0.006 and 79.4% vs. 66.4%, P<0.001, respectively). Group F was also associated with a lower incidence of inadequate control of pain at rest and while moving than group T (RR, 0.37 [0.23–0.60], P<0.001, and 0.43 [0.33–0.55], P<0.001, respectively). Group B was associated with a higher incidence of inadequate control of moving pain than group T (RR, 1.78, [1.40–2.26], P<0.001).Conclusions: A combination of tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after caesarean section, but the combination of tramadol and butorphanol may produce an antagonistic effect.Trial registration: Not applicable.

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The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis

The Open Anesthesia Journal ◽

10.2174/2589645801913010093 ◽

2019 ◽

Vol 13 (1) ◽

pp. 93-99

Author(s):

Seunghyuk Lee ◽

Sang W. Yoon ◽

Geun J. Choi ◽

Yong-Hee Park ◽

Hyun Kang ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Rating Scale ◽

Numerical Rating Scale ◽

Nausea And Vomiting ◽

University Hospital ◽

Gynecologic Surgery ◽

Gynecological Surgery ◽

Propensity Score Matching Analysis ◽

Post Operative Nausea

Background: Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV). Objectives: This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery. Methods: We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group. Results: Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%] vs. 45[10.4%], P = 0.002) and POD1 (60[19.0%] vs. 59[13.6%], P = 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49 vs. 3.13 ± 1.53, P = 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75 vs. 0.21 ± 0.62, P = 0.027) and rescue anti-emetics (27 [17.2%] vs. 15 [9.6%], P = 0.047) on POD 0 were both lower in the group P. Conclusion: In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.

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Video-assisted thoracoscopic thymectomy is feasible for large thymomas: a propensity-matched comparison

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz320 ◽

2020 ◽

Vol 30 (4) ◽

pp. 565-572

Author(s):

Wenhan Weng ◽

Xiao Li ◽

Shushi Meng ◽

Xianping Liu ◽

Peng Peng ◽

...

Keyword(s):

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Recurrence Free Survival ◽

Free Survival ◽

Propensity Score Matching Analysis ◽

Video Assisted ◽

Significant Difference ◽

Group A ◽

Group B

Abstract OBJECTIVES Video-assisted thoracoscopic thymectomy is becoming the preferable approach for early-stage thymoma. However, large thymomas are still recognized as a relative contraindication due to the possible risk of incomplete resection or capsular disruption. Thus, the aim of this study is to evaluate the feasibility of video-assisted thoracoscopic thymectomy for large thymomas. METHODS Patients diagnosed with Masaoka stage I–IV thymoma between April 2001 and December 2018 were retrospectively reviewed. All patients were divided into 2 groups: thymoma <5.0 cm (group A) and thymoma ≥5.0 cm (group B). Propensity score matching analysis was performed to compare postoperative results. Recurrence-free survival and overall survival were compared for oncological evaluation. RESULTS A total of 346 patients were included in this study. In the propensity score matching analysis, 126 patients were included both in group A and group B. There was no significant difference between these 2 groups in terms of the R0 resection rate (95.2% vs 94.4%, P = 1.000), conversion rate (1.6% vs 3.2%, P = 0.684), operation time (119.4 ± 48.4 vs 139.1 ± 46.6 min, P = 0.955), blood loss (93.2 ± 231.7 vs 100.5 ± 149.3 ml, P = 0.649), duration of chest drainage (2.7 ± 1.6 vs 2.8 ± 2.0 days, P = 0.184), length of hospitalization (5.0 ± 3.9 vs 5.2 ± 2.9 days, P = 0.628) or postoperative complications (5.9% vs 8.5%, P = 0.068). There was no significant difference between these 2 groups in terms of the overall survival (P = 0.271) and recurrence-free survival (P = 0.288). CONCLUSIONS Video-assisted thoracoscopic thymectomy is a safe and effective approach for large thymomas (≥5 cm) with comparable surgical and oncological results.

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