Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

S-Ketamine As An Adjuvant in Patient-controlled Intravenous Analgesia for Prevention of Postpartum Depression: A Randomized Controlled Trial

(1) Background: Postpartum depression (PPD) is a common complication after cesarean section. Recent studies have shown that intravenous S-ketamine during surgery could be effective in preventing PPD. However, no evidence shows S-ketamine used in patient-controlled intravenous analgesia (PCIA) could reduce the incidence of PPD. Our aim was to explore the effect of S-ketamine as an adjuvant in patient-controlled intravenous analgesia (PCIA) for prevention of postpartum depression. (2) Methods: In a single center, 375 parturients scheduled to undergo cesarean section were recruited and randomly assigned to two groups: Control group (C group) or S-ketamine group (S group). Parturients in both groups received PCIA, the formula of Group C: sufentanil 2 μg/kg + tropisetron 10 mg, S group was the same as C group except 0.5mg/kg S-ketamine. The primary outcome was the incidence of PPD measured by the Edinburgh Postnatal Depression Scale (EPDS) after surgery. The secondary outcomes were EPDS scores, Visual analogue scale (VAS) scores, and Ramsay Sedation Scale (RSS) scores, and incidence of related adverse events. (3) Results: A total of 275 puerpera were finally included and randomly assigned to two groups. The incidence of depression at postoperative 3, 14, 28days in C group and S group were 17.6%vs8.2%, P<0.05;24.2%vs9.8%, P<0.05, and 19.0%vs 17.2%, P=0.76, respectively). As for EPDS scores, C group and S group at 3,14, and 28 days after cesarean were 7.65±3.14vs6.00±2.47, p<0.05,7.62±3.14vs6.38±2.67, p<0.05, and 7.35±3.17vs6.90±2.78, p=0.15, respectively. Adverse events such as headache and nausea were 3.3% vs 4.1%, p=0.755; 5.9%vs8.2%, p=0.481. (4) Conclusions: 0.01mg/kg/h S-ketamine as an adjuvant in patient-controlled intravenous analgesia can significantly reduce the incidence of postpartum depression within 14 days and relieve postoperative pain within 48h after cesarean section, without increasing the incidence of adverse reactions.Trial registration: ChiCTR, ChiCTR2100050263，retrospectively registered. Registered 24/08/2021.

Controlled Hypotension Combined with Femoral Nerve Block for Knee Replacement without Tourniquet

In the process of knee replacement surgery, the use of tourniquet technology for hemostasis is the most common method. But the adverse reactions of tourniquets in knee replacement surgery have become more prominent in recent years. More and more scholars have begun to advocate the optimization of the use of tourniquet technology, thereby controlling the use of tourniquet technology. In this study, 125 patient cases were randomly divided into four experimental groups for comparative analysis. The two sets of variables are whether to use tourniquet during surgery and use intravenous analgesia or nerve block analgesia. Studies have shown that when using a tourniquet for knee replacement surgery, the chance of hidden blood loss increases after use. The tourniquet was not used during the operation, the patient's thighs were swollen, and postoperative pain was reduced. Compared with intravenous analgesia, knee joint replacement with uncontrolled tourniquet combined with femoral nerve block has a better analgesic effect and can effectively relieve pain after knee replacement. Therefore, under the method of controlled hypotension combined with femoral nerve block, TKA surgery without using tourniquet technology is more conducive to early health recovery and pain relief after TKA surgery, as well as functional exercise and knee joint recovery during postoperative recovery.

Combination of Dexmedetomidine and Tramadol in Patient-Controlled Intravenous Analgesia Strengthens Sedative Effect in Pregnancy-Induced Hypertension

Objective: The aim of the present study is to explore the combination of dexmedetomidine (DXM) and tramadol (TMD) on sedative effect in patients with pregnancy-induced hypertension (PIH).Methods: A total of 356 patients with pregnancy-induced hypertension (PIH) were randomly divided into three groups: DXM, TMD and DXM + TMD groups. These patients were treated with different doses of DXM, TMD or combination of DXM and TMD by a patient-controlled intravenous injection device. The scores of static pain and dynamic pain, sedation degree, and adverse reaction were recorded. The plasma levels of inflammatory mediators IL-10 and C-reactive protein (CRP), and the serum level of p-p38-MAPK were evaluated.Results: It was found that administration with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg result in stronger sedative effect than single administration with DXM or TMD. The mean arterial pressure (MAP) and heart rate (HR) of patients with PIH were decreased with the combinational treatment of DXM and TMD. Interestingly, the PIH patients injected with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg showed stronger sedative effect. In addition, the plasma level of level of IL-10 was increased and CRP decreased. The serum level of p-p38/MAPK was decreased.Conclusion: Taken together, our study indicates that combination of DXM and TMD effectively lowers blood pressure and reduces inflammation through increasing the level of IL-10, reducing CRP and inhibiting p-p38/MAPK in patients with PIH. This study suggests that the combination of DXM and TMD could be an anesthetic choice in the management of PIH.