Continuous infusion of dipyrone in bitches in the intraoperative period: cardiorespiratory effects

Dipyrone is an effective analgesic for managing moderate or severe postoperative pain and can be used alone for mild pain or in combination with other analgesics for any type of pain. This study aimed to examine the administration of dipyrone by continuous infusion (CI) as an adjuvant analgesic in the intraoperative period for bitches undergoing elective ovariohysterectomy (OH) and its effect on these patients’ cardiorespiratory parameters. Twenty bitches underwent an elective OH procedure. The pre-anesthetic agent was a combination of acepromazine and morphine. Propofol was used to induce anesthesia, and isoflurane was used for maintenance. Subsequently, the animals were randomly allocated into two groups: the dipyrone group (DG) received a bolus dose of dipyrone (25 mg kg-1) by CI at a rate of 10 mg kg-1 h, and the control group (CG) received a bolus dose and a CI of 0.9% NaCl solution, both groups at a rate of 5 mL kg-1 h. The parametric variables were analyzed by ANOVA, followed by Tukey's test (p<0.05). The paired t-test (p<0.05) was used for comparison between the groups. Statistical differences were observed for heart rate, systolic, diastolic, and mean arterial pressure, respiratory rate, and blood glucose between the periods in both groups. There were differences only in the basal values of MAP between the groups; however, most values remained within the physiological range for the species. Using the drug as an adjuvant to anesthesia did not alter cardiorespiratory parameters, and it can be used as an adjuvant in analgesia during the intraoperative period of OH.

Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

Pain management after a surgical intervention is one of the fundamental pillars for optimal patient recovery. In obstetric patients, this management may affect the mother and the newborn. The gold standard for analgesic management is the use of intrathecal morphine due to its long-lasting effect; however, adverse effects related to the use of opioids are evidenced, whether administered intrathecally or systemically in case of contraindication to the neuraxial approach or if a long-acting opioid is not available. Cesarean sections have been associated with moderate-to-severe postoperative pain. Multimodal analgesic management seeks to minimize the undesirable effects on the mother-newborn binomial in order to increase maternal satisfaction. The most studied regional blocks for this surgery are the transversus abdominis plane block and the ilioinguinal-iliohypogastric block, which shows contradictory evidence at the time of evaluate pain where there is no significant difference compared with intrathecal morphine, but there were fewer side effects with the TAP block group when assessing pruritus, nausea, and vomiting. Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless of them having a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrates better outcomes compared with intrathecal morphine.

New Surgical Technique to Induce Reversible Liver Fibrosis by Surgical Closure of Major Duodenal Orifice in Dogs

This study was conducted to induce and evaluate reversible liver fibrosis in dogs by surgical closure of the major duodenal orifice. The study was performed on six healthy local adult dogs. Reversible liver fibrosis was surgically induced in all animals by surgical closure of major duodenal papilla using absorbable suture material for 60 days. Induced liver fibrosis was assessed by clinical, ultrasonographical examination, laboratory and histological methods. The clinical manifestation of the jaundiced dogs showed reduced food intake, pale-yellowish mucus membrane, inflammatory signs of the wound site and severe postoperative pain. Biochemically, there was significantly increased values of the aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, indirect bilirubin, direct bilirubin and total bilirubin especially during the first two days after surgery followed by a gradual decrease of these values until the end of the but still higher than normal values. Ultrasonographic examinations showed abnormal changes in the liver tissue such as an increase in both size and wall thickness of the gall bladder and mottled heterogeneous appearance of the liver during the first two weeks following the surgical induction of the hepatic fibrosis. Histological evaluation of liver samples revealed showed necrosis of hepatocytes and deposition of eosinophilic material, infiltration of inflammatory cells, recent thrombus in the hepatic vein, fatty change. Slight clinical, biochemical, ultrasonographic improvement was observed at 30th post-operative day. In conclusion, surgical induction of reversible liver fibrosis in dogs was an easy technique by surgical closure of major duodenal papilla and the results were confirmed by the clinical, ultrasonographical, laboratory and histological examination.

CURRENT CONCEPTS IN ANAESTHESIAAND ANALGESIA FOR SHOULDER SURGERY

Shoulder surgery varies from simple diagnostic arthroscopy to major total shoulder arthroplasty. Patients present for shoulder surgery may be young and t with a sports injury or elderly sick with rheumatoid arthritis need arthroplasty of the shoulder joint. Choice of anaesthesia based on the type of surgery, and the comorbidity of a patient. Management of severe postoperative pain is a major challenge for the anaesthesiologist. Regional anaesthetic techniques effectively control static as well as dynamic pain and facilitate early mobilization. However regional blocks are not free from the side effects or complications

Epipleural surgical block and ultrasound-guided erector spinae plane block for analgesia in VATS

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.

Risk Factors for Moderate-to-severe Postoperative Pain After Percutaneous Nephrolithotomy:A Retrospective Study

Backgroud and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing renal calculus ,but a large number of patients experience acute moderate-to-severe pain despite the analgesia provided.The aim of this study is to explore the risk factors for postoperative pain after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of postoperative pain after PCNL.Methods: According to the inclusion and exclusion criteria, the clinical data of 331 patients who underwent PCNL in our hospital from September 2019 to February 2021 were retrospectively collected. General anesthesia was induced with propofol, sufentanil and rocuronium and maintained with sevoflurane, remifentanil and rocuronium.Depending on whether the patient had moderate-to-severe postoperative pain, they were divided into mild or no pain group and moderate-to-severe pain group. We collected and analyzed data on age,gender, body mass index (BMI),ASA grading,co-morbidities,number of renal calculus,renal calculus size,degree of hydronephrosis,preoperative urine culture,preoperative creatinine,stone burdens,expansion method,tract diameter,nephrostomy tube,calculi residual,operative position ,puncture time ,number of expanded channels,expanded channel time, duration of surgery,vital signs and VAS pain score.The indicators with statistically significant differences were selected and multivariate logistic regression analysis was carried out to determine the risk factors for postoperative pain. Results: Among 331 patients, 221 had moderate-to-severe pain and the incidence rate was 66.77%. Univariate analysis and multivariate logistic regression analysis showed that independent risk factors for moderate-to-severe pain after PCNL were:number of renal calculus(OR=5.303，P=0.001),stone burdens (OR=7.623，P=0.001),calculi residual(OR=0.2377，P=0.001),duration of surgery (min)(OR=1.024， P=0.001). Conclusions: The main risk factors for pain after PCNL are number of renal calculus,stone burdens ,calculi residual and duration of surgery.

Efficacy and safety of sufentanil sublingual tablet system in postoperative pain management: a systematic review and meta-analysis

BackgroundSufentanil sublingual tablet system (SSTS) is a recently approved formulation for postoperative pain management that has become popular due to its pharmacokinetic properties such as good bioavailability, rapid attainment of equilibrium and elimination without any metabolites, along with its pharmacodynamic properties such as rapid onset and effective pain reduction. It is also relatively well tolerated by patients.ObjectiveThis is a quantitative analysis of the efficacy and safety of SSTS in patients with moderate to severe postoperative pain.DesignThis is a systematic review and meta-analysis. Databases such as Cochrane Library, MEDLINE and EMBASE were searched for eligible articles.SettingsRandomised controlled trials published after 2000 in English language and which assessed at least one of the outcome measures of interest with pain intensity difference between 12 hours and a maximum of 96 hours.ParticipantsAdults with moderate to severe postoperative pain and taking SSTS for pain management.MethodsData were analysed using Review Manager (RevMan) V.5.3. Risk of bias (RoB) assessment was done using RoB-2 scale, and overall grading of evidence of each outcome was done using GRADEpro Guideline Development Tool.ResultsAnalysis of SSTS versus control indicates a statistically significant reduction in summed pain intensity difference at 12 hours (mean difference (MD)=−12.33 (95% CI −15.5 to −9.17), p<0.00001), summed pain intensity difference at 48 hours (MD=−43.57 (95% CI −58.65 to −28.48), p<0.00001), time-weighted total pain relief over 12 hours (MD=−4.77 (95% CI −6.28 to −3.27), p<0.00001) and pain intensity difference (MD=–0.73 (95% CI −1.00 to −0.46), p<0.00001) with SSTS, alongside high quality of evidence. Success of treatment as assessed by Patient Global Assessment (OR=4.01 (95% CI 2.74 to 5.89), p<0.00001) and Healthcare Professional Global Assessment (OR=4.46 (95% CI 3.03 to 6.56), p<0.00001) scoring at 72 hours was observed in a significantly high number of individuals using SSTS, with high quality of evidence. There was no difference in adverse events except for dizziness (RR=1.90, 95% CI 1.02 to 3.52). There was a significantly higher number of total adverse events in orthopaedic surgery in the SSTS group than in the comparator.ConclusionSSTS is effective in postoperative pain management in patients with moderate to severe pain. It also has good tolerability and high patient satisfaction.PROSPERO registration numberCRD42018115458.

Intraoperative Dexmedetomidine has no Effect on Postoperative Pain Scores for Posterior Spinal Fusion

Background: Posterior Spinal Fusion (PSF) for idiopathic scoliosis results in severe postoperative pain. At our institution, a protocol for postoperative analgesia is followed, but anesthetic maintenance is decided by the anesthesiologist. Previous studies have shown that postoperative use of dexmedetomidine may improve analgesia for these patients, but the effect of intraoperative dexmedetomidine on postoperative pain scores remains unknown. Purpose: We sought to retrospectively compare pain scores from the Postoperative Anesthesia Care Unit (PACU) and from PACU discharge until midnight between PSF patients who did and did not receive intraoperative dexmedetomidine. Methods: After obtaining IRB approval, we retrospectively identified 79 patients aged 10-17 years who had undergone PSF for idiopathic scoliosis from June 2015-August 2018 and who received intrathecal morphine. Patients were then divided into two groups based on whether or not they received intraoperative dexmedetomidine. A multivariable linear regression model was constructed with the dependent variable of highest PACU pain score and exposure of interest intraoperative dexmedetomidine use. Secondary analyses were conducted similarly within those who received dexmedetomidine to examine the effects of dose on PACU pain scores, using a p-value < 0.05. Results: After adjusting for age, weight, sex, levels fused, intrathecal morphine, diazepam, and ketamine doses, there was no statistically significant difference in average PACU pain scores between those who did and did not receive intraoperative dexmedetomidine (β = -0.85, 95% CI: -2.48, 0.68; p = 0.31). Conclusion: Intraoperative use of dexmedetomidine during posterior spinal fusion for adolescent idiopathic scoliosis appears to have no effect on postoperative pain scores.

Erector spinae plane block (ESPB): an adjuvant multimodal analgesic in the Combined Mandibulectomy and Neck Dissection (COMMANDO)—a case report

Background The Combined Mandibulectomy and Neck Dissection (COMMANDO) surgery results in severe postoperative pain and requires multimodal analgesia (MMA) for its management. We speculated that the erector spinae plane block (ESPB) which is the ultrasound (US)-guided regional technique and has been used in various types of surgeries due to its analgesic benefits could be used as an effective analgesic adjunct in COMMANDO surgery. Case presentation We report a case of a 68-year-old female patient who underwent left side COMMANDO surgery for carcinoma cheek. She was given an ultrasound-guided left erector spinae plane block (ESPB) in the preoperative period with catheter insertion at T3 (3rd thoracic vertebral level). Two boluses of local anesthetic were given each with 10 ml 0.25% ropivacaine one before and one after surgery, and then, the infusion was started with a volumetric pump. The ESPB provided effective intraoperative as well as postoperative pain relief without any side effects. Conclusion US-guided ESPB could be used as a potential opioid-sparing multimodal analgesic in head and neck surgeries based on the pain relief provided and the spread of contrast on imaging. This hypothesis needs to be explored in the form of case series and adequately powered randomized controlled trials.