Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients

BACKGROUND According to clinical data,a significant percentage of patients experience pain after surgery,highlighting the importance of alleviating postoperative pain.The current approach involves intravenous self-control analgesia,often utilizing opioid analgesics such as morphine,sufentanil,and fentanyl.Surgery for colo-rectal cancer typically involves general anesthesia.Therefore,optimizing anes-thetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative recovery.The study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients'postoperative pain.AIM To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal cancer.METHODS Following the inclusion criteria and exclusion criteria,a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included,of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group,and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research group.After data collection,the effects of postoperative analgesia,sedation,and recovery were compared.RESULTS Compared to the control group,the research group had shorter recovery times for orientation,extubation,eye-opening,and spontaneous respiration(P<0.05).The research group also showed lower Visual analog scale scores at 24 h and 48 h,higher Ramany scores at 6 h and 12 h,and improved cognitive function at 24 h,48 h,and 72 h(P<0.05).Additionally,interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group(P<0.05).Levels of CD3+,CD4+,and CD4+/CD8+were also lower in the research group at multiple time points(P<0.05).CONCLUSION For patients with colorectal cancer,general anesthesia coupled with epidural anesthesia and multi-mode analgesia can achieve better postoperative analgesia and sedation effects,promote postoperative rehabilitation of patients,improve inflammatory stress and immune status,and have higher safety.

Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma

Backgroud: Transarterial chemoembolization(TACE) is the primary palliative treatment for patients with unresectable hepatocellular carcinoma(HCC). However, it is often accompanied by postoperative pain which hinder patient recovery. This study was to examine whether preemptive parecoxib and sufentanilbased patient controlled analgesia(PCA) could improve the pain management in patients receiving TACE for inoperable HCC. Methods: From June to December 2016, 84 HCC patients undergoing TACE procedure were enrolled. Because of the willingness of the individuals, it is difficult to randomize the patients to different groups. We matched the patients’ age, gender and pain scores, and divided the patients into the multimodal group( n = 42) and control group( n = 42). Patients in the multimodal group received 40 mg of parecoxib, 30 min before TACE, followed by 48 h of sufentanil-based PCA. Patients in the control group received a routine analgesic regimen, i.e., 5 mg of dezocine during operation, and 100 mg of tramadol or equivalent intravenous opioid according to patient’s complaints and pain intensity. Postoperative pain intensity, percentage of patients as per the pain category, adverse reaction, duration of hospital stay, cost-effectiveness, and patient’s satisfaction were all taken into consideration when evaluated. Results: Compared to the control group, the visual analogue scale scores for pain intensity was significantly lower at 2, 4, 6, and 12 h(all P < 0.05) in the multimodal group and a noticeably lower prevalence of post-operative nausea and vomiting in the multimodal group(31.0% vs. 59.5%). Patient’s satisfaction in the multimodal group was also significantly higher than that in the control group(95.2% vs. 69.0%). No significant difference was observed in the duration of hospital stay between the two groups. Conclusion: Preemptive parecoxib and sufentanil-based multimodal analgesia regime is a safe, efficient and cost-effective regimen for postoperative pain control in HCC patients undergoing TACE.

Construction of meloxicam and bupivacaine co-delivery nanosystem based on the pathophysiological environment of surgical injuries for enhanced postoperative analgesia

Besides peripheral nerve injury,the acute inflammation is one of the pathological features of tissues after surgery,which exacerbates the postoperative pain,especially in the first 48 h after the surgery.Multimodal analgesia(MMA),such as the combination of non-steroidal anti-inflammatory drugs(NSAIDs)with local anesthetics,has shown enhanced potency compared with the usage of local anesthetics alone.However,rare formulations can provide long-term analgesia at a single dose.Herein,bupivacaine(BUP,a local anesthetic)loading poly(lactic-co-glycolic acid)(PLGA)nanoparticles(NPB)were coated with meloxicam(MLX,an NSAID)loading lipid bilayer(LPM),forming a core–shell nanosystem(NPB@LPM)to provide enhanced and long-term analgesia to treat postoperative pain.MLX was encapsulated in the lipid shell,which enabled high dose MLX to be released in the first 48 h after surgery to reduce the acute inflammation induced pain.BUP was encapsulated in the PLGA core to provide a long-term release for the nerve block.This nanosystem provided a 7-day(whole recovery cycle)effective analgesia in the Brennan’s plantar incision rat model.The tissue reactions of NPB@LPM are benign.This work will provide feasible strategies on designing drug delivery systems for postoperative pain management.

Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement

Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.

Acupoint Injection Decreases Anesthetic Cosumption during Combined Spinal-Epidural and Patient-Controlled Epidural Labor Analgesia

Objective:To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia(CSEA)and patient-controlled epidural analgesia(PCEA)for labor analgesia.Methods:A total of 307 participants were prospectively collected from July 2017 to December 2019.The participants were randomized into the combined acupoint injection with CSEA plus PCEA group(AICP group,n=168)and CSEA plus PCEA group(CP group,n=139)for labor analgesia using a random number table.Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process,and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli(ST 36)and Sanyinjiao(SP 6)were selected in addition.The primary outcome was Visual Analogue Scale(VAS)score,and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses.Safety evaluations were performed after intervention.Results:The VAS scores were significantly lower in the AICP group than in the CP group at 10,30,60,and 120 min after labor analgesia(all P<0.05).The latent phase of the AICP group was shorter than that of the CP group(P<0.05).There were less additional anesthetics consumption,lower incidences of uterine atony,fever,pruritus and urinary retention in the AICP group than those in the CP group(all P<0.05).Conclusion:Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption,improve analgesic quality,and reduce adverse reactions in the parturients.(Registration No.ChiMCTR-2000003120)

A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction

Objectives:Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery.Methods:A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed.Data captured included demographics,postoperative inpatient pain,pain at postoperative visits,morphine equivalent doses(MEDs)administration,medication history,and comorbidities.Data were analyzed using regression models,χ2 tests,and student’’st-tests.Results:Seventy-three percent of patients were discharged with opioid medication,with over half(53.4%)continuing to take opioids at their second postoperative visit,and over one-third(34.2%)continuing to take them around 4-month postoperatively.One out of every five(20.3%)opioid-na?ve patients chronically took opioids postoperatively.There was a poor association between inpatient postoperative pain scores and daily MEDs administered(R2=0.13,0.17,and 0.22 in postoperative Days 3,5,and 7,respectively).Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage.Conclusions:For patients undergoing head and neck free flap operations,opioid medications are commonly used for postoperative analgesia.This practice may increase the chance an opioid-na?ve patient uses opioids chronically.We found a poor association between MEDs administered and patient-reported pain scores,which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted.Level of Evidence:3(Retrospective cohort study).

Stratified pain management counseling and implementation improving patient satisfaction:a prospective,pilot study

Background:Post-operative pain is unpleasant for patients and may worsen surgical recovery.Peri-operative multimodal analgesia has been used for many years;however,its efficacy still needs improvement.In the present study,a thorough peri-operative pain counseling and stratified management program based on risk assessment was implemented,with the goal of improving postoperative analgesia and patient satisfaction.Methods:This prospective,controlled,pilot study included 361 patients who underwent elective surgery.Of these 361 patients,187 received peri-operative pain risk assessment and stratified analgesia and counseling(stratified analgesia group),while 174 received conventional multimodal analgesia(conventional group).The two groups were compared regarding the post-operative pain intensity,rescue analgesia administration,post-operative quality of recovery as assessed via the quality of recovery 40 questionnaire,total dosage of peri-operative opioids,analgesic satisfaction,and analgesic costs.Results:Compared with the conventional group,the stratified analgesia group reported decreased pain intensity during motion at 24 h post-operatively and required lower dosages of rescue analgesia(P=0.03).The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional group(P=0.04);the stratified analgesia group also reported better scores for analgesic satisfaction(P=0.03)and received lower dosages of opioids(P=0.03).Analgesic costs were lower in the stratified analgesia group than the conventional group;the cost-effective ratio was 109 in the conventional group and 62 in the stratified analgesia group.Conclusions:The analgesic efficacy was improved by the implementation of stratified analgesia based on surgical pain risk assessment and counseling.This stratified analgesia protocol increased the patients5 analgesic satisfaction and improved the quality of recovery without increasing healthcare costs.The present findings may help improve the efficacy of peri-operative multimodal analgesia in clinical practice.