<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and s...<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.展开更多
Background A link between postoperative pain intensity and heart rate variability （HRV） had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV. M...Background A link between postoperative pain intensity and heart rate variability （HRV） had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV. Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009. The visual analogue scale （VAS） and the short-form McGill pain questionnaire （SF-MPQ） were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency （HF）, low frequency （LF）, very low frequency power, and LF/HF ratio. Results A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried （P 〈0.05）. The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient＇s age were negative （P 〈0.05）. The total SF-MPQ pain scores positively correlated with the LF/HF ratio （P 〈0.05）. Conclusions The multidimensional pain assessment tool （SF-MPQ） reflects better the patients＇ post-operative pain than the single-dimensional assessment tool （VAS）. HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.展开更多
文摘<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.
文摘Background A link between postoperative pain intensity and heart rate variability （HRV） had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV. Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009. The visual analogue scale （VAS） and the short-form McGill pain questionnaire （SF-MPQ） were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency （HF）, low frequency （LF）, very low frequency power, and LF/HF ratio. Results A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried （P 〈0.05）. The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient＇s age were negative （P 〈0.05）. The total SF-MPQ pain scores positively correlated with the LF/HF ratio （P 〈0.05）. Conclusions The multidimensional pain assessment tool （SF-MPQ） reflects better the patients＇ post-operative pain than the single-dimensional assessment tool （VAS）. HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.
