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.

Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids:A retrospective study

BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

Analysis of the Effects of Local Injection of Epinephrine and Lidocaine on Postoperative Pain and Bleeding in Children Undergoing Tonsillectomy

Objective:To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy.Methods:Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected.The children were randomly divided into two groups of 34 cases each.The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine.The postoperative pain,operation time,blood pressure changes,and intraoperative blood loss of the two groups of children were observed and analyzed.Results:The postoperative pain,operation time,and intraoperative blood loss scores of the children in the observation group were 4.36±0.69,0.36±0.09,and 39.36±1.78 respectively,which were significantly better than those of the children in the control group(P<0.05)at 5.36±0.77,0.79±0.05,and 45.36±1.56,respectively.The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group(P>0.05).Conclusion:Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

Neuroanatomical Basis of Postoperative Pain and Assessment of Its Management in a Series of Patients Undergoing Caesarean Sections

Introduction: In recent decades, the cost of postoperative pain has been the subject of many studies based on protocols developed by scientific societies for its assessment and optimization. At the Regional Hospital of Saint-Louis (Senegal), several protocols have been developed for pain management, but no study has focused on the assessment of postoperative pain management specifically. We therefore initiated this work, the objectives of which were to remind the neuroanatomical and neurophysiological bases of postoperative pain, and to analyze the assessment and management of this pain in patients who have undergone a caesarean section. Materials and methods: This was a prospective and descriptive study, which took place in the gynecology-obstetrics department, over a period from January 2019 to July 2020. All patients who gave birth by cesarean section were included. The data was collected from a survey sheet written for this purpose. For each of the patients, the information was taken every day throughout the duration of postoperative hospitalization. Results: It appears from our work that after a cesarean section, the pain felt evolves on the first postoperative days with a peak during the second day. As in the data reported in the literature, there does not seem to be a difference in terms of pain intensity and analgesia dosage between scheduled and emergency caesarean sections. However, young age and female gender—for other types of surgeries—are risk factors associated with high postoperative pain scores. This trend is probably related to the low pain experience of tested patients. Our initial hypothesis was that acute post-operative pain after caesarean sections could be linked to defects in the perception and processing of pain by caregivers. Indeed, we have shown that awareness-raising, information, and training actions have made it possible to significantly improve the management of pain after a cesarean section. Conclusion: After a cesarean section the pain is intense, especially when the effects of the morphine wear off. However, in our context where morphine and its derivatives are only slightly used, the post-operative pain is maximal rapidly. This pain therefore needs to be researched and treated appropriately. After a campaign to raise awareness among healthcare personnel, it is possible to significantly improve the systematic administration of analgesics.

Postoperative pain assessment and management among nurses in selected hospitals in Benin City,Edo State,Nigeria

Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.

Pain threshold, anxiety and other factors affect intensity of postoperative pain in gastric cancer patients: A prospective cohort study

Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale(HADS) questionnaire and Life Orientation Test-Revised(LOT-R) questionnaire on the day before surgery. Heat pain threshold(HPT), cold pain threshold(CPT) and pressure pain threshold(PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia(PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain.Results: In total, 83 patients(35.2%) had postoperative pain. Body mass index(BMI) ≥28 kg/m^(2) [odds ratio(OR): 2.67;95% confidence interval(95% CI): 1.07-6.67], total gastrectomy(OR: 2.64;95% CI: 1.42-4.91),preoperative anxiety score ≥8(OR: 2.37;95% CI: 1.12-5.02), heat pain threshold ≤4.9 s(OR: 2.14;95% CI:1.06-4.32), pressure pain threshold ≤4 g(OR: 2.05;95% CI: 1.05-4.03), and female gender(OR: 1.99;95% CI:1.04-3.83) were risk factors for postoperative pain.Conclusions: Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.

Knowledge of Nursing Staff on Postoperative Pain: The Case of the Laquintinie Hospital in Douala, Cameroon

Background and objective: Pain is a major concern in the surgical environment, but its management remains insufficient due to several factors related to the nursing staff, the organization of the structure or the patient himself. The objective of this study was to assess the knowledge of the nursing staff on postoperative pain at the Laquintinie Hospital in Douala. Methodology: This was a cross-sectional study carried out at the Laquintinie Hospital in Douala from September to December 2018. Participants were consecutively selected among members of nursing staff in charge of operated patients in the visceral surgery, trauma surgery, surgical reanimation, gynaecology and obstetrics services. Socio-professional data and data related to knowledge of postoperative pain were collected from this personnel using a pre-tested semi-structured questionnaire. Results: With regard to knowledge of postoperative pain, the proportion of correct answers to the knowledge questions was 61.4%. This proportion varied significantly with the specific training received on pain and the specialization of the nursing staff (p < 0.001). Conclusion: The results of the study reveal knowledge in this population that deserves to be improved with a view to better management of patients undergoing surgery.

Effect of auricular acupoint sticking and pressing on postoperative pain of patients with mixed hemorrhoids:A Meta-analysis

Objective:To systematically evaluate the application effect of auricular acupuncture in postoperative analgesia in patients with mixed hemorrhoids.Methods:We searched Chinese Biomedical Literature Database,CNKI,WanFang,PubMed,Embase,and The Cochrane Library to collect randomized controlled trials about auricular acupuncture on Postoperative patients with mixed hemorrhoids.According to the inclusion criteria and exclusion criteria screening literature.RevMan 5.3 software was used for meta-analysis.Results:A total of 20 articles and 21 studies were included,including 1999 patients after mixed hemorrhoids.The control group was treated with routine nursing analgesia.The experimental group was treated with auricular acupressure beans based on the control group.The meta-analysis showed that the pain relief rate of the experimental group was better than that of the control group[OR=2.84,95%CI(2.12,3.80),P<0.05].Subgroup analysis showed that the application of auricular acupressure after milligan morgan was superior to the control group in the analgesic effect[OR=3.68,95%CI(2.62,5.18),P<0.05],but it is not yet possible to apply auricular acupoint pressing to relieve pain after Stapler hemorrhoidectomy(P>0.05).The pain scores of 24 hours and 48 hours after operation in the experimental group were lower than those of the control group,indicating that auricular acupoint sticking can relieve the pain after operation.The improvement of the postoperative anal margin edema was better in the experimental group than in the control group,24 h[SMD=-1.99,95%CI(-2.84,-1.14),P<0.05],48 h[SMD=-1.92,95%CI(-2.72,-1.11),P<0.05].The adverse reactions were lower than the control group.Conclusion:The application of ear acupoint pressure pea after external exfoliation of mixed hemorrhoids can improve the analgesic effect and reduce the symptoms of postoperative anal edge edema,and the price is low,the operation is convenient,and the side effects are few.It is recommended to be popularized in clinical practice.

Diabetic Patients Develop Greater Intensity of Postoperative Pain than Non-Diabetics after Open Cholecystectomy: A Pilot Study

Background: Pre-clinical and clinical studies have shown that inflammatory pain intensity is increased under diabetes condition. Open cholecystectomy (OC) is a surgical procedure with predictable postoperative pain. However, the comparison of postoperative pain due to open cholecystectomy in diabetic and non-diabetic patients remains unknown. The research question to answer was whether diabetic patients undergoing OC development greater intensity of postoperative pain than non-diabetic patients. Methods: The study was conducted between June 2016 and February 2018 at the Regional Hospital of High Specialty “Dr. Juan Graham Casasús” of Villahermosa, Tabasco, Mexico. Seventy patients in two groups of 35 patients each scheduled for OC under general anesthesia were studied. Pain was assessed using the 11-point numerical rating scale (NRS). The primary endpoint was to know NRS pain scores after awaking of general anesthesia. Secondary outcomes included the time of onset of pain and comparing NRS scores between diabetic and non-diabetic patients undergoing OC. Results: Diabetic patients reported significantly greater intensity pain than non-diabetic patients. The mean overall pain score in the diabetic and non-diabetic patients was 7.2 ± 0.3 and 5.3 ± 0.3 (P = 0.0002), respectively. Furthermore, 60% of diabetic patients had severe pain (NRS ≥ 8) compared to 20% of non-diabetics (P = 0.006). The time to onset postoperative pain was about 35 minutes in both groups (P = 0.876). Conclusions: Diabetic patients undergoing OC have greater intensity postoperative pain and also more frequency of patients with severe pain scores compared with non-diabetic patients. Therefore, analgesic treatment in those patients should consider this point in order to provide a satisfactory postoperative analgesia.

Clinical Observation on 100 Cases of Postoperative Pain of Anal-Intestinal Diseases Treated with Vitamine K Blocking at Changqiang Point

Since the latter half of 1996, we have used vitamine K blocking at Changqiang (GV 1) for relieving the postoperative pain of anal fissure with satisfactory results. A report follows.……

Duration of Cessation of Smoking before Elective Surgery: Impact on Intraoperative Hemodynamics and Early Postoperative Pain in Developing Country

Aim and Background: It is estimated that up to 20% of patients coming for elective surgery are smokers and carry a risk of perioperative complications. Though smoking cessation and its impact on perioperative outcome are widely investigated worldwide we were unable to find any data in Pakistan. The objective of the study is to determine the impact of the duration of smoking cessation before elective surgery on intraoperative hemodynamics and postoperative pain in Pakistani population. Methods: It was a prospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan, for one-year duration. A total of 260 patients scheduled for elective noncardiac surgery under general anaesthesia were recruited. Surgery under regional anaesthesia and minor surgery under general anaesthesia were excluded. Data on self-reported duration of smoking cessation by patients, intraoperative haemodynamics, postoperative pain scores and duration of hospital stay were collected by independently trained data collectors from the preoperative area until the patient is discharged from the hospital. Results: A data from 256 patients were analyzed. On the basis of self-reported duration of preoperative smoking cessation, patients were divided into 4 groups (Group 1: less than 2 days, Group 2: more than 2 days to 7 days, Group 3: more than 7 days to 4 weeks and Group 4: more than 4 weeks). It was found that the longer the duration of cessation of smoking is the less haemodynamic changes and lower postoperative pain scores. Length of stay did not show any difference among all four groups. No major postoperative pulmonary complication was found in any study patient. Conclusions: Duration of cessation of smoking before elective surgery is a significant predictor of intraoperative haemodynamics and early postoperative pain in Pakistani population. A short duration of smoking cessation also helps to avoid some of the adverse effects and reduces perioperative complications.

Effectiveness of the Suprainguinal Ultrasound-Guided Block for the Management of Postoperative Pain after Application of a Total Hip Prosthesis

Objective: To assess the effectiveness of ultrasound-guided supraginguinal block (SIB) in the management of pain after total hip replacement. Material and Methods: This was a prospective, randomized, single-blind controlled study carried out in the anesthesia-intensive care unit of the Donka National Hospital in Conakry, over a period of 06 months (01/01/2020 to 30/06/2020). It concerned 32 patients: 16 patients in the “ultrasound-guided SIB” group and 16 patients in the “standard analgesia” group. Results: The pain scores assessed by the simple verbal scale and collected at the different time intervals (6H, 12H, 24H, 36H, 48H) showed mean scores < 1 in the ultrasound-guided SIB group while the mean scores were ≤3 in the standard analgesia group (P < 0.001). On movement, the mean pain scores were ≤1 for the ultrasound-guided SIB group versus mean scores > 3 in the standard analgesia group (P < 0.001). The time to mobilization was greater than 48 hours in all patients in the standard analgesia group while it was less than 48 hours in the majority of patients (75%) in the ultrasound-guided SIB group. Nausea and vomiting were the most observed side effects. We did not observe any respiratory distress. The length of day hospitalization of patients in the ultrasound-guided SIB group was on average 5.50 ± 0.52 compared with 13.44 ± 1.55 in the group of standard analgesia patients (P = 0.001). The vast majority of patients in the ultrasound-guided SIB group were satisfied and unhappy in the standard analgesia group. Conclusion: Our study demonstrated that echo-guided SIB provided better analgesia compared to standard analgesia for the management of postoperative pain after total hip replacement.

Effects of Electroacupuncture on Pain Threshold and Prostaglandin E2 in Spinal Cord in Postoperative Pain Rat

Objective:Electroacupuncture(EA)is good at post-surgical pain.But point selection method in treating incision-induced pain remains a major clinical challenge.We reasoned that different acupoints may work though adjusting prostaglandin E2 in spinal cord.We wish to explore the analgesic mechanism of electroacupuncture on plantar incision pain rats and provide more therapeutic ideas for acupuncture analgesia.Methods:A total of 50 male rats were randomly divided into a sham operation group,a model group,an EA 1,EA 2 and a drug group(n=10,each).A rat model of left plantar incision pain was established.The rats in EA1 group was needled at ipsilateral Yanglingquan(GB34)and Taixi(KI3).The rats in EA2 group was needled at ipsilateral Quchi(LI11)and Hegu(LI4).EA stimulation(2/100 Hz,1-2-3 mA)was administered 30 minutes immediately after operation.The rats in drug group were fed with Fenbid by gavage 20 minutes before incision(30 mg/kg,p.o.).The hot plate pain detector was used to measure the thermal pain threshold(TPT)before and 24 hours after operation Prostaglandin E2 content of spinal cord was detected by enzyme-linked immunosorbent assay(ELISA)at 1 and 24 hours after operation.Results:Compared with sham operation group,the TPT in model group decreased 41%.Compared with the model group,the TPT increased 56%in EA1,29%in EA2,190%in drug group(P>0.05).At 1 h after operation,compared with the sham operation group,PGE_2 in model group increased 15%.Compared with the model group,PGE_2 in drug group decreased 5%.At 24 hours after operation,compared with sham operation group,PGE_2 in model group increased 9%.Compared with model group,it decreased 4%in EA 1 group,8%in drug group and increased 3%in EA2 group.Conclusion:Both the drug and the electroacupuncture can adjust the 24-hour pain threshold and PGE_2 in spinal cord.The curative effects of the drug are better than that of electroacupuncture.The proximal point is better than that of the distal point.Electroacupuncture can treat postoperative pain by regulating PGE_2 in spinal cord.

Change in mean postoperative pain in patients undergoing tonsillectomy with cold water versus usual practice:A pragmatic trial

Introduction:Tonsillectomy is one of the most common procedures performed in otolaryngology.There are various methods to perform tonsillectomies(cold and hot).Thermal damage and inflammation of the surrounding tissue using monopolar cautery is said to point to increased pain whereas immediate cooling of the burnt area is thought to reduce pain owing to heat dissipation.Our objective was to determine the difference in mean post‐tonsillectomy pain scores among patients irrigated with cold water(4℃)and in patients not irrigated with cold water.Material and Methods:A quasi‐experimental trial was conducted from January 2016 to December 2017 at a tertiary care hospital.All tonsillectomies were carried out with monopolar cautery at a power of 20 W.Patients either received cold water irrigation post tonsillectomy of the tonsillar bed(intervention arm)or no irrigation(control arm).The pain score was measured on Days 0,1,3,5,and 7.Pain scores were charted on a visual analog scale on the respective days.Results:Seventy‐eight patients were included in the study.The mean age of our patients was 10.26(4.24)years old in the intervention arm,and 11.95(4.19)years old in the control arm.It was observed that the pain was significantly lower in patients with cold water irrigation of the tonsillar fossa on Days 1,3,5,and 7(p=0.001).There were no readmissions postprocedure and none of our patients developed any complications postsurgery.Conclusions:In this trial,we report a reduced pain score at all days of observation in the intervention group.Irrigation of the tonsillar fossa is a safe,cost-effective,and less technically demanding technique that could be employed to reduce postoperative pain.Further studies with randomization,blinding and a larger sample size could further improve on our results.

Foot and ankle surgery:Tourniquet placement site to cause as little postoperative pain as possible

There is controversy in the literature on where to place the tourniquet(thigh,calf,ankle)for foot and ankle surgery.While some authors prefer the ankle tourniquet to the calf tourniquet,others state that the surgeon can decide between using the thigh tourniquet or the ankle tourniquet,since there was no difference in postoperative pain between them.Where to place the tourniquet during foot and ankle surgery to cause the least possible postoperative pain to the patient as a result of the tourniquet is a common question in clinical practice.The reality is that,unfortunately,there is no consensus on this issue.Perhaps the only possible way to answer this question would be to conduct a comparative study with sufficient statistical power to reach scientifically sound conclusions.It does not seem easy to carry out such a study,but it would be important to be able to answer the question posed in the title of this Editorial once and for all.

Early Application Study of Intravenous Pain Pump Combined with Parecoxib Injection in Relieving Pain in Patients after Thoracoscopy

Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.

Effects of anesthetic depth on postoperative pain and delirium:a meta-analysis of randomized controlled trials with trial sequential analysis

Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusions:Deep anesthesia reduced early postoperative pain but increased postoperative delirium.The current evidence does not support the use of deep anesthesia in clinical practice.

Effect of acupuncture on short-term pain after standard thoracotomy

Background:To observe the effect of perioperative acupuncture on postoperative pain in patients undergoing standard sternotomy.Methods:57 patients who received standard median sternotomy were randomly divided into acupuncture group(30 cases)and control group(27 cases).The control group was treated with routine operation and nursing,and the acupuncture group was treated with acupuncture for 10 days on the basis of perioperative period.The pain levels of the two groups before and after operation were compared.Results:The pain level of the acupuncture group was significantly lower than that of the control group on the 2nd,10th,and 30th days after operation(P<0.05),and the short-term pain levels in the two groups were statistically significant(P<0.05).Conclusion:The perioperative acupuncture treatment has a significant analgesic effect on short-term pain for patients undergoing anterior midline thoracotomy,and it is helpful for patients to recover quickly after surgery.

Persistent Post-Surgical Pain after Total Knee Arthroplasty at a Tertiary Care Hospital of a Low-Middle Income Country

Background: Persistent post-surgical pain (PPSP) is pain that lasts for 3 months or more after a surgical intervention, where other causes of pain have been excluded. There is scarce knowledge about the prevalence of PPSP in low- and middle-income countries (LMICs). The aim of our study was to assess the prevalence of PPSP after total knee arthroplasty (TKA) at our university hospital and explore factors associated with it. Methods: It was a prospective cross-sectional study. Approval was obtained from the Ethics Review Committee. Patients undergoing elective unilateral total knee arthroplasty under general or regional anaesthesia were recruited over a six months period. A designated pain nurse called the patients three months after surgery and asked about the presence of pain, its location, type, degree and associated factors. Patients who reported pain at three months were called a year after the surgery and the same questions were asked. Results: Eighty-two patients had TKA during the study period. At the time of discharge, 57 (69.5%) patients were satisfied with their postoperative pain management. Three months after the surgery, 13 (15.8%) patients reported pain. Pain was mild in 11 and moderate in two patients. At one-year follow-up, three patients (3.6%) reported pain that was mild to moderate in intensity. Pain disturbed sleep in all three patients and disturbed daily life routines in one patient. No significant difference was found in any of the variables when compared with patients who did not report pain at three months. Conclusions: Although PPSP is a recognized adverse outcome after TKA, little is known about its prevalence in LMICs. In our patient population, 15.8% reported pain three months after TKA, while at one year, 3.6% of patients reported mild to moderate pain. Multicenter studies are recommended for determining the overall prevalence in our patient population and for getting directions for making targeted efforts towards its prevention and treatment.

High Eckardt score and previous treatment were associated with poor postperoral endoscopic myotomy pain control:A retrospective study

BACKGROUND Peroral endoscopic myotomy(POEM)is a safe and effective endoscopic treatment for achalasia.However,postoperative pain management for these patients is often neglected by anesthesiologists because of the short operative time,short hospital stay and the minimally invasive nature of the procedure.AIM To assess the pain and sleep quality of achalasia patients receiving the POEM procedure and investigate factors that affect postoperative pain.METHODS This observational study included patients with achalasia who underwent POEM at Zhongshan Hospital from December 2017 to March 2018.General anesthesia was performed with endotracheal intubation.The postoperative visual analog scale(VAS),postoperative sleep quality,basic patient information,and surgical parameters were collected.Depending on whether the 12-h post-POEM VAS score was less than 4,patients were divided into two groups,a well-controlled pain group and a poorly controlled pain group.Univariate,multivariate,and stepwise logistic regression analyses were used to investigate risk factors for poor pain control.A prediction model of post-POEM pain risk was established in the form of a nomogram.The calibration curve and receiver operating characteristic curve were used to evaluate the clinical usage of the prediction model.Repeated measures analysis of variance and simple effect analysis were used to verify whether differences in the VAS and sleep scores of the high-and low-risk groups,divided by the model from the raw data,were statistically significant.RESULTS A total of 45 eligible patients were included.Multivariate logistic regression and further stepwise logistic regression analysis found that the preoperative Eckardt score[odds ratio(OR):1.82,95% confidence interval(CI):1.17-2.84,P<0.001],previous treatment(OR:7.59,95%CI:1.12-51.23,P=0.037)and the distance between the end of the muscle incision and the cardia(OR:1.52,95%CI:0.79-293.93,P=0.072)were risk factors for post-POEM pain.Repeated measures analysis of variance demonstrated that VAS(P=0.0097)and sleep scores(P=0.043)were higher in the highrisk group,and the interactions between the two main effects were obvious(VAS score:P=0.019,sleep score:P=0.035).Further simple effect analysis found that VAS scores were higher in the high-risk group at 2 h,6 h and 12 h(P=0.005,P=0.019,P<0.001),and sleep scores were higher in the high-risk group at day 1(P=0.006).CONCLUSION Achalasia patients who underwent POEM experienced serious postoperative pain,which may affect sleep quality.A higher Eckardt score,previous treatment,and a longer distance between the muscle incision ending and the cardia were risk factors for poor post-POEM pain control.