ObjectiveTo review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery.MethodsRegular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years.ResultsAs for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently.ConclusionHeretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.
Objective To review and summarize the multimodal analgesia regimen in total hip arthroplasty (THA), and to provide basis for individual analgesia in clinic. Methods The literature of multimodal analgesia regimen in THA in recent years was systematically searched and summarized. The perioperative pain management regimens of THA in authors’ center were introduced at the same time. Results Postoperative pain of THA is an important factor affecting patient satisfaction, so pain management is one of the key points in perioperative management of THA. At present, multimodal analgesia regimen is used in THA, which works by blocking pain conduction pathway at different levels, including wound ice compress, non-steroidal anti-inflammatory drugs, local infiltration anesthesia, peripheral nerve block, intraspinal anesthesia, central analgesics, and so on. Conclusion Multimodal analgesia regimen is the perioperative pain management of THA, which includes many analgesic methods. The safe and effective analgesic methods should be chosen according to the specific conditions of patients in order to achieve individualized analgesia.
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
ObjectiveTo prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG).MethodsSixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group (n=30) and control group (n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation (P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared.ResultsThe operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups (χ2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group (P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group (P<0.05). There was no significant difference in VAS score between two groups at other time points (P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge (P<0.05), while no significant difference was found at 2 and 3 days postoperatively (P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge (P<0.05).ConclusionThe MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.
In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
ObjectiveTo explore the effect of standardized multimodal analgesia (SMA) on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway. MethodsPatients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively. The patients were divided into two groups: SMA group (n=175) and control group (n=632). The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs, combined with regional anesthesia, local anesthetic wound infiltration or intrathecal opioid. The postoperative opioid consumption in oral morphine equivalents, the pain scores on movement and at rest, the postoperative rehabilitation were recorded and compared between the two groups. ResultsPatients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group (median: 51 mg vs. 85 mg, P<0.001). The pain scores on movement and at rest at 24, 48, 72 h after surgery in the SMA group were lower than those in the control group (P<0.05). Time to first flatus, time to first ambulation, postoperative hospital stay in the SMA group were significantly shorter than those in the control group (P<0.05), and the quality of life scores at 5 d after surgery increased significantly (P<0.05). The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups (P>0.05). After controlling for confounding factors, multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery (P<0.001). ConclusionSMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.
ObjectiveTo investigate the clinical effect of transversus abdominis plane (TAP) block as part of multimodal analgesia in enhanced recovery after surgery (ERAS) program for patients with hepatic hydatidosis. MethodsThis study was a randomized controlled trial (The registration number was ChiCTR2100053689). According to the established inclusion and exclusion criteria, the patients diagnosed with hepatic hydatidosis treated in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from October 2019 to August 2021 were prospectively included. The odd and even by obverse and reverse of coin was adopted to assign into the study group and the control group, respectively. The patients in the study group were treated with ERAS + TAP block + patient controlled intravenous analgesia (PCIA) + tramadol and the patients in the control group were treated with ERAS + PCIA + tramadol. The intraoperative and postoperative statuses of the two groups were compared. ResultsA total of 64 patients were enrolled in this study, including 32 patients in the study group and 32 patients in the control group. There were no statistical differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function, and liver hydatid type between the two groups (P>0.05). The operations of 64 patients were performed successfully, and there was no perioperative death. There were no statistical differences in the operation time, intraoperative bleeding, and operation mode between the two groups (P>0.05). Compared with the control group, the points of visual analogue scale of postoperative pain on day 1 and 2 were lower (P<0.05), the dosage of tramadol within 2 d after operation and hospitalization expenses were less (P<0.05), and the getting out of bed time, eating liquid diet time, postoperative exhaust time, and total hospital stay were shorter (P<0.05) in the study group. The total complication rate of the study group was lower than that of the control group [28.1% (9/32) vs. 78.1% (25/32), χ2=16.063, P<0.001]. The comprehensive complication index was positively correlated with the total hospital stay (r=0.941, P<0.001) and hospitalization expenses (r=0.958, P<0.001). ConclusionPreliminary results of this study suggest that multimodal analgesia included TAP block is effective in ERAS, and could shorten hospital stay and reduce hospitalization expenses.
Objective To study the analgesic effect of a new “cocktail” of local infiltration analgesia (LIA) with Deprosone after total hip arthroplasty (THA). Methods In a prospective randomized controlled study, 100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January 2018 and December 2018 were enrolled and randomly divided into observation group and control group, with 50 cases in each group. There was no significant difference in age, gender, operative side, disease type, body mass index, American Society of Anesthesiologists (ASA) classification, preoperative rest and activity visual analogue scale (VAS) score, hip Harris score (HHS), quality of life scale (SF-12) score, and other general data between the two groups (P>0.05). The patients in the observation group were treated with a new “cocktail” LIA around the hip joint before suturing the incision, and the drug formula was ropivacaine 200 mg, Diprospan 1 mL, morphine 10 mg, and added normal saline to 80 mL; the patients in the control group were not treated with LIA. The operation time, postoperative hospital stay, the amount of morphine used during hospitalization, and the range of motion of hip joint at discharge were recorded, and the complications were counted. The VAS score at rest and activity, HHS score, and SF-12 score [physiological score (PCS) and psychological score (MCS)] of the hip joint were recorded before and after operation, and the postoperative analgesic effect and the recovery of hip joint function were evaluated. Results There was no significant difference in the operation time between the two groups (P>0.05), and the postoperative hospital stay in the observation group was significantly shorter than that in the control group (P<0.05). The postoperative morphine consumption in the observation group was significantly less than that in the control group (P<0.05), and the total morphine consumption in the observation group was less than that in the control group during hospitalization, but the difference was not significant (P>0.05). Patients in both groups were followed up to 6 months after operation. The resting VAS scores of the observation group were significantly lower than those of the control group at 2, 6, 12 hours after operation and in the morning and afternoon of the first day after operation, and the active VAS scores of the observation group were significantly lower than those of the control group at 6, 12 hours after operation and in the morning of the first day after operation, and the differences were significant (P<0.05). There was no significant difference in the resting and active VAS scores between the two groups on the day of discharge and at 3 and 6 months after operation (P>0.05). At discharge, the flexion range of motion of hip joint in the observation group was significantly greater than that in the control group (P<0.05), but there was no significant difference in the abduction range of motion of hip joint between the two groups (P>0.05). There was no significant difference in HHS score and SF-12 score between the two groups at 3 and 6 months after operation (P>0.05). There was no significant difference in analgesic satisfaction and functional satisfaction between the two groups at last follow-up (P>0.05). There was no complication such as skin pruritus, superficial and deep infection of incision, skin necrosis, deep venous thrombosis of lower extremity, and pulmonary embolism in both groups. There was no significant difference in the incidence of complications such as nausea and vomiting, urine retention, fat liquefaction of incision, local hematoma, and large fluctuation of blood sugar between the two groups (P>0.05). ConclusionThe new “cocktail” LIA with Diprospan can effectively reduce the early postoperative pain of THA, reduce the dosage of opioids, shorten the length of hospital stay, and is conducive to the early functional rehabilitation of patients.