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Objective: To prospectively investigatethe incidence and influencing factors of Subsyndromal delirium (SSD) in elderly patients undergoing pancreatic surgery. Methods: According to a prospective observational study, elderly patients (aged ≥60 years) who underwent pancreatic surgery in the pancreatic center of our hospital from August 2023 to February 2024 were selected. Patients were divided into SSD and Normal groups based on the evaluation of the Delirium Rating Scale-revised-98 in the first 1-4 days postoperatively. Multivariate logistic regression was performed to determine the influencing factors, and subject operating characteristic curves were used to assess the predictive effect of risk factors for subsyndromal delirium. Results: A total of 179 elderly pancreatic surgery patients were included in this study. 67 elderly patients developed subsyndromal delirium with an incidence of 37.43%. Multivariable Logistic regression revealed that risk factors for SSD included age, age-adjusted Charlson Comorbidity Index (aCCI), and postoperative fever, while and education level with senior high school or above was found to be protective factors. Receiver operating characteristic (ROC) curve showed that the combination of age and aCCI predicted SSD in elderly pancreatic surgery patients (Area Under Curve = 0.815, 95% Confidence Interval: 0.752 - 0.878), with sensitivity and specificity of 80.6% and 75.9%, respectively. Conclusion: The incidence of subsyndromal delirium after elderly pancreatic surgery was as high as 37.43%. Effective assessment and prevention of subsyndromal delirium are crucial. In the early postoperative period, special attention should be given to elderly patients with more preoperative comorbidities and lower education levels, and their temperature should be monitored in a timely manner. [ABSTRACT FROM AUTHOR]

Background: Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP. Here, we hypothesized that CCB would decrease the incidence of HDP compared to ISB while still providing effective pain relief after surgery. Methods: Seventy patients who underwent arthroscopic rotator cuff repair were randomly allocated to receive either ultrasound-guided CCB (n = 35) or ISB (n = 35). Each group received 0.2% ropivacaine (20 ml CCB, 10 ml ISB). The primary outcome was the incidence of HDP, as measured using M-mode ultrasound. Diaphragmatic excursion, pulmonary function test results, opioid consumption, and pain scores were evaluated. Results: Sixty-six patients were included. CCB group had a significantly lower incidence of HDP than those in the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.87 cm) group than in the CCB (0.25 cm) group (P < 0.001). The decrease in forced vital capacity and forced expiratory volume in 1 s from baseline was significantly greater in the ISB. There was no significant difference in opioid consumption between the two groups during the entire postoperative period. Conclusions: Compared with ISB, CCB significantly reduced the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB may be a viable option for diaphragmatic-sparing analgesia after shoulder surgery. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. Methods: This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5 mg·kg−1 followed by an infusion of 1.5 mg·kg−1·h−1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24 h after surgery. Results: The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80 min versus 78.21 ± 9.12 min; p < 0.001 and 237.14 ± 9.14 min versus 215.00 ± 10.12 min; p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38 min in the lidocaine group and 127.14 ± 23.35 min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24 h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24 h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. Conclusion: During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective cohort study. Objective.: Although there are several methods available to assess upper limb function in patients with cervical spondylotic myelopathy, few methods can evaluate the degree of upper limb functional impairment in activities of daily living. Summary of Background Data.: We devised and evaluated the utility of a new assessment method called the 10 Coins Test, which is based on daily movements. Materials and Methods.: The study included 39 patients who underwent spinal surgery for cervical spondylotic myelopathy and who were followed up for 1 year postoperatively. The mean age was 65.2±11.5 years, with 31 (79.5%) male and 8 (20.5%) female patients. The 10 Coins Test is a simple examination that measures the time it takes to pick up and move 10 coins forward. Patient satisfaction with surgery was evaluated on a 5-point scale. We compared the 10 Coins Test results, patient satisfaction, and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) results before and after surgery. Results.: The mean time to perform the 10 Coins Test was 27.4 seconds for the dominant hand and 24.5 seconds for the nondominant hand preoperatively. In the control group, the average time was 14.6 seconds for the dominant hand and 15.0 seconds for the nondominant hand. The cut-off value was 16.2 seconds. There was a significant difference in the 10 Coins Test time and satisfaction for both hands at 1 week postoperatively compared with preoperatively. The JOACMEQ upper limb motor function showed a significant improvement 3 months postoperatively compared with preoperatively. The 10 Coins Test result was correlated with satisfaction and the JOACMEQ upper limb motor function. Conclusion.: The 10 Coins Test allows for the quantitative evaluation of complex movements. It is convenient and highly useful for assessing upper limb function in patients with cervical spondylotic myelopathy. [ABSTRACT FROM AUTHOR]

Objective: To assess the changes of thalamic metabolites before and after surgery in patients with Cervical Spondylotic Myelopathy (CSM) using Hydrogen Proton Magnetic Resonance Spectroscopy (1H-MRS) and to investigate its association with improvement in neurological function. Methods: Forty-eight CSM patients who underwent cervical decompression surgery from December 2022 to June 2023 were included, and 33 healthy volunteers were recruited. All subjects underwent bilateral thalamic 1H-MRS scans before the surgical procedure, and subsequently again 6 months later. Neurological function was assessed pre-operatively and post-operatively (6 months) in all patients with CSM using the modified Japanese Orthopedic Association (mJOA). The changes of mJOA (ΔmJOA = postoperative mJOA–preoperative mJOA) were employed as an indicator of neurological improvement. The pre- and postoperative metabolic ratio of N -acetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol/creatine (mI/Cr), glutamate and glutamine complex/creatine (Glx/Cr) were statistically compared in CSM patients and healthy controls (HCs). A correlation analysis was conducted to determine the relationship between alterations in pre- and postoperative metabolite ratios (ΔNAA/Cr, ΔCho/Cr, ΔmI/Cr, ΔGlx/Cr) and ΔmJOA. Results: Compared to the HCs, patients with CSM showed significantly lower pre- and post-operative NAA/Cr (Z = −4.235, p < 0.001; Z = −3.184, p = 0.001), Cho/Cr (Z = −5.050, p < 0.001; (Z = −2.624, p = 0.007) and mI/Cr (Z = −3.739, p = 0.001; Z = −2.014, p = 0.044). There was no difference in Glx/Cr between patients in patients with CSM, either preoperatively or postoperatively, compared to HCs. Post-operative NAA/Cr (Z = −2.285, p = 0.041) and mI/Cr (Z = −2.925, p = 0.021) were increased in CSM patients compared to pre-operative NAA/Cr and mI/Cr. In CSM patients, ΔmI/Cr correlated significantly with ΔmJOA (r = 0.507, p < 0.001). Conclusion: The preliminary findings indicate that metabolites in the thalamus of CSM patients exhibit changes following surgery. Additionally, it has been demonstrated that elevated postoperative mI correlates with improvements in neurological function. [ABSTRACT FROM AUTHOR]

Background: Optimal management of anaemia following surgery for colorectal cancer remains unclear. Peri-operative anaemia is common in patients undergoing resectional surgery for colorectal cancer. A significant amount of research has been conducted into the management of pre-operative anaemia; however, little work has investigated post-operative anaemia. We intended to investigate the facilitators of and barriers against the standardised correction of post-operative anaemia. These can aid in identifying optimum treatment for patients following surgery for colorectal cancer. Methods: Four focus groups were held with 29 participants from a multidisciplinary panel of healthcare professionals from two different NHS hospital sites in the UK. The discussions were audio recorded and underwent professional transcription. Transcripts were checked against recordings before undergoing thematic analysis using a realist approach. Results: Four themes were identified. The key barriers to standardised post-operative anaemia correction were a lack of protocoled guidelines or a defined pathway, insufficient education and training, and systemic barriers, such as financial drivers and drug availability. The key facilitator identified was collaboration and communication. Discussion: This study has identified several key barriers and thresholds which can be used in future studies to improve the standardised management of post-operative anaemia. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound-guided transmural drainage (EUS-TD) is widely performed to treat postoperative peripancreatic fluid collection (POPFC). Recent reports on EUS-TD lack a consensus on stent selection. This study aimed to assess the efficacy of EUS-TD for POPFC using an external drainage-based approach. Methods: We retrospectively examined the medical records of patients with POPFC treated with EUS-TD using external drainage from October 2016 to July 2024. Technical success was defined as successful placement of the external drainage. Clinical success was defined as the reduction in fluid collection, as evidenced by follow-up computed tomography 1 week post-procedure. Results: This study included 14 patients. The median duration from surgery to endoscopic treatment was 13 (range: 11–26) days. The median procedural time was 26 (range: 13–35) min. The technical success rate was 100%, and 6 Fr endoscopic nasocystic drainage was performed in all patients. The clinical success rate was 100%, and no adverse events were observed. One patient experienced self-removal and required repuncture. Conclusions: EUS-TD for POPFC with an external drainage-based approach is safe and effective, with a short procedure time. However, this was a retrospective study with a small sample size, suggesting that future prospective studies are warranted. [ABSTRACT FROM AUTHOR]

AIM- The objective of the systematic review is to evaluate the incidence of postoperative pain after single-visit and multiple-visit root canal therapy. METHODS- Published research indexed in PubMed or Scopus or Cochrane or DOAJ or Web of Science evaluating the frequency percentage of postoperative aching after one and several root canal therapy appointments through randomized controlled trials or prospectively were included. RESULT- Most surveys utilized VAS (Visual Analogue Scale) to estimate the degree of pain among the participants. The majority of the studies (n-8) showed no difference between postoperative pain during single-sitting endodontic treatment or multiple-sitting endodontic treatment. On the contrary, several studies (n-6) also revealed that post-obturation pain in a single-appointment root canal therapy is less compared to multi-visit root canal therapy. The current research results give insight into the incidence of postoperative endodontic pain among the study participants undergoing root canal treatment through single or multiple visit appointments. CONCLUSION- The lack of consistency between studies is due to the different ways in which pain intensity is measured and differences in treatment methods, patient selection and treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: Postoperative atrial fibrillation (POAF) is a known complication after cardiac surgery. This study investigated the incidence, perioperative outcomes, and predictors of POAF. Methods: We conducted a retrospective review of all eligible patients undergoing cardiac surgery procedures at King Khalid University Hospital, Riyadh, Saudi Arabia, between April 2015 and June 2021. Prespecified demographic, perioperative, and comorbidity data were collected, and summary statistics were done. Results: The incidence of POAF was 10.8% (114/1053 patients). Most patients had POAF detected in the first 72 h, except those who underwent septal defect repair procedures. Patients who developed POAF had significantly higher rates of complications, including major adverse cardiovascular events, pneumonia, bleeding and shock, acute kidney injury, and congestive heart failure (all had a P ≤ 0.005). Advanced age and increased body mass index were the preoperative predictors of POAF. Furthermore, undergoing coronary artery bypass grafting (CABG), valve replacement surgery, or a combined procedure were also predictors of POAF. Conclusion: POAF after cardiac surgery is a common complication with increased risks of significant complications. Efforts to prevent POAF incidence are required through prediction and preventive measures. More studies are needed to determine if early detection and prompt treatment could mitigate the clinical sequelae of POAF. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess whether parasternal block with multihole catheters inserted before surgical incision enables to alleviate postoperative analgesia and opioid reduction in cardiac surgery patients with sternotomy. Methods: Twenty-six adult patients scheduled for cardiac surgery with sternotomy aged between 18 and 84 olds were included in this prospective, monocentric, open, single-group trial. Two parasternal multihole catheters were inserted on each side of the sternum before the surgical skin incision for cardiac surgery and 10 mL of ropivacaine 7.5 mg mL–1 was initially administered in each catheter. Local anesthetic administration followed by continued infusion at 3 mL hr–1 of ropivacaine 2 mg mL–1 per catheter for 48 h postoperatively upon patient arrival in the intensive care unit. The efficacy of the parasternal block was assessed according to a composite endpoint including pain score at rest, pain score during movements (dynamic pain), and morphine consumption over 48 hours. Results: The treatment failed in 11 patients and was considered effective in 15 patients. Sixteen patients out of 26 had a sternal pain score ≤≤3/10 on more than 75% of observations, and the treatment was considered successful. In 23/26 patients (88%), the mean pain score at cough was ≤≤3.5/10 and the treatment was considered successful. Morphine consumption over 48 h was significantly lower in the intervention group compared to the control group 7 mg [6; 21] versus 142 mg [116; 176] (P < 0.001). Conclusions: Parasternal block with multihole catheters inserted before the surgical incision is an effective technique for postoperative analgesia and opioid reduction. [ABSTRACT FROM AUTHOR]

Background: Paediatric kidney transplantation has an increased risk of surgical and vascular complications, with intensive care monitoring required postoperatively. This study aimed to determine if perioperative management affects early graft function in living donor paediatric kidney transplantation. Methods: Clinical data was extracted from the electronic medical record for living donor kidney transplants at two paediatric centres covering the state of New South Wales (NSW), Australia from 2009 to 2021. Estimated glomerular filtration rate (eGFR) of 7 days and 1-month post-transplant were calculated as measures of early graft function. Results: Thirty-nine eligible patients (female n (%) 13 (33%)) with a median (IQR) age of 6 (3–9) years and pre-transplant eGFR of 7 (6–10) mL/min/1.73 m2 were analysed. Mean (SD) central venous pressure (CVP) after revascularisation was 11 (4) mmHg. Intraoperatively, mean volume of fluid administered was 84 (39) mL/kg, and 34 (87%) patients received vasoactive agents. Average systolic blood pressure (BP) in the first 24-h post-transplant was 117 (12) mmHg. Postoperatively, median volume of fluid administered in the first 24 h was 224 (159–313) mL/kg, and 17 (44%) patients received vasoactive agents. Median eGFR 7 days and 1-month post-transplant were 115 (79–148) and 103 (83–115) mL/min/1.73 m2, respectively. Linear regression analyses demonstrated that after adjusting for age, the average CVP after revascularisation and average systolic BP in the first 24-h post-transplant were not associated with eGFR in the first month post-transplant. Conclusions: Targeted intraoperative and postoperative fluid and haemodynamic characteristics were achieved but did not correlate with early graft function. [ABSTRACT FROM AUTHOR]

Resection is often the primary treatment for large brain tumors but is less practical for multiple brain metastases (BM). Current guidelines recommend stereotactic radiosurgery (SRS) for untreated BMs or following the surgical removal of a solitary BM to reduce the risk of local tumor recurrence. Preoperative SRS (pre-SRS) shows promise with fewer complications and more precise targeting, but it lacks tissue diagnosis and may hinder wound healing. This study aims to compare the safety and efficacy of pre-SRS and postoperative SRS (post-SRS) for BM treatment. A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Cochrane Library. Studies were selected based on PICO criteria, including patients with metastatic intracranial lesions undergoing preoperative or postoperative radiosurgery. Data related to outcomes and complications were extracted. Meta-analysis was performed, employing the fixed effect model due to study design similarities and limited patient numbers. Four studies encompassing 616 BM patients (221 preoperative, 405 postoperative) were included. Patient characteristics, including age, gender, cancer source, and lesion location, were similar between groups. Radiosurgery modalities included LINAC and Gamma Knife, with hypofractionated treatments more common postoperatively. Outcomes showed comparable overall survival (p = 0.07), local failure (p = 0.26), and distant failure rates (p = 0.84) between groups. The preoperative group had lower risks of radiation necrosis (p = 0.02) and leptomeningeal disease (p = 0.03) in 1-year follow-up, with significantly better composite outcomes (p = 0.04). No significant difference in wound issues was observed (p = 0.98). This review reveals pre- and post-SRS for BM have similar outcomes for LF, DF, and OS. Pre-SRS potentially lowers RN and LMD risks, with better tumor targeting and less radiation to healthy tissue, while post-SRS targets residual disease but with higher complication risks. Future research should optimize SRS protocols. [ABSTRACT FROM AUTHOR]

Purpose: To determine the frequency and clinical features of new- and early-onset benign paroxysmal positional vertigo (BPPV) after different otologic surgical operations with and without surgical drilling. Methods: All unilateral otologic operations performed at the otolaryngology clinic of a tertiary university hospital between January 2021 and May 2023 were screened, and 437 adult cases were included in the study. Of these patients, those who were diagnosed with BPPV within the first month postoperatively were examined. Results: The overall incidence of BPPV after otologic operations was 2.28% (10 out of 437 patients). This incidence was 3% (8/266 patients) in cases where a drill was used and 1.16% (2/171 patients) in those where a drill was not used. There was no significant difference between the two groups (p > 0.05). Clinical symptoms related to BPPV appeared on average in 13.3 ± 6.8 (range: 3–25) days following surgery and presented as canalolithiasis. All cases involved the posterior semicircular canal (SCC) on the operated side. In addition, one patient with a cochlear implant had involvement of both the posterior and lateral SCCs. All patients responded well to repositioning maneuvers during follow-up. Conclusion: Otologic surgery, especially operations involving drilling, is a potential risk factor for the development of BPPV. Postoperative BPPV, primarily presenting as canalolithiasis in the posterior SCC on the operated side, can be effectively managed with repositioning maneuvers. Clinicians should be vigilant for BPPV in patients experiencing vertigo/dizziness within four weeks following otologic surgery. [ABSTRACT FROM AUTHOR]

Background: Transversus abdominis plane (TAP) block has been shown to be an effective analgesic modality for various abdominal surgeries. In this study, a direct comparison between continuous TAP block with continuous epidural block was made in kidney transplant recipients. Methods: A total of 62 participants were randomly allotted to receive either continuous epidural or continuous TAP block. In the epidural group,: infusion of 0.25% ropivacaine at a rate of 4–10 mL per hour depending on patient characteristics and block level as assessed clinically. In the TAP block group,: after an ultrasound-guided posterior approach TAP block, a bolus of 0.25% ropivacaine (20 mL) was deposited in the plane, followed by a continuous infusion of 0.25 ropivacaine. In both groups, the infusion was continued for 24 h postoperatively. Rescue analgesia was provided in the form of patient-controlled fentanyl intravenously. Numerical pain rating score (0–100) was recorded at each of the study points (0, 1, 2, 6, 12, and 24 postoperatively). Results: Demographic data and baseline investigations were not significantly different between the groups. No significant difference was found between the median numerical pain rating scale (NRS) scores at rest and on coughing at all study points (P > 0.05). The mean consumption of fentanyl in 24 h postoperatively was similar in group E (685.48 ± 76.86) and group T (695.16 ± 78.37). Similarly, no significant difference was noted in the hemodynamic parameters and patient satisfaction (P > 0.05). Conclusions: Continuous TAP block is non-inferior to epidural technique for postoperative analgesia in patients undergoing renal transplant recipients. [ABSTRACT FROM AUTHOR]

This study assessed the efficacy of magnesium sulfate and ketamine hydrochloride in reducing the demand for propofol, remifentanil, and postoperative rescue analgesia in cats undergoing elective ovariohysterectomy. Thirty cats were premedicated with acepromazine (0.05 mg/kg) and morphine (0.3 mg/kg) intramuscularly and induced to unconsciousness with propofol for orotracheal intubation. The continuous infusion (CI) of propofol and remifentanil were started and animals and were randomly allocated into three groups: the magnesium sulfate group (MG) received one bolus (50 mg/kg) and CI (80 mg/kg/h) of magnesium sulfate; the ketamine group (KG) received bolus (0.5 mg/kg) and CI (1.8 mg/kg/h) of ketamine hydrochloride; the control group (CG) received bolus and CI of 0.9% saline solution. Cardiovascular and respiratory functions, extubation time, and rescue postoperative scores were assessed and data were described with a significance level of 95% (P < 0.05). The infusion period of treatments was 21.5 ± 3.4 and 21.0 ± 2.4 minutes in the KG and MG, respectively (P = 0.194). The infusion rates of remifentanil (P = 0.336) and propofol (P = 0.716) were similar between groups. Analysis of the postoperative pain scales revealed no significant intergroup differences in rescue frequency, rescue score, and time to the first rescue analgesia. In conclusion, the proposed protocols were safe and effective, yet it is noteworthy that both magnesium sulfate and ketamine failed to demonstrate significant additional postoperative analgesic or adjuvant anesthetic effects. [ABSTRACT FROM AUTHOR]

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Background: To investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer. Methods: Data from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day). Data regarding gender, age, body mass index, preoperative Nutrition Risk Screening 2002 (NRS 2002) score, American Society of Anesthesiologists Physical Status classification system, age-adjusted Charlson Comorbidity Index, diabetes, hypertension, chronic lung disease, and the Tumor-Node-Metastasis (TNM [Eighth edition]) classification were collected for propensity score matching (PSM). Postoperative indicators were monitored. A power analysis was performed during the design phase of this study to ensure that statistical power exceeded 80% to reliably detect differences between the 2 groups. Results: After PSM, data from 128 patients were analyzed (H-SPN, n = 64; L-SPN, n = 64). The H-SPN group experienced shorter postoperative hospital stay (8.11 ± 6.00 days vs. 10.38 ± 7.73 days; P = 0.045) and a lower number of infectious complications (36 [56.3%] vs. 60 [93.8%]; P < 0.001), particularly pulmonary infections, compared with the L-SPN group. Additionally, no increase in hospitalization costs or non-infectious complications occurred in the H-SPN group. Subgroup analysis revealed that H-SPN significantly reduced the incidence of infectious complications among those < 65 years of age (hazard ratio [HR] [95% confidence interval (CI) 0.240 0.069–0.829]; P = 0.024), NRS 2002 score ≥ 3 (HR 0.417 [95% CI 0.156–0.823]; P = 0.028), age-adjusted Charlson Complexity Index < 2 (HR 0.106 [95% CI 0.013–0.835]; P = 0.033), and TNM stage III (HR 0.504 [95% CI 0.224–0.921]; P = 0.046). Conclusions: H-SPN effectively reduced postoperative infectious complications and the length of hospital stay, suggesting that early postoperative H-SPN may be an advantageous nutritional support strategy for patients diagnosed with gastric cancer. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Data Sources Results Conclusions Implications for Patient Care Impact Reporting Method Patient or Public Contribution Protocol Registration To synthesise the best available empirical evidence about the effectiveness of multimodal analgesics on pain after adult cardiac surgery.A systematic review with meta‐analysis.Indexed full‐text papers or abstracts, in any language, of randomised controlled trials of adult patients undergoing cardiac surgery investigating multimodal postoperative analgesic regimen effect on mean level of patient‐reported pain intensity at rest.Eight databases, via two platforms and three trial registries were searched from 1 January 1995 to 1 June 2024 returning 3823 citations.Of the 123 full‐text papers assessed, 29 were eligible for inclusion. Data were independently extracted by a minimum of two reviewers in Covidence. There were 2195 participants, aged 60.4 ± 6.6 (range 40–79) years, who were primarily male (n = 1522, 76.1%), randomised in the included studies. Risk of bias was high and reporting quality was poor. Patient‐reported pain was measured at rest in 28 (96.6%) trials. Data were suitable for pooled analysis from 10 (34.5%) of these trials with an average rest pain intensity of 3.3 (SD 1.5) in the control and 2.7 (SD 1.9) in the intervention groups, respectively. No trials compared combinations of nonopioid, opioid‐agonist–antagonist, partial opioid agonists or full opioid agonists. Most trials (n = 11, 37.9%) compared two different full opioid options for less than 72 h (n = 24, 82.7%).Robust trials are needed to determine which multimodal analgesic combination will optimise patient recovery after adult cardiac surgery. There is an urgent need to test and refine high‐quality end‐point measures.Adequate assessment precedes ideal pain treatment. The findings from this review reveal neither are sufficient, and the impact of suboptimal pain management on postoperative recovery is grossly underinvestigated.The optimal combination of multimodal analgesics is unknown despite being recommended in best practice guidelines for enhanced recovery after cardiac surgery. Almost 30% of adults continue to experience ongoing pain up to a year after cardiac surgery, and findings from this review reveal a dearth of robust empirical evidence for optimal pain management, and heterogeneity in the way pain is assessed, measured and managed. This review provides a premise for robust trials focused on acute postoperative recovery in cardiac surgery and beyond.This review was conducted in accordance with the PRISMA‐P statement.There was no patient or public contribution.PROSPERO: CRD42022355834 [ABSTRACT FROM AUTHOR]

Background : Hip fractures are a source of severe pain among the elderly population and pose challenges due to limited analgesic tolerance. Perioperative methadone has shown promise in our pilot study suggesting a safe dose of 0.10 mg/kg, prompting further investigation into its benefits for elderly hip fracture patients. Methods: This study employs a double-blinded randomized controlled trial to assess the analgesic effects of a single dose of methadone during hip fracture surgery. Patients aged ≥ 60 years are consecutively enrolled and randomized to receive either perioperative methadone (treatment group) or a saline solution (placebo group). A sample size of 130 patients is required for 88% statistical power. The medication is administered intravenously at anesthesia induction and monitored until discharge. A follow-up observation is conducted 3 months post-surgery. Discussion: Primary outcome: Daily consumption of opioids within the first 3 days after surgery. Secondary outcomes include pain, mobility, nausea, vomiting, time to discharge, need for antidote, delirium, and constipation. The 3-month follow-up includes opioid use, pain, EQ-5D-5L scores, mobility, and persistent side effects. If statistically significant advantages are found in the treatment group, perioperative methadone could be considered as standard care for hip fracture patients, potentially enhancing their pain management. The study's outcomes will provide insights into the feasibility and effectiveness of incorporating methadone into routine clinical practices for this patient group. Trial registration: ClinicalTrials.gov ID: NCT06086171, submitted 4. October 2023. EU-CT: 2023–506252-24–00, UTN: U1111-1294–6125. [ABSTRACT FROM AUTHOR]

Background: The aim of this research was to investigates the prognostic importance of change in carcinoembryonic antigen (CEA) levels (particularly abnormal high concentration) in patients with non-small cell lung cancer (NSCLC) between before and after surgery. Methods: The study involved 68 patients with NSCLC (preoperative CEA value ≥ 10 ng/ml) who received curative operation from 2012 to 2020. Preoperative and postoperative serum CEA levels, CEA reduction, and other clinicopathological factors were determined on medical records. Receiver operating characteristic curves were used to calculate cut-off levels for prognostic markers. Multivariate analyses with a Cox proportional hazards regression model were performed to identify Independent prognostic variables. Results: The optimal cut-off was value for the CEA reduction rate was 77.3%. The area under the curve for the CEA reduction rate was greater compared with those for preoperative and postoperative CEA levels. The Kaplan–Meier method revealed a significantly worse prognosis in the low CEA reduction rate group versus the high CEA reduction rate group regarding overall survival (OS) (p = 0.002). In the multivariate analysis, the CEA reduction rate (hazard ratio: 3.36, 95% confidence interval: 1.32–8.51, p = 0.011) was identified as an independent and exclusive prognostic marker for OS. Conclusions: In NSCLC, which is characterized by high preoperative CEA levels, the CEA reduction rate after surgery is a useful prognostic factor. Importantly, it is a more powerful indicator for OS compared with postoperative CEA levels. Further, large-sample-size cohort studies focusing on this issue are warranted. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study is to evaluate the accuracy of a digital template on the three-dimensional accuracy of edentulous implantation through a retrospective study to provide more clinical evidence for the use of digital templates in edentulous patient. Materials and methods: This study evaluates the efficacy of a digital surgical template in edentulous jaws, comparing preoperative plans with postoperative outcomes across four metrics: platform, apex, depth, and angular deviations. Utilizing a patient with an edentulous maxilla as a case study, this research employs CBCT for preoperative and postoperative assessments, with deviations analyzed via 3-Shape software. Comparing these deviations with average deviations in lierature. Results: The average platform deviations at positions 12, 14, 16, 22, 24, 26 were 0.98 ± 0.03 mm, 1.43 ± 0.02 mm, 1.27 ± 0.04 mm, 1.35 ± 0.03 mm, 1.34 ± 0.02 mm, and 1.42 ± 0.03 mm, respectively. The average apex deviations were 1.28 ± 0.02 mm, 1.39 ± 0.03 mm, 1.47 ± 0.04 mm, 1.26 ± 0.04 mm, 1.40 ± 0.04 mm, and 1.48 ± 0.03 mm, respectively, the average angular deviations were 3.50°± 0.08°, 2.87°± 0.07°, 3.49°± 0.06°, 3.36°± 0.10°, 3.41°± 0.13°, and 3.69°± 0.11°, and average depth deviations were 0.29 ± 0.03 mm, 0.26 ± 0.05 mm, 0.59 ± 0.05 mm, 0.28 ± 0.04 mm, 0.47 ± 0.02 mm, 0.53 ± 0.03 mm. Compared with a total mean deviation of 1.2 mm (1.04 mm to 1.44 mm) of platform deviation, 1.4 mm (1.28 mm to 1.58 mm) of apex deviation, angular deviation of 3.5°(3.0° to 3.96°) and depth deviation of 0.2 mm (-0.25 mm to 0.57 mm) reported in literature. While all measured deviations fell within clinically acceptable limits, certain parameters exceeded the benchmarks, suggesting areas for improvement in digital surgical planning and execution. Conclusions: This study indicates that while all measured deviations fell within clinically acceptable limits, certain parameters exceeded the benchmarks, suggesting areas for improvement in digital surgical planning and execution. Based on these data, the potential of digital guide plates to fulfill precision requirements in edentulous jaw implantation can be proved, contributing valuable insights into the optimization of implant surgery protocols. Clinical relevance: Now, the digital template is accepted by many doctors. However, clinical research has not thoroughly verified whether the new digital technology is more accurate than traditional technology. So, this study aims to explore the effect of a whole-process digital template on edentulous implantation and provide more clinical evidence. [ABSTRACT FROM AUTHOR]