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A letter to the editor of the journal Perioperative Medicine discusses a randomized controlled trial comparing the analgesic efficacy of two regional blocks after modified radical mastectomy. The study found that the transverses thoracic muscle plane-pectoral nerve block (TTP-PECS) provided improved postoperative analgesia compared to the thoracic paravertebral nerve block (TPVB), with decreased opioid consumption and increased quality of recovery. However, the letter raises concerns about the study's design and results, including the lack of standardized factors that could influence the primary outcome assessment, small differences in pain scores between the two groups, the use of an opioid-based analgesia regimen, and the limited assessment of other outcome variables. The authors argue that the clinical significance of the findings is debatable and that the study does not answer whether the improved pain control and recovery can translate into postoperative benefits for patients. [Extracted from the article]

A letter to the editor of the journal "Pain & Therapy" discusses a recent article by Zhu et al. that examined the benefits of ultrasound-guided multipoint fascial plane block in elderly patients undergoing combined thoracoscopic-laparoscopic esophagectomy. The authors of the letter raise concerns about certain aspects of the study, including the lack of clear description regarding trocar site infiltration of local anesthetic, the use of parecoxib as a rescue analgesic, the definition of chronic pain, and the absence of important outcomes related to fast functional recovery and adequate pain control. The authors conclude that further clarification is needed to determine if the addition of multipoint fascial plane block improves the targets of current enhanced recovery after surgery (ERAS) protocols. [Extracted from the article]

A recent article in the BJOG journal compared the effectiveness of continuous wound infiltration (CWI) and continuous intravenous fentanyl (IVF) for pain control after gynecological surgery. The study found that the postoperative analgesic efficacy of CWI was not inferior to IVF. However, there were some limitations to the study, including the lack of patient status during pain evaluations and the high doses of opioids used in both groups. The study did not meet the requirements of current enhanced recovery after surgery (ERAS) protocols, which recommend the use of non-opioid analgesics. Additionally, patient satisfaction with pain control was not assessed. Therefore, the authors do not agree that CWI is non-inferior to IVF for postoperative pain control in gynecological surgery. [Extracted from the article]

For patients undergoing gynecological oncology surgery, postoperative pain is actually more severe during movement than in a resting state.[2] We are concerned that this issue would have biased their results of pain assessment. In a randomized controlled trial including 99 patients who underwent gynecological oncology surgery in the context of the Enhanced Recovery After Surgery (ERAS) protocols, Ben-Arye and colleagues[1] assessed the effects of integrative therapies on postoperative pain and anxiety. [Extracted from the article]

In patients undergoing single port video-assisted thoracoscopic surgery, this is evidently unsatisfied postoperative analgesia for successful use of enhanced recovery after surgery protocols, in which multimodal analgesia regimen is recommended and analgesics should be universally titrated to achieve patient comfort and minimal pain, that is, a NRS score of 3 or less. We believe that this study would have provided more useful data comparing efficacy and clinical values of SAPB and INB for postoperative analgesia after single port video-assisted thoracoscopic surgery. [Extracted from the article]

Dear Editor, In the recent article by Zorrilla-Vaca et al. [[1]] examining the risk factors of postoperative acute kidney injury (AKI) in patients undergoing colorectal surgery with an enhanced recovery pathway, we noted that several methodological issues were not addressed well. Third, by multivariable analysis, age > 60 years, male gender, American Society of Anesthesiologists physical status classifications III-IV, chronic kidney disease and hypoalbuminemia were identified as independent risk factors of postoperative AKI. As the diagnostic criteria of chronic kidney disease were not provided in the Methods section, it was unclear whether patients with occult or mild chronic kidney disease (stages 1 and 2) were included in the study. [Extracted from the article]

This article discusses a recent study on the efficacy of a regional block as a postoperative analgesia technique for pediatric patients undergoing certain surgical procedures. The authors of the article raise several questions and concerns about the methodology and results of the study. They question the target pain scores set for postoperative analgesia and argue that the control group may have been ineffective, potentially biasing the outcomes. They also criticize the lack of standardized analgesic prescriptions and the limited use of non-opioid analgesics in the study. Additionally, they highlight inconsistencies in the time to first analgesic need in the ward. The authors conclude by requesting a reasonable explanation for these findings. [Extracted from the article]

The article discusses a study that assessed the postoperative analgesic efficacy of a regional block called serratus posterior superior intercostal plane block (SPSIPB) for video-assisted thoracoscopic surgery. The authors raise concerns about the study's methodology, including the lack of a control group in the pilot study and the non-standard application of non-opioid analgesics in the comparator groups. They also argue that the study's use of an opioid-dominated analgesic strategy is not in line with recommended protocols for thoracic surgery. Additionally, the authors question why the target of postoperative analgesia was not achieved in the control group. [Extracted from the article]

This document is a letter to the editor of the Journal of Anesthesia, commenting on a study that compared different intercostal nerve block modalities for postoperative analgesia in patients undergoing thoracoscopic pulmonary resection. The authors of the letter raise several concerns about the study, including the use of high concentration ropivacaine, the lack of incisional local anesthetic infiltration in the control group, the assessment of postoperative pain levels, the clinical significance of the opioid-sparing effect, and the inconsistent use of non-opioid basic analgesics. The authors also note that the results of the multivariable logistic regression analysis were not provided. It is important for library patrons to consider these limitations and potential biases when interpreting the findings of the original study. [Extracted from the article]

A study published in the Asian Journal of Endoscopic Surgery compared the effectiveness of continuous thoracic epidural analgesia (TEA) and single-shot rectus sheath block (RSB) in managing postoperative pain in patients who underwent laparoscopic surgery. The study found that TEA was superior to RSB in terms of pain control. However, the authors of the article raised several questions about the methodology and results of the study, including concerns about the selection of the non-inferiority margin, the choice of primary endpoint, and the definition of adequate postoperative analgesia. The authors of the article did not receive any funding for their work and declared no conflicts of interest. [Extracted from the article]

Third, in this study, intravenous tramadol (1 mg/kg) was administered as rescue analgesia, if the NRS pain score was 4 or more and the proportion of patients needing rescue analgesia was significantly reduced in the M-TAPA group. As opioid sparing is one of the main objectives of postoperative multimodal analgesia protocols including a nerve or fascial plane block [[3]], the authors should provide whether morphine milligram equivalent of tramadol for rescue analgesia was significantly different between groups. Keywords: Laparoscopic cholecystectomy; Postoperative analgesia; Thoracoabdominal nerves block through perichondrial approach; Local infiltration EN Laparoscopic cholecystectomy Postoperative analgesia Thoracoabdominal nerves block through perichondrial approach Local infiltration 495 496 2 06/01/23 20230601 NES 230601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03158-0. [Extracted from the article]

Re: Intermittent peri-tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial In a prospective double-blinded randomized controlled trial including 64 patients who underwent percutaneous nephrolithotomy, Ahuja et al.1 assessed the effect of additional dexamethasone on the efficacy of intermittent peri-tubal ropivacaine infiltration for postoperative pain control and showed that the addition of dexamethasone to local anesthetic can significantly prolong the duration of analgesia. Indeed, the NRS scores at 4, 6, 12, 48, and 60 h postoperatively were significantly increased in patients receiving ropivacaine alone compared to patients receiving dexamethasone and ropivacaine. [Extracted from the article]

The available evidence indicates that preoperative pain is common among patients undergoing arthroscopic shoulder surgery and both preoperative pain severity and opioid use are the strongest independent risk factors of postoperative pain [[2]]. Keywords: Remifentanil; Shoulder arthroplasty; Postoperative analgesia; Analgesic consumption EN Remifentanil Shoulder arthroplasty Postoperative analgesia Analgesic consumption 665 666 2 09/30/22 20221001 NES 221001 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03085-0. [Extracted from the article]

As adequate movement pain control is very important for postoperative functional recovery in patients undergoing AKT, we were very interested in knowing why designed goal of postoperative pain control was not achieved in some time points, especially for patients receiving ACB alone. Keywords: iPACK; Adductor canal block; Periarticular block; Postoperative analgesia; Total knee arthroplasty EN iPACK Adductor canal block Periarticular block Postoperative analgesia Total knee arthroplasty 447 448 2 06/03/22 20220601 NES 220601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03047-6. Adductor canal block, Postoperative analgesia, Total knee arthroplasty, iPACK, Periarticular block. [Extracted from the article]

Given the fact that the bilateral TTMPB only improved pain control analgesic within 24 h following surgery and the mean length of hospital stay was 152-195 h, however, we consider that these clinical benefits cannot be completely attributable to improved postoperative analgesia by the bilateral TTMPB. By a randomized, double-blind controlled trial, Zhang et al.1 assessed the perioperative benefits of bilateral transversus thoracis muscle plane block (TTMPB) in patients undergoing open cardiac surgery and showed that bilateral TTMPB decreased intraoperative and postoperative sufentanil consumption, improved postoperative pain control and sleep quality, and enhanced recovery after surgery. [Extracted from the article]