Search

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]

By a randomized controlled trial (RCT) of 128 geriatric patients undergoing pulmonary resection, I Heng et al i [1] showed that in comparison to conventional patient-controlled analgesia (PCA), continuous thoracic paravertebral block (CTPB) decreased the incidence of postoperative delirium (POD) and improved postoperative pain control. I Re: Heng et al i Thoracic paravertebral block ameliorates postoperative delirium in geriatric patients. [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]

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 article discusses a study that examined the analgesic efficacy and clinical benefits of bilateral continuous erector spinae plane blocks (ESPB) in pediatric liver transplant recipients. The study found that the addition of bilateral continuous ESPB reduced oral morphine equivalents by 40% to 60% in the first two days after surgery and improved bowel function. However, the study had some limitations, including differences in opioid administration between the two groups and a lack of information on the use of acetaminophen. The authors suggest that future randomized controlled trials are needed to further investigate the benefits of bilateral continuous ESPB in pediatric liver transplant recipients. [Extracted from the article]

A study published in Acta Anaesthesiologica Scandinavica compared the effectiveness of continuous erector spinae plane block (ESPB) and continuous paravertebral block (PVB) for pain control following lung surgery. The study found that patients who received ESPB had higher pain intensity, a higher incidence of analgesia failure, and higher opioid consumption compared to those who received PVB. However, there are concerns about the study's methods and results, including inconsistent pain evaluation, inadequate pain control in the early post-operative period, and the clinical significance of the differences in pain scores and morphine consumption between the two groups. The authors caution that the study's findings should be interpreted with caution. [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]

A letter to the editor of the European Spine Journal raises questions about a study conducted by Stewart et al. on the benefits of adding bilateral erector spinae plane blocks (ESPBs) to postoperative pain management after open lumbar laminectomy. The letter highlights concerns about the methodology and results of the study, including the use of standardized anesthetic and analgesic management, the assessment of postoperative pain levels, the achievement of pain control goals, and discrepancies in the reported results. The authors of the letter request clarification and responses from the original study authors. [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]

Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. Keywords: Emergence delirium; Emergence agitation; Children EN Emergence delirium Emergence agitation Children 156 156 1 02/02/22 20220201 NES 220201 Cho EA, et al. As postoperative pain is a known precipitating factor for ED in children, we were concerned that unbalanced postoperative pain treatments would have biased their findings. [Extracted from the article]