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Breast cancer is the most common cancer diagnosed in Canadian women, with an estimate that 1 in 8 will receive a diagnosis within their lifetime. (1) Breast cancer death rates [...], Background: The COVID-19 pandemic highlighted the importance of maximizing sameday discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia. Methods: We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications. Results: A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, p = 0.001), bilateral mastectomy (91% v. 9%, p = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, p = 0.04). Preoperative acetaminophen (83% v. 17%, p < 0.001), multilevel intercostal block (83% v. 17%, p < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, p < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications. Conclusion: We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting. Contexte : La pandémie de COVID-19 a mis en lumière l&apos;importance d&apos;encourager la chirurgie de 1 jour afin d&apos;atténuer les risques associés à l&apos;hospitalisation et de ménager les précieuses ressources hospitalières. L&apos;adoption du congé le jour même après la chirurgie mammaire, et plus particulièrement la mastectomie, a été lente, même si de récentes recherches ont attesté de ses bienfaits physiques et psychologiques. Nous avons voulu comparer les facteurs propres à l&apos;hospitalisation et à la chirurgie de 1 jour dans les cas de mastectomies dans un hôpital communautaire de Vernon en Colombie-Britannique. Méthodes : Nous avons réalisé une analyse rétrospective de tous les cas de mastectomies totales sans reconstruction à l&apos;Hôpital Jubilee de Vernon, un hôpital communautaire de 196 lits, entre avril 2016 et mars 2019. Les caractéristiques des malades, des interventions et de l&apos;analgésie ont été comparées selon que la mastectomie a requis une hospitalisation ou une chirurgie de 1 jour. Nous avons aussi comparé les nombres de réadmissions, de réinterventions et de complications dans les 7 jours suivants. Résultats : En tout, 187 mastectomies ont été analysées, dont 72 (38,5%) en chirurgie de 1 jour. Les facteurs associés aux hospitalisations ont été une durée plus longue de l&apos;intervention (66,1 min c. 53,5 min, p = 0,001), la mastectomie bilatérale (91% c. 9%, p = 0,01) et une apnée obstructive du sommeil présumée ou avérée (32% c. 17%, p = 0,04). La prise d&apos;acétaminophène avant l&apos;intervention (83% c. 17%, p < 0,001), les blocs nerveux intercostaux multiniveaux (83% c. 17%, p < 0,001) et une ordonnance d&apos;acétaminophène plus tramadol (58% c. 42%, p < 0,001) ont été associés aux chirurgies de 1 jour. On n&apos;a observé aucune différence significative entre les groupes hospitalisation et chirurgie de 1 jour en ce qui concerne les nombres de réadmissions, de réinterventions et de complications postopératoires dans les 7 jours suivants. Conclusion : Nous n&apos;avons observé aucune différence significative dans les paramètres évalués selon que les mastectomies ont requis une hospitalisation ou une chirurgie de 1 jour. Ces observations s&apos;ajoutent au corpus de données qui s&apos;accumulent et selon lesquelles la mastectomie effectuée en chirurgie de 1 jour est sécuritaire en milieu communautaire.

Author(s): Samarjit Dey [1]; Indubala Maurya (corresponding author) [2]; Ayush Lohiya [3]; Prateek Arora [4]; Rizwan Suliankatchi Abdulkader [5]; Sairem Mangolnganbi Chanu [6] INTRODUCTION The goals of postoperative pain management [...], Background and Aims: Flupirtine has been used for various chronic pain conditions, but its utility in the perioperative period as an analgesic is still inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of flupirtine for postoperative pain. Methods: PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) were explored for the randomised controlled trials (RCTs) which compared flupirtine with other analgesic/placebo for perioperative pain in adult patients undergoing surgery. The standardised mean difference (SMD) of pain scores, the need for rescue analgesia and all adverse effects were assessed. Heterogeneity was assessed using Cochrane&apos;s Q statistic test and I[sup.2] statistic. Cochrane Collaboration&apos;s tool was used to evaluate the risk of bias and the quality of the RCTs. Results: A total of 13 RCTs (including 1,014 patients) that evaluated the use of flupirtine for postoperative pain were included in the study. The pooled SMD of postoperative pain scores revealed that flupirtine and other analgesics were comparable at 0, 6, 12 and 24 hours (P > 0.05), while at 48 hours, flupirtine showed poor pain control (P = 0.04) as compared to other analgesics. There were no significant differences at other time points and on comparison of flupirtine with placebo. The side effect profile was comparable between flupirtine and other analgesics. Conclusion: The current evidence suggests that perioperative flupirtine was not superior to other most commonly used analgesics and placebo for the treatment of postoperative pain. Keywords: Acute pain, flupirtine, non-opioid analgesic, post-operative pain

Author(s): Ramanarayanan Ragupathy [1]; S.C.Ganesh Prabhu [1]; Dhivya Thiyagarajan (corresponding author) [1]; Vijay Anto [2] INTRODUCTION Though laparoscopic surgeries are considered relatively painless and are associated with early recovery and [...], Background and Aims: Opioids have nowadays become superfluous because of their adverse effects involving post-operative recovery of the patients. So, we aimed at comparing opioid-free anaesthesia with opioid-based technique for post-operative pain relief in laparoscopic surgeries. The primary objective was to assess the pain scores in the post-operative period using visual analogue scale (VAS) for 24 h, and the secondary objective was to compare intraoperative haemodynamic parameters, duration of postoperative analgesia and total analgesics consumed in the first 24 h. Methods: This study was conducted in 60 patients aged between 20 and 70 years, belonging to the American Society of Anesthesiologists physical class I and II posted for laparoscopic surgeries. Anaesthetic doses of lidocaine, magnesium and paracetamol in combination with fascial plane block for post-operative pain relief were given for 30 patients, and the other 30 patients received the conventional opioid-based anaesthesia. Mann-Whitney test was used for VAS scores, and Friedman test was used for repeated measures comparison. Results: VAS scores were higher in the conventional group as compared to the opioid-free group at 0, 2, 4, and 6 h during rest and at 0, 2, 4, 6, 24 h during movement and were statistically significant (P-value < 0.05). The duration of analgesia for the conventional group was 13.8 + 6.7 h, and for opioid-free anaesthesia was 6.7 + 2.2 hours. Intraoperative haemodynamic parameters did not show a statistically significant difference except for systolic blood pressure which was higher in the opioid-free group but was clinically insignificant. (P-value 0.013). Conclusion: Opioid-free anaesthesia along with erector spinae plane block provides better post-operative pain relief when compared to conventional opioid anaesthesia. Keywords: Block, magnesium, opioid, postoperative pain

Author(s): Shibani Padhy [1]; Abhiruchi Yeshwant Patki [1]; Akhya Kumar Kar (corresponding author) [1]; Padmaja Durga [1]; L Sireesha [1] INTRODUCTION The primary analgesic goals in total knee arthroplasty (TKA) [...], Background and Aims: Adductor canal block (ACB), though an effective procedure for postoperative analgesia in total knee arthroplasty (TKA), does not provide analgesia to the posterior articular aspect of the knee joint. Infiltration between the popliteal artery and the capsule of the knee (IPACK block) and sensory posterior articular nerves of the knee (SPANK block) are two single injection techniques that have been shown to provide effective analgesia in posterior knee pain. This study aims to compare the effect of IPACK block and SPANK block when combined with ACB for analgesia and postoperative rehabilitation in TKA. Methods: A total of 82 patients were randomised into two groups: (1) ACB combined with IPACK, (2) ACB combined with SPANK block. The primary outcome was the pain scores from 6 h to 48 h after surgery and the duration of postoperative analgesia. The secondary outcome measures were 24 h opioid consumption, ambulation parameters like mobilisation ability, quadriceps muscle strength and patient satisfaction score at discharge. Results: Numerical rating scale (NRS) scores at rest and on movement, duration of analgesia, total opioid consumption, and patient satisfaction were significantly better (P < 0.05) in the IPACK group than in the SPANK block. There were no significant differences in the knee rehabilitation parameters between the blocks. Conclusion: ACB with IPACK block offers better analgesia, less opioid consumption and better patient satisfaction with comparable knee rehabilitation parameters in the immediate postoperative period after TKA compared to ACB with SPANK block. Keywords: Analgesia, arthroplasty, knee, nerve block, ultrasonography

Total knee arthroplasty (TKA) is associated with considerable pain in the postoperative period. (1,2) This pain is most intense during the first few days after surgery but can last for [...], Background: Femoral nerve block (NB) and periarticular injection (PI) are 2 common options for pain control after total knee arthroplasty (TKA). We performed a prospective triple-blinded randomized trial comparing continuous femoral NB to PI, with follow-up to 1 year. Methods: Patients younger than 70 years of age who were scheduled to undergo elective primary TKA under spinal anesthesia between 2009 and 2010 were randomly allocated to receive either continuous femoral NB or PI. Patients in the NB group received ropivacaine through an NB catheter and a sham saline PI. The PI group received a PI of ropivacaine, morphine, ketorolac and epinephrine, and a sham saline infusion via an NB catheter. Both groups had standardized oral analgesia preoperatively, spinal anesthesia and sedation, and postoperative analgesia. Surgeons, anesthesiologists, patients and assessors were blinded to group assignment. Pain was measured twice daily on postoperative days 1 and 2, at rest and with motion, with a numeric rating scale. Patient satisfaction, pain (Oxford Knee Score) and range of motion were assessed at 1 year. Results: There were 39 participants in the NB group and 35 participants in the PI group. There were no statistically significant differences between the groups at baseline. Statistically but nonclinically significant reductions in pain scores on postoperative day 2 and in narcotic need on the day of surgery were found in the PI group. Patient-reported satisfaction did not differ at any time point. At 1 year, knee flexion was significantly greater in the NB group than in the PI group (mean range of motion 120[degrees] v. 110[degrees], p = 0.03). Conclusion: There was no demonstrated improvement in pain control with the use of an NB versus PI when used with multimodal analgesia. Clinicians should opt for the modality that has the best efficiency for their surgical environment. ClinicalTrials.gov # NCT00869037 Contexte : Le bloc nerveux (BN) fémoral et l&apos;infiltration périarticulaire (IP) sont 2 options d&apos;usage courant pour maîtriser la douleur après l&apos;arthroplastie totale du genou (ATG). Nous avons procédé à un essai prospectif randomisé à triple insu afin de comparer le BN fémoral et l&apos;IP, avec un suivi allant jusqu&apos;à 1 an. Méthodes : Les patients de moins de 70 ans qui devaient subir une ATG élective sous épidurale entre 2009 et 2010 ont été assignés aléatoirement à un BN fémoral continu ou à une IP. Les patients du groupe soumis au BN recevaient de la ropivacaïne par un cathéter de BN et une IF simulée (solution saline). Le groupe soumis à l&apos;IP recevait de la ropivacaïne, de la morphine, du kétorolac et de l&apos;épinéphrine et une perfusion simulée (solution saline) par un cathéter de BN. Les 2 groupes avaient reçu une analgésie orale standard avant l&apos;intervention, une anesthésie rachidienne avec sédatifs et une analgésie postopératoire. Les chirurgiens, les anesthésiologistes, les patients et les évaluateurs ne connaissaient pas l&apos;assignation des agents aux différents groupes. La douleur a été mesurée 2 fois par jour aux jours 1 et 2 postopératoires, au repos et à la mobilisation, au moyen d&apos;une échelle numérique. La satisfaction des patients, la douleur (questionnaire d&apos;Oxford pour le genou) et l&apos;amplitude de mouvement ont toutes été évaluées après 1 an. Résultats : Le groupe soumis au BN comptait 39 participants et le groupe soumis à l&apos;IP en comptait 35. Il n&apos;y avait aucune différence statistiquement significative entre les groupes au départ. Des réductions statistiquement (et non cliniquement) significatives des scores de douleur au deuxième jour postopératoire et du recours aux narcotiques le jour de la chirurgie ont été notées dans le groupe soumis à l&apos;IP. La satisfaction autodéclarée des patients n&apos;a différé à aucun moment. Au bout de 1 an, la flexion du genou était significativement plus marquée dans le groupe soumis au BN que dans le groupe soumis à l&apos;IP (amplitude de mouvement moyenne 120[degrees] c. 110[degrees], p = 0,03). Conclusion : On n&apos;a démontré aucune amélioration de la maîtrise de la douleur avec l&apos;utilisation du BN c. IP avec analgésie multimodale. Les médecins devraient opter pour la modalité qui offre le meilleur degré d&apos;efficience en fonction de leur environnement chirurgical. ClinicalTrials.gov # NCT00869037