Comparison of analgesic efficacy between erector spine plane block and intravenous patient-controlled analgesia with morphin after open heart surgery

Pain after cardiac surgery is always an obsession of patients and a top concern of anesthesiologists. Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control, working memory, mental flexibility, problem solving, and information processing speed. The two most commonly used analgesia methods are patient-controlled analgesia (PCA) and erector spinea plane block (ESP). Our study aimed to compare the analgesic effect of ESP with PCA in patients after cardiac surgery using extracorporeal circulation and evaluate the disavantages of these two pain relief techniques. Subject and methods: This study was a randomized controlled intervention study of adult patients who underwent open-heart surgery patients with extracorporeal circulation from May 2020 to September 2021 in the Department of Anesthesiology and Intensive Care Unit - Hanoi Heart Hospital. Results: Two hundred and four (204) consecutive patients were collected, included 108 patients in the ESP group and 96 patients in the PCA group. The mean intraoperative fentanyl amount in the ESP group (0.57±0.50 mg) was lower than in the PCA group (1.00±0.00 mg) (p<0.05). The average VAS score when the patient was lying still and taking deep breaths at the time of assessment in both groups was below 3 (corresponding to low pain level) (p>0.05). The mean morphin consumption 24 hours after surgery was significantly lower in the ESP group (0,23±0,12 mg) than in the PCA group (17,92±3,32 mg) (p<0.05). The mean time after surgery in the ESP group (3.80±1.02 hours) and the PCA group (5.21±1.10 hours) had a clear difference between p<0.05. The mean time of extubation in the ESP group (8.06±1.60 hours) was statistically significantly lower than in the PCA group (8.83±1.43 hours) (p<0.05). The rate of nausea in the ESP group (20.98%) was lower than in the PCA group (58.33%) (p<0.05). Conclusion: Both methods had good analgesic effect with an average VAS score ≤ 3. The ESP group had a lower mean postoperative morphine consumption, a higher patient satisfaction level, and a lower rate of nausea, vomiting, and slow breathing statistically significant less than the PCA group.

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

The Usefulness of Dual Channel Elastomeric Pump for Intravenous Patient-Controlled Analgesia in Geriatrics: A Randomized, Double-Blind, Prospective Study

Background: Intravenous patient-controlled analgesia (IV-PCA) is well applied in postoperative period. However, determining an appropriate opioid dose was difficult. A previous study suggested the usefulness of variable-rate feedback infusion. In this study, we used a dual-channel elastomeric infusion pump to provide changes in PCA infusion rate by pain feedback.Methods: 90 patients of ASA I-III and 65 to 79 years undergoing orthopedic surgery were participated in the study. All patients were applied a dual-chamber PCA. Patients were randomly allocated into treatment group (Group D; PCA drugs were divided into both chambers.) or control group (Group C; PCA drugs were contained only in the constant flow chamber, but normal saline was contained in the adjustable flow chamber.) The primary outcome was the amount of fentanyl consumption via PCA bolus. The secondary outcome variables were pain score, total fentanyl consumption, rescue analgesic use, patient satisfaction, recovery scores and adverse events including postoperative nausea and vomiting (PONV).Results: Group D showed decreased fentanyl consumption in PCA bolus. Moreover, group D showed in a decrease in rescue analgesic use and better patient satisfaction. The incidence of PONV was much higher in group C. There was no difference in other adverse events.Conclusions: We showed the usefulness of dual chamber IV-PCA to change the flow rate to the pain feedback without any complication. Our results suggested noble implications that may improve existing IV-PCA equipment.Clinical trial registration: The study registered at UMIN clinical trial registry (registered date: 05/03/2020, registration number: UMIN000039702).

POST-OPERATIVE PATIENT-CONTROLLED ANALGESIA

Background. Unsatisfactory cases of pain management resulted in poor treatment outcomes have been reported in the last quarter of XX century and unfortunately the number of the cases is not decreasing nowadays. Moderate or severe pain are critical causes of complications, increase in morbidity and mortality in the postoperative period after surgical procedures. Patient-controlled analgesia (PCA) is an effective strategy for postoperative pain management as it may provide suitable analgesic dose just after system activation thus reducing periods of pain and an increasing patients’ satisfaction. The purpose of this study is to elucidate the optimal and modern method of postoperative pain-controlled pain managements. Materials and methods. The study material was selected by keyword searching throughout databases Google, PubMed, journal "Anaestesia and Analgesia". Keywords entered into the database search boxes were as following: "patient- controlled analgesia", "postoperative anesthesia", "postoperative anesthesia". The study provides the lattest approaches, benefits and shortcomings in post-operative pain management. Conclusions. Ptient-controlled analgesia is a promisitng mode to control acute pain. A few advantages of this technique can be distinguished, for example, a higher analgesic level with a patient&apos;s satisfactions. Today, there is still no single opinion on which way or medicine is the best to be used in clinical practice because clinical efficiency / safety depends on a complex understanding of the pharmacokinetic profile of medicines for various routes of administration. In addition, pharmacoeconomic research is needed to assess the economic efficiency of these approaches.