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Background The high prevalence and prolonged duration of inflow pain and drain pain experienced by peritoneal dialysis (PD) patients following PD catheter implantation impact their quality of life. However, there is limited data on the frequency and predisposing factors of these pains in the Chinese population undergoing peritoneal dialysis. Methods This study encompassed individuals who underwent peritoneal dialysis catheter implantation at our institution from September 1, 2023, to March 31, 2024. Patients’ experiences of inflow pain and drain pain were evaluated using a questionnaire survey and the visual analog scale (VAS), with pain status followed up via telephone for 3 months post-surgery. Results A total of 141 patients were included in this study. Inflow pain occurred at rates of 56.0%, 20.9%, 16.9%, and 17.3% at 1-week, 1-month, 2-month, and 3-month postoperatively, respectively, while drain pain rates were 51.8%, 24.3%, 22.3%, and 19.5% for the same period. Slowing down the infusion rate of dialysate (57.0%) or stopping its drainage (60.3%) proved effective in reducing pain. Logistic regression analysis revealed that age (OR = 0.96, P  = 0.02), gender (OR = 0.37, P  = 0.03), and the method of PD catheter implantation (OR = 2.37, P  = 0.04) were independent factors associated with inflow or drain pain within 1-week postoperatively. Conclusion The occurrence of inflow pain and drain pain following peritoneal dialysis catheter implantation is notable. Age, gender, and the method of catheter implantation were identified as independent factors influencing the incidence of inflow or drain pain within the first postoperative week.

Background Severe pain occurs after cardiac surgery in the sternum and chest tubes sites. Although analgesia targeting the sternum is often prioritized, the analgesia of the drain site is sometimes overlooked. This study of patients undergoing coronary artery bypass grafting (CABG) aimed to provide optimized analgesia for both the sternum and the chest tubes area by combining parasternal block (PSB) and serratus anterior plane block (SAPB). Methods Ethics committee approval (E.Kurul-E2-24-6176, 07/02/2024) was received for the study. Then, the trial was registered on www.clinicaltrials.gov ( https://clinicaltrials.gov/ ) under the identifier NCT05427955 on 17/03/2024. Twenty patients between the ages of 18–80, with ASA physical status classification II-III, undergoing coronary artery bypass grafting CABG with sternotomy, were included. While the patients were under general anesthesia, PSB was performed through the second and fourth intercostal spaces, and SAPB was performed over the sixth rib. The primary outcome was VAS (Visual Analog Scale) during the first 12 h after extubation. The secondary outcomes were intraoperative remifentanil consumption and block-related side effects. Results The average age of the patients was 64 years. Five patients were female, and 15 were male. For the sternum area, only one patient had resting VAS scores of 4, while the VAS scores for resting for the other patients were below 4. For chest tubes area, only two patients had resting VAS scores of 4 or above, while the resting VAS scores for the other patients were below 4. The patients’ intraoperative remifentanil consumption averaged 2.05 mg. No side effects related to analgesic protocol were observed in any of the patients. Conclusions In this preliminary study where PSB and SAPB were combined in patients undergoing CABG, effective analgesia was achieved for the sternum and chest tubes area.

The aim of this study is to evaluate the incidence of shoulder pain after single port transumbilical laparoscopic myomectomy and analyze patient and operative specific factors associated with post-laparoscopy shoulder pain (PLSP). This information can inform preoperative risk assessment and intervention. This is a prospective cohort study. Two hundred and twenty patients undergoing elected single-port laparoscopic myomectomy under general anaesthesia were divided into two groups according to whether they had shoulder pain after surgery. Patient demographic data and duration of surgery, intraoperative blood loss volume, intraoperative carbon dioxide (CO ) usage volume, the usage of an abdominal drainage tube or not, the usage of patient-controlled intravenous analgesia (PCIA) or not were recorded. Statistical analyses were performed using SPSS. Data were compared using Student's -test or chi-square test. Risk factors were analyzed using logistic regression. The incidence of shoulder pain was 43.18%. The body mass index (BMI) of the shoulder pain group was significantly lower than that of the non-shoulder pain group (OR = 0.629,  < 0.05). Patients with BMI < 21.64 are more likely to experience postoperative shoulder pain. The use rate of abdominal drainage tubes was higher in the non-shoulder pain group (OR = 0.509,  < 0.05). PLSP is more likely to occur in patients with lower BMI (<21.64), and placing an abdominal drainage tube can reduce the occurrence of shoulder pain.

ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration number NCT02212717

IntroductionMedical thoracoscopy (MT) is an invasive procedure, performed under local anaesthetic and sedation. Intra and post procedural discomfort can be significant. Erector spinae plane (ESP) blocks are a regional anaesthetic technique used for pain relief in thoracic procedures. Our centre has recently begun using ESP blocks pre-procedure for post operative analgesia for day case MT, and a service evaluation project examined patient satisfaction and pain outcomes.Methods9 patients undergoing MT from Sept 2021 to Feb 2022 were included. Peri- and post-operative opioid use and depth of required sedation was recorded. Pain scores during procedure, in recovery and at home were recorded by retrospective interview and review of recovery charts, and a functional pain questionnaire was administered via telephone.ResultsThe average greatest depth of sedation required using propofol target controlled infusion was 1.92 (standard error of mean [SEM] 0.27), with remifentanil 2.52 (SEM 0.46). 78% of patients required oral analgesia on day 0 post discharge. 55% of patients required oral analgesia on post-op day 1. Patients used an average of 3.33 mg oral morphine (SEM 2.35) in hospital, and 3 mg (SEM 2) on post-op day 1. Periprocedural pain scores were 0.66 (SEM 0.27). Pain scores in recovery were 1.56 (SEM 0.76). Pain scores 3–12 hours post discharge were 3.56 (SEM 0.7), while pain scores on post-op day 1 were significantly higher at 5.56 (SEM 0.90) (figure 1). Functional pain scoring showed that overall patients were able to tolerate activities of daily living well on discharge and reported a good ability to breathe & cough, but felt less able to perform activities such as light housework or heavier exercise (figure 2). There was a non-significant trend towards greater levels of function overall on post-op day 0 than on day 1. 100% of patients felt that overall their pain was well controlled on the day of the procedure and after returning home. No complications of block were reported.Abstract P127 Figure 1Pain scores over time following procedure assessed by telephone questionnaire (n=9)Abstract P127 Figure 2Functional pain scoring following discharge from hospital (n=9)DiscussionESP blocks provide good peri-procedural analgesia for MT. Pain scores were in keeping with a significant analgesic effect lasting several hours then wearing off. The project showed pain outcomes and patient acceptability were good for the use of regional anaesthesia for MT. A formal randomised controlled trial is now planned.

Background Video-assisted thoracoscopic surgery (VATS) offers reduced postoperative pain and faster recovery, yet optimal analgesia remains essential. Regional anesthesia techniques, such as the erector spinae plane (ESP) block and intercostal nerve block (ICNB), are commonly employed. This study compares preoperative ESP block with surgeon-performed intraoperative ICNB in VATS patients. Methods In this retrospective study, 82 patients (≥ 18 years; ASA I–III) underwent elective VATS between January 2020 and December 2022 were analyzed. Forty patients received a postoperative ESP block and 42 an intraoperative ICNB. Primary outcomes included postoperative pain scores using the Visual Analog Scale, postoperative peak expiratory flow (PEF), postoperative IV opioid analgesic use, drainage time, and hospital length of stay. Results Baseline demographics were similar. VAS scores were comparable at postoperative 1, 3, 6, 12 and 24 h. At postoperative 48 h, the ICNB group had significantly lower VAS scores (4.17 ± 1.03 vs. 4.78 ± 1.03; p  = 0.00987). No significant differences were observed in postoperative iv opioid analgesic use, drainage time or hospital stay. Conclusions Both techniques provide effective early analgesia in VATS, with ICNB showing prolonged pain relief. Further prospective studies are warranted.

Background The use of a tourniquet is common during anterior cruciate ligament (ACL) reconstruction, offering convenience for the surgical procedure. However, the potential adverse effects of tourniquet use have gained increasing attention from clinical researchers. We conducted this systematic review and meta-analysis to compare the clinical outcomes of tourniquet application versus non-tourniquet approach during arthroscopic ACL reconstruction. Methods A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases, was performed through March 2023 to identify controlled clinical trials. The main outcomes assessed included post-operative drain output, post-operative pain using a visual analogue scale (VAS), operation time, calf girth, and thigh girth. A random-effects meta-analysis was performed to account for heterogeneity, with weighted mean difference (WMD) and 95% confidence intervals (CI) used as pooled estimates for clinical outcomes. Results Of the nine potentially related studies, seven eligible studies (sufficient quantitative data) were included in the meta-analysis. Postoperative drain output in the tourniquet group was on average 100 ml higher than in the non-tourniquet group (95% CI: 36 to 168). Pain, measured by the VAS at 24 h postoperatively, was 0.42 points higher in the tourniquet group (95% CI: 0.08 to 0.76), with the increase persisting at 48 h, averaging 0.40 points (95% CI: 0.12 to 0.69). Thigh girth in the tourniquet group was reduced by 1.8 cm (95% CI: -2.7 to -0.94). No significant differences were observed for calf girth and the operation time. Conclusion Our meta-analysis indicates that tourniquet use during arthroscopic ACL reconstruction is associated with higher pain levels, increased postoperative drain output, and reduced thigh girth. However, performing the surgery without a tourniquet does not significantly extend the operation time. Trial registration The protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023417604).

Background Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS). Methods Ninety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain. Results NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months. Conclusion In conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery. Trial registration ClinicalTrials.gov, NCT03230019. Registered July 23, 2017.

Objective to compare the efficacy and safety of subcutaneous suture reapproximation alone versus suture plus subcutaneous drain or non-closure for the prevention of wound complications in obese women undergoing elective cesarean delivery (CD). Methods This randomized controlled open label trial was conducted on 352 obese women candidates for elective CD. Participants were randomized into 4 groups: group I ( n  = 89) were allocated for interrupted closure of subcutaneous tissue with insertion of subrectus drain, group II ( n  = 88) were allocated for interrupted closure of subcutaneous tissue, group III ( n  = 88) were allocated for insertion of subrectus drain, group IV ( n  = 87) were allocated for non-closure of subcutaneous tissue without insertion of subrectus drain The primary outcome parameter was the development of wound complications including seroma, infection and dehiscence. Secondary outcome included postoperative pain assessed by VAS, postoperative fever, time of hospital stay and duration of surgery. Results There were significant differences between the 4 groups regarding the mean duration of surgery (48.67 ± 2.84, 46.56 ± 4.80, 45.95 ± 4.29, and 41.59 ± 5.08 in combined, sutures only, drain only and none groups, respectively, P  < 0.001). Assessment of outcome parameters revealed significant differences between the 4 groups regarding postoperative pain (2.93 ± 1.95, 3.62 ± 2.26, 3.83 ± 2.16, and 3.99 ± 2.032, P  = 0.006), postoperative fever (3/68 (3.5%),5/86 (5.8%),3/68 (3.5%),, and 12/86 (14%), P  = 0.017) wound infection (4/68 (4.7%),7/86 (8.1%),4/68 (4.7%),, and 13/86 (15.1%), P  = 0.035) and wound dehiscence (4/68 (4.7%),6/86 (7%),8/68 (9.3%),, and 16/86 (18.6%), P  = 0.011) and highly statistical significant differences regarding wound seroma (4/68 (4.7%),13/86 (15.1%),6/68 (7%),, and 21/86 (24.4%), P  < 0.001) and redressing(10/68 (11.6%),17/86 (19.8%),19/68 (22.1%), and 32/86 (37.2%), P  < 0.001) 08 in combined, sutures only, drain only and none groups, respectively. Conclusion The additional use of a subcutaneous drain along with a standard subcutaneous suture reapproximation technique is effective for the prevention of wound complications named seroma, redressing, dehiscence and infection in obese women undergoing CD. Trial Registration NCT04177381 Date of registration: 21/11/2019.

Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach. There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, etc.), resection (pancreticoduodenectomy, etc.) and combined drainage/resection procedures (Frey procedure, etc.). Additionally, many centers currently perform total pancreatectomy with islet autotransplantation, in addition to minimally invasive options that are intended to tailor therapy to individual patients. Operative management of chronic pancreatitis often improves quality of life, and is associated with low rates of morbidity and mortality. The decision as to which procedure is optimal for each patient should be based on a combination of pathologic changes, prior interventions, and individual surgeon and center experience. •Pain secondary to chronic pancreatitis is a difficult clinical problem to manage.•Surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach.•Operative management of chronic pancreatitis can improve quality of life with low rates of morbidity and mortality.•This article summarizes current surgical therapies for chronic pancreatitis.