Lumbar spine surgery is one of the most widespread types of surgery for treating back and leg pain. However, the postoperative period always presents with severe pain due to the removal of skin, subcutaneous tissues, bones, and ligaments. Patients usually require high doses of opioids to relieve pain during the initial three days after operation, as well as experience drugrelated complications and prolonged length of stay in hospital. We found that Erector spinae plane block significantly reduced postoperative opioid consumption and pain scores. The present systematic review revealed that ESPB was effective and safe for postoperative analgesia.
Background. Although video-assisted thoracoscopy has a smaller incision than traditional surgery, the postoperative pain is still severe. Ultrasound-guided pectoral nerve block (PECS) II is a new technique that can reduce pain in patients, and it had not been reported in the analgesia after thoracoscopic lobectomy. Methods. 40 patients scheduled for thoracoscopic lobectomy were randomly divided into two groups. Patients in the PECS II group received 0.5% ropivacaine 25 ml before the general anesthesia, while patients in the placebo group received 0.9% saline. Thirty minutes after the block was performed, a pin-prick test was used to analyze the sense of pain of T2-T6 segments. The primary endpoint was the total consumption of fentanyl. Data were collected in the postanesthesia care unit (PACU) and in the ward within 24 hours after operation. Results. The total consumption of fentanyl and the consumption of fentanyl in the intravenous analgesia pump within 24 hours after the operation were significantly lower in the PECS II group compared to the placebo group ( p < 0.05 ). The implementation rate of rescue analgesia during operation and in PACU in the PECS II group was significantly lower than that in the placebo group ( p < 0.05 ). The numerical rating scale (NRS) in 1 and 4 h after operation was lower in the PECS II group ( p < 0.05 ). Mean arterial pressure (MAP) and heart rate (HR) of the PECS II group at chest entering (T1) were significantly lower than those in the placebo group ( p < 0.05 ). Conclusion. Preconditioning of PECS II can stabilize the intraoperative circulation and significantly reduce pain and the consumption of opioids after operation.
Background: Studies have confirmed that CYP3A4 and CYP3A5 genotypes affect fentanyl metabolism in vivo. This study explores the application value of CYP3A4 and CYP3A5 genetic polymorphism in the individualized use of fentanyl in thoracoscopic surgery. Patients and Methods: One hundred American Society of Anesthesiologists physical status I or II patients, aged 40–65 years, with a body mass index of <30 kg/㎡ were scheduled for thoracoscopic surgery for lung cancer under general anesthesia. The patients were divided into the wild homozygote group (group I), heterozygote group (group II), and mutant homozygote group (group III) according to gene detection results. The induction dose of fentanyl was 6 µg/kg, 5 µg/kg, and 4 µg/kg, respectively; the background infusion rate of patient-controlled intravenous analgesia (PCIA) was 2 mL/h, 1.5 mL/h, and 1 mL/h, respectively; the patient-controlled analgesia (PCA) dose was 2 mL, 1.5 mL, and 1 mL, respectively; the locking time was 15 min; and the visual analog scale (VAS) score of ≤ 3 was used as the effective analgesia. The operation and recovery times were recorded. Surgical plethysmography index (SPI) and blood glucose levels were recorded on admission, immediately after tracheal intubation, during skin cutting, during surgery for 1 h, and during skin suturing. Furthermore, the VAS and Bruggemann comfort scale (BCS) scores were recorded in the resting states of immediate consciousness and 6 h, 12 h, 24 h, and 48 h after the operation. The total fentanyl consumption, the effective times of PCIA compression, and the incidence of adverse drug reactions (nausea, vomiting, itching, sleepiness, and respiratory depression) were recorded during the operation and within 48 h after the operation. Results: No significant intergroup differences in terms of SPI and blood glucose levels (p > 0.05) were observed. No statistically significant difference in VAS and BCS scores was found after operation (p > 0.05). The intraoperative and postoperative fentanyl doses and the amount of effective PCA decreased in all groups (p < 0.05). There were no significant differences in the incidence of adverse reactions within 48 h after surgery between all groups (p > 0.05). Conclusion: This study suggests that it is feasible to use individualized application of fentanyl according to CYP3A4 and CYP3A5 genotypes
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