Background The complications of postoperative pain, such as hypertension, hypermetabolism, irritability, and postoperative cognitive dysfunction, significantly affect the postoperative rehabilitation of elderly patients. Intrathecal morphine prolongs analgesia after surgery, but has been implicated in nausea and vomiting, pruritus, postoperative respiratory depression, or apneic episodes. The present study explored the effect and safety of low-dose morphine used adjunctively with bupivacaine during single spinal anesthesia or sufentanil patient-controlled intravenous analgesia (PCIA) in elderly patients with hip fracture surgery. Since elderly patients often need anticoagulant therapy in the early postoperative period, single spinal anesthesia was involved in completing the operation in this study. Methods Eighty elderly patients aged 70–85 years who underwent elective hip fracture surgery with single spinal anesthesia were divided into two groups, 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of morphine (morphine group, group M) and 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of sufentanil PCIA (sufentanil group, group S). The analgesia scores using the visual analogue scale (VAS), the Brinell comfort scale (BCS) were evaluated at 6, 12, 24, and 48 h after operation, and adverse reactions were recorded such as nausea and vomiting, pruritus, sedation, respiratory depression, and POD (postoperative delirium) with Delirium Rating Scale-r 98. Results Within 24 h after operation, the analgesic and BCS scores of group M were better than those of group S (P < 0.05). Group M had higher frequency of skin pruritus than group S within 24 h, and the difference was statistically significant. The incidence of POD in group M (2 cases) was lower than that in group S (6 cases) (5.71% vs 18.18%) (P < 0.05) with the DRS-r 98 scores. No significant difference was observed in nausea and vomiting between the two groups, and the difference of severe respiratory depression was not found in both groups. Conclusion Compared with sufentanil PCIA, low-dose intrathecal morphine has a satisfactory analgesic effect, and little effect on the patient's cognitive function with low medical cost. Under effective respiratory monitoring, it can be used safely and effectively in elderly patients with hip fracture. Trial registration Registered with the Chinese Clinical Trial Registry under ChiCTR2100042706. 26/01/2021.

Background: Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients. Methods: The subjects were 60 elderly patients in our hospital (aged 65–80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L 3 – 4 . They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L 3 – 4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain). Results: No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) ( P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference ( P > .05). Conclusion: Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.

Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology: We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Among the 472 articles selected from the databases, based on abstract reading, 272 articles were excluded according to the criteria in Figure 1. After reading the complete text, among the 78 remaining articles, excluded were 15 articles with no relevant data about the outcome of restrictive fluid therapy for major abdominal surgery, 54 that were not RCTs, 2 that were meta-analyses, and 7 that were from the same trial. Finally, 11 RCTs published between 2000 and 2018 that compared restrictive fluid therapy with liberal fluid therapy were included. Two studies by the same team were taken as one trial and shared the same study number because some data from the two studies were complementary.. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: the current meta-analysis assessed the effects of restrictive fluid therapy in a meticulous way. Though the large proportional reduction in risk of complications as indicated in the previous literature was not confirmed, moderate but clinically notable reduction in complications is still worth our attention. The application of restrictive fluid therapy requires communication and cooperation between medical workers and patients. RCTs on restrictive fluid therapy with long-term follow-up are needed. Hospital costs and quality of life after surgery should also be taken into account. Furthermore, the benefits of restrictive fluid therapy in elderly patients and patients who have undergone other surgeries might be the focus of future research..

Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.