Rejected

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.

Background Total knee arthroplasty (TKA) is a procedure that has improved the quality of life of patients with knee arthritis. Postoperative pain and blood loss are the two major drawbacks of TKA which affect patient satisfaction and delay recovery and rehabilitation. Local infiltration analgesia has shown better results in controlling immediate postoperative pain, thus enabling early rehabilitation and mobilization, while local infiltration of antifibrinolytic agents has shown impressive results in controlling blood loss. In this study, we evaluate the effect of a combination of intra-articular infiltration of ropivacaine cocktail along with intra-articular instillation of tranexamic acid in reducing patient-reported postoperative pain and the level of blood loss control after TKA. Methodology Patients presenting with high-grade osteoarthritis and undergoing TKA were included and randomly allocated to two groups: one receiving the intra-articular infiltration (group A), and the other not receiving any infiltration (group B). Postoperative pain was measured through the Visual Analog Scale (VAS) every three hours for the first 24 hours, and then at 48 hours and 72 hours postoperatively. The need for additional analgesia, in the form of a slow epidural infusion, in patients experiencing severe postoperative pain was evaluated in both groups. Postoperative blood loss was assessed by measuring total drain output (in mL) and by comparing preoperative and postoperative (at 24 hours) hemoglobin, hematocrit drift, and blood transfusion rates. The duration of the postoperative hospital stay and the time taken to start postoperative knee mobilization exercises and weight-bearing were noted to assess the recovery and rehabilitation of the patients in the two groups. Results The study included 42 patients (group A, 22 patients; group B, 20 patients) with 28 knees in each group. Patients with intra-articular infiltration using ropivacaine cocktail with tranexamic acid showed excellent pain control compared to the non-infiltrated patients in the early 48 hours postoperatively. There was a significant drop in postoperative hemoglobin and hematocrit values in the non-infiltrated patients compared to the other group. Further, the intra-articular infiltration-instillation significantly reduced blood loss through the drain, the requirement of postoperative blood transfusions, and the duration of hospital stay. Conclusions It can be safely concluded that ropivacaine cocktail and tranexamic acid instillation postoperatively in knee arthroplasty patients is a very useful and effective technique to reduce postoperative pain and blood loss.

Mode of delivery and intrapartum analgesia for women with Chiari I malformation pose a challenge to the obstetrician and anaesthetist. Clinicians often advocate caesarean section delivery under general anaesthetic to prevent an uncontrolled rise in intracranial pressure or a fall in cerebrospinal fluid pressure during labour that may result in neurological complications, or rarely, brainstem herniation. This case report discusses a woman with hitherto undiagnosed Chiari I malformation who delivered by CS due to obstetric concerns, but remained asymptomatic throughout the preceding labour and in spite of multiple epidural insertion attempts. We discuss considerations for future pregnancies, and review the literature to challenge the view that women with Chiari I need planned caesarean or must avoid epidural/spinal analgesia; instead presenting evidence to support the safety and suitability of vaginal delivery and neuroaxial block in labouring parturients with this condition.

Breast cancer has become the most common malignancy worldwide. Experimental and, retrospective, clinical data indicate that anaesthetic technique might influence the risk of metastasis after cancer surgery by modulating the immune system. The purpose of this study is to investigate the effect of perioperative lidocaine injection on immune cells such as T lymphocytes and natural killer cells (NK cells) and the quality of postoperative recovery in breast cancer patients and to propose new ideas and relevant theoretical evidence for the selection of anesthetic protocols for perioperative tumor patients.

In this report, we assessed the effectiveness of erector spinae plane block for postoperative analgesia after kidney transplant.

Baimai is a complex of structure and function with the characteristics of wide distribution, complex structure, and multi-dimensional functions. Baimai, consisting of the channels in brain, the internal hidden channels connecting the viscera, and the external channels linking the limbs, governs the sensory, motor, and information transmission functions of human. According to Tibetan medicine, Baimai functions via "Long"(Qi) which moves in Baimai. "Long" is rough, light, cold, tiny, hard, and dynamic. The dysfunction of Baimai is manifested as numbness, swelling and pain, stiffness, atrophy, contracture, disability, hyperactivity, etc. The clinical manifestations of Baimai disease are facial paralysis, limb numbness, hemiplegia, contracture and rigidity, pain, opistho-tonos, paralysis, unconsciousness, head tremor, aphasia and tongue stiffness, and other abnormalities in facial consciousness, limb movement, and tactile sensation. Baimai Ointment for external use is used for the treatment of Baimai disease. It is mainly composed of medicinals which are spicy and bitter, warm, soft, mild, heavy, moist, and stable, and thus it is effective for the rough, light, cold, tiny, hard, and dynamic "Long" of Baimai disease. In clinical practice, it is mainly used for musculoskeletal diseases, such as osteoarthritis, scapulohumeral periarthritis, cervical spondylosis, low back pain, myofascitis, and tenosynovitis, nervous system diseases, such as paralysis and shoulder-hand syndrome, and limb stiffness caused by stroke, spastic cerebral palsy, trigeminal neuralgia, and facial neuritis, and limb motor and sensory dysfunction caused by trauma. According to the main symptoms of Baimai disease such as stiffness, rigidity, contraction, numbness, sensory disturbance and pain, clinicians should apply the Baimai Ointment via the inunction treatment of Tibetan medicine and in combination with Huo'ermai therapy and physiotherapy.

Cold hypersensitivity in the hands and feet (CHHF) is a disease characterized by abnormal cold in the limbs with limited treatment options. Compared to traditional drug therapy, lumbar sympathectomy is a new minimally invasive surgical method for treating CHHF.

Medically unexplained symptoms refers to a clinical syndrome characterized by somatic symptoms that cannot be reasonably explained by any organic disease. Chronic pain can be a type of medically unexplained symptom. The current treatment modalities for chronic pain mainly include drugs and psychotherapy. The use of stellate ganglion block for treatment of chronic pain has rarely been reported. Herein, we report a patient whose chronic pain was completely relieved after receiving a stellate ganglion block.

Genus Astragalus belongs to the family Fabaceae and is one among the largest genera consisting of around 3000 species. The plants have been used traditionally in treatment of various ailments in folklore. The study was planned to assess the analgesic and inflammatory activity of (Forssk.) Muschl extract of the stem.

We conducted a systematic review and meta-analysis comparing motor control, isometric, and isotonic trunk training intervention for pain, disability, and re-injury risk reduction in chronic low back pain patients. The EMBASE, MEDLINE, CENTRAL, PsycINFO, SPORTDiscus, and CINAHL databases were searched from inception until 25 February 2021 for chronic low back pain intervention based on any trunk training. Outcomes include the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for disability, the Numerical Pain Rating Scale (NPRS) for pain, and the Sorensen Test (ST) for future risk of re-injury. Isometric training was superior to the control with a mean difference (MD) = -1.66, 95% confidence interval (CI) [-2.30, -1.01] in pain reduction; MD = -7.94, 95% CI [-10.29, -5.59] in ODI; MD = -3.21, 95% CI [-4.83, -1.60] in RMDQ; and MD = 56.35 s, 95% CI [51.81 s, 60.90 s] in ST. Motor control was superior to the control with a MD = -2.44, 95% CI [-3.10, -1.79] in NPRS; MD = -8.32, 95% CI [-13.43, -3.22] in ODI; and MD = -3.58, 95% CI [-5.13, -2.03] in RMDQ. Isometric and motor control methods can effectively reduce pain and disability, with the isometric method reducing re-injury risk.