Articles: operative.
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This study aimed to characterize the sensory responses observed when electrically stimulating the white matter surrounding the posterior insula and medial operculum (PIMO). We reviewed patients operated on under awake conditions for a glioma located in the temporoparietal junction. Patients' perceptions were retrieved from operative reports. ⋯ Heat sites were located in the thalamo-OP1 tract. In the 227 awake surgeries performed for a tumor located outside of the PIMO region, no patients ever reported pain or heat sensations when stimulating the white matter. Thus, we propose that the thalamo-PIMO connections constitute the main cortical inputs for nociception and thermoception and emphasize that preserving these fibers is of utmost importance to prevent the postoperative onset of a debilitating insulo-opercular pain syndrome.
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Minerva anestesiologica · Mar 2024
Randomized Controlled TrialEffects of erector spinae plane block on opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy: a randomized controlled trial.
The erector spinae plane block is a relatively new regional anesthesia technique that is expected to provide some benefits for postoperative analgesia. This study investigated the effects of erector spinae plane block on postoperative opioid consumption in kidney donors undergoing hand-assisted laparoscopic donor nephrectomy for renal transplantation. ⋯ Preoperative erector spinae plane block is not an effective strategy for reducing postoperative pain or opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy. Different block combinations are needed for optimal pain management in hand-assisted laparoscopic donor nephrectomy.
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Anesthesia and analgesia · Mar 2024
Randomized Controlled TrialInfluence of Intravenous S-Ketamine on the Pharmacokinetics of Oral Morphine in Healthy Volunteers.
Subanesthetic ketamine may reduce perioperative consumption of opioids. We studied whether intravenous S-ketamine alters the pharmacokinetics of oral morphine in healthy volunteers. ⋯ Intravenous S-ketamine inhibited the metabolism of oral morphine and delayed its absorption, resulting in a net reduction in the exposure to morphine during the first 1.5 hours. Intravenous S-ketamine may delay the absorption and impair the efficacy of orally administered analgesics and other drugs.
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To assess postoperative pain intensity in adults, the numeric rating scale (NRS) is used. This scale has shown acceptable psychometric features, although its scale properties need further examination. We aimed to evaluate scale properties of the NRS using an item response theory (IRT) approach. ⋯ Response categories on the NRS are ordered but have different widths. The interval scale properties of the NRS should be questioned. In dealing with missing linearity in pain intensity ratings using the NRS, IRT methods may be helpful.
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Anesthesia and analgesia · Mar 2024
Observational StudyMelanin-Concentrating Hormone Is Associated With Delayed Neurocognitive Recovery in Older Adult Patients With Preoperative Sleep Disorders Undergoing Spinal Anesthesia.
Aging and preoperative sleep disorders are the main risk factors affecting postoperative cognitive outcomes. However, the pathogenesis of delayed neurocognitive recovery after surgery remains ambiguous, and there is still a lack of potential biomarkers for delayed neurocognitive recovery in older adult patients with preoperative sleep disorders. Our study aimed to explore the relationship between melanin-concentrating hormone (MCH) and delayed neurocognitive recovery early after surgery in older adult patients with preoperative sleep disorders. ⋯ In older adult patients with preoperative sleep disorders, MCH is associated with the occurrence of delayed neurocognitive recovery after surgery. Preoperative testing of CSF MCH or plasma MCH may increase the likelihood of identifying the high-risk population for delayed neurocognitive recovery in older adult patients with preoperative sleep disorders.