Complex spinal surgery is associated with significant postoperative pain. The purpose of this paper is to review recent literature on postoperative pain management in adult and adolescent patients ...having complex spinal surgery.
We conducted a literature search using the Medline database for relevant publications from 2020 to 2022 on postoperative pain after complex spinal surgery. Although opioids remain the mainstay to manage pain after complex spinal surgery, they are associated with adverse effects. Multimodal analgesia may be used to reduce these adverse effects by combining different drugs targeting different parts of the pain pathway. Recent publications suggest continuous low dose fentanyl or morphine infusion, methadone, intravenous paracetamol and ibuprofen, ketorolac, ketamine, magnesium infusion, lidocaine infusion and dexmedetomidine appear to be effective and safe to manage pain after complex spinal surgery. Regional techniques including bilateral erector spinae block, interfascial plane block and intrathecal morphine also appear to be effective and safe.
Pain management after complex spinal surgery remains challenging. Therefore, further studies are still required to determine the optimal multimodal analgesic regimen for these patients.
The purpose of this article is to review the practice of sedation for adults having gastrointestinal endoscopy in Australia and to compare it with practice in other countries.
The practice of ...sedation for endoscopy in Australia is dominated by anaesthesiologists, who have a preference for deep propofol-based sedation. The recent literature includes a number of guidelines for sedation developed by multidisciplinary groups, anaesthesiologists and gastroenterologists in Australia and other countries. The appropriate health practitioner to provide deep sedation and general anaesthesia, to use propofol for sedation and to manage higher risk patients remains controversial. The estimated risks associated with endoscopy vary by provider, sedation technique and study design (prospective or retrospective, single- or multicentre). New airway management techniques are being investigated that may be useful in patients at high risk of hypoventilation and hypoxia.
Endoscopy sedation is safe but more high-quality, multicentre observer-blinded randomized controlled trials are required.
LiMn x Fe 1−x PO 4 is a promising positive electrode material for Li-ion batteries. In order to understand the failure mechanisms of this material, LiMn 0.8 Fe 0.2 PO 4 /graphite pouch cells were ...cycled at 40 or 55 °C over three voltage ranges: 2.5–3.6 V (Fe plateau), 3.6–4.2 V (Mn plateau), and 2.5–4.2 V (full voltage range). Cells cycled at higher temperature and over the full voltage range had the highest capacity fade. Differential voltage analysis showed that cells cycled over the Mn plateau and full voltage range had the highest Li inventory loss, and there was no active mass loss in any of the cells. Micro X-ray fluorescence spectroscopy showed that cells with higher levels of Mn deposition on the negative electrode had higher Li inventory loss. Constant voltage storage experiments at 55 °C showed rapid capacity loss for cells held at top of charge. Despite having similar Li inventory loss trends to the cycled cells, there was less Mn deposition on the negative electrodes. Thus, the capacity fade mechanisms are different for cells that undergo cycling and storage.
Reason for withdrawal from publication
July 2016
Owing to the age, retraction of studies (Lehmann 2001; Lehmann 2002; Triem 2006), and possible errors in the conversion of dose for the purpose of ...analysis the decision has been reached to withdraw the review from the CDSR pending update and amendment of the review.
A systematic review of clinical trials confirms that including nitrous oxide in the gas mixture for general anaesthesia has minor short-term benefits and does not impact most patient safety outcomes. ...However, no risk-benefit analysis of nitrous oxide should ignore its known environmental effects. If continued nitrous oxide use is supported, strategies to minimise and monitor the contribution of medical nitrous oxide to global warming are vital.
Postoperative hypotension is common after major surgery and is associated with patient harm. Vasopressors are commonly used to treat hypotension without clear evidence of benefit. We conducted a ...systematic review to better understand the use, impact, and rationale for vasopressor administration after noncardiac, non-obstetric surgery in adults.
We conducted a prospectively registered systematic review. Cochrane CENTRAL, EMBASE, MEDBASE, and MEDLINE were searched for RCTs and cohort studies of adult patients receiving vasopressors after noncardiac, non-obstetric surgery. Study quality was critically appraised by two investigators. Findings from the review were synthesised, but formal meta-analysis was not performed because of significant variability in study populations and outcomes.
A total of 3201 articles were screened, of which seven RCTs, two prospective cohort studies, and 15 retrospective cohort studies were included in the analysis (24 in total). One study was graded as high quality, two as moderate quality, and the remaining 21 as low quality. Sixteen studies relied on clinical assessment alone to decide on therapeutic interventions. Vasodilation was the most common suggested physiological disturbance. The median proportion of patients receiving vasopressors was 42% (interquartile range: 11.5–74.7%). Norepinephrine was the most common vasopressor used.
The evidence supporting the use of vasopressors to treat postoperative hypotension is limited. Future research should focus on whether vasodilatation or other physiological disturbance is driving postoperative hypotension to allow rational decision-making.
Factors influencing quality of recovery in cranial and spinal neurosurgical patients are not known, possibly because of lack of a suitable instrument. Therefore, the authors measured quality of ...recovery using the QoR-40 score (a 40-item questionnaire on quality of recovery from anesthesia).
With informed consent, 200 patients undergoing elective neurosurgery were recruited. The QoR-40 score, visual analog scores for pain and quality of recovery, and data on complications were collected over 90 days. The psychometrics of the QoR-40 were tested and regression models were developed to determine predictors of quality of recovery and postoperative pain.
The QoR-40 score demonstrated significant responsiveness, validity, and reliability. In cranial surgery patients, QoR-40 scores were lower on days 1 and 2 than either preoperatively or on days 3, 30, and 90. In spinal surgery patients, QoR-40 scores were lower preoperatively and on days 1 and 2 than on days 3, 30, and 90. Longer duration of surgery, more complications, and higher visual analog scores for pain were predictors of poor quality of recovery on day 3. Cranial surgery patients had moderately severe pain on days 1 and 2, whereas spinal surgery patients reported moderate pain for the whole study period. Neurologic deficits were negatively correlated with QoR-40 scores in cranial and spinal surgery patients.
The QoR-40 score is a useful instrument with which to assess quality of recovery in cranial and spinal surgery patients. Postoperative pain and neurologic deficits correlate with poor quality of recovery in these patients.
We conducted a cohort study of adult patients presenting for orthopaedic trauma surgery at a statewide trauma centre, with the aims of determining (i) the incidence and risk factors for severe acute ...pain in the PACU, and (ii) the incidence and risk factors for persistent post-surgical pain at 3 months.
Data were collected before operation, in the PACU, 72 h after surgery and 3 months after surgery, and included numerical rating scale (NRS) scores for pain, and modified Brief Pain Inventory-Short Form, Kessler Psychological Distress Scale, World Health Organization Disability Assessment Schedule, and Pain Catastrophizing Scale scores.
Severe acute pain in the PACU was reported by 171 (56%; 95% confidence interval CI: 51%, 62%) of the 303 included patients. Female sex (odds ratio OR: 1.86; 95% CI: 1.06, 3.26) and prior post-injury surgery (OR: 2.21; 95% CI: 1.11, 4.41) remained associated with severe acute pain after multivariable adjustment. Persistent post-surgical pain at 3 months was reported by 149 (65%; 95% CI: 59%, 71%) of the 229 included patients. The preoperative NRS score (OR: 1.17; 95% CI: 1.03, 1.32) remained associated with persistent pain after multivariable adjustment.
We identified three easy-to-measure risk factors: female sex, prior post-injury surgery for severe acute pain, and preoperative NRS scores for persistent pain. Further research is required to identify pain management strategies and psychosocial interventions to reduce the burden of pain, disability, and distress in these patients.
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