Chronic Pregabalin Treatment and Oxycodone Requirement after Spinal Surgery Versus Short Course Perioperative Administration: A Prospective, Nonrandomized Study.

BACKGROUND: Although being controversial, pregabalin (PGB) is proposed during a short perioperative period  to improve pain relief.Comparisons between chronic and short-term users during lumbar spine surgery are lacking. OBJECTIVES: The purpose was to compare opioid requirements and postoperative pain among PGB chronic users and naive patients receiving a 48-hour perioperative administration. STUDY DESIGN: Prospective nonrandomized study. SETTING: Tertiary care hospital. METHODS: Chronic users (group PGB, n = 39) continued their treatment, naive patients (group C, n = 43) received a dose of 150 mg preoperatively and 75 mg/12 hours for 48 hours. Anesthesia and analgesia were standardized. The primary outcome was the cumulative oxycodone consumption at 24 hours, other outcomes included pain scores, DN4 (Douleur Neuropathique 4 Questions) scores, and side effects. RESULTS: Group PGB consumed less oxycodone at 24 hours (median [interquartile range] 10 mg [10-17.5] vs. 20 mg [10-20], P = 0.013], at 48 hours (15 mg [10-20] vs. 20 mg [12.5-30], P = 0.018), and required less intraoperative remifentanil (P = 0.004). Both groups showed similar pain scores during the 48-hour follow-up and at 3 months.Based on multivariate analysis, chronic users of PGB before surgery exhibited lower oxycodone requirements at 24 hours (odds ratio, 3.98; 95% confidence interval, 1.44-7.74; P = 0.008]. No differences were noted regarding side effects and DN4 scores. LIMITATIONS: Nonrandomized study. CONCLUSIONS: Patients chronically treated with PGB required less opioid when compared with a short perioperative administration before spinal surgery. Further prospective studies are required to confirm these results in spinal surgeries.

A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy.

INTRODUCTION: Postoperative pain, nausea and vomiting are frequent symptoms after tonsillectomy. There have been controversies concerning the advantages and drawbacks of different analgesics in this setting, especially non-steroidal anti-inflammatory drugs, because of potential side effects. We have evaluated the effectiveness and safety of a shift from prednisolone to ibuprofen for postoperative analgesia after tonsillectomy. PATIENTS AND METHODS: Data from 1231 children scheduled for tonsillectomy over a period of 30 months were analysed. During the first period, children received a combination of paracetamol-prednisolone with codeine as a rescue therapy; in the second period, they received paracetamol and ibuprofen, with tramadol as a rescue therapy. All children received IV dexamethasone at 0.1mg/kg for antiemetic prophylaxis. The primary end-point was the incidence of severe pain defined as an Objective Pain Scale (OPS) score≥6 at the seventh postoperative day (POD7). Other end-points were postoperative nausea or emesis (PONV), sleep disturbance, oral intake and postoperative haemorrhage and reoperation. RESULTS: Six hundred and seventy-two and 559 children were included in the prednisolone and ibuprofen groups respectively. OPS scores≥6 were observed in 3.1% of cases (95% confidence interval, 2.3-4.2%) on POD7 for the entire study population. Ibuprofen reduced the incidence of OPS scores≥6 on POD7 (relative risk 0.37, 95% CI: 0.18-0.78; P=0.009), OPS scores in the ambulatory unit (P<0.001) and POD1 (P<0.001), nalbuphine requirements (RR 0.42, 95% CI, 0.34-0.5, P<0.0001), and PONV (P=0.01) compared with prednisolone. Ibuprofen enhanced sleep quality on POD0 (P<0.0001) and POD7 (P=0.02), and oral intake on POD1 (P<0.0001). The incidence of bleeding requiring reoperation was comparable between the two groups (RR 0.8 [95% CI, 0.13-4.78], p=0.8). Predictive factors for an OPS score≥6 at POD7 were OPS score>4 on the morning and the evening of POD1 (OR 1.24, 95% CI 1.02-1.49, P=0.03 and OR 1.30, 95% CI 1.12-1.55, P=0.008, respectively) and prednisolone use (OR 2.37, 95% CI 1.06-5.31, P=0.04). CONCLUSION: The administration of ibuprofen compared to prednisolone improves postoperative comfort in children undergoing ambulatory tonsillectomy without increasing the incidence of side effects.

Perineural ultrasound-guided catheter bacterial colonization: a prospective evaluation in 747 cases.

BACKGROUND AND OBJECTIVES: Ultrasound guidance is increasingly used for catheter insertion and could make it more complicated to guarantee aseptic insertion of catheters. The current study evaluated the incidence of colonization of ultrasound-guided perineural catheter (US-PNC) placed for postoperative analgesia. METHODS: We evaluated prospectively for 14 months 760 ultrasound-guided catheters in a single center placed under sterile conditions. Quantitative culture of all the catheters was performed after withdrawal. Colonization was defined as ≥10(3) colony-forming units/mL. Infection was defined as the isolation of the same microorganism from the colonized catheter and from blood culture and/or culture of an abscess. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors of US-PNC colonization. RESULTS: Incidences of colonization and infections were 10.4% (95% confidence interval [95% CI], 8.2%-14.4%) and 0.13% (95% CI, 0%-3.8%), respectively, in a total of 747 catheters. Coagulase-negative staphylococci colonization was documented in 69% of the colonized catheters. Local inflammation was more frequently noted when catheters were colonized (26.9% [95% CI, 15.2%-38.7%] versus 8.1% [95% CI, 4.2%-11.9%], P = 0.005). Independent factors for ultrasound-guided catheter colonization were duration of catheter placement more than 48 hours (odds ratio [OR], 4.9; 95% CI, 1.1-12.7; P = 0.003), diabetes (OR, 2.3; 95% CI, 1.4-9.6; P = 0.004), and antibiotic administration during the month preceding surgery (OR, 1.8; 95% CI, 1.5-7.8; P = 0.01). CONCLUSIONS: Although infection rate is low, there is a risk of ultrasound-guided catheter colonization that deserves careful monitoring of the insertion site in the postoperative period.