Efficacy of botulinum toxin injection using the right-sided unilateral retrocrural approach for celiac plexus in a cancer survivor with persistent abdominal pain: a case report.

Cancer survivors often face persistent abdominal pain, necessitating optimal pain management. While celiac plexus block (CPB) and botulinum toxin (BT) injection are viable options, traditional methods may encounter challenges due to patient-specific concerns and anatomical complexities. Here, the case of a cancer survivor in his 70 s experiencing recurrent abdominal pain, who declined conventional percutaneous CPB approaches due to anxiety related to aortic puncture, is presented. Following a pancreaticoduodenectomy, the patient developed chronic abdominal pain attributed to adhesions leading to small bowel obstruction. Concurrently, there was notable psychological distress, including anxiety, depression, and heightened concerns regarding tumor recurrence. Considering the patient's specific concerns, a right-sided unilateral retrocrural single-needle technique was proposed, aimed at alleviating pain, while avoiding conventional CPB approaches. Initial right-sided retrocrural CPB offered short-term relief, prompting a subsequent BT injection using the same approach. Following BT injection, the patient reported significant and sustained pain reduction (from 8 to 1 on an 11-point numerical rating scale) at both 12 and 20 weeks post-procedure. Right-sided retrocrural BT injection offers an alternative approach, addressing patient concerns and demonstrating prolonged pain relief. This may benefit cancer survivors with upper abdominal pain, emphasizing the importance of personalized and innovative pain management strategies.

Effects of thermal softening of endotracheal tubes on postoperative sore throat: A randomized double-blinded trial.

BACKGROUND: Postoperative throat complications after intubation are undesirable but frequent outcomes. A randomized, double-blinded study was performed to determine whether thermal softening of endotracheal tubes reduced throat complications after intubation. METHODS: Patients (n = 196) undergoing nasal surgery were randomly allocated into the control group and thermal softening groups. Sore throat and hoarseness were evaluated 1 and 24 hours after extubation. The severity of sore throat was evaluated using the numeric rating scale (NRS). The primary outcome was the incidence of sore throat 1 hour after extubation and sore throat was defined as a painful or scratchy feeling in the throat. The secondary outcomes were the incidence of hoarseness 1 hour after extubation, the incidence of sore throat and hoarseness 24 hours after extubation, severity of sore throat, and vocal cord injuries. RESULTS: The incidence of sore throat 1 hour after extubation was lower in the thermal softening group than in the control group (35.1% vs 52.7%, P = .02). Moreover, thermal softening decreased the mean NRS score for sore throat in the thermal softening group by 10% an hour after extubation (thermal softening group, 1.29 [95% CI, 0.88-1.70] vs control group, 2.33 [95% CI, 1.77-2.89]; P < .01). At 24 hours after extubation, the incidence of sore throat (38.3% vs 40.7%, P = .77) and hoarseness (34.0% vs 35.2%, 0.95 [0.52-1.74], P = .74) were comparable between the two groups. CONCLUSIONS: Intubation using endotracheal tubes with thermal softening significantly decreased the incidence of sore throat 1 hour after extubation when compared with endotracheal tubes without thermal softening.

Risk Factors of Postoperative Delirium in the Intensive Care Unit After Liver Transplantation.

BACKGROUND: Postoperative delirium after liver transplantation is relatively common, especially due to preexisting conditions such as hepatic encephalopathy. Most studies of delirium after liver transplantation were based on ICU practices using deep hypnosedation. Therefore, risk factors and consequences of postoperative delirium after liver transplantation were evaluated in the light sedation era. METHODS: A total of 253 liver transplantation patients were evaluated for postoperative delirium. Clinical outcomes including mortality were compared between patients who suffered delirium and those who did not. Risk factors for postoperative delirium were analyzed with subgroup analysis depending on MELD scores and type of liver transplantation. RESULTS: Post-liver transplant delirium developed in 17% of the patients, 88% of which occurred within the first postoperative day. Alcoholic liver cirrhosis, class C Child-Pugh score, higher MELD scores, higher proportion of deceased donor liver transplantation, and reintubation were more frequent in patients who developed delirium, but there was no difference in mortality. Higher preoperative MELD group (15-24 vs. <15; OR 4.10, 95% Cl [1.67-10.09], P = 0.002, ≥25 vs. <15; OR 5.59, 95% CI [2.06-15.19], P < 0.01), higher APACHE II scores (OR 5.59, 95% CI [2.06-15.19], P < 0.01), and reintubation (OR 6.46, 95% CI [2.10-19.88], P < 0.01) were identified as significant risk factors for postoperative delirium. CONCLUSION: Postoperative delirium after liver transplantation was associated with worse clinical outcomes. MELD scores greater than 15 were predictive of postoperative delirium in both living and deceased donor liver transplantation.