Effects of local infiltration of analgesia and tranexamic acid in total knee replacements: safety and efficacy in reducing blood loss and comparability to intra-articular tranexamic acid

INTRODUCTION@#The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA).@*METHODS@#A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured.@*RESULTS@#Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups.@*CONCLUSION@#Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses / Influência da composição do cimento endodôntico na dor pós-operatória de dentes permanentes tratados endodonticamente: uma revisão sistemática e meta-análise

Postoperative pain is a frequent complication after root canal treatment. Its management is an important aspect of endodontic practice. Some treatment-related parameters were associated with the development of postoperative pain, including the sealer composition and extrusion. Objective: This systematic review aimed to answer the clinical question: Do root canal sealers composition influence postoperative pain after endodontic treatment of permanent teeth? Material and Methods: Electronic searches were conducted in PubMed, Scopus, Web of Science, Cochrane, LILACS, and grey literature databases until September 2021. The studies were qualitatively assessed using the RoB2 tool (Cochrane) and the certainty of evidence (GRADE). Sensitivity and pooled estimates were calculated using a random-effects model. Twelve articles were included. Results: The risk of bias was high in one study, low in nine, and two had some concerns. Qualitative analyses showed no influence of sealer extrusion on postoperative pain. Meta-analyses showed no significant difference in postoperative pain with moderate to very low levels of certainty between AH Plus and calcium silicate-based sealers, in a 95% confidence interval. Analysis between AH Plus, Zinc Oxide and Eugenol (ZOE), and calcium hydroxide (Ca(OH)2)-based sealers were not performed due to heterogeneity and lack of data. Conclusion: Literature showed contrasting results in postoperative pain between AH Plus and ZOE-based sealers, with low to moderate certainty of evidence. Regarding Ca(OH)2-based sealers, a single study with a low level of certainty concluded that AH Plus presented less postoperative pain than Apexit Plus. Therefore, further studies are needed to assess the influence of these sealers on postoperative pain. Evidence showed no difference in postoperative pain between AH Plus and calcium silicate-based sealers. Sealer extrusion is a variable that requires further studies (AU)

A dor pós-operatória é uma complicação frequente após o tratamento endodôntico. O seu manejo é um importante aspecto na prática endodôntica. Algumas variáveis relacionados ao tratamento foram associados com o desenvolvimento da dor pós-operatória, incluindo a composição e extrusão dos cimentos endodônticos. Objetivo: Esta revisão sistemática objetivou responder a seguinte pergunta clínica: A composição dos cimentos endodônticos podem influenciar a dor pós-operatória de dentes permanentes tratados endodonticamente?Material e Métodos: Buscas eletrônicas foram realizadas nas bases de dados no PubMed, Scopus, Web of Science, Cochrane, LILACS, e literatura cinzenta até setembro de 2021. Os estudos foram avaliados qualitativamente usando a ferramenta RoB2 (Cochrane) e a certeza de evidência (GRADE). A sensibilidade e as estimativas agrupadas foram calculadas usando um modelo de efeitos aleatórios. Doze artigos foram incluídos. Resultados: O risco de viés foi alto em um estudo, baixo em nove e dois tiveram algumas preocupações. A análise qualitativa mostrou que não há influência da extrusão do cimento na dor pós-operatória. A meta-análise mostrou que não houve diferença estatisticamente significante na dor pós-operatória entre o AH Plus e os cimentos a base de silicato de cálcio com moderada a muito baixa certeza de evdência. Análises entre os cimentos AH Plus, óxido de zinco e eugenol (OZE) e hidróxido de cálcio não foram realizados devido a heterogeneidade e falta de dados. Conclusão:A literatura sugere resultados contrastantes com relação a dor pós-operatória e entre os cimentos AH Plus e OZE, com baixa a moderada certeza de evidência. Já os cimentos a base de hidróxido de cálcio, um único estudo com baixa certeza de evidência concluiu que o AH Plus apresentou menos dor pós tratamento endodôntico do que o Apexit Plus. Portanto,mais estudos são necessários para avaliar a influência desses tipos de cimentos na dor pós-operatória. Com relação ao cimento AH Plus e os cimentos a base de silicato de cálcio não houve diferença estatística entre eles e a dor. A extrusão dos cimentos é uma variável que requer mais estudos (AU)

Progress on study of factors influencing the prognosis and complications of surgery for discoid meniscus injury in children / 中国骨伤

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Postoperative analgesic efficacy of nefopam after anorectal surgery: a retrospective observational study

Objective: To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries. Methods: We retrospectively reviewed the electronic medical records of patients who underwent anorectal surgeries from January 2019 to March 2022 at two medical centers. The data were divided into nefopam and conventional groups. The primary outcome was the number of patients who requested additional opioids in the 24-h postoperative period. The secondary outcomes were numeric rating pain scores (NRPS) within a 24-h postoperative period and analgesic drugs-related side effects. Results: Eighty-seven patients in the conventional group and 60 in the nefopam group were recruited. The nefopam group reported less additional opioid consumption than the conventional group in all dimensions of analysis, including overall, adjusted to anesthetic techniques and types of surgery. However, these did not reach statistical significance (P = 0.093). Only patients in the nefopam group who underwent hemorrhoidectomy under TIVA or spinal anesthesia significantly required fewer additional opioids (P = 0.016, 60% mean difference). Similarly, the 24-h postoperative morphine consumption was lower in the nefopam group (mean difference = -3.4, 95%CI: 0.72,6.08). Furthermore, significantly lower NRPS were reported in the nefopam group during the 12-18 h postoperative period (P = 0.009). On the other hand, analgesic drugs related side effects were similar in both groups. Conclusions: The administration of nefopam after major anorectal surgery is beneficially evident in reducing postoperative opioid requirements. (AU)

Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial

Abstract Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidec-tomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.

Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract Background: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. Methods: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. Conclusion: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO registration: CRD42022339628 PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID=339628

Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Quadratus Lumborum block as primary anesthetic technique for colostomy procedure: a case report

Abstract An elderly patient was admitted to the hospital due to an enterovesical fistula and a terminal colostomy was proposed. The patient had a high anesthetic risk and thus a quadratus lumborum block was chosen as the sole anesthetic technique. This block has been described to provide both somatic and visceral analgesia to the abdomen. In fact, it yielded good anesthetic conditions to perform the procedure and allowed the patient to be hemodynamically stable and comfortable throughout the case. The postoperative period was uneventful.

La recuperación mejorada después de la cirugía, una necesidad del ahora / Enhanced Recovery After Surgery, a Current Need

Estimado editor: El protocolo de recuperación optimizada Enhanced Recovery After Surgery (ERAS)® se inició como un proyecto del autor y del profesor Kenneth Fearon de Edimburgo, en el Reino Unido en 2001.1,2 ERAS® es un conjunto de estrategias multimodales perioperatorias basadas en la evidencia, y cuya finalidad es reducir el estrés metabólico causado por el trauma quirúrgico y por apoyar la recuperación temprana del paciente. Actualmente abarca todas las cirugías abdominales mayores, las de cabeza y cuello, cardíacas y torácicas.3,4) Antes de la llegada de los protocolos ERAS, los grupos quirúrgicos tenían sus propios programas de fast track, consistían en el alivio del dolor, la alimentación y la movilización tempranas y la disminución del estrés con la anestesia regional.3 La Sociedad ERAS® estableció desde el principio que los protocolos por sí solos no eran suficientes para poder aplicarlos en lugar de los cuidados tradicionales, por lo cual se designaron centros de excelencias, encargados de implementar los programas y contribuir a su desarrollo y difusión en la región; ejemplo fiel de ello es el ERAS LatAm,3 capítulo latinoamericano de la Sociedad ERAS, que abarca...(AU)

Acupuntura: intervenção terapêutica natural para controle dos efeitos adversos do pós-operatório / Acupuncture: natural therapeutic intervention to control adverse effects post-operative / Acupuntura: intervención terapéutica natural para el control efectos adversos postoperatorios

Apesar da evolução da tecnologia minimamente invasiva com procedimentos cirúrgicos extremamente seguros, são recorrentes no período pós-operatório complicações como dor, náusea, vômito, cefaleia, sonolência e depressão respiratória, sendo estes os principais motivos de internações hospitalares prolongadas. A pesquisa da Acupuntura reveste-se portanto de grande interesse, na medida em que poderá traduzir estes conhecimentos milenares, contribuindo para sua aceitação e incorporação no âmbito hospitalar e ambulatorial... (AU)

Despite the evolution of minimally invasive technology with extremely safe surgical procedures, complications such as pain, nausea, vomiting, headache, drowsiness and respiratory depression are recurrent in the postoperative period, being the main reasons for prolonged hospitalizations. A Research in acupuncture is, therefore, of great interest, as it can translate this ancient knowledge, contributing to its acceptance and incorporation in hospital and outpatient settings... (AU)

Apesar de la evolución de la tecnología mínimamente invasiva con procedimientos quirúrgicos extremadamente seguros, complicaciones como dolor, náuseas, vómitos, cefalea, somnolencia y depresión respiratoria son recurrentes en el postoperatorio, siendo los principales motivos de estancia hospitalaria prolongada. Por lo tanto, la investigación en acupuntura es de gran interés, ya que puede traducir este conocimiento antiguo, contribuyendo a su aceptación e incorporación en entornos hospitalarios y ambulatorios.

Actualización en analgesia preventiva y analgesia multimodal / Update on preventive analgesia and multimodal analgesia

Una deficiente calidad del manejo del dolor post operatorio agudo genera aumento en la morbilidad perioperatoria, disminuye la calidad de vida del paciente, aumenta los reingresos hospitalarios y, finalmente, los costes en salud. La analgesia preventiva y multimodal son dos estrategias que han sido implementadas para tratar de optimizar el manejo del dolor. Si bien en la primera, la evidencia es favorable a su empleo, aún no existe un total consenso en esto. A su vez, la analgesia multimodal, al emplear diferentes fármacos y/o técnicas, ha logrado evidenciar de mejor manera su utilidad y los beneficios al implementarla como terapia. En este artículo, revisamos la evidencia que certifica y avala el uso de éstas. Finalmente, a nuestro parecer, lo más importante en el quehacer del clínico, es lograr individualizar la estrategia que usaremos en el manejo del dolor postoperatorio, adaptándonos a las necesidades y el contexto propio de cada uno de nuestros pacientes.

A poor quality of acute postoperative pain management generates an increase in perioperative morbidity, decreases the quality of life of the patient, increases hospital readmissions and finally, increases health costs. Preventive and multimodal analgesia are two strategies that are implemented to try to optimize pain management. Although in the first, the evidence is favorable to its use, there is still no total consensus. At the same time, multimodal analgesia, by using different drugs and/or techniques, has demonstrated, in a better way, its usefulness and benefits when implemented as a therapy. In this article, we review the evidence that certifies and supports the use of these techniques. Finally, in our opinion, the most important thing in the clinician's task is to be able to individualize the strategy that we will use in postoperative pain management, adapting to the needs and context of each one of our patients.

Ultrasound-guided continuous costoclavicular block through retrograde stimulating catheter technique for postoperative analgesia in shoulder surgery: a case series

Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

Evaluación del dolor crónico postoperatorio en hernioplastia TAPP versus Lichtenstein por Residentes / Evaluation of chronic postoperative pain in hernioplasty Tapp versus Lichtenstein by residents

La incidencia de la hernia inguinal a lo largo de la vida es variable, pero con una mayor prevalencia en los hombres. Hoy en día no existe una técnica superior en términos de reducir el dolor postoperatorio crónico, que es la mayor morbilidad que afecta a los pacientes. Es por eso que realizamos un breve análisis comparativo, donde evaluamos la incidencia de dolor crónico entre el ensayo convencional versus laparoscópico de la patología de la hernia

The incidence of inguinal hernia throughout life is variable, but with a higher prevalence in males. Today there is no superior technique in terms of reducing chronic postoperative pain, which is the greatest morbidity that afflicts patients. That is why we carried out a brief comparative analysis, where we evaluated the incidence of chronic pain between conventional versus laparoscopic rehearsal of hernia pathology

Percepção dos cuidadores frente a dor pós-operatória pediátrica e cuidados de enfermagem / Percepición de los cuidadores sobre el dolor posoperatorio pediátrico y los cuidados de enfermería / Caregivers' perception of pediatric postoperative pain and nursing care

Objetivo: descrever a percepção dos cuidadores frente a dor pós-operatória pediátrica e cuidados de enfermagem. Método: estudo descritivo, realizado na Unidade de Pediatria de um Hospital Universitário no Paraná com dados coletados mediante formulário sociodemográfico e questionário de Dor de MCGill-Melzack adaptado e análise a partir de estatística descritiva. Resultados: participaram do estudo 24 cuidadores de crianças submetidas a intervenções cirúrgicas, predominantemente, mulheres (22), preponderando as crianças do sexo masculino. Os resultados apresentaram maior utilização de dipirona como analgesia (50%), tendo a maioria dos cuidadores descrito a dor como breve (33,3%). O principal comportamento de dor relatado foi choro (35%). De forma geral, os cuidadores classificaram a assistência de enfermagem como muito boa ou excelente. Conclusão: o profissional de enfermagem, reconhece a dor como um evento importante e presta assistência. O estudo incita a necessidade de padronização de instrumentos de avaliação e manejo da dor pediátrica pós-operatória.

Objective: to describe the perception of caregivers regarding pediatric postoperative pain and nursing care.Method:descriptive study, carried out at the Pediatrics Unit of a University Hospital in Paraná with data collected using a sociodemographic form and an adapted MCGill-Melzack Pain questionnaire and analysis based on descriptive statistics. Results: 24 caregivers of children undergoing surgical interventions participated in the study, predominantly women (22), with a predominance of male children. The results showed a greater use of dipyrone as analgesia (50%), with most caregivers describing the pain as brief (33.3%). The main reported pain behavior was crying (35%). In general, caregivers rated nursing care as very good or excellent.Conclusions: the nursing professional recognizes pain as an important event and provides assistance. The study highlights the need for standardization of postoperative pediatric pain assessment and management instruments.

Objetivo: describir la percepción de los cuidadores sobre el dolor posoperatorio pediátrico y el cuidado de enfermería. Método: estudio descriptivo, realizado en la Unidad de Pediatría de un Hospital Universitario de Paraná con datos recolectados mediante formulario sociodemográfico y cuestionario MCGill-Melzack Pain adaptado y análisis con base en estadística descriptiva. Resultados: participaron del estudio 24 cuidadores de niños sometidos a intervenciones quirúrgicas, predominantemente mujeres (22), con predominio de niños varones. Los resultados mostraron un mayor uso de dipirona como analgesia (50%), con la mayoría de los cuidadores describiendo el dolor como breve (33,3%). La principal conducta de dolor reportada fue el llanto (35%). En general, los cuidadores calificaron la atención de enfermería como muy buena o excelente. Conclusiones: el profesional de enfermería reconoce el dolor como un evento importante y brinda asistencia. El estudio destaca la necesidad de estandarizar los instrumentos de evaluación ymanejo del dolor pediátrico posoperatorio.

Efficiency of topical ozone gel as an adjunct to antibiotics and analgesics on sequelae after extraction of impacted mandibular third molar / Eficiencia del gel de ozono tópico como complemento de antibióticos y analgésicos en las secuelas tras la extracción del tercer molar mandibular impactado

Introduction: Extraction of the impacted mandibular third molar is a common procedure in dentistry. Many complications may arise after this operation, the most common being pain, trismus, and swelling. Systemic medications have been used in an attempt to manage these problems, but because of their side effects, the need for non-medication treatment arises to treat these complications without side effects, such as cryotherapy, ice packs, low-level laser therapy, and ozone. Ozone is one of the most effective antimicrobials used in the dentistry field, and it also has a positive effect on soft tissue healing, activates cellular metabolism, and can react with blood components; for these reasons ozone is used to manage trismus, swelling, and pain after removal of the mandibular third molar. Aim: The purpose of the study was to assess the effects of topical ozone gel on complications from the extraction of the impacted mandibular third molar. Materials and Methods: Thirty patients were enrolled in the current study and were randomly divided into two equal groups. Preoperatively clinical examination included measurement of facial swelling measurements and maximum mouth opening. The position and configuration of the impacted lower third molar, the surrounding bone, the mandibular canal, and the neighboring tooth were all assessed using a panoramic X-ray. On days 2 and 7, after surgery, the facial swelling dimensions and maximum mouth opening were again assessed. Statistics were used to analyze results. Results: Findings indicate statistical significance for pain, but not for swelling or mouth opening. Conclusions: After lower third molar surgery, topical ozone gel helps reduce postoperative pain.

Introducción: La extracción del tercer molar mandibular retenido es un procedimiento común en odontología. Pueden surgir muchas complicaciones después de esta operación, siendo las más comunes dolor, trismo y edema. Se han utilizado medicamentos sistémicos en un intento de controlar estos problemas, pero debido a sus efectos secundarios, surge la necesidad de tratamientos sin medicamentos para tratar estas complicaciones sin efectos secundarios, como crioterapia, bolsas de hielo, terapia con láser de baja intensidad y ozono. El ozono es uno de los antimicrobianos más eficaces utilizados en el campo de la odontología, además tiene un efecto positivo en la cicatrización de los tejidos blandos, activa el metabolismo celular y puede reaccionar con los componentes sanguíneos; Por estas razones, el ozono se utiliza para controlar el trismo, la hinchazón y el dolor después de la extracción del tercer molar mandibular. Objetivo: El propósito del estudio fue evaluar los efectos del gel de ozono tópico sobre las complicaciones de la extracción del tercer molar mandibular impactado. Materiales y Métodos: Se inscribieron treinta pacientes en el estudio actual y se dividieron aleatoriamente en dos grupos iguales. El examen clínico preoperatorio incluyó la medición de la hinchazón facial y la apertura máxima de la boca. La posición y configuración del tercer molar inferior impactado, el hueso circundante, el canal mandibular y el diente vecino se evaluaron mediante una radiografía panorámica. Los días 2 y 7, después de la cirugía, se evaluaron nuevamente las dimensiones de la hinchazón facial y la apertura máxima de la boca. Se utilizaron estadísticas para analizar los resultados. Resultados: Los hallazgos indican significación estadística para el dolor, pero no para la hinchazón o la apertura de la boca.Conclusión: Después de la cirugía del tercer molar inferior, el gel de ozono tópico ayuda a reducir el dolor postoperatorio.

Efficacy of serratiopeptidase in third molar surgery: a systematic review and meta-analysis / Eficacia de la serratiopeptidasa en cirugía del tercer molar: una revisión sistemática y un metanálisis

Objective: To determine the efficacy of serratiopeptidase in third molar surgery. Materials and Methods: A bibliographic search was carried out until April 2022, in the biomedical databases: Pubmed/Medline, Cochrane Central Registry of Clinical Trials, Scopus, Scielo and Google Scholar. Studies reporting the ef-ficacy of serratiopeptidase in third molar surgery, which were randomized clinical trials, in English and without time limits, were included. The RoB 2.0 tool was used to assess the risk of the included studies and the GRADEPro GDT tool to assess Results: The preliminary search yielded a total of 116 articles, discarding those that did not meet the selection criteria, leaving only 10 articles. Six articles entered a meta-analysis and found that serratiopeptidase reduces trismus but not reduce inflammation and pain after third molar surgery. Conclusions: The literature reviewed suggests that ser-ratiopeptidase is effective in reducing trismus after third molar surgery.

Objetivo: Determinar la eficacia de la serratiopeptidasa en la cirugía del tercer molar. Materiales y Métodos: Se realizó una búsqueda bibliográfica hasta abril de 2022, en las bases de datos biomédicas: Pubmed/Medline, Registro Cochrane Central de Ensayos Clínicos, Scopus, Scielo y Google Scholar. Se incluyeron estudios que reportaron la eficacia de la serratiopeptidasa en cirugía de terceros molares, que fueron ensayos clínicos aleatorios, en inglés y sin límite de tiempo. Se utilizó la herramienta RoB 2.0 para evaluar el riesgo de los estudios incluidos y la herramienta GRADEPro GDT para evaluar la calidad de la evidencia y la fuerza de recomendación de los resultados. Resultados: La búsqueda preliminar arrojó un total de 116 artículos, descartando aquellos que no cumplieron con los criterios de selección, quedando solo 10 artículos. Seis artículos participaron en un metanálisis y encontraron que la serratiopeptidasa reduce el trismo, pero no reduce la inflamación y el dolor después de la cirugía del tercer molar. Conclusión: La literatura revisada sugiere que la serratiopeptidasa es efectiva para reducir el trismo después de la cirugía del tercer molar.

Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events. Methods MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity. Results The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable. Conclusion There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.