The effects of acupuncture after thyroid surgery: A randomized, controlled trial.

BACKGROUND: Acupuncture is a safe and well-tolerated treatment for pain relief. Previous studies supported the effectiveness of several acupuncture techniques for postoperative pain. The aim of this randomized, controlled trial was to evaluate the efficacy of acupuncture in reducing pain after thyroid surgery. METHODS: We randomized 121 patients to a control group (undergoing only standard postoperative analgesic treatment with acetaminophen) and an acupuncture group, undergoing also either electroacupuncture (EA) or traditional acupuncture (TA). Pain was measured according to intraoperative remifentanil use, acetaminophen daily intake, Numeric Rating Scale (NRS), and McGill Pain Questionnaire on postoperative days (POD) 1-3. RESULTS: Acupuncture group required less acetaminophen than controls at POD 2 (P = .01) and 3 (P = .016). EA patients required less remifentanil (P = .032) and acetaminophen than controls at POD 2 (P = .004) and 3 (P = .008). EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls. EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients. No differences occurred between TA patients and controls. CONCLUSION: Acupuncture may be effective in reducing pain after thyroid surgery. EA is more useful; TA achieves no significant effects.

Ropivacaine versus levobupivacaine for minor breast surgery in outpatients: inversion of postoperative pain relief efficacy.

The number of ambulatory surgical procedures is growing and local anesthesia represents the technique of choice for outpatients undergoing minor surgery. The aim of this study was to verify whether differences exist in postoperative pain relief using equipotent doses of two long-acting local anesthetics, ropivacaine and levobupivacaine, in patients who underwent minor breast surgery. A series of 86 consecutive women (median age=55, range=39-75 years) with small (<2 cm in size) breast masses requiring surgical excision were prospectively enrolled in the study. Patients were randomly selected to receive 7.5 mg/ml ropivacaine (group A, 42 patients) or 5 mg/ml levobupivacaine (group B, 44 patient). For post-surgical measurement of pain intensity a visual analog scale (VAS) was used. The age of the patients (56.4±9.6 vs. 56.7±9.5 years; p=0.88) and operative time (38.4±4.3 vs. 39.8±5.0 min; p=0.16), did not differ significantly between the groups (A vs. B). Transient adverse effects were observed in 5 (11.9%) and 4 (9.1%) patients (p=0.49) of groups A and B, respectively. The pain VAS four (t4) and 24 (t24) hours from the end of surgery was significantly (p<0.05) different between the groups, but an inversion of pain relief efficacy and a crossing point of the two pain-time lines at the sixth hour was observed. In conclusion, ropivacaine results in more effective pain relief at time t4, while levobupivacaine should be the drug of choice when long-term postoperative analgesia is required.

Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: a controlled clinical trial.

Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P <.05). The treatment of group A proved to be safer also than treatment of group B. Patients randomized in group B showed a higher prevalence of infections (90.0% of cases versus 55.5% of cases; P <.01) mainly because of bacterial (80.0% versus 50.0%; P <.05) and viral (50.0% versus 16.6%; P <.05) agents. In conclusion, the study shows that intravenous administration of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d is more effective and safer than intravenous dose of 1,000 mg of methylprednisolone for three consecutive days in the treatment of acute cellular rejection in patients with liver transplantation.