Smoking May Increase Postoperative Opioid Consumption in Patients Who Underwent Distal Gastrectomy With Gastroduodenostomy for Early Stomach Cancer: A Retrospective Analysis.

OBJECTIVES: Although nicotine has an analgesic effect, the incidence and severity of chronic pain is higher in smokers than nonsmokers. Acute pain is more intense in smokers during the perioperative period. This study evaluated whether smokers require higher doses of opioid to reduce pain when they undergo surgery. METHODS: A retrospective review of 236 patients who had intravenous patient-controlled analgesia after distal gastrectomy with gastroduodenostomy between October 2013 and September 2014 was performed to analyze the difference in postoperative opioid requirements between smokers and nonsmokers. Total opioid consumption was observed from the day of operation to postoperative day 2. Patients were grouped into smokers (N=117) and nonsmokers (N=119) for comparison. Simple and multiple regression analyses were performed to identify predictors of postoperative opioid requirements. RESULTS: Opioid consumption by male smokers was higher than nonsmokers. Multiple regression analysis showed that age, smoking, and amount of intraoperative remifentanil were the only significant factors for postoperative opioid requirements. DISCUSSION: Our results suggest that smokers undergoing distal gastrectomy with gastroduodenostomy required more opioid than nonsmokers for postoperative pain. Old age, smoking status, and increment of remifentanil use seemed to be predictors of postoperative opioid consumption.

Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region.

Background. The cervical epidural space can be detected by the loss of resistance (LOR) technique which is commonly performed using air. However, this technique using air has been associated with a high false-positive LOR rate during cervical interlaminar epidural steroid injections (CIESIs). Objective. We investigated whether the detection of LOR with contrast medium might reduce the false-positive LOR rate on the first attempt. Methods. We obtained data retrospectively. A total of 79 patients were divided into two groups according to the LOR technique. Groups 1 and 2 patients underwent CIESI with the LOR technique using air or contrast medium. During the procedure, the injection technique (median or paramedian approach), final depth, LOR technique (air or contrast), total number of LOR attempts, and any side effects were recorded. Results. The mean values for the total number of LOR attempts were 1.38 ± 0.65 (Group 1) and 1.07 ± 0.25 (Group 2). The false-positive rate on the first attempt was 29.4% and 6.6% in Groups 1 and 2, respectively (P = 0.012). Conclusions. The use of contrast medium for LOR technique is associated with a lower rate of false-positivity compared with the use of air.

A case report: Clinical application of celiac plexus block in bile duct interventional procedures.

Although percutaneous transhepatic biliary drainage (PTBD) and tract dilatation (TD) are very painful procedures, almost all of those procedures have been conducted under local anesthesia and opioid injection due to the lack of manpower and time. Celiac plexus block (CPB) is an interventional technique used for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. CPB decreases the side effects of opioid medications and enhances analgesia from medications. We present the case of a patient who underwent PTBD and TD under CPB in order to reduce procedure-related abdominal pain.CPB can be a useful alternative technique for pain management during and after biliary interventional procedures, although CPB-induced complications must always be kept in mind.

The comparison of predictive performance in bispectral index prediction during target effect-site controlled infusion of propofol using different blood effect-site equilibration rate constants in the same pharmacokinetic model.

BACKGROUND: Blood-brain equilibration rate constant (ke0 ) is derived from either pharmacokinetic and pharmacodynamic modeling (k e0_model) or a model-independent observed time to peak effect (k e0_tpeak). Performance in bispectral index (BIS) prediction was compared between k e0_model and k e0_tpeak for microemulsion or long chain triglyceride (LCT) propofol. METHODS: Time to peak effect (tpeak, time to a maximally reduced BIS value) of microemulsion propofol after an intravenous bolus (1 mg/kg) was measured in 100 patients (group Amicro). An observed tpeak of 1.6 min for LCT propofol was obtained from an earlier study. Another 40 patients received a target controlled infusions of microemulsion propofol (k e0_model = 0.187/min, group Bmicro = 20) or LCT propofol (k e0_model = 0.26/min, group BLCT = 20) and remifentanil. The k e0_tpeak's in group Bmicro and BLCT were calculated using the observed tpeak value obtained from group Amicro and 1.6 min, respectively. Effect-site concentrations of propofol were recalculated using the amounts of propofol infused over time and k e0_tpeak's. Predicted BIS values calculated by sigmoid Emax equations with k e0_model and k e0_tpeak were compared with observed BIS values during induction and emergence for both formulations of propofol. RESULTS: Observed tpeak of microemulsion propofol was 1.68 min. The median performance errors of BIS in group Bmicro were -1.83% (-24.8 to 18.9, k e0_model) and -2.42% (-26.1 to 36.2, k e0_tpeak), while 8.01% (-20.5 to 30.1, k e0_model) and 7.37% (-27.0 to 49.1, k e0_tpeak) in group BLCT. The median absolute performance errors of BIS in group Bmicro were 11.87% (2.2-31.1k e0_model) and 14.38% (-0.6 to 44.6, k e0_tpeak), while 17.31% (5.54-36.0, k e0_model) and 18.28% (-0.1 to 56.0, k e0_tpeak) in group BLCT. CONCLUSIONS: The k e0_model showed better performance in BIS prediction than the k e0_tpeak.