The Analgesic Efficacy of Intraperitoneal Ropivacaine Versus Bupivacaine for Laparoscopic Cholecystectomy: a Meta-Analysis.

INTRODUCTION: This meta-analysis aimed to compare the analgesic efficacy of intraperitoneal ropivacaine versus bupivacaine for laparoscopic cholecystectomy. METHODS: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases from inception through January 2020 and included randomized controlled trials (RCTs) evaluating the analgesic efficacy of ropivacaine versus bupivacaine for laparoscopic cholecystectomy. RESULTS: Five RCTs are included in the meta-analysis. In patients with laparoscopic cholecystectomy, ropivacaine and bupivacaine demonstrated comparable pain scores at 2 h (SMD = -0.22; 95% CI = -0.54 to 0.10; p = 0.18), 4 h (SMD = -0.16; 95% CI = -0.42 to 0.10; p = 0.22), 8 h (SMD = -0.60; 95% CI = -1.19 to -0.01; p = 0.05), and 24 h (SMD = 0.33; 95% CI = -1.19 to 1.84; p = 0.67), as well as time to first analgesic requirement (SMD = 0.10; 95% CI = -0.23 to 0.42; p = 0.56). CONCLUSIONS: Intraperitoneal ropivacaine and bupivacaine have a similar analgesic efficacy for laparoscopic cholecystectomy.

Diagnostic Value of Multimodal Intraoperative Neuromonitoring by Combining Somatosensory-With Motor-Evoked Potential in Posterior Decompression Surgery for Thoracic Spinal Stenosis.

Background: Intraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic spinal stenosis (TSS) are limited. Furthermore, patients who are at the highest risk of waveform changes during the surgery remain unknown. Our purpose was to (1) assess the diagnostic accuracy of IONM by combining somatosensory-evoked potential (SSEP) with motor-evoked potential (MEP) in predicting PONDs for patients who underwent the surgery and (2) identify the independent risk factors correlated with IONM changes in our study population. Methods: A total of 326 consecutive patients who underwent the surgery were identified and analyzed. We collected the following data: (1) demographic and clinical data; (2) IONM data; and (3) outcome data such as details of PONDs, and recovery status (complete, partial, or no recovery) at the 12-month follow-up visit. Results: In total, 27 patients developed PONDs. However, 15, 6, and 6 patients achieved complete recovery, partial recovery, and no recovery, respectively, at the 12-month follow-up. SSEP or MEP change monitoring yielded better diagnostic efficacy in predicting PONDs as indicated by the increased sensitivity (96.30%) and area under the receiver operating characteristic (ROC) curve (AUC) value (0.91). Only one neurological deficit occurred without waveform changes. On multiple logistic regression analysis, the independent risk factors associated with waveform changes were as follows: preoperative moderate or severe neurological deficits (p = 0.002), operating in the upper- or middle-thoracic spinal level (p = 0.003), estimated blood loss (EBL) ≥ 400 ml (p < 0.001), duration of symptoms ≥ 3 months (p < 0.001), and impairment of gait (p = 0.001). Conclusion: Somatosensory-evoked potential or MEP change is a highly sensitive and moderately specific indicator for predicting PONDs in posterior decompression surgery for TSS. The independent risks for IONM change were as follows: operated in upper- or middle-thoracic spinal level, presented with gait impairment, had massive blood loss, moderate or severe neurological deficits preoperatively, and had a longer duration of symptoms. Clinical Trial Registration: [http://www.chictr.org.cn]; identifier [ChiCTR 200003 2155].

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study.

Background: The effect of a bolus dose of dexmedetomidine on intraoperative neuromonitoring (IONM) parameters during spinal surgeries has been variably reported and remains a debated topic. Methods: A randomized, double-blinded, placebo-controlled study was performed to assess the effect of dexmedetomidine (1 µg/kg in 10 min) followed by a constant infusion rate on IONM during thoracic spinal decompression surgery (TSDS). A total of 165 patients were enrolled and randomized into three groups. One group received propofol- and remifentanil-based total intravenous anesthesia (TIVA) (T group), one group received TIVA combined with dexmedetomidine at a constant infusion rate (0.5 µg kg-1 h-1) (D1 group), and one group received TIVA combined with dexmedetomidine delivered in a loading dose (1 µg kg-1 in 10 min) followed by a constant infusion rate (0.5 µg kg-1 h-1) (D2 group). The IONM data recorded before test drug administration was defined as the baseline value. We aimed at comparing the parameters of IONM. Results: In the D2 group, within-group analysis showed suppressive effects on IONM parameters compared with baseline value after a bolus dose of dexmedetomidine. Furthermore, the D2 group also showed inhibitory effects on IONM recordings compared with both the D1 group and the T group, including a statistically significant decrease in SSEP amplitude and MEP amplitude, and an increase in SSEP latency. No significance was found in IONM parameters between the T group and the D1 group. Conclusion: Dexmedetomidine delivered in a loading dose can significantly inhibit IONM parameters in TSDS. Special attention should be paid to the timing of a bolus dose of dexmedetomidine under IONM. However, dexmedetomidine delivered at a constant speed does not exert inhibitory effects on IONM data.

Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures.

Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.

Efficacy of procaine combined with ketamine and propofol in pediatric epidural anesthesia.

In the present study, the effect of procaine combined with ketamine and propofol in pediatric epidural anesthesia was analyzed. A total of 74 children scheduled to undergo surgery under epidural anesthesia were included in the study, and were divided into two groups using a random number table. Accordingly, 37 patients received epidural anesthesia using ketamine and propofol (control group), whereas the remaining patients received procaine combined with ketamine and propofol (observation group). The vital signs, sedative effects, anesthetic effects, pain intensity, anesthetic dose and incidence of adverse reactions were compared between the groups. It was revealed that the heart rate and mean arterial pressure at T4 (following epidural administration) in the observation group was significantly lower compared with those of the control group (P<0.05). However, no statistical difference was observed in the proportion of patients with sedation at Ramsay levels 1-6 between the observation and the control group (P>0.05). Compared with the control group, the observation group reported a shorter latent period for the onset of the anesthetic effect and the disappearance of pain, and a longer period for the recovery of pain sensation (P<0.05). The observation group exhibited prominently lower visual analog scale scores at 6, 12, 18 and 24 h post-surgery compared with the control group (P<0.05). Additionally, the observation group received a lower dose of ketamine and propofol compared with the control group (P<0.05). An incidence of adverse reactions of 8.11% was noted in the observation group during the surgery and anesthesia recovery period, which was lower compared with that of the control group (29.73%) (P<0.05). The results of the present study indicated that the combination of procaine with ketamine and propofol in pediatric epidural anesthesia may be more commonly employed, considering its advantages in accelerating the anesthesia process, improving the anesthetic effects and guaranteeing anesthesia safety. However, only a few indicators of the anesthesia efficacy and a small group of patients were included in the present study, and a long-term comprehensive analysis using a larger sample size is required to address this issue.

Comparison of Clinical and Radiologic Outcome Between Mini-Open Wiltse Approach and Fluoroscopic-Guided Percutaneous Pedicle Screw Placement: A Randomized Controlled Trial.

OBJECTIVE: To compare clinical efficacy, radiographic outcome, and radiation exposure between mini-open pedicle screw (MPS) fixation with the Wiltse approach and percutaneous pedicle screw (PPS) fixation in treatment of young and middle-aged patients with thoracolumbar burst fractures. METHODS: Of 60 patients with thoracolumbar vertebrae fractures treated in our hospital from January 2017 to January 2018, 30 were randomly assigned to the MPS group and 30 were randomly assigned to the PPS group. Clinical efficacy, radiographic outcome, and radiation exposure were compared between the 2 groups. RESULTS: The average age of patients was 42.2 ± 6.7 years in the MPS group and 43.0 ± 6.9 years in the PPS group (P = 0.668). There was no significant difference between the 2 groups in blood loss, hospital stay, postoperative visual analog scale score for back pain, and Oswestry Disability Index score. The vertebral body height and vertebral body angle of the MPS group were significantly better than those of the PPS group at the last follow-up. There was no significant difference in the accuracy rate of pedicle screw placement between the MPS group and the PPS group; the facet joint violation was significantly higher in the PPS group. The average radiation exposure dosage was lower in the MPS group. CONCLUSIONS: Both MPS fixation with the Wiltse approach and PPS fixation are safe and effective in the treatment of single-segment thoracolumbar vertebral fractures. Nevertheless, considering the surgical duration, radiation exposure, facet joint violation, vertebral body height, and vertebral body angle at the last follow-up, MPS fixation with the Wiltse approach is a better choice than PPS.

Andrographolide inhibits secretagogue-induced pseudo-allergic reaction.

Many kinds of drugs induce pseudo-allergic reactions due to activation of mast cells. We investigated the anti-pseudo-allergic effect of andrographolide (Andro). The effects of Andro on pseudo-allergic reactions were investigated in vivo and in vitro. Andro suppressed compound 48/80 (C48/80) induced pseudo-allergic reactions in mice in a dose-dependent manner. Andro also inhibited C48/80-induced local inflammatory reactions in mice. In vitro studies revealed that Andro reduced C48/80-induced mast cells degranulation. Human phospho-kinase array kit and western blotting showed that Andro could inhibit pseudo-allergic responses via the calcium signaling pathway.

Adding dexmedetomidine to ropivacaine for femoral nerve block inhibits local inflammatory response.

BACKGROUND: Peripheral nerve block has an anti-inflammatory effect that is confirmed in animal studies, while inconclusive in human studies. Dexmedetomidine (DEX), a highly selective α2-adenoceptor agonist, has a potent anti-inflammatory effect. The aim of this study was to evaluate the effect of DEX added to ropivacaine for femoral nerve block (FNB) on local inflammatory response after total knee arthroplasty (TKA). METHODS: Sixty patients scheduled for TKA were randomized into two equal groups in a prospective randomized study. They were all treated with FNB preoperatively. In group R, 20 mL of 0.5% ropivacaine were injected for the block; in group RD, 20 mL of 0.5% ropivacaine plus 1 µg/kg DEX were administered. Visual Analog Scale (VAS), the circumference of the operated knee, and the concentration of interleukin-6 (IL-6) and prostaglandin E2 (PGE2) in joint fluid were evaluated. Adverse events such as hypotension, bradycardia and hypoxia were recorded. RESULTS: VAS was lower in group RD for 12 to 48 hours after surgery (P<0.03). Knee circumference was smaller in group RD at each time point after surgery (P<0.05). PGE2 in joint fluid in group RD was lower at 6, 12, 24, and 48 hours after surgery (P<0.02), IL-6 was lower at 12, 24, and 48 hours after surgery (P<0.03). No adverse events were observed. CONCLUSIONS: Adding 1 µg/kg dexmedetomidine to ropivacaine for femoral nerve block had a significantly inhibitory effect on local inflammatory response and showed superior postoperative pain control to ropivacaine alone after TKA.

Repression of neuronal nitric oxide (nNOS) synthesis by MTA1 is involved in oxidative stress-induced neuronal damage.

The Metastasis-associated protein 1 (MTA1) coregulator, an essential component of the nucleosome remodeling and deacetylase (NuRD) complex, potentiates neuroprotective effects against ischemia/reperfusion (I/R) injury. But the underlying mechanism(s) remain largely unknown. Here, we discovered that neuronal MTA1 was a target of oxidative stress, and stimulation of neurons with oxygen glucose deprivation (OGD) treatment significantly inhibited MTA1 expression. Additionally, MTA1 depletion augmented ischemic oxidative stress and thus promoted oxidative stress-induced neuronal cell death by OGD. While studying the impact of MTA1 status on global neuronal gene expression, we unexpectedly discovered that MTA1 may modulate OGD-induced neuronal damage via regulation of distinct nitric oxide synthase (NOS) (namely neuronal NOS, nNOS) signaling. We provided in vitro evidence that NOS1 is a chromatin target of MTA1 in OGD-insulted neurons. Mechanistically, neuronal ischemia-mediated repression of NOS1 expression is accompanied by the enhanced recruitment of MTA1 along with histone deacetylases (HDACs) to the NOS1 promoter, which could be effectively blocked by a pharmacological inhibitor of the HDACs. These findings collectively reveal a previously unrecognized, critical homeostatic role of MTA1, both as a target and as a component of the neuronal oxidative stress, in the regulation of acute neuronal responses against brain I/R damage. Our study also provides a molecular mechanistic explanation for the previously reported neurovascular protection by selective nNOS inhibitors.

[Effect of Femoral and Sciatic Nerve Block on Tourniquet Reaction and Postoperative Pain during Total Knee Arthroplasty].

OBJECTIVE: To observe the effect of femoral and sciatic nerve block on tourniquet reaction and postoperative pain during total knee arthroplasty (TKA). METHODS: Totally 60 patients scheduled for TKA were equally divided into two groups according to the random number table (n=30):femoral nerve block (F) group and femoral and sciatic nerve block (SF) group. The changes of mean arterial pressure (MAP) and heart rate (HR) in each group were recorded at the tourniquet inflated immediately (T1),30 minutes (T2),60 minutes (T3),90 minutes (T4),loose tourniquet (T5) and post extubation (T6). The total amount of anesthetics drugs propofol and remifentanil were calculated. The pain score after extubation and the location of pain were recorded. RESULTS: MAP and HR in group SF were steady at T1-T6 (all P>0.05). Compared with group SF,MAP in group F were significantly increased at T2-T4 and T6 (all P<0.05),and the HR at T4 and T6 were significantly increased (all P<0.05). Compared with the group F,the total amount of propofol and remifentanil were significantly decreased in group SF (all P<0.05),and pain scores at rest and on movement were reduced (P<0.05);in addition,90% patients in group F complained of posterior popliteal pain. CONCLUSION: Femoral nerve and sciatic nerve block applied in TKA can obviously inhibit the tourniquet reaction,keep hemodynamic stability,reduce the dosage of anesthetic drug,and relieve the postoperative pain.