Comparison of analgesic effectiveness between nefopam and propacetamol in living kidney donors following rectus sheath block after hand-assisted living donor nephrectomy: a prospective, randomized controlled trial.

BACKGROUND: Nefopam and propacetamol are the most commonly used analgesics in postoperative multimodal analgesic regimens. Distinct mechanisms are involved in each drug's anti-nociceptive effects. No studies have compared pain relief efficacy between the two drugs in patients undergoing transplantation surgery. Here, we investigated whether the administration of nefopam or propacetamol to healthy living kidney donors who underwent rectus sheath block (RSB) for parietal pain could reduce the subsequent opioid dose necessary to produce adequate analgesia. METHODS: This prospective, randomized controlled trial included 72 donors undergoing elective hand-assisted living donor nephrectomy into two groups: propacetamol (n = 36) and nefopam (n = 36). Intraoperative RSB was performed in all enrolled donors. The primary outcome was the total volume of intravenous opioid-based patient-controlled analgesia (PCA) used on postoperative day 1 (POD 1). Additionally, the Numeric Rating Scale scores for flank (visceral) and umbilicus (parietal) pain at rest and during coughing were compared, and the Korean adaptation of the Quality of Recovery-15 Questionnaire (QoR-15 K) was evaluated on POD 1. RESULTS: Both groups had similar preoperative and intraoperative characteristics. On POD 1, the total amount of PCA infusion was significantly lower in the nefopam group than in the propacetamol group (44.5 ± 19.3 mL vs. 70.2 ± 29.0 mL; p < 0.001). This group also reported lower pain scores at the flank and umbilical sites and required fewer rescue doses of fentanyl in the post-anesthesia care unit. However, pain scores and fentanyl consumption in the ward were comparable between groups. The QoR-15 K scores were similar between groups; there were substantial improvements in breathing, pain severity, and anxiety/depression levels in the nefopam group. The incidences of postoperative complications, including sweating and tachycardia, were similar between groups. CONCLUSION: Compared with propacetamol, nefopam provides a greater analgesic effect for visceral pain and enhances the effects of blocks that reduce the opioid requirement in living kidney donors with parietal pain managed by RSB. TRIAL REGISTRATION: The trial was registered prior to patient enrollment in the clinical trial database using the Clinical Research Information Service (registration no. KCT0007351 , Date of registration 03/06/2022).

Effect of ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer: a randomized controlled study.

BACKGROUND: The first-line treatment for lung cancer is surgical resection, and one-lung ventilation (OLV) is the most basic anesthetic management method in lung surgery. During OLV, inflammatory cytokines are released in response to the lung tissue damage and promote local and contralateral lung damage through the systemic circulation. We designed a randomized, prospective study to evaluate the effect of the urinary trypsin inhibitor (UTI) ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer. METHODS: Adult patients aged 19 to 70 years, who were scheduled for video-assisted thoracic lobectomy surgery to treat lung cancer between May 2020 and August 2020, were enrolled in this randomized, prospective study. UTI (300,000 units) mixed with 100 mL of normal saline in the ulinastatin group and 100 mL of normal saline in the control group was administered over 1 h after inducing anesthesia. RESULTS: The baseline (T0) interferon-γ (IFN-γ)/interleukin-4 (IL-4) ratio was not different between the groups (6941.3 ±â€Š2778.7 vs. 6954.3 ±â€Š2752.4 pg/mL, respectively; P  > 0.05). The IFN-γ/IL-4 ratio was significantly higher in ulinastatin group at 30 min after entering the recovery room than control group (20,148.2 ±â€Š5054.3 vs. 6674.0 ±â€Š2963.6, respectively; adjusted P < 0.017). CONCLUSION: Administering UTI attenuated the anti-inflammatory response, in terms of INF-γ expression and the IFN-γ/IL-4 ratio, after video-assisted thoracic surgery in lung cancer patients. TRIAL REGISTRATION: Clinical Research Information Service of Korea National Institute of Health (CRIS), KCT0005533.

Effects of anesthetic method on inflammatory response in patients with Parkinson's disease: a randomized controlled study.

BACKGROUND: The pathogenesis of Parkinson's disease (PD) involves degeneration of dopaminergic neurons, which is influenced by innate and adaptive immunity. IL-17 is a characteristic cytokine secreted by Th17 cells, which acts as a powerful stimulator of neutrophil migration and infiltration and promotes the secretion of inflammatory cytokines. General anesthesia and surgical stress induce immune and inflammatory responses that activate the immunosuppressive mechanism in the perioperative period. The present study investigated changes in levels of inflammatory cytokines, such as IL-17, IL-1ß, and TNF-α, in patients with PD undergoing general anesthesia with inhalational anesthetics or TIVA. METHODS: Adult patients, aged 40-75 years, scheduled for cerebral stimulator implantation were enrolled. Upon arrival at the operating theater, patients were allocated to the inhalational (I) or TIVA (T) group using block randomization. In group I, anesthesia was induced by tracheal intubation 1-2 min after intravenous administration of propofol (1-2 mg/kg) and rocuronium (0.6-1 mg/kg). Thereafter, anesthesia was maintained with 1-2 vol% sevoflurane, 0.01-0.2 µg/kg/min remifentanil, and O2/air (FiO2 0.4). In group T, propofol (3-6 µg/mL), remifentanil (2-6 ng/mL), and rocuronium (0.6-1 mg/kg) were administered using target controlled infusion (TCI) for induction of anesthesia. Blood samples were obtained preoperatively (T0), 2 h after induction of anesthesia (T1), and 24 h after surgery (T2). IL-17, IL-1ß, and TNF-α levels were evaluated by ELISA. RESULTS: Serum levels of IL-17 were elevated at T2 in group I compared to group T but the difference was not statistically significant. IL-1ß tended to be greater in group I compared to group T, but the differences were not significant. TNF-α was slightly higher at all time points in group T and showed a tendency to increase at T2 in both groups, but this was not statistically significant. CONCLUSIONS: TIVA may be useful for inhibiting neuroinflammation by inhibiting the increase in serum levels of IL-17 24 h after implantation surgery. Serum IL-17 level may be used as a biomarker for PD progression. TRIAL REGISTRATION: Clinical Research Information Service of Korea National Institute of Health (CRIS) Identification number: KCT0002061 . Registered 25 October 2019 - Retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=15125.

The effect of a continuous infusion of low-dose esmolol on the requirement for remifentanil during laparoscopic gynecologic surgery.

STUDY OBJECTIVE: To investigate whether a continuous infusion of low-dose esmolol results in an opioid-sparing effect during surgery. DESIGN: Randomized, double-blinded, placebo-controlled clinical comparison study. SETTING: Operating room of a university hospital. PATIENTS: 56 ASA physical status 1 and 2 patients, aged 20 to 60 years, undergoing laparoscopic gynecologic surgery of less than two hours' duration. INTERVENTIONS: The esmolol group (n = 28) received a 0.5 mg/kg loading dose of esmolol followed by an infusion of esmolol 30 µg/kg/min; the saline group (n = 28) received equivalent volumes of normal saline. MEASUREMENTS: The effect-site concentration of remifentanil (ng/mL) to maintain adequate anesthetic depth before infusion of the study drug (before-concentration) was measured. During infusion of study drug, the effect-site concentration of remifentanil was adjusted every 5 minutes to maintain systolic blood pressure within 15% of baseline and a Bispectral Index value between 50-60. The average of these adjusted concentrations (after-concentration) was measured and compared to the before-concentration. The quality of postoperative recovery was assessed. MAIN RESULTS: In the esmolol group, the after-concentration of remifentanil was decreased by 33.3% compared with the before-concentration. The total dose of remifentanil infused was also lower in the esmolol group (0.09 ± 0.1 vs 0.14 ± 0.03 µg/kg/min; P = 0.031). The esmolol group had lower scores on a pain numerical rating scale and required less fentanyl in the Postanesthesia Care Unit. CONCLUSIONS: Intraoperative esmolol infusion decreases both the requirement for remifentanil and postoperative administration of rescue analgesics.

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation.

BACKGROUND: The pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality. METHODS: Perioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression. RESULTS: The 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality. CONCLUSIONS: A sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.