Anesthesiology Research and Practice最新文献

{"title":"A Comparative Study Between Ultrasound-Guided Genicular Nerve Block Combined With Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee Block versus Adductor Canal Block in Total Knee Replacement.","authors":"Marwa M Abouseeda, Mohamed Mohsen Rashed, Mostafa M Hussein, Riham F Nady, Ahmad M Ehab","doi":"10.1155/anrp/8937826","DOIUrl":"10.1155/anrp/8937826","url":null,"abstract":"<p><p><b>Background:</b> Total knee arthroplasty (TKA) is a surgical intervention that relieves patients experiencing severe pain and joint dysfunction. <b>Objective:</b> The aim is to evaluate ultrasound-guided genicular nerve block (GNB) paired with infiltration between the popliteal artery and the capsule of the posterior knee IPACK block in comparison with adductor canal block (ACB) regarding the analgesia effectiveness and postoperative functional outcomes and rehabilitation parameters for TKA. <b>Methods:</b> This randomized controlled trial enrolled 50 individuals of both genders with American Society of Anesthesiologists Class I-III, planned for TKA with spinal anesthesia. The patients were randomly allocated into two groups of 25 each. Group A underwent an ultrasound-guided GNB combined with an IPACK block, while Group B received an ACB. The amount of morphine consumed postoperatively during the initial 48 h was the main outcome. Additional outcomes encompassed postoperative knee range of motion (ROM), straight leg raising (SLR), and time up and go (TUG) test. <b>Results:</b> Group A patients exhibited significantly lower pain perception scores at 6 and 12 h (<i>p</i> < 0.001) and lower 48 h morphine dose in comparison to Group B (<i>p</i> < 0.001). Group A had significantly better results in ROM and TUG tests on the first and second days (<i>p</i> < 0.001). No significant difference was observed in patients achieving SLR on Day 1 (<i>p</i>=0.999). Overall, Group A had a faster recovery regarding ROM and TUG and better SLR by Day 2. Group A had better satisfaction. <b>Conclusions:</b> In TKA, combined IPACK and GNB offer superior postoperative analgesia, reduced opioid use, and improved functional outcomes compared to ACB. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06423339.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"8937826"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Genicular Nerve Blocks in Enhancing Postoperative Pain Management After Total Knee Arthroplasty: A Retrospective Study.","authors":"Yuki Aoyama, Shinichi Sakura, Yoshimi Nakaji, Kornkanok Yuwapattanawong, Tetsuro Nikai","doi":"10.1155/anrp/8827996","DOIUrl":"10.1155/anrp/8827996","url":null,"abstract":"<p><p><b>Background:</b> Total knee arthroplasty (TKA) is associated with intense postoperative pain, for which continuous femoral triangle block (FTB) and infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) block have been used. Genicular nerves supply sensation to a part of the knee joint that the two blocks do not affect, so we recently started adding genicular nerve blocks (GNBs) to the combination of FTB and iPACK block. In this retrospective study, we examined to see if the addition of GNBs benefited patients undergoing TKA. <b>Methods:</b> We conducted a retrospective analysis of data that had been collected prospectively from patients undergoing TKA and receiving our standard analgesic regimen including continuous FTB and iPACK block in our hospital. We compared patients with and without GNBs regarding intra- and postoperative data including the time needed for block performance, visual analog scale (VAS) pain scores, analgesic requirements, and adverse events. The two-tailed Student's <i>t</i> test, Mann-Whitney <i>U</i> test, chi-square test, and Fisher's exact test were used for statistical analysis. <b>Results:</b> Seventy-four patients including 41 and 33 patients with and without GNBs, respectively, were evaluated. The demographics of the patients were comparable. VAS pain score at rest on postoperative day 1 was not different between patients who received GNBs and those who did not (20 [0-36] vs. 25 [19-45] in median [IQR], <i>p</i> = 0.205). Other measurements related to postoperative pain were also similar throughout the two postoperative days. No severe complications related to blocks were observed. <b>Conclusion:</b> The results of this exploratory retrospective study suggest that the additional benefits of GNBs, if any, are limited for the early postoperative period when combined with continuous FTB and iPACK block in patients undergoing TKA. However, larger, sufficiently powered, and more robust clinical trials are needed to confirm the present results.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"8827996"},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforaminal Epidural Steroid Injection in Lumbar Disc Prolapse: Impact on Pain Intensity and Cognitive Function in Relation to MicroRNA-155 Serum Level.","authors":"Wael Fathy, Mona Hussein, Rehab Magdy, Mona Nasser, Jehan Mohamed, Doaa Moaz Sayem, Hatem Elmoutaz, Nesma Mounir, Dina Mahmoud Fakhry, Mohamed Abdelbadie","doi":"10.1155/anrp/2201031","DOIUrl":"https://doi.org/10.1155/anrp/2201031","url":null,"abstract":"<p><p><b>Background:</b> Lumbar disc prolapse is a common cause of disabling low back pain. The prevalence of disc prolapses or herniation in the general population increases with age. <b>Objective:</b> This work aimed to evaluate the impact of transforaminal epidural steroid injection (TFESI) in lumbar disc prolapse on pain intensity, cognitive function, and miR-155 serum level. <b>Methods:</b> The present case-control study was conducted on 44 patients with symptomatic lumbar disc prolapse (L4-L5) and another 44 age- and sex-matched controls. Assessment of the pain intensity and functional disability was done before and 1 month after TFESI using the numeric rating scale (NRS), Oswestry disability index (ODI), and functional rating index (FRI). Cognitive assessment was done before and 1 month after TFESI. Estimation of miR-155 serum level was done for the included patients (before and 1 month after TFESI) and controls. <b>Results:</b> There was a statistically significant improvement in pain scales and cognitive test scores 1 month following TFESI (<i>p</i> value ≤ 0.05 in all comparisons). There was also a statistically significant reduction in miRNA-155 serum level in the included patients one month following TFESI (<i>p</i> value < 0.001). The median values for the change in NRS were 2 (1-4.75), in ODI were 18 (7-33), in FRI were 23.5 (12-31), in PALT were 1 (0-1.5), in COWAT were 2 (0.25-5), in PASAT were 3 (1.25-4), and in miRNA-155 were 0.555 (0.16-0.738). There were statistically significant correlations between miRNA-155 serum levels in the included patients and the scores of all the pain and disability scales (NRS, ODI, and FRI) and the scores of all the cognitive tests before TFESI (<i>p</i> value ≤ 0.05 in all correlations). <b>Conclusion:</b> This study highlights the epigenetic mechanisms of TFESI in lumbar disc prolapse, causing significant downregulation of miRNA-155, reduced pain intensity, and improved cognitive function. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05626283.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"2201031"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noise Perception, Sensitivity, and Patient Outcomes During Cesarean Delivery.","authors":"Unyime Ituk, Erik Anderson, Michelle N Bremer Gama, Carl Skoog","doi":"10.1155/anrp/5707084","DOIUrl":"https://doi.org/10.1155/anrp/5707084","url":null,"abstract":"<p><p><b>Introduction:</b> Noise in the operating room (OR) is a recognized hazard, known to impair communication among staff and increase stress levels. While its effects on healthcare personnel have been studied, little is known about patient perception of noise, particularly during cesarean delivery (CD) under neuraxial anesthesia, where patients are fully conscious. This study aimed to investigate if patients undergoing CD perceive OR noise as stressful and to examine the correlation between actual noise levels and patient-reported stress. <b>Methods:</b> This prospective observational study was conducted on women undergoing CD at the University of Iowa Hospitals and Clinics. Eligible participants had sound levels recorded in the two ORs and completed three questionnaires 24 h postsurgery: the Weinstein Noise Sensitivity Questionnaire Short Form (WNSSF), a noise perception questionnaire, and a noise-related stress questionnaire. Noise levels were measured using a Spartan model 730 noise dosimeter, and the study analyzed the correlation between noise sensitivity, perception, and stress, as well as the effect of surgery urgency on noise levels. <b>Results:</b> Out of 70 participants, 67 were included in the final analysis. The ambient noise levels in the ORs were 53.4 and 58.5 dB, respectively. The mean noise sensitivity score was 17.6 (±3.9). Noise was perceived as very soft or soft by 23% of patients, comfortable by 67.8%, and loud or unpleasant by 9.2%. A significant association was found between noise sensitivity and stress (OR 1.15 [95 CI 1.03-1.31], <i>p</i>=0.038). <b>Conclusions:</b> The study found that a subset of patients experienced noise-related stress during CD, particularly those with higher noise sensitivity. These findings suggest the need for interventions to reduce OR noise or manage patient perceptions of noise.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"5707084"},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver and Adolescent Perspectives on Giving and Receiving Care After NonEmergency Surgery: A Qualitative Study.","authors":"Sydney E S Brown, Camila Costa, Alyssa Kelly, Sarah Oh, Daniel Clauw, Afton Hassett, Noelle E Carlozzi","doi":"10.1155/anrp/9344365","DOIUrl":"https://doi.org/10.1155/anrp/9344365","url":null,"abstract":"<p><p><b>Objectives:</b> Over 1.5 million adolescents undergo surgery each year in the United States. While surgery is performed to improve pain and physical functioning, there may be temporary disability and an increased reliance on caregivers during recovery. Caregivers not accustomed to providing this level of care for adolescents used to greater independence may struggle. We sought to better understand the dyadic experience of at-home care for adolescent patients after nonemergency surgery. <b>Methods:</b> We conducted semi-structured interviews with adolescent patients aged between12and 17 years and an associated caregiver, separately, 2 weeks following nonemergency surgery at a tertiary care pediatric hospital. Interviews were analyzed using latent manifest content analysis concurrent with data collection. Recruitment occurred until thematic saturation was reached. <b>Results:</b> Semi-structured interviews were conducted among 31 adolescent-caregiver dyads. Sixteen caregivers and 12 adolescents described needing or providing help with activities of daily living (ADLs) and/or instrumental ADLs. Four themes emerged: (1) caregiver feelings of overwhelm, primarily among those helping with ADLs; (2) care activities described as something a \"good caregiver\" does contrasted with the more neutral way in which adolescents described needing help; (3) discrepancies between caregiver and adolescent perspectives regarding increased family interactions resulting from needing or providing care; and (4) the importance of peer friendships to adolescents throughout surgical recovery. <b>Discussion:</b> Half of the adolescents and caregivers reported providing or requiring significant assistance with basic care needs after surgery. While some caregivers felt overwhelmed, others derived satisfaction from being a \"good\" caregiver and increased family time; adolescents felt more neutral about these interactions. Connections with friends (in-person or online) were helpful to adolescents. Results suggest that interventions directed toward improving caregiver support and helping them find positive aspects of caregiving, as well as encouraging adolescent connection with their friends may improve the perceived quality of recovery in this population.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"9344365"},"PeriodicalIF":1.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an Integrated Pediatric Perioperative Pain Pathway: A Quality Improvement Initiative.","authors":"Brynn P Charron, Niveditha Karuppiah, Ushma Shah, Ryan Katchky, Raju Poolacherla","doi":"10.1155/anrp/8014510","DOIUrl":"10.1155/anrp/8014510","url":null,"abstract":"<p><p><b>Purpose:</b> A quality improvement initiative was developed, implemented, and evaluated to improve pediatric postsurgical pain management and reduce hospital length of stay. <b>Methods:</b> An interdisciplinary working group developed the novel integrated pediatric perioperative pain (IP3) pathway adhering to the 3P approach to pain management. Preoperative psychological intervention, patient and caregiver education, standardized medication ordersets, and early identification of increased pain were the focus. Length of stay, opioid consumption, and achievement of physiotherapy goals were compared pre- and postpathway for children undergoing posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). <b>Results:</b> The prepathway (<i>n</i> = 34) and postpathway (<i>n</i> = 29) groups were well matched for age, gender, weight, number of levels fused, and socioeconomic status. Postpathway, length of stay in the intensive care unit (pre 1.06 days and post 0.76 days, <i>p</i> ≤ 0.01) and length of hospital stay (pre 6.24 days and post 5.11 days, <i>p</i> ≤ 0.01) significantly decreased. Standardized physiotherapy goals were achieved earlier postpathway implementation. Day of surgery postoperative opioid consumption was reduced in the postpathway group. <b>Discussion:</b> Implementation of the IP3 pathway resulted in significant improvement in pain management for children undergoing major orthopedic surgery. Shortened hospital stay, earlier achievement of physiotherapy goals, and reduced initial opioid consumption were realized. Future efforts will focus on applying this pathway to other pediatric surgeries, optimizing surgical scheduling, and enhancing staff education.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"8014510"},"PeriodicalIF":1.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Dose of Magnesium Sulfate Infusion in Obese Patients: A Double-Blind Randomized Trial.","authors":"Silva Filho S E, Matias G F, Dainez S, Gonzalez M A M C, Angelis F, Bandeira C, Soares F B, Vieira J E","doi":"10.1155/anrp/8854830","DOIUrl":"10.1155/anrp/8854830","url":null,"abstract":"<p><p><b>Background:</b> Magnesium sulfate reduces opioid use and its associated side effects. However, no consensus exists on whether the optimal dosing should be based on actual body weight or adjusted ideal body weight. The primary objective of this study was to compare postoperative analgesia after magnesium sulfate infusion, using doses calculated based on actual body weight versus adjusted ideal body weight. <b>Methods:</b> This prospective, randomized, double-blind, controlled clinical trial included 75 participants who underwent target-controlled intravenous general anesthesia. The participants were divided into three groups: a control group (CG), a group receiving magnesium sulfate calculated by actual body weight (AWG), and a group receiving magnesium sulfate calculated based on the adjusted ideal body weight (IWG). <b>Results:</b> The AWG had significantly lower pain scores than the CG (<i>p</i> < 0.001) and IWG (<i>p</i>=0.017). Opioid use was similar between the AWG and IWG, but significantly higher in the CG (AWG = IWG, <i>p</i>=0.08; CG > AWG, <i>p</i> < 0.001; CG = IWG, <i>p</i> 0.03). The increase in magnesium concentration did not reach clinically relevant levels. Neuromuscular blockade latency decreased in the groups receiving magnesium sulfate (<i>p</i> < 0.001 in both comparisons) compared to the CG. <b>Conclusion:</b> Calculating the dose of magnesium sulfate based on actual body weight enhances postoperative analgesia. The increase in magnesium concentration was not clinically significant and did not interfere with the action of cisatracurium in the groups receiving magnesium sulfate. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04645719.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"8854830"},"PeriodicalIF":1.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Laryngoscope-Guided Insertion and Standard Blind Insertion of the Laryngeal Mask Airway: A Systematic Review and Meta-Analysis.","authors":"Zhihao Zheng, Haibo Li, Congcong Dai, Liwei Bi, Wei Sun, Miao Yu, Zhanfei Hu, Xiaodong Liang","doi":"10.1155/anrp/1224567","DOIUrl":"10.1155/anrp/1224567","url":null,"abstract":"<p><p><b>Background:</b> The insertion of a laryngeal mask airway (LMA) using a laryngoscope-guided technique has produced inconsistent outcomes. The use of laryngoscope guidance in facilitating LMA insertion needs further investigation. This meta-analysis compared its effectiveness and safety against standard blind insertion. <b>Method:</b> We systematically searched PubMed, Cochrane Library, Web of Science, and Ovid Medline for randomized controlled trials comparing laryngoscope-guided (Group L) and blind LMA insertion (Group B). The primary outcome measured was fiberoptic staging. The secondary outcomes included oropharyngeal leak pressure (OLP), insertion time, success rate on the first attempt, and the incidence of postoperative sore throat and blood staining. <b>Results:</b> Nine RCTs (1016 patients) were analyzed. The fiberoptic staging in Group L was found to be significantly higher than that in Group B (RR = 1.54; 95% CI: 1.14-2.08; <i>p</i>=0.005). In addition, the OLP of Group L is significantly higher than that of Group B (MD = 2.10 cmH₂O; 95% CI: 0.38 cmH₂O-3.83 cmH₂O; <i>p</i>=0.02). The success rate for the first attempt was also higher in Group L (RR = 1.14; 95% CI: 1.06-1.22; <i>p</i>=0.0005). The insertion time (MD = 3.92 s; 95% CI: -6.69 s-14.52 s; <i>p</i>=0.47), the incidence of sore throat (RR = 0.90; 95% CI: 0.50-1.65; <i>p</i>=0.74), and the incidence of blood staining (RR = 1.19; 95% CI: 0.29-4.79; <i>p</i>=0.81) did not demonstrate statistically significant differences. <b>Conclusion:</b> The use of LMA with laryngoscope guidance may improve fiberoptic staging and OLP and increase the success rate of first-attempt insertion, without significantly raising the incidence of sore throat or blood staining in anesthetized patients.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"1224567"},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Diclofenac Suppositories on Post-Cesarean Section Pain: A Systematic Literature Review.","authors":"Sara Agyemang Antwi, Prince Kwabena Agyemang Antwi, Samuel Akwasi Adarkwa, Kwesi Boadu Mensah, Eric Woode","doi":"10.1155/anrp/5457722","DOIUrl":"10.1155/anrp/5457722","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Managing postoperative pain after Cesarean section is imperative, as acute postoperative pain is considered a risk factor for chronic postoperative pain. We investigated the role of diclofenac suppositories in postoperative pain management after Cesarean section. &lt;b&gt;Methods:&lt;/b&gt; For this systematic review, we searched PubMed, Scopus, the Cochrane Library, Google Scholar, and two other clinical trial registers from database inception up to July 23 to July 26, 2024. We included randomized controlled trials and other studies in which diclofenac suppositories were administered as an intentional intervention. We excluded studies not reported in English and without a focus on the principal medicine (diclofenac suppository). Two researchers independently chose studies and assessed the risk of bias using RoB-2, following the PRISMA-2020 guidelines. Primary outcomes included pain severity or intensity measured with validated clinical scales. We synthesized the studies narratively. The PICO was used to generate the research question: Population-Cesarean section patients, Intervention-diclofenac suppository, Comparison-opioids, Outcome-lower pain scores and a reduced need for more pain medications, Research question-the effectiveness of diclofenac suppositories in preventing postoperative pain and reducing the consumption of pain medicines in Cesarean section patients. &lt;b&gt;Findings:&lt;/b&gt; From an initial pool of 203 records, 20 records were selected for review. Notably, discrepancies in the study design and reporting were observed. This raised concerns about the consistency and reliability of the results obtained from the different studies. The visual analogue scale (VAS) emerged as the frequently used pain assessment tool. Diclofenac suppository was compared against other treatments under three categories: placebo, other nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids or opioid-like medicines. The findings revealed that diclofenac suppository was effective in reducing pain compared to placebo and hence, minimized the need for opioids. The concept of combining pain medicines for postoperative management, known as multimodal analgesia, was central to most of the studies. &lt;b&gt;Interpretation:&lt;/b&gt; Combination of diclofenac suppositories with other pain relief medicines reduces the need for rescue pain medicines, which are usually opioids such as morphine, meperidine, or pentazocine. &lt;b&gt;Clinical Implications:&lt;/b&gt; Patient satisfaction can be improved with these enhanced pain management strategies. Also, reliance on opioids for postoperative pain management and its related side effects will be reduced. This research reinforces the importance of multimodal analgesia in postoperative pain management. The findings also open pathways for further clinical trials to explore the appropriate combinations, dosages, and administration of NSAIDs for specific surgical populations and settings. Future research should focus on standardizing metho","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"5457722"},"PeriodicalIF":1.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of the Effect of Two Doses of Oral Melatonin as Premedication on Orientation Score, Induction Compliance, and Emergency Agitation of Children Undergoing Elective Surgeries: A Double-Blinded Randomized Trial.","authors":"Haider Muhy Al Bareh, Mohammed Jawad Kadhim Al Kidsawi, Zainab Zuhair Knaish Al Ghrabiu, Mohamed Kahloul","doi":"10.1155/anrp/8832216","DOIUrl":"10.1155/anrp/8832216","url":null,"abstract":"<p><p><b>Background:</b> Following sedation or general anesthesia, emergent agitation (EA) presents as a sequence of abrupt, complicated psychomotor problems marked by perceptual abnormalities, delusions, and disorientation. Studies have proved that melatonin significantly decreases the incidence of postoperative agitation in children after anesthesia. The primary objective of this study was to compare the effectiveness of two doses of oral melatonin as a premedication for orientation score, induction compliance, and emergency agitation of children undergoing surgeries. <b>Methods:</b> In this double-blinded randomized controlled trial, 126 children, aged 4-14, of either sex, with an ASA I or II, scheduled for elective surgery were randomly assigned to get either melatonin 0.4 mg/kg (Group M4) or melatonin 0.2 mg/kg (Group M2), with 63 kids in each group. All children have had the same anesthetic strategy. As a primary outcome, orientation score, induction compliance to intravenous induction anesthesia, and decreased emergency agitation were assessed. <b>Results:</b> Both groups were comparable in terms of demographic characteristics and baseline data. Orientation scores were similar between the groups. Preoperatively, all patients were oriented in both time and place. The two groups had no statistically significant difference according to induction compliance distribution (<i>p</i>=0.065). There was a statistically significant difference in agitation behavior after 5, 10, and 15 min postoperatively in M 4, 2, and total participants (<i>p</i> < 0.001). <b>Conclusion:</b> In pediatric surgical patients, the melatonin dosage does not affect children's compliance with induction but impacts their postoperative behavior by reducing the likelihood of agitation. Administering oral melatonin before surgery could potentially aid in managing postoperative delirium in children.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"8832216"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}