Anesthesiology Research and Practice最新文献

{"title":"Analgesic and Sedative Effect of Fentanyl Versus Dexmedetomidine Infusion in Postoperative Mechanically Ventilated Children After Open Abdominal Surgeries: Randomized Controlled Trial.","authors":"Amany Mohamed Abotaleb, Mai Rabie Elsheikh, Khalid Mohamed Elshimy, Mohamed Elsaid AbdelFattah","doi":"10.1155/anrp/9699738","DOIUrl":"10.1155/anrp/9699738","url":null,"abstract":"<p><p><b>Background:</b> Optimal sedation and analgesia management in mechanically ventilated (MV) children post-abdominal surgery remain controversial. This study compared the efficacy and safety of fentanyl versus dexmedetomidine infusion in this population. <b>Methods:</b> A randomized, double-blinded study enrolled 54 MV children aged 4-11 years post-open abdominal surgeries. Patients received either fentanyl (1 μg/kg bolus, 1-5 μg/kg/h infusion) in Group F or dexmedetomidine (1 μg/kg bolus, 0.2-0.7 μg/kg/h infusion) in Group D. Hemodynamic parameters, sedation (COMFORT-B scale), pain (FLACC scale), and weaning times were assessed. <b>Results:</b> Group D showed significantly lower mean arterial pressure and heart rates from 6 to 24 h post-intervention (<i>p</i> < 0.05). Oxygen saturation remained similar between groups. Dexmedetomidine provided superior sedation (COMFORT-B: 7 [6-8] vs. 8 [7-8], <i>p</i>=0.022) and analgesia (FLACC: 1 [1-2.5] vs. 2 [2-3], <i>p</i>=0.005). However, dexmedetomidine achieved faster weaning (25.89 ± 2.01 vs. 29.19 ± 1.44 h, <i>p</i> < 0.001) and higher extubation times (51.93 ± 4.84 vs. 43.78 ± 5.32 min, <i>p</i> < 0.001). <b>Conclusions:</b> While dexmedetomidine offered better sedation and pain control, fentanyl facilitated quicker weaning and extubation from MV and better hemodynamics in postoperative MV children after open abdominal surgeries. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06994273.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"9699738"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607200","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 Nasal and Oropharyngeal Bleeding in Video Laryngoscopy Versus Direct Laryngoscopy for Nasotracheal Intubation in Maxillofacial Trauma: A Randomized Controlled Trial.","authors":"Ayman Mohamady Eldemrdash, Mohamed A Alazhary, Zaher Zaki Zaher, Tarek S Hemaida, Mohammed Essam Yahia, Soudy S Hammad","doi":"10.1155/anrp/7797828","DOIUrl":"10.1155/anrp/7797828","url":null,"abstract":"<p><p><b>Background:</b> Nasotracheal intubation (NTI) is commonly used in maxillofacial trauma but carries a high risk of bleeding and airway complications, particularly with direct laryngoscopy (DL). Video laryngoscopy (VL) provides better glottic visualization and may reduce airway trauma. This study compares VL and DL for NTI in maxillofacial trauma patients, focusing on bleeding severity, intubation efficiency, and complications. <b>Methods:</b> This randomized controlled trial included 64 patients undergoing NTI for maxillofacial trauma, randomly assigned to VL or DL. The primary outcome was nasal and oropharyngeal bleeding severity, assessed using Fromme's scale. Secondary outcomes included first-pass success rate, intubation time, need for adjunctive maneuvers (Magill forceps and cervical spine extension), and intubation-related complications. All intubations were performed under general anesthesia following standardized airway preparation. <b>Results:</b> VL resulted in significantly lower nasal and oropharyngeal bleeding severity, with no bleeding (score 0) observed in 43.8% of the VL patients versus 12.5% of the DL group (<i>p</i>=0.005). VL also resulted in shorter intubation times (51.9 ± 7.9 s vs. 58.1 ± 8.7 s; <i>p</i>=0.003). The need for adjunctive maneuvers was significantly lower in the VL group (<i>p</i> < 0.001), and severe complications such as fractured teeth or deep lip injuries occurred more frequently in the DL group (<i>p</i>=0.02). The first-pass success rate was higher in the VL group (96.9%) than in the DL group (78.1%) though the difference was not statistically significant (<i>p</i>=0.058). <b>Conclusion:</b> VL demonstrated superior intubation efficiency and reduced bleeding severity compared with DL in maxillofacial trauma patients. Given its safety advantages and reduced need for adjuncts, VL appears to be a preferable technique for NTI in maxillofacial trauma though further multicenter studies are ensured. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06386757.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"7797828"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607201","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":"Dexamethasone, Dexmedetomidine, and Combination of Dexamethasone-Dexmedetomidine as Adjuvants to Bupivacaine for Costoclavicular Block: A Randomized Controlled Study.","authors":"Keerthana Kalaimani, Anisha Pauline Paul, Aruna Parameswari, Mahesh Vakamudi, Varun Karuppiah Thiagarajan, Kishore Manivannan","doi":"10.1155/anrp/5683873","DOIUrl":"https://doi.org/10.1155/anrp/5683873","url":null,"abstract":"<p><p><b>Background:</b> The costoclavicular block is an upcoming approach in blocking the brachial plexus for upper limb surgeries. The addition of dexamethasone and dexmedetomidine to the local anesthetic mixture can prolong the duration of analgesia of brachial plexus block. We compared the addition of three different adjuvants-dexamethasone, dexmedetomidine, and dexamethasone-dexmedetomidine combination with bupivacaine in costoclavicular block. <b>Methods:</b> We randomized 105 patients undergoing elective hand and forearm surgery under ultrasound guided costoclavicular block. Along with the local anesthetics, Group D patients received 4 mg dexamethasone, Group X patients received 1 µg/kg dexmedetomidine, and Group D-X patients received 4 mg dexamethasone and 1 µg/kg dexmedetomidine. The primary outcome analyzed was the analgesic duration. The secondary outcomes studied were the duration of sensory and motor block, time to onset of sensory and motor block, sedation scores, and adverse effects. <b>Results:</b> The duration of analgesia was significantly prolonged in Group D-X when compared to that in Group X and Group D [(19 h; IQR, 18.5-19.0 h) versus (16 h; IQR, 15.5-16.5 h) versus (13 h, IQR, 12-14 h) <i>p</i> value < 0.001]. The duration of sensory block was significantly prolonged in Group D-X compared to that in Group X and Group D [(15 h, IQR, 15-16 h) versus (13 h, IQR, 12-14 h) versus (10 h, IQR, 10-11 h) <i>p</i> value < 0.001]. Similarly, the duration of motor block was prolonged in Group D-X compared to that in Group X and Group D [(16 h; IQR: 16-17.5 h) versus (14 h; IQR; 13-15 h) versus (11 h; IQR: 11-12 h) with significant <i>p</i> value < 0.001. Also, the time to onset of sensory and motor block was earlier in Group D-X. The sedation scores were not significant, and no adverse events were observed. <b>Conclusion:</b> Addition of dexamethasone and dexmedetomidine together to a local anesthetic in ultrasound guided costoclavicular block resulted in faster onset with longer analgesic and sensorimotor block duration. <b>Trial Registration:</b> Clinical Trials Registry-India: CTRI/2024/01/061072.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"5683873"},"PeriodicalIF":1.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625292","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 Epidemiology and Outcomes of Acute Kidney Injury in Patients With Chronic Kidney Disease: A Single-Center Retrospective Cohort Study.","authors":"Shunsuke Oura, Marie Okada, Ryo Miyashita, Shuji Yamamoto","doi":"10.1155/anrp/6657933","DOIUrl":"10.1155/anrp/6657933","url":null,"abstract":"<p><p><b>Background:</b> Previous studies have highlighted the association between chronic kidney disease (CKD) and the increased incidence of postoperative acute kidney injury (AKI). However, the risk factor and incidence of postoperative AKI in patients with CKD undergoing elective surgery remained unclear. This retrospective study aimed to evaluate the perioperative predictors of postoperative AKI in patients with CKD. <b>Methods:</b> Data from 137 patients with CKD, defined by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², who underwent elective surgery under general or regional anesthesia between November 2018 and October 2023, were retrospectively reviewed. Patients were placed on a peripheral arterial catheter, and dual arterial blood gas analysis was performed within 30 min before and after surgery. Patients undergoing cardiac surgery, emergency surgery, preoperative renal replacement therapy, as well as those with missing data, were excluded from the study. Both general and local anesthesia modalities were included in the analysis. <b>Results:</b> The incidence of postoperative AKI was 24%. All cases of AKI were classified as Stage 1. Preoperative ischemic heart disease (odds ratio: 2.660, 95% CI: 1.16-6.10, <i>p</i>=0.00207) and lower eGFR (odds ratio: 0.947, 95% CI: 0.915-0.980, <i>p</i>=0.00181) were associated with increased risk of postoperative AKI. More patients who developed postoperative AKI converted to maintained dialysis compared to patients who did not develop AKI (15% vs. 2.1%, <i>p</i>=0.0021). <b>Conclusions:</b> History of ischemic heart disease and preoperative lower eGFR and may serve as risk factors for postoperative AKI in CKD patients.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2025 ","pages":"6657933"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214640","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 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}