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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 23227

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Prof. Dr. Sang Hun Kim

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Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-Gu, Gwangju 61453, Korea
Interests: acute pain management; chronic pain management; patient’s safety; novel medicines and medical devices; clinical researches
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Special Issue Information

Dear Colleagues,

In this Special Issue of Medicina, titled “Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine”, I want to touch on a wide range of topics relating to perioperative management in the fields of anesthesia and pain medicine.

This Issue will provide evidence on the usefulness of new or current medicine or devices, in addition to future directions for research in these fields.

Opioids are commonly used to manage perioperative, acute and chronic pain. However, opioids are a group of medicine that are like double-edged swords. It has been known that they are useful in safely controlling the intraoperative hemodynamic changes related with surgical and aesthetic procedures and postoperative pain. However, recently, opioid-related risks have emerged as a topic of interest. Thus, we need to evaluate the effect of opioid-free anesthesia, postoperative pain management, as well as the additional perioperative benefit of various opioids.

There are various methods of postoperative pain management, including regional nerve block, patient controlled analgesia (PCA), etc., with or without opioids. PCA especially sometimes cannot provide sufficient postoperative analgesia due to technical or personal problems. Therefore, we need to further evaluate effective methods to deliver satisfactory analgesia.

Perioperative safety is very important for most anaesthetics, neuromuscular blockers, and other medicines, especially as some patients require personalized specified anesthetic management, including premedication, intubation, hemodynamic, ultrasound, and disease-specified medicine.

Based on all the above, it is my pleasure to announce this Special Issue entitled “Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine”. I welcome any papers on any subject, if appropriate for this Special Issue. Meta-analysis, reviews, or original articles are particularly welcome.

Prof. Sang Hun Kim
Guest Editor

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Keywords

Anesthesia
Opioids
Perioperative pain
Anesthetics
Neuromuscular blocker
Perioperative safety
Intubation
Perioperative hemodynamic

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Published Papers (8 papers)

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10 pages, 316 KiB

Open AccessArticle

Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data

by Xianwen Chen, Lisong Yang, Xueli Liu, He Zhu, Fei Yu, Carolina Oi Lam Ung, Hao Hu, Waisin Chan, Honghao Shi and Sheng Han

Medicina 2021, 57(5), 451; https://doi.org/10.3390/medicina57050451 - 6 May 2021

Cited by 3 | Viewed by 2359

Abstract

Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was “NSAIDs + opioids” (55.92%), followed by “NSAIDs only” (17.85%), and “NSAIDs + Opioids + Non-opioid central analgesics” (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

7 pages, 9133 KiB

Open AccessArticle

The Influence of Ultrasound-Guided Technique Using a Catheter-Over-Needle on the Incidence of Accidental Intravascular Injection during Caudal Block-A Retrospective Case Series Study

by Daeseok Oh

Medicina 2021, 57(4), 318; https://doi.org/10.3390/medicina57040318 - 30 Mar 2021

Viewed by 4650

Abstract

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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13 pages, 1810 KiB

Open AccessArticle

Effect of Nefopam-Based Patient-Controlled Analgesia with and without Fentanyl on Postoperative Pain Intensity in Patients Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Non-Inferiority Trial

by Ki Tae Jung, Keum Young So, Seung Chul Kim and Sang Hun Kim

Medicina 2021, 57(4), 316; https://doi.org/10.3390/medicina57040316 - 27 Mar 2021

Cited by 11 | Viewed by 2813

Abstract

Background and Objectives: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 μg (Group NF), equivalent to fentanyl 1200 μg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. Results: NRS scores were not significantly different between the groups throughout the postoperative period (p = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], −0.05 [−0.73 to 0.63], 0.10 [−0.29 to 0.50], and 0.28 [−0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups (p = 1.000) and other outcomes were also not significantly different between the two groups (p ≥ 0.225). Conclusions: PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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9 pages, 403 KiB

Open AccessArticle

The Relationship between the Timing of Sugammadex Administration and the Upper Airway Obstruction during Awakening from Anesthesia: A Retrospective Study

by Eunsu Kang, Byeong Cheol Lee, Jae Hong Park, Sang Eun Lee, Se Hun Kim, Daeseok Oh, Dae Yun Choi and Myoung Jin Ko

Medicina 2021, 57(2), 88; https://doi.org/10.3390/medicina57020088 - 21 Jan 2021

Cited by 1 | Viewed by 2278

Abstract

Background and Objectives: The harmonization of recovery of consciousness and muscular function is important in emergence from anesthesia. Even if muscular function is recovered, tracheal extubation without adequate recovery of consciousness may increase the risk of respiratory complications. In particular, upper airway obstruction is one of the common respiratory complications and can sometimes be fatal. However, the association between the timing of sugammadex administration and the upper airway obstruction that can occur during awakening from anesthesia has rarely been studied. Materials and Methods: The medical records of 456 patients who had surgery under general endotracheal anesthesia (GETA) at the Haeundae Paik Hospital between October 2017 and July 2018 and who received intravenous sugammadex to reverse rocuronium-induced neuromuscular blockade were analyzed. The correlations between bispectral index (BIS) and minimum alveolar concentration (MAC) at the time of sugammadex administration, the incidence of complications, and the time to tracheal extubation were analyzed to investigate how different timings of sugammadex administration affected upper airway obstruction after tracheal extubation. Conclusions: The effect of BIS and the duration from anesthetic discontinuation to sugammadex administration on upper airway obstruction was not statistically significant. However, the odds ratio of complication rates with MAC < 0.3 compared with MAC ≥ 0.3 was 0.40 (95% confidence interval 0.20 to 0.81, p = 0.011), showing a statistically significant increase in risk with MAC ≥ 0.3 for upper airway obstruction. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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10 pages, 1412 KiB

Open AccessArticle

Effects of Sevoflurane on Lewis Lung Carcinoma Cell Proliferation In Vivo and In Vitro

by Yeojung Kim, Sangwon Yun, Keun-A Shin, Woosuk Chung, Youngkwon Ko, Yoon-Hee Kim and Chaeseong Lim

Medicina 2021, 57(1), 45; https://doi.org/10.3390/medicina57010045 - 7 Jan 2021

Cited by 8 | Viewed by 2001

Abstract

Background and objectives: There are several studies that sevoflurane could enhance proliferation of cancer cells, while others suggest no effect on clinical outcome. We conducted in vivo and in vitro experiments to investigate the effects of sevoflurane, a volatile anesthetic, on proliferation and outcomes of Lewis lung carcinoma (LLC) cells. Materials and Methods: A total of 37 mice were injected with LLC cells to compare the tumor size and survival of the sevoflurane exposed group (sevo group) and control group. The sevo group was exposed to 2% sevoflurane and 4 L/min of oxygen for 1 h per day 3 times per week, and the control group was exposed only to 4 L/min of oxygen. In vitro study, 12 plates incubated with LCC cells. 6 plates were exposed to 2% sevoflurane for 1 hr/day for 3 days and 6 plates were not exposed, and cell proliferation was compared after 3 days. Results: There were no significant differences in survival or tumor size between mice exposed to sevoflurane and control mice (survival: 29.06 ± 4.45 vs. 28.76 ± 3.75, p = 0.836; tumor size: 0.75 (0.41–1.02) vs. 0.49 (0.11–0.79), p = 0.153). However, in vitro study, the proliferation of LLC cells exposed to sevoflurane increased by 9.2% compared to the control group (p = 0.018). Conclusions: Sevoflurane (2 vol%) exposure could promote proliferation of LLC cells in vitro environment, but may not affect proliferation of LLC cells in vivo environment. These results suggest that in vitro studies on the effects of anesthetics on cancer may differ from those of in vivo or clinical studies. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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14 pages, 6638 KiB

Open AccessArticle

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

by Ki Tae Jung, Keum Young So, Seung Un Kim and Sang Hun Kim

Medicina 2021, 57(1), 42; https://doi.org/10.3390/medicina57010042 - 6 Jan 2021

Cited by 3 | Viewed by 2043

Abstract

Background and objectives: The fixed-rate continuous background infusion mode with bolus dosing is a common modality for intravenous patient-controlled analgesia (PCA). However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM) where the background injection rate varies depending on the patient’s bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated to either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data on bolus demand count, total infused volume, and background infusion rate were downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (p = 0.621), decreasing with time in both groups (p < 0.001). The bolus demand count was not significantly different between groups throughout (p = 0.756). The mean total cumulative infused PCA volume was lower in group OBIM (84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM (102 (97.8−106.0) mL; p < 0.001). The total cumulative opioid dose in fentanyl equivalents, after converting sufentanil to fentanyl using an equipotential dose ratio, was lower in group OBIM (714.1 (647.4−780.9) μg) than in group TBIM (963.7 (870.5−1056.9) μg); p < 0.001). The background infusion rate was significantly different between groups throughout the study period (p < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour and lower from the 18th to the 48th postoperative hour. Conclusions: The OBIM combined with bolus dosing reduces the cumulative PCA volume and opioid consumption compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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10 pages, 3870 KiB

Open AccessArticle

Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches

by Byeongcheol Lee, Sang Eun Lee, Yong Han Kim, Jae Hong Park, Ki Hwa Lee, Eunsu Kang, Sehun Kim, Jaehwan Kim and Daeseok Oh

Medicina 2021, 57(1), 8; https://doi.org/10.3390/medicina57010008 - 24 Dec 2020

Cited by 5 | Viewed by 2851

Abstract

Background and objectives: The purpose of this study was to compare and to analyze contrast spread patterns between the paramedian and midline approaches to cervical interlaminar epidural injection (CIEI). Materials and Methods: We retrospectively enrolled 84 CIEI cases that had been performed for unilateral cervical spinal pain from April 2019 to April 2020. After 3 mL of contrast had been injected into the epidural space, fluoroscopic images were obtained. The CIEI was divided into a midline (Group M, n = 42) and a paramedian (Group P, n = 42) approach by anteroposterior imaging. The P Group was classified into a more medial (Group Pm, n = 26) and a more lateral (Group Pl, n = 16) group. Using ImageJ on an anteroposterior image, we assessed the grayscale brightness ratio of the ipsilateral or contralateral side of the vertebral body as well as the intervertebral disc space one level just above the needle location. We identified the dispersion of contrast into the ventral epidural space. Results: The grayscale brightness ratio was significantly higher in Group P than in Group M (p < 0.001). The incidence of ventral epidural spread in Group M was 57.1% versus 88.1% in Group P, which was significantly different (p = 0.001). Conclusions: The fluoroscopic CIEI finding in the paramedian approach predominantly showed an excellent delivery of the injectate to the ipsilateral side in comparison to the contralateral side. This showed a greater advantage in delivery toward ventral epidural space as compared to the midline approach. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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7 pages, 2061 KiB

Open AccessCase Report

Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report

by Byeong-Cheol Lee, Dae-Seok Oh, Hyun-Seong Lee, Se-Hun Kim, Jae-Hong Park, Ki-Hwa Lee, Hyo-Joong Kim, Ji-Hyun Yang and Sang-Eun Lee

Medicina 2021, 57(5), 486; https://doi.org/10.3390/medicina57050486 - 12 May 2021

Cited by 4 | Viewed by 3367

Abstract

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome. Full article

(This article belongs to the Special Issue Frontiers in Perioperative Medicine of Anesthesia and Pain Medicine)

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