We conclude that intraperitoneal administration of Dex 1 μg/kg combined with bupivacaine improves the quality and the duration of postoperative analgesia and provides an analgesic sparing effect compared to bupivacaine alone without significant adverse effects in patients undergoing laparoscopic colorectal cancer surgery.

Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

AimEvaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post‐mastectomy pain syndrome (PMPS).MethodsPatients with PMPS randomized to Group TS (n = 33) received radiofrequency thoracic sympathectomy, and those randomized to Group Sham (n = 33) received no radiofrequency current. Postoperative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the proportion of patients who showed >50% reduction in their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during the 6‐month follow‐up period.ResultsA significantly higher proportion of patients experienced >50% reduction in pain in Group TS (Group TS 25/30 [83.3%] vs. Group Sham 18/31 [58%], P = 0.032); the proportion of patients who experienced >50% reduction in their pain without analgesics was significantly higher in Group TS (Group TS 10/25 [40%] vs. Group Sham 0/18 [0%], P = 0.001). Furthermore, the proportion of patients treated with tramadol + duloxetine + pregabalin who experienced >50% reduction in their pain was significantly lower in Group TS (Group TS 0/25 [0%] vs. Group Sham 13/18 [75%], P = 0.001). The VAS pain score was significantly lower in Group TS at 2 weeks and at 1, 2, 3, and 6 months following the procedure. The GPE was significantly higher in Group TS (Group TS median GPE [interquartile range]) 7 [5, 7] vs. Group Sham median GPE [interquartile range]) 5 [4, 6]) P < 0.001).ConclusionsRadiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain scores and reduced the need for anti‐neuropathic drugs, particularly opioid medications, and provided better patient satisfaction.

IntroductionEnd stage knee arthritis is commonly treated with total knee replacement (TKR). As the population ages, the frequency of this surgery proportionally increases [1] bringing with it the challenge of managing older patients with frequent comorbid diseases and increased risk of complications. Poorly controlled pain immediately after surgery is still a key issue for this procedure that may influence the patient's participation in physiotherapy, time to discharge from hospital, and the long-term outcome. Optimal postoperative analgesia can lead to early mobilization, ambulation, and return to a normalized gait pattern. Traditionally, this has been managed by epidural analgesia, peripheral nerve blocks and parenteral or spinal opioids [2]. Multimodal analgesia protocols for TKR have been effective in decreasing requirements for narcotic medications in the early postoperative period. Consequently, decreasing the opioid adverse effects that can slow down rehabilitation such as nausea, vomiting, hypotension, respiratory depression, and constipation [3,4].The efficacy of femoral nerve block (FNB) as a part of a multimodal analgesic protocol has been well documented [3][4][5][6]. FNB has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay while avoiding many of complications associated with other techniques such as continuous epidural analgesia or intrathecal opioids [6]. We hypothesized that the combination of single-shot ultrasound-guided FNB and low dose intrathecal morphine (0.2 mg ITM) would improve the quality of postoperative pain control and decrease side effects of systemic opioid use. So, we designed this study to demonstrate the additive effect of combined femoral nerve block (FNB) and 0.2 mg intrathecal morphine (ITM) compared with either technique alone for postoperative analgesia in patients undergoing unilateral (TKR) under spinal anesthesia.