Background While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy. Methods We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Result A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93–3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11–2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05–1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33–3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001). Conclusion In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132.

Introduction This study aimed to compare the efficacy between patient-controlled caudal epidural analgesia (PCCA) and patient-controlled intravenous analgesia (PCIA) after perianal surgery, to provide a feasible solution to postoperative pain. Methods This was a prospective, randomized controlled trial comprising 100 patients who underwent caudal epidural block on perianal surgery at Chengdu Shang Jin Nan Fu Hospital of West China Hospital at Sichuan University between April and August 2020. Patients were randomly divided into the PCCA and PCIA groups. Visual analog scale (VAS) scores were recorded at 2, 4, 6, 24, 48, and 72 h after surgery, and at the first dressing change and first defecation. The lower limb mobility in the post-anesthetic recovery room (PACU) was determined. The analgesic effect, usage amount of patient-controlled analgesia (PCA), usage amount and frequency of remedial analgesic measures, number of individuals who must be catheterized, and incidence of adverse reactions were recorded. Satisfaction of postoperative analgesic effect and convenience of PCA were also assessed. Results The patients in the PCCA group had significantly lower VAS scores at 4, 6, 24, 48, 72 h, the first dressing change, and the first defecation compared with the PCIA group. There were more patients receiving postoperative remedial analgesics in the PCIA group than in the PCCA group. The outcome of the number of PCA and catheterization rates did not differ significantly between the groups. There were two cases of sensory numbness below the S3 plane. The major postoperative complications in the PCIA group were pruritus (3/47, 6.4%), nausea, and vomiting (6/47, 12.8%) (one case combined with pruritus). Patients in the PCCA group were more satisfied with the analgesic effect, while those in the PCIA group were more satisfied with the convenience. Conclusion In the postoperative analgesia program of perianal surgery, PCCA may provide a better analgesic effect without increasing the incidence of complications. Trial Registration Chinese Clinical Trial Registry identifier, ChiCTR2000038425, September 2020, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00411-y.

Background Both hypospadias and circumcision are common genital surgeries in pediatric patients who that can cause serious postoperative pain and have long-term effects.Pudendal block (PNB) has recently been studied in children undergoing both hypospadias surgery and circumcision. Objective We sought to perform a meta-analysis to estimate the analgesic efficacy, relative complications and satisfaction of pudendal block for hypospadias repair and circumcision in children. Evidence Review We identified comparative studies of pudendal block versus dorsal penile nerve block (DPNB) or caudal blocks (CB); studies were published or presented through 31 December 2021. Data were abstracted from studies comparing pudendal block versus dorsal penile nerve block (DPNB) or caudal blocks (CB). Original source data were used when available. Data from 298 patients in four RCTs were included. Findings Compared with traditional nerve blocks, the pudendal nerve block group showed no detectable difference in terms of patients who needed additional analgesia within 24 hours after the surgery (OR 0.12; p=0.09)or at 30 min(OR 0.10; p=0.13). However, it showed that fewer people needed additional analgesia at 18 h (OR 0.02; p＜0.0001) and at 12 h (OR 0.02; p=0.0001). Limited data showed that fewer people needed additional analgesia at 6 h (OR 0.03; p<0.00001), 1 h (OR 0.11; p=0.04), and 5 min (OR 0.05; p=0.0004). Compared with traditional nerve blocks, the pudendal nerve block group showed no detectable difference in terms of postoperative complications (OR 0.19; p=0.13). Compared with traditional nerve blocks, the pudendal nerve block group had better surgical satisfaction (OR 8.71; p=0.0001) and parent satisfaction (OR 12.52; p＜0.00001). Conclusions Compared with traditional blocking methods (CB and DNPB), for pediatric penile surgery, it hasshown that pudendal nerve block has better early postoperative analgesia and better surgical satisfaction and parental satisfaction with no obvious postoperative complications.