Introduction The effects of deep neuromuscular block (DNMB) on chronic postsurgical pain (CPSP) have not been conclusively determined. Moreover, a limited number of studies have examined the impact of DNMB on long-term recovery quality after spinal surgery. We investigated the impact of DNMB on CPSP and the quality of long-term recovery in patients who had been subjected to spinal surgery. Methods This was a randomized, controlled, double-blind, single-center study performed from May 2022 to November 2022. A total of 220 patients who underwent spinal surgery under general anesthesia were randomly assigned to receive either DNMB (post-tetanic count at 1–2) (the D group) or moderate NMB (MNMB) (train-of-four at 1–3) (the M group). The primary endpoint was the incidence of CPSP. The secondary endpoints included the visual analogue scale (VAS) score in the post-anesthesia recovery unit (PACU), at 12, 24, 48 h and 3 months after surgery; postoperative opioid consumption; quality of recovery-15 (QoR-15) scores on the second postoperative day, before discharge, and 3 months after surgery. Results The incidence of CPSP was significantly lower in the D group (30/104, 28.85%) than in the M group (45/105, 42.86%) ( p = 0.035). Besides, VAS scores were significantly reduced at the third month in the D group ( p = 0.016). In the PACU and 12 h after surgery, VAS scores were also significantly lower in the D group than in the M group ( p < 0.001, p = 0.004, respectively). The total amount of postoperative opioid consumption (expressed in total oral morphine equivalents) was significantly less in D group than M group ( p = 0.027). At 3 months after surgery, QoR-15 scores were significantly higher in D group than M group ( p = 0.003). Conclusions Compared with MNMB, DNMB significantly reduced CPSP and postoperative opioid consumption in spinal surgery patients. Moreover, DNMB improved the long-term recovery of patients. Trial Registration Chinese Clinical Trial Registry (ChiCTR2200058454).

Background Thyroid surgery is often considered minor, and the postoperative pain is usually ignored. However, according to previous researches, the pain after thyroid surgery ranged from moderate to severe. Poorly controlled pain may lead to a series of adverse events, including dissatisfaction of patients, bad recovery, and extended hospital stay. Intravenous infusion of lidocaine has been proven to be effective in relieving pain after cholecystectomy, spinal surgery, and colorectal surgery. This meta-analysis was designed to explore the effects of lidocaine infusion on pain management and quality of recovery after thyroid surgery. Methods We conducted a comprehensive search of the Cochrane Library, PUBMED, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and China Biomedical Literature Database (CBM) from inception to September 12, 2022. Based on our previously established inclusion and exclusion criteria, eligible studies were involved. The primary outcomes were postsurgical pain scores and quality of recovery. The secondary outcomes included opioids consumption, hemodynamics variables, time to awareness and extubation, and adverse events. All analyses were performed using the random effects model with RevMan 5.4 software. We also evaluated the evidence quality of results by GRADEprofiler 3.6. Results A sum of 11 RCTs with 761 patients were involved. Compared to the controlled group, lidocaine reduced pain scores at 2h, 4h, 8h, and 12h after surgery, but not at 24h and 48h. Besides, lidocaine also facilitated recovery (mean difference [MD] = 7, 95% CI [4.78–9.25], P = 0.40, I2 = 0%), reduced opioids consumption during surgery (MD=-5.61, 95% CI [-7.90, -3.31], P = 0.97, I2 = 0%), and lowered the incidence of cough during extubation (RR = 0.41, 95% CI [0.30, 0.56], P = 0.34, I2 = 10%). No lidocaine-related adverse events was found in our meta-analysis. Conclusions Perioperative infusions of lidocaine could alleviate postoperative pain and facilitate recovery on the first day after surgery, without causing adverse events. Considering the high heterogeneity and relatively low quality of evidence among most of the results, further validation is reasonable.

Bone cancer pain (BCP) is severe chronic pain caused by tumor metastasis to the bones, often resulting in significant skeletal remodeling and fractures. Currently, there is no curative treatment. Therefore, insight into the underlying mechanisms could guide the development of mechanism-based therapeutic strategies for BCP. We speculated that Rac1/PAK1 signaling plays a critical role in the development of BCP. Tumor cells implantation (TCI) into the tibial cavity resulted in bone cancer-associated mechanical allodynia. Golgi staining revealed changes in the excitatory synaptic structure of WDR (Wide-dynamic range) neurons in the spinal cord, including increased postsynaptic density (PSD) length and thickness, and width of the cleft. Behavioral and western blotting test revealed that the development and persistence of pain correlated with Rac1/PAK1 signaling activation in primary sensory neurons. Intrathecal injection of NSC23766, a Rac1 inhibitor, reduced the persistence of BCP as well as reversed the remodeling of dendrites. Therefore, we concluded that activation of the Rac1/PAK1 signaling pathway in the spinal cord plays an important role in the development of BCP through remodeling of dendritic spines. Modulation of the Rac1/PAK1 pathway may be a potential strategy for BCP treatment.