Analgesic therapy improves arterial endothelial function following non‑cardiovascular surgery: A randomized, placebo‑controlled trial

Abstract

Pain subsequent to non-cardiac surgery may affect the endothelial function, which in turn contributes to myocardial injury (MI). The present study examined whether effective pain control is able to improve the postoperative endothelial function. Patients (n=160) undergoing laparoscopic cholecystectomy were randomly assigned into two groups, treated with tramadol analgesic or saline (placebo) following surgery. On preoperative day 1 (baseline) and postoperatively at 2 h, 1 day and 5 days, pain was assessed on a visual analogue scale (VAS), and B-mode ultrasound was used to measure brachial endothelium-dependent flow-mediated dilation (FMD) and nitroglycerin-induced dilation. At 2 h postoperatively, the FMD in the two groups was significantly lower compared with that at the other three time points (P≤0.005), while VAS was significantly higher (P<0.05). Patients in the tramadol group presented significantly reduced VAS values in comparison with those in the placebo group at 2 h and 1 day postoperatively (P=0.013 and 0.031, respectively), as well as significantly higher FMD at 2 h (6.7±1.5 vs. 6.0±1.7%; P=0.001) and 1 day postoperatively (7.3±1.3 vs. 6.9±1.4%; P=0.03). A VAS score of <5 was independently associated with postoperative FMD of ≥7 (odds ratio, 2.5; 95% confidence interval, 1.0–6.0; P=0.047). Backward multivariate linear regression also demonstrated that FMD was independently correlated with age and VAS score (B=−1.403, P=0.011; B=−0.579, P=0.003). The response to nitroglycerin-induced dilation remained stable in all patients at baseline and at all postoperative time points. In conclusion, analgesic treatment may improve the arterial endothelial function following non-cardiac surgery, which may help prevent postoperative MI.

Clinical Efficacy Analysis of the Combination of the Laparoscope and Preoperative or Intraoperative Duodenoscope in the Treatment of Cholecystolithiasis with Choledocholithiasis: A Retrospective Study

“…The laparoscopic cholecystectomy (LC) has been considered as the golden standard for cholecystolithiasis in clinical practice; however, there were still many controversies over the treatment of choledocholithiasis. 9,10 Nowadays, open common bile duct exploration, laparoscopic common bile duct exploration, choledochoscopic common bile duct exploration, and endoscopic retrograde cholangiopancreatography (ERCP) (including endoscopic sphincterotomy [EST], endoscopic papillary balloon dilation [EPBD], and endoscopic nasobiliary drainage [ENBD]) are widely adopted in the treatment of choledocholithiasis. Usually, a multiple-method combination is adopted since a single method cannot completely clear the lithiasis.…”

The effect of remote ischaemic preconditioning on endothelial function after hip fracture surgery

“…Clinical studies in non‐cardiac surgery have shown that surgery causes a state of acute endothelial dysfunction lasting for days after the surgical procedure 3,4 . The extent of endothelial dysfunction after surgery seems to be influenced by perioperative factors such as type of surgery, anaesthetics and pain 3,5‐7 . While pre‐operative endothelial dysfunction has been associated with the risk of developing perioperative major adverse cardiovascular events 8‐10 the clinical consequences of endothelial dysfunction in the perioperative period remain to be established.…”

“…3,4 The extent of endothelial dysfunction after surgery seems to be influenced by perioperative factors such as type of surgery, anaesthetics and pain. 3,[5][6][7] While pre-operative endothelial dysfunction has been associated with the risk of developing perioperative major adverse cardiovascular events 8-10 the clinical consequences of endothelial dysfunction in the perioperative period remain to be established. Endothelial dysfunction early after surgery may play a role in the pathophysiology of myocardial injury.…”