Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial

Wu, Zhi‐Ying; Wen, Liang; Miao, Jianzhong; Hu, Yongming; Xue, Ruiping

doi:10.1186/s12871-015-0046-4

Cited by 18 publications

(13 citation statements)

References 10 publications

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“…Current literature evaluating the impact of epidural analgesia on lymphocyte function [13–15], Th1 vs. Th2 balance [16], and systemic markers of inflammation [17–20] has yielded mixed results. Furthermore, oncological relevant biomarkers to measure the impact of regional anesthesia on the response to surgery have not been established.…”

Section: Introductionmentioning

confidence: 99%

Impact of epidural analgesia on the systemic biomarker response after hepatic resection

et al. 2019

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BackgroundPerioperative inflammation is associated with poor oncologic outcomes. Regional analgesia has been shown mitigate some of these inflammatory changes and be associated with better oncologic outcomes in patients with hepatic malignancies. The mechanism for this effect, however, remains unclear. The authors sought to compare systemic biomarker concentrations in a comprehensive and oncologically relevant panel in the perioperative setting between patients undergoing thoracic epidural analgesia (TEA) and intra-venous patient- controlled analgesia (IV-PCA) for resection of hepatic metastatic disease.ResultsClinicopathologic variables and baseline biomarkers were similar between TEA (n = 46) and IV-PCA (n = 16) groups. Of the biomarkers which were significantly changed from baseline, there was a lower fold change from baseline in the TEA patients compared to IV-PCA including IL-6 (13.5vs19.1), MCP-1 (1.9vs3.0), IL-8 (2.4vs3.0), and Pentraxin-3 (10.8vs15.6). Overall decreased systemic concentrations of TGFb signaling were noted in TEA patients on POD1 TGFb3 (243.2 vs. 86.0, p = 0.005), POD3 TGFb1 (6558.0 vs. 2063.3, p = 0.004), POD3 TGFb2 (468.3 vs. 368.9, p = 0.036), POD3 TGFb3 (132.2 vs. 77.8, p = 0.028), and POD5 TGFb3 (306.5 vs. 92.2, p = 0.032). POD1 IL-12p70 concentrations were significantly higher in TEA patients (8.3 vs. 1.6, p = 0.024).ConclusionEpidural analgesia damped the postoperative inflammatory response and systemic immunosuppressive signaling, as well as promoted Th1 systemic signaling early in the post-operative period after hepatic resection for metastatic disease. These differences elaborate on known mechanisms for improved oncologic outcomes with regional anesthesia, and may be considered for biomarker monitoring of effective regional anesthesia in oncologic surgery.Materials and MethodsPatient data, including clinicopathologic variables were collected for this study from the database of a randomized controlled trial comparing perioperative outcomes in patients undergoing hepatic resection with TEA vs. IV-PCA. Patients undergoing resection for metastatic disease were selected for this study. Plasma concentrations (pg/mL) of well-studied biomarkers (IL-1b/2/4/5/6/7/8/10/12p70/13/17, MCP-1 IFNγ, TNFα, MIP-1b, GM-CSF, G-CSF, VEGF, Resistin, TGFb1, TGFb2, and TGFb3), as well as novel perioperative markers (CXCL12, CXCL10, Omentin-1, sLeptin R, Vaspin, Pentraxin-3, Galactin-3, FGF-23, PON-1, FGF-21) were measured preoperatively, and on postoperative day (POD)1, POD3, and POD5 using multiplex bead assays. Clinicopathologic variables and perioperative variations in these biomarkers were compared between TEA vs IV-PCA groups.

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Section: Introductionmentioning

confidence: 99%

Impact of epidural analgesia on the systemic biomarker response after hepatic resection

et al. 2019

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“…Although opioids are an important components of postoperative pain management, they are associated with side-effects, [ 16 ] and so, the pre-emptive analgesic approach with the use of celecoxib, which has less adverse effects, has been recommended for relieving postoperative pain. [ 17 , 18 ]…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery

Zhou

Du²,

Huang³

et al. 2017

Medicine

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This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90o flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90o VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90o flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.

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“…A analgesia preventiva é uma forma de intervenção da dor antes da estimulação nociva e tem sido indicada com o objetivo de aliviar a DPO, podendo ser associada à terapia multimodal (KHALILI; JANGHOR-BANI; SARYAZDI, 2013). Nesse sentido, um estudo verificou se a combinação de analgesia multimodal e analgesia preventiva (analgesia preventiva multimodal) poderiam ter melhor efeito analgésico no manejo da dor e redução de efeitos colaterais (CHEN, et al, 2015). Tal estudo avaliou a analgesia preventiva multimodal com flurbiprofeno, fentanil e cetamina em cem pacientes submetidos à histerectomia transabdominal e evidenciou que a analgesia preventiva multimodal pode reduzir significativamente a escala analógica visual (EVA), inibir a resposta ao estresse e reduzir a resposta inflamatória nesses pacientes, o que pode ser uma estratégia racional para o controle da dor.…”

Section: Discussionunclassified

Tratamento Farmacológico E Não Farmacológico No Manejo Da Dor De Pacientes Em Pós-Operatório Imediato (Poi)

et al. 2020

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O objetivo deste estudo foi analisar evidências científicas referentes às modalidades farmacológicas e não farmacológicas utilizadas no manejo da dor de pacientes em Pós-Operatório Imediato (POI) de cirurgias em geral. Este é uma revisão integrativa da literatura realizada nas bases LILACS, MEDLINE/PUBMED, Scopus e Web of Science, entre 2002 e 2017, que resultou na análise de 38 artigos científicos. Dos artigos analisados, 71% abordaram métodos farmacológicos e 28% medidas não farmacológicas para o tratamento da dor no POI. O manejo adequado da dor é de responsabilidade dos profissionais envolvidos no cuidado e os hospitais devem ter equipes e procedimentos para alívio da dor para diminuir efeitos colaterais, tempo de hospitalização e acelerar a recuperação do paciente. Os métodos não farmacológicos podem ser uma modalidade complementar promissora para melhorar a dor no pós-operatório, pois são técnicas acessíveis e fáceis de serem executadas e quando praticada por profissionais capacitados, os eventos adversos ocorrem raramente.

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Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial

Cited by 18 publications

References 10 publications

Impact of epidural analgesia on the systemic biomarker response after hepatic resection

Impact of epidural analgesia on the systemic biomarker response after hepatic resection

The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery

Tratamento Farmacológico E Não Farmacológico No Manejo Da Dor De Pacientes Em Pós-Operatório Imediato (Poi)

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