Maldonadoherskind1976

and effective alternative in the management of pain in this group of patients. KEY WORDS Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain, palliative care, analgesia, nerve block.BACKGROUND Meperidine, a synthetic opioid, has a rapid onset and short duration of action. Mounting evidence has challenged meperidine's analgesic benefits, and concerns have been raised about its safety profile. Despite recommendations to restrict the prescription of meperidine, the drug remains frequently used. OBJECTIVES The aim of this study was to evaluate the evidence regarding the efficacy and safety of meperidine for acute postoperative and labor pain. STUDY DESIGN This was a narrative review of the analgesic efficacy and side effects of meperidine compared to other analgesic drugs for acute postoperative and labor pain in adults. SETTING Randomized controlled trials that compared the analgesic efficacy and side effect profile of meperidine versus another analgesic drug in adult patients were evaluated. METHODS A systemized search of randomized controlled trials studying meperidine for acute postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was performed. Inc uncommon side effects, such as central nervous system toxicity. In addition, some of the included clinical studies were old. CONCLUSION Considering the availability of other effective analgesics with potentially fewer side effects, the use of meperidine for acute postoperative or labor pain should not be recommended. KEY WORDS Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine.BACKGROUND Conventional open surgical procedures may cause massive dissections of the spine, higher perioperative complications, prolonged hospitalization, protracted rehabilitation programs and recovery. Percutaneous endoscopic lumbar interbody fusion (PELIF) is an evolving treatment option. OBJECTIVES To present the detailed procedure and preliminary clinical and radiologic results of PELIF for degenerative lumbar diseases. STUDY DESIGN A retrospective cohort study. SETTING A university affiliated tertiary hospital. METHODS The medical records of patients with degenerative lumbar diseases who underwent PELIF between January 2016 and December 2017 were retrospectively reviewed. Surgical level, surgical time, blood loss, hospital length of stay, and perioperative complications were discussed. Patients were also evaluated for pain by the Visual Analog Scale (VAS), and functional assessment by the Oswestry Disability Index (ODI) and the 36-Item Short Form Health Survey (SF-36), including Physical Component Summpecific degenerative lumbar diseases. Randomized studies with larger sample size and long-term follow-up duration are needed to validate the superiorities of this versatile surgery. KEY WORDS Endoscopic, minimally invasive spine surgery, lumbar interbody fusion, disc herniation, spondylolisthesis.BACKGROUND During lumbar epidural injection (LEI) using a midline approach, we might encounter failure of identifying the epidural space owing to an equivocal or absent loss of resistance (LOR) sensation. The reason for such absence of LOR sensation has been suggested as paucity of midline ligamentum flavum, paravertebral muscle, and cyst in the interspinous ligament of the lumbar spine. Despite its low specificity, LOR is the most commonly used method to identify the epidural space. OBJECTIVES The purpose of this study was to analyze lumbar epidural pressure decrease patterns and identify factors contributing to this pressure decrease. STUDY DESIGN Prospective randomized trial. SETTING An interventional pain management practice in South Korea. METHODS This prospective study included 104 patients receiving LEI due to lumbar radiculopathy. A midline or paramedian approach of LEI was determined with randomization. Among various factors, gender, age, body mass index (BMI), and diagnosis were analyzed using a subgroup that included 60 cases of only a paramedian approach. RESULTS Grades I, II (abrupt decrease), and III (gradual decrease) were found as patterns of epidural pressure decrease. Abrupt pressure decrease was more frequently observed in the paramedian group (P less then 0.001). Age, gender, BMI, and diagnosis did not show any significant difference in frequencies between abrupt and gradual pressure decrease. LIMITATIONS We could not match LOR sensation with epidural pressure decrease shown in the monitor. CONCLUSIONS This study demonstrates that abrupt pressure decrease occurs more frequently with the paramedian approach. However, age, gender, BMI, or diagnosis did not affect the incidence of epidural pressure decrease. KEY WORDS Epidural, paramedian, midline, pressure decrease.BACKGROUND Premedication in children with ketamine is useful to produce mild sedation, decrease anxiety, help the child separation from parents, and provide postoperative pain relief with no or little adverse effects. OBJECTIVES The aims of this study were to compare the level of sedation, parental separation, successful venous cannulation, and postoperative analgesia of oral or nebulized ketamine in preschoolers undergoing elective surgery. STUDY DESIGN A prospective, comparative, double-blind, randomized study. SETTING Zagazig University Hospitals. selleck chemicals METHODS In the preparation room, 30 minutes before induction of anesthesia, 62 children were randomly divided into 2 groups group O (n = 31) received oral ketamine 10 mg/kg in 2 mL apple juice, and group N (n = 31) received nebulized ketamine 3 mg/kg plus 2 mL isotonic saline solution by a standard hospital jet nebulizer via a mouth mask with a continuous 6 L/min flow of 100% oxygen. RESULTS At 10 minutes after premedication, sedation score was 3 in group O (34.4an 3 mg/kg nebulized ketamine in producing more sedation, satisfactory separation from parents, successful venous cannulation, and effective postoperative analgesia, as it is more tolerable and accepted by preschoolers undergoing elective surgery. KEY WORDS Nebulized ketamine, oral ketamine, preschooler, elective surgery.BACKGROUND Opioid-based postoperative analgesia provides adequate analgesia with much adverse effects and immunosuppression. Dexmedetomidine and ketorolac have properties of opioid-sparing, antiinflammation, and immune protection. OBJECTIVES To investigate the efficacy and safety of whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia and its effect on inflammatory response and immune function in thoracoscopic surgery of lung cancer. STUDY DESIGN Double-blind, randomized control trial. SETTING The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China. METHODS Sixty patients scheduled for thoracoscopic surgery were enrolled and randomly divided into 2 groups to receive a combination of intraoperative usage of dexmedetomidine and postoperative patient-controlled intravenous analgesia of dexmedetomidine 0.1 µg/kg/h and ketorolac 3 mg/kg (DEX group) or only postoperative patient-controlled intravenous analgesia of sufentanil 1.5 µg/kg and ketorolac 3 mg/kg (SUF group) for 48 hours.