Application of Bone Morphogenetic Protein in Spinal Fusion Surgery

Lumbar and cervical fusions are one of the most common types of spine surgeries performed globally with approximated 450,000 spinal fusion surgeries performed annually. (give reference) Bone Morphogenetic Proteins (BMPs) are secreted cytokines with several functions, within the TGF-b superfamily. BMP act as a disulfide-linked homo- or heterodimers and have been recognized as strong and effective regulators of important biological processes like formation and repair of osteocytes and chondrocytes, cell proliferation during embryonic development. Recombinant human bone morphogenetic protein 2 (rhBMP-2) is a very effective osteogenic growth factor that has been demonstrated to be effective in different types of spinal fusions and reduces the reliance on the use autologous iliac crest bone graft. In recent years there have been limitations regarding the use of rhBMP-2 because of issues like high costs, benefits, and safety issues about rhBMP-2. In this review, a comprehensive overview about the application of rhBMP-2 in spinal fusion surgery is given

Low Level Laser Therapy (LLLT) Combined with Physical Exercise, A More Effective Treatment in Low Back Pain

INTRODUCTION: Low back pain is one of the most common musculoskeletal disorders,which is prevalent among the public population. Depending on the severity of the patients’ pain, different treatments are selected for them. Few studies have addressed, so far, the therapeutic effects of laser in such pains and different results have been published in this regard. The aim of this study is to investigate the therapeutic effect of low intensity laser therapy (LILT) on these diseases.METHODS: Sixty patients are randomly divided into three groups, one received low intensity laser therapy (LILT), the second group the low intensity laser and physical exercises simultaneously and the other the laser placebo and physical exercises simultaneously. Laser therapy was performed for 6 weeks, two sessions per week.Pain and disability were measured and compared, at 0, 6 and 12 weeks after the treatment in the three groups.RESULTS: Patient’s disability in groups 1 and 2 at week 6 showed a significant improvement compared to the beginning of the study. (Group I, P=0.02, P=0.012, group II, P=0.031, P=0.042, respectively).The rate of pain and disability at the week 12 improved significantly compared to the week 6 of the study in each group of 1 and 2. (Group I, P=0.002, P=0.02, group II, P=0.043, P=0.02, respectively). In the comparison of the groups at week 12, the values of pain (P=0.02) and disability (P=0.03) had improved in group I (laser therapy accompanied with physical exercise).CONCLUSION: Our Results revealed that laser therapy accompanied with physical exercise can be the most effective way for improving the chronic back pains including pain relief and reduction of disability in the patients

Applications of Drug Anesthesia in Control Chronic Pain

Surgery is one of the major causes of chronic pain in patients that have undergone any kind of surgeries. These complain are not only associated with major surgeries; even common minor surgeries like hernia repair have a significant risk of chronic pain. The development of chronic postsurgical pain (CPSP) depends on the type of surgical technique used. Furthermore, changes in the central nervous system have been associated with the development of persistent and chronic pain after surgical trauma and nerve injury. Anesthesia agents that block the mechanisms stimulating the process of central sensitization may be efficient in reducing the incidence of CPSP and finally psychosocial factors have been reported to be an important factor in the progression of chronic pain and as such should be addressed as part of perioperative care. The purpose of this mini-review is to give a comprehensive summary of the application of anesthesia drugs to reduce or control chronic pain during or after surgery

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Abstract Introduction: Acute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics. Objective: To review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain. Methods: Medline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements. Results: From 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension. Conclusion: Dexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration

Wpływ stosowania dożylnej N-acetylocysteiny w zapobieganiu migotaniu przedsionków po pomostowaniu aortalno-wieńcowym: badanie z randomizacją i grupą kontrolną prowadzone metodą podwójnie ślepej próby

Background: Atrial fibrillation (AF) is one of the most frequently occurring dysrhythmias after coronary artery bypass graft (CABG) surgery. Aim: The aim of this study was to evaluate the effect of intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG surgery. Methods: In a double-blind, randomised controlled trial, a total of 150 patients who were scheduled for on-pump CABG surgery were randomly assigned into two groups. In group A, patients received an intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These patients additionally received two intravenous doses of NAC on postoperative days 1 and 2. Patients in group B received normal saline (as a placebo) with the same volume, during the same time interval. During the first three days after surgery, postoperative AF (POAF) was assessed by continuous electrocardiogram monitoring; serum high-sensitivity C-reactive protein (hsCRP) level was also assessed before and three days after surgery. Results: During follow-up, 17 patients (17/141, 12.1%) developed POAF. POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08–0.82; p = 0.02). In the multivariable logistic regression analysis, the only predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06–0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was different from the trend in the control group (group time interaction or interaction effect) (p < 0.001). Conclusions: It seems that perioperative intravenous NAC therapy can be effectively used to reduce inflammation and the incidence of POAF after CABG surgery. The clinical trial registration number: IRCT2015040921669N1Wstęp: Migotanie przedsionków (AF) jest jednym z najczęstszych zaburzeń rytmu u chorych po zabiegu pomostowania aortalno-wieńcowego (CABG). Cel: Badanie przeprowadzono w celu oceny wpływu stosowania N-acetylocysteiny (NAC) w postaci dożylnej na zapobieganie AF po zabiegu CABG. Metody: W badaniu z randomizacją i grupą kontrolną przeprowadzonym metodą podwójnie ślepej próby 150 chorych zakwalifikowanych do zabiegu CABG z wykorzystaniem krążenia pozaustrojowego (on-pump) przydzielano losowo do jednej z dwóch grup. W grupie A po indukcji znieczulenia podawano chorym NAC w infuzji dożylnej (50 mg/kg). Chorzy z tej grupy otrzymywali dwie dodatkowe dawki dożylne NAC w 1. i 2. dniu po zabiegu. Pacjentom z grupy B podawano roztwór soli fizjologicznej (jako placebo) w takiej samej objętości i w takich samych odstępach czasowych. Przez pierwsze 3 dni po zabiegu stosowano ciągłe monitorowanie elektrokardiograficzne w celu wykrycia ewentualnych epizodów pooperacyjnego AF (POAF). Ponadto przed zabiegiem i 3 dni po nim oznaczono stężenie białka C-reaktywnego metodą wysokoczułą (hsCRP). Wyniki: W okresie obserwacji POAF wystąpiło u 17 chorych (17/141; 12,1%). Pooperacyjne AF wykryto u 4 chorych z grupy NAC (5,6%) i u 13 pacjentów z grupy placebo (18,8%); (OR 0,23; 95% CI 0,08–0,82; p = 0,02). W wieloczynnikowej analizie regresji logistycznej jedynym parametrem predykcyjnym AF po zabiegu CABG było stosowanie NAC (OR 0,21; 95% CI 0,06–0,73; p = 0,01). Stwierdzono również różnicę w zakresie trendu stężeń hsCRP między grupą NAC a grupą kontrolną (interakcja czasowa lub efekt interakcji) (p < 0,001). Wnioski: Uzyskane wyniki sugerują, że podawanie NAC w postaci dożylnej w okresie okołooperacyjnym może być skuteczne w ograniczaniu stanu zapalnego i zmniejszaniu częstości POAF po CABG. Numer rejestracyjny badania klinicznego: IRCT2015040921669N1

Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial

We conducted a randomised double-blind, placebo-controlled trial to assess whether a bolus dose of lidocaine during the induction of general anaesthesia would reduce postoperative pain over 24 h. Level of satisfaction with pain control at 48 h after surgery and Apgar score were also examined. A total of 100 women aged 20–35 years, who were candidates for elective caesarean section (CS) were randomised to receive either 1.5 mg/kg lidocaine or placebo during the induction of general anaesthesia. Results showed that lidocaine decreased pain intensity over 24 h after surgery (p < .001), and decreased postoperative morphine consumption from median (range) of 3.79 (0–9) mg in the placebo group to 0 (0–12) mg and in the lidocaine group (p <.001). Lidocaine was not associated with postoperative nausea and vomiting or any side effects in women and newborn babies. We conclude that a small bolus dose of lidocaine attenuates postoperative pain, thus reducing the requirement for opioid consumption in the postoperative period.Impact statement • With its anti-inflammatory, anti-hyperalgesic and analgesic properties, intravenous perioperative lidocaine infusion (IVLI) has been used for optimal postoperative care in different surgeries. Limited evidence suggests that IVLI may be a useful adjuvant during general anaesthesia. There is a report of a positive effect on several outcomes after surgery including postoperative pain over 24 h after laparoscopic abdominal surgery or open abdominal surgery. However, there was a paucity of information regarding the efficacy of a bolus dose of lidocaine in patients undergoing caesarean section (CS). In this randomized, placebo-controlled trial the use of a bolus dose of 1.5 mg/kg lidocaine 2%, compared with placebo, during the induction of general anaesthesia for elective CS resulted in a significant decrease in postoperative pain score as well as decreased postoperative morphine consumption over 24 h. Lidocaine use was not associated with any side effect in participants and newborns. • This study provides the first evidence that a bolus dose of lidocaine may be a safe and simple alternative therapeutic intervention for enhanced postoperative recovery in terms of pain and postoperative opioid consumption. Future studies are needed to examine pain reducing effect of perioperative bolus dose of lidocaine after CS under spinal or epidural anesthesia