CONSORT 2010 Flow Diagram.

<p>CONSORT 2010 Flow Diagram.</p

Effects of systemic lidocaine versus magnesium administration on postoperative functional recovery and chronic pain in patients undergoing breast cancer surgery: A prospective, randomized, double-blind, comparative clinical trial

<div><p>Introduction</p><p>We aimed to compare the effects of intraoperative lidocaine and magnesium on postoperative functional recovery and chronic pain after mastectomy due to breast cancer. Systemic lidocaine and magnesium reduce pain hypersensitivity to surgical stimuli; however, their effects after mastectomy have not been evaluated clearly.</p><p>Methods</p><p>In this prospective, double-blind, clinical trial, 126 female patients undergoing mastectomy were randomly assigned to lidocaine (L), magnesium (M), and control (C) groups. Lidocaine and magnesium were administered at 2 mg/kg and 20 mg/kg for 15 minutes immediately after induction, followed by infusions of 2 mg/kg/h and 20 mg/kg/h, respectively. The control group received the same volume of saline. Patient characteristics, perioperative parameters, and postoperative recovery profiles, including the Quality of Recovery 40 (QoR-40) survey, pain scales, length of hospital stay, and the short-form McGill pain questionnaire (SF-MPQ) at postoperative 1 month and 3 months were evaluated.</p><p>Results</p><p>The global QoR-40 scores on postoperative day 1 were significantly higher in group L than in group C (<i>P =</i> 0.003). Moreover, in sub-scores of the QoR-40 dimensions, emotional state and pain scores were significantly higher in group L than those in groups M and C (<i>P</i> = 0.027 and 0.023, respectively). At postoperative 3 months, SF-MPQ and SF-MPQ-sensitive scores were significantly lower in group L than in group C (<i>P</i> = 0.046 and 0.036, respectively).</p><p>Conclusions</p><p>Intraoperative infusion of lidocaine improved the quality of recovery and attenuated the intensity of chronic pain in patients undergoing breast cancer surgery.</p></div

Postoperative chronic pain data.

<p>Postoperative chronic pain data.</p

Assessing the Stability and Safety of Procedure during Endoscopic Submucosal Dissection According to Sedation Methods: A Randomized Trial

<div><p>Background</p><p>Although endoscopic submucosal dissection (ESD) is routinely performed under sedation, the difference in ESD performance according to sedation method is not well known. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods.</p><p>Methods</p><p>One hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE (intermittent midazolam/propofol injection by endoscopist) or CPIA (continuous propofol infusion by anesthesiologist) method. The primary endpoint of this study was to compare the level of satisfaction of the endoscopists between the two groups. The secondary endpoints included level of satisfaction of the patients, patient’s pain scores, events interfering with the procedure, incidence of unintended deep sedation, hemodynamic and respiratory events, and ESD outcomes and complications.</p><p>Results</p><p>Level of satisfaction of the endoscopists was significantly higher in the CPIA Group compared to the IMIE group (IMIE vs. CPIA; high satisfaction score; 63.2% vs. 87.2%, <i>P</i>=0.001). The incidence of unintended deep sedation was significantly higher in the IMIE Group compared to the CPIA Group (IMIE vs. CPIA; 17.1% vs. 5.1%, <i>P</i>=0.018) as well as the number of patients showing spontaneous movement or those requiring physical restraint (IMIE vs. CPIA; spontaneous movement; 60.5% vs. 42.3%, <i>P</i>=0.024, physical restraint; 27.6% vs. 10.3%, <i>P</i>=0.006, respectively). In contrast, level of satisfaction of the patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, <i>P</i>=0.027). Pain scores of the patients, hemodynamic and respiratory events, and ESD outcomes and complications were not different between the two groups.</p><p>Conclusion</p><p>Continuous propofol and remifentanil infusion by an anesthesiologist during ESD can increase the satisfaction levels of the endoscopists by providing a more stable state of sedation.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://www.clinicaltrial.gov/ct2/show/NCT01806753?term=nct01806753&rank=1" target="_blank">NCT01806753</a></p></div

Patients’ characteristics.

<p>Patients’ characteristics.</p

Postoperative acute pain data.

<p>Postoperative acute pain data.</p

Sedation-related data, speed of recovery and satisfaction scores.

<p>Values are mean ± SD or n (%) of patients.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; N/A, not applicable.</p><p>Sedation-related data, speed of recovery and satisfaction scores.</p

Demographic data.

<p>Values are mean ± SD or n (%) of patients.</p><p>^aAntiplatelet agents or anticoagulants include aspirin, non-steroidal anti-inflammatory drugs and warfarin. The aforementioned drugs were discontinued in all patients prior to endoscopic submucosal dissection. ‘Use of antiplatelet agents or anticoagulants’ indicates the number of patients who took these medications.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; ASA, American Society of Anesthesiologists.</p><p>Demographic data.</p

Modified Observer’s Assessment of Alertness/Sedation Scale [18].

<p>Modified Observer’s Assessment of Alertness/Sedation Scale [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0120529#pone.0120529.ref018" target="_blank">18</a>].</p

Lesion characteristics and outcomes of endoscopic submucosal dissection.

<p>^aThe percentage of this variable was calculated based on the number of early gastric cancer lesions.</p><p>^bThe percentage of this variable was calculated based on the number of patients.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; ESD, endoscopic submucosal dissection; N/A, not applicable.</p><p>Lesion characteristics and outcomes of endoscopic submucosal dissection.</p