Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain. The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

OBJECTIVE: Our study aimed to investigate the effect of pre-operative sleep quality on post-operative pain and emergence agitation.
METHODS: Our study was performed 80 patients with American Society of Anesthesiologists I-II and 18-65 years of age. The patients were divided into poor (Group A, n = 40) and good sleep quality (Group B, n = 40). All patients were operated on under standard general anesthesia. The emergence agitation and pain status of all groups were evaluated in the recovery room and post-operative period.
RESULTS: There was no significant difference between the groups regarding demographic data. Post-operative numeric rating scale scores and analgesic consumption were significantly higher in Group A than in Group B (p < 0.05). There was no significant difference between the groups regarding post-operative emergence agitation and extubation quality (p > 0.05).
CONCLUSIONS: In our study, poor pre-operative sleep quality increases post-operative pain and analgesic consumption; however, emergence agitation is not associated with sleep quality in the pre-operative period.
OBJECTIVE: Nuestro estudio tuvo como objetivo investigar el efecto de la calidad del sueño preoperatorio sobre el dolor posoperatorio y la agitación de emergencia.
UNASSIGNED: Nuestro estudio se realizó en 80 pacientes con ASA I-II y de 18 a 65 años de edad. Los pacientes se dividieron en mala (grupo A, n = 40) y buena calidad del sueño (grupo B, n = 40). Todos los pacientes fueron operados bajo anestesia general estándar. La agitación de emergencia y el estado del dolor de todos los grupos se evaluaron en la sala de recuperación y en el período postoperatorio.
RESULTS: No hubo diferencia significativa entre los grupos con respecto a los datos demográficos. Las puntuaciones NRS postoperatorias y el consumo de analgésicos fueron significativamente más altos en el Grupo A que en el Grupo B (p < 0.05). No hubo diferencia significativa entre los grupos con respecto a la agitación de emergencia postoperatoria y la calidad de la extubación (p > 0.05).
UNASSIGNED: En nuestro estudio, la mala calidad del sueño preoperatorio aumenta el dolor posoperatorio y el consumo de analgésicos; sin embargo, la agitación de emergencia no se asocia con la calidad del sueño en el período preoperatorio.

OBJECTIVE: In this randomized and prospective research, we aimed to relieve surgical and muscle-related pain early after lumbar disc operations with caudal preemptive analgesia.
METHODS: A total of 120 patients with single-level lumbar disc herniation were included in this study. The caudal epidural injection was performed for all patients 20 min before surgery. The patients were divided into three groups. Non-steroidal anti-inflammatory drugs or tramadol use were recorded. Pre-operative and post-operative pain was interpreted through a visual analog scale.
RESULTS: There was a difference between the groups in all post-operative measurements (p < 0.05), between Group 1 and Group 3, and between Group 2 and Group 3. A statistical significance has been achieved between the groups at the 1st h, 2nd h, 4th h, and 24th h (p < 0.05). The difference between the pain intensities of the patients at the 24th h and the 1st week was statistically significant in Groups 1 and 2 (p < 0.05). Evaluation of the effects of medical treatments reduced the severity of back pain and foot pain.
CONCLUSIONS: The preemptive bupivacaine or in combination with methylprednisolone caudal injection is an effective and safe method to reduce post-operative pain and ameliorate functional capacity for the treatment of lumbar disc herniation.
OBJECTIVE: En esta investigación prospectiva aleatorizada, nuestro objetivo fue aliviar el dolor quirúrgico y muscular temprano después de las operaciones de disco lumbar con analgesia preventiva caudal.
UNASSIGNED: en este estudio se incluyeron un total de 120 pacientes con hernia de disco lumbar de un solo nivel. La inyección epidural caudal se realizó para todos los pacientes 20 minutos antes de la cirugía. Los pacientes fueron divididos en tres grupos. Se registró el uso de AINE o tramadol. El dolor preoperatorio y postoperatorio se interpretó a través de una escala analógica visual.
RESULTS: Hubo diferencia entre los grupos en todas las medidas postoperatorias (p < 0.05), entre el grupo 1 y el grupo 3, y entre el grupo 2 y el grupo 3. Se ha logrado una significación estadística entre los grupos a la 1a hora, 2a hora, 4 y 24 horas (p < 0.05). La diferencia entre las intensidades de dolor de los pacientes a la hora 24 y la primera semana fue estadísticamente significativa en los Grupos 1 y 2 (p < 0.05). La evaluación de los efectos de los tratamientos médicos redujo la gravedad del dolor de espalda y de pie.
UNASSIGNED: La bupivacaína preventiva, o en combinación con la inyección caudal de metilprednisolona, es un método eficaz y seguro para reducir el dolor posoperatorio y mejorar la capacidad funcional para el tratamiento de la hernia de disco lumbar.

The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines. The 79 studies selected using our criteria showed a clear prevalence of dexamethasone (n=24) and dexmedetomidine (n=33) over other adjuvants. Different meta-analyses comparing adjuvants suggest that dexamethasone administered perineurally achieves superior blockade with fewer side effects than dexmedetomidine. Based on the studies reviewed, we found moderate evidence to recommend the use of dexamethasone as an adjuvant to peripheral regional anaesthesia in surgeries that can cause moderate to severe pain.

OBJECTIVE: Total hip arthroplasty (THA) is an increasingly common orthopaedic procedure, with moderate to severe postoperative pain. Pericapsular nerve group (PENG) block is a recent block that seems to provide adequate analgesia without significant motor blockade. The aim of this study is to retrospectively compare the analgesic efficacy and safety of PENG block with those of epidural analgesia, in patients undergoing THA.
METHODS: This is a retrospective observational study of patients who underwent primary THA, submitted to epidural analgesia or single-shot ultrasound-guided PENG block, during a one-year period. Data regarding demographic characteristics, surgery and anaesthesia techniques, pain scores, opioid consumption, complications and time to hospital discharge were retrieved from institutional records and compared between the 2 groups (epidural analgesia vs PENG block).
RESULTS: No significant difference was found regarding pain scores, opioid consumption, and mean time to hospital discharge between the 2 groups. Pain scores at rest (1.20 epidural vs 1.67 PENG) or with movement (3.95 epidural vs 3.72 PENG) were similar between groups. Total number of complications was higher in the epidural analgesia group (50 % epidural vs 5% PENG). Paresthesia was reported in both groups. Motor block, sedation, nausea and catheter-related complications were only found in the epidural analgesia group.
CONCLUSIONS: PENG block seems to be equivalent to epidural analgesia regarding quality of postoperative analgesia for patients subject to primary THA, supporting routine use of this block in these patients. The low rate of reported complications limits conclusions on this topic.

OBJECTIVE: Achieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS).
METHODS: Eighty female patients who were scheduled for elective MRM, with ASA score I-II, and aged between 18 and 60 years, were included in the study. Patients were randomized into four groups, the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25 ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48 h after surgery for the duration of analgesia (primary outcome).
RESULTS: ESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group.
CONCLUSIONS: PECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.

OBJECTIVE: Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series.
METHODS: Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received CPB block associated with supraclavicular nerve block. The primary objective was to assess pain on a VAS scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis.
RESULTS: Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h; and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88μg/kg. Postoperatively, nine patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis.
CONCLUSIONS: Our series supports the anaesthetic and analgesic efficacy of CPB block for osteosynthesis of midclavicular fractures.

We describe this series of 15 cases who were scheduled for single level lumbar spine decompression with instrumentation. Here we describe ultrasound (US) guided sub-multifidus block (SMFB). Injections of local anesthetic deep to the multifidus muscle provided reliable block of dorsal rami of spinal nerves at multiple levels in this series. With US the multifidus muscle can be identified both in axial and parasagittal planes. Needle tip is easily visualized beneath the multifidus and medial to transverse process. A good quality analgesia was documented by pain scores. There were no adverse events. This block needs to be compared with routine multimodal analgesia or with the recently describe thoracolumbar interfascial plane block to compare safety and analgesic efficacy.

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

BACKGROUND: Analgesia by specialists with formal training in pain management could be more effective, to find out, the results of a team of an acute pain service will be determined.
METHODS: Retrospective study (n = 108) of post-operative (POP) analgesia; two evaluations were taken: before starting analgesics in the immediate POP period and the second at 24 h. A multivariate analysis was performed to establish independent risk factors associated with the effectiveness of the treatment.
RESULTS: The effectiveness was 81.48% at 24 h. The risk factors associated with poor management effectiveness were: a comorbidity, prevalence ratio (PR) = 1.22; fibromyalgia (PR = 8.47), and cancer (PR = 2.47). The duration of surgery was associated with poor control PR = 1.10 for each hour elapsed. Protective factors for poor pain control: administration of non-steroidal anti-inflammatory drugs during the POP period (PR = 0.11) and use of analgesia controlled by the patient (PR = 0.29).
CONCLUSIONS: POP pain relief is multifactorial; the participation of specialists was very effective. Identification of risk factors led to closer follow-up.
OBJECTIVE: La analgesia por especialistas con entrenamiento formal en manejo del dolor podría ser más efectiva, para averiguarlo se determinarán los resultados de un servicio de dolor agudo.
UNASSIGNED: Estudio retrospectivo (n = 108) de analgesia postoperatoria; se tomaron dos evaluaciones: antes de iniciar analgésicos en el postoperatorio inmediato y la segunda a las 24 horas. Se realizó un análisis multivariado para establecer los factores de riesgo independientes asociados con la efectividad del tratamiento.
RESULTS: La disminución promedio fue 51,75% en el primer día postoperatorio. La efectividad fue del 81,48% a las 24 horas. Los factores de riesgo asociados con la mala efectividad del manejo fueron: una comorbilidad, razón de prevalencia (RP) = 1,22; fibromialgia (RP = 8,47) y cáncer (RP = 2,47). La duración de la cirugía se asoció con un mal control PR = 1,10 por cada hora transcurrida. Factores protectores para el mal control del dolor: administración de antiinflamatorios no esteroideos durante el postoperatorio (RP = 0,11) y uso de analgesia controlada por el paciente (RP = 0,29).
UNASSIGNED: el alivio del dolor posoperatorio es multifactorial, la participación de especialistas fue muy eficaz. La identificación de los factores de riesgo condujo a un seguimiento más estrecho.