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Introduction: Hyperalgesia frequently occurs after surgery and is associated with adverse effects on surgical outcomes. Thus, we aimed to examine whether the hypothalamus-pituitary-adrenal (HPA) axis function after surgery is involved in the development of postoperative hyperalgesia. Methods: Surgery- and pain-related variables were measured 24 and 48 h after the first and second total knee arthroplasties (TKAs) in postmenopausal patients undergoing 1-week-interval staged bilateral TKA. Two sets of saliva samples were consecutively collected from patients before (pre-T1) and 1 week after (post-T1) the first TKA (n = 69). HPA axis function was analyzed in a subgroup of 20 patients with a typical cortisol awakening response (CAR) in both the sets of saliva samples. Results: Surgery-related variables were comparable between the first and second TKAs. However, pain-related variables (pain ratings and the amount of opioid analgesics consumed) were greater after the second than the first TKA. Cortisol and dehydroepiandrosterone (DHEA) secretion during the post-awakening period (CARauc and Daucawk, respectively) was higher at post-T1 than at pre-T1, but the molar CARauc/Daucawk ratio was comparable between the time points examined. No relationship was observed between the pre-T1 CARauc and pain ratings after the first TKA. However, post-T1 CARauc showed a positive correlation with pain ratings after the second TKA. Postoperative pain ratings were negatively correlated with Daucawk and positively correlated with the molar CARauc/Daucawk ratio at all examined time points. Discussion/Conclusion: The results suggest that adrenocortical steroidogenic activity favoring the production of cortisol over DHEA after surgery may contribute to the development of hyperalgesia during the early postoperative period.

Objective The objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques. Design Systematic review and meta-analysis of randomized controlled trials. Setting PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched. Participants Patients undergoing thoracic surgeries. Intervention Erector spinae plane block with local anesthetics for postoperative analgesia. Measurement and Main Results Seventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] –17.49, 95% CI –26.87 to –8.12), pain score at rest (MD –0.82, 95% CI –1.31 to –0.33), and pain score at movement (MD –0.77, 95% CI –1.20 to –0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73). Conclusion Erector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.

The aim of this study was to evaluate the safety of drinking carbohydrate-containing fluids two hours prior to surgery in older adults using ultrasonography.We conducted a nonrandomized and noninferiority comparative study in 60 patients aged over 65 yr who were scheduled for total knee arthroplasty. Patients who were fasted from midnight (fasting group) or who drank 400 mL of a carbohydrate-containing fluid (carbohydrate ingestion group) two hours prior to surgery were matched for age, sex, and body mass index. We measured the cross-sectional area (CSA) of gastric antrum using ultrasound and estimated the gastric fluid volume as the study's primary outcome measure. The noninferiority margin (δ) for the mean difference was predefined as 50 mL. The secondary outcome measures included CSA of the antrum and qualitative gastric volume.The mean (standard deviation) gastric volume was not significantly different between the fasting group and the carbohydrate ingestion group (30.2 [25.4] mL vs 28.4 [35.8] mL; each group, n = 30; P = 0.81). The mean difference in gastric volume was -1.9 mL (95% confidence interval [CI], -17.9 to 14.2), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit (δ = 50 mL). Secondary outcomes were not significantly different between the two groups.Drinking of carbohydrate-containing fluid two hours prior to surgery was noninferior to overnight fasting with respect to residual gastric volume at induction of anesthesia in healthy older adults who undergoing total knee arthroplasty.ClinicalTrials.gov (NCT04514380); registered 14 August 2020.RéSUMé: OBJECTIF: L’objectif de cette étude était d’évaluer l’innocuité de la consommation d’une préparation glucidique deux heures avant une chirurgie chez les personnes âgées à l’aide de l’échographie. MéTHODE: Nous avons mené une étude comparative non randomisée et de non-infériorité chez 60 patients âgés de plus de 65 ans qui devaient bénéficier d’une arthroplastie totale du genou. Les patients étaient à jeun depuis minuit (groupe à jeun) ou avaient bu 400 mL d’une préparation glucidique (groupe d’ingestion de glucides) deux heures avant la chirurgie et ont été appariés pour l’âge, le sexe et l’indice de masse corporelle. Nous avons mesuré la section transversale de l’antre gastrique à l’aide de l’échographie et estimé le volume de liquide gastrique en tant que mesure du critère d’évaluation principal de l’étude. La marge de non-infériorité (δ) pour la différence moyenne a été prédéfinie à 50 mL. Les mesures de critères d’évaluation secondaires comprenaient la section transversale de l’antre et le volume gastrique qualitatif. RéSULTATS: Le volume gastrique moyen (écart type) n’était pas significativement différent entre le groupe à jeun et le groupe d’ingestion de glucides (30,2 [25,4] mL vs 28,4 [35,8] mL; chaque groupe, n = 30; P = 0,81). La différence moyenne de volume gastrique était de -1,9 mL (intervalle de confiance [IC] à 95 %, -17,9 à 14,2), et la limite supérieure de l’IC 95 % était inférieure à la limite de non-infériorité prédéfinie (δ = 50 mL). Aucune différence intergroupe significative n’a été observée dans les critères d’évaluation secondaires. CONCLUSION: La consommation d'une préparation glucidique deux heures avant la chirurgie n'était pas inférieure au jeûne nocturne en ce qui concerne le volume gastrique résiduel à l'induction de l'anesthésie chez les personnes âgées en bonne santé qui bénéficient d'une arthroplastie totale du genou. ENREGISTREMENT DE L'éTUDE: www.ClinicalTrials.gov (NCT04514380); enregistrée le 14 août 2020.

This article aims to provide auto-ethnography for self-growth and individuation through the experience of applying sandplay therapy to school counseling of 11 professional teacher-counselors and professional school counselors, changes in the counseling effect, and the counselors’ own sandplay therapy and dream symbol analysis. The auto-ethnographical research has mainly been about the experiences of one or two researcher(s)-participant(s), but in this study, 11 researchers-participants participated in the study to express and inform their common experiences in school counseling. The researcher-participants have experience of school counseling from 2 years and 5 months to 11 years and 5 months, and they are all female counselors. Research data include dreams and dream associations, sandpictures and association about sandplay pictures, related life events and experiences, contemplation, recollection, insights, observations of researchers/research participants, sharings by group SNS, individual interviews have been used. The four common themes are found: 1. dreaming of becoming school teacher-counselor/school counselor, 2. frustration: self-blame and resentment, 3. searching for breakthrough: finding identity, 4. accepting incompleteness, which is still in progress. Among them, searching for breakthrough: finding identity has two sub-themes: sandplay and dream: encounter with the inner world and wrestling with regrets for children.

BACKGROUND The role of intraoperative magnesium for the prevention of emergence agitation or delirium is unclear as there have been conflicting results reported by several randomized controlled trials. AIMS The aim of this study was to investigate the effect of magnesium sulfate on emergence agitation or emergence delirium in pediatric patients. METHODS Electronic databases, including PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science, were searched to identify studies which evaluated the effects of magnesium on postoperative emergence agitation or emergence delirium. The primary outcome was the incidence of emergence agitation or emergence delirium during the post-anesthesia stay. The secondary outcome was the agitation or delirium score upon admission to the post-anesthesia care unit. We estimated the odds ratio and standardized mean difference using a random-effect model. RESULTS A total of 712 pediatric patients from 10 randomized controlled trials were included in the final analysis. The incidence of emergence agitation or emergence delirium was 29.7% in the magnesium group and 50.5% in the control group. The pooled effect size revealed that the administration of magnesium sulfate significantly reduced the incidence of postoperative emergence agitation or emergence delirium in pediatric patients undergoing surgery with general anesthesia (Odds ratio, 0.31; 95% confidence interval, 0.15 to 0.64; p = 0.002). Additionally, children in the magnesium group reported significantly lower agitation or delirium scores than those in the control group (standardized mean difference, -0.70; 95% confidence interval, -1.15 to -0.24; p = 0.003). CONCLUSION The administration of magnesium sulfate reduced the incidence and severity of emergence agitation or emergence delirium in pediatric patients after the use of general anesthesia during surgery.

Background Delirium is a critical postoperative complication in older patients. Based on the hypothesis that intraoperative dexmedetomidine sedation would lower postoperative delirium than propofol sedation would, the authors compared the incidence of postoperative delirium in older adults, using the mentioned sedatives. Methods This double-blinded, randomized controlled study included 748 patients, aged 65 yr or older, who were scheduled for elective lower extremity orthopedic surgery, between June 2017 and October 2021. Patients were randomized equally into two groups in a 1:1 ratio according to the intraoperative sedative used (dexmedetomidine vs. propofol). The postoperative delirium incidence was considered the primary outcome measure; it was determined using the confusion assessment method, on the first three postoperative days. The mean arterial pressure and heart rate were evaluated as secondary outcomes. Results The authors enrolled 732 patients in the intention-to-treat analyses. The delirium incidence was lower in the dexmedetomidine group than in the propofol group (11 [3.0%] vs. 24 [6.6%]; odds ratio, 0.42; 95% CI, 0.201 to 0.86; P = 0.036). During sedation, the mean arterial pressure (median [interquartile range] mmHg) was higher in the dexmedetomidine group (77 [71 to 84]) than in the propofol group (74 [69 to 79]; P < 0.001); however, it significantly fell lower (74 [68 to 80]) than that of the propofol group (80 [74 to 87]) in the postanesthesia care unit (P < 0.001). Lower heart rates (beats/min) were recorded with the use of dexmedetomidine than with propofol, both during sedation (60 [55 to 66] vs. 63 [58 to 70]) and in the postanesthesia care unit (64 [58 to 72] vs. 68 [62–77]; P < 0.001). Conclusions Dexmedetomidine showed a lower incidence of postoperative delirium than propofol in healthy older adults undergoing lower extremity orthopedic surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The present study aimed to investigate the incidence of preoperative ionized hypomagnesemia and compare with that of total hypomagnesemia.This prospective observational study included 536 patients aged20 years who were scheduled for elective surgery. Total and ionized magnesium levels were evaluated before and after the surgery. Based on these levels, patients were classified into the following groups: ionized hypo- (0.42 mmol/L), normo- (0.42-0.59 mmol/L) and hypermagnesemia (0.59 mmol/L), as well as total hypo- (1.9 mg/dL[0.78 mmol/L]), normo- (1.9-2.7 mg/dL[0.78-1.11 mmol/L]) and hypermagnesemia (2.7 mg/dL [1.11 mmol/L]). The primary objective was to establish the incidence of preoperative ionized hypomagnesemia.There was a marked difference between the incidence of preoperative ionized and total hypomagnesemia (28% vs. 19%; p0.001). The postoperative values of ionized magnesium, ionized calcium, and albumin were significantly lower than the respective preoperative values (p0.001 for all three variables).The incidence of hypomagnesemia, determined by ionized magnesium concentration, was higher than that determined by total magnesium concentration.

To assess the effects of various concentrations of dexmedetomidine on the human blood coagulation profile using rotational thromboelastometry (ROTEM). Venous blood samples were collected from 11 healthy volunteers and divided into four specimen bottles; dexmedetomidine was added to attain final sample concentrations of 0, 0.5, 1.0, and 1.5 ng/mL. ROTEM was performed on each study sample. The concentration of dexmedetomidine increased, and the ROTEM values showed a hypercoagulable state. The change in clotting time (CT) for INTEM was larger in samples with a dexmedetomidine concentration of 1.5 ng/mL (− 34%) than in the 0.5 ng/mL samples (− 16%) (P = 0.010). The change in clot formation time (CFT) for INTEM was greater in 1.5 ng/mL samples (− 16%) than in 0.5 ng/mL samples (− 4%) (P = 0.004). A greater decrease in CT for EXTEM was identified in the 1.0 ng/mL and 1.5 ng/mL samples (− 36% and − 37%, respectively) than in the 0.5 ng/mL samples (− 12%) (P = 0.003 for both categories). The change in CFT for EXTEM was greater in the 1.0 ng/mL and 1.5 ng/mL samples (− 11% and − 13%, respectively) than in the 0.5 ng/mL samples (− 4%) (P = 0.006 and P = 0.001, respectively). A bigger change in maximum clot firmness (MCF) for EXTEM was observed in the 1.5 ng/mL samples (4%) than in the 0.5 ng/mL samples (0%) (P = 0.002). The change in MCF for FIBTEM was greater in the 1.5 ng/mL samples (19%) than in the 0.5 ng/mL samples (5%) (P = 0.001). All coagulation pathways showed a hypercoagulable state as the concentration of dexmedetomidine increased. Nevertheless, most of the values of ROTEM were maintained within the reference ranges. Clinical Trial NCT04269278.

This study aimed to identify the benefits of thoracic paravertebral block (PVB) by focusing on its role in reducing chronic postsurgical pain (CPSP) after thoracic surgery.A systematic review and meta-analysis of randomized controlled trials (RCTs).Electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, were searched to identify studies.Patients undergoing thoracic surgeries.Paravertebral block for postoperative analgesia.A total of 1,028 adult patients from 10 RCTs were included in the final analysis. The incidence of CPSP at 3 months after surgery was not reduced in the PVB group compared with the no-block (odds ratio [OR] 0.59, 95% CI 0.34-1.04; p = 0.07; IThoracic PVB does not prevent CPSP after thoracic surgery. Further large RCTs are required to confirm and validate the authors' results.

The development of three-dimensional electrode substrates is a strategy for designing powerful electrolysis cells for hydrogen production combined with electrochemical oxidation of various refractory organic compounds. Herein, to achieve highly effective and low-cost anodic treatment of pollutants and simultaneous cathodic hydrogen evolution in a single electrolysis cell containing sulfate-laden wastewater, we fabricated carbon-coated TiC nanoarrays (C@TiC NAs) as efficient three-dimensional (3D) electroactive supports. The anodes prepared via the deposition of boron-doped diamond (BDD) on 3D C@TiC NAs (BDD@TiC NAs) exhibited 1.9-fold higher efficiency for benzoic acid degradation and 4.4-fold higher peroxydisulfate (PDS) generation than the conventional plate type BDD electrode. Moreover, with multi-activity assessment using 8 organic substances, the BDD@TiC NAs enabled successful anodic treatment of all tested refractory organics and the kinetic rate did not depend on the substrate type. For the cathode, Pt nano-dots (NDs) coated on C@TiC NAs (Pt@C@TiC NAs) can be simply prepared via salt coating and subsequent thermal reduction. Uniformly decorated Pt NDs with a low mass loading of 0.029 mg cm−2 on C@TiC NAs showed the same hydrogen evolution reaction performance as that of a commercial Pt plate. When a single electrolysis cell was configured using BDD@TiC NAs and Pt@C@TiC NAs, the cell performance surpassed that of a conventional ideal electrolysis cell (flat BDD//Pt plate) in all efficiency aspects: degradation of benzoic acid, sulfate radical generation, and hydrogen production.

Background: When an imbalance occurs between the demand and capacity for protein folding, unfolded proteins accumulate in the endoplasmic reticulum (ER) lumen and activate the unfolded protein response (UPR). In addition, unfolded proteins are cleared from the ER lumen for ubiquitination and subsequent cytosolic proteasomal degradation, which is termed as the ER-associated degradation (ERAD) pathway. This study focused on changes in the UPR and ERAD pathways induced by the repeated inhalation anesthetic exposure in Caenorhabditis elegans. Methods: Depending on repeated isoflurane exposure, C. elegans was classified into the control or isoflurane group. To evaluate the expression of a specific gene, RNA was extracted from adult worms in each group and real-time polymerase chain reaction was performed. Ubiquitinated protein levels were measured using western blotting, and behavioral changes were evaluated by chemotaxis assay using various mutant strains. Results: Isoflurane upregulated the expression of ire-1 and pek-1 whereas the expression of atf-6 was unaffected. The expression of both sel-1 and sel-11 was decreased by isoflurane exposure, possibly indicating the inhibition of retro-translocation. The expression of cdc-48.1 and cdc-48.2 was decreased and higher ubiquitinated protein levels were observed in the isoflurane group than in the control, suggesting that deubiquitination and degradation of misfolded proteins were interrupted. The chemotaxis indices of ire-1, pek-1, sel-1, and sel-11 mutants decreased significantly compared to N2, and they were not suppressed further even after the repeated isoflurane exposure. Conclusion: Repeated isoflurane exposure caused significant ER stress in C. elegans. Following the increase in UPR, the ERAD pathway was disrupted by repeated isoflurane exposure and ubiquitinated proteins was accumulated subsequently. UPR and ERAD pathways are potential modifiable neuroprotection targets against anesthesia-induced neurotoxicity.

Background: We compared preoperative residual gastric volume (GV) between the first and second stages of total knee arthroplasty (TKA) in older adults after drinking carbohydrate-containing fluid 2 h prior to surgery.Methods: In this study, 36 patients, aged > 65 years, scheduled for staged bilateral TKA with one-week interval, were enrolled. The patients consumed 400 ml of carbohydrate-containing fluid 2 h prior to surgery. Before the induction of spinal anesthesia, the gastric antral cross-sectional area was measured at the first and second TKA using ultrasound, and the residual GV was calculated. The primary outcome was the residual GV. Qualitative GV (grades 0, 1, and 2) and analgesic consumption after the first TKA were assessed as secondary outcomes.Results: The GV (median [Q1, Q3]) was greater in the second-stage TKA (41.1 [22.5, 62.8] ml) than in the first-stage TKA (10.3 [0.0, 27.1] ml) (P < 0.001). In the qualitative assessment, the distribution was not different between the two stages of TKA (P = 0.219) and only one patient showed grade 2 gastric content in the second TKA. When opioid consumption was converted to an equivalent dose of morphine, an average of 53.9 mg of morphine was required after the first TKA.Conclusions: Residual GV after drinking carbohydrate-containing fluid differed according to the stage of TKA, showing a larger residual GV in the second TKA than in the first one. In older adults scheduled to undergo bilateral staged TKA, caution is required in preoperative fasting practice, especially in second-stage surgery.

Patient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements.Randomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models.A total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 μg/L; 95% CI, 298.13 to 449.56; P 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group.This study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.

This meta-analysis aimed to determine whether peripheral nerve blocks (PNB) reduce postoperative delirium (POD) in elderly patients undergoing hip surgery. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022328320). The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) on 26 April 2022. A total of 19 RCTs with 1977 participants were included. Perioperative PNB lowered the POD incidence on the third postoperative day (OR: 0.59, 95% CI [0.40 to 0.87], p = 0.007, I2 = 35%), in patients without underlying cognitive impairment (OR: 0.47, 95% CI [0.30 to 0.74], p = 0.001, I2 = 30%), and when a fascia iliaca compartment block (OR: 0.58, 95% CI [0.37 to 0.91], p = 0.02, I2 = 0%) or a femoral nerve block (OR: 0.33, 95% CI [0.11 to 0.99], p = 0.05, I2 = 66%) were performed. The pain score was also reduced (SMD: −0.83, 95% CI [−1.36 to −0.30], p = 0.002, I2 = 95%) after PNB. Perioperative PNB can lower the POD incidence and pain scores up to the third postoperative day. However, considering the wide variety of PNBs performed, more trials are needed to identify the effects of each PNB on POD.

Hyperalgesia frequently occurs after surgery and is associated with adverse effects on surgical outcomes. Thus, we aimed to examine whether the hypothalamus-pituitary-adrenal (HPA) axis function after surgery is involved in the development of postoperative hyperalgesia.Surgery- and pain-related variables were measured 24 and 48 hours after the first and second total knee arthroplasties (TKAs) in postmenopausal patients undergoing one-week-interval staged bilateral TKA. Two sets of saliva samples were consecutively collected from patients before (pre-T1) and one week after (post-T1) the first TKA (n = 69). HPA axis function was analyzed in a subgroup of 20 patients with a typical cortisol awakening response (CAR) in both sets of saliva samples.Surgery-related variables were comparable between the first and second TKAs. However, pain-related variables (pain ratings and the amount of opioid analgesics consumed) were greater after the second than the first TKA. Cortisol and dehydroepiandrosterone (DHEA) secretion during the post-awakening period (CARauc and Daucawk, respectively) was higher at post-T1 than at pre-T1, but the molar CARauc/Daucawk ratio was comparable between the time points examined. No relationship was observed between the pre-T1 CARauc and pain ratings after the first TKA. However, post-T1 CARauc showed a positive correlation with pain ratings after the second TKA. Postoperative pain ratings were negatively correlated with Daucawk and positively correlated with the molar CARauc/Daucawk ratio at all examined time points.The results suggest that adrenocortical steroidogenic activity favoring the production of cortisol over DHEA after surgery may contribute to the development of hyperalgesia during the early postoperative period.

Lithium-sulfur batteries (LSBs) can replace lithium-ion batteries by delivering a higher specific capacity. However, the areal capacity of current LSBs is low because the intrinsic limitations of sulfur make achieving a high sulfur loading difficult. Herein, the authors report vertically aligned reduced graphene oxide (rGO) with sulfur and poly(ethylene oxide)-based polymer electrolyte double-shell layers (VRG@S@PPE) as a high-loading sulfur cathode. The addition of vapor-grown carbon fiber (VGCF) into rGO is the key to success, as it allows for gas evacuation from internal nano/micropores without structural collapse, enabling perfect double-shell layer contact. Owing to the anisotropic rGO lamellar structure that enables straightforward ion/electron transport and provides numerous active sites, sulfur-infiltrated rGO reinforced via VGCF (VRG@S) exhibits a high capacity of 998 mAh g

The role of lidocaine patch (LP) in reducing postoperative pain by local anesthetic absorption has been evaluated in several studies; however, these trials have shown inconsistent results. This meta-analysis aimed to identify the benefits of LP, focusing on its pain-reducing and morphine-sparing effect in patients after surgery.Meta-analysis.Published randomized controlled trials (RCTs) comparing the analgesic effects of LP after surgery to those of placebo or no patch.Eleven RCTs including 539 patients.We searched electronic databases to identify relevant RCTs.The primary outcome was postoperative pain score up to 48 h assessed using a numerical rating or visual analog scale, and the secondary outcomes were postoperative morphine consumption and side effects. The effect size was estimated by calculating the mean difference (MD) or risk ratio (RR), with 95% confidence interval (CI).LP significantly decreased postoperative pain score at 6 h (MD, -1.85; 95% CI, -2.98 to -0.72; p = 0.001), 12 h (MD, -1.48; 95% CI, -2.07 to -0.88; p 0.001), 24 h (MD, -1.18; 95% CI, -1.65 to -0.7; p 0.001), and 48 h (MD, -1.33; 95% CI, -2.46 to -0.19; p = 0.022). In contrast, no significant effect on postoperative morphine consumption was observed at 24 h (MD, -3.48 mg; 95% CI, -7.94 to 0.98 mg; p = 0.127) or 48 h (MD, -5.29 mg; 95% CI, -13.28 to 2.71; p = 0.195). LP was unrelated to local (RR, 1.00, 95% CI, 0.67 to 1.49; p = 0.987) or systemic side effects (RR, 0.76, 95% CI, 0.52 to 1.11, p = 0.151).LP can lower postoperative pain without side effects, compared to placebo or no patch. However, its morphine-sparing effect remains unclear.

Background The risk of selenium deficiency increases for infants receiving long-term parenteral nutrition (PN). This study analyzed selenium deficiency in neonates and infants requiring long-term PN and evaluated the effect of intravenous (IV) selenium provision. Methods This study was a retrospective study of neonates and infants who were admitted to neonatal intensive care unit from January 2010 to December 2019, received PN for at least 2 weeks, and had their serum selenium concentration measured. Patients were divided into two groups depending on their serum selenium concentration, a deficient group (n = 55) and a non-deficient group (n = 47). Results Of the study subjects, 53.9% (55/102) were deficient in selenium. No difference in demographic and clinical characteristics existed between the two groups except for the incidence of bronchopulmonary dysplasia. A subgroup analysis was performed for patients who were supplemented with IV selenium and whose serum selenium concentrations were monitored (n = 29). The average dose of IV selenium administered to patients was 2.7 ± 1.0 μg/kg/day. The average initial serum selenium concentration was 36.5 ± 18.0 μg/L and the serum concentration significantly increased to 52.5 ± 19.1 μg/L after IV selenium administration (p Conclusions Selenium deficiency is common in neonates and infants receiving long-term PN. Serum selenium concentration increased proportionally as the IV selenium dose increased. Therefore, it is recommended to supply a proper dose of IV selenium depending on the degree of selenium deficiency. This article is protected by copyright. All rights reserved.