Effect of sugammadex versus glycopyrrolate–neostigmine mixture on catheter-related bladder discomfort after retrograde intrarenal surgery: A retrospective observational analysis

Background: Catheter-related bladder discomfort (CRBD) is one of the most common postoperative symptoms. Although sugammadex and glycopyrrolate–neostigmine mixture are both used for the reversal of neuromuscular blockade, their effects on CRBD have not been compared side-to-side. We investigated the effect of the neuromuscular blockade reversal agents on CRBD after urologic surgery. Methods: We retrospectively reviewed the medical records of 136 patients who underwent retrograde intrarenal surgery between July 2018 and January 2019. Patients were divided into the S group (sugammadex; n = 65) and the G group (glycopyrrolate–neostigmine mixture; n = 71). Primary outcome was moderate-to-severe CRBD at 0 h postoperatively. We also evaluated moderate-to-severe CRBD at 1, 2, and 6 h postoperatively, duration of postanesthetic care unit (PACU) stay, postoperative pain, postoperative analgesic requirement, and drug-related side effects. Results: The incidence of moderate-to-severe CRBD at 0 h postoperatively was significantly lower in the G group than in the S group (39.4% vs. 69.2%, p = 0.001). The two groups did not show significant differences in the incidences of moderate-to-severe CRBD at 1, 2, and 6 h postoperatively, postoperative pain, and postoperative analgesic requirement. The duration of PACU stay was significantly shorter in the G group (46.0 min vs. 53.0 min, p = 0.047). Except for dry mouth, drug-related side effects did not show significant differences between the two groups. Conclusion: Compared with sugammadex, glycopyrrolate–neostigmine mixture was associated with a lower incidence of CRBD immediately after urologic surgery and shorter PACU stay.

Postoperative Analgesic Requirement and Pain Perceptions after Nonaerodigestive Head and Neck Surgery

Objectives Little data exist on associations between patient factors and postoperative analgesic requirement after head and neck (H&N) surgeries. Such information is important for optimizing postoperative care considering concerns regarding opioid misuse. We analyzed factors associated with narcotic use and pain perception following H&N surgery sparing the upper aerodigestive tract. Study Design Prospective cohort. Setting Tertiary referral center. Subjects and Methods From May to October 2017, data were collected for patients undergoing nonaerodigestive H&N procedures requiring hospitalization. Patients completed a preoperative survey querying chronic pain history, narcotic usage, and postoperative pain expectation. Demographics, surgical data, postoperative narcotic use defined by morphine milligram equivalents (MME), pain scores, and Overall Benefit of Analgesia Score (OBAS) were analyzed. Results Seventy-six patients, 44 (57.9%) females and 32 (42.1%) males with a mean age of 54.0 years, met inclusion criteria. The most common procedures were parotidectomy (27.6%) and total thyroidectomy (19.7%). Average cumulative 24-hour postoperative MME and calculated MME per hospital day (MME/HD, cumulative MME for hospitalization divided by length of stay) were 40.5 ± 30.6 and 60.8 ± 60.1, respectively. Average pain score throughout the initial 24 hours after surgery was 3.7/10 ± 2.0. Female sex and prior chronic pain diagnosis were associated with higher OBAS after multivariate linear adjustments. Conclusion Postoperative narcotic requirement in nonaerodigestive H&N surgery is overall low. Female sex and prior chronic pain diagnosis may be associated with higher postoperative OBAS, a validated assessment of pain and opioid-related side effects. This study may serve as a comparison for future studies evaluating narcotic-sparing analgesia and pain perception in nonaerodigestive H&N surgery.

Laparoscopic management of giant ovarian cyst in young woman: a case report

Giant ovarian cysts are very rare nowadays and were conventionally treated by full midline laparotomy. In recent years, the laparoscopic approach is also practiced but it needs a lot of expertise and only a few cases have been reported. As the surgical treatment of choice has become less invasive, laparoscopic surgery is considered more beneficial over laparotomy because of better cosmetic results, less blood loss, reduced postoperative analgesic requirement, early mobilization and faster discharge from the hospital and early resumption to normal day to day activity. We report a case of laparoscopic extirpation of a giant right ovarian cyst measuring 15 × 21 × 22 cm in young 24-year female.