(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients undergoing thoracotomy for major surgery, such as resection of lung malignancies and lung transplantation. (2) Methods: This is a retrospective, dual-center observational study including patients that underwent major thoracic surgery including lung transplantation and received concurrent placement of thoracic epidural catheters for post-operative analgesia. An electronic system of referral and documentation of complications was used, and information was retrieved from our electronic critical care charting system. (3) Results: In total, 1145 patients were included in the study. None of the patients suffered any major complication, including hematoma, abscess, or permanent nerve damage. (4) Conclusions: the present study showed that in experienced centers, post-operative epidural analgesia in patients with thoracotomy is a safe technique, manifesting minimal, none-serious complications.

Background: Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. Objective: The current investigation aimed to examine the analgesic efficacy and the opioid sparing effects of intravenous parecoxib in combination with continuous femoral blockade. Study Design: Randomized, double-blind, prospective trial. Setting: University hospital in the United Kingdom. Methods: In total, 90 patients underwent TKA under subarachnoid anesthesia and received continuous femoral block initially as a bolus with 20 mL of ropivacaine 0.75%. Infusion of 0.2% on 10 mL/h followed. Patients were randomized into 2 groups. Group D and Group P received parecoxib and placebo, respectively at 12 hour time intervals. Visual analog scale (VAS) pain scores were obtained at different time intervals including 4, 8, 12, 24 and 36 hours. The pain scores were measured with patients in a resting position. Morphine could also be administered with a patient controlled analgesia (PCA) pump if the specified analgesia was deemed inadequate (VAS > 5). Results: None of the patients were withdrawn from the study. Parecoxib provided greater relief than placebo following TKA. The VAS pain scores measured at rest were statistically significantly lower in parecoxib-treated patients compared to the placebo group (P = 0.007) at 4 (P = 0.044), 12 (P = 0.001), and 24 hours (P = 0.012), postoperatively. Patients receiving parecoxib consumed less morphine at all time intervals than patients receiving placebo, with borderline statistical significance (P = 0.054). In each time period, all patients receiving continuous femoral block irrespectively of the treatment group, required low morphine doses. Limitations: Current protocol did not answer question as to functional recovery. Conclusion: According to our findings intravenous parecoxib in combination with continuous femoral block provided superior analgesic efficacy and opioid sparing effects in patients undergoing TKA. Key words: Anesthesia, TKA, morphine, opioids, VAS scores, continuous femoral block

Recent advances in neuromodulation are opening new pathways for treating chronic pain, with spinal cord stimulation (SCS) poised for substantial transformation in the coming years. Evolving technologies and a deeper understanding of pain mechanisms are driving a move away from traditional, standardized stimulation models toward more precise and personalized interventions. This shift reflects not only technical progress but also a growing emphasis on tailoring treatment to individual patient profiles. Advances in neuromodulation have introduced new stimulation patterns such as high-frequency, burst and dorsal root ganglion stimulation, which developed to address the limitations of conventional tonic SCS, especially declining long-term efficacy and the need for paresthesia. Early studies show promising results for these newer modalities, but findings are inconsistent and long-term data remain limited. In this article, we explore the current landscape of SCS innovation, highlight emerging clinical approaches and discuss the conceptual and technological trends that are likely to redefine the role of neuromodulation in chronic pain management.

Intravenous administration of parecoxib could provide significant pain relief in surgical operations that require additional forms of analgesia. However, very little is known about its effects on the anxiety levels of patients before a surgical procedure. The aim of this prospective study was to investigate whether intravenous parecoxib, pre-emptively administered, has an effect on anxiety levels experienced post-surgically after total knee arthroplasty (TKA) and if it influences the reported pain of the procedure itself.

Background: Postoperative thrombocytopenia is a frequent finding after cardiac surgery, affecting approximately 10–40% of patients. The early decline in platelet count, typically observed within the first 48–72 h, is usually explained by hemodilution, perioperative platelet consumption, and the inflammatory or mechanical impact of cardiopulmonary bypass (CPB). However, a secondary decrease occurring beyond postoperative day 5 should raise suspicion for more serious causes, the most important being heparin-induced thrombocytopenia (HIT), a rare but potentially life-threatening complication. Objectives: This review aims to outline the characteristic patterns of postoperative thrombocytopenia in cardiac surgery, provide a practical framework for differential diagnosis, and summarize up-to-date evidence on the diagnosis and management of HIT. Methods: A narrative review was conducted through searches in PubMed, Scopus, and Embase up to September 2025. Conclusions: Recognizing platelet count trends early and applying a stepwise diagnostic approach can help distinguish benign postoperative thrombocytopenia from HIT and other critical causes. The combination of clinical assessment using the 4Ts score and appropriate confirmatory testing remains central to accurate diagnosis. Tailoring anticoagulant therapy to individual patient requirements—including surgical procedure, renal and hepatic function, and bleeding risk—is essential for reducing thrombotic events and improving postoperative outcomes.

Background: Total Knee Arthroplasty (TKA) is a well-established surgical procedure for the treatment of knee joint diseases. This operation leads to severe acute and chronic pain, and intravenous administration of parecoxib could provide significant pain relief. Objective: The aim of the study was to compare the hemodynamic data and safety profile of patients who received parecoxib compared to placebo following TKA. Methods: Ninety patients were followed during this study and were randomly assigned into two equal groups. Group P received parecoxib and Group C received the placebo. Exclusion criteria included age < 40 or > 80 years, ASA III or higher, obesity (>140 kg), allergy to local anaesthetics, opioid dependence, contraindications for subarachnoid anaesthesia, femoral block or the administration of parecoxib. The haemodynamic data collected were Systolic Arterial Pressure (SAP), Diastolic Arterial Pressure (DAP), Heart Rate (HR), Oxygen Saturation (Ox-Sat), blood transfusion requirements and side effects. Recordings were performed every hour for up to 10 hours and at 15min, 4, 8, 12, 24, 36 hours postoperatively. Results: The postoperative SAP and DAP data presented similar findings among groups (p>0.05) within the aforementioned time intervals. The postoperative HR data for both groups displayed no statistically significant difference between the two cohorts (p>0.05). Regarding the occurrence of transfusion, there is no statistically significant difference between the parecoxib and placebo cohorts. The frequency of side effects was negligible and could not be correlated with either group. Conclusion: Therefore, parecoxib did not render any noticeable impact on the hemodynamic profile of the patients.