Background and Objectives: This study aimed to examine the efficacy of tapentadol immediate release (IR) and morphine hydrochloride in the treatment of acute postoperative pain after total abdominal hysterectomy, as well as to examine the frequency of opioid-related side effects in observed patients. Materials and Methods: The prospective observational study was conducted over five months, and it included a total number of 100 patients. The two cohorts had different types of postoperative analgesia, and the effects were observed for 24 h postoperatively, by following the pain scores on NRS (Numerical Pain Scale), contentment with analgesia, and opioid-related side effects. Results: Statistical significance was found when assessing pain 24 h after surgery while coughing, where patients in the tapentadol IR group had significantly higher mean pain scores (p < 0.01). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in the tapentadol IR group (p = 0.005). Vertigo appeared significantly more in patients from the morphine group (p = 0.03). Conclusions: Tapentadol IR (immediate release) and morphine hydrochloride are both effective analgesics used in the first 24 h after total transabdominal hysterectomy. Overall satisfaction of patients with analgesia was good. The frequency of side effects was higher in the morphine group, with statistical significance regarding the vertigo.

Insulinoma represents a benign, insulin-secreting neuroendocrine tumor of the beta cells of islets of Langerhans in the pancreas, which leads to frequent episodes of hypoglycemia. Surgery is the definite treatment. However, the perioperative treatment of patients with insulinoma is highly challenging. We present the perioperative management of a 46-year-old obese male patient with insulinoma. As the patient reported frequent severe hypoglycemia episodes, the main priority of the perioperative treatment was to prevent hypoglycemia before tumor resection and to control rebound hyperglycemia after tumor removal. Maintaining normoglycemia was challenging during the regular fasting period before abdominal surgery, as well as during the intervention, as general anaesthesia masks the symptoms of hypoglycemia. Obesity further complicated the anaesthetic management, due to expected difficult airway management and central venous access. Glycemia was monitored in 15-minute intervals during surgery and in 30-minute intervals postoperatively, and dysglycemia was corrected according to the trend of variations. As insulinoma is a rare phenomenon with an unpredictable clinical course, current reportings regarding the anaesthetic management of patients with this pathology are relatively lacking. Therefore, our case report could contribute to expanding the limited data about the perioperative treatment of patients with this condition.

Acupuncture is a traditional Chinese therapeutic method that uses a sterile thin needle technique to puncture the skin at specific strategic points on the body. World Health Organisation has acknowledged acupuncture as a complementary treatment method for over 300 diseases. Nowadays, many available studies conducted in China, the United States, and Europe confirm the efficacy of acupuncture, its analgesic effect, while providing direct health benefits without or with minimal side-effects. There are many scientific evidence mechanisms of acupuncture’s analgesic effects. One of the mechanisms is described in the oldest and best-known Gate Control Theory which explains how pain pathways are modulated through normal anti-nociceptive pathways in the spinal cord. The second mechanism of analgesia shows that there are changes in descendent inhibition of pain pathway and secretion of neurotransmitters when the acupuncture needle is placed at the specific acupuncture point. In addition, it has been proved that there is an increased secretion of endogenous opioids during acupuncture procedures, which help reduce the pain sensations. Analgesic effects of acupuncture on cerebral function have been confirmed with use of functional magnetic resonance imaging and positron emission tomography scans. Although there is an increased number of relevant studies that confirm the effects and benefits of acupuncture therapy in the perioperative period, some important factors are still missing: the standardization process of acupuncture technique, the determination of types of surgery where the acupuncture method shows the best therapeutic effect, the determination of the best technique and time interval for the most effective analgesia.

Background: Many studies have shown that geriatric patients with altered nutritional status are at higher risk of developing complications during medical treatment. Our study aimed to examine the role of preoperative nutritional status in developing postoperative complications and the length of hospital stay in geriatric patients who suffer from cancer and undergo major abdominal surgery. Methods: Prospective research was conducted at the Oncology Institute of Vojvodina from January 2020 until April 2021. This study included 82 patients over 65 years old, who were admitted to have radical surgery for gastrointestinal cancer performed. There were 6 patients excluded from the study. Nutritional status analysis was performed using BMI (Body mass index), preoperative serum albumin level, MNA-SF (Mini nutritional assessment- short form), and GNRI (Geriatric nutritional risk index). The classification of surgical complications was done using the Clavien-Dindo classification scale. Results: Of the total number of patients, 57 of them (75%) developed at least one surgical complication. Nonsurgical complications have been recognized in 28 patients (36.84%). Overweight patients, according to BMI, had a greater chance of developing grade I (p < 0.01) and grade II (p < 0.05) surgical complications of the Clavien-Dindo classification. Patients with normal serum albumin levels had a significantly lower chance of developing surgical complications of any grade (p = 0.00). BMI and MNA- SF were the most important predictors of delirium. Patients without GNRI risk (GNRI: >98) had a significantly lower chance of developing nonsurgical complications regarding comorbidity exacerbation (p = 0.03), and delirium (p = 0.00). Conclusion: None of the nutritional assessment tools used in our study were better or more efficient than the others in our sample of patients. Precise nutritional status assessment is complex and we cannot use only one scoring system or scale to get accurate results.

Background/Aim. Postoperative nausea and vomiting (PONV) is one of the most common causes of patient dissatisfaction in the postoperative period after general anaesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been adequately studied so far. Methods. Forty female patients with breast cancer were recruited, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. Balanced general anaesthesia with propofol induction and sevofluran maintenance was administered. Twenty patients received a volatile mixture with inspiratory fraction of inspired oxygen (FiO2) of 0.8 intraoperatively and 3 L/min oxygen via face mask for two hours after surgery. The other 20 patients received a FiO2 of 0.4 during the intervention, without further administration of oxygen in the early postoperative period. The presence and severity of PONV was assessed at 30 minutes, 4/24/32/48/56 hours after surgery and a numerical PONV Intensity Scale by Wengritzky was applied to evaluate clinically significant PONV in the first 6 hours after surgery. Data were collected in Excel spreadsheet and analysed using the independent Student's t-test. Results. The overall incidence of PONV 30 minutes after the intervention was 17.5% (15% in the group of patients receiving FiO2 of 0.8 intraoperatively and 20% in the group of patients receiving volatile mixture with FiO2 of 0.4). There was no statistically significant difference (p≥0.05) between the two groups in the frequency and severity of PONV, as well as in the values of PONV Intensity Score by Wengritzky. Conclusion. We found no benefit of intraand postoperative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia in addition to antiemetics in patients undergoing breast cancer surgery for the prevention of PONV.