Background: Propofol is widely used for sedation of hysteroscopy. It can cause injection pain, respiratory depression, and hypotension. Remimazolam is a novel ultra-short-acting benzodiazepine. Clinical practice has found that the use of remimazolam alone often leads to body movement during hysteroscopy, which decreases the safety and comfort. Here this study is to investigate whether remimazolam combined with low-dose propofol can improve the sedation effect and safety of hysteroscopy. Patients and Methods: In this prospective, randomized, parallel-controlled trial, women (18 to 60 years) undergoing hysteroscopy were randomly assigned to receive propofol (Group P), remimazolam tosylate (Group R), or remimazolam tosylate plus propofol (Group RP). Intraoperative sedation depth was kept at the bispectral index (BIS) value of 40– 60. 6 μg/kg alfentanil was used for analgesic before sedation. Intraoperative low pulse oxygen saturation (SpO₂), body movement, injection pain, mean arterial pressure (MAP), heart rate (HR), and postoperative recovery time, dizziness, nausea and vomiting were recorded and compared. Results: From February to July 2022, 193 patients were recruited and randomly assigned to group P (n=64), group R (n=64), or group RP (n=65). There was no significant inter-group difference of the intraoperative BIS values. The incidence of low SpO₂, injection pain, hypotension, and postoperative dizziness in group RP were less than that in group P, and had no significant difference from group R. The incidence of body movement in group RP was less than that in group R, and had no significant difference from group P. Postoperative recovery time of group RP was shorter than that of the other two groups. No significant inter-group difference in bradycardia, nausea and vomiting was observed. Conclusion: Remimazolam tosylate combined with low dose of propofol improved sedation and safety in hysteroscopy, and may be a more ideal sedative method for hysteroscopy.

Background: Chronic postsurgical pain (CPSP) is common and would reduce the quality of life of patients. Transversus abdominal plane (TAP) block has been widely used in lower abdominal surgery and many researches demonstrated that it could improve acute postsurgical pain. We aim to determine whether TAP block could improve chronic postoperative pain at 3 months and 6 months after colorectal surgery. Methods: A total of 307 patients received selective colorectal surgery under general anesthesia between January, 2015 and January, 2019 in a single university hospital were included: 128 patients received TAP block combined with patient-controlled intravenous analgesia (PCIA) for postsurgical analgesia (group TP) and 179 only administrated with PCIA (group P). Main outcome was the NRS score of pain at 3 months after colorectal surgery. The data was analyzed by two-way repeated measures anova and the chi-square test. Results: The NRS score at rest and during movement was decreased significantly at 24 h after surgery (rest NRS 1.07 ± 1.34 vs 1.65 ± 1.67, movement NRS 3.00 ± 1.45 vs 3.65 ± 1.89; all P = 0.003) in group TP than those of group P. There was no significant difference of NRS score at 48 h after surgery (P > 0.05). At 3 months after surgery, the NRS score during movement was also lower in group TP than that in group P (0.59 ± 1.23 vs 0.92 ± 1.65, P = 0.045). There was no significant difference of NRS score at 6 months after surgery (P > 0.05). The prevalence of CPSP was 19.5% (25/128) in group TP and 20.7% (37/179) in group P at 3 months after surgery. 13.2% (17/128) of patients suffered from CPSP in group TP and 13.9% (25/179) in group P at 6 months after surgery. Both at 3 months and 6 months after surgery, there was no statistical difference of the prevalence of CPSP between the two groups (all P > 0.05) . Conclusions: TAP block reduced NRS during movement at 3 months after surgery but did not reduce the incidence of CPSP at 3 months and 6 months after selective colorectal surgery.

Background: Inflammatory pain poses a significant clinical challenge, with its underlying mechanisms not yet fully elucidated. This study investigated the role of Caveolin-1 (Cav1) in inflammatory pain and elucidated its molecular mechanisms. Methods: We analyzed public databases and employed a mouse model of inflammatory pain induced by complete Freund’s adjuvant (CFA). Cav1-knockout (Cav1^-/-) mice were used to evaluate Cav1’s function. The study incorporated behavioral tests, immunohistochemistry and molecular analyses. BV2 microglial cells served as the in vitro model. Results: Following CFA injection, Cav1 expression was markedly elevated in the dorsal horn of spinal cord, correlating with pain behavior and inflammatory responses. Cav1^-/- mice demonstrated significantly reduced pain behavior and inflammatory responses after CFA induction. Mechanistically, Cav1 enhanced inflammation by activating the cGAS-STING pathway and inhibiting autophagy. In BV2 microglia, Cav1 overexpression increased proinflammatory cytokine expression (TNF-α, IL-1β, IL-6) while inhibiting autophagy, whereas Cav1 knockdown produced opposing effects. Conclusion: This study reveals a novel role of Cav1 in inflammatory pain, demonstrating its regulation of inflammation through modulation of the cGAS-STING pathway and autophagy. These findings advance our understanding of the pathogenesis of inflammatory pain and identify Cav1 as a potential therapeutic target.

Objective To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. Study Design This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic—Clinic for Acceptance Recovery and Empowerment (CARE)—between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. Results A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05–1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76–1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36–1.84). Conclusion In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. Key Points

Background: Postoperative delirium (POD) is one of the most common complications in geriatric patients following surgery. Physiological concentration of bilirubin possesses anti-inflammatory, antioxidant and neuroprotective effects, which are important protective mechanisms against POD. This study aimed to explore the relationship between preoperative serum bilirubin and POD in geriatric patients undergoing joint replacement. Methods: Geriatric patients who underwent hip or knee joint replacement surgery under intrathecal anesthesia were included. These patients had American Society of Anesthesiologists (ASA) grades I to III. The patients with a history of psychiatric or neurological disorders, infectious diseases or sepsis, hemolytic anemia, liver diseases, performed general anesthesia or intrathecal anesthesia combined with general anesthesia, or insufficient surgical information were excluded. Patients’ age, gender, weight, height, ASA classification, liver function and bilirubin within one week before surgery, preoperative Mini–Mental State Examination (MMSE) scores, surgical type, dosage of medications, intraoperative bleeding volume, postoperative average numeric rating scale (NRS) pain scores, the occurrence of POD and Delirium Rating Scale–Revised–98 (DRS–R–98) scores for POD were collected. Results: A total of 269 patients were eligible for inclusion in the study, with 23.05% (62/207) exhibiting POD. Patients with POD exhibited higher age and ASA classification, and had lower weight, serum total serum bilirubin (TBIL) and indirect bilirubin (IBIL) within one week before surgery, and preoperative MMSE scores (all p < 0.05). Univariate logistic regression analysis showed that the above variables were correlated with the occurrence of POD (all p < 0.05). Multivariate logistic regression analysis revealed that age was a risk factor (p < 0.001, OR = 1.14, 95% CI [1.07–1.21]), while weight (p = 0.041, OR = 0.96, 95% CI [0.92–0.99]), IBIL levels within one week before surgery (p = 0.012, OR = 0.65, 95% CI [0.47–0.91]) and preoperative MMSE scores (p < 0.001, OR = 0.84, 95% CI [0.78–0.91]) served as protective factors against the occurrence of POD. The serum IBIL concentration within one week before surgery was performed receiver operating characteristic (ROC) curve analysis. The estimated cutoff value for predicting the occurrence of POD was 6.65 μmol/L, and area under the curve (AUC) was 0.63. Patients with preoperative serum IBIL concentration below 6.65 μmol/L had a higher incidence of POD. Conclusion: Patients with lower preoperative serum IBIL levels exhibited a higher incidence of POD in geriatric patients undergoing joint replacement. Low serum IBIL was a risk factor and a predictor for the occurrence of POD.

Objective: To explore the optimal bolus dose of oxycodone for patient controlled intravenous analgesia (PCIA) without background dose in elderly patients after laparoscopic surgery for gastrointestinal cancer.Methods: In this prospective, randomized, double-blind, parallel-controlled study, we recruited patients aged 65 years or older. They underwent laparoscopic resection for gastrointestinal cancer and received PCIA after surgery. Eligible patients were randomly divided into 0.01, 0.02, or 0.03 mg/kg group according to the bolus dose of oxycodone in PCIA. The primary outcome was VAS scores of pain on mobilization at 48 h after surgery. Secondary endpoints included the VAS scores of rest pain, the total and effective numbers of press in PCIA, cumulative dose of oxycodone used in PCIA, the incidence of nausea, vomiting and dizziness, as well as patients’ satisfaction at 48 h after surgery.Results: A total of 166 patients were recruited and randomly assigned to receive a bolus dose of 0.01 mg/kg (n = 55), 0.02 mg/kg (n = 56) or 0.03 mg/kg (n = 55) of oxycodone in PCIA. The VAS scores of pain on mobilization, the total and effective numbers of press in PCIA in 0.02 mg/kg group and 0.03 mg/kg group were lower than those in 0.01 mg/kg group (P < 0.05). Cumulative dose of oxycodone used in PCIA and patients’ satisfaction in 0.02 and 0.03 mg/kg groups were more than those in 0.01 mg/kg group (P < 0.01). The incidence of dizziness in 0.01 and 0.02 mg/kg groups was lower than that in 0.03 mg/kg group (P < 0.01). There were no significant differences in VAS scores of rest pain, the incidence of nausea and vomiting among three groups (P > 0.05).Conclusion: For elderly patients undergoing laparoscopic surgery for gastrointestinal cancer, 0.02 mg/kg bolus dose of oxycodone in PCIA without background infusion may be a better choice.