Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins.

Recent advances in intraoperative nociception monitoring, such as the Surgical pleth index (SPI, GE Healthcare, Helsinki, Finland), may help optimize opioid use. Obese patients are particularly susceptible to opioid-related side effects, making this approach of interest in bariatric surgery. In this randomized pilot study, we investigated whether SPI-guided fentanyl administration would influence intraoperative opioid use and postoperative pain. We enrolled 49 patients undergoing laparoscopic gastric sleeve surgery under sevoflurane-based general anesthesia with multimodal perioperative analgesia, randomized to conventional fentanyl dosing at the anesthetist’s discretion (n = 25) or SPI-guided dosing (n = 24). The primary endpoint was intraoperative fentanyl consumption. Secondary outcomes included time to extubation, hemodynamic events, pain scores in the first 90 min postoperatively and rescue analgesia. Fentanyl use did not differ significantly between groups (SPI: 400 ± 101 mcg vs. control: 450 ± 56 mcg, p = 0.100). Extubation was faster with SPI guidance (8.1 ± 1.6 vs. 9.6 ± 1.3 min, p < 0.001). Hemodynamic events and rescue analgesia were less frequent in the SPI group, though not statistically significant. Pain scores were comparable, and no opioid-related adverse effects occurred. In our study, SPI-guided opioid administration did not reduce overall intraoperative fentanyl requirements compared with conventional practice but was associated with a modestly shorter time to extubation.

Objective: Is there a place for non-technical skills training in the ICU? And what teaching strategy should we implement in this process? This narrative review analyzes the benefits of teaching ethics in the ICU environment by applying high-fidelity simulation scenarios to real-life situations, thereby improving communication, moral reasoning, self-reliance, cooperation, and perceptual skills. Methods: In the literature, there are few publications on the training of ICU residents in non-technical skills and ethical dilemmas using high-fidelity simulations. After searching and scoping the database, we have identified 8 publications relevant to this narrative review. Results: In the reviewed studies, the main topics discussed and rehearsed using simulations were as follows: communicating an adverse event during anesthesia in one study, delivering bad news in two studies, the ethics of end-of-life care, and the do-not-resuscitate order in three studies, and ethical non-technical skills such as communications, teamwork and confidence in emergent real-life situations in four studies. Conclusions: Developing a more structured approach to teaching ethics-related events is important, particularly in critical care settings. All reviewed studies reached the same conclusion: high-fidelity simulation training is an educational strategy for ICU residents to develop a foundation in ethical considerations and moral reasoning by improving ethical non-technical skills, such as confidence, communication, teamwork, delivering bad news, and end-of-life care.