In this retrospective study, the incidence of postoperative nausea and vomiting（PONV）and postoperative pain after thoracoscopic lung surgery were compared between patients who received patient-controlled epidural analgesia（PCEA）and intravenous patient-controlled analgesia（IVPCA）. Seventy-two patients（group E）received PCEA using ropivacaine and fentanyl, while 86 patients （group V）received IVPCA using fentanyl after surgery. There was no significant difference in the incidence of PONV up to postoperative day 1（group E：12.5% vs. group V：15.1%, p=0.64）, while the need for bolus PCEA and IVPCA or rescue analgesics and pain scores were also similar. IVPCA did not raise the incidence of PONV and worse postoperative pain compared to PCEA.

Herein, we report the case of a newborn girl who was diagnosed with sacrococcygeal teratoma during the fetal period. After delivery by caesarean section at 34 weeks of pregnancy, the newborn underwent postnatal tracheal intubation, and respiratory and circulatory management was provided in the Neonatal Intensive Care Unit. At 11 days of age, tumor resection of the sacrococcygeal teratoma was performed under general anesthesia. The feeding artery was dissected in the early stages, but excessive bleeding beyond what was expected occurred during the tumor extirpation. Since it was difficult to evaluate the volume of bleeding and the change in body weight, hemodynamics were maintained by providing rapid blood transfusion and administration of catecholamine, using blood pressure, pulse rate, urine volume, and tension of the anterior fontanelle as indicators. In addition, strict respiratory management was required to accommodate frequent postural changes.

We report a patient who underwent pulsed radiofrequency（RF）of sinuvertebral nerve for persistent low back pain. A 37-year-old man with L4/5 lumbar disc herniation suffered from low back pain for several years. He was treated with intradiscal condoliase injection therapy, but his pain persisted throughout the entire lumbar region. No tenderness, lower limb symptoms, or neurological abnormalities were observed. The patient reported a pain score of 7/10 on a numerical rating scale (NRS). Pulsed RF of his right sinuvertebral nerve was performed 1 month after the first visit, while a pulsed RF of his left sinuvertebral nerve was performed 1 month later. Ultimately, the patient reported a minimum pain score of 2/10 on NRS. In recent years, intradiscal condoliase injection therapy has become available and its pain-relieving effects scientifically proven, but this treatment was ineffective in this case. Pulsed RF of sinuvertebral nerve might be an alternative treatment to other percutaneous or surgical treatments for such pain.

Aspirin-exacerbated respiratory disease（AERD）is a chronic inflammatory airway disorder, in which some kinds of drugs and food additives induce a severe asthma attack. Mid-point transverse process to pleura（MTP）block is a peripheral nerve block technique with a local anesthetic injection behind the superior costotransverse ligament around the transverse process and the head of the rib that induces a PVB-like effect.

We planned a medial upper limb tumor resection using regional anesthesia and sedation in an AERD patient with a history of severe asthma attacks during general anesthesia. Brachial plexus block alone provides insufficient analgesia for medial upper limb surgery, because the medial brachial side of the arm is innervated by both the medial brachial cutaneous nerve（the branch of the brachial plexus）and the intercostobrachial nerve（the branch of intercostal nerve）. We were able to provide excellent perioperative analgesia without an asthma attack by combining both blocks in the patient.

Postpolio syndrome（PPS）is a disease in which patients with a history of acute poliomyelitis develop a variety of symptoms such as muscle weakness and chronic pain after a stable period of several decades. We present the case of a female patient in her sixties with PPS who underwent emergency surgery for an orbital floor fracture under general anesthesia. We administered rocuronium under neuromuscular monitoring. The patient recovered from anesthesia and was discharged without any postoperative complications. Patients with PPS have a number of diseases that require attention in the perioperative period such as increased sensitivity to anesthetic agents including muscle relaxants, respiratory dysfunction, sleep apnea, and dysphagia, but the severity of these diseases varies. In this case, we were able to safely manage the patient with PPS by taking thorough note of her medical history and conducting detailed monitoring despite the limited availability of preoperative examinations due to the urgent nature of her surgery.

The impact of the rapid aging of the Japanese population on anesthesiology was investigated using government statistics. The study focused on postoperative activities of daily living（ADLs）and anesthesia techniques.

From 2008 to 2019, the number of general anesthesia patients aged 75 years and over doubled, while the number of general anesthesia patients aged 85 years and over increased 2.5-fold. In addition, the number of difficult anesthesia cases doubled during this time. The number of large-scale surgeries for patients aged 75 years and over and 85 years and over increased 1.8-fold and 1.3-fold, respectively, during these 11 years.

The number of surgeries being performed is increasing, and older patients’ADLs may deteriorate after surgery even in the absence of complications. In our investigation using the National Hospital Organization’s database of about 310,000 patients, we found that postoperative ADL deterioration rates increased significantly in patients aged 70 years and over, reaching 20% in patients aged 90 years and over.

According to the current literature, it is not clear whether anesthesia techniques affect postoperative ADLs in elderly patients who have undergone hip fracture surgery, but it has been suggested that good postoperative analgesia may contribute to ADL maintenance.

Perioperative delirium and sleep disturbances result from environmental changes and perioperative stress in predisposed patients. Postoperative cognitive dysfunction has been defined variously in previous studies, but was clearly defined in 2018. Aged patients tend to experience postoperative delirium, but age is a fixed factor. On the other hand, low physical function as represented by frailty and preoperative cognitive decline including mild cognitive impairment are modifiable factors. Chronic insomnia is also a risk factor for the development of delirium. In addition, acute insomnia occurring after hospitalization was related to functional disability 3 months after surgery. We are examining the effects of Effective Medical Creation（EMC）, which involves stimulation of the five senses and thoughts/impressions on cognitive function and sleep.

Acetaminophen and nonsteroidal anti-inflammatory analgesics are commonly used for postoperative pain management after neurosurgery（craniotomy）, but they often result in inadequate analgesia. Local infiltration anesthesia of the scalp and nerve blocks to the peripheral nerves distributed in the scalp（so-called scalp blocks）are classic methods that have been reported for more than 100 years. Still, they are being reevaluated as perioperative analgesia methods with the widespread use of awake craniotomy in recent years. The application of regional anesthesia to the scalp can reduce the requirement for intraoperative opioid analgesics and alleviate pain in the immediate postoperative period. At present, pain control measures are needed after the effects of local anesthetics have expired, so multimodal pain management methods should be considered.

Our facility is a local base and teaching hospital and is designated as an advanced treatment hospital. In our department, we focus not only on perioperative management, but on pain clinics and palliative care as well, so we see and treat many types of pain including acute pain, chronic pain, and cancer pain. Although there are many specialists who are familiar with perioperative management, pain clinic, palliative care and regional anesthesia, acute pain service（APS）had never been established in our facility until now. In this article, we review our activities related to postoperative pain management in the past, present and future. Furthermore, we present an outline of specialized and original APS, which is focused on total pain in our facility.

Minimally invasive cardiac surgery has emerged as a popular approach in recent years. Although the wound is smaller than that required for open heart surgery, postoperative pain control remains an important concern. Postoperative pain is a major contributor to the worsening of a patient’s general condition, respiratory and cardiovascular dysfunction, and chronic pain. Postoperative pain management is important to maintain patients’ quality of life. Nerve blocks of the chest wall have gained attention in recent times as a useful option for postoperative pain following cardiac surgery. These blocks may provide effective postoperative analgesia after cardiac surgery.

There have been major technical advances in pediatric cardiac catheterization that have changed it into a therapeutic intervention tool rather than a primarily diagnostic tool. This has made pediatric cardiac catheter anesthesia more complex. This report aims to outline common issues and precautions in pediatric cardiac catheter anesthesia.

The efficacy of opioids for chronic pain in a short-term period is shown by many randomized controlled trials. However, their efficacy and safety in the long term are unknown. Opioids often cause dependence/abuse because they produce not only an analgesic effect but also euphoria. Long-term opioid therapies for chronic pain have increased dramatically in the past 20 years, particularly in the United States. The dependence/abuse induced by prescribed opioids has also increased, as have deaths from overdoses（opioid-related deaths）. It is essential that patients with risk factors for opioid dependence/abuse be screened before starting opioid therapy. Opioids should be prescribed in the minimum amount possible so that their disadvantages do not exceed their benefits, and long-term opioid prescribing should be avoided.

Over the past decade or so, many ultrasound-guided peripheral nerve block techniques have been established, and several anesthesiologists have performed peripheral nerve blocks in their daily practice. However, a complete professional requires both expertise in performing a peripheral nerve block and the ability to respond appropriately to complications.

In this article, based on a case of neuropathy after general anesthesia with a peripheral nerve block, we will learn how to avoid neuropathy that results from peripheral nerve block and how to diagnose neuropathy if it occurs. We will also learn how to diagnose neurological disorders if they occur.