Abstract Background and Aims: Pain management strategies in pediatric penile surgery are an essential component of anesthetic care that directly influences maternal-child comfort in the postoperative period. While caudal analgesia remains the standard technique, ultrasound-guided regional techniques, particularly the pudendal nerve block, have emerged as viable alternatives. This study explores the analgesic efficacy of ultrasound-guided pudendal block versus caudal blockade using clonidine as an adjuvant in children undergoing penile surgeries. Material and Methods: This prospective, randomized, comparative study included 60 children aged 6 months to 6 years scheduled for penile surgery. Children were randomly assigned to either Group A (Caudal Block) or Group B (Ultrasound-Guided Pudendal Nerve Block) and received 0.2% ropivacaine with clonidine (1 mcg kg -1 ) as an adjuvant. A blinded observer assessed the FLACC scale, the number of rescue analgesia doses within 24 hours, and the duration of analgesia. The primary outcome was the difference in rescue analgesia requirements. Results: There was no significant difference in rescue analgesia requirements between the groups (P 0.92). Eleven patients (36.7%) in both the groups did not require any rescue analgesia within 24 hours postextubation. The median time to first rescue analgesia was 11.5 hours (6–24) in Group A and 12.3 hours (6.5–24) in Group B (P- 0.72). The FLACC scores were comparable between groups. Conclusions: The pudendal nerve block provides analgesia comparable to caudal block in terms of rescue analgesia requirements and duration of analgesia when clonidine is added with local anesthetics.

Abstract Background and Aims: Managing acute postsurgical pain following midline exploratory laparotomy in colorectal cancer patients involves various approaches, such as central neuraxial blockade, patient-controlled intravenous analgesia with opioids, and bilateral continuous paravertebral block. However, each of these modalities carries its disadvantages. The Quadratus Lumborum Block’s role in delivering adequate analgesia in abdominal surgical cases has recently gained prominence across different patient populations, including adults, pediatrics, and pregnant patients. This study aims to compare the analgesic and perioperative effects of continuous bilateral quadratus lumborum block [CQL (II)] (using the QL2 approach) with continuous epidural block [Epi]. Material and Methods: In this noninferiority randomized controlled trial, all eligible patients, aged 18 to 80 undergoing exploratory laparotomy for colorectal cancer surgery, falling within the American Society of Anesthesiologists (ASA) Physical Status Class I, II, and III, who voluntarily provided written informed consent were randomly assigned to the CQL (II) or the Epi group using computer-generated randomization. Due to the presence of invasive catheters, both patients and investigators could not be masked regarding group allocation. Separate anesthesiologists performed the block procedures, operating room anaesthesia management, and postoperative pain follow-up. Results: No significant disparities in age, height, weight, BMI, gender, and ASA physical status between the two groups. The upper limit of the 95% confidence interval (1.63) crosses the noninferiority margin (1.0), indicating that the NRS score at rest after 24 hours of surgery is inferior in the CQLII group compared to the Epi group. Among other postoperative outcomes, sleep quality ( P value = 0.0015), patient satisfaction score ( P value = 0.0000), total postoperative rescue fentanyl use ( P value = 0.0005), and postoperative time for first activity out of bed ( P value = 0.016) were significantly better in the Epi group. Conclusions: The continuous bilateral quadratus lumborum block failed to demonstrate noninferiority to the epidural block in providing similar NRS scores at rest at 24 hours and other postoperative outcomes.

Abstract Background and Aims: Previous studies found that low-flow sevoflurane anesthesia in respiratory mechanics is comparable with higher flow during laparoscopic surgery, but metabolic flow has not been studied adequately. The study compares the effect of metabolic flow with the low-flow technique on respiratory mechanics during laparoscopic procedures. Material and Methods: Sixty adult patients of either sex, American Society of Anesthesiologists physical status I-II scheduled for laparoscopic surgery of <3 h were randomly assigned into group M: metabolic (n = 30) and group L: low-flow anesthesia (n = 30). Both groups received fresh gas flow (FGF) of 6 L/min of oxygen, air, and sevoflurane until they attained a minimum alveolar concentration (MAC) of 1; FGF was changed to 1 L/min in group L. In group M, the FGF was changed to estimate the metabolic flow of oxygen (Brody’s formula) plus the leak detected during the pre-use check. The delivered FiO 2 was maintained above 50%, and The dial concentration of sevoflurane was adjusted to maintain a target MAC-1 throughout the procedure in both groups. The primary objective was to compare postoperative forced vital capacity (FVC) after achieving a Modified Aldrete Score of ≥9. The secondary objectives included comparing arterial blood gas (ABG) parameters, hemodynamic parameters, and sevoflurane consumption. Results: There was no statistically significant difference in the FVC, ABG, and hemodynamic parameters between the two groups pre- (T1) and postoperatively (T2, T3, T4). There was a statistically significant decrease in sevoflurane consumption ( P = <0.001) in the metabolic-flow group. Conclusions: The effects of metabolic-flow anesthesia on pulmonary mechanics and gas exchange were similar to those of the low-flow anesthesia technique.

Abstract Background and Aims: Second-generation supraglottic airway devices (SADs) have the risk of gastric insufflation and aspiration with positive pressure ventilation. Gastric ultrasound is an emerging point-of-care tool used to assess gastric volume and evaluate perioperative aspiration risk. Hence, we planned this study to compare gastric insufflation using ultrasound between the LMA Protector and i-gel. The primary outcome was to compare the antral cross-sectional area (CSA) between the two SADs. Secondary outcomes included comparison of oropharyngeal leak pressure, peak airway pressure, and postoperative complications. Material and Methods: After institutional ethics committee approval and trial registration, 92 patients aged 18–60 with American Society of Anesthesiologists physical status I/II/III were recruited. Patients were randomly allocated to groups I (i-gel) and P (LMA Protector). Antral CSA and gastric volume were evaluated before induction, after facemask ventilation (FMV), and before removal of SAD. Categorical variables were analyzed using Chi-square or Fisher’s exact test. Quantitative variables (CSA, gastric volume) were analyzed using independent samples t -test. Results: The mean antral CSA (c m 2) and hence gastric volume increased significantly from before induction (2.56; 2.17) to after FMV (2.82; 2.57) and at the end of surgery (3.45; 3.19) in both groups I and P, respectively. However, the difference in CSA and gastric volume between the two groups at any time point was not statistically significant, indicating a comparable increase with both devices ( P = 0.147; 0.356; 322). Oropharyngeal leak pressure (cm H 2 O) was significantly higher in group P (32.43) than in I (35.98) ( P = 0.008). Peak airway pressure and postoperative complications were similar between the groups. Conclusion: Both LMA Protector and i-gel functioned comparably in terms of gastric insufflation.