Additional Analgesic Requirements Research Articles

Comparison of the effectiveness of thoracic epidural and rectus sheath catheter as analgesic modalities following laparotomy: A systematic review and meta-analysis.

Rectus sheath catheters are used as an analgesic alternative to thoracic epidural. The aim of this meta-analysis is to compare the analgesic effects and side effects of thoracic epidural and rectus sheath catheter in the setting of emergency or elective laparotomy. A systematic review of the Cochrane library, Embase, PubMed and Medline was conducted. Papers that directly compared thoracic epidurals and rectus sheath catheters following laparotomy were identified. Literature published between 2001 and 2021 were included. Data were extracted on the following postoperative outcomes: additional analgesic requirements, pain scores, hypotension and ambulation. A random effects meta-analysis model was used to compare additional opioid requirements between thoracic epidural and rectus sheath catheter. Eight publications were included from five countries. This comprised 484 patients, with 120 patients being extracted from randomised trials. Thoracic epidural reduced the requirement for additional intravenous analgesia compared with rectus sheath catheters (p = 0.004). Despite this, both analgesic techniques were equivalent with regard to reported pain scores. Furthermore, rectus sheath catheters have a lower rate of postoperative hypotension and allow for earlier ambulation compared with thoracic epidural. The literature suggests that rectus sheath catheters provide similar analgesic effect to thoracic epidurals, but rectus sheath catheters have a favourable side effect profile.

Regional Anesthesia in Circumcision Surgery: Which of the Two Things Is Better?

Postcircumcision pain in children can cause restlessness, crying and bleeding due to trauma. However, there are various methods to prevent postoperative pain, caudal and penile blocks are in the foreground. The primary objective of this study is to evaluate the effectiveness of CB and PB for the relief of postcircumcision pain. The secondary aim is to evaluate the postoperative additional analgesic requirement and side effects of these blocks. A total of 148 children between the ages of 2 and 10 who underwent circumcision surgery were randomly assigned to two groups in terms of postoperative analgesia. 1) A group of caudal block (0,5 ml/kg %0.25 levobupivacaine) and 2) A group of penile block (0,3 ml/kg %0,25 levobupivacaine). Premedication and sedoanalgesia were standardized. The pain (FLACC Pain Score), analgesic consumption, motor block (Bromage Scale) and side effects (vomiting, hematoma, urinary retention) were assessed postoperatively for 4 hours. Postoperative FLACC scores were lower for caudale block group in the 1st, 3rd and 4th hours. There was no significant difference in postoperative analgesic consumption between the groups. The most common postoperative side effect was vomiting in both groups. Caudal block provided more effective analgesia than penile block in postcircumcision pain control.

Evaluating the Efficacy of Pre-incisional Infiltration and Intraperitoneal Instillation of a Local Anesthetic Agent on Postoperative Analgesia and Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia.

AimThe study aimed to compare the effects of 0.5% bupivacaine injection at pre-incisional port sites and intraperitoneal application on postoperative pain in laparoscopic cholecystectomy cases.MethodsAfter taking ethical clearance, a total of 60 patients of the American Society of Anaesthesia (ASA) grades 1 and 2 scheduled to undergo laparoscopic cholecystectomy were enrolled in the study and were randomized into two groups. Group 1 (n=30) received 20 ml of 0.5% bupivacaine infiltration subcutaneously over the port sites before being given incision. Group 2 (n=30) received 20 ml of 0.5% bupivacaine applied in the intraperitoneal subdiaphragmatic space and in the gall bladder fossa after removal of the gall bladder. The efficacy in terms of abdominal pain, hemodynamics, complications, and total analgesic requirements were assessed at regular intervals throughout the postoperative period for 24 hours.ResultsNo significant difference in terms of demographic variables in the groups. The mean visual analog score (VAS) score for abdominal pain was found to be significantly lower in group 1 from the first postoperative hour till the twenty-fourth hour. Also, no significant difference was seen between the groups regarding hemodynamic parameters. No significant difference between the groups was seen regarding postoperative nausea and vomiting (PONV). The supplemental analgesic requirement was significantly higher in group 2 than in group 1.ConclusionIt was observed from this study that pre-incisional infiltration of a local anesthetic agent produces effective postoperative analgesia in the immediate postoperative hours and reduces additional analgesic requirements without causing any adverse reactions.

Comparison of Single-Injection and Multiple-Injection Thoracic Paravertebral Block in Preventing Pain after Video-Assisted Thoracoscopic Surgery

Aim: In our study, we aimed to compare the effect of single and multiple thoracic paravertebral block (TPVB) patients who underwent video asisted thoracoscopic surgery (VATS) on hemodynamic parameters, postoperative visual analog scale (VAS) and sedation scores, and total analgesic consumption. Materials and Method: The ASA II-III, age between 18 to 65 years, and body mass index lower than thirty, 60 patients who underwent elective VATS were included to this study. Patients were divided into two groups as single (Group S), (n:30) and multiple (Group M), (n:30) TPVB. Block was performed at T6 level in Group S and at T4, T6, T8 levels in Group M by using 21 mL 0.5 % bupivacaine. Intravenous patient controlled analgesia (PCA) was performed for both groups after surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), Ramsay sedation score (RSS), tramadol consumption during 24 hours, resting and coughing VAS scores were recorded before PCA and at 30th, first, second, 6th, 12th, 20th, and 24th hours of postoperative periods. 50 mg iv dexketoprophene was administered when coughing VAS score above the 4. Despite the iv dexketoprophene, in case of consistent pain 1 gr iv paracetamol was given to the patients, and all additional analgesic requirement was recorded. Results: Hemodynamic parameters were similar in both groups during postoperative period (p>0.05). VAS scores were higher in Group M but there were not statistically significant (p>0.05). Additional analgesic requirement was significantly higher in Group M, (p>0.04). Cumulative tramadol consumption was comparable between the groups, (p>0.05). Conclusion: In TPVB, it was observed that single and multiple injections provided similar postoperative pain scores and postoperative cumulative tramadol consumption, but we observed a high additional analgesic requirement in multiple injection group. Based on this result, we concluded that there would be no need to disturb patient comfort and prolong the procedure by applying multiple injections.

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Aim: Thoracotomy is among the most painful surgical incisions and causes severe acute pain in the postoperative period. Many analgesic methods have been suggested for thoracotomy pain treatment. Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are common regional methods for post-thoracotomy pain. In this study, we aimed to compare the efficacy and the side effects of TEA and TPVB methods applied for post-thoracotomy analgesia.
 Material and Method: After ethical committee approval, we retrospectively analyzed postoperative analgesia records of patients, who underwent thoracotomy, received TEA or TPVB for postoperative analgesia between 01.01.2019 and 01.01.2021. Visual analog scale (VAS) scores of the patients who received analgesic treatment for 24 hours postoperatively after TEA or TPVB application were evaluated.
 Results: Data of 474 patients were found eligible for analysis. Demographic data of patients, VAS scores, patient satisfaction, and additional analgesic requirements were not statistically significant between the groups (p>0.05). Nausea-vomiting, hypotension, headache, itching, and sweating was statistically significantly higher in the TEA group when compared to patients who underwent TPVB (p

Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty

Purpose: This study aimed to compare the effectiveness of ultrasound-guided femoral and anterior sciatic (FAS) nerve blocks and genicular (G) nerve blocks as preventive analgesia methods after total knee arthroplasty.
 Materials and Methods: Fifty patients, aged 55–80 years were divided into two groups preoperatively. Patients in the FAS group (n=25) received 20 mL solutions (10 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 9 mL saline) in both femoral and sciatic blocks. Patients in the G group (n=25) received 5 mL solutions (2 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 2 mL saline) for each nerve. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesic requirement, total analgesic dose, and postoperative complications during the first 24 h were recorded.
 Results: VAS scores at postoperative 0, 1, and 6 h and the total amount of tramadol consumed 24 h were lower in the FAS group than in the G group. There was no requirement for additional analgesia in the first 24 h in the FAS group; however, 9 patients required additional analgesia in the G group. 
 Conclusion: USG FAS nerve blocks were superior to the genicular nerve blocks in TKA. Additionally, the genicular block doesn’t cause motor block. A genicular block can be considered as an alternative with this regard.

Parameters Affecting Nausea and Vomiting After Thoracoscopic Wedge Resection in Patients With Pneumothorax.

Background: Postoperative nausea and vomiting (PONV) is one of the complications that can occur frequently in the first 24 hours postoperatively. We aimed to investigate the parameters that could predict PONV in patients who underwent thoracoscopic wedge resection for pneumothorax.Materials and Methods: After obtaining the approval of the ethics committee (ID: 2012-KEAK-15/2358, Date: 14.09.2021), the records of patients who underwent elective video-assisted thoracic surgery (VATS) between January 2018 and June 2021 were analyzed retrospectively. The patients who underwent elective thoracoscopic wedge resection for pneumothorax, who were between the ages of 18-65, American Society of Anesthesiologists (ASA) I-III, and whose body mass index (BMI) was between 18-30 kg/m2 were included in the study. However, patients who received a blood transfusion or used antiemetics, anticholinergic drugs, and analgesics continuously were not included. In addition, patients with a history of chronic pain were not included in the study. The patients were divided into two groups, the PONV group (Group 1) and the control group (Group 2). The PONV incidence, visual analog scale (VAS) scores, 24-hour morphine consumption, additional analgesic requirement, neutrophil/lymphocyte ratios (NLR), and platelet/lymphocyte ratios (PLR) were evaluated.Results: The groups were similar in terms of demographic data (p > 0.05). Additional analgesic requirement and 24-hour morphine consumption were significantly higher in the PONV group (p: 0.005, p < 0.001, respectively). Preoperative NLR (p < 0.001), postoperative NLR (p < 0.001), preoperative PLR (p < 0.022), the VAS scores of the first hour (p: 0.004), and 24th hour (p < 0.001) were statistically significantly higher in the PONV group compared to the control group.Conclusions: NLR parameters can be effective with high sensitivity and specificity in predicting PONV during the preoperative and postoperative period. Besides, preoperative PLR may also be effective in predicting PONV. A treatment that can be planned according to these parameters may play a key role in preventing PONV. In addition, efficient perioperative analgesia management may be effective in reducing PONV by limiting the emetogenic analgesics.

Comparison of Single-Injection and Multiple-Injection Thoracic Paravertebral Block in Preventing Pain after Video-Assisted Thoracoscopic Surgery

Aim: In our study, we aimed to compare the effect of single and multiple thoracic paravertebral block (TPVB) patients who underwent video assisted thoracoscopic surgery (VATS) on hemodynamic parameters, postoperative visual analog scale (VAS) and sedation scores, and total analgesic consumption. Materials and Method: The ASA II-III, age between 18 to 65 years, and body mass index lower than thirty, 60 patients who underwent elective VATS were included to this study. Patients were divided into two groups as single (Group S), (n:30) and multiple (Group M), (n:30) TPVB. Block was performed at T6 level in Group S and at T4, T6, T8 levels in Group M by using 21 mL 0.5 % bupivacaine. Intravenous patient-controlled analgesia (PCA) was performed for both groups after surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), Ramsay sedation score (RSS), tramadol consumption during 24 hours, resting and coughing VAS scores were recorded before PCA and at 30th, first, second, 6th, 12th, 20th, and 24th hours of postoperative periods. 50 mg iv dexketoprophene was administered when coughing VAS score above the 4. Despite the iv dexketoprophene, in case of consistent pain 1 gr iv paracetamol was given to the patients, and all additional analgesic requirement was recorded. Results: Hemodynamic parameters were similar in both groups during postoperative period (p&gt;0.05). VAS scores were higher in Group M but there were not statistically significant (p&gt;0.05). Additional analgesic requirement was significantly higher in Group M, (p&gt;0.04). Cumulative tramadol consumption was comparable between the groups, (p&gt;0.05). Conclusion: In TPVB, it was observed that single and multiple injections provided similar postoperative pain scores and postoperative cumulative tramadol consumption, but we observed a high additional analgesic requirement in multiple injection group. Based on this result, we concluded that there would be no need to disturb patient comfort and prolong the procedure by applying multiple injections.

Gilaburu extract (Viburnum opulus Linnaeus) is as effective as Tamsulosin in medical expulsive therapy of distal ureteral calculi.

To compare the extract of Gilaburu (Viburnum opulus Linnaeus) and Tamsulosin as a medical expulsive therapy (MET) in patients with distal ureteral calculi of 10mm or less. Data of 86 patients were prospectively collected. The patients were divided into two groups. In the first group, Viburnum opulus 1000mg peroral 3×2 and diclofenac 50mg peroral on-demand (n=43), in the second group Tamsulosin 0.4mg peroral 1×1 and diclofenac 50mg peroral on-demand (n=43) was given for MET in patients with distal ureteral calculi. Stone expulsion rates, time until expulsion, additional analgesic requirement, need for emergency admission, need for additional treatment were evaluated. In addition, subgroup analyses of ≤5 and 5-10mm were also performed. There was no difference between the groups in terms of stone expulsion rates and time until the expulsion in all stones. Additional analgesic requirement and need for emergency admission were found to be lower in the Viburnum opulus group (37.2% vs 65.1%, P=.017 and 11.6% vs 34.8%, P=.02, respectively). In subgroup analyses, while stone expulsion rates were similar in subgroups, it was found shorter in the time until expulsion, lower additional analgesic requirement and need for emergency admission in V. opulus group than Tamsulosin group in 5-10mm stone size subgroup (7.1±4.2 vs 11.8±5.2, P=.005, 32.2% vs 77.7%, P=.001 and 12.9% vs 40.7%, respectively). V. opulus can be used effectively and safely for the treatment of MET in distal ureteral calculi.

The Effect of Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Study.

BackgroundThis study aimed to investigate the effect of ultrasound-guided transmuscular quadratus lumborum block (QLB) on postoperative opioid consumption in patients undergoing percutaneous nephrolithotomy (PCNL).MethodologyA total of 40 patients aged between 18 and 60 who were classified as American Society of Anesthesiologists status I-II and scheduled for unilateral PCNL were randomly divided into two groups. Patients in Group QLB (n = 20) received a single-shot QLB with 20 mL of 0.25% bupivacaine in the preoperative period. No intervention was performed in the control group (Group C, n = 20). Dermatomes affected by the block procedure were evaluated in the preoperative period in the group of patients who were administered the block procedure. General anesthesia was administered to all patients in both groups. In the postoperative period, opioid consumption, pain scores, side effects related to opioid consumption, and additional analgesic requirements were recorded.ResultsOpioid consumption was significantly lower in Group QLB compared to Group C at all times (p < 0.05). Postoperative visual analog scale (VAS) scores during the movement were significantly lower in Group QLB compared to Group C at all times (p < 0.05). VAS scores at rest were reported to be significantly lower in Group QLB compared to Group C, except for the eighth and twelfth hours (p < 0.05). The requirement for additional analgesic agents was significantly lower in Group QLB compared to Group C (p < 0.05).ConclusionsQLB reduced postoperative opioid consumption and VAS scores by providing more effective analgesia compared to the control group in patients who underwent PCNL.

Intravenous lidocaine vs. NSAIDs for migraine attack in the ED: a prospective, randomized, double-blind study.

Although different forms of lidocaine are used for migraine attack headaches, the effect of intravenous lidocaine is still limited. This study aimed to investigate the effects of intravenous lidocaine infusion for the treatment of migraine attack headaches. A hundred patients with migraine attacks, aged between 18 and 65, were randomly divided into two groups. The lidocaine group (n = 50) received a 1.5mg/kg lidocaine bolus and a 1mg/kg infusion (first 30min), followed by a 0.5mg/kg infusion for a further 30min intravenously. The non-steroidal anti-inflammatory drug (NSAID) group (n = 50) received 50mg dexketoprofen trometamol and saline at the same volume as the lidocaine at the same time intervals intravenously. The Visual Analog Scale (VAS) pain scores, additional analgesia requirement, side effects, and revisits to the emergency department were recorded. The VAS score was significantly lower in the lidocaine group than in the NSAID group for the first 20th and 30th minutes (p = 0.014 and p = 0.024, respectively). There was no difference between the VAS scores for the remaining evaluation times (p > 0.05). In terms of secondary outcomes, rescue medication requirement was not different between the two groups at both the 60th and 90th minutes (p > 0.05). However, the number of patients revisiting ED within 48-72h was statistically less in the lidocaine group than in the NSAID group (1/50 vs. 8/50; p = 0.031). Intravenous lidocaine may be an alternative treatment method for patients with migraine attack headaches in the emergency department.

Pediatrik İnguinal Herni Onarımı Sonrası Postoperatif Analjezi: Transvers Abdominis Plan Bloğu veya Caudal Epidural Blok

PURPOSE: Transversus abdominis plane (TAP) block under ultrasonography and caudal epidural block are techniques used to provide postoperative analgesia in children. The aim of this study was to compare the effect of these two analgesic techniques in pediatric inguinal hernia operations. &#x0D; MATERIAL AND METHOD: The study included 64 patients aged 4-12 years who underwent surgery for unilateral inguinal hernia. Caudal epidural block was applied to 33 patients (Group C) and TAP block to 31 (Group T). Routine follow-up of postoperative pain for pediatric patients was made with the Wong-Baker faces pain rating scale. A record was made for each patient of the time of requirement for additional analgesia, complications during the intervention and side-effects. &#x0D; RESULTS: In the evaluation of the faces pain rating scale, the scores of Group C were found to be significantly lower than those of Group T at 6, 8, and 12 hours postoperatively (p=0.04, p=0.03, p=0.03). The duration of postoperative analgesia was found to be mean 220 mins (min-max; 118.65 – 355.3 mins) for Group T, and 351.2 mins (min-max; 167.8-617.65 mins) for Group C. The time of first requirement for additional analgesia was mean 13±4.8 hours in Group C, and 8±3.5 hours in Group T (p=0.02). &#x0D; CONCLUSION: The application of caudal block provided more effective postoperative analgesia than TAP block applied under ultrasonography guidance in pediatric inguinal hernia repair.

Comparison of Two Ultrasound-guided Plane Blocks for Pain and Postoperative Opioid Requirement in Lumbar Spine Fusion Surgery: A Prospective, Randomized, and Controlled Clinical Trial.

IntroductionThe erector spinae plane (ESP) block and thoracolumbar interfascial plane (TLIP) block were two novel plane blocks. The purpose of this study was to investigate TLIP block and ESP block on the effect of analgesic and opioid consumption in lumbar spine fusion surgery in the perioperative period.MethodsThree hundred and four patients who suffered lumbar spine fusion were included and randomly divided into three groups: a control group (n = 102), an ESP block group (n = 100), and a TLIP block group (n = 102). We recorded the numerical rating scale (NRS) pain at movement and static during the postoperative 48 h, opioid consumption, additional analgesic requirement, frequency of patient-controlled analgesia (PCA) compressions, Bruggemann Comfort Scale (BCS) score, side effects, duration of hospital stay, and the life quality score (LQS) after operation at 6 months.ResultsThe patients in the ESP block group have better analgesia during 12–48 h postoperative time at static state, a lower frequency of PCA compressions at 24–48 h after surgery, and the opioid consumption in the PCA (sufentanil) were less than those in the TLIP block group (P < 0.05). However, the BCS and LQS scores were no different between the two plane block groups after surgery at 6 months. There was no difference in hospital stay and the incidence of side effect among the three groups.ConclusionsOur results found that patients who suffered ESP block have better analgesic effects and less pain scores in static states and less frequency of PCA compression and opioid analgesic consumption compared with those that suffered TLIP block.Trial RegistrationChiCTR1800019639.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00295-4.

English

BACKGROUND Inguinal hernia is a frequently encountered surgical problem. General anaesthesia carries the risk of possible airway complications. Regional blocks improve acute post-operative pain, decrease post-operative visual analogue scale (VAS) score and patient can mobilise early. The purpose of this study was to compare the effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB) block for post-operative analgeia in inguinal hernia surgeries. METHODS We conducted a research on 64 patients of age &gt; 18 years with American society of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy. Patients were randomized into two groups. Group T received TAP block in which 20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5 ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly (total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any was noted. RESULTS The demographic data of both the groups were comparable. Also, pre and postoperative heart rate, blood pressure, IV fluids, ephedrine use, operative time and complications were statistically insignificant. As compared to group T, group P had lower VAS score from 2nd – 12th hour which was statistically significant (P &lt; 0.05). Although more time is required to perform paravertebral block but the time for request of first rescue analgesia was quite prolonged in paravertebral block. Time of ambulation in group P was significantly lower than group T. CONCLUSIONS PVB requires more time to perform due to multiple site of injection, the comparison of both techniques in the present study revealed that PVB showed relatively higher efficacy in the management of post-operative pain, early ambulation and had significant reduction in dose requirement of additional analgesia (diclofenac) and antiemetics (ondansetron) over tap block. KEYWORDS Paravertebral Block, Transversus Abdominis Block, Inguinal Hernia

Challenges in Anesthesia Management for Peroral Endoscopic Myotomy: A Retrospective Analysis.

Peroral endoscopic myotomy (POEM) is used to treat achalasia with efficacy and reliability. However, during the procedure potential complications require attention in terms of anesthesia. This study aimed to investigate complications of the POEM procedure and its effects on arterial blood gas (ABG) parameters, peak airway pressures (PIP), hemodynamics, and postoperative analgesia requirements. Data from 220 patients who underwent POEM between 2014 and 2017 were retrospectively assessed. During the procedure, ABG samples, PIP, mean arterial pressure, and heart rate were recorded. The effects of the procedure and paracentesis on ABG, PIP, mean arterial pressure, heart rate, perioperative complications, and postoperative analgesia requirements were assessed. Data from 220 POEM patients were analyzed. During the procedure, the mean PaCO2 was 48.27±6.34 mm Hg, which was significantly higher than the PaCO2 values before and after the procedure. The mean increase in maximum PIP was 5.90±3.49 cmH2O during the procedure. However, there was a significant decrease in PaCO2 and PIP values in cases with paracentesis compared with those without paracentesis. With regards to complications, subcutaneous emphysema (48, 21.8%), pneumoperitoneum requiring decompression (66, 30%), pneumothorax (1, 0.5%), aspiration pneumonia (1, 0.5%), and bronchospasm (5, 2.2%) were observed during the procedure. In the postoperative period, 58 patients (26%) had additional analgesia requirements because of visual analog scale values >3. Periprocedural abdominal decompression with veress needle led to a reduction in arterial PaCO2 and PIP, and improved postoperative analgesia. Serious complications because of perioperative aspiration and CO2 insufflation were observed during the POEM procedure.

Comparative Evaluation of Effect of Dexmedetomidine Versus Normal Saline on Blood Glucose Levels in Diabetes Mellitus Patients Undergoing Spinal Anaesthesia Surgeries

ontext: Surgical trauma gives rise to a stress response in the human body resulting in hyperglycaemia in the perioperative period. This adversely affects the patient’s outcome. Hyperglycaemia is particularly detrimental in patients with diabetes mellitus. Dexmedetomidine, an alpha 2 adrenoreceptor agonist attenuates this surgical stress response and helps in preventing perioperative hyperglycaemia. Aims: The aim of our study was to monitor and compare the effect of dexmedetomidine versus normal saline on blood glucose levels intraoperatively and postoperatively in patients with diabetes mellitus undergoing spinal anaesthesia surgeries. Other objectives were, to compare haemodynamic changes, ramsay sedation scores intraoperatively andthe requirement of analgesia in the postoperative period between both the groups. Methods: A double blind prospective randomized controlled study was conducted in a tertiary hospital. Out of 60 patients with diabetes mellitus, 30 random patients were administered with intravenous dexmedetomidine after giving spinal anaesthesia. The other half of patients received a placebo. Vital parameters and blood glucose levels were monitored and compared in both the groups. Statistical analysis used: Data was tabulated and compared using unpaired T-test. Results: Statistically significant differences were found in mean heart rate and blood pressure between both the groups. The differences in the blood sugar values in the intra operative period and the postoperative period between both the study groups were also statistically significant. Requirement of additional postoperative analgesics were also considerably less in the dexmedetomidine group. Conclusion: Intravenous dexmedetomidine attenuates the surgical stress response by inhibiting the adrenal surge and prevents hyperglycaemia.

Factors Affecting Cecal Intubation Time in Colonoscopy: Impact of Obesity.

ObjectiveThis study aims to determine the factors that prolong cecal intubation time (CIT) and determine the effect of obesity on CIT measured using multiple indexes.MethodsPatients who underwent elective colonoscopy between July 10, 2020, and January 20, 2021, were evaluated in this prospective observational study. Age, gender, constipation, bowel preparation, presence of diverticulosis, previous surgery history, auxiliary maneuver and additional analgesic requirement, cecum intubation length (CL) and obesity indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR)] were analyzed. Factors affecting CIT were assessed by both univariate and multivariate logistic regression (LR) analyses.ResultsA total of 512 patients were analyzed. Mean CIT was 5.6 ± 1.6 min, and median CIT was 5.17 min. The CIT median was ≤5.17 min in 264 (51.5%) of the patients, and the CIT median was >5.17 min in 248 (48.5%). In the univariate LR results, young age, constipation, poor bowel preparation, increased CL, additional analgesic requirement, low WHtR, and low BMI (<25 kg/m2) were the factors that prolonged CIT (p <0.05). In the multivariate LR analysis results, WHtR >0.5 and BMI >30 kg/m2 were found to be independent factors that decrease CIT [OR: 0.01 (0.01 0.03) p <0.001; OR: 0.28 (0.13 0.57) p <0.001].ConclusionYounger age, low WHtR, low BMI, increased CL, constipation, inadequate bowel preparation, and the use of extra analgesics were found to be associated with longer CIT. When all factors were evaluated together, obesity measured by only WHtR (>0.5) and BMI (>30 kg/m2) were the best predictors of decreased CIT.

Pain and dyspnea control during awake fiberoptic bronchoscopy in critically ill patients: safety and efficacy of remifentanil target-controlled infusion

PurposeFlexible fiberoptic bronchoscopy is frequently used in intensive care unit, but is a source of discomfort, dyspnea and anxiety for patients. Our objective was to assess the feasibility and tolerance of a sedation using remifentanil target-controlled infusion, to perform fiberoptic bronchoscopy in awake ICU patients.Materials, patients and methodsThis monocentric, prospective observational study was conducted in awake patients requiring fiberoptic bronchoscopy. In accordance with usual practices in our center, remifentanil target-controlled infusion was used under close monitoring and adapted to the patient’s reactions. The primary objective was the rate of successful procedures without additional analgesia or anesthesia. The secondary objectives were clinical tolerance and the comfort of patients (graded from “very uncomfortable” to “very comfortable”) and operators (numeric scale from 0 to 10) during the procedure.ResultsFrom May 2014 to December 2015, 72 patients were included. Most of them (69%) were hypoxemic and admitted for acute respiratory failure. No additional medication was needed in 96% of the patients. No severe side-effects occurred. Seventy-eight percent of patients described the procedure as “comfortable or very comfortable”. Physicians rated their comfort with a median [IQR] score of 9 [8–10].ConclusionRemifentanil target-controlled infusion administered to perform awake fiberoptic bronchoscopy in critically ill patients is feasible without requirement of additional analgesics or sedative drugs. Clinical tolerance as well as patients’ and operators’ comfort were good to excellent. This technique could benefit patients’ experience.

Effect of perineural bupivacaine infiltration on reducing inguinodynia in patients undergoing inguinal meshplasty – a randomized controlled trial

Introduction Inguinodynia after inguinal meshplasty is a notable complication with an incidence of 13–37%. We wanted to determine if a perineural infiltration of bupivacaine given intraoperatively would reduce the incidence of immediate postoperative pain and inguinodynia. Methodology We have conducted a single-blinded randomized controlled trial including 100 patients with inguinal hernia. Patients in the control group received only spinal anaesthesia. The intervention group received perineural bupivacaine infiltration in addition to spinal anaesthesia. Intraoperatively Ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve was identified and 2 mL of 0.5% bupivacaine was given perineurally along these identified nerves. Presence of inguinodynia, immediate post-operative pain scores using the Wong-Baker faces pain scale, duration of analgesics use, use of additional analgesics along with Paracetamol 500 mg tablet, and the length of hospital stay between the groups were recorded. Results 100 patients were randomized in the study, 49 in control and 51 in the intervention group. Both the group was comparable in terms of demographic characteristics. The intervention group had significantly lower median pain score at 3 h [4 ± 1.662 vs. 6 ± 1.55; p = .0001] and 6 h [4 ± 1.33 vs. 6 ± 1.307; p = .0001]. The incidence of inguinodynia did not significantly differ between the two groups (p-value = .12). Conclusion Intraoperative Perineural bupivacaine infiltration significantly reduces the immediate postoperative pain. However, there was no significant reduction in the incidence of inguinodynia or additional analgesic requirement.

Ultrasound-Guided Fascia Iliaca Plane Block for the Treatment of Donor Site Pain in the Burn-Injured Patient: A Randomized Control Trial

Burn injuries requiring surgical intervention often result in split-thickness skin grafting procedures, with donor skin frequently harvested from the patient's anterolateral thigh. The donor site is often reported as the primary site of postoperative pain due to the damage sustained to localized nociceptors. A randomized control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient-reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomized to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0-10). During the postoperative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range [IQR] 0-0), compared to the control group median 6 (IQR 4-7) (P < .001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0-4) compared to control group median 4.5 (IQR 2-6) (P = .043). The study findings demonstrated that regional anesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.