Analgesic Administration Research Articles

STING controls opioid-induced itch and chronic itch via spinal tank-binding kinase 1-dependent type I interferon response in mice

BackgroundPatients receiving epidural or intrathecal opioids administration for neuraxial analgesia frequently suffer from an irritating itch. STING (stimulator of interferon genes), an innate immune modulator, is strongly implicated in pain pathogenesis via neuron-immune modulation. Given that pain and itch share some common neurocircuits, we evaluate the therapeutic potential of STING agonists in opioid-induced itch and chronic itch.MethodsOpioids (morphine, fentanyl and sufentanil) were intrathecally injected to induce acute itch. Chronic itch was induced by dry skin and contact dermatitis. Opioids analgesic effect, itch-induced scratching behavior, spinal expression of STING, phosphorylation of TBK1 (tank-binding kinase 1), IRF3 (interferon regulatory factor-3) and ERK (extracellular signal-regulated kinase), as well as production of IFN-α and IFN-β were examined. STING agonists (DMXAA and ADU-S100), TBK1 inhibitor, recombinant IFN-α and IFN-β elucidated the mechanism and treatment of itch. Whole-brain functional connectivity was evaluated using resting-state fMRI.ResultsWe report the primary expression of STING protein by the spinal dorsal horn neurons. Intraperitoneal injection of DMXAA dose-dependently reduces morphine-induced scratch bouts, without impairing morphine antinociception. Simultaneously, DMXAA alleviates fentanyl- and sufentanil-induced itching-like behavior, and chronic scratching behavior caused by dry skin and contact dermatitis. Furthermore, DMXAA drastically increases spinal phosphorylation of TBK1 and IRF3 following morphine exposure, dry skin and contact dermatitis. DMXAA-induced anti-pruritus effects and spinal productions of IFN-α and IFN-β are compensated by intrathecal delivery of the TBK1 inhibitor. Also, ADU-S100, recombinant IFN-α and IFN-β exhibits remarkable attenuation in scratching behaviors after morphine injection and dermatitis. Recombinant IFN-α inhibits morphine-induced spinal phosphorylation of ERK. Finally, DMXAA prevents dermatitis-induced the increase of cerebral functional connectivity between regions of interests such as primary somatosensory cortex, piriform cortex, retrosplenial cortex, colliculus and ventral thalamus.ConclusionsSTING activation confers protection against opioid-induced itch and chronic itch through spinal up-regulation of TBK1-IRF3-type I interferon cascades in mice, suggesting that STING agonists are promising candidates in translational development for pruritus relief.

COMPARISION OF DEXAMETHASONE AND MAGNESIUM SULPHATE AS ADJUVANTS TO BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES USING TRANSVERSUS ABDOMINIS PLANE BLOCK

Background:Transversus abdominis plane block is regional anaesthesia technique that provides analgesia to the parietal peritoneum as well as skin and muscles of the anterior abdominal wall.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexamethasone is a potent glucocorticoid,has anti-inflammatory as well as analgesic properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of Bupivacaine with Magnesium sulphate and Dexamethasone using Transversus abdominis plane block. Methods: After approval of ethical committee and informed written consent A total of Sixty ASA grade I and II patients aged between 18-60 years undergoing lower abdominal surgeries were randomnly allocated to receive TAP block and divided into two groups of 30 each . Group BD received 20ml of 0.25% Bupivacaine +2ml(8mg) Dexamethasone , Group BM received 20ml 0f 0.25% Bupivacaine+1ml of 25% Magnesium sulphate(250mg)+1ml of normal saline respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia and side effects were recorded postoperatively. Analgesia was given when VAS score was more than 4. Results: The postoperative visual analogue scale scores was significantly less in group BM.Time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with Bupivacaine reduces postoperative pain scores, prolongs the postoperative analgesia compared with Dexamethasone without any systemic side effects.

A COMPARATIVE STUDY BETWEEN EPIDURAL NALBUPHINE AND FENTANYL WITH BUPIVACAINE FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERIES

Background:The shorter duration of action of typical local anaesthetics used for spinal anaesthesia demands the early need for postoperative analgesia. Epidural analgesic administration reduces the stress reaction to pain and surgery, reduces the requirement for systemic analgesics, and promotes early rehab.1 It was discovered that using opioids as an adjuvant to local anaesthetics has synergistic effects. The advantages of this combination were improved pain alleviation, motor sparing, and less toxicity.2 Objective:To compare the efficacy of epidural analgesia by using fentanyl and nalbuphine as adjuvants along with bupivacaine following lower limb surgeries with respect to Onset, Duration, and side effects. Meterials and Methods:Prospective randomized doubled blind comparative study would be conducted on 60 adult patients of ASA grade I & II in the age group of 18 to 59 years of either sex, posted for lower limb surgeries after taking informed written consent. Patients were randomly divided on an alternative basis into 2 groups of 30 each. In study conducted in AL-AMEEN MEDICAL COLLEGE. VIJAYAPUR, KARNATAKA during the period of April 2021 to December 2022. If visual analogue score is more than one ,GROUP A: Patient received 50ug of fentanyl + 2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). GROUP B: Patient received 5mg of nalbuphine +2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). . Noting onset and duration analgesia also monitoring of patients SBP,DBP,SpO2,RR,VAS score till 15 min followed by 30 min,1hr ,2hr,4hr ,6hr,8hr is done and asked for any side effects like nausea ,vomiting, pruritis ,sedation and urinary retention. Conclusion: Epidural fentanyl has faster onset of action compared to nalbuphine and has longer duration of action compared to nalbuphine , for post operative epidural analgesia. There was no any statistically significant side effects in any of the two groups.

The impact of different types of anaesthesia on the course of tonsillectomy surgery

Recurrent tonsillitis is considered to be one of the most common ENT diseases. Tonsillectomy as a method of recurrent tonsillitis' treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how quickly he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anaesthetic management.
 Our study aimed to optimise the approach to choosing between endotracheal anaesthesia and local anaesthesia. Clinical studies were made among 158 patients with recurrent tonsillitis who underwent a bilateral tonsillectomy. The patients were divided into two groups.
 The first group consisted of 97 patients undergoing tonsillectomy using local anaesthesia. The control group included 61 patients undergoing tonsillectomy using endotracheal anaesthesia. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period.
 Conclusions: tonsillectomy surgery using local anaesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and fewer incidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anaesthesia.

Erector Spinae Plane Block With Liposomal Bupivacaine: Analgesic Adjunct in Adult Pectus Surgery

IntroductionPain management may be challenging in patients undergoing pectus excavatum (PE) bar removal surgery. To enhance recovery, opioid sparing strategies with regional anesthesia including ultrasound-guided erector spinae plane block (ESPB) have been implemented. The purpose of this study was to evaluate the safety and efficacy of bilateral ESPB with a liposomal bupivacaine/traditional bupivacaine mixture as part of an enhanced patient recovery pathway. Materials and methodsA retrospective review of adult patients who underwent PE bar removal from January 2019 to December 2020 was performed. Perioperative data were reviewed and recorded. Patients who received ESPB were compared to historical controls (non-ESPB patients). ResultsA total of 202 patients were included (non-ESPB: 124 patients; ESPB: 78 patients). No adverse events were attributed to ESPB. Non-ESPB patients received more intraoperative opioids (milligram morphine equivalents; 41.8 ± 17.0 mg versus 36.7 ± 17.1, P = 0.05) and were more likely to present to the emergency department within 7 d postoperatively (4.8% versus 0%, P = 0.05) when compared to ESPB patients. No significant difference in total perioperative milligram morphine equivalents, severe pain in postanesthesia care unit (PACU), time from PACU arrival to analgesic administration, PACU length of stay, or postprocedure admission rates between groups were observed. ConclusionsIn patients undergoing PE bar removal surgery, bilateral ESPB with liposomal bupivacaine was performed without complications. ESPB with liposomal bupivacaine may be considered as an analgesic adjunct to enhance recovery in patients undergoing cardiothoracic procedures but further prospective randomized clinical trials comparing liposomal bupivacaine to traditional local anesthetics with and without indwelling nerve catheters are necessary.

Impact of postoperative NSAIDs administration on anastomotic leak after esophago-gastric surgery: systematic review and meta-analysis.

Anastomotic leak (AL) is a feared complication of esophago-gastric surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat postoperative pain. Previous analyses conveyed heterogeneous data for colorectal surgery with a tendency toward high risk for AL after NSAIDs administration. In the setting of upper gastrointestinal (GI) surgery data are even more puzzled. The purpose of the present study was to assess whether an association exists between postoperative NSAIDs administration and AL after esophago-gastric surgery. PubMed, MEDLINE, Scopus, and Web of Science were searched up to November 2022. The included studies evaluated outcomes for NSAIDs vs. no NSAIDs administration after esophago-gastric surgery. The primary outcome was anastomotic leak (AL). Risk ratio (RR) and 95% confidence intervals (95% CI) were used to assess pooled effect size and relative inference. Six studies (43,784 patients) were included. The patient age ranged from 31 to 84years, 82.4% were males and preoperative BMI ranged from 15 to 31kg/m2. Esophagectomy was performed in 95% of patients. NSAIDs were administered in 18,075 (41.3%) patients. The cumulative incidence of AL was similar for NSAIDs vs. no NSAIDs (13.6% vs. 13.4%). The risk for postoperative AL was similar for NSAIDs vs. no NSAIDs administration (RR 1.49; 95% CI 0.81-2.75; p = 0.19). The cumulative incidence of postoperative gastrointestinal bleeding (0.36% vs. 0.39%), acute kidney injury (0.62% vs. 0.71%), and in-hospital mortality (2.39% vs. 2.66%) were comparable. NSAIDs administration for postoperative analgesia seems not associated with an increased risk for AL after esophago-gastric surgery.

Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial

PurposeThe purpose of this study was to explore the effect of electroacupuncture (EA) at Baliao point on short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH) in patients with mixed hemorrhoids.MethodsA total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57), with patients in the control group receiving only PPH surgery and patients in the EA group receiving PPH surgery and EA at Baliao point.ResultsThe visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group. The anal distension scores at 8, 48, and 72 h after operation were also significantly lower than those of control group. The number of postoperative analgesic drug administration per patient was also significantly lower in the EA group. The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery.ConclusionEA treatment at the Baliao point can alleviate short-term anal pain and anal swelling after the procedure for prolapse and hemorrhoids, reduce the incidence of urinary retention, and decrease the use of postoperative analgesic drugs.Trial registrationThis study was approved and registered by the Chinese Clinical Trial Center, Registration number: ChiCTR2100043519, Registration time: February 21, 2021 (https://www.chictr.org.cn/).

Effect of epidural blockade on immune parameters in the perioperative period: randomized controlled study

BACKGROUND: The potential benefits of anaesthesia techniques in the parameters of cellular immunity and prevention of metastasis in various types of cancer are attracting increasing attention.
 OBJECTIVE: Our aim was to estimate the influence of the epidural blockade as a component of the anesthesia support on the immunity indexes in the patients operated for gastric cancer.
 MATERIALS AND METHODS: 89 patients operated on for gastric cancer, divided into two groups were investigated: in the 1st group (n=27) there was general anesthesia (GA) in combination with extended epidural blockade; in the 2nd group (n=24) GA with postoperative intravenous administration of analgesics. T-cell counts (CD3+, CD4+ CD8+, CD4+/CD8+) and cytokines (IL-4, IL-6, IL-10, INF-y and TNF-a) were determined.
 RESULTS: The CD3+ T-cell levels in both groups were significantly (р 0.05) reduced immediately after surgery. On the 2nd and 3rd day the decrease in CD3+ T-cells was more pronounced (р 0.05) in the 2nd group compared to the 1st group. The content of CD4+ T-cells decreased by the 1st day of the postoperative period (р 0,05) but then gradually increased, the CD4+ level in the 1st group was significantly (р 0.05) higher than in the 2nd group. The changes of CD8+ content between the studied groups were not statistically significant. The immunoregulatory index in both groups decreased by1st day (р 0.05). On the 9th day the index in the 1st group returned to the basic values, while in the 2nd group it remained significantly lower. On the 1st and 3rd day, the levels of IL-4 and IL-6 significantly (р 0.05) increased, while in the 2nd group the levels were higher than in the 1st group (р 0.05). On the 9th day IL-4 and IL-6 indices returned to their initial values. The changes of IL-10 level had a similar pattern, while in the 1st group the rate was significantly higher (р 0.05). At all stages of investigation, the level of IFN- was significantly (р 0.05) higher in the 2nd group, the level of TNF- was higher in the 1st group (р 0.05).
 CONCLUSION: The use of postoperative epidural analgesia during gastric resection for malignant neoplasm is associated with a less suppressive effect on the content of subpopulations of T-lymphocytes and cytokines in comparison with intravenous administration of analgesics and may contribute to the activation of antitumor immune response. Prospective long-term studies are needed to evaluate physician epidural analgesia for oncological outcomes after surgery for gastric cancer.

Comparison of Pregabalin and Gabapentin as Pre-emptive Analgesics in Patients Undergoing Abdominal Surgeries

Objective: To compare the analgesic effects of Pregabalin and Gabapentin during elective abdominal surgeries.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021.
 Methodology: Patients with ASA physical status I, II, and III were enrolled in the study. The total number of patients was 152,divided into Group-A, which received 300mg of oral Gabapentin. In contrast, Group-B received 75 mg of oral Pregabalin an hour before induction of general anaesthesia. In addition, the analgesic requirement in the postoperative period, pain visual analogue scores and side effects were recorded.
 Results: Out of 152 patients recruited in the study 68(44%) were males whereas 84(56%) were females with a mean age of 42.86±7.07 years. Based on ASA classification, 33(22%) patients were from ASA-I, 91(60%) patients were from ASA-II, and 27(18%) patients were from ASA-III. Pregabalin was a potent analgesic with a significant influence on the visual analogue score, increased duration to the first analgesic administration and a decreased consumption of opioids post-operatively compared with Gabapentin revealing significant results (p-value <0.001). However, no statistically significant association was derived regarding adverse effects between the two groups.
 Conclusion: Pregabalin significantly reduces post-operative visual analogue scores, increased duration to first analgesic dose requirement and Opioid consumption post-operatively when compared with Gabapentin with no significant difference in adverse effect profile.

Paravertebral Block in the Treatment of Patients With Blunt Chest Trauma

The study was conducted in the Thoracoabdominal Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine to explore the role of paravertebral block in the treatment of blunt chest trauma. The study included 715 patients with isolated chest trauma hospitalized between January 1, 2020 and August 2021. 55 patients received analgesic therapy in the form of paravertebral block. The comparison group included 660 patients who did not undergo paravertebral block, in their case pain relief was provided by systemic administration of analgesics. The compared groups did not differ significantly in sex and age composition. There were also no differences in the frequency of chronic diseases and interpleural complications. There were no significant complications during the block. The comparison revealed a significant decrease in the incidence of pleurisy and a shorter length of stay in hospital. Paravertebral block is an effective and safe method of pain management for patients with blunt chest trauma. The use of this technique reduces the incidence of post-traumatic pleurisy and duration of hospitalization.

Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic.

The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].

Studi Kasus: Asuhan Keperawatan pada Pasien Fraktur Tertutup dengan Gangguan Rasa Aman Nyaman Nyeri Melalui Tindakan Pemberian Kompres Dingin Di Rumah Sakit TK II Putri Hijau Medan

A closed fracture is a several severing of bone tissue that is not accompanied by injury to the outside caused by trauma or injury that causes pain so that the individual feels an uncomfortable sensation and may interfere with daily activities. The administration of analgesics is the choice of many patients to overcome pain, one of the non-pharmacological therapies that can be given is the administration of cold compresses / ice. The purpose of the study was to determine the reduction in pain of closed fracture patients through the act of giving cold compresses. This research method is a case study that includes assessment, diagnosis, intervention, implementation (giving cold compresses during pain appears) and evaluation, the subjects used are 2 closed fracture patients with a pain scale of 6. The results of the case study showed that before cold compresses were performed on both patients, closed fractures with a pain scale of 6, after giving cold/ice compresses with a temperature of 15⁰C for 10 minutes, the patient's pain was reduced to a pain scale of 3 (0-10). In conclusion, the researchers concluded that Nursing care in closed fracture patients with cold compresses can reduce pain intensity.

Non-opioid analgesics for procedural pain in neonates.

Non-opioid analgesics for procedural pain in neonates.

PAIN MANAGEMENT IN POSTOPERATIVE TOTAL KNEE ARTHROPLASTY IN EPIDURAL BUPIVACAINE INJECTION VERSUS INTRA-ARTICULAR INJECTION

Total Knee Arthroplasty (TKA) improves the quality of life of osteoarthritic and rheumatoid arthritis patients, however, is associated with moderate to severe postoperative pain. There are multiple methods of managing postoperative pain that include epidural anesthesia but it prevents early mobilization and results in postoperative hypotension and spinal infection. Controlling local pain pathways through intra-articular administration of analgesics is a novel method and is inexpensive and simple. Hence, we assess the effects of postoperative epidural bupivacaine injection along with intra-articular injection in total knee replacement patients.The methodology included 100 patients undergoing TKA randomly divided into two groups, one administered with only epidural bupivacaine injection and the other with intra-articular cocktail injection. The results were measured based on a 10-point pain assessment scale, knee's range of motion (ROM), and Lysholm knee score.The VAS score was lower in the intra-articular cocktail group compared to the bupivacaine injection group until the end of 1-week post-administration (p<0.01). Among inter-group comparisons, we observed that the range of motion was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p<0.05). Lysholm's score was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p<0.05).Our study showed that both epidural bupivacaine injection and intra-articular injection were effective in reducing pain after TKA and have a comparable functional outcome at the end of 4 weeks follow up. However, the pain relief was faster in cases with intra-articular injection, providing the opportunity for early rehabilitation. Thus, we recommend the use of intra-articular cocktail injection for postoperative management of pain after total knee arthroplasty, which enables early rehabilitation and faster functional recovery of these patients.

EVALUATION OF PULSE-OXIMETRY PERFUSION INDEX AS A TOOL FOR ASSESSMENT OF EFFICACY OF RESCUE ANALGESIA IN POST OPERATIVE PATIENTS

Background: Pain in post operative patients is underestimated due to difculty of its assessment. Various scales and hemodynamic changes are used for pain assessment which are difcult to assess and sometimes not reliable. Masimo pulse oximetry derived perfusion index is a simple noninvasive, rapid and objective tool for pain evaluation in post operative patients. Objective: To evaluate usefulness of perfusion index as objective indicator of pain after rescue analgesia administration in post operative patients. Materials And Methods: Data were collected from 120 non intubated post operative patients of age group 18 to 80 years. Masimo pulse oximetry probe was connected to the patients. At the rst request of analgesia (T1) perfusion index, BPS-NI, patients haemodynamic were recorded following which rescue analgesia was given. Second measurements of the above parameters were taken again thirty minutes there after (T2). Results: There was signicant increase of perfusion index with signicant decrease of BPS-NI, MAP, heart rate following rescue analgesia administration. There was no signicant change in mean axillary temperature, peripheral oxygen saturation following rescue analgesia. Conclusion: Pulse oximetry derived perfusion index is a non-invasive, easy method, less time consuming. It can be used for evaluation of pain assessment and assessment of efcacy of rescue analgesia in post operative patients.

Analgesic use in ED patients with long-bone fractures: A national assessment of racial and ethnic disparities

BackgroundIt is vital to ensure equitable care is given to all patients and to eliminate any disparities in administration of analgesics and opioids in emergency department (ED) patients with long-bone fractures. Our objective was to determine whether sex, ethnic, or racial disparities still exist in administration and prescription of analgesics and opioids in ED patients with long-bone fractures using a current nationally representative database. MethodsThis was a retrospective, cross-sectional analysis of ED patients ages 15–55 years with long-bone fractures included in the National Hospital and Medical Care Survey (NHAMCS) database from 2016 to 2019. Our primary and secondary outcomes were administration of analgesics and opioids in the ED and our exploratory outcomes were prescription of analgesics and opioids in discharged patients. Outcomes were adjusted for age, sex, race, insurance, fracture location, number of fractures, and pain severity. ResultsOf the estimated 2.32 million ED patient visits analyzed, 65% received analgesics and 50% received opioids in the ED. On multivariable analyses, administration of analgesics was associated with female sex (OR 2.11; 95% CI 1.08–4.12) and Black race (OR 2.84; 95% CI 1.03–7.80), but not with Hispanic/Latino ethnicity (OR 2.09; 95% CI 0.72–6.04). No associations were found between opioid administration or analgesic or opioid prescription and female sex, Hispanic/Latino ethnicity, or Black race. ConclusionsBetween 2016 and 2019 there were no significant sex, ethnic, or racial disparities in administration or prescription of analgesics or opioids in ED adult patients with long-bone fractures.

Analgesic Profile in Intensive Observation Room (Ruang Observasi Intensif/ ROI) Dr. Soetomo General Hospital Surabaya

Introduction: Pain is a condition that the majority of critical care patients will possibly suffer at some point during their stay in the intensive care unti (ICU). In both medical and surgical ICU patients, the incidence of considerable pain is still 50% or greater. Analgesic administration is considered one of the most effective pain managements. While useful, it can cause detrimental effects if not used according to its indications and regulations.Objective: To obtain the analgesic profile used in intensive observation room (ruang observasi intensif/ROI) Dr. Soetomo General Hospital Surabaya.Methods: This study is a retrospective descriptive study with 537 medical records met the inclusion criteria.Result: The most frequent analgesic used is metamizole (44.41%) and paracetamol (16.08%) while ketamine was used the least (0.24%). Most commonly used analgesic adjuvants is phenytoin (6.12%). The amount of single drug administration (52.70%) is more frequent than multimodal analgesic (47.30%). Metamizole with paracetamol is the most popular analgesic combination (20.74%), followed by metamizole with tramadol (14.17%), and metamizole with fentanyl (12.99%). The most common procedures recorded are obstetrics and gynaecological (29.98%), cranial and general surgery with the same result (21.42%), and orthopaedic (12.29%). 205 samples with Wong-Baker FACES Pain Ratings Scales stated that there is an increase in patients who do not experience pain after administration of analgesics (N=25 to N=132), patients that underwent mild pain decreased (N=134 to N=65), and patients with moderate and severe pain also decreased (N=43 to N=8 and N=3 to N=0 respectively).Conclusion: Non-opioid analgesic dominates the analgesic profile in ROI Dr. Soetomo General Hospital Surabaya compared to opioids that generally used the most worldwide. Giving analgesics to patients has been proven successful in reducing the pain degree.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO BUPIVACAINE FOR POSTOPERATIVE EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

Background:Pain is pathologic entity,noxious stimulus and a most common problems challenging the anaesthetist.Regional anaesthesia is a safe,inexpensive technique that inhibits the nerve transmission to relieve pain and also provide postoperative analgesia.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexmedetomedine is α2 receptor antagonist with analgesic and sedative properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of epidural bupivacaine with Magnesium sulphate and dexmedetomidine. Methods: After approval of ethical committee and informed written consent A prospective randomised study was conducted with Sixty ASA grade I and II patients aged between 18-60 years undergoing lower limb surgeries were divided into two groups of 30 each .Group BM and Group BD received 10ml of 0.125% bupivacaine with 100mg of 20%MgSo4 and 12.5mcg of dexmedetomidine respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia were recorded postoperatively.Epidural analgesia was given when VAS score was more than 4. Results:VAS was significantly less in group BM,time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with bupivacaine provides prolonged postoperative analgesia compared with Dexmedetomidine without any systemic side effects.

Effects of Tourniquet Inflation on Blood Pressure, Mean Arterial Pressure, and Pulse Rate during the Maintenance of Anesthesia Using a Combination of Dexmedetomidine and Isoflurane for Patients Undergoing Lower Extremity Surgery

Introduction: The utilization of pneumatic tourniquets in surgery can help surgeons optimize the surgical field and reduce the amount of bleeding. It can also cause hyperdynamic cardiovascular responses, such as increased blood pressure, mean arterial pressure, and pulse rate, which the administration of analgesia, anti-hypertension, and increased depth of anesthesia cannot correct. Excessive hemodynamic responses can lead to complications due to the utilization of tourniquets, namely increased intracranial pressure and acute heart failure. This study aims to analyze differences in the effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane compared to that using only isoflurane for patients undergoing lower extremity surgery. Methods: This observational cohort study. The statistical test in this study was conducted using the Shapiro-Wilk test for normality and the Spearman test for correlation. The Chi-Square test was carried out to ensure the characteristics of patients in the two groups. Results: The results showed no significant effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane. Meanwhile, tourniquet inflation during the maintenance of anesthesia using only isoflurane resulted in significant effects on blood pressure, mean arterial pressure, and pulse rate. The results also indicated significant differences between the effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane and that using only isoflurane on the blood pressure, mean arterial pressure and pulse rate of patients undergoing lower extremity surgery. Conclusion: There are no significant effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane on the blood pressure, mean arterial pressure, and pulse rate of patients undergoing lower extremity surgery.

Perioperative anesthesia in children with oncological diseases: prospective single-center continuous cohort study of a 6-year clinical experience

BACKGROUND: Effective anesthesia is one of the most important factors in rapid and successful rehabilitation after surgery. Inadequately selected analgesia and consequent pain significantly slow down the recovery process and are associated with several complications that cover almost all organs and systems and reduce the patients quality of life in the long term.
 OBJECTIVE: This study aimed to analyze 6 years of clinical experience with perioperative epidural anesthesia in the Research Institute of Pediatric Oncology, considering the effectiveness, safety, and satisfaction of patients and their legal representatives with this medical aid.
 MATERIALS AND METHODS: A prospective single-center continuous cohort study was conducted on patients who received epidural analgesia as part of perioperative anesthesia in the period from 2016 to 2021. Data from 702 (48.5%) boys and 745 (51.5%) girls were analyzed. Children were divided into three main groups according to age: from 1 month to 1 year (14.3%), from 1 year to 7 years (37.8%), and from 8 years to 18 years (47.8%). The area of surgical intervention was also considered: abdominal surgery (65.2%), thoracic (8.5%), and orthopedic (26.4%). The choice of the local anesthesia level has also influenced the results. The main study outcomes were the intensity of postoperative pain syndrome in pediatric oncosurgery and additional consumption of narcotic analgesics after the administration of a mixture of topical drugs with or without adjuvants into the epidural space.
 RESULTS: The effectiveness of epidural anesthesia in the intraoperative period was quite high, which is confirmed by the stability of hemodynamic parameters. Intraoperatively, additional administration of systemic narcotic analgesics was noted in 5% of the total sample. In all observed patients, epidural adjuvants (morphine and promedol) ensured the optimal duration of action and analgesic efficacy of caudal blockade in the postoperative period; therefore, additional painkillers were not needed. Satisfaction with the intervention was generally high, with 98% providing a rating of very good or good.
 CONCLUSION: Anesthesia methods (epidural blockade), optimal pain control, and active postoperative recovery (including early oral nutrition and mobilization) in fast-track surgery reduce stress reactions and organ dysfunction, significantly reducing the time required for a full recovery.