Analgesia In Surgery Research Articles

Periarticular Injections for Post-Surgical Analgesia in Shoulder Surgeries: A Systematic Review of Literature and Meta-Analysis

Periarticular Injections for Post-Surgical Analgesia in Shoulder Surgeries: A Systematic Review of Literature and Meta-Analysis

Post Operative Epidural Analgesia in Pediatric Abdominal Surgery: Comparison of Clonidine and Dexmedetomidine as an Adjuvant

Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population. Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications. Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg). Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries.

Study to Compare Epidural Bupivacaine with Buprenorphine and Bupivacaine with Fentanyl for Characteristics of Block and Prolongation of Postoperative Analgesia in Adult Orthopaedic Lower Limb Surgeries

Study to Compare Epidural Bupivacaine with Buprenorphine and Bupivacaine with Fentanyl for Characteristics of Block and Prolongation of Postoperative Analgesia in Adult Orthopaedic Lower Limb Surgeries

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block

BackgroundIn reconstructive surgeries, iliac crest bone graft harvesting is commonly preferred. The pain experienced after surgery at the anterior iliac crest (AIC) donor site might be more intense compared to the pain at the primary surgical area where the graft is placed. To address this issue, we defined a novel technique called the anterior iliac block (AIB), which can provide analgesia with lower volumes. In this study, the effect of this technique for AIC bone greft harvesting was evaluated.MethodsPatients who were operated on and had AIC bone graft harvested included in this retrospective study. The study collected age, height, weight, ASA classification, and duration of surgery, information on the regional anesthesia technique, block performance, postoperative pain severity, opioid consumption, rescue analgesics used in the first postoperative 24 h.ResultsData from 16 patients were analyzed. The popliteal sciatic block was performed in eight patients, infraclavicular brachial plexus block in four patients, supraclavicular brachial plexus block in one patient, PENG block in one patient, and proximal adductor canal block in two patients two provide analgesia for primary surgery. The median morphine consumption at postoperative 24th hour was 3.5 mg, median NRS score was 1 at postoperative 1st hour, and 0 at postoperative 6th, 12th and 24th hours.ConclusionsThe study findings indicate that the AIB provides adequate analgesia for AIC graft harvesting in the first postoperative 24-hour period. It can be used as an adjuvant to the peripheric nerve block for the primary surgical site.Trial registrationNCT06295224.

Bi‐Level Ultrasound Guided Erector Spinae Block V/S Paravertebral Block in Post Operative Analgesia After Breast Cancer Surgeries

Bi‐Level Ultrasound Guided Erector Spinae Block V/S Paravertebral Block in Post Operative Analgesia After Breast Cancer Surgeries

Impact of dextrose supplementation on intraoperative blood glucose levels in pediatric patients undergoing major surgeries under general anesthesia with caudal analgesia

Abstract Background and Aims: In children undergoing surgery, the stress responses of surgery can result in blood glucose elevation consequent to release of cortisol and catecholamines. The use of a regional block could attenuate the stress responses and lower the blood glucose levels. We compared the blood glucose values at specified time points during surgery with and without additional dextrose to evaluate the need for glucose supplementation as our primary outcome. Intraoperative hemodynamics and the need for any intervention for correction of blood sugars were noted secondarily. Material and Methods: Children aged between 6 months and 8 years undergoing elective major surgery were randomized to group D (received 1% dextrose in Ringer’s lactate) or group P (received only Ringer’s lactate). Blood sugars were measured half hourly for 2 h following intubation, and data was analyzed using Student’s t-test and Chi-square test. Results: Demographic variables and the duration of surgery were comparable. The baseline blood glucose value was lower in group D. Analysis of covariates test for a comparison of adjusted mean blood glucose (MBG) showed the values at 30, 60, and 90 min to be comparable. However, toward the end of surgery, the MBG value was significantly higher in group D (P = 0.019). Heart rate and mean arterial pressure were comparable at the same points of measurement. Conclusion: Dextrose supplementation is not needed for children receiving caudal analgesia for major surgeries of 2–3 h duration and may raise blood sugars at the end of surgery. Key Messages: Caudal analgesia could attenuate the stress response and lower the blood glucose levels. In our study, we observed that children undergoing major surgeries with caudal analgesia do not need supplemental dextrose for correction of hypoglycemia. Additional dextrose could increase blood sugars at the end of surgery.

A comparative study of epidural nalbuphine versus tramadol as an adjuvant to bupivacaine for post operative analgesia in lower limb orthopaedic surgeries

A comparative study of epidural nalbuphine versus tramadol as an adjuvant to bupivacaine for post operative analgesia in lower limb orthopaedic surgeries

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries. Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p&lt;0.05 was taken as statistically significant. Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p&lt;0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p&lt;0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038). Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

Earlier preoperative percutaneous intercostal cryoanalgesia improves recovery after pectus excavatum surgery

Background and aimsMinimally invasive repair of pectus excavatum is associated with intense postoperative pain. We aimed to evaluate the effectiveness of percutaneous intercostal cryoanalgesia according to the different timing of...

Postoperative analgesic effect of lumbar erector spinae plane block for developmental hip dysplasia surgery: a randomized controlled double-blind study.

Open surgery for developmental dysplasia of the hip (DDH) may cause severe pain due to tenotomies and pelvic-femoral osteotomies. This study aims to evaluate the analgesic effect of ultrasound-guided Lumbar Erector Spina Plane (L-ESP) Block in pediatric patients undergoing DDH surgery. Sixty children scheduled for DDH surgery were randomly assigned into two groups. Group I (n = 30) received L-ESP with 0.5 mL/kg of 0.25% bupivacaine before surgery. In contrast, Group II (n = 30), as the control group, received the same volume of saline injection. Identical postoperative analgesia protocol was adjusted for both groups. Parental satisfaction, pain levels, ibuprofen, and opioid consumption were recorded. Pain levels were evaluated with the FLACC (Face, Legs, Activity, Crying, Consolability) scale. FLACC scores at the first 24th hours were lower in the L-ESP group than the control group (p < 0.001). Rescue opioid utilization was higher in the control group (15/26) than in the L-ESP group (2/29) (p < 0.001). The consumption of ibuprofen was higher in the control group than in the L-ESP group in the ward (24/26 vs. 3/29, p < 0.001, respectively). Parental satisfaction was superior in the L-ESP group (p = 0.024). To provide postoperative analgesia for DDH surgery, ultrasound-guided L-ESP may be an effective and alternative regional anesthetic technique.

Ultrasound-guided popliteal sciatic nerve block for surgical anesthesia in wound care patients with ongoing anticoagulant/antiaggregant therapy: A single-center, prospective study.

Ultrasound-guided peripheral nerve blocks may be a good alternative in patients under antithrombotic drugs. We evaluated the efficacy of ultrasound-guided popliteal sciatic nerve block in patients undergoing lower extremity wound debridement of whom antithrombotic drugs could not be stopped. We focused on hemorrhagic complications related to sciatic nerve block. Wound care patients followed by Cardiovascular Surgery Department scheduled for lower extremity wound surgery were included in this prospective observational study. Data was collected between March 2021 and September 2022. All patient were under antithrombotic therapy and discontinuation of anticoagulant drugs were not possible. Single-insertion and multiple-injection sciatic nerve block at popliteal region was applied to all patients under ultrasound guidance. Primary outcome was the rate of hemorrhage. Secondary outcomes were block onset times, block success and postoperative analgesia times. Data of 105 patients was evaluated, 87 were male and 18 were female. Mean patient age was 61.92 ± 10.06, mean patient body mass index was 25.68 ± 6.33. All patients were under 1 or more antithrombotic drugs. Only one minor hematoma was detected by postoperative ultrasonography control in 1 patient. Hemorrhage complication rate was 1 of 105 (% 0.95, 95% CI, 0.00024-0.051). Overall block success rate was 99.05%. Mean block onset time was 16.27 ± 5.69 minutes. Mean postoperative analgesia time was 19.5 ± 11.22 hours. Sciatic nerve block under ultrasound guidance using in-plane technique was safe and provided sufficient surgical anesthesia and postoperative analgesia for lower extremity wound debridement surgery in patients on antithrombotic drugs.

Pharmacogenetic features of tramadol metabolism affecting the quality of postoperative analgesia in vascular surgery

BACKGROUND: The issue of the efficacy and safety of medications employed for postoperative analgesia has not been resolved to date. Insufficient analgesia constitutes one of the primary risk factors for developing cardiovascular complications postoperatively. Tramadol is a medication that is frequently used for postoperative pain relief following minor and moderately traumatic operations. The biotransformation of this drug is considerably slowed by the presence of CYP2D6 gene polymorphisms G1846A and C100T, which play a significant role in its metabolism. In such patients, a decrease in the quality of postoperative analgesia can be anticipated, which will consequently lead to an increase in cardiac complications. AIM: To assess the efficacy of a postoperative analgesia regimen based on tramadol and the incidence of cardiac complications during vascular operations depending on the presence/absence of polymorphisms of the CYP2D6 gene polymorphisms, an isoenzyme of cytochrome P-450. MATERIALS AND METHODS: An examination of 109 patients undergoing planned vascular surgery was conducted. The frequency of occurrence of polymorphisms G1846A and C100T of the CYP2D6 gene was determined. All patients were assessed for the severity of postoperative pain syndrome during activity and at rest using a visual analog scale on the first day following surgery. Cardiovascular complications that arose while the patients were in the hospital were documented. To assess the autonomic nervous system, patients underwent cardiointervalography. RESULTS: Polymorphism G1846A was detected in 28 (25.7%), while C100T was detected in four (3.7%) patients. Patients without polymorphisms were included in group 1 (n=77). Patients with polymorphisms were assigned to group 2 (n=32). Pain syndrome at rest and during activity was higher in group 2 patients (p 0.05). The tension index before surgery did not differ between the groups; however, it was greater in group 2 patients after surgery (p 0.001). Cardiac complications were identified in 9.1% of group 1 and 18.8% of group 2 patients (p=0.20). CONCLUSION: The frequency of polymorphisms G1846A and C100T of the CYP2D6 gene in patients who underwent vascular surgery was 29.4%. Such patients experienced pain syndrome of greater severity. The patient groups did not exhibit any significant differences in the frequency of cardiac complications.

Comparison of the effectiveness of subcostal transversus abdominis plane and rectus sheath blocks in postoperative analgesia in major open gynecological cancer surgeries: a prospective randomized study.

The transversus abdominis plane block (TAPB) is frequently used for postoperative analgesia in abdominal surgery. However, it remains insufficient for analgesia during upper abdominal surgeries. Therefore, we compared the efficacy of the subcostal transversus abdominis plane block (STAPB) or rectus sheath block (RSB), in addition to the posterior transversus abdominis plane block (PTAPB), for postoperative analgesia in major gynecologic cancer surgeries. This prospective randomized study included 50 patients aged > 18 years (American Society of Anesthesiologists physical status II or III), who underwent gynecologic cancer surgery through a midline incision. All patients underwent PTAPB, STAPB, or RSB according to the randomization. The following parameters were recorded and compared: demographic data; intraoperative hemodynamic parameters; numeric rating scale (NRS) pain levels at the 1st, 6th, 12th, and 24th postoperative hours; opioid consumption; number of requests and boluses; adverse effects; surgical complications within 24 h. Forty-seven patients were included in this study. In the STAPB group, postoperative 1, 12 and 24 h NRS values were lower; opioid consumption, opioid demand, and bolus numbers were lower during the postoperative 24 h as compared to RSB (P < 0.05). The intraoperative opioid and hemodynamic values were similar in both groups. STAPB in addition to PTAPB provides more effective analgesia than RSB for postoperative pain management in open gynecologic cancer surgeries.

Anesteziyoloji ve Reanimasyon Hekimleri Arasında Sezaryen Cerrahisi ve Doğum Sonrası Ağrı Yönetiminde; Prosedüre Özgü Ağrı Yönetimi (PROSPECT) Farkındalığı Anket Çalışması

Objective: Procedure-specific pain management (PROSPECT) provides clinicians with evidence-based recommendations for postoperative pain management. It was aimed to evaluate the preferences of Anesthesiology and Reanimation physicians for postpartum analgesia management. Methods: A questionnaire consisting of 19 questions was prepared, including demographic data, cesarean surgery and postpartum analgesia practices, and whether PROSPECT recommendations were followed. This questionnaire was sent to participants via e-mail. Results: The study included 247 participants. Thirtysix percent of participants reported following PROSPECT recommendations and 55.1% of participants reported prefering opioids routinely or in combination with other techniques for cesarean surgery and postpartum analgesia. Eightyfive percent of the participants think that inadequate postpartum analgesic treatment was performed. Conclusion: Inadequate postpartum analgesia appears to be a common problem. The potential of maternofetal interaction is reported to be the most important reason for this situation. We think that training on postoperative pain management following cesarean surgery will make a significant contribution to eliminating concerns about maternal-fetal interaction. Keywords: Cesarean section, postpartum analgesia, prospect, anesthesiology and reanimation, questionnaire study

Evaluation of postoperative pain on Transversus Abdominis Plane block and Erector Spinae Plane block in patients undergoing gynecological surgery: a prospective, comparative study

INTRODUCTION: Moderate to severe pain after gynecological surgery has an impact on postoperative recovery and mobilization. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block have been used as multimodal analgesia for abdominal surgery. OBJECTIVES: This study aims to compare postoperative pain in patients undergoing either ESP blocks or TAP blocks, and the need for postoperative morphine in patients undergoing gynecological surgery.MATERIALS AND METHODS: This was a single-center, prospective, double-arm, comparative study. Forty subjects were enrolled in this study, and classified into two groups. One group of 20 subjects underwent ESP block, and the remaining 20 subjects underwent TAP block following a gynecologic surgical procedure. Patients were then assessed using with the Numeric Rating Scale (NRS) pain score which will be observed at intervals of 0–1 hour, 1–6 hours, 6–12 hours, and 12–24 hours. Numerical data analysis was done using an unpaired T-test on normally distributed data and the Mann-Whitney test on non-normally distributed data. Categorical data analysis was done using Fisher's Exact Test. RESULTS: NRS score at rest was higher in the TAP block group at 1–6 hours and 6–12 hours (pain scale 3) than in the ESP block group (pain scale 1). Movement-evoked pain NRS score was higher in the TAP block groups significantly. CONCLUSION: ESP block results in a lower postoperative pain score NRS value and reduces the need for morphine in post-gynecological surgery patients with a median incision compared to the TAP block.

A PECS II Block as Post Operative Analgesia After Modified Radical Mastectomy

A PECS II Block as Post Operative Analgesia After Modified Radical Mastectomy

COMPARISON OF TWO DIFFERENT DOSES OF ORAL GABAPENTIN FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY UNDER SPINAL ANAESTHESIA

Background: Pre-emptive analgesia is a technique of pain control where treatment is initiated before intervention and operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure. Gabapentin has demonstrated analgesic effects in clinical trials as a preemptive analgesic in acute postoperative pain management with very few side effects. Owing to the protective effect of gabapentin on the nociceptive pathways, preemptive analgesia has the potential to be more effective and hence reduce postoperative pain and development of chronic pain. Objective: We therefore designed this study to compare two different doses of Oral Gabapentin (300mg and 600mg) given as pre-emptive analgesic for post-operative pain relief in lower limb surgeries under spinal anaesthesia. Method: After the approval from ethical committee this prospective randomized double blinded clinical study was conducted over a period of two years in department of anaesthesia in M.G.M.s medical college, Aurangabad. Randomly allocated two groups were given Oral Gabapentin 300mg and 600mg respectively, one hour prior to giving spinal anaesthesia for post operative analgesia in lower limb surgeries. Conclusion: There is no statistically significant difference between group G300 (gabapentin 300mg) and group G600 (gabapentin 600mg) regarding age, gender, duration of analgesia (i.e. demand for first rescue analgesic), total dose of analgesics in first twenty four hours after surgery, duration of sensory block (i.e. L1 regression), highest ramsay sedation score and VAS scores. No significant difference was seen in cases hemodynamic stability and incidence of side effects.

Bilateral erector spinae plane block by multiple injection for pain control in pseudomyxoma peritonei surgery: a single-blind randomized controlled trial

ObjectiveCurrently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP.MethodsFifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB.ResultsThe Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P < 0.001), 4 (2.4 ± 1.5 vs. 3.7 ± 1.0, P = 0.001), and 6 h (2.7 ± 1.1 vs. 3.8 ± 1.4, P = 0.004) post-extubation during rest. Similarly, the VAS scores in Group E were significantly lower than those in Group C at immediate post-extubation (3.0 ± 1.4 vs. 4.6 ± 1.2, P < 0.001), and at 2 (3.8 ± 1.7 vs. 4.9 ± 1.4, P = 0.019), 4 (3.5 ± 1.3 vs. 5.3 ± 1.5, P < 0.001), and 6 h (3.9 ± 1.8 vs. 4.9 ± 1.3, P = 0.004) post-extubation during movement. In Group E, the intraoperative remifentanil administration (2319.3 ± 1089.5 vs. 2984.6 ± 796.1, P = 0.017) and the amount of rescue analgesia within 2 h post-extubation (0 vs. 4, P = 0.037) were significantly less than in Group C, and the first rescue analgesia time was shorter as well (231.4 ± 147.5 vs. 668.8 ± 416.7, P < 0.001).ConclusionCompared to general anesthesia alone, bilateral multiple-injection ESPB with 0.2% ropivacaine can enhance analgesia and reduce opioid administration in patients with PMP. However, the duration of analgesia with ESPB is relatively short due to the low concentration of the local anesthetic used.Trial registrationChinese Clinical Trial Registry, ChiCTR2300069504, 20/03/2023.

A COMPARISON OF EFFICACY OF EPIDURAL BUTORPHANOL AND FENTANYL FOR POST-OPERATIVE PAIN ANALGESIA IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES UNDER EPIDURAL ANESTHESIA: A PROSPECTIVE RANDOMIZED DOUBLE-BLINDED STUDY

Objective: Lower doses of epidural opioids can achieve post-operative analgesia for infraumbilical surgeries. A study was conducted to compare the efficacy of epidural butorphanol and fentanyl for post-operative analgesia, onset, duration, and side effects in infraumbilical surgeries. Methods: A study was conducted on 80 adult patients, both male and female, aged between 20 and 60 years, having American Society of Anesthesiologists Physical Status I and II, who were undergoing lower abdominal and lower limb surgeries under epidural anesthesia. The patients were randomly divided into two groups: Group A and Group B. Both groups were given injections of bupivacaine 20 mL of 0.5% epidurally. In the post-operative period, when the patient’s Visual Analog Scale score was more than 4, Group A was administered butorphanol 2 mg followed by top-up doses of 0.5 mg, and Group B was administered fentanyl 50 μg followed by top-up doses of 15 μg, which were diluted to 10 mL in normal saline. Along with cardiorespiratory parameters, the study also noted onset, duration, quality of analgesia, and the number of epidural doses in 24 h. The statistical analysis was done using Student’s t-test and two-tailed Fisher’s exact test or Chi-square (χ2) test, and a significant value of p&lt;0.05 was considered. Results: In comparing the post-operative analgesia between both groups, it was found that Group B had significant early onset of analgesia (2.600±0.4557 vs. 6.087±0.7501), shorter duration of analgesia (200.08±26.257 vs. 366.25±42.829), a higher number of epidural doses administered (3.75±1.171 vs. 2.98±0.733), lower quality of analgesia (2.55±0.504 vs. 3.18±0.636), and a greater incidence of vomiting (30.0% vs. 2.5%) when compared to group A. Conclusion: Superior analgesia with higher sedation can be achieved through epidural butorphanol, while fentanyl has a quicker onset of analgesia but a higher tendency for vomiting. Our conclusion is that both options, fentanyl and epidural butorphanol, are safe and effective for achieving post-operative pain relief.