Analgesia For Caesarean Section Research Articles

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 μg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Intravenous Dexamethasone versus intrathecal Dexamethasone in Prolonging the Duration of Spinal Anesthesia and Postoperative Analgesia in Elective Cesarean Section

Abstract Background Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists. Aim of the Work To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section. Participants and Methods 66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2 mL intravenously (IT group ), or dexamethasone 2 mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2 mL plus 1 mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results The study groups, There was significantly higher post-operative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value <0.001. There was no effect on the time of onset of sensory block with no significant complications were detected. Conclusion The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia.

Analgesic Effect of Intrathecal Nalbuphine versus Intrathecal Fentanyl as Adjuvant to 0.5% Bupivacaine for Cesarian Section under Spinal Anaesthesia

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective To assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl. Methods This randomized comparative clinical trial was conducted in Ain Shams University Hospitals’ operating rooms on 48 patients undergoing cesarean section within a period of six months after approval of ethical committee of Faculty of Medicine, Ain Shams University. Results This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine. It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine. Conclusion Either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 μg) combined with Bupivacaine improves intraoperative analgesia and prolongs post- operative analgesia in cesarean section. There was statistically significant difference between them, intrathecal nalbuphine had a prolonged duration of post-operative analgesia, lesser amount of rescue analgesia needed and fewer side effects than intrathecal fentanyl.

Pharmacologic Analgesia for Cesarean Section: An Update in 2024.

With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens. Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.

Spinal Anestezi Altında Sezaryen Doğumda Postoperatif Analjezi için Transversalis Fasya Plan Bloğunun Transversus Abdominis Plan Bloğuyla Karşılaştırılması: Retrospektif Bir Çalışma

Objective: Transversalis fascia plane (TFP) and transversus abdominis plane (TAP) blocks are used for postoperative analgesia in many lower abdominal procedures such as cesarean section. This study aimed to retrospectively compare the postoperative effects of TFP and TAP blocks for postoperative multimodal analgesia in patients who underwent cesarean section under spinal anesthesia. Methods: We retrospectively searched electronic medical records to identify patients who underwent cesarean section under spinal anesthesia between November 2021 and June 2022. A total of 497 patients were identified, and 120 patients were included that meet our criteria in our analysis. The patients were divided into three groups: TFP, TAP, and control. Data were obtained from the files of the patients. Results: The block groups had significantly lower numeric rating scale (NRS) scores, less non-steroidal anti-inflammatory drug consumption, and lower complications than the control group. No opioid consumption was observed in the block groups. Although no non-steroidal anti-inflammatory drug consumption until the 4th hour and no opioid consumption until the 8th hour were observed in the control group, the need for additional analgesics increased as time passed. While the TFP group needed analgesics later than the TAP group, the NRS scores and total analgesic consumption were lower (p<0.001). Patient satisfaction was higher in the block groups than in the control group (p<0.001). Conclusion: Transversalis fascia plane and TAP blocks are effective as part of multimodal analgesia in cesarean section. The TFP block is superior to the TAP block in terms of pain scores, additional analgesic requirements, and patient satisfaction. Keywords: Cesarean section, postoperative pain, ultrasound-guided regional anesthesia, transversus abdominis plane block, transversalis fascia plane block

Perioperative Analgesia and Patients' Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine.

Perioperative analgesia for cesarean section aims to ensure the mother's comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 μg) and M (morphine, standard dose 100 μg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann-Whitney U test, p < 0.001) and higher level of satisfaction (Mann-Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann-Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other.

P148 An evaluation of the reasons for unsuccessful top-up of labour epidural analgesia for caesarean section

P148 An evaluation of the reasons for unsuccessful top-up of labour epidural analgesia for caesarean section

DEXAMETHASONE ADDED TO LEVOBUPIVACAINE IN TRANSVERSUS ABDOMINIS PLAIN BLOCK INCREASED THE DURATION OF POSTOPERATIVE ANALGESIA AFTER CAESAREAN SECTION DELIVERIES

Introduction: When Dexamethasone added to local anaesthetics, it can prolong the duration of peripheral blocks. Dexamethasone has a long and efcient glucocorticoid structure and having anti-inammatory properties.The aim of this study is to determine the effect of Dexamethasone on the block duration when added to Levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. Methods: 28 patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I and II Risk group were included in the study and divided into two groups. Bilateral 30ml 0.25% Levobupivacaine and 2 ml 0.9% NaCl for the Levobupivacaine group and bilateral 30 ml 0.25% Levobupivacaine and 2 ml Dexamethasone (8mg) for the Dexamethasone group were administered in a TAP block performed. The time need for the rst analgesic in the postoperative period was recorded. The time before Result: the administration of the rst additional analgesic dose was prolonged signicantly in the Dexamethasone group in compared to Levobupivacaine group. The Conclusion: utilization of Dexamethasone, which has a prolonging effect on the TAP block, may be alternative to epidural opioid analgesia in caesarean section.

Analysis of intrathecal clonidine as an adjuvant in the subarachnoid block on post-operative analgesia and safety profile in obstetric surgeries: A randomised controlled trial

Background: Clonidine has long been considered an 'off-label' medication for use in obstetrics. Different doses of clonidine are studied and it is found that higher doses are associated with sedation and haemodynamic instability. Hence, we analysed a mini dose of intrathecal clonidine of 30 μg for its impact primarily on post-operative analgesia and secondarily on the quality of spinal anaesthesia, haemodynamics, sedation and neonatal outcomes in caesarean sections.Methods: One hundred participants were randomised them to receive the interventions. Group B received 11 mg of 0.5% hyperbaric bupivacaine (2.2 mL) and Group C received 10 mg of 0.5% hyperbaric bupivacaine with 30 μg of clonidine (2.2 mL). Motor, sensory and haemodynamic characteristics with time to rescue analgesics were observed in both the groups and analysed using univariate analysis.Results: Time to rescue analgesics (P < 0.001), visual analogue scores in the post-operative period and time to grade 0 Bromage (P = 0.002) were statistically significant in Group C. Time to T6 dermatomal level and time to grade 4 Bromage were similar in both the groups. Apgar scores were comparable and no adverse events were noted in both the groups.Conclusions: A low dose of intrathecal clonidine (30 μg) can prolong the duration of post-operative analgesia in caesarean section with comfortable maternal sedation and good neonatal outcome without significant complications.(Clinical Trials Registry- India, number CTRI/2018/08/015250)

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P&gt;0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P&lt;0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P&lt;0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

Quality of recovery after intrathecal morphine for elective Caesarean deliveries

Background: Recent supply issues with diamorphine have meant a change in practice to use of intrathecal morphine. The Obstetric Anaesthetists’ Association (OAA)1 guidelines state that intrathecal diamorphine or morphine provides adequate analgesia after Caesarean section. They discourage the use of parenteral opioids in women who have received neuraxial opioids, owing to the increased risk of respiratory depression. Other side-effects such as nausea and vomiting and pruritus may differ in severity for each drug. We reviewed the side-effects and adherence to the enhanced recovery pathway in elective deliveries receiving intrathecal morphine. Methods: Prospective data were collected for 50 women undergoing Caesarean section with intrathecal opioid analgesia (fentanyl 15 μg and morphine 100 μg) within a 5-week period. Data were collected at Day 1 and Day 2 postoperatively. These included: pain score, postoperative nausea and vomiting (PONV), pruritus, oral opioid use, anti-emetic use, chlorphenamine use, time spent in recovery, and occurrence of urinary retention. Pain score, nausea and vomiting, and pruritus were recorded using a verbal rating scale (VRS). Results: The majority (56.5%) of patients reported only mild pain, 37% reported moderate to severe pain, but of these most (94.7%) only required 20–40 mg of oral morphine in addition to simple analgesia. In addition, the majority (58.7%) of patients reported no PONV. Meanwhile, 45.7% of patients reported mild pruritus, and 43.5% reported no pruritus. Only three of the 50 women did not follow the enhanced recovery pathway. Two remained as inpatients for monitoring after obstetric haemorrhage, and one for intravenous antibiotics. There was no reported respiratory depression. Time spent in recovery was between 1 and 4 h. Although the reason for prolonged recovery stay was not audited, it was thought that requirement for oxytocin infusion increased recovery stay as the ward did not accept patients on an infusion. Conclusions: Our results show an acceptable side-effect profile after elective Caesarean delivery using intrathecal morphine, with adherence to the current enhanced recovery pathway. We aim to implement updated Caesarean delivery guidelines which include prescription of regular ondansetron and chlorphenamine as required, in conjunction with patient education, to try and reduce the incidence of bothersome PONV and pruritus. 1. Obstetric Anaesthetists’ Association, OAA commentary on alternatives to intrathecal and epidural diamorphine for caesarean section analgesia, 2018. Available from: https://www.oaa-anaes.ac.uk/ui/content/content.aspx?ID=4717

Comments on published article: Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

Comments on published article: Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

COMPARISON OF THE EFFECTS OF PRE-EMPTIF ANALGESIA PREGABALINE 75 WITH 150 MG ON THE GRADE OF PAIN AND CAESARIAN SECTION SEDATION SCORE WITH SUBARAKHNOID BLOCK

In recent years, many studies have been carried out on the pre-emptive analgesia of pregabalin for various types of surgery with varying results. Preemptive analgesia in caesarean section (SC) usually uses pregabalin at a dose of 150 mg, and there have been no studies using low doses (75 mg) Objective This study aimed to determine the effects of pregabalin 75 mg vs 150 mg doses for controlled pain, their sedation score in patients after C-section under spinal anesthesia. Methods This study was a double-blind randomized trial study examining 20 samples of patients who underwent elective C-sections under spinal anesthesia and divided into 2 equal groups, P75 (who received oral pregabalin 75 mg) and P150 (who received pregabalin 150 mg). The Results There were no significant differences in NRS between the 75 vs 150 mg group (p&gt;0.05), and there were significant differences in Ramsay sedation score between the 75 vs 150 mg group on 2 and 6 hours after surgery(p&lt;0.05) and there were no significant differences about the need for fentanyl rescue between 75 vs 150 mg group (p&gt;0.05). Pregabalin has an opioid-sparing effect and larger doses of pregabalin may increase its efficacy. The sedative effect that arises is due to the mechanism of action of pregabalin which binds potently to the 2δ subunit calcium channel and modulates calcium influx at nerve endings, thereby reducing the release of several excitatory neurotransmitters (glutamate), such as the mechanism of action of various intravenous and inhaled anesthetic agents. Preemptive administration of pregabalin 75 mg is recommended for C-section surgery because it might reduce NRS and the need for fentanyl rescue with minimal sedation side effects.

Study of pain scores and need for rescue analgesia with intrathecal fentanyl as an adjuvant with 0.5% hyperbaric bupivacaine for cesarean section

Background: Cesarean section contributes to the major part of surgeries taking place in any hospital now a days. Hence, improving anesthesia in cesarean section is of paramount importance. Intrathecal fentanyl can produce rapid, profound analgesia for cesarean section, early labor with minimal side effects. It also has minimal respiratory depressant effect on fetus. Present study was aimed to study pain scores and need for rescue analgesia with intrathecal fentanyl as an adjuvant with 0.5% hyperbaric bupivacaine for cesarean section. Aims and Objectives: Primary Objective was to evaluate intrathecal fentanyl as an adjuvant with 0.5 % hyperbaric Bupivacaine for caesarean section. The secondary objective was to compare onset and duration of sensory and motor blockade as well as to assess pain scores, analgesic requirements and side effects. Materials and Methods: The present study was hospital-based randomized double-blind control study conducted in pregnant women of 18–35 years age, 50–70 kg weight, ASA-II, posted for elective cesarean section. 60 patients were randomly divided into Group I (study group, n=30, receiving 0.5 % hyperbaric bupivacaine 1.6 ml+intrathecal fentanyl 0.4 ml/20 mcg) and Group II (control group, n=30, receiving 0.5% hyperbaric bupivacaine 1.6 ml+0.4 ml normal saline). Results: The difference in mean time for onset of sensory block, onset of motor block, maximum time taken to achieve highest level of sensory analgesia, total duration of motor block, and degree of motor block was statistically insignificant. The difference in mean duration of time to sensory regression was statistically highly significant (P&lt;0.0001). VAS score was used to assess pain postoperatively initially every 5 min then every 30 min up to 5 h. VAS score in post-operative period was less in Group I and difference was statistically significant. Mean Apgar Score at 1 and 5 min were comparable in both the groups with no statistically significant difference. Diclofenac consumption was significantly decreased in Group I as compared to group II. Conclusion: We conclude that the 0.5% hyperbaric Bupivacaine 8 mg with Fentanyl 20 μg is safe, effective, superior for spinal anesthesia, provided more longer duration of analgesia and significantly reduced number of rescue analgesia doses in cesarean section.

P.45 Retrospective review of perioperative analgesia for caesarean section comparing intrathecal morphine with combined intrathecal morphine and fentanyl

P.45 Retrospective review of perioperative analgesia for caesarean section comparing intrathecal morphine with combined intrathecal morphine and fentanyl

The Effect of COVID-19 Disease on General Anaesthesia Rates for Caesarean Section

(Anaesthesia. 2021. PMID: 33300126)

Analgesic Efficacy of Dexamethasone and Dexmedetomidine as an Adjuvant to 2% Lignocaine Adrenaline and 0.5% Bupivacaine in Transversus Abdominis Plane Block after Caesarean Delivery

Introduction: The ultrasound-guided Transversus Abdominis Plane (TAP) block is an analgesic technique which involves injection of a local anesthetic between the internal oblique abdominal and the transversus abdominis muscle planes. It provides analgesia to the cranial branches of T10-L1 nerve roots. It has been a practice to provide analgesia in patients following various surgical procedures including the gynecological procedures like hysterectomy and caesarean section. Aim: To assess the analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine in TAP block following caesarean delivery. Materials and Methods: This was a cross-sectional study conducted at Konaseema Institute of Medical Sciences and Research Foundation (KIMS&amp;RF), Amalapuram, Andhra Pradesh, India for a period of one year from January 2021 to December 2021. One hundred patients with an American Society of Anaesthesiologists (ASA) physical scores of I-II, who underwent caesarean section under the Pfannenstiel incision method under subarachnoid anaesthesia with 0.5% heavy bupivacaine, were enrolled in the study. Group I consisted of patients that received an ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 20 mcg dexmedetomidine. Group II included patients who received ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine adrenaline, and 8 mg dexamethasone. The Electrocardiogram (ECG) recordings and blood pressure were recorded during the block in each patient. This approach enabled a more precise analgesic approach for each individual patient. The patients were assessed for pain up to 12 hours of surgery based on a Visual Analog Scale (VAS), where 0 represented no pain and 10 represented ‘the worst pain ever possible. Results: The patients who received ultrasound-guided TAP block with dexmedetomidine were significantly less on-demand of tramadol (p-value=0.005) and had significantly lower VAS scores at 3 hours (p-value=0,000014), 6 hours (p=0.015) and 12 hours (p-value=0.006), postoperatively. Conclusion: This study proved that dexmedetomidine was more effective when compared to dexamethasone, when added as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine. Ultrasound guided TAP block was a safe and effective postoperative analgesia in cesarean section.

Postoperative Analgesic Efficacy of Transverse Abdominis Plane Block versus Port Site Local Infiltration in Laproscopic Gynaecological SurgeriesA Randomised Clinical Trial

Introduction: Pain relief postoperatively has advantages related to better patient satisfaction in terms of early ambulation and discharge and also better cardiovascular stability, decreased infections, neurological complications, prevention of thromboembolic phenomenon, and chronic pain syndrome. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are the most commonly used drugs in pain management. Transverse Abdominis Plane (TAP) block is a regional analgesic technique, which provides analgesia of the anterolateral abdominal wall and hence can be used to provide analgesia for cesarean section, hernia repairs, hysterectomies, cholecystectomy. Aim: To compare the effectiveness of bilateral TAP block versus port sites local anaesthetic infiltration to relieve postoperative pain in laparoscopic gynaecological surgeries. Materials and Methods: This single-blinded randomised controlled study conducted at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The clinical trial was conducted on 80 patients belonging to American Society of Anesthesiologists (ASA) I and II posted for elective laparoscopic gynaecological surgeries. Patients were randomly allocated into two groups with 40 patients in each group. Group T (TAP block) received 0.6 mL/ kg of 0.25% bupivacaine for bilateral ultrasound guided TAP block and group O (port sites local infiltration) received 0.6 mL/ kg of 0.25% bupivacaine for port sites infiltration. At the end of surgery, patients received either TAP block or port site infiltration as per the group allocated and then extubated. Postoperative pain intensity using Visual Analogue Scale (VAS) score were recorded at the time of shifting as 0 hr and then every 2 hrs, 4 hrs, 6 hrs, 8 hrs, 12 hrs, 24 hrs. The mean time for first rescue analgesia and total number of rescue analgesic given in first 24 hrs were noted. Haemodynamic parameters and side-effects with study drug were noted. For inferential statistics, numerical data was analysed by Chi-square test and for categorical data student’s t-test was used. A p-value &lt;0.05 was considered as statistically significant. Results: Demographic parameters in both groups were comparable. There was no significant difference in VAS score up to 4 hours in between two groups. But mean VAS score was significantly low in group T when compared to group O at 6 hours (2.2±0.4 vs 2.7±0.5), 8 hours (2.7±0.4 vs 3.2±0.7) and 12 hours (3.3±0.5 vs 3.6±0.5). The time to receive rescue analgesic was longer in TAP block group (13.7±1.5 vs 10.6±1.64 hrs) when compared to port sites local infiltration group. And total number of rescue analgesia received was low in TAP block group (70% recieved single dose) when compared to port sites local infiltration group (80%received two doses). Conclusion: The TAP block and port sites infiltration in patients undergoing laparoscopic gynaecological surgeries are used for effective postoperative analgesia as part of multimodal analgesia, which reduces the use of other analgesics like NSAIDS and opioids. However, TAP block provides superior and prolonged pain relief when compared to port sites local infiltration.

The use of perineural dexamethasone and transverse abdominal plane block for postoperative analgesia in cesarean section operations under spinal anesthesia: an observational study

BackgroundDuring transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events.MethodsThis is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant.ResultsThe time to first analgesic request was 8.5 h (8.39–9.79) in the TAPD group versus 5.3 h (5.23–5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05).ConclusionAn additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.