Analgesia In Lower Abdominal Surgeries Research Articles

Comparison of nalbuphine and morphine as intrathecal adjuvant to 0.5% bupivacaine for post-operative analgesia in lower abdominal surgeries – A randomized and control study

Background: The use of a higher volume of 0.5% bupivacaine, however, is associated with hemodynamic instability. Adjuvants such as morphine and other opioids are added in with the local anesthetic to reduce this adverse effect and extend the duration of sensory block, hence extending the length of analgesia. However, opiates are associated with a high risk of respiratory depression and other side effects. Nalbuphine has been used to counteract these adverse effects. Thus, we decided to compare the analgesic effect of intrathecal (IT) nalbuphine with IT morphine. Aims and Objectives: The aim of the study was to compare IT morphine with nalbuphine as adjuvant to a spinal anesthetic agent. The primary objective was to compare between the time of onset of sensory and motor blockade and the post-operative analgesic duration between the two adjuvants, while hemodynamic variables and side effects were studied as secondary variables. Materials and Methods: This randomized controlled study was conducted after Ethical Committee approval for a period of 1 year on 100 patients who fulfilled the inclusion criteria. They were randomized into two groups to receive sub-arachnoid block: Group A: 3 mL of 0.5% Hyperbaric Bupivacaine and 0.2 mg morphine and Group B:3 mL of 0.5% Hyperbaric Bupivacaine and 0.5 mg nalbuphine. The following parameters were monitored – Height, Weight, blood pressure, American Society of Anesthesiologists grading, time of onset, maximum duration and regression of Motor and sensory blocks, and total duration of analgesia. Results: The onset of sensory blockade was comparable in both groups while the onset of motor blockade was significantly longer in the morphine group (P≤0.001). The duration of analgesia in the morphine group was longer as compared to nalbuphine group and was statistically significant (P<0.05). The incidence of side effects was 26% in the morphine group and 6% in the nalbuphine group, which was statistically significant (P<0.05). Fourteen patients in the morphine group had pruritus and four patients in the nalbuphine group experienced nausea. Conclusion: IT nalbuphine with 0.5% bupivacaine produces rapid onset of anesthesia and early post-operative analgesia with minimal side effects, but the total analgesic duration was more with IT morphine.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

Posterior quadratus lumborum versus caudal epidural block for perioperative analgesia in pediatric patients undergoing upper abdominal surgeries: Arandomized, double-blind trial

ABSTRACT Background Ultrasound-guided Quadratus Lumborum block (QLB) has become an established modality for perioperative analgesia in lower abdominal surgeries. However, its efficacy in upper abdominal surgeries is still understudied. Objectives The study aimed to determine QLB2 efficacy as a perioperative analgesic modality in upper abdominal surgeries, compared to caudal epidural block (CEB), regarding FLACC score, the time to the first rescue analgesia, the amount of fentanyl consumed intraoperatively, amount of rescue analgesia administered, parents’ satisfaction, as well as the incidence of complications. Study design A randomized, prospective, double-blind, and single-center study. Setting Ain Shams University Hospitals Methods/patients/interventions/measurements Fifty-two pediatric patients scheduled for upper abdominal surgeries under general anesthesia were assigned randomly to undergo CEB or ultrasound guided QLB 2. As assessed by FLACC, postoperative pain scores were the primary outcome. The secondary outcomes included the amount of fentanyl consumed intraoperatively, the time to first rescue analgesia, the amount of rescue analgesia given, parents’ satisfaction, and the incidence of complications. Results The QLB cohort demonstrated decreased FLACC scores than the CEB group. Total fentanyl consumption was significantly lower (33.4 ± 14.9 µg vs. 56.5 ± 17.0 µg, p-value of 0.003), time to first rescue analgesia was more prolonged (14.4 ± 1.3hrs vs. 1.8 ± 1.2 hr, p-value <0.001), and parents’ satisfaction was significantly higher. Postoperative nausea incidence was significantly alleviated (11 (42.3%) vs. 22 (84.6%), p-value 0.002), whereas vomiting was substantially decreased (0 (0.0%) vs. 15 (57.7%), p-value <0.001). Conclusion Perioperative analgesia in pediatric patients can be effectively achieved using QLB type 2. Compared to CEB, it provides more stable hemodynamics, lower FLACC scores, less need for rescue analgesia, and higher parent satisfaction.

Comparison of ultrasound-guided transversus abdominis plane block and caudal epidural block for postoperative analgesia in paediatric lower abdominal surgeries: A randomised controlled trial.

Ultrasound-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in lower abdominal surgeries. This study aims to compare the duration and efficacy of an ultrasound-guided TAP block with those of a caudal epidural for paediatric unilateral lower abdominal surgeries. After ethical approval, sixty children aged 1 to 9 years were randomised into ultrasound-guided TAP block or caudal block with general anaesthesia for unilateral lower abdominal surgeries. The primary endpoint was time for the first rescue analgesia in the postoperative period. The secondary endpoints were total postoperative opioid consumption, modified Children Hospital of Eastern Ontario Pain Scale (CHEOPS) and the Face, Legs, Activity, Cry and Consolability (FLACC) scale in the postoperative period. The mean time for first rescue analgesia was 11.33 ± 2.80 h in the TAP block group, while in the caudal group, it was 13.18 ± 2.67 h (95% confidence interval [CI] mean difference 2.58-10.58, P = 0.017). The total postoperative morphine requirement was comparable in both groups at both 12 h (TAP block group 0.50 ± 0.12 mg vs. caudal block group 0.56 ± 0.12 mg, 95% CI mean difference 0.09-0.02, P = 0.08) and 24 h (TAP block group 0.96 ± 0.30 mg vs. caudal block group 0.81 ± 0.34 mg, 95% CI mean difference 0.06-0.32, P = 0.06) time period. The mean time for first rescue analgesia was lesser in the TAP block group as compared to caudal group.

A Comparative Study of Epidural Butorphanol and Fentanyl as Adjuvants with 0.5% Bupivacaine for Postoperative analgesia in Lower Abdominal Surgeries

The pain is considered as sixth vital sign. Achieving adequate peri-operative and post -operative analgesia is of paramount importance to the anesthesiologist. This can be done by multiple approaches. One such technique is use of Epidural opioids. This study evaluates the analgesic efficacy of epidural fentanyl and butorphanol in lower abdominal surgeries for post -operative analgesia. Aims: To compare the degree of post-operative analgesia using butorphanol and fentanyl administered by epidural route. Settings and Design: Study setting: Tertiary care Hospital Study Design: A Prospective Double Blinded Randomised Clinical Study Methods and Material: A total of 60 Patients posted for elective lower abdominal surgeries were randomly selected for the study. The patients aged 20-60 years of ASA grade one and two posted for elective lower abdominal surgery were selected for the study. Drugs used were explained to the patients and also educated about Verbal numerical scale for assessment of pain. Patients were divided into two groups: Group A: receives Butorphanol 1mg mixed with 15 ml Bupivacaine 0.5%diluted upto 20 ml. Group B: receives Fentanyl 100 microgram mixed with 15 ml Bupivacaine 0.5% diluted upto 20 ml. Statistical analysis used: Statistical data was analysed using • Chi-square test • Student t-test (Paired and unpaired t-test) • A P value of &lt; 0.05 is significant and &gt;0.05 is not significant Results: The demographic variables were comparable in both groups. Both inj. Butorphanol 1 mg and Inj. Fentanyl 100 mcg given epidurally with Inj. Bupivacaine 0.5% as a single shot provided excellent operative conditions and satisfactory post-operative analgesia in both the groups. However, the duration of post-operative analgesia was much longer in the butorphanol group than Fentanyl group and was statistically significant. No serious side effects were noted in both groups. The method is economical, safe, convenient and acceptable and also poly pharmacy is avoided. Conclusions: Both fentanyl and butorphanol are safe and effective as epidural agents for postoperative analgesia with little side effects.

Postoperative Analgesic Efficacy Of Ilioinguinal-Iliohypogastric Block In Inguinal Hernia Surgeries: A Prospective Randomized Single-Blind Study

Introduction: Ilioinguinal-iliohypogastric (II/IH) nerve block is used for postoperative analgesia in lower abdominal surgeries. We aimed to compare the postoperative analgesic efficacy of ultrasound (US) guided II/IH nerve block, tramadol, and paracetamol in patients scheduled for unilateral inguinal hernia surgery. Materials and Methods: The study population consisted of patients who underwent surgery diagnosed with inguinal hernia. Sixty male cases aged 18-65 years and ASA I-II were included in the study. After spinal anesthesia, those who underwent II/IH nerve block under US guidance for postoperative analgesia were classified as Group B (n=20), those who received tramadol were classified as Group T (n=20), and those who received paracetamol were classified as Group P (n=20). Demographic characteristics, hemodynamic parameters, time before postoperative first analgesic requirement, amount of analgesic used in the first 24 hours, additional analgesic requirement, Visual Analogue Scale (VAS) score, and patient satisfaction were recorded. Results: There was no significant difference between the groups regarding demographic data, ASA score, and operation. Up to 24 hours postoperatively, patient satisfaction in Group B was significantly higher than in the other two groups. While the time before the first analgesic requirement was 295 minutes in Group B, it was 129.5 minutes in Group T and 122 minutes in Group P (p=0.001). While the VAS scores in the first 12 hours postoperatively were lower in Group B, they were similar in all three groups after the 12th hour. Conclusion: The study findings demonstrated II/IH nerve block reduces the need for analgesia in the first 24 hours postoperatively in inguinal hernia operations performed under spinal anesthesia. In addition, it was determined that II/IH nerve block ensures better postoperative patient satisfaction and prolongs the first analgesic requirement time.

Surgical Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries: A Prospective Interventional Study

Introduction: Pain from lower abdominal surgeries originates from the abdominal wall incision. The Transversus Abdominis Plane (TAP) is a fascial plane between the internal oblique and the transversus abdominis muscle, which contains the nerve bundles. TAP block involves infiltrating this plane with anaesthetic drugs that block the somatic component of postoperative pain. Traditionally, the TAP block is given by anaesthesiologists as a blind procedure or under Ultrasound (US) guidance. In 2010, an innovative surgical TAP block method was developed, where the surgeon gives TAP block under direct vision before closing the abdomen during abdominal surgery. Many studies have recommended surgical TAP block as an intervention for achieving postoperative pain relief. Aim: To evaluate the efficacy of the surgical TAP block technique for postoperative analgesia following lower abdominal surgeries using Visual Analogue Scale (VAS) scores and by comparing the need for rescue analgesia and the total amount of analgesic drugs utilised within the first 24 hours of surgery. Materials and Methods: This hospital-based prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India, from January 2022 to December 2022. The study participants included 108 women undergoing lower abdominal surgeries under spinal or epidural or combined regional anaesthesia and belonging to the American Society of Anaesthesiologists (ASA) physical status classification system ASA I or ASA II or ASA IIE. The study group included 54 women who received surgical TAP block with 20 mL 0.25% bupivacaine and 4 mg of dexamethasone, intraoperatively on either side before closure of the abdomen. Postoperative pain was assessed using VAS at regular intervals within 24 hours of surgery. VAS was also recorded whenever the participants demanded rescue analgesia. The control group included 54 women who received intravenous tramadol 50 mg eight hourly for postoperative pain relief, while the study group received rescue analgesia on demand or if the VAS score was recorded as three or more. The time for the first request for rescue analgesia and the total dose of rescue analgesic required in the first 24 hours after surgery were also recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. For inferential statistics, numerical data were analysed by Chi-square test, and for continuous data, the Student’s t-test was used. A p-value &lt;0.05 was considered statistically significant. Results: The study group had significantly lower postoperative pain VAS scores when compared to the control group at four hours and beyond time intervals. The mean VAS scores at six hours were 1.85 in the study group and 2.35 in the control group (p-value=0.01), at 24 hours it was 2.04 in the study group and 2.24 in the control group (p-value=0.04). The mean time for the first rescue analgesia in the study group and control group was 11 hours 25 minutes and 2 hours 43 minutes, respectively, and the total tramadol consumption was 77.78±46.24 mg and 117.59±36.55 mg, respectively. Both results were statistically significant (p-value&lt;0.001). Conclusion: Surgical TAP block significantly delays the need for rescue analgesia and decreases the total analgesia required in the first 24 hours after surgery. It is an effective, safe, and simple technique for achieving postoperative pain relief.

Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block versus Epidural Block for Postoperative Analgesia Following Lower Abdominal Cancer SurgeriesA Randomised Clinical Study

Introduction: Effective post-operative analgesia improves patient’s outcome and satisfaction. Many methods are available to provide best analgesia after major abdominal surgery. Epidural anaesthesia is “gold standard” but it is associated with its own drawbacks. Transversus Abdominis Plane (TAP) block is a comparable technique to epidural to provide reliable analgesia in lower abdominal surgeries. Aim: To compare the efficacy of Ultrasonography (USG) guided TAP block and the epidural block for the post-operative pain management in lower abdominal cancer surgery. Materials and Methods: This randomised clinical double-blinded study, conducted in 60 female patients undergoing lower abdominal cancer surgery under General Anaesthesia (GA) from July 2022 to September 2022. Patients were randomised to Group-E and Group-T. Group-E (Epidural) received injection (inj.) 0.2% Ropivacaine (10 ml) plus inj. Morphine 2 mg via epidural. Group-T (TAP) received inj. 0.2% Ropivacaine (20 ml) plus inj. Morphine 2 mg on each side via USG guided TAP block postoperatively. The Visual Analog Scale (VAS) Score, first rescue analgesia, total analgesic consumption and any side-effects in 24 hours were recorded. The Statistical Package for Social Sciences(SPSS) version 22.0 International Business Management (IBM) Corporation (NY) was used for statistical analysis. Unpaired t test, Chi-square test and Fisher’s-exact test and one-way Analysis of Variance (ANOVA) test were used as and when appropriate. Results: Data of total 60 female patients , 30 patients in each group(Group E mean age: 47.33±9.614 years and Group T mean age: 47.77±12.370 years) was collected and analysed. Both the groups were comparable with respect to age, height, weight, American Society of Anaesthesiologists (ASA) grade, mean duration of surgery and duration of anaesthesia (p&gt;0.05). More patients in group-E had moderate pain at rest and coughing (VAS-4 to 6) at six hours and 12 hours which is statistically significant (p&lt;0.05). None of the patient in both groups had severe pain. Time for need of first rescue analgesic was lower in Group-E (399.6±25.32 min) and in Group-T it was higher (462.6±26.94 min) which is also statistically highly significant (p&lt;0.001). Conclusion: TAP has advantage over epidural in terms of effective postoperative analgesia, time of need and quantity of postoperative analgesics.

Ultrasound-guided posterior transversus abdominis plane block versus epidural analgesia for postoperative pain relief in lower abdominal surgeries

Background: Among the regional anesthesia techniques used for postoperative analgesia for lower abdominal surgeries, epidural analgesia (EA) has been the gold standard and time-tested technique, but complications and contraindications for the same warrant the need for other equally good analgesic techniques. Aim: The present study compared posterior transversus abdominis plane (TAP) block to EA for postoperative analgesic efficacy in patients undergoing lower abdominal surgeries. Methods: Prospective, observational study in patients undergoing lower abdominal surgeries under general anesthesia. Patients received ultrasound-guided (USG) 20 ml 0.2% ropivacaine each side in TAP block (Group A, n = 50) or 10 ml of 0.2% ropivacaine was administered in epidural (Group B; n = 50) before extubation. The Visual analog scale (VAS) score, hemodynamic parameters, and ill effects were recorded. Results: The blood pressure was significantly lower in first 6 h of block in Group B. VAS score was significantly lower in Group A in first 6 h of surgery. It was observed that a significantly higher number of patients in the Group B required rescue analgesic and at higher dosages. Postoperative nausea and vomiting were found in 32% of Group B and 22% of Group A patients. Conclusion: TAP block has almost no complications, keeps the patient more hemodynamically stable, and offers a better early postoperative analgesia when compared to EA in patients undergoing lower abdominal surgeries.

A study to compare the efficacy of intrathecal dexmedetomidine versus nalbuphine as an adjuvant to 0.5% hyperbaric bupivacaine for postoperative analgesia in lower abdominal surgeries

BackgroundThe subarachnoid block is a commonly used technique for lower abdominal surgeries. Bupivacaine being a cost-effective drug gives satisfactory analgesia for 90–120 min. Adjuvants such as dexmedetomidine and nalbuphine extend the analgesia in the postoperative period. In this study, we aimed to compare the effects of intrathecal dexmedetomidine and nalbuphine as an adjuvant to hyperbaric bupivacaine regarding the duration of analgesia as the primary objective and the time of onset of sensory and motor blockade, duration of motor blockade, haemodynamics parameters like mean heart rate and mean arterial blood pressure, and side effects if any being the secondary objectives. Eighty patients, aged 18–65 years of ASA physical status I and II, were randomly allocated into two groups. Group NB (n = 40) received 0.5% Inj. hyperbaric bupivacaine 18 mg (3.6 ml) + Inj.nalbuphine 1.0 mg (0.1 ml) while group DB (n = 40) received 0.5% Inj. hyperbaric bupivacaine 18 mg (3.6 ml) + Inj.dexmedetomidine 10 μg (0.1 ml).ResultsPatients in group DB had a significantly prolonged duration of analgesia as compared to group NB. The early onset of sensory and motor blockade was noted in group DB(P < 0.05). The duration of motor blockade was significantly prolonged in group DB (P < 0.05). Patients in both groups showed no significant difference in haemodynamic changes and incidence of side effects (P > 0.05).ConclusionsDexmedetomidine as an intrathecal adjuvant was found to have prolonged sensory and motor block and provide good quality of postoperative analgesia and stable haemodynamics with minimal side effects as compared to nalbuphine.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

A comparative study between transversus abdominis block with ropivacaine (0.2%) and fentanyl versus plain ropivacaine (0.2%) for postoperative analgesia in lower abdominal surgeries under general anesthesia

Background: Lower abdominal surgeries are associated with significant visceral, somatic, and neuropathic pain in postoperative period. Transversus abdominis plane block (TAP) is a technique used in the management of surgical abdominal pain by injecting local anesthetic in the plane between internal oblique and transversus abdominis muscles. We compared utility of TAP block using ropivacaine alone and also in combination with fentanyl for patients undergoing abdominal surgeries. Aim: To compare ropivacaine (0.2%) versus ropivacaine (0.2%) plus fentanyl (1 mcg/kg) used in transversus abdominal plane for the management of postoperative abdominal pain. Objective: To evaluate quality and duration of analgesia in the management of patients. Materials and Methods: Thirty patients undergoing abdominal surgeries were equally divided into two groups. Group-I received ropivacaine (0.2%) and Group-II received ropivacaine (0.2%) along with fentanyl (1 mcg/kg) as transversus abdominal block. Patients with stable hemodynamic parameters, American Society of Anesthesiologists grade I and II, and undergoing elective procedures were included in the study. Patients with significant comorbidities and emergency procedures were excluded. Vitals were recorded intraoperatively and subsequent to the procedure. Visual analog scale was recorded at 2nd, 4th, 12th, and 24th h postoperatively. Results: The hemodynamic parameters including blood pressure and heart rate were similar in both the groups with nonsignificant difference. Time to rescue analgesia in the form of injection tramadol was significantly earlier in the group that received ropivacaine alone. Patients receiving ropivacaine significantly had a higher severity pain at all the time points. No serious adverse events were noted in the either of the groups. Conclusion: TAP block using ropivacaine along with fentanyl may provide a higher quality of analgesia in patients undergoing abdominal surgeries in postoperative period.

Evaluation of 0.25% bupivacaine vs. 0.375% ropivacaine for postoperative analgesia using ultrasound guided transversus abdominis plane block for caesarean section: A comparative study

Background: Pain after Caesarean section is described as moderate to severe by most patients. Ultrasound guided transversus abdominis plane (TAP) block is now increasingly being used for postoperative analgesia in lower abdominal surgeries. Hence this study was undertaken to compare 0.25% Bupivacaine with 0.375% Ropivacaine for postoperative analgesia using TAP block in caesarean section. Methods: Seventy patients were randomized into Group B (n = 35) and Group R (n = 35). TAP block was administered after completion of surgery under ultrasound guidance using 15 mL of 0.25% Bupivacaine in Group B and 15 mL of 0.375% Ropivacaine in Group R on each side of the abdomen. Time to requirement of first analgesic dosage was observed in both the groups. Total analgesic requirement in the first 24 h, visual analogue scale (VAS) scores at 2, 4, 6, 8, 12 and 24 h, patient satisfaction and complications were also noted. Results: Mean time for the first dose of rescue analgesia after completion of surgery was 298.2 ± 93.6 min in Group B and 447.6 ± 85.2 min in Group R (P = 0.0001). Total requirement of Diclofenac Sodium injection was 162.86 ± 46.88 mg in Group B whereas it was only 130.71 ± 44.49 mg in Group R (P = 0.003). VAS at 4,6 and 8 h after surgery were significantly lower in the Ropivacaine group. Conclusion: 0.375% Ropivacaine provided longer duration of analgesia and resulted in lesser analgesic requirement than 0.25% Bupivacaine when used in TAP block after caesarean section.

Comparison of Ultrasound-Guided Transversus Abdominis Plane Block and Caudal Epidural Block for Pain Relief in Children Undergoing Infraumbilical Surgeries.

Background:Caudal epidural block combined with general anesthesia remains a popular choice of anesthesia for both supraumbilical and infraumbilical surgeries. More recently transversus abdominis plane block performed under ultrasound guidance is being described as an effective technique for postoperative analgesia for lower abdominal surgeries. The present study aims to compare the efficacy of ultrasound –guided TAP block and caudal epidural for paediatric infraumbilical surgeries.Aims and Objectives:To compare the duration and efficacy of postoperative pain relief between TAP block and caudal epidural block in children undergoing lower abdominal surgeries.Methods:Fifty children of age group 2-7 years undergoing lower abdominal surgeries were randomized to groups T and C. All patients were given general anesthesia as per standardized anesthesia protocol. Group T were given ultrasound guided TAP block with 0.5 ml.kg-1 of 0.2% Ropivacaine. Group C were given 1 ml.kg-1 of 0.2% ropivacaine as caudal block. All the children were assessed using FLACC scale. Their vitals, pain scores, duration of postoperative analgesia and requirement of supplemental analgesics were noted.Results:Rescue analgesic requirement was significantly less in Group T compared to Group C. Mean postoperative analgesia time was significantly more in Group T (342 mins) as compared to Group C (198 mins).Conclusion:Ultrasound guided TAP block provides better postoperative analgesia after loer abdominal surgeries in children.

Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block versus Ultrasound Guided Transversus Abdominis Plane Block for Lower Abdominal Surgeries: A comparative Clinical Study

Background: Effective pain relief is of utmost importance to anyone undergoing surgery. Postoperative pain relief increases patient comfort and satisfaction. This is best accomplished with a multi-modal approach. Recent trends in minimally invasive surgery and improved recovery protocols have addressed pain treatment in light of these goals. Aim of the work: Comparison between ultrasound-guided Ilioinguinal and Iliohypogastric nerve block with ultrasound-guided transversus abdominis plane block regarding postoperative analgesia in patients scheduled for lower abdominal surgeries. Patients and methods: Seventy patients of ASA I or II, aged 21-50 years, who planned for elective open lower abdominal surgeries were included. They signed an informed consent and were randomly classified into two groups: [Group I] scheduled for Ilioinguinal and Iliohypogastric nerve block, and [Group II] scheduled for transversus abdominis plane block guided by ultrasound. Postoperative pain assessment was conducted by numerical rating score. Results:In inguinal hernia repair, pain score at rest was significantly reduced in the TAP group when compared to Group-I at 30 minutes till the seventh hour postoperatively and at 12 up to 15 hours postoperatively. Also, in the CS group, the pain score was significantly decreased in TAP block when compared to nerve block at 90, 105 minutes, and from 4 up to seventh postoperative hours. With movement, pain scores were significantly lower at the 4, 5, 6, 7, 8, 9, 10, and 11 -hours in group II in inguinal hernia. It was significantly decreased at the 90 minutes to 2 -hours in group II in the CS subgroup. The total analgesic requirements were significantly lower in group II. Conclusion: Ultrasound-guided TAP block tended to be more effective than Ultrasound-guided II/IH nerve block in lowering postoperative pain scores and decreasing the need for rescue analgesia in lower abdominal surgeries.

A Randomized Controlled Double-Blind Comparative Study between Bupivacaine 0.25% Plus Fentanyl and Bupivacaine 0.25% Plus Dexmedetomidine for Caudal Epidural Postoperative Analgesia in Pediatric Lower Abdominal and Urogenital Surgeries in Indian Genotype

Abstract Objectives This study aimed to clinically evaluate and compare the efficacy of caudal epidural bupivacaine in prolonging the postoperative analgesia, with adjuvants like fentanyl or dexmedetomidine among children of Indian genotype. Materials and Methods A prospective double-blind randomized comparative study. The study population of 68 patients of Indian phenotype were randomly taken from a random number table and divided into two groups with 34 patients in each group. They received single shot caudal epidural blocks, with group A receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg fentanyl, group B receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg dexmedetomidine. Global Assessment of anesthesia, defined as the time from caudal injection to the first administration of rescue analgesia, will be recorded for both the groups. Results The addition of either fentanyl or dexmedetomidine as adjuvants in caudal block provided excellent postoperative analgesia, and sedation was significantly longer duration with dexmedetomidine (18.0 hours) than fentanyl (13.1 hours). We observed good hemodynamic stability in both the groups. Conclusion Addition of dexmedetomidine over fentanyl to bupivacaine for caudal epidural analgesia in pediatric age group has multiple advantages like better control of intraoperative and postoperative hemodynamics, significantly longer duration of postoperative analgesia, lesser bleeding during surgery, and achieving good surgical satisfaction. As the children are pain-free, calm, quiet, and sedated but arousable, the parents’ satisfaction is rewarding. The caudal epidural dose of 0.25% bupivacaine 0.75 mL/kg with adjuvants like dexmedetomidine or fentanyl is effective for postoperative analgesia in lower abdominal surgeries and is without side effects among the Indian population.

Evaluating the effect of intramuscular dexmedetomidine or clonidine on the duration of anaesthesia and analgesia for lower abdominal surgeries under sub-arachnoid block

Spinal anaesthesia in the form of subarachnoid block is the common modality of anaesthesia for lower abdominal surgeries. However, its main drawback is the limited duration of anaesthesia and analgesia. To overcome this several adjuncts to spinal anaesthesia have been tried by various routes to prolong the duration of action. We aimed at evaluating the effect of intramuscular Dexmedetomidine or Clonidine on the anaesthetic and analgesic effect after subarachnoid Bupivacaine.: 90 patients undergoing lower abdominal surgeries were randomized to 3 groups of 30 each to receive normal saline or 1µg/kg Dexmedetomidine or 2µg/kg Clonidine intramuscularly 30 minutes prior to spinal anaesthesia. Patient’s sedation score, duration of sensory, motor block and request for first analgesic following surgery were noted.: Baseline characteristics were comparable among the 3 groups, the onset time of sensory and motor block was not different for the 3 groups. Sedation was greater for the Dexmedetomidine and Clonidine group than the control. Duration of anaesthesia and analgesia was significantly prolonged in Dexmedetomidine group when compared to the others.Intramuscular Dexmedetomidine or Clonidine given by intramuscular route prior to lower abdominal surgeries prolongs the duration of anaesthesia and analgesia without causing significant side effects.

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB)...

Comparing Effect of 0.25% Bupivacaine and 0.5% Ropivacaine in Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries

Comparing Effect of 0.25% Bupivacaine and 0.5% Ropivacaine in Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries

Comparative Study between Epidural Butorphanol, Nalbuphine, and Fentanyl for Post-Operative Analgesia in Lower Abdominal Surgeries: A Prospective Randomised Double Blinded Trial

Comparative Study between Epidural Butorphanol, Nalbuphine, and Fentanyl for Post-Operative Analgesia in Lower Abdominal Surgeries: A Prospective Randomised Double Blinded Trial