Analgesia In Lower Limb Surgeries Research Articles

Efficacy of ultrasound-guided classical versus parasacral parallel shift technique of sacral plexus block for lower limb surgeries - A randomised controlled trial.

Ultrasound-guided sacral plexus block has been used for anaesthesia and analgesia in lower limb surgeries. This study aimed to compare the block performance characteristics after ultrasound-guided (USG) sacral plexus nerve block (SNB) using the parasacral parallel shift (PSPS) approach versus the classical approach in patients undergoing orthopaedic below-knee limb surgeries. In this randomised study, 144 adult patients were randomised to receive USG SNB either by the classical approach (Group C) or the PSPS approach (Group P). A fixed dose of 20 ml of 0.5% ropivacaine was administered. Patients also received USG femoral nerve block with 10 ml of 0.5% ropivacaine. The primary outcome was the scanning time between the two groups. Secondary outcomes were the needling time, sensory and motor block onset and postoperative analgesic characteristics between the two groups. A P value of <0.05 was considered statistically significant. The needling time and the scanning time were significantly lesser in Group P than in Group C (P < 0.05). Complete sensory and motor nerve blockade of the sciatic nerve was significantly higher in Group P (P = 0.029). Block performance time, time for sensory block and time for motor block were significantly less in Group P compared to Group C (P < 0.001). The postoperative analgesic characteristics were comparable between the two groups. The sacral plexus block with ultrasound-guided parasacral parallel shift technique had a lower block performance time with lesser needling and scanning time than the classical approach.

A proof-of-concept study of ultrasound-guided continuous parasacral ischial plane block for postoperative pain control in patients undergoing total knee arthroplasty

BackgroundContinuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous sacral plexus block procedure for analgesia during total knee arthroplasty.MethodsThe study comprised two stages. In Stage I, the authors built upon previous theories and technological innovations to develop a novel continuous sacral plexus block method, ultrasound-guided continuous parasacral ischial plane block (UGCPIPB) and subsequently conducted a proof-of-concept study to assess its effectiveness and feasibility. Stage II involved a historical control study to compare clinical outcomes between patients undergoing this new procedure and those receiving the conventional procedure.ResultsThe study observed a 90% success rate in catheter placement. On postoperative day (POD) 1, POD2, and POD3, the median visual analog scale (VAS) scores were 3 (range, 1.5–3.5), 2.5 (1.6–3.2), and 2.7 (1.3–3.4), respectively. Furthermore, 96.3% of the catheters remained in place until POD3, as confirmed by ultrasound. The study revealed a significant increase in skin temperature and peak systolic velocity of the anterior tibial artery on the blocked side compared with those on the non-blocked side. Complications included catheter clogging in one patient and leakage at the insertion site in two patients. In Stage II, the novel technique was found to be more successful than conventional techniques, with a lower catheter displacement rate than the conventional procedure for continuous sciatic nerve block.ConclusionUGCPIPB proved to be an effective procedure and safe for analgesia in total knee arthroplasty.Chinese Clinical Trial Registry NumberChiCTR2300068902.

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Background: Opioid analgesics with local anesthetics in an epidural route are extremely safe, effective, and reliable methods of post-operative pain relief. Aims and Objectives: The primary objective is to compare the duration of analgesia and pain scoring by visual analog scale. The secondary objective is to monitor sedation, hemodynamic changes, and side effects such as nausea, vomiting, shivering, and pruritus. Materials and Methods: A prospective randomized comparative study of 0.2% ropivacaine with nalbuphine and 0.2% ropivacaine with fentanyl in epidural route for post-operative analgesia in elective lower limb surgeries under spinal anesthesia was carried out in a population of 80 patients. After 1½ h of surgery under spinal anesthesia, patients in group RF received 10 mL of 0.2% ropivacaine with 25 mcg of fentanyl and those in group RN received 10 mL of 0.2% ropivacaine with 2.5 mg of nalbuphine and were observed for the study parameters over time. Results: The mean duration of analgesia was longer in group RN than in group RF (398.45 vs. 222.88 min). The hemodynamic parameters such as heart rate, mean arterial pressure, and respiratory ratewere statistically significant from 240 to 480 min which is 4–6 h in group RF and 6–8 h in group RN. 27.5% of patients in group RN attained sedation whereas 7.5% of subjects in group RF had a sedation score of 2 and above at 30 min. The subjects in group RN had a lower visual analog score than group RF. 12% and 4% of patients had vomiting in group RN and group RF, respectively. Conclusion: Epidural nalbuphine in a dose of 2.5 mg with 0.2% ropivacaine provided a longer duration of analgesia with better pain score and more sedation which was advantageous for post-operative patient compliance and satisfaction as compared to 25 mcg of fentanyl with 0.2% ropivacaine.

A Randomized Comparative Study of Ultrasound-guided Femoral Nerve Block Versus Fascia Iliaca Compartment Block for Reducing Pain Associated with Positioning for Spinal Anesthesia in Patients with Proximal Femur Fracture

Abstract Context: Peripheral nerve blocks are widely accepted as the gold standard for providing perioperative and postoperative analgesia in lower limb surgeries. Aims: This study aimed to determine which block is better in terms of onset of action among ultrasound-guided femoral nerve block (USG FNB) and ultrasound-guided fascia iliaca compartment block (USG FICB) for positioning for spinal anesthesia in patients operated for proximal femur fracture and find the total duration of analgesia, total consumption of rescue analgesics, and complications. Settings and Design: This was a prospective, randomized, comparative, interventional, single-blinded study. Subjects and Methods: Patients in Group A (n = 43) were administered USG FNB with 15 mL of 0.25% bupivacaine and patients in Group B (n = 43) were administered USG FICB with 30 mL of 0.25% bupivacaine. The primary objective was to find out which nerve block was better in reducing pain associated with a sitting position for spinal anesthesia, and the secondary objective was to find the difference in the mean time of first rescue analgesia. Statistical Analysis: Data analysis was done using the Student’s t-test and Chi-square tests. Results: Before block administration, patients in Group A had a Visual Analog Scale (VAS) score of 7.65 ± 0.75, and patients in Group B had a VAS score of 7.79 ± 0.74 (P = 0.389). The primary objective was to achieve VAS &lt; 3. It was 3 min in Group A and 5 min in Group B (P = 001). The secondary objectives were the duration of postoperative analgesia in Group A was 330.58 ± 28.16 min and in Group B was 482.33 ± 19.89 min (P &lt; 0.001). The mean value of tramadol consumption in 24 h in both the study groups was comparable (P = 1.000). The anesthesiologist satisfaction score, patient satisfaction score, and proportion of side effects in both study groups were comparable. Conclusion: USG FICB is more efficacious. Although the onset of action delays by 2 min, it provides longer postoperative analgesia compared to USG FNB.

Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Intrathecal adjuvants can be added to extend the duration of analgesia. To achieve this, several adjuvants, such as the combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine, have been used with local anaesthesia during lower limb surgeries. Aim: To compare the combination of dexmedetomidine versus fentanyl with bupivacaine administered intrathecally for the onset and duration of sensory and motor block, as well as their sideeffects and the prolongation of postoperative analgesia in lower limb surgeries. Materials and Methods: A randomised clinical study was conducted on 120 American Society of Anaesthesiologists (ASA) grade I or II patients, aged between 18 and 65 years, who were admitted to the Department of Orthopaedics and General Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, India for lower limb surgeries under spinal anaesthesia. The patients were randomly assigned to two groups using a computer-generated technique. Group BD received 0.5% bupivacaine (2.5 mL)+10 mcg dexmedetomidine (0.5 mL), while Group BF received 0.5% bupivacaine (2.5 mL)+25 mcg fentanyl (0.5 mL). The onset and duration of sensory and motor blockade, haemodynamic parameters, sedation, and sideeffects of the drugs were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 2.0 after collecting all the data. Results: There were no statistically significant differences in the subjects’ demographics or duration of surgery. However, the duration of sensory block and motor block was significantly prolonged in Group BD compared to Group BF, with values of 720±32 and 640±32, respectively. The mean Heart Rates (HR) differed significantly between of the two groups (p-value=0.03). There was no significant difference in sedation scores between the two groups. Group BD showed a higher incidence of bradycardia (n=35) and hypertension (n=32). Conclusion: The combination of dexmedetomidine with bupivacaine, when used intrathecally for lower limb surgeries, demonstrated superior effectiveness in terms of prolonging sensory and motor block duration and providing extended postoperative analgesia, compared to the combination of bupivacaine and fentanyl. However, it is important to note that patients receiving the dexmedetomidine-bupivacaine combination had a higher incidence of bradycardia and hypertension. Therefore, careful monitoring and management of haemodynamic parameters are necessary when using this combination.

Comparative study between Bupivacaine and Levobupivacaine in ultrasound guided fascia iliaca compartment block for post-operative analgesia for lower limb surgery

Comparative study between Bupivacaine and Levobupivacaine in ultrasound guided fascia iliaca compartment block for post-operative analgesia for lower limb surgery

Efficacy of Different Volumes of 0.2% Ropivacaine in Suprainguinal Fascia Iliaca Compartment Block for Multimodal Analgesia in Lower Limb Surgery

Efficacy of Different Volumes of 0.2% Ropivacaine in Suprainguinal Fascia Iliaca Compartment Block for Multimodal Analgesia in Lower Limb Surgery

A randomised prospective study to assess the analgesic efficacy of peripheral nerve block using ropivacaine with dexamethasone vs. dexmedetomidine for postoperative analgesia in lower limb surgeries

A randomised prospective study to assess the analgesic efficacy of peripheral nerve block using ropivacaine with dexamethasone vs. dexmedetomidine for postoperative analgesia in lower limb surgeries

To Evaluate the Efficacy of Ultrasonography Guided Lumbar Plexus Block for Postoperative Analgesia in Lower Limb Surgeries

To Evaluate the Efficacy of Ultrasonography Guided Lumbar Plexus Block for Postoperative Analgesia in Lower Limb Surgeries

Comparative Study of Oral Pregabalin Vs Gabapentin for Post Operative Analgesia in Lower Limb Surgeries under Spinal Anaesthesia

Comparative Study of Oral Pregabalin Vs Gabapentin for Post Operative Analgesia in Lower Limb Surgeries under Spinal Anaesthesia

Comparison of Ultrasound-Guided Anterior and Posterior Approaches to Sciatic Nerve Block for Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Sciatic nerve block is used for anaesthesia and analgesia in lower limb surgeries. The anterior approach to the sciatic nerve is rarely performed due to unreliable anatomical surface markings. Aim: To compare the anterior and posterior approaches to sciatic nerve block in terms of patient comfort and technical difficulty. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. A total of 84 patients who underwent lower limb surgeries from November 2020 to August 2022 were included. Informed consent was obtained, and patients were randomised into two groups-Group-A and Group-P-using the card method. Ultrasound-guided sciatic nerve block was performed using the anterior approach in Group-A and the posterior approach in Group-P. Sensory and motor blockade, time to perform the block, number of attempts, duration of analgesia, and patient satisfaction were recorded. Statistical analysis was performed using the Chi-square test, Analysis of Variance (ANOVA), student t-test, and the results were represented in tables. Results: The median age in Group-A was 42.95±12.69 years, and in Group-P was 43.95±8.68 years. Males were higher in number with 26 (31%) in Group-A and 23 (27%) in Group-P, respectively. Patient satisfaction, duration of analgesia (10.3±3.5 years Group-P and 10.5±4.0 years Group-A), onset of sensory (11.85±7.35 years Group-P and 9.53±5.40 years Group-A), and motor blockade (18.67±7.05 years Group-P years and 17.82±5.70 years Group-A) were similar in both groups. The number of attempts (2.85±0.90 years Group-P and 3.05±0.91 years Group-A) and time taken for performing the sciatic nerve block (6.75±1.10 years Group-P and 7.44±1.00 years Group-A) was higher in the anterior approach compared to the posterior approach. Conclusion: Although both approaches to sciatic nerve block are equally effective, this study concludes that the posterior approach is simpler to perform, requires less time, and provides better patient comfort and satisfaction. Ultrasound-guided posterior sciatic nerve block offers effective anaesthesia and excellent post-operative analgesia.

Comparison of Pre-Operative Ultrasound Guided Fascia Iliaca Block and Quadratus Lumborum Block for Reduction of Pain During Positioning for Spinal Anaesthesia and Post-Operative Analgesia in Patients with Femoral Neck Fracture

Background and aims Fascia iliaca block FIB provides analgesia in lower limb surgeries. However efficacy of quadratus lumborum block QLB for post-operative analgesia in lower limb surgeries is less explored. The present study was designed to compare efficacy of QLB with FIB to facilitate positioning for spinal anaesthesia SAB and post-operative analgesia in patients with femoral neck fracture.Methods Fifty patients were assigned to one of the two groups group A receiving FIB n25 and group B receiving QLB n25. Both the groups received bupivacaine 0.125 30 mL 20 minutes before SAB. Visual analogue pain scale VAS after block during positioning for spinal anaesthesia and during post-operative period were recorded. SAB was administered with 0.5 heavy bupivacaine 10 mg. Post-operative duration of analgesia and rescue analgesics required for 24 hours were recorded. Statistical evaluation of data was done using IBM SPSS version 22 software. Quantitative data was assessed by Shapiro Wilk test Chi-square Fisher Exact test Student t test Mann Whitney U test. Paired t test was used for intra group comparison. Appropriate tests were applied p value lt 0.05 was considered as statistically significant.Results Demographic parameters were comparable. VAS scores at baseline and 20 minutes after block and duration of analgesia were comparable. The requirement of rescue analgesia PCT in the post-operative period for 24 hours was 2666.66plusmn866 mg in group-A and group-B required 3111.11plusmn600.9 mg p0.22 and second rescue analgesic tramadol in group-A and B were comparable p0.34. But reduction in VAS score at the time of positioning for SAB was higher in group-B p0.003 Group-A 5.66 plusmn 0.86 Group-B 6.55plusmn1.13. No significant side effects were noted in both the groups.Conclusion QLB was associated with marginally better reduction in pre-operative pain compared to FIB during positioning for spinal anesthesia but did not prolong duration of post-operative analgesia or decrease the analgesia requirement.

Anterior quadratus lumborum block for postoperative recovery after total hip arthroplasty: a study protocol for a single-center, double-blind, randomized controlled trial

BackgroundAppropriate pain management is essential to improve the postoperative recovery after total hip arthroplasty (THA). Various case reports have indicated that anterior quadratus lumborum block (QLB) provides effective postoperative analgesia in lower limb surgeries. However, few randomized controlled trials have confirmed the efficacy of anterior QLB for lower limb surgeries. The aim of this single-center, double-blind, randomized controlled trial is to confirm the efficacy of anterior QLB for postoperative recovery after THA.MethodsThe participants will be randomly assigned to either the anterior QLB or placebo groups, using a set of random numbers for the allocation sequence. Only pharmacists will be aware of the allocations; other investigators will be blinded until study completion. After induction of general anesthesia, anterior QLB will be performed by using 0.25% levobupivacaine or normal saline. Fentanyl will be administered according to blood pressure change during the surgery. The primary outcome will be the quality of recovery 40 score (QoR-40). Secondary outcomes will include the visual analog scale score of pain intensity at rest and movement, intraoperative and postoperative doses of fentanyl, and incidence of postoperative nausea and vomiting. Statistical analysis will be performed by using the Student’s t test, Mann–Whitney U test, and Fisher’s exact test as appropriate. A P value of less than 0.05 will be considered statistically significant.DiscussionThe results of our study will reveal whether anterior QLB is effective for postoperative recovery after THA.Trial registrationUMIN Clinical Trials Registry, UMIN000032255. Registered on 15 April 2018.

Comparative study of bupivacaine with nalbuphine and buprenorphine intrathecally for postoperative analgesia in lower limb surgeries

Comparative study of bupivacaine with nalbuphine and buprenorphine intrathecally for postoperative analgesia in lower limb surgeries

Effectiveness of Ropivacaine versus Levobupivacaine for Spinal Anaesthesia and Analgesia in Lower Limb Surgery

Effectiveness of Ropivacaine versus Levobupivacaine for Spinal Anaesthesia and Analgesia in Lower Limb Surgery

Clonidine, Fentanyl or their Combination for Postoperative Epidural Analgesia in Lower Limb Surgeries: Comparative Study

Clonidine, Fentanyl or their Combination for Postoperative Epidural Analgesia in Lower Limb Surgeries: Comparative Study

Comparative Evaluation of Three Different Doses of Spinal Isobaric Ropivacaine in Patients Undergoing Day Care Perineal Surgeries: A Randomized Double-blind Study.

Background and objective:Ropivacaine owing to its propensity of causing motor blockade of reduced duration, is preferred for ambulatory day care surgery. Intrathecal ropivacaine has shown effective analgesia for lower limb surgery. Our study plans to evaluate spinal ropivacaine in three different doses in patients undergoing day care perineal surgery.Methodolgy:90 ASA-I patients scheduled to undergo day care perineal surgery were randomized to receive intrathecal ropivacaine. Group I (n=30) received 15mg of intrathecal ropivacaine, Group II (n=30) received 18.75 mg of intrathecal ropivacaine and Group III (n=30) received 22.5 mg of intrathecal ropivacaine. Onset of sensory block at T 10, peak sensory block level, duration of sensory block, onset and duration of motor block and relevant safety data were recorded.Result:Onset of analgesia was significantly shorter in Group III (3.5 min ; P <0.0001). However, time taken for peak sensory blockade was comparable in group II and III (12.76 and 11.93 mins). Duration of analgesia was longer and statistically significant in Group III (201.6 mins: P <0.0001) when compared to Group I and II. Onset of motor block was observed to be shortest in Group III (6.7 mins) and duration of motor block was longest in Group III (153.73 mins). These two parameters were statistically significant than Group I and II (P <0.0001).Conclusion:Intrathecal ropivacaine in a dose of 18.75 and 22.5 mg were observed to be equally effective in providing satisfactory analgesia. However, higher dose was associated with profound sensory and motor block.

Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

Intravenous Dexmedetomidine Promotes Spinal Bupivacaine Anesthesia and Postoperative Analgesia in Lower Limb Surgery: A Double-Blind, Randomized Clinical CONSORT Study.

Dexmedetomidine (DEX) has been reported to have synergistic action with local anesthetics. This prospective, randomized, double-blind clinical study was designed to observe the efficacy of intravenous DEX without loading dose on spinal blockade duration, postoperative sedation, patient-controlled analgesia and its morphine-sparing effect in lower limb surgeries.Seventy-five patients, scheduled for lower limb surgery under spinal anesthesia, were randomly allocated into 2 groups: group BS (received 15 mg of 0.5% of bupivacaine for subarachnoid anesthesia and continuous intravenous infusion of saline in Ringer solution) and BD group (received 15 mg of 0.5% of bupivacaine for subarachnoid anesthesia and continuous intravenous infusion of DEX in Ringer solution at a rate of 0.25 μg/kg/h). Intravenous infusion started 15 minutes before spinal anesthesia.The onset time of sensory and motor blockade was shorten, the duration of sensory and motor blockade was significantly prolonged in BD patients when compared to BS patients. The Ramsay sedation score measured immediately after surgery was greater in BD group than BS group. BD patients also shown increased time to the first request of postoperative morphine and decreased total morphine consumption as compared with BS patients.Collectively, intravenous administration of DEX without loading dose promoted the efficacy of spinal bupivacaine anesthesia and postoperative analgesia in patients undergoing lower limb surgery.

The Effect of Dexamethasone on the Dynamics of Inflammation, Cortisol and analgesia in Lower Limb Surgery

Background: Dexamethasone is currently used as a part of multimodal analgesia on postoperative pain management. Dexamethasone considered providing effective analgesia as a steroid anti-inflammatory. This study aimed to examine the effects of preoperative single dose of intravenous dexamethasone to the inflammation, cortisol response and analgesia in lower limb surgery. Methods: This is a clinical experimental study conducted in randomized double-blind trial performed at Wahidin Sudirohusodo Hospital, Makassar Indonesia. Thirty patients with lower limb surgery under spinal anesthesia meet the inclusion criteria were randomly divided into 2 groups: (1) group received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and PCA morphine (dexamethasone group) and (2) group received perioperative analgesia paracetamol and PCA morphine (control group). Blood samples were taken at the time before anesthesia, immediately post-surgery, 4 and 24 hours after surgery to measure plasma levels of CRP and Cortisol with the ELISA test. We recorded the intensity of rest pain and morphine requirement in 4 and 24 hours after surgery. Results: Both of groups found increase in CRP plasma levels at the 24 hours after surgery (p<0.05). Cortisol in the dexamethasone group decreased significantly at the 24 hours after surgery while in the control group did not change (p<0.05). Rest pain intensity and morphine requirement in the dexamethasone group was lower in the 24 hours after surgery than the control group (p<0.05). No differences changes in blood pressure, heart rate, respiration and the side effects between the two groups. Conclusion: The addition of single dose dexamethasone preoperatively on the combination of paracetamol and morphine did not abolish inflammation process but decrease cortisol response after surgery with sufficient analgesia and minimal side effect.