Postoperative Analgesia In Patients Research Articles

Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3-4, 6-8, 12-16 and 24h. Opioid consumption in the first postoperative 24h was significantly lower in the NB group (MD=- 9.02, 95% CI - 14.29 to - 3.75, P<0.05), I2=95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD=43.15, 95% CI 4.74-81.56, P<0.05, I2=96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07-0.28, P<0.05, I2=0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22-0.48; P<0.05; I2=0%). There was no significant difference in operation duration between the two groups. Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of 30 mg Oral Dextromethorphan and Placebo on Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background and Objective: Laparoscopic cholecystectomy is considered a global standard procedure for the surgical treatment of gallstones. The present study aimed to compare the effect of dextromethorphan and oral placebo on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This double-blind clinical trial study was performed on 114 ASA I and II patients who were candidates for laparoscopic cholecystectomy. Two hours before the induction of anesthesia, the intervention group was administered 30 mg of plain dextromethorphan syrup, and the control group was given 2 cc of placebo of an oral syrup. Pain intensity, systolic and diastolic blood pressure, heart rate, and SPO2 at the time of recovery, 1, 6, and 12 hours after surgery, and the amount of pethidine were recorded. Data were analyzed in SPSS software (version 24) at a significance level of 0.05. Results: The mean pain intensity was statistically significant in the control and intervention groups. The mean pain intensity in the intervention group was lower than that in the control group (P&lt;0.05). Diastole blood pressure, heart rate, and SPO2 in the two groups did not have a statistically significant difference (P&gt;0.05), while systolic blood pressure statistically differed (P&lt;0.05). The amount of pethidine consumption in the intervention group was higher than that in the control group. Conclusion: As evidenced by the obtained results, low-dose dextromethorphan (30 mg) is effective in postoperative analgesia for patients undergoing laparoscopic cholecys-tectomy and reduces opioid use.

COMPARITIVE STUDY OF 0.25% BUPIVACAINE WITH DEXAMETHASONE AND O.25% BUPIVACAINE WITH CLONIDINE FOR TRANSVERSUS ABDOMINIS PLANE BLOCK AS POST-OPERATIVE ANALGESIA IN PATIENTS UNDERGOING LSCS.

Introduction: To compare 0.25% bupivacaine with dexamethasone and 0.25% bupivacaine with clonidine for TAP block as post-operative analgesia in patients undergoing LSCS. A randomized prospective controlled study wa Study Design: s conducted in 100 patients undergoing LSCS. Participants were divided into 2 groups. Group A received 0.25% bupivacaine with dexamethasone 4mg.Group B received 0.25% bupivacaine with 75mcg clonidine. The postoperative pain was evaluated by VAS scoring. The average duration of analgesia with TAP Results: block for overall study population was 316.15min. The average VAS score in patients who received 0.25% bupivacaine with dexamethasone was 1.50 which is signicantly lower than for whom received 0.25% bupivacaine with clonidine which is 1.95. Further the duration of analgesia is longer in Group A than Group B. TAP block is safe and effective way of relieving post Conclusion: operative pain in LSCS patients. Addition of dexamethasone to bupivacaine signicantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine

Ultrasound-guided erector spinae plane block for postoperative short-term outcomes in lumbar spine surgery: A meta-analysis and systematic review.

Patients undergoing lumbar spine surgery usually suffer from moderate to severe acute pain. Erector spinae plane block (ESPB) has been applied to relieve acute pain in various surgeries and improve postoperative outcomes. This study aimed to further identify the efficacy and safety of erector spinae plane block in patients undergoing lumbar spine surgery. This study also evaluates the outcomes of the erector spinae plane block compared with other regional blocks. We searched PubMed, Web of Science, Cochrane library, Embase, and CINAHL databases to identify all randomized controlled trials evaluating the effects of ESPB on postoperative pain after lumbar spine surgery. The primary outcome is postoperative total opioid consumption in 24 hours. The secondary outcomes are postoperative pain scores, intraoperative opioid consumption, time to first rescue analgesia, number of patients requiring rescue analgesia, first time to ambulation after surgery, length of hospital stay, patients' satisfaction score, and postoperative side effects such as postoperative nausea and vomiting, itching. A total of 19 randomized controlled trials are included in the final analysis. Compared with no/sham block, ultrasound-guided erector spinae plane block can decrease perioperative opioid consumption including intraoperative opioid consumption: standardized mean difference (SMD) = -3.04, 95% confidence interval (CI) (-3.99, -2.09), P < .01, and opioid consumption postoperatively: (SMD = -2.80, 95% CI [-3.61, -2.00], P < .01); reduce postoperative pain at 2, 6, 12, 24, and 48 hours both at rest and movement; meanwhile shorten time to hospital length of stay: (SMD = -1.01, 95% CI [-1.72, 0.30], P = .006), decrease postoperative nausea and vomiting (RR = 0.35, 95% CI [0.27, 0.46], P < .00001), and improve patient satisfaction (SMD = -2.03, 95% CI [-0.96, 3.11], P = .0002). But ultrasound-guided ESPB doesn't shorten the time to ambulation after surgery (SMD = -0.56, 95% CI [-1.21, 0.08], P = .09). Additionally, ESPB is not superior to other regional blocks (e.g., thoracolumbar interfascial plane/midtransverse process to pleura block). This meta-analysis demonstrates that ultrasound-guided ESPB can provide effective postoperative analgesia in patients undergoing lumbar spine surgery and improve postoperative outcomes, and it deserves to be recommended as an analgesic adjunct in patients undergoing lumbar spine surgeries.

Efficacy of Oral Gabapentin and Intravenous Paracetamol for Postoperative Analgesia in Laparoscopic Surgeries: A Prospective Randomised Double Blind Study

Background: Post-operative pain is a matter of great concern for anaesthesiologists and surgeons. We compared the efficacy of oral Gabapentin and intravenous Paracetamol for postoperative analgesia in patients undergoing laparoscopic surgeries.&#x0D; Methods: After obtaining written informed consent and ethical committee approval, a total of 70 patients undergoing laporoscopic surgeries were randomly allocated into two groups- 35 patients included in Group A were given 600 mg oral Gabapentin 2 hours before the surgery and Group B patients were given 1gm I.V. PCM 30 minutes before the surgery. The NRS scores at 30 min, 2 hours, 6 hours, 8 hours, 12 hours, and 24 hours were recorded. The time at which first rescue analgesic given and Different hemodynamic parameters like heart rate, blood pressure and oxygen saturation were also recorded at different time intervals.&#x0D; Results: NRS scores and MAP was higher in Group B with a significant p-value at 8 and 12 hours. The need of first rescue analgesic required was at 7.79±3.49 hours in Group A. In Group B requirement of first rescue analgesia was at 6.09±2.75 hrs. The total dose of tramadol used was significantly higher in Group B with mean 92.86±36.67 than Group A 64.29±28.62 with statistically significant p-value (p=0.001).&#x0D; Conclusion: Both oral Gabapentin and intravenous Paracetamol are effective modes of postoperative analgesia hence both can be used as preemptive analgesic agents. Oral Gabapentin has a longer duration of action up to 12 hours in the postoperative period while intravenous Paracetamol is effective up to 6 hours postoperatively.

Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery

Background &amp; Objective: The postoperative pain after spine surgery is almost always severe. A recently described loco-regional procedure called the erector spinae plane block (ESPB) has been claimed to be associated with positive outcomes. We evaluated the ESPB's efficacy for the relief of postoperative pain after lumbar spine surgery.&#x0D; Methodology: This randomized controlled clinical investigation was conducted at the Ain Shams University Hospitals during the course of a year starting January 2021. Patients were randomly allocated to one of the two groups: Group C (the control group) patients underwent lumbar spine surgery under conventional general anesthesia (GA) in accordance with hospital policy. Group ESP was administered GA similar to the control group, but the patients received bilateral ultrasound-guided ESPB before starting lumbar spine surgery. The primary objective was total morphine consumption. Numeric rating scale (NRS) scores were measured at rest on shifting to post-anesthesia care unit (PACU) and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward. Complications, e.g., PONV and hemodynamic parameters were recorded on shifting to PACU and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward.&#x0D; Results: Total morphine consumption was higher in the control group than the Group ESP, at the 6th, 12th, and 18th hours postoperatively, the numeric rating scale scores in Group ESP were lower compared to the control group, and ESPB significantly reduced the time to first mobilization when compared to the control group. In terms of PONV and postoperative vital signs, there was no statistically significant difference; however, the patient satisfaction was higher in Group ESP was far more satisfied than the control group overall.&#x0D; Conclusion: We conclude that bilateral ultrasound guided ESPB is useful for postoperative analgesia in patients having lumbar spine operations. It lowered postoperative opioid consumption, decreased pain scores at various time intervals, and increased patient satisfaction while reducing the occurrence of PONV.&#x0D; Key words: Ultrasound; Erector spinae plane block; Pain; Pain management; Spine surgery&#x0D; Citation: Hamdi AA, Abo Zeid GSE, Al Shaer AN, Shoukry RA, Sayed AG. Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2022;27(1):37−42; DOI: 10.35975/apic.v27i1.2115&#x0D; Received: August 28, 2022; Reviewed: December 20, 2022; Accepted: December 22, 2022

Application of Self-Adaptive Medical Ultrasonic Imaging Algorithm-Based Obturator Nerve Block in Transurethral Resection of Bladder Tumor

The application values of ultrasound-guided obturator nerve block (ONB) optimized by self-adaptive algorithm in transurethral resection of bladder tumor (TURBT) are investigated. For this purpose, total of 50 patients receiving TURBT areselected and randomly rolled into a control group (Ctrl group, ONB under traditional resectoscope) and an experimental group (Exp group, self-adaptive algorithm-based ultrasound-guided ONB (algorithm+ultrasound ONB)). Each group contains 25 cases. The results of the comprehensive assessment of each index showed that the self-adaptive algorithm enhanced the solution of ultrasonoscopy, which was morebeneficial for the intraoperative guidance on block. The success rate of the block in the Exp group reached 100%, higher than that in the Ctrl group (92%). The block time was 6.53±1.28 minutes, which was obviously shorter than that in the Ctrl group (10.34±1.76 minutes). The incidence of complications (IoC) (16%) was significantly lower than that in the Ctrl group (36%). Besides, postoperative visual analogue scale/score (VAS) (2.01±0.84 points) was remarkably lower based on the score in theCtrl group (4.73±1.15 points). The above differences all show statistical significance (P &lt;0.05). To sum up, self-adaptive algorithm could enhance the quality of surgical ultrasound-guided ONB, which showed significant values in the prevention of obturator nerve reflex, postoperative analgesia for patients, and the recovery.

The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities

In this article, the authors discuss the place of modern analgesics of central action (nefopam hydrochloride) in the analgesia of patients with explosive injuries of the lower extremities. Currently, there is no information in global practice regarding the use of centrally acting analgesics for analgesia in patients with combat trauma. An example was the analgesia of patients in the p/o period with a severe explosive injury of the lower extremities. Attention is drawn to the need for effective analgesia for patients with a combo injury not only in the acute period. A feature of the treatment of such patients is the need for major restorative and reconstructive surgical interventions, which in turn are accompanied by a pronounced pain syndrome. In our experience, the addition of non-narcotic analgesics of central action (nefopam hydrochloride) to the scheme of multimodal analgesia is appropriate to improve analgesia in this category of patients. The addition of nefopam hydrochloride to a multimodal analgesia regimen at 20 mg IV every 6 hours was effective in the treatment of severe acute postoperative pain.

Comparison of the safety and efficacy of nalbuphine 10 mg with 0.125% bupivacaine versusbutorphanol 2 mg with 0.125% bupivacaine by epidural route for providing postoperative analgesia in patients undergoing elective abdominal surgeries

Comparison of the safety and efficacy of nalbuphine 10 mg with 0.125% bupivacaine versusbutorphanol 2 mg with 0.125% bupivacaine by epidural route for providing postoperative analgesia in patients undergoing elective abdominal surgeries

Features of postoperative pain relief in patients with a low level of consciousness: a prospective randomised study

AIM: To determine the possibility of using analgonociception monitoring (analgesia nociception index, ANI) to assess the need for postoperative analgesia in patients with prolonged impairment of consciousness.&#x0D; MATERIAL AND METHODS: This pilot prospective randomized study enrolled 34 consecutive patients with chronic impairment of consciousness (vegetative state/minimal state of consciousness) who underwent neurosurgical interventions. Randomization was made by the envelope method for the grouping of the patients: study group (SG, n=17), received anesthesia with intravenous paracetamol 1000 mg according to ANI in the postoperative period; control group (CG, n=17), without additional anesthesia in the postoperative period. Patients with arrhythmias were excluded. The groups are comparable in terms of the main clinical parameters (all parameters p 0.05). The ANI (MetroDoloris device, France) was recorded at 1, 4, 8, 12, and 24 h after surgery. The valuation was based on the revised scale for assessing pain in a coma, i.e., Nociception Coma ScaleRevised (NCS-R) [7], after 4, 12, and 24 h.&#x0D; RESULTS: An intragroup comparison of the changes in ANI during postoperative day 1 showed an adequate level of pain relief (60.1 [55.362.5]), whereas in the group without postoperative analgesia with paracetamol, by 4 h after the operation, ANI dropped to the lower limit (46.3 [40.251.9]). In an intergroup comparison in the first 8 h after surgery, ANI was significantly higher than in the group without anesthesia (p=0.04) and had values of 55, which indicates the absence of pronounced vegetative reactions indicating the presence of pain. From 12 oclock, the values are leveled out, not going beyond the limits of indicators of inadequate anesthesia (p=0.69). When assessing nociception on the NCR-R scale during the postoperative day in both groups, a tendency to the appearance of weak autonomic responses was observed (6 [5; 8] in SG and 6 [5; 7] in CS, respectively), which did not differ significantly. The presence of pain 4 h after surgery was confirmed by increased levels of cortisol and salivary alpha-amylase in patients without postoperative analgesia (p=0.03).&#x0D; CONCLUSION: No generally recognized and available evidence-based instrumental methods are available for the assessment of pain intensity in patients with chronic impairment of consciousness. There is no single position of the professional community on the need for postoperative analgesia in such patients. Further studies to evaluate the effectiveness of using the ANI Metro Doloris monitoring system with a significant number of observations will lead to the determination of adequate perioperative analgesia regimens in patients with various forms of prolonged impairment of consciousness.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Single-Shot Epidural Block for Postoperative Analgesia in Patients Undergoing Inguinal Hernia Surgery.

Background Transversus abdominis plane (TAP) block and epidural analgesia are two frequently used regional anaesthesia techniques that attenuate postoperative pain after inguinal hernia repair. Aim To compare the analgesic efficacy between the single-shot epidural block and TAP block for postoperative analgesia in patients undergoing inguinal hernia repair surgery. Methods Forty patients of either gender undergoing elective inguinal hernia surgery of American Society of Anesthesiologists (ASA) class Ⅰ and Ⅱ were randomly allocated into two groups. Group E received a single-shot epidural with 20 ml of 0.25% bupivacaine. Group T received a TAP block with 20 ml of 0.25% bupivacaine under ultrasound guidance. Postoperative pain was evaluated by the visual analog scale (VAS). Rescue analgesia was given on VAS score ≥ 4 or on-demand in the postoperative period. The primary outcome included VAS score at 15 min, 1st h, 2nd h, 6th h, 12th h, and 24th h after the block. The secondary outcome was the analgesia duration, the total rescue analgesia dose required, and the patient satisfaction level. Results The VAS pain scores were significantly lower in the epidural group compared to the TAP group at the 2nd, 6th, 12th, and 24th h postoperatively (p<0.0001). The mean duration of analgesia was significantly more in Group E (576.75±96.64 min) compared to Group T (276.75±105.56 min). The total analgesic consumption was seen significantly more in 24 h in Group T than in Group E. Patient satisfaction score was significantly higher with a mean value of 5.55±0.6 in group E compared to 4.75±0.72 in group T. Conclusion A single-shot epidural provides better postoperative pain control than a TAP block. The duration of the first analgesic demand was prolonged, with less analgesic consumption in the epidural group.

Effect of multiple disciplinary team led by pain specialist nurses on postoperative analgesia in patients undergoing mastectomy

This study aims to analyze the effect of multiple disciplinary team (MDT) led by pain specialist nurses on postoperative analgesia in patients undergoing mastectomy. 140 patients with breast cancer admitted to our hospital were treated with mastectomy and randomly divided into the control group and the intervention group. Routine pain care was applied in the control group, while pain care of MDT led by pain specialist nurses was applied in the intervention group based on the control group. The degree of pain, total postoperative analgesic dose, the first ambulation time, the time for recovery of surgical wound and hospital stay were compared between both groups. The psychological status, stress response-related indicators before and after intervention were compared between both groups, and the incidence of postoperative complications and analgesic satisfaction were counted. In contrast to the control group, the numerical rating scale (NRS) score of the intervention group was lower (p &lt; 0.05); total postoperative analgesic dose, the first off-bed activity time, the time for surgical wound recovery, the drainage tube placement time and the hospital stay of the intervention group were reduced (p &lt; 0.05); after intervention, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the intervention group were diminished (p &lt; 0.05); after intervention, decreased noradrenaline (NE), adrenocorticotropic hormone (ACTH) and Cor indexes were presented in the intervention group (p &lt; 0.05); the incidence of postoperative complications of the intervention group was 7.14%, lower than 18.57%of the control group (p &lt; 0.05); the analgesic satisfaction of the intervention group was 95.71%, higher than 84.29% of the control group (p &lt; 0.05). Therefore, we conclude that MDT led by pain specialist nurses is worthy of clinical application.

Evaluation of the effect of preoperative and postoperative erector spinae plane block on perioperative hemodynamics and postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled study

Evaluation of the effect of preoperative and postoperative erector spinae plane block on perioperative hemodynamics and postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled study

Evaluation of Postoperative Analgesia on Addition of Dexmedetomidine to Ropivacaine 0.2% in Femoral Nerve Block in Patients undergoing Open Knee Surgery-A Randomised Single Blinded Study

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India which included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-Group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p&lt;0.05 considered as significant. Result: Duration of analgesia was significantly longer in Group RD (484±26.98 min) than in Group R (338±29.40 min), p&lt;0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in Group RD (207±25 milligram (mg)) than in Group R (290±30 mg), p&lt;0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.

Postoperative analgesia in patients with burns injury

Postoperative analgesia in patients with burns injury

Comparison of effectiveness of clonidine versus pregabalin as an oral premedication for hemodynamic response and post-operative analgesia in patients undergoing laparoscopic cholecystectomy under general anesthesia

Comparison of effectiveness of clonidine versus pregabalin as an oral premedication for hemodynamic response and post-operative analgesia in patients undergoing laparoscopic cholecystectomy under general anesthesia

Analgesic Efficacy and Outcomes of Ultrasound-guided Erector Spinae Plane Block in Patients Undergoing Bariatric and Metabolic Surgeries: A Systematic Review.

Erector spinae plane block (ESPB) has been used as an intervention for providing postoperative analgesia in patients undergoing bariatric and metabolic surgeries. After registering the protocol in PROSPERO, randomized controlled trials and nonrandomized observational studies were searched in various databases till July 2022. The primary outcome was 24-h opioid consumption; the secondary outcomes were intraoperative opioid use, pain scores, time to rescue analgesia, and complications. The risk of bias and Newcastle-Ottawa scale were used to assess the quality of evidence. From the 695 studies identified, 6 studies were selected for analysis. The 24-h opioid consumption was significantly lesser in ESPB group when compared to control (mean difference [MD]: -10.67; 95% confidence interval [CI]: -21.03, -0.31, I² = 99%). The intraoperative opioid consumption was significantly less in the ESPB group (MD: -17.75; 95% CI: -20.36, -15.13, I² = 31%). The time to rescue analgesia was significantly more in the ESPB group (MD: 114.36; CI: 90.42, 138.30, I² = 99%). Although pain scores were significantly less at 6 and 24 h in ESPB group (MD: -2.00, 95% CI: -2.49, -1.51; I² = 0% and MD: -0.48; 95% CI: -0.72, -0.24; I² = 48%), at zero and 12 h, the pain scores were comparable (MD: -1.53, 95% CI: -3.06, -0.00, I² = 97% and MD: -0.80; 95% CI: -1.80, 0.20, I² = 88%). Bilateral ESPB provides opioid-sparing analgesia and better pain scores when compared to control. These results should be interpreted with caution due to high heterogeneity among the included studies.

Oxycodone versus Morphine for Post-operative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Oxycodone versus Morphine for Post-operative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Intraperitoneal instillation of levobupivacaine plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy

Introduction: Laparoscopic procedures have many advantages over open procedures, such as less haemorrhage, better cosmetic results, less post-operative pain and shorter recovery time, leading to a shorter hospital stay and less expenditure. Hence, the present study was undertaken for comparing the effect of intraperitoneal installation of levobupivacaine (L-B) plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: This was a prospective randomized study conducted in our hospital on 60 American Society of Anaesthesiologists grade I or II patients of either sex, aged 18–55 years, scheduled to undergo LC surgery under general anaesthesia. All patients were randomly divided into two groups of 30 each: Group 1: Patients were given 20 ml of 0.5% L-B plus 0.25-μg/kg dexmedetomidine intraperitoneally after gallbladder removal, and Group 2: Patients were given 20 ml of 0.5% ropivacaine plus 0.25-mg/kg dexmedetomidine intraperitoneally after gallbladder removal. Post-operatively, the patients were assessed for pain utilizing a visual analogue scale (VAS). VAS was graded on a scale of 0–10. VAS was recorded at 0, 1, 8, 12 and 24 h post-operatively and compared. Results: Mean time to first analgesic requirement among patients of Group 1 and Group 2 was 365.1 min and 297.2 min, respectively, which shows a statistically significant longer post-operative analgesic effect in Group 1 patients. While comparing VAS at different time intervals in between the two study groups, all the readings were comparable. The difference was found to be non-significant in the two groups (P > 0.05). Nausea and vomiting were seen in two patients in Group 1 and three patients in Group 2. Complications were noted in <10% of the patients in both groups. Conclusion: Intraperitoneal instillation of local anaesthetic solution in LC provides effective post-operative analgesia, and analgesia provided by L-B plus dexmedetomidine is better than ropivacaine plus dexmedetomidine.

Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia in Patients undergoing Open Nephrectomy: A Randomised Controlled Study

Introduction: Open nephrectomy poses a challenge for the anaesthesiologist due to its large subcostal incision and association with both somatic and visceral pain. While various methods exist for postoperative pain management, a single modality approach remains largely ineffective in adequate pain management. Epidural analgesia, intravenous Patient Controlled analgesia pumps, and ultrasound-guided peripheral nerve blocks are commonly used. Aim: To evaluate the efficacy of ultrasound-guided Erector Spinae Plane Block (ESPB) as a part of multimodal analgesia for postoperative pain in patients undergoing open nephrectomy, to enhance recovery after surgery. Materials and Methods: This randomised controlled study was conducted at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, on 48 patients undergoing open nephrectomy. They were randomly assigned to two groups: Group I received ultrasound-guided ESPB, while Group II did not receive a block before anaesthesia reversal. In the Post-Anaesthesia Care Unit (PACU), all patients were kept on intravenous Patient Controlled Analgesia (PCA) morphine, and pain was assessed using the Numeric Rating Scale (NRS) scoring. The time of first analgesic requirement and the total morphine consumption in the first 24 hours were recorded. Patient satisfaction and quality of sleep at night were evaluated using a Likert scale. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.0. Categorical data were assessed using the Chi-square test, while the Independent t-test/Mann-Whitney test was used to determine the association between continuous data. A p-value of &lt;0.05 was considered statistically significant. Results: There were no significant differences found between the two groups in terms of age (p-value=0.999) and ASA grade (p-value=0.336). The total morphine consumption was lower in the ESP group (11 versus 17.58 mg, p-value &lt;0.0001) compared to the control group. The NRS scores during the follow-up period in the ESP group were consistently lower compared to the control group. The average number of analgesia attempts and demand for rescue analgesia were higher in the control group compared to the ESPB group. A higher proportion of ESPB patients agreed (p-value=0.002) that the overall pain management was good. More patients in the ESPB group agreed that they had slept well at night (41.7% versus 12.50%, p-value=0.023). Conclusion: Ultrasound-guided ESPB was more effective in reducing postoperative pain, facilitating enhanced recovery, and significantly reducing the requirement for opioids in the postoperative period after abdominal surgery such as open nephrectomy.