Analgesia In Postoperative Period Research Articles

A Comparative Analysis of Intravenous Clonidine and Dexmedetomidine for Hemodynamic Stability and intraoperative bleeding in Lumbar Spine Surgeries

Lumbar spine surgeries are complex procedures often associated with challenges in maintaining hemodynamic stability and controlling intraoperative bleeding, which are crucial for optimizing patient outcomes. Clonidine and dexmedetomidine both are α2-adrenergic agonists with sedative and analgesic properties, known for their potential to attenuate sympathetic responses and stabilize hemodynamics. However, their comparative efficacy in lumbar spine surgeries remains underexplored. METHODOLOGY This study was carried out in 40 patients, ASA grade1 and 2, undergoing lumbar spinal instrumentation requiring laminectomy. The patients were randomly allocated into two groups (20 each) using the computer generated random number table. Group C received 2 µg/kg of clonidine diluted in 10 ml of normal saline, given slowly intravenous infusion over 10 min before induction of general anaesthesia. Group D received 1 µg/kg of dexmedetomidine diluted in 10 ml normal saline, given slow intravenous infusion over 10 minutes before induction of general anaesthesia. Heart rate, systolic, diastolic, and mean arterial pressure were monitored before intubation as the baseline and after intubation, 15, 30, and 60 minutes after starting the surgery, and after extubation. The amount of intraoperative blood loss was estimated based on the volume of blood in the suction bottle and the number of the blood-soaked gauze pads (20 mL for a completely blood-soaked gauze and 50 mL for a completely blood-soaked long gauze). OBSERVATION No statistically significant difference was found on comparing the two drugs in terms of Baseline characteristics, Mean Arterial Pressure and the amount of blood loss. However Dexmedetomidine group had a higher reduction in Heart Rate as compared to the Clonidine Group. CONCLUSION In conclusion, both the alpha2 agonist drugs; intravenous clonidine and dexmedetomidine represent valuable options for achieving stable hemodynamics as well as decreases the intraoperative surgical bleeding in lumbar spine surgeries. Total opioid requirements for intraoperative and rescue analgesia in postoperative period were decreased in both the groups.

A comparative study of levobupivacaine 0.25% with dexmedetomidine and dexamethasone as adjuvant in caudal block for pediatric patients undergoing infraumbilical surgeries

Background: The caudal epidural block is one of the most commonly used regional techniques for post-operative pain management in pediatric age group patients undergoing infraumbilical surgeries. Adjuvants use increase the duration of analgesia and decrease local anesthetic dose requirement, thereby decreasing the risk of toxicity. Aims and Objectives: The aim of the present study was to compare the prolongation of the duration of analgesia, hemodynamic parameters, and side effects if any, provided by the addition of dexmedetomidine (DEX) or dexamethasone as an adjuvant to levobupivacaine in the caudal block. Materials and Methods: A total of 60 patients with the American Society of Anesthesiologists grade I/II scheduled for elective infraumbilical surgeries were randomly allocated into two groups of 30 each. Group 1 received levobupivacaine 0.25% 1 mL/kg+DEX 1 mcg/kg and Group 2 received levobupivacaine 0.25% 1 mL/kg+dexamethasone 0.1 mg/kg for caudal block. The duration of analgesia, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2. Post-operative face, leg, activity, cry, consolability, (FLACC) pain scores were significantly lower in Group 1 when compared with Group 2. The mean duration of analgesia was prolonged in Group 1 at 824.23±53.53 min than in Group 2 with a mean duration of analgesia 480.50±31.66 min which was statistically significant (P<0.005). Adverse events were comparable between the two groups and were statistically not significant (P>0.05). Conclusion: The addition of DEX to levobupivacaine in caudal block significantly prolongs the duration of analgesia in post-operative period in comparison to the addition of dexamethasone with levobupivacaine. It also provides more hemodynamic stability during the intraoperative and post-operative period, lower FLACC pain scores, and is associated with minimal side effects.

Ketamine as a pre-emptive analgesia in patients undergoing caesarean delivery under spinal anesthesia

BACKGROUND & OBJECTIVES: Lower segment caesarean section (LSCS) leads to moderate to severe pain in the patient. Pain severity is directly proportional to the functional limitations and depression in the postpartum period, making it essential to provide good pain relief after surgery. Maternal wellbeing and better nursing care of newborn requires good postoperative analgesia with minimal side effects. The main objective of the study was to evaluate the analgesic effect of intravenous low-dose ketamine, when administered pre-emptively, in patients undergoing caesarean delivery under spinal anesthesia.
 METHODOLOGY: Two groups were made, each with 50 full-term pregnant females with a plan of caesarean section under spinal anesthesia. Group-A received spinal anesthesia with bupivacaine 0.5% along with intravenous placebo of 2cc normal saline, whereas group-B received 0.5mg/kg ketamine intravenously after administration of spinal anesthesia but before the start of surgical incision. Pain intensity was monitored using a visual rating pain scale (VRS), till the need for the first analgesic dose postoperatively.
 RESULTS: Both groups were comparable in terms of age and weight. Analgesia was markedly prolonged, and postoperative pain scores were significantly less in Group-B (ketamine group) as compared to Group-A; with p-value< 0.001, demonstrating analgesic properties of ketamine when administered pre-emptively as an intravenous dose.
 CONCLUSION: Our study concluded that pre-emptive analgesic dose of ketamine (administered before surgical incision), leads to prolong analgesia in post-operative period in patients who underwent LSCS under spinal anesthesia.

Comparison of Ropivacaine Plus Dexmedetomidine and Ropivacaine Plus Magnesium Sulfate Infiltration for Postoperative Analgesia in Patients Undergoing Lumbar Spine Surgeries.

Acute painafter lumbar spine surgery is due to soft tissue and muscle separation at the operation site. Local anesthetic wound infiltration is a safe and effective method for postoperative analgesia following lumbar spine surgery. In this study, we aimed to investigate and compare the efficacy of ropivacaine plus dexmedetomidine and ropivacaine plus magnesium sulfate for postoperative analgesia in lumbar spine surgeries. This prospective randomized study was conducted on 60 patients, aged between 18 and 65 years, either sex,American Society of Anesthesiologists classification I and II patients scheduled for single-level lumbar laminectomy.Patients were randomly allocated into two groups 30 patients each. Twenty to 30 minutes before skin closure and after hemostasis was achieved, the surgeon infiltrated 10 mL of study drugs into paravertebral muscles on each side. Group A received 20 mL of 0.75% ropivacaine plus dexmedetomidine and group B received 20 mL of 0.75% ropivacaine plus magnesium sulfate. Postoperative pain was assessed by the visual analog scale at 0 minute (immediately after extubation), 30 minutes, 1st hour, 2nd hour, and thereafter at 4th hour, 6th hour, 12th hour, and 24th hour. Time to rescue analgesia, total analgesic consumption, hemodynamic variables,and complications if any were recorded. Statistical analysis was done using SPSS version 20.0 (Armonk, NY: IBM Corp.). The time to first requirement of analgesia in postoperative period was significantly longer in group A (10.05 ± 1.62 hours) than in group B (8.07 ± 1.83 hours)(p < 0.001). Total analgesic consumption was significantly higher in group B (197.50 ± 36.76 mL) compared to group A (142.50 ± 22.88 mL)(p < 0.001). Heart rate and mean arterial pressure were significantly lower in group A compared to group B (p < 0.05). Local infiltration of surgical site with ropivacaine plus dexmedetomidine provided better pain control than ropivacaine plus magnesium sulphate infiltration and is safe and effective analgesia for patients undergoing lumbar spine surgeries in postoperative period.

Premedication of Oral Clonidine 2mcg/kg and 4mcg/kg for Analgesic and Pressure Response During First Twenty-four Hours After Upper Abdominal Surgery: A Comparative Study

Traditionally postoperative period analgesia was maintained by opoids and which frequently increasethe hospital stay time and cost by delayed bowel movement and others side effects. on the other handupper abdominal surgery is very much painful, usually Opiods are used as good analgesic, but havesome adverse effect and addiction effect; anaesthesiologists want to reduce its requirements. In upperabdominal surgery adequate analgesia, stable haemodynamic, early bowel movement, free from nauseaand vomiting is wanted, as a part of multimodal analgesic approach, premedication by clonidine is veryimportant for it analgesic, angiolytic and sedative properties. Alpha two (α–2) adrenoreceptor agonist,Clonidine exerts central sympatholytic effect for 8 to 10 hours as its half life is 9-12 h. So thatpremedication with oral clonidine causes reduction of anxiety, reduction of perioperative analgesicdrugs and also reduction of anaesthetic doses. In addition, clonidine increases cardiac baroreceptorreflex sensitivity to increase in systolic blood pressure, and thus stabilizes blood pressure. Clonidine israpidly and almost completely absorbed after oral administration with a time to maximum plasmaconcentration of between 1.5 and 2 hr and elimination half-life of 8 to 12 hr. But clonidine producesanalgesia in a dose dependent manner, achieving complete pain relief for up to 5 hours without sensoryor motor block at large doses (oral 7000 to 900 mcg) however large doss were associated withdisadvantage including hypotension, bradycardia and transient sedation. It also reported thatclonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient afterorthopedic surgery. Because of its dose, route, and surgical variation it is very much important tospecify the dose for upper abdominal surgery.The primary aim of this study to compare the effects of clonidine premedication at different doses (2 &amp;4mcg/kg) on postoperative analgesia and hemodynamic status in upper abdominal surgery with largeincision area. (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipplesoperations). JBSA 2022; 35 (2) : 17-21

Comparison of treatment of pilonidal sinus using phenol injection versus wide excision with secondary healing.

Objective: To compare mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol versus wide excision with open healing. Study Design: Randomized Controlled Trial. Setting: Department of Surgical, Allied Hospital Faisalabad. Period: 13-10-2018 to 12-04-2019. Material &amp; Methods: A total of 60 patients were operated in our unit during the study period and were allocated into two groups randomly: Group A and Group B. The patients in Group A underwent treatment using crystallized phenol. Patients in Group B underwent wide local excision of the pilonidal sinus tract. All patients were given single dose of broad-spectrum antibiotic at time of procedure. Analgesia in post-operative period was maintained by using Diclofenac Sodium (Inj Artifen 75mg/3ml IM) as requested by the patient as long as the safe dose is not exceeded. First assessment of all patients was done at 24 hours after surgery. The analgesic requirement and visual analog scale score were documented for patients of both groups at this time. Follow up visit for patients in both groups was scheduled at 3 weeks after treatment. All the data was collected with the help of a specially designed Performa. Results: Mean pain score in Group-A was calculated as 1.36±0.55 and in Group-B it was 3.23±0.82, p value was 0.0001, comparison of wound healing in both groups shows that wound healing in Group-A was in 80%(n=24) and in Group-B, it was 30%(n=9), p value was 0.0001. Conclusion: We concluded that mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol is significantly lower when compared with wide excision with open healing.

The Analgesic Effect of Dexamethasone and Magnesium Sulphate (MgSO4) as an adjuvant to 0.25% Bupivacaine in ultrasound guided Pectoral Nerve Block (PEC Block) for unilateral Modified Radical Mastectomy: A Comparative Study

Background: Postoperative pain following unilateral modified radical mastectomy (MRM) has been managed with Pectoral nerve block (PEC block). Several initiatives are ongoing to get the effective and safe way of prolongation analgesic effect postoperatively. Therefore, many types of adjuvants are adding to the local anaesthetic agents to prolong their analgesic effect. In this study either dexamethasone or magnesium sulphate (MgSO4) has added as an adjuvant to 0.25% bupivacaine in pectoral plane block (PEC block) for unilateral modified radical mastectomy. Here we observed which of the adjuvant would prolong the analgesic effect of 0.25% bupivacaine. Methods: This randomized controlled trial was conducted at the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College following approval of the ethical committee. These patients were selected from the department of General Surgery, Dhaka Medical College during preanaesthetic checkup periods. Total 50 patients were scheduled for modified radical mastectomy and divided into Group A and Group B (each group contain 25 patients). The patients of the both groups were given pectoral plane block under ultrasound guide with 0.25% bupivacaine. The patients of Group A received magnasium sulphate 150 mg and Group B received dexamethasone 10 mg as an adjuvant to 0.25% bupivacaine. Pectoral nerve block was performed before induction of general anaesthesia and onset of sensory block was assessed among the both groups. All patients were observed peri-operatively and data were recorded into the data collection form. Finally, data was analyzed by SPSS version 22. Observation and Results: Socio-demographic profile were similar among the both groups (p&gt;0.05). No significant difference was noted in terms of ASA score and BMI (p&gt;0.05). Mean duration of the analgesia (min) and time requirement of rescue analgesic therapy were significantly higher in dexamethasone group (p&lt;0.05) than MgSO4 group. Post-operative requirement of pethidine (72.5±8.5vs 55.2±5.4 mg; p&lt;.045) was also higher in MgSO4 group. Side effects profile like nausea and vomiting also significantly small in dexamethasone (4%) group than people received MgSO4 group (20%) (p&lt;0.05). Conclusion: Use of dexamethasone in comparison to MgSO4 as an adjuvant to bupivacaine could prolong analgesia in postoperative period for pectoral plane block in unilateral modified radical mastectomy. CBMJ 2022 January: vol. 11 no. 01 P: 4-13

Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study.

ABSTRACTBackground and Aims:Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM.Methods:A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 mg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 mg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed.Results:The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups.Conclusion:Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM.

A Randomized Controlled Trial on the Effectiveness of Tramadol as an Adjunct to Bupivacaine for Caudal Analgesia in Children

Introduction: The purpose of analgesia in postoperative period is to minimize pain with the fewest probable side effects and to obtain the highest possible cost-effectiveness in our environment. In children, caudal anesthesia is often given in combination with general anesthesia for postoperative and intraoperative anesthesia. To extend the length of anesthesia; adjuvants can be further added to local anaesthetics. This research was performed to determine the caudal bupivacaine anesthesia duration given in combination with tramadol. Study Design: A prospective, comparative, randomized, double-blinded study Place and duration: In the department of Anesthesia, Khyber Teaching Hospital, Peshawar for one-year duration from 21st January 2021 to 20th January 2022. METHODS: 80 patients, 3-8 years of age, enduring elective urological, lower limb and lower abdominal surgery. Patients were randomised in to group A (n = 40) given 0.25% bupivacaine 1 ml / kg and group B (n = 40) receiving bupivacaine 0.25% in dose of 1 ml / kg plus 1 mg / kg tramadol. The hemodynamic responses, side effects and analgesia total duration were observed and analyzed. Results: The patients were comparable in groups A and B in terms of hemodynamic response and demographics and were not significant statistically (p greater than 0.05). It was detected that the analgesia mean time was longer significantly in B group (464.2 ± 167.1 minutes vs 238.1 ± 71.5 minutes, P &lt;0.001). The postoperative vomiting was perceived in two cases, one in each group. Conclusions: One mg / kg Tramadol adjuvant to 0.25% bupivacaine for caudal anesthesia in children effectively lengthens the analgesia duration deprived of increasing side effects. Keywords: bupivacaine; tramadol and caudal analgesia.

Оптимізація анестезіологічного забезпечення пері- та післяопераційного періоду при хірургічному лікуванні колоректального раку

Мета дослідження — вибір оптимального методу анестезіологічного захисту хворих від операційної агресії при хірургічному лікуванні колоректального раку. Проведено порівняльний аналіз клінічних показників і результатів лікування при використанні атаралгезії з подальшою аналгезією наркотичними анальгетиками та комбінованої методики з використанням низькопотокової анестезії севофлураном та епідуральної аналгезії з подальшим подовженим епідуральним знеболюванням. Показано вірогідну перевагу комбінованої методики перед тотальною внутрішньовенною анестезією за рахунок нормодинамічного типу гемодинаміки упродовж всієї операції, ранньої регресії постнаркозної депресії і можливості екстубації пацієнта в операційній, ефективної аналгезії в ранньому післяопераційному періоді. Методика подовженої епідуральної аналгезії порівняно з опіатною аналгезією забезпечила значне зниження потреби в опіоїдних анальгетиках, ефективну і якісну аналгезію в післяопераційному періоді, нівелювала побічні ефекти опіатних препаратів, знизила тривалість перебування пацієнта у відділенні інтенсивної терапії. Впроваджена методика дозволила знизити частоту післяопераційної летальності, кількість ускладнень, середню тривалість ліжко-дня і частоту повернень пацієнтів у відділення інтенсивної терапії.

Comparison of postoperative analgesic efficacy of epidural ropivacaine and ropivacaine with tramadol in adults undergoing abdominal surgeries under general anaesthesia

Objectives: This prospective study was conducted to compare the postoperative analgesic efficacy of epidural 0.2% Ropivacaine and 0.2% Ropivacaine with Tramadol in patients undergoing abdominal surgeries under general anesthesia.Observations:•The duration of analgesia in postoperative period in patients who received epidural 0.2% Ropivacaine with Tramadol was comparatively longer than that of patients who received epidural 0.2% Ropivacaine.•The Ramsay sedation score was observed to be more in patients who received epidural 0.2% Ropivacaine with Tramadol compared to patients who received epidural 0.2% Ropivacaine.•There was no significant difference in the postoperative nausea and vomiting episodes in both the groups.•There was no significant difference in occurrence of pruritus in both the groups.•There was no statistical difference between the two groups with respect to heart rate, mean arterial pressure, oxygen saturation and respiratory rate.

Transversus abdominis plane block by landmark technique with ropivacaine versus bupivacaine for post-operative analgesia in patients undergoing lower segment caesarean section deliveries

Transversus Abdominis Plane (TAP) Block is an efficacious abdominal field block which is widely used component of multimodal analgesia. Compare the efficacy of Inj. Ropivacaine 0.2% and Inj. Bupivacaine 0.2% when used in TAP block for post-operative analgesia in lower segment caesarean section deliveries(LSCS) done under spinal anaesthesia. Randomized double blinded prospective study conducted after institutional ethics committee in our institute. We have recruited sixty patients scheduled for an elective LSCS which were enrolled into two groups to receive TAP block with bupivacaine 0.2% 15ml Group B (n=30) versus ropivacaine 0.2% 15ml Group R (n=30) + dexamethasone 2mg bilaterally. TAP block was administered on completion of surgery. Primary objective was to compare time to rescue analgesia in postoperative period. Secondary Objectives wereto compare hemodynamic response during postoperative period, measure the intensity of pain using visual analogue scale (VAS), number of analgesic doses in first 24 hours, patient satisfaction with pain management and complications if any.SPSS software 16 version. Time for rescue analgesia was shorter in Group B (6.7 hour) than in Group R (9.47 hour) (p = 0.00). VAS was lower in Group R. Higher dose of analgesics was required in Group B (p=0.008). All this led to higher patient satisfaction score in Group R. This study concludes that 0.2% ropivacaine provided a longer duration of analgesia compared to 0.2% bupivacaine when used in TAP block for post-operative analgesia in LSCS deliveries.

A Comparison of Costoclavicular Block and Interscalene Block for Pain Relief after Arthroscopic Shoulder Surgery

Abstract Introduction Interscalene block (ISB) is commonly used for efficient pain relief after arthroscopic shoulder surgery. But, it is linked with a greater occurrence of unilateral diaphragmatic paralysis (UDP). This may add to patient dissatisfaction and also may not be tolerated well by patients having respiratory diseases. We have compared the efficacy of costoclavicular block (CCB) with ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. Materials and Methods Fifty patients were divided into two groups of 25 each (ISB or CCB group). In total, 20 mL of 0.5% levobupivacaine along with 4 mg of dexamethasone as adjuvant was used during both ultrasound-guided ISB and CCB. Numerical rating scale (NRS) scores for pain were assessed at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours in postoperative period. The mean onset time of block, time of first painkiller demand, total painkiller demand for 24 hours postoperatively, patient wellbeing, incidence of UDP, and any other complications were recorded. Results NRS pain scores in both groups at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours were comparable. (p &gt; 0.05) Mean onset time of block was earlier in ISB group contrary to CCB group (p &lt; 0.05). There was higher occurrence of UDP in ISB group contrary to CCB group (p &lt; 0.05). There was no notable variation regarding the time of first painkiller demand and total painkiller demand in the first 24 hours. Patients were more satisfied in CCB group contrary to ISB group. Conclusion As CCB provided equivalent analgesia in postoperative period like ISB without any risk of UDP, it can be a better substitute to ISB for pain relief in arthroscopic shoulder surgery.

A COMPARISION OF INTRATHECAL HYPERBARIC BUPUVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE ALONE IN GYNAECOLOGICAL SURGERIES FOR POSTOPERATIVE ANALGESIA

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P&lt;0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.

Tramadol or Nalbuphine; Which One is Superior for Analgesia in Post-Operative Period after Percutaneous Nephrolithotomy

Background: Kidney stones has got high prevalence worldwide especially in our part of world and per-cutaneous nephrolithotomy (PCNL) is gold standard operative modality for renal stone management. Pain control after PCNL is the most important task for treating surgeon as effective pain control causes smooth patient recovery in post-operative period. For analgesia, many drugs can be used, out of which tramadol and nalbuphine always been in comparison for effective analgesic activity. Objective: To compare efficacy of tramadol and nalbuphine as potent analgesic in patients after PCNL. Study Design: A prospective randomized study. Settings: Department of Urology and Kidney Transplantation, Allied Hospital/Faisalabad Medical University, Faisalabad and Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: From September 2016 to September 2020 (4 Years). Methodology: 286 patients undergoing PCNL for either gender and sides enrolled in study according to inclusion and exclusion criteria. Patients divided into Group A (Administered with tramadol) and Group B (administered with nalbuphine) and patients evaluated for pain up to 48 hours after surgery using 11-point numerical pain rating scale rating from0-10 where 0 is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain and 10 as worst pain and use of rescue analgesia observed in either groups. Data obtained and statistical evaluation done. Results: 286 patients enrolled from age 15-75 years with mean age of 40.2 years. Among 286 patients, 161 were male and 125 were female patients. Both groups A and B having 143 patients each. Analysis showed that tramadol has superiority over nalbuphine and need of analgesia is more in patient given nalbuphine (118 vs 31) as maintenance analgesic agent in post-operative period after PCNL. Conclusion: This study showed that tramadol has superiority over nalbuphine for analgesia after PCNL.

Study to Evaluate Usefulness of Magnesium Sulphate and Dexmedetomidine as Adjuvant to Bupivacaine for Lower Limb and Abdominal Surgeries Under Epidural Anaesthesia

Objective: Central neuraxial blockade not only provides good anaestheti Background andcand surgical conditions but it has also advantages over general anaesthesia. To compare time of onset and duration of motor and sensory blockade, duration of analgesia, hemodynamic stability, adverse effects if any and number of rescue analgesia in first 24hours after surgery. Materials and Methods: After ethical committee permission and patient consent, study was conducted on 90 patients aged 18 to 65 years belonging to ASA- I and II undergoing lower limb and lower abdominal surgeries, were randomly divided into 3 groups. GROUP A received epidural bupivacaine 0.5 % (17 ml) + 1ml 0.9% normal saline. GROUP B received epidural Bupivacaine 0.5 %( 17 ml) + 1ml 0.5mcg per kg dexmedetomidine. GROUP C received epidural Bupivacaine 0.5 % (17 ml) + 1ml 50mg magnesium sulphate. Exclusion criteria include patient’s with bradyarrythmias, cerebrovascular diseases, neurodegenerative diseases, renal and hepatic diseases, uncontrolled hypertension, bronchial asthma, ischemic heart disease, drug and alcohol abuse and uncontrolled diabetes mellitus.The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. Test of significance were ANOVA and chisquare test. P value &lt;0.05 statistically significant. Results: Analgesia in postoperative period and less number of rescue analgesia was better in Group C, Duration of sensory and motor blockade was prolonged and better hemodynamic stability in Group B Conclusion: Hence addition of magnesium sulphate to epidural bupivacaine provides better post-operative analgesia and dexmedetomidine to epidural bupivacaine increases duration of motor and sensory blockade with better hemodynamic stability.

CONCEPT OF POST OPERATIVE PAIN AND ITS MANAGEMENT IN AYURVEDA: A LITERATURE REVIEW

Adequate analgesia in postoperative period is an essential and humanitarian factor for faster recovery. Currently used analgesics are opioids and NSAIDs which have certain adverse effect. So there is need to search pain management measures from alternative science to minimise use of opioids and NSAIDs. Sushruta samhita (Sushruta’s compendium) is the oldest reference for surgery in the world. He did various surgeries including laprotomy for intestinal obstruction, perforation, rhinoplasty, cataract and so many minor surgeries like cyst, lipoma etc removal thousand years back. Certainly he managed postoperative pain also. An effort is made in this article to explore Sushruta concept of postoperative pain and its management. Also currently available online articles regarding postoperative pain management in Ayurveda are searched. By using Ayurvedic protocols, polyherbal formulations effective pain management is possible and use of NSAIDs and opioids can be minimised.

Thoracic epidural block - A sole anasthetic procedure for breast surgeries

Introduction: Breast cancer is one of the most common cancers in middle and old aged females. Oncological breast surgeries have commonly been performed under General Anaesthesia (GA). Thoracic Epidural Anaesthesia (TEA) is a safe and advantageous technique associated with fewer post surgical recovery complications, shorter hospital stay and consequently, decreased health care costs. TEA provides better control of pain and provides satisfactory analgesia in postoperative period without any respiratory complications. Materials and Methods: A prospective study was carried out in Anaesthesiology and Critical care department of Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) in 40 female patients aged between 30 and 60 years with ASA grade I, II, III underwent for breast surgeries during February 2007 to July 2008. Pre operative assessment of the patient including history, clinical examination and relevant investigations were done. Pre operative assessment of the patient including history, clinical examination and relevant investigations were done. Explanation regarding procedure and consent was taken from all the patients. The procedure and techniques were performed as per standard protocol. Observations: Maximum numbers of cases (32 cases, 80%) were in the age group of 45-60 yrs. Mean age in our study was 49.0 ± 6.6 yrs. The mean duration of onset of block was 7.67±1.14min. The mean duration was 117.12±28.90min. In maximum number of patients (21), duration of surgery was 91-120 min and mean duration of surgery was 123.1.±13.16min.Preoperative mean SBP was 120 ± 7.45mm of Hg. Intraoperative SBP ranged from 119.8 ±7.02mm of Hg to 125.15 ±8.43mm of Hg. Preoperative mean DBP was 77.6 ±4.34mm of Hg. Introperative DBP ranged from 71.±5.61mm of Hg to 77. ±4.63mm of Hg. Preoperative mean of PR was 84.1 ±5.12/min. Intraoperative mean PR ranged from 80.4 ±4.41/min to 83.35 ±4.54/min and minimum PR was 80.4 ±4.41/min. Preoperative mean of RR was

Tourniquet Use in Arthroscopic ACL Reconstruction: A Blinded Randomized Trial.

Despite knowing, that tourniquet induces ischemia and soft tissue damage surgeons still use it. The purpose of this study is to compare post operative pain and quadriceps function in patients undergoing arthroscopy assisted ACL reconstruction with tourniquet and without tourniquet. A blinded randomized prospective trial conducted at Orthopaedic department of a tertiary institute in India from Feb 2019 to June 2019. 45 patients undergoing Arthroscopic ACL reconstruction aged between 18 and 60years were recruited in the study according to selection criteria. Patients were distributed in 2 groups randomly, namely, tourniquet and non-tourniquet. Preoperatively serum CPK measurement and thigh girth measurement was done. Following standard arthroscopic procedure VAS score monitoring for pain was done for 5days. Serum CPK levels were performed on postoperative day 1. Thigh girth was measured on postoperative day 21. Pain was significantly high in patients in whom tourniquet was used. VAS scores were significantly high in tourniquet group. Tourniquet group patients required more amount of additional analgesics in postoperative period (p < 0.001). Serum CPK levels were comparable preoperatively while significantly high postoperatively in tourniquet group (p < 0.001). Difference in mean of thigh girth was significant between the groups (p < 0.001) and there is difficulty experienced by patients in performing straight leg raise test after tourniquet use (p = 0.002). Tourniquet use is associated with increased pain, analgesic requirement, damage to muscles and compromises muscle function in early postoperative period. This can not only lead to increased patient discomfort but also difficult initial rehabilitation. Arthroscopic procedures can be uneventfully performed without the use of a tourniquet, and alternative methods should be looked upon and emphasized.

TO STUDY AND COMPARE THE EFFECT OF DEXMEDETOMIDINE AND FENTANY AS AN ADJUVANT TO LEVOBUPIVACAINE IN INTERSCALENE BRACHIAL PLEXUS BLOCK FOR HUMERUS SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED STUDY

Introduction: Interscalene brachial plexus block provides complete and reliable anaesthesia for surgery of humerus as well as analgesia for postoperative period. Many studies are being done for the search for an adjuvant which when added to a local anaesthetic, prolong the duration of postoperative analgesia. Therefore we compared the effect of fentanyl and dexmedetomidine on postoperative analgesia when added to levobupivacaine for Interscalene brachial plexus block. Material and Methods: In this prospective study, 90 patients were randomly allocated to 3 groups: Group C (n=30) recieved 30 ml of 0.5% levobupivacaine, Group D (n=30) recieved 30 ml of 0.5% levobupivacaine + dexmedetomidine 1 μg/kg, Group F (n=30) recieved 30 ml of 0.5% levobupivacaine + fentanyl 1 μg/kg. The duration of blockade and analgesia were assessed for all the three groups.&#x0D; Observations: Demographic profile was comparable in all the groups. The onset of sensory and motor block and duration of analgesia and motor block were enhanced in Group D and Group F as compared to Group C. The mean pulse rate and mean arterial pressure were slightly lower in dexmedetomidine group than in other two groups.&#x0D; Results: Compared to the use of levobupivacaine alone for interscalene brachial plexus block, addition of 1 mcg/kg dexmedetomidine or 1 mcg/kg fentanyl to levobupivacaine enhanced the onset of blockade as well as increased the duration of blockade and post-operative analgesia. Also, the blockade characteristics were better improved with addition of dexmedetomidine to levobupivacaine than addition of fentanyl to levobupivacaine without increasing incidence of any unwanted side-effects.&#x0D; Keywords: Interscalene brachial plexus block, Levobupivacaine, Fentanyl, Dexmedetomidine.