Longer Duration Of Analgesia Research Articles

Comparison of Patient-Controlled Epidural Analgesia (PCEA) with Basal Infusion and Programmed Intermittent Epidural Bolus (PIEB) with PCEA in Labour Analgesia – A One-Year Retrospective Study

Introduction: For the past thirty years, patient-controlled epidural analgesia (PCEA) with basal infusion regimen has successfully improved the variable intensity of labour pain due to its advantage in allowing self-titration by the parturient. However, a recent review on programmed intermittent epidural bolus (PIEB) with PCEA regimen proved to be superior compared to PCEA with basal infusion, in terms of higher maternal satisfaction with longer duration of analgesia and lower local anaesthetic consumption. Following the introduction of PIEB at our institution, we did a study to compare maternal satisfaction, mode of delivery and neonatal outcome between these two methods of epidural labour analgesia. Methodology: We conducted a one-year retrospective analysis of data from obstetric analgesia service (OAS) record sheet and hospital information system evaluating outcomes after labour analgesia delivered by PCEA with basal infusion regimen (PCEA + basal infusion) and PIEB with PCEA regimen (PIEB+PCEA). The primary outcome was maternal satisfaction towards their labour analgesia. Other outcome parameters were the mode of delivery and neonatal Apgar scores. Outcomes were compared using independent t-test and Chi-square test. Result: There was no significant difference in maternal satisfaction between the two groups (P=0.398). However, a higher percentage of excellent satisfaction was found in the PIEB + PCEA group compared to that in the PCEA + basal infusion group (PIEB+PCEA 146/172 (84.9%) vs PCEA + basal infusion 138/171 (80.7%) respectively). There was no significant difference in the mode of delivery (P=0.296). However, PIEB+PCEA group had a higher percentage of spontaneous vaginal deliveries (PIEB+PCEA 87/172 (50.6%) vs PCEA + basal infusion 70/171 (40.9%) respectively) and a lower percentage of Caesarean deliveries (PIEB + PCEA 71/172 (41.3%) vs PCEA + basal infusion 87/171 (50.9%) respectively). Despite statistically significant differences found in Apgar scores in 1 minute (P=0.036), there was no significant difference in the scores at 5 minutes (P=0.107). Apgar scores and mean (SD) at 1 minute and 5 minutes for PIEB + PCEA were 7.77(0.85) and 8.91(0.55) respectively, and for PCEA + basal infusion the scores at 1 minute and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA regimen is a newer epidural delivery technique for labour analgesia in our centre, which produced a comparable outcome to PCEA with basal infusion regimen.

Patient satisfaction with regional anaesthesia and general anaesthesia in upper limb surgeries: An open label, cross-sectional, prospective, observational clinical comparative study.

Background and Aims:An important assessment of the quality of health care is patient satisfaction. However, only few studies are available which look into this aspect. The primary objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. The length of hospital stay and duration of analgesia between the two techniques were the secondary objectives.Methods:This cross-sectional study was carried out in a tertiary care teaching hospital. Patients aged between 18 years and 60 years, of physical status American Society of Anesthesiologists (ASA) grade 1–3, undergoing upper limb surgeries were included in the study. Patient satisfaction with anaesthesia was assessed in patients receiving GA and RA, with 100 patients in each group, at least 24 h after the surgery with a 10-item predesigned peri-operative questionnaire. The continuous variables were compared between the groups using Mann–Whitney–Wilcoxon test, and for categorical variables Chi-square test was used.Results:The patients in group RA showed significantly higher satisfaction scores than those in GA (P < 0.001) with respect to all the 10 items of the questionnaire and the total score. Duration of analgesia was also significantly longer in RA than GA (P < 0.001). Duration of hospital stay was also significantly longer in GA than in RA (P < 0.001).Conclusions:RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

Ketamine plus bupivacaine versus Nalbuphine plus bupivacaine caudal anesthesia in pediatric sub umbilical surgeries

Background: Caudal anaesthesia is used as pain control for many sub umbilical surgical procedures. Study Design: A prospective randomized double blind observational study. Study setting: Qena university hospital, South Valley University, Qena, Egypt. Duration: From May 2019 to August 2020. Patients and method(s): The study was conducted on 60 healthy paediatric patients undergoing elective lower abdominal and pelvic surgeries were allocated to two groups according to mode of blocking agents and caudal region. Result(s): efficacy of ketamine bupivacaine versus nalbuphine bupivacaine to provide intraoperative and postoperative pain relief. The time to first analgesic administration was longer in the ketamine bupivacaine group about (8 hrs) than nalbuphine bupivacaine about (5.8 hrs)., Conclusion: Caudal nalbuphine and caudal ketamine are safe in pediatric surgeries in the lower half of the body and effectively reducing postoperative pain with longer duration of analgesia in ketamine group than nalbuphine group with no obvious side effects in both groups.

Effect of pre-emptive epidural Mg sulphate versus dexmedetomidine on postoperative analgesia requirement after open abdominal surgeries

Background: epidural approach is used to provide anaesthesia and analgesia (pain relief) in abdominal surgeries. Objectives:To estimate total cumulative dose of post-operative rescue analgesia & to estimate time to 1st post-operative analgesic request. Patients and method(s):A prospective randomized double blind observational study, conducted in Qena university hospital, South Valley University, Qena, Egypt. The study was conducted on sixty patients (ASA I or II) scheduled for major abdominal surgeries with general anesthesia combined with epidural anesthesia were included. Their ages ranged between 25 and 60 years old. Result(s):regardingassessment ofpost-operative pain by visual analogue scale (VAS) we find that there was statistically significant difference between the three groups 24hour post-operative. there were significant difference (P<0.05) about the time to reach VAS 4 , that the time to reach VAS 4 in dexmedetomidine group is longer than the time to reach VAS 4 in Mg sulphate group than the time to reach VAS 4 in control group. Conclusion: Epidural Dexmedetomedine and Epidural Magnesium sulphate are safe in open abdominal surgeries and effectively reducing postoperative pain with longer duration of analgesia in Dexmedetomedine group

Caudal versus intravenous ketamine for supplementation of analgesia in children undergoing hypospadias repair: a randomized controlled trial

Background Different additives have been reported to prolong the duration of caudal anesthesia in pediatrics. Although these drugs successfully increased the duration of the block, ketamine has been found to effectively increase the duration of caudal block in pediatrics. Aim This study aimed to assess the clinical effectiveness of ketamine after caudal or intravenous administration in pediatric patients who underwent hypospadias repair to distinguish between local and systemic analgesia. Patients and methods After induction of general anesthesia, 48 patients, aged 1–6 years, assigned to undergo hypospadias repair, received a caudal injection of bupivacaine and were randomly blinded into two groups: K1 group received 1 mg/kg S-ketamine as the caudal group, and K2 group received 1 mg/kg S-ketamine as the intravenous group. Postsurgical measurements included the effectiveness of postsurgical analgesia, which was assessed by using observational pain scale, duration of analgesia, sedation score, and hemodynamic and complications. Results The caudal block was successful in all the patients included in the study. None of the patients in either groups required intraoperative rescue analgesia. All patients remained vitally stable during the procedure, and intraoperative hemodynamic parameters were comparable in the two groups. The time to the administration of first analgesia was statistically longer in K1 group (11.5±4.6 h) than in the K2 group (8.7±3.1 h). Time to spontaneous leg movement and time to first micturition were statistically nonsignificant between both groups. The number of patients requested for additional analgesic drugs (acetaminophen and ibuprofen) was statistically significant, being higher in the K2 group than the K1 group. Conclusion This study demonstrates that ketamine if added to caudal epidural in a dose of 1 mg/kg provided prolonged postoperative analgesia with improved quality, had longer duration of analgesia, decreased the supplemental acetaminophen analgesia during the first 24 h postoperatively, had stable hemodynamic changes, and had comparable adverse effects and complications in comparison with systemic ketamine in a dose of 1 mg/kg.

Comparative Study of Intravenous Dexmedetomidine Sedation With Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block in Upper Limb Orthopaedic Surgery.

BackgroundDexmedetomidine is being used as an adjuvant analgesic, both as intravenous (IV) and intrathecal infusion. The role of perineural (P) dexmedetomidine has evoked attention recently. The aim of this study was to compare the effect of IV dexmedetomidine and P dexmedetomidine as an adjunct to supraclavicular brachial plexus block in upper limb orthopaedic surgery. MethodsPatients were randomly divided into two equal groups (n=20). Group I (IV dexmedetomidine) received dexmedetomidine 1 mcg/kg IV as loading dose over 10 minutes, followed by continuous infusion of dexmedetomidine 0.4 mcg/kg/hr IV. Group P (P dexmedetomidine) received dexmedetomidine at 1 mcg/kg perineurally. After adequate motor response with the aid of peripheral nerve stimulator a supraclavicular block with 40 ml solution containing 5 mg/kg lignocaine (2%) with adrenaline (1:200,000) and 2 mg/kg of bupivacaine (0.5%) was injected to both the groups. Group P also received dexmedetomidine perineurally with block. Onset and duration of sensory and motor block, Ramsay sedation score, hemodynamic parameters, and postoperative analgesia requirement were assessed along with side effects. The data obtained were recorded as mean ± SD, ranges, numbers, and ratios. Results were analyzed using the chi-square test, the Mann-Whitney test for non-parametric data, and an unpaired ‘t’-test for parametric data. Statistical analysis was carried out using the SPSS (version 10, 2002; SPSS Inc., Chicago, IL, USA) for Windows statistical package. P value less than 0.05 was considered statistically significant. ResultsMean onset of sensory block was earlier in group I than in group P (p<0.05) although mean onset of motor block was not significantly different (p>0.05). Duration of sensory and motor blockade was longer in group I (p<0.05). Patients in group I demonstrated lower pulse rate and lower systolic and diastolic blood pressures throughout the period with comparable SpO2 values. There was no difference in intraoperative Ramsay sedation scores in both groups, but postoperative Ramsay sedation scores at 9, 12, and 15 hours were better in group I (p<0.05). The average time to rescue analgesia (visual analogue scale >4) was higher in group I (p>0.05).ConclusionIV dexmedetomidine produced early onset of sensory block, longer duration of sensory and motor block, and longer duration of analgesia as compared with P dexmedetomidine as an adjuvant to supraclavicular block with 5 mg/kg lignocaine (2%) and 2 mg/kg bupivacaine (0.5%) in upper limb orthopaedic surgeries.

Effects of Lignocaine-Diazepam Combination in Lumbo-Sacral Epidural Anaesthetized Dogs Undergoing Caudectomy

General anaesthesia is known to be associated with the risk of cardiopulmonary depression, therefore the use of a safer means of anaesthesia as an alternative has to be explored. Epidural anaesthesia technique is known for its simplicity, safety and effectiveness and is one of the most frequently used regional anesthetic techniques described for surgical procedures caudal to the umbilicus in small animal practice. The main aim of this study was to evaluate the effects of lumbo-sacral epidural injection of a mixture of 7.5 mg/kg of 2% lignocaine solution and 0.2 mg/kg 0.5% diazepam solution in 10 apparently healthy Nigerian local dogs undergoing caudectomy. Onset of neural blocked recorded was 6.5 ± 1.35 min (mean ± SD), duration of analgesia was 54.4 ± 5.38 min (mean ± SD) and duration of recumbency was 115.1 ± 36.1min (mean ± SD). Changes observed in the Pulse rate (PR), Mean arterial blood pressure (MAP), Respiratory rate (RR) and Rectal temperature (RT) were recorded at 10 min intervals throughout the duration of the procedure. There were no significant differences (p&gt;0.05) in the mean physiological parameters observed as compared to the baseline values. Blood samples were also taken at 15 min interval throughout the duration of the procedure to determine the effects of the epidurally administered lignocaine-diazepam combination on haematological and serum biochemical indices. No significant differences (p&gt;0.05) were observed in the mean haematological (PCV, RBC, WBC, Hb and CBC) and serum biochemical indices (ALT, ALP, Creatinine and BUN). It was concluded that epidurally administered lignocaine-diazepam mixture at 7.5 mg/kg and 0.2 mg/kg respectively had a fast onset of neural blockade, adequate and long duration of analgesia without profound effects on haemodynamic and cardiopulmonary system.

Anesthetic efficacy and safety of 2% lidocaine hydrochloride with 1:100,000 adrenaline and 4% articaine hydrochloride with 1:100,000 adrenaline as a single buccal injection in the extraction of maxillary premolars for orthodontic purposes.

BackgroundPalatal injection of local anesthetics is the most painful injection. To obviate the need for palatal injections, local anesthetic agents with diffusibility are being investigated. Hence the present study was designed to analyze the anesthetic efficacy of 2% lidocaine hydrochloride (HCl) with 1:100,000 adrenaline and 4% articaine hydrochloride (HCl) with 1:100,000 adrenaline using single buccal infiltration for the extraction of maxillary premolars.MethodsA prospective, double-blind, crossover, randomized clinical study was performed on 60 consecutive systemically healthy patients with an age range of 15-30 years, requiring extraction of asymptomatic bilateral maxillary premolars for orthodontic purposes. They received 1ml buccal infiltration of 4% articaine HCl with 1:100,000 adrenaline on one side and 2% lidocaine HCl with 1:100,000 adrenaline on the other side. The extraction procedure on either side was scheduled 14 days apart. Parameters assessed were the time of onset of anesthesia, intraoperative discomfort, hemodynamic parameters, and the duration of analgesia. Analysis of the data was done using the Mann-Whitney test, the Wilcoxon test, the Kruskal-Wallis ANOVA test, and the chi-square test. Statistical significance was established at P < 0.05.ResultsArticaine showed a faster time of onset and longer duration of analgesia than lidocaine. However, the difference in the intraoperative discomfort and hemodynamic parameters was statistically insignificant.ConclusionWithin the limitations of the study, it can be concluded that the extraction of maxillary premolars can be performed with a single buccal infiltration of 2% lidocaine HCl with 1:100,000 adrenaline, which is one of the most commonly used local anesthetic agent.

Lumbosacral injection of lidocaine, detomidine and lidocaine–detomidine in goats: anti-nociceptive effects and changes on haematobiochemical parameters

ABSTRACT This study was carried out to compare the analgesic effects and haematobiochemical changes produced by the administration of lidocaine, detomidine and lidocaine–detomidine combination in the epidural space of goats. All goats were assigned to all of the three different epidural treatments using a balanced crossover design with two-weeks washout period. Nociception was investigated by pinprick; times to the onset and duration of anti-nociception in the perineal region were demonstrated. Incoordination, ataxia and analgesic effects were carefully observed and recorded according to the scoring system. The blood samples for haematological and biochemical changes were collected at 0, 30, 60, 90 and 120 min post-treatment. Our results showed that detomidine treatment produced a highly significant (P < 0.01) and (P < 0.0001) earlier onset time than lidocaine and lidocaine–detomidine combination, respectively. Detomidine treatment had a significantly longer duration of analgesia than lidocaine (P < 0.01) and lidocaine–detomidine combination (P < 0.0001) treatments. Moreover, all treatments showed no effect on haematological or biochemical parameters, with no obvious systemic effects. In conclusion, administering a detomidine provided a longer duration of analgesia and a useful level of systemic sedation in goats.

Comparison of Lidocaine, and Lidocaine-Neostigmine for Epidural Analgesia in Dogs

ABSTRACT Objectives: Evaluate and compare the analgesic effect of epidural lidocaine and lidocaine- neostigmine combination in dogs. Methods: Six healthy dogs of mixed breed weighing 12–15 kg were selected for this study. All dogs received all treatments in a cross-over design with at least a one-week interval. Dogs were premeditated with Xylazine (0.5 mg/kg) and general anesthesia was induced with thiopental sodium (12.5 mg/kg) to perform the lumbosacral puncture. Epidural analgesia was done using either 6 mg/kg of lidocaine 2% or a combination of 6 mg/kg of Lidocaine 2%, with 10 µg/kg neostigmine. The degree of analgesia was evaluated using a numerical rating scale. Analgesia was defined as lack of response to pinprick test and pressure from hemostat clamp and was performed after one hour of epidural injection, and thereafter every 10 min until complete recovery. Heart rate (HR), respiratory rate (RR), and rectal temperature (RT) were recorded before (baseline, 0) and at every 10 min until a complete recovery was observed. Results: HR, RR and RT did not differ between treatments at any time point. The lidocaine–neostigmine combination produced a significant (P < 0.05) longer duration of analgesia than lidocaine alone. The addition of neostigmine resulted in a significantly longer duration of analgesia. Co-administration of epidural neostigmine and lignocaine appears to be a useful technique for postoperative analgesia as it increases the duration of analgesia Conclusion: Adding neostigmine to epidural administered lidocaine in dogs increases the analgesic effect on both hind limbs and perineal region. Short running title: Lidocaine-neostigmine epidural in the dog.

Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study.

Pain due to coughing after thoracoscopic surgery remains a clinical problem, and its relief by intrapleural analgesia has not been extensively studied. This study attempts to determine the suitable volume of 0.75% ropivacaine needed for intrapleural analgesia after thoracoscopic surgery. A double-blind, randomized, controlled trial was performed. Forty-five patients were randomly divided into three groups: R20, R15, and R10 (n = 15); 20 ml, 15 ml, or 10 ml of 0.75% ropivacaine was injected into the pleural cavity of each patient in the 3 groups, respectively, when the pain score from postoperative coughing was ≥4. The primary outcome was pain score upon coughing (C-NRS), and the secondary outcomes were pain score at rest (R-NRS), morphine consumption, time of onset, and duration of intrapleural analgesia. All patients in the R20 and R15 groups reported effective pain relief after intrapleural injection when postoperative coughing occurred. However, only 7 patients in the R10 group reported effective relief of pain. Compared with the patients in the R10 group, patients in the R20 and R15 groups had lower C-NRS scores, less morphine consumption at 8 h and 24 h, a shorter time to pain relief, and a longer duration of analgesia. There was no significant difference of R-NRS among the three groups. Intrapleural analgesia with 0.75% ropivacaine at a volume of 15 ml or 20 ml effectively relieved pain due to coughing after thoracoscopic surgery. ChiCTR1800017515.

Clinico-biochemical study on different pre-anesthetic drugs combined with propofol for neutering dogs

The objective of present study was to select the best pre-anesthetic to be used in combination with propofol for neutering dogs. A prospective randomized study was conducted on 18 clinical cases of mongrel dogs admitted for neutering were subjected in to three groups (n=6). In group A (xylazine @ 2.2 mg/kg), group B (diazepam@ 0.25 mg/kg) and group C (medetomidine @ 40 µg/kg body weight), were injected intramuscular as preanesthetics. After 3-5 minutes of pre-anesthetic, the propofol injection @ 6 mg/kg of body weight was administered intravenous as anesthetic drug in all three groups. Analgesia was tested by the presence or absence of following reflexes - tail pricking, toes pinch, pedal reflex and patellar reflex. Rapid onset (9.13 ± 1.41 minutes) and long duration (59.67± 5.50 minutes) of analgesia was observed in group C compared other groups (onset 13.661±1.72 A, 20.16 ± 1.75 B minutes) and duration of analgesia (48.56 ± 4.61 A and 40.66± 5.46 B minutes). CBC, ALT, AST, ALP and blood urea nitrogen values were non-significantly (P e” 0.5) same within and between all three groups. There was significant (P d” 0.5) increase in ALT, AST, ALP, BUN and serum creatinine in group B at 24 hours interval. The results of our study showed that there was non significant decrease (P e” 0.5) in Hb and total erythrocytes count while non-significant increase (P e” 0.5) in total leukocyte count was noted in all three groups. The results showed that Medetomidine HCl in combination with propofol produce, rapid onset, and long duration of analgesia, with rapid and smooth recovery and no effects on haematological parameters of dogs.

Long-term pain relief in canine osteoarthritis by a single intra-articular injection of resiniferatoxin, a potent TRPV1 agonist.

The translational potential of analgesic approaches emerging from basic research can be augmented by client-owned dog trials. We report on a peripheral interventional approach that uses intra-articular injection of the ultrapotent TRPV1 agonist resiniferatoxin (RTX) to produce a selective long-term chemoinactivation of nociceptive primary afferent nerve endings for pain control in naturally occurring canine osteoarthritis. A single injection of 10 µg of RTX, produced suppression of pain, improvement in gait, weight bearing, and improvement in the dog's activities of daily living lasting 4 months or longer. Two to 3 years after the injection, there are no alterations to suggest that removal of inflammatory pain caused accelerated joint degeneration (Charcot joint) in any of the dogs. To amplify the effective use of canine subjects in translational analgesia research, we report a high-quality canine dorsal root ganglion transcriptome. Some targets for analgesia are highly conserved both in protein sequence and level of expression within a target tissue while others diverge substantially from the human. This knowledge is especially important for development of analgesics aimed at peripheral molecular targets and provides a template for informed translational research. The peripheral site of action, long duration of analgesia, apparent safety, and retention of coordination, all resulting from a single dose suggest that intra-articular RTX may be an effective intervention for osteoarthritis pain with few or no side effects and lead to an improved quality of life.

Is ultrasound-guided transversus abdominis plane block in providing analgesia in pediatric cases safe and efficient?: A retrospective study

Objective:&nbsp;&nbsp;The use of high or insufficient doses of analgesics in pediatric cases unfavorably affects the patient’s health in the postoperative period. Ultrasound-guided transversus abdominis plane (TAP) block is used in the management of postoperative pain in pediatric cases. The present study aims to evaluate the efficacy of ultrasound-guided TAP block in pediatric patients using a mixture of lidocaine and bupivacaine. Methods:&nbsp;The medical records of cases, who underwent surgery for the repair of the inguinal hernia and undescended testis using ultrasound-guided TAP block in the department of pediatric surgery, were retrospectively reviewed (28 cases). The study included ASA I-II pediatric cases aged 2-12 years. The amount of drug administered while performing USG-guided TAP block, time to first analgesic use in the postoperative period, pain score and the amount of first analgesic administration were recorded. The satisfaction of the surgeon and patient’s companion was evaluated. Results:&nbsp;A p-value &lt;0.05 was considered statistically significant. The findings showed that pain score was the lowest in the group with the highest patient’s companion and physician satisfaction score, and the highest in group with the lowest satisfaction score and the difference was statistically significant (p&lt;0.001). The satisfaction of the physicians (p=0.010) and the patient’s companion (p=0.027) increased with increasing drug volume. Conclusions:&nbsp;The volume of 0.4 ml.kg-1 (50:50 1% lidocaine and 2.5% bupivacaine) achieved the best physician and patient’s companion satisfaction and the longest duration of analgesia in pediatric cases undergoing surgery for the repair of the inguinal hernia and undescended testis. The lack of any complications in the present study suggests that USG-guided TAP block is a safe procedure in pediatric patients in experienced hands. Further studies are required.

Contribution of Ultrasound-Guided Transversus Abdominis Plane Block to Intraoperative Anesthesia in children - Randomized Controlled Study

Aim: The aim of this study is to investigate the contribution of transversus abdominis plane (TAP) block supported by intravenous ketamine sedation in children on intraoperative anesthesia and analgesia. Method: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided in three groups; the TAP block and ketamine group; the TAP block by inserting the laryngeal mask(LMA) and sevoflurane grup; and the LMA and sevoflurane group. Peroperative heart rates(HR), mean arterial pressures(MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, time required for the first analgesia were recorded. Results: Of the patients average age was 4 ± 1.1. There was no difference between the two block groups, in terms of HR and MAP; HR were higher and MAP were lower in the only sevoflurane group. In the group supported by a TAP block, the amount of sevoflurane used decreased(p<005). In the postoperative period, the HR, MAP and pain scores were higher in the only sevoflurane group(p <0,05). Rescue analgesia was applied to less number of patients in the groups with added block. There were longer analgesia durations in the block-supported groups(p<0.05). Conclusion: In this study, it was determined that TAP block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration and less analgesia need in the postoperative period.

Study of Wound Instillation Technique for Effective Postoperative Analgesia using Ropivacaine in Lumbar Spine Surgery.

Background:Instillation of local anaesthetics over incision site is a simple technique done as a part of multimodal analgesia targetting incisional pain for post-operative pain relief following lumbar laminectomy.Aim:To determine postoperative analgesic effect of ropivacaine in wound instillation for lumbar laminectomy.Study Design:Prospective, randomised, double blind study.Methodology:Forty patients scheduled for elective lumbar laminectomy under general anaesthesia were enrolled and randomly allocated into two groups namely Group R (n=20 receiving 20ml of 0.25% ropivacaine) and Group N (n=20 receiving 20ml normal saline) as instillation over incision site. If the NRS exceeded ‘4’ at any point of time, rescue analgesia with inj. Diclofenac 75 mg deep intramuscular was administered. Post- operative pain score, duration of analgesia and total rescue analgesic required in 24 h were compared between the groups.Results:The pain score was less in ropivacaine group as compared to normal saline group (p value 0.0001). Duration of analgesia in normal saline group (N) is 4.3± 1.03 and in ropivacaine group(R) is 12.15±1.49. Mean amount of rescue analgesic required in normal saline group was 191.25± 38.28mg and in ropivacaine group was 97.5± 35.26 mg.Conclusion:The patients who received ropivacaine wound instillation had better pain control, longer duration of analgesia and less analgesic requirement as compared to patients who received normal saline wound instillation.

Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients

Objectives:Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data.Methods:We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded.Results:Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up.Conclusion:Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.

Intrathecal nalbuphine as an adjuvant to bupivacaine in spinal anesthesia for lower-limb surgeries: intraoperative and postoperative effects

Background Many opioids are added to intrathecal local anesthetics to provide longer duration of analgesia; however, we have to choose an additive with the longest analgesic time and least intraoperative and postoperative side effects. In this study, nalbuphine was compared with fentanyl and pethidine as additives to hyperbaric bupivacaine used in spinal anesthesia for lower-limb surgeries. Patients and methods A total of 100 patients of both sexes, American Society of Anesthesiologists I and American Society of Anesthesiologists II, scheduled for lower-limb surgeries under spinal anesthesia were assigned randomly into four groups: group B received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml sterile water; n=25); group N received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml nalbuphine 500 μg; n=25); group F received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml fentanyl 25 μg; n=25); and group P received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml pethidine 10 mg; n=25). We recorded the onset of sensory and motor blocks, peak sensory and motor block times, sensory block levels and two-segment regression time using the pin-prick method, motor block level using the modified Bromage scale, and any intraoperative or postoperative complications. Results The mean onset of sensory block significantly decreased in groups N, F, and P compared with group B, whereas the peak sensory time did not significantly change in all the four groups. In contrast, the mean onset of the motor block in all four groups was nonsignificantly different, whereas the mean time for peak motor block was significantly short in both the N group (nalbuphine and bupivacaine) and the P (pethidine and bupivacaine) group compared with the B (bupivacaine alone) and F (fentanyl and bupivacaine) groups. There was significant prolongation in both two-segment regression time and the first analgesic request time in groups N, F, and P (all narcotics and bupivacaine) compared with group B (bupivacaine alone). Conclusion Nalbuphine, fentanyl, and pethidine as adjuvants to spinal anesthesia prolong the duration for first-rescue analgesia with minimal hemodynamic and respiratory complications; however, nalbuphine at a dose of 0.5 mg has the best quality of spinal block when added to intrathecal 0.5% heavy bupivacaine in patients undergoing lower-limb surgeries.

Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine.

Background and Aims:Knee replacement surgery causes tremendous post-operative pain and adductor canal block (ACB) is used for post-operative analgesia. This is a randomised, controlled, three-arm parallel group study using different doses of dexmedetomidine added to ropiavcaine for ACB.Methods:A total of 150 patients aged 18–75 years, scheduled for simultaneous bilateral total knee replacement, received ultrasound-guided ACB. They were randomised into three groups -Group A received ACB with plain ropivacaine; Groups B and C received ACB with ropivacaine and addition of dexmedetomidine 0.25 μg/kg and 0.50 μg/kg, respectively, on each side of ACB. The primary outcome was the duration of analgesia. Total opioid consumption, success of early ambulation, and level of patient satisfaction were also assessed.Results:The patient characteristics and block success rates were comparable in all groups. Group C patients had longer duration of analgesia (Group C 18.4 h ± 7.4; Group B 14.6 ± 7.1; Group A 10.8 ± 7; P < 0.001); lesser tramadol consumption (Group C 43.8 mg ± 53.2; Group B 76.4 ± 49.6; Group A 93.9 mg ± 58.3; P < 0.001) and lesser pain on movement (P < 0.001). The patients in Group B and C walked more steps than in Group A (P < 0.002). The level of patient satisfaction was highest in Group C (P < 0.001).Conclusions:The addition of dexmedetomidine to ropivacaine resulted in longer duration of analgesia after adductor canal block for simultaneous bilateral total knee replacement surgery.

Radiofrequency thermocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes.

Radiofrequency thermocoagulation (RFT) has been reported to be used safely to treat ischemic lower extremity pain. The objective of the present study was to evaluate efficiency of RFT for treatment of lower extremity ischemic pain and to compare effectiveness of monopolar RFT and bipolar RFT modes. Following ethics committee approval, 30 American Society of Anesthesiologists classification I-III patients with ischemic lower extremity pain aged between 18 and 65 years were recruited. Patients were randomly allocated into 2 groups: MRT group (n=15) received monopolar RFT (80°C) for 2 minutes at L2-3 level, and BRT group (n=15) received bipolar RFT (80°C) for 2 minutes at L2-3 level. Systolic and diastolic blood pressure, heart rate, pain score, and supplemental analgesic requirements were recorded at 24 hours after application and at 7, 30, and 90 days. Numerical rating scale values in both groups decreased significantly over time and it was found to be significantly lower in BRT group after first and third months (p<0.05). Supplemental analgesic requirements were similar with no significant difference between the 2 groups at any point of study period (p>0.05). No adverse event or complication related to procedure or treatment was reported. In patients with ischemic lower extremity pain, both monopolar and bipolar RFT treatment modalities were found to significantly decrease pain levels. However, bipolar mode led to lower pain scores at 30 and 90 days, and longer duration of analgesia than monopolar mode.