Analgesic Requirements Research Articles

Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.

Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP. A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis. A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27kg/m2 (24-32kg/m2), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381). Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.

Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized clinical trial

BackgroundIn an aging surgical patient population, preventing complications such as oversedation has taken increasing priority in perioperative care. Intraoperative use of virtual reality (VR) may decrease sedative requirements. We hypothesize that the use of immersive VR during total knee arthroplasty (TKA) will lead to decreased propofol requirements, improved patient-reported satisfaction, and reduced postoperative opioid requirements compared to active and usual care controls.MethodsThis is a single-center, randomized clinical trial of older (age > 60) patients undergoing TKA. Participants will be randomized into three groups (2:2:1): VR immersion, music, and sham VR plus usual care. All patients will receive a regional block and spinal anesthesia. Patients in the immersive VR and music groups will use patient-controlled sedation (PCS) with propofol, while those in the sham VR group will act as the standard of care control group and will receive monitored anesthesia care (MAC) with propofol infusion.Statistical analysisAnalyses will be conducted using IBM SPSS Statistics Version 25, considering a two-sided p-value < 0.05 to be statistically significant. The primary outcome is the intraoperative dose of propofol (mg kg−1 min−1). Secondary outcomes include patient satisfaction, post-anesthesia care unit (PACU) length of stay, postoperative pain scores and analgesic requirements, functional outcomes, postoperative delirium, and postoperative neurocognition.DiscussionVR used as a non-pharmacological adjunct to regional and spinal anesthesia during TKA may reduce sedative requirements while maintaining patient satisfaction. If true, this approach to minimizing sedation may impact clinical outcomes including perioperative complications and length of stay for older patients, while maintaining a high degree of patient satisfaction.Trial registrationThis trial was registered on ClinicalTrials.gov on January 29, 2021. The registration number is NCT04748549.

Efficacy of Perineural Dexmedetomidine in Ultrasound-guided Interscalene Block on Rebound Pain after Shoulder Arthroscopy.

This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene block (ISB) during shoulder arthroscopy. 47 patients were enrolled in this study. Patients were randomly assigned to 2 groups: Group DEX and Group Control received ultrasound-guided ISB using 12mL of 0.5% ropivacaine with 50ug of dexmedetomidine or without dexmedetomidine. Pain scores at 6, 12, 24, 48 h after surgery were assessed with Numeric Pain Rating Scale (NRS). Additional analgesic requirements and side effects in the first 48h postoperatively, as well as sleep disturbance on the night and other complications of surgery were examined. The incidence of rebound pain was lower in the group DEX than in the Control group. Perineural DEX decreased pain scores at 12 h and 24 h postoperatively. Group DEX had a prolonged time to first analgesic request, PCA sufentanil consumption in group DEX was less than group Control during the first 48 hours postoperatively. The number of patients with sleep disturbance and nausea and vomiting in the DEX group was lower on the first night postoperative. Perineural dexmedetomidine added to ISB exerts beneficial effect on the incidence of rebound pain after ISB in patients with pain catastrophizing undergoing shoulder arthroscopy. Perineural dexmedetomidine facilitated the implementation of multimodal analgesia in the early stage after operation.

A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block.

Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB). Forty patients were randomly allocated to receive a PENG block or FNB and ONB, both combined with wound infiltration (WI). The main outcome was pain, assessed using a Numeric Rating Scale (NRS) 30 minutes after the block, in Post Anesthesia Care Unit (PACU) and in the postoperative 6, 12 and 24 hours. Secondary outcomes included intra and postoperative analgesic requirement, need to increase the level of sedation and postoperative complications. We observed, except for 12 hours post-surgery, higher NRS values for PENG group compared to FNB + ONB group, with a median (IQR) NRS of 3 (2-4) vs. 2 (1-3.25) 30 minutes after the block, 1.5 (0-3.25) vs. 0 (0-1.25) at PACU, 1.5 (0-2) vs. 1 (0-2.25) at 6 hours, 1.5 (0-2) vs. 2 (1-2) at 12 hours, and 2 (0-2) vs. 1.5 (0-2) at 24 hours. Despite this, no result was statistically significant; all P>0.05. No differences were observed as regards other secondary outcomes. Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.

Combination of ultrasound-guided pectoral nerve block I and serratus anterior plane block for attenuation of surgical stress response during modified radical mastectomy: A prospective interventional randomized controlled trial

Background: General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane (SAP) block were used for surgical stress response attenuation and post-operative analgesia. Aims and Objectives: This study aimed to compare the efficacy of combined PECS I and SAP block to intravenous (IV) multimodal analgesia in attenuating surgical stress response and post-operative analgesia in patients who underwent modified radical mastectomy with axillary clearance. The primary objective was to estimate the intraoperative fentanyl requirement to reduce autonomic response due to surgical stimulus. The intraoperative vitals, post-operative numeric rating scale pain score, post-operative analgesic use in the recovery room, and incidence of post-operative nausea vomiting were the secondary objectives. Materials and Methods: Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received IV analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline were noted in the both groups. Intraoperative vitals, post-operative pain score, analgesic requirement, and incidence of post-operative nausea, and vomiting were also recorded in the both groups. Results: Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C (intraoperative fentanyl [mean±SD], 116.11±25.70 μg vs. 134.44±20.07 μg, P=0.023). Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B (SBP reduction [mean±SD], 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P=0.045 and HR reduction [mean±SD], 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P=0.009, respectively). The apparently higher pain scores in the control group were statistically insignificant. Conclusion: A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.

Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.

Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation. A single-center prospective, randomized, controlled study was conducted on ASA I-II patients aged 18-65 who underwent elective living donor hepatectomy. Participants were randomized into ESPB (N.=20) and control (N.=21) groups. ESPB was performed under ultrasound guidance with 0.25% bupivacaine (20 mL bilaterally) at T7-T9 levels. The control group received no block. Postoperative analgesia included IV acetaminophen, opioids, alongside fentanyl patient-controlled analgesia. Pain intensity was assessed using Numeric Rating Scale (NRS) at various time intervals. Primary outcome was to compare postoperative opioid consumption levels and secondary outcomes were to evaluate postoperative pain scores, requirement of rescue analgesia, and opioid-related side effects. Patients in ESBP group exhibited lower total fentanyl consumption (P=0.023) and lower meperidine use for rescue analgesia (P=0.001) compared to controls. While static pain scores showed no significant difference, Group ESPB reported lower dynamic pain scores in the immediate postoperative period (P=0.047). The incidence of nausea was lower in Group ESPB (6 vs. 17, P=0.002) with no observed complications. ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.

Intraperitoneal Bupivacaine 0.25% versus intravenous Diclofenac on post-operative analgesia in the cesarean section under spinal anesthesia: A prospective randomized comparative study in a tertiary care hospital of India

Background: Cesarean section (CS) is a common surgical procedure, often accompanied by significant post-operative pain, which can hinder recovery, bonding with the baby, and breastfeeding. Effective pain management is crucial to prevent complications such as chronic pain and depression. Intraperitoneal (IP) instillation of local anesthetics, such as Bupivacaine has shown promise in providing analgesia, while intravenous (IV) Diclofenac is a common alternative. Aims and Objectives: This study aimed to compare the post-operative analgesic efficacy of IP Bupivacaine with IV Diclofenac in parturients undergoing lower segment CS (LSCS). Materials and Methods: A randomized, double-blind, prospective study was conducted in Deen Dayal Upadhyay Hospital, New Delhi, with 60 patients divided into two groups: Group B received IP Bupivacaine (30 mL, 0.25%) and Group D received IV Diclofenac (1 mg/kg). Post-operative pain was assessed using the Visual Analog Scale (VAS) at various time points up to 24 h. The time to first rescue analgesia and total analgesic requirement were also measured. Results: Group B had significantly lower VAS scores at 6, 8, 10, 12, and 24 h post-operatively (P&lt;0.05). Time to first rescue analgesia was longer in Group B (7.26±1.04 h) compared to Group D (5.01±0.49 h) (P=0.001), and the total analgesic requirement was lower in Group B (P=0.01). Early breastfeeding was more feasible in Group B. Conclusion: IP Bupivacaine provided superior analgesia compared to IV Diclofenac, promoting earlier mobilization, bonding, and breastfeeding. It is a simpler and more effective method for post-operative pain management in LSCS.

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Pain level and analgesic requirements in patients who underwent vaginal pelvic floor surgery following general or spinal anesthesia.

This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent GA or SA during vaginal pelvic floor surgeries. A retrospective cohort study. Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, P=0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p=0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient's age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR= 0.33, p=0.008) and mid-urethral sling placement (aOR= 0.37, p=0.004). Limitaions: This is a rerospective study, thus the choice of anesthesia may be biased. SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries. GENERAL ANESTHESIA; SPINAL ANESTHESIA, ANALGESIA, PELVIC FLOOR SURGERY, PELVIC ORGAN PROLAPSE, STRESS URINARY INCONTINENCE, ERAS. Vaginal pelvic floor surgeries under spinal anesthesia is associated with less postoperative pain and intravenous analgesia requirement.

Procedure time-of-day effects on postoperative opioid requirements in children.

Postoperative analgesic requirements in adults follow circadian rhythm patterns with requirements for opioids and local anesthetics highest in the morning. Procedure time of day may also potentially affect circadian rhythm patterns with surgery at night promoting wakefulness during nighttime hours. This disruption may produce a shift in the circadian rhythm and potentially affect when postoperative opioid requirements are highest. We hypothesized that children undergoing surgery at night would have higher postoperative opioid requirements during nighttime hours secondary to a shift in the circadian rhythm with those requirements remaining higher than daytime requirements for the duration of the hospital stay. A retrospective cohort was completed on all children aged 1-18 years undergoing a laparoscopic appendectomy for complicated appendicitis between January 2018 and December 2019. Outcomes were total postoperative morphine equivalents (mg/kg), including total daytime and nighttime postoperative morphine equivalents (mg/kg) in children undergoing surgery during the day and at night. There were 999 children who underwent a laparoscopic appendectomy for complicated appendicitis at Texas Children's Hospital from January 1, 2018 to December 31, 2019. Of these, 758 children underwent the procedure during the day and 241 children at night. The total, daytime, and nighttime median morphine equivalents (mg/kg) for children undergoing an appendectomy during the day were 0.1 (0.0-0.4), 0.0 (0.0-0.2), 0.1 (0.0-0.2), respectively. The total, daytime, and nighttime morphine equivalents (mg/kg) for children undergoing an appendectomy at night were 0.2 (0.0-0.5) (p = -0.01), 0.1 (0.0-0.3) (p = 0.01), and 0.1 (0.0-0.2) (p = 0.03), respectively. All children, irrespective of the procedure time of day, required more morphine equivalents during daytime hours than during nighttime hours. We found that procedure time of day did not impact postoperative opioid requirements in children undergoing a laparoscopic appendectomy for complicated appendicitis. Both children undergoing an appendectomy during the day or at night required more morphine equivalents during daytime hours than during nighttime hours. Surgery at night did not produce a shift in opioid requirements postoperatively from daytime hours to nighttime hours in children undergoing an appendectomy at night.

Comparison of frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing transurethral resection of prostate with and without postoperative catheter traction.

Objective: To determine and to compare the frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing TURP with and without postoperative catheter traction. Study Design: Analytical Cross Sectional Study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Dec 2023 to March 2024. Methods: After ERC approval &amp; informed consent a total of 48 patients with comparable baseline characteristics such as age and preoperative prostate size who underwent TURP and were having significant postoperative hematuria (≥ grade 2 on a standardized hematuria colorimetric card) were enrolled in the study &amp; were divided into two groups i.e. group A and group B, each having 24 patients. Group A patients were subjected to postoperative catheter traction with thigh using an adhesive band that was maintained over the night, while group B patients were not subjected to this postoperative intervention. Patients of both the groups received a single shot of IM diclofenac sodium 75mg in the recovery room and later on oral diclofenac sodium 50mg was given twice a day. All Patients were presented with a visual analogue scale (VAS) every 6 hourly during the first 24 hours postoperatively and were given additional IM diclofenac sodium 75mg if the reported pain was of moderate-severe intensity as indicated by the VAS score and an entry was made on the pro forma. Also, at the time of discharge total days spent in the hospital by patients of both the groups after undergoing TURP and any postoperative complications were noted. Results: 79.16% of group A patients required additional postoperative analgesia as compared to a value of 29.16% of group B patients (p= 0.0001). The mean hospital stay of group A and group B was 4.04 ± 0.65 days and 3.25 ± 0.65 days respectively (p=0.0001).

Transdermal Buprenorphine Patch in the Management of Postoperative Acute Pain following Mandibular Resection and Reconstruction

BackgroundTransdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has not been evaluated. PurposeTo evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft. Study design, setting and sampleThis triple-blinded, randomized controlled trial included 30 subjects in the age range of 18 to 60 years with benign mandibular pathologies. Subjects visiting the Outpatient Department of Dept. of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, India were included in the study. Subjects with known allergies to any drugs, using sedatives, alcohol, pregnant and lactating mothers, and with respiratory problems were excluded. PredictorThe predictor variable was postoperative pain management and subjects were randomly assigned to TBP or a placebo patch group. Main outcome variableIt was the postoperative pain, which was measured by visual analog scale (VAS) for seven consecutive days. Secondary outcome variables were requirement of rescue analgesics and drug-related adverse effects. CovariatesAge at surgery, sex, diagnosis, duration of the operation and amount of fentanyl used during the operation were covariates. AnalysesDescriptive statistics, Mann-Whitney U, Chi-square, Repeated Measures ANOVA and post-hoc analysis (Bonferroni test) were used. A P-value <0.05 was considered as a level of statistical significance. ResultsThirty subjects were randomly allocated to TBP and control group. The mean VAS score during the study period was 0.8±2.37 and 3.49±2.37 in TBP and control group subjects respectively (P<0.001). Compared to control group, the mean VAS score in TBP group subjects was significantly less till the end of post-operative day-4 (P<0.001). The mean rescue analgesic requirement during post-operative period was 5.33±15.8mg and 47.6±37.7mg in the TBP and control group subjects (P<0.001). Nausea was most common drug-related adverse effect in both the group subjects (46.7%) (P>0.9). Conclusion and RelevanceThe highest VAS score in TBP group subjects was 1.53±0.92 on post-operative day-1 morning, whereas it was 6.47±1.3 at 6-hours after operation in control group subjects. Thus, a TBP was adequate for the management of post-operative pain following mandibular resection and reconstruction.

Optimal Programmed Intermittent Epidural Bolus Interval Timing When Using 10 mL of 0.1% Ropivacaine and 0.5 mcg/mL Sufentanil for Labor Analgesia in Patients Without Breakthrough Pain: A Prospective, Randomized Study.

Interval time, defined as the period of time that effective analgesia can be achieved without the need for patient-controlled epidural analgesia (PCEA), has been investigated as an important parameter for the design of programmed intermittent epidural bolus (PIEB) approaches to labor analgesia. PCEA approaches offer flexibility in the management of labor-related pain while minimizing the risk of patient overdose. Here, the optimal interval between PIEB boluses of 0.1% ropivacaine and 0.5μg/mL sufentanil was evaluated while using revised criteria to define effective analgesia that allowed for the administration of a rescue PCEA bolus during these intervals. Participants were assigned at random to five different groups with PIEB intervals that ranged from 35 to 55minutes. Labor epidural analgesia was initiated by administering 15mL of 0.1% ropivacaine with 0.5μg/mL sufentanil over a 2-minute period. Analgesia was considered effective if there was no additional requirement for manual analgesia or an additional PCEA bolus beyond a maximum of one PCEA bolus between intervals during the first stage of labor. Probit regression analyses were used to estimate the effective PIEB intervals that achieved 50% (EI50) and 90% (EI90) success rates in patients. The final analysis included 142 patients who underwent PIEB for maintaining analgesia during labor. Intervals of 55, 50, 45, 40, and 35minutes were associated with analgesia efficacy odds of 82.8% (24/29), 86.2% (25/29), 96.3% (26/27), 100% (29/29), and 100% (28/28), respectively. The respective EI50 and EI90 intervals associated with patients not suffering from breakthrough pain were 62.9 (95% CI 57.2-91.8) and 50.4 (95% CI 45.3-54.9) minutes. Under the condition of this study, the optimal PIEB interval for the administration of 10 mL boluses of 0.1% ropivacaine and 0.5μg/mL sufentanil is approximately 50minutes.

Impact of Ultrasonography-Guided Transversus Abdominis Plane Block and Local Anesthetic Infiltration in the Surgical Field on Postoperative Analgesic Requirements for Laparoscopic Cholecystectomy Procedures

Impact of Ultrasonography-Guided Transversus Abdominis Plane Block and Local Anesthetic Infiltration in the Surgical Field on Postoperative Analgesic Requirements for Laparoscopic Cholecystectomy Procedures

Effect of total intravenous anesthesia versus sevoflurane anesthesia on intraoperative facial nerve monitoring: a randomized controlled trial.

Intraoperative facial nerve monitoring (IFNM) facilitates effective nerve preservation during ear and head and neck surgeries. Quantitative differences in the timely feasibility of IFNM during total intravenous anesthesia (TIVA) vs sevoflurane anesthesia have not been investigated. We conducted a randomized controlled trial in which 98 patients undergoing ear surgery were allocated to either the TIVA or sevoflurane group. We used quantitative neuromuscular monitoring of train-of-four (TOF) responses to assess achievements of IFNM-feasible conditions, and recorded the TOF count (TOFC) or TOF ratio of T4/T1 (TOFR). The primary outcome was the time interval between a TOFR of 0.25 and 0.75 (recovery index). The most important secondary outcome was the time to reach a TOFR of 0.25. We also recorded the quality of IFNM, intubation condition, patient-ventilator dyssynchrony, surgeon's satisfaction, and postoperative analgesic and antiemetic requirements. Ninety-two patients completed the study. The median [interquartile range] recovery index was significantly shorter in the TIVA group (9 [7-11]min) than in the sevoflurane group (34 [24-53]min), with a difference in medians of 25min (95% confidence interval, 20 to 31; P < 0.001). Before IFNM requests, the time to TOFR of 0.25 was achieved earlier in the TIVA group (34 [29-41]min) than in the sevoflurane group (51 [43-77]min) (P < 0.001). Both groups achieved neuromuscular recovery in time for IFNM without a need for reversal agents. Intraoperative facial nerve monitoring was feasible earlier and faster under TIVA than under sevoflurane anesthesia. We suggest that TIVA may be a preferable choice over sevoflurane to meet a surgeon's request for an earlier IFNM. CRIS.nih.go.kr ( KCT0006676 ); first submitted 7 October 2021.

Caudal versus regional block with the use of ultrasound in pediatric analgesia: a systematic review of the main clinical results

Introduction: Regional anesthesia has been gaining prominence in recent decades. A variety of peripheral and central nerve blocks have been developed to ensure that perioperative pain can be effectively controlled. Caudal block is one of the most widely administered techniques of regional anesthesia, and the use of ultrasound has enabled the optimization and precision of the techniques. Objective: This study aimed to analyze the main clinical considerations and outcomes of ultrasound-guided caudal and regional block for pediatric analgesia. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found. 75 articles were evaluated and 27 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with a high risk of bias and 21 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 = 18.7% &lt; 50%. All these techniques protect children from perioperative pain and, combined with periprocedural sedation, allow surgical interventions with spontaneous breathing in groups of patients with maximum risk of difficult airways. We consider this specific point the main advantage of regional anesthesia in pediatric patients. Ultrasound-guided caudal epidural, performed under sedation with a non-instrumented airway, is an effective technique in daily clinical routine; however, higher body weight and surgical procedures in the mid-abdomen are risk factors for pain-related block failure. Patients who, regardless of chronological age, were born as extremely premature infants have a higher risk of respiratory events. For bilateral inguinal hernia surgeries, ultrasound-guided caudal epidural block and transversus abdominis plane block showed similar analgesic efficacy in the first six hours postoperatively. Furthermore, ultrasound-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and longer-lasting analgesia compared with ultrasound-guided caudal block for pediatric lower limb surgeries. Ultrasound-guided erector spinae block was safe and effective in pediatric patients undergoing unilateral lower abdominal surgery, as it provided longer-lasting analgesia and fewer analgesic requirements than caudal block and fewer side effects. In children undergoing regional anesthesia, the incidence of infection, hematoma, and local anesthetic toxicity is low.

Erector spinae plane block (ESPB) enhances hemodynamic stability decreasing analgesic requirements in surgical stabilization of rib fractures (SSRFs)

ObjectiveTo evaluate the efficacy of erector spinae plane block (ESPB) on intraoperative hemodynamic stability, opioid and inhalation anesthetic requirements and postoperative analgesic effects in patients undergoing surgical stabilization of rib fractures (SSRFs).MethodsWe retrospectively reviewed 173 patients who underwent surgical stabilization of rib fractures between May 2020 and December 2023. The patients were allocated into the ESPB group or the control group. Demographic data, intraoperative hemodynamic parameters, total intraoperative opioid consumption, the average minimum alveolar concentration (MAC) of inhalational anesthetics, postoperative simple analgesics and opioid consumption and the length of hospital stay were included in the analysis.ResultsCompared with the control group, the ESPB group had a lower heart rate (HR) in the first 90 min after surgical incision and lower systolic blood pressure (SBP) and mean arterial pressure (MAP) at the beginning of surgery. Intraoperatively, a notable reduction in fentanyl consumption was observed in the ESPB group (p = 0.004), whereas no significant difference was observed in the average MAC of inhalational agents (p = 0.073). Postoperatively, the ESPB group required fewer doses of simple analgesics in the first 24 h (p < 0.001) and 48 h (p = 0.029). No statistically significant difference in the length of hospital stay (p = 0.608) was observed between the groups.ConclusionESPB was shown to enhance intraoperative hemodynamic stability, reduce opioid consumption and decrease postoperative analgesic consumption in patients who underwent SSRF. These results suggest that ESPB may serve as a valuable component of multimodal analgesia protocols for SSRF. Larger prospective studies are warranted to confirm the results and evaluate long-term outcomes.

The efficacy of transversalis fascia plane block in pediatric inguinal herniotomy: a randomized controlled study.

The post-operative analgesic efficacy of transversalis fascia plane (TFP) block is controversial in pediatric patients undergoing herniotomy. This study aims to compare the efficacy of TFP block and standard analgesic methods. Sixty patients aged 1-8 years who underwent the open procedure of herniotomy were randomly divided into two groups TFP block (n = 30) or control group (n = 30). The TFP group received 0.25% bupivacaine at 0.5 mL/kg. Routine analgesia protocol was applied to Group C. Pain scores (FLACC), family satisfaction, block complications, nausea, sedation score, and additional analgesic requirements were recorded. FLACC pain scores at post-anesthesia care unit (PACU), 1st, 2nd, and 4th h were statistically significantly lower in Group TFP compared to group control (p < 0.05). Three patients in Group TFP and 12 in group control required rescue analgesics at PACU (p = 0.015). Ibuprofen was required in two patients in Group TFP and 11 in Group Control (p = 0.010). Parental satisfaction is higher in the TFP group than in Group Control (p < 0.001). There was no statistically significant difference between the groups in terms of post-operative nausea and sedation scores (p > 0.05). We conclude that TFP block in pediatric patients is an appropriate approach as a part of multimodal analgesia. It creates fewer pain scores in the early post-operative period, requires less additional analgesia, and increases family satisfaction.

Comparative Analysis of Effect of Lidocaine and Adrenaline Soaked Gauze Versus Normal Saline Soaked Gauze at Skin Graft Donor Site of Thigh: A Randomized Control Trial

Objective: To compare the hemostatic effect of Lidocaine and Adrenaline soaked gauze with normal saline soaked gauze at skin graft donor site of thigh. Study Design: Randomized control trial (Trial ID: NCT04344483). Place and Duration of Study: Plastic &amp; Reconstructive Surgery Department, Dow University of Health Sciences Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun to Oct 2020. Methodology: A randomized controlled trial was carried out on 60 Patients under treatment in burn surgery unit. Patients were randomly assigned to 2 groups. Patients in both groups at donor sites received subcutaneous infiltration for 10 minutes, either with 2% Lidocaine and 1:100,000 Adrenaline soaked gauze or with normal saline soaked gauze. Outcomes included intraoperative bleeding, number of dressings required in first 24 hours after surgery, post-operative pain in first 24 hours, systemic analgesia requirement after surgery within 24 hours and donor-site epithelization at 14th post-operatively. Statistical Package for Social Sciences version 25 was used to analyze the data. Results: out of 60 patients, the mean age was estimated as 36.58±12.42 years and 44(73.3%) patients were males while 16(26.7%) were females. Statistically significant difference was observed in number of dressings (p=0.001), mean pain score in first 24 hours (p=0.001), intra-operative bleeding (p=0.001) and systemic analgesia requirement in 24 hours of surgery (p=0.001) between both groups. Conclusion: In comparison to normal saline soaked gauze, the Lidocaine and Adrenaline soaked gauze was effective in terms of number of dressings, pain in first 24 hours, intra-operative

A prospective comparitive study of transdermal patches for post operative pain management in laprotomy surgeries: efficacy and rescue analgesic requirements

A prospective comparitive study of transdermal patches for post operative pain management in laprotomy surgeries: efficacy and rescue analgesic requirements