Analgesic Demand Research Articles

Ultrasound-guided modified intercostal nerve block improves analgesia after radical mastectomy: A randomized controlled trial

BackgroundRadical mastectomy often causes acute and chronic pain. One aimed to explore whether unilateral, ultrasound-guided, single-injection modified intercostal nerve block (MINB) could improve postoperative analgesia compared with no-MINB (Control group) in patients undergoing radical mastectomy. MethodsSixty-five patients were randomly assigned to receive no-MINB (Control group) or MINB (MINB group) with 0.33 % ropivacaine (30 ml). The primary outcome was Visual Analogue Scale (VAS) scores at rest 6 h postoperatively. Secondary outcomes included VAS scores at rest and during movement at 0 h, 12h, 24h, 48h, and 90 days postoperatively; use of intraoperative opioids; postoperative rescue analgesia; time of first ambulation; complications; and score of China version of the Quality of recovery-15 (QoR-15) questionnaire (0 = extremely poor QoR; 150 = excellent QoR) at 24 h after surgery. ResultsThe MINB group showed lower resting VAS (resting) pain score at 6 h postoperatively (median [interquartile], 1 (0–2), vs 2 (2–3), 95 % CI difference in medians 1–2; P < 0.001), and significantly lower scores at resting and during movement at 0–24 h postoperatively. The MINB group showed lower intraoperative opioid use, a better quality of recovery on the QoR-15 scale, and more patients needed rescue analgesia in control group compared to those in MINB group. None of the MINB subjects showed MINB-related complications. ConclusionPreoperative ultrasound-guided MINB markedly improved analgesia and concurrently reduced rescue analgesia demands and better recovery in patients undergoing radical mastectomy.

Adequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception.

Background/Objectives: Hemodynamic instability and inappropriate postoperative pain perception (IPPP) with their consequences constitute an anesthesiological challenge in patients undergoing primary elective open lumbar infrarenal aortic aneurysm repair (OLIAAR) under general anesthesia (GA), as suboptimal administration of intravenous rescue opioid analgesics (IROAs), whose titration is optimized by Adequacy of Anaesthesia (AoA) guidance, constitutes a risk of adverse events. Intravenous or thoracic epidural anesthesia (TEA) techniques of preventive analgesia have been added to GA to minimize these adverse events. Methods: Seventy-five patients undergoing OLIAAR were randomly assigned to receive TEA with 0.2% ropivacaine (RPV) with fentanyl (FNT) 2.5 μg/mL (RPV group) or 0.2% bupivacaine (BPV) with FNT 2.5 μg/mL (BPV group) or intravenous metamizole/tramadol (MT group). IROA using FNT during GA was administered under AoA guidance. Systemic morphine was administered as a rescue agent in all groups postoperatively in the case of IPPP, assessed using the Numeric Pain Rating Score > 3. The maximum score at admission and the minimum at discharge from the postoperative care unit to the Department of Vascular Surgery, perioperative hemodynamic stability, and demand for rescue opioid analgesia were analyzed. Results: Ultimately, 57 patients were analyzed. In 49% of patients undergoing OLIAAR, preventive analgesia did not prevent the incidence of IPPP, which was not statistically significant between groups. No case of acute postoperative pain perception was noted in the RPV group, but at the cost of statistically significant minimum mean arterial pressure values, reflecting hemodynamic instability, with clinical significance < 65mmHg. Demand for postoperative morphine was not statistically significantly different between groups, contrary to significantly lower doses of IROA using FNT in patients receiving TEA. Conclusions: AoA guidance for IROA administration with FNT blunted the preventive analgesia effect of TEA compared with intravenous MT that ensured proper perioperative hemodynamic stability along with adequate postoperative pain control with acceptable demand for postoperative morphine.

Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl transdermal patch in the management of postoperative pain after lower limb surgery

Background: Postoperative pain represents a significant medical issue that needs immediate attention. Despite advancements in pain management, managing postoperative pain remains challenging. Transdermal drug delivery systems (TDDS) offers a straightforward, reliable, non-invasive, and patient-friendly approach for alleviating post-surgical pain. Hence, this study was planned to evaluate the analgesic efficacy of buprenorphine and fentanyl transdermal patch in the management of post-operative pain after lower limb surgery. Methods: In this prospective, randomised study, 82 adult patients of either sex undergoing elective lower limb surgery were randomly allocated into two groups- Group A (Transdermal Buprenorphine 20 mg patch) and Group B (Transdermal Fentanyl 50 mcg patch). Postoperative pain was assessed by 10-point Visual Analogue Scale (VAS) every 6 hours following surgery on the first day and then daily for next 4 days. All patients were also monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status. Statistical analysis was carried out using student t-test and Chi-square test. A p-value &lt;0.05 was considered significant. Results: The mean pain intensity scores were found to be significantly different (p&lt;0.0001) between the two groups, with VAS scores consistently lower in Buprenorphine group as compared to Fentanyl group. Also, Buprenorphine group had the lowest demand for rescue analgesic, with 58.5% of patients requiring two administrations and 36.6% needing only one. Patients belonging to Fentanyl group exhibited higher occurrence of nausea (46.3%), vomiting (46.3%) and pruritus (31.7%). Conclusions: Our study concludes that transdermal patch of buprenorphine demonstrates superior efficacy and safety profile as compared to fentanyl patch for post-operative pain management in lower limb surgeries.

Effect of Addition of Hyaluronidase as an Adjuvant to Lidocaine and Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Abstract Background Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post- operative pain control. Objective The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block. Methods This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month). Results There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 ± 47.97 mins, group B: 610.5 ± 57.9 mins) and motor (group A: 660.5 ± 47.29 mins, group B: 625.5 ± 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 ± 48.74 mins, group B: 618 ± 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 ± 1.56 mg). Conclusion This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block ….etc), the difference between the two groups was also significant statistically.

Effectiveness of Lignocaine Tramadol Hydrochloride Combination in Bier’s Block on Post-Operative Analgesia

Background: Bier’s block has been most commonly used for hand and wrist surgery. Though it reduces the potential complication of general anaesthesia, significant post-operative pain is very common just after tourniquet release. Many adjuvants have been used so far with local anaesthetic to produce a dense block and to provide adequate post–operative analgesia. Of them, Tramadol Hydrochloride was used very successfully as it has got less potential side effects. This study was done to see the effect of Tramadol Hydrochloride in Bier’s block for post-operative analgesia after tourniquet release. Methods: This study was carried out in the Department of Anaesthesiology, Bangladesh Medical College Hospital, Dhaka, during the period of July ’2011 to march ’2012. A total sixty patients aged 20-60 years of ASA-1 and ASA-2 undergoing hand and wrist surgery of less than 40-minute duration were enrolled for the study. The effectiveness of combination of Lignocaine and Tramadol Hydrochloride as an anaesthetic solution in Bier’s block was assessed in terms of reduction of tourniquet pain, quality of anaesthesia, the time of first analgesic demand, and the amount of total analgesic needed in post-operative 24-hours period. Patients in control group (Gr-L) received 40 ml of 0.5% Lignocaine and patients in trial group (Gr-LT) received 38 ml of Lignocaine with 2ml (100mg) of Tramadol Hydrochloride as an anaesthetic solution. Patients were observed post-operatively for 24 hours. Pain was assessed in terms of VAS. Results: Tourniquet pain was significantly less in Gr-LT (p&lt;0.000). Post-operative analgesia was also significantly prolonged in Gr-LT (109.61±12.32 min) than in Gr-L (75.8±9.30 min). The number of total analgesic demand in post-operative 24 hours period was also significantly reduced in Gr-LT (P&lt;0.000).Conclusion: The Lignocaine and Tramadol Hydrochloride mixture in Bier’s block provides adequate post-operative analgesia and causes less analgesic demand in post-operative period.

Effect of non-invasive bilateral sphenopalatine ganglion block on postoperative pain in patients undergoing septorhinoplasty surgery: a randomized controlled study.

The objective of this study was to assess the impact of preoperative sphenopalatine ganglion block (SPGB) on postoperative pain and assess intraoperative and postoperative analgesic consumption in patients undergoing septorhinoplasty. In this prospective, randomized controlled study, 72 patients were included and divided into two groups: group 1 (36 patients) received the sphenopalatine ganglion block (SPGB), while group 2 (36 patients) served as the control group. Patient assessments, using the numerical rating scale (NRS), were conducted at the postoperative first hour, fourth hour, and 24th hour. Additionally, intraoperative hemodynamics, analgesic requirements, and postoperative analgesic requirements were documented. The patients in group 1 exhibited significantly lower NRS scores at postoperative first, fourth, and 24th hour than those in group 2 (P<0.001 for all three time points). Additionally, the mean Riker Sedation-Agitation Scale (RSAS) scores were significantly lower in group 1 than in group 2 (P=0.006). Both intraoperative remifentanil use and postoperative analgesic consumption were significantly higher in patients in group 2 (P<0.001 and 0.004, respectively) than those in group 1. Analysis of intraoperative heart rate and mean arterial pressure (MAP) revealed that patients in group 1 had lower postoperative heart rates (P=0.040) than those in group 2, and MAP values after intraoperative block, at 30 min, and postoperatively were significantly lower (P=0.005, P=0.001, and P=0.034, respectively) than those in group 2. We advocate for the adoption of the noninvasive SPGB method in patients undergoing septorhinoplasty surgery. This approach significantly reduces the need for intraoperative analgesics, alleviates postoperative pain, and reduces the demand for postoperative analgesics. Moreover, it improves the overall surgical experience because of its ease of application, contributing to a more comfortable surgical process.

Assessment of Three Distinct Approaches to Postoperative Pain in Laparoscopic Inguinal Hernia Repair, a Randomized Prospective Study.

Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups (P > .05). Procedure duration was found to be significantly longer in IINB group compared with others (p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o (P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o (p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.

Empowering Expecting Mothers: The Impact of Antenatal Classes on Child Birth Experience.

Introduction Antenatal education is one of the ways to increase a woman's knowledge about pregnancy and childbirth, which could improve self-efficacy during labor, making the expecting mothers well-prepared for labor and nursing. One of the ways for its delivery could be via well-structured antenatal classes. Such classes are part of many countries' healthcare systems and have proven to decline maternal anxiety, shorten labor, increase partner involvement, and overall improve labor experience. However, at the same time, such classes can augment more interventions in labor, induction of labor, and epidural usage. Despite the heterogeneous results of their effect, the high demands of antenatal education amongpregnant women can justify its incorporation into antenatal care. By allowing the women to identify labor correctly and preventing admission in false labor, shortening the labor, and teaching women non-pharmacologic ways to manage labor pains, it can reduce the patient and fiscal burden on the already overwhelmed maternity units of Pakistan, hence proving to be an inexpensive health promotion tool. Methods This cross-sectional study was conducted in the Department of Obstetrics and Gynecologyof Aga Khan University Hospital Karachi, Pakistan, between December 2020 and June 2021. All pregnant women, aged 18 to 45 years, between gestational ages of 37 to 42 weeks, with singleton, cephalic pregnancy, booked during the first or second trimester, and who attended at least one antenatal class, were invited to participate. Women who had any contraindication to vaginal delivery, whose labor was induced, or who suffered from medical, psychological, or obstetric comorbidities were excused. The participants were observed for labor outcomes in terms of stage of labor on arrival, use of epidural analgesia, mode of delivery, and childbirth experience, using a validated research tool, known as the Questionnaire for Assessing the Childbirth Experience (QACE)to identify women with a positive or negative childbirth experience. A higher score representing on the questionnaire represented a more negative birth experience. A score of less than 19 was considereda positive birth experience. Data was analyzed using IBMStatistical Package for Social Sciences (SPSS) Statistics for Windows, Version 19. Results The mean QACE score was reported as 18.2±3.00, reflecting that on average the mothers had a positive childbirth experience. Modes of delivery revealed 57.6% of the women delivering spontaneously, with 60.4% of them arriving in the labor room in active labor. Demand for labor analgesia in the form of epidural was 64%. Majorly the participants attended only one antenatal class, with 66.91% of women reporting a positive childbirth experience. Conclusion Antenatal education classes are a low-input, high-yielding resourcethat can be used to empower mothers with pertinent information and support for a pleasant childbirth experience while simultaneously taking the edge off the overburdened maternity wards of low resources, in densely populated countries like Pakistan. Hence it is the need of the hour to devise plans to invest in these classes to make them available to the masses.

Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial

BackgroundImproved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. ObjectiveThis study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. Study DesignIn this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. ResultsMedian (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2–4] vs 3 [2–4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0–19.0] hours vs 15.3 [13.3–17.0] hours, estimated median difference, 1.5; 95% CI, 1–2; P<.001). ConclusionAs a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.

Monitored Anesthesia Care (MAC) as an Alternative to General Anesthesia (GA): Prospective Double-Blinded Randomized Controlled Study Comparing Efficacy and Safety of Dexmedetomidine and Ketamine Infusions with Ultrasonography (USG) Guided Pectoral Nerve Block (PECs) for Postoperative Analgesia in Breast Surgery.

PECs blocks are usually combined for breast surgery under general anesthesia (GA) to provide postoperative analgesia rather than primary anesthesia technique. A prospective, interventional, single-center, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was conducted in a tertiary care teaching center after obtaining the Ethics Committee's approval and patients' written informed consent. Forty-eight American Society of Anesthesiologists physical status I/II patients aged 18-60 years, undergoing elective unilateral breast surgery were enrolled. Patients were block-randomized (computer-generated) to two equal groups (24 patients each), with one of them receiving Dexmedetomidine and the other one Ketamine. For concealment, sequentially numbered, sealed, opaque envelopes were used. The study was double-blinded for both the anesthesiologist and outcome assessor anesthesiologist. Obese patients (body mass index > 30), those with infection at block site, coagulopathy and known hypersensitivity to local anesthetics or study medications as well as individuals who refused participation in research were all excluded. The Dexmedetomidine group received a bolus of 0.5 mcg/kg over ten minutes, followed by an infusion of 0.3 mcg/kg/hour, while the Ketamine group received a bolus of 0.5 mg/kg over ten minutes, followed by an infusion of 0.3 mg/kg/hour. Postoperative analgesia was compared using a visual analogue scale (VAS) at regular intervals. When VAS exceeded four, 1 mg/kg intravenous Pethidine was administered as a rescue analgesic. Sub-anesthetic low-dose Ketamine was more effective than low-dose Dexmedetomidine in prolonging PECs block analgesia, which was statistically significant (p value < 0.001). The Ketamine group had lower rescue analgesic Pethidine consumption and longer first-rescue analgesia demand time. There was no significant hemodynamic difference between the study groups. Ketamine was more efficient than Dexmedetomidine for postoperative analgesia.

Effect of Topical Application of an NSAID Lateral to the Incision on Postoperative Pain Following Unicompartmental Knee Arthroplasty: A Double-Blind Randomized Controlled Trial.

How to minimize postoperative pain following knee replacement surgery has been a great challenge. This study was performed to evaluate the effect of applying a topical nonsteroidal anti-inflammatory drug (NSAID) lateral to the incision for postoperative pain following unicompartmental knee arthroplasty (UKA). The randomized controlled trial enrolled 100 patients from August 2023 to January 2024. One hundred patients who underwent UKA were randomized into two groups. The intervention group received a topical NSAID lateral to the incision postoperatively, and the control group received a placebo lateral to the incision postoperatively. The primary outcome measures were the amount of opioid consumption and the visual analogue scale (VAS) score (12, 24, 36, 48, and 72 h after operation) for pain. The secondary outcome measures were the American Knee Society Score (AKSS, preoperation and 1-month follow-up after operation), the time of first analgesic demand, side effects of opioids, operation time, postoperative stay, surgery-related complications, and postoperative incision healing grade. Independent sample t test and paired sample t test were used to compare continuous data. Chi-square test and Fisher's precision probability tests were used to analyze the categorical data. Ninety-eight patients (intervention group, 48 patients; control group, 50 patients) were analyzed. Opioid consumption was significantly lower in the intervention group than in the control group during the first 12 h, 12 to 24 h, and 24 to 48 h postoperatively (p < 0.05). The VAS score for pain within 72 h postoperatively was significantly lower in the intervention group than in the control group (p < 0.05). There was no significant difference in the AKSS, operation time, postoperative stay, complications, or postoperative incision healing grade between the two groups. The time of first analgesic demand for patient-controlled analgesia was significantly later in the intervention group than in the control group (p < 0.05). There were fewer side effects of opioids in the intervention group (8.3%) than in the control group (18.0%). Postoperative application of topical NSAIDs lateral to the incision is an effective and safe method for pain management after UKA, helping to decrease the pain score and reduce opioid consumption postoperatively with no increase in side effects.

Comparison of First Analgesic Demand in Post-Operative Period Among Diclofenac Group Versus Paracetamol Group

Background: Pain after major surgery causes delays in patients' postoperative recovery, extended hospitalization periods, excessive use of analgesics, and is extremely stressful for both surgery and anesthesia. Preemptive analgesia is a treatment that begins before surgery to prevent the development of central sensitization caused by incisional and inflammatory damage that occur during surgery and in the early postoperative period. Opioids and nonsteroidal anti-inflammatory medications (NSAIDs) are commonly used for this purpose. Diclofenac sodium is a typical, inexpensive NSAIDS. Preemptive analgesia can reduce the severity and duration of pain while also delaying it. Objectives: The aim of the study was to evaluate the Comparison of first analgesic demand in post-operative period among Diclofenac group versus Paracetamol group. Methods: This randomized controlled trial study was carried out in the Department of Anaesthesiology &amp; ICU Bangladesh Medical College Hospital Dhaka, Bangladesh during 18th January 2020 to 17th July 2020. A total of 50 patients were participated in the study. Sample was selected by random sampling in two groups distributed as- group A (Oral diclofenac sodium), group B (Oral paracetamol). Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The majority of patients (63.0%) were between 40 and 59 years old, with a mean age of 48.3 ± 11.2 years. In groups A (58%) and B (56%), nearly two-thirds of the patients had an ASA grade of one. There was no statistically significant difference between the two groups (p&gt;0.05). At baseline, no significant change in heart rate, SBP, or DBP was seen across groups. The postoperative heart rate and other haemodynamic state were assessed at two, six-, and twelve-hours following surgery. Conclusion: Preemptive oral Diclofenac sodium had significant effect on reducing postoperative pain and postoperative .......

Impact of a transversus abdominis plane block with low-dose magnesium sulphate coupled to bupivacaine on postoperative pain after laparoscopic cholecystectomy: A randomized trial

ObjectivesThe subcostal transversus abdominis plane (STAP) block has recently been included in the enhanced recovery after surgery (ERAS) protocol for laparoscopic cholecystectomy (LC). In our study on STAP for LC, we compared the effectiveness of adding low-dose magnesium sulphate (MgSO4) to bupivacaine versus using bupivacaine alone. MgSO4 was hypothesized to enhance the analgesic effects of bupivacaine and therefore aid in the recovery process. MethodsSixty patients, aged 18–65 years, ASA I–II, undergoing LC, were randomly assigned to receive bilateral STAP 15 min before skin incision with 20 ml bupivacaine 0.25 % and either 150 mg MgSO4 (BM group) or 1.5 ml normal saline (B group). Pain scores, time to initial analgesic demand, overall analgesic requirement, sedation, emetic episodes, time to get out of bed, and patient satisfaction were recorded for the first 24 h following surgery. The Mann-Whitney U test was used to analyze the non-normally distributed data between groups, while the Chi-square test or Fisher’s exact test was used to test categorical data. ResultsThe BM group had statistically significant but clinically insignificant lower pain scores at rest and during coughing in the post-anesthesia care unit (PACU) (P = 0.005 and P = 0.003), at 1 h (P = 0.005 and P = 0.015), 6 h (P = 0.009 and P = 0.003), 12 h (P = 0.017 and P = 0.001), and 24 h (P = 0.001 and P = 0.001) after surgery compared to the B group. Kaplan–Meier curves for times to the first paracetamol and morphine doses showed significant differences (log-rank test) between the groups (P = 0.001 and P = 0.003, respectively). Additionally, the total doses of paracetamol (P = 0.001) and morphine (P = 0.001) in the BM group were significantly lower than those in the B group during the first 24 h after surgery. Sedation and emetic episodes were identical between the groups. The Patient in the BM group ambulated faster (P = 0.001) and were more satisfied (P = 0.026) than those in the B group. ConclusionsAdding a low-dose (150 mg) of MgSO4 to bupivacaine in the STAP block for LC was associated with improved analgesic outcomes in the first 24 h after surgery. Ethical approvalMedical Ethics Committee of Faculty of Medicine, IRB no: 17,100,622 on November 15, 2016. Trial registrationClinicalTrials.gov (NCT03612947) on August 2, 2018.

Essential Oils from the Genus Piper Promote Antinociception by Modulating TRP Channels and Anti-Inflammatory Effects in Adult Zebrafish.

The Piper genus, known for its pharmacological potential, comprises 2,263 species primarily found in tropical regions. Despite recent advancements in pain therapies, the demand for more effective and well-tolerated analgesics and anti-inflammatories, particularly for chronic pain, remains. This study assessed the effects of essential oils from Piper caldense, Piper mosenii, and Piper mikanianum on nociceptive behavior induced by formalin and capsaicin, as well as their anti-inflammatory impact induced by carrageenan, using adult zebrafish models. Results indicated non-toxic essential oils with antinociceptive properties in both neurogenic and inflammatory phases of formalin-induced nociception through interaction with the TRPA1 receptor. Additionally, P. mosenii essential oil also blocked the nociceptive effect of capsaicin, a TRPV1 receptor agonist. Furthermore, essential oils from P. caldense and P. mikanianum exhibited significant anti-inflammatory effects by reducing carrageenan-induced abdominal edema. These findings highlight the pharmacological potential of Piper's essential oils as antinociceptive and anti-inflammatory agents.

Efficacy of Transcutaneous Electrical Acupoint Stimulation on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Lobectomy: Study Protocol for a Prospective Randomized Controlled Trial.

Patients undergoing video-assisted thoracoscopic lobectomy (VATL) often experience chronic postsurgical pain (CPSP). Postoperative pain can affect the recovery of postoperative lung function, prolong postoperative recovery time, and increase patient hospitalization expenses. Transcutaneous electrical acupoint stimulation (TEAS) is an alternative therapy based on acupuncture that has shown promise in postoperative recovery and pain management across various medical fields. However, research specifically focused on the improvement of CPSP after VATL is currently lacking. The purpose of this study is to evaluate whether TEAS can effectively reduce the severity and occurrence of chronic postsurgical pain in patients undergoing VATL. By investigating the potential benefits of TEAS in mitigating CPSP after VATL, this study aims to provide valuable clinical evidence to support the integration of TEAS into postoperative care protocols for patients undergoing VATL. This study is a prospective, single-center, double-blinded, randomized controlled trial to be conducted at the 920th Hospital of Joint Logistics Support Force. Eighty patients undergoing VATL will be randomly divided into an experimental group (TEAS group) and a control group (sham group). The experimental group will receive TEAS at bilateral PC6, LI4, LR3, LU5, TE5, and LI11. The control group will not receive TEAS at the same acupoints. Both groups will receive TEAS or no TEAS before anesthesia induction and 1-7days after surgery, with each session lasting 30min. The primary outcome will be the incidence of CPSP at 3months after surgery. Secondary outcomes will include the incidence of CPSP at 6months after surgery, the numerical rating scale (NRS) scores at 3 and 6months after surgery, as well as the NRS scores at 24, 48, and 72h after surgery, remifentanil consumption during general anesthesia, demand for rescue analgesics, number and duration of indwelling chest tubes, incidence of postoperative nausea and vomiting, and changes of norepinephrine (NE), cortisol (Cor), tumor necrosis factor (TNF- α), and interleukin 6 (IL-6) in serum. ChiCTR2300069458. Registered on March 16, 2023.

Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study

BackgroundThere is an association exists between cardiac surgery, performed through median sternotomy, and a considerable postoperative pain.ObjectivesThe aim of the current study is to compare the effects of transversus thoracic muscle plane block (TTMPB) and pecto-intercostal fascial plane block (PIFB) upon postoperative opioid consumption among the patients who underwent open cardiac surgery.MethodsThe present prospective, randomized, comparative study was conducted among 80 patients who underwent elective on-pump cardiac surgery with sternotomy. The subjects were randomly assigned to two groups with each group containing 40 individuals. For the TTMPB group, bilateral ultrasound-guided TTMPB was adopted in which 20 ml of 0.25% bupivacaine was used on each side. In case of PIFB group, bilateral ultrasound-guided PIFB was adopted with the application of 20 ml of 0.25% bupivacaine on each side. The researchers recorded the first time for rescue analgesia, the overall dosage of rescue analgesia administered in the first 24 h after the operation and the postoperative complications.ResultsThe PIFB group took significantly longer time to raise the first request for rescue analgesia (7.8 ± 1.7 h) than the TTMPB group (6.7 ± 1.4 h). Likewise, the PIFB group subjects had a remarkably lower ‘overall morphine usage’ in the first 24 h after the operation (4.8 ± 1.0 mg) than TTMPB group (7.8 ± 2.0 mg).ConclusionBilateral ultrasound-guided PIFB provided a longer time for the first analgesic demand than bilateral ultrasound-guided TTMPB in patients undergoing open cardiac surgery. In addition to this, the PIFB reported less postoperative morphine usage than the TTMPB and increases satisfaction in these patients.Trial registrationThis study was registered at Clinical Trials.gov on 28/11/2022 (registration number: NCT05627869).

Comparison of two different doses of dexmedetomidine for continuous epidural analgesia for lower limb surgeries: A randomized double-blind study.

Bolus epidural dexmedetomidine provides potent analgesia but the incidence of hemodynamic instability is high. There are only a few studies that have evaluated the efficacy of epidural dexmedetomidine infusion but none of them compared different doses to find the optimum safe dose. We compared the analgesic efficacy and safety of two different doses of dexmedetomidine in continuous epidural for postoperative analgesia. Patients undergoing lower limb surgeries were divided randomly into two groups: Group I (n = 36) received an epidural infusion of 0.1% ropivacaine + 0.5 μg/kg/24 h of dexmedetomidine and Group II (n = 36) received epidural infusion 0.1% ropivacaine + 1 μg/kg/24 h of dexmedetomidine. Both groups received epidural infusion at the rate of 5 ml/h over 48 h postoperatively. Pain scores, demand for rescue analgesics, hemodynamic parameters, and sedation scores were compared between the groups. Statistical analysis was done using an independent t-test and Chi-square test. 1 μg/kg group (Group II) had a significantly reduced pain score at all time intervals and less demand for rescue analgesia (P = 0.03). The severity of pain was more in the 0.5 μg/kg group (Group I), at all times (P = 0.000). Incidence hypotension was higher in Group II. Bradycardia was seen in two patients in Group II and none in Group I. Dexmedetomidine in a dose of 1 μg/kg/24 h with 5 ml of 0.1% ropivacaine through epidural infusion provides better analgesia with a safe hemodynamic profile.

Meta-Analysis of Open-Heart Surgery Pain Relief Using Transversus Thoracic Plane Blocks

Background. Severe postoperative pain is commonly reported following open-heart surgery, necessitating the implementation of effective pain management strategies to facilitate patient recovery. The benefits of the transverse thoracic muscle plane (TTMP) block for open-heart surgery remain unclear. Therefore, a meta-analysis was conducted to systematically evaluate the effect of TTMP on postoperative analgesia and recovery in patients undergoing open-heart surgery. Methods. A computer search was performed in PubMed, Cochrane, Embase, CNKI, and Wangfang databases. The primary outcome was 24-hour postoperative opioid consumption, and the secondary outcomes were 12- and 24-hour postoperative resting and motor pain scores, time of first analgesia demand, extubation time, length of stay in the intensive care unit (ICU), time of first feces, incidence of nausea and vomiting, and length of hospitalization. Results. Thirteen randomized controlled trials (RCTs) involving a total of 766 patients were included in this meta-analysis. Compared with the control group, the TTMP group showed a significant reduction in opioid consumption within 24 h postoperatively (mean difference = −41.88 mg; 95% confidence interval: −51.99, −31.77; p&lt;0.001; and I2 = 98%). However, the 12- and 24-hour postoperative resting and moment VAS pain scores were significantly lower in the TTMP group. In addition, the TTMP group had a longer time of first analgesic demand; shorter endotracheal intubation time, ICU stay duration, time of first feces, and length of hospital stay; and a lower incidence of nausea and vomiting. Conclusions. Perioperative TTMP block can reduce the use of opioids in patients undergoing open-heart surgery for 24 h postoperatively, decrease the early postoperative pain scores, prolong the time of first analgesic demand, shorten the time of extubation and the length of ICU stay and hospitalization, and reduce the incidence of nausea and vomiting, which are all conducive to the recovery of patients. Registration. This trial is registered with PROSPERO database (CRD42022312435).

Effect of dexamethasone as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia in subjects undergoing lower segment cesarean section

Background: Inadequate pain relief after caesarean section is a common problem in every part of the world. Transversus abdominis plane (TAP) block provides adequate post-operative pain relief following abdominal surgeries. TAP block duration is limited to effect of administered local anesthetics. Hence, adjuvant medications are added to local anaesthetic (LA) to prolong the effect of TAP block. The primay objective of this study was to analyse the analgesic effect of dexamethasone added to levobupivacaine in comparison with analgesic effect of levobupivacaine alone in TAP block. The secondary objectives are to analyse the number of supplemental analgesic requirements in the first 24 hrs after surgery and to analyse the duration of postoperative analgesia which is time to first analgesic request from the time of TAP block. Methods: 116 women scheduled for lower segment cesarean section (LSCS), belonging to ASA physical status 2 or 3, aged between 18 and 35 years, under SAB were recruited. Ultrasonogram (USG) guided TAP block was performed on each side after the completion of the surgery. Subjects in group L (n = 58) received TAP block on each side with 20 ml of 0.375% levobupivacaine and group LD (n = 58) with 19 ml of 0.375% levobupivacaine + 1ml (4mg) of dexamethasone. They were evaluated for pain at 10min, 30min, 45min, 1hour, 2hrs, 4hrs, 8hrs, 12hrs and 24hrs after the block using visual analog scale (VAS) score. Duration of postoperative analgesia and requirement of rescue analgesia were also analysed. Results: The post-operative visual analogue scale (VAS) scores were lower in group LD at 8, 12 and 24 hrs (p &lt; 0.05). Mean duration of analgesia was significantly prolonged in group LD with lesser requirement of rescue analgesics (p &lt; 0.05) up to 24 hrs. Conclusion: Dexamethasone (4 mg) as an adjuvant to levobupivacaine in USG guided TAP block reduces post-operative pain scores prolongs the duration of analgesia and decreases demands for rescue analgesics.

The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority trial.

Spine surgeries have experienced exponential growth over the past 2 decades. These surgeries are often accompanied by long and severe perioperative pain, presenting a significant management challenge. This study aims to assess and compare the efficacy of two techniques for postoperative pain (POP) management in lumbar spine surgeries: ultrasound-guided erector spinae plane block (ESPB) and intraoperative freehand ESPB. In this prospective randomized non-inferiority trial (Registration Number: IRCT20221107056427N1), adult patients who were candidates for lumbar spinal fusion surgery were randomly divided into two groups: ultrasound-guided ESPB (n = 29) and freehand ESPB (n = 29). The primary outcomes were the total amount of morphine consumed during the first 24h following the surgery and the numerical rating scale (NRS) pain score at various time points within the first 24h following the surgery. The secondary outcome was the fentanyl used during surgery. Participants in the intraoperative freehand approach had considerably higher total morphine consumption in the first postoperative 24h. The trend of NRS changes in both the ultrasound-guided ESPB group and the freehand ESPB group during the first 24h after surgery showed a significant decrease. Still, there was no significant difference between the two groups. However, the first analgesic demand time was significantly shorter in the intraoperative freehand ESPB group compared to the ultrasound-guided approach. According to our results, the ultrasound-guided approach of ESPB is more effective in POP management and opioid sparing in lumbar spinal fusion surgeries compared to the freehand approach. However, the data from this study are not sufficient to draw robust conclusions, and further randomized controlled trials with larger sample sizes are required to validate our results.