Analgesic Demand Research Articles

Effect of Pregabalin on Succinylcholine Induced Fasciculation, Myalgia and Hyperkalemia in Spine Surgery

A randomized control trial was done between January and December of 2018, in the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine of Dhaka Medical College Hospital, Bangladesh, to evaluate the preventive effect of pregabalin on succinylcholine induced adverse effects, i.e., fasciculation, myalgia and hyperkaliemia in spine surgery. Sixty patients of elective spine surgery under general anaesthesia were selected and divided into two groups. Pregabalin 150 mg was given to one group and matching placebo was given to another group orally with sips of water one hour before surgery. Succinylcholine 1.5 mg/kg was given after induction agent. Muscle fasciculation was observed just after succinylcholine administration. Serum potassium was measured 5 minutes before induction and 5 minutes after succinylcholine administration. After completion of surgery reversal was given. Time of first analgesic demand was recorded. Injection Morphine 0.15 mg/kg intramuscular was given when patient complained about pain. Myalgia (muscle pain not associated with surgery) was observed 24 hours after anaesthesia and total morphine consumption was recorded. Use of pregabalin 150 mg one hour before surgery reduced the severity of fasciculation and the incidence and severity of postoperative myalgia. It also reduced the rise of serum potassium concentration after succinylcholine administration though the rise was within normal limit. Pregabalin also reduced the total opioid consumption after surgery.
 CBMJ 2023 January: Vol. 12 No. 01 P: 73-80

Effects of single-injection intercostal nerve block as a component of multimodal analgesia for pediatrics undergoing autologous auricular reconstruction: A double-blinded, prospective, and randomized study

Backgroundː Pain management is essential in postoperative settings, especially with pediatric patients. Donor site pain after rib cartilage harvest is severe, particularly during the early postoperative period. This study aimed to explore the effectiveness of ultrasound guided single-injection intercostal nerve block (ICNB) as a component of multimodal analgesia for pediatrics undergoing autologous auricular reconstruction. Methodsː Fifty pediatric patients aged 6–16 years and scheduled for 2 rib cartilages harvest surgery were enrolled in this double-blind, prospective and randomized study. Pediatrics were randomly assigned into two groups: the intercostal nerve block group (group B) and the control group (group C). The nerve block was performed with 2 ml 0.25% ropivacaine each intercostal nerve in group B. Patients from group C received Tramadol 2 mg/kg by the end of the surgery as control. Tramadol-based patient-controlled intravenous analgesia and rescue analgesia were given in both groups. The primary outcome was pain scores at early postoperative period (VAS and FLACC scale, 4 h, and 8 h). The secondary outcome was the postoperative Tramadol consumption and time point of first rescue analgesic demand. Resultsː VAS score was significantly lower in group B than group C at 4 h and 8 h postoperatively [2.5(2–5) vs. 4(2.5–5.5), p = 0.041 at 4 h; 3(2.5–4.5) vs. 4(3–5), p = 0.047 at 8 h]. Total Tramadol consumption in group B decreased significantly in contrast with group C at 8 h (p < 0.01), 12 h, 24 h and 48 h (p < 0.05, respectively). The first rescue analgesia demand and number of rescue Tramadol in block group was considerably delayed or reduced than control group (p < 0.01, p < 0.05, respectively). Conclusionsː Our findings indicated that ultrasound guided ICNB slightly but significantly reduced pain scores, and Tramadol consumption in pediatric patients after rib cartilage harvest as compared to who didn't receive nerve block at 4 h and 8 h postoperatively. Unified ICNB ropivacaine dosage might detrimental to providing superior analgesia.

Effect of common OPRM1, COMT, SLC6A4, ABCB1, and CYP2B6 polymorphisms on perioperative analgesic and propofol demands on patients subjected to thyroidectomy surgery

BackgroundPerioperative anesthetic and/or analgesic demand present considerable variation, and part of that variation appears to be genetic in origin. Here we investigate the impact of common polymorphisms in OPRM1, COMT, SLC6A4, ABCB1, and CYP2B6 genes, on the intra-operative consumption of remifentanil and propofol, as well as the postoperative analgesic needs, in patients subjected to thyroidectomy surgery.MethodsWe conducted a prospective cohort study with 90 patients scheduled to undergo elective thyroidectomy, under total intravenous anesthesia achieved by target control infusion (TCI) of propofol and remifentanil. Postoperative analgesics were administered by protocol and on-demand by the individual patient. Genotyping was established by PCR–RFLP methods. Genotyping data, intra-operative hemodynamics, and total consumption of remifentanil and propofol, as well as postoperative analgesic needs and pain perception, were recorded for each individual.ResultsPatients with the ABCB1 3435TT genotype appeared to experience significantly less pain within one hour post-operatively, compared to C carriers [mean VAS (SD) = 0.86 (1.22) vs. 2.42 (1.75); p = 0.017], a finding limited to those seeking rescue analgesic treatment. Intra-operatively, homozygotes patients for the minor allele of OPRM1 A118G and CYP2B6 G516T appeared to consume less remifentanil [mean (SD) = 9.12 (1.01) vs. 13.53 (5.15), for OPRM1 118GG and A carriers] and propofol [median (range) = 14.95 (11.53, 1359.5) vs. 121.4 (1.43, 2349.4), for CYP2B6 516TT and G carriers, respectively] but the difference was not statistically significant in our sample.ConclusionsThe ABCB1 C3435T polymorphism appears to affect the postoperative perception of surgical pain among patients with low pain threshold. The small number of minor allele homozygotes for the OPRM1 A118G and CYP2B6 G516T polymorphisms precludes a definitive conclusion regarding the inclusion of the latter in a TCI-programming algorithm, based on the results of this study.Clinical trial registration numberACTRN12616001598471.

Does Intraoperative Multi-Drug Wound Infiltration Relieve Postoperative Pain Following Single-Level TLIF Surgery? A Randomized Controlled Trial

BACKGROUND: How to minimize postoperative pain following spinal surgery has been a great challenge for both surgeons and patients. We hypothesized that intraoperative multi-drug wound infiltration could relieve postoperative pain following single-level transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVES: To evaluate the effect of intraoperative multi-drug wound infiltration for postoperative pain following single-level TLIF surgery. STUDY DESIGN: A randomized, double-blinded controlled trial (RCT). SETTING: Department of Orthopaedic Surgery, Qilu Hospital of Shandong University. METHODS: The RCT enrolled 50 patients with 25 cases in 2 groups. The study group received intraoperative wound infiltration of mixed solution with lidocaine, ropivacaine, and epinephrine before wound closure. The control group was infiltrated with an equal amount of normal saline. The primary outcome measure was the visual analog scale (VAS) of postoperative incision pain. The secondary outcome measures were the postoperative opioids dosage, the time of first analgesic demand, and the Oswestry Disability Index (ODI). RESULTS: The VAS of postoperative pain in the study group was significantly lower than the control group within postoperative 24 hours. The opioid dosage was significantly less and the time of first analgesic demand of patient-controlled analgesia (PCA) in the study group was significantly longer than the control group. None of the patients in the study group required analgesic supplementation. The side effects of opioids were significantly less in the study group. There was no significant difference in ODI, operation time, intraoperative blood loss, postoperative drainage, and postoperative incision complications between the 2 groups. LIMITATIONS: Single-center study for single-level TLIF surgery. CONCLUSIONS: Intraoperative multi-drug wound infiltration before closure could significantly relieve postoperative pain following single-level TLIF surgery. KEY WORDS: Transforaminal lumbar interbody fusion, postoperative pain, wound infiltration, multi-drug, randomized controlled trial

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

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

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

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

Clinical comparison of analgesic efficacy of addition of injection dexamethasone 8mg to 20ml 0.5% levobupivacaine in ultrasonography assisted supraclavicular brachial plexus block

Background: Ultrasonography-assisted supraclavicular block is an efficacious and practical method and allows us to use a lower volume of local anesthetic in compactly arranged brachial plexus. The study envisioned evaluating the analgesic and anesthetic effects of Inj. dexamethasone (8mg) as an adjuvant to 0.5% levobupivacaine to determine the time for first rescue analgesia and number of rescue analgesics needed in 24 hours duration in brachial plexus blockade in adult patients listed for upper limb surgeries. Results: This prospective randomized double-blind interventional study was carried out in ASAI and II, aged 20 to 55 years. In group A (n=30) Inj. Levobupivacaine 20ml and Inj. Normal saline 2ml was given. In group B (n=30) Inj. Levobupivacaine 20ml and Inj. Dexamethasone 2ml was given. The time for the demand of the first rescue analgesia was 431.50 ± 46.15 minutes in group A and 749.38 ± 62.41 minutes in group B, with a p-value &lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We deduce with our study, with the addition of dexamethasone, the time for rescue analgesia is prolonged, and the number of rescue analgesic demands is reduced, with a faster onset and extended duration of both sensory and motor block.

Effectiveness of Ultrasonography Guided Pectoral Nerve Block and Paravertebral Block For Post-Operative Analgesia in Modified Radical Mastectomy

Background: Incomplete alleviation of postoperative pain in modified radical mastectomy surgery causes significant morbidity and patient dissatisfaction. General anaesthesia with postoperative NSAIDs and opioids commonly used technique for postoperative analgesia after breast surgeries. Along with regional anaesthesia various peripheral nerve blocks are performed to manage this problem. Paravertebral block and pectoral nerve block are exercised widely to reduce postoperative pain after modified radical mastectomy.Objective: The aim of this study is to assess the effectiveness of ultrasonography guided paravertebral block and pectoral nerve block for postoperative analgesia for modified radical mastectomy.Methods: This randomized control trial was conducted at Dhaka Medical College &amp; Hospital, Dhaka from July 2020 to June 2021. Total 60 patients, scheduled for modified radical mastectomy and randomly divided into two groups having 30 patients in each (Group-A= paravertebral block and Group-B =pectoral nerve block). Among them, 5 patients were excluded from the study due to block failure (three in group A and two in group B). So, finally, data were calculated for the 55 patients (27 patients in group A and 28 in group B). Heart rate, systolic blood pressure, mean arterial pressure, the time of first analgesic demand and the total amount of analgesic consumption in the first 24 hours by VAS were recorded and compared between two groups during postoperative period. Statistical analysis was done by SPSS version 25. Chi-square test was done for qualitative variables and Student’s t-test was done for quantitative variables. P &lt; 0.05 was considered statistically significant.Results: The demographic profile were well matched between two groups (P &gt; 0.05). The mean VAS score was significantly lower in pectoral nerve block as compared to the paravertebral block at all-time intervals except at 12 hours and 20 hours (P &lt; 0.05). Patients with pectoral nerve block had significantly late 1st analgesic demand (12.2 ± 2.1 hours’ vs 8.3 ± 1.8 hours) (P &lt; 0.05) and significantly less total opioid consumption (165.7 ± 18.2mg vs 255.6 ± 15.8mg) (P &lt; 0.05) compared to patients with paravertebral block. Post-operative side effects were noted significantly more in patients with paravertebral block compared to pectoral nerve block.Conclusion: Pectoral nerve block performed in patients scheduled for modified radical mastectomy results in better pain control, late first analgesic demand and less postoperative opioid consumption in the first 24 hours than paravertebral block.

A Prospective Randomized Trial of Ropivacaine 5 mg with Sufentanil 2.5 μg as a Test Dose for Detecting Epidural and Intrathecal Injection in Obstetric Patients.

Objectives: Traditional epidural test dose is somewhat unsuited in obstetrics because of potential risk of severe adverse effects when it is accidentally injected into the subarachnoid space. Some hospitals use a proportion of the total dose of epidural labor analgesia as a test dose. The aim of our study was to assess the effectiveness and safety of ropivacaine 5 mg with sufentanil 2.5 μg to detect intrathecal injection. Methods: This prospective randomized study enrolled parturients who had the demand for epidural labor analgesia and randomly divided them into two groups. Then, 5 mL of 0.1% ropivacaine with sufentanil 2.5 μg was injected into the epidural space or the subarachnoid space in the epidural (EP) group and the intrathecal (IT) group, respectively. The ability to detect intrathecal injection and side effects were assessed to work out the effectiveness and safety. Results: For spinal injection, the sensitivity and the specificity of the symptoms of either warmth or numbness or both assessed at 3 min were both 100%, and the observed negative predictive value (NPV) and positive predictive value (PPV) were 100%. All parturients in the IT group and 2.33% of parturients in the EP group had sensory blockade to cold or pinprick (p < 0.0001). A total of 77.55% (38 of 49) of parturients in the IT group were found to have a motor block. A 10 min assessment showed the median cephalad cold and pin levels were T8 and T10, respectively, and the median Bromage score was 4 in the IT group. Incidences of adverse effects in both groups were low. Conclusions: Ropivacaine 5 mg with sufentanil 2.5 μg is effective and safe to detect intrathecal injection as an epidural test dose in obstetric patients.

Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients

Abstract&#x0D; Background: Patients with chronic renal insufficiency need to have arteriovenous fistula (AVF) for hemodialysis.Ultrasound guided axillary brachial plexus block is a good substitute to general anesthesia or local anesthesia as it causes vasodilatation and minimum hemodynamic derangement, besides offering prolonged postoperative analgesia. We compared three types of local anesthetic solutions; bupivacaine 0.5%, bupivacaine 0.5% plus lidocaine2% and lidocaine 1.5% for onset and duration when used for axillary brachial plexus block.&#x0D; Methodology: Sixty-six patients were randomly allocated to one of the three different groups: Group B: patients received 30 ml of bupivacaine 0.5% for the block; Group BL: received 15 ml of bupivacaine 0.5% with 15 ml lidocaine 2% and Group L: received 30 ml of lidocaine 1.5% for the block under US guidance. Onset of sensory and motor anesthesia were registered, and the time to first analgesic demand postoperatively was noted. Statistical analysis of the results was undertaken.&#x0D; Results: Results showed that regarding the onset of sensory anesthesia, lidocaine group had the shortest time and the results were statistically significant compared to the other two groups. A statistically non-significant difference was found between Group B and Group BL, where Group BL had shorter time of onset than Group B, e.g., 9.05 ± 1.36 vs. 9.77 ± 0.97 min. The onset of motor block was the earliest in Group BL and the result was considered nonsignificant between Group L and Group B being shorter in Group L; the difference in results was also non-significant between Group BL and Group L. Significantly longer duration of motor and sensory blocks was noted in Group B and compared to the BL and L groups. As regards the timing of first analgesic need, there was statistically significant difference between all groups being longest in Group B (608.68 ± 21.74 min)&#x0D; Conclusion: This study revealed that using 30 ml of bupivacaine 0.5% in axillary brachial plexus block with ultrasound guidance in ESRD patients for AVF creation gives much better results than 30 ml of lidocaine 1.5% or a mixture of Abdelhady ISM, et al local anesthetics for axillary brachial plexus block www.apicareonline.com 744 Open access attribution (CC BY-NC 4.0) bupivacaine 0.5% with lidocaine 2% as regards to onset of anesthesia, postoperative analgesia and patient satisfaction.&#x0D; Trial Registry: PACTR202208582938205&#x0D; Abbreviations: AVF: arteriovenous fistula; BPB: Brachial plexus block; ESRD: End stage renal disease; GA: General anesthesia; NRS: Numeric rating scale; RA: Regional anesthesia&#x0D; Key words: Bupivacaine; Lidocaine; Hemodialysis; Brachial plexus block&#x0D; Citation: Abdelhady ISM, Ghallab MAA, Zaki MSM, Abdelrahman KAS, Soliman AFH. Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients. Anaesth. pain intensive care 2022;26(6):743−748; DOI: 10.35975/apic.v26i6.2055&#x0D; Received: September 14, 2022; Reviewed: October 28, 2022; Accepted: October 31, 2022&#x0D;

To compare the efficacy of Gabapentin with Paracetamol for Preemptive Analgesia in children undergoing Tonsillectomy.

Aim: To compare the mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Method: This random controlled trial was conducted by Anesthesia team in ENT OT in Jinnah Hospital, Lahore from January 1, 2018 to June 30, 2018. After taking informed consent, 60 patients fulfilling the selection criteria were recruited and after obtaining demographic information, two groups were formed using lottery method Group G and Group P each having 30 patients. Patients were given oral Paracetamol 20 mg/kg and oral Gabapentin 10 mg/kg 120 minutes before induction of anesthesia in Group P and Group G respectively. Post-operatively, patients’ pain was monitored with VAS after every 30 minutes. When VAS exceeded 3, it marked the demand of first post-operative rescue analgesia was given and time was noted. Injection Ketorolac 0.5mg/kg was given as rescue analgesia. Mean time of first rescue analgesia was compared in between 2 groups via SPSS 19 Results: There were no significant differences for variables such as age and BMI in between two groups. The main result of study is that mean time for first rescue analgesia in group G and group P found to be 468.00± 57.14 &amp; 377.00±51.47 minutes respectively. The calculated p-value was P &lt; 0.0001 proving significant difference in duration for first analgesia in between two groups. Conclusion: There is significant difference in mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Keywords: Preemptive Analgesia, Gabapentine, Paracetamol, Post-operative pain control

An observational study on the effect of high versus low carbon dioxide pressure in laparoscopic cholecystectomy

Background: Gall bladder stone is one of the common diseases of hepatobiliary system. If it is symptomatic then it needs to be treated and sometimes it may lead to multiple complications. Laparoscopic approach for cholecystectomy is widely acceptable and routinely done procedure for gall bladder stone. Laparoscopic cholecystectomy reduces postoperative pain and hospital stay as compared to open surgery. Laparoscopic surgeries require carbon dioxide (CO2) to inflate peritoneal cavity.Methods: It is an observational study at tertiary care centre. In present study authors have included all patients undergoing elective laparoscopic cholecystectomy. Patients required conversion to open cholecystectomy from laparoscopic cholecystectomy and emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy for malignancy were not included. In present study, patients were randomly allocated into two groups: group A (n=50) low CO2 pressure (8-10 mmHg) pneumoperitonium and group B (n=50) high CO2 pressure (12-14 mmHg) pneumoperitonium to perform laparoscopic cholecystectomy. In present study authors have compared post operative effects in term of pain (at 4, 8 and 12 hrs post operatively), hospital stay and requirements of injectable analgesics between group A and group B.Results: 14 patients in group B complained of post operative shoulder tip pain as compared to only 5 patients in group A. Analgesic requirement and mean length of post operative hospital stay were also less in group A as compared to group B.Conclusions: Low pressure laparoscopic cholecystectomy (LPLC) significantly decrease the frequency and intensity of post operative shoulder tip pain. So, LPLC decrease the demand for postoperative analgesics and decrease post operative hospital stay.

Peritonsillar Infiltration of Ropivacaine and Pain Control in Immediate Postoperative Period Following Tonsillectomy Surgery in Adult Patients

Introduction: To study about the efficacy of Peritonsillar infiltration of Ropivacaine and pain control in immediate postoperative period following tonsillectomy surgery in adult patients. Methods: 80 patients were included in the study of age 18 to 50 years. After informed consent, patients were divided into two groups. In Group R 0.5%Ropivacaine with 1:100000 Adrenaline and in Group C 0.9%normal saline with 1:100000 Adrenaline was injected into the tonsillar fossa following tonsillectomy. Surgery duration, blood loss, time to demand for 1st analgesia, analgesic consumption in 24 hours, and VAS score in 1hr, 2hr, 4hr, 6hr, 12hr, 24hr were noted. Results: We observed significant pain control during first 4 post-operative hours with Value of &lt;0.01, &lt;0.01 and 0.019 respectively in first, second and fourth post-operative score. We also observed significant difference in the time for first analgesia request in two groups with the study group requesting for first analgesic at 518±175 postoperative minutes and control group at 132±47.95 postoperative minutes (P value &lt;0.01). Total analgesia requirement was 61±22.48 in the study group and 102±27.84 in control group (P value &lt; 0.01). Conclusions: It is concluded that intraoperative Peritonsillar infiltration of Ropivacaine causes analgesia in the immediate postoperative hours with the decrease in the requirement of analgesia in the first 24 postoperative hours. It is therefore recommended to use it in adult patient undergoing Tonsillectomy.

Intravenous Dexamethasone Reduces Pain in Middle Ear Surgery.

Few studies evaluated the treatment of postoperative pain in middle ear surgery. We conducted a randomized clinical trial to evaluate the efficacy of dexamethasone in the management of postoperative pain in middle ear surgery. Group G1 received an intravenous injection of 2 ml of physiological saline 30 minutes before the end of the procedure. Group G2 received a 2 ml intravenous solution containing 8 mg of dexamethasone, 30 minutes before the end of the procedure. Pain perception was measured by the Visual analog scale (VAS) every 10 min during the first hour and then every 6 hours during the 24 hours postoperatively. The delay of the first analgesic demand and the consumption of analgesics use during the first 24 hours postoperatively, were recorded. VAS values were lower in G2at all measurement points during the first hour, as well as the first 24h postoperatively (Mann-Whitney test, P<0.05).The delay of the analgesic request was (0 (0-60) for G1 versus 0 (0-80) for G2, P=0.04, Mann-Whitney test). Morphine was used in 44% of the patients in G1 against 19% for G2 (P = 0.031). There was a significant difference between G1 and G2 in terms of the total dose of morphine consumed (P= 0.028, Mann-Whitney test). Paracetamol demand was lower in group 2 at all points of assessment during the first 24 hours postoperatively. Intravenous dexamethasone is effective in decreasing pain and analgesic requirement, during the first 24 hours postoperatively, in patients undergoing middle ear surgery.

Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Pain Relief in Children Undergoing Lower Abdominal Surgeries: A Randomized, Double-Blind Comparative Study.

The quadratus lumborum (QL) block, also known as the abdominal truncal block, was developed to provide visceral and somatic analgesia during abdominal procedures. This study aimed to assess pain alleviation, the incidence of complications in lower abdominal procedures, and hemodynamic stability between the caudal block and ultrasound-guided QL block. Fifty-two patients aged 1 to 7 years old from both genders scheduled for unilateral lower abdominal surgery were randomly assigned to 2 study groups: group QL, unilateral QL block (n = 26), and group C, caudal block (n = 26). In group C, children received caudal block. In group QL, an ultrasound-guided QL block was performed. The time to first rescue analgesia was evaluated as a primary outcome. The quality of analgesia was determined using the face, legs, activity, cry, consolability scale (FLACC scale), hemodynamic parameters, and incidence of complications because hemodynamic instability was recorded under ultrasound guidance. Signs of local anesthetics toxicity and the parents' satisfaction were secondary outcomes. The time until the first demand for analgesia postoperatively was statistically longer in group QL compared to group C. A non-significant difference was observed between the 2 groups (P > 0.05) regarding age, weight, gender, duration of surgery, type of surgery, FLACC scale, and hemodynamics (SBP, systolic blood pressure), except at 30 minutes, which was significant in QL block. Also, a non-significant difference was observed in the severity of postoperative pain up to 1 day postoperatively. Group QL showed more satisfaction than group C. No intraoperative complications were detected. Compared to caudal block, QL block produced sustained and adequate analgesia time postoperatively, with higher satisfaction.

Efficacy of ultrasound-guided transversus abdominis plane block versus erector spinae plane block for postoperative analgesia in patients undergoing emergency laparotomies: A randomized, double-blinded, controlled study

ABSTRACT Ninety-three adult ASA I–III E patients undergoing emergency laparotomies were investigated in this research. Subjects were randomly divided into three groups. Following general anesthesia, bilateral peripheral nerve blocks guided by ultrasound Transversus abdominis plane block (TAPB) or erector spinae plane block (ESPB) were administered. Pain scores at rest and movement, time to first analgesic request, and total fentanyl consumption were recorded postoperatively and compared. Pain scores at rest were significantly reduced in the research groups for 12 and 18 h in TAPB and ESPB, respectively, also there was a significant decrease at 2, 4, 6, and 8 h in the ESPB group compared to the TAPB group. While pain scores at movement were significantly reduced in the ESPB group for the first 8 h than in the TAPB group both study groups demonstrated significantly reduced pain scores than the control group for the first 8 h for the ESPB group and the first 4 h for TAPB group. The time to first analgesic demand was longer in the ESPB group than in the TAPB group and both study groups were longer than the control group. Fentanyl consumed in the ESPB group was reduced than in the TAPB group and both study groups were reduced than the control group in the first 24 h. For patients having emergency laparotomies, bilateral ultrasound-guided ESPB with 40 ml of 0.25% bupivacaine reduces pain scores both at rest and motion, fentanyl use, and extends the duration of analgesia postoperatively compared to bilateral ultrasound-guided TAPB.

Comparison Between The Effectiveness of Lateral and Posterior Transversus Abdominis Plane Block by Using Bupivacaine After Total Abdominal Hysterectomy.

Background: Transversus Abdominis Plane (TAP) block is a regional anaesthetic technique used for postoperative pain management following abdominal surgery. Local anesthetics like bupivacaine can be used in this block and it can be performed in various approaches. Among them ultrasound-guided lateral and posterior approaches are popular. Objective: Aim of this study is to compare the effectiveness of lateral and posterior approaches of ultrasound-guided TAP block using bupivacaine in the management of post-operative pain after total abdominal hysterectomy under subarachnoid anesthesia. Materials and Methods: This randomized clinical trial was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Total 90 patients were scheduled for elective total abdominal hysterectomy and assigned into two equal groups, group A and group B received ultrasound guided TAP block in lateral approach and in posterior approach respectively. Then patients were observed for pain intensity at rest and during deep breath by visual analog scale (VAS), after 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours of TAP block. The time of first analgesic demand was noted. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean pain intensity at rest and during deep breath was statistically significant (p&lt;0.05) at 4, 6, 12 and 24 hours after TAP between two groups. The mean duration of first analgesic demand was 5.04±0.54 hours in group A and 6.59±0.69 hours in group B was statistically significant (p&lt;0.05) between two groups. Conclusion: TAP block in posterior approach provided considerably effective postoperative analgesia in first 24 hours than lateral approach after total abdominal hysterectomy. KYAMC Journal Vol. 13, No. 02, July 2022: 66-71

Clinical efficacy of ultrasound guided erector spinae plane block in patients undergoing microwave ablation.

To compare the effect of pre-emptive erector spinae plane block (ESPB) applied before the procedure on opioid consumption during the procedure and analgesic demand and opioid consumption after the procedure. American Society of Anesthesiologists Physical Status Classification (ASA) I-II, 30 patients, with liver tumor and planned for microwave ablation (MWA) treatment were included in the interventional radiology clinic, Erciyes University, Kayseri, Turkey, Turkey between 2021 and 2022. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB block with 20mL of 0.25% bupivacaine was performed preoperatively in the ESPB group patients, and the patients who was not performed the ESPB the control group. All the patients were administered 1 µg/kg fentanyl, 1-2mg/kg propofol, and 1mg/kg ketamine for sedation during the MWA procedure after standard monitoring. Total opioid consumption and numeric rating scale (NRS) scores for pain were recorded at 0, 20, 40, and 60 minutes, and at 2, 4, 6, 12, and 24 hours after the procedure. Total opioid consumption and total opioid amount during the procedure were statistically significantly lower in the ESPB group (p<0.001). Although all of the patients in the control group needed additional fentanyl throughout the procedure, only 5 patients in the ESPB group needed additional fentanyl (p<0.001). Post-procedure NRS score values were significantly lower in the ESPB group at 40 minutes, 60 minutes and 4 hours (p<0.05). Numeric rating scale values at other times were statistically similar (p>0.05) CONCLUSION: This study showed that ESPB provided effective preemptive analgesia during MWA procedures.

A comparative study between the use of dexmedetomidine vs. dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries

Background &amp; objective: Transversus abdominis plane (TAP) block using local anesthetics is associated with relatively shorter duration of action, and thus additional analgesic drugs are required in the postoperative period. We compared the efficacy and duration of postoperative analgesia achieved with using dexmedetomidine or dexamethasone as adjuvants to bupivacaine in TAP block for lower abdominal surgeries.&#x0D; Methodology: We enrolled 45 adult patients aged from 20-60 y, and randomly divided them into three equal groups. Group A received ultrasound guided TAP block with 0.25% bupivacaine 20 ml plus 4 mg dexamethasone on each side. Group B received 0.25% bupivacaine 20 ml plus dexmedetomidine 0.5 µg/kg on each side, and Group C (control group) patients received only 0.25% bupivacaine 20 ml on each side. Postoperative pain was assessed with VAS on arrival in post-anesthesia care unit (PACU), at 2 h, 6 h, 12 h, 18 h, and at 24 h postoperatively. Duration of analgesia was the time from drug injection to the time of first rescue of analgesia was recorded.&#x0D; Results: Mean duration to first dose of rescue analgesia among patients of dexmedetomidine group (Group B) was significantly prolonged as compared to dexamethasone group and bupivacaine only group. Regarding postoperative pain scores there were no statistically significant difference between the three groups; except at 6 h between the A and B groups and the control group. Both dexamethasone group and dexmedetomidine group showed better pain control than bupivacaine only at 6 h interval.&#x0D; Conclusion: Dexmedetomidine added to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries prolongs the time to initial postoperative pain presented by time to first rescue analgesic demand than dexamethasone added to bupivacaine; the shortest time to first rescue analgesic was observed in bupivacaine alone group.&#x0D; Abbreviations: TAP: Transversus abdominis plane block; LA: Local anesthetic; PACU: Post anesthesia care unit; VAS: Visual Analogue Scale; ASA: American Society of Anesthesiologists; SD: Standard deviation; IQR: Inter quartile range.&#x0D; Citation: Sobhy YS, Gadalla RR, Nofal WH, Saleh MAE, Abdou KM. A comparative study between the use of dexmedetomidine .vs dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries. Anaesth. pain intensive care 2022;26(5):681–688; DOI: 10.35975/apic.v26i5.2031

Methylprednisolone as an Adjunct to Local Infiltration on Laminoplasty or Laminectomy before Wound Closure: A Randomized Controlled Trial.

TrialDesign. Patients undergoing laminoplasty and laminectomy often experience severe postoperative pain. Local infiltration analgesia during spine surgery significantly reduces postoperative pain, which only upholds for a short time. Whether methylprednisolone and local anaesthetics are better than local anaesthetics alone in postoperative analgesia is yet to be determined. The primary aim of this research was the postoperative evaluation of efficacy and safety of methylprednisolone when used as an adjunct to local anaesthesia, ropivacaine, before wound closure after surgical procedures, laminoplasty or laminectomy. Methods. 132 patients were divided with a ratio of 1 : 1 into methylprednisolone-ropivacaine and ropivacaine alone groups. Every 30 ml of local infiltration solution consisted of 15 ml of 1% ropivacaine with 14 ml of saline along with 1 ml of 40 mg methylprednisolone and 15 ml of 1% ropivacaine with 15 ml of saline in methylprednisolone-ropivacaine group and ropivacaine group, respectively. The standardization of the study solution depended on the number of levels involved in surgery. Primary outcome was the 48-hour cumulative sufentanil demand. Results. Demographic characters and surgical variables among the groups were identical. The average 48-hour cumulative sufentanil demand was 32.5 ± 20.6 μg in the methylprednisolone-ropivacaine group and 50.9 ± 27.2 μg in the ropivacaine group (p < 0.001). The estimated median time of demand of the first analgesia via patient-controlled analgesia (PCA) pump was 2.5 hours and 2 hours in the methylprednisolone-ropivacaine group and the ropivacaine group, respectively (hazard ratio (HR) was 0.53, with 95% Cl 0.33 to 0.87 and Log-rank of p = 0.0019). Conclusion. The infiltration of methylprednisolone as adjunct ropivacaine before wound closure is a safe and efficient strategy for pain management following laminoplasty or laminectomy.