Analgesic Requirements Research Articles

Fentanyl versus Magnesium Sulfate with 0.5% Ropivacaine in Adductor Canal Block for Knee Surgeries

Abstract Background: Adductor canal block (ACB) is an emerging technique for postoperative analgesia following knee surgery. ACB technique is relatively easy and is performed under ultrasound guidance. Aims: This study aimed to compare the efficacy of fentanyl and magnesium sulfate as adjuvants with 0.5% ropivacaine in ACB for patients undergoing knee surgeries. Adverse events if any were also noted. Materials and Methods: The study was conducted on 100 patients aged 40–80 years posted for knee surgeries. They were divided into two groups of 50 each: Group ropivacaine with fentanyl (RF) and Group ropivacaine with magnesium (RM). Group RF received 30 mL of 0.5% ropivacaine with 50 μg of fentanyl. Group RM received 30 mL of 0.5% ropivacaine with 125 mg of magnesium sulfate. Both the groups were compared on the basis of time for the first rescue analgesia given after the block. The results were analyzed using the SPSS software. Results: The mean time of the first rescue analgesia was 8.40 ± 0.85 h in Group RF and 10.63 ± 1.10 h in Group RM, which was higher and statistically significant (P = 0.002). Rescue analgesia was given more frequently in Group RF (5.77±3.84) compared to group RM (3.20±1.27) and this was statistically significant (P = 0.000). There were no significant adverse events noted in both the groups. Conclusion: Both the adjuvants, when added to ropivacaine, prolong the duration of blockade and reduce the requirement of rescue analgesia without causing significant adverse effects, but magnesium sulfate has an extra edge over fentanyl in terms of longer duration of postoperative analgesia.

Efficacy of bilateral erector spinae block for intraoperative and post-operative analgesia in lumbar decompression surgeries: A prospective randomized controlled trial

Background: Lumbar surgery is known to cause severe pain in the post-operative period. Modalities to reduce pain in the perioperative period include opioids, non-steroidal anti-inflammatory drugs, neuraxial blocks, and erector spinae block (ESB). Aims and Objectives: In this study, we aimed to evaluate whether ESB could reduce perioperative pain, opioid consumption, and muscle relaxant consumption. Materials and Methods: Fifty patients scheduled for lumbar decompression spine surgery were randomly allocated to two groups, the erector spinae plane (ESP) group (n=25) and the control group multimodal analgesia group (n=25). Intraoperative hemodynamics, muscle relaxant requirement, opioid consumption post-operative visual analog score, and rescue analgesia were evaluated. Results: Compared with the control group, heart rate (91.24±14.86 and 90.20±14.26) (77.12±11.96 and 77.44±11.96) arterial blood pressures (87.12±8.45 mmHg) (85.25±7.25) (78.73±5.56 and 79.64±5.95) were higher during surgical incision and 1st-time interval than in ESP group, respectively. The visual analog scale scores were higher in the control group than in the ESP group during all measurements of time. The requirement for rescue analgesia was more in the control group compared to the ESP group. Post-operative analgesia lasted for 15–18 h. Conclusion: Ultrasound-guided ESP block is a simple and safe technique which provides effective intraoperative, and post-operative analgesia and patient satisfaction with reduced opioid and muscle relaxant consumption.

Comparative Study of 0.5% Bupivacaine, 0.5% Ropivacaine, and 0.75% Ropivacaine With Fentanyl as a Continuous Intraoperative Epidural Infusion on Post-operative Analgesia.

Introduction Persistent postoperative pain leads to impaired patient recovery and delays in discharge of patients. The aim was to compare the efficacy of 0.5% bupivacaine to two varying concentrations of ropivacaine, specifically 0.5% and 0.75%, along with fentanyl as a continuous epidural infusion in providing adequate pain relief for patients subjected to infraumbilical surgeries. Materials and methods A prospective randomized comparative study was carried out on 150 patients and was divided into three groups, namely group B, group R, and group RP. Group B indicates (0.5% bupivacaine), group R means (0.5% ropivacaine),and finally, group RP means (0.75% ropivacaine); the three groups had 50 patients each. Group B was administered an epidural infusion of bupivacaine at a concentration of 0.5%, group R was given 0.5% ropivacaine, and group RP was treated with 0.75% ropivacaine; all three groups included 40 mcg fentanyl. The duration of the motor and sensory blockade and the time needed for the first rescue analgesia after the stoppage of epidural infusion were assessed in all three groups.The data were statistically analyzed using the ANOVA, "post hoc Tukey," and chi-square tests. Results Comparison of the duration of motor and sensory blockade among all three groups showed that group RP (0.75% ropivacaine with 2 mcg/cc fentanyl)had the longest duration of 328.8 and 406 minutes, and the difference was statistically significant (p < 0.001). Comparison of the time of stoppage of epidural infusion to the requirement of first rescue analgesia showed that the group that received 0.75% ropivacaine with 40 mcg fentanyl had the highest value of 258.6 minutes and was statistically significant (p < 0.001). Conclusion Epidural intraoperative infusion of 0.75% ropivacaine with fentanyl offers better postoperative pain relief as compared to both 0.5% bupivacaine and 0.5% ropivacaine with fentanyl.

A Prospective Randomized Clinical Study to Assess and Compare the Efficacy of Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Abdominal Hysterectomy Under General Anaesthesia

Abstract Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P &lt; 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P &lt; 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P &lt; 0.0001). No significant hemodynamic changes or side effects were observed (P &gt; 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

A Comparative Study of Ultrasound Guided Erector Spinae Plane Block versus Local Anaesthetic Infiltration in Spine Surgeries for Intraoperative and Post-operative Analgesia

Abstract Background: Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA). Aim: This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia. Materials and Methods: Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement. Results: NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site. Conclusion: Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.

Intraoperative Ultrasound: Bridging the Gap between Laparoscopy and Surgical Precision during 3D Laparoscopic Partial Nephrectomies.

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.

Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.

Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and analgesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Study included 88 patients aged 18-60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentanyl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Both groups had similar demographic characteristics. The opioid-free group required lesser analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 ± 28.2 vs. 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associated with decreased PONV.

A COMPARATIVE STUDY OF EFFECT OF DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO 0.2% ROPIVACAINE FOR ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INFRAUMBILICAL SURGERIES

Background: The relief of pain and suffering is, and always has been, one of the primary concerns of mankind and one of the prime factors that has influenced the course of history of medicine. Transversus abdominis plane (TAP) block is a regional anaesthetic technique which blocks the abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscle. Aim: To compare the efficacy of Dexmedetomidine and dexamethasone as an adjuvant to 0.2%ropivacaine in ultrasound guided transverses abdominis plane block in infra umbilical surgeries in terms of, 1. Time to initial postoperative pain. 2. Time to initial rescue analgesia. 3. Quality of block.. 4. Total postop analgesic consumption. 5. Patient satisfaction with regard to pain relief. 6. Post-operative nausea and vomiting. Materials And Methods: We included 80 patients of age between 18-60 years of American Society of Anesthesiologists status (ASA)I and II scheduled for elective infraumbilical surgeries in our study. We randomly allotted these patients into two groups namely Group A and Group B of each. Patients in Group APatients who received transversus abdominis plane block with - 18ml Ropivacaine 0.2%+ 2 ml Dexamethasone 8mg. Patients in Group B received transversus abdominis plane block with-18ml Ropivacaine 0.2%+ 2 ml Dexmedetomidine .This TAP block was given soon after the surgery is completed. The duration of block and regression of sensory block, time for rescue analgesia, degree of sedation, hemodynamic parameters, post operative analgesia and adverse effects were noted. Result: The two groups were comparable on the basis of duration of surgery, site of surgery, ASA and BMI. Heart rates and mean arterial pressure were compared and it was found to be significantly lower in group B compared to group A until initial 5 hours. In our study we found that the visual analogue score at rest and on coughing between groups A and B was statistically insignificant. However, the time to first rescue analgesia (330 mins vs 240 mins) and total analgsic consumption in the 24 hours period post operatively was significantly lesser for group A compared to group B. Ramsey sedation score was significantly higher in group B compared to group A until 8 hourspost operatively. Nausea and vomiting in 3 cases of group A , and 2 cases in group B. No other significant side effects were noted. Conclusion: USG-guided TAP block is an effective and safe adjunct for postoperative analgesia in infra umblical surgeries. Addition of dexamethasone as an adjuvant prolongs the duration and reduces post-operative analgesic requirement in patients significantly more than dexmedetomidine whereas dexamethasone provides better control of the heart rate and mean arterial pressure.

Assessing safety and feasibility of monopolar transurethral resection of the prostate without post-operative catheter traction: A randomized controlled trial.

Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction (n = 30) or non-traction (n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.}. No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss (p-value- 0.632), fall in hemoglobin (p-value- 0.719) and hematocrit (p-value- 0.937) levels, and length of postoperative hospital stay (p-value- 0.797). However, the traction group reported significantly higher postoperative pain scores (p-value < 0.001) and increased analgesic requirements (p-value < 0.001). The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain.

Comparison of the Efficacy of Sterile Silicone Studs Versus Lidocaine for the Attenuation of the Hemodynamic Response to Skull Pin Insertion: A Randomized Controlled Trial

BackgroundSkull pin insertion causes hypertension and tachycardia that adversely affects cerebral hemodynamics. We compared the efficacy of sterile silicone studs (SS) and pin site infiltration with lidocaine in attenuation of the sympathetic response to skull pin insertion. MethodsOne hundred and twenty adult patients undergoing supratentorial craniotomy under general anesthesia were randomized to receive either medical-grade sterile SS (Group SS) or 2 ml of 2% plain lidocaine infiltration at each pin site (Group LO). The primary objective was the comparison of the hemodynamic (heart rate [HR] and mean arterial pressure [MAP]) response to skull pin insertion at baseline and 0, 1, 2, 3 and 5 minutes of skull pin insertion. The secondary objectives were to assess the requirement of rescue analgesia (fentanyl), complications like pin-site bleeding, and the surgeon satisfaction score. ResultsThe HR in Group LO was significantly greater at 0, 1, 2, 3 and 5 mins post pin insertion as compared to Group SS (P <0.05). The MAP was also significantly higher in Group LO at 0, 1, 2, and 3 mins post pin insertion (P = 0.001, 0.01, 0.034 and 0.042 respectively) as compared to Group SS. The number of patients requiring fentanyl [17/60 (28.3%) v/s 40/60 (66%), P=0.001] was lower in Group SS. The incidence of pin site bleeding was also lower in Group SS along with a greater surgeon satisfaction score. ConclusionSterile SS appears to be more effective than lidocaine infiltration in attenuating the hemodynamic response to skull pin insertion with minimal adverse effects. Further multi-centre studies are necessary to conclusively establish the safety and efficacy of sterile SS.

ARE NEUROVASCULAR CHARTS APPROPRIATE FOR DIAGNOSING COMPARTMENT SYNDROME?

IntroductionCompartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network.Materials &amp; MethodsAll major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded.ResultsA response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1st webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts.ConclusionsIn 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network.

Evaluation of Ketamine in Premedication on Postoperative Rescue Analgesia Requirement in Cats Undergoing Ovariohysterectomy

Feline ovariohysterectomy is a routine surgery that may cause neglected pain. This work evaluated, in a prospective, comparative, randomized and blind study, the ketamine in comparison to morphine in preanesthetic medication on postoperative analgesia requirement in cats undergoing ovariohysterectomy. Thirty healthy female cats were divided into morphine group (MG, n = 15) and ketamine group (KG, n = 15). Cats received intramuscular dexmedetomidine (10 µg/kg), and either ketamine (5 mg/kg) or morphine (0.3 mg/kg) as premedication. The anesthesia was induced with propofol and maintained with isoflurane in oxygen. Sedation and analgesia were evaluated using the GRINT, and UNESP-Botucatu scales, respectively, immediately after extubation, and hourly for 6 hours following the ovariohysterectomy. Rescue analgesia was performed with morphine (0.1 mg/kg) when pain scores were ≥ 8 on the UNESP-Botucatu scale. The side effects were observed after surgery, including mydriasis in all animals from both groups, dysphoria in 80% of the KG group and in 20% of the MG, sedation in fourteen (93.33%) animals of the MG group, but not in the KG group (p &lt;0.001). In the KG group, 13 animals required only one rescue analgesia (86.66%), while 11 animals in the MG group (73.33%) required multiple and consecutive rescue analgesia. The need for rescue analgesia in the MG group was 5.34 times higher than in the KG group (p &lt;0.05). This study suggests a reduced need for analgesic opioids in the treatment of postoperative pain. Keywords: Analgesia. Feline. Opioid. Pain. Sedation. Resumo A ovariohisterectomia felina é uma cirurgia de rotina que pode causar dor negligenciada. Este trabalho avaliou, em um estudo prospectivo, comparativo, aleatório e cego, a cetamina em comparação com a morfina na medicação pré-anestésica sobre necessidade de analgesia pós-operatória em gatas submetidas à ovariohisterectomia. Trinta gatas saudáveis foram divididas em grupo morfina (MG, n = 15) e grupo cetamina (KG, n = 15). Os gatos receberam dexmedetomidina intramuscular (10 µg/kg) e cetamina (5 mg/kg) ou morfina (0,3 mg/kg) como pré-medicação. A anestesia foi induzida com propofol e mantida com isoflurano em oxigênio. A sedação e a analgesia foram avaliadas pelas escalas GRINT e UNESP-Botucatu, respectivamente, imediatamente após a extubação e a cada 6 horas após a ovariohisterectomia. A analgesia de resgate foi realizada com morfina (0,1 mg/kg) quando os escores de dor foram ≥ 8 na escala UNESP-Botucatu. Os efeitos colaterais foram observados após a cirurgia, incluindo midríase em todos os animais de ambos os grupos, disforia em 80% do grupo KG e em 20% do MG, sedação em quatorze (93,33%) animais do grupo MG, mas não no grupo KG. Grupo KG (p &lt;0,001). No grupo KG, 13 animais necessitaram de apenas uma analgesia de resgate (86,66%), enquanto 11 animais do grupo MG (73,33%) necessitaram de analgesia de resgate múltipla e consecutiva. A necessidade de analgesia de resgate no grupo MG foi 5,34 vezes maior do que no grupo KG (p &lt; 0,05). Este estudo sugere uma menor necessidade de opióides analgésicos no tratamento da dor pós-operatória. Palavras-chave: Analgesia. Felino. Opióide. Dor. Sedação.

Factors affecting Urethral Catheter Placement Following Flexible Ureterorenoscopy: RIRSearch Study Group

Background/Purpose: To investigate the factors affecting UC placement following flexible ureterorenoscopy (fURS) and the effect of urethral catheter (UC) placement on patient quality of life. Methods: The present study was performed in prospective manner from 1st January 2015 to 30th December 2023, and patients with renal stones smaller than two centimeters who underwent fURS were analyzed for study inclusion. Patients’ demographic characteristics, operative parameters, success of procedure, complications, and VAS score were recorded. Patients were categorized into two groups according to UC placement or not. These groups were compared according to preoperative parameters, intraoperative data, complications, success and VAS at postoperative 6th hour. Results: In total, 324 patients were enrolled into the study. UC was inserted in 170 patients following fURS and was not inserted to 154 patients. In the patient group with UC placement, ratio of male patients (p= 0.002), ratio of anticoagulant use (p= 0.002), preoperative creatinine level (p=0.001), stone size (p= 0.001), stone burden (p= 0.001), and ratio of multiple stones (p= 0.001) were significantly higher. Operation time was significantly longer (p= 0.003) and intraoperative complications (p= 0.045) were significantly higher in patients with UC insertion. Need for additional analgesia and VAS score was significantly lower in patients without UC placement (p= 0.004 vs. p= 0.001). Multivariate analysis revealed that male gender, higher preoperative creatinine level, higher stone size and stone burden, and longer operation time were predictive factors for UC placement following fURS (p= 0.008, p= 0.001, p= 0.001, p= 0.010, and p= 0.001, respectively). Conclusion: The present study demonstrated that UC placement following fURS was associated with increased analgesia requirements and more pain. Moreover, our study demonstrated that male gender, higher preoperative creatinine level, higher stone size and stone volume, and longer operation time resulted in UC insertion after fURS.

Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial

Study objectivesThe study aimed to compare the analgesic effect of USG-guided PENG (Peri capsular nerve group) block with Intravenous Nalbuphine hydrochloride (IVN) in patients with hip fracture coming to the emergency department (ED). The purpose was also to monitor the adverse effects and rescue analgesic requirements in both treatment modalities. MethodsThe study was an open-label randomised controlled trial (RCT) comparing PENG block versus IVN in treating patients with femoral head and neck fractures, as well as pubic rami fracture of the hip (HF). The participants in the PENG group received a USG-guided PENG block by injection of 25 ml of 0.25% bupivacaine, whereas the IVN group received 0.15 mg/kg of nalbuphine. An emergency physician with expertise in ultrasound-guided nerve blocks performed the PENG blocks. The primary outcome was to measure the improvement of the NRS (Numerical rating scale) score at 30 min in both static position (Patient-chosen position for the best comfort) and dynamic position (15-degree passive affected lower limb elevation). Secondary outcomes were to measure static and dynamic NRS pain scores at 2 h, 4 h, and 6 h after intervention in both groups. The requirement for rescue analgesia, adverse events and any block-related complications were also recorded. ResultsA total of 60 patients with HF were included in the final analysis. The static and dynamic NRS score was significantly lower in the PENG group compared to the IVN group at 30 min, 2 h, 4 h, and 6 h post-intervention. In the PENG group, the static NRS score was improved by 5.73 ± 1.17, while In the IVN group, the static NRS score was just improved by 2.13 ± 0.97 at 30 min. In the same duration, the Dynamic NRS score in the PENG group was improved by 6.13 ± 1.38, while In the IVN group, it improved just by 2.43 ± 1.28. Rescue analgesia was required in 50.0% of patients in the IVN group but none in the PENG group. Further, no block-related complications or adverse events were observed in the patients of the PENG group. ConclusionThe study provides evidence that the ultrasound-guided PENG block has a better analgesic effect and has fewer adverse events than IV opioids in patients with HF.

Satisfaction rates, function, and return to activity following young adult total hip arthroplasty.

Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes' disease (15; 13.6%) were the commonest indications for THA. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes.

A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain.

This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. Level 3, Non-randomized controlled cohort/follow-up study.

Effectiveness of Intravenous Low-Dose Ketamine Versus Morphine for Procedural Burn Pain Management During Dressing Changes: A Randomized Clinical Trial

Background: There is limited literature on using low-dose intravenous ketamine as a single agent for procedural burn pain management during adult dressing changes. Aims &amp; Objectives: To determine the effectiveness of low-dose ketamine compared to morphine as a single analgesic agent in procedural burn pain management during dressing changes. Materials &amp; Methods: We performed an institutional review board-approved, randomized, prospective, double-blinded, controlled, non-inferiority trial. All adult patients 18 years and above scheduled for dressing change were screened. Patients who consented were randomized to receive low-dose ketamine infusion at 0.2mg/kg/hr. In the treatment group, morphine infusion at 0.1mg/kg/hr. In the control group. The primary endpoint was pain intensity, measured using a visual analog scale. Data were analyzed on an intention-to-treat (ITT) approach. Secondary endpoints included rescue analgesia requirements and the occurrence of adverse effects in both groups. Results: 82 patients were enrolled (ketamine 41 vs. morphine 41). We compared VAS scores at 5-minute intervals during the dressing changes. Overall, pain scores are similar in both groups (p-value=0.595). The pain control was homogenous. However, the morphine group required more rescue analgesia throughout the dressing changes than the low-dose ketamine group (p=0.013 at T15, p&lt;0.001 at T20, and p&lt;0.001 at T30). The occurrence of side effects was similar in both groups. Conclusion: This study suggests that low-dose ketamine provides as effective and more predictable procedural analgesia as morphine during dressing procedures for adult burn patients.

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

BackgroundVideo-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS.Study designThis is a double-blinded randomized controlled trial.MethodsAdult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100 mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6 h for three cycles. The primary outcome was total analgesic consumption at 24 h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality of recovery at 24 h and 48 h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3 months postoperatively.ResultsThe study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24 h and 48 h postoperatively (24 h: median difference: − 100 µg equivalent intravenous fentanyl [95% confidence interval (CI) − 200 to − 5 μg], P = 0.037; 48 h: median difference: − 140 μg [95% CI − 320 to − 20 μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24 h post-surgery, with no significant difference at 48 h. All pain scores except for coughing at 48 h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP.ConclusionPerioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics.

Outcomes of percutaneous vertebroplasty in multiple myeloma: a tertiary neurosciences experience with long-term follow-up.

Multiple myeloma is diagnosed in 5,800 people in the United Kingdom (UK) each year with up to 64% having vertebral compression fractures at the time of diagnosis. Painful vertebral compression fractures can be of significant detriment to patients' quality of life. Percutaneous vertebroplasty aims to provide long-term pain relief and stabilize fractured vertebrae. Data was collected from all cases of percutaneous vertebroplasty performed on patients with multiple myeloma from November 2017 to January 2019. Pain scores were measured using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-procedure, 2 months post procedure and 4 years post-procedure. Procedure related complications and analgesia use were also documented. 22 patients were included with a total of 119 vertebrae treated. Patients reported a significant improvement in overall pain score with a median pre-procedure VAS of 8 and a median post-procedure VAS of 3.5 (p<0.0001). There was a median pre-procedure ODI score of 60% and a median post-procedure ODI score of 36% (p<0000.1). There was improvement across all ODI domains and a 77% reduction in analgesic requirement. There were small cement leaks into paravertebral veins or endplates at 15 levels (12%) which were asymptomatic. There were 8 responders to the long-term follow-up questionnaire at 4 years. This demonstrated an overall stable degree of pain relief in responders with a median VAS of 3.5 and median ODI of 30%. At this center, vertebroplasty has been shown to reduce both VAS and ODI pain scores and reduce analgesia requirements in patients with VCFs secondary to multiple myeloma with long lasting relief at 4 years post-procedure.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial.

Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) andlaparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.