Block Anesthesia Research Articles

Application of propofol-remifentanil intravenous general anesthesia combined with regional block in pediatric ophthalmic surgery

ObjectiveThe aim of this study is to observe the anesthetic effect and safety of intravenous anesthesia without muscle relaxant with propofol-remifentanil combined with regional block under laryngeal mask airway in pediatric ophthalmologic surgery.MethodsA total of 90 undergoing ophthalmic surgery were anesthetized with general anesthesia using the laryngeal mask airway without muscle relaxant. They were randomly divided into two groups: 45 children who received propofol-remifentanil intravenous anesthesia combined with regional block (LG group), and 45 children who received total intravenous anesthesia (G group). The peri-operative circulatory indicators, awakening time after general anesthesia, postoperative analgesic effect and the incidence of anesthesia-related adverse events were respectively compared between the two groups.ResultsAll the children successfully underwent the surgical procedure. The awakening time after general anesthesia and removal time of laryngeal mask were significantly shorter in the LG group than in the G group (P < 0.05). There was no statistically significant difference in the heart rates in the perioperative period between the two groups (P > 0.05). There was no statistically significant difference in the incidence of intraoperative physical response, respiratory depression, postoperative nausea and vomiting (PONV) and emergence agitation (EA) between the two groups (P > 0.05). The pain score at the postoperative hour 2 was lower in the LG group than in the G group (P < 0.05).ConclusionPropofol-remifentanil intravenous anesthesia combined with long-acting local anesthetic regional block anesthesia, combined with laryngeal mask ventilation technology without muscle relaxants, can be safely used in pediatric eye surgery to achieve rapid and smooth recovery from general anesthesia and better postoperative analgesia. This anesthesia scheme can improve the comfort and safety of children in perioperative period, and has a certain clinical popularization value.

Effect of ultrasound-guided quadratus lumborum block on neuroendocrine stress response and postoperative analgesia in paediatric patients undergoing elective open pyeloplasty - A randomised clinical trial.

Quadratus lumborum block (QLB) is a compartmental block of the anterior abdominal wall. Surgical trauma produces neuroendocrine surgical stress responses, which are modified by anaesthetic blocks. The aim of this study was to evaluate the effect of ultrasound (US)-guided QLB on analgesia and surgical neuroendocrine stress response in paediatric patients undergoing pyeloplasty. A randomised trial was conducted in 60 children aged 1-7 years undergoing elective open pyeloplasty. Patients were randomised into Group QLB [US-guided QLB with 0.5 ml/kg of 0.25% ropivacaine after induction of general anaesthesia (GA)], and Group GA, which received only GA. Perioperative haemodynamic parameters, serum cortisol, blood glucose, analgesic consumption and postoperative FLACC scores were recorded. Unpaired t-test, Wilcoxon rank-sum test or Mann-Whitney U test was used to compare variables between the two groups. Two-way analysis of variance or the Friedmann test was used to compare quantitative variables at various points within a group. A decrease in serum cortisol and blood glucose values was observed in Group QLB at 30 min after surgical incision and 24 h after surgery compared to the preoperative value and compared to Group GA (P < 0.05). The quality of analgesia assessed by the FLACC scale was significantly better in group QLB. Dose of fentanyl consumption (µg/kg) was higher in Group GA compared to Group QLB in the intraoperative and postoperative period (P < 0.05). QLB is effective as part of multimodal analgesia and attenuates the neuroendocrine stress in paediatric patients undergoing open pyeloplasty.

Effect of transcutaneous electrical acupoint stimulation on postoperative urinary function in elderly patients undergoing total hip arthroplasty.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative urinary function in elderly patients undergoing total hip arthroplasty (THA). One hundred and eighty elderly patients undergoing unilateral THA without indwelling urinary catheters were randomly assigned to a TEAS group (90 cases, 3 cases dropped out, 4 cases were eliminated) and a sham TEAS group (90 cases, 1 case dropped out, 4 cases were eliminated). Both groups received fascia iliac block and subarachnoid block anesthesia under ultrasound guidance. The patients in the TEAS group were treated with TEAS at Zhongji (CV 3), Guanyuan (CV 4), and bilateral Huiyang (BL 35), Ciliao (BL 32) 30 minutes before anesthesia initiation, with dissperse-dense wave, frequency of 2 Hz/100 Hz, until 30 minutes after surgery. The patients in the sham TEAS group underwent the same procedure with the device applied at the same acupoints but without electrical stimulation. The incidence of postoperative urinary retention (POUR), time to first void, voiding threshold, urinary adenosine triphosphate (ATP) level, postoperative abnormal voiding status (bladder residual volume, re-catheterization rate, nocturia occurrence), and postoperative incidence of urinary tract infection (UTI) and prosthetic joint infection (PJI) were observed in both groups. The incidence of POUR in the TEAS group was lower than that in the sham TEAS group (P<0.05); the time to first void in the TEAS group was shorter than that in the sham TEAS group (P<0.05); the voiding threshold in the TEAS group was lower than that in the sham TEAS group (P<0.05); the urinary ATP level in the TEAS group was higher than that in the sham TEAS group (P<0.05); the bladder residual volume in the TEAS group was lower than that in the sham TEAS group (P<0.05); the nocturia occurrence in the TEAS group was lower than that in the sham TEAS group (P<0.05). However, there was no statistically significant difference in re-catheterization rate, incidence of UTI, and incidence of PJI between the two groups (P>0.05). TEAS could effectively reduce the occurrence of postoperative urinary retention and improve the postoperative urinary function in elderly patients undergoing THA, which might be related with increasing the urinary ATP level.

Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block versus Local Anesthesia Wound Infiltration for Postoperative Pain Relief After Laparoscopic Appendicectomy in Children: A Study Protocol for a Multicenter Double-Blind Randomized Controlled Phase III Trial.

Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration. We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery. No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic.

Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study.

Objective To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI). Materials and Methods A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use. Results There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group ( p = 0.04 and p = 0.02 respectively). Conclusion We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study.

Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception.

For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Comparative assessment of hemodynamic parameters during anesthesia in orthopedic and traumatological operations on the lower extremities in children

Objective. To conduct a comparative analysis of hemodynamic parameters during orthopedic and traumatological operations on the lower extremities in children performed under conditions of multicomponent balanced general and combined anesthesia. Materials and methods. A single-center prospective study. The present study included 60 children aged 6 to 17 years who underwent planned orthopedic and trauma surgery interventions on the lower extremities. Patients were divided into two groups depending on the method of anesthesia: Group 1 (n = 25) - multicomponent balanced general anesthesia, Group 2 (n = 35) - combined anesthesia (multicomponent balanced general anesthesia in combination with regional blocks of the sciatic and femoral nerves). To solve these problems, a comparative analysis of heart rate, systolic, diastolic and mean arterial blood pressure was carried out at seven stages of the study: 1st stage - initial, child on the operating table; 2nd stage - induction of anesthesia; 3rd stage - placement of the laryngeal mask; 4th stage - start of the operation; 5th stage - traumatic stage of the operation; 6th stage - completion of the operation; 7th stage - after removal of the laryngeal mask. Results. In all cases, the surgical interventions were successful. The study found that in the group of children who underwent multicomponent general anesthesia at the 4th (start of surgery), 5th (traumatic stage of surgery) and 6th (end of surgery) stages, heart rate (HR) was higher compared to the group of combined anesthesia. Systolic and mean arterial blood pressure during the traumatic phase of surgery were also higher in children undergoing multicomponent general anesthesia. The values of diastolic blood pressure did not differ between groups throughout the study with the exception of the 3rd stage (laryngeal mask placement) where lower values were observed in patients of the Group 1. Diastolic blood pressure values did not differ between groups throughout the study, with the exception of 3th stage (laryngeal mask placement), where lower values were noted in Group 1 patients. Conclusion. Combined methods of anesthesia based on the combination of multicomponent general anesthesia and conductive peripheral nerve blocks provide the greatest hemodynamic stability during orthopedic and traumatologic surgeries on the lower extremities in children.

Hematoma Block Verses General Anesthesia For Close Reduction And Percutaneous Pinning Of Distal Radius Fractures In Elderly Patients

Objective: The objective of our study is to compare two techniques used for analgesia, hematoma block and general anaesthesia, in patients presented with a fracture of the distal radius in the trauma centre of Aziz Bhatti Shaheed Hospital Gujrat. Methods: Our study was conducted at the Trauma Centre of Aziz Bhatti Shaheed Hospital Gujrat from January 2021 to April 2023. All the patients having distal radius fractures who met the inclusion criteria were included in our study. The patients were placed into two groups, A and B. All the patients were treated by close reduction and percutaneous pinning. The analgesia method used in group A was Hematoma block while in group B was general anesthesia. Data was analyzed using SPSS. Results: 156 patients met the inclusion criteria. The mean age was 61.3 ± 6.6 years. These patients were placed in two groups, A and B, of 78 patients each. There was significantly less pain intensity at 2 and 6 hours after the procedure in the hematoma block group (P &lt; 0.001). Duration for manipulation did not differ significantly between the two groups. Duration for surgery was significantly shorter for the hematoma block group (P 0.02). In 100 per cent of cases, anatomical reduction was achieved in both groups. Conclusion: Hematoma block used as analgesia for the management of fractures of the distal radius in elderly patients is a more effective and safe method than general anaesthesia in emergency trauma centres. Keywords: Hematoma block, distal radius fracture, elderly.

Student training in administering inferior alveolar nerve block anesthesia with a simple manufactured simulation model.

To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator. This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p<0.05). The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p<0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p=0.08 and 0.11, respectively). No difference in success was observed (p>0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful. Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons.

The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial

BackgroundThe Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study.MethodsA total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score.ResultsTotal morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively.ConclusionDexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption.Trial registration(ID: PACTR202203906027106; Date: 31/07/2023).

Use of concomitant anesthesia (endotracheal anesthesia and femoral nerve block) in cardiac surgery: a prospective, cross-sectional study

BACKGROUND: Regional anesthesia reduces pain impulse transmission, which reduces hormonal and metabolic responses to operational stress. No studies have reported on the use of combined anesthesia, such as endotracheal anesthesia and femoral nerve block, in cardiac surgery. OBJECTIVE: To determine the efficacy of combined anesthesia by analyzing the cortisol, glucose, and lactate levels in cardiac surgery. MATERIALS AND METODS: Prospective cross-sectional study was conducted. The study included 60 cardiac surgery patients. The patients were divided into two groups: group 1, with endotracheal anesthesia and femoral nerve blockade, and group 2, with endotracheal anesthesia (control group). All patients underwent aortocoronary bypass grafting under artificial circulation conditions. Cortisol, glucose, and lactate levels at the five stages of the perioperative period were investigated. RESULTS: Data analysis showed that the cortisol level of patients with combined anesthesia was significantly 1.2 times lower (p=0.042) than that in the control group in step 2. Glucose levels were significantly lower in the combined anesthesia group by 1.28 times (p=0.0017) than in the control group in step 4 and significantly lower by 1.2 times (p=0.0016) in step 5. Additionally, lactate level was significantly lower in the combined anesthesia group than in the control group in step 4 by a factor of 1.3 (p=0.03) and in step 5 by a factor of 1.35 times (p=0.005). CONCLUSION: The determination of cortisol, glucose, and lactate levels can be used as a component of endocrine-metabolic anesthesiological monitoring when performing cardiac surgery under artificial circulation conditions. Stable parameters of endocrine-metabolic monitoring were established using both anesthesia methods. The use of femoral nerve block in combined anesthesia reduces stress response to surgery.

Perioperative regional anaesthesia in kidney transplantation

Background. Postoperative analgesia in kidney transplant recipients is challenging due to potential nephrotoxicity of nonsteroidal anti-inflammatory drugs and the reduced clearance of opioid metabolites during transient renal impairment. Opioid-sparing multimodal postoperative analgesia using regional analgesia methods could provide better pain control and early activation after kidney transplantation.Aim. To evaluate the clinical results of treatment using regional pain management methods in kidney transplant recipients.Material and methods. A single-center study was conducted at Republican Research Center of Emergency Medicine from 2020 to 2022. The study included 97 patients who underwent heterotopic kidney transplantation from a living related donor. Patients were divided into 3 groups. In group 1 (31 patients), general anesthesia was used. For postoperative analgesia opioid analgesics in combination with metamizole 1000 mg were used. In group 2 (33 recipient patients), a combination of general anesthesia and open transversus abdominis plane block was used. In group 3 (33 recipient patients), a combination of general anesthesia and erector spine plane block was performed. Opioid analgesics were used as a "rescue analgesia" when necessary. The primary study end points were the pain intensity assessed by a visual analogue scale and opioid consumption on the first day after surgery. Secondary endpoints were the time of intestinal motility recovery, the presence of nausea and vomiting, the Intensive Care Unit length of stay and the hospital length of stay.Results. Pain intensity 6 hours after surgery in patients of group 1 was 13.5% and 24.6% higher than in patients of group 2 and 3, respectively. In group 2, pain intensity was 12.8% higher compared to group 3 (p=0.0017). At 12 hours after surgery, the pain intensity was 42% higher in group 1 compared to group 2 and group 3 (p&lt;0.0001). After 18 hours, the pain score in group 3 was 48.5% and 35.7% lower compared to groups 1 and 2, respectively (p&lt;0.0001 and p=0.0016). 24 hours after surgery, the sensation of pain was 18.6% and 65.3% higher in group 1 compared to groups 2 and 3 (p&lt;0.0001). The mean dose of narcotic analgesic equivalent to morphine in group 1 was 22.6±8.6 mg, which was 18.5% higher than in group 2 patients. In group 3, it was 12.0±4.3 mg and was 47% lower compared to group 1 (p&lt;0.0001) and 34.7% lower compared to group 2 (p&lt;0.0001) (all comparisons are statistically significant). The adequacy of analgesia and less opioid consumption contributed to the absence of postoperative nausea and vomiting in 75% of cases, early restoration of intestinal motility in 63% compared with the group of patients where opioid analgesics were used for postoperative pain relief.Conclusion. The combined use of general anesthesia and erector spine plane block may be recommended as a method of effective perioperative analgesia in kidney transplantation.

Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis.

Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.

Application Effects of Light Lumbar Anesthesia and Nerve Block Anesthesia in Elderly Hip Joint Surgery

Objective: To analyze the application effects of light lumbar anesthesia and nerve block anesthesia in elderly hip joint surgery. Methods: A total of 40 patients indicated for hip joint surgery from February 2021 to February 2022 were randomly divided into the control group and the observation group, each with 20 patients. The control group received nerve block anesthesia and the observation group was given light lumbar anesthesia. Results: Based on the results, the anesthetic effect in the observation group was better than that in the control group (P &lt; 0.05), the difference was statistically significant. Conclusion: Compared with nerve block anesthesia, light lumbar anesthesia can achieve better analgesic effects and stable blood circulation in elderly patients undergoing hip joint surgery.

Feasibility of tension-free repair of inguinal hernia in senile patients under ultrasound-guided local nerve block

The clinical characteristics of open hernia repair under local nerve block guided by ultrasound and epidural anesthesia under daytime surgery mode were compared and analyzed, and the safety, rationality and effectiveness of tension-free repair of inguinal hernia in elderly patients under local nerve block guided by ultrasound were discussed. The clinical data of 200 patients who underwent inguinal hernia day surgery in Liaocheng People's Hospital Affiliated to Shandong First Medical University from January 2022 to October 2022 were retrospectively analyzed, including 150 patients who underwent local anesthesia block surgery and 50 patients who underwent epidural surgery. The visual analog score of the ultrasound local anesthesia group was lower than that of the epidural surgery group at 4 h after operation. The time of getting out of bed and postoperative exhaust were shorter than those of epidural operation group. The recovery rate of unrestricted activity 2 weeks after surgery was higher than that in epidural surgery group (P < 0.05). The incidence of postoperative acute urinary retention between the two groups was lower in local ultrasound anesthesia group, and the difference was statistically significant (P < 0.05). The median follow-up time was 4(1–6) months, and the follow-up rate was 100%. Postoperative complications were seroma, wound infection, chronic pain and recurrence, and there was no statistical significance between the two groups (P > 0.05). No serious complications occurred in both groups. Compared with open epidural surgery, ultrasound-guided local nerve block tension-free day surgery in the elderly has the advantages of less pain, faster recovery, and is safe and feasible.

Measurements of pupillary unrest using infrared pupillometry fail to detect changes in pain intensity in patients after surgery: a prospective observational study

PurposeThe pupil displays chaotic oscillations, also referred to as pupillary unrest in ambient light (PUAL). As pain has previously been shown to increase pupillary unrest, the quantitative assessment of PUAL has been considered a possible tool to identify and quantify pain. Nevertheless, PUAL is affected by various states, such as vigilance, cognitive load, or emotional arousal, independent of pain. Furthermore, systematically applied opioids are known to reduce PUAL, thus potentially limiting its usefulness to detect pain or changes in pain intensity. To test the hypothesis that PUAL can reliably identify changes in pain intensity in a clinical setting, we measured PUAL in patients experiencing substantial pain relief when regional anesthesia interventions were applied after surgery.MethodsWe conducted an observational study at an academic surgery centre following institutional review board approval. Eighteen patients with unsatisfactory pain control following surgery underwent regional anesthesia procedures to improve pain control. We used infrared pupillometry to assess pupillary unrest before and after the regional block. We then compared the changes in pupillary unrest with the changes in pain scores (numeric rating scale [NRS], range 0–10).ResultsEighteen patients received epidural anesthesia (n = 14) or peripheral nerve blocks (n = 4), resulting in improvement of mean (standard deviation [SD]) NRS pain scores from 7.2 (1.7) to 1.9 (1.8) (difference in means, −2.2; 95% confidence interval [CI], −6.3 to −4.1; P < 0.001). Nevertheless, pupillary unrest did not change as pain decreased; the mean (SD) PUAL was 0.113 (0.062) before analgesia and 0.112 (0.068) after analgesia (difference in means, −0.001; 95% CI, −0.018 to 0.015; P = 0.88).ConclusionIn this prospective observational study, pupillometric measurements of pupillary unrest did not identify changes in pain intensity in a postoperative, predominantly opioid-exposed patient population. While the sample size was small, the use of measurements of pupillary unrest to detect and quantify pain has to be questioned.

A COMPARATIVE STUDY BETWEEN CLONIDINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN BRACHIAL PLEXUS BLOCK THROUGH USG-GUIDED AXILLARY APPROACH

Objective: To improve the quality of block in regional anaesthesia, several adjuvants are added to local anaesthetic drugs. The effects of clonidine and dexmedetomidine were compared with regard to the onset and duration of sensory and motor block as well as the length of analgesia when used as an adjuvant to bupivacaine in brachial plexus block by axillary approach.&#x0D; Objective: The present study was conducted to compare the onset time, duration and analgesic efficacy of clonidine vs dexmedetomidine when added as adjuvant to bupivacaine (0.5%) for USG guided brachial plexus by axillary approach.&#x0D; Methods: This is a prospective, randomized; comparative study conducted in elective unilateral upper limb forearm and hand surgeries. The study was conducted at Government General Hospital, Srikakulam, between March 2023 to September 2023 after obtaining permission from the Institutional Ethics Committee and from the patients. Group BC received 30 ml of 0.5% bupivacaine with Clonidine 1µg/kg (n=30) and Group BD received 30 ml of 0.5% bupivacaine with dexmedetomidine 1µg/kg (n = 30). The onset and duration of sensory and motor block total duration of analgesia were studied in both groups.&#x0D; Results: The mean time for onset of sensory block in Group BD was 4.7 min, which was lower than Group BC 8.47 min. The mean time for onset of motor block in Group BD was 9.63 min the mean time for total duration of sensory block in Group BD was 537.8 min. This was higher than the Group BC 319.1 min. The total duration of analgesia in Group BD was 666.27 min. This was higher than in Group BC 375.23 min. Bupivacaine dexmedetomidine group had better quality analgesia than the bupivacaine clonidine group.&#x0D; Conclusion: The addition of Dexmedetomidine (1μg/kg) to bupivacaine (0.5%) in brachial plexus block by USG-guided axillary approach results in a shorter onset time for sensory and motor blockade, prolongs the duration of sensory and motor blockade and also total duration of analgesia.

Comment on “Combined thoracic epidural anaesthesia and interscalene brachial plexus block for modified radical mastectomy in a high-risk patient”

Comment on “Combined thoracic epidural anaesthesia and interscalene brachial plexus block for modified radical mastectomy in a high-risk patient”

A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study.

The objective of this research was to conduct a comparison and evaluate the pain perception and time of onset of 2% lignocaine 1:80,000 epinephrine with 4% articaine 1:100,000 epinephrine in the pediatric population. A split-mouth randomized control trial was conducted on 50 children aged 9-14 years who required inferior alveolar nerve block (IANB) anesthesia for bilateral dental treatment in the mandibular arch. The time of onset was recorded when no sensation was reported even when maximum electrical stimulus was applied in an electric pulp testing (EPT). The pain perception was assessed using a visual analog scale (VAS) rated by the patient for subjective symptoms and face, legs, activity, cry, and consolability (FLACC) scale for objective pain rated by the operator. The mean onset of time, pain-VAS, and FLACC score decreased by 1.31, 12.07, and 18.39%, respectively in 4% articaine as compared to 2% lignocaine but the difference did not reach statistical significance (p > 0.05), that is, found to be statistically the same.In conclusion, it can be inferred that the utilization of 4% articaine is as potent as 2% lignocaine solution but showed slightly better onset of anesthesia and pain experience among the children although the findings were not statistically significant. Local anesthesia (LA) is one of the main methods of pain management in pediatric practice which makes it essential to choose an LA agent with a shorter time of onset and less pain on administration. Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024;17(1):67-71.