Block For Postoperative Analgesia Research Articles

Pro's and con's of different blocks for postoperative analgesia after video-assisted thoracic surgery.

Although there are a lot of studies examining the effects of different blocks for postoperative analgesia after video-assisted thoracic surgery (VATS), the results are controversial. Paravertebral block, serratus anterior plane block and erector spinae plane block appear to be effective and beneficial for post-VATS analgesia, but probably in different manners. All three blocks can be suggested for daily practice, the choice should be based on personal experience and preference of the anesthetist. Better studies are required for objective decision.

Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial

IntroductionBoth the quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block provide effective postoperative analgesia after hip surgery while minimizing the impact on motor function. This study aimed...

The Effect of Quadratus Lumborum Block vs Erector Spinae Block in Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background However, the postoperative pain following laparoscopic cholecystectomy consists of both somatic and visceral components with pain originating from port entry wounds, gallbladder resection and abdominal insufflation that leads to peritoneal distention and peritoneal damage. Aim of the Work to compare analgesic efficacy of Quadratus lumborum block versus erector spinae block in postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Study Design prospective randomized controlled clinical trial Methods This prospective randomized controlled clinical trial was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals from March until August 2023. During this study, 80 patients electively scheduled for laparoscopic cholecystectomy were enrolled and divided into two equal groups; group A subjected to quadratus lumborum block and group B subjected to erector spinae block. Intraoperative, Post Anaesthesia Care Unit and postoperative haemodynamic, postoperative VAS score, first time of postoperative analgesic request, total amount of postoperative analgesia, time needed for postoperative mobilization and side effects of study procedures were evaluated. Results In this study there was no significant difference between the two groups as regards VAS score. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study time needed for mobilization was insignificant different between two groups. In this study, no statistically significant disparity was observed between the two groups in terms of side effects. In this study, no significant difference was found between the two groups according to the first time postoperative analgesia. Conclusion This study showed comparable effect of both QLB and ESPB in patients undergoing laparoscopic cholecystectomy.

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

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

A comparative evaluation of dexamethasone and MgSO4 as an adjuvant to ropivacaine in transversus abdominis plane block for post operative analgesia in patients undergoing elective cesarean section, a triple blinded randomised controlled trial

: In regional blocks, dexamethasone and magnesium sulphate (MgSO4) have been used as an adjunct to local anesthesia. But more research needs to be done on each one's effectiveness. This study aims to assess the efficacy of dexamethasone 4mg and MgSO4 150mg as an adjunct to ropivacaine 0.375% in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing cesarean section under subarachnoid block (SAB).: Ninety patients undergoing cesarean section under SAB belonging to American Society of Anesthesiologists physical status I or II, were recruited and randomised in three groups. Each group comprised of 30 patients. Group RS received 20ml 0.375% ropivacaine with 2 ml normal saline, Group RD received 20ml 0.375% ropivacaine with 4 mg dexamethasone and Group RM received 20ml 0.375% ropivacaine with 150 mg MgSO4.Time to first analgesic request, VAS score at rest and movement, patient satisfaction score, hemodynamic parameters and side effects were recorded in each group post-TAP block for 24 hours. Time to first analgesic request was significantly longer in group RD (814.0± 277.3 min) compared to group RM (606.5 ± 279.9 min) and group RS (545.5 ± 254.3 min) (p = 0.001). The mean value of tramadol requirement was statistically higher in Group RS compared to Group RD and Group RM (p<0.001). The mean differences in VAS score at rest and movement at 6 & 8 h was significantly lower in dexamethasone and MgSO4 compared to control group p=0.001. The addition of dexamethasone to ropivacaine in TAP block significantly prolonged the duration of analgesia, reducing the need for systemic analgesia with minimal side effects.

Laparoscopy-guided transverse abdominis plane block versus port site infiltration for post-operative pain relief after laparoscopic cholecystectomy.

Post-operative analgesia is an important component of patient satisfaction and early discharge from the hospital. A variety of modalities have been tested and are still evolving. The present study is one such evaluation of a novel technique of laparoscopy-guided transverse abdominis plane (LTAP) block for post-operative analgesia in laparoscopic cholecystectomy. A prospective randomised control trial was conducted to verify the effectiveness of LTAP block over port site local anaesthesia infiltration (PSLAI) for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. This study was done over a period of 18 months in a tertiary hospital. A total of 84 patients were recruited and were divided equally into two groups (LTAP and PSLAI). There was no statistical difference between the two groups with respect to gender distribution, comorbidities, number of gallstones, duration of symptoms and surgery time. The rescue dose of diclofenac requirement was less for the LTAP group in comparison to the PSLAI group. No difference was observed in the pain score at 1st h. However, LTAP proved efficient later in the post-operative course (6 h, 24 h and at discharge). There was significant a difference in the pain scores between the two groups, favouring the LTAP group. Hospital stay in the LTAP group was less in comparison to the PSLAI group. LTAP block is an effective method of post-operative analgesia. It impacts analgesia to the whole anterior abdominal wall for a prolonged period when compared to the PSLAI without adding any extra procedural time.

Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections.

Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th,and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.

Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial.

Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.

Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial.

Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer. In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48h post operation, and the incidence of postoperative adverse reactions were compared between the two groups. The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48h post operation than at 2, 6, 12, and 24h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups. Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery. https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.

Comparative study between the analgesic efficacy of pectoralis major block II versus erector spinae block versus paravertebral block in postoperative analgesia in modified radical mastectomy

Comparative study between the analgesic efficacy of pectoralis major block II versus erector spinae block versus paravertebral block in postoperative analgesia in modified radical mastectomy

Meta-analysis of the efficacy of anterior quadratus lumborum block and pudendal nerve block in postoperative analgesia after abdominal surgery

Meta-analysis of the efficacy of anterior quadratus lumborum block and pudendal nerve block in postoperative analgesia after abdominal surgery

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Block and Three-in-one Block in Elderly Patients Undergoing Hip Surgeries: A Randomised Double-blinded Clinical Trial

Introduction: Hip surgery is a common surgical procedure in the elderly population, leading to significant pain. Ultrasound (USG) guided regional nerve blocks are a newer, safe, and effective postoperative pain control modality for elderly patients. Aim: To compare the analgesic efficacy of Fascia Iliaca Compartment Block (FICB) with the three-in-one block for postoperative analgesia in elderly patients after lower limb orthopaedic surgeries. Materials and Methods: It was a randomised double- blinded study performed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India on 60 elderly patients of Americian Soceity of Anaesthesiologists (ASA) class I-II scheduled for elective hip and femur shaft surgery under spinal anaesthesia.All patients were randomly allocated into two groups. Group A received ultrasound-guided FICB with 35-40 mL of 0.25% bupivacaine, and group B received ultrasound-guided three-in-one block with 35-40 mL of 0.25% bupivacaine after completion of surgery. In the postoperative period, pain was assessed using the Visual Analogue Scale (VAS), and inj. diclofenac sodium 1.5 mg/kg intravenous (i.v.) was given as rescue analgesic whenever VAS was ≥4. The primary outcome was changes in VAS scores at rest and during passive leg elevation between the two groups at various time intervals within 24 hours. Secondary outcomes measured were the duration of analgesia and total rescue analgesic required in 24 hours. Qualitative variables were compared between groups using the Chi-square test. A p-value&lt;0.05 was considered statistically significant. Results: Demographic data were comparable in both groups, with a mean age of 65.11±1.89 years in Group A and 65.57±1.46 years in Group B. The VAS score at rest was significantly lower in Group A compared to Group B at the 6th hour (1.21±1.17 vs. 1.61±0.78) and 12th hour (2.80±0.12 vs. 3.33±0.92), respectively. The VAS score during passive movement was significantly lower in Group A at the 6th hour and 12th hour compared to Group B. The mean time for the first demand of rescue analgesic was 9.27±2.16 hours in the Fascia Iliaca Compartment Block (FICB) group and 6.67±1.45 hours in the three-in-one group. The difference was significant, with a p-value of 0.006. The mean requirement of total rescue analgesia was 133.33±33.27 mg in Group A and 198.53±29.16 mg in Group B, which was statistically significant. Conclusion: The fascia iliaca block had lower pain scores both at rest and during passive movement compared to the three-inone block. Total analgesic requirement was lower in the fascia iliaca group compared to the three-in-one block group.

Evaluation of the Effectiveness of Transversus Abdominis Plane Block and Transversalis Fascia Plane Block in Postoperative Analgesia in Pediatric Patients Undergoing Lower Abdominal and Genitourinary Surgery: A Retrospective Study

Evaluation of the Effectiveness of Transversus Abdominis Plane Block and Transversalis Fascia Plane Block in Postoperative Analgesia in Pediatric Patients Undergoing Lower Abdominal and Genitourinary Surgery: A Retrospective Study

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p &amp;lt; 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p &amp;lt; 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdomins Plane (TAP) Block for Analgesia in Patients Undergoing Laparoscopic Cholecystectomy Surgery

Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block became a common analgesic method after surgery involving the abdominal wall. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work to compare dexmedetomidine versus dexamethasone added to bupivacaine as adjuvant to the local anesthetic bupivacaine during Ultrasoundguided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy, characteristics including duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods The current study included 40 patients scheduled for elective laparoscopic cholecystectomy surgery were given Ultrasound-guided transversus abdominis plane (TAP) block after induction of general anesthesia. The patients were randomly allocated into two groups. Group (DM): patients received 22 ml of Bupivacaine 0.25 %in 20 ml + 1 ug/kg of dexmedetomidine in 2 ml on both sides. Group (DS): patients received 22 ml of Bupivacaine 0.25 % in 20 ml + 4 mg of dexamethasone in 2 ml on both sides. Results VAS pain score at rest especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. VAS pain score at movement especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. 1st rescue dose of analgesics was delayed up to (19.76±2.51 hrs), in dexmedetomidine group in comparison to (12.92±2.17 hrs) in dexamethasone group. The total dose of paracetamol required by patients in the dexmedetomidine group was (3.18±1.07 gm) compared to (5.33±1.16 gm) in dexamethasone group, indicating longer pain-free period and less requirement of analgesia in the dexmedetomidine group. Therefore, use of dexmedetomidine in TAP block has a beneficial effect in reducing the dose of systemic analgesic requirements. Conclusion co administration of 1 ug/kg of dexmedetomidine vs dexamethasone 4 mg to 0.25 % bupivacaine on both sides by US guided TAP block leaded to significant changes in the form of lower HR at 12, 24, 48 hrs, lower sedation score at 1, 6, 12, 24, 48 hrs and no significant changes in systolic blood pressure, diastolic blood pressure, oxygen saturation and respiratory rate.

Effect of Adding Magnesium Sulphate as An Adjuvant to Bupivacaine in Ultrasound-Guided Transversus Abdominis Plane [TAP] Block for Postoperative Analgesia after Moderate-Sized Umbilical Hernia Repair

Effect of Adding Magnesium Sulphate as An Adjuvant to Bupivacaine in Ultrasound-Guided Transversus Abdominis Plane [TAP] Block for Postoperative Analgesia after Moderate-Sized Umbilical Hernia Repair

Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia following inguinal hernia repair

Postoperative analgesia for inguinal hernia procedures can be provided safely and effectively with USG guided TAP blocks. In the TAP block following inguinal hernia repair, we compared the analgesic effectiveness of dexmedetomidine and clonidine.: Seventy four patients undergoing inguinal hernia repair under spinal anesthesia were randomly divided in to Group LD (n=37) and Group LC (n=37). Patients in Group LD received a unilateral USG-guided TAP block with 0.5% levobupivacaine 18ml and dexmedetomidine 1 μg/kg in NS to make a total 20ml at the conclusion of surgery after regression of sensory block to the T10 dermatome, whereas patients in Group LC received 0.5% levobupivacaine 18ml and clonidine 1 μg/kg. Duration of postoperative analgesia, quality of analgesia (VAS), total rescue analgesic consumption in 24 hours and adverse effects were noted.Time for the initial application of rescue analgesia took substantially longer in Group LD (1006.49± 29.89 min) than in Group LC (512.35 ±27.14 min) (p ≤0.0001). At 8h, 16h, and 20h postoperatively, Group LD had a significantly lower VAS score both at rest and during hip flexion. It was discovered that Group LD had considerably decreased overall analgesic consumption. Incidence of postoperative side effects was comparable between two groups.: In comparison to clonidine, TAP block with dexmedetomidine as an adjuvant to levobupivacaine greatly prolongs postoperative analgesia and lowers 24-hour analgesic use.

Gallstone Ileus of the Sigmoid Colon: Rare cause of Bowl Obstruction in a Case Report

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

Benefits of the Femoral Nerve Block in Total Knee Replacements: Analytical and Descriptive Study of a Series of 35 Cases

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

The Effect of Transversus Abdominis Plane Block in Kidney Transplantation: A Systematic Review and Meta-Analysis

Introduction: The aim of the study was to evaluate the effect of transversus abdominal (TAP) block for postoperative analgesia after renal transplantation. Methods: We searched PubMed, Embase, the Cochrane Library, and the Chinese Biomedical Literature Database for relevant studies. The related trials that met the inclusion criteria were analysed using RevMan 5.4 software. Results: We found 15 randomized controlled trials and two retrospective studies that, on meta-analysis, showed that TAP block group had significantly lower requirement of opioid consumption (MD −11.89, 95% CI −17.13∼−6.65) at 24 h for pain mitigation and pain intensity VAS at rest at 6h (MD −1.13, 95% CI −1.76∼−0.49), 12 h (MD −0.83, 95% CI −1.30∼−0.36) and 24 h (MD −0.47, 95% CI −0.75∼−0.20). Also, postoperative nausea and vomiting were not statistically significant (RR 1.00, 95% CI 0.78∼1.27). Conclusion: TAP block appears to significantly reduce renal transplantation pain and the amount of opioid use on the first postoperative day after renal transplantation.