Block For Postoperative Analgesia Research Articles

Application of Genicular Nerves Block Combined with iPACK Block in Postoperative Analgesia of Total Knee Arthroplasty

The incidence of moderate to severe pain after total knee arthroplasty (TKA) ranges from 30-60% [1]. In the context of enhanced recovery after surgery, multimodal analgesia with peripheral nerve block as the core has become the main method of postoperative analgesia after TKA, and good analgesia is conducive to the early recovery of patients. Genicular nerve block (GNB) provides good analgesia anterior to the knee, while infiltration between the popliteal artery and capsule of the knee (iPACK) block provides good analgesia posterior to the knee [2]. We report a case of genicular nerve block combined with iPACK block for postoperative analgesia after total knee arthroplasty.

Efficacy of Ultrasound-Guided Quadratus Lumborum Block in Postoperative Analgesia of Total Hip Replacement

compromising early postoperative recovery. Previous studies have reported favorable results using anterior, posterior and lateral quadratus lumborum block for pain control during hip surgery. In this study, we evaluate the effectiveness of ultrasound-guided quadratus lumborum block in postoperative analgesia of total hip replacement. 200 patients who underwent total hip arthroplasty in our hospital between January 2020 and January 2021 were recruited and assigned via random number table method to receive either ultrasoundguided quadratus lumborum block (study group) or fascia iliaca block (observation group) for anesthesia. All patients were given self-administered intravenous analgesia postoperatively. Outcome measures included cumulative postoperative sufentanil use, resting pain, motor pain, postoperative hip mobility and incidence of nausea and vomiting. Ultrasound-guided quadratus lumborum block resulted in significantly less sufentanil use in patients at 24 h and 48 h postoperatively (52.14±5.11, 105.74±8.14) vs. fascia iliaca block (77.58±7.93, 150.18±10.58) (p<0.05). Patients in the study group showed lower visual analogue scale scores both at rest and at exercise than those in the observation group at 12, 24 and 48 h postoperatively (p<0.05). The study group had significantly greater maximum hip flexion and abduction mobility at 24 h and 48 h postoperatively than the observation group (p<0.05). Ultrasound-guided quadratus lumborum block was associated with a lower incidence of nausea and vomiting (7.00 %) vs. fascia iliaca block (39.00 %) (p<0.05). Ultrasoundguided quadratus lumborum block reduces the use of opioids in total hip replacement patients, significantly alleviates surgical pain, promotes early functional recovery and lowers the incidence of adverse effects.

A prospective, randomized, double blinded comparative study between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in supraclavicular brachial plexus block for post operative analgesia in upper limb surgery: Pentazocine as adjuvant in brachial plexus block

In upper limb surgery supraclavicular brachial plexus (SCBP) block with 0.5% bupivacaine is commonly used for anesthesia. To increase the duration of sensory block opioids are used along with bupivacaine, but data on the effect of pentazocine as adjuvant with bupivacaine in SCBP block is still lacking. The study aimed to compare the duration of postoperative analgesia, sensory and motor block between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in SCBP. Methods: The study was conducted on 60 consenting patients, posted for upper limb orthopedic surgery involving the forearm under SCBP block. Patients were randomly divided into two groups. Group B received 19 ml of 0.5 % bupivacaine with 1 ml of normal saline; Group BP received 19 ml of 0.5 % bupivacaine with 1 ml pentazocine (30 mg). Block characteristics, duration of postoperative analgesia, and side effects if any were recorded. Statistical analysis was done using the student t-test and Chi-square test for continuous and categorical variables respectively. Results: The onset of sensory (11.47 ± 1.57 vs. 16.8 ± 2.23 min) and motor (8.17 ± 1.14 vs. 13.9 ± 2.44 min) block was significantly faster in the BP group. Duration of sensory (392.33 ± 9.92 vs. 357.2 ± 8.76 min) and motor (379.27 ± 9.28 vs. 347.27 ± 9.13 min) block was also prolonged in group BP (p &lt; 0.0001). Duration of postoperative analgesia was more (p &lt; 0.0001) in the BP group (407.43 ± 10.46 vs 367.3 ± 8.74min). Conclusion: Pentazocine as an adjuvant with bupivacaine in SCBP block provides faster onset, prolonged duration of the block, and postoperative analgesia.

Lateral Femoral Cutaneous Nerve Block for Postoperative Pain Control After Total Hip Arthroplasty Using the Direct Anterior Approach: A Single-blinded Randomized Control Trial

Background Total hip arthroplasty (THA) employing the direct anterior approach (DAA) is increasingly performed as a less invasive procedure with faster recovery than other approaches. Unlike other approaches, the skin incision is made on the lateral thigh, distal to the inguinal ligament. However, the effectiveness of ultrasound-guided lateral femoral cutaneous nerve (LFCN) block for postoperative analgesia after THA using DAA has not been investigated.We hypothesized that ultrasound-guided LFCN block using DAA would reduce postoperative pain after THA.

Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery.

To compare the effects of ultrasound-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) on postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. This is a retrospective observational study. The records of patients who underwent upper abdominal surgery in our hospital from June 2019 to January 2021 were selected and retrospectively divided into two groups based on the analgesia method. Fifty-nine patients received ultrasound-guided SAPB analgesia (SAPB-group) and 55 patients received ultrasound-guided TPVB analgesia (TPVB-Group). Patients were matched for age, gender and body-mass index (BMI). The visual analogue scale (VAS) scores of pain at two hours(T1), six hours (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after the operation were compared between the two groups. The levels of interleukin-6 (IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) at the completion of surgery (T0) and T4 were compared between the two groups. The duration of block in SAPB-group was higher than that in TPVB-group (P<0.05). VAS scores of SAPB-groups were significantly lower than those of TPVB-group at all-time points (P<0.05) except at rest 48 hour after the procedure. The levels of IL-6, IL-10 and TNF-α at 24 hours after the operation in both groups were significantly higher than immediately at the end of the operation (P<0.05). Levels of IL-6 and TNF-α 24 hours after the operation were significantly lower in the SAPB-group than in the TPVB-group (P<0.05), while the levels of IL-10 24 hours after the operation were significantly higher in the SAPB-group (P<0.05). SAPB block under ultrasound guidance for patients undergoing upper abdominal surgery has good anesthetic and analgesic effect and can significantly improve the level of postoperative inflammation.

Inter-semispinal plane (ISP) block for postoperative analgesia following cervical spine surgery: A prospective randomized controlled trial

Study objectiveWe evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery. DesignProspective, randomized, controlled, double-blinded trial. SettingOperating room and surgical ward. Patients60 patients aged 18–60 years of either gender, ASA I-II, undergoing elective posterior cervical spine surgery. InterventionsPatients were randomly assigned into a control group (general anesthesia only), ISP group received bilateral ultrasound guided ISP block at the level of C5 using 20 ml bupivacaine 0.25% on each side. MeasurementsVisual analog scale (VAS), intraoperative fentanyl and 24 h postoperative pethidine consumptions and time to first rescue analgesic request were documented. Main resultsThe median (quartiles) of 24 h postoperative rescue pethidine consumption was significantly lower in the ISP group [0 (0–46.25) mg] compared to that of the control group [143 (116.75–169.00) mg]; P < 0.001). VAS was significantly lower in the ISP group at 30 min, 1 h, 2 h,4 h, 6 h, 8 h and 12 h postoperative compared to control group (P < 0.05). At 18 and 24 h, VAS was not significantly different between groups. The median (quartiles) of intraoperative fentanyl consumption in the ISP group [0 (0–40.75) μg] was significantly lower compared to that of the control group [63.5 (39.5–90.25) μg]; P < 0.001]. The time to first rescue analgesic administration was significantly longer in the ISP group compared to the control group (P < 0.001). ConclusionBilateral ultrasound-guided ISP block can provide decreased 24 h postoperative analgesic consumption as well as lower pain scores in the first 12 postoperative hours in patients undergoing posterior cervical spine surgery.

Adductor canal block vs. femoral nerve block in patients undergoing arthroscopic anterior cruciate ligament reconstruction using levobupivacaine: a comparative randomized controlled double-blind study

BackgroundThe aim of this study was to compare the efficacy of ultrasound-guided adductor canal block versus femoral nerve block in postoperative analgesia, as well as their effect on quadriceps muscle strength.ResultsThe study included 66 patients who were underwent arthroscopic anterior cruciate ligament reconstruction under general anesthesia. They were randomly divided into 2 groups; A and F, of 33 patients in each. Patients in group A received an adductor canal block, while patients in group F received a femoral nerve block. The primary outcome was the total morphine requirements in the first 24 h after the procedure. Secondary outcomes included time to first analgesic request and the patients’ ability to perform straight leg raise in the post-anesthesia care unit and 2 h later. The straight leg raise was impaired in group F compared with group A both in the post-anesthesia care unit (p value = 0.017) and 2 h postoperatively (p value = 0.020). While there was no differences between both groups regarding time to first analgesic request, and total morphine requirements.ConclusionsCompared with femoral nerve block, the adductor canal block may be an effective analgesic alternative with the advantage of sparing the quadriceps muscle strength in anterior cruciate ligament reconstruction surgeries.

Comparative study of ropivacaine and ropivacaine with dexmedetomidine in ultrasound-guided transversus abdominis plane (TAP) block for post operative analgesia in laparoscopic cholecystectomies

Background and aims: TAP block is an effective way to provide postoperative analgesia .TAP block using ropivacaine alone has not been consistently proven to be effective in alleviating pain after laparoscopic surgeries. The study aimed to compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone in TAP block for laparascopic cholecystectomy patients for post operative analgesia. Materials and Methods: 60 patients of ASA health status I or II, were divided equally into 2 groups. Groups R received bilateral US- TAP blocks with 20 mL 0.375% Ropivacaine and Group RD received, 20 ml 0.375% ropivacaine with 50μg dexmedetomidine. Each patient was assessed in the PACU for first 24 hr for pain duration of analgesia,and need for rescue analgesic. Results: The mean of VAS pain score was least in group RD compared to group R and statistically significant (P &lt; 0.05).The total rescue analgesia ( tramadol ) consumption in 24 h after surgery was (116.6±37.9) mg in group RD against (160±67.4) mg in group R, which was also statistically significant (P &lt; 0.05). Duration of analgesia was greater in group RD (7.7 ± .53) compared to group R (4.5 ± .56).

EFFECTIVENESS OF FASCIA ILIACA COMPARTMENT BLOCK FOR POST OPERATIVE ANALGESIA AFTER SURGERY FOR FEMUR BONE FRACTURE

Background:Multimodal analgesia is given to alleviate postoperative pain in fracture neckfemur.Present study is done to assess the effectiveness of fascia iliaca compartment block for post operative analgesia after surgery for femur fractures. Aims &amp; Objectives: 1) To study effect on pain at rest and with movement 2) To study duration of post operative analgesia with fascia iliaca compartment block 3) TO study post operative analgesic requirement Methods: Afer approval from institution review board committee, this prospective randomised observational study was conducted at our institute after taking informed consent from each patient. Total 60 adult patients (ASA I/II) aged 18 to 70 years, of either sex undergoing femur bone fracture surgery under subarachnoid block were included. Sub arachnoid block was performed in the sitting posture under strict aseptic precautions in theL2-L3 or L3-L4 space using 23G Quincke needle with 3.5ml of 0.5%Bupivacaine (hyperbaric, dextrose 80mg/ml) in all patients. Patients were randomly divided in two groups, Group A (n=30): The FICNB group was received ultrasound guided fascia iliaca compartment block with 0.25% bupivacaine 30ml at the end of the operation. Group B (n=30): were managed without FICNB Hemodynamic variables like heart rate, non invasive blood pressure, saturation of oxygen, were recorded after the block. The analgesia provided by either of the modes was assessed by using Visual analogue scale scores at 5 mins,10 mins,15 mins,20 mins,25 mins,30 mins,40 mins,50 mins,1, hr,then hourly upto,12 hour,then 2 hourly upto 24 hour. Postoperative hemodynamic monitoring was done and depicated in tabular form. Patients were watched for adverse effects of drugs and complications of procedure itself.The duration of postoperative analgesia was compared between the 2 groups using visual analogue scale and in terms of first rescue analgesic and total analgesic dose requirement with inj. diclofenac sodium75 mg.The data were studied using mean values and mean ± SD and then compared using unpaired ttest. p value &lt;0.05 was considered significance Results:The result obtained in study At 1hr Mean VAS in group A was 2.23 ±0.43 and in group B it was 4.93±0.25 At 7hr Mean VAS in group A was 2.96 ± 0.18 and in group B it was 4.9±0.31 At 12hr Mean VAS in group A was 4.66±0.80 and in group B it was 3.83±0.38 At 14hr Mean VAS in group A was 1.86±1.25 and in group B it was4.93±0.25 Post-operative VAS at rest and moment were significantly higher in group B, compared to group A (p&lt;0.001). After 24 hr statistically significant difference was not observed in mean VAS between group B and group C. The mean consumption of analgesic was 137.5±28.42 mg diclofenac in Group A and 295±19.03 mg diclofenac in group B.

CLINICAL EVALUATION OF EFFICACY AND SAFETY OF TRANSVERSUS ABDOMINIS PLANE BLOCK INJ. LEVOBUPIVACAINE AND INJ. ROPIVACAINE FOR POST OPERATIVE ANALGESIA FOLLOWING LOWER SEGMENT CESAREAN SECTION : A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY

Backgrounds and Aims :Levobupivacaine is a pure S-enantiomer of bupivacaine with similar anesthetic profile and with reduced toxic potential than racemic bupivacaine.This study aims to compare efficacy and safety of Transverse Abdominal Plane block inj. Levobupivacaine Vs. Inj. Ropivacaine for post operative analgesia following lower segment cesarean section. Methods and Material:A prospective, randomized, controlled, double blind clinical study. 60 patients divided in 2 groups by computer generated randomization.60 healthy women undergoing cesarean delivery under spinal anesthesia were randomized into two groups (Group I, Group II). Group I received TAP block with 15 ml of 0.25% ropivacaine while Group II received TAP block with 15 ml of 0.25% levobupivacaine on each side. Postoperatively, time for first request for rescue analgesia and number of women requesting analgesia in 6 h,8 h, 10 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. Statistical analysis used:The data were analyzed with Students t‑test. Results:The duration of analgesia was significantly prolonged in Group I than group II. The VAS score in patients who received Inj. Ropivacaine was significantly lower than who received inj. Levobupivacaine. Patient and surgeon satisfaction score were significantly higher in Ropicavaine than levobupivacaine. Conclusions:0.25% Ropivacaine provided longer duration of analgesia compared to 0.25% Levobupivacaine in TAP Block for postoperative analgesia after lower segment cesarean section.

Abstract No.: ABS3227: To study the efficacy of ultrasound guided quadratus lumborum block for post Operative analgesia after lower segment caesarean section: a randomised prospective controlled study

Background & Aims:Various previous studies have shown the role of quadratus lumborum block (QLB)in post operative pain management after lower abdominal surgeries; so we assessed its role in post operative analgesia (measured with NRS score) after LSCS and compared it with wound infiltration.Methods:Sixty-seven patients who were American Society of Anesthesiologists physical statusII, with normal singleton pregnancies with a gestation of at least 37 weeks, and scheduled for elective caesarean section under spinal anaesthesia, were enroled into the study. They were randomly assigned to receive a QLB (n =30) with 0.25% levobupivacaine 15 ml on each side (total 30 ml) (Group 1) or a wound infiltration group (n =37) with same volume of drug.Results:USG QLB proved to be significantly more efficacious in the management of postoperative analgesia after lower segment caesarean section as compared to wound infiltration. It leads to less opioid consumption with no side effects related to opioid and having advantages of less rescue analgesia requirement along with early ambulation, and early lactation better satisfaction and better care of the new born.Conclusion:The study showed that ultrasound guided QLB proved to be significantly more efficacious in the management of postoperative analgesia after lower segment caesarean section as compared to wound infiltration. Overall pregnant females who were given QLB were more satisfied in terms of quality of pain relief, with early ambulation, and early lactation with better care of the new born.

Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia

ABSTRACT Background Effective analgesia after cardiac surgery contributes to fast recovery, and discharge from the critical care unit. Aim: This study was conducted to evaluate PECS II block for controlling post-sternotomy pain in pediatric population in ultrafast track cardiac surgery. Methods In this double-blind, randomized control trial, 40 children, 1–5 years old, underwent cardiac surgery via median sternotomy, Group (A) control: Analgesics were administered intravenously. Group (B): received 0.25% bupivacaine at 0.5 ml/kg divided equally to both sides for PECS block. Results PECS group had lower median Modified Objective Pain Score (MOPS) immediately, two, four, and 6 h postoperatively. PECS group had lower median fentanyl utilization by 35% than the control group with median utilization of 2.72 (95% CI 2.490–2.960) mic/kg/in the first 24 hours in contrast to 4.17 (95% CI 3.834–4.516) mic/kg/in the first 24 hours in the control group (P < 0.001). First rescue analgesia was later in PECS group compared to the control group with median time (7 hours) and (2 hours), respectively. Furthermore, Pediatric Anesthesia Emergence Agitation (PAED) score was lower in the intervention group with median 9.5 and 12 in the control group (P < 0.001). PECS group had shorter ICU stay than the control group (P < 0.05), with mean ICU stay 52 hours (95% CI 43.522–62.378) compared to 80.40 hours (95% CI 64.310–96.490). Conclusion PECS block is an efficient technique that can be implemented as an integral part of fast-track cardiac surgery.

Surgical transversus abdominis plane block versus surgical rectus sheath block for postoperative pain control in morbid obese patients undergoing major gynaecological surgery: a prospective, randomized, blinded study

BackgroundPostoperative analgesia for major abdominal surgeries, especially with midline incisions, can be challenging particularly in morbid obese patients. This study aimed to compare surgical transversus abdominis plane (TAP) block and surgical rectus sheath (RS) block for postoperative analgesia in patients undergoing major gynaecological surgery regarding their efficacy and adverse effects. Sixty female patients aged 18–60 years were randomly allocated to two equal groups; (group TB, n = 30) patients received surgical TAP block, or (RB group, n = 30) patients received surgical RS block.ResultsPostoperative total morphine consumption was significantly higher among patients in the TB group than patients in the RB group (Mean ± SD; 18.2 ± 4.4 mg versus 14.3 ± 3.5 mg respectively, P value < 0.001). There was no significant difference between patients in either group regarding pain scores at rest and cough except at 6-h postoperatively when patients in the RB group experienced lower pain scores (P value < 0.001). The RB group showed better respiratory functions at the first hour, 6 h and 12 h postoperatively. There was no significant statistical difference between both groups regarding the incidence of postoperative complications.ConclusionsSurgical RS block provided more favourable outcomes than surgical TAP block concerning postoperative analgesia in morbid obese patients with similar incidence of postoperative complications.Trial registrationWe carried out this trial at Ain-Shams University Hospitals, Cairo, Egypt, between October 2018 and January 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University (code number: FMASU R55/2018), and then registered in the ClinicalTrials.gov (registration no. NCT03732027) https://clinicaltrials.gov/ct2/show/NCT03732027.

A0021 - Laparoscopic versus ultrasound guided Transversus Abdominis Plane (TAP) block for postoperative analgesia after radical prostatectomy: A randomized controlled trial

A0021 - Laparoscopic versus ultrasound guided Transversus Abdominis Plane (TAP) block for postoperative analgesia after radical prostatectomy: A randomized controlled trial

Reduction of leakage from insertion site during continuous femoral nerve block with catheter-through-needle versus catheter-over-needle technique for postoperative analgesia after total knee arthroplasty: a randomized controlled trial

BackgroundContinuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A different type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare the incidence of leakage from the catheter insertion site during CFNB while using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA).MethodsThis prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN or CON groups. All patients in both groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine (a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 h postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups.ResultsThe CON group had a significantly lower incidence and degree of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes.ConclusionsUse of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage.Trial registrationThe study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

Comparison of Dexamethasone and Dexmedetomidine as adjuvants for TAP block for postoperative analgesia after abdominal hysterectomy under spinal anaesthesia

Comparison of Dexamethasone and Dexmedetomidine as adjuvants for TAP block for postoperative analgesia after abdominal hysterectomy under spinal anaesthesia

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing various types of surgery

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing various types of surgery

Efficacy of dexmedetomidine as adjuvant to ropivacaine in paravertebral block for post-operative analgesia in breast cancer surgery

Background: Paravertebral block can be given for pain management after modified radical mastectomy (MRM). Although many additives to ropivacaine in PVB have been tried for post-operative analgesia, none has been found ideal. Aims and Objectives: We have compared the duration of analgesia in PVB using adjuvant like dexmedetomidine with ropivacaine after MRM. Materials and Methods: Sixty female patients posted for MRM and axillary dissection were split into two groups. Group R administered ultrasound-guided PVB with 20 ml ropivacaine 0.5% and Group RD administered 20 ml of 0.5% ropivacaine with dexmedetomidine 1 mcg/kg. After confirming PVB, surgery was done under general anesthesia in all patients. Time for 1st analgesia requirement was the main objective of our trial. Other objectives were to record visual analog scale scores and total analgesic need. Results: Post-operative analgesia duration was increased in the group RD (7.11 ± 1.42 h) in contrary to Group R (3.68 ± 1.85 h). Total paracetamol consumption post-operative 24 h was decreased in Group RD (1.63 ±0.89 g) in contrary to Group R (2.74 ± 0.76 g). Conclusion: Dexmedetomidine in PVB provides prolonged pain relief after MRM.

Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block.

In order to monitor the effect of nerve block in postoperative analgesia more accurately, this paper puts forward the application research of ultrasonic real-time intelligent monitoring of nerve block in postoperative analgesia. Ultrasonic real-time intelligent monitoring of nerve block in upper limb surgery, lower limb surgery, and abdominal surgery combined with the nerve stimulator. The experiments show that there are 5 cases of adverse reactions when the nerve stimulator is only used, but no adverse reactions occur when combined with ultrasound-guided block. Continuous subclavian brachial plexus block with the ultrasound-guided nerve stimulator can clearly see the subclavian brachial plexus and its surrounding tissue structure, the direction of needle insertion in the plane, and the diffusion of narcotic drugs. The average success rate of block was up to 95.2%, which was significantly higher than that of nerve stimulator alone, and the success rate of recatheterization after the first failure was also improved. The average postoperative analgesia satisfaction was 85.6%, the average operation time was only 20 min, and the subclavian artery and pleura were avoided effectively. No pneumothorax and other complications occurred. The average success rate of ultrasound-guided subclavicular brachial plexus block in 1-2-year-old children was 97%, which was much higher than the average success rate of nerve stimulator localization with 63%. Ultrasound-guided nerve block not only directly blocks nerves under visual conditions but also helps to observe the structures around nerves and dynamically observe the diffusion of local anesthetics, which can significantly improve the accuracy and success rate of nerve block and reduce the incidence of complications.

Comparative Study Between Bupivacaine 0.5% Versus Bupivacaine 0.5% with Fentanyl in TAP Block for Post-Operative Analgesia After Appendectomy

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Objective to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus 0.5% bupivacaine with Fentanyl for postoperative analgesia in patients undergoing appendectomy. Patients and Methods After ethical committee approval and informed consent from the patients, this prospective randomized control study, randomization done by closed envelope method &amp; was performed on total 60 patients who underwent surgical appendectomy in Ain Shams University hospitals for 3 months from January to March 2019. Results In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only while the fentanyl group in which 50 ug of fentanyl were added to bupivacaine. All patients received equal volumes. Our study showed that addition of a 50 microgram of fentanyl to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the onset of sensory block and prolonged the duration of the sensory block. In addition, fentanyl prolonged the duration of analgesia significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of fentanyl also did not affect the hemodynamics to a significant level. This makes fentanyl with bupivacaine more superior than the use of bupivacaine alone. Conclusion Fentanyl as an adjuvant to bupivacaine in Ultra-sound guided TAP block reduced post-operative pain scores, porolonged the duration of analgesia and decreased demand for rescue analgesics.