Bupivacaine For Postoperative Pain Relief Research Articles

A STUDY OF THE EFFICACY AND SAFETY OF CLONIDINE AS AN ADJUNCT TO BUPIVACAINE FOR CAUDAL ANALGESIA IN CHILDREN

Aim to assess the efcacy of 1μ|kg of Clonidine as a caudal adjunct to bupivacaine for postoperative pain relief in paediatric patients. To assess the safety of Clonidine, as a caudal adjunct to bupivacaine to increase the duration of analgesia. This prospective randomised study was conducted on 40 paediatric patients. 20 in each group of ASA-I,II were posted for lower abdominal surgeries. After induction of anaesthesia the patients were positioned in left lateral position with hips and knees exed. With 22G hypodermic needle caudal epidural block given at sacral hiatus after conrming negative aspiration. Group B received 0.25% bupivacaine alone. Another group BC received 0.25% bupivacaine with Clonidine 1microgram/kg

Comparison of Fentanyl and Nalbuphine as an Adjuvant to Bupivacaine for Spinal Anesthesia in Lower Limb Surgeries

Background: Opioids commonly used as adjuvant anaesthetics during spinal anesthesia, are favored technique for lower limb surgeries. Nalbuphine is an opioid adjuvant that acts as antagonist at μ-receptors and agonist at k-receptors that work reasonably potent analgesia. In this study we compare the efficacy of epidural Fentanyl with bupivacaine versus Epidural Nalbuphine with Bupivacaine for post-operative pain relief in lower limb surgeries.
 Methods: Altogether 80 patients of lower limb surgeries were randomly allocated into two groups. 40 patients in Group I (Inj. 0.5% Bupivacaine (H) 2.5ml + Inj. Fentanyl 25mcg (0.5ml) and 40 patients in Group II (Inj. 0.5% Bupivacaine (H) 2.5ml+ Inj. Nalbuphine 5mg (0.5ml). Age of patients ranged from 18-65 years of age and male:female ratio in the present study was 1: 0.5. Patients in both the above groups were comparable on age, gender, anthropometric variables, and baseline hemodynamic variables.
 Results: In the study the mean age (36.30±14.10) of group II was comparatively more than the group I (33.88±9.42) while the mean weight (61.80±11.33) of group II was also comparatively more than group I mean weight (53.80±15.59). And the mean value of duration of surgery for the group I was (112.93±12.22) while it was (110.63±10.26) for group II. A significant difference was found in weight. The intergroup comparison of level of motor blockade where in group I the level of motor blockade was (65.0%) at 2 min (B/S-1) while in group II level of blockade (70.0%) at 2 min (B/S-1) after that from 8 min to 130 min it was (100%). The level of sensory blockade of group I (72.5%) at 2 min while it was (72.5%) at 6 min after that it was NA from 8 min to 130 min and in the group II level of sensory blockade (50.0%) at 2 min and (50.0%) at 8 min after that it was (100%) from 10 min to 130 min. During Intergroup Comparison of VAS significant differences was found at 30 min and 480 min.
 Conclusion: Nalbuphine when compared to Fentanyl is almost safe and hemodynamically stable drug that can be used as an adjuvant in combined spinal epidural anesthesia with similar safety profile as for Fentanyl.

To Compare the Analgesic Efficacy Of Wound Infiltration with Bupivacaine and Mixture of Bupivacaine and Tramadol for Postoperative Pain Relief in Cesarean Section Under Spinal Anesthesia

Background: The cesarean section is one of the common obstetrical surgery. Multimodal techniques can provide the mother with the best pain alleviation. One of the simplest and safest procedure is wound infiltration. The study is to compare the analgesic efficacy of bupivacaine wound infiltration and a mixture of tramadol and bupivacaine for postoperative pain relief. Materials and Methods: After receiving approval from the institutional ethics committee, 60 pregnant women aged 18–35 years who had undergone elective cesarean section under spinal anesthesia were included in the study. The patients were randomized into two groups of 30 each. Group B patients received 0.25% bupivacaine 0.7 mg/kg (diluted to 20 ml with normal saline), while group BT patients received 2 mg/kg tramadol mixed with 0.25% bupivacaine 0.7 mg/kg (diluted to 20 ml with normal saline). Time to first analgesia request, pain score by visual analogue scale, and diclofenac consumption in 24 h were compared. Adverse effects such as nausea, vomiting, and shivering were also noted. Results: The time to the first request for analgesia in Group T was 386.17 ± 233.84 min compared to Group B which was 192.50 ± 134.77 (P < 0.0002). Total diclofenac consumption in the first 24 h was significantly reduced in Group T compared to Group B (P < 0.0068). Conclusions: Subcutaneous infiltration of the wound with tramadol and bupivacaine prolongs the absence of pain and the consumption of analgesics after cesarean section and at the same time increases patient satisfaction.

Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery

Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery

English

BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P < 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain

Comparitive Study of Epidural Fentanyl and Bupivacaine with Epidural Clonidine and Bupivacaine for Postoperative Pain Relief in Lower Abdominal and Lower Limb Surgeries: RCT

Postoperative pain and discomfort are the major concerns in all patients undergoing any surgery. Delay of discharge is mainly due postoperative pain. So, postoperative pain relief becomes very important. Epidural anal gesiaisone of many recent evidence-base dregimens for postoperative pain relief after surgeries particularly surgeries of abdomen. The objective of this study is to compare the efficacy, onset and duration of epidural analgesia of Bupivacaine - Clonidinecombination Vs. Bupivacaine-Fentanyl combination for post-operative analgesia in lower abdominal and lower limb surgeries. Materials and Methods: 50 patients belonging to ASA 1 and 2 were assigned into two groups (25 each). Group F received epidural Fentanyl with 0. 25% Bupivacaine and Group C received epidural Clonidine with 0.25% Bupivacaine. Results: With regard to anxiolysis, increased sedative property with easy arousal, longer and better quality analgesia and patient comfort, epidural clonidine and Bupivacaine combination was found to be superior to epidural Fentanyl and Bupivacaine. Various parameters like HR, Blood pressure (both systolic and diastolic), SPo2, Visual Analogue Scale (VAS) and Ram say Sedation Score (RSS) were observed for 24 hours post operatively. It was follow edup at 15 minutes, 30 min, 120 min, 240 min, 360 min, 480 min, 600 min, 720 min, 840 min, 960 min, 1080 min, 1200 min, 1320 min and 1440 min. Incidencesof side effects were also noted. Conclusion: Clonidine has proved to be very efficient compared to Fentanyl in postoperative analgesia.

Preoperative dexamethasone and intraperitoneal bupivacaine for postoperative pain relief

Introduction: Remarkable advancement in managing post-operative pain is made using various analgesics. Dexamethasone is a potent anti-inflammatory, analgesic, and anti-emetic agent and readily available, easy to administer, and a safe adjunct for postoperative analgesia. The intraperitoneal use of local anesthetics is known to improve postoperative pain. The present study is aimed to assess the effectiveness of preoperative dexamethasone combined with intra-peritoneal bupivacaine for postoperative pain relief. Objective: To assess the effectiveness of preoperative Dexamethasone combined with intra-peritoneal Bupivacaine for postoperative pain relief following surgery. Material and Methods: A prospective, randomized controlled study was done over a period of one year on 172 women scheduled for elective gynecological surgeries. The study group received Dexamethasone 8mg IV, 5 minutes prior to induction of anesthesia or before surgical incision, and intra-operatively 30ml of 0.25% Bupivacaine intraperitoneally under aseptic precautions. The control group received standard anesthesia as per the routine hospital protocol. Postoperatively patients monitored for vitals, pain assessment using Visual Analogue Score. The severity of postoperative nausea and vomiting (PONV) was evaluated. After a 24-hour assessment period, patients were asked to make an overall rating of satisfaction with post-operative pain relief on a verbal response (VReS). Results: It was noted that the mean consumption of analgesic doses was significantly high in group B compared to group A (3.01±0.52 vs 1.46±0.83; p<0.001).The mean VRes scores in group A were significantly high compared to group B (2.95±1.01 vs 0.20±0.51; p<0.001). Conclusion: Dexamethasone combined with intra-peritoneal Bupivacaine is highly effective in reducing postoperative pain along with PONV.

A Double-Blind, Randomized Controlled Trial of Pre-incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post-operative Pain Relief in Open Thyroid and Parathyroid Surgery.

Pre-incision wound infiltration using NSAID is an alternative method to manage post-operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti-inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine. The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed. Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8min (SD = 56.5), and mean length of hospital stay was 4.7days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20h starting from 4h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24h duration was lower in the diclofenac group as compared to bupivacaine group [13.8mg (SD = 24.9) vs. 36.2mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p < 0.01] or [USD 0.83 (SD = 0.36) vs. USD 3.21 (SD = 0.40), p < 0.01]. Pre-incision wound infiltration using diclofenac provides better post-operative pain relief compared to bupivacaine for patient who had underwent open thyroidectomy or parathyroidectomy. Diclofenac is cheap and easily available in the limited resource setting. This approach offers a superior alternative for post-operative pain relief as compared to bupivacaine.

A prospective study of comparing efficacy of combined clonidine to intrathecal hyperbaric bupivacaine and bupivacaine alone in post-operative analgesia

Background: Objective of the is to compare the efficacy of combined clonidine to intrathecal hyperbaric bupivacaine and bupivacaine alone on post operativie analgesla in lower limb ortho surgeries and the side effects of clonidine.Methodology: To assess efficacy of 2 doses of intrathecal clonidine added to bupivacaine for postoperative pain relief following orthopedic surgeries of lower limb. This was a randomized, double blind, controlled study involving 75 patients divided into three groups C, C1, C2 of 25 each.Results: In our study, the mean duration of postoperative analgesia was 158.60 min in group C as compared to 349.20 min in group C1 and 623.56 min in group C2. This showed that clonidine produces dose dependent increase in the duration of postoperative analgesiaConclusion: Addition of clonidine to intrathecal bupivacaine prolonged the duration and efficacy of postoperative analgesia, but increased the incidence of mild side effects.

Comparative Study of Dexmedetomidine and Fentanyl as an Adjuvant to Epidural Bupivacaine for Post-operative Pain Relief in Hepato-biliary Pancreatic Surgery

Background: Postoperative pain responsible for neurohumoral changes which may cause various organ dysfunctions, prolong hospitalization and convalescence. Epidural analgesia confers excellent pain relief and complete dynamic analgesia leading to a substantial reduction in the surgical stress response.&#x0D; Objectives: The aim of the study was to compare the postoperative analgesic effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in adult patients undergoing hepatobiliary pancreatic surgery.Material and method: Eighty(80) patients were selected in the pre anaesthetic checkup room who were going to be operated for hepatobiliary pancreatic disorders. Each patient in group D(Dexmedetomidine group): Dexmedetomidine 2ml (100 µgm) was mixed with 48ml bupivacaine 0.125% in a syringe 50ml and infused epidurally @ 4ml/hr. for the postoperative 48 hours. Group F (fentanyl group): Fentanyl 2ml (100 µgm) was mixed with 48 ml bupivacaine 0.125% in a syringe 50 ml and infused epidurally @ 4ml/hr. for the postoperative 48 hours.&#x0D; Results: The quality of analgesia was almost similar with dexmedetomidine and fentanyl group but perioperative haemodynamic stability was more in dexmedetomidine group than fentanyl group (p=&lt;0.05). The incidence of post-operative nausea and vomiting, pruritus, urinary retention and respiratory depression significantly lower with dexmedetomidine compared to fentanyl group (p=&lt;0.05).&#x0D; Conclusion: Dexmedetomidine is an ideal adjuvant to epidural bupivacaine for postoperative analgesia compared to fentanyl in patients undergoing hepatobiliary pancreatic surgery.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 143-149

Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial.

BackgroundPostoperative pain is a major problem, especially in children, as their tolerance level is lower and several drugs are contraindicated in childhood. This study aimed to compare the effect of dexmedetomidine added to local infiltration of bupivacaine for postoperative pain relief in children undergoing inguinal herniorrhaphy.MethodsThis double-blind, randomized clinical trial included 60 children aged 6–72 months undergoing unilateral herniorrhaphy at selected hospitals in Shiraz, Iran, randomly allocated into two groups, 30 in each group. One group received 1 µg/kg dexmedetomidine plus local infiltration of 0.2 ml/kg bupivacaine 0.5% at the incision site before surgery (BD), and the other group received bupivacaine and normal saline (BO). Analgesic requirements, emergence time, and nausea/vomiting, postoperative pain and sedation scores were assessed for 4 h after the operation. Heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SaO2) were recorded at baseline, and at 10 and 20 min after injection.ResultsEighty percent were boy in each group; mean age was 22.75 ± 18.63 months. SaO2 and SBP were not different between the groups, while HR was significantly lower in the Group BD at 10 and 20 min after injection (P < 0.05). Group BD had a lower pain score at 1 and 2 h after the operation, a higher sedation score at the first three time intervals, and longer emergence time than Group BO (all P < 0.001). Group BD had a lower pain score at 1 and 2 h after the operation (P < 0.001, P < 0.047 respectively).ConclusionsAddition of dexmedetomidine to local infiltration of bupivacaine in children undergoing herniorrhaphy significantly reduced postoperative pain and increased sedation.

Intraincisional injection of tramadol versus bupivacaine in post-caesarean pain relief

The aim of this study is to compare the analgesic efficacy of intraincisional infiltration of Inj. Tramadol versus Inj. Bupivacaine for postoperative pain relief in Caesarean section under spinal anaesthesia and to compare postoperative pain scores and total consumption of rescue analgesics. Materials and Methods: This study was carried out in the Department of Obstetrics and Gynaecology in Rajah Muthiah Medical College and Hospital from 2018 -2020 after getting the approval of Ethical Committee. Sixty Antenatal mothers of age group (18-35 yrs) with BMI (18.5 – 40 Kg/m2) scheduled for caesarean under spinal anaesthesia were included in the study. Patients under exclusion criteria were excluded in this study. Informed written consent was obtained prior to procedure. Under spinal anaesthesia caesarean section was performed. At the time of skin closure patients were randomly divided into two groups. Group A (n=30) – treated with Inj. Tramadol 40 mg. Group B (n= 30) – treated with Inj. Bupivacaine 0.25% 0.7 mg/kg. All drugs were diluted with sterile normal saline to 20 ml solution and administered intraincisionally at the time of skin closure. On arrival in recovery room, pain intensity is assessed by Visual Analogue Scale ranging from 0 to 10 and then 15, 30, 60 minutes, 2 hrs, 6 hrs, 12 hrs, 24 hrs after arrival from recovery. If analgesia is considered inadequate, rescue analgesics Inj. Diclofenac 75 mg intramuscular or Inj. Tramadol 1mg/kg intramuscular was added. The frequency of nausea, vomiting, rigor and mean arterial blood pressure were evaluated.At the end of 24 hours patients were asked about the quality of pain relief using the following score – excellent – 4,very good-3, good -2, poor-1. Results: Demographic data - age distribution, BMI, gravidity showed no significant difference. Mean age, BMI group A 25.43 ± 3.61, 25.11 ± 3.61 and Group B was 25.03 ± 4.26, 23.37 ± 2.74. Both were homogenous. Mean Pain scores by Visual analogue scale for group A was 0.76 ± 1.16, 1.90 ± 0.92 and 0.97 ± 1.12 and for group B was 0.53 ± 0.68, 1.17 ± 0.74 and 0.30 ± 0.53 at 6, 12 and 24 hours. The pain score was slightly higher in Group B than Group A. The ‘f’ value of Group B is higher in nature but the Pain score was statistically significant ‘P’ of 0.001 was obtained for both groups. Group B was more effective in postoperative analgesia but Group A also has significant postoperative analgesic effect. The Mean Systolic and Diastolic BP is higher in Group B. Also the Systolic BP was statistically significant. On comparing complications 2 patients reported nausea in Group A and 6 patients reported rigors in Group B. Conclusion: In this comparative study, even though Bupivacaine had better analgesic effect, Tramadol also proved to have significance in pain scores and prolonged analgesic effect and less complications. Therefore Intraincisional infiltration of Tramadol and Bupivacaine before skin closure in caesarean sections prolonged the postoperative analgesic effect, reduced consumption of rescue analgesics, better compliance for mother and baby and enhanced patient satisfaction

To Evaluate the Effect of Wound Infiltration With 0.5% Bupivacaine for Post-operative Pain Relief After Laparoscopic Cholecystectomy

To Evaluate the Effect of Wound Infiltration With 0.5% Bupivacaine for Post-operative Pain Relief After Laparoscopic Cholecystectomy

A comparative study of pre-incisional and post-incisional wound infiltration of bupivacaine for post-operative pain relief in abdominal surgeries

A comparative study of pre-incisional and post-incisional wound infiltration of bupivacaine for post-operative pain relief in abdominal surgeries

Comparison of Efficacy of Epidural Ropivacaine versus Bupivacaine for Postoperative Pain Relief in Total Knee Replacement Surgeries.

Background:Epidural analgesia has become the standard of care for knee replacement surgeries worldwide. Bupivacaine has been used successfully for many years. Epidural ropivacaine is now being used increasingly and seems to have benefits other than just pain relief, in terms of a better safety profile.Aim:To compare the efficacy of bupivacaine 0.125% (Group B) versus two concentrations of ropivacaine 0.1% (Group R1) and 0.2% (Group R2), in terms of pain scores, requirement of rescue analgesia, related adverse effects, and duration of postoperative (PO) hospital stay.Materials and Methods:A retrospective study was conducted from the acute pain service data of patients who underwent joint replacement surgeries in one or both limbs, over a span of 6 months. Patients were allocated to and analyzed under one of the three groups based on the drug concentration used postoperatively by epidural infusion. Data retrieved were demographic data, daily average visual analog scale (VAS) pain scores, rescue analgesia given, adverse effects, and PO hospital stay days for all three groups.Results:Demographic data were comparable between the three groups. Daily average VAS pain scores on days 1 and 2 were significantly higher in Group R1. Groups B and R2 were comparable. There was significantly more requirement of rescue analgesia in Group R1 on day 1. Day 2 showed no significant difference in rescue analgesic requirement in all three groups. Days of PO hospital stay were significantly higher in Group R1. Adverse effects such as hypotension and delayed motor block were higher in Group B.Conclusion:Ropivacaine 0.2% and bupivacaine 0.125% were equally efficacious in terms of VAS pain scores, rescue analgesic requirement, and duration of PO hospital stay, but ropivacaine had a better safety profile in terms of less hypotension and lesser motor block.

Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies.

ObjectivesTo evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty.DesignMeta-analysis.MethodsA systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software.ResultsA total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD −0.55; 95% CI −0.89 to −0.22; p<0.001) and narcotic consumption (SMD −0.32; 95% CI −0.55 to −0.08; p=0.008) during the period of 24 hours postoperatively and narcotic consumption during the period between 24 and 48 hours postoperatively (SMD −0.32; 95% CI −0.55 to −0.08; p=0.009). However, there was no significant difference in the mean VAS pain score during the period between 24 and 48 hours postoperatively (SMD −0.09, 95% CI −0.30 to 0.11; p=0.37) and in the incidence of adverse effects 24–72 hours postoperatively (RR 0.97; 95% CI 0.60 to 1.57; p=0.91).ConclusionsThe administration of IA bupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects.

Comparative study of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine for postoperative pain relief in adult patients undergoing total knee replacement: a randomized study

Abstract Background: Epidural analgesia is a common method for the management of postoperative pain after total knee replacement. The aim of the study was to compare the postoperative analgesic effect of dexmedetomidine

Comparative study of ultrasound-guided paravertebral block with ropivacaine versus bupivacaine for post-operative pain relief in children undergoing thoracotomy for patent ductus arteriosus ligation surgery.

Background and Aims:Thoracotomy incision following patent ductus arteriosus (PDA) ligation surgery is often associated with severe post-operative pain that has deleterious effects on respiratory function. We aimed to assess pain relief with thoracic paravertebral block using either bupivacaine or ropivacaine in these surgeries.Methods:One hundred paediatric patients of age group between 2 and 10 years undergoing PDA ligation surgery were randomised either to bupivacaine or ropivacaine group in this prospective double-blinded study. After induction of general anaesthesia, the ultrasound-guided paravertebral block was carried out using 0.25% bupivacaine 0.4 ml/kg in Group B patients and 0.2% ropivacaine 0.4 ml/kg in Group R patients. Monitoring included minimum mandatory monitoring with pulse rate, pulseoximetry (SpO2), electrocardiogram, blood pressure, temperature during surgery and also in Intensive Care Unit (ICU). Additionally, modified objective pain score (MOPS) was used in ICU for assessment of pain for 12 h after surgery. Incidence of complications was noted.Results:Mean values of MOPSs were comparable in both the groups. The time to rescue analgesic was 8 to 10 h in over 80% of patients in both the groups. More patients had hypotension and bradycardia in bupivacaine group compared to ropivacaine group.Conclusion:Paravertebral injection of 0.4 ml/kg of either 0.2% ropivacaine or 0.25% bupivacaine provided equipotent analgesia, but ropivacaine had a better side effect profile. Ultrasound-guided paravertebral block is a safe and effective mode of analgesia in paediatric patients undergoing thoracotomy.

Comparative study between epidural morphine and bupivacaine with epidural clonidine and bupivacaine for postoperative pain relief in abdominal surgeries.

Background:Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia.Aims:The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 μg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries.Settings and Design:Double-blind retrospective randomized study.Methodology:All the patients (n = 60) varying from age group belonging to American Society of Anesthesiologists I–II were randomly allocated to receive epidural analgesia Group A - Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (n = 30), Group B - Clonidine (2 μ/kg) + Bupivacaine (0.125%) (n = 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1st dose.Statistical Analysis Used:Continuous data are analyzed by Student's t-test (paired ‘t’-test for intragroup variations and unpaired ‘t’-test for intergroup variations). Chi-square test was used for categorical data. A P ≤ 0.05 was considered to be statistically significant.Results:Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (P < 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients.Conclusions:Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.

Intrathecal hydromorphone instead of the old intrathecal morphine

Intrathecal hydromorphone instead of the old intrathecal morphine