Plain Bupivacaine Research Articles

Comparative Study between the Efficacy of Fentanyl, Antihistamines, and Dexmedetomidine in Suppressing Photic Sneeze Reflex during Peribulbar Block.

Background:The photic sneeze reflex (autosomal dominant) is a condition that causes sneezing in response to numerous stimuli, such as looking at bright lights or periocular (surrounding the eyeball) injection. Unexpected or sudden sneezing during injection can be a dangerous side effect in periocular injection, in which abrupt head movement may cause globe injury.Aims:We intended to evaluate the efficacy of adding fentanyl, dexmedetomidine, and antihistamines on the incidence of the sneeze reflex associated with propofol sedation during periocular local anesthesia injections.Settings and Design:Our study was a randomized, prospective, double-blinded and controlled clinical study.Patients and Methods:This study was conducted in Ain Shams and Fayoum university hospitals at the ophthalmic surgery department. After obtaining approval from our universities ethical committee and written informed valid consents from the patients, 90 patients were included in this study. The study population included patients of both sex, ASA grade 1 and 2, in the age ranging from 18-65 years. Patients were scheduled for cataract extraction surgeries and received peribulbar block. Then patients were randomly divided into three groups (30 patients each) using a computer- generated table of random numbers. Patients were preoxygenated with supplemental oxygen by nasal cannula, all 90 patients received intravenous propofol 1mg.kg- 1 bolus for sedation and were randomized to receive adjunctive drug 2 to 4 minutes prior to propofol injection: 30 patients received intravenous fentanyl 1 μmg.kg-1 (Group F), 30 patients received dexmedetomidine 1μmg.kg-1 (Group D), and 30 patients received antihistamine (pheniramine 22.75 mg) (Group H). The same local anesthetic admixture, consisting of 5 mL 2% lidocaine with 90 IU hyaluronidase, combined with 5 mL 0.5% plain bupivacaine in a 10-mL syringe at room temperature was administered to all patients using peribulbar block technique. A masked observer (surgeon or anesthesia assistant) recorded whether the patient had a sneezing event. Continuous cardiorespiratory monitoring was performed intraoperatively. Intraoperative and postoperative medication side effects were recorded including bradycardia (HR <55 beats/min), hypotension (MAP <50 mmHg sustained for >10 min), oxygen desaturation (SpO2<90%), nausea, vomiting and prolonged sedation using Ramsay Sedation Score (RSS).Statistical Analysis Used:Student's t-test and Chi-square test were used for analysis.Results:The demographic data of the three study groups revealed non-significant differences between the three study groups as regards age, sex distribution, and the duration of surgery. No patient was excluded after inclusion to the study. All patients were able to complete the entire study and their data were included in the final analysis. Five events of sneezing had occurred in 90 patients. Two in (D) group and three in (H) group with is no statistically significant difference between the three groups as regard sneezing. Bradycardia, hypotension and sedation had occurred significantly in group (D) compared to group (F) and group (D). No patient suffered from nausea, vomiting or oxygen desaturation in all studied groups. No statistically significant difference as regards patient satisfaction between the three studied groups.Conclusion:Fentanyl, dexmedetomidine and antihistamines with propofol sedation suppress photic sneeze reflex during peribulbar block.

A Comparative Study between Bupivacaine and Clonidine Combination versus Bupivacaine (Plain) for Brachial Plexus blocks using Supraclavicular Approach

A Comparative Study between Bupivacaine and Clonidine Combination versus Bupivacaine (Plain) for Brachial Plexus blocks using Supraclavicular Approach

The effects of adding dexamethasone to epidural bupivacaine for lower limb orthopedic surgery

Introduction Dexamethasone when given epidurally with local anesthetics is known to reduce postoperative pain and postoperative analgesic consumption in several types of surgical procedures. Objective The objective of this study was to evaluate the effect of epidural dexamethasone on postoperative analgesia in patients who were undergoing lower limb orthopedic surgery. Patients and methods It is a prospective, randomized, double-blinded comparative study carried out in Assiut University Hospital, Egypt. It included 50 patients divided into two equal groups (25 in each), who underwent lower limb orthopedic surgery. The saline group: who received 15 ml epidural plain bupivacaine (0.5%)+2 ml normal saline (BS) and the dexamethasone group: who received 15 ml epidural plain bupivacaine (0.5%)+8 mg dexamethasone (2 ml) (BD). Postoperatively, when the pain score of at least 4, the rescue analgesia was given in the form of fentanyl and bupivacaine epidurally and paracetamol (perfalgan) 1 g was given routinely for all patients intravenous drip/8 h. Pain was evaluated by visual analog scale every 4 h in the postoperative 24 h. Time to first request for analgesia and total dose of rescue analgesia (epidural fentanyl/bupivacaine) in the first, 24 h postoperative was recorded. Results Dexamethasone significantly reduced the first, 24 h postoperative pain score (visual analog scale), and postoperative epidural fentanyl consumption (70.00 vs. 43.40 μg) in the first, 24 h postoperative. Dexamethasone also significantly prolonged the time to first request for analgesia (3.38 ± 0.072 vs. 15.24 ± 2.03 h). Conclusion Epidural dexamethasone with bupivacaine offers favorable effects on postoperative analgesia in lower limb orthopedic surgery.

Postincision wound infiltration with bupivacaine versus pethidine for postoperative pain relief following myomectomy under spinal anesthesia

Context: Bupivacaine is commonly used agent for wound infiltration because of its local anesthetic effect. However, pethidine an opioid has both local anesthetic and systemic analgesic effect. The combined analgesic effect of pethidine may be superior to bupivacaine that has only a local anesthetic effect. Few studies have however supported the superiority of pethidine over bupivacaine for wound infiltration. Aims: The aim of this study is to evaluate the analgesic effect of pethidine in comparison with bupivacaine wound infiltration for postoperative pain control in nonparturients scheduled for myomectomy under spinal anesthesia. Setting and Design: This study is a prospective, randomized, double-blinded control trial of the analgesic efficacy of plain bupivacaine versus pethidine for patients scheduled for myomectomy under spinal anesthesia in a Tertiary Healthcare center in Nigeria. Subjects and Methods: Seventy-six American Society of Anesthesiologists 1 and 11 patients billed for myomectomy using spinal anesthesia were randomized into two groups. Group bupivacaine had wound infiltration with 50 mg isobaric bupivacaine at a concentration of 0.25%. Group pethidine had 1 mg/kg pethidine. In the ward, pain was assessed at various intervals at rest and on coughing using the numerical rating scale (NRS) pain assessment tool and the time of the first analgesic request. Statistical Analysis: NRS scores were presented as median with interquartile range, Continuous variables such as duration of analgesia and total analgesic consumption were analyzed using the unpaired Student's t-test. Results: The pethidine group had a longer time to first analgesic request, lower pain scores and a higher level of satisfaction. Conclusion: This study showed that postincision wound infiltration with pethidine at 1 mg/kg as a component in multimodal analgesia is more effective than 0.25% bupivacaine in the management of postmyomectomy pain.

Plain bupivacaine versus bupivacaine with adjuvants for ultrasound-guided supraclavicular brachial plexus block in patients undergoing below shoulder upper limb surgeries

Background Adding of an adjuvant to local anesthetics improves the quality of nerve block and reduces the need of postoperative analgesic intake. Aim The aim of this study was to compare the block characteristics of bupivacaine when used alone with those characteristics after using different adjuvants in ultrasound-guided supraclavicular brachial plexus block (US-guided SCBPB) in patients undergoing below shoulder upper limb surgeries. Patients and methods A prospective, double-blinded, randomized, controlled trial. A total of 108 patients undergoing elective upper limb surgeries under US-guided SCBPB were randomly allocated according to the studied solution into four equal groups (n=27): (i) Group C: 30 ml bupivacaine 0.5%+5 ml 0.9% saline. (ii) Group D: 30 ml bupivacaine 0.5%+100 μl dexmedetomidine diluted to 5 ml using 0.9% saline. (iii) Group N: 30 ml bupivacaine 0.5%+10 mg nalbuphine hydrochloride diluted to 5 ml using 0.9% saline. (iv) Group M: 30 ml bupivacaine 0.5%+5 ml of 10% MgSO4. We compared the onset and duration of sensory and motor blockade, hemodynamic stability, sedation, complications and postoperative analgesia. Results There were no significant differences in the times of onset of both sensory and motor blocks between the four groups. The analgesic duration and duration of motor block were significantly longer in all adjuvant groups. The total consumption of paracetamol during the first 24 h was significantly higher in group C. Patients in groups D and M had statistically significantly higher sedation scores at different times during the study. Conclusion Adding either dexmedetomidine, nalbuphine, or magnesium sulfate to bupivacaine in US-guided SCBPB prolongs both sensory and motor blockade. Both dexmedetomidine and magnesium sulfate produces significant sedation when added to bupivacaine.

Comparison of Postoperative Analgesia Following Epidural Bupivacaine and Epidural Bupivacaine with Verapamil in Orthopaedic Lower Limb Surgeries

Comparison of Postoperative Analgesia Following Epidural Bupivacaine and Epidural Bupivacaine with Verapamil in Orthopaedic Lower Limb Surgeries

Incidence of adverse events attributable to bupivacaine liposome injectable suspension or plain bupivacaine for postoperative pain in pediatric surgical patients: A retrospective matched cohort analysis.

Surgical wound infiltration with local anesthetics is common as part of multimodal analgesia and enhanced recovery pathways in pediatric surgical patients. Liposomal bupivacaine can provide up to 92hours of pain relief, and was approved by the U.S Food and Drug Administration for local infiltration in adults. It is also commonly used by pediatric surgeons, but its safety profile in this age group has not been described. The aim of this study was to describe the incidence of local anesthetic systemic toxicity syndrome in pediatric surgical patients receiving liposomal bupivacaine compared to plain bupivacaine for surgical wound infiltration. We conducted a retrospective, single center, assessor blinded cohort study of pediatric surgical inpatients having open or laparoscopic surgery in the Cleveland Clinic between 2013 and 2017 and receiving wound infiltration with local anesthetics. We compared the incidence of local anesthetic systemic toxicity among those who received any dose of liposomal bupivacaine and those who received plain bupivacaine. Groups were matched 1:2 according to procedure type, age, and physical status score. Local anesthetic systemic toxicity was primarily defined as at least two signs or symptoms possibly related to anesthetic toxicity, as judged by two independent adjudicators blinded to the type of local anesthetic. A sensitivity analysis compared the incidence of a single sign/symptom possibly related to anesthetic toxicity. A total of 924 surgical cases were included in the final analysis (356 liposomal bupivacaine and 568 plain bupivacaine cases). The primary outcome did not occur in any patient. The sensitivity analysis found three cases in the liposomal bupivacaine group and two cases in the plain bupivacaine group having a single sign/symptom possibly related to local anesthetic administration (relative risk 2.4, 95% CI 0.4-14.0, P=0.38). In a cohort of pediatric surgical patients receiving wound infiltration with either plain or liposomal bupivacaine, we identified no cases of local anesthetic systemic toxicity syndrome, and only few patients with any sign or symptom that could potentially be related to local anesthetic toxicity.

Fluoroscopic-guided sacroiliac, joint injections for treatment of chronic axial low back pain in a tertiary Hospital in Nigeria: a preliminary study.

The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria. This was a prospective observational interventional study. The study was carried out at a tertiary hospital in Nigeria. Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and. Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention. Pain relief and functional improvement were the main outcome measures. The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively. Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain. Not declared.

ED50 of intrathecal ropivacaine for cesarean delivery with and without epidural volume extension with normal saline: a randomized controlled study.

BackgroundIt was reported that epidural volume extension could decrease the ED50 of intrathecal plain bupivacaine. In this study, we investigated the ED50 of intrathecal hyperbaric ropivacaine followed by epidural normal saline bolus for cesarean section.MethodsSixty parturients were allocated into two groups in this prospective study. About 10 mL of epidural normal saline was given after the intrathecal dose of hyperbaric ropivacaine in the Group S (normal saline group), and no epidural injection of normal saline was given after the intrathecal ropivacainve injection in the Group C (control group). The dose of intrathecal ropivacaine for each parturient was decided by up-down allocation method. The initial dose was set as 10 mg. Effective anesthesia was defined as the level of T6 or above achieved within 10 minutes after intrathecal injection and no additional epidural drug to complete operation. The Massey formula was applied to calculate the ED50 of intrathecal ropivacaine.ResultsThe ED50 of intrathecal ropivacaine for cesarean section determined by up-and-down method was 7.51 mg (95% CI, 7.09–7.93 mg) in the Group S and 8.29 mg (95% CI, 7.73–8.85 mg) in the Group C, and there was a significant difference in ED50 of ropivacaine between the two groups (P<0.05). Compared with the Group C, the ED50 of intrathecal ropivacaine decreased when followed by epidural normal saline bolus.ConclusionThe ED50 of intrathecal hyperbaric ropivacaine for cesarean section is 8.29 mg, and it is reduced when followed by epidural normal saline bolus (www.chictr.org.cn, registration number: ChiCTR-ROC-17013382).

Liposomal Bupivacaine Utilization in Total Knee Replacement Does Not Decrease Length of Hospital Stay

Liposomal bupivacaine has reportedly been used as an adjunct for perioperative pain management in total knee replacement (TKR). The purpose of our single-blind, prospective study is to show that wound infiltration with long-acting liposomal bupivacaine during TKR will shorten length of stay (LOS) as compared with standard bupivacaine injection and spinal anesthetic with or without spinal narcotic. A total of 195 patients were randomized into three groups: wound infiltration with bupivacaine and a spinal with narcotic (Group 1, N = 65), wound infiltration with liposomal bupivacaine and a spinal without narcotic (Group 2, N = 67), and bupivacaine wound infiltration with a spinal without narcotic (Group 3, N = 64). The groups were then compared with look for any benefit in using the liposomal bupivacaine with regard to LOS, pain control, function, and complications. There was a trend toward a decreased LOS (days) in the liposomal bupivacaine (Group 2) with a mean LOS of 1.83 as compared with wound infiltration with bupivacaine with spinal narcotic LOS of 2.04 (Group 1) and without spinal narcotic LOS of 1.94 (Group 3). These results were not statistically significant (p = 0.37). Patient-reported pain scores were no different between the three groups. The daily narcotic usage (morphine equivalents) during the hospitalization was statistically highest in the liposomal bupivacaine group at 77.2 versus 55.0 in Group 1 and 68.1 in Group 3 (p = 0.025). Nausea or vomiting was most common in Group 1 at 42%, followed by 28% in Group 2 and 22% in Group 3. Pruritus was most common in the spinal narcotic group at 38% versus Group 2 at 14% and Group 3 at 11%.Liposomal bupivacaine showed a trend toward a decreased LOS, but this was not statistically significant. There was no difference in pain scores reported by these patients. In conclusion, we cannot justify the extra cost of liposomal bupivacaine as compared with plain bupivacaine as an adjunct for perioperative pain management in TKR patients.

Ultrasound guided bilateral rectus sheath block and serum TNF-α and IL-6 after radical prostatectomy: A randomized double blinded study

BackgroundGeneral anesthesia can affect postoperative cytokine levels, leading to cellular immune inhibition following surgery. The primary objective of this study was to evaluate the effect of bilateral rectus sheath block on serum levels of TNF-α and IL-6 after radical prostatectomy.MethodsFifty patients undergoing radical prostatectomy, under general anesthesia were randomly allocated into two groups. Group RSB: A bilateral single shot of 20 ml plain bupivacaine 0.25% or 20 ml normal saline (Group C) in each side of rectus sheath. Postoperative pain was controlled by morphine as a rescue analgesia. Primary outcome was postoperative serum levels of TNF-α and IL-6. Secondary outcome measures: The total morphine consumption and evaluation of the visual analog pain score at 24 and 48 h postoperative.ResultsBoth TNF-α and IL-6 were significantly lower in the RSB group at 24 h postoperative, the mean value of TNF- α was 76.26 ± 4.07 pg/ml in RSB group and 93.15 ± 6.90 pg/ml in the control group (p < 0.001), while IL-6 was 89.65 ± 13.00 and 102.6 ± 24.70 pg/ml in both groups respectively (p = 0.01). In RSB group, the visual analog pain score and the total morphine consumption were significantly lower (p < 0.05) during the first 24 h postoperative while, the first time requested for rescue analgesia was significantly longer (p < 0.001).ConclusionGeneral anesthesia combined with bilateral rectus sheath block could decrease serum level of TNF-α and IL-6 after radical prostatectomy as well as decrease postoperative pain intensity with less opioid administration.Clinical trials.gov ID: NCT03074097.

Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials.

Objective Peripheral nerve blocks for postoperative analgesia have improved block success, but analgesia efficacy has been limited by the short duration of traditional local anesthetics. The results of randomized trials comparing liposome bupivacaine with conventional local anesthetic formulations (e.g., plain bupivacaine and ropivacaine) have generated conflicting results. This study was conducted to systematically review the effectiveness of analgesic efficacy of liposome bupivacaine infiltration at the surgical site versus plain local anesthetic bupivacaine or ropivacaine in patients undergoing surgery. Methods PRISMA statement guidelines were followed. A search of electronic databases National Library of Medicine's PubMed database, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from January 2012 to September 2017 was performed. Among the 1,612 records identified, 9 randomized controlled trials involving 779 patients were eligible for data extraction and meta-analysis. Results Liposome bupivacaine did not reduce postsurgical pain at rest compared to plain local anesthetics at 24 and 48 hours after surgery. Moreover, liposome bupivacaine did not reduce postoperative opioid consumption at 24, 48, or 72 hours when compared to plain local anesthetics. Liposome bupivacaine did reduce postoperative nausea when compared to plain local anesthetics (P =<0.3). There was no significant difference in hospital length of stay between study groups, the use of plain bupivacaine or ropivacaine, or among orthopedic or nonorthopedic procedures. No manifestations of local anesthetic toxicity were reported. Conclusions Our results suggest that liposome bupivacaine does not have an analgesic advantage when compared to plain local anesthetics at the surgical site for patients undergoing surgical procedures.

A Comparative Study of Diclofenac and Wound Infiltration to Additional Ilioinguinal/iliohypogastric Nerve Block With 0.25% Plain Bupivacaine for Pain Relief in Children Undergoing Groin Surgery – University Teaching Hospital (UTH), Lusaka

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Objective: Surgery in the groin region is commonly performed in paediatric patients at the University Teaching Hospital (UTH). Intramuscular (IM) Diclofenac and wound infiltration, with lignocaine, are the commonest analgesics administered intraoperatively.This study aimed at determining whether an additional ilioinguinal/iliohypogastricnerve block with 0.25% plain bupivacaine, done using the landmark technique,would improve postoperative analgesia in children undergoing groin surgery at the UTH when compared to IM diclofenac and wound infiltration with 1% lidocaine (with adrenaline 1:200,000).Methods: A non-randomized intervention study of 36 children undergoing unilateral inguinalherniotomy, hydrocelectomy and orchidopexy was conducted at UTH. The children were allocated to two groups – Group 1 (control) received IM diclofenac and wound infiltration (UTH usual care), while Group 2 (intervention group) received medication as in control plus an ilioinguinal/ iliohypogastric nerve block performed by landmark technique. The Mann-Whitney U test was used to compare the pain scores between the two groups and any resultyielding a p-value of less than 5 percent was statistically significant.Results: The operations done were unilateral inguinal herniotomy, hydrocelectomy and orchidopexy. Half of the participants were between 2-5years old and the other half between 5-7years. Post-operatively, the pain scores measured at times 0and 1 hour were statistically non-significant in both groups (p-values 0.181 and 0.355 respectively). At the 6th hour post-operative, all of the participants had pain scores of 0. Oral Paracetamol (15 - 20 mg/kg) was the only post-operative analgesic received by the patients in the study.Conclusion: This study showed that the addition of ilioinguinal/iliohypogastric nerve block, done with the landmark technique, does not offer superior pain relief during the post-operative period in children undergoing unilateral groin surgery at UTH.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

A Comparative Study of Diclofenac and Wound Infiltration to Additional Ilioinguinal/iliohypogastric Nerve Block With 0.25% Plain Bupivacaine for Pain Relief in Children Undergoing Groin Surgery – University Teaching Hospital (UTH), Lusaka

ABSTRACT&#x0D; Objective: Surgery in the groin region is commonly performed in paediatric patients at the University Teaching Hospital (UTH). Intramuscular (IM) Diclofenac and wound infiltration, with lignocaine, are the commonest analgesics administered intra- operatively. This study aimed at determining whether an additional ilioinguinal/iliohypogastric nerve block with 0.25% plain bupivacaine, done using the landmark technique,would improve post- operative analgesia in children undergoing groin surgery at the UTH when compared to IM diclofenac and wound infiltration with 1% lidocaine (with adrenaline 1:200,000).&#x0D; Methods: A non-randomized intervention study of&#x0D; 36 children undergoing unilateral inguinal herniotomy, hydrocelectomy and orchidopexy was conducted at UTH. The children were allocated to two groups – Group 1 (control) received IM diclofenac and wound infiltration (UTH usual care), while Group 2 (intervention group) received &#x0D; medication as in control plus an ilioinguinal/ iliohypogastric nerve block performed by landmark technique.&#x0D; The Mann-Whitney U test was used to compare the pain scores between the two groups and any result yielding a p-value of less than 5 percent was statistically significant.&#x0D; Results: The operations done were unilateral inguinal herniotomy, hydrocelectomy and orchidopexy. Half of the participants were between 2-5years old and the other half between 5-7years. Post-operatively, the pain scores measured at times 0 and 1 hour were statistically non-significant in both groups (p-values 0.181 and 0.355 respectively). At the 6th hour post-operative, all of the participants had pain scores of 0. Oral Paracetamol (15 - 20 mg/kg) was the only post-operative analgesic received by the patients in the study.&#x0D; Conclusion: This study showed that the addition of ilioinguinal/iliohypogastric nerve block, done with the landmark technique, does not offer superior pain relief during the post-operative period in children undergoing unilateral groin surgery at UTH.

Düşük doz seyreltilmiş bupivakain ile fentanil yoğunluğunun transüretral prostatektomi için uygulanan spinal blok süresi ve kalitesi üzerine etkisi

Purpose: In this prospective randomized controlled trial, we investigated whether density of low dose diluted bupivacaine with fentanyl effects the duration and quality of the spinal block for transurethral prostatectomy (TURP) in elderly patients.Materials and Methods: Sixty patients requiring elective TURP were randomly allocated into two groups. Group H (n=30) received fentanyl 20 mcg+hyperbaric bupivacaine 0.5% (1.5 ml)+ saline 1.1 ml. Group I (n=30) received fentanyl 20 mcg+plain bupivacaine 0.5% (1.5 ml)+ saline 1.1 ml in total, bupivacaine 0.25% (3 ml) intrathecally. Onset, duration of the sensory block, the degree of motor block, perioperative anesthesia quality, side-effects, analgesic-free period were assessed.Results: The median peak level of the sensory block was significantly higher in Group H than in Group I. The time to the first analgesic request was longer in Group H). There were no differences between the groups for degree of the motor block, quality of anaesthesia, or adverse effects.Conclusion: Low-dose diluted hyperbaric bupivacaine with fentanyl provides adequate anaesthesia, postoperative analgesia without haemodynamic instability or prolonging the recovery time for TURP in elderly patients.

Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial.

Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6h (P = 0.043) and opioid requirement at 6h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores. Pre registration: The trial was registered in Sri Lanka clinical trial registry-SLCTR/2016/011 ( http://www.slctr.lk/trials/357 ).

Prospective Randomized Controlled Study Comparing Caudal Block versus Dorsal Penile Nerve Block as Postoperative Analgesia in Children Presented for Penile Surgery

AbstractBackground: Caudal block is recommended for analgesia during and after surface operation on the penis, for example circumcision and hypospadias repair. The aim of this study was to compare caudal block versus dorsal penile block in children undergoing penile surgery, regarding duration and quality of post-operative analgesia.Aim of the Study: To compare caudal block versus dorsal penile block in children undergoing penile surgery, our primary outcome was the duration of postoperative analgesia while our secondary outcome was the quality of post-operative analgesia.Patients and Methods: 60 children, ASA I-II, 1-4 year's old undergoing penile surgery under general anesthesia were enrolled in the study. Children were randomly classified into two groups: (Group I) (penile group=30 patients) received a penile block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%) on each side, Group II (caudal block group=30 patients) patients of this group received a caudal block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%). Assessment of post-operative will be done by the Faces Pain Scale which is a self-report measure of intensity developed for children. It was adapted from the Faces Pain Scale to make it possible to score the sensation of on the widely accepted 0-to-10 metric, 0 equals no pain and 10 equals very much pain. This done immediately postoperative and every 2H until 6H post-operative.Results: Faces score was significantly lower in group II at 2H, 4H and 6H post-operative with increase on the duration of block in Group II, also there was significant decrease in heart rate in Group II at 30min, 45min, 75min, 90min, 105min, 120min and 135min respectively from the start of surgery so there was significant increase of bradycardia and need of atropine in group.Conclusions: Caudal block seemed to be more effective in reducing post-operative score and decreasing the need of rescue analgesia with prolongation of the duration of the block.

Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

BackgroundIn parturients with increased physiologically intra-abdominal pressure (IAP) and a short stature, a greater cephalad spread of spinal anesthesia is often observed after a fixed amount of plain bupivacaine is administered. Therefore, we designed this prospective study to test whether IAP and vertebral column length (VCL) were predictors of spinal spread in parturients undergoing a cesarean section.MethodsA total of 113 parturients, all undergoing elective cesarean sections with single-shot spinal anesthesia, were enrolled. The L3-L4 interspace was entered, and 2 mL of 0.5% plain bupivacaine was injected into the subarachnoid space. Upon loss of temperature sensation at the T4 level, IAP was measured through a bladder catheter while the patient was in the supine position with a 10°left lateral tilt. Parturient demographic variables, including age, height, weight, IAP, and VCL were recorded. Linear regressions and multiple regressions were performed to analyze the relationships between parturient variables and the spread of spinal anesthesia.ResultsA total of 109 parturients were included in the analysis. Linear regression analysis showed a significant univariate correlation of height, weight, body mass index (BMI), IAP, and VCL with cephalad spread (all P< 0.004). Multiple linear regression analysis showed that IAP and VCL were the key determinants of spinal spread (both P < 0.0001), where as exclusion of age, weight, and height did not change the result (all P> 0.209).ConclusionsOur data indicated that IAP and VCL were significant predictors of intrathecal spread of plain bupivacaine, and there was a positive association between IAP and abdominal girth in term parturients.

Liposomal Bupivacaine vs Plain Bupivacaine in Periarticular Injection for Control of Pain and Early Motion in Total Knee Arthroplasty: A Randomized, Prospective Study

BackgroundThe use of multimodal pain regimens has been shown to be an effective technique for the treatment of postoperative pain after total knee arthroplasty. Periarticular injections, of both short-acting and long-acting anesthetics, have emerged as an additional method of providing significant improvement in postoperative pain relief. The purpose of this study is to compare the efficacy of periarticular injection using long-acting vs short-acting preparations. MethodsA randomized, prospective study of 80 consecutive patients was performed comparing liposomal bupivacaine vs plain bupivacaine periarticular injection. The primary outcomes included pain relief, total narcotic usage, and completion of physical therapy goals, specifically range of motion. ResultsNo significant improvements were noted between liposomal bupivacaine and plain bupivacaine injection groups in overall pain reduction, range of motion, or total narcotic usage. At 24 hours, small statistically significant differences in physical therapy pain scores were noted with liposomal bupivacaine vs plain bupivacaine and control patients, but these differences did not persist at later time points. Both preparations demonstrated statistically significant improvements in range of motion when compared to historical controls, but no differences were noted between preparations. ConclusionOverall, minimal significant differences were noted between liposomal bupivacaine and plain bupivacaine at early and late time points. Both preparations of periarticular injection demonstrated superiority over control pain regimens but were relatively equivalent to one another in direct comparison.

Fascia iliaca blockade with the addition of liposomal bupivacaine vs. plain bupivacaine for perioperative pain management following hip arthroscopy.

A newer formulation of bupivacaine, encapsulated within carrier molecules, has garnered attention for its role in providing extended post-operative analgesia. The purpose was to evaluate the addition of liposomal bupivacaine to fascia iliaca blockade during hip arthroscopy. Retrospective cohort study of patients undergoing hip arthroscopy with a pre-operative fascia iliaca blockade with either liposomal bupivacaine (Group 1; 266mg + 20cc 0.5% plain bupivacaine) or bupivacaine (Group 2; 40cc 0.25% plain bupivacaine). All patients received standardized pre-operative oral pain medications. The primary outcome was the defense veteran pain rating scale (DVPRS). Secondary outcomes included duration of hospital admission, PACU opioid use, PACU pain scores, and duration of nerve blockade. Thirty-eight males and 30 females, mean age of 33 years (range 14-56). There was no difference in pre-operative DVPRS between the groups (n.s.). There was no difference in post-operative DVPRS pain scores at POD0 (3.7 vs. 3.9, n.s.), POD1 (4.2 vs. 3.8, n.s.), POD2 (4.2 vs. 3.7, n.s.), POD3 (3.9 vs. 3.7, n.s.) or POD14 (2.2 vs. 2.4, n.s.). Group 1 trended towards longer mean total hospital admission time (872 vs. 822min, n.s.), and greater mean morphine equivalents administered in the PACU (33 vs. 29mg, n.s.). 68% of patients in group 1 reported continued anterior thigh numbness at POD3, compared to 34% in group 2 (p = 0.008). Despite the advertised benefits of prolonged post-operative analgesia using liposomal bupivacaine, there were no significant differences in post-operative pain scores or PACU opioid consumption. Our results support that acceptable pain scores are successfully achieved at all time periods with the use of multimodal analgesia including fascia iliaca blockade despite the type of pain medication administered. III.