Pethidine Consumption Research Articles

Comparison between ultrasound-guided transversus abdominis plane block and quadratus lumborum block for open nephrectomy surgeries

BackgroundThis prospective randomized study was performed on 80 patients, 21–60 years old, scheduled for open nephrectomy surgery. Patients were equally allocated to two groups: the transversus abdominis plane block (TAPB) group and the quadratus lumborum block (QLB) group. Both groups received 0.3 ml/kg of bupivacaine 0.25% on the side of the operation. Total postoperative pethidine consumption, time to rescue analgesia, postoperative visual analogue scale (VAS), and pethidine-related postoperative nausea and vomiting (PONV) were recorded.ResultsTotal postoperative pethidine consumption was significantly lower in the QLB group: 73.75 ± 23.99 mg versus 115.63 ± 31.87 mg in the TAPB group. Time to 1st rescue analgesia was significantly prolonged in the QLB group: 477.075 ± 49.2 min versus 430.825 ± 48 min in the TAPB group. The VAS was significantly lower in the QLB group, on arrival to the Post-Anesthesia Care Unit (PACU), and at 1, 4, 8, and 12 postoperative hours. At 16 and 24 postoperative hours, both groups showed nonsignificant differences in the VAS scores. In the QLB group, 20% of patients had PONV versus 35% of patients in the TAPB group with no significant difference.ConclusionsQLB efficiently reduced pain after open nephrectomy surgeries, in terms of quality and duration of pain control compared to TAPB.Trial registrationFMASU MD 90a/2021/2022. The trial was registered on the 23rd of May 2021, with Pan Africa Clinical Trials Registry (PACTR202110858627849) on 27 October 2021

Effect of 30 mg Oral Dextromethorphan and Placebo on Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background and Objective: Laparoscopic cholecystectomy is considered a global standard procedure for the surgical treatment of gallstones. The present study aimed to compare the effect of dextromethorphan and oral placebo on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This double-blind clinical trial study was performed on 114 ASA I and II patients who were candidates for laparoscopic cholecystectomy. Two hours before the induction of anesthesia, the intervention group was administered 30 mg of plain dextromethorphan syrup, and the control group was given 2 cc of placebo of an oral syrup. Pain intensity, systolic and diastolic blood pressure, heart rate, and SPO2 at the time of recovery, 1, 6, and 12 hours after surgery, and the amount of pethidine were recorded. Data were analyzed in SPSS software (version 24) at a significance level of 0.05. Results: The mean pain intensity was statistically significant in the control and intervention groups. The mean pain intensity in the intervention group was lower than that in the control group (P<0.05). Diastole blood pressure, heart rate, and SPO2 in the two groups did not have a statistically significant difference (P>0.05), while systolic blood pressure statistically differed (P<0.05). The amount of pethidine consumption in the intervention group was higher than that in the control group. Conclusion: As evidenced by the obtained results, low-dose dextromethorphan (30 mg) is effective in postoperative analgesia for patients undergoing laparoscopic cholecys-tectomy and reduces opioid use.

Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial

Background & Objectives: Hip arthroscopy is a minimally invasive technique that has been widely used to treat a variety of hip joint diseases. However, severe postoperative pain usually follows these surgeries, necessitating the use of multimodal pain control strategies. Regional blocks like femoral nerve block (FNB) and fascia iliaca compartment block (FICB) allow for better postoperative analgesia while using less parenteral opioids. The purpose of this study was to evaluate and compare the efficacy of ultrasound guided FNB versus ultrasound guided FICB for postoperative analgesia. 
 Methodology: A total of 60 patients, planned for hip arthroscopy, aged 21−65 y, of either sex and ASA I−II were randomly divided into two groups: Group FICB (n= 30), in which FICB with 40 mL levobupivacaine 0.25% was done after induction of general anesthesia (GA) and Group FNB (n = 30) in which FNB with 20 mL levobupivacaine 0.25% was done after induction of GA. Time to the first analgesic use was the primary outcome, whereas total pethidine consumption as rescue analgesic in the first 24 h postoperatively, VAS scores, and the assessment of postoperative early ambulation were the secondary outcomes.
 Results: Patients in the Group FICB experienced a significantly shorter time to ambulation compared to Group FNB; 17.2 ± 2.1 vs. 19.8 ± 2.1 h respectively (P < 0.001). There were no significant differences between the two groups regarding time to first analgesic requirement (pethidine), total pethidine consumption, and the VAS scores. No cases of drug allergy were reported in both groups.
 Conclusion: Both fascia iliaca compartment block and femoral nerve block were effective in reducing postoperative pain; however, fascia iliaca compartment block was superior regarding early ambulation.
 Abbreviations: FNB: Femoral Nerve Block; FICB: Fascia Iliaca Compartment Block; GA: General Anesthesia; US: Ultrasound; VAS: Visual Analog Scale
 Key words: Hip arthroscopy; Fascia iliaca compartment block; Femoral Nerve Block; Pain; Pain Management; Postoperative pain
 Citation: Alasnsary AM, Elgouhary MO, Rashed MM, Ali MM. Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial. Anaesth. pain intensive care 2022;27(1):23−30; DOI: 10.35975/apic.v27i1.2120
 Received: September 10, 2022; Reviewed: November 05, 2022; Accepted: November 16, 2022

Comparison of adjuvant therapy with midazolam, paracetamol, tramadol, or magnesium sulfate during intravenous regional anesthesia with ropivacaine: A randomized clinical trial.

Intravenous (IV) regional anesthesia is an easy, safe, reliable, and efficient option for inducing anesthesia during surgeries but with tourniquet-related pain. This study aimed to evaluate midazolam, paracetamol, tramadol, and magnesium sulfate administration as adjuvants with ropivacaine on pain relief and hemodynamic changes in IV regional anesthesia. A randomized, double-blind, placebo-controlled trial was conducted in subjects undergoing forearm surgery with IV regional anesthesia. The block randomization method was used to assign eligible participants to each of five study groups. Hemodynamic parameters were assessed before applying the tourniquet, at prespecified time points (5, 10, 15, and 20 min), then and every subsequent 10 min until surgery completion. A Visual Analog Scale was used to assess pain severity at baseline followed by every 15 min until completion of the surgery, and after tourniquet deflation every 30 min to 2 h, and at 6, 12, and 24 h postoperative. Data were analyzed using Chi-square and analysis of variance with repeated data testing. The shortest onset and the longest duration of sensory block were observed in the tramadol group and the shortest onset of motor block in the midazolam group (P < 0.001). Pain score was estimated to be significantly lower in the tramadol group at the time of tourniquet application and release, and 15 min to 12 h after tourniquet release (P < 0.05). In addition, the lowest dose of pethidine consumption was observed in the tramadol group (P < 0.001). Tramadol appeared to be able to effectively relieve pain, shorten the onset of sensory block, prolong the duration of sensory block, and achieve the lowest consumption of pethidine.

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.

The Effect of Pre-emptive Oral Melatonin versus Placebo on Post-operative Analgesia in Infants after Thoracotomy for Closed Cardiac Surgeries: A Randomized Controlled Study

BACKGROUND: Thoracotomy pain is one of the severest types of pain that should be managed properly, especially in children. Opioids are the most widely prescribed analgesics for post-operative pain, but they can have a number of undesirable side effects. Melatonin could be employed as an adjuvant analgesic therapy during procedural discomfort as it had no known major side effects. STUDY DESIGN: This was a double-blinded, controlled randomized study. METHODS: Fifty patients divided randomly into two equal groups. One hour before surgery, children in M group (n = 25) were given 0.5 mg/kg orally of melatonin 3 mg tablets) and patients in Group P (n = 25) received a placebo (5 ml of water by syringe 5 ml) orally. Post-operative pethidine consumption over the 1st 24 h (mg) was recorded, the intraoperative fentanyl consumption (HR and ABP) at baseline, 1 min after induction, at skin incision, and every 30 min till the end of the surgery were recorded. Neonatal Infant Pain Score (NIPS) at 4 h, 6 h, 8 h, 12 h, 18 h, and 24 h postoperatively was recorded. Other reported data include demographic data, extubation time, days of ICU stay, and complications. RESULTS: Total post-operative pethidine consumption (mg) over 24 h was significantly lower in M group than P group (3.48 ± 2.23 vs. 7.68 ± 4.52 p = 0.01). Intraoperative fentanyl consumption (ug) was significantly lower in M group than P group (10.28 ± 4.98 vs. 17.08 ± 7.39 p &lt; 0.001). As regards NIPS, it was statistically lower in M group than P group in all times except at 8 h and 24 h with significant difference. CONCLUSION: Oral melatonin is an effective and safe pre-emptive drug as it reduces the total post-operative pethidine consumption over the first 24 h and decreased post-operative pain scores without any unpleasant effects in pediatrics undergoing closed heart surgery.

Analgesic Efficacy of Pre-Operative Oral Pregabalin in Dacryocystorhinostomy Surgery

Background: External dacryocystorhinostomy (DCR) is still considered the golden standard for lacrimal surgery. It is a painful procedure that involves intra- and extra-ocular dissection with a high prevalence post-operative nausea and vomiting (PONV). Aims: This study was designed to evaluate the effects of preoperative oral pregabalin on postoperative pain and analgesic requirements in patients undergoing DCR surgery. Design: A prospective randomized double-blind clinical trial. Patients and methods: 100 American Society of Anesthesiologists (ASA) physical classes I and II patients in an age ranging from 18 to 65 years of either sex, had DCR surgery. Patients were divided randomly into two equal groups (each = 50). In pregabalin group, they received two capsules of pregabalin (one at the night of the surgery, the other at 2 hours before the surgery), while patients in control group received two identical placebo capsules. Hemodynamics were monitored, postoperative VAS scores, the time of first analgesic request, total pethidine requirements, and the incidence of PONV were recorded as well. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The pregabalin group exhibited a significant lower incidence of postoperative pain, pethidine consumption and nausea, without any statistically significant differences regarding hemodynamic parameters in comparison to control group. Conclusion: Preoperative oral administration of pregabalin can be a promising modality for alleviation of postoperative pain and reduction in postoperative opioid consumption.

Pre-emptive analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in laparoscopic cholecystectomy

Background Transversus abdominis plane (TAP) block creates satisfactory somatic analgesia at T6–L1 with minimal or no visceral blockade, whereas quadratus lumborum block (QLB) provides somatic and visceral analgesia of the whole abdomen. Aim To compare the efficacy of QLB with TAP block in controlling pain after laparoscopic cholecystectomy. Patients and methods A total of 70 patients with American Society of Anesthesiologists I and II, aged 18–50 years, who underwent elective laparoscopic cholecystectomy were allocated into two groups: group I (subcostal TAP block) and group II (lateral QLB). Results Pain scores were lower in group II compared with group I at 4, 6, 8, and 10 h postoperatively. The time of first rescue analgesia was prolonged in group II in comparison with group I. Heart rate and mean arterial pressure showed insignificant differences between the two groups intraoperatively. However, there was a significant decrease in heart rate and mean arterial pressure in group II compared with group I at 4, 6, 8, and 10 h postoperatively. There was no reported local anesthetic toxicity or technique-related complication in the two groups. Conclusion Bilateral ultrasound-guided QLB was more effective than bilateral ultrasound-guided subcostal TAP block in patients undergoing laparoscopic cholecystectomy with prolonged postoperative analgesia and less pethidine consumption.

Imrecoxib versus celecoxib as postoperative analgesia for patients receiving arthroscopic knee surgery: a randomized, controlled, non-inferiority study.

Imrecoxib is a novel cyclooxygenase-2 inhibitor independently developed in China, which exhibits a good efficacy and tolerance in orthopedic disorders. The current study aimed to further compare its efficacy and safety with celecoxib as postoperative analgesia in arthroscopic knee surgery (AKS). Patients receiving AKS were enrolled and randomly assigned to imrecoxib (n = 64) and celecoxib (n = 62) group to receive analgesia for 72h after surgery. Pain at rest and movement, pethidine consumption, patient's satisfaction, Lysholm score, and adverse events were assessed after AKS. Meanwhile the upper limit of 95% CI of pain-score mean difference (MD) between imrecoxib and celecoxib was calculated, then, the non-inferiority was defined if the all-time-point upper limits of 95% CI less than 1. Imrecoxib was non-inferior to celecoxib for alleviating pain at rest (upper limit of 95% CI of MD ranging from 0.443 to 0.782, all time-point values less than 1); as well as for attenuating pain at movement (upper limit of 95% CI of MD ranging from 0.398 to 0.582, all time-point values less than 1). Moreover, rescue analgesia rate (P = 0.583), pethidine consumption (P = 0.454), patient's satisfaction at 72h (P = 0.408), and Lysholm score at M3 (P = 0.776) were of no difference between imrecoxib group and celecoxib group. Additionally, the main adverse events in two groups were nausea (P = 0.425), constipation (P = 1.000), vomiting (P = 0.715), headache (P = 1.000), and dizziness (P = 0.667), which were mild and manageable. Imrecoxib is non-inferior to celecoxib in postoperative analgesia and exhibits an acceptable tolerance in patients undergoing AKS.

The Pain Control Efficacy of Zolpidem versus Melatonin after Intervertebral Disc Herniation Surgery under General Anaesthesia: A Randomised Clinical Trial.

Background:Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias.Objectives:The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia.Materials and Methods:Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp).Results:Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores (P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events.Conclusion:The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.

Evaluation of opioid consumption trends for pain in Taiwan and comparison with neighboring Asian countries.

Opioids are effective analgesics for pain relief, however, inappropriate use may cause risks. The aims of the study were to evaluate trends of opioid consumption for pain management in Taiwan and compare them among neighboring Asian countries. Opioid consumption data, including fentanyl, morphine, oxycodone, hydromorphone, codeine, and pethidine, were collected from the Controlled Drugs Management Information System of Taiwan Food and Drug Administration from 2008 to 2018. Data of different continents and neighboring Asian countries were retrieved from the WHO website. The major findings include: (1) In Taiwan, the total annual opioid consumption has gradually increased from 2008 to 2018, with fentanyl being the most frequently consumed opioid analgesic, followed by morphine. Codeine and pethidine consumption dropped significantly over the years. (2) In neighboring Asian countries, the opioid consumption in order from highest to lowest consumption were South Korea, Japan, Taiwan, Singapore, Hong Kong (China), and China. We concluded that, from 2008 to 2018, the total opioid consumption trend for pain management in Taiwan has slowly increased, with fentanyl and morphine being the most commonly used opioids. When compared with neighboring Asian countries, level of opioid consumption in Taiwan was between Japan and Singapore. The research results may provide a reference for healthcare professionals worldwide.

Efficacy of superficial cervical plexus block versus cervical retrolaminar block both combined with auriculotemporal nerve block in parotid surgeries

BackgroundRegional techniques in parotid surgeries include superficial cervical plexus block (SCPB) and auriculotemporal nerve (ATN) block, which can be used as an anesthetic technique for awake parotidectomy. This study aimed to evaluate the efficacy of cervical retrolaminar block (RLB) as an alternative to SCPB both, used in combination with auriculotemporal nerve (ATN) block, in parotid surgery. Material and methodsA total of 40 patients undergoing parotid surgery were prospectively randomized into either the SCPB group (n = 20) or the cervical RLB group (n = 20) using 20 ml of 0.25% bupivacaine plus 5 mcg\\mL epinephrine. Both were combined with ATN block using 5 ml of 0.25% bupivacaine plus 5 mcg\\mL epinephrine. ResultsThe time to first request for analgesia was longer in the RLB group than the SCPB group. Total intra operative fentanyl consumption and post-operative pethidine consumption in the first 24h were lower in group RLB. All patients (n = 20) in the SCPB group required rescue analgesia using pethidine, while only 40% of patients required pethidine in the RLB group. Visual analog scale was lower in the RLB group from 2 to 24-h post-operatively, but it was associated with hypotension and longer block technique time occurred with RLB than SCPB. There was no significant difference in side effects except for 20% Horner's syndrome in the SCPB group. ConclusionCervical RLB is more effective analgesic technique than SCPB, as the cervical RLB showed longer time to first analgesic request, lower intraoperative anesthetic consumption, lower total post-operative pethidine consumption and lower VAS.

The analgesic effect and safety of preoperative versus postoperative administration of celecoxib in patients who underwent arthroscopic rotator cuff repair: a randomized, controlled study.

Celecoxib presents a good analgesic effect in patients who undergo arthroscopic rotator cuff repair (ARCR) surgery, while few studies investigate the optimal timing of celecoxib administration. This study aimed to explore the analgesic effect of preoperative versus postoperative administration of celecoxib in ARCR-treated patients. A total of 106 ARCR-treated patients were enrolled and randomized at a 1:1 ratio into preoperative analgesia group (N = 53) and postoperative analgesia group (N = 53). The pain visual analog scale (VAS) score at rest or flexion, salvage consumption of pethidine, patient's satisfaction score, modified University of California at Los Angeles (UCLA) score and adverse events were evaluated. Pain VAS scores at rest at 12h and D1 (but not D2, D3 or D7) and pain VAS scores at flexion at 12h, D1 and D2 (but not D3 or D7) were decreased in preoperative analgesia group compared to postoperative analgesia group. Meanwhile, rescue analgesia rate and 7-day pethidine consumption in preoperative analgesia group were lower than that in postoperative analgesia group. Besides, the overall satisfaction scores at D1 and D3 (but not at D7 or M3) were elevated in preoperative analgesia group compared to postoperative analgesia group. However, no difference of modified UCLA scores at D7 or M3, or the occurrences of adverse events were found between the two groups. Celecoxib preoperative administration remits acute pain and facilitates satisfaction but does not improve long-term shoulder joint function recovery compared to its postoperative administration in patients who undergo ARCR surgery.

Comparison of analgesic consumption of hemophilic and non-hemophilic patients in knee arthroplasty.

Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Postoperative Analgesia after Laparoscopic Cholecystectomy - Prospective, Randomized, Double Blind, Control Trial

In this prospective, randomized, double blind control trial we aim to investigate which of the most used analgesic techniques after laparoscopic cholecystectomy is the most efficient. Methods: This study included 81 patients that were randomly distributed into 3 groups using a computer-generated random number which was enclosed in a sealed envelope: group A (control) received classic multimodal iv opioid analgesia, group B received Tap block in oblique subcostal approach (OSTAP) and group C received local anesthetic infiltration of the trocar insertion sites (LAI). The primary outcome of this trial was to evaluate the efficacy of each analgetic technique by measuring VAS pain scores. Secondary outcome included intraoperative opioid requirement and the opioid consumption in the first 24h postoperatively. Intraoperative parameters and outcome data were recorded by an anesthesiologist who was blinded to the study groups. Results: We analyzed a total of 75 patients. For the primary outcome variable, VAS pain scores at rest were significantly reduced in OSTAP group at each time point assessed in the first 24 hours after surgery compared with LAI group and IV opioid analgesia group (p 0.001). Intraoperative fentanyl consumption and 24h pethidine consumption were also significantly reduced in TAP block group compared with LAI group and IV opioid analgesia group (p 0.001). Conclusions: Our study showed that OSTAP block is a more efficient analgesia technique compared with IV opioid analgesia and with local anesthetic infiltration of trocar sites after laparoscopic cholecystectomy surgery. This trial was registered at www.clinicaltrials.gov (NCT02707250).

Ketamine versus Dexmedetomidine in Local Wound Infiltration for Postoperative Pain Relief in Cesarean Section

Background: Cesarean delivery is a frequently obstetric operation in Egypt with a recently reported over all cesarean section rate of 54% and it causes moderate to severe postoperative discomfort. Infiltration of the wound site is a method to improve postoperative analgesia. The aim of the work: To compare the pain relief effects of ketamine versus dexmedetomidine combined to bupivacaine in local wound infiltration in patients underwent cesarean section and to estimate side effects of medications. Patients and Methods: This randomized, controlled study including 90 women were subjected for elective cesarean delivery under general anesthesia and were divided at random into 3 equal groups to receive 40 ml bupivacaine (0.25%) + either 2 mg/kg ketamine in (group A), 2 μg/kg dexmedetomidine in (group B) or 2 ml saline in (group C) via local wound infiltration. The primary outcome was time of the first analgesia requested. The secondary outcomes were total dose of analgesia per 24 hours, Visual analogue scale, time of starting movement, breast-feeding, passing flatus or stool, start of eating and adverse effects of medications. Results: A significant increase in time of the first analgesic request in group A (8.4 ±1.91) h. and group B (7.5±1.81) h. than group C (4.3±1.24) h. A significant decrease in pethidine consumption in group A (59 ± 28.93 mg) than group B (72 ± 23.1 mg) and group C (102 ±16 mg). The visual analogue scale (VAS) was significantly lower (p <0.001) in groups A and B than in group C. The time of start movement, breast-feeding, passing flatus and eating was decreased in groups A and B than in group C Conclusions: Addition of ketamine or dexmedetomidine to local anesthetics wound infiltration increased time to the first analgesia request and decreased total analgesic consumption, but ketamine is superior.

Intraperitoneal Local Instillation of Levo-Bupivacaine versus Magnesium Sulfate versus Levobupivacaine Plus Magnesium Sulfate for Postoperative Pain Relief after Laparoscopic Sleeve Gastrectomy: Prospective Randomized Clinical Trial

Abstract Background: Laparoscopic sleeve gastrectomy is the gold standard option for the management of morbid obesity, it is a less invasive procedure with better cosmetic results and shorter operative time and hospital stay. Moreover, the current body of evidence shows that laparoscopic interventions are generally associated with less post-operative pain and analgesic requirements. Aim of Study: To compare the efficacy and safety of intraperitoneal levobupivacaine, and/or magnesium sulphate in different combinations for post-operative pain relief in patients undergoing laparoscopic sleeve gastrectomy. Methods: This is double blind prospective randomized clinical trial set at Ain Shams University Hospitals over a period of 7 months from February to September 2020 on 60 patients who were scheduled to undergo laparoscopic sleeve gastrectomy at Ain Shams University Hospitals. 60 patients were divided into three groups: Group A included patients received intraperitoneal instillation of 30ml of 0.25% Lev-obupivacaine alone, group B included patients received intra-peritoneal instillation of 30ml Magnesium Sulphate 10% alone and Group C included patients received intraperitoneal instil-lation of 15ml Magnesium Sulfate 10% plus 15ml of 0.25% Levobupivacaine to a total volume of 30ml. Results: The average Time to 1st dose of post-operative analgesia demand was also the longest in LevMg group compared to Mg group and Lev group (8.75±4.51 hours compared to 1.40±0.50 hours and 4.95±1.76 hours respectively) which was also highly significant. When total analgesia consumption in 24 hours was analysed, LevMg group had 35.00±26.66mg, Mg group had 136.50±19.27mg and Lev group 87.00±33.73 mg of Pethidine consumption which was highly significant Bupivacaine group had mild tomoderate pain and most of the patients in bupivacaineplus magnesium sulphate group had mild pain in first 24 hours of surgery. Conclusion: Intraperitoneal combination of levobuivacaine and maghnesium sulphate is more effective than levobupiavacaine or maghnesium sulphae alone for post-operative pain after laparscopic sleeve gastrectomy.

Rationale for preoperative (versus postoperative) administration of meloxicam for acute pain management and assessment of satisfaction in patients with femoroacetabular impingement who underwent hip arthroscopy

Objective: This study is aimed to compare the analgesic effect and safety of preoperative (versus postoperative) meloxicam administration in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy (HA).&#x0D; Methods: Totally, 136 FAI patients who scheduled for HA were recruited, then they were randomly assigned to preoperative administration (PREA) group (orally meloxicam 7.5 mg in 12h, 24h before operation, then orally 7.5 mg/d from 12h to Day 7 after operation; N=68) or postoperative administration (POSA) group (orally meloxicam 7.5 mg/d from 12h to Day 7 after operation; N=68) in 1:1 ratio. Furthermore, pain visual analog scale (VAS) score, patient satisfaction score, Harris hip score (HHS) and adverse events were assessed. Besides, the accumulated pethidine consumption for rescuing analgesia was calculated.&#x0D; Results: Acute pain VAS score at rest (Day1 – Day2) and pain VAS score at motion (Day1 – Day3) were decreased, meanwhile short-term patient satisfaction score (Day1–Day3) was increased in PREA group compared with POSA group; however, these scores in long-term period were of no difference between PREA group and POSA group (Day3–Month3). Furthermore, accumulated pethidine consumption on Day3 and Day7 were attenuated in PREA group compared with POSA group. Additionally, HHS at any assessed time points (Day7–Month3) did not differ between two groups. Besides, no difference in the incidence of adverse events was found between two groups.&#x0D; Conclusions: Preoperative meloxicam administration displays superior efficacy in short-term pain control, patient satisfaction improvement and attenuated consumption of rescue analgesia over postoperative meloxicam administration in FAI patients who underwent HA.

Intravenous lidocaine reduces perioperative opioids without negatively affecting the electrical stapedial reflex threshold in pediatric cochlear implants

BackgroundTotal intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric cochlear implants (CIs) surgery as it does not suppress the electrical stapedial reflex threshold (ESRT). However, high doses of remifentanil exacerbate postoperative pain and increase opioid consumption. Intravenous lidocaine reduces pain and opioid requirement. This study investigated the effect of intravenous lidocaine on perioperative opioid consumption and ESRT in pediatric CIs.ResultsThe mean (95% CI) remifentanil consumption was significantly lower in lidocaine group than in placebo group [0.57 (0.497–0.643) vs 0.69 (0.63–0.75)] μg/kg/min, P = 0.016. The mean (95% CI) propofol consumption was significantly lower in lidocaine group than in placebo group [155.5 (146–165) vs 171 (161–181) μg/kg/min, P = 0.02. MBP and HR were significantly lower after surgical incision, laryngeal mask airway (LMA) removal, and at PACU admission in the lidocaine group compared with the placebo group. The PACU pain score was significantly lower in the lidocaine group compared to the placebo group. The mean (95% CI) pethidine consumption in PACU was significantly lower in the lidocaine group than in the placebo group 7.0 (6.17–7.83) vs. 8.9 (7.84–9.96) mg, P = 0.012. There were no differences between groups regarding ESRT response.ConclusionsIntravenous lidocaine infusion reduced perioperative opioid requirements without altering the ESRT in pediatric CIs.Trial registrationClinical registration number: NCT04194294.

Sodium Bicarbonate-Based Warm Saline Versus Warm Saline for Peritoneal Irrigation in Diagnostic Hysteroscopy-Laparoscopy: A Prospective Randomized Controlled Trial

ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice. ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice. Keywords: Laparoscopy, Pain, VAS, Sodium bicarbonate, PONV.