Rescue Analgesic Consumption Research Articles

A PROSPECTIVE RANDOMIZED CONTROL STUDY COMPARING POST-OPERATIVE ANALGESIA AFTER WOUND INFILTRATION WITH ROPIVACAINE ALONE AND ROPIVACAINE WITH DEXMEDETOMIDINE IN SPINE FIXATION SURGERIES WITH PROSTHESIS

Objective: To compare postoperative analgesia after wound infiltration with ropivacaine alone and ropivacaine with dexmedetomidine in spine fixation surgeries with prosthesis. This is aprospective randomized double-blind clinical trial.
 Methods: A total of 60 patients were recruited in this study based on inclusion and exclusion criteria. Written informed consent was obtained from every patient. Patients were randomized by computer-generated randomization into two groups. Group R received an injection ropivacaine 0.5% in a dose of 2 mg/kg for wound infiltration, while those in group RD received an injection dexmedetomidine 0.5mcg/Kg along with ropivacaine 0.5% 2 mg/kg for wound infiltration at the end of surgery. Patients were observed till 24 h postoperatively. VAS score, duration of analgesia, total rescue analgesic consumption, any side effects were observed and noted at specified time intervals.
 Results: VAS score was found to be lower in group RD at any time interval till 24 h postoperatively, with a p value = 0.004. Time to first rescue analgesic demand was 281.43±11.1 min in group R while it was 912.57±52.61 min in group RD. This difference was found to be statistically significant (p value = 0.01). In group R, 200±39.39 mg of tramadol was consumed as rescue analgesic, while in group RD 136.67±28.42 mg of tramadol was consumed till 24 h post-operatively. Tramadol consumption was found to be significantly low in group RD (p =0.007). No significant side effect was observed in either of the groups.
 Conclusion: Based on our study, we conclude that dexmedetomidine as an adjuvant to ropivacaine for local wound infiltration improves analgesic profile, increase analgesia duration and reduces opioid requirement in patients undergoing spine surgeries with prosthesis.

Analgesic efficacy of pre-emptive ultrasound-guided mid-point transverse process to pleura block for patients undergoing posterolateral thoracotomy incisions: Randomized controlled trial

ABSTRACT Background For anesthesiologists, managing pain during and after thoracic surgery remains a significant challenge. This research aims to assess the safety and efficacy of ultrasound (US)-guided pre-emptive mid-point transverse process to pleura (MTP) block for posterolateral thoracotomy. Methods This prospective randomized, double-blind clinical trial was conducted on 70 patients scheduled for a posterolateral thoracotomy operation under general anesthesia (GA). Patients were classified randomly and equally into Group I (MTP group) received MTP blocks, and Group II (sham block) received 2 ml of saline solution. The blocks were done after induction of GA but before the skin incision. Results Numerical rating scale (NRS) at rest and cough, total morphine consumption, the incidence of chronic pain at 3 months, and undesirable side effects (nausea, vomiting, respiratory depression) were significantly lower in MTP block than in sham block. Oxygen saturation and SpO2/FiO2 raised significantly in the MTP block than in the sham block (P < 0.001). Conclusions The US-guided MTP block provided effective analgesia with a lower pain score, lesser rescue analgesics consumption, and reduced risk of developing chronic pain posterolateral thoracotomy.

Ultrasound Guided Quadratus Lumborum Block for Post-Operative Analgesia in Patients Undergoing Total Hip Arthroplasty: A Prospective, Double Blind, Placebo Controlled Study

Background: Primary objective:&#x0D; &#x0D; Duration of block&#x0D; Post-operative pain score&#x0D; Post-operative rescue analgesic consumption&#x0D; &#x0D; Secondary objective:&#x0D; &#x0D; To observe patient satisfaction score&#x0D; Occurrence of post-operative complications if any.&#x0D; &#x0D; Methods: A total of 60 patients, aged between 18-60yrs, belonging to ASA I &amp; II with hip osteoarthritis requiring total hip arthroplasty (THA) were divided into two groups of 30 each. Patients were randomized into two groups and were given ipsilateral USG guided anterior QLB in the fascial plane between QL and psoas major muscles after surgery. Group C received 30ml NS and group T received 30ml of inj. Ropivacaine 0.2%. Post operatively patient received inj. PCM 1G TDS. Duration of block, requirement of rescue analgesia, VAS score and side effects were the parameters those were monitored and compared.&#x0D; Results: Mode pain score by VAS was significantly lower in T group(p&lt;0.05) than C group which required more analgesia. (The chi-square value-5.9341, p=0.0148). Duration of block was more in T group. Patient satisfaction was noted to be better in T group.&#x0D; Conclusion: Use of post-operative USG guided Ant. QLB reduced VAS score in patient undergoing THA. It also significantly decreased the requirement of post- operative rescue analgesia and improved patient satisfaction.

The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis.

Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed. The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use. A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02). BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.

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

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

Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12h postoperatively) and swelling (48h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24h follow-up; swelling and trismus intensity ameliorated at 48h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.

Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta-analysis of randomized clinical trials.

Duloxetine has been used as an adjunct in multimodal analgesia for acute postoperative pain in clinical studies. This meta-analysis aims to conclude whether oral duloxetine, when given perioperatively, is any better than a placebo in managing postoperative pain. Effects of duloxetine on postoperative pain scores, time to first rescue analgesia, postoperative rescue analgesia consumption, side effects attributable to duloxetine, and patient satisfaction profile were assessed. MEDLINE, Web of Science, EMBASE, Scholar Google, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched with keywords including "Duloxetine" AND "postoperative pain", "Duloxetine" AND "acute pain" and with "Duloxetine" till October 2022. This meta-analysis included randomized clinical trials in which perioperative duloxetine 60 mg per oral was administered not more than 7 days before surgery and for at least 24 after surgery but not more than 14 days after surgery. All RCTs in which the comparator is placebo and outcomes related to analgesic efficacy like pain scores, opioid consumption, and side effects of duloxetine until 48 h postoperatively were included. Data were extracted from the studies and a risk of bias summary was formed using the Cochrane Collaboration tool. Effect sizes were given as standardized mean differences for continuous outcomes and risk ratios (RR) by the Mantel-Haenszel test for the categorical outcome. Confirmation of publication bias was done by Egger's regression test (p < 0.05). If publication bias or heterogeneity was detected, the trim-and-fill method was used to calculate the adjusted effect size. Sensitivity analysis was done by leaving one out method after excluding the study with a high risk of bias. Subgroup analysis was done based on the type of surgery and gender. The study was prospectively registered in the PROSPERO under the registration number CRD42019139559. 29 studies with 2043 patients met the inclusion criteria and were reviewed for this meta-analysis. Postoperative pain scores at 24 h [Std. Mean Difference (95% CI); -0.69 (-1.07, -0.32)] and at 48 h [-1.13 (-1.68, -0.58)] are significantly less with duloxetine (p-value < 0.05). Time to first rescue analgesia was significantly more in patients where duloxetine was administered [1.27 (1.10, 1.45); p-value > 0.05]. Opioid consumption up to 24 h [-1.82 (-2.46, -1.18)] and 48 h [-2.48 (-3.46, -1.50)] was significantly less (p-value < 0.05) in patients who received duloxetine. Complications and recovery profiles were similar in patients receiving either duloxetine or a placebo. Based on GRADE findings, we conclude that there is low to moderate evidence to advocate the use of duloxetine for managing postoperative pain. Further trials are needed to replicate or refute these results based on robust methodology.

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing "3-in-1" Procedure Surgery: A Prospective Randomized Controlled Trial.

Patellar dislocation is a common injury in sports medicine. While surgical treatment is an important option, pain is severe after surgery. This study compared the analgesic effect and early rehabilitation quality between adductor canal block combined with general analgesia (ACB + GA) and single general analgesia (SGA) after recurrent patellar dislocation (RPD) for "3-in-1" procedure surgery. From July 2018 to January 2020, a prospective randomized controlled trial was conducted in analgesia management after RPD for "3-in-1" procedure surgery. The 40 patients in the experimental group received ACB (0.3% ropivacaine 30 mL) + GA, while the 38 patients in the control group received SGA. Patients in both groups received "3-in-1" procedure surgery, standardized anesthesia, and analgesia during hospitalization. The outcomes included the visual analog scale (VAS), quadriceps strength, Inpatient Satisfaction Questionnaire (IPSQ), Lysholm scores, and Kujala scores. Total rescue analgesic consumption and adverse events were also recorded. One-way analysis of variance (ANOVA) was used to compare continuous variables between groups and chi-square or Fisher's exact tests were used to compare count data. Nonparametric Kruskal-Wallis H tests evaluated ranked data. No significant differences in resting VAS scores were observed at 8, 12, and 24h postoperatively. However, the flexion and moving VAS scores of the ACB + GA group were significantly lower than those of the SGA group (p < 0.05). Meanwhile, the first triggering of rescue analgesics was advanced in the SGA group (p < 0.0001), and the dose of opioid analgesics was significantly higher (p < 0.0001). The quadriceps strength of the ACB + GA group was higher than that of the SGA group at 8 h postoperatively. The IPSQ of the ACB + GA group was significantly higher 24 h postoperatively. We observed no significant differences in Lysholm and Kujala scores between the two groups at 3 months after surgery. Early analgesia management of ACB + GA showed excellent analgesia effectiveness and a positive hospitalization experience for RPD patients undergoing "3-in-1" procedure surgery. Moreover, this management was good for early rehabilitation.

Analgesic Efficacy of COX-2 Inhibitors in Periodontal Surgery: A Systematic Review and Meta-Analysis.

The objective of this systematic review and meta-analysis was to evaluate the analgesic efficacy of COX-2 inhibitors versus other drugs in periodontal surgery. Two researchers searched PubMed, Google Scholar, ACM Digital, BASE, EBSCOhost, Scopus, or Web of Science for clinical trials using various combinations of words. All articles that met the selection criteria were assessed using the Cochrane Collaboration's risk of bias tool. For data analysis, the inverse variance and mean difference statistical method was used with Review Manager 5.3 software for Windows. According to the conclusion of each study (qualitative evaluation), only one clinical trial had results in favor of a COX-2 inhibitor when compared to placebo, one clinical study informed that a COX-2 was better that an active control, four studies showed similar analgesic efficacy to active controls, and one clinical study informed the analgesic effect of one celecoxib-caffeine combination in comparison with celecoxib alone and placebo (n = 337). The COX-2 inhibitors showed a decrease in the rescue analgesic consumption (n = 138; I2 = 15%; mean difference = -0.31; 95%CIs = -0.6 to -0.01), and lower pain intensity at four hours (n = 178; I2 = 0%; mean difference = -2.25; 95%CIs = -2.94 to -1.55; p = 0.00001) when compared to active controls after periodontal surgery. In conclusion, the data indicate that COX-2 agents produce better pain relief in comparison to placebo and other drugs after periodontal surgery.

Analgesic potential of transdermal nicotine patch in surgery: a systematic review and meta-analysis of randomised placebo-controlled trials

We aimed (1) to systematically review the efficacy of transdermal nicotine patches (NP) for postoperative analgesia, (2) to establish the current quality of evidence and assist clinical decision-making on the subject, and (3) to identify methodological limitations and the need for more well-designed studies. We searched six electronic databases, protocol records, and other sources without date or language restriction until March 2022. To develop the search strategy, we formulated a clinical question by using the PICOD method. Eligibility criteria included randomised placebo-controlled trials on the analgesic potential of NP for surgical procedures. This systematic review followed the PRISMA 2020 statement, and we registered the protocol in PROSPERO (#CRD42020205956). We included 10 randomised placebo-controlled trials (535 patients). The NP administered before induction of anaesthesia and at beginning of surgery reduced the pain immediately after surgery (-0.38; 95% confidence interval [CI]: -0.73 to -0.02), and 6h (-0.34; 95% CI: -0.68 to -0.01), 12h (-0.43; 95% CI: -0.71 to -0.15) and 24h (-0.35; 95%CI: -0.59 to -0.10) after surgery, compared with the placebo patch (PP) group. Sensitivity testing suggests that opioid use could underestimate NP analgesia. Late demand for the first analgesic and consumption of rescue analgesics tended to be lower in the NP group. The current findings suggest, with low certainty of evidence, the analgesic potential of NP for surgical procedures. Perioperative use of NP significantly improved postoperative pain, even when opioids were administered or prescribed. Nevertheless, the clinical relevance should be interpreted with caution, owing to the effect sizes of the summary measures and methodological issues. The analgesic potential of NP as an adjuvant therapy to regulate pain and acute inflammation may offer certain clinical advantages, thus warranting further investigation.

Ultrasound-guided transversalis fascia plane block versus lateral quadratus lumborum plane block for analgesia after inguinal herniotomy in children: a randomized controlled non-inferiority study

BackgroundSurgical repair of inguinal hernia is one of the most common day case surgeries in the pediatric population. This study compared the postoperative analgesic effects of transversalis fascia plane block (TFB) versus quadratus lumborum block (QLB) in children scheduled for open unilateral inguinal herniotomy.MethodsIn this prospective, randomized, double-blind, controlled non-inferiority study, 76 eligible patients were recruited. Patients were randomly allocated to either the TFB or QLB group. The primary outcome measure was the proportion of patients who needed rescue analgesia during the first postoperative 12 h. The secondary outcomes were, the time needed to perform the block, the postoperative FLACC score, intraoperative heart rate (HR) and mean arterial pressure (MAP).ResultsThe proportion of patients who required a rescue analgesic was comparable (p = 1.000) between the TFB group (7/34, 20.5%) and the QLB group (6/34, 17.6%). The median [Q1-Q3] time needed to perform the block (min) was significantly longer (p < 0.001) in the QLB group (5[5]) compared with the TFB group. The postoperative FLACC pain scale was comparable between the two groups at all-time points of assessment. There is no difference regarding the heart rate and mean arterial blood pressure values at the time points that the values were recorded. (P > 0.005).ConclusionsBoth TFB and QLB similarly provide good postoperative analgesia by reducing the proportion of patients who required rescue analgesia, pain scores and analgesic consumption. Moreover, TFB is technically easier than QLB.

The Efficacy of Transverse Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Prospective Study.

Postoperative pain is an inevitable acute pain for which a multimodal analgesic approach is required. The aim of this study was to quantify and compare the efficacy of transverse abdominis plane (TAP) block as a postoperative analgesic for patients undergoing laparoscopic hysterectomies versus intravenous opioid analgesics. Sixtyfemale patients were enrolled and randomized into two groups following a computer-generated sequence of numbers. In group T (n=30) patients received an ultrasound-guided bilateral TAP block with 20 of 0.375% levobupivacaine on each side immediately after surgery. Patients in group O (opioid group, n = 30) received intravenous (i.v.) tramadol (100mg) immediately after surgery.Rescue analgesic (inj. tramadol 50mg) i.v. bolus given in both groups if visual analog scale (VAS) >4. In the postanesthesia care unit (PACU), the vital signs, episodes of nausea, vomiting, and VAS score of each patient were recorded every two hours for the first 24 hours. Total consumption of rescue analgesic (inj. tramadol 50 mg i.v.) during the first 24 hours was significantly higher in group O (186.47+37.48mg) than in group T (107.28+26.34mg). No significant difference was observed in intraoperative vital parameters (HR, NIBP, SPO2). The VAS scores were significantly low in group T.Incidence of postoperative nausea and vomiting (PONV) was significantly higher in group O (13 out of 28 patients) than in group T (five out of 28 patients) with P value =0.043. Our study indicated bilateral ultrasound-guided TAP block is a good alternative to opioids for postoperative analgesia.

Effect of Pre-Treatment with Ketorolac Tromethamine on Post-operative Pain Following Periodontal Surgery: A Randomized Crossover Clinical Trial

Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material &amp; Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg &amp; Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.

The efficiency of ultrasound-guided erector spinae plane block in early cervical cancer patients undergoing laparotomic radical hysterectomy: A double-blind randomized controlled trial.

We aim to compare the efficiency of erector spinae plane block (ESPB) with transversus abdominis plane block (TAPB) in patients undergoing laparotomic radical hysterectomy because only a few studies are reported exploring this matter. In this randomized controlled trail, 154 eligible patients were randomly allocated into ESPB group [ESPB + patient-controlled intravenous analgesia (PCIA)] and TAPB group (TAPB + PCIA) at 1:1 ratio. The primary outcome was visual analog scale (VAS) score at rest state at 12 h. We found that ESPB group was associated with the lower VAS scores at rest and cough state than TAPB group at 2, 4, 6, 12, and 24 h postoperatively (P < 0.05). Less analgesic consumption and sufentanil consumption in PCIA pump were found in the ESPB group (P < 0.05). Moreover, ESPB group was followed by fewer rescue analgesia requirements, less rescue analgesic consumption, less adverse reactions, and higher analgesia satisfaction (P < 0.05). Our study found that ESPB had advantages on analgesic effect and opioids consumption. In the future, more studies were needed to confirm our findings. Systematic Review Registration: https://www.chictr.org.cn/index.aspx, identifier: ChiCTR2100044240.

Comparison of the anesthesia effect of ultrasound-guided middle and low interscalene brachial plexus block: a randomized, controlled, non-inferiority trial

BackgroundUltrasound-guided low interscalene brachial plexus block (LISB) can provide satisfactory anesthesia for surgery at or below the elbow. However, the anesthesia effect of ultrasound-guided middle interscalene brachial plexus block (MISB) has not been fully investigated. We hypothesized that MISB provides a non-inferior anesthesia effect to LISB for surgery at or below the elbow.MethodsA total of 82 patients with ASA I-III (18–65 years) scheduled for elective surgery at or below the elbow were randomized to the MISB group or the LISB group equally, located 1/2 or 2/3 of the caudal distance from C6 to the clavicle. Both groups were administered 15 mL 0.5% ropivacaine at the lower part of the brachial plexus with the first injection and equivalent volume at the upper part with the second injection.ResultsFor the primary outcome, 92.3% in the MISB group experienced successful anesthesia compared to 94.6% in the LISB group [difference: –2.3%, 95% confidence interval (CI) –13.4% to 8.8%], exceeding the predefined non-inferiority margin -15%. For the secondary outcomes, the incidence of pleura suppression for the first injection (7.7% vs. 45.9%, P < 0.001) and the time to perform the block (9.9 ± 1.3 vs. 10.7 ± 1.3 min, P = 0.006) were significantly less in MISB compared to LISB. No significant differences were observed in the consumption of perioperative rescue analgesics, VAS score, and adverse events within the two groups.ConclusionsMISB provides a non-inferior anesthesia effect to LISB for surgery at or below the elbow.Trial registrationChinese Clinical Trial Register (identifier: ChiCTR2100054196).

Effects of catheter orifice configuration (triple-hole versus end-hole) in continuous infraclavicular brachial plexus block on analgesia after upper limb surgery.

The configuration of a nerve block catheter may affect the local anesthetic spread in epidural analgesia and continuous peripheral nerve blocks. This prospective and randomized study aims to compare the multi-orifice nerve block catheter with an end-hole catheter in ultrasound-guided continuous infraclavicular brachial plexus block (BPB) in terms of providing postoperative analgesia for the orthopedic upper limb surgery below the shoulder. The primary outcome measure was mean pain scores. Secondary outcome measures were the consumption of rescue analgesic and the amount of local anesthetics delivered by a Patient-Controlled Analgesia (PCA) device. A total of 58 adult patients who underwent orthopedic upper limb surgery below the shoulder were randomly assigned into two groups: group end-hole catheter (EHC) (n=31) and group multi-orifice catheter (MOC) (n=27). All patients received a single-shot infraclavicular BPB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% administrated through a Tuohy needle. Then, a multi-orifice (triple-hole) nerve catheter was placed in the group MOC and an end-hole (one-hole) catheter in the group EHC at the same location. Bupivacaine 0.125% was infused through the catheters via PCA (infusion rate: 2 mlh-1, automated regular bolus: 5 mlh-1, patient-controlled bolus: 3 ml, lock-out time: 1 hour, 4 hours limit: 40 ml). Pain intensity was evaluated using a visual analogue scale (VAS). Mean VAS scores were higher in group EHC than group MOC in the first postoperative day (p=0.001). Mean rescue analgesic consumption, the number of bolus demand on PCA, PCA bolus demand dose, and total PCA dose were higher in group EHC than group MOC during the first postoperative day (p<0.05). It is concluded that the use of MHC is more effective than EHC for continuous infraclavicular brachial plexus blocks in providing postoperative pain relief during the first 24 hours.

Opioid-sparing post-cesarean analgesia using intravenous diclofenac-acetaminophen combination: A prospective, randomized clinical trial

Background: Current research promotes opioid-sparing analgesia as an approach to enhanced recovery after cesarean (ERAC). In developing countries, non-opioid-based analgesia is routinely practiced in obstetric settings, as opioids are not freely accessible. There are no randomized trials evaluating intravenous diclofenac and acetaminophen for postoperative analgesia following elective cesarean section. Methods: Women scheduled for elective cesarean delivery under subarachnoid block were enrolled if they fulfilled the inclusion criteria. They were randomized to receive either intravenous diclofenac or intravenous diclofenac-acetaminophen combination at the end of surgery and at predefined time intervals during the 24-hour postoperative period. The primary outcome measure of our study was 24-hour rescue analgesic (tramadol) consumption. Secondary outcome measures included time to first request for rescue analgesia, postoperative pain at rest and on movement, episodes of nausea, retching, and vomiting during the 24-hour postoperative period and overall patient satisfaction. Results: The 24-hour rescue analgesic consumption was significantly lesser in the diclofenac-acetaminophen group compared to the diclofenac group (56.25 ± 47.73 mg vs. 92.86 ± 50.83 mg; P = 0.00). Time to first request for rescue analgesia was earlier in the diclofenac group compared to the diclofenac-acetaminophen group (3.96 ± 2.40 h vs. 5.64 ± 3.58 h, P = 0.01). Parturients given a combination of intravenous diclofenac and acetaminophen used 40% less tramadol in the first 24 hours following cesarean section and were more satisfied with their pain management when compared to those given intravenous diclofenac alone. Conclusion: Following cesarean section, intravenous diclofenac-acetaminophen combination provides superior analgesia with significantly lesser opioid consumption and higher patient satisfaction when compared to intravenous diclofenac alone. This combination is effective, easy to administer, opioid-sparing and is compatible with ERAC regimens.

Postoperative Analgesic Efficacy of Low Dose Intravenous Dexmedetomidine and Intraperitoneal Dexmedetomidine with Bupivacaine in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Prospective StudyPostoperative Analgesic Efficacy of Low Dose Intravenous Dexmedetomidine and Intraperitoneal Dexmedetomidine with Bupivacaine in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Prospective Study

Introduction: Providing a better analgesia in the postoperative period improves the overall outcome in any surgical procedure in terms of better patient satisfaction, early recovery and shorter hospital stay. Multimodal analgesia using α 2 agonists like clonidine and dexmedetomidine along with local anaesthetics via intraperitoneal route had been proved to provide better analgesia in laparoscopic cholecystectomy. Aim: To evaluate the postoperative analgesic efficacy of low dose 0.5 µg/kg dexmedetomidine via intravenous (i.v.) and intraperitoneal (IP) route in laparoscopic cholecystectomy. Materials and Methods: This was a randomised prospective study carried out at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India from December 2020 to September 2022. The study comprised of 99 patients of either gender, with American Society of Anaesthesiologists (ASA) Grade-I or II, were randomly allocated into three groups using computer generated randomised slips with 33 in each group (Group IV, Group IP, Group C). Group C (Control) patients received 30 mL of Normal Saline (NS) i.v. and 40 mL of 0.25% bupivacaine IP, Group IV patients received 0.5 µg/kg dexmedetomidine infusion i.v. in 30 mL NS over 10 minutes and 40 mL of 0.25% bupivacaine, IP. Group IP patients received 30 mL NS IV and 0.5 µg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The time of rescue analgesia, total consumption of diclofenac in 24 hours, Visual Analogue Scale (VAS) pain score at 0.5, 1, 2, 4, 6, 12, 24 hours was compared among the three groups. Side-effects of the study drugs especially hypotension and bradycardia were monitored. All the data was analysed using statistical tests (Independent t-test, Kruskal-Wallis test, Chisquare test). The p-value was found to be statistically significant (p&lt;0.005). Results: The VAS score was found to be consistently high in control group at all given time intervals, and significantly low in both i.v. and IP groups which were comparable. The Group IV had the longest mean time for rescue analgesia (180.91±41.617 minutes), followed by the Group IP (106.06±8.269 minutes), and the Group C (55.00±6.960 minutes). The consumption of total rescue analgesic (diclofenac) was determined to be highest in the Group C (241.82±30.767 mg) and lowest in the Group IP (115.30± 30.896 mg). Conclusion: The total consumption of diclofenac and VAS score was less in intraperitoneal dexmedetomidine was found to be effective in producing postoperative analgesia and can be considered as an effective alternative

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 µg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groupsRP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 µg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 µg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p&lt;0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

The effects of perioperative low-dose magnesium sulfate infusion on postoperative pain in lumbar surgery

This paper aimed at evaluating the effect of low-dose perioperative magnesium sulfate (MgSO4) on postoperative pain in lumbar surgery. Sixty adult patients were included in this randomized controlled double-blind study. After intubation, an infusion of MgSO4 (10 mg/kg/h) and isotonic saline 0.9% (10 mg/kg/h) were administered in groups M and C, respectively. Heart rate and mean arterial pressure were recorded before and during surgery. Serum magnesium levels were recorded before and after the surgery. Perioperative remifentanil consumption and extubation time were recorded. In the post-anesthesia care room (PACU), Agitation-sedation with Richmond Agitation-Sedation Scale (RASS), the pain was evaluated with Visual Analogue Scale (VAS) and recorded at the baseline, at 5th, 10th, 15th and 30th minutes. Patients were transferred to surgical ward with intravenous patient-controlled analgesia (PCA) for postoperative analgesia and received diclofenac sodium for rescue analgesia if VAS &gt;4. Postoperative VAS scores at 2nd, 4th, 6th and 24th hours, opioid consumption after 4 and 24 hours and rescue analgesic consumption for postoperative 24 h were recorded. In the PACU, RASS scores were statistically lower in group M than in group C (p = 0.001), and VAS scores were statistically lower at all measurement times in group M than in group C. In the surgical ward, VAS Scores were statistically lower in Group M at the 6th and 24th hours than in group C (p = 0.015, p = 0.009, respectively). The need for post-operative rescue analgesic was statistically lower in Group M (p &lt; 0.001). The side effect incidence of both groups was similar. Our findings suggest that perioperative low-dose (10 mg/kg/h) MgSO4 infusion reduces early post-op agitation, VAS scores and the need for analgesics up to 24 hours postoperatively. Low dose MgSO4 infusion can be effectively applied for pain management in patients undergoing lumbar surgery.