Cumulative Analgesic Consumption Research Articles

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

BackgroundVideo-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS.Study designThis is a double-blinded randomized controlled trial.MethodsAdult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100 mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6 h for three cycles. The primary outcome was total analgesic consumption at 24 h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality of recovery at 24 h and 48 h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3 months postoperatively.ResultsThe study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24 h and 48 h postoperatively (24 h: median difference: − 100 µg equivalent intravenous fentanyl [95% confidence interval (CI) − 200 to − 5 μg], P = 0.037; 48 h: median difference: − 140 μg [95% CI − 320 to − 20 μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24 h post-surgery, with no significant difference at 48 h. All pain scores except for coughing at 48 h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP.ConclusionPerioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics.

"SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU).

Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.

Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial

Previous research has not evaluated the potential effect of erector spinae plane block (ESPB) on quality of recovery (QoR) after laparoscopic sleeve gastrectomy. Therefore, we investigated the effect of an ultrasound-guided ESPB performed on patients with obesity who have undergone laparoscopic sleeve gastrectomy, measured using the 15-item QoR (QoR-15) scale. A total of 172 patients were enrolled in the study who were aged 18 to 65 years, had a body mass index ≥30 kg/m², were classified as having American Society of Anaesthesiologists physical status Ⅱ to Ⅲ, and had undergone laparoscopic sleeve gastrectomy. The patients were randomly divided into an ESPB group and a sham group (treated with normal saline). The primary outcome was the QoR-15 score, measured using the questionnaire 24 and 48 hours after surgery. The secondary outcomes were postoperative pain score, postoperative cumulative analgesic drug consumption, number of patient-controlled analgesia (PCA) requests, rate of rescue analgesia required at 48 hours, incidence of respiratory complications, and nerve block-related complications. The time of discharge from the postanesthesia care unit, postoperative activity, and length of stay at the hospital were also recorded. There was no significant difference in the global QoR-15 scores 24 and 48 hours after the operation. However, the groups' subdimension scores for the emotional state in QoR-15 at 24 and 48 hours after surgery were statistically different (P < 0.05). Meanwhile, patients in the ESPB group who indicated they were "feeling rested" at 24 and 48 hours after surgery and "having a feeling of general well-being" at 24 hours after surgery were significantly better than those in the sham group (P < 0.05). Compared with the sham group, participants in the ESPB group had lower resting pain scores at 6 and 12 hours after surgery and lower movement pain scores at 6, 12, 24, and 36 hours after surgery (P < 0.05). There was no statistical difference between the groups in postoperative cumulative analgesic drug consumption, number of PCA requests, incidence of respiratory complications, time of discharge from the postanesthesia care unit, or postoperative activity. Our results indicate that a single ESPB does not improve the global QoR-15 scores after laparoscopic sleeve gastrectomy. However, the visual analog scale score for postoperative pain is reduced.

The Effect of Intravenous Lidocaine, Ketamine, and Lidocaine-Ketamine Combination in Colorectal Cancer Surgery: A Randomized Controlled Trial.

Colorectal resections are associated with a pronounced inflammatory response, severe postoperative pain, and postoperative ileus. The aim of this study was to evaluate the main effects of lidocaine and ketamine, and their interaction in colorectal cancer (CRC) patients after open surgery. The interaction could be additive if the effect of 2 drugs given in combination equals the sum of their individual effects, or multiplicative if their combined effect exceeds the sum of their individual effects. We hypothesized that the combination of lidocaine and ketamine might reduce the inflammatory response additively or synergistically. Eighty-two patients undergoing elective open colorectal resection were randomized to receive either lidocaine or placebo and either ketamine or placebo in a 2 × 2 factorial design. After induction of general anesthesia, all subjects received an intravenous bolus (lidocaine 1.5 mg/kg and/or ketamine 0.5 mg/kg and/or a matched saline volume) followed by a continuous infusion (lidocaine 2 mg·kg-1·h-1 and/or ketamine 0.2 mg·kg-1·h-1 and/or a matched saline volume) until the end of surgery. Primary outcomes were serum levels of white blood cell (WBC) count, interleukins (IL-6, IL-8), and C-reactive protein (CRP) measured at 2 time points: 12 and 36 hours after surgery. Secondary outcomes included intraoperative opioid consumption; visual analog scale (VAS) pain scores at 2, 4, 12, 24, 36, and 48 hours postoperatively; cumulative analgesic consumption within 48 hours after surgery; and time to first bowel movement. We assessed the main effects of each of lidocaine and ketamine and their interaction on the primary outcomes using linear regression analyses. A Bonferroni-adjusted significance level was set at .05/8 = .00625 for primary analyses. No statistically significant differences were observed with either lidocaine or ketamine intervention in any of the measured inflammatory markers. No multiplicative interaction between the 2 treatments was confirmed at 12 or 36 hours after surgery: WBC count, P = .870 and P = .393, respectively; IL-6, P = .892 and P = .343, respectively; IL-8, P = .999 and P = .996, respectively; and CRP, P = .014 and P = .445, respectively. With regard to inflammatory parameters, no evidence of additive interactions was found. Lidocaine and ketamine, either together or alone, significantly reduced intraoperative opioid consumption versus placebo, and, except for lidocaine alone, improved pain scores. Neither intervention significantly influenced gut motility. Our study results do not support the use of an intraoperative combination of lidocaine and ketamine in patients undergoing open surgery for CRC.

Oral enzyme combination with bromelain, trypsin and the flavonoid rutoside reduces systemic inflammation and pain when used pre- and post-operatively in elective total hip replacement: a randomized exploratory placebo-controlled trial.

Early mobilization after total hip replacement (THR) is key for fast recovery but is often limited by pain. Oral enzyme combinations (OECs) have demonstrated anti-inflammatory and pain-relieving effects. This prospective, randomized, double-blind, placebo-controlled exploratory trial evaluated the effects of pre- and post-operative use of OEC (90 mg bromelain, 48 mg trypsin, 100 mg rutoside) following elective THR, on post-operative recovery. Candidates for primary elective cementless THR owing to osteoarthritis were eligible for participation [age ⩾50 years, body mass index 25-35 kg/m2, C-reactive protein (CRP) ⩽6 mg/L]. Following randomization to OEC or placebo, intervention started pre-operatively and continued onwards until day 42. Main outcomes included post-operative CRP levels (days 1-7), self-reported hip pain at rest (by 0-10 cm visual analogue scale on post-operative days 1-42), post-operative analgesic use [by cumulative analgesic consumption score (CACS) days 7-42], tolerability and adverse events. Patients (N = 34) were recruited from a tertiary orthopaedic hospital in the Czech Republic, of whom 33 completed the study (OEC/placebo: n = 15/18). Baseline characteristics across the groups were comparable. Compared with placebo, the OEC group had numerically lower CRP levels on post-operative days 1-7, including peak level [mean (standard deviation) OEC versus placebo: 81.4 (28.3) versus 106.7 (63.3) mg/L], which translated into a significant 32% lower CRP area under the curve (p = 0.034). The OEC group reported significantly less pain during post-operative days 1-7 versus placebo (analysis of variance treatment × visit [F(4) = 3.989]; p = 0.005). Analgesic use was numerically reduced as assessed through an accumulated CACS. No deleterious effects on haemorheological parameters were observed in either group. Pre- and post-operative use of OEC significantly reduced CRP levels and patient self-reported pain. OEC may be an efficacious and safe treatment option to facilitate post-operative recovery following THR. EudraCT number 2016-003078-41.

Effects of Ketamine and Lidocaine Infusion on Acute Pain after Elective Open Abdominal Surgery, a Randomized, Double-Blinded Study.

Background: Most patients suffer from moderate to severe pain after elective laparotomy. They often require opioids to alleviate their pain. Opiates invariably induce certain side effects and, occasionally, dependence. Intraoperative infusion of lidocaine and low-dose ketamine reduces postoperative pain and analgesic requirements. This study aims to evaluate the effects of simultaneous infusion of lidocaine and ketamine during open abdominal surgery on the postoperative pain severity and analgesic consumption. Methods: In this randomized, double-blinded, single-center study that was performed in Iran, 80 patients scheduled for elective open abdominal surgery under general anesthesia were enrolled in two LK and P groups. Group LK (n=40) received lidocaine-ketamine infusion, and group P (n=40) received placebo (normal saline). Both infusions were started thirty minutes after initiation of surgery and were terminated once the surgery was completed. For postoperative pain management, patient-controlled analgesia (PCA), including fentanyl and paracetamol, was administered for both groups. All patients were evaluated for pain visual analogue scale (VAS) and total adjunctive analgesic (diclofenac suppository) consumption within the first 24 hours after the surgery. The data were analyzed using SPSS. P values <0.05 were considered significant. Results: Intraoperative infusion of Lidocaine and Ketamine resulted in desirable postoperative pain control. Patients of LK group demonstrated a significant reduction in the pain score at 1, 6, 12, 18, and 24 hours after termination of surgery (p<0.001). It also resulted in a decreased requirement for postoperative analgesics, as cumulative analgesic consumption was decreased meaningfully in the patients of LK group (p<0.001). Conclusion: Intravenous infusion of lidocaine and ketamine during elective open abdominal surgery reduces pain intensity and analgesic requirements in the first 24 hours postoperatively, without major additional side effects.

Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy.

Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH). This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention. There was a significant difference in the duration of analgesia among the groups (P ¼ .00). It was significantly longer in group Q (mean ¼ 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean ¼ 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean ¼ 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P ¼ .001) and the cumulative analgesic consumption (P ¼ .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block. It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect.

Pain-related Prescribing Patterns and Associated Factor in Breast Cancer Patients

Other SectionsAbstractBody대상 및 방법연구 결과고 찰결 론감사의 말씀이해상충TableReferenceBackground: With an increase in the number of breast cancer survivors, greater importance is attached to health-related quality of life, particularly pain and symptom control. This study aimed to identify the factors that are associated with pain in cancer patients based on the patterns of prescribing opioid, non-opioid, and adjuvant analgesics. Methods: This analysis included new patients who had developed breast cancer between 2003 and 2012. The degree of pain was analyzed based on the socio-demographic (age, income quintile, number of hospitalizations, and duration of disease), indicator (Body Mass Index; BMI, Charlson Comorbidity Index; CCI, Cumulative Analgesic Consumption Score; CACS), operation (mastectomy, lymph node dissection), and therapy (chemotherapy, radiation therapy), as well as complication-related variable (lymphedema). Results: As for the patterns of prescribing analgesics by stages, non-opioid and opioid analgesics constituted 30.7 and 69.3%, respectively. The mean value and variance of CACS were 5.596 and 12.567, respectively. The factors that significantly affected the degree of pain were age (≥50; IRR: 1.848, 95% CI 1.564- 2.184, p=0.000), income quintile (IRR: 0.964, 95% CI 0.938-0.991, p=0.008), BMI (≥ 25; IRR: 1.479, 95% CI 1.222-1.795, p= 0.000), CCI (≥ 4; IRR: 1.649, 95% CI 1.344-2.036, p=0.000), and lymphedema (yes; IRR: 1.267, 95% CI 1.006-1.610, p=0.047). Conclusions: It is necessary to develop systematic and comprehensive pain control measures to improve the quality of life for breast cancer survivors, especially for those who are 50 years or older, lie in the lower-income quintile, have BMI of ≥25 and CCI score ≥ 4, or have lymphedema.Keywords : Breast neoplasms, cancer pain, comorbidity, analgesics, prescriptions

Ultrasound-Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty: A Randomized Controlled Study.

Postoperative pain after abdominoplasty can delay postoperative ambulation, leading to life-threatening complications. Previous reports have shown the utility of quadratus lumborum block in providing adequate pain relief and avoiding side effects after numerous abdominal operations. The purpose of this randomized controlled trial was to demonstrate the efficacy of the quadratus lumborum block in abdominoplasty. Patients were randomly allocated to receive a bilateral quadratus lumborum block with either ropivacaine or normal saline. Postoperative cumulative analgesic medication consumption, pain severity at rest and on movement, and quality of recovery were evaluated and compared in both groups. Twenty patients were allocated to each group. Total morphine dose received in the postanesthesia care unit was lower in the ropivacaine group than in the control group, with a mean of 3.4 mg and 6.6 mg, respectively. Cumulative tramadol consumption per patient in the first 48 hours postoperatively was significantly lower in the ropivacaine group compared with the control group (42.5 mg versus 190 mg; p = 0.0031). The Numeric Rating Scale both at rest and with effort was significantly lower in the ropivacaine group compared with the control group. The median quality of recovery for the ropivacaine group was 133 compared with 112 for the control group (p < 0.0001). Quadratus lumborum block in abdominoplasty reduces postoperative pain and opioid consumption and improves the quality of recovery. Further studies are needed to compare the quadratus lumborum block to more traditional blocks. Therapeutic, II.

Efficacy of Different Doses of Dexamethasone as Pre-emptive Analgesia in Patients Undergoing Total Abdominal Hysterectomy under General Anaesthesia: A Prospective Non Randomised Placebo Controlled Study

Introduction: Pre-emptive analgesia reduces postoperative analgesic requirement, avoiding side-effects that occur with parenteral narcotics. Dexamethasone, a long acting synthetic corticosteroid with predominantly glucocorticoid activity is one of the entities used for pre-emptive analgesia. The optimum dose of dexamethasone for pre-emptive analgesia is not defined. Aim: To study the efficiency of different (low, intermediate and high) doses of dexamethasone as pre-emptive analgesia in patients undergoing total abdominal hysterectomy under general anaesthesia. Materials and Methods: The prospective non randomised placebo controlled dose range study was conducted in the Department of Anaesthesiology, at a tertiary care institute at Srinagar, Jammu and Kashmir, India, over a period of two years from July 2017 to June 2019. Eighty female patients (age 40-65 years, American Society of Anaesthesiologists (ASA) I and II) scheduled for total abdominal hysterectomy were divided into four groups (Groups A, B, C and D) on the basis of dexamethasone dose. Group A with low dose (0.1 mg/kg), group B with intermediate dose (0.12-2 mg/ kg), group C with high dose (&gt;0.2 mg/Kg) and group D with no dexamethasone. Early and late acute postoperative pain {Visual Analog Scale (VAS) score}, cumulative analgesic consumption upto 24 hours, intraoperative blood sugar levels, Postoperative Nausea and Vomiting (PONV), and adverse events were recorded. Analysis of variance (ANOVA) was used for intergroup comparison of means and Chi-square test was used for categorical variables. Results: The mean age (years) of group A was 52.3±8.87, group B was 48.3±5.23, group C was 49.8±6.85 and group D was 51.7±4.46. Postoperative VAS score for 0 hour, 1 hour, 2 hour, 3 hour, 4 hour was more in patients who had not received dexamethasone pre-emptively (p-value &lt;0.05). VAS score at 6 hour, 12 hour, 24 hour was more in patients who had not received dexamethasone pre- emptively. There was a statistically significant difference in VAS score at 6, 12, 24 hours when low dose dexamethasone group was compared with intermediate and high dose dexamethasone groups (p-value &lt;0.05). Rescue analgesia consumption was significantly less in patients who received intermediate to high dose dexamethasone. Blood sugar levels increased significantly in patients receiving dexamethasone, but returned to baseline after 24 hours. The incidence of nausea and vomiting and the need for rescue antiemetic was significantly less in patients receiving dexamethasone (p-value &lt;0.05). The incidence of postoperative adverse effects was not different among these groups (p-value &gt;0.05). Conclusion: Intermediate and high dose dexamethasone, given preoperatively in patients undergoing abdominal hyster-ectomy produces better postoperative analgesia with added antiemetic benefit.

Implementation of magnesium sulphate as an adjunct to multimodal analgesic approach for perioperative pain control in lumbar laminectomy surgery: A randomized placebo-controlled clinical trial

ObjectiveTo investigate the effect of systemic intraoperative administration of magnesium sulphate when used in the context of a multimodal pain management plan on analgesics consumption and pain scores, and perioperative outcomes after lumbar laminectomy surgery. MethodsSeventy-four patients undergoing lumbar laminectomy were enrolled in this randomized, double-blind, placebo-controlled trial. Participants were randomly allocated to receive magnesium (20 mg/kg iv given as bolus before anesthesia induction followed by 20 mg/kg/h civ until surgery completion) or saline. Hemodynamic variables and desflurane consumption were noted at predefined time-intervals intraoperatively. Primary outcome was postoperative cumulative analgesic consumption over 24 h, while pain intensity (assessed by Visual Analogue Scale [VAS] at 1, 2, 4, 6 and 24 h), intraoperative hemodynamics and opioid requirements, recovery profile, time to first analgesic request, and adverse effects constituted secondary end-points. ResultsDemographics, surgery duration, desflurane requirements, and recovery profile were comparable between groups. Magnesium attenuated hemodynamic response during incision and emergence from anesthesia. Postoperative analgesics consumption in morphine iv equivalents (mean difference −9.24 [95 %CI −13.31, −5.17] mg; p = 0.001) and VAS scores at all-time points of assessment were lower in magnesium group; this effect peaked at 4 h (mean difference −2.15 [95 %CI −3.21,−1.09; p = 0.001]. Magnesium reduced intraoperative remifentanil consumption and prolonged the time-interval to first rescue analgesia (p < 0.01). No notable adverse effects were recorded. ConclusionIt occurs that magnesium infusion during lumbar laminectomy surgery potentiates perioperative analgesia and reduces analgesic requirements up to 24 h postoperatively. No profound adverse effect on either intraoperative hemodynamics or any other clinically relevant endpoints becomes evident.

Ultrasound-Guided Intercostal Nerve Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Posted for Open Cholecystectomy: A Randomized Controlled Trial.

Background:Effective postoperative analgesia leads to early mobilization, fewer pulmonary complications, and shorter hospital stay.Aims:We compared the analgesic effects of ultrasound-guided intercostal nerve (ICN) blocks, subcostal transversus abdominis plane (SCTAP) block, and a control group in open cholecystectomy.Settings and Design:This was a prospective, randomized controlled, double-blind, multi-arm and parallel study.Materials and Methods:The study was conducted on patients of American Society of Anaesthesiology Physical Status Classes I and II, either sex, 18–60 years of age, and body mass index 18–30 kg.m−2. Exclusion criteria were infection at the injection site, coagulopathy, thrombocytopenia, and allergy to the drugs used. Group I (n = 41) received ICN blocks, Group T (n = 41) SCTAP block, and Group C (n = 41) no postoperative block. The duration of analgesia was the primary outcome, and the analgesic consumption, the pain intensity, adverse events, and patient satisfaction were the secondary outcomes.Statistical Analysis:For the continuous data, analysis of variance was used for multiple group comparison and intergroup data were analyzed by Student's t-test. Kruskal-Wallis and Mann-Whitney U tests were applied for ordinal data. P = 0.05 or less was considered statistically significant.Results:The duration of postoperative analgesia was significantly longer in the ICN (mean = 441.6 min; 95% confidence interval [CI], 407.71, 475.49) and SCTAP block (mean = 417.6 min; 95% CI, 390.94, 444.26) as compared to control (mean = 33.98 min; 95% CI, 26.64, 41.32) (P = 0.00) with no significant intergroup difference between the two intervention groups (P = 0.278). The cumulative analgesic consumption was not significantly different between the intervention groups but was significantly reduced in the study groups when compared with the control group (P < 0.001). No notable adverse events were observed. Patients with both the techniques were very satisfied in comparison with the control group (P = 0.00).Conclusion:Both the ICN and SCTAP blocks have similar results in terms of analgesia and patient satisfaction for cholecystectomy.

Effectiveness of perineural and intravenous dexamethasone added to bupivacaine for transversus abdominis plane block in post-cesarean delivery pain control: A prospective cohort study

BackgroundCesarean delivery (CD) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Abdominal field blocks like TAP block are mostly preferred as postoperative analgesia for this operation. Using different adjuvants like dexamethasone by different routes increases the quality and duration of block and maximizes patient satisfaction. The objective of this study was to compare the effectiveness of perineural and intravenous dexamethasone for post-cesarean delivery pain control. MethodologyAn institutional based prospective cohort study was conducted on 87 patients. Data collection methods include a preoperative chart review, intraoperative observation, and postoperative patient interview at 4 th, 6 th, 8 th, 12 th, and 24 th hours. Kruskal Wallis with post hoc analysis was used to compare postoperative severity of pain score and cumulative analgesic consumption. Time to first analgesic request was analyzed using Kaplan Meier survival analysis with log rank. Categorical variables were analyzed by chi-square. ResultTime to first analgesic request was significantly longer in TAP-IVD and TAP-PD compared to TAP alone (p < 0.05). The postoperative NRS score at rest and on coughing was significantly lowered in TAP-PD and TAP-IVD group compared to TAP alone group (p < 0.05). The total analgesic consumption in the first 24 h was significantly lower in TAP-IVD and TAP-PD group compared to TAP alone group (p < 0.05). ConclusionDexamethasone 8 mg both intravenously and perineurally is effective adjuvant to bupivacaine on bilateral TAP block with prolonged and potent analgesia and reduced analgesic consumption. Research registryUIN = researchregistry5538.

Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur

Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesicrequest in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesic request in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Citation: Raiger LK, Gehlot RK, Bedi V, Betkeker SA. Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur. Anaesth pain &amp; intensive care 2019;23(3):284-289

Addition of Intrathecal Morphine for Postoperative Pain Management in Pediatric Spine Surgery: A Meta-analysis.

Meta-analysis. The objective of this study was to determine whether adjunctive intrathecal morphine (ITM) reduces postoperative analgesic consumption following pediatric spine surgery. Previous studies that have tested supplemental ITM to manage pain after pediatric spine surgery have been limited by small sample sizes. A comprehensive search of PubMed, Web of Science, Clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials was performed for clinical trials and observational studies. Time to first analgesic demand, postoperative analgesic use, pain scores, and complication data were abstracted from each study. Mean difference (MD) and 95% confidence interval (CI) were used to compare continuous outcomes and odds ratios (OR) and 95% CI were used for dichotomous outcomes. A total of 5 studies, including 3 randomized controlled trials and 2 retrospective chart reviews, containing 636 subjects, were incorporated into meta-analysis. Subjects that were administered ITM in addition to postoperative analgesics (ITM group) were compared with those receiving postoperative analgesics only (control group). In the ITM group, time to first analgesic demand was longer (MD, 8.79; 95% CI, 4.20-13.37; P<0.001), cumulative analgesic consumption was reduced at 24 hours (MD, -0.40; 95% CI, -0.56 to -0.24; P<0.001), and cumulative analgesic consumption was reduced at 48 hours (MD, -0.43; 95% CI, -0.59 to -0.27; P<0.001). Neither postoperative pain scores at 24 hours (P=0.16) nor 48 hours (P=0.18) were significantly different between ITM and control groups. Rates of respiratory depression, nausea, vomiting, and pruritus were not different between groups (all Ps>0.05). Addition of ITM in pediatric spine surgery produced a potent analgesic effect in the immediate postoperative period. Patients administered ITM did not request opiates as early as control and consumed fewer opiates by the second postoperative day. Furthermore, use of ITM did not increase complications such as respiratory depression, nausea, vomiting, or pruritus.

The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery

Introduction:The aim of this systematic review is to investigate the effects of perioperative intravenous administration of MgSO4 on postoperative pain, analgesic consumption and adverse effects in patients undergoing orthopedic surgery.Methods:Two investigators independently searched for articles on randomized controlled trials (RCTs) from 1998 to 2016 in Pubmed, Web of science and Google scholar. We evaluated clinical outcomes, comparing postoperative pain scores, cumulative analgesic consumption, time to first analgesia, and adverse effects between orthopedic surgery patients with and without the administration of MgSO4.Results:After screening 2350 articles, 11 RCTs (with a total sample size of 535 subjects) were included in this systematic review. Perioperative intravenous administered MgSO4 could reduce postoperative pain intensity compared with control in 6 trials (55%), but without significant difference in 5 trials (45%). With MgSO4 treatments, postoperative analgesic consumption was significantly reduced in 8 trials (73%), and without significant difference in 2 trials (18%). Two trials evaluated the time to first request of analgesic after surgery and showed prolong of 2.3 hours and 93 minutes respectively. MgSO4 group had less postoperative nausea (relative risk [RR] = 0.32, 95% confidence interval [CI] = 0.12–0.82, number needed to harm [NNH] = 8.8), vomiting (RR = 0.38, 95% CI = 0.15–0.92, NNH = 9.7), and shivering (RR = 0.31, 95% CI = 0.11–0.88, NNH = 5.2).Conclusion:Perioperative intravenous administration of MgSO4 in orthopedic surgery could reduce postoperative analgesic consumption and adverse effects such as vomiting, nausea, and shivering. These trials do not provide convincing evidence of beneficial effects on postoperative pain intensity and the time to first analgesic request. More trials should be conducted for the roles of MgSO4 in pain management for orthopedic surgery. However, intravenous MgSO4 administration should be considered as a strategy to relieve postoperative pain in orthopedic surgery patients.

Comparison between bupivacaine\u2013dexmedetomidine mixture and bupivacaine\u2013magnesium mixture when used for wound infiltration before skin incision in surgeries for hernia repair regarding their intraoperative and postoperative analgesic effects

BackgroundWound infiltration with local anesthetics was developed to provide intraoperative and postoperative analgesia and to reduce opioid consumption and its side effects.MethodsThis is a prospective randomized, double-blinded study. A total of 45 patients, American Society of Anesthesiologists physical status I–II, aged from 18 to 60 years scheduled for open abdominal surgeries were randomly assigned to one of the following groups to receive wound infiltration 2 min prior to skin incision: group I: bupivacaine 0.25% alone (20 ml) (n = 15), group II: bupivacaine 0.25% + magnesium sulfate (1 g) (20 ml) (n = 15), and group III: bupivacaine 0.25% + dexmedetomidine (70 μg) (20 ml) (n = 15). Induction and maintenance were done according to our hospital protocol. Heart rate (HR) and systolic blood pressure (SBP) at baseline and every 15 min till the end of surgery, the need for supplemental fentanyl, and the concentration of inhalational anesthetic were assessed. Postoperatively, Ramsay sedation scale was assessed 10 min post extubation and every 30 min for 6 h; visual analog scale was assessed at rest and every 30 min for 6 h postoperatively; time to the first request of analgesia and the cumulative analgesic consumption were recorded; HR and SBP were recorded for 6 h.ResultsThe concentration of inhalational isoflurane and the need for supplemental fentanyl intraoperatively were significantly lower in group III than in groups I and II. Postoperatively in group III, HR and SBP and visual analog scale scores were significantly lower compared with groups I and II. Ramsay sedation score was significantly higher in group III up to 2 h after recovery in comparison to groups I and II. Group III showed longer time for the first request of analgesia and a lower need for postoperative opioids in comparison to groups I and II.ConclusionsWound infiltration with dexmedetomidine–bupivacaine mixture before skin incision decreases the anesthetic requirements, provides prolonged analgesia, and decreases the need for rescue analgesics in patients undergoing open abdominal surgeries.

A randomized clinical study comparing the analgesic efficacy of intra venous patient- controlled analgesia of morphine with fentanyl in post-operative pain management of major surgery patients

Background: Post-operative pain is a protective but an unwanted effect which is to be treated for the better outcome of surgery. Aims and Objectives: The aim of this study is to compare the safety and analgesic efficacy of intravenous patient-controlled analgesia (IV PCA) using morphine and fentanyl for post-operative pain management in major surgery patients. Materials and Methods: The randomized clinical study initiated after the ethics committee approval and informed consenting. A total of 60 patients belonging to the American Society of Anesthesiology Grade - I, II, and III physical status, scheduled for major abdominal, oncological surgeries under general anesthesia were randomly allocated to two groups. Group M received IV PCA with morphine (basal continuous infusion 0.02 mg/kg/h, bolus dose of 0.02 mg/kg, and lockout period of 20 min), and the Group F received IV PCA with fentanyl (basal continuous infusion 0.5 μg/kg/h, bolus dose of 0.5 μg/kg, and lockout period of 20 min). Fentanyl dosage was converted into morphine equivalents. The outcomes such as visual analog scale (VAS), sedation score, hemodynamic parameters, and adverse effects were compared between groups and analyzed statistically. Results: Morphine provides better analgesia than fentanyl as indicated by lower VAS scores (score = 3) at the end of 24-72 h. Mean cumulative analgesic consumption was higher in fentanyl group (436.3 ± 330.2 mg) compared with morphine group (123.9 ± 28.2 mg) by 72 h. Regarding the hourly consumption, Group M consumed less drug than fentanyl group was statistically significant (P = 0.05). Conclusion: Morphine provides more effective post-operative analgesia than fentanyl administered through IV PCA. The PCA allows patients to balance between administration of analgesics and adverse events by self-adjusting the dose of analgesic used.

Evaluation of pain relief sufficiency using the Cumulative Analgesic Consumption Score (CACS) and its modification (MACS).

Postoperative pain is one of the major complications in general and bariatric surgery, associated with ongoing problems such as ileus, pneumonia and prolonged mobilization. In this study, patients undergoing bariatric surgery were analyzed according to their postoperative pain relief regime. In one group patients were treated with a patient-controlled analgesia (PCA) device, while the other group was treated with oral and intravenous analgesic medication. The aim of this study was to analyze which postoperative pain relief therapy would be more appropriate. We chose the Cumulative Analgesic Consumption Score (CACS) and Numeric Rating Scale (NRS) for pain measurement. For better comparison, we performed a modification of CACS according to PCA treatment. We observed better pain relief in the PCA group. Furthermore, we observed an advantage of treatment with laxatives in patients treated with PCA. In conclusion, PCA devices are appropriate instruments for postoperative pain relief in bariatric patients. CACS is a practical tool for postoperative pain measurement, describing individual pain sensation more objectively, although holding further potential in modification.

Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.

The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection. A retrospective study of patients undergoing video-assisted thoracoscopic wedge resection from 2010 to 2015 was performed. We selected patients who stayed longer than 24 h in hospital. Primary outcomes were length of stay and postoperative analgesic use at 12-h intervals from 24 to 72 h. Intercostal blocks were performed with liposomal bupivacaine in 62 patients and bupivacaine/epinephrine in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. Those who received liposomal bupivacaine consumed fewer analgesics than those who received bupivacaine/epinephrine, with a statistically significant difference from 24 to 36 h (20.25 vs 45.0 mg; P = 0.0059) and from 60 to 72 h postoperatively (15.0 vs 33.75 mg; P = 0.0350). In patients who stayed longer than 72 h, the median cumulative analgesic consumption in those who received liposomal bupivacaine was statistically significantly lower than those who received bupivacaine/epinephrine (120.0 vs 296.5 mg; P = 0.0414). Median length of stay for the liposomal bupivacaine and bupivacaine/epinephrine groups were 45:05 h and 44:29 h, respectively. There were no adverse events related to blocks performed with liposomal bupivacaine. Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.