Cumulative Morphine Consumption Research Articles

Anterior quadratus lumborum block provided superior pain control and reduced opioid consumption in kidney transplantation: A randomized controlled trial.

The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.

Single-bolus injection of local anesthetic, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomized controlled unblinded trial

IntroductionPrevious trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled...

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

BackgroundTo determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0–3 years after cardiac surgery with cardiopulmonary bypass.MethodsMulti-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016–July 2020. Children aged 0–3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if numeric rating scale (NRS) pain scores exceeded predetermined cutoff values. Primary outcome was median weight-adjusted cumulative morphine dose in mcg/kg in the first 48 h postoperative. For the comparison of the primary outcome between groups, the nonparametric Van Elteren test with stratification by center was used. For comparison of the proportion of patients with one or more NRS pain scores of 4 and higher between the two groups, a non-inferiority analysis was performed using a non-inferiority margin of 20%.ResultsIn total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. Fourteen of the enrolled 208 children were withdrawn from the study before start of study medication leaving 194 patients for final analysis. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median weight-adjusted cumulative morphine consumption in the first 48 h postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0–432.5) mcg/kg vs 692.6 (IQR, 532.7–856.1) mcg/kg; P < 0.001). The rescue morphine consumption was similar between the groups (p = 0.38). Non-inferiority of IV paracetamol administration in terms of NRS pain scores was proven; difference in proportion − 3.1% (95% CI − 16.6–10.3%).ConclusionsIn children aged 0–3 years undergoing cardiac surgery, use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 h after surgery by 79% with equal pain relief showing equipoise for IV paracetamol as primary analgesic.Trial Registration Clinicaltrials.gov, Identifier: NCT05853263; EudraCT Number: 2015-001835-20.

Role of tramadol as an adjuvant in ultrasound-guided serratus anterior muscle block for modified radical mastectomy - A randomized control trial.

Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25-60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet. We hypothesize that the addition of tramadol to ropivacaine for SAM block may reduce morphine consumption in the post-operative period in patients undergoing elective MRM surgeries. The primary aim of the study was to compare cumulative post-operative morphine consumption over 24 h in patients receiving SAM block with or without tramadol. The secondary aims were to observe adverse events related to the procedure or medications. The other parameters recorded were non-invasive blood pressure (NIBP), pulse rate, respiratory rate, and nausea or vomiting. Patients scheduled to undergo MRM were randomly allocated by block randomization into two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) with tramadol 100 mg while the control group (Group P) received a SAM block with 18 ml of 0.25% ropivacaine and 2 ml of saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h post-operatively. Cumulative morphine consumption over 24 h in the post-operative period was less in the group T (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg; P 0.001). Time to the first analgesic requirement was more in group T (10.44 ± 5.04 h vs 6.11 ± 2.73 h; P < 0.001). Pain scores were significantly lower in the group T at all time points. Tramadol, when used as an adjuvant to ropivacaine for SAM block reduces post-operative pain scores in the first 24 h and prolongs the time of first morphine requirement.

Comparison of the analgesic effect of oral morphine with that of intravenous morphine in pediatric patients: multicenter open-label randomized blinded prospective clinical study

BACKGROUND: Certain children with recurrent episodes of acute nociceptive pain experience chronic pain. In accordance with the recommendations of the World Health Organization, short-acting morphine is the main drug used to relieve severe pain and breakthrough pain. In published studies, morphine provided adequate analgesia in the majority (90%) of the patients; however, no such studies have compared the use of morphine tablets with a control group of pediatric patients.&#x0D; OBJECTIVE: To evaluate the effectiveness and safety of morphine tablets at a dose of 5 mg and compare them with those of morphine given intravenously at a dose of 10 mg/mL in children with severe pain syndrome in the postoperative period.&#x0D; MATERIALS AND METHODS: A multicenter open randomized blind prospective clinical study was conducted in parallel groups of 100 patients aged 3–18 years with severe pain syndrome in the postoperative period between September 21, 2020, and December 15, 2022. Cumulative morphine consumption, visual analog scale analgesic efficacy, patient satisfaction scores, and adverse events (AEs) / serious adverse events (SAEs) were assessed.&#x0D; RESULTS: The comparative analysis of the average values of the total number of doses of an additional analgesic drug administered during treatment with the study drug (group 1)/comparison drug (group 2) in patients of different age groups (cohorts 1, 2, 3) did not reveal significant differences (p=0.05). This finding indicated the equal effectiveness of the used forms of drugs in both groups. Moreover, no significant differences were noted in the development of AEs associated with the study drug (group 1) compared with AEs of the reference drug (group 2) in patients of different age groups (cohorts 1, 2, 3); (p=0.05).&#x0D; CONCLUSION: The study demonstrated the effectiveness and safety of the study drug in tablets in comparison with an injection drug in children with severe pain syndrome.

Morphine Consumption and/or Numerical Scale in Pain Studies: Silverman Integrating Approach (SIA SCORE)

Introduction: Ligamentoplasty pain management is dynamic performance, demanding constant vigilance and adaptation. The aim of this prospective study was to compare the analgesic efficacy of three techniques for knee ligamentoplasty using an integration score, the SIA score.&#x0D; Methods: The study included 165 patients undergoing primary reconstruction of the anterior cruciate ligament of the knee. The first group, systemic analgesia (SA), received balanced systemic analgesia postoperatively for a minimum of five days, based on Paracetamol, Diclofenac, and a morphine PCA. In addition to the systemic analgesia already described, the second group, femoral analgesia (FA), will benefit from a femoral peri-nervous catheter in the crural position. The third intra-articular analgesia (IAA) group received, in addition to the same systemic analgesia, an infusion through an epidural catheter of 20 ml of 0.125% bupivacaine, followed by maintenance with 8 ml/h of the same local anesthetic via an electric syringe pump for 36 h. Cumulative morphine consumption was assessed, as well as pain at rest, using a numerical scale (EN) from 1 to 10 and an integration of these two parameters.&#x0D; Results: Morphine consumption was lower in the AF group. The lowest mean rank was in the AF group, followed by the AIA group, and the difference was statistically significant with an H = 6.89 and a p= 0.032. The difference was significant between the AS group and the AF group (p = 0.09); the other inter-group differences were not significant. 23.2% of patients had an AIS score between [-100, -200], and were in little pain and consumed little morphine (effective treatment); 14.2% of patients had an AIS score between [100, 200] and were in great pain and consumed a lot of morphine (morphine-resistant or very sensitive to pain).&#x0D; Conclusion: Analgesia in the femoral peri-nerve group was more effective, with a reduction in mean EN compared with the other two groups.

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Introduction: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. Methods: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients’ 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. Results: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p &gt; 0.05). Conclusions: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

Pulmonary Lobectomy for Early-Stage Lung Cancer with Uniportal versus Three-Portal Video-Assisted Thoracic Surgery: Results from a Single-Centre Randomized Clinical Trial.

Video-assisted thoracic surgery (VATS) is a consolidated approach; however, there is no consensus on the number of ports leading to less postoperative pain. We compared early postoperative pain after uniportal and three-portal VATS lobectomy for early-stage NSCLC. In this randomized clinical trial, patients undergoing VATS lobectomy were randomly assigned to receive uniportal (U-VATS Group) or three-portal (T-VATS Group) VATS. The inclusion criteria were age ≤ 80 years and ASA < 4. The exclusion criteria were clinical T3, previous thoracic surgery, induction therapy, chest radiotherapy, connective tissue or vascular diseases, major organ failure, and analgesics or corticosteroids use. The postoperative analgesia protocol was based on NRS. Pain was measured as analgesic consumption; the secondary endpoints were intra- and postoperative complications, conversion rate, surgical time, dissected lymph nodes, hospital stay, and respiratory function. Out of 302 eligible patients, 120 were included; demographics were distributed homogeneously. The mean cumulative morphine consumption (CMC) in the U-VATS Group after 7 days was lower than in the T-VATS Group (77.4 mg vs. 90.1 mg, p = 0.003). Intraoperative variables and postoperative complications were comparable. The 30-day intercostal neuralgia rate was lower in the U-VATS Group, without reaching statistical significance. Patients undergoing U-VATS showed a lower analgesic consumption compared with the T-VATS Group; analgesic consumption was moderate in both groups.

Erector spinae plane block for post-operative analgesia in thoracolumbar spine surgery: A randomised controlled trial

Background and Aims: Thoracolumbar spine surgery is one of the most painful surgical procedures. This study's primary objective was to evaluate the effect of erector spinae plane (ESP) block on post-operative cumulative morphine consumption at 24 h in patients undergoing thoracolumbar spine surgery. Methods: Seventy adults posted for thoracolumbar spine surgery were randomised into the control group [Number of patients (n)=35], who received general anaesthesia without any nerve block, and the intervention group (n = 35), who received bilateral ultrasound (US)-guided ESP block at the level of spine surgery with 0.25% bupivacaine 20 mL after standard general anaesthesia. Along with intravenous patient-controlled analgesia morphine, post-operative analgesia was standardised for both groups. Total morphine consumption, visual analogue scale (VAS) score to evaluate pain, overall patient satisfaction, and any side effects were compared at 24 h. The statistical analysis was done using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL). Results: Post-operative total morphine consumption at 24 h was significantly decreased in the intervention group compared to the control group [5.69 (1.549) versus 9.51 (1.634) mg; P &lt; 0.001]. Post-operative VAS scores were also significantly decreased in the intervention group at rest (P &lt; 0.001) and on movement (P &lt; 0.001). Patient satisfaction scores were more favourable in the intervention group [3.8 (0.4) versus 3.2 (0.6); P &lt; 0.001]. Post-operative nausea and vomiting were found more in the control group but were not significant (n = 14 versus 8; P = 0.127). Conclusion: US-guided ESP block significantly reduces post-operative morphine consumption and improves analgesia and patient satisfaction without adverse effects in patients undergoing thoracolumbar spine surgery.

Does Adding an IPACK Block to the Suprainguinal Fascia Iliaca Block Improve the Quality of Analgesia in Patients Undergoing Knee Arthroplasty under Spinal Anesthesia? A Retrospective Cohort Study.

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I-III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia.

Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study.

Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group.

Comparative Study Between Systemic Balanced Analgesia, Continuous Femoral Perineural Analgesia and Continuous Intra-articular Analgesia for Primary Reconstruction Surgery of the Anterior Cruciate Ligament of the Knee

Introduction. The aim of this prospective study was to compare the analgesic efficacy of three techniques for knee ligamentoplasty and quadricipital deficit with a view to early physiotherapy. Hypothesis. Continuous intra-articular analgesia and well-managed systemic analgesia could replace continuous femoral peri-nerve analgesia in resource-limited countries. Material. - We included 165 patients undergoing primary reconstruction of the anterior cruciate ligament of the knee. All patients underwent spinal anaesthesia. The first group, systemic analgesia (SA), received balanced systemic analgesia postoperatively for a minimum of five days, based on Paracetamol, Diclofenac and a morphine PCA. In addition to the systemic analgesia already described, the second group, femoral analgesia (FA), will benefit from a femoral peri-nervous catheter in the crural position. 20 ml of bupivacaine at 0.125% concentration is injected; maintenance is set up immediately with a continuous flow of 8 ml/h for 36 h. The third intra-articular analgesia (IAA) group received, in addition to the same systemic analgesia, an infusion through an epidural catheter of 20 ml of 0.125% bupivacaine, followed by maintenance with 8 ml/h of the same local anesthetic via an electric syringe pump for 36 h. Cumulative morphine consumption, pain estimation at rest and on mobilization using a numerical scale (EN) from 1 to 10, and quadriceps deficit were evaluated. Results. - Morphine consumption was lower in the AF group and the difference was statistically significant with an F = 3.539(2) and a p = 0.031. A mean difference of 6.12 ± 2.41 between the AS and AF groups with a significant p = 0.012, a mean difference of 1.67 ± 2.41 with a non-significant p = 0.49 between the AF and AIA groups and a mean difference of 4.45 ± 2.31 with a p = 0.056 at the limit of significance between the AS and AIA groups. Analgesia in the femoral peri-nerve group was more effective, with a reduction in mean EN compared with the other two groups. Efficacy was statistically significant at H4, then from H24 to H36 compared with systemic analgesia, but not significant compared with intra-articular analgésia. Intra-articular analgesia was only significantly effective compared with systemic analgesia at H36. Quadriceps muscle deficit is an incident specific to femoral blocks. Discussion. - This study suggests that a continuous intra-articular or even a well-conducted systemic analgesia provides satisfactory analgesia for knee ligamentoplasty, compared with a more effective femoral peri-nerve. The quadricipital lock absent in intra-articular treatment could be an advantage in speeding up functional recovery.

Analgesia for Knee Ligamentoplasty: Comparisons of Three Techniques using the Silverman Integrating Approach (SIA Score)

The aim of this prospective study was to compare the analgesic efficacy of three techniques for knee ligamentoplasty using an integration score, the SIA score. Hypothesis. The use of a statistical approach to integrate data from pain scores and morphine consumption will identify four patient subgroups that may hamper the accuracy of the comparative study Material. - We included 165 patients undergoing primary reconstruction of the anterior cruciate ligament of the knee. All patients underwent spinal anaesthesia. The first group, systemic analgesia (SA), received balanced systemic analgesia postoperatively for a minimum of five days, based on Paracetamol, Diclofenac and a morphine PCA. In addition to the systemic analgesia already described, the second group, femoral analgesia (FA), will benefit from a femoral peri-nervous catheter in the crural position. 20 ml of bupivacaine at 0.125% concentration is injected; maintenance is set up immediately with a continuous flow of 8 ml/h for 36 h. The third intra-articular analgesia (IAA) group received, in addition to the same systemic analgesia, an infusion through an epidural catheter of 20 ml of 0.125% bupivacaine, followed by maintenance with 8 ml/h of the same local anesthetic via an electric syringe pump for 36 h. We evaluated cumulative morphine consumption, pain estimation at rest using a numerical scale (EN) from 1 to 10, and an integration of these two parameters. Results. - The mean age was identical for all three groups, at around 30 years. Analgesia in the femoral peri-nerve group was more effective, with a reduction in mean EN compared with the other two groups. Morphine consumption was lower in the AF group. The lowest mean rank was in the AF group, followed by the AIA group, and the difference was statistically significant with an H = 6.89 and a p= 0.032. The difference was significant between the AS group and the AF group (p = 0.09); the other inter-group differences were not significant. 23.2% of patients had an AIS score between [-100, -200], and were in little pain and consumed little morphine (effective treatment); 14.2% of patients had an AIS score between [100, 200] and were in great pain and consumed a lot of morphine (morphine-resistant or very sensitive to pain). For the difference (ranked pain score - ranked morphine), 4.5% of cases had values between [- 100, - 200] and were therefore not very painful but consumed a lot of morphine (propensity), while 3.9% had values between [100, 200] and were therefore very painful but consumed little morphine (intolerant). Discussion. - This study suggests that the use of a statistical approach to integrating data from pain scores and morphine consumption, such as the Silverman Integrating Approach (SIA), will yield four patient subgroups that may hamper the accuracy of the comparative study, including the morphine-resistant subgroup and the propensity subgroup. Comparison of the means of the therapeutic efficacy group will eventually be more precise. Continuous femoral block really does provide added analgesia and morphine sparing, and should therefore be preferred wherever possible to intra-articular or systemic therapy.

Comparison of the effects of subcostal anterior quadratus lumborum block and thoracic paravertebral block in laparoscopic nephrectomy: a randomized study.

Thoracic paravertebral block (TPVB) may provide sufficient postoperative analgesia in laparoscopic nephrectomy (LSN) by ensuring ipsilateral somatic and visceral analgesia. However, there are serious reservations due to the complexity of the technique, and various complications thereof. Subcostal anterior quadratus lumborum block (S-QLB3) may be a safe alternative in LSN procedures. Therefore, this study aimed to compare the postoperative analgesic effects of TPVB and S-QLB3. This prospective, randomized, double-blind study included 60 patients aged 18-70 years who were planned to undergo LSN. The patients were randomly assigned to receive either unilateral ultrasound-guided S-QLB3 or TPVB. The primary outcome was postoperative cumulative 24-h morphine consumption. In addition, numeric rating scale (NRS) scores at rest/activity and the American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR) scores were also evaluated. While postoperative cumulative 24-h morphine consumption was lower in the TPVB group compared to the other group (mean±SD, 12±3.4 mg vs. 15.4±7.8 mg, P=0.03), NRS pain scores at rest/activity were similar in both groups at all measurement points. Considering the postoperative APS-POQ-R-TR data, only the score related to the pain-daily activity relationship was high in the S-QLB3 group (median [Q1-Q3], 0 [0-1] vs. 2 [0-5], P=0.004), whereas there was no difference between the other scores. In this study, NRS and APS-POQ-R-TR scores were similar in the S-QLB3 and TPVB groups, whereas cumulative morphine consumption was modestly lower in the TPVB group. This suggested that S-QLB3 could be an alternative to TPVB in patients undergoing LSN.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p &amp;lt; 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p &amp;lt; 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

The Efficacy of Fascia Iliaca Block for Pain Control after Total Hip Arthroplasty

Abstract Background Total hip arthroplasty (THA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after THA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction. Aim of the Study To assess the efficacy and safety of FICB compared with standard multimodal analgesia in patients undergoing THA. Patients and Methods Ninety adult patients scheduled for total hip arthroplasty (THA), under spinal anesthesia were included in this study. The patients' age was ranging from 18 to 65 years and with the American Society of Anesthesiologists (ASA) Class II and III. Patients were included in the study, and were divided into two groups (n = 42; each); group FICB and control group. Results At PACU arrival there is no difference between two groups as two groups were recovering from anesthesia then facia illiaca block group showed the best response as regard as pain control post operatively for 12 hours postoperative then there is no statistical difference between two groups. There was statistically significant difference between groups as regard as visual analog score. As regard to total dose of morphine used in each group, facia illiaca block scientifically used less amount of morphine than control group (P &amp;lt; 0.001). Conclusion Fascia iliaca compartment block is effective for pain relief during the early post-operative period after total hip arthroplasty. Meanwhile, it can reduce the cumulative morphine consumption and the risk of opioid-related adverse effects.

Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: A prospective, double-blind, placebo-controlled study

BackgroundThe present study aimed to evaluate the efficacy of ultrasound-guided anterior iliopsoas muscle space block (AIMSB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. MethodsIn this prospective, double-blind, placebo-controlled study, 80 patients undergoing primary THA under general anesthesia were included in the final analysis between March 22, 2022, and June 1, 2022. All patients were randomly assigned to receive AIMSB combined with LIA (AIMSB group, n = 40) or sham AIMSB and LIA (Sham group, n = 40). The primary outcome was cumulative morphine consumption (mg) within 24 h after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS) at rest or during motion after surgery, time to first rescue analgesia, cumulative morphine consumption during hospitalization, intraoperative consumption of opioids, postoperative recovery, and postoperative adverse effects. ResultsPatients in the AIMSB group consumed significantly less morphine than the Sham group within the first 24 h and throughout hospitalization, as well as smaller amounts of intraoperative opioids. Also, significantly lower pain scores were recorded at rest or during motion within 24 h after surgery in AIMSB patients. Patients in the AIMSB group recovered more quickly than Sham patients. No significant difference was observed in quadriceps strength and postoperative complications between the two groups. ConclusionsCompared to treatment with LIA alone, ultrasound-guided AIMSB combined with LIA can provide better postoperative pain relief, decrease opioid consumption, promote motor sparing, and enhance the recovery of THA patients.

Comparison of the postoperative analgesic efficacy of ultrasound-guided suprainguinal fascia iliaca block applied with two different concentrations of bupivacaine in patients undergoing hip surgery under spinal anesthesia

Aim: Management of postoperative pain in hip surgeries is important for the quality of recovery. When regional anesthesia techniques are added to the multimodal analgesia plan, they increase the effectiveness of the analgesia plan. Supra-inguinal fascia iliaca block (SIFIB) is a technique that has been reported to be effective in hip surgery but requires the use of high-volume local anesthetics. Our aim in this retrospective study is to investigate the efficacy of local anesthetic in SIFIB when administered at a concentration lower than the conventional concentration.Material and Methods: The files of the patients who underwent hip hemiarthroplasty were planned to be evaluated retrospectively. Patients were grouped according to the bupivacaine concentration used in SIFIB (0.25% vs. 0.20%) and statistically evaluated in terms of morphine requirement, pain scores, and time to first analgesic.Results: There was no significant difference between the groups in terms of NRS score and cumulative morphine consumption at the 3rd, 6th, 12th, 18th, and 24th hours (p&gt;0.05). When compared the first analgesia requirement times, there was no significant difference between Groups (p&gt;0.05).Conclusion: A single shot SIFIB administered at a concentration of 0.20% also has analgesic properties, as do the conventional concentration of SIFIB containing 0.25% bupivacaine.

Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study

BackgroundThe liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores.MethodsNinety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group.ResultsThere were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively.ConclusionIntraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia.

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis.

Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.