Rescue Analgesic Demand Research Articles

Efficacy of Transcutaneous Electrical Acupoint Stimulation on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Lobectomy: Study Protocol for a Prospective Randomized Controlled Trial.

Patients undergoing video-assisted thoracoscopic lobectomy (VATL) often experience chronic postsurgical pain (CPSP). Postoperative pain can affect the recovery of postoperative lung function, prolong postoperative recovery time, and increase patient hospitalization expenses. Transcutaneous electrical acupoint stimulation (TEAS) is an alternative therapy based on acupuncture that has shown promise in postoperative recovery and pain management across various medical fields. However, research specifically focused on the improvement of CPSP after VATL is currently lacking. The purpose of this study is to evaluate whether TEAS can effectively reduce the severity and occurrence of chronic postsurgical pain in patients undergoing VATL. By investigating the potential benefits of TEAS in mitigating CPSP after VATL, this study aims to provide valuable clinical evidence to support the integration of TEAS into postoperative care protocols for patients undergoing VATL. This study is a prospective, single-center, double-blinded, randomized controlled trial to be conducted at the 920th Hospital of Joint Logistics Support Force. Eighty patients undergoing VATL will be randomly divided into an experimental group (TEAS group) and a control group (sham group). The experimental group will receive TEAS at bilateral PC6, LI4, LR3, LU5, TE5, and LI11. The control group will not receive TEAS at the same acupoints. Both groups will receive TEAS or no TEAS before anesthesia induction and 1-7days after surgery, with each session lasting 30min. The primary outcome will be the incidence of CPSP at 3months after surgery. Secondary outcomes will include the incidence of CPSP at 6months after surgery, the numerical rating scale (NRS) scores at 3 and 6months after surgery, as well as the NRS scores at 24, 48, and 72h after surgery, remifentanil consumption during general anesthesia, demand for rescue analgesics, number and duration of indwelling chest tubes, incidence of postoperative nausea and vomiting, and changes of norepinephrine (NE), cortisol (Cor), tumor necrosis factor (TNF- α), and interleukin 6 (IL-6) in serum. ChiCTR2300069458. Registered on March 16, 2023.

Comparison of two different doses of dexmedetomidine for continuous epidural analgesia for lower limb surgeries: A randomized double-blind study.

Bolus epidural dexmedetomidine provides potent analgesia but the incidence of hemodynamic instability is high. There are only a few studies that have evaluated the efficacy of epidural dexmedetomidine infusion but none of them compared different doses to find the optimum safe dose. We compared the analgesic efficacy and safety of two different doses of dexmedetomidine in continuous epidural for postoperative analgesia. Patients undergoing lower limb surgeries were divided randomly into two groups: Group I (n = 36) received an epidural infusion of 0.1% ropivacaine + 0.5 μg/kg/24 h of dexmedetomidine and Group II (n = 36) received epidural infusion 0.1% ropivacaine + 1 μg/kg/24 h of dexmedetomidine. Both groups received epidural infusion at the rate of 5 ml/h over 48 h postoperatively. Pain scores, demand for rescue analgesics, hemodynamic parameters, and sedation scores were compared between the groups. Statistical analysis was done using an independent t-test and Chi-square test. 1 μg/kg group (Group II) had a significantly reduced pain score at all time intervals and less demand for rescue analgesia (P = 0.03). The severity of pain was more in the 0.5 μg/kg group (Group I), at all times (P = 0.000). Incidence hypotension was higher in Group II. Bradycardia was seen in two patients in Group II and none in Group I. Dexmedetomidine in a dose of 1 μg/kg/24 h with 5 ml of 0.1% ropivacaine through epidural infusion provides better analgesia with a safe hemodynamic profile.

Perioperative Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Pain in Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial.

This study aimed to determine the effects of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain management in patients undergoing thoracic surgery. In the prospective, randomized, controlled study, a total of 84 patients undergoing video-assisted thoracoscopic surgery (VATS) were randomly allocated to the TEAS group (Group T) or control group (Group C). Patients in the Group T received TEAS at Neiguan (PC6) and Hegu (LI4) acupoints for 30 min before anesthesia induction and 30 min after thoracoscopic surgery. Patients in the Group C received the same placement of electrodes but without electrical stimulation. The numeric rating scale (NRS) pain score, remifentanil consumption, demand for rescue analgesics and incidence of postoperative nausea and vomiting (PONV), patient satisfaction, and the levels of plasma β-endorphin (EP) and IL-6 were recorded. Patients in the Group T had significantly lower NRS pain scores at 6 h, 12 h, 24 h, and 48 h after surgery than those in the Group C. Compared with Group C, patients in Group T had lower remifentanil consumption during operation, lower demand for rescue analgesics and lower rate of PONV within 24 h after surgery. Patients in Group T also had lower IL-6 content, higher β-EP content and higher satisfaction degree than those in the Group C. Perioperative TEAS significantly decreased postoperative pain and rescued analgesia requirements and the incidence of PONV in patients undergoing thoracoscopic surgery, with a higher patient satisfaction. This trial is registered with ChiCTR2100051841.

Comparison of efficacy of intercostal nerve block versus peritract infiltration with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial.

Postoperative pain following percutaneous nephrolithotomy (PCNL) adds to the morbidity of patients requiring additional analgesia. Various modalities of pain control techniques, such as intercostal nerve block (ICNB) and peritract infiltration (PTI), are being studied for better pain management. This study compares the efficacy of ICNB with PTI for postoperative pain management. A double-blinded, prospective, randomized control study was conducted, in which 0.25% bupivacaine, either ICNB or PTI, was given at the puncture site at the end of PCNL. The primary outcome was a comparison of postoperative pain score measured with resting Visual analogue Scale (r-VAS) and dynamic VAS (D-VAS) recorded at 2 h, 4 h, 8 h, 10 h, 12 h, 24 h, and at discharge. Injection ketorolac was given as rescue analgesia. Secondary outcomes include time to first rescue analgesia and total analgesic requirement (TAR). Sixty patients were randomized into two equal groups with 63.3% male and 36.6% female, with a mean age of 37.25 ± 13.09 years. In Group ICNB, 24 (40%) and 6 (10%) patients and in Group PTI, 21 (35%) and 9 (15%) patients underwent standard and mini PCNL, respectively, in each group. All cases were PCNL doen in prone position. The mean R-VAS and D-VAS scores at 2, 4, 8, 12, 24, and 48 h were similar in both groups. The mean TAR was 56.84 ± 0.33.00 mg and 55.54 ± 0.29.64 mg of injection ketorolac in Group ICNB and PTI, respectively (P < 0.894). The time to first rescue analgesic demand were 7.11 ± 4.898 h and 6.25 ± 3.354 h (P < 0.527). Both the groups were comparable in terms of length of hospital stay, stone clearance rate, and complication rate. The ICNB was as efficacious as PTI for postoperative pain control with 0.25% bupivacaine following PCNL.

Tramadol - A Better Alternative to Clonidine as an Additive Agent to Ropivacaine for Postoperative Analgesia in Below Umbilical Surgeries

Abstract Background: Epidural anesthesia is commonly used for providing both postoperative analgesia in infra umbilical surgeries. An adjuvant increases the effectiveness of the local anesthetic drug by prolonging its action and also causes decreased doses of the local anesthetic agent. Aims: The sight and focus of our study are to juxtapose the effect of clonidine and tramadol as an additive to epidural ropivacaine for postoperative analgesia. Materials and Methods: A randomized, concurrent cohort, prospective study was performed on 60 patients (American Society of Anesthesiologists [ASA] Grade I and ASA Grade II) of either gender, those who were planned for chosen elective infraumbilical surgery under combined spinal epidural anesthesia, and divided into two groups. The patients in Group I were administered 15 mL 0.5% ropivacaine + clonidine (2 μg/kg), whereas Group II patients received 15 mL 0.5% ropivacaine + tramadol (2 mg/kg). Postanesthesia vitals, the duration for motor and sensory effects, i.e., block, adverse effects, and time to rescue analgesia, was recorded. Results: A significant decrease in the heart rate was observed in clonidine group patients compared with tramadol group patients after spinal anesthesia. The duration of motor and sensory block in the tramadol group was significantly longer. Time to rescue analgesia was also prolonged significantly in the tramadol group. The incidence of adverse effects was comparable in the two groups. Conclusion: Tramadol, as an additive to epidural ropivacaine, was found to have a better motor and sensory block, prolonged postoperative analgesia, and minimal adverse side effects. A significantly decreased demand for rescue analgesics was seen compared to clonidine.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value &amp;lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value &amp;lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

BackgroundModified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). MethodsPatients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. ResultsThe global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). ConclusionIn our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register NumberNCT05199922.

Efficacy of Wound Instillation With Bupivacaine Through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison With Conventional Intravenous Analgesics.

Introduction A laparotomy can cause severe postoperative pain, which, if treated adequately, can result in reduced incidence of lung atelectasis and ileuspromoting early mobilization and faster recovery and in turn reducing the duration of hospital stays. Hence, effective postoperative analgesia is important to reduce postoperative stress and improve early surgical outcomes. Therefore, the hypothesis is based on the fact that following a midline laparotomy, instillation of local anaesthetic agent 0.25% bupivacaine through a wound catheter placed in the subcutaneous plane may provide better analgesia compared to the conventional intravenous analgesics and improve the early surgical outcomes. Methodology A prospective, comparative, quasi-experimental study was conducted on 80 patients planned for emergency or elective midline laparotomy procedures over a period of 18 months, who were randomly distributed into two groups of 40 each. The bupivacaine group consisted of 40 patients who received 10ml of 0.25% bupivacaine instilled through a wound catheter placed in the subcutaneous plane following a midline laparotomy. This was repeated every six hours for the first 24 hours followed by every 12 hours for the next 24 hours. The conventional intravenous (IV) analgesics group involved 40 patients who received conventional IV analgesics routinely used. Pain scores were recorded every four hours for 60 hours using the visual analogue scale (VAS) and dynamic visual analogue scale (DVAS). The parameters assessed were mean VAS and DVAS scores, number of rescue analgesic demands, cumulative rescue analgesic requirement, and early surgical outcomes. Wound complications were also assessed. Results Both groups shared similar demographic characteristics in terms of age, gender, comorbidities, and duration of operation. In comparison to patients who got standard IV analgesics, those who received 0.25% bupivacaine had improved postoperative analgesia. Between the two groups, there were statistically significant results in the number of rescue analgesic demands in the first 24 hours, but in the next 24 hours, it was statistically insignificant. The study also showed that bupivacaine instillation led to a significant decrease in postoperative lung complications and the length of hospital stays; however as hypothesised, it did not improve early surgical outcomes. Conclusion This modality, the instillation of bupivacaine through a wound catheter, is an efficient and technically simple method to provide optimal postoperative analgesia. It substantially reduces the need for systemic analgesics and can potentially avoid their related side effects. Hence, the armamentariumof multimodal analgesia can therefore include this method of delivering postoperative analgesia.

The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery: A Triple-blind Randomized Clinical Trial

Controlling postoperative pain and nausea (PONV) following orthognathic surgery can be challenging. The aim of the study was to assess the efficacy of dexmedetomidine (DEX) in reducing pain and preventing nausea and vomiting in subjects undergoing orthognathic surgery. The authors implemented a triple-blinded, randomized clinical trial. Healthy adults with class III jaw deformity scheduled for bimaxillary orthognathic surgery were included. Subjects were randomized to the DEX or placebo groups. The DEX group received premedication with DEX 1μg/kg IV over 10minutes followed by a maintenance dose (0.2μg/kg/hour) while the placebo group received normal saline. The primary outcome variables were postoperative pain, postoperative nausea, and postoperative vomiting . Pain was assessed using a visual analog scale at 1, 3, 6, 12, 18, and 24hours, postoperatively). Nausea and vomiting were recorded throughout the postoperative period. Statistical analysis was performed using χ2, t test, and repeated measures ANOVA with a P value<.05 considered significant. A total of 60 consecutive subjects with a mean age of 24.6±3.5years completed the study. There were 38 females (63.33%) and 22 males (36.66%). The mean visual analog scale was significantly lower in the DEX group at all time-points (P<.05). There was a significantly greater demand for rescue analgesics in the placebo group compared to the DEX group (P=.01). Fourteen subjects (46.7%) in the placebo group and one subject (3.3%) in the DEX group reported nausea (P<.001). Postoperative vomiting was not observed in any of the subjects. Premedication with DEX can be considered a viable treatment option for reducing postoperative pain and postoperative nausea after bimaxillary orthognathic surgery.

Efficacy of erector spinae nerve block for pain control after lumbar spinal surgeries: a systematic review and meta-analysis.

The review aimed to examine the evidence on the efficacy of erector spinae nerve block (ESPB) for pain control after lumbar spinal surgeries. PubMed, CENTRAL, Embase, and Web of Science were examined for published randomized controlled trials (RCTs) assessing ESPB with control for lumbar spinal surgery patients. The primary review outcome was 24-hour total opioid consumption in morphine equivalents. The secondary review outcomes were pain at rest at 4-6 hours, 8-12 hours, 24 hours and 48 hours, first rescue analgesic timing, needing rescue analgesics number, and postoperative nausea and vomiting (PONV). 16 trials were eligible. Total opioid consumption was significantly lower with ESPB as compared to controls (MD: -12.68 95% CI: -18.09, -7.28 I2=99% p<0.00001). Pain scores at 4-6 hours (MD: -1.37 95% CI: -1.98, -0.76 I2=95% p<0.0001), 8-12 hours (MD: -1.18 95% CI:-1.84, -0.52 I2=98% p=0.0004), 24 hours (MD: -0.53 95% CI:-1.03, -0.04 I2=96% p=0.04) and 48 hours (MD: -0.36 95% CI:-0.84, 0.13 I2=88% p=0.15) were significantly lower in the ESPB group. The meta-analysis found that the ESPB group required a significantly longer time for the first analgesic request (MD: 5.26 95% CI: 2.53, 7.99 I2=100% p=0.002), had lower demand for rescue analgesics (OR: 0.12 95% CI: 0.07, 0.21 I2=2% p<0.00001) and fewer incidence of PONV (OR: 0.27 95% CI: 0.15, 0.49 I2=51% p<0.0001). ESPB can be highly efficacious for postoperative analgesia in lumbar surgery patients. The block has the capability of reducing opioid consumption in the first 24 hours and pain scores up to 48 hours along with a significant reduction in the need for rescue analgesics and PONV.

Effects of single-injection intercostal nerve block as a component of multimodal analgesia for pediatrics undergoing autologous auricular reconstruction: A double-blinded, prospective, and randomized study

Backgroundː Pain management is essential in postoperative settings, especially with pediatric patients. Donor site pain after rib cartilage harvest is severe, particularly during the early postoperative period. This study aimed to explore the effectiveness of ultrasound guided single-injection intercostal nerve block (ICNB) as a component of multimodal analgesia for pediatrics undergoing autologous auricular reconstruction. Methodsː Fifty pediatric patients aged 6–16 years and scheduled for 2 rib cartilages harvest surgery were enrolled in this double-blind, prospective and randomized study. Pediatrics were randomly assigned into two groups: the intercostal nerve block group (group B) and the control group (group C). The nerve block was performed with 2 ml 0.25% ropivacaine each intercostal nerve in group B. Patients from group C received Tramadol 2 mg/kg by the end of the surgery as control. Tramadol-based patient-controlled intravenous analgesia and rescue analgesia were given in both groups. The primary outcome was pain scores at early postoperative period (VAS and FLACC scale, 4 h, and 8 h). The secondary outcome was the postoperative Tramadol consumption and time point of first rescue analgesic demand. Resultsː VAS score was significantly lower in group B than group C at 4 h and 8 h postoperatively [2.5(2–5) vs. 4(2.5–5.5), p = 0.041 at 4 h; 3(2.5–4.5) vs. 4(3–5), p = 0.047 at 8 h]. Total Tramadol consumption in group B decreased significantly in contrast with group C at 8 h (p < 0.01), 12 h, 24 h and 48 h (p < 0.05, respectively). The first rescue analgesia demand and number of rescue Tramadol in block group was considerably delayed or reduced than control group (p < 0.01, p < 0.05, respectively). Conclusionsː Our findings indicated that ultrasound guided ICNB slightly but significantly reduced pain scores, and Tramadol consumption in pediatric patients after rib cartilage harvest as compared to who didn't receive nerve block at 4 h and 8 h postoperatively. Unified ICNB ropivacaine dosage might detrimental to providing superior analgesia.

Clinical comparison of analgesic efficacy of addition of injection dexamethasone 8mg to 20ml 0.5% levobupivacaine in ultrasonography assisted supraclavicular brachial plexus block

Background: Ultrasonography-assisted supraclavicular block is an efficacious and practical method and allows us to use a lower volume of local anesthetic in compactly arranged brachial plexus. The study envisioned evaluating the analgesic and anesthetic effects of Inj. dexamethasone (8mg) as an adjuvant to 0.5% levobupivacaine to determine the time for first rescue analgesia and number of rescue analgesics needed in 24 hours duration in brachial plexus blockade in adult patients listed for upper limb surgeries. Results: This prospective randomized double-blind interventional study was carried out in ASAI and II, aged 20 to 55 years. In group A (n=30) Inj. Levobupivacaine 20ml and Inj. Normal saline 2ml was given. In group B (n=30) Inj. Levobupivacaine 20ml and Inj. Dexamethasone 2ml was given. The time for the demand of the first rescue analgesia was 431.50 ± 46.15 minutes in group A and 749.38 ± 62.41 minutes in group B, with a p-value &lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We deduce with our study, with the addition of dexamethasone, the time for rescue analgesia is prolonged, and the number of rescue analgesic demands is reduced, with a faster onset and extended duration of both sensory and motor block.

A comparative study between the use of dexmedetomidine vs. dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries

Background &amp; objective: Transversus abdominis plane (TAP) block using local anesthetics is associated with relatively shorter duration of action, and thus additional analgesic drugs are required in the postoperative period. We compared the efficacy and duration of postoperative analgesia achieved with using dexmedetomidine or dexamethasone as adjuvants to bupivacaine in TAP block for lower abdominal surgeries.&#x0D; Methodology: We enrolled 45 adult patients aged from 20-60 y, and randomly divided them into three equal groups. Group A received ultrasound guided TAP block with 0.25% bupivacaine 20 ml plus 4 mg dexamethasone on each side. Group B received 0.25% bupivacaine 20 ml plus dexmedetomidine 0.5 µg/kg on each side, and Group C (control group) patients received only 0.25% bupivacaine 20 ml on each side. Postoperative pain was assessed with VAS on arrival in post-anesthesia care unit (PACU), at 2 h, 6 h, 12 h, 18 h, and at 24 h postoperatively. Duration of analgesia was the time from drug injection to the time of first rescue of analgesia was recorded.&#x0D; Results: Mean duration to first dose of rescue analgesia among patients of dexmedetomidine group (Group B) was significantly prolonged as compared to dexamethasone group and bupivacaine only group. Regarding postoperative pain scores there were no statistically significant difference between the three groups; except at 6 h between the A and B groups and the control group. Both dexamethasone group and dexmedetomidine group showed better pain control than bupivacaine only at 6 h interval.&#x0D; Conclusion: Dexmedetomidine added to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries prolongs the time to initial postoperative pain presented by time to first rescue analgesic demand than dexamethasone added to bupivacaine; the shortest time to first rescue analgesic was observed in bupivacaine alone group.&#x0D; Abbreviations: TAP: Transversus abdominis plane block; LA: Local anesthetic; PACU: Post anesthesia care unit; VAS: Visual Analogue Scale; ASA: American Society of Anesthesiologists; SD: Standard deviation; IQR: Inter quartile range.&#x0D; Citation: Sobhy YS, Gadalla RR, Nofal WH, Saleh MAE, Abdou KM. A comparative study between the use of dexmedetomidine .vs dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries. Anaesth. pain intensive care 2022;26(5):681–688; DOI: 10.35975/apic.v26i5.2031

The effect of continuous intercostal nerve block vs. single shot on analgesic outcomes and hospital stays in minimally invasive direct coronary artery bypass surgery: a retrospective cohort study

BackgroundMinimally invasive direct coronary artery bypass (MIDCAB) grafting surgery is accompanied by severe pain. Although continuous intercostal nerve block (CINB) has become one of the multimodal analgesic techniques in single port thoracoscopic surgery, its effects on MIDCAB are unclear. The purpose of this study was to compare the effects of CINB and single shot on analgesic outcomes and hospital stays in patients undergoing MIDCAB in a real-world setting.MethodsA retrospective cohort study was carried out at Peking University Third Hospital, China. Two hundred and sixteen patients undergoing MIDCAB were divided into two groups: a CINB group and a single block (SI) group. The primary outcome was postoperative maximal visual analog scale (VAS); secondary outcomes included the number of patients with maximal VAS ≤ 3, the demand for and consumed doses of pethidine and tramadol, and the length of intensive care unit (ICU) and hospital stays. The above data and the area under the VAS curve in the 70 h after extubation for the two subgroups (No. of grafts = 1) were also compared.ResultsThe maximum VAS was lower in the CINB group, and there were more cases with maximum VAS ≤ 3 in the CINB group: CINB 52 (40%) vs. SI 17 (20%), P = 0.002. The percentage of cases requiring tramadol and pethidine was less in CINB, P = 0.001. Among all patients, drug doses were significantly lower in the CINB group [tramadol: CINB 0 (0–100) mg vs. SI 100 (0–225) mg, P = 0.0001; pethidine: CINB 0 (0–25) mg vs. SI 25 (0–50) mg, P = 0.0004]. Further subgroup analysis showed that the area under the VAS curve in CINB was smaller: 28.05 in CINB vs. 30.41 in SI, P = 0.002. Finally, the length of ICU stay was shorter in CINB than in SI: 20.5 (11.3–26.0) h vs. 22.0 (19.0–45.0) h, P = 0.011.ConclusionsCINB is associated with decreased demand for rescue analgesics and shorter length of ICU stay when compared to single shot intercostal nerve block. Additional randomized controlled trial (RCT) is needed to support these findings.

Abstract No.: ABS1074 : Evaluation of efficacy of superficial cervical plexus block for surgeries in head and neck region: A comparative randomised control study

Background and Aims:Superficial cervical plexus block can provide analgesia in head and neck surgeries. This study aimed to evaluate analgesic efficacy of superficial cervical plexus block (SCPB) in various head and neck surgeries, with the primary objectives of assessing time to first rescue analgesic, total dose of rescue analgesics in 24 hours, intraoperative analgesic requirement and associated perioperative complications.Methods:Sixty patients of American Society of Anesthesiologists physical class II,III (30 patients in each group) were included. Group A received general anaesthesia(GA) with systemic analgesia and group B received GA followed by SCPB with injection bupivacaine 0.25% 10ml on each side according to site of surgery. Visual analogue scale(VAS) scores, intra and postoperative analgesic requirement in 24 hours, time of first rescue analgesic demand and peri-operative complications were noted. All quantitative data were analysed by student-t test and qualitative data was analysed by chi-square test.Results:Time of first rescue analgesia was earlier and intraoperative fentanyl requirement and postoperative total rescue analgesic requirement were higher in group A (32.33+_38.39, 38.33+_12.61, 2566.667 + _504.006) than group B(1092+_396.55 minutes, 10.66+_13.11, 833.33+_874.28 ) with p value <0.001 (table 1,2). No significant complication was noted in any patient.Conclusion:SCPB provides better perioperative analgesia and decreases intraoperative as well as postoperative analgesic requirements and associated side effects with no significant perioperative complications in various head and neck surgeries.

Evaluation of ultrasound guided erector spinae plane block efficacy on post operative pain in lumbar spine surgery: a randomized clinical trial.

Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well. Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p<0.05 considered as statistically significant. In all time intervals, pain score in case group was significantly lower than control group. In case group, eight patients demanded rescue analgesic (40%) which was significantly lower than that in control group (15 patients [75%]) (p=0.025). Total amount of meperidine consumption was 57.50±45.95 in control group and 22.50±32.34 in case group (p=0.01) which was higher in control group and statistically significant. ESPB reduces post-operative pain score and opioid consumption, while it does not affect intraoperative bleeding in lumbar spine surgery.

Comparison of Intrathecal Bupivacaine with Clonidine Versus Intrathecal Bupivacaine with Fentanyl for Post-operative Pain Treatment in Lower Limb Procedures

Background: One of the anaesthesiologist's key goals during spinal anaesthesia is to keep the body physiology as close to normal as feasible. As we all know, subarachnoid block causes significant hemodynamic changes, especially in trauma and elderly individuals. Sympathetic nervous system denervation, skeletal muscle weakness, or loss of proprioception are not linked to neuraxial opioids. They primarily operate on the receptors found in the substantia gelatinosa of the spinal cord to exert their synergistic analgesic impact on visceral pain. Opioids and local anaesthetics delivered intrathecally have a powerful synergistic analgesic effect. A 2 adrenergic agonist, Clonidine is sometimes used as a local anaesthetic adjuvant with mixed effects. The effects of intrathecal Clonidine vs Fentanyl with 0.5 percent hyperbaric bupivacaine on postoperative analgesic duration and adverse effects were compared.&#x0D; Objectives: The purpose of this study was to compare the efficacy of 0.5 percent hyperbaric bupivacaine with Clonidine (75 gs) vs Fentanyl (25 gs) for spinal anaesthesia in patients undergoing lower limb procedures, as well as the postoperative pain alleviation and adverse effects in both groups.&#x0D; Methods: This was a prospective study involving 80 patients who were scheduled for elective lower limb surgery under spinal anaesthesia. The participants were randomly assigned to one of two groups: Group C (15mg 0.5 percent bupivacaine + 75gs Clonidine) or Group F (15mg 0.5 percent bupivacaine + 25gs Fentanyl).&#x0D; Results: We discovered a time delay in the start of sensory and motor block in group C after assessing the outcomes of our investigation. Group C's sensory and motor block lasted significantly longer compared to group F. The average duration of analgesia in groups C and F was 234.7529.71 minutes and 170.8732.38 minutes, respectively. Compared to group C, the demand for rescue analgesics was higher in group F throughout 24 hours. Bradycardia affected 12 individuals in group C, while pruritus affected 12 patients in group F. Five of the patients in group F experienced nausea.&#x0D; Conclusion: In compared to 25gs Fentanyl, adjuvant use of Clonidine 75gs with hyperbaric bupivacaine prolongs the duration of both sensory and motor blockage, as well as the length of analgesia postoperatively, without generating substantial hemodynamic compromise or other side effects.

Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy

Background and Aims:Erector spinae plane (ESP) block is a simple and safe interfascial plane block reported to provide good analgesia after thoracolumbar surgeries. We compared its efficacy with conventional peritubal local anesthetic infiltration following percutaneous nephrolithotomy (PCNL).Material and Methods:A total of 60 adult patients posted for elective PCNL were randomly allocated into two groups. Postoperatively, Group I received ultrasound (US) guided peritubular infiltration block with 20 ml of 0.25% levobupivacaine and Group II received US guided ESP block with 20 ml of 0.25% levobupivacaine. The two groups were compared for the time to first rescue analgesic (Injection tramadol), number of rescue analgesic demands, total analgesic consumption in first 24 hours, VAS (rest and dynamic) scores and the adverse effects. The data were analyzed by unpaired t-test and Mann Whitney U test.Results:The time to first rescue analgesic demand was significantly longer in Group II (6.93 ± 2.15 h vs. 16.21 ± 7.53 h). The VAS scores (rest and dynamic) at eight and twelve hours of measurement were significantly lower in Group II (P < 0.05). The number of analgesic demands were less in group II (2.97 ± 0.49 vs. 1.00 ± 1.05). The total analgesic consumption in first 24 hours was less in Group II (148.33 ± 24.51 mg vs. 51.92 ± 45.78 mg).Conclusion:ESP block is a very effective and safe technique to provide prolonged duration of postoperative analgesia following PCNL. Peritubal local anesthetic infiltration is also a reliable technique for postoperative analgesia.