Anesthesia Department Research Articles

The 50% effective dose of hydromorphone and morphine for epidural analgesia in the hemorrhoidectomy: a double-blind, sequential dose-finding study

BackgroundAlthough previous studies have showed that epidural morphine can be used as a complement to local anesthetics for analgesia after postcesarean delivery under spinal anesthesia, there is little known about the analgesic dosage of epidural morphine and hydromorphone for hemorrhoidectomy. Therefore, we conducted this study to examine the potency ratio of hydromorphone to epidural morphine as well as effective analgesic dose for 50% patients (ED50) undergoing elective hemorrhoidectomy.Methods80 patients under elective hemorrhoidectomy with combined spinal and epidural anesthesia(CSEA) in department of anesthesia, Dongguan Tungwah hospital. To assess the ED50, patients were treated with epidural morphine or epidural hydromorphone randomly using a biased coin method-determined dose with a sequential allocation procedure. Following surgery, standardized multimodal analgesia was administered to all patients. A pain response score of ≤ 3 (on a scale of 0–10) was determined to be the effective dose after 24 h following CSEA. The ED50 in both groups were determined using the probit regression and isotonic regression method. We also measured pain intensity by patient interview using a 10 point verbal numeric rating scale prospectively at 6, 12 and 24 h after CSEA, and adverse effects were also noted.ResultsThe ED50 was 0.350 mg (95% CI, 0.259–0.376 mg) in hydromorphone group and 1.129 mg (95% CI, 0.903–1.187 mg) in morphine group, respectively, estimated by isotonic regression method. Regression analysis with the probit, the ED50 of epidural hydromorphone was 0.366 mg (95% CI, 0.276–0.388 mg) and epidural morphine was 1.138 mg (95% CI, 0.910–1.201 mg). Exploratory findings showed that there was no difference between the most frequent dosages of epidural hydromorphone or epidural morphine in the occurrence of nausea, vomiting and pruritus. When administered with epidural opioids at ED50 doses or higher, 97.5% (39/40) of epidural morphine patients and 97.5% (39/40) epidural hydromorphone of patients were satisfied with their analgesia.ConclusionEffective hemorrhoidectomy analgesia requires a 3:1 ratio of epidural morphine to epidural hydromorphone. Both drugs provide excellent patient satisfaction.

The Practice of Multimodal Analgesia Technique for Patients Undergoing Surgery under General Anaesthesia in Debre Markos Compersive Specialized Hospital Debre Markos, East Gojjam, Ethiopia, 2022. A Cross-Sectional Study

Background: Practice guidelines for preoperative pain management recommend that multimodal analgesic therapy should be used for postsurgical patients. This method uses different analgesic agents, which may target different components of pain transmission to improve post-operative analgesia and decrease reliance on opiate-based medication. The practice of Multimodal analgesia includes the combined use of neuraxial blockage regional anesthesia and systemic medications and has been shown to reduce opioid use and side effects in surgical patients. However, the proportion of patients who receive this evidence-based approach is unknown. To assess the practice of multimodal analgesia among patients undergoing surgery under general anesthesia at Debere Markos Compressive Specialized Hospital, Northwest Ethiopia, 2022. Methods: After obtaining ethical approval a hospital-based cross-sectional study was conducted from February 22 to May 10, 2022, in Debere Markos Compressive specialized hospital. Data was collected, prospectively using questionnaires from anesthetists, nurses in the recovery room, and anesthesia record sheets. Patients were considered to have multimodal analgesia if they received two or more analgesics. Descriptive statistics were performed to identify the practice of multimodal analgesia. Results: A total of 200 participated in our study. We observed the practice of multimodal analgesia in patients who had undergone surgery under general anesthesia in the study period was 47%. Opiod is the most widely administered analgesia. It was given to 81.5% of patients. The practice of multimodal analgesia in emergency surgery was found to be 61.7%. During the study period, multimodal analgesia was more practiced among Bsc anesthetists and it was found to be 42.5%. The practice of multimodal analgesia in PACU was found to be 9%. Conclusion and Recommendation: The practice of multimodal analgesia for surgical patients in Debre Markos Specialized Compressive Hospital is underutilized. Anesthesia professionals should use a multimodal approach for preoperative pain management for all surgical patients. The Department of Anesthesia should develop a guideline for the treatment of perioperative pain.

Dexmedetomidine in Fluoroscopic Guided Splanchnic Nerve Neurolysis for Pain Control: A Randomized, Controlled Trial

BACKGROUND: Splanchnic nerve neurolysis (SNN) shows beneficial effects in reducing malignancy-associated refractory abdominal pain. Using adjuvants, such as dexmedetomidine to improve the pain was studied. OBJECTIVE: To detect any role of dexmedetomidine as an additive to local anesthetics with an alcohol injection in the chemical SNN process to improve pain in patients having upper-abdominal cancer. STUDY DESIGN: Double-blinded, prospective randomized study. SETTING: Department of Anesthesia and Intensive Care, faculty of medicine, Minia University, Egypt. METHODS: Forty patients with upper-abdominal malignancy-associated refractory abdominal pain underwent fluoroscopic guided SNN were divided into 2 groups. The SNN was performed by using 1.5 mL lidocaine 1%, dexmedetomidine 2 mu-g/kg, and then an injection of 4.5 mL of ethanol 96% on each side in group D and without dexmedetomidine in group C is done. Patients gave the score of abdominal pain expressed by the Visual Analog Scale (VAS), which measures the pain intensity. Scors were recorded prior to injection, during injection, after injection by 5 min, and after 2, 6, 12, 24, 72 hours, one week (W), 2 W, one month (M), and 2 M. Also, we recorded the amount of morphine required to relieve the residual pain after injection, the effect of procedure on quality of life (QOL), and any complication after injection. RESULTS: VAS scores showed a significant increase in group C in comparison to group D during injection, after injection by 5 min, 2, 6, 12, 24 hours, one and 2 months (P < 0.0001, 0.0001, 0.029, 0.031, 0.025, 0.040, 0.020, 0.015), respectively. The morphine requirement was significantly increased at one W, one M, and 2 M in group C in comparison to Group D (P < 0.044, 0.017, 0.033) with no significant change in the QOL observed between groups. LIMITATIONS: The limitations of this study were a relatively small sample size and short period of follow-up. CONCLUSIONS: This study revealed that using dexmedetomidine in the chemical SNN process improves the pain results from injection of alcohol and refractory cancer related pain with reduction in the consumption of morphine in patients with upper-abdominal malignancy. KEY WORDS: Splanchnic nerve neurolysis, dexmedetomidine, alcohol, chronic cancer pain

Comparison of Intravenous Dexamethasone along with Caudal Block versus Caudal Block Alone for Postoperative Analgesia in Pediatric Lower Abdominal Surgeries

dexamethasone to a caudal block in enhancing the duration and quality of postoperative analgesia in pediatric patients undergoing lower abdominal surgeries. Methodology: This Randomized Control Trial was carried out Department of Anesthesia, Holy Family Hospital, Rawalpindi from December 2021May 2022. Patients fulfilling inclusion criteria were divided into two groups. Both groups received caudal block with 1 ml/kg of 0.25% Bupivacaine while group A received 0.25 mg/kg of Dexamethasone intravenously as an adjuvant. Post operatively patients were assessed by FLACC scores at different time intervals. All surgeries were conducted under general anesthesia with endotracheal intubation. Either Mapleson F (Jackson Rees Modification of Ayre’s T piece) or circle system used as breathing circuit. Induction of anesthesia using propofol at a dose of 2-2.5 mg/kg along with O2 100% or with sevoflurane 2 to 3% at fresh gas flow of 6 L/minute was carried out. Data was analyzed using SPSS 26.0. Results: Mean duration of analgesia in Group A was 7.77 ± 1.38 hours while it was 5.44 ± 0.91 hours in group B. The difference was statistically significant with a p value of less than 0.05 on Mann Whitney U test. Conclusion: Addition of intravenous dexamethasone to caudal block significantly enhances the duration and quality of analgesia among pediatric patients undergoing lower abdominal surgeries.

Evaluation of Preventive Effect of Zinc Lozenge on Sore Throat after Placement of ProSeal Laryngeal Mask Airway: A Randomised Controlled Study

Introduction: Postoperative Sore Throat (POST) is a known complication after general anaesthesia with an endotracheal tube (14.4% to 50%) and less so with Supraglottic Airway (SGA) devices (5.8% to 34%). Various modalities and drugs can decrease POST. Zinc possesses anti-inflammatory and antioxidant properties and is utilised in oral mucositis and xerostomia. Aim: To evaluate the effect of preoperative administration of a zinc lozenge on POST after the removal of the Proseal Laryngeal Mask Airway (PLMA). Materials and Methods: In this randomised, double-blinded controlled study was conducted at the Department of Anaesthesia at Pt. BD Sharma PGIMS, Rohtak, Haryana, India, over a period of five months from August 2020 to December 2020. 100 patients aged 18-60 years of either sex belonging to American Association of Anesthesiologists (ASA) I and II undergoing elective surgery under general anaesthesia with PLMA placement were randomly allocated into two groups to receive a 40 mg zinc lozenge (Group-I) or placebo (Group-II) and were asked to chew it 30 minutes preoperatively. Patients with upper respiratory tract infections, at risk of aspiration, or with anticipated difficult intubation were excluded from the study. The incidence and severity of POST were assessed on a 4-point scale (0-3) at 30 minutes, 2, 4, and 24 hours postoperatively. The primary outcome of the study was the incidence of POST at four hours postoperatively, and the secondary outcome was the severity of POST at 30 minutes, two hours, and 24 hours postoperatively. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software programme. The Chi-square test and unpaired t-test were used for statistical analysis. Results: The mean age in Group-I was 38.6±12.32 years and in Group-II was 37.90±14.84 years (p-value 0.79). Data regarding the distribution of patients according to sex were comparable with a p-value of 0.31. There was a significantly lower incidence of POST in Group-I (zinc group) than in Group-II (placebo group) at four hours with a p-value of 0.004. Conclusion: The present study has shown that the preoperative administration of a 40 mg zinc lozenge effectively reduces the incidence and severity of POST in the postoperative period, peaking at four hours after general anaesthesia. Zinc lozenges are easy, convenient, non invasive, and successfully prevent POST.

Study to compare the incidence of post-dural puncture headache in obstetric patients using cutting and pencil-point spinal needle in spinal anesthesia

Background: Spinal anesthesia is one of the most commonly used regional anesthesia techniques. Post-dural puncture headache (PDPH) is a well-known iatrogenic consequence of spinal anesthetic and diagnostic lumbar puncture, primarily caused by loss of cerebral spinal fluid. To reduce complications, spinal needles have undergone modifications. The two most important modifiable risk variables for PDPH were needle shape and size. In young expecting mothers, post-cesarean sections are associated with an increased incidence of PDPH. Aims and Objectives: The aims and objectives of the study are to compare the incidence of PDPH in obstetric patients using cutting and pencil-point spinal needles following spinal anesthesia. Materials and Methods: This 1-year double-blind study was carried out in the Department of Anaesthesia from August 2021 to July 2022. The study comprised obstetric patients who were scheduled for elective-segment cesarean section. The subarachnoid block needle was divided into Groups A and B at random: Group A 25-gauge Whitacre spinal needle with a pencil point, whereas Group B 25-gauge Quincke spinal needle with a cutting bevel. Records were kept on age, height, weight, and gestational age. A follow-up was conducted up until the discharge date. The incidence and severity of PDPH after spinal anesthesia were examined in both groups. The results were analyzed with SPSS 20.0, and the Fischer exact and Chi-square tests were used to look for statistical significance. Results: The current study included 120 patients in total, 60 patients in each of Groups A and B. When a pencil point Whitacre was used, the incidence of PDPH was 2 (3.3%), however, when a cutting Quincke needle was used, the incidence was 7 (10.8%). With a P < 0.05, the relationship between the two was considered statistically significant. The pain severity was mild in both patients of Group A. Of the seven patients in Group B, four had mild pain, two had moderate pain, and one had severe pain. Conclusion: The pencil-point 25-G Whitacre spinal needle has a lower incidence of PDPH than the traditional 25-G Quincke needle and was suggested for patients at risk of PDPH. In light of this, the current study suggested using pencil-point spinal needles for lumbar punctures and spinal anesthesia in obstetric patients.

Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal isobaric levobupivacaine in lower segment caesarean section

Background/Aim: Caesarean section is one the most common surgeries encountered in the operating room worldwide in the younger demo-graphic ages from 18-39 years of age. The objective of this study was to compare the efficacy of dexmedetomidine versus fentanyl as adjuvants to intrathecal levobupivacaine in the lower segment caesarean section. Methods: This quasi-experimental study was carried out at the Anaesthesia Department, Combined Military Hospital, Rawalpindi, Punjab, Pa-kistan from July 2021 to July 2023. A total of 240 patients were studied. They were divided into the dexmedetomidine group (n = 120) and fentanyl group (n = 120) group. Patients in both groups received 2.5 mL of 0.5 % of isobaric levobupivacaine with the dexmedetomidine group receiving 5 mcg of the drug and the fentanyl group 25 mcg of fentanyl to a total volume of 3 mL. Primary variables measured were: time to complete sensory and motor block, total duration of the block, time to first rescue analgesia after block regression in the post anaesthesia care unit (PACU) and mean PACU stay. Secondary variables observed were hypotension, nausea, vomiting and shivering. Results: The time on onset for a sensory block in the dexmedetomidine group was delayed compared to the fentanyl group (4.35 ± 0.14 min and 3.39 ± 0.11 min, respectively), (p < 0.0001). The duration of the block was longer for the dexmedetomidine group with a mean time of 327.26 ± 12.60 min versus 243.3 ± 22.75 min (p < 0.0001). When comparing the motor blockade, the time of onset to successfully reach Bromage score 3 was similarly delayed in the dexmedetomidine group with a mean time of onset of 3.33 ± 0.12 min versus 2.36 ± 0.09 min (p < 0.0001). A similar trend was seen in the duration of the block with a mean time of 262.17 ± 13.31 min versus 203.34 ± 1.47 min (p < 0.0001). Conclusion: Dexmedetomidine offered advantages over fentanyl as an adjunct to levobupivacaine spinal anaesthesia with a longer block duration and less adverse effects profile. It is recommended to use dexmedetomi-dine due to its better safety profile, longer duration and better hemodynamic stability. Fentanyl should be reserved when the early onset of the block is required in emergency cases.

A Single-Centre Experience of an Anesthesia-Led Pediatric Peripherally Inserted Central Catheter Service at a Specialized Cancer Institute

Introduction: To report our experience of establishing a pediatric peripherally inserted central catheter (PICC) line procedure led by the anesthesia department of a tertiary care cancer center. Materials / Patients and Methods: A retrospective review was conducted over a period of 28 months. Variables such as demographic data, indications, the number of days the line remained in situ, and the frequency of adverse events were considered. Results A total of 112 patients between the ages of one and fourteen years who had PICC lines inserted were included. All procedures were done under general anesthesia by two separate anesthesia teams with established protocols. Insertion was guided by ultrasonography through the basilic (n = 84, 75%), median cubital (n = 12, 10.7%), femoral (n=1, 0.9%), or cephalic (n=15, 13.39%) veins in the non-dominant arm. The insertion success rate was 97.3% while the unsuccessful in 2.7%. The 4Fr (French number) PICC line was used in 95 (84.82%) patients and 5F in 17 (15.17%) patients. The PICC line was used for an average of 85.47 days (ranging from 0 to 350 days). Chemotherapy (n = 89, 78.47%), difficult Intravenous (IV) access (n=15, 13.39%), and palliative care (n=8 7.14%) patients require long-term venous access. 38 (33.92%) patients had completed treatment with PICC line while 4 (3.57%) patients lost follow-up. Conclusion: PICC - lines are an essential element of cancer treatment in children. Anesthesia-led PICC line service is a reliable option. They maintain operating room, PICC line sterility during insertion, and complications comparable to follow the recommended precautions.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p < 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

Comparison of Dexmedetomidine with Tramadol for Treatment of Shivering Post Spinal Anaesthesia

Objective: To compare the efficacy of Dexmedetomidine with Tramadol for shivering post-spinal anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: A total of 158 patients who underwent gynaecological, orthopaedic and general surgical procedures under spinal anaesthesia using 0.5% hyperbaric Bupivacaine 12-15 mg were included in the study. Out of these 158 patients, 64% (102 patients) developed shivering after spinal anaesthesia. These 102 patients were divided into two equal groups, i.e., Group-D (n=51), who received 0.5 μg/kg Dexmedetomidine and Group-T (n=51), who received 0.5 mg/kg tramadol. The response in the next 15 mins was evaluated objectively as “effective” or “non-effective” by the treating Anesthesiologist. Results: Dexmedetomidine and Tramadol were effective in treating shivering following spinal anaesthesia. Our study showed that Dexmedetomidine was more effective than Tramadol in treating shivering, with an effectiveness of 88.2 % shivering relief in Group-D and an effectiveness of 51 % shivering relief in Group-T. The effectiveness was significant in both groups, with statistical significance in Group-D compared to Group-T (p<0.05). Conclusion: Shivering relief was more responsive in patients who received Dexmedetomidine than Tramadol after spinal anaesthesia.

Comparative Efficacy of Fentanyl Vs Dexmedetomidine Intrathecally as an Adjuvent to Isobaric Levo-Bupivacaine in Infra-Umbilical Surgery: A Prospective Randomized Study

Background: Fentanyl is a potent, highly lipophilic, synthetic opioid analgesic used as an adjuvant in spinal anaesthesia. Dexmedetomidine is also a potent, lipophilic, selective α2-adrenergic agonist. Compared to Dexmedetomidine, it has an earlier onset of block, better intraoperative analgesia with increased side effects(such as, nausea, vomiting or respiratory depression). Aim: To compare Fentanyl(25 ug) versus Dexmedetomidine(10 ug) as an adjuvant with 0.5% isobaric Levo-Bupivacaine in infra-umbilical surgeries. Material & Methods: A prospective, randomized, controlled study. Department of Anaesthesia, K. D. Medical College, Hospital and Research Centre in Mathura. Patients between 20-60 years of either sex, ASA Grade I – II, scheduled for elective infra-umbilical procedures with no co-morbid conditions. Simple random method(sealed envelope). Results: The sensory block duration is 7.71±0.31 hrs in D group and 3.78±0.83 hrs in group F with p value <0.05. The mean time taken for attaining motor blockade is 2.06 ± 1.17 mins in D group, 2.45 ± 1.39mins in F group. but statistically not significant between group D and in F group (p=0.2). The motor block duration is 7.33 ± 0.28hrs in group D and 3.39 ± 0.91 hrs in F group which suggestive of statistically highly significant (p=0.001). Conclusion: In infra-umbilical surgery, levo-Bupivacaine with adjuvant dexmedetomidine (10 ug) intrathecally has a longer duration of sensory and motor block with preserved hemodynamic stability and lesser adverse effects in comparison to adjuvant fentanyl(25 ug). However, onset of sensory block is earlier with fentanyl.

Comparison of the Mean Post-Operative Pain Score with Ultrasound Guided Transversus Abdominis Plane (TAP) Block and Wound Infiltration with Local an Aesthetic Agent in Abdominal Surgeries

Objectives: To compare the mean post-operative pain score with ultrasound-guided transversus abdominis plane block and wound infiltration with local anaesthetic agents in abdominal surgeries. Study design: Comparative prospective study Place and Duration of Study: Department of Anaesthesia, Intensive Care and Pain Management, Combined Military Hospital, Bahawalpur Pakistan, from Oct 2018 to Apr 2019. Methodology: Sixty patients undergoing abdominal surgery aged 18-60 years were included. The patients in Group-A received transverses abdominis plane block with 20 ml of 0.25% Bupivacaine bilaterally, while those in Group-B received 20 ml of 0.25% Bupivacaine as local wound infiltration. Each patient was followed till 6 hours post-operatively. Results: Out of 60 patients, 35(58.33%) were male, and 25(41.67%) were females. In our study, the Visual analogue score was 1.63±0.85 in Group-A (ultrasound-guided TAP block) compared with 4.47±1.07 in patients with Group-B (wound infiltration with a local anaesthetic agent) with a p-value of 0.001, which was statistically significant. Conclusion: The study concluded that the mean pain score in patients with ultrasound-guided Transversus abdominis plane block is less compared to wound infiltration with local anaesthetic agents in abdominal surgeries.

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Pain Management after Total Abdominal Hysterectomy

Background: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.Methods: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.Results: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min & 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p< 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p< 0.001).Conclusion: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.

Comparison Between Caudal and Combined Caudal with Spinal Anesthesia in Paediatric Bilateral Inguinal Hernia Surgery

Objective: To compare the analgesic efficacy and adverse effect profile of using caudal anaesthesia versus caudal combined with spinal anaesthesia for paediatric patients undergoing bilateral inguinal hernia surgery. Study Design: Prospective longitudinal study. Place and Duration of Study: Anaesthesia Department of Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Eighty paediatric patients between ages 5-10 years requiring bilateral inguinal hernia repair were included in the study. The Caudal Group received 0.25% Bupivacaine per the Armitage regime at a 1 ml/kg volume to reach an effective sensory level of T10. The Combined Group received spinal anaesthesia at a dose of 0.3 mg/kg for >15 kg patients and 0.4 mg/kg for 5-15 kg patients in the L4-L5 epidural space for an effective spinal level of T10. Once the spinal was administered, the same caudal dose as per the caudal Group's Armitage regime. Results: The total duration of block and subsequent reversal to the S1 level was 326.2±12.6 minutes in the Caudal Group versus 441.22±31.8 minutes in the Combined Group (p<0.001). The mean time for the first dose of analgesia for pain was required after 5.27±0.24 hours in the caudal versus 7.03±0.20 hours in the Combined Group. Conclusion: We conclude that the combined caudal spinal approach offers better and superior pain control, resulting in less IV analgesic requirement and less hospital stay, offering a good alternative to general anaesthesia in paediatric surgeries.

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications in the Post-anesthesia Care Unit: A Prospective Observational Study.

Background Neuromuscular blocking agents (NMBAs) are employed during general anesthesia induction for endotracheal intubation and to facilitate specific surgeries requiring muscle relaxation. However, residual neuromuscular blockade (RNMB) can lead to respiratory complications in post-anesthesia care units (PACUs). This study investigates RNMB incidence in PACUs and its association with postoperative airway and respiratory issues. Methods A prospective observational study on patients undergoing general anesthesia with NMBAs was conducted at the Department of Anesthesia, Salmaniya Medical Complex, Bahrain, over six months (April to September 2023). Train-of-four (TOF) ratios were calculated using an acceleromyograph upon PACU arrival. Data on demographics, perioperative variables, and postoperative complications were recorded. Results Among 82 patients, 30 (36.6%) had RNMB upon PACU arrival. RNMB incidence declined: 17.1% at 10 minutes, 6.1% at 20 minutes, and 2.4% at 30 minutes, resolving by 40 minutes. Demographics and procedure duration showed no correlation with RNMB. Postoperative respiratory complications affected 23.2% of patients, notably higher in those with RNMB (p = 0.001). Among patients with TOF <90% at PACU arrival, 46.7% experienced complications compared to 9.6% with TOF ≥90% (p<0.001). Participants without RNMB had a significantly higher weight (p = 0.046). Airway support was required for 30% of patients, all with TOF <90% (p<0.001). Conclusion This study emphasizes the importance of assessing and monitoring neuromuscular function to detect and prevent RNMB in PACUs. RNMB presence correlated with an increased susceptibility to postoperative respiratory complications. Regular quantitative neuromuscular monitoring is advisable in clinical practice to proactively mitigate RNMB incidence and its complications.

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

ObjectivesAnaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of the...

Implementation and evaluation of an event reporting system in an academic anaesthesia department

BackgroundReporting adverse clinical events is essential to a culture of safety in healthcare. However, self-reporting such events is generally not widely prevalent in a typical academic anaesthesia department.MethodsWe set out...

Oral cannabidiol (CBD) as add-on to paracetamol for painful chronic osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial.

Painful knee osteoarthritis (KOA) is common, pharmacological treatment, however, is often hampered by limited tolerability. Cannabidiol, which preclinically showed anti-inflammatory, analgesic activity, could supplement established analgesics, but robust clinical trials are lacking. The aim of our study was to investigate the effects of oral high-dose CBD administered over 8 weeks on pain, function and patient global assessment as an add-on to continued paracetamol in chronic symptomatic KOA. Prospective, randomized, placebo-controlled, double-blind, parallel-group study. Single center, Outpatient Clinic, Department of Special Anaesthesia and Pain Therapy at Medical University of Vienna, Austria. Eligibility criteria included: age: 18-98 years; painful KOA; score ≥5 on the pain subscale of the Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Index; KOA confirmed by imaging. Participants were on continued dosage of paracetamol 3g/d and randomly assigned by web-based software 1:1 to oral cannabidiol 600mg/d (n=43) or placebo (n=43). Study period: 8 weeks. Primary outcome: Change in WOMAC pain subscale scores (0=no pain, 10=worst possible pain) from baseline to week 8 of treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04607603. Trial is completed. The trial was conducted from October 1, 2020 to March 29, 2022. 159 patients screened, 86 randomized. Among 86 participants (mean age, 62.8 [SD 20.3] years; 60 females [69.8%]), 58 (67.4%) completed the trial. Mean baseline WOMAC pain subscale was 6.0±1.1. Analysis: Intention-to-treat principal. Mean reduction in WOMAC pain subscale was 2.5 (95% CI: 1.8-3.3) in the cannabidiol group and 2.4 (95% CI: 1.7-3.2) in the placebo group with no significant group difference (p=0.80). Adverse events were significantly more frequent with cannabidiol (cannabidiol: 135 [56%]; placebo: 105 [44%]) (p=0.008). Rise above baseline of liver aminotransferases and gamma-glutamyltransferase was significantly more common in the cannabidiol (n=15) than the placebo group (n=5) (p=0.02). In KOA patients, oral high-dose add-on cannabidiol had no additional analgesic effect compared to adding placebo to continued paracetamol. Our results do not support the use of cannabidiol as an analgesic supplement in KOA. Trigal Pharma GmbH.

A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions

: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I &amp; II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.

Knowledge and Attitudes of Anesthesia Staff on Pain in the Hospitals of Niamey

Aim of the study: To assess the knowledge and attitudes of anesthesia staff on the management of pain in the hospitals of Niamey. Patients an method: This was a multicenter descriptive cross-sectional study carried out in five hospitals in Niamey (Republic of Niger) from July 3rd to December 3rd, 2021. Were been included in the study, all the anesthesia staff who agreed to answer the questionnaire. The variables studied were: age, gender, seniority, sector of activity and qualification, definition of pain, different types of pain, the impact of pain on the body, tools used for assessment of pain, difference between acute and chronic pain, knowledge about analgesics, the practical attitudes of pain management. The data were intered and processed with Epi info 7.2 software and the Microsoft Office 2019 pack. Results: Our study concerned 106 agents from the anesthesia and resuscitation department of the hospitals that served as our study framework. There is a female predominance of 55.42% with a sex ratio of 0.80. The 45-54 age group was the most represented with 40.07% of cases. The average age of respondents was 44.95 ± 8.9 years. Anesthesia nurses were the most represented with 90.36%. The operating theatre unit was the most represented sector of activity with 85.54%. All the respondents knew the definition of pain. The different types of pains were known by 45.78% of respondents. The most used pain scales were visual analog scale (VAS) and verbal descriptor scale (VDS) respectively in 53.01 % and 12.05 % of cases. Tramadol and paracetamol were the mostly used analgesics respectively in 98.80 % and 97.59%. Intravenous morphine titration was known to 67.47% of the respondents. Only 18.07% of the respondents benefited from a training on the management of pain. Conclusion: The knowledge and attitudes of anesthetists on pain deserve to be updated through theorical and practical training to improve the management of pain in our hospitals.