Analgesic Dose Research Articles

Efficacy of Gasserian Ganglion High‐Voltage, Long‐Duration Pulsed Radiofrequency Combined With Block on Acute/Subacute Zoster‐Related Trigeminal Neuralgia

Background: Trigeminal postherpetic neuralgia (TPHN) is a severe chronic pain that can lead to various socioeconomic consequences. Therefore, it is necessary to explore optimal treatment options for acute/subacute herpes zoster (HZ)–related trigeminal neuralgia and prevent the further development of TPHN. High‐voltage, long‐duration pulsed radiofrequency (HL‐PRF) of the Gasserian ganglion is a new surgical intervention used to treat PHN. A ganglion block has been reported to possess anti‐inflammatory effects and potential analgesic benefits.Methods: We included 83 patients with HZ‐related acute/subacute trigeminal neuralgia admitted from January 1, 2021, to June 1, 2023, and received Gasserian ganglion HL‐PRF combined with block. A 6‐month follow‐up was conducted, including Numerical Rating Scale (NRS) scores, Pittsburgh Sleep Quality Index (PSQI), the incidence of TPHN, the dosage of anticonvulsants and analgesics, efficacy, and adverse events.Results: All patients showed a significant decrease in postoperative NRS scores (p < 0.05). The NRS scores of the acute HZ group were consistently lower than those of the subacute HZ group at different time points (p < 0.01). The overall incidence of TPHN from the onset of HZ to 12 weeks is 21.68%. The incidence of TPHN in the acute phase group was 12.77%, significantly lower than the 33.33% in the subacute phase group (p = 0.024). The effective rate was 74.7% in all patients, at 3 months after the treatment. The effective rate was 82.98% in the acute phase group and 63.89% in the subacute phase group, showing a statistically significant difference (p = 0.047). The PSQI score of the acute group was consistently lower than that of the subacute group (p < 0.01). The dosage of analgesics and anticonvulsants used in the acute HZ group was lower than that in the subacute group (p < 0.01). All patients did not experience serious adverse reactions.Conclusions: Gasserian ganglion HL‐PRF combined with block can be an effective and safe technique to relieve the pain of acute/subacute zoster‐related trigeminal neuralgia and prevent the incidence of TPHN.

The effectiveness of intravenous ibuprofen versus intravenous ketorolac for postoperative pain relief after caesarean section

Background Caesarean deliveries are currently the most frequent surgical procedure performed worldwide. Nonsteroidal anti-inflammatory drugs are frequently used to control postoperative pain as a part of the multimodal analgesia technique. We studied the efficacy of intravenous ibuprofen versus intravenous ketorolac to relieve postoperative pain following caesarean delivery under general anaesthesia. Patients and methods Fifty adult parturients aged 20–30 were studied and classified to the American Society of Anaesthesiologists (ASA) class II scheduled for elective caesarean delivery under general anaesthesia. Patients were divided into groups: group A (n=25), 30 mg ketorolac in 200 ml normal saline every 6 h, and group B (n=25), 800 mg ibuprofen in 200 ml normal saline every 6 h. They were evaluated for haemodynamic stability, visual analog score (VAS) score, 24-h opioid requirement, time to ambulate, and time to first analgesic dose. Results Group B (ibuprofen group) showed a lower VAS score through all the 24 h postoperatively at rest and during movement with allover VAS at rest (3.17±1.08) versus (4.32±1.3) P=0.008 and allover VAS during movement (3.21±1.11) versus (4.56±1.92) P=0.001. Also, lower 24-h opioid requirement in group B (ibuprofen group) with a mean value of (42.0 ±21.31) mg versus (110.0±17.68) mg in group A (ketorolac group) P=0.0021 and longer time to first analgesic dose in group B (ibuprofen group) with a mean value of (328.0±89.63) min versus (158.40 ±57.13) min in group A (ketorolac group) P=0.001 with more haemodynamic stability. Group B also showed lower ambulation time and less nocturnal awakening due to pain. Conclusions Intravenous ibuprofen is more effective than intravenous ketorolac in reducing postoperative pain following caesarean delivery. It reduces the 24-h opioid requirement and VAS at rest and during movement.

A Prospective Study of Total Extra Peritoneal Inguinal Hernia Repair Fixation versus no Fixation of Mesh

Background: The necessity of mesh fixation in laparoscopic totally extra peritoneal (TEP) inguinal hernia repair remains controversial. We performed a single-center prospective study to compare the effectiveness of mesh fixation versus nonfixation in laparoscopic TEP repair. Materials and Methods: This study was conducted in the Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India, from August 2021 to July 2023. All patients admitted to the General surgical unit with uncomplicated inguinal hernias were included. A total of 96 patients were included in the study, of which 44 patients underwent TEP repair with fixation of mesh using tacks (GROUP A) and the remaining 52 patients whose mesh was not fixed (GROUP B). Results: Ninety-six patients were randomized to fixation or non-fixation group in TEP. The pain scores at 24 hours, 72 hours, 7 days, 1 month, and 3 months were comparable, but not statistically significant (Day 1 Fixation, 2.7 ± 0.79; Non-fixation 2.48 ± 0.78, P = 0.104, 1 week (Fixation, 0.02 ± 0.15; Non-fixation, 0.08 ± 0.27, P = 0.236). The length of hospital stay (Fixation, 2.07 ± 0.59 days; Non-fixation, 2.1 ± 0.41 days, P = 0.785) and days taken to resume normal activities (Fixation, 3.7 ± 1.02 days; Non-fixation, 3.54 ± 0.94 days, P = 0.41) were also similar for both groups. There was no recurrence in either group at a minimum follow-up of 12 months. The cost of surgery was significantly different between the fixation group and the nonfixation group with a p-value <0.0001. Conclusion: There was no statistical significance between the fixation and non-fixation groups in terms of postoperative pain, requirement and dosage of analgesics, duration of in-hospital stay, time to return to normal activity, complications, recurrence of hernia, except the cost of surgery which was higher in the fixation group.

Application of Dexmedetomidine in Epidural Labor Analgesia: A Systematic Review and Meta-Analysis on Randomized Controlled Trials.

To summarize and appraise the use of dexmedetomidine in epidural labor analgesia, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We conducted the literature search about the RCTs of epidural labor analgesia with or without dexmedetomidine from inception until Nov 1,2022 in the following databases: PubMed, the Cochrane Library and Embase. The primary outcome was visual analogue scale(VAS) within 2h after epidural intubation. The secondary outcomes included the duration of the first and second labor stage, Apgar score, umbilical blood pH, dosage of analgesics, and side effects. 8 RCTs including 846 parturients were included. The VAS score of dexmedetomidine group was significantly lower than that of the control group at the time of 15min(MD -1.41,95%CI -2.23,-0.59)、30min(MD -1.02,95%CI -1.70,-0.33)、60min(MD -0.90,95%CI -1.36,-0.44)、90min(MD -0.70,95%CI -1.16,-0.23). The incidence of pruritus in dexmedetomidine group was lower than that of control group（MD 0.28,95%CI 0.11,0.74）but the incidence of maternal bradycardia was higher (MD 6.41,95%CI 1.64,25.04). There were no significant difference in other outcomes. Dexmedetomidine combined with local anesthetic for epidural labor analgesia can improve the VAS score of parturients. Except for the increased incidence of maternal bradycardia, it seems to be safe for the parturients and fetuses.

Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trial.

Although laparoscopic cholecystectomy (LC) is a minimally invasive surgery, it can cause moderate to severe postoperative pain. Erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are considered effective means for pain management in such cases; however, there is inconclusive evidence regarding their analgesic efficacy. This meta-analysis aimed to compare the efficacy of ESP block and TAP block for pain control in LC. We systematically searched Medline, PubMed, Scopus, Embase, and Google Scholar until 26 January 2024. All randomized clinical trials compared the efficacy of erector spinae plane block (ESPB) and transversus abdominis plane block (TAPB) for postoperative pain relief after LC. The primary outcomes were pain scores at rest and on movement at 1, 2, 6, 12, and 24 h postoperatively. The secondary outcomes were total opioid consumption, first analgesia request time, and rates of postoperative nausea and vomiting. We analyzed all the data using RevMan 5.4. A total of 8 RCTs, involving 542 patients (271 in the ESPB group and 271 in the TAPB group), were included in the analysis. The ESP block demonstrated statistically significant lower pain scores at rest and on movement than the TAP block at all-time points except at the 1st and 6th h on movement postoperatively; however, these differences were not considered clinically significant. Additionally, patients who received the ESP block required less morphine and had a longer time before requesting their first dose of analgesia. There were no significant differences in postoperative nausea and vomiting incidence between the two groups. In patients undergoing LC, there is moderate evidence to suggest that the ESP block is effective in reducing pain severity, morphine equivalent consumption, and the time before the first analgesia request when compared to the TAP block during the early postoperative period.Systematic review registration: PROSPERO CRD42024505635, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024505635.

Efficacy of memantine premedication in alleviating postoperative pain- A systematic review and meta-analysis.

Many premedication agents with opioid-sparing properties have been used in patients undergoing various elective surgeries. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has been used by many researchers as an opioid-sparing strategy. Various databases like PubMed, Scopus, Cochrane Library, and clinicaltrials.gov were searched after registering the review protocol in PROSPERO for randomized-controlled trials (RCTs) that investigated the efficacy and safety of memantine premedication in adult patients undergoing various elective surgeries. The risk of bias (RoB-2) scale was used to assess the quality of evidence. From the 225 articles that were identified after a database search, 3 studies were included for a qualitative systematic review and a quantitative meta-analysis. The pooled analysis revealed that the use of memantine provided better pain scores at 2nd (mean difference: -0.82, 95% CI: -1.60, -0.05, P = 0.04) with significant heterogeneity (P = 0.06; I² =71%), and 6 hours postoperatively (mean difference: -1.80, 95% CI: -2.23, -1.37, P < 0.00001), but not at 1 hour. The sedation scores at 1 hour were higher in the memantine group but comparable in the 2nd hour. The number of doses of rescue analgesia and nausea/vomiting in the postoperative period was comparable in both groups. The results of this review suggest that memantine premedication could provide better pain scores in the immediate postoperative period with acceptable adverse effects. However, the current evidence is insufficient to suggest the routine use of memantine as a premedication before elective surgeries.

Анализ эффективности интраоперационной локальной инфильтрационной аналгезии при эндопротезировании коленного сустава

The problem of postoperative pain after knee replacement is a significant problem that worsens the condition of patients and impedes the activation and rehabilitation of patients. To prevent the development of severe pain after knee replacement, local infiltration analgesia has been proposed, including an anesthetic drug, a non-steroidal anti-inflammatory drug and adrenaline.Purpose of the study: to evaluate the effectiveness of local infiltration analgesia in knee replacement with assessment of postoperative pain.Methods. A single-center retrospective study examined the outcomes of 81 patients with knee osteoarthritis who were scheduled for primary knee replacement between January 2022 and December 2023. Patients in the main group (40 people) were administered a single dose of local infiltration analgesia intraoperatively, while patients in the control group (41 people) did not. The results were compared in terms of postoperative pain and narcotic analgesic consumption in both groups.Results. Patients in the study group had significantly lower pain scores from the first postoperative day (VAS was 3.05) to the fourth postoperative day (2.75) compared with the control group (5.06 and 3.2) (p&lt;0.001) . The consumption of narcotic analgesics in the main group was also much lower compared to the control group.Conclusions. The use of local infiltration analgesia during surgery can effectively reduce postoperative pain and the need for narcotic analgesics in patients with knee replacement.Key words: endoprosthetics, infiltration analgesia, knee joint, postoperative pain.

Evaluation of the anodyne effect of Terminalia bellirica fruit pulp in mouse models of Swiss albino strain

Background: Terminalia bellirica has been extensively investigated and used since time immemorial as part of Ayurvedic practice entirely because of its curable properties. Their antioxidant, hepatoprotective, antibacterial, and immunemodulatory activities are mostly attributed to the presence of glucoside, gallic acid, and its esters, chebulinic acid, etc. Aims and Objectives: The aim of the study is to analyze the effects of sub-acute administration of T. bellirica fruit pulp aqueous extract (TBFPAE) in ameliorating pain in mouse models of the Swiss albino strain. Materials and Methods: Young mice of Swiss albino strain typically 3 months’ of age; Male gender and weighing approximately 20–30 g were used for the purpose of the study. The mice were investigated by grouping them into five sets of six each randomly as control, standard, and trial groups. Group I was allotted as vehicle and given 1% gum acacia (10 mL/kg) as control; Group II was given pentazocine (5 mg/kg) as standard for central anti-nociceptive activity, while the IIIrd, IVth, and Vth groups received the investigative product TBFPAE per oral in doses of 9, 18 and 36 mg/kg, respectively. Eddy’s hot plate technique was employed for assessing central anodyne activity. Results: All the test groups of TBFPAE were found to have an analgesic effect but doses 18 mg/kg and 36 mg/kg demonstrated greater effects, especially at 30 and 60 min. Maximum analgesic effect with TBFPAE was seen with 36 mg/kg dose at 60 min. Conclusion: Therefore, T. bellirica has some analgesic potential. However, further studies are required to confirm its dose and usage.

Monitored Anesthesia Care Primarily Using Dexmedetomidine Provides Safe Sedation and Analgesic Effect in Uterine Artery Embolization: A Case Report

Monitored anesthesia care (MAC) has been used as a specific anesthesia service for diagnostic or therapeutic procedures performed under local anesthesia along with sedation and analgesia. Procedures such as trans arterial chemoembolization (TACE) or uterine artery embolization (UAE) performed in interventional radiology are typically accompanied by post-embolization syndrome (PES). While in TACE for hepatocellular carcinoma treatment, the severity of PES tends to be milder due to the liver’s dual blood supply, the degree is notably more severe in the case of UAE. Furthermore, the symptoms of PES after UAE procedure tend to follow a typical pattern. Most UAE patients do not develop pain until after the procedure has concluded. It is during the recovery period that patients frequently need significant doses of narcotics and analgesics to alleviate the pain. This report elucidates the application of MAC using dexmedetomidine in UAE, aimed to maintain adequate sedation during procedure and reduce severe pain after procedure.

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 &gt;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&lt;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.

PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY

ObjectiveTo compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. Materials and MethodsOne hundred patients were randomly divided into four groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. ResultsThe mean VAS value corresponding to the 2nd-hour pain level of the combined group was statistically significantly lower than the other groups (p=0.003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (p≤ 0.001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (p=0.038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0–2 (p=0.528) and days 0–7 (p=0.129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (p=0.030). ConclusionPreemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these two regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

ANALGESIC POWER OF THE INSOLUBLE FRACTION N-HEXANE OF MELINJO LEAVES (Gnetum gnemon L.) IN SWISS MICE (Mus musculus)

Melinjo (Gnetum gnemon L.) contains various secondary metabolites, including alkaloids, flavonoids, saponins, and tannins. Flavonoids function as analgesics and inhibit cyclooxygenase enzymes, which reduce prostaglandin production and pain. This study aimed to determine the analgesic power of the n-hexane-insoluble fraction of melinjo leaves (Gnetum gnemon L.) as an effective analgesic in male white mice (Mus musculus) and to determine the most effective analgesic dose. This research was conducted using test animals of 25 male white mice (Mus musculus) divided into 5 groups, each consisting of 5 mice. The negative control group (Na-CMC) was 0.5%, the positive control group received a mefenamic acid dose of 65 kg/BW, and the insoluble fraction hexane group (ifh) received doses of 50 mg/kg BW, 100 mg/kg BW, and 200 mg/kg BW. The chemical stimulus was administered at a dose of 400 mg/kg body weight acetic acid. The number of wriggles in male white mice (Mus musculus) was measured every 10 minutes for 60 minutes. The results of the study showed a significant difference between the negative control (Na-CMC 0.5%) and various doses of insoluble fraction hexane groups, while the positive control (mefenamic acid 65 mg/kg BB) showed no difference with ifh doses of 100 mg/kg BB and 200 mg/kg BB ...

Efficacy of High-Voltage Pulsed Radiofrequency in Zoster-Associated Pain: A Meta-Analysis and Systematic Review.

Zoster-associated pain (ZAP) is often refractory to conventional treatments and can seriously affect patients' physical and mental health. High-voltage pulsed radio frequency (H-PRF) is a new method for treating ZAP with pulse voltages above 60 V or even up to 100 V. The purpose of this paper was to conduct a systematic review and meta-analysis to evaluate the efficacy of H-PRF in the management of ZAP. PubMed, Embase, and the Cochrane library were searched from their inception to June 2022 to identify controlled trials which evaluated the effectiveness of H-PRF compared with standard PRF and sham operations. The primary outcome was pain scores at different treatment times. The secondary outcomes included SF-36 scores, rescue analgesic dose, and side effects. We reviewed 6 randomized controlled trials involving 428 patients. There was no significant difference between the H-PRF and standard PRF pain scores at 1 week after surgery and the sham operation group at 1 month. At 1, 3, and 6 months, the H-PRF group had better pain score than the standard PRF group, and at 3 months, the pain score was better than the sham operation group. The H-PRF group showed improvement in the SF-36 score, and there were no significant complications in the H-PRF group. H-PRF is an effective and safe treatment method that has better effects in relieving pain and improving the quality of life and physical and mental health. Although H-PRF provides pain relief rates comparable to those of the control group in the early stages, it remains the preferred and alternative treatment for relieving herpes zoster-related pain.

Differentiated approach to the treatment of musculoskeletal pain: higher doses of analgesics provide a better effect. A brief narrative review

Effective pain control is one of the main goals in the treatment of patient with musculoskeletal disorders. The main suffering of patients is associated with pain: decrease in working capacity and quality of life, disability and severe psycho-emotional disturbances. The pathogenesis of musculoskeletal pain is complex and includes damage (due to an autoimmune process, mechanical or metabolic stress), inflammation, peripheral and central sensitization, degenerative processes (neoangiogenesis, heterotopic ossification, fibrosis), muscle tension, psychoemotional disorders (depression, anxiety), negative behavioral reactions. Pain treatment should be comprehensive and include pharmacotherapy as well as non-pharmacological therapy and rehabilitation methods.Nonsteroidal anti-inflammatory drugs (NSAIDs) are at the forefront of pain treatment. They are effective, convenient and affordable, but can cause a wide range of complications. A personalized approach to pain management is therefore based on the choice of the “right” NSAID. Based on the balance between efficacy and safety, celecoxib can be considered the first choice. It has an extensive evidence base confirming its therapeutic potential in acute pain, osteoarthritis, chronic back pain, systemic rheumatic diseases and other pathologies, as well as a relatively low risk of gastrointestinal and cardiovascular complications. The prescription of celecoxib should be personalized: for severe pain and systemic rheumatic diseases, treatment should be started with a dose of 400 mg/day (600 mg can be used on the first day), followed by a transition to a maintenance dose of 200 mg/day once pain control is achieved.

Usefulness of ultrasound-guided serratus-anterior block in prevention of postoperative pain after breast surgery. A cohort study

ObjectiveTo evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. MethodologyA prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99).Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. ResultsPain intensity, measured by the EVN scale, had a mean of 1.02 +/− 1.656 in the Postoperative Unit; 1.20 +/− 1.448 at 24 h; 0.76 +/− 1208 seven days; and 0.34 +/− 0.757 one month after surgery.Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. ConclusionsSuperficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.

A Comparative Study of the Efficacy of Intrathecal Injection of Hyperbaric Bupivacaine with Fentanyl Versus Hyperbaric Bupivacaine with Dexmedetomidine in Lower Abdominal Surgeries: A Prospective Randomized Study

Background: Spinal anaesthesia is the most common technique used for lower abdominal surgeries. Spinal anaesthesia using plain hyperbaric bupivacaine has disadvantages like delayed onset, shorter duration etc. Adding adjuvants like fentanyl, dexmedetomidine has overcome these disadvantages and improve post operative analgesia and stable hemodynamic condition with minimal side effects. Aim of the study was to determine the time of onset and duration of sensory and motor block, sedation score and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine as adjuvant to bupivacaine in lower abdominal surgeries.&#x0D; Methods: This prospective, double blind, randomized study included total 100 patient-divided equally in 2 groups (group F-fentanyl and group D-dexmedetomidine) after matching the inclusion and exclusion criteria. Group F received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 25 mcg Fentanyl and Group D received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 5mcg Dexmedetomidine intrathecally. The onset and duration of sensory and motor block, sedation score, duration of postoperative analgesia and need of rescue analgesia along with haemodynamic parameters were recorded.&#x0D; Results: The mean time for onset of sensory block in group D was (3.5 ± 0.88 mins) significantly lower than group F (4.4 ± 1.2 mins) (p=0.001). And the mean time of onset of motor block in group D (3.23 ± 1.0mins) was significantly lower than in group F (4.3 ± 1.1 mins). Duration of sensory and motor block was significantly higher in group D as compared to group F. The mean analgesic dose in group D was 1.4 ± 0.78 and in group F was 3.6 ± 0.73(p&lt;0.005).&#x0D; Conclusion: From our study we concluded that Dexmedetomidine is a better adjuvant than Fentanyl as it provides rapid onset and prolonged sensory and motor block, hemodynamic stability with excellent post operative analgesia.

Evaluation of Patient's Quality of Life before and after Implantation of Abbott's Proclaim™ XR Spinal Cord Stimulator with BurstDR™ Stimulation in Chronic Pain Syndrome.

Background and Objectives: In case of the ineffectiveness of pharmacological and non-pharmacological treatments in managing chronic neuropathic pain, spinal cord stimulation (SCS) with BurstDR™ stimulation may reduce pain and increase the quality of life. The term "burst" refers to a series of stimulation impulses that are compressed into small packets and separated by intervals of latency. Materials and Methods: A group of 30 consecutive patients who received the BurstDR™ stimulator using the minimally invasive percutaneous method was selected. Patients selected for our study underwent numerous spinal surgeries before SCS implantation. In the study, analgesics and co-analgesics and their doses used by patients before and 6 months after SCS implantation were examined and compared. Using the visual analogue scale (VAS), pain was compared before and after the procedure. Patients` quality of life was assessed using the Oswestry Disability Index (ODI). Results: We observed a significant reduction in opioid daily doses by an average of 32.4% (±36.1%) and a reduction in paracetamol daily doses by an average of 40% (±33.4%). There was a reduction in pregabalin doses as well. Ketoprofen daily dose reduction was 85.4 mg. The mean VAS difference before and after procedure was 3.9 (±2.3), and the mean difference in ODI was 12.9 (±9), which benefits operative treatment. The VAS and ODI results were statistically significant as well. Conclusions: According to our research, BurstDR™ stimulation improves the quality of life by reducing doses of analgesics and the level of pain.

Comparison of analgesic effects between erector spinae and transversus abdominis plane blocks in patients undergoing laparoscopic cholecystectomy.

To compare the analgesic effects and incidence of postoperative adverse events after the erector spine plane (ESP) and transversus abdominis plane (TAP) blocks in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective observational study, clinical data of 103 patients undergoing LC in Changxing County People's Hospital from October 2020 to October 2022 were retrospectively reviewed, and the patients were divided into ESP-group (n=56) and TAP-group (n=57) based on the block method. The operation time, the change of visual analogue scale (VAS) score of static (sVAS) and dynamic (dVAS) pain after operation, the patient-controlled dose, and the remedial analgesic dose at 24 hours after the operation were compared between the two groups. The occurrence of postoperative adverse reactions in both groups was recorded. The dVAS scores of the ESP-group at one hour, three hours, six hours, and 12 hours after the operation were lower than those of the TAP-group (P<0.05). The patient-controlled dose and remedial analgesia dose of the ESP-group were significantly lower than those of the TAP-group (P<0.05). There was no difference in the incidence of postoperative nausea and vomiting between the two groups (P>0.05). ESP block and TAP block in LC patients have similar operation time and incidence of postoperative adverse events such as nausea and vomiting. However, short-term postoperative analgesic effect of ESP block is superior to TAP and requires a lower dose of analgesia.

Intravenous S-ketamine's analgesic efficacy in third molar surgery. A randomized placebo-controlled double-blind clinical trial.

In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred. The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44years, with a body weight between 50 and 100kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25mg/kg or low: 0.125mg/kg) with placebo (saline). A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12min later in the high-dose ketamine group. Pre-emptive S-ketamine 0.25mg/kg gave a global significant reduction of pain by VAS during the first 24h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.

Expert consensus on management of pain, agitation and related issues in adult patients with critical respiratory diseases

As patients with critical respiratory diseases suffer from the discomfort of disease, frequent medical and nursing procedures, and the noise disturbance of the ICU environment, it is necessary to implement analgesia and sedation to reduce their negative stress and oxygen consumption. Special emphasis will be placed on the clinical practice of analgesia, sedation and rehabilitation in critically ill patients with respiratory diseases, as different pathophysiological features of the respective pulmonary diseases are presented, such as severe asthma and acute exacerbations of chronic obstructive pulmonary disease, as well as the exclusive situations during respiratory therapy, such as recruitment maneuvers, bedside bronchoscopy and operation of extracorporeal membrane oxygenators. To standardize the prevention and management of pain, agitation, delirium, immobility, and sleep disturbance in adult patients with critical respiratory diseases, the Chinese Thoracic Society and Critical Care Medicine Group of Chinese Association of Chest Physicians, Chinese Medical Doctor Association organized pulmonary and critical care experts to discuss 19 important issues and ultimately provided 20 recommendations based on the best available evidence.Assessment, prevention and management of pain should be prioritized before the administration of continuous infused sedatives in all patients with critical respiratory diseases. Bundles that include multiple strategies of non-pharmacological interventions to prevent and manage delirium and sleep disruption are encouraged. For the patients with stable respiratory and hemodynamic status, early mobility and exercise could be safe and beneficial. Respiratory drive control by addressing patient and ventilator factors should be the priority before administration of analog-sedation protocol in the ARDS patients. Deep sedation could be necessary in the early stage of ARDS with high respiratory drive, and during the recruitment maneuver, prone position and measurement of the respiratory mechanics. Maintaining spontaneous breathing with a lower level of sedation is recommended in COPD patients on invasive mechanical ventilation, while a deeper level of sedation, even with a short course of neuromuscular blockade, may be beneficial among severe asthma patients with high peak airway pressure. Pharmacokinetic alterations in patients with critical respiratory diseases during ECMO support are complicated as varied factors are involved, including ECMO circuit factors, drug factors, and patient factors. Therefore, the dosage of analgesics and sedatives should be adjusted according to the target of analog-sedation protocol in the respective disease.