Dose Of Rescue Analgesia Research Articles

Abstract No. : ABS1591: Effect of erector spinae block and PECS block on quality of recovery and analgesia after modified radical mastectomy

Background and Aims:Breast cancer is the most common malignancy in women ; modified radical mastectomy is one of the standard treatments.This study compared the effect of erector spinae block and pectoralis(PECS) block on quality of recovery and analgesia after modified radical mastectomyMethods:The present randomised controlled double-blind study was conducted on 90 patients undergoing unilateral modified radical mastectomy for breast cancer. The patients were randomised into group-I (PECS block 20ml 0.25% bupivacaine, n=30), group-II (erector spinae block 20ml 0.25% bupivacaine, n=30) and group-III (control group, n=30). Along with clinical anddemographical data, the requirement of the first dose of rescue analgesia, total rescue analgesic consumption, visual analogue scale(VAS) scores and Quality of Recovery(QoR) -40 scoreswere compared. Anaesthesia and surgical interventions were done as per standard protocol.Results:Mean first rescue analgesic requirement was significantly delayed in group-I followed by group-II compared to controls . Mean total rescue analgesic consumption was much lower in group-I and group-II as compared to group-III and the difference was statistically significant (p<0.0001)(figure 1). Mean VAS scores were also much lower in group-I followed by group-II as compared to group-III at different follow-ups, and difference was statistically significant. The global QoR-40 at 24 hours showed significantly better outcomes in group-1(table 1)Figure 1Global QoR-40 between the groupsTable 1Postoperative tramadol requirementAnalgesic requirementGroup B (n=30)Group C (n=30) P Time for 1st need of tramadol (h)8.10±1.480.7±0.38<0.001Total tramadol consumption (mg)68±48.55210±52.65<0.0001Total numberof patients requiring tramadol (%) 24 h10 (33.33%)30 (100%)<0.0001Table 1Quality of Recovery(QoR) -40 scores between the groupsGlobal QoR-40 (0-200)Group I (n=30)Group-II (n=30)Group-III (n=30) P Pre-operative186.63±7.78185.53±6.73186.34±7.56P=0.8360At 24 h183.64±6.36179.68±6.38171.37±6.88P<0.001* P t=1.63, P=0.1086t=3.455, P=0.0010*t=8.021, P<0.001*Conclusion:Both PECS and ESP block can be used efficaciously for providing analgesia in modified radical mastectomy for breast cancer. However, PECS shows better outcomes.

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.

Effect of ultrasound-guided erector spinae plane block on post-surgical pain in patients undergoing nephrectomy: a single-center, randomized, double-blind, controlled trial.

ObjectiveErector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group.MethodsIn a single-center, double-blind randomized comparative trial, patients undergoing nephrectomy with a subcostal flank incision under general anesthesia were divided into the following two groups: ESP block group (ESP block before anesthesia) and non-ESP (control) group (no intervention). The primary outcome measure was pain score (Numeric Rating Scale [NRS] 0 to 10). Secondary outcomes were postoperative opiate use, anesthetic and surgical complications, length of hospital stay, and patient-reported outcomes.ResultsPostoperatively (0 to 24 hours), the ESP block group experienced less pain and had lower NRS pain scores 0 to 24 hours postoperatively than the non-ESP group. Opioid consumption and the number of rescue analgesic doses decreased significantly in the ESP group compared with the non-ESP group. Patient-Reported Outcomes Information System (Quality of Recovery-15) scores significantly improved in the ESP group compared with the non-ESP block group.ConclusionsPatients receiving an ESP block for intraoperative and postoperative analgesia during radical nephrectomies experienced less postoperative pain 0 to 24 hours compared with the non-ESP group.

ARTROSKOPİK OMUZ CERRAHİSİNDE PREEMPTİF PREGABALİN YÖNETİMİNİN POSTOPERATİF VE POSTOPERATİF ANKSİYETE VE POSTOPERATİF ANALJEZİ ÜZERİNE ETKİNLİĞİ: PROSPEKTİF, RANDOMİZE, ÇİFT KÖR, PLASEBO KONTROLLÜ BİR KLİNİK ÇALIŞMA

Aim: Few studies have investigated pregabalin use as preemptive analgesia in the management of acute pain and anxiety following arthroscopic shoulder surgery. We hypothesized that the preemptive use of oral pregabalin might decrease pain and postoperative anxiety on arthroscopic shoulder surgery pain during the initial 48 hours. Patients and methods: In this prospective, randomized, double-blind, placebo-controlled study, 65 eligible patients were randomly divided into two groups, the preemptive pregabalin 150 mg (group P) and the control group (group C). The primary outcomes were pain levels measured both rest and during active motion based on a visual analog scale (VAS). Secondary outcomes were the level of anxiety (STAI-S and STAI-T), patient satisfaction, and complications. Results: Group P showed lower pain (p &amp;lt; 0.001), better opioid consumption (p &amp;lt; 0.001), longer time to first requirement of analgesia (p &amp;lt; 0.001), and lower rescue analgesic dose (p &amp;lt; 0.001) than the control group at postoperative 48 h follow-up. Also, group P showed less preoperative and postoperative anxiety (p &amp;lt; 0.001) and greater patient satisfaction (p &amp;lt; 0.001) than group C. The rate of postoperative adverse effects was similar between the groups (p &amp;gt; 0.05). Conclusion: The preemptive use of oral pregabalin received 150 mg daily for 2 days before surgery provided postoperative analgesia in both rest and active motion, and improved preoperative and postoperative anxiety levels and greater patient satisfaction in patients undergoing arthroscopic surgery.

English

BACKGROUND Adequate pain management has a great importance for smooth postoperative recovery, early hospital discharge and early rehabilitation. In this study, we compare the analgesic effect and possible side effects of different routes of magnesium sulphate administration in cases of spinal anaesthesia for knee arthroscopy. METHODS This is an experimental prospective randomized control study. 196 patients undergoing knee arthroscopy were divided into 4 groups (49 each): Group A: Given bupivacaine intrathecally during spinal anaesthesia. Group B: Given magnesium sulphate 50 mg with bupivacaine intrathecally. Group C: Given magnesium sulphate IV 10 min after intrathecal injection (30 mg/kg MgSo4). Group D: Given magnesium sulphate intra-articular route, 10 min before the end of surgery (800 mgSo4 diluted in 12 ml normal saline (0.9 % NaCl). Operative time in minutes, VAS at rest and after procedure, time lapse before first analgesic dose after surgery, total dose of rescue analgesics used, pulse rate, mean arterial pressure and side effects were observed and analysed. RESULTS In regards to the lapse of time between end of surgery and first rescue analgesic given, total doses of tramadol used during the 24 hours after the procedure were significantly better in patients given intra-articular magnesium sulphate than other groups (P = 0.001). Patients of Group C who received IV magnesium sulphate were significantly better than patients who were given intrathecal magnesium sulphate in relation to time taken from end of surgery until first analgesic dose. VAS at rest and during the period of first 24 hours followed by surgery was statistically significant in patients who received intra-articular magnesium sulphate (p- 0.001). CONCLUSIONS Intra-articular administration of magnesium sulphate was observed to be superior to other routes of administration or not using at all. Next to intra-articular route, intravenous magnesium sulphate was found to be superior to intrathecal route in providing post operative analgesia in arthroscopy patients. KEY WORDS Analgesia, Knee Arthroscopy, Pain, Magnesium Sulphate, Intrathecal, Intra-articular

Comparison of Levobupivacaine with dexmedetomidine in Infraumbilical surgeries

Introduction: Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h. Materials and Methods: We assumed that sevoflurane will provide clinically acceptable conditions for endotracheal intubation comparable to propofol-suxamethonium in children. All patients received diazepam 0.2 mg/kg orally, the night before surgery. The patients were preloaded with Lactated Ringer's solution 15 mL/kg. They were monitored with automated noninvasive blood pressure, pulse oximetry, and electrocardiogram. Results: In Group LD, increase in VAS was observed at 210 min and the first dose of rescue analgesia was given at 5th h postoperatively. The second dose of recue analgesia was given at 12th h and the third dose was given at 21st h. Postoperative VAS scores at different time intervals were significantly lower in Group LD than Group L, thus indicating superior analgesia. The time of request of the first dose of rescue analgesia was delayed in Group LD as it was demanded at 309.93 ± 23.19 min and in Group L was at 168.30 ± 12.32 min. The difference in the two groups was highly significant (P< 0.001). Conclusion: Sevoflurane provides clinically acceptable intubating conditions and can be a suitable alternative to propofol-suxamethonium for endotracheal intubation in children.

Dexmedetomidine Combined with Femoral Nerve Block Provides Effective Analgesia Similar to Femoral Nerve Combined with Sciatic Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.

BackgroundTotal knee arthroplasty (TKA) is a severe traumatic procedure, and femoral nerve block (FNB) combined with a sciatic nerve block (SNB) is widely used in TKA. However, injury of the sciatic nerve is clinically reported. Dexmedetomidine (DEX) could reduce stress and inflammation, as well as improve pain in TKA. This study aims to observe the analgesic impact of DEX combined with FNB in TKA.MethodsEighty-eight patients undergoing TKA were included and randomly divided into two groups: DF group (FNB combined with DEX 0.6μg/kg before surgery, followed by DEX 0.2–0.4μg/kg/h until articular closure) and SF group (FNB combined with SNB). Each nerve was blocked with 0.375% ropivacaine 20mL, and all patients received general anesthesia routinely. The primary endpoint was the pain visual analog scale (VAS) score during activities at postoperative 24 hours.ResultsThere was no statistical difference in the pain VAS scores at any time point. The mean duration of analgesia for patients with rescue analgesic requests was comparable between the two groups: 25.4 ± 6.3 hours in the DF group vs 24.8 ± 6.4 hours in the SF group (two-sample t-test, p=0.738). The total dose of sufentanil was similar between groups (P=0.355). The maintenance dose of propofol and dose of rescue analgesics were comparable (all P>0.05). There were no statistical differences in the incidence of adverse events. However, the time to extubate in the DF group was significantly longer than those in the SF group (P<0.001).ConclusionDEX combined with FNB could provide effective analgesia similar to SNB combined with FNB in TKA.Clinical Trial RegistrationThe trial was registered at the Chinese Clinical Trial Registry on November 17, 2019 (identifier: ChiCTR1900027552).

Comparison Between Epidural Bupivacaine with and without Magnesium Sulphate in Patients Undergoing Elective Total Abdominal Hysterectomy: A Double-blinded Randomised Clinical Trial

Introduction: The effectiveness of a local anaestheticis increased by the addition of an adjuvant. Magnesium sulphate along with bupivacaine is effective in reducing the pain and extending the analgesia period. Aim: To compare the duration of analgesia among subjects receiving plain bupivacaine and bupivacaine with magnesium sulphate among patients undergoing total abdominal hysterectomy. Materials and Methods: This double-blinded randomised clinical trial was conducted in Department of Anaesthesiology at Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India, (tertiary care center) between November 2019 and October 2021. The study was done among 50 subjects undergoing elective total abdominal hysterectomy. The subjects were divided into two groups, one group received only bupivacaine while the other group received bupivacaine with 500 mg magnesium sulphate. Onset and duration of blocks were observed. Haemodynamic parameters were monitored intraoperatively and postoperatively. Data was analysed using Chi-square test, Fischer’s exact test. Results: Demographic variables like age (p-value=0.17), height (p-value=0.62), weight (p-value=0.14) and BMI (p-value=0.24) were comparable between the two groups. The mean duration of analgesia was significantly more among the bupivacaine and magnesium sulphate group (416.72±93.6) in comparison to the bupivacaine alone group (204.56±71.25). The bupivacaine and magnesium sulphate group required two doses of rescue analgesia in 24 hours, while the other group required four doses of analgesia. Significantly more side-effects were noted among the bupivacaine alone group (12 vs 6) (p-value=0.04). Conclusion: The study showed that bupivacaine and magnesium sulphate group showed less intraoperative side effects, reduced postoperative VAS score increased duration of analgesia, decreased requirement of analgesia required in 24 hours and reduced postoperative side-effects.

Evaluation of 0.25% bupivacaine vs. 0.375% ropivacaine for postoperative analgesia using ultrasound guided transversus abdominis plane block for caesarean section: A comparative study

Background: Pain after Caesarean section is described as moderate to severe by most patients. Ultrasound guided transversus abdominis plane (TAP) block is now increasingly being used for postoperative analgesia in lower abdominal surgeries. Hence this study was undertaken to compare 0.25% Bupivacaine with 0.375% Ropivacaine for postoperative analgesia using TAP block in caesarean section. Methods: Seventy patients were randomized into Group B (n = 35) and Group R (n = 35). TAP block was administered after completion of surgery under ultrasound guidance using 15 mL of 0.25% Bupivacaine in Group B and 15 mL of 0.375% Ropivacaine in Group R on each side of the abdomen. Time to requirement of first analgesic dosage was observed in both the groups. Total analgesic requirement in the first 24 h, visual analogue scale (VAS) scores at 2, 4, 6, 8, 12 and 24 h, patient satisfaction and complications were also noted. Results: Mean time for the first dose of rescue analgesia after completion of surgery was 298.2 ± 93.6 min in Group B and 447.6 ± 85.2 min in Group R (P = 0.0001). Total requirement of Diclofenac Sodium injection was 162.86 ± 46.88 mg in Group B whereas it was only 130.71 ± 44.49 mg in Group R (P = 0.003). VAS at 4,6 and 8 h after surgery were significantly lower in the Ropivacaine group. Conclusion: 0.375% Ropivacaine provided longer duration of analgesia and resulted in lesser analgesic requirement than 0.25% Bupivacaine when used in TAP block after caesarean section.

A comparative evaluation of oral clonidine and oral gabapentin as a premedication on postoperative analgesia duration in patients undergoing spinal anesthesia

Background and Objectives: Premedication with oral clonidine or gabapentin reduces the perioperative pain and decreases the requirement of analgesics. Our study aims at comparing the efficacy of oral clonidine and oral gabapentin for postoperative analgesia duration in surgeries done under spinal anesthesia. Materials and Methods: A prospective, double-blinded study was conducted in randomly selected 100 patients undergoing spinal anesthesia for any surgery (excluding cesarean section). Group C received 100 μg oral clonidine and Group G received 600 mg oral gabapentin, 1 h before spinal anesthesia. Blood pressure, heart rate, and Spo2 were recorded at 0, 15, 30, and 60 min interval. Visual analog scale (VAS) was documented for pain assessment at 2, 4, 6, 8, and 24 h from the time of onset of spinal anesthesia. The number of rescue analgesic doses required in 24 h postoperatively was noted. The data regarding the patient's demography, changes in the hemodynamics, VAS score, and requirement of rescue analgesia were analyzed. Results: There was no statistically significant difference in the hemodynamic changes with either group. The mean VAS score in the first postoperative hour was significantly higher for Group C than Group G (P < 0.0001). The mean requirement of rescue analgesic doses per patient was 3.00 ± 0.35 and 1.84 ± 0.58 in Groups C and G, respectively (P < 0.0001). Conclusions: Oral gabapentin is more effective than oral clonidine as a premedication in patients undergoing spinal anesthesia belonging to American Society of Anesthesiologists I and II.

Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department: A randomized, double-blind clinical trial.

OBJECTIVES:This study aimed to compare the efficacy of intravenous (IV) morphine plus ibuprofen or ketorolac versus IV morphine alone in controlling renal colic pain in the emergency department.METHODS:This double-blind, randomized clinical trial was conducted during November 2018 and March 2019 in Iran. Patients aged 18–65 years with acute renal colic and numerical rating scale (NRS) score of higher than 6 of 10 were enrolled to the study. They were randomly assigned to I, K, and control groups receiving 5 mg morphine with 800 mg ibuprofen (n = 65), 5 mg morphine with 30 mg ketorolac (n = 65), or only 5 mg morphine (n = 65) intravenously, respectively. NRS was evaluated 0, 15, 30, 60, and 120 min after injection.RESULTS:A total of 195 participants took part in the study. The presence of stone in pelvis area was higher in I group (P = 0.027). The mean rescue analgesic dose was higher in the control group and lower in K group (P = 0.031). From the 15th min, the NRS reduction in I and K group was higher than the control group (P < 0.001), but the difference between I and K group was not statistically significant in total (P = 1.0) or in the all follow-up time intervals (15th P = 0.864, 30th P = 0.493, 60th P = 0.493, and 120th min P = 1.0). The largest difference in pain reduction was observed in 120th min and mean of NRS was 2.9 (95% confidence interval [CI]: 2.6–3.3), 2.9 (95% CI: 2.6–3.3) and 7.0 (95% CI: 6.7–7.4) in I, K and control group, respectively. The adverse effects showed in 18.5%, 20.0%, and 13.8% of I, K, and control group, respectively.CONCLUSION:IV ibuprofen plus morphine and IV ketorolac plus morphine had similar effects in reducing renal colic pain but were more effective than IV morphine alone.

Postoperative Analgesic Effect of Morphine Added to Ropivacaine for Fascia Iliaca Compartment Block following Femoral Fracture Surgeries: A Randomized Controlled Trial

Background: Fascia iliaca compartment block (FICB) following femoral fracture surgery provides effective analgesia. Reports of morphine added to ropivacaine for peripheral nerve blocks are limited. We designed this study to investigate the effects of morphine as an adjuvant to ropivacaine in FICB for femoral fracture surgery. Methods: Seventy patients undergoing spinal anaesthesia for femoral fracture surgery were randomized to undergo ultrasound aided FICB with ropivacaine alone (n = 35) or in combination with morphine (n = 35). FICB was performed postoperatively with 20 ml of 0.375% ropivacaine plus 2 ml normal saline or 20 ml of 0.375% ropivacaine plus 2 ml (1 mg/ ml) morphine. Primary outcome parameter was the duration of analgesia. Secondary outcome parameters were total doses of rescue analgesics, sedation scores, Numeric Rating Scale (NRS) scores for pain and patient satisfaction. Results: Demographic data were similar between the two groups. Patients receiving morphine adjuvant had longer duration of postoperative analgesia (541 ± 167 vs 634 ± 164 mins, p = 0.01; Mean difference -92.71; 95% CI: -171.95 – -13.47). Requirement of postoperative rescue analgesics for the first 24h was significantly lesser (tramadol 77 ± 25 vs 62 ± 22 mg, p = 0.01; Mean difference 14.28 ;95% CI: 2.95 – 25.63) in patients receiving morphine adjuvant. Postoperative NRS scores and sedation scores were comparable between the two groups. Conclusion: Morphine as an adjuvant to ropivacaine for FICB significantly prolongs the duration of postoperative analgesia.

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

Postoperative Analgesic Efficiency of Transversus Abdominis Plane Block with and without Magnesium Sulphate after Surgical Repair of Moderate Size Umbilical Hernia

Abstract Background The transversus abdominis plane (TAP) block is a known approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work The aim of this study is to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing surgical repair of moderate sized umilical hernia under general anathesia. As regard postoperative pain and opioid consumption using Visual Analogue scale VAS. Patients and Methods the study was carried out on 40 patients who was undergo surgical hernial repair, after ethical approval of Ain Shams University Hospital and informed consent from patients ,patients assigned in two group ,each group include 20 patients, Group 1: receive TAP block with Bupivacaine 0.25% 20 ml per side. Group 2: receive TAP block with Bupivacaine 0.25% 18 mL+2 ml magnesium sulphate. Results By the end of our study we found that VAS pain score was less in group II than in group I at 0,1,2 and 24 hours postoperatively and most significant at 4,6 and 12 hours the VAS score less in group II than group I (p value &amp;lt;0.05).And the mean time for first rescue analgesic dose was delayed in group II (872.87±265.25mins) compared to group I(466.54±118.29mins) (p value &amp;lt;0.001). Conclusion MgSO4 as an adjuvant to Bupivacaine in Ultra-sounded guided TAP block reduces postoperative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

Duration of postoperative analgesia with Nalbuphine vs Butorphanol as an adjunct to spinal anesthesia for lower limb orthopedic surgeries: A randomized double-blind active control trial.

Background and Aims:Nalbuphine as well as butorphanol as adjuvant to intrathecal bupivacaine have been studied in comparison to bupivacaine alone. Both are kappa receptor agonist and have never been compared for its efficacy in terms of postoperative analgesia. The aim of this study was to evaluate duration of postoperative analgesia as well as intraoperative block characteristics using intrathecal nalbuphine hydrochloride (800 μg) or butorphanol (25 μg) as adjuvant to hyperbaric bupivacaine (12.5 mg) in lower limb fracture femur surgeries as compared to active control, that is, saline and bupivacaine.Material and Methods:This prospective, randomized, double-blind, active control study was conducted on 90 adult patients of either sex belonging to ASA grade I/II, aged 18–70 years, being operated for fracture femur surgeries in tertiary care hospital of North India. Patients were randomly divided into 3 groups (n = 30) Group A: received 0.5% hyperbaric bupivacaine 12.5 mg with 800 μg nalbuphine. Group B: Received 0.5% hyperbaric bupivacaine 12.5 mg with 25 μg butorphanol. Group C: Received 0.5% hyperbaric bupivacaine 12.5 mg with normal saline. Total volume injected was 3.0 ml. Duration of analgesia, mean VAS scores, requirement of rescue analgesia in 24 h along with intraoperative sensory or motor characteristics of block and hemodynamic parameters were studied. Statistical analysis was done using ANOVA with post-hoc Tukey test, Student’s t-test and Chi-Square test.Results:Demographic profile was comparable among all the three groups. Mean duration of postoperative analgesia was 348.33 ± 66.96, 156.17 ± 43.9 and 110.36 ± 29.18 min in group A, B, and C, respectively (P = 0.006). Total doses of rescue analgesia were least in group A (32), followed by group B (42) and group C (64), respectively (P = 0.001). Group A had significantly earlier onset of sensory action (P = 0.03) as compared to group B and C. There was significant difference in sensory (P = 0.08) and motor duration (P = 0.04) among all the three groups. However, onset of motor block, haemodynamic profile and side effects were comparable among groups A, B, and C (P > 0.05).Conclusion:Addition of 800 μg nalbuphine and 25 μg butorphanol as adjuvant to intrathecal bupivacaine has better outcome as compared to active placebo group. But intrathecal nalbuphine was more effective compared to intrathecal butorphanol in terms of prolonging postoperative analgesia, reducing rescue analgesic doses and onset of sensory block. However, hemodynamic profile and side effects were comparable among all groups.

Peripheral nerve stimulator guided erector spinae plane block for post-operative analgesia after total abdominal hysterectomies: A feasibility study.

Background and Aims:The pain following total abdominal hysterectomy (TAH), a very commonly performed gynaecological surgery, is usually taken care of by various opioids, non-opioids, regional and peripheral nerve blocks. Erector spinae plane block (ESPB) under ultrasound guidance is a relatively new approach for postoperative analgesia in thoracic and abdominal surgeries. Ultrasound availability and expertise to use it is a limitation at times. The primary aim of this study was to determine the analgesic efficacy of ESPB using peripheral nerve stimulation (PNS) technique in patients undergoing TAH.Methods:A total of 60 American Society of Anesthesiologists physical status I and II female patients were posted for abdominal hysterectomy after obtaining ethical committee clearance in a tertiary care centre. Group I (n = 30) received spinal anaesthesia, whereas Group II (n = 30) received ESPB under peripheral nerve stimulator (PNS) guidance with 20 mL of 0.375% ropivacaine before spinal anaesthesia. Post-operative pain intensity reported using the Visual Analogue Scale (VAS) was considered as the primary outcome. The haemodynamic variables, total duration before the first rescue analgesia, total consumption of tramadol, level of satisfaction regarding analgesia and any complications were considered as secondary outcomes. The data were recorded in an excel sheet, and analysis was performed using the Statistical Package for the Social Sciences version 23.0.Results:VAS score was significantly lower (P < 0.001) in Group II at 0, 1, 2, 3, 4, 6, 12, 18 and 24 h post-operatively. The total dose of rescue analgesia was significantly reduced in the ESPB group.Conclusion:PNS-guided ESPB is effective in relieving pain in patients undergoing TAH.

English

BACKGROUND Caudal epidural block is a highly popular method of administering analgesia to children undergoing infraumbilical surgeries. Addition of clonidine, a centrally acting alpha 2 agonist as an adjuvant to caudal bupivacaine has added advantages of providing prolonged post-operative analgesia and also, thus reducing the number of doses of post-operative rescue analgesics. In this study, we wanted to compare the efficacy and safety of caudally administered clonidine as an adjuvant to bupivacaine. METHODS This was a prospective, comparative interventional study and was conducted in the Department of Anaesthesia at JNMC, Sawangi (Meghe) Wardha in accordance with the guidelines and permission of the institutional ethical review board. The study was carried out with 40 patients in each group randomly allocated using computer generated software, posted for infraumbilical surgeries between the age group 2 years to 7 years, American Society of Anaesthesiologists (ASA) grade I and II. Group B (control group) – Caudal epidural with 0.25 % bupivacaine 1 ml/kg + 1 ml normal saline. Group C (study group)- Caudal epidural with 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg + 1 ml normal saline. RESULTS In our study, the mean duration of analgesia i.e. mean time for requirement of first rescue analgesia in group C was 9.9 ± 1.4 hours as compared to 4.7 ± 1.4 hours in group B (P &lt; 0.0001). In this study, we used FLACC (face, legs, activity, cry, consolability) pain scale with its 0 - 10 score range for assessing the pain intensity. At FLACC pain score 4 or more, first dose of rescue analgesic was given. This score was reached at 8.8 hours in Group C (mean FLACC score at 3.8 ± 0.7) and 3.6 hours in Group B (mean FLACC score 3.4 ± 0.9) with P value (= 0.014) (significant). Group C required significantly lesser number of rescue analgesics in comparison to Group B. The number of doses of rescue analgesics required in the Group B were definitely more than that in Group C wherein 62.5 % required 3 doses and 25 % required 4 doses of rescue analgesics. On the other hand, in Group C the number of patients requiring more than 2 doses of rescue analgesia was 0 % thus proving the efficacy of clonidine in prolonging post-operative analgesia. CONCLUSIONS We concluded that caudally administered clonidine, in a dose of 1 microgram/kg as an adjuvant to 0.25 % bupivacaine 1 ml/kg, proved to be efficacious in providing prolonged analgesia both intraoperatively and post-operatively. Also, we observed that this addition, reduced the requirement of post-operative rescue analgesia and its associated side effects. KEY WORDS Caudal Epidural, Infraumbilical Paediatric Surgery, Clonidine, Bupivacaine, Postoperative Analgesia

Opioid-free general anaesthesia for transthoracic oesophagectomy: does it improve postoperative analgesia and other recovery criteria? A prospective randomised study

BackgroundSide effects related to intraoperative opioid administration are well known. Recently, it was found that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. Hence, peri-operative use of opioids might affect long-term oncological outcomes in cancer surgical patients. Opioid-free anaesthesia (OFA) is a methodology that dodges narcotic use during anaesthesia by using blends of several drugs added to common anaesthetic agents.The study aims to test the impact of OFA in transthoracic oesophagectomy in comparison with opioid-based anaesthesia technique (OBA) on postoperative analgesia and recovery criteria (hemodynamics, respiratory rate and haemoglobin oxygen saturation).ResultsThe postoperative VAS was significantly lower in OFA group (A) than OBA group (B) in the measured time points (immediate postextubation, 30 min, 2 and 4 h postoperative) with P values 0.001, 0.001, 0.0012 and 0.0065 respectively. The time passed till first rescue analgesia requested was significantly longer in OFA group (A) than OBA group (B) and the total dose of rescue analgesia given to the patients were significantly higher in group B than group A. The recorded postoperative respiratory rate was significantly faster in OBA group (B) than OFA group (A), and the haemoglobin oxygen saturation (SPO2) showed statistically significant lower values in the OBA group (B) than the OFA group (A).ConclusionsWe emphasise the perioperative safety and efficacy of the opioid-free anaesthesia techniques provided for transthoracic oesophagectomy with better postoperative analgesia and other post recovery criteria.Trial registrationWe carried out our trial at Ain-Shams University Hospitals, Cairo, Egypt, between June 2020 and November 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University and then registered in the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) with the following ID (PACTR202010907549506).

Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus

Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children. Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption. Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p&lt;0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I. Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.

Dexmedetomidine as an adjuvant for extension of postoperative analgesia in ropivacaine induced supraclavicular brachial plexus block

Pain is recognized as the fifth vital sign. The pain must be adequately treated esp. in postoperative period. The study was carried out at Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences Indore. The aim of the study was to assess the role of Dexmedetomidine in extension of post-operative analgesia. The study included 88 participants who were equally divided randomly into two groups i.e. with and without Dexmedetomidine intervention after the inclusion and exclusion criteria’s. The duration of post-operative analgesia in both groups indicating that contemplated surgery could be finished without need for additional analgesic supplement as the minimum and maximum time for surgery were within the range of effective analgesia without movement of limb. The time for demand of dose of rescue analgesic by the patients in both groups was 493.6±48.6 minutes and 961.0±141.6 minutes. The Dexmedetomidine group had a less demand of rescue analgesia. (P = 0.000). Whereas 23(52.2%) patients of Nonintervention group needed 2 to 4 doses of injection of diclofenac sodium by intramuscular route to control pain.Addition of Dexmedetomidine 100 mcg to ropivacaine 0.5% solution for conduct of supraclavicular block improved the block quality and provided prolonged postoperative pain free period and decreased the demand of systemic analgesics.