Double-blind Comparative Study Research Articles

A Randomized Double-Blind Comparative Study of the Intubating Conditions and Hemodynamic Effects of Rocuronium and Succinylcholine in Pediatric Patients.

The incidence of unanticipated difficult airways is higher in pediatric age groups than in adults due to the different airway anatomy, difficulty in airway examination, and congenital malformations. Rocuronium bromide has a comparable onset time to succinylcholine at its proportionate dose. Hence, we compared rocuronium bromide with succinylcholine to assess intubating conditions and their side effects, if any. A total of 200 pediatric patients ofAmerican Society of Anesthesiologists (ASA) grades I and II between one and 14 years of age of either sex posted for elective surgery were included in the study. After randomization, group R (n = 100) received 1.2 mg/kg rocuronium, and group S (n = 100) received 2 mg/kg succinylcholine intravenously. After confirming the mask ventilation, the study drugs were administered, and intubating conditions were assessed as excellent, good, poor, or impossible. Hemodynamic changes post-intubation were recorded as our secondary outcome. Intubating conditions were excellent( 65%), good( 25%) and fair (10%) in patients of group R, while results in group S were excellent( 60%), good( 20%), fair (15%), and poor (5%) (p = 0.010). The heart rate was significantly increased post-intubation in group S, while there was no significant increase in systolic or diastolic blood pressure in either group. At a dose of 1.2 mg/kg body weight, rocuronium was a better alternative to succinylcholine for providing rapid intubating conditions and stable hemodynamics without associated adverse effects.

Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n=65) and group B (n=64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n=64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n=60), B (n=60), and C (n=60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p=0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.

A comparative study of intravenous dexmedetomidine and clonidine as pre-emptive analgesia to intrathecal bupivacaine in subarachnoid block - A randomized double blind study

: Several drugs and drug regimens are used as adjuncts to local anaesthetics for neuraxial blockade in order to enhance its efficacy. In recent times novel drugs, adrenergic agonists like dexmedetomidine and clonidine are extensively used. Very few studies have compared the equipotent doses of both the drugs when given as pre-emptive analgesia. This study compares the efficacy of pre-emptive intravenous dexmedetomidine and clonidine for prolongation of bupivacaine spinal anaesthesia.: This is a prospective double-blind comparative study conducted at a tertiary care center from January 2021 to May 2022. 90 participants satisfying inclusion criteria were chosen after obtaining ethical Committee approval and informed consent. Study participants were randomly divided into two groups. Group C (n=45) received clonidine 0.5mcg/kg IV and Group D (n=45) received 0.5mcg/kg IV over 10mins following which subarachnoid block was given with hyperbaric bupivacaine 0.5% 15mg intrathecally. The following parameters were measured as onset, duration of sensory and motor blockade, duration of analgesia and number of rescue analgesics given in the postoperative period. Onset of sensory blockade (2.40+ 0.81) and motor blockade (2.78+ 0.88) was significantly faster in group D when compared to group C. Sensory blockade duration in group C and D was (100.22+ 11.38) and (129.33+ 13.55) respectively and was statistically significant. Similarly, Motor blockade duration was prolonged in group D (156.67+ 12.25) than in group C (121.78+ 14.35). Mean duration of analgesia in group D (169.51+19.23) and group C (143.8+18.78) illustrated statistically significant difference.: Dexmedetomidine when given as a pre-emptive analgesia enhances the effectiveness of bupivacaine by prolonging its duration of action when compared to clonidine at given doses.

COMPARISON OF 0.5% LEVOBUPIVACAINE- FENTANYLAND 0.5% ROPIVACAINE-FENTANYL IN INFRAUMBILICAL SURGERIES

Spinal anaesthesia is a commonly performed procedure when the surgical site is located on the lower abdomen, perineum or lower extremities. The advantages are an awake and spontaneously breathing patient, minimal drug costs, reduction of poly-pharmacy and rapid patient turnover. Regional anesthesia techniques have seen numerous modifications over the last two decades with the advent of many new and safer local anesthetics. Presently, hyperbaric bupivacaine is the most commonly used drug for administration of spinal anaesthesia. Levobupivacaine and ropivacaine have recently become available in India for clinical use. Very few studies have been done comparing these two drugs in India. Hence, present study was undertaken to compare 0.5% Levobupivacaine (isobaric)-fentanyl(25µg) and 0.5% Ropivacaine (isobaric)-fentanyl(25µg)with regards to onset and duration of blockade infra umbilical surgeries in spinal anaesthesia. Methods and materials- this is a hospital based randomized double blinded comparative clinical study. Adult patients scheduled for elective infra umbilical surgeries under spinal anaesthesia. Eighty patients were randomized to two groups: group LF and RF (n=40 for each group). All patients received drug volume of 3.5ml containing 3 ml isobaric levobupivacaine (15 mg) + 0.5 ml (25 mcg) fentanyl in group LF, and 3ml isobaric ropivacaine (15mg) + 0.5 ml (25 smcg) fentanyl in group RF. The time for completion of intrathecal administration of study drugs injection is considered as TIME 0. The following parameters were observed – time of onset and duration of sensory block, motor block. Results: In the present study, mean onset of sensory block was faster in Group LF (5.25±0.74 min) than in Group RF (6.53 ± 0.51 min) and was statistically significant (p value &lt; 0.001). In the present study, mean onset of motor block was faster in Group LF (7.25±0.98 min) than in Group LF (11.2 ± 0.61 min) and was statistically significant (p value &lt;0.001). Conclusion: LF group provided better sensory and motor blockade with higher dermatome coverage than RF group.

Comparison of Baska Mask Versus Proseal Laryngeal Mask Airway in Elective Surgeries Under General Anaesthesia: A Randomized Clinical Trial.

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMAgroup (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI)of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patientswere insertedwitheither BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which wasstatistically significant. The BMprovided a higher OSP(31.34 +1.638 cmH2O)when compared to PLMA(24.81±1.469 cmH2O) andwas statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMAin patients under controlled ventilation.

The Efficacy of Erector Spinae Plane Block Compared With Intrathecal Morphine in Postoperative Analgesia in Patients Undergoing Lumbar Spine Surgery: A Double-blind Prospective Comparative Study

BACKGROUND: Severe postoperative pain is experienced by most patients who undergo spine surgery. Erector spinae plane block (ESPB) is a successful method for postoperative analgesia and has only minor complications. Intrathecal morphine (ITM) demonstrates high efficacy for analgesia up to 24 hours postsurgery. ESPBs and ITM for postoperative analgesia in lumbar spine surgeries have never been compared in prior studies. OBJECTIVES: This study aimed to compare the efficacy of ESPB and ITM in postoperative analgesia after lumbar spine surgeries. STUDY DESIGN: A double-blind prospective comparative study. SETTING: This study was performed at Al Fayoum University Hospital after being confirmed by the local institutional ethical committee (#80) with approval number M520 and retrospectively registered at clinicaltrials.gov number (NCT05123092). METHODS: A prospective randomized double-blinded interventional trial was conducted with 82 patients, 41 in each group. In the ESPB group, a 0.25% bupivacaine injection was used to conduct a bilateral ultrasound-guided ESPB. In the ITM group, an injection of 0.3 mg morphine intrathecally was done. The Visual Analog Scale (VAS) was recorded as the primary outcome. The time to the first analgesic request, intra- and postoperative opioid consumption, hemodynamics, sedation score, and complications were also recorded as secondary outcomes. RESULTS: Postoperative VAS scores were significantly lower in the intrathecal group throughout the postoperative period at all recorded study time points until 48 hours (P &lt; 0.001). Time to the first rescue analgesia and doses of postoperative analgesic required were significant, with a P value of 0.000. Significant differences were found in postoperative oxygen saturation up to 24 hours (P &lt; 0.001) and the sedation score up to 6 hours (P &lt; 0.01). A higher incidence of complications was recorded in the ITM group (P = 0.000). LIMITATIONS: We did not measure patient preoperative VAS scores to ensure that the 2 groups were matched in pain severity. Also, we did not compare patient satisfaction. Another limitation was the inability to determine the degree of pain relief of ESPB since there was no control group in our study. CONCLUSION: We concluded that ITM 0.3 mg provides more potent analgesia up to 48 hours postoperatively than an ESPB, based upon VAS score, analgesic durations, and postoperative analgesic requirements. KEY WORDS: Intrathecal morphine, erector spinae, spine, Visual Analog Scale

Effect of platelet counts and activator in platelet-rich plasma on the treatment of androgenetic alopecia, split-head comparison: A randomised, double-blind study.

Background Androgenetic alopecia is a common, chronic, non-scarring alopecia. It is characterised by stepwise miniaturisation of the hair follicles, due to alteration in the hair cycle dynamics, leading to the transformation of terminal hair follicles into a vellus ones. Oral finasteride and topical minoxidil are the only approved drugs for treating this condition. Due to a limited number of effective therapies for androgenetic alopecia, platelet-rich plasma may be an effective alternative treatment. Aims To study the effect of activator in platelet-rich plasma and baseline platelet count in platelet-rich plasma on the treatment of androgenetic alopecia. Methods A randomised, double-blind split-head comparative study. The sample size was calculated and randomisation was done. Patients with androgenetic alopecia were allocated into two groups; in the first group, autologous activated platelet-rich plasma was injected in the right half of the affected scalp and autologous non-activated platelet-rich plasma was injected in the left half of the affected scalp and vice versa in the second group. Patients were also categorised on the basis of platelet counts in their platelet-rich plasma in three groups; group A (6-8 lakh/mm3), group B (8.1-10 lakh/mm3) and group C (>10 lakh/mm3). Interventions were done monthly for three months and followed up for the next three months. Effects of interventions were assessed by hair density, hair thickness, patient self-assessment and clinical photography. Results A total of 80 patients were included in the study. Activated platelet-rich plasma produced significant improvement of hair density after four months and hair thickness at 6 months. An increase in platelet count led to a significant increase in hair density and hair thickness after three and four months respectively and a highly significant increase in both parameters at the end of the study. Limitations Long-term follow-up of cases was not done and no measurement of vellus hair count was done. Conclusion There is a significant effect of activator and platelet count of the platelet-rich plasma on hair density as well as hair thickness.

A prospective, randomized, double blinded comparative study between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in supraclavicular brachial plexus block for post operative analgesia in upper limb surgery: Pentazocine as adjuvant in brachial plexus block

In upper limb surgery supraclavicular brachial plexus (SCBP) block with 0.5% bupivacaine is commonly used for anesthesia. To increase the duration of sensory block opioids are used along with bupivacaine, but data on the effect of pentazocine as adjuvant with bupivacaine in SCBP block is still lacking. The study aimed to compare the duration of postoperative analgesia, sensory and motor block between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in SCBP. Methods: The study was conducted on 60 consenting patients, posted for upper limb orthopedic surgery involving the forearm under SCBP block. Patients were randomly divided into two groups. Group B received 19 ml of 0.5 % bupivacaine with 1 ml of normal saline; Group BP received 19 ml of 0.5 % bupivacaine with 1 ml pentazocine (30 mg). Block characteristics, duration of postoperative analgesia, and side effects if any were recorded. Statistical analysis was done using the student t-test and Chi-square test for continuous and categorical variables respectively. Results: The onset of sensory (11.47 ± 1.57 vs. 16.8 ± 2.23 min) and motor (8.17 ± 1.14 vs. 13.9 ± 2.44 min) block was significantly faster in the BP group. Duration of sensory (392.33 ± 9.92 vs. 357.2 ± 8.76 min) and motor (379.27 ± 9.28 vs. 347.27 ± 9.13 min) block was also prolonged in group BP (p &lt; 0.0001). Duration of postoperative analgesia was more (p &lt; 0.0001) in the BP group (407.43 ± 10.46 vs 367.3 ± 8.74min). Conclusion: Pentazocine as an adjuvant with bupivacaine in SCBP block provides faster onset, prolonged duration of the block, and postoperative analgesia.

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 µg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groupsRP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 µg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 µg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p&lt;0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility

Background &#x0D; Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia.&#x0D; Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block.&#x0D; Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5).&#x0D; Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves territories; however, it was not significant statistically (p value &gt; 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p &lt; 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value &gt; 0.05).&#x0D; Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine.

Effect of Oral Clonidine Premedication on Hemodynamic Stress Response to Laryngoscopy and Tracheal Intubation

Introduction: Different techniques have been tried to blunt undesirable hemodynamic effects like tachycardia, hypertension and dysarrhythmias during and after laryngoscopy and tracheal intubation.&#x0D; Objective: To find out the effect of oral clonidine premedication on hemodynamic stress response to laryngoscopy and tracheal intubation.&#x0D; Methodology: It was a prospective, randomized, double-blind comparative study conducted in patients undergoing laparoscopic cholecystectomy. Either oral clonidine 300 mcg (n=30) or placebo (n=30) was given one hour before the surgery. Depth of anesthesia was monitored and maintained at 40-60 level using bispectral index (BIS) monitor. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP) and oxygen saturation (SpO2) at baseline, one hour after premedication, on operation theatre (OT) table, just before and after one, two and five minutes after laryngoscopy and intubation were compared in Clonidine and placebo group using Paired t test and Chi-square test. SPSS was used for statistical analysis at P-value&lt;0.05&#x0D; Results: Hemodynamic variables like HR, SBP, DBP and MBP were significantly lower in the clonidine group compared to placebo just before and after the first five minutes of laryngoscopy and tracheal intubation (P&lt;0.05). Propofol requirement for induction of anesthesia was less in the clonidine group (95±31.8 mg vs 75.3±28.5 mg, p=0.014) compared to the placebo group. Adverse effects like hypotension and bradycardia were comparable in the groups. Time taken for extubation, time to follow verbal commands and time to orientation after surgery were similar in the both groups (P&gt;0.05).&#x0D; Conclusion: Oral clonidine premedication was effective in blunting undesirable hemodynamic stress response to laryngoscopy and tracheal intubation compared to the placebo.

Desarda’s repair versus Mesh hernioplasty for a strangulated inguinal hernia a randomized double-blind comparative study

Groin hernias are the commonest abdominal wall hernias; these hernias are known to develop various complications. Strangulation is a serious and life-threatening complication. Various surgical procedures like primary tissue repair, mesh repair, keep open with secondary repair, etc. are in practice for strangulated groin hernias. Post-operative infection and recurrence are the main concerns with these procedures. The aim of conducting this study was to compare the outcomes of the mesh hernioplasty with Desarda’s purely tissue hernioplasty in the treatment of strangulated inguinal hernia. A total of one hundred and twenty-four patients were included in the study. These patients were grouped into group A (mesh hernioplasty group) and group B (Desarda’s tissue repair group) and randomization was done. Results of these two techniques were compared with respect to post-operative seroma, surgical site infection, recurrence, and chronic pain. Seroma formation was more in group A, which accounts for 35.48%(22) of patients than in group B patients accounts for 19.35%(12). Operative site infection was more in group A, which accounts for 35.48%(22) patients than in group B 9.67%(6) patients. Recurrence was more in Group A patients which accounts for 22.58%(14) than in Group B patients which accounts for 3.22%(2). More patients account for 19.35%(12) in group A experienced chronic pain than the patients 1.61%(1) in Group B. The current study showed that Desarda’s technique is a safe, effective, and single-sitting technique with a significantly reduced risk of seroma, surgical site infection, chronic pain, and recurrence than mesh hernioplasty for strangulated inguinal hernia

Effect of Two Different Volumes of Ropivacaine and Lignocaine at Two Different Sites in Ultrasound-Guided Supraclavicular Brachial Plexus Block on Diaphragm Motility

Ultrasound (USG) guided supraclavicular brachial plexus block (BPB) helps in precise delivery of local anesthetic injection, reduced volume or dose of drug providing excellent surgical anesthesia with fewer complications. Objective of the study was to compare effect of two different volumes of Ropivacaine and Lignocaine at two different sites of USG-guided supraclavicular BPB on diaphragmatic motility, quality of block and tourniquet pain. A prospective randomized double-blinded comparative study was conducted among adult patient with below elbow elective surgery. In group A patients (n=17), 20ml of anesthetic solution was injected in the corner pocket and 10ml in the nerve cluster guided with USG. In group B patients (n=17), 15ml of the anesthetic solution was injected in the corner pocket and 5ml in the nerve cluster guided with USG. Hemodynamic parameters, diaphragmatic excursion, onset of anesthetic effects were measured at frequent intervals. The data were analyzed using Statistical Package for Social Sciences at P-value less than 0.05. Hemodynamic profile of the patients were similar in both groups (P-value&gt;0.05). Statistically significant hemi-diaphragmatic dysfunction (partial and complete paralysis) after 15 and 30minutes of blockade was more common in group A than Group B (P&lt;0.05). At 30 minutes after the injection of the anesthesia, all patient in both the groups had complete sensory and motor block in all nerve territory. Tourniquet time was lower in group A (80.35±9.59 minutes vs 84.12±7.75 minutes); however, it was statistically not significant (P-value&gt;0.05). The present study showed that the patients who received lesser half of the required volume of local anesthetics had less incidence of hemidiaphragmatic dysfunction with similar successful rate of blockage (100%) and similar quality of the block as compared to the patients who received greater half of the required volume of local anesthetics.

Enhanced Bioavailability and Pharmacokinetics of a Natural Self-Emulsifying Reversible Hybrid-Hydrogel System of Quercetin: A Randomized Double-Blinded Comparative Crossover Study.

Despite the vast array of health beneficial pharmacological effects, the bioavailability of the dietary flavonoid quercetin was found to be poor due to insolubility, incompatibility, and rapid biotransformation. Herein, we investigated the solubility, morphology, particle size, stability, in vitro release, and human pharmacokinetics of a hybrid-hydrogel formulation of quercetin (FQ-35) using fenugreek galactomannans as the hydrogel scaffold. Physicochemical characterization revealed that the crystalline quercetin was well encapsulated in the hydrogel matrix to form translucent microgel particles of FQ-35 with enhanced solubility (96-fold). The mean particle size was found to be 183.6 ± 42.7 nm with a zeta potential of 35.1 ± 3.8 mV. Pharmacokinetic investigation on healthy volunteers (N = 16) employing tandem mass spectrometric (ultra-performance liquid chromatography-electrospray tandem mass spectrometry) measurements of the concentration of free (unconjugated) and conjugated quercetin metabolites revealed an 18.6-fold improvement in free (unconjugated) quercetin bioavailability and 62-fold improvement in total quercetin (sum of free and conjugated) bioavailability, compared to the unformulated quercetin extracted from Sophora japonica. In summary, the natural self-emulsifying reversible hybrid-hydrogel delivery system was found to offer significant solubility, stability, and bioavailability of quercetin upon single-dose oral administration.

Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Pain Relief in Children Undergoing Lower Abdominal Surgeries: A Randomized, Double-Blind Comparative Study.

The quadratus lumborum (QL) block, also known as the abdominal truncal block, was developed to provide visceral and somatic analgesia during abdominal procedures. This study aimed to assess pain alleviation, the incidence of complications in lower abdominal procedures, and hemodynamic stability between the caudal block and ultrasound-guided QL block. Fifty-two patients aged 1 to 7 years old from both genders scheduled for unilateral lower abdominal surgery were randomly assigned to 2 study groups: group QL, unilateral QL block (n = 26), and group C, caudal block (n = 26). In group C, children received caudal block. In group QL, an ultrasound-guided QL block was performed. The time to first rescue analgesia was evaluated as a primary outcome. The quality of analgesia was determined using the face, legs, activity, cry, consolability scale (FLACC scale), hemodynamic parameters, and incidence of complications because hemodynamic instability was recorded under ultrasound guidance. Signs of local anesthetics toxicity and the parents' satisfaction were secondary outcomes. The time until the first demand for analgesia postoperatively was statistically longer in group QL compared to group C. A non-significant difference was observed between the 2 groups (P > 0.05) regarding age, weight, gender, duration of surgery, type of surgery, FLACC scale, and hemodynamics (SBP, systolic blood pressure), except at 30 minutes, which was significant in QL block. Also, a non-significant difference was observed in the severity of postoperative pain up to 1 day postoperatively. Group QL showed more satisfaction than group C. No intraoperative complications were detected. Compared to caudal block, QL block produced sustained and adequate analgesia time postoperatively, with higher satisfaction.

Clove bud (Syzygium aromaticum L.) polyphenol helps to mitigate metabolic syndrome by establishing intracellular redox homeostasis and glucose metabolism: A randomized, double-blinded, active-controlled comparative study

• Influence of Clovinol verses synthetic Glutathione (s-GSH) in metabolic syndrome. • Clovinol enhanced Nrf2 and plasma GSH levels by 6-fold compared to s-GSH. • Clovinol helps balanced intracellular redox homeostasis. • Clovinol modulated glucose and lipid metabolism. • Clovinol may help balanced immunity. Present randomised double-blinded comparative study investigated the influence of clove buds ( Syzygium aromaticum ) polyphenol extract (Clovinol) in comparison with synthetic glutathione (s-GSH) (250 mg/day for 84 days) on healthy adults (N = 70) characterised with metabolic syndrome (MetS). Outcome measures included plasma concentration of endogenous antioxidants, inflammatory markers, blood sugar and lipid metabolism markers, in addition to haematological and biochemical parameters of safety. Clovinol enhanced the plasma concentration of GSH by 6-fold and offered statistically significant enhancement in Nrf2, antioxidant enzymes and in GSH/GSSG ratio. Treatment with Clovinol also improved FBS, PPG, HbA1c, HOMA-IR and insulin levels indicating modulation of insulin resistance. Moreover, Clovinol caused significant reduction in total cholesterol, triglycerides, LDL and increased HDL, while s-GSH showed no significant effect on blood glucose and lipid metabolism. Clovinol did not show any significant side effects or toxic deviations in haematological and biochemical parameters, but significantly increased the total leukocyte and reduced neutrophil/lymphocyte ratio and inflammatory markers (IL-1β and TNF-α).

Comparative Double-Blind Study of Efficacy of Pre-Cleaners for Surgical Instruments and Medical Devices in the Central Sterile Services Department

The Central Sterile Supply Department (CSSD) is one of the hospital's critical support services. It is a place to receive medical equipment blood-stained from the other departments to be cleaned. It is responsible for cleaning, receiving, storing, sterilizing, and returning medical equipment to everyone and delivered to different departments within the hospital. Nowadays, various cleaning and dissolving blood stains are used to clean and remove blood stains. This research aimed to compare the efficacy of pre-cleaning spray and pre-cleaning spray foam cleaners for blood-contaminated surgical instruments and medical devices in the Central Sterile Services Department. The pre-cleaning spray was significantly higher than the pre-cleaning spray foam (p ≤ .005). A significant difference in the 2-minute pre-cleaning spray was observed by using cleaning indicators. The pre-cleaning spray foam started dissolving blood after 5 minutes. Therefore, from the study, using the pre-cleaning spray for dissolving blood stains and pre-cleaning has a more practical effect than pre-cleaning foam.

Analgesic efficacy of the erector spinae plane block using bupivacaine vs. bupivacaine/magnesium sulphate in patients undergoing lumbar spine surgery: a randomized, double-blinded comparative study

Abstract&#x0D; Background &amp; Objectives: Postoperative pain is one of the most troublesome pains for the surgical patient, and is one of the causes of morbidity and prolonged hospital stay. Opiates and non-steroidal anti-inflammatory drugs have been routinely used across the world. Recent resurge of regional anesthetic techniques offer some advantages, especially reduced post-operative nausea and vomiting and less sedation. &#x0D; We compared the efficacy of bupivacaine with a combination of bupivacaine/magnesium sulphate for the Erector Spinae Plane (ESP) block in patients for postoperative pain undergoing lumbar spinal fusion under general anesthesia.&#x0D; Methodology: A total of 30 ASA-I and II patients, 20-60 y old, who undergoing lumbar spinal fusion were enrolled. They were randomly divided into two groups; Group B (n = 15) to receive bupivacaine 0.25 percent, 20 mL injected on each side to provide ESP block; and Group BMG (n = 15): to receive 20 mL of 0.25 percent bupivacaine plus 500 mg magnesium sulphate, injected on each side for ESP block.&#x0D; The parameters measured included; the surgery time, non-invasive mean blood pressure during surgery, postoperative heart rate at 1, 6, 12, and 24 h, The time to first request for analgesics time after surgery referred to as the postoperative period (h). Postoperative total analgesic (pethidine needed per 24h) required and postoperative pain at rest and on moving, measured with VAS (Visual Analogue Scale) at the 1st, 6th, 12th, and 24th h.&#x0D; Results: Both at rest and through moving the VAS (Visual Analogue Scale) among both groups. No significant difference could be seen at the first, sixth, twelfth, and twenty-fourth hours. The time to the first request for analgesics was significantly prolonged in the Group BMG than the Group B. The total analgesic need after surgery was significantly lower in Group BMG than the Group B.&#x0D; Conclusion: The use of a combination of bupivacaine plus magnesium for bilateral erector spinae plane block after lumbar spinal fusion surgery is better in terms of prolonged postoperative analgesia and reducing the opioid use as compared to bupivacaine alone in patients undergoing lumbar spinal fusion under general anesthesia.&#x0D; Abbreviations: ESP - Erector spinae plane; VAS - Visual Analogue Scale; NSAIDs - Non-steroidal anti-inflammatory drugs;&#x0D; Key words: Adult; Analgesia; Analgesics, Opioid / therapeutic use; Bupivacaine; Humans; Lumbar spine; Magnesium sulfate; Nerve Block; Pain, Postoperative / drug therapy; Pain, Postoperative / prevention &amp; control; Paraspinal Muscles&#x0D; Citation: Abdelbadie M. Analgesic efficacy of the erector spinae plane block using bupivacaine vs. bupivacaine/magnesium sulphate in patients undergoing lumbar spine surgery: a randomized, double-blinded comparative study. Anaesth. pain intensive care 2022;26(4):439-444; DOI: 10.35975/apic.v26i4.1945&#x0D; Received: April 17, 2022; Reviewed: May 06, 2022; Accepted: June 17, 2022&#x0D;

Comparative Study of Pain on Injection of Propofol MCT-LCT with Propofol Nanoemulsion for General Anaesthesia

Introduction: Pain during injection of propofol continues to be a major discomfort for patients. Different propofol formulations have been introduced to reduce the incidence of pain.&#x0D; Aims: To know the incidence, severity of pain at induction and post operative amnesic effect of two different formulations of propofol.&#x0D; Methods: This double-blinded comparative study involved randomly selected 100 patients undergoing elective surgery under general anesthesia with physical status score I or II (American Society of Anesthesiologists). Out of 100 patients, 50 received medium and long chain triglyceride Propofol (Group A) while another 50 received nanoemulsion Propofol (Group B) intravenously. Parameters measured and compared were the gender, age, weight, physical status score, pain on injection and postoperative recall of pain during injection of propofol.&#x0D; Results: Both groups were comparable with regards to age, gender, physical status score, mean duration of surgery. The presence of pain during injection with propofol in group A was 76% (38 patients) while 36% (18 patients) in group B which was statistically significant (p =0.0001). Severity of pain was more in group A which was statistically significant in comparison to group B (p=0.0001). The arm withdrawal during the injection of propofol was found more in Group A than Group B, 24% vs 0% (p=0.0002). Recall of pain after 4 hours postoperatively was found in 5 patients of Group A (10%) and 3 patients of Group B (6%) which came out to be statistically insignificant (p=0.715). There was no significant difference between groups regarding heart rate, mean arterial pressure, respiratory rate and arterial hemoglobin oxygenation at all assessed times (p &gt; 0.05) intraoperatively.&#x0D; Conclusion: This study clearly shows the incidence and severity of pain on intravenous administration in nanoemulsion Propofol is significantly less. However, amnestic effect was equally present in both the groups.

Lomber Radiküler Ağrı Tedavisinde Kambin Üçgeni Yaklaşımı ile Uygulanan Steroid Enjeksiyonunun Etkinliğinin Konvansiyonel Transforaminal Yaklaşımla Karşılaştırılması: Prospektif Randomize Çalışma

ABSTRACT Objective: Low back pain is a very troublesome and common issue among patients irrespective of age and sex and is very difficult to manage with conservative management. It can lead to disability and mental issues. Methods: After ethical committee approval, a prospective, randomised, double-blind comparative study on 40 patients aged 20-70 years, suffering from lumbar radicular pain was carried out by two different approaches i.e., conventional transforaminal and Kambin’s triangle approach and epidural steroids were administered. Change in pain intensity using the Verbal Numerical Rating Scale was recorded as our primary outcome. Change in functional status using Oswestry Disability Index and Patient Satisfaction Score were our secondary outcomes. Any adverse event, complication, failure was also noted. Results: Multiple logistic regression showed no difference in pain relief or improvement of functional status due to variable differences like the age, sex, disc level or the type of approach. Conclusion: Both approaches of transforaminal epidural steroid injection were effective in reducing pain and increasing functional status significantly. There was no significant difference in their effectiveness and neither was superior to the other. Keywords: Low back pain, transforaminal approach, Kambin’s triangle approach