Duration Of Postoperative Analgesia Research Articles

0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial

IntroductionIn an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of...

A Comparative Study to Evaluate Postoperative Analgesia with USG Guided Unilateral Adductor Canal by using Combination of Bupivacaine with Dexamethasone or Morphine After Total Knee Replacement

TKR surgery refer to surgical intervention in the knee joint to replace diseased joint and many studies investigated post operative pain control, Adductor canal block is a newer alterative to femoral block after TKR with better multimodal analgesia and better quadriceps muscle strength, Many studies investigated the prolongation of analgesic duration when adjunct is added to a local anesthetic. A prospective randomized ,double blind, parallel- two group trial. A total of 78 ASA 1 and ASA 2 patients undergoing total knee replacement were included in the study. Seventy eight patients undergoing TKR were randomly allocated into two groups and received block as per the study protocol and the main outcome measure was the duration of postoperative analgesia. The result revealed that at equal volumes Bupivacaine 0.5% with 30mcg/kg of morphine has an advantage over Bupivacaine 0.5% when combined with 8mg of dexamethasone. We conclude that adductor canal block with 0.5% Bupivacaine with 30mcg/kg of morphine has better outcome over conventional intravenous paracetamol analgesia

Effects of a Modified Long-Acting Cocktail on Analgesia and Enhanced Recovery After Total Hip Arthroplasty: A Double-Blinded Randomized Clinical Trial

BackgroundWe compared the efficacy and safety of a modified cocktail for postoperative analgesia and early functional rehabilitation in patients undergoing total hip arthroplasty (THA). MethodsA prospective, double-blind randomized controlled trial was conducted with 200 patients who underwent unilateral primary THA at our hospital. Magnesium sulfate and sodium bicarbonate were added to a traditional cocktail of ropivacaine, epinephrine, and dexamethasone. Primary outcome measures were visual analogue scale (VAS) pain scores at various intervals after surgery; morphine consumption for rescue analgesia after surgery; and time to first rescue analgesia. Secondary outcomes were hip function after surgery, daily walking distance, and quadriceps muscle strength. The third index was the incidence of postoperative adverse reactions. ResultsMorphine consumption was significantly lower in the modified cocktail group than in the control group in the first 24 hours after surgery (6.2 ± 6.0 versus 14.2 ± 6.4 mg, P < 0.001), as was total morphine consumption (10.0 ± 8.6 versus 19.2 ± 10.1 mg, P < 0.001). The duration of the first rescue analgesia was significantly prolonged (23.7 ± 10.3 versus 11.9 ± 5.8 mg, P < 0.001). Morphine consumption was also significantly reduced in the magnesium sulfate and sodium bicarbonate groups over a 24-hour period compared with that in the control group (9.4 ± 6.5 versus 14.2 ± 6.4 mg, P < 0.001, 9.6 ± 6.4 versus 14.2 ± 6.4 mg, P < 0.001). The modified cocktail group had significantly lower resting VAS pain scores than the control group at 6, 12, and 24 hours after surgery (P = 0.036, P = 0.010, and P = 0.017, respectively). The VAS pain scores during movement at 6 and 12 hours after surgery were also significantly lower than those in the control group (P = 0.045, P < 0.001, respectively). The modified cocktail, magnesium sulfate, and sodium bicarbonate groups showed better hip range of motion (P < 0.001, P = 0.013, P = 0.046, respectively) and longer walking distance (P < 0.001, P = 0.014, P = 0.019, respectively) on the first postoperative day, and levels of inflammatory markers were significantly reduced. The incidence of postoperative adverse reactions was similar among the four groups. ConclusionThe modified cocktail with a new adjuvant can prolong the duration of postoperative analgesia, reduce the dosage of rescue analgesics, and accelerate early postoperative functional recovery in patients undergoing THA.

Randomised control trial comparing postoperative analgesia between nalbuphine and fentanyl as an adjuvant with intrathecal levobupivacaine for lower abdominal gynaecological surgeries

Background Effective post-operative pain management is crucial for patient comfort and recovery following lower abdominal gynaecological surgeries. This study protocol outlines a randomised control trial designed to compare the efficacy and safety of two intrathecal adjuvants, nalbuphine and fentanyl, in conjunction with hyperbaric levobupivacaine for postoperative analgesia. Methods The study will be conducted at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, DMIMS (DU), and affiliated institutions. Sixty eligible patients aged 35-75 years undergoing lower abdominal gynaecological surgeries under subarachnoid block will be randomly assigned to one of two groups. Group A will receive nalbuphine with levobupivacaine, while Group B will receive fentanyl with levobupivacaine. Patients will be monitored for the duration of post-operative analgesia, onset of sensory and motor block, hemodynamic effects, and side effects. Outcomes The primary outcome is the comparison of post-operative analgesia duration between nalbuphine and fentanyl. Secondary outcomes include assessing sensory and motor block onset, hemodynamic changes, ephedrine usage, and side effects. Aim To evaluate the efficacy and safety of intrathecal nalbuphine and fentanyl as adjuvants with hyperbaric levobupivacaine for postoperative analgesia in lower abdominal gynaecological surgeries.

Dexmedetomidine addition to local anesthetic mixture for peribulbar anesthesia in strabismus surgery

Aim To evaluate the effect of the addition of dexmedetomidine to the local anesthetic mixture for peribulbar anesthesia in strabismus surgeries. Methods A randomized controlled study included 58 patients who were divided into two groups, group І: included 29 patients who received peribulbar block by a mixture of local anesthetics only, and group II: included 29 patients who received peribulbar block by a mixture of local anesthetics with dexmedetomidine. All cases underwent preoperative full ophthalmic examination. The onset and duration of sensory block, onset and duration of motor block, hemodynamic parameters, sedation level, and duration of analgesia were assessed. Results The onset of sensory and motor block was shortened (P =0.021 and &lt;0.001, respectively) and their duration was prolonged (P &lt;0.001) and the duration of postoperative analgesia was significantly longer in the dexmedetomidine group (P &lt;0.001). Dexmedetomidine group achieved higher sedation scores and lower intra and early postoperative pain scores (P 0.001 and &lt;0.001, respectively) with higher levels of patient and surgeon satisfaction. Conclusion The addition of dexmedetomidine with the local anesthetic mixture for peribulbar anesthesia in strabismus surgeries accelerates the onset of anesthesia and akinesia of the globe and prolongs their duration. It extends the time to the first analgesic request and enhances the satisfaction of both patients and surgeons.

Comparison of nalbuphine and morphine as intrathecal adjuvant to 0.5% bupivacaine for post-operative analgesia in lower abdominal surgeries – A randomized and control study

Background: The use of a higher volume of 0.5% bupivacaine, however, is associated with hemodynamic instability. Adjuvants such as morphine and other opioids are added in with the local anesthetic to reduce this adverse effect and extend the duration of sensory block, hence extending the length of analgesia. However, opiates are associated with a high risk of respiratory depression and other side effects. Nalbuphine has been used to counteract these adverse effects. Thus, we decided to compare the analgesic effect of intrathecal (IT) nalbuphine with IT morphine. Aims and Objectives: The aim of the study was to compare IT morphine with nalbuphine as adjuvant to a spinal anesthetic agent. The primary objective was to compare between the time of onset of sensory and motor blockade and the post-operative analgesic duration between the two adjuvants, while hemodynamic variables and side effects were studied as secondary variables. Materials and Methods: This randomized controlled study was conducted after Ethical Committee approval for a period of 1 year on 100 patients who fulfilled the inclusion criteria. They were randomized into two groups to receive sub-arachnoid block: Group A: 3 mL of 0.5% Hyperbaric Bupivacaine and 0.2 mg morphine and Group B:3 mL of 0.5% Hyperbaric Bupivacaine and 0.5 mg nalbuphine. The following parameters were monitored – Height, Weight, blood pressure, American Society of Anesthesiologists grading, time of onset, maximum duration and regression of Motor and sensory blocks, and total duration of analgesia. Results: The onset of sensory blockade was comparable in both groups while the onset of motor blockade was significantly longer in the morphine group (P≤0.001). The duration of analgesia in the morphine group was longer as compared to nalbuphine group and was statistically significant (P&lt;0.05). The incidence of side effects was 26% in the morphine group and 6% in the nalbuphine group, which was statistically significant (P&lt;0.05). Fourteen patients in the morphine group had pruritus and four patients in the nalbuphine group experienced nausea. Conclusion: IT nalbuphine with 0.5% bupivacaine produces rapid onset of anesthesia and early post-operative analgesia with minimal side effects, but the total analgesic duration was more with IT morphine.

Effectiveness of Single Intravenous Dexamethasone in Prolongation of Spinal Anesthesia for Postoperative Analgesia in Elective Cesarean Section: A Systematic Review of Randomized Controlled Trials.

The analgesic effectiveness of a single perioperative dose of dexamethasone is not clearly defined. The administration of systemic medication like dexamethasone, opioids, and non-steroidal anti-inflammatory drugs has a positive effect on the prolongation of postoperative analgesia after cesarean section under spinal anesthesia. A single-dose administration of dexamethasone with moderate to high dose reduces postoperative pain, reduces opioid consumption, and prolongs spinal anesthesia after cesarean delivery. The aim of this systematic review was to investigate the effectiveness of single intravenous dexamethasone in prolongation of spinal anesthesia for postoperative analgesia in elective cesarean section. We conducted a search on PubMed, Google Scholar, the Cochrane Library, Hinari, and review articles on the effectiveness of intravenous dexamethasone for extending spinal anesthesia during elective cesarean sections, until June 2023. The searches were conducted by using keyword (IV dexamethasone OR/AND analgesia OR postoperative pain AND cesarean section OR child birth AND prolongation of spinal anesthesia). The articles included describe the analgesic efficacy of dexamethasone for prolongation of spinal anesthesia during cesarean section. A total of 25,384 papers were found using different searching methodologies from different electronic databases. The EndNote reference manager was used to remove duplicates, and 438 articles were selected for screening. Of those, 57 were included for critical evaluation, and 49 were removed with justification. The effectiveness of IV dexamethasone on the prolongation of spinal anesthesia and postoperative analgesia in women undergoing cesarean delivery is the subject of eight RCT studies on 628 parturients that are presented in the chosen journal articles from various countries. Intravenous dexamethasone administration immediately after clamping of the umbilical cord prolongs the duration of spinal block in patients undergoing cesarean sections and has a significant impact on reduction of postoperative pain severity, opioid consumption, and other pain requirements. When high-dose dexamethasone is administered intravenously, it can overcome complications that may arise after severe pain and increase patient satisfaction by extending the duration of postoperative analgesia and sensory block.

Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial.

Spinal anesthesia is a widely used regional anesthesia technique for surgeries below the umbilicus, butpostoperative analgesia is of major concern due to the relatively short duration of the local anesthetic. Various drugs were used as an additive to local anesthetic to prolong the duration of postoperative analgesia. This study aims to compare the efficacy ofnalbuphine and fentanyl as an intrathecal additive along with local anesthetic. A total of 166 patients aged between 18 and 65 years belonging to the American Society of Anesthesiologists(ASA) I and II undergoing elective infraumbilical surgeries were included in the prospective double-blind randomized controlled trial. The patients were allocated into two groups of 83 each. Group N was given 2.5 mL of 0.5% bupivacaine + 1 mg of nalbuphine (0.5 mL), and group F received 2.5 mL of 0.5% bupivacaine + 25 mcg fentanyl (0.5 mL). Both groups were compared for postoperative analgesia, onset and duration ofboth sensory and motor blockade, intraoperative hemodynamics, and side effects. All demographic data, hemodynamic parameters, and side effects were not statistically significant among the two groups. However, other parameters, such as the mean duration of analgesia, which was 267.27 ±172.099 minutes in group N and 161.35 ±14.957 minutes in group F; meantime for the onset of sensory blockade, whichwas 3.94 ±1.769 minutes in group N and 5.94 ±0.929 minutesin group F; onset of complete motor blockade, which was 7.10 ±1.858 minutes in group N and 11.61 ±1.218 minutes in group F; duration of motor blockade, which was 182.57 ±13.011 minutes in group N and 112.53 ±7.389 minutes in group F;and mean time taken for two-segment regression, which was 118.20 ±12.61 minutes in group N and 113.72 ±8.84 minutes in group F, were all comparable between the two groups. Nalbuphine was found to be more efficacious for prolongation of postoperative analgesia with better hemodynamic stability.

A Novel USG-Guided PEC Block with Ropivacaine and Fentanyl for Postoperative Analgesia in Chest Wall Surgeries: A Randomized Controlled Trial

Background: Perioperative analgesia can be administered through various routes to patients undergoing chest wall surgeries. A recently introduced technique is the ultrasound-guided pectoral nerve block, which aims to alleviate pain effectively. Objectives: The purpose of this study is to investigate and compare the total duration of analgesia and the timing of the first rescue analgesia. Methods: In this prospective, randomized, triple-blind study, 60 adult patients scheduled for elective chest wall surgeries were enrolled. They were randomly divided into two equal groups: Group R received 38 mL of 0.2% ropivacaine and 2 ml of normal saline, and group F received 38 mL of 0.2% ropivacaine and 2 mL of fentanyl (100 mcg). All patients were administered general anesthesia and the PEC1 and PEC2 blocks postoperatively prior to extubation. The primary objective was to assess the total duration of postoperative analgesia, the Numeric Rating Scale (NRS) pain score, and the time to first rescue analgesia in both groups. The secondary outcome was the total consumption of postoperative analgesics. Results: The total duration of analgesia, as well as the consumption of paracetamol and fentanyl postoperatively in group F, were 11.02 ± 2.01 hours, 1.5 ± 0.5 g, and 0 mcg, respectively. In contrast, in group R, these were 8.28 ± 0.51 hours, 2.2 ± 0.8 grams, and 35.1 ± 13.4 mcg, respectively. The NRS scores at rest and during movement in group F were lower compared to group R. Conclusions: Ultrasound-guided PEC1 and PEC2 blocks with fentanyl as an adjuvant to ropivacaine have significantly reduced the requirements for analgesia and pain scores.

Comparison between peri‑capsular nerve group and supra inguinal fascia iliaca block for analgesia and ease of positioning during neuraxial anesthesia in hip fracture patients: A randomized double-blind trial

ABSTRACT Introduction Patients with fractured hips almost always have marked pain that results in unfavorable positioning for the central neuraxial block. It was revealed that regional block approaches, including suprainguinal fascia-iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block, might effectively alleviate pain in patients with hip fractures. This research aimed to evaluate the influence of S-FICB and PENG block on patients positioning during central neuraxial block and compare their analgesic efficacy. Methods This randomized double-blinded trial included 60 cases aged ≥ 40 years old and ASA I-III with hip fracture with persistent pain and scheduled for surgery under spinal anesthesia (SA). Cases were randomized equally into two groups. Group I (S-FICB) received ultrasound (US) guided S-FICB, and group II (PENG group) received US guided PENG. Both blocks were performed by the same operator using 23 ml of ropivacaine 0.25% + 2 ml (8 mg) of dexamethasone. Results The ease of spinal positioning (EOSP) score was significantly better in the PENG group than the S-FICB group (p < 0.001). Twenty minutes after blocks, the numeric rating scale (NRS) reduced significantly in PENG than in SFICB groups at rest (p < 0.015) and movement (p < 0.010). The first request for analgesia, NRS in the first 24-hour period postoperatively, and the number of tramadol doses were similar between both groups (p = 0.552) and (p < 0.370), respectively. Conclusions Although each block provides comparable duration of postoperative analgesia, PENG block achieved more analgesic effect and easier positioning than S-FICB for SA in patients who had hip fractures surgery.

Comparison of post-operative analgesia with caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia

Post-operative pain relief following pediatric abdominal surgery is of paramount consideration and caudal block is still a popular, easy as well as safe analgesic technique for effective analgesia in children. With the advent of newer local anaesthetics, there has been a renewed interest in pediatric caudal blocks after lower abdominal surgeries following general anaesthesia. The aim of our study was to compare the efficacy and duration of postoperative analgesia using caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia.: The study was conducted on sixty, ASA grade 1, pediatric patients of age 2 to 6 years, of either sex, posted for elective infraumbilical surgery under general anaesthesia. They were randomly divided in two groups of 30 patients each. Group 1: - (n = 30) received caudal block with injection Ropivacaine, 0.25%, 1ml/kg. Group 2: - (n = 30) received caudal block with injection Levobupivacaine, 0.25%, 1ml/kg. Comparative, randomized, single blinded, observational study. : The demographic data was comparable in both the groups. Postoperatively, the quality of analgesia was assessed by the MOP (Modified Objective Pain Scale) score. Duration of postoperative analgesia was assessed by noting the time of giving rescue analgesia in the post-operative period. We also noted side effects, if any in both the groups. The quality of analgesia was found to be similar with both the drug groups (p value &amp;#62;0.05). The duration of analgesia was longer and statistically significant (p value = 0.0006) in the Ropivacaine group (8.43 ± 0.77 hours) as compared to the Levobupivacaine group (7.03 ± 2.03 hours). Statistically significant difference (P value = 0.026) was seen in the requirement rescue analgesia between Ropivacaine (3.33%) and Levobupivacaine (26.67%) groups. There were no major side effects in either of the groups, apart from a single patient out of 30 patients of Levobupivacaine group who had vomiting, compared with none in the Ropivacaine group.We conclude that caudal block with 0.25% Ropivacaine has a longer duration of action as compared to 0.25% Levobupivacaine in children undergoing infraumbilical surgery under general anaesthesia. Both Ropivacaine and Levobupivacaine, have similar quality of postoperative analgesia and side effect profile.

Antishivering effect of intrathecal versus intravenous tramadol in patients undergoing urethroscopic lithotripsy under spinal anesthesia

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P&lt;0.001). The additional tramadol requirement was significantly lower in Group T versus I and in Group T versus C but comparable among Group I versus C. Conclusion: The addition of 25 mg tramadol to IT 0.5% bupivacaine heavy is effective in preventing intraoperative shivering in patients undergoing urological surgeries like URSL.

Effects of Ketamine and Tramadol As Adjuvants to Bupivacaine in Spinal Anesthesia for Unilateral Open Ovarian Cystectomy: A Randomized Controlled Trial.

Spinal anesthesia offers numerous advantages and desirable features. However, it is associated with various side effects related to local anesthetic agents used. Reducing the dose of local anesthetic in spinal anesthesia can help minimize side effects but may lead to a diminished analgesic effect or failure of anesthesia. Therefore, adding an adjuvant may enhance the benefits while mitigating side effects. This study aimed to evaluate the effects of ketamine and tramadol as adjuvants to bupivacaine on the duration of spinal analgesia. The objectives were to compare the three groups and prove their analgesic effects, safety, and superiority.The primary outcomes werethe duration of spinal analgesia, as well as the onset and duration of both sensory and motor blocks. Secondary outcomes included the heart rate, mean arterial pressure, and the incidence of undesired effects such as nausea, vomiting, sedation, shivering, and postoperative headache. In this double-blind randomized controlled trial, 120 female patients undergoing elective open unilateral ovarian cystectomy under spinal anesthesia were studied. The inclusion criteria included patients aged 16-45 years with a physical status classified as American Societyof Anesthesiologists (ASA) class I and II. Patients were randomly allocated into three groups: group B (n=40) received only bupivacaine, group BK (n=40) received bupivacaine mixed with preservative-free ketamine, and group BT (n=40) received bupivacaine mixed with preservative-free tramadol. The mean duration of spinal analgesia, measured in minutes, showed significant differences (P < 0.001) between group BK (165 ± 4) and group B (170 ± 5). There was also a significant difference between group BT (313 ± 8) and group B (170 ± 5) (P < 0.001). Additionally, significant differences were observed between group BK (165 ± 4) and group BT (313 ± 8) (P < 0.001). The administration of 25 mg of ketamine and 25 mg of tramadol as adjuvants to bupivacaine in spinal anesthesia significantly affected the postoperative duration of analgesia. Tramadol prolonged the duration of spinal anesthesia, while ketamine shortened it. The use of both adjuvants did not result in undesired effects.

VARIOUS TYPES OF LOCOREGIONAL ANALGESIA IN PEDIATRIC PATIENTS

The regional blocks, as a part of multimodal analgesia, can improve pain managementin the postoperative period and reduce the rate of complications that arise when usinga single anesthesia regimen.The aim of the study – to compare the efficacy of various regional analgesia techniques.Materials and Methods. All patients were divided into two groups: Group I included31 children who underwent anterior abdominal wall surgery under general anesthesiawith the transversalis fascia plane block (TFPB); Group II comprised 32 children whounderwent anterior abdominal wall surgery under general anesthesia with the TFPB,combined with the quadratus lumborum block 4 (QLB-4) via a single injection.Results. In children of the I group, the pain intensity indicator on the visual analog scale(VAS) after one hour constituted 4.6±0.16 points, while in the children of the II group it was 3.5±0.15 (р&lt;0.05). The assessment of pain intensity according to VAS in thedynamics of the postoperative period showed that children of group I 6 hours aftersurgery have 1.2 times higher pain indicators compared to children of group II (p&lt;0.05),after 12 hours – by 1.7 times, after 24 hours – 1.6 times, after 36 hours – 1.5 times,and at discharge – 1.6 times (р&lt;0.001). According to the results of the LIKERT scale,significantly higher pain indicators were established in children of group I after surgeryand at the time of discharge (10.12±0.15 and 5.45±0.22 compared to 5.93±0.19 and3.50±0 .15 in children of group II (p&lt;0.001). The smallest volume of paracetamol usedfor pre-emptive and multimodal analgesia in children of group I was 95 ml, while inchildren of group II it was 40 ml. The largest volume, required by the children duringanalgesia was 220 mL and 150 mL in groups I and II, respectively.The mean time tocomplete the QLB-4 was 117.3±1.76 sec, while the TFPB was 121.8±3.56 sec (p =0.27).The duration of postoperative analgesia after performing the combined locoregionaltechnique was 32.56±0.5 hours, while when using the TFPB monoblock it was 22.9±0.57hours (p&lt;0.001).Conclusions. The use of a combined block for regional analgesia during operations onthe anterior abdominal wall is accompanied by: a lower indicator of pain intensity in thepostoperative period (p&lt;0.001); reducing the need to use «rescue doses of analgesics» inthe postoperative period (p&lt;0.001); the spread of the sensory block at the level of T7-L2dermatomes; an increase in the duration of postoperative analgesia (p&lt;0.001) comparedto the corresponding indicators when using the TFPB monoblock.

Comparison Between Dexamethasone Versus Clonidine as Adjuvants to 0.75% Ropivacaine in Ultrasound Guided Brachial Plexus Block for Upper Limb Orthopedic Surgeries: A Randomized Prospective Clinical Study

Background: Ropivacaine is an amino-amide local anesthetic, extensively used for peripheral nerve blocks, numerous adjuvants have been added to Ropivacaine to prolong the duration of analgesia. Aim: To compare the effectiveness of adding Dexamethasone to Ropivacaine versus adding Clonidine to Ropivacaine in ultrasound guided supraclavicular brachial plexus block in terms of analgesic duration, onset &amp; duration of sensory and motor blockade.&#x0D; Methods: A prospective randomized single blinded study carried out in 70 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective upper limb orthopedic surgeries. Patients were randomly allocated into two groups, Group RC - patients received 20ml of 0.75% ropivacaine along with 1mcg/kg of clonidine diluted to 2ml of normal saline, Group RD - patients received 20ml of 0.75% ropivacaine along with 8mg of dexamethasone (2ml). Statistical Analysis: Onset &amp; duration of sensorimotor blockade, duration of analgesia was assessed by Unpaired t-test. If p-value &lt;0.05, results were statistically significant &amp; p-value &lt;0.001 were highly significant.&#x0D; Results: Duration of analgesia is superior and statistically significant in Group RD (1,172.57± 18.37 vs 931.09± 16.3). Onset time for sensory (3.14 ± 1.00 vs 9.71± 1.23) and motor (7.60 ± 1.54 vs 13.66± 1.03) block is rapid in Group RD. Duration of sensory (1,106.57± 20.28 vs 786.26± 31.43) and motor (997.74 ± 24.9 vs 674.57 ± 2.18) block is enhanced in Group RD.&#x0D; Conclusion: Dexamethasone as an adjuvant to ropivacaine provided superior post-operative analgesia, faster onset and longer duration of sensory and motor blockade.

Analgesic effects of caudal versus intravenous dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries

Background: Singleshot caudal block provides short lived postoperative analgesia necessitating continued exploration for adjuvants. Aim was to compare the analgesic efficacy between intravenous and caudal dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries. Methods: Following ethical clearance and parental consent, 69 children aged 1-6 years, of American society of anesthesiologists (ASA) physical status classification I and II were randomized into groups A, B and C, of 23 each. All subjects underwent laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen, and had caudal block with 1 ml/kg bupivacaine 0.25%. Additionally, groups B and C received caudal 0.1mg/kg and intravenous preinduction 0.25 mg/kg dexamethasone, respectively. Pain was assessed using FLACC scale. The time to first analgesic request (TTFAR) was defined as the interval from caudal injection until pain score was ≥4; at this point, analgesic was given. Results: All 69 children were completely studied. The mean TTFAR (in minutes) was longest in Group B (485.40±24.50) followed by C (459.60±36.40), and shortest in group A (253.63±71.55), p=0.001, 0.024 and 0.968 for A versus B, A versus C and B versus C respectively, with greatest 24 hours pethidine consumption in Group A relative to groups B and C, p=0.001 and 0.025. Conclusions: Caudal 0.1 mg/kg or intravenous 0.25 mg/kg dexamethasone combined with bupivacaine significantly prolonged postoperative analgesic duration, with comparable analgesic profile between the caudal and intravenous routes, and without adverse effects.

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

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

COMPARISON OF LEVOBUPIVACAINE WITH TWO DIFFERENT ADJUVANTS (DEXAMETHASONE VS. DEXMEDETOMIDINE) IN ULTRASONOGRAPHY-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR UNILATERAL INGUINAL HERNIORRHAPHY: A RANDOMIZED DOUBLE-BLINDED CONTROL TRIAL

Objectives: Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in patients undergoing intraabdominal surgery. This study was aimed to compare the post-operative analgesia, hemodynamic variables, sedation, and adverse effects of levobupivacaine with two different adjuvants (dexamethasone and dexmedetomidine) in USG-guided TAP block for patients undergoing unilateral inguinal herniorrhaphy under subarachnoid block. Methods: A double-blind randomized control study, conducted on 96 patients, allocated in three groups of 32 each. Patients in group C received 0.25% levobupivacaine (20 mL) with normal saline (2 mL), group D1 received 0.25% levobupivacaine (20 mL) added with 0.1 mg/kg dexamethasone (2 mL) and group D2 received 0.25% levobupivacaine added with 0.5 mcg/kg dexmedetomidine diluted in NS (2 mL). Pain was assessed using Visual Analog Scale (VAS). The time for request of first analgesia (TFA), total number and total dose of rescue analgesic in 24 h were recorded. Statistical analysis was done using unpaired Student’s t-test and ANOVA. Results: At 12 and 24 h &gt;30% of patients had VAS ≥4 in control group while it was &lt;10% in groups D1 and D2 (p&lt;0.001). TFA was earliest in control group (6.10±0.96 h) as compared to group D1 (7.26±1.22 h) and group D2 (7.49±1.02 h) (p&lt;0.001). The total number and total dose of analgesic given were higher in the control group than other two groups (p&lt;0.001). However, it was comparable between groups D1 and D2 (p&lt;0.05). Conclusion: Dexamethasone and dexmedetomidine when added as an adjuvant to levobupivacaine for TAP significantly prolonged the duration of post-operative analgesia as compared to levobupivacaine alone, however, it was found to be comparable between adjuvant groups.

Comparative Study of Ropivacaine Alone Versus Combination of Ropivacaine with Either Dexmedetomidine or Dexamethasone for Ultrasound Guided Supraclavicular Brachial Plexus Block

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block.Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups.Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia.Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

Effect of dexamethasone as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia in subjects undergoing lower segment cesarean section

Background: Inadequate pain relief after caesarean section is a common problem in every part of the world. Transversus abdominis plane (TAP) block provides adequate post-operative pain relief following abdominal surgeries. TAP block duration is limited to effect of administered local anesthetics. Hence, adjuvant medications are added to local anaesthetic (LA) to prolong the effect of TAP block. The primay objective of this study was to analyse the analgesic effect of dexamethasone added to levobupivacaine in comparison with analgesic effect of levobupivacaine alone in TAP block. The secondary objectives are to analyse the number of supplemental analgesic requirements in the first 24 hrs after surgery and to analyse the duration of postoperative analgesia which is time to first analgesic request from the time of TAP block. Methods: 116 women scheduled for lower segment cesarean section (LSCS), belonging to ASA physical status 2 or 3, aged between 18 and 35 years, under SAB were recruited. Ultrasonogram (USG) guided TAP block was performed on each side after the completion of the surgery. Subjects in group L (n = 58) received TAP block on each side with 20 ml of 0.375% levobupivacaine and group LD (n = 58) with 19 ml of 0.375% levobupivacaine + 1ml (4mg) of dexamethasone. They were evaluated for pain at 10min, 30min, 45min, 1hour, 2hrs, 4hrs, 8hrs, 12hrs and 24hrs after the block using visual analog scale (VAS) score. Duration of postoperative analgesia and requirement of rescue analgesia were also analysed. Results: The post-operative visual analogue scale (VAS) scores were lower in group LD at 8, 12 and 24 hrs (p &lt; 0.05). Mean duration of analgesia was significantly prolonged in group LD with lesser requirement of rescue analgesics (p &lt; 0.05) up to 24 hrs. Conclusion: Dexamethasone (4 mg) as an adjuvant to levobupivacaine in USG guided TAP block reduces post-operative pain scores prolongs the duration of analgesia and decreases demands for rescue analgesics.