Duration Of Postoperative Pain Relief Research Articles

Protocol for a prospective comparative randomized clinical study for the comparison of two different doses of dexmedetomidine with bupivacaine in pediatric caudal anesthesia for infraumbilical surgeries in a tertiary hospital in central India

Background Pediatric caudal anesthesia is a well-established technique for providing intraoperative and postoperative pain relief in children undergoing infraumbilical surgeries. Dexmedetomidine, an α2-adrenergic agonist, has shown promise as an adjuvant to local anesthetics in caudal blocks, potentially improving the quality and duration of pain relief. This study aims to compare two doses of dexmedetomidine with bupivacaine to assess their efficacy in pediatric caudal anesthesia. Methods A prospective comparative randomized clinical study will be conducted over two years in the Department of Anaesthesiology at Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH) in Central India. Patients aged six months to six years, with American Society of Anesthesiologists (ASA) Class 1 or 2, scheduled for infraumbilical surgeries, will be included. They will be randomly allocated to receive either Group A (1 ml/kg of 0.25% bupivacaine with 1 μ/kg dexmedetomidine) or Group B (1 ml/kg of 0.25% bupivacaine with 0.5 μ/kg dexmedetomidine) in a double-masked fashion. The primary outcome is the duration of postoperative pain relief. Secondary outcomes include intraoperative hemodynamic stability, time first to rescue analgesia, incidence of adverse effects, and patient and parent satisfaction. A cost-effectiveness analysis will also be conducted. Conclusions The study will provide insights into the efficacy and safety of different doses of dexmedetomidine in pediatric caudal anesthesia for infraumbilical surgeries. The results will guide clinical practice and inform anesthesia protocols for pediatric patients in the study setting. Registration CTRI (CTRI/2023/05/057050; 29 August 2023).

Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases

AimWe retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies.Materials and methodsThis is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1.ResultsEighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery.ConclusionMicrovascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.

Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study.

Prospective, randomized controlled double-blinded study. To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia. 81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded. The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; P < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29mg; P < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03mL, 380.74 ± 77.80mL) than the control group (498.89 ± 71.22mL) (P < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief. Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.

Fentanyl versus midazolam added to bupivacaine for spinal analgesia in children undergoing infraumbilical abdominal surgery: A randomized clinical trial

ABSTRACT Background The addition of fentanyl or midazolam to intrathecal bupivacaine was tested to reduce the occurrence and pain degree in children undergoing infraumbilical surgery under sevoflurane anesthesia with intrathecal analgesia. Methodology Children (6–8 years) were randomized into three groups of 30 patients each with consent from parents. Groups C, F, and M received 0.3 mg/kg of 0.5% bupivacaine + 0.9% NaCl (placebo),0.3 mg/kg of 0.5% bupivacaine + 0.2 µg/kg of fentanyl, and 0.3 mg/kg of 0.5% bupivacaine + 0.5 mg of midazolam, respectively. Assessments included time to first analgesic request, postoperative pain score, the total amount of rescue analgesics, motor and sensory blocks, sedation, family satisfaction, and adverse effects. Results The Children’s Hospital of Eastern Ontario score was higher in the control than in the midazolam and fentanyl groups. The mean time to the first request for rescue analgesia was longer in group M (297.1 ± 10.7 min) than in groups F (219.9 ± 25.4 min) and C (162.7 ± 37.5; P = 0.000). The total analgesic consumption was higher in both control and fentanyl groups (P = 0.044). Family satisfaction was significantly higher in group M (P = 0.013) with no adverse effects. Conclusion In the present study, intrathecal midazolam (0.5 mg) was superior to intrathecal fentanyl (0.2 μg/kg) in increasing the duration of postoperative pain relief with lower postoperative pain scores and less incidences of adverse effects. Consequently, intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not accessible or contraindicated.

Double Blinded Comparative Study of Bupivacaine with and without Dexamethasone in Supraclavicular Brachial Plexus Block

Background: Through the use of bupivacaine-induced brachial plexus blocking, it is possible to achieve high levels of anaesthesia and analgesia for surgical procedures. When dexamethasone was given to bupivacaine as an additive, the anaesthesia and analgesia lasted significantly longer in the patients who participated in the study. Aim: To study sensory and motor blockade, as well as the duration of postoperative analgesia and the duration of postoperative pain relief. Methods: We were able to enrol 60 patients in the experiment after they were approved by the Institutional Ethical Committee and provided written informed consent to participate. ASA I and II patients, ranging in age from 18 to 60 years old, who had undergone elective surgery on their upper extremities were included in this study. They were separated into two groups of almost equal size.. Results: The mean age in group 1 was 42.6 years with 13.6 SD whereas in group 2 mean age was 37.8 years with 12.5 SD. In group 1 mean weight was 61.7 kgs with 5.9 SD whereas in group 2 the mean weight was 58.2 kgs with 4.8 SD. The descriptive analysis of group 1 and group 2 showed that the mean pulse rate with SD was 83 ± 6.5 and 84 ± 7.2 respectively. While the systolic BP was recorded as 122 and 126 for groups 1 and 2 the standard deviation in this case was 7.8 and 6.4 respectively. Diastolic blood pressure for group 1 was 75 ± 8.2 SD and for group 2 it was recorded as 78 ± 7.9 SD. The analysis of SPO2 for group 1 was 97.3 ± 1.4 SD while group 2 showed 97.5 ± 1.1 SD as mean and SD values. For group 1 the onset of motor block ( minutes) was 3.8 ± 0.8 SD and for group 2 it was 17.5 ± 2.3 SD. Onset of sensory block ( minute) for group 1 was 7.2 ± 1.5 SD and for group it was 15.6 ± 1.6 SD. Conclusion: The addition of 15 millilitres of 0.5% bupivacaine to 15 millilitres of dexamethasone significantly accelerates the onset of sensory and motor blockage in the patient. It has been demonstrated to significantly increase the duration of sensory and motor blockage as well as analgesia. It has been demonstrated that dexamethasone adjuvant is completely safe and has no negative effects when used in the brachial plexus block. Keywords: Double blinded study, upper limb, supraclavicular brachial plexus

Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery

Background &amp; Objective: Hyperbaric bupivacaine is the most commonly used local anesthetic for spinal anesthesia, alone or in combination with various adjuvants. Opioids are frequently used for their rapid onset and intense block characteristics. Fentanyl is the preferred intrathecal opioids with rapid onset of action but has a shorter duration of action. Buprenorphine is a mixed agonist-antagonist with high affinity at both mu and kappa opioid receptors. We compared administration of buprenorphine with fentanyl as adjuvants with intrathecal hyperbaric bupivacaine in gynecological surgeries.&#x0D; Methodology: After Institutional Ethical Committee approval and written informed consent, 60 patients aged 18–65 y, scheduled for lower abdominal gynecological surgery, were divided into two equal groups; Group F to receive 0.5% hyperbaric bupivacaine 2.5 ml with fentanyl 25 µg intrathecal and Group B to receive 0.5% hyperbaric bupivacaine 2.5 ml with buprenorphine 75 µg intrathecal. Block characteristics and associated side effects were compared between two groups. The data was analyzed using Chi square test and Fisher’s exact test. For comparing two group of mean, independent student’s t test was used. P-value &lt; 0.05 was considered as statistically significant.&#x0D; Results: The mean onset of sensory and motor block was significantly earlier in Group F than Group B (p &lt; 0.001). Mean duration of sensory block was significantly prolonged in Group B compared to Group F (p &lt; 0.05). Whereas, the duration of motor was comparable in both of the groups (p &gt; 0.05). Duration of analgesia was significantly prolonged in Group B than Group F (p &lt; 0.001).&#x0D; Conclusion: We conclude that when a longer duration of postoperative pain relief is needed, buprenorphine can be a suitable drug to be used with intrathecal hyperbaric bupivacaine for gynecological surgeries because of prolonged duration of action.&#x0D; Key words: Spinal anesthesia; Fentanyl; Buprenorphine; Bupivacaine&#x0D; Citation: Singh Y, Yadav AK, Vijeta Bajpai, Diwedi P, Verma S, Verma RK. Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery. Anaesth. pain intensive care 2021;26(1):39-43.&#x0D; DOI: 10.35975/apic.v26i1.1764

Comparison of the Efficacy of Intraperitoneal Instillation of Butorphanol Versus Nalbuphine as Adjuvants to Ropivacaine for Postoperative Pain Relief in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Randomized, Double-Blind Placebo-Controlled Study.

Postoperative pain after laparoscopic cholecystectomy is very common complication hindering the early return of routine activity. Since agonist opioids are not easily available, the most common drug used for intraoperative analgesia is intravenous butorphanol in our institute. The purpose of our study is to compare the analgesic effect of intraperitoneal butorphanol and nalbuphine as additives with ropivacaine in laparoscopic cholecystectomy for postoperative pain. Randomized, double-blind prospective study undertaken after approval from the Institutional Ethics Committee. In this study, 90 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: group A received intraperitoneal ropivacaine 0.2% of 20 mL with butorphanol 2 mg; Group B received intraperitoneal ropivacaine 0.2% 20 mL with nalbuphine 10 mg; and Group C received intraperitoneal ropivacaine 0.2% 20 mL with 0.9% normal saline. The primary outcome was to compare the analgesic efficacy of butorphanol with nalbuphine and the duration of postoperative pain relief. The secondary outcomes included the comparison of hemodynamic parameters, frequency of rescue analgesia, and complications among the three groups. The data analysis was carried out with ANOVA and Chi-square test using the SPSS software version 26.0. The mean of the Numeric Rating Scale pain score was insignificant in Group A versus B at all-time intervals indicating similar efficacy of butorphanol and nalbuphine in terms of pain relief postoperatively. However, the time to first rescue analgesia was significantly higher in Group A (5.70 ± 3.57 h), followed by Group B (3.95 ± 2.06 h) and Group C (2.50 ± 1.24 h). Butorphanol is better analgesic than nalbuphine as postoperative pain-free period was relatively more with lesser complications.

Comparative Randomised Study between Bupivacaine with Clonidine and Ropivacaine with Clonidine Used Caudally for Postopertaive Analgesia in Paediatric Hypospadias Surgery

Background: This study was conducted to compare and evaluate the caudal epidural clonidine when mixed with ropivacaine and bupivacaine in prolonging postoperative analgesia in children of Indian genotype undergoing hypospadias surgery, as well as compare the intraoperative haemodynamics using caudal bupivacaine with clonidine vs ropivacaine with clonidine. The study was also aimed at studying the side effects and the duration of post-operative pain relief of bupivacaine with clonidine v/s ropivacaine with clonidine.&#x0D; Methods: This is a prospective randomised comparative study that was carried out in the Department of Anaesthesiology, KEM Hospital, Pune, over 12 months (from October 2016 to September 2017), among 56 children having an ASA Grade of II, aged between 1 to 8 years admitted for hypospadias surgery. The data gathered was cleaned using Microsoft Excel, before statistical analysis was done.&#x0D; Results: It was observed that caudal epidural analgesic duration was more in the bupivacaine clonidine group than in the ropivacaine clonidine group. The sedation score was higher at the second hour in the bupivacaine clonidine group. The HR and mean arterial pressure values were found to be notably higher in the ropivacaine clonidine group than those in the bupivacaine clonidine group. Intraoperatively and postoperatively, there was a decrease in pulse rate and MAP but at no time did the value reach the criteria for intervention. Other side effects like postoperative vomiting, nausea, motor blockade, respiratory distress not observed in any group.&#x0D; Conclusion: Bupivacaine 0.25 % 0.5 ml per kg with clonidine 1 microgram / kg via caudal route increased the duration of postoperative analgesia with no adverse effects as compared to ropivacaine 0.25 % with clonidine 1 microgram/ kg. Hence clonidine is more efficient in increasing postoperative analgesia when added with Bupivacaine as compared to ropivacaine in Indian genotype in hypospadias surgery.

A randomized control trial on the efficacy of bilateral ilioinguinal-iliohypogastric nerve block and local infiltration for post-cesarean delivery analgesia

Background and Aims: The management of post-cesarean delivery pain is of utmost importance to prevent undesirable outcomes. Local anesthetic wound infiltration and bilateral ilioinguinal-iliohypogastric (ILIH) nerve block are two potential techniques to provide better postoperative analgesia. In this study, these two techniques have been compared for the management of postoperative pain in the elective cesarean section. Materials and Methods: After approval from the institutional ethics committee and informed consent from patients, this study was conducted on 150 patients who underwent elective cesarean section under spinal anesthesia. Patients were allotted into three groups: group C (postoperative sham injection), group L (postoperative infiltration of incision site with 20 mL of 0.5% ropivacaine), and the group I (postoperative bilateral ILIH block with 10 mL of 0.5% ropivacaine on each side under ultrasound guidance). The objectives of our study were to evaluate the duration of analgesia, visual analog scale (VAS) score, and the cumulative analgesic requirement for pain relief and a number of analgesic demands. Student t-test and Mann-Whitney U test were used to compare the analgesic parameters among the groups. Results: Group I had a significantly longer duration of analgesia (515.64 ± 82.87 min) compared to group L (280.87 ± 39.47 min), and group C (246.89 ± 37.85 min). Group I had significantly lower VAS scores compared to the groups L and C. Group I (1.72 ± 0.68) had lower analgesic demands compared to group L (3.26 ± 0.64) and group C (4.62 ± 0.65). The cumulative analgesic requirement was significantly lower in group I. Conclusion: ILIH nerve block has a longer duration of postoperative pain relief in cesarean delivery patients compared to local infiltration and placebo.

Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

Background: Abdominal hysterectomy is often a long duration procedure and warrants intense pain relief in the post-operative period. Dexmedetomidine when added to bupivacaine in subarachnoid block prolongs the duration of surgical anaesthesia, decreases blood loss and prolongs duration of post-operative pain relief. Aims and Objective: To compare two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block in abdominal hysterectomy surgeries. Materials and Methods: 60 patients of age group 30-60 years posted for elective abdominal hysterectomies under American Society of Anaesthesiologists (ASA) physical classification I or II were randomly allocated into 2 groups of 30 each. Group A received 5 micrograms (μg) of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Group B received 10 μg of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Changes in blood pressure, heart rate, respiratory rate, oxygen saturation, ephedrine consumption, blood loss, duration of sensory block, duration of motor block, duration of analgesia were compared between two groups. Results: There was no significant difference in change in heart rate, respiratory rate, oxygen saturation, duration of sensory block, duration of motor block between two groups. Patients in group B had significant decrease in blood pressure, blood loss and significant increase in ephedrine consumption compared to Group A. The duration of analgesia was also prolonged in group B compared to Group A. Conclusion: Dexmedetomidine in dose of 10 μg is a better adjuvant to bupivacaine for abdominal hysterectomy surgeries.Asian Journal of Medical Sciences Vol.8(2) 2017 59-63

Caudal Epidural Analgesia in Pediatric Patients: Comparison of 0.25% Levobupivacaine and 0.25% Ropivacaine in Terms of Motor Blockade and Postoperative Analgesia.

Context:Ropivacaine and Levo-Bupivacaine have been safely used for caudal anaesthesia in children, but there are limited studies comparing the efficacy of 0.25% Ropivacaine and 0.25% Levo-Bupivacaine for caudal anaesthesia in infraumbilical surgeries.Aims:The aim of this study was to compare the incidence of motor blockade and postoperative analgesia with 0.25% ropivacaine and 0.25% levobupivacaine for the caudal block in children receiving infraumbilical surgery.Settings and Design:This was a randomized double-blinded study.Subjects and Methods:Sixty patients of either sex, between 1 and 10 years posted for elective infraumbilical surgeries, to receive caudal block with either (Group R) ropivacaine 0.25% or (Group L) levobupivacaine 0.25% of volume 1 ml/kg were included in the study. Motor blockade was assessed using motor power scale, and pain was assessed every 1 h for first 6 h, then 2nd hourly for following 18 h using modified Hannallah objective pain scale. If pain score is ≥4, the patients were given paracetamol suppositories 20 mg/kg as rescue analgesia.Statistical Analysis Used:All analyses were performed using Chi-square test, Student's independent t-test, Kruskal–Wallis test, Mann–Whitney U-test.Results:The time for full motor recovery was similar in both groups; in Group R, ropivacaine: 180.50 ± 14.68 min, and in Group L, levobupivacaine: 184.50 ± 18.02 min, with P = 0.163. The duration of postoperative pain relief between the groups was 330.50 ± 9.54 min in Group L (levobupivacaine) and 312.67 ± 5.56 min in Group R (ropivacaine) with P = 0.165 not statistically significant.Conclusions:Both ropivacaine 0.25% and levobupivacaine 0.25% have similar recovery from motor blockade and postoperative analgesia.

Comparison of intrathecal isobaric levobupivacaine, levobupivacaine-clonidine, with hyperbaric bupivacaine as a control for quality of anaesthesia intraoperative hemodynamics and duration of post-operative pain relief in patients undergoing vaginal hysterectomy

Patients presenting with uterovaginal prolapse for vaginal hysterectomies will usually be in the age group of above 50years. Effective and prolonged post-operative analgesia will be of paramount importance in this group of patients as it is not uncommon to find associated comorbidities such as hypertension, diabetic mellitus and ischaemic heart diseases in these population.

Adrenaline with lidocaine for digital nerve blocks.

Surgery on fingers is a common procedure in emergency and day care surgery. Adrenaline combined with lidocaine can prolong digital nerve block and provide a bloodless operating field. Extended postoperative pain relief can reduce the need for analgesics and can facilitate hand rehabilitation. Conventionally, adrenaline is avoided at anatomical sites with end arteries such as digits, penis and pinna because of concerns about arterial spasm, ischaemia and gangrene distal to the site of drug infiltration. To assess the safety and efficacy of use of adrenaline (any dilution) combined with lidocaine (any dilution) for digital nerve blocks (fingers and toes). We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2014), MEDLINE via Ovid SP (1966 to 18 November 2014) and EMBASE via Ovid SP (1980 to 18 November 2014). We also searched specific websites, such as www.indmed.nic.in; www.cochrane-sadcct.org; and www.Clinicaltrials.gov. We included randomized controlled trials (RCTs) that compared the use of adrenaline with lidocaine and plain lidocaine in patients undergoing surgery on digits (fingers and toes). Our primary outcomes were duration of anaesthesia, adverse outcomes such as ischaemia distal to the injection site and cost analysis. Our secondary outcomes were duration of postoperative pain relief and reduced bleeding during surgery. We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We performed all analyses on an intention-to-treat basis. We used a fixed-effect model when no evidence of significant heterogeneity between studies was found and a random-effects model when heterogeneity was likely. We included four RCTs with 167 participants. Risk of bias of the included studies was high, as none of them reported method of randomization, allocation concealment or blinding. Only one trial mentioned our primary outcome of duration of anaesthesia. The mean difference in duration of anaesthesia with use of adrenaline with lidocaine was 3.20 hours (95% confidence interval (CI) 2.48 to 3.92 hours; one RCT, 20 participants; low-quality evidence). No trial reported adverse events such as ischaemia distal to the injection site, and no trial reported cost analysis. One trial mentioned the secondary outcome of duration of postoperative pain relief, but available data were insufficient for analysis of the findings. Two trials reported the secondary outcome of reduced bleeding during surgery.Bleeding during surgery was observed in nine out of 52 participants as compared with 25 out of 51 participants in the adrenaline with lidocaine and plain lidocaine groups, respectively. The risk ratio for bleeding in the adrenaline with lidocaine group was 0.35 (95% CI 0.19 to 0.65; two RCTs, 103 participants; low-quality evidence). From the limited data available, evidence is insufficient to recommend use or avoidance of adrenaline in digital nerve blocks. The evidence provided in this review indicates that addition of adrenaline to lidocaine may prolong the duration of anaesthesia and reduce the risk of bleeding during surgery, although the quality of the evidence is low. We have identified the need for researchers to conduct large trials that focus on other important outcomes such as adverse events, cost analysis and duration of postoperative pain relief.

English

BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine) was varied from 4-8 minutes (mean 5.2 minutes) and duration of analgesia lasted for 2-4 hours (mean 2.98)(p<0.0001) where as in group BB patients (2mg butorphanol + 0.125% bupivacaine) the onset was 2-4 minutes (mean 2.69) and duration of analgesia lasted for 6-8 hours (mean 6.98) (p<0.0001).The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001). CONCLUSION: This study concludes that addition of butorphanol (2mg) to bupivacaine (0.125%) gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without

Comparative Evaluation of 0.5% Ropivacaine and 0.5% Bupivacaine for Day Case Inguinal Herniorrhaphy in a Nigerian Tertiary Health Institution.

Background: Day case inguinal herniorrhaphy is a common surgical procedure performed in our environment with lidocaine used for field block. The study was aimed at comparing 0.5% ropivacaine and 0.5% bupivacaine for the field block, determine their effectiveness and safety in our environment. Methods: In a double-blind randomized study, 52 ASA physical status I-II patients (age >18yrs) scheduled for field block for day case inguinal herniorrhaphy were assigned to two study groups to receive 0.5% ropivacaine 25ml (n = 26) or 0.5% bupivacaine 25ml (n = 26). Onset of analgesia, adequacy of block, duration of postoperative pain relief and pain score at first requirement of analgesic were recorded. Results: One patient in the bupivacaine group did not complete the study. Patient demographic characteristics and surgical times were similar in the two groups. Mean onset time of anaesthesia was shorter in the bupivacaine group than the ropivacaine group (5.37± 0.50 min vs 5.48 ± 0.45 min) although this was not significant (P = 0.44). Adequacy of block was similar in the two groups (P = 0.55). Postoperative pain relief was significantly longer for the ropivacaine group 6.83 ± 0.57hr than for the bupivacaine group 6.32 ± 0.35 hr (P = 0.0004, unpaired t-test). Mean pain score at the first requirement for analgesic was lower in the ropivacaine group 1.38 ± 0.49 than the bupivacaine group (1.56 ± 0.51), but this was not significant (P = 0.22). Few untoward effects of nausea and dizziness were observed in this study. Conclusion: Ropivacaine and bupivacaine have comparable onset of actions and adequacy of anaesthesia when used for day case inguinal herniorrhaphy and are safe. Key words: Blood glucose, fasting, elective surgery.

Penile block for paediatric urological surgery: A comparative evaluation with general anaesthesia

Aim:Peri-operative pain relief in children can be provided by conventional general anaesthesia or by regional nerve blocks. The present study was carried out to evaluate and compare the effectiveness of penile block for penile surgery with the standard technique of general anaesthesia (GA) of short duration of less than two hours, and also to evaluate the postoperative pain relief obtained by penile block.Materials and Methods:The study was carried out in the department of Anaesthesiology and Intensive care of our hospital, on 60 children in the age group of 1-10 years, belonging to American Society of Anesthesiologists (ASA) grades I and II, and divided randomly into two groups: Group B and group G, comprising of 30 patients each. Group B children received a penile block whereas group G children underwent a standard general anaesthetic procedure. Baseline, intra-operative and post-operative heart rate (HR), electrocardiogram (ECG), non-invasive blood pressure (NIBP) (systolic and diastolic) and pulse oximeter oxygen saturation (SpO2) were recorded at regular intervals. The duration of post-operative pain relief, time to rescue analgesia and time to first feed were also evaluated and recorded. Statistical analysis was carried out using statistical package for social sciences (SPSS) 11 version for windows and employing analysis of variance (ANOVA), unpaired student t test, Chi-square test and Mann Whitney U test for various parameters. Value of P<0.05 was considered as significant and P<0.0001 as highly significant.Results:The demographic characteristics were comparable in both the groups. Heart rate, systolic blood pressure, diastolic blood pressure and pulse oximetry showed remarkable differences at various time intervals during intra-operative and post-operative period, which were statistically significant on comparison (P<0.05 and P<0.0001). Post-operative pain relief, time to first rescue analgesia and time to first feed also showed statistically significant differences.Conclusions:Penile block is very effective when used along with light sedation for distal penile surgeries of less than 2 hours duration as compared to standard GA as reflected by more stable haemodynamics in peri-operative period, excellent pain relief extending up to 6-8 hrs postoperatively and absence of any significant complications or side effects.

Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair

The effect of dexmedetomidine on the duration of sensory blockade has not been studied in humans. We evaluated the effect of adding dexmedetomidine to bupivacaine on the duration of postoperative analgesia in children who underwent repair of a cleft palate. Thirty children who were scheduled for repair of a complete cleft palate using a combination of general anaesthesia and greater palatine nerve block were allocated randomly into one of two equal groups (n = 15). In both groups, the greater palatine nerve block was performed bilaterally using 0.5 ml of solution on each side. The B group received bupivacaine 0.25%, whereas the BD group received bupivacaine 0.25% with 1 microg kg(-1) dexmedetomidine. Heart rate, systolic blood pressure, pain score, the time to the first request for analgesia, and the degree of sedation were recorded. There was no difference in haemodynamic variables between the two groups. The pain score was significantly higher in the B group as compared with the BD group. The time to the first request for analgesia was significantly longer in children in the BD group (mean 22 h, range 20.6-23.7 h) as compared with those who received bupivacaine alone (14.2 h, 13-15 h). Sedation scores in the postoperative period did not differ between the study groups. Greater palatine nerve block with a combination of dexmedetomidine and bupivacaine increased the duration of analgesia after repair of a cleft palate by 50% with no clinically relevant side effects.

Buprenorphine With Bupivacaine for Intraoral Nerve Blocks to Provide Postoperative Analgesia in Outpatients After Minor Oral Surgery

The demonstration that opioid receptors exist in the peripheral nervous system offers the possibility of providing postoperative analgesia in the ambulatory surgical patient. Over the previous decade, many investigators have studied this approach and have compared the efficacy of various opioids added to the local anesthetic near the brachial plexus; and it appears from several of these studies that buprenorphine provides the longest duration of analgesia, the most important parameter of postoperative analgesia in outpatients. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but none of the studies was performed in patients undergoing minor oral surgery to check the efficacy of buprenorphine to provide postoperative analgesia in dental patients. The present study was undertaken to ascertain the efficacy of buprenorphine in providing prolonged postoperative analgesia when added to 0.5% bupivacaine with epinephrine 1:200,000. Fifty healthy, consenting adult patients scheduled for upper extremity surgery were enrolled in the study. Patients were assigned randomly to 1 of 2 equal groups based on the agents used for the blocks. Patients in group I received 40 mL of a local anesthetic alone, and those in group II received the same local anesthetic plus buprenorphine 0.3 mg. The study was kept double-blind by having one dentist prepare the solutions, a second dentist perform the blocks, and a third dentist monitor the anesthesia and analgesia thereafter, up to and including the time of the first request for an analgesic medication. The data were reported as means +/- standard errors of the mean, and differences between groups were determined using t test. A P value less than .01 was considered statistically significant. The mean duration of postoperative pain relief after injection of the local anesthetic alone was 8.34 +/- 0.11 hours compared with 28.18 +/- 1.02 hours after buprenorphine was added, a difference that was statistically (and clinically) significant (P < .001). The addition of buprenorphine to the local anesthetic used for intraoral nerve blocks in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of patients. This practice can be of particular benefit to patients undergoing minor oral surgery by providing prolonged analgesia after discharge from the hospital.

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

Dexmedetomidine (DEX) is a highly selective alpha(2)-adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period. Sixty children (ASA status I) aged 1-6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n = 30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 microg/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted. The end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P < 0.05). The duration of analgesia was significantly longer (P < 0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P < 0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P < 0.05). Caudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 microg/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief.

Caudal Additives in Pediatrics: A Comparison Among Midazolam, Ketamine, and Neostigmine Coadministered with Bupivacaine

Single-shot "kiddie caudal" with bupivacaine alone is losing popularity because of its duration of 4-8 h. In a prospective randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief. Eighty children (ASA status I) aged 5-10 yr undergoing unilateral inguinal herniotomy were allocated randomly in equal numbers (n = 20) into 4 groups to receive a caudal injection of 0.25% bupivacaine (1 mL/kg) with or without ketamine (0.5 mg/kg), midazolam (50 microg/kg), and neostig-mine (2 microg/kg), after the induction of standardized general anesthesia without premedication. Monitoring for pain, sedation, postoperative nausea/vomiting, dizziness, and pruritus was performed by anesthesiologists blinded to the study allocation. The time to first analgesic administration (paracetamol syrup) was longer (P < 0.05) in the bupivacaine-neostigmine group and the bupivacaine-midazolam group than in the other groups. Undesirable effects, such as emesis, pruritus, and dizziness, were comparable in all groups. However, the incidence of hallucination was more frequent in the bupivacaine-ketamine group compared with the other groups. This study shows that single-shot caudal coadministration of bupivacaine-neostigmine and bupivacaine-midazolam was associated with an extended duration of postoperative pain relief.