Duration Of Postoperative Analgesia Research Articles

The effect of combined pudendal nerve and spermatic cord block or caudal epidural block on postoperative analgesia after posterior urethroplasty: a randomized trial

BackgroundPostoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB).MethodsSixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively.ResultsTwo patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB.ConclusionsPN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB.Trial registrationThis study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).

The role of adjuvants in regional anesthesia: the postoperative analgesic effectiveness of dexamethasone vs. tramadol given as adjuvants to bupivacaine for ultrasound-guided supraclavicular block for upper extremity surgery—a prospective cohort study

BackgroundBrachial plexus block is used as a surgical anesthesia and analgesia for postoperative pain. Recently, the use of local anesthetics for regional nerve block has been enhanced by mixing them with a different class of drugs as adjuvants. These adjuvants of local anesthetics improved the quality and duration of nerve block and reduced the dose-dependent side effects of local anesthetics. However, the effectiveness of these adjuvants varies depending on the nature of the nerve block and the type of local anesthetics used. Therefore, we aimed to compare the postoperative analgesic effectiveness of dexamethasone vs. tramadol when used as adjuvants to bupivacaine for ultrasound-guided supraclavicular block in upper extremity surgery.MethodsUtilizing a prospective cohort study design, 126 consecutive patients who were undergoing upper extremity surgery with ultrasound-guided supraclavicular block were included. Patients were divided into three groups based on the preference of the responsible anesthetist to use adjuvants with bupivacaine for the block. The dexamethasone group (n = 42) were given 30 ml of 0.25% bupivacaine with 8 mg dexamethasone, the tramadol group (n = 42) were given 30 ml of 0.25% bupivacaine with 100 mg tramadol, and the non-adjuvant group (n = 42) were given 30 ml of 0.25% bupivacaine alone. The primary outcomes evaluated were postoperative pain severity using the numerical pain rating scale (NRS), the duration of analgesia, and the total postoperative analgesic consumption. Secondary outcomes included the incidence of postoperative complications.ResultA total of 126 patients were recruited and analyzed. There was no statistical difference in the demographic data among the groups. The postoperative NRS score was significantly reduced in the dexamethasone and tramadol group compared with the non-adjuvant group (p < 0.001). The NRS score in the dexamethasone group at 18 and 24 h was statistically much lower than in the tramadol and non-adjuvant group. The postoperative duration of analgesia was significantly prolonged in the dexamethasone (1,069 ± 316.99 min) group compared with the tramadol (617.02 ± 214.05 min) and non-adjuvant (434.17 ± 111.23 min) groups (p < 0.001). Patients in the non-adjuvant group had a significantly higher total analgesic consumption over 24 h. The dexamethasone group experienced significantly fewer incidences of nausea, with no differences in other complications among the groups.ConclusionThe addition of dexamethasone as an adjuvant to bupivacaine for ultrasound-guided supraclavicular block improves postoperative analgesia. We recommend the integration of dexamethasone as an adjuvant to local anesthetics during nerve blocks to enhance postoperative pain management after surgery.

Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study

BackgroundNasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA. ObjectivesThis study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption. Patients and methodsThis double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side. ResultsA significant decrease in the incidence of EA was found in G1 compared to G2 (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h vs. 3 h). ConclusionSPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery. RegistrationNational Clinical Trial Registry, NCT04168879

Dexmedetomidine and Dexamethasone as Adjuvants to the Local Anesthetic Mixture in Rhomboid Intercostal and Sub-Serratus Block for Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind, Controlled Trial.

The utilization of adjuvants such as dexamethasone and dexmedetomidine in combination with local anesthetics has proven effective in extending analgesia duration. We aimed to investigate the potential efficacy of combining dexmedetomidine and dexamethasone in rhomboid intercostal and sub-serratus (RISS) block for prolonging postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS). We did this randomized, double-blind, controlled trial in two tertiary-care hospitals. A total of eighty-eight patients undergoing VATS under general anesthesia were enrolled in this study. They were randomly assigned into four groups: ropivacaine (R) group, ropivacaine + dexmedetomidine (RM) group, ropivacaine + dexamethasone (RS) group, or ropivacaine + dexmedetomidine + dexamethasone (RSM) group. The primary outcome measure was the duration of analgesia. Secondary outcomes included Numeric Rating Scale (NRS) scores, cumulative oxycodone consumption, and adverse effects. The RSM group exhibited a significantly prolonged duration of analgesia at 1073.5min (932.0-1283.3) compared to the R group with a duration of 154.5min (80.5-199.3) and the RS group with a duration of 282.0min (195.3-350.0, P < 0 0.001). The cumulative oxycodone consumption during the 0-12hours and 0-24-hours period was significantly reduced in the RSM group compared to the R group (P < 0.05). There was also a lower incidence of nausea at 48hours postoperatively in the RSM group compared to the RM group. However, there were no significant differences between the four groups regarding NRS pain scores. The combination of ropivacaine, dexmedetomidine, and dexamethasone in RISS block significantly prolongs the duration of postoperative analgesia following VATS.

A Clinical Prospective Randomised Comparative Study Of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane Block And Port Site Infiltration With Bupivacaine For Post-Operative Analgesia In Patients Undergoing Laparoscopic Cholecystectomy.

Background: Post-operative pain management is critical in laparoscopic cholecystectomy to enhance patient recovery and satisfaction. This study compares the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block and port site infiltration with bupivacaine for post-operative analgesia. Methods: In this prospective, randomized, comparative study, 60(30/30) patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of two groups: Group A received an ultrasound-guided bilateral subcostal TAP block with 0.25% bupivacaine (20 ml on each side), while Group B received port site infiltration with 0.25% bupivacaine (5 ml per port). The primary outcome was the duration of post-operative analgesia, assessed by the time to first rescue analgesic request. Secondary outcomes included total analgesic consumption in the first 24 hours post-operatively, pain intensity measured by the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours, and any complications related to the procedures. Results: The TAP block group (Group A) demonstrated a significantly longer duration of analgesia compared to the port site infiltration group (Group B) (p &lt; 0.05). Group A also exhibited lower total analgesic consumption and lower VAS scores at all time points. No significant complications were observed in either group. Conclusion: Ultrasound-guided bilateral subcostal TAP block with bupivacaine provides superior post-operative analgesia compared to port site infiltration in patients undergoing laparoscopic cholecystectomy, with a longer duration of pain relief and reduced analgesic requirements. This technique should be considered a viable option for enhancing post-operative recovery in these patients.

A Comparative Study Between Femoral Nerve Block and Suprainguinal Fascia Iliaca Compartment Block for Post-Operative Analgesia in Femur Fracture Fixation

Introduction: Femur fractures and their surgical fixations are common. Adequate postoperative pain relief is mandatory as it facilitates rapid recovery by enhancing early ambulation and mitigating stress response. This is barely achievable with conventional pain control methods. Ultrasound-guided regional blocks like femoral nerve block and supra-inguinal fascia iliaca compartment block are simple yet promising techniques for postoperative analgesia in femur fractures. Aims: To compare post-operative analgesia duration and satisfaction attained between the patients receiving ultrasound-guided femoral nerve block with, those receiving ultrasound-guided supra-inguinal fascia iliaca compartment block, after femur fracture fixation. Methods: Seventy-four patients, aged 16−85 years, of either sex, ASA I−II, who underwent femur fracture surgical fixations under spinal anesthesia, were randomly divided into two equal groups: groups 1 and group 2. Postoperatively, Group 1 (n= 37) received a femoral nerve block with 15 ml 2.5% bupivacaine whereas Group 2 (n = 37) received a supra-inguinal fascia iliaca compartment block with 30 ml 2.5% bupivacaine. Duration of analgesia, patients' level of satisfaction, visual analogue scale scores, and hemodynamic parameters at different time intervals were recorded in the first 24 hours postoperatively and compared. Results: The demographic profiles between the two groups were comparable. Group 2 had a significantly longer duration of analgesia than Group 1, with the means 795.14 vs 538.65 minutes respectively, and a P value of .002. Although group 1 patients had predominantly 3 and 4 levels of satisfaction whereas group 2 had 4 and 5, there was no statistically significant difference in patients’ level of satisfaction between the groups (P=.249). Conclusion: Supra-inguinal fascia iliaca block provides a longer duration of analgesia than femoral nerve block in femur fracture fixation. The level of satisfaction in both groups is high and comparable.

Supraclavicular Brachial Plexus Block with and without Dexamethasone as Local Anaesthetics

Background: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block. Methods: In this prospective randomized, controlled, double blinded study which was conducted at Department of Anesthesia, 250 Beded Hospital, Lalmonirhat, Rangpur, Bangladesh from January to June 2023. We included 70 ASA I &amp; II patients who were aged between 18 years &amp; 60 years, underwent elective upper limb surgeries. They were divided into two equal groups. Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg (2ml). Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline (2ml). We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups. Results: In this study of patients according to their age and weight. 37.26±15.55 years were mean age in group 1 and in group 2 it was 36.56±16.86 with p value being 0.8678. 58.466± 3.9642 kg was the mean weight in group 1 and in group 2 it was 60.4±4.95 kg with p value of 0.1002. So both the groups were comparable in terms of age and weight. In this study out of 70 patients, group1 consisted of 68.6% males whereas there were 60% in group 2 and group 1consisted of 31.4% of females and 40% in group2, hence males’ outnumbered females in both the groups. The mean duration of surgery in group 1 was 50±19.95 minutes and in group 2 were 46.6±15.55 minutes with p value of 0.4646. There was no statistical difference between both the groups. The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes. The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min. The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes. The duration of post-operative analgesia was 815±13.57 minutes in group 1. The duration of post-operative analgesia in group 2 was 393.8±42.88 minutes. There were no complications in both the groups in intra operative period and post-operative period. Conclusion: Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.

Comparative Analysis of Intrathecal Bupivacaine With Fentanyl Versus Intrathecal Bupivacaine With Midazolam in Lower Abdominal and Lower Limb Surgeries.

Many different adjuvants are added intrathecally along with local anaesthetics to prolong intraoperative and postoperative analgesia. Hence, this study aimed to compare intrathecal bupivacaine with fentanyl and bupivacaine with midazolam in lower abdominal and lower limb surgeries. Following permission from the Hospital Ethical Committee (Research Protocol No.: IESC/PGS/2022/143), the study was conducted on a sample of 60 patients, divided into two groups, Group F and Group M, with 30 patients each, representing the American Society of Anaesthesiologist's (ASA) grades I and II. The patients were between the ages of 18 and 60 and featured both males and females, scheduled to undergo elective surgical procedures on the lower abdomen and lower limbs via spinal anaesthesia. Group "F": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (25 mcg) of fentanyl (preservative-free) intrathecally. Group "M": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (2.5 mg) of midazolam (preservative-free) intrathecally. The primary aim was to study the onset of motor and sensory block and duration of analgesia with the addition of midazolam or fentanyl to 0.5% heavy bupivacaine in the sub-arachnoid block. A secondary aim was to evaluate the quality of anaesthesia and postoperative analgesia, determine the haemodynamic stability in the intraoperative and postoperative period in the two study groups, andobserve any adverse effects of study drugs. Group F exhibited a substantially longer duration for both sensory (211.5 vs. 154.4 min) and motor blockade (269.8 vs. 214.6 min) compared to Group M, as well as a rapid onset time for both sensory (2.6 vs. 3.3 min) and motor blockade (3.1 vs. 3.9 min). Also, Group F had a significantly longer duration of effective analgesia compared to Group M (266 ± 15.9 vs. 197.6 ± 13.7 minutes). The addition of 0.5 ml (2.5 mg) Midazolam with 0.5% hyperbaric Bupivacaine intrathecally prolonged the duration of anaesthesia and postoperative analgesia; however, fentanyl 0.5 ml (25 mcg) has a more prolonged duration of intraoperative and postoperative analgesia.

Comparative Analysis of Oral Clonidine Versus Oral Gabapentin on Subarachnoid Block Duration and Postoperative Analgesic Needs.

Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being. In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups. The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV). Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VASscores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct.

Effect of Dexmedetomidine Addition to Bupivacaine in Lumbar Erector Spinae Plane Block on the Duration of Postoperative Analgesia after Hip Arthroplasty A Randomized Double-Blind Controlled Study

Effect of Dexmedetomidine Addition to Bupivacaine in Lumbar Erector Spinae Plane Block on the Duration of Postoperative Analgesia after Hip Arthroplasty A Randomized Double-Blind Controlled Study

A Comparative Study Of Caudal Epidural Bupivacaine And Midazolam-Bupivacaine Mixture For Post-Operative Analgesia In Children Repairing Congenital Inguinal Hernia

Background: Managing postoperative pain in pediatric anesthesia is challenging, with caudal epidural anesthesia being a preferred technique for its safety and efficacy. Enhancing analgesia duration through adjuvants like midazolam may improve outcomes. Objective: This study compares the effectiveness of caudal epidural bupivacaine alone versus a bupivacainemidazolam mixture in children undergoing repair of congenital inguinal hernia, circumcision, and hypospadias repair, focusing on postoperative analgesia duration and side effects. Materials and Methods: A double-blind randomized controlled trial was conducted at Islami Bank Medical College Hospital from October 2023 to March 2024, involving 50 children aged 2-8 years, divided into two groups: Group A (bupivacaine-midazolam) and Group B (bupivacaine alone). Pain was assessed using the FLACC scale at specified intervals up to 24 hours post-surgery. Results: Group A experienced significantly longer postoperative analgesia (10.72 ± 4.07 hours) compared to Group B (6.13 ± 1.98 hours). Mild pain was more common in Group A (72.7%) than Group B (87.5%), while moderate pain was higher in Group A (27.3%) than Group B (12.5%). Side effects were minimal, with Group A having no side effects and Group B experiencing 8% nausea and vomiting and 4% other side effects. Conclusion: The addition of midazolam to caudal bupivacaine significantly prolongs postoperative analgesia and reduces the need for rescue analgesia in children, with minimal side effects

Comparison of Postoperative Analgesic Effectiveness of Bupivacaine and Bupivacaine Plus Dexmedetomidine Wound Infiltration in Abdominal Surgeries under General Anesthesia

Abdominal surgeries were major surgical procedures that were performed at any teaching hospital. Pain control was a major concern during intra-operative as well as post-operative periods in these patients. Objective: To compare post-operative analgesic effectiveness of bupivacaine and bupivacaine plus dexmedetomidine wound infiltration in abdominal surgeries under General Anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesia, Sahiwal Teaching Hospital Sahiwal from 1st April, 2024 till 31st May 2024. Sixty-four patients underwent a pre-operative assessment on the day before surgery. Both Groups received wound infiltration with studied drugs at the end of surgery. After surgery, patients were assessed for pain using a Visual Analog Scale (VAS) and data was collected and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The mean post-operative analgesia duration of the patients on bupivacaine was 11.78 ± 1.64 but the mean post-operative analgesia duration of the patient on bupivacaine plus dexmedetomidine was 19.19 ± 2.49. (2-tailed significance 0.001). The mean opioid consumption in mg of the patients in bupivacaine was 20.69 ± 4.31 but the mean opioid consumption in mg of the patient in bupivacaine plus dexmedetomidine was 10.88 ± 4.53. (2-tailed significance 0.001). In bupivacaine, patients with bradycardia were 0% and patients without bradycardia were 100% but in bupivacaine plus dexmedetomidine, patients with bradycardia were 15.6% and patients without bradycardia were 84.4%. Conclusions: There was a difference in the analgesic effectiveness of dexmedetomidine when added to bupivacaine in wound infiltration in abdominal surgeries.

Comparison of the Efficacy Between Ultrasound-Guided Paravertebral Block and Erector Spinae Block for Postoperative Analgesia in Percutaneous Nephrolithotomy Using Levobupivacaine: A Prospective and Randomized Study.

Introduction Various techniques have been developed in the current era of regional anesthesia practice. With the advent of ultrasound, the visualization of needle and pleura in real time enables a better outcome with negligible adverse events. This study was designed to compare the efficacy between ultrasound-guided erector spinae plane block (ESPB) and paravertebral block (PVB) in percutaneous nephrolithotomy (PCNL) for the duration of postoperative analgesia with levobupivacaine, a local anesthetic with higher lipid solubility, making it more potent and resulting in a longer duration of action. Methods This prospective randomized single-blinded study enrolled 50 patients of ASA grades I and II, aged between 20 and 60 years, who were scheduled for PCNL under general anesthesia. Patients were divided into two groups of 25 each: group ESPB andgroup PVB, and 25 mL of 0.25% levobupivacaine was administered to both groups. They were primarily evaluated for the duration of postoperative analgesia. Total rescue analgesic requirements, hemodynamic parameters, and any adverse effects were also assessed. Results Both ESPB and PVB provided a significant duration of analgesia postoperatively. Demographic characteristics in both groups were comparable. The duration of postoperative analgesia in group ESPB was 746 ± 58.6 minutes when compared to group PVB, which is 768 ± 68.6 minutes (p = 0.08). Intravenous (IV) paracetamol was used as a rescue analgesic. The doses used were also comparable in both groups, with the visual analog score (VAS) being high after around 12 hours of surgery. The total rescue analgesic requirement was similar in both groups (group ESPB, 2.0 ± 1.6; group PVB, 2.2 ± 1.4; p = 0.51). There were no significant hemodynamic or other adverse effects in either group. Conclusion We conclude that both ESPBand PVB using isobariclevobupivacaine 0.25% as a local anesthetic are equally efficacious in providing effective postoperative analgesia in patients undergoing PCNL under generalanesthesia.

Comparing the Efficacy of Landmark-Based Fascia Iliaca Compartment Block and Pericapsular Nerve Group Block for Preoperative Positioning and Postoperative Analgesia in Patients Undergoing Surgery for Hip Fractures: A Randomized Controlled Trial.

Subarachnoid block is the most common anesthetic technique for patients having corrective hip surgeries. However, adequate positioning for a successful subarachnoid block is a major challenge in this particular population of patients, owing to the site of fracture. Regional anesthesia, in the form of nerve blocks, is an effective means of alleviating such constraints and gives an added benefit of prolonged postoperative analgesia. The pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB), under ultrasonography guidance, are a few examples of the commonly performed peripheral nerve blocks in such settings. However, the landmark-based techniques of nerve blockade still hold good in many resource poor settings, given the lack of ultrasonography facilities. To compare the ease of spinal positioning using the patient sitting satisfaction score between the landmark-guided FICBand PENG block. This study was done on 80 patients of the American Society of Anesthesiology (ASA) grade I or II with intertrochantericfractures of the hip joint scheduled for proximal femoral nailing. Patients were allocated into two groups of 40 each through computer generated random numbers, to receive 30 ml of 0.5% ropivacaine via the landmark-guided technique of FICB in Group F and peripheral nerve stimulator assisted landmark-guided PENG block in Group P, 30 minutes prior to spinal positioning. Time to passive leg raise (PLR) to 15 degrees and time to PLR to 30 degrees with a standard goniometer guidance at visual analogue scale (VAS) score < 4 and ease of spinal positioning through the sitting satisfaction score at the 30th minute were assessed. Any adverse effects and events of failure were noted. The duration of postoperative analgesia was measured through the time to the first dose of paracetamol on arrival at the post-anesthesia care unit. Statistical analysis was done using JASP version (0.18.3.0) using the independent samples t-test and significance was taken when p value was < 0.001. The time to PLR to 15 degrees and 30 degrees were achieved faster in the patients who received the PENG block in comparison to the patients who received the FICB, and the average patient sitting satisfaction score was significantly higher in Group P as compared to Group F (p < 0.001). While the overall amount of analgesics used in both groups was similar, the overall period of postoperative analgesia was prolonged in Group F compared to Group P (p < 0.001). The landmark guided PENG block is feasible and superior to the landmark-guided FICB for preoperative positioning and analgesia. The FICB provides a longer duration of postoperative analgesia for patients with intertrochanteric fractures.

Comparative study of different doses of intrathecal clonidine as an adjuvant to bupivacaine for lower limb surgeries: A prospective observational study

Clinical studies suggested that intrathecal clonidine as an adjuvant to hyperbaric bupivacaine prolongs sensory as well as the motor block of spinal anesthesia, decreases local anesthetic drug requirement, and provides postoperative analgesia.In the present study, we have examined the effects of two distinct clonidine dosages administered intrathecally as an adjuvant to hyperbaric bupivacaine in individuals undergoing elective lower limb operations, to find out the optimal dose among them. Two groups of thirty patients each posted for lower limb surgery were included in this study. Patients in Group A Received inj. bupivacaine (hyperbaric) 0.5% 3ml (15 mg) + inj. clonidine 0.2 ml (30 µg) + normal saline 0.1 ml intrathecally, in Group B patients received inj. bupivacaine (hyperbaric) 0.5% 3ml (15 mg) + inj.clonidine 0.3 ml (45 µg) intrathecally.Throughout spinal anesthesia; both groups were prospectively observed for various parameters.Compared to patients in group A, patients in group B experienced sensory and motor block for longer durations of time. As compared to group A patients, group B patients experienced increased hypotension, bradycardia, and dry mouth; however, overall adverse effects are mild and easily treated. In addition, we observed that group B patients experienced analgesia for a longer duration of time than did Group A patients. Addition of intrathecal clonidine to bupivacaine significantly hastens the onset of sensory and motor block, provides excellent surgical analgesia, prolongs the duration of superior quality postoperative analgesia and reduced postoperative analgesic requirements with relative hemodynamic stability.

Effect of Ketamine as an Adjuvant to Bupivacaine in Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Analgesia after Inguinal Hernia Repair

Ilioinguinal and Iliohypogastric nerve block is one of the methods exercised widely to reduce postoperative pain after inguinal hernia repair. Several initiatives are ongoing to prolong the duration of postoperative analgesia by adding various adjuvants to the local anaesthetic agents in different nerve blocks. In this study ketamine has been added as an adjuvant to local anaesthetic bupivacaine in Ilioinguinal and Iliohypogastric nerve blocks. Our study aims to evaluate the effect of adding ketamine to local anaesthetic bupivacaine in ultrasound guided Ilioinguinal and Iliohypogastric nerve block in patient scheduled for inguinal hernia repair under subarachnoid block. This randomized control trial was carried out among 94 patients scheduled for elective inguinal hernia repair under subarachnoid block in Dhaka Medical College Hospital, Dhaka, Bangladesh. Two nerves, Ilioinguinal and Iliohypogastric were blocked by 0.25% bupivacaine under ultrasound guidance after the completion of surgery for postoperative analgesia. The study population was divided equally into two groups having 47 patients in each. Patients of group-A was received 20 ml of 0.25% bupivacaine and 2ml normal saline in the block procedure. Another group, group B patients received 20ml of 0.25% bupivacaine and 1mg/kg of ketamine in the same nerve block. Demographic profiles had no significant differences between two groups (p&gt;0.05). Mean duration of the analgesia or the time of first rescue analgesic requirement were significantly higher in ketamine group (595.24±15.90 minutes) than normal saline group (226.4±20.6 minutes). (p&lt;0.05); Postoperative total analgesic (pethidine) requirement within first 24 hours (178.3±18.3 vs. 92.3±15.3) milligrams, (p&lt;0.05) was higher in normal saline group. Our data suggests that ketamine when used as an adjuvant to bupivacaine for ilioinguinal and iliohypogastric nerve block prolongs the time to first analgesic request as well as decreases the analgesic requirement during postoperative period. CBMJ 2024 July: vol. 13 no. 02 P: 203-212

A comparative study to assess the effects of intrathecal fentanyl and intrathecal tramadol combined with 0.5% bupivacaine heavy in patients undergoing elective urological surgeries: A prospective randomized study

Background: Urological operations frequently involve the use of spinal anesthesia. In the present scenario, adding different adjuvants to local anesthetic improve its quality and duration has become common. Aims and Objectives: In patients undergoing elective urological procedures, the purpose of this study was to assess the effects of intrathecal fentanyl or tramadol with 0.5% bupivacaine heavy. Materials and Methods: Patients were divided into two groups of 30 patients each, a total of 60 patients aged 20–60 years undergoing elective urological surgeries participated in this prospective, randomized study in which 25 μg fentanyl and 2.5 mL of 0.5% bupivacaine heavy were given to Group F, while 25 mg tramadol and 2.5 mL of 0.5% bupivacaine heavy were given to Group M. The onset and duration of sensory and motor blockage, the duration of analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Fentanyl had a lower mean time of onset for sensory (2:33±0:22 min vs. 4:50±0:33 min) and motor block (3:36±0:28 min vs. 5:52±0:38 min) (P&lt;0.001), the duration of sensory (185.67±3.155 min vs. 152.60±4.264), motor block (172.00±4.177 min vs. 136.40±5.575 min), and post-operative analgesia was longer in the fentanyl group (P&lt;0.001), whereas the incidence of adverse effects such as pruritus, shivering, and nausea was lower in the tramadol group. Conclusion: The quality and duration of spinal anesthesia were found to be significantly increased by the use of fentanyl as an adjuvant in our study. However, tramadol also produced stable hemodynamics and exhibited fewer adverse effects than fentanyl.

Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial.

In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 µg/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 µg/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

A PROSPECTIVE, RANDOMIZED STUDY COMPARING THE ANALGESIC EFFICACY OF SCALP BLOCK WITH 0.25% BUPIVACAINE VS PRE-INCISIONAL LOCAL INFILTRATION WITH 0.25% BUPIVACAINE WITH ADRENALINE (1:400,000) IN PATIENTS UNDERGOING ELECTIVE CRANIOTOMIES

Background and Aims: Pain is often referred to as the fifth vital sign. Pain management in patients undergoing craniotomies pose a great challenge to the anaesthesiologists. Scalp block forms an important aspect in the multimodal approach to the post-craniotomy pain. The following study compares the analgesic efficacy of Scalp block with traditionally used local wound infiltration technique in providing analgesia to craniotomy patients. Methods: Performed double blinded, prospective, randomized controlled trial on 60 patients undergoing elective craniotomies divided into 2 groups comparing the analgesic efficacy of Scalp block with 0.25% Bupivacaine vs Pre- incisional wound infiltration with 0.25% Bupivacaine with Adrenaline (1:400,000). Results:There were significant differences in intra-operative hemodynamics between the two groups. Scalp block resulted in statistically significant reduction in HR, SBP, DBP &amp; MAP. There was increased duration of post-operative analgesia in scalp block group when compared with the local infiltration group. The opioid requirement in the intra-operative period was significantly lesser in scalp block group when compared with the local infiltration group. Requirement of rescue analgesic is significantly lesser during early post-operative period (Upto 8 hours) in the scalp block group when compared with local infiltration group. Conclusion :Scalp block with 0.25% Bupivacaine is effective and superior to Pre-incisional Local infiltration with 0.25% Bupivacaine with 1:400,000 Adrenaline in attenuating hemodynamic responses, providing increased duration of post-operative analgesia, significant reduction in intra-operative opioids and post-operative rescue analgesic requirements.

Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections.

Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th,and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.