Duration Of Postoperative Analgesia Research Articles

Peri-anal infiltration versus caudal block for multimodal analgesia in paediatric patients with Hirschsprung's disease undergoing transanal endorectal pull-through procedure: A randomised trial.

Transanal endorectal pull-through (TERPT) is a standard procedure for managing paediatric patients with Hirschsprung's disease (HD). This study aimed to evaluate peri-anal infiltration versus caudal block as a part of multimodal analgesia for paediatric patients with HD undergoing the TERPT procedure. This randomised trial included 60 patients of both genders, aged 6 to 18 months who underwent the TERPT procedure under general anaesthesia. The patients were randomly assigned into two groups to receive either peri-anal infiltration or caudal block with 1 ml/kg bupivacaine 0.25% and dexmedetomidine 1 µg/kg in 0.5 ml normal saline. The primary outcome was the time to the first rescue analgesia. The secondary outcomes were the total consumption, the frequency of nalbuphine administration as rescue analgesia within 24 hours and the level of postoperative sedation. The time to first rescue analgesia was significantly shorter in the peri-anal infiltration group versus the caudal block group (median [interquartile range] 10 [7.5-12.5] h versus 16 [13.5-18.5] h, respectively, P = 0.008). The frequency of administration and the total dose of nalbuphine was significantly higher in the peri-anal infiltration group (P = 0.003 and 0.013, respectively). The sedation score was significantly higher in the caudal block group postoperatively. For paediatric patients undergoing the TERPT procedure, peri-anal infiltration was less effective than caudal block in terms of the duration of postoperative analgesia. However, both techniques were comparable during the first 6 hours postoperatively.

Effects of dexmedetomidine as an adjuvant to ropivacaine or ropivacaine alone on duration of postoperative analgesia: A systematic review and meta-analysis of randomized controlled trials.

Ropivacaine is a long-acting local anesthetic that is used to treat postoperative pain. Adjuvant use of dexmedetomidine in regional anesthesia may prolong the duration of analgesia. The objective of this systematic review and meta-analysis was to investigate the duration and effect of ropivacaine alone vs. ropivacaine in combination with dexmedetomidine for postoperative analgesia. The PubMed, EMBASE, Web of Science, and Google Scholar databases were searched for randomized controlled trials (RCTs) of ropivacaine alone or ropivacaine in combination with dexmedetomidine for regional anesthesia. The primary outcome was duration of analgesia, defined as the time from onset of the block to the time of the first analgesic request or initial pain report. Secondary outcomes were duration of sensory block, duration of motor block, consumption of sufentanil for analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting. Eighteen studies with 1148 patients were included. Overall quality of the RCTs, as assessed by the Jadad scale, was high. The meta-analysis demonstrated that ropivacaine combined with dexmedetomidine significantly prolonged the duration of postoperative analgesia from local anesthetics compared to ropivacaine alone (WMD: 4.14h; 95%CI: 3.29~5.0h; P<0.00001; I2 = 99%). There was evidence of high heterogeneity between studies. The duration of sensory and motor block was significantly increased, and consumption of sufentanil for analgesia and the incidence of postoperative nausea and vomiting were significantly reduced in patients who received ropivacaine combined with dexmedetomidine compared to ropivacaine alone. There was no significant difference in length of hospital stay. Compared to ropivacaine alone, ropivacaine combined with dexmedetomidine significantly prolonged the duration of postoperative analgesia and sensory and motor block, and reduced consumption of sufentanil for analgesia and the incidence of postoperative nausea and vomiting, across an array of surgeries.

Ultrasound-guided pericapsular nerve group (PENG) block versus femoral nerve block for positioning during spinal anaesthesia in proximal femur fractures: A randomised comparative study.

Femoral nerve block is a widely used analgesia technique for positioning before spinal anaesthesia for proximal femur fracture surgeries. Pericapsular nerve group (PENG) block is a newer technique with motor-sparing characteristics. We compared the analgesic efficacy of these blocks for patient positioning for spinal anaesthesia. In this study, 60 patients were randomised to either the PENG group (n = 30) or the femoral group (n = 30). After performing the block, the pain was assessed every 10 min using a visual analogue scale (VAS) score for 30 min. The primary objective was the median [interquartile range (IQR)] reduction in pain (dynamic VAS with 15-degree passive limb elevation) at 30 min. Secondary objectives were ease of spinal position score (EOSP), angle obtained during positioning, duration of postoperative analgesia and quadriceps weakness. The demographics were comparable in both groups. After 30 min, the median (IQR) VAS was 6 (5-7) in the PENG group and 5 (5-6) in the femoral group (P = 0.004). Secondary outcomes such as EOSP score and angle obtained by patients were comparable. In the postoperative period, patients had significantly lower pain in the PENG group compared to the femoral group. The duration of analgesia was prolonged with PENG block. Quadriceps weakness was significantly low with PENG block (P < 0.001). PENG block provides better analgesia than a femoral block before spinal anaesthesia for proximal femur fracture surgery. The postoperative duration of analgesia was also longer.

Efficacy of adding nalbuphine to caudal bupivacaine for postoperative analgesia in children undergoing hypospadias repair surgery. Randomized controlled trial

ABSTRACT Background We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery. Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis. Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p < 0.001). The number of patients who needed postoperative supplemental analgesia was significantly lower in the nalbuphine group (p < 0.001). Total paracetamol consumption was significantly higher in the control group (p < 0.001). The FLACC and RASS were significantly lower in the nalbuphine group. Postoperative cortisol levels were lower in the nalbuphine group compared to the control group. Conclusions Adding caudal nalbuphine 0.1 mg/kg to bupivacaine 0.25% provides better postoperative pain control than bupivacaine alone in children undergoing hypospadias repair.

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE AND DEXMEDETOMIDINE AS ADJUVANTS TO HYPERBARIC BUPIVACAINE FOR LOWER LIMB ORTHOPEDIC SURGERIES

Objective: Sub arachnoid block is a reasonably safe and simple technique of regional anesthesia. This randomized double-blind study was conducted to compare the efficacy of intrathecal nalbuphine and Dexmedetomidine as adjuvant with hyperbaric bupivacaine for lower limb orthopedic surgeries. Methods: Sixty adult patients of American Society of Anaesthesiologists physical status 1 and 2 who were scheduled for elective lower limb orthopedic surgeries were divided into two groups, D and N, of 30 each. Group D patients received dexmedetomidine 4 mcg and Group N received nalbuphine 2 mg as adjuvant along with bupivacaine heavy 0.5% (3 mL) intrathecally. Sensory and motor block characteristics and time to first rescue analgesic (intravenous tramadol 100 mg) were the primary end points and drug-related side effects such as pruritis, nausea, vomiting, and respiratory depression were taken as secondary end points. Subsequently, data were entered into Microsoft Excel spreadsheet and Statistical Package for the Social Science software version 22 was used for statistical analysis. Results: All 60 patients showed adequate block. The onset of sensory and motor block was statistically comparable in both groups. The duration of sensory and motor block and duration of analgesia were markedly extended in dexmedetomidine group patients. There were no significant intraoperative or post-operative side-effects in both group of patients. Conclusion: Dexmedetomidine (4 mcg) increases the sensory and motor block duration and duration of post-operative analgesia significantly more than nalbuphine (2 mg), when administered intrathecally as an adjuvant to bupivacaine (15 mg).

Comparison of Two Different Doses of Buprenorphine as Adjuvants to Intrathecal Levobupivacaine in Lower Abdominal Surgeries

Background: Levobupivacaine because of its longer duration of action and better safety profile has gained popularity in regional anaesthesia. Intrathecal opioids synergise with Local anaesthetics and potentiate subarachnoid block. We conducted this study with the primary aim to compare analgesic efficacy of two different doses of buprenorphine as adjuvant to isobaric Levobupivacaine and the secondary aim to compare the onset and duration of sensory and motor blockade, hemodynamic variability and adverse effects if any.&#x0D; Methods: One hundred and twenty patients of American society of anaesthesiologist (ASA) I and II were divided in 3 groups of 40 each. Group A :0.5%levobupivacaine, group B: 0.5%levobupivacaine with 60 mcg buprenorphine Group C:0.5 %levobupivacaine with 90mcg buprenorphine. Duration of analgesia, onset of sensory and motor block, VAS scores, haemodyanamic parameters and adverse effects were noted.&#x0D; Results: The duration of analgesia was significantly prolonged in group C (11±0.41) h than group B (8.5±0.61) hour and Group A (4.8 ±40) hour (p &lt; 0.001). Onset and duration of Sensory and motor blockade was not significantly different. VAS score was significantly lower in group C (p&lt;0.001), hemodynamic parameters were well preserved with higher incidence of PONV in group C (10%).&#x0D; Conclusion: Addition of buprenorphine to intrathecal Isobaric Levobupivacaine prolonged the duration and quality of postoperative analgesia after lower abdominal surgery. Increasing the dose of buprenorphine from 60mcg to 90mcg provided longer duration of analgesia with minimal adverse effects like dizziness and PONV which were not significant to hinder recovery.

To evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block: A prospective, randomized, double-blind study

Background: Post-operative pain is of great concern in pediatric age group. Intravenous dexamethasone has been found to be promising in reducing post-operative pain when administered as an adjuvant to epidural anaesthesia in abdominal and orthopedic surgeries. However, little is known about its efficacy in children receiving caudal block for post-operative pain relief. Aims and Objectives: This study aimed to evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block in children posted for infraumbilical surgeries. Materials and Methods: This interventional, double-blinded, randomized controlled study included 110 children aged 1–5 years with American Society of Anesthesiologists Grade I and II undergoing elective infraumbilical surgeries. To test our hypothesis, the superiority of intravenous dexamethasone was compared with the control group. All children received caudal bupivacaine 0.25% (1 mL/kg). Children were randomly allocated to two groups to receive: normal saline 0.075 mL/kg (Group C) and IV dexamethasone 0.3 mg/kg (0.075 mL/kg) (Group D). Post-operative pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC] score), duration of analgesia, post-operative analgesic consumption, and intraoperative hemodynamics were compared. Results: FLACC score was found to be higher in Group C than Group D at all times. The mean FLACC score was significantly less with the study drug compared to the control group (P&lt;0.001). The time to request for first rescue analgesia was significantly less in Group C as compared to Group D (4.01±0.69 h vs. 5.51±0.50 h, P=0.019). The mean total analgesic consumed in the first 24 h was significantly higher in Group C than in Group D (666.09±174.69 mg vs. 384.55±125.04 mg, P=0.015). Hemodynamic parameters were comparable in both the groups. Conclusion: Intravenous administration of dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine 0.25% provides significantly longer duration of post-operative analgesia and lesser total analgesic consumption compared to the use of caudal bupivacaine 0.25% alone.

Low Dose Caudal vs Dorsal Penile Nerve Block for Postoperative Analgesia after Circumcision

Abstract Background Circumcision is a painful surgery that is mostly performed under general anesthesia in order to eliminate fear and anxiety. Regional techniques are more effective than systemic opioids, non steroidal anti-inflammatory drugs, and acetaminophen for postoperative analgesia in circumcision, The most preferred techniques are dorsal penile nerve block and caudal block. Objective To investigate the effectiveness of post operative analgesia and complications among dorsal penile nerve block, caudal block and the combination of both. Patients and Methods Our study was carried out to compare the effectiveness, duration of postoperative analgesia, and the complications among dorsal penile nerve block (DPNB), caudal nerve block (CNB) and the combination of both. This study was carried out on 81 male patients, aged from 3-12 years old &amp; undergoing circumcision. The patients were divided into 3 groups, each is composed of 27 patients; group 1 including DPNB patients, group 2 including CNB patients and group 3 for combined block. This study compared between the three groups regarding the intraoperative vital data (HR,BP), post-operative VAS scores and the complications (nausea, vomiting, urinary retention, itching, constipation &amp; CNS depression). Results The demographic data (age, weight &amp; height) does not differ between the three groups of the study. There is difference in the VAS score post operatively, being significantly less in the CNB group. There was no significant difference in the percentage of complications between the groups, except for urinary retention being slightly increased in the CNB group. Conclusion Our results showed that, CNB is superior to DPNB in intraoperative and postoperative analgesia after circumcision as regarding pain control. However CNB is associated with more complications compared to the DPNB. Also, the results showed that there‟s no need to combine both blocks as it gave the same results as with the CNB alone.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p &amp;lt; 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p &amp;lt; 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

A Comparative Evaluation of Intra-articular Bupivacaine vs Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgeries.

Background The studywas done to determinethe duration of postoperative analgesia brought on by incorporating intra-articular Bupivacaine with Dexmedetomidine as an adjuvant following knee arthroscopies. Methods A prospective randomized control study was conducted on 60 patients of ASA classes I and II, between the ages of 20 and 60 years, undergoing arthroscopic surgeries of the knee under spinal anaesthesia. The patients were divided into group B and group D, each containing 30 patients. The participants in group B were administered Inj. Bupivacaine 0.5% 19 mL + 1 mL of normal saline intra-articularly and the participants in group D were administered Inj. Bupivacaine 0.5% 19 mL, Inj. Dexmedetomidine 1 μg/kg and normal saline post-surgery. Thenumber of analgesics used in the first 24 hours, pain levels using the visual analogue scale and the timing of administration of the first analgesic dose between the two study groups were evaluated. Results In comparison to the Bupivacaine group, the Dexmedetomidine group required fewer rescue analgesics. The visual analogue visual scale score in group B at four hours and six hours was 2.7 ± 1.39 and2.9 ± 1.03, respectively, and in group D at four hours and six hours was 1.9 ± 1.09 and 1.83 ± 0.91. The visual analoguescale scores at these times were statistically significant. The visual analogue scale scores at 12 hours and 24 hours were statistically not significant. Conclusion Dexmedetomidine added to Intra-articular Bupivacaine provides an increased duration of postoperative analgesia in patients undergoing arthroscopic surgeries of the knee. The combination offers improved analgesia and reduces the overall dosage of rescue analgesics needed without causing substantial side effects.

A Comparative Study between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Brachial plexus blocks are among the most commonly performed peripheral nerve blocks for upper extremity surgeries in clinical practice. It offers many advantages over general anaesthesia for upper limb surgeries such as sympathetic block, better postoperative analgesia, high success rate and fewer side effects. Objective To compare the efficacy of bupivacaine plus dexamethasone versus bupivacaine plus dexmedetomidine as adjuvants on the block characteristics including: onset and duration of sensory and motor blockade, duration of postoperative analgesia, the first analgesic request time, adverse effect and hemodynamic parameters of patients. Patients and Methods After obtaining approval from the medical ethical committee in El Demerdash Ain Shams University Hospital, this study was conducted in El Demerdash Ain Shams University Hospital. It included patients scheduled for elective upper limb orthopedic and plastic surgery. A written informed consent was obtained from every patient after explaining the procedure. Results Regarding demographic data and operative characteristics there were no statistically significant difference between the two groups. The current study showed that the addition of dexmedetomidine to bupivacaine for supraclavicular brachial plexus block leads to prolongation of motor and sensory block duration, prolongation of duration of analgesia and decrease in total 24 hrs analgesia in comparative to dexamethasone. Conclusion Regarding comparison between dexmedetomidine and dexamethasone as an additive to bupivacaine in ultrasound guided supraclavicular block, it could be concluded that the addition of dexmedetomidine to bupivacaine shortened the onset times of both sensory and motor blocks, significantly prolonged their durations and prolonged the analgesia of brachial plexus block with subsequent consumption of less amounts of postoperative analgesics. Also the use of ultrasound guided technique decreased the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

Post-Operative Analgesic Effect of Intra-Articular Local Anesthetic Infiltration versus Adductor Canal Block after Knee Arthroscopic Surgeries

Abstract Background Knee arthroscopic surgery is one of the most common orthopaedic procedures. Postoperative pain after Knee arthroscopy is caused by irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection. Aim of the Work To compare between intra-articular local anaesthetic infiltration and ultrasound guided adductor canal block to achieve effective and safe postoperative analgesia after knee arthroscopic surgeries as regarding duration of postoperative analgesia, need for analgesic supplements postoperatively, patient satisfaction, time of ambulation, and presence of any associated complications or side effects. Patients and Methods A prospective randomized comparative study was conducted in Ain Shams University hospitals, on patients aged from 20 to 60 years, ASA class I-II-III assigned for knee arthroscopic surgeries. For six to eight months started after approval from ethical committee of Ain Shams University. A written informed consent had been obtained from all patients. Every patient received an explanation for the purpose of the study and research results only used for scientific purposes. Results The study showed that adductor canal group had lower Pain perception (VAS-10) at rest, but the differences were statistically significant beginning from hour-8. Also, adductor canal group had lower Pain perception (VAS-10) during movement, but the differences were statistically significant beginning from hour-8. Rescue analgesia was significantly less frequent in adductor canal group. High satisfaction (Good/excellent) grades were significantly more frequent in adductor canal group. Conclusion The findings of our study revealed that ACB Provides better postoperative analgesia after knee arthroscopic surgeries than intra-articular local anaesthetic infiltration at rest and movement. Furthermore it facilitated earlier mobility than local anaesthetic infiltration. However, in clinical practice intra-articular local anaesthetic infiltration is easier to perform than ACB which requires experienced anaesthesiologist.

Analgesic Sparing Effect of Dexamethasone with Levobupivacaine in Quadratus Lumborum Block in Patients Undergoing Unilateral Inguinal Hernia Repair

Abstract Background The QLB is an effective analgesic technique for various abdominal wall incisinos. The QLB covers T7 to L2 dermatomes. Levobupivacaine is a long-acting LA agent, commonly used for peripheral nerve block due to its better safety profile than that of bupivacaine. Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction and lesser incidence of nausea and vomiting. Objective To assess the analgesic sparing effect of adding dexamethasone to levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair under general anesthesia. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this prospective double blind randomized clinical trial study was conducted in Ain Shams University Hospitals. Sixty patients scheduled for elective ingunial surgeries under general anesthesia were included in this study. Results Our study did not have any complications associated with the use of dexamethasone with levobupivacaine in QLB. Type 1 QLB failed to provide postoperative analgesia in surgeries involving dissection in the retroperitoneal area as there were high chances of damaging the thoracolumbar fascia. Conclusion The addition of dexamethasone to levobupivacaine in QLB in unilateral inguinal hernia repair surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to levobupivacaine alone group.

Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdomins Plane (TAP) Block for Analgesia in Patients Undergoing Laparoscopic Cholecystectomy Surgery

Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block became a common analgesic method after surgery involving the abdominal wall. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work to compare dexmedetomidine versus dexamethasone added to bupivacaine as adjuvant to the local anesthetic bupivacaine during Ultrasoundguided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy, characteristics including duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods The current study included 40 patients scheduled for elective laparoscopic cholecystectomy surgery were given Ultrasound-guided transversus abdominis plane (TAP) block after induction of general anesthesia. The patients were randomly allocated into two groups. Group (DM): patients received 22 ml of Bupivacaine 0.25 %in 20 ml + 1 ug/kg of dexmedetomidine in 2 ml on both sides. Group (DS): patients received 22 ml of Bupivacaine 0.25 % in 20 ml + 4 mg of dexamethasone in 2 ml on both sides. Results VAS pain score at rest especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. VAS pain score at movement especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. 1st rescue dose of analgesics was delayed up to (19.76±2.51 hrs), in dexmedetomidine group in comparison to (12.92±2.17 hrs) in dexamethasone group. The total dose of paracetamol required by patients in the dexmedetomidine group was (3.18±1.07 gm) compared to (5.33±1.16 gm) in dexamethasone group, indicating longer pain-free period and less requirement of analgesia in the dexmedetomidine group. Therefore, use of dexmedetomidine in TAP block has a beneficial effect in reducing the dose of systemic analgesic requirements. Conclusion co administration of 1 ug/kg of dexmedetomidine vs dexamethasone 4 mg to 0.25 % bupivacaine on both sides by US guided TAP block leaded to significant changes in the form of lower HR at 12, 24, 48 hrs, lower sedation score at 1, 6, 12, 24, 48 hrs and no significant changes in systolic blood pressure, diastolic blood pressure, oxygen saturation and respiratory rate.

Safety and Analgesic Efficacy of General Versus Caudal Block in Pediatric Infra Umbilical Surgery

Background: Caudal analgesia has become popular in the management of intraoperative and postoperative pain management, further with the use of adjuvants to prolong its duration each with varying results. Caudal block is the most preferred postoperative analgesia in pediatrics, despite its limited duration of action. Many additives are used to improve the effectiveness of caudal blocks, such as opioids or a2 agonists. Recently, the use of caudal dexamethasone as an analgesic after surgery has increased. Objectives: The aim of this study is to evaluate the safety and analgesic efficacy of general versus caudal block in pediatric infra umbilical surgery. Methods: This is an observational study. This study was carried out on 50 patients the find out about the population including children in the Department of Anaesthesia, Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh. The duration of the period from January 2022 to December 2022. Statistical evaluation of the results used to be got via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: The mean duration of postoperative analgesia was 3 times longer in Bupivacaine with preservative free Clonidine Group. Bupivacaine solution Group received significantly more doses of rescue analgesic than Bupivacaine with preservative free Clonidine Group (p-value of 0.004). There was no significant bradycardia, hypotension, sedation or urinary retention in either of the groups. There was no residual motor blockade at 6 hours. Incidence of vomiting was similar in both the groups. Conclusion: Dexamethasone in combination with bupivacaine reduces postoperative pain intensity and total analgesic consumption and prolongs analgesia.

A randomized controlled trial of dexmedetomidine vs magnesium sulfate as adjuvants to bupivacaine in infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery

Background &amp; Objective: Cleft lip surgery is routinely performed in children under general anesthesia (GA). Infraorbital nerve block (IONB) has been used by some anesthetists to enhance the perioperative pain management in addition to the routine intravenous analgesics. We compared the addition of dexmedetomidine (Dex) plus bupivacaine with magnesium sulphate (MgSO4) plus bupivacaine for IONB in combination with GA, regarding their efficacy, effect on the duration of postoperative analgesia, and any adverse events.&#x0D; Methodology: A total of 75 patients, aged 3 months to 7 y, of either sex, were randomly allocated into three equal groups. After induction of GA with a standardized method, Group D received IONB with Dex + bupivacaine; Group M received the nerve block with MgSO4 + bupivacaine, and a control group (Group C) received block with bupivacaine only. Acetaminophen infusion was used when additional analgesic was required in the postop period. The primary outcome was the duration of time until the first analgesic was administered, while the secondary outcomes were the amount of acetaminophen taken within the first 24 h following surgery, pain scores, and the frequency of side effects.&#x0D; Results: The mean time to first requested analgesia was significantly longer in the Group D, followed by the Group M, and it was the shortest in the Group C (13.9 ± 1.7 h, 11.5 ± 2 h, 5.9 ± 1.3 h respectively, P &lt; 0.001). Total acetaminophen consumption and pain scores were significantly lower among the Group D than the Group M and highest in the Group C (P &lt; 0.001). Emergence agitation and vomiting were non-significantly less frequent in the Group D than the Group M and more frequent in the Group C. No significant difference regarding hypotension, bradycardia, and shivering, was observed among all the groups. Respiratory depression was not recorded in any of the groups.&#x0D; Conclusion: Dexmedetomidine and magnesium sulphate, both offered prolonged analgesia when added to bupivacaine for infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery under general anesthesia. However, dexmedetomidine was superior to magnesium sulphate regarding the duration of postoperative analgesia.&#x0D; Abbreviations: ASA-PS - American Society of Anesthesiologists Physical Status classification; Dex – Dexmedetomidine; FiO2 - Fraction of inspired oxygen; IONB - Infraorbital nerve block; MBP - Mean blood pressure; NIBP - Non-invasive blood pressure; PACU - Post Anesthesia Care Unit&#x0D; Key words Bupivacaine; Cleft Lip; Dexmedetomidine; Infraorbital Nerve Block; Magnesium Sulfate&#x0D; Citation: Alansary AM, Ali MM, Elshafie MA. A randomized controlled trial of dexmedetomidine vs magnesium sulfate as adjuvants to bupivacaine in infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery. Anaesth. pain intensive care 2023;27(4):514−522; DOI: 10.35975/apic.v27i4.2261&#x0D; Received: May 22, 2023; Reviewed: June 02, 2023; Accepted: June 11, 2023

Evaluation of Anaesthetic Efficacy of Ropivacaine for the Removal of Impacted 3rd Molars- A Randomised Control Study

This study involved 20 healthy patients (ASA 1) with bilaterally impacted mandibular third molar were randomly selected of both Sexes between age group of 20-40 years. Purpose: This study was done to evaluate the efficacy of Ropivacaine in comparison with Lignocaine for mandibular anaesthesia for bilaterally impacted mandibular third molars in aspect of onset, duration of anaesthesia, analgesia and postoperative requirement of analgesics. Method: Patients received 2ml of 2% Lignocaine with adrenaline on one side and 2ml of 0.75 % plain ropivacaine on the other side at two different appointments. Pain experiences were measured by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Results: In ropivacaine group, the means of onset of anesthesia, duration of anaesthesia, duration of post-operative analgesia and requirement of post-operative analgesics were 5.8±2.33 min, 533.3±142.2 min, 539.6±114.7 min and 4.2±0.8 no’s respectively and there was a significant difference between these group (&lt;0.001). Conclusion: The efficacy of plain ropivacaine 0.75% is superior to 2% lignocaine with adrenaline 1:1,00,000 in terms of duration of anaesthesia and analgesia, intraoperative and post-operative pain control but the onset of action of plain ropivacaine is slightly higher. We conclude that Plain Ropivacaine 0.75% can be used as an alternative to lignocaine in third molar surgeries and other minor surgical procedures which necessitates longer duration of anaesthesia and analgesia in oral and maxillofacial region.

INFILTRATION ANAESTHESIA FOR TYMPANOPLASTY: A COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS TO LIGNOCAINE AND ADRENALINE

INFILTRATION ANAESTHESIA FOR TYMPANOPLASTY: A COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS TO LIGNOCAINE AND ADRENALINE

The Comparison of Dexmedetomidine to Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block in Upper Limb Surgeries.

Background The clinical utility of adjuvants with local anesthesia produces an excellent nerve block with prolonged duration and faster onset.Brachial plexus block is widely used nowadays in patientsundergoing upper limb surgery There are several approaches to achieve brachial plexus block such as interscalene, supraclavicular, infraclavicular, and axillary. The objective of this study is to compare the effectiveness of dexamethasone to dexmedetomidine as adjuvants to bupivacaine in patients undergoing ultrasound-guided infraclavicular brachial plexus (USG-ICBP) block. Methods A randomized, prospective, double-blind study was undertaken on the patients posted for upper limb surgeries under ultrasound-guided infraclavicular brachial plexus block. Sixtypatients with the American Society of Anesthesiologists (ASA) classes I and II were randomly allocated into two groups. Group A received 25 mL of 0.5% bupivacaine and 1.5 mL (6 mg) of dexamethasone, and group B received 25 mL of 0.5% bupivacaine and 0.75 mL (75 mcg) of dexmedetomidine along with 0.75 mL of 0.9% normal saline (NS). Student's t test or Mann-Whitney test and chi-square test were used for statistical analysis. Results The onset of sensory block was significantly faster in the patients in group B as compared to the patients in group A. In terms of the duration of the block, sensory and motor blocks were maintained for a significantly longer duration in the group A patients as compared to those in group B. Moreover, the duration of postoperative analgesia was significantly longer-lasting in the group A patients. In terms of adverse effects, procedure-related complications such as the failure of the block and inadequate block were comparable across the groups. However, drug-related adverse effects were significantly more common in group B. Conclusion As compared to 75 mcg of dexmedetomidine, the addition of 6 mg of dexamethasone as adjuvant to 25 mL of 0.5% bupivacaine resulted in significantly longer-lasting sensory and motor blocks, postoperative analgesia, and a delayed time for first rescue analgesia without increasing undue adverse effects. Dexmedetomidine use is associated with more sedation as compared to dexamethasone.

A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries.

Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups. Sixty-three children aged 1-6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 μg/kg, Group M received morphine 30 μg/kg, and Group C received clonidine 1.5 μg/kg. All groups also received 0.2% ropivacaine (1-1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation. The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward. Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.