Effective Method Of Analgesia Research Articles

The Management of Spinal and Epidural Anesthesia-related Hypotension in the United States during C-section Childbirth

Currently, neuraxial analgesia is the most effective method of analgesia during childbirth. However, the leading side effect, hypotension, makes it crucial to understand the existing treatments for spinal anesthesia-induced hypotension. This study attempts to elucidate anesthesia-induced hypotension and existing therapies. Researchers performed a scoping review using PubMed and Rayyan to select articles. Inclusion criteria were peer-reviewed articles written in English within the last five years, and nulligravida/primigravida women under 35 years old who reside in the USA. Researchers revealed the different means of treatment to reduce the incidence of spinal anesthesia-induced hypotension in mothers during C-sections. Norepinephrine and epinephrine showed to be more effcacious in maintaining blood pressure while avoiding unfavorable sequelae for the mother following delivery. The study outcome of participants receiving fixed-rate infusions of either norepinephrine or phenylephrine favored the use of norepinephrine. These patients exhibit lower rates of bradycardia ( p=0.004), contributing to a lesser need for bolus rescue of atropine ( p=0.01). Using colloid solutions during C-section compared to crystalloid solutions also revealed a lower incidence of hypotension with a p-value of < 0.00001. Modalities such as wrapping and subsequent elevation of the lower extremities also displayed a significantly higher systolic and diastolic blood pressure and ephedrine dose than the control group. Pharmacological treatment modalities are more effective than non-pharmacological treatments at preventing maternal hypotension. Epinephrine was the most effective treatment for maintaining maternal blood pressure, heart rate, and cardiac output. Further studies should be done to determine the optimal epinephrine dosage. There was no funding provided for this research. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Evaluation of Bupivacaine Injection Instillation Directly in the Rectus Sheath in LSCS Cases as an Effective Analgesia Method

Evaluation of Bupivacaine Injection Instillation Directly in the Rectus Sheath in LSCS Cases as an Effective Analgesia Method

Comparison of TAP block and epidural analgesia for postoperative analgesia after robotic-assisted radical prostatectomy

Pain remains an important problem after radical prostatectomy, leading to discomfort and sometimes prolonged hospital stays. Despite the fact that laparoscopic procedures are less invasive surgical interventions, they can still be challenging in terms of postoperative pain, as both somatic and visceral pain pathways are involved. To alleviate pain and optimize improved recovery after laparoscopic prostatectomy, regional anesthesia techniques have been used to avoid or reduce the need for opioids. The aim of our study was to investigate the postoperative recovery of patients after laparoscopic robotic-assisted radical prostatectomy, depending on the method of postoperative analgesia and in the context of the peculiarities of anesthesia in robotic surgery. To achieve this goal, the “Medical Plaza” Medical Center examined 49 patients who underwent radical prostatectomy using a robotic system. Patients were divided into 2 groups. Group 1 (n=25) – combined intraoperative anesthesia with epidural analgesia with 0.125% bupivacaine. Patients in group 2 (n=24) underwent TAP-block with 15 ml of 0.25% bupivacaine immediately after the last suture was placed on the skin both sides of the abdomen. Patients in the groups did not differ in age, height, body weight and physiological status (р>0.05) according to the American Society of Anesthesiologists (ASA) scale. When analyzing the statistical data it was found that the volume of the prostate did not differ in the study groups, as well as the duration of the operation and the amount of blood loss (р>0.05). Blood pressure and heart rate fluctuations were similar between the groups. The amount of muscle relaxants used had no statistical difference in the study groups (р>0.05). The amount of opiates used during anesthesia did not differ (р>0.05). Mobilization of patients in both groups occurred in 8 hours without statistical difference (p=0.094). A direct medium strength significant correlation was found between the method of analgesia and weakness in one of the lower limbs at the time of mobilization (r=0.69; p=0.039), a direct medium strength significant correlation was found between the size of the prostate and the time to tracheal extubation (r=0.39; p=0.041). So, the level of intraoperative blood loss did not depend on the variants of perioperative analgesia. Haemodynamics and heart rate did not decrease with the addition of intraoperative epidural analgesia. Intraoperative initiation of epidural analgesia with a low concentration of local anesthetic does not affect the rate of postoperative mobilization. Pain after robotic radical prostatectomy is moderate, but requires multimodal treatment for faster mobilization of the patient, adaptation to the existing urinary catheter. Both epidural analgesia and TAP block have shown sufficient safety profile and efficacy in postoperative pain management. After radical prostatectomy, the TAP-block is an effective method of analgesia, while not interfering with the timely full mobilization of the patient. Epidural analgesia has a high analgesic profile, but is associated with certain risks of catheter migration and interference with full mobilization of the patient.

A Review of the Paravertebral Block: Benefits and Complications.

Paravertebral nerve blocks (PVB) have experienced a surge over the past 2 decades as improved access to ultrasound has increased ease of performance. The purpose of this review is to identify recent findings with regard to PVB's uses, including benefits, risks, and recommendations. PVB is reported as an effective method of analgesia both in intraoperative and postoperative applications, with novel applications showing its potential to replace general anesthesia for certain procedures. The use of PVB as a method of analgesia postoperatively has shown lower opioid usage and faster PACU discharge, when compared to alternative approaches like the intercostal nerve block, erector spinae plane block, pectoralis II block, and patient-controlled analgesia. Thoracic epidural analgesia and a serratus anterior plane block are comparable to PVB and can be used as alternatives. The incidence of adverse events is consistently reported to be very low with few new risks being identified as the use of PVB expands. While there are worthwhile alternatives to PVB, it is an excellent option to consider, particularly for higher-risk patients. For patients undergoing thoracic or breast surgery, PVB can improve opioid usage and shorten the length of stay leading to an overall positive impact on patient recovery and satisfaction. More research is needed to further expand novel applications.

Research progress on analgesic effect of adductor canal block after knee arthroplasty

To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once "gold standard" femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block in dogs undergoing ovariectomy.

In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluate the analgesic efficacy of TAP block, guided by ultrasound in female dogs submitted to ovariectomy. Therefore, 32 animals randomly assigned in two groups (n = 16) were used. Groups consisted of TAP block control (TBC) which received water injection (0.2 ml kg-1 point), and TAP block bupivacaine (TBB) which received bupivacaine (0.2 ml kg-1 point at 0.25%); both groups were submitted to four-point approach. Animals were pre-medicated with acepromazine (0.03 mg kg-1) and meperidine (2 mg kg-1) IM, propofol was used as anesthetic induction (3-5 mg kg-1) IV, and isoflurane was used to maintain. To standardize groups, the animals received a continuous infusion of remifentanil (0.2μg kg-1 min) and rocuronium (0.6 mg kg-1) IV in the intraoperative period. Variables measured were the heart and respiratory rates, blood pressure, temperature, peripheral oxyhemoglobin saturation, exhaled carbon dioxide concentration, exhaled isoflurane concentration, serum cortisol, analgesia, and sedation. Before the pre-anesthetic medication (Baseline) and 1, 2, 4, 6, and 8 h after extubation, pain and sedation were assessed using a numeric rating scale (NRS), Glasgow composite measure pain scale (GCMPS-SF), and sedation scale. Moreover, serum cortisol was measured at different moments. The results show that in the intraoperative period, there was no significant difference between groups. After surgery, in TBC, 13 out of 16 animals required analgesic rescue, whereas, in TBB, this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed a significant difference when compared to the baseline time in the traction of the first ovary (p < 0.0001), 2 h (p = 0.0441), and 8 h (p = 0.0384) after extubation. In TBB, cortisol showed a significant increase only in the traction of the first ovary and 2 h after extubation (p < 0.0001). The technique using ultrasound-guided TAP block in two points approach by hemiabdomen with 0.2 ml kg-1 bupivacaine 0.25% was effective in providing post-operative analgesia in dogs undergoing ovariectomy.

Мультимодальная сбалансированная анестезия при кесаревом сечении

Выполнено 97 операций кесарева сечения у пациенток в возрасте от 21 до 39 лет без тяжелой экстрагенитальной патологии. I группу составили 49 пациенток, которым не проводили упреждающую аналгезию, во II группе (48 пациенток) в качестве упреждающей аналгезии за 15–20 минут до операции в/в вводили Инфулган в течение 15 минут. В послеоперационном периоде обезболивание осуществляли Инфулганом. Плановая суточная доза Инфулгана не превышала 4 г. Длительность терапии не превышала двух дней.Проведенные клинические исследования показали, что Инфулган высокоэффективен при использовании его в упреждающей аналгезии, исключает возможность использования наркотических анальгетиков в послеоперационном периоде без ущерба для качества обезболивания. Исключает риск развития депрессии внешнего дыхания у пациентов с высоким риском осложнений. Спинальная анестезия Лонгокаином Хеви является высокоэффективным методом анестезиологической защиты пациента в периоперационном периоде, не оказывает отрицательного влияния на плод и новорожденного.

How periarticular corticosteroid injections impact the integrity of arthroscopic rotator cuff repair

IntroductionMultimodal analgesic (MMA) injections combined with corticosteroids have recently been shown to be effective for managing pain after arthroscopic rotator cuff repair. HypothesisThe goal of this study was to analyze the effects of corticosteroid injections on the integrity of tendon repairs using magnetic resonance imaging (MRI). The hypothesis was that MMA injections combined with corticosteroids have no deleterious effects on functional outcomes and tendon healing 1 year after surgical rotator cuff repair. MethodsThis was a prospective, double-blind study of 50 patients undergoing arthroscopic rotator cuff repair who were randomized into two groups. The study group (n=25) received a periarticular injection of a mixture of ropivacaine, morphine and methylprednisolone at the end of the procedure. The control group (n=25) received a placebo injection. The clinical outcomes were the pain level and complications, while the functional outcomes consisted of the Constant-Murley Score (CMS), American Shoulder and Elbow Surgeons Shoulder (ASES) score and Simple Shoulder Test (SST). The structural integrity of the operated tendons was analyzed on MRI at a mean follow-up of 15.1±1.3 months for the study group and 15.2±1.1 for the control group (p=0.848). ResultsPain on a visual analog scale was significantly reduced in both groups after the surgery. Nevertheless, there was no significant difference between groups at the final follow-up visit (p=0.803). Compared to the preoperative values, the CMS, ASES and SST significantly improved in both groups after surgery but were not significantly different between groups at the final assessment (p=0.801, 0.869 and 0.769, respectively). MRI revealed supraspinatus tendon retears in 16% of patients in the study group and 36% in the control group (p=0.107). There were no infections in the study group as of the final assessment. Advanced age (p=0.049), diabetes (p<0.01) and posterior extension of the tear (p=0.039) negatively impact healing. Corticosteroid injection did not negatively impact healing (p=0.197). ConclusionThis study shows that MMA injection combined with corticosteroids does not alter the tendon healing, clinical outcomes, or functional outcomes 1 year after arthroscopic rotator cuff repair. It remains a safe and effective analgesia method during rotator cuff repair surgery. Level of evidenceII, low-powered placebo-controlled, randomized study.

The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology.

BackgroundPatients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings.ObjectiveThe main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients.MethodsClinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters.ResultsTwenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs.ConclusionsThe use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine.

MODERN METHODS OF REGIONAL ANESTHESIA OF THE PERIOPERATIVE PERIOD IN CHILDREN IN ABDOMINAL SURGERY. A REVIEW

Perioperative anesthesia in abdominal surgery at present is a main problem in anesthesiologist practice. According to the literature regional methods of anesthesia are used for anesthesia in the perioperative period. The analgetic effectiveness of the QLB in pediatric practice is not sufficiently studied. Materials and methods: There were articles in English and Ukrainian languages for the period from 1996 to 2018, which are part of the PubMed, EMBASE, Cochrane, and Google Scholar research databases. Discussion: This article presents the results of the using of basic methods of regional analgesia that are used in surgery. More and more data from studies in adult patients indicate that QLB is an effective method of analgesia in abdominal surgery. It should be noted that in the literature there is a small amount of clinical applications of the QLB block in pediatric practice. Therefore, it is necessary to carry out further study of efficiency, safety, and improve the methodology for implementing the QLB unit, especially in pediatric practice.

Postoperative analgesia by a surgically inserted transversus abdominis plane catheter versus a thoracic epidural catheter after flank incision: randomized-controlled trial

Introduction Transversus abdominis plane (TAP) block has been reported to be an effective method of analgesia after abdominal surgery. This prospective randomized study compared the analgesic effect by a surgically inserted TAP catheter versus a thoracic epidural catheter in the postoperative period after a flank incision. Patients and methods Sixty-four American Society of Anesthesiologists physical status I and II patients, 18–59 years of age scheduled for renal surgery for a nonmalignant lesion with a flank incision, were allocated randomly to two equal groups. The group E ( n =29; three excluded) received 0.125% bupivacaine with fentanyl 2 µg/ml at the rate of 5–8 ml/h, whereas the group T ( n =30; two excluded) received 1 mg/kg bupivacaine 0.375%/8 h. Rescue analgesia of 5 mg morphine bolus doses was administered upon patients’ requests with a maximum dose of 10 mg/4 h. Visual analog scale, morphine consumption in 48 h, and incidence of postoperative complications were assessed. Results Visual analog scale and morphine consumption were comparable in the two groups. No significant complications were found in the TAP group, whereas the incidences of hypotension and motor block were higher in the epidural group. Conclusion A surgically assisted-TAP catheter is an easy, safe and effective method for analgesia after a flank incision and can be a good alternative to epidural analgesia, especially when the latter is contraindicated.

Comparison of fast track after total knee replacement surgery with continuous femoral nerve block analgesia and intravenous analgesia

Objective Comparing fast track after total knee arthroplasty(TKA) with continuous femoral nerve block(CFNB) analgesia and intravenous analgesia. Methods Sixty ASAⅠor Ⅱpatients, aged 45-78 years, undergoing unilateral TKA were randomly divided into 2 groups(n=30): patient controlled nerve block analgesia(PCNA) group and patient controlled intravenous analgesia(PCIA) group. All patients received spinal anesthesia combined with epidural anesthesia. In the postoperative period, the VAS in resting and exercise were recorded to evaluate the degree of postoperative pain, the numbers of patient-controlled analgesia(PCA) pressing and meperidine using, muscle strength of limb, the active movement angle, adverse reactions and analgesic associated complications were observed and recorded. Results In 6, 12, 24, 48 h postoperative resting state, there was no significant differences in pain score between CFNB group and PCIA group(P<0.05). There was significantly less VAS scores in the PCNA group comparing the PCIA group during the continuous passive movement of knee postoperatively at 24 h and 48 h[(3.6±0.5) vs(4.7±0.6), (3.4±0.5) vs (4.5±0.4)](P<0.05). The numbers of PCA pressing and meperidine using of PCNA group were significantly lower than that of PCIA group after surgery(P<0.05). Angle of knee active movement postoperatively at 24 h and 48 h in the PCNA group was larger than PCIA group(P<0.05). Blood glucose level of PCNA group was lower than that of PCIA group after surgery(P<0.05). Postoperative complications such as deep vein thrombosis, adverse reactions such as lethargy, respiratory depression were fewer in the PCNA group(P<0.05). Patients satisfaction scores in the PCNA group was higher than the PCIA group [(9.6±1.4) vs (7.9±1.2)](P<0.05). Conclusions CFNB has superior early analgesic effect to PCIA in total knee replacement surgery, as well as fewer adverse reactions, better knee function recovery, shorter hospital time and higher patient satisfaction. CFNB is in accordance with fast track surgery concept and it is a safe, practical and effective method for analgesia after TKA. Key words: Femoral nerve block; Intravenous analgesia; Total knee arthroplasty; Fast track

Impact of water analgesia on the pain relief for primiparas in labor

Objective To explore the effect of water analgesia on the pain relief for primiparas in labor, especially on the point of the acutest pain and total time of severe pains by tracking and comparing with remifentanil patient-controlled intravenous analgesia and the conventional vaginal delivery. Methods A total of 139 singleton and full-term primiparas who chosed analgesia labor were selected. There were 3 groups: 56 cases in water analgesia group (hereinafter referred to shortly as water group), 37 cases in remifentanil patient-controlled intravenous analgesia group (hereinafter referred to shortly as vein group ) and 46 cases in traditional vaginal delivery group (hereinafter referred to shortly as traditional group). In addition, labor pain intensity was assessed with numerical rating scale (NRS). All groups were evaluated by NRS score in five different time points during the delivery: cervical dilation to 2-3 cm or 1 minute before labor analgesia; labor analgesia after 10 minutes; labor analgesia after 30 minutes; labor analgesia after 60 minutes; point of acutest pain. Meanwhile, total time of acutest pain, progress of labor, use of oxytocin, mode of delivery, postpartum hemorrhage and neonatal asphyxia were all observed. Results Comparison of labor progress and postpartum bleeding, mode of delivery and neonatal Apgar score in three groups of primipara showed no significant difference (P>0.05). Compared with the traditional group, the NRS score and point of acutest pain in water group obviously declined, the total time of severe pain shortened 36.58 min on average, which showed significant difference (t=-4.400, P < 0.05). Compared with the vein group, the NRS score of water group at 10 minutes after labor analgesia was below the vein group (t=-2.358, P < 0.05), so was point of acutest pain (t=-2.703, P < 0.05). But the score of water group was higher than intravenous analgesia after 60 minutes, which showed significant difference (t=2.833, P<0.01). The rate of oxytocin application in water group was only 12.5% (7/56), significantly less than the rate in vein group, which was 37.84% (14/37), there were significant differences (χ2=8.182, P < 0.05). Conclusions Water analgesia can effectively alleviate maternal pain and reduce intrapartum intervention, and more, less influence on maternal and newborn, and is a safe and effective analgesia method. Key words: Labouring in water; Remifentanil patient-controlled intravenous analgesia; Point of acutest pain; Total time of the severe pain

PTU-046 The Use of Entonox as an Analgesic During Colonoscopy – Ninewells Endoscopy Unit Experience

Introduction Entonox is a safe and effective method of analgesia used for patients undergoing colonoscopy. It has a number of advantages over sedo-analgesia and is available for use in a large number of Endoscopy Units in the UK. The aim of the study was to assess the effectiveness of Entonox as an analgesic during colonoscopy in our unit, and to evaluate the experience of patients, nurses and endoscopists involved. Methods This study was carried out over a two month period between 1st June 2014 and 31st July 2014. All patients undergoing out-patient colonoscopy and all trained endoscopy nurses and endoscopists who worked in the unit were invited to take part. A questionnaire, focussing on discomfort, anxiety and discharge planning was completed by patients choosing to have Entonox before leaving the department. Nurses and endoscopists were questioned on their experience of Entonox as an analgesic and the effect on flow within the unit, at the end of the study period. Results 489 patients had a colonoscopy during the study period, 89 (18%) chose to have Entonox. Of these patients 56% were male. 71% were aged between 40 and 69 years. 89% of procedures were diagnostic and 11% therapeutic. Colonoscopy was complete to caecum in 99% of procedures. 15% of patients experienced mild side effects such as dry mouth, light headedness and sweating. 84% of patients who used Entonox were fit for discharge less than 30 minutes after the procedure: 23% drove home and 89% went home without an escort. Patients reported a mean satisfaction score of 8.4 and 70% said they would use Entonox again. Of the 21 endoscopy nurses and 17 endoscopists who completed the end of study questionnaire, 95% of nurses and 94% of endoscopists were satisfied with Entonox as an effective method of pain control for colonoscopy. All nurses felt Entonox should continue to be offered to patients and 88% of Endoscopists said it should be implemented in NHS Tayside’s other two endoscopy units. There was a cost saving of £75.05 over the two month study period: This would make a predicted annual saving of £772.35. Conclusion Our study has shown that Entonox is a suitable analgesic option for our patients having a colonoscopy. It is safe and simple to use, does not impact on colonoscopy completion rate and is cost effective. Patients have a shorter recovery period and are discharged quickly after the procedure. Patients are able to drive after the procedure and go home without an escort. Patients, nurses and endoscopists all reported high satisfaction scores. Entonox will continue to be offered to patients within Ninewells Hospital Endoscopy Unit and is currently being introduced in the other NHS Tayside Endoscopy Units. Disclosure of Interest None Declared

Ultrasound-Guided Thoracic Paravertebral Block Experience in a Child.

Ultrasound-Guided Thoracic Paravertebral Block Experience in a Child.

Effects of a thoracic paravertebral block on postoperative analgesia in patients undergoing modified radical mastectomy

Following mastectomy, 50% of patients have chronic postoperative pain. Studies have shown that a paravertebral block is an effective method of analgesia as well as anaesthesia. The aim of this study is to compare postoperative pain values and opioid consumption after a single dose of 150 mg levobupivacaine with a thoracic paravertebral block in patients undergoing mastectomy. Enrolled in the study were forty patients, aged 20 to 65, diagnosed with breast cancer, and undergoing modified radical mastectomy and axillary dissection. Patients were randomized into two groups, as control group (group K, n=20) and thoracic paravertebral group (Group T, n=20). Postoperative pain values were recorded at 0, 1st, 6th, 12th and 24th hour at rest, using a 0-10 mm Visual Analogue Scale (VAS). Additional quantities of postoperative tramadol (1.5 mg/kg, iv infusion) were recorded. Postoperatively, at 0, 1st, 6th, 12th and 24th hour, patients in the control group had significantly higher VAS values than the group treated with a thoracic paravertebral block (p<0.01). Compared to VAS scores at postoperative 0 h, there was a statistically significant decrease in VAS scores at 1st, 6th, 12th and 24th hour in both groups (p<0.01). Additional use of tramadol was significantly lower in group T (p<0.01). A paravertebral block with a single dose of 150 mg levobupivacaine before general anaesthesia in patients undergoing modified radical mastectomy and axillary lymph node dissection decreases postoperative pain values and the need for analgesics during the postoperative 24 hours.

Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis

BackgroundThoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors’ technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime.MethodsRecords for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient’s perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded.Results28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method.ConclusionsLocal anaesthetic administration via an intrapleural catheter is a safe and effective method of analgesia following thoracoscopic anterior scoliosis correction. Post-operative pain following anterior thoracic scoliosis surgery can be reduced to ‘mild’ levels by combined analgesia regimes.

Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: A non-randomized controlled study

To investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) on four specific acupuncture points Hegu (LI4), Neiguan (PC6), Danshu (BL19) and Weishu (BL21) for reducing pain in labor. A total of 160 voluntary nulliparous women who were willing to receive TENS for analgesia were assigned to the treatment group after cervical dilation of more than 2 cm. Another 145 matched nullipara were recruited as the control group. Visual analogue scale (VAS) was used to assess the pain before and 0.5 h after the application of TENS. Then, VAS was assessed every one hour until delivery. Percentage of VAS score decreased by > 25% was the primary outcome, the delivery mode and neonatal outcome were measured as secondary outcomes. Adverse reactions were also recorded during TENS. The percentage of VAS score decreased by > 25% was 68.6% in the TENS treatment group. Maternal delivery mode and neonatal outcomes were not significantly different between the two groups. In addition, the incidence of postpartum hemorrhage in the TENS treatment group was less than the control group (P<0.05). There was no adverse reaction recorded with TENS on acupoints. As a novel and non-invasive approach, TENS on specific acupoints including Hegu (LI4), Neiguan (PC6), Danshu (BL19) and Weishu (BL21) was an effective method for analgesia in labor.

Multimodality Therapy for Chronic Pain Syndrome in Critical Lower Extremity Ischemia

Objective: to evaluate the efficiency of multimodal epidural analgesia (EA) in patients with chronic critical lower extremity ischemia (CLEI) in the preoperative period. Subjects and methods. A prospective randomized controlled study was conducted in 150 patients.According to the anesthesia mode, the patients were divided into 5 groups: 1) EA with a local anesthetic; 2) EA in combination with a nonsteroidal anti-inflammatory drug (ketoprophen); 3) EA in combination with ketoprophen and subnarcotic doses of ketamine; 4) EA in combination with fentanyl and ketoprophen; 5) EA in combination with fentanyl, ketoprophen, and ketamine. Results. The developed procedure for prolonged multimodal EA allows the stabilization of hemodynamics, the concentration of cortisol and metabolites (glucose, lactate), and the values of regional blood flow. Conclusion. EA with a local anesthetic in combination with fentanyl, ketoprophen, and ketamine is the most effective method for analgesia in patients with CLEI in the preoperative period. Key words: multimodal analgesia.

The efficacy of acupuncture in extracorporeal shock wave lithotripsy.

Our aim was to evaluate the safety and efficacy of acupuncture in comparison with intravenous (IV) sedation in extracorporeal shock wave lithotripsy (ESWL). One hundred patients, who were scheduled for ESWL, were divided randomly into two groups of fifty patients (acupuncture and IV sedation). In the first group, acupuncture was carried out with special needles (0.30 x 18 mm), in two points 30 minutes before the procedure: point of 36 from the stomach meridian with an angle of 90 degrees and point of 60 from the urinary bladder meridian with an angle of 90 degrees. In the IV sedation group morphine 0.1 mg/kg was injected intramuscularly 30 minutes and intravenous diazepam 0.1 mg/kg for muscle relaxation and anti-anxiety, one minute before the procedure. The two groups were similar in terms of confounding factors. Pain (scored in 4 levels), blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were recorded prior to IV sedation or acupuncture, 30 minutes after each, at the beginning of ESWL, 10 minutes after ESWL, and at the end of the procedure (times 1 to 5). In acupuncture group the pain intensity was less than IV sedation group (for time 3, p=0.019, for time 4, p=0.002, for time 5, p=0.05). Considering the pain incidence (each pain score except zero), there was a significant difference at time 4 (p=0.012). None of the procedures was stopped because of pain and none of the patients experienced complications during operation. Arterial blood oxygen saturation was between 95% and 100% for all of the patients in acupuncture group and recovery time was faster (p<0.0001). Acupuncture is a safe and effective method for analgesia. It has a faster recovery time and economical benefits. It also provides the ability to increase the shock wave voltage. We believe that it is a good alternative for IV sedation in ESWL, particularly in patients with lung and heart disease.