Efficacy Of Anesthesia Research Articles

Patient’s pain perception and surgeon satisfaction with topical anaesthsia in phacoemulsification surgery

As the cataract surgery has taken the quantum leaps, so does the advancements in various anaesthetic techniques, aiming to provide a safer, painless and comfortable surgery. Topical anaesthesia is a less invasive anaesthetic option which provides adequate analgesia with wide margin of safety. We aimed to evaluate the efficacy of topical anaesthesia as a routine in a standard phacoemulsification surgery.A total of200 patients scheduled for routine phacoemulsification were enrolled in a prospective, non-randomized comparative clinical study. Patients were then distributed to either topical anaesthesia group (TA) or peribulbar anaesthesia group (PA) to evaluate for patient and surgeon satisfaction, and intraoperative complications.The study groups were comparable demographically. Pain scores were higher during late stages of surgery in TA (p<0.01), while higher scores were noticeable in PA (p<0.01) during administration and in the postoperative periods. Significantly higher rate of chemosis was seen in PA (p<0.01). The patients in the TA had an overall better surgical experience as compared to the PA (p<0.01).Though surgeon does note higher per-operative pain perception (p=0.027) and ocular motility (p<0.01) in the TA there was no significant difference as far as ease of surgery was concerned.Despite higher per-operative pain perception most of the patients describe their surgical experience with topical anaesthesia as satisfactory. In view of its minimally invasive nature, topical anaesthesia is a safer alternative to peribulbar anaesthesia practically avoiding all block related complications especially in at risk eyes, and thus can be safely administered as a routine in phacoemulsification surgery.

Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?

General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements.

Local anaesthesia vs. general anaesthesia for percutaneous microwave ablation in hepatocellular carcinoma: efficacy, safety, and cost analysis.

To compare the efficacy, safety, and cost of local anaesthesia and general anaesthesia modalities for percutaneous microwave ablation as a curative treatment for hepatocellular carcinoma patients. This comparative, retrospective study analysed 175 patients who were treated for hepatocellular carcinoma (HCC) from July 2015 to September 2020. Conventional transcatheter arterial chemoembolization (cTACE) combined with sequential percutaneous microwave ablation (MWA) was performed on every lesion in every patient. Patients were divided into two cohorts according to the anaesthesia modality applied during MWA. To investigate the differences in efficacy between the two groups, overall survival (OS) and local recurrence-free survival (LRFS) were estimated by the Kaplan-Meier method and compared by the log-rank test. Cost and safety between the two groups were also compared accordingly. There were 105 patients with 128 HCC lesions in the local anaesthesia (LA) group and 70 patients with 107 lesions in the general anaesthesia (GA) group. There were no significant differences in OS (P = 0.798) or LRFS (P = 0.406) between the two groups. Fifty-two pairs of patients were matched with 77 lesions in the GA group and 67 lesions in the LA group after PSM. There was no significant difference in OS (P = 0.522) or LRFS (P = 0.410) between the two groups. Compared to the LA group, the GA group had longer operations, consumed more medical resources, had a heavier financial burden, and experienced more anaesthesia adverse events. There was no significant difference in the incidence of post-ablation pain (p=0.487), fever (P=0.678), nausea or vomiting (P=0.808), mild liver dysfunction (P=0.753), haemolytic uraemic syndrome (P=0.595), pleural effusion (P=0.622), liver abscess (0.544), asymptomatic perihepatic fluid (0.703) or subcapsular liver hemorrhage (P=0.666) between the two groups. Due to the higher cost and adverse events of general anaesthesia, local anaesthesia may be more suitable for ablation procedures for HCC patients within the Milan criteria.

Effect of photobiomodulation on the efficacy of anesthesia in maxillary permanent molar teeth with molar incisor hypomineralization: A randomized clinical trial.

Difficulty in anesthetizing teeth that have been diagnosed with molar incisor hypomineralization (MIH) is a frequently reported clinical problem. The effects of low-level laser application (photobiomodulation) on the efficacy of anesthesia during the dental treatment of patients with MIH have not yet been studied. To assess the effects of photobiomodulation therapy (PBMT) on the efficacy of anesthesia in maxillary permanent molar teeth with MIH. This prospective, parallel-arm control, randomized, triple-blind clinical trial included children aged 7-12 years. Maxillary permanent first molar teeth with MIH that required pulpotomy treatment were included. Seventy participants were randomly divided into two groups: experimental (with PBMT) and control (placebo). In the experimental group, before the administration of local infiltration anesthesia, PBMT (diode laser: 940 nm; continuous mode; 0.5 W; 78 J/cm2) was applied to the oral mucosa for 60 s each. In the control group, the laser probe was channeled toward the mucosa but was not activated. Pain scores were evaluated during the access cavity preparation of the pulpotomy treatment (when using the dentin cutting handpiece and while entering into the pulp) using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Additional anesthesia requirements were assessed in both groups. The data obtained were analyzed for statistical significance (p < .05). The chi-squared test was used to determine the effect of PBMT on categorical outcomes. The no-pain scores of the experimental group were higher than those of the control group (29% vs. 20%). Moderate-to-high pain was more frequent in the control group than in the experimental group (43% vs. 20%). While 31% of the experimental group required supplemental anesthesia, 49% of the control group required supplemental anesthesia during pulpotomy of the tooth with MIH. No statistical difference, however, was found between the two groups in terms of pain scores and the need for supplemental anesthesia (p = .235, p = .143). Anesthesia with and without PBMT caused no difference in pain during the treatment of maxillary molar teeth with MIH.

Efficacy of opioid-free anesthesia in modified radical mastectomy: a cross-sectional observational study.

Perioperative management of female patients undergoing breast surgeries differs from other patients due to chronic pain and postoperative nausea and vomiting. The anesthesia could consist of opioid-free general anesthesia (OFA) or non-opioid-free general anesthesia (NOFA). OFA relies on multimodal analgesia preoperatively and postoperatively. However, it is not yet established whether OFA could replace NOFA as a standard regimen for the management of breast surgeries. The aim of this study is to evaluate the efficacy of OFA for breast surgeries in female patients. Patients undergoing modified radical mastectomy were retrospectively recruited. Two groups were defined: group 1, consisting of treated patients using OFA and group 2, consisting of treated patients using NOFA. Mean time to extubate and mean dose of morphine after recovery were computed. Postoperative morphine and antiemetic use were assessed for up to 24h. A comparison of the computed data was conducted between both groups. A total of 116 patients were included with a mean age of 53±13 years. Group 1 consisted of 56 (mean age was 54±14 years). Group 2 consisted of 60 patients (mean age was 51±12 years). Demographic parameters and time to extubate did not yield significant differences. We noticed morphine sparing at T0 and T12 with statistically significant differences P=0.043 and P=0.006, respectively. OFA could be considered in modified radical mastectomy management in female patients; nerve block seemed to act as morphine sparing in operative and postoperative settings by providing significantly less time to extubate with less postoperative morphine requirement.

372 Is the Mixing of Local Anaesthetic Agents for Perineal Block in TP Prostate Biopsy Patients Advantageous? a Comparative Study of Local Anaesthetic Efficacy

Abstract Aim Traditional mixing of short and long-acting local anaesthetics for perineal blocks for TP Biopsies might risk altering their pH and allow the use of suboptimal dose of the mixed agents. Method This is a prospective study in which we look at 102 patients who have had transperineal prostate biopsies. The patients were divided into 2 groups according to the type of peri-prostatic local anaesthetic i.e. mixed (10mls of 1% lignocaine and 10 mls of 0.5% levobupivacaine) and non-mixed (20mls 0.5% levobupivacaine). Patients were asked to fill a pain score and satisfaction questionnaire after the procedure. Results The two groups were matched in their demographics including age, PSA and prostate volume. The pain threshold was similar in both groups during administration of the perineal block. The difference in pain threshold between the ‘mixed’ vs ‘non-mix’ group was statistically significant during the biopsy sampling i.e., 4(std 2) for the ‘mixed’ and 2(std1) for the ‘non-mix’ group. 84.8% of the ‘mixed’ group vs 97.7% of the ‘non-mix’ group said they would recommend the procedure. The response was the same when asked whether they would repeat the procedure if required (84.4% in ‘mixed’ vs 97.7% in ‘non-mix’). The cancer detection rate had no statistical difference between the 2 groups although core-length’s taken from target lesions were shorter in ‘mixed’ vs ‘non-mixed’ group (mean 7mm vs 9.5mm). Conclusions Our study confirms that using a pure agent gave better pain scores with the same cancer detection rates as compared to mixed agents.

US Guided vs Landmark Guided in Paramedian Spinal in Elderly

Abstract Background The ultrasound-assisted paramedian technique reduces the technical difficulty of spinal anaesthesia in the elderly. Compared with the landmark-guided paramedian technique, the use of ultrasound reduced the number of needle manipulations required for success, increased the firstattempt success rate and reduced block-associated pain and discomfort. Aim of the Work The study aims to evaluate whether ultrasound assisted paramedian spinal anaesthesia in the elderly can achieve successful dural puncture with fewer needle passes compared with the conventional landmark guided paramedian technique. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain shams University; this study conducted in the operating theatres of Ain Shams University Hospitals with sample size of 10 patients / group will be needed. The patients randomly divided pre-operatively into two groups using their computer-generated random numbers such that „even numbers‟ will be enrolled in “group-L” for patients receive spinal anaesthesia by the paramedian approach by landmark guided palpation and „odd numbers‟ will be enrolled in “group-s” for patients ultrasound assisted approach. Results Ultrasonography might improve the efficacy of spinal anaesthesia by improving the accuracy of identification of intervertebral level, depth measurement of the intrathecal space and location of the interlaminar window that permits needle passage compared with the landmark guided technique, ultrasound assisted spinal anaesthesia decreases the number of puncture attempts and improves the success rate at the first attempt in patients with potential technical difficulties we believe that individualisation is a key element of minimising technical difficulties. Because of the large intersubject variability in anatomy, the blind technique have a theoretical upper limit of success rate. Through which we obtained success rates of 90 and 100% at the first attempt and within two attempts, respectively, in the ultrasound group. Conclusion Ultrasound-assisted paramedian spinal anaesthesia significantly reduces the number of needle manipulations required for success, increases the success rate at first pass and decreases periprocedural pain and patient discomfort compared with the landmark-guided paramedian technique in the elderly. Our results suggest that the neuraxial ultrasonography enhances the efficacy and comfort of spinal anaesthesia in the elderly.

Comparative Evaluation of the Anesthetic Efficacy of 1% Chloroprocaine Vis-a-vis 2% Lignocaine with Adrenaline (1:80,000) in Third Molar Surgery.

To evaluate the anesthetic efficacy of 1% chloroprocaine in comparison to 2% lignocaine hydrochloride and adrenaline (1:80,000) in third molar surgery. A randomized single-blind trial comprising of 30 healthy patients requiring bilateral extraction of impacted lower third molars with similar difficulty index was undertaken. A test dose was administered to all patients with subdermal infiltration of 1% chloroprocaine with 0.5ml. A classic inferior alveolar and long buccal nerve block was given using 1% chloroprocaine 2ml on one side and 2% lignocaine hydrochloride 2ml with adrenaline on the other side. The time to onset and duration of action were noted. Pain during the surgical intervention, need for additional local anesthetic solution during the surgical intervention and the hemodynamic changes associated with the administration of the drugs were monitored. Chloroprocaine had an early onset of action with a mean of 1.17 ± 0.55min as compared to lignocaine 4.2 ± 0.48min. Patients administered with lignocaine experienced less postoperative pain compared with chloroprocaine since the duration of action of chloroprocaine was lesser than that of lignocaine. Additional amount of LA was required when chloroprocaine was administered as compared to lignocaine. Chloroprocaine alone did not cause any appreciable changes in the hemodynamics, but lignocaine with adrenaline caused a transient increase in arterial pressure and heart rate 2min following the administration. It was also observed that more blood was lost following chloroprocaine administration than with lignocaine. Chloroprocaine has a rapid onset of action and short duration of action with minimal effects on the hemodynamic changes than lignocaine. Considering the fact that it is a safe drug with no effects of the cardiovascular system it can be advocated that Chloroprocaine can be used as an effective local anesthetic agent for performing oral and maxillofacial surgical interventions of short duration.

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.

Articaine Infiltrations of the Mandibular Lateral Incisor—Is It Volume or Location of the Infiltrations That Affect Success? A Prospective, Randomized Crossover Study

IntroductionA combination labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor was found superior to a labial infiltration of 1.8 mL of the same solution. However, it is not known whether the volume or the location had the greatest effect. Therefore, the purpose of this prospective, randomized crossover study was to determine the anesthetic efficacy of a labial infiltration of a 3.6 mL volume of 4% articaine with 1:100,000 epinephrine compared with labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor. MethodsOne hundred subjects randomly received 2 sets of injections, using 4% articaine with 1:100,000 epinephrine, consisting of labial and lingual infiltrations of 1.8 mL (3.6 mL total) and 2 labial infiltrations of 1.8 mL (3.6 mL total) of the mandibular lateral incisor in 2 separate appointments. Electric pulp testing was used to determine anesthetic success (highest 80/80 reading). The data were analyzed statistically. ResultsThe labial and lingual combination exhibited a significantly higher anesthetic success rate (97%) when compared with the 2 labial infiltrations (74%) and had significantly higher 80/80s readings from 1 minute to 58 minutes. ConclusionsWithin the limitations of this clinical study, a combination labial plus lingual infiltration using a 3.6-mL volume of 4% articaine with 1:100,000 epinephrine significantly increased pulpal anesthetic success for the mandibular lateral incisor when compared with a labial infiltration using a 3.6-mL volume of articaine. Therefore, location of the infiltrations was more important than volume.

Efficacy of intravenous dexmedetomidine-lignocaine infusion compared to morphine for intraoperative haemodynamic stability in modified radical mastectomy: A randomised controlled trial.

In recent times, non-opioid analgesic-based anaesthesia has been gaining popularity as it can achieve the goals of hypnosis, amnesia, and haemodynamic stability while avoiding opioid side effects. Our study compares the efficacy of opioid-free anaesthesia and opioid-based general anaesthesia regarding intraoperative haemodynamic stability, anaesthetic requirements, awareness, and recovery profile. After receiving ethical approval and registering the trial, we conducted this randomised, single-blinded study on American Society of Anesthesiologists (ASA) physical status I and II patients who were aged 18-65 and were scheduled for modified radical mastectomy under general anaesthesia. Patients were randomised into two groups of 60 each. Group DL received IV dexmedetomidine 1 μg/kg loading over 10 min, 10 min before induction and 0.5 μg/kg/h infusion after that along with IV lignocaine 1.5 mg/kg at bolus followed by 1.5 mg/kg/h infusion. Group MN received IV morphine 0.15 mg/kg. Standard monitoring and general anaesthesia protocol were followed. Intraoperative haemodynamics, anaesthetic requirement, extubation time, and recovery profile were monitored. Data were analysed using Stata version 14 software, and statistical tests (Chi-squared test for qualitative variables, unpaired t-test and Mann-Whitney U test for quantitative variables) were performed. Both groups had comparable haemodynamic stability (P > 0.05). Group DL had a significantly lower propofol requirement for induction and maintenance (P < 0.001). Ramsay sedation score (P = 0.002) and extubation time (P = 0.029) were significantly higher in Group MN. The recovery profile was favourable in Group DL, with there being lower postoperative complications. Dexmedetomidine and lignocaine IV infusion demonstrated stable intraoperative haemodynamic stability, lower anaesthetic requirement, and better recovery profile than morphine without significant complications.

Recent Research Advances in Nano-Based Drug Delivery Systems for Local Anesthetics.

From a clinical perspective, local anesthetics have rather widespread application in regional blockade for surgery, postoperative analgesia, acute/chronic pain control, and even cancer treatments. However, a number of disadvantages are associated with traditional local anesthetic agents as well as routine drug delivery administration ways, such as neurotoxicity, short half-time, and non-sustained release, thereby limiting their application in clinical practice. Successful characterization of drug delivery systems (DDSs) for individual local anesthetic agents can support to achieve more efficient drug release and prolonged duration of action with reduced systemic toxicity. Different types of DDSs involving various carriers have been examined, including micromaterials, nanomaterials, and cyclodextrin. Among them, nanotechnology-based delivery approaches have significantly developed in the last decade due to the low systemic toxicity and the greater efficacy of non-conventional local anesthetics. Multiple nanosized materials, including polymeric, lipid (solid lipid nanoparticles, nanostructured lipid carriers, and nanoemulsions), metallic, inorganic non-metallic, and hybrid nanoparticles, offer a safe, localized, and long-acting solution for pain management and tumor therapy. This review provides a brief synopsis of different nano-based DDSs for local anesthetics with variable sizes and structural morphology, such as nanocapsules and nanospheres. Recent original research utilizing nanotechnology-based delivery systems is particularly discussed, and the progress and strengths of these DDSs are highlighted. A specific focus of this review is the comparison of various nano-based DDSs for local anesthetics, which can offer additional indications for their further improvement. All in all, nano-based DDSs with unique advantages provide a novel direction for the development of safer and more effective local anesthetic formulations.

Comparison of Topical Anesthesia, Intracameral 1% Lignocaine and Topical Anesthesia and Intravenous Acetaminophen and Topical Anesthesia for Phacoemulsification in Cataract Surgery

Objective: To compare the effectiveness of topical Proparacaine 0.5%, topical Proparacaine 0.5% and topical Proparacaine 0.5% for intraoperative analgesia and surgeon’s score undergoing simple cataract surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan,from Sep 2022 to Mar 2023. Methodology: Sixty patients aged 40 years and more, ASA-l and ll, undergoing elective simple cataract surgeries were observed by taking 20 patients in all three groups (n=20). Group-T: Topical Anesthesia group, 0.5% Proparacaine Group-I: Topical Anesthesia &amp; Intracameral 1% Lignocaine Group-A: Topical Anesthesia and IV Acetaminophen groups were randomly allocated for pretreatment to either receive the 0.5% Proparacaine Eye drops (Group-T) or 0.5%Proparacaine eye drops with Intracameral 1ml 1% Lignocaine (I group) or 0.5% Proparacaine Eye drops with intravenous Acetaminophen 15ml/kg (A group). Incidence of pain by Visual analogue scale/wong-baker faces scale was noted. The surgeon’s comfort was assessed by using Gupta’s surgeon score questionnaire. Results: The results showed Group-I had better analgesic score than Group-T with only 1(5%) patient had a score of 4 but even more significant efficacy of intravenous acetaminophen plus topical anesthesia (Group-A) was shown as compared to rest of the groups with none (0%) patient had a VAS score of 4 (p-value=0.002). The results also showed Group-I had better surgeon comfort score than both Group-T and Group-A, with only 1(5%) patient had a score of 7 or above as compared to Group-T, 9(45%) patients and Group-A 7(35%) patients. (p-value=0.005). Conclusion: Intravenous acetaminophen plus topical

Efficacy of Local Anesthetic in Post-Operative Laparoscopic Cholecystectomy

Background: Pain management is medically pertinent for optimal care in surgical patients. Although development and advancement in understanding of the pathophysiology of pain, analgesic's pharmacology and the development of better effective techniques for postoperative pain control, patients still continue to experience considerable discomfort. Objectives: To compare the efficacy (in terms of pain) of local anesthetic in postoperative laparoscopic cholecystectomy compared to control group. Methods: A total of 60 patients undergoing laparoscopic cholecystectomy and of age 20-50 year were included. Group A included the cases in which at the end of laparoscopic surgery, prior to port withdrawal, a local anesthetic mixture, a short acting (Lidocaine 2%) plus a long acting (Bupivacaine 0.5%) was instilled through the port lumen between the abdominal wall layers while group B included the cases in which conventional analgesics (narcotics and NSAID) was given post - operatively. All the patients were assessed by the researcher himself up to 12 hours post-operatively and efficacy was noted by Visual Analogue Scale (VAS). This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Duration of study was 1 year from August, 2018 to August, 2019. Results: Efficacy in control of pain of Group A (local anesthetic) was seen in 22(73.33%) while in Group B (control group) was seen in07 (23.33%) patients as shown in Table VI (p- value = 0.0001). Conclusion: The study concluded that the efficacy of local anesthetic in postoperative laparoscopic cholecystectomy is better as compared to control group.

Comparison of the Efficacy of Opioid-Free Anesthesia With Conventional Opioid-Based Anesthesia for Nasal Surgeries - A Prospective Randomized Parallel Arm Triple-Blinded Study.

Introduction In the setting of nasal surgeries, the use of opioid-free anesthesia involving the use ofdexmedetomidine,and lignocaine is being investigated as a potential alternative to opioids. This combination of drugs provides sympatholysis, pain relief, and sedative properties, thereby aiming at reducing the negative effects commonly associated with opioid usage. The objective of this study is to evaluate and compare the effectiveness of opioid-free anesthesia using dexmedetomidineand lignocaineversus conventional opioid anesthesia with fentanylfor nasal surgeries. The comparison will be based on the primary outcome of postoperative visual analog scale(VAS) scores. Secondary outcomes assessed were the amount of rescue analgesic consumption, intraoperative sevoflurane usage, intraoperative blood loss, hemodynamic stability, postoperative nausea and vomiting (PONV) scores, and postoperative Ramsay Sedation Scores. Methods A triple-blind, prospective, randomized, parallel arm study in which 48 patients planned for elective nasal surgery were allocated randomly to one of two groups. In the study, the population labeled as Group D, comprising 24 participants, received dexmedetomidine at a dosage of 1 mcg.kg-1 via intravenous infusion lasting for a duration of 10 minutes prior to the induction of anesthesia. This was followed by a continuous infusion of 0.6 mcg.kg-1 h-1 throughout the intraoperative period, and intravenous Lignocaine 1.5 mg.kg-1 was administered three minutes prior to induction, subsequently an intraoperative infusion of 1.5 mg.kg-1 h-1. In Group F, consisting of 24 participants,intravenous fentanyl of 2 mcg.kg-1was administered three minutes before the induction. This was subsequently followed by a fentanyl infusion of 0.5 mcg.kg-1h-1in the intraoperative period. Results The study findings indicate that Group D had considerably lower postoperative VAS scores from 30 minutes to two hours compared to Group F (p<0.05). The utilization of sevoflurane during the intraoperative period was comparatively reduced in Group D in order to achieve the desired bispectral index (BIS) range of 40-60 (p<0.01). Mean intraoperative blood loss was also lower in Group D (85 ml) compared to Group F (115 ml )(p<0.01). Additionally, Group D had significantly lower rescue analgesic consumption and lower incidence of PONV up to 60 minutes compared to Group F (P-value <0.01).A statistically significant difference was observed between Group D and Group F in terms of lower mean values of both mean arterial pressure (MAP) and heart rate in Group D(p<0.01). The results indicate that the postoperative sedation scores within the first two hours were significantly greater in Group D compared to Group F(p<0.01). Conclusion The usage of opioid-free anesthesia has been found to be superior to a traditional opioid-based approach in various aspects, including the provision of sufficient pain relief after surgery, maintenance of stable hemodynamics during the operation, and reduction in occurrences of postoperative nausea and vomiting.

Comparison of dental anesthetic efficacy between the periodontal intraligamentary anesthesia and other infiltration anesthesia: a systematic review and meta-analysis.

Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia. The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023. Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; p = 0.65; I2= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; p = 0.09; I2= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; p<0.0001; I2= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia. Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.

Blended (Combined Spinal and General) vs. General Anesthesia for Abdominal Hysterectomy: A Retrospective Study.

Adequate pain management for abdominal hysterectomy is a key factor to decrease postoperative morbidity, hospital length of stay and chronic pain. General anesthesia is still the most widely used technique for abdominal hysterectomy. The aim of this study was to assess the efficacy and safety of blended anesthesia (spinal and general anesthesia) compared to balanced general anesthesia in patients undergoing hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. We retrospectively collected data from adult ASA 1 to 3 patients scheduled for laparoscopic or mini-laparotomic hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. Exclusion criteria were age below 18 years, ASA > 3, previous chronic use of analgesics, psychiatric disorders, laparotomic surgery with an incision above the belly button and surgery extended to the upper abdomen for the presence of cancer localizations (e.g., liver, spleen or diaphragm surgery). The cohort of patients was retrospectively divided into three groups according to the anesthetic management: general anesthesia and spinal with morphine and local anesthetic (Group 1), general anesthesia and spinal with morphine (Group 2) and general anesthesia without spinal (Group 3). NRS was lower in the spinal anesthesia groups (Groups 1 and 2) than in the general anesthesia group (Group 3) for every time point but at 48 h. The addition of local anesthetics conferred a small but significant NRS decrease (p = 0.009). A higher percentage of patients in Group 3 received intraoperative sufentanil (52.2 ± 18 mcg in Group 3 vs. Group 1 31.8 ± 16.2 mcg, Group 2 44.1 ± 15.6, p < 0.001) and additional techniques for postoperative pain control (11.4% in Group 3 vs. 2.1% in Group 1 and 0.8% in Group 2, p < 0.001). Intraoperative hypotension (MAP < 65 mmHg) lasting more than 5 min was more frequent in patients receiving spinal anesthesia, especially with local anesthetics (Group 1 25.8%, Group 2 14.6%, Group 3 11.6%, p < 0.001), with the resulting increased need for vasopressors. Recovery-room discharge criteria were met earlier in the spinal anesthesia groups than in the general anesthesia group (Group 1 102 ± 44 min, Group 2 91.9 ± 46.5 min, Group 3 126 ± 90.7 min, p < 0.05). No differences were noted in postoperative mobilization or duration of ileus. Intrathecal administration of morphine with or without local anesthetic as a component of blended anesthesia is effective in improving postoperative pain control following laparoscopic or mini-laparotomic hysterectomy, in reducing intraoperative opioid consumption, in decreasing postoperative rescue analgesics consumption and the need for any additional analgesic technique. We recommend managing postoperative pain with a strategy tailored to the patient's physical status and the type of surgery, preventing and treating side effects of pain treatments.

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study.

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique. The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R). The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference. The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Comparison of posterior superior alveolar and greater palatine nerve block with local infiltration for extraction of maxillary molars in oral surgery – A randomized controlled trial

Administration of local anesthetic drug that prevents pain during dental treatment is of absolute importance. Act of injecting local anesthetic should be nonpainful and atraumatic. The maxilla is very porous and highly vascular. Therefore, anesthesia of maxillary teeth can be accomplished more easily than with mandibular teeth. The aim of this study is to determine the anesthetic efficacy of the conventional technique of posterior superior alveolar (PSA) and greater palatine nerve(GP) block anesthesia as compared to the buccal and palatal technique in terms of pain during injection, after extraction, after 15mins of the procedure and quality of anesthesia during the extraction procedure. The study also intends to determine the incidence of positive aspiration in the infiltration technique. This randomized clinical study was carried out on 154 patients who reported to the Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences &amp; Hospital Bangalore, requiring extraction of maxillary second and third molar teeth. The patients received anesthesia using the conventional nerve block technique and infiltration technique randomly on each side of the mouth. Patients were assessed for pain during the injection, after extraction, and after 15mins of the procedure with each technique using Visual Analog Scale (VAS). The patients were also assessed for pain using the Verbal Response Scale (VRS). The positive aspiration was assessed for each technique. During tooth extraction, quality of anesthesia was assessed using an eight-point category rating scale. The results obtained were analyzed using Chi-square test. It was concluded that the buccal infiltration technique is less painful for the patient as compared to the posterior superior alveolar nerve block. This technique has a lower frequency of positive aspiration as compared with the PSA nerve block. However, the PSA nerve block technique provides better-quality of anesthesia. It can be concluded that the infiltration technique appears to be a successful alternative with additional advantages, as compared to the nerve block technique.

Comparison of spinal anaesthesia and erector spinae plane block in unilateral inguinal hernia: Randomised clinical trial.

The objective of our study was to compare erector spinae plane block (ESP) with spinal anaesthesia (SA) for inguinal hernia repair with respect to anaesthetic efficacy, post-operative analgesia, mobilisation, discharge, complication and side effects. The study included 52 patients over 50 years of age, with the American Society of Anaesthesia physical status Class I-III. Group ESP ( n = 26) was applied 30 ml of mixed local anaesthetic mixture applied at the L1 level to the plane of the erector spinae and 10 ml of tumescent when necessary, while Group SA ( n = 26) was applied 3 ml of 0.5% bupivacaine at the L3-L4/L2-L3 level. Intraoperative Visual Analogue Scale (VAS) value was lower in Group S, whereas the 6 th -h VAS value was lower in Group ESP ( P < 0.05). There was no significant difference between the VAS values at hour 12 and 24 ( P > 0.05). Reaching post-anaesthesia discharge criteria 9 and time to mobilisation and oral feeding was shorter in Group ESP, whereas post-procedure waiting time was shorter in Group S ( P < 0.05). While the need for post-operative analgesics was higher in Group S ( P < 0.05), there was a high level of patient satisfaction in Group ESP ( P = 0.05). Intraoperative midazolam requirement was lower in Group S, post-operative diclofenac requirement was lower in Group ESP ( P < 0.05), post-operative urinary retention and tremor were higher in Group S ( P = 0.05). ESP block provides adequate surgical anaesthesia compared to SA (non-inferiority) for inguinal hernia repair. It is associated with less analgesic requirement, low post-operative pain, less complication rate and high patient satisfaction in the post-operative period.