Excellent Intraoperative Analgesia Research Articles

Can I take my normal painkillers doctor? Therapeutic management of pain following dermatological procedures.

Dermatological procedures performed purely under local anaesthesia can provide excellent intraoperative analgesia. However, post-procedure patients can have significant pain. Consequences of pain include patient distress, poor compliance with dressings and subsequent delayed wound healing as well as the potential fear and avoidance of further procedures. Anecdotally the same postoperative analgesia regime is given to all dermatology patients. There is a general fear by dermatologists of nonsteroidal anti-inflammatory drugs (NSAIDs) due to perceived risk of postoperative bleeding and of tramadol due to its sedative effects. Understanding of pharmacology within the patient population and their comorbidities is necessary in choosing the appropriate analgesic regime. We reviewed the most commonly used analgesics, giving a summary of the important pharmacology and evidence of their use in the literature in order to allow clinicians to give individual approach to managing post-procedure analgesia.

Retrobulbar anaesthesia for adjustable strabismus surgery in adults: a prospective observational study

ObjectiveTo characterize the ocular response to retrobulbar anaesthesia and to evaluate the efficacy of retrobulbar anaesthesia for adjustable strabismus surgery in adults. DesignProspective observational study. ParticipantsAdult patients undergoing adjustable strabismus surgery under retrobulbar anaesthesia. MethodsSurgical success was defined by ocular alignment within 10 prism diopters (PD) of orthotropia for horizontal rectus surgery and within 5 PD for vertical rectus surgery. After retrobulbar injection of Xylocaine with epinephrine, the onset time and the degree of visual impairment, ocular akinesia, and analgesia were evaluated. Postoperative parameters included the restoration of vision, onset of pain, resolution of ptosis, normalization of pupil, resolution of extraocular motility deficits, and the timing of postoperative adjustment. Perioperative complications were also documented. ResultsA total of 33 patients were initially included in this study. Two patients experienced complications (perioperative retrobulbar hemorrhage, postoperative suprachoroidal hemorrhage) and were excluded from data analysis. Of the remaining 31 patients (mean age, 50.2 ± 14.8 years), surgical outcome was satisfactory in 30/31 (96.8%) patients at the first postoperative visit and in 15/19 (78.9%) cases at last follow-up (mean, 6.1 ± 1.6 months). Excellent intraoperative ocular akinesia and analgesia was achieved with retrobulbar anaesthesia. After retrobulbar injection, visual impairment was the first to resolve to preoperative levels within (mean ± SD) 3.7 ± 1.9 hours postinjection, followed by onset of pain at 4.1 ± 1.0 hours, resolution of ptosis at 4.3 ± 1.9 hours, and normalization of pupil reactivity at 6.1 ± 1.0 hours. The resolution of anaesthesia upon extraocular motility occurred within 5.7 ± 1.0 hours postinjection (range, 4.5–8.0 hours), allowing for subsequent same-day postoperative adjustment. ConclusionsRetrobulbar anaesthesia in the context of adult, adjustable strabismus surgery is a relatively safe and effective technique. It provides excellent intraoperative analgesia and akinesia. Retrobulbar anaesthesia enables for same-day suture adjustments to be reliably performed.

Anaesthetic management of brachytherapy

Radiotherapy is a commonly employed modality for cancer therapy. The large dose of radiation used has its inherent radiation hazard. To minimize this source specific ‘brachytherapy’ is employed. Brachytherapy is administered by inserting a radiation source inside a specific cancer site. Both insertion and removal of implant is done under anaesthesia. Hence we decided to study the anaesthesia requirements in employing these modalities. Our study aims (1) To study anaesthetic, analgesic and sedative requirement of patients for application of implants. (2) Hemodynamic effects associated with implant insertion. (3) Study the effectiveness of various anaesthetic modalities and (4) Note side-effects due to anaesthetic techniques. The present study was performed in 70 ASA 1, 2 & 3 patients scheduled for brachytherapy under local, regional and general anaesthesia. Written and informed consent was obtained. After thorough pre-operative evaluation for any co-morbidities, previous radiation exposure, airway assessment and blood and radiological evaluation, patients were given consent. Patients posted for Head & Neck and breast implants were given general anesthesia, Pelvic implant patients were given spinal + epidural anesthesia and intra caviatory radiation was performed under total intravenous anaesthesia. Out of 70 patients studied, 18 patients were given total intravenous anaesthesia, 23 given general anaesthesia, 3 given subarachnoid block, 20 were given combined spinal+epidural anaesthesia and 6 were given local anaesthesia. Of these 4 patients had hypotension, 1 had bradycardia & bronchospasm each, 2 had hypertension and 3 patients experienced hypoxia. Successful anaesthetic management of brachytherapy requires accurate preoperative assessment, vigilant intraoperative monitoring & excellent intraoperative analgesia.

Ultrasound guided interscalene block for major shoulder surgery in a high risk patient : A case report

Single shot interscalene block is a safe and effective method which provides excellent intraoperative analgesia with a high degree of patient acceptance for shoulder surgery. High risk patients can be avoided from complications of general anesthesia using interscalene block as a sole anesthetic technique. Visualisation of the nerves using ultrasound helps to decrease the need of local anesthesic drugs and contributes to increase in block success rates. We report a case of 71 years old, obese patient with chronic obstructive pulmonary disease who had shoulder arthroplasty. In this case, a single injection ultrasound guided interscalene block provided sufficient surgical anesthesia without significiant pulmonary complications.

Local anesthetic agents along with hyaluronidase for inguinal hernia block provides excellent analgesia: a double blind study

Background: Inguinal hernia block is cost effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether hyaluronidase along with local anesthetic agent provides good analgesia for hernia block. The aim was to evaluate the effectiveness of hyaluronidase along with local anesthetic agents for inguinal hernia block in patients undergoing inguinal hernioplasty. Methods: 50 patients ASA grade I and II, age above 18 years, undergoing inguinal hernioplasty were randomized into two groups. Group A received inguinal hernia block with local anesthetic agents without hyaluronidase and Group B received inguinal hernia block with hyaluronidase and local anesthetic agents. Both groups received premedication 10 minutes before induction in the form of inj. Fentanyl, Midazolam, Ranitidine and Ondansetron Results: In Group B, out of 25 patients only 4 patients required intraoperative analgesia while in group A 16 patients required intraoperative analgesia. Post operative pain was assessed for 24 hours using the pain rating scale. The mean duration of analgesia was significantly longer in group B (16.16±6.8780 hrs) compared to group A (7.32±2.5285 hrs); pain score was compared between the two groups. Group B had lower pain scores than group A which was statistically significant (P<0.05). Conclusion: It concludes that hyaluronidase with local anesthetic agent for inguinal hernia block provides excellent intraoperative analgesia and also prolongs the post operative analgesia.

Intravenous Regional Anaesthesia With Lignocaine, Fentanyl And Pancuronium – Prospective Randomised Controlled Double Blind Study.

Intravenous Regional Anaesthesia (IVRA) is a simple and effective technique for upper limb distal surgery. However, a relatively large dose of LA is required to induce motor and sensory blockade. Lignocaine 3mg/kg as a 0.5% solution is needed to ensure adequate analgesia. Systemic toxic reactions (convulsions, coma, cardiac arrest) can occur when the tourniquet deflates unexpectedly during the procedure or when it deflated intentionally at the end of short surgery.Therefore we conducted this prospective randomized double blind study to compare and evaluate the effects of addition of fentanyl and pancuronium to reduced dose of LA against the standard practice of 0.5% lignocaine.In this study, 75 patients of both sexes in the age group more than 18 years belonging to ASA 1 and 2 undergoing both elective and emergency surgeries of the forearm and hand were divided randomly into group L, group P and group F with 25 patients in each group.In patients belonging to group L, 40 cc of 3mg/kg of 0.5% lignocaine diluted in normal saline was used for administering IVRA, and in patients of group F 40 cc of 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg , and in patients of group P 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg and pancuronium 0.5mg was used.The time for onset of sensory blockade in group L was 11.76.± 3.08 minutes , group F was 12.96±3.06 minutes , and group P was 10.20±3.52 minutes which was clinically comparable in all the groups. However the time for onset of motor blockade was significantly delayed in group F (21.1±2.7 minutes) as compared to other two groups: group L (12.5±2.6minutes and group P (11.36±3.5 minutes). The patients in group P were showing significantly excellent muscle relaxation and excellent intraoperative analgesia as compared to other two groups. Post operative analgesia in group P (56.4±2.6minutes ) was significantly longer as compared to group F (46.8 ±4.9 minutes) and group L (39 ± 8 minutes). Our results showed that hemodynamic parameters like pulse rate, blood pressure, respiratory rate were well maintained throughout the intra and post operative period in all the patients of all the groups. There were no major untoward side effects were noticed.Thus from the present study, we conclude that the addition of fentanyl 1mg/kg and pancuronium 0.5mg to 0.25% of lignocaine enhances lignocaine action and results in-Adequate sensory and motor block.Excellent intraoperative analgesia.-Excellent intraoperative muscle relaxation. Thus, using this combination the dose of lignocaine for IVRA can be reduced to a non toxic level for the same quality of analgesia and at the same time not offer any post analgesic benefit as all study patients were required supplement of analgesics post operatively after about 50-60 minutes.. INTRODUCTION Intravenous regional anesthesia was first described by August Gustav Bier in 1908. This technique is a simple, easy to administer, effective and reliable method for anesthesia. It involves intravenous injection of local anesthetics into the limb on which surgery is to be performed after the limb is exsanguinated and a tourniquet has been applied proximally. It is the surest way of obtaining a block with a very minimal failure rate, and has gained immense popularity more so for upper limb surgeries. Besides it is extremely useful for emergency surgeries. Being a regional technique it avoids all the complication of general anesthesia, more so in patients coming for emergency surgery as well as patients belonging to ASA class 3 and 4. However the dose of local anesthetic agent required to induce motor and sensory blockade has the potential to cause systemic local anesthetic toxicity. Therefore various methods have been tried to reduce the dose of Local anesthetic used in Intravenous regional anesthesia ,such as alkalization of the local anaesthetic solution, addition of an opioid, muscle relaxant , non steroidal anti-inflammatory drugs, potassium, and Ketamine 9 with various results. We conducted this prospective randomized double blind Intravenous Regional Anaesthesia With Lignocaine, Fentanyl And Pancuronium – Prospective Randomised Controlled Double Blind Study. 2 of 9 study to know the effect of combining fentanyl 1/kg alone and fentanyl1g/kg plus pancuronium 0.5mg with reduced dose of lignocaine( 0.25%) for Intravenous regional anesthesia. AIMS & OBJECTIVES To study the effect of IVRA with lignocaine 0.5% with lignocaine 0.25% plus fentanyl 1/kg and lignocaine 0.25% plus fentanyl1g/kg plus pancuronium 0.5mg with respect to : Time of onset of sensory block. Time of onset of motor block The degree of muscle relaxation Intraoperative analgesia.

HYPOTENSION DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION: IMPLICATIONS, DETECTION PREVENTION AND TREATMENT

Regional anaesthesia is preferred by most anaesthetists for the majority of caesarean sections. The major advantage of regional anaesthesia is the avoidance of maternal morbidity and mortality associated with general anaesthesia. The importance of this can be seen in the most recent Report of Confidential Enquires into Maternal Deaths in which it was reported that of the direct maternal deaths attributed to anaesthesia, all six were associated with difficulties during general anaesthesia. Although a number of regional anaesthesia techniques are available, spinal anaesthesia is particularly popular because it is fast, easy to perform and provides excellent intraoperative analgesia.

Interscalene block for shoulder arthroscopy: Comparison with general anesthesia

Arthroscopic shoulder surgery can be performed under regional or general anesthesia. The objective of this study was to demonstrate that regional anesthesia has several benefits over general anesthesia for this type of surgery, particularly in the ambulatory patient. Forty patients received general anesthesia and 63 an interscalene block. The regional block was found to be safe and effective, with a high degree of patient acceptance. It provided excellent intraoperative analgesia and muscle relaxation. Postoperatively, regional anesthesia resulted in fewer side effects, fewer hospital admissions, and a shorter hospital stay than did general anesthesia.