First Request For Analgesia Research Articles

Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block and Thoracic Epidural Analgesia for Breast Surgery

Background: Breast surgery is a common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane block in breast surgery. Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20) received combined general anesthesia and thoracic epidural analgesia, by receiving 6–8 ml of 0.25% bupivacaine and 0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with general anesthesia. Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the groups according to nausea and vomiting. Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.

Use of infusion paracetamol in the multimodal management of post myomectomy pain: A randomised control study

Objective: The study evaluated the use of infusion paracetamol in the multimodal management of post myomectomy pain and its analgesic sparing effects while comparing the side effect profile.Methods: Sixty-two ASA I and II patients undergoing myomectomy under subarachnoid block were randomized into two groups which were either given infusion Paracetamol (perfalgan, Bristol-Myers Squibb) 100ml and rectal diclofenac (Voltaren, Novartis ), or infusion normal saline 100ml and rectal diclofenac (voltaren, Novartis) after the last skin stitch. Pain was assessed using NRS (Numerical rating scale). Patients were assessed for the presence of motor or sensory complications, rectal bleeding or gastrointestinal discomfort, postoperative nausea and vomiting and sedation. The presence of other side effects was noted. Patients’ satisfaction with pain relief using the 5-point Likert scale was also evaluated.Results: Time to first analgesic request was longer in the paracetamol/diclofenac group compared to the saline/diclofenac group. The time from intrathecal injection of bupivacaine and pethidine to first request for analgesia was 319.12±9.5 minutes in the paracetamol group as against 213.29±9.5 in the saline group. The mean pain scores at 2nd and 5th hour and at the time of first analgesic request were lower in patients in group P compared to the patients in the saline group. (4.83±1.6 vs 5.93±1.4) (P=0.012-test. Total analgesic consumption was more in the saline group.Conclusion: Infusion paracetamol provides additional analgesia in the management of post myomectomy pain.

Dexmedetomidine as an adjuvant for patients undergoing breast cancer surgery: A meta-analysis.

Background:The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis.Methods:Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software.Results:Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = −0.65) and morphine (total: SMD = −2.23; patient-controlled analgesia: SMD = −1.45) as well as intraoperative requirement for fentanyl (SMD = −1.60), and lower the pain score at 1 (SMD = −0.30), 2 (SMD = −1.45), 4 (SMD = −2.36), 6 (SMD = −0.63), 8 (SMD = −2.47), 12 (SMD = −0.81), 24 (SMD = −1.78), 36 (SMD = −0.92), and 48 (SMD = −0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05).Conclusion:DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.

Intraoperative clonidine vs lidocaine on hemodynamic response to laryngoscopic intubation and immune function in gynecological surgeries

BackgroundThis prospective randomised double-blind study was carried out on forty patients American Society of Anesthesiologists (ASA) physical status I–II , aged 40–60 years, scheduled for elective abdominal gynecological surgeries under general anesthesia after obtaining the approval of the local institutional ethical committee and oral consent of the patients. This study was conducted to evaluate the effects of perioperative intravenous clonidine versus lidocaine on hemodynamic stress response to laryngoscopic intubation, immune function, pain intensity, time to the first request for analgesia, and total dose of analgesic requirement in the first 24 h postoperatively in gynecological surgeries.ResultsThroughout the study, heart rate and mean arterial blood pressure were significantly lower in clonidine group (group C) compared to lidocaine group (group L). Postoperatively, the levels of IL-6 were significantly higher in (group L) compared to (group C). VAS pain scores were lower in the clonidine group in comparison to the lidocaine group. There was a higher total dose of analgesia in the lidocaine group when compared to the clonidine group.ConclusionsBoth clonidine and lidocaine can be used to attenuate the hemodynamic response; however, clonidine was better in the reduction of postoperative pain scores and the decrease in the production of pro-inflammatory cytokines.

Pulse-oximetry Derived Perfusion Index as a Predictor of the Efficacy of Rescue Analgesia After Major Abdominal Surgeries

Study Objective: The use of an easy to apply reliable tool is essential to assess pain in patients in intensive care units. This study aimed primarily to evaluate perfusion index usefulness as an objective indicator of pain. Methods and Measurements: Data were collected from 40 non-intubated adult patients admitted to the surgical intensive care unit postoperatively. The Masimo pulse co-oximetry perfusion index (PI) probe was attached to the patient. At the time of the first request for analgesia (T1), the Behavioural pain scale non-intubated scoring system (BPS-NI) was recorded with the PI and patients' haemodynamics following which rescue analgesia was given. Thirty minutes thereafter (T2), second measurements for the mentioned parameters were taken. Main Results: There was a statistically significant reduction in the BPS-NI score, blood pressure and heart rate after analgesic administration (P-values, &lt;0.001, 0.039 and 0.001, respectively), together with a significant increase in the PI (P-value, 0.004). This means that the PI increases with adequate relief from pain, as indicated by a decrease in BPS-NI score and haemodynamics, but the correlation was not statistically significant between their changes. Conclusion: There was no statistically significant correlation between the PI and the pain score or other clinical indicators of pain either before or after the administration of analgesic.

Comparative study between saddle block and local anesthesia on excision of pilonidal sinus by using ligaSure

BackgroundThe excision of the pilonidal sinus starts at 1833. Local, spinal, or general anesthetic procedures for the disease are widely used. The excision of the pilonidal sinus by using ligaSure reduces blood loss, reduces procedure time, and reduces patient length of stay. Therefore, the purpose of this study is to compare between local anesthesia and saddle block on the excision of the pilonidal sinus by using ligaSure, with respect to recovery time, postoperative complications, and patient satisfaction.ResultsForty patients were analyzed; the mean time of anesthesia, operation time, and operating room time were showing highly significantly lower in group LA when compared to group SA (P value < 0.01). At the postoperative period, patients in group LA experienced less intense postoperative pain with prolonged time of the first request for analgesia than patients in other groups.ConclusionLocal anesthesia has more efficacy in early start of anesthesia, early discharge from the hospital with prolonged analgesia, strong hemostasis, more patient satisfaction, and more than saddle block .Therefore, local anesthesia is considered as an alternative to the saddle block on the excision of the pilonidal sinus by using ligaSure.

COMPARATIVE STUDY BETWEEN INTRAVENOUS KETAMINE OR MAGNESIUM SULFATE OR BOTH ON POSTOPERATIVE MORPHINE CONSUMPTION AFTER MAJOR ABDOMINAL SURGERY

Background: Intravenous patient-controlled analgesia (IV-PCA) with morphine is commonly used for postoperative pain control following major abdominal surgery. However, large amounts of morphine may lead to significant adverse events. Multimodal analgesia using a non-opioid analgesic, in addition to an opioid analgesic, has been suggested as a way to improve postoperative pain control and to reduce opioid use. Objective: To compare the difference between intravenous Ketamine or Magnesium Sulfate or both on postoperative morphine consumption after major abdominal surgery. Patients and Methods: This study included 100 patients of both sexes admitted for major abdominal surgery. They were randomly allocated into four equal groups. Group I: Control group, Group II received only ketamine, Group III received only magnesium sulfate and Group IV received both ketamine and magnesium sulfate. The following parameters were assessed in the four groups: Heart rate (HR), blood pressure (BP), respiratory rate (RR), end tidal Co2, the severity of pain on modified Ramsay sedation scale, time to first request for analgesia postoperatively, the number of rescue analgesia given, , adverse events, the level of the patient satisfaction and total dose of morphine consumption postoperatively (mg/48h). Results: This study showed that the hemodynamics of the patients were more stable in (ketamine + magnesium sulfate) and ketamine only group than in magnesium sulfate only group and control group throughout all 48 hours postoperative. Usage of ketamine decreases postoperative pain and analgesic consumption in the first 48 hours after surgery along with longer pain free period compared to patients who were given magnesium sulfate only and control group. Ketamine is highly effective in postoperative pain control in major abdominal surgery without any hazards on patients. The total consumption of morphine, and additional analgesic requirements were less, while the satisfaction level of patients were higher in (ketamine+ magnesium sulfate) and ketamine only group. Conclusion: Ketamine is one of the most advantageous adjuvant drugs for treating postoperative pain, while magnesium sulfate alone is less effective, with increase in opioid side effect. Combination of ketamine+ magnesium sulfate is better in treating postoperative pain and preserve patient hemodynamics with decrease in opioid side effect.

Transverses Abdominis Plane Block Versus Trocar Site Infiltration in Gynecologic Laparoscopy An Observational Study

Background and Aims: Laparoscopic surgery is nowadays gold standard procedure undertaken for various surgical procedures and people prefer laparoscopic approach but the effective analgesic regimen for such patients has not been devised and anaesthesiologists prefer multimodal regimes. Despite the minimally invasive nature of this procedure, patients experience a considerable amount of pain in the first 24 h postoperatively. In our study, we are comparing the degrees of pain relief with TAP block vs Trocar site infiltration using VAS, the duration of postoperative analgesia achieve by TAP block and compare it with Trocar site infiltration and total consumption of rescue analgesia consumed in first 24 hours postoperatively in patients undergoing gynaecologic Laparoscopic surgeries. Methods: After obtaining approval from the hospital Ethical committee and written informed consent from patients, this observational study was undertaken at the Government Lalla Ded Hospital which is one of the associated hospitals of Government Medical College, Srinagar during routine hours on 100 patients posted for elective Gynecological Laparoscopic surgery under general anesthesia. A total sample size of 100 patients (n= 50) for each group was calculated using PASSE (power and sample estimation) for study design and analysis. Assuming 30% improvement in pain score with error of 0.05 (i.e. 5% of DOF (degree of freedom). Results: Visual analogue scale at different time intervals were statistically significantly lower at all times in Group A than Group B p-value (p&lt;0.05). The time to first request for analgesia was higher in group A as compared to group B with statistical difference among the study groups p-value (p&lt;0.05).&#x0D; Conclusion: As a promising novel post-operative pain treatment procedure, TAP block is cost effective and one of the safest, easiest and the most effective supplemental techniques as part of analgesic regimen. It improves pain scores in gynecologic laparoscopy.

Efficacy of Serratus Anterior Plane Block Using Bupivacaine/ Magnesium Sulfate Versus Bupivacaine/ Nalbuphine for Mastectomy: A Randomized, Double-Blinded Comparative Study.

BackgroundMastectomy is a common surgical procedure associated with intra and postoperative pain if untreated adequately will lead to chronic pain.ObjectivesThis study aimed to evaluate the efficacy of serratus anterior plane block using bupivacaine/magnesium sulfate versus bupivacaine/ nalbuphine for mastectomy.Methods40 ASA I and II female patients age 25 - 60 years underwent breast cancer surgery received the block before induction of general anesthesia were divided into two groups GBM (n = 20): (bupivacaine/magnesium sulphate): received bupivacaine 30 mL 0.25% and 500 mg magnesium sulphate, GBN (n = 20): (bupivacaine/nalbuphine): received bupivacaine 30 mL 0.25% and nalbuphine 0.2 mg/kg. The following parameters were recorded: The sensory block, motor block, postoperative heart rate, noninvasive mean blood pressure: at 1, 6, 12, 24 h, postoperative time to first request of analgesics (hours), VAS at rest and movement at 1, 6, 12, 24 h, postoperative analgesic requirements (pethidine mg/24 h).ResultsThe sensory block was statistically significantly lower in the GBM group than the GBN group at 24 hours postoperatively. The Medical Research Council scale was statistically significantly lower in the GBN group than the GBM group at 24 hours postoperatively. Postoperative time to first request of analgesics (hours) was statistically significantly longer in the GBN group than the GBM group, VAS at rest was statistically significantly lower in the GBN group than GBM group at 6th and 24th hours, VAS at movement showed no statistically significant differences between the two groups. Intraoperative fentanyl and postoperative analgesic requirements (pethidine mg/24 h) showed no statistically significant differences between the two groups.ConclusionsSerratus anterior plane block using bupivacaine/nalbuphine provided effective postoperative analgesia, reduced postoperative pain than bupivacaine/magnesium sulfate in a mastectomy.

The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial.

Current options for effective postoperative analgesia after renal transplantation are limited, due to altered renal clearance and the risk of renal damage. This study compared the analgesic effect of the transversus abdominis plane block, with or without dexmedetomidine, in renal transplant recipients. This prospective randomized double-blinded clinical trial was performed from November 2014 to March 2017. Patients were randomly divided into group C (morphine intravenous patient-controlled analgesia), group R (morphine intravenous patient-controlled analgesia and transversus abdominis plane block), and group RD (morphine intravenous patient-controlled analgesia and transversus abdominis plane block with 1μg/kg dexmedetomidine). Morphine consumption, time to first request for analgesia, pain, sedation, nausea, vomiting, respiratory depression, and bradycardia were measured at 2, 4, 6, 12 and 24h after surgery. The visual analogue pain score in group C was the highest among the three groups at the 2nd and 4th hour. Morphine consumption was the highest in group C at all assessed time intervals (p<0.01). By the 12th hour and 24th hour, morphine consumption (calculated by time interval) was the lowest in group RD (p<0.05), while no statistical difference was found between groups C and R. The average time to first request of analgesia was the longest and shortest in group RD and group C, respectively (p<0.01). The overall incidence of nausea and vomiting was the highest in group C (p<0.05). The transversus abdominis plane block reduced morphine consumption in the first 24h following renal transplantation, and the addition of dexmedetomidine provided a more effective analgesic effect.

Ultrasound-guided transversus abdominis plane block using ropivacaine and dexmedetomidine in patients undergoing caesarian sections to relieve post-operative analgesia: A randomized controlled clinical trial.

Dexmedetomidine, which is a highly selective α2 adrenoreceptor agonist, enhances the analgesic efficacy and prolongs the analgesic duration when administered in combination with local anesthetics. The current study aimed to evaluate the effects of dexmedetomidine combined with ropivacaine in ultrasound-guided transversus abdominis plane (TAP) block on post-operative analgesia following cesarean section (CS). A total of 70 patients scheduled for CS were divided randomly into 2 groups: The ropivacaine (R) group, in which patients were administered bilateral 20 ml 0.3% ropivacaine and 2 ml 0.9% normal saline, and the dexmedetomidine (RD) group, in which patients were administered bilateral 20 ml 0.3% ropivacaine and 2 ml dexmedetomidine (0.5 µg/kg). The primary outcome was pain-free duration, and secondary outcomes included heart rate (HR) and mean blood pressure (MBP) measurements, visual analogue scale (VAS) pain scores, number of patients who required rescue analgesic, time to first request for analgesia and patient satisfaction. There was no significant difference in HR and MBP between the two groups at 1 h post-surgery (P>0.05). However, VAS pain scores decreased at 6 and 8 h post-surgery [2 (1-2) vs. 0 (0-0.25) and 2 (2-3) vs. 0 (0-1), respectively; P<0.05], pain-free duration was prolonged (5.91±1.08 vs. 9.62±1.46 h; P<0.05), the number of patients who required rescue analgesic was reduced (19 vs. 9; P<0.05), the time to first request for analgesia was prolonged (7.10±1.21 vs. 11.60±2.11 h; P<0.05) and patient satisfaction was improved [3.5 (3-4) vs. 4 (4-5); P<0.05] in the RD group compared with the R group. Furthermore, no bradycardia or hypotension was observed. In conclusion, the results of the present study demonstrated that adding 0.5 µg/kg dexmedetomidine to 0.3% ropivacaine used in TAP block in patients undergoing CS prolonged pain-free duration, decreased VAS pain scores, reduced the number of patients who required rescue analgesic, prolonged the time to first request for analgesia and improved the patient satisfaction without serious side effects.

ULTRASOUND-GUIDED RECTUS SHEATH BLOCK ALONG WITH RIGHT SIDE SUBCOSTAL TRANSVERSE ABDOMINIS PLANE BLOCK VERSUS PORTSITE INFILTRATION WITH LOCAL ANESTHETICS IN LAPAROSCOPIC CHOLECYSTECTOMY FOR POST-OPERATIVE PAIN RELIEF: A COMPARATIVE STUDY

Objectives: The objective of the study was to compare the efficacy between ultrasound guided rectus sheath block and the right side subcostal transverse abdominis plane with portsite infiltration with local anesthetics in laparoscopic cholecystectomy for post operative pain relief.&#x0D; Methods: Sixty patients posted for laparoscopic cholecystectomy were divided into two groups of 30 each. Group A received total dose of 80 mg (16 ml) of 0.5% ropivacaine 4 ml in each port and Group B received bilateral rectus sheath block with right-sided subcostal TAP block postoperatively, 80 mg (40 ml) of 0.2% ropivacaine was divided into two parts 20 ml in right-sided subcostal TAP and 20 ml in rectus sheath block, 10 ml in each side. Results: The first request of analgesia was significantly longer in combined block group than in the port site infiltration group (p=0.000). The numeric rating scale was reduced in patients given with abdominal field blocks when compared to patients obtaining port site infiltration. Mean NRS score was peak in pain score at the 6th h postoperatively in Group A and remained higher till 24 h in comparison Group B and was statistically significant. The overall tramadol consumption in Group A was approximately twice (215±51 mg) as compared to Group B (105±28 mg). Three cases of PONV were seen in Group A that is not statistically significant. The patient satisfaction score after 24 h was much higher with Group B in comparison to Group A (P 0.000).&#x0D; Conclusion: It is concluded that ultrasound-guided right-sided subcostal TAP and rectus sheath block produce effective post-operative analgesia for the incisional pain in laparoscopic cholecystectomy surgeries and act as a supplementary method in multimodal analgesia.

Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery: A systematic review and meta-analysis.

Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = -1.90; 95% confidence interval [CI], -2.90 to -0.91; P < .001) and at 24 hours after surgery (WMD = -1.01; 95% CI, -1.64 to -0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = -1.93; 95% CI, -3.51 to -0.34; P = .017) and at 24 hours (WMD = -11.88; 95% CI, -15.50 to -8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = -85.52; 95% CI, -121.47 to -49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91-453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.

Comparative study between Fentanyl with (Lidocaine and Bupivicaine) Versus (Lidocaine and Bupivicaine) alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Aim of the Work to study the effect of Fentanyl as an adjuvant to bupivacaine and Lidocaine in supraclavicular brachial plexus block. After taking approval from Local Ethical Committee approval and informed written consent from each patient, this randomized prospective comparative study was conducted on 60 patients who were divided into two groups: Group A (Control group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1 ml of Normal Saline 0.9%. Group B (Fentanyl group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1ml of fentanyl 50 ug/ml. Results our study showed that addition of a 50 microgram of fentanyl to bupivacaine and lidocaine in ultrasound-guided supraclavicular nerve block has statistically significant effect on the onset of sensory and motor block and prolonged the duration of the sensory and the motor block. In addition, fentanyl prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine and lidocaine groups. Addition of fentanyl also did not affect the hemodynamic to a significant level Conclusion fentanyl with bupivacaine and lidocaine more superior than the use of bupivacaine and lidocaine alone.

Comparison between Intravenous and Perineural Dexamethasone in Prolonging the Analgesic Effect of Supraclavicular Plexus Nerve Block

Abstract Background poor controlled acute pain post-surgery is accompanied with several unwanted postoperative consequences, including patient agony, distress, myocardial ischemia, increased hospital stays and an increased possibility of post-operative chronic pain. Aim of the Work to study the effect of dexamethasone as a supplementary to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the motor and sensory blocks, the duration of analgesia of the block and their effect on the postoperative analgesic needs. The effect of the drugs on hemodynamics and monitoring for the occurrence of any complication. Patients and Methods in our study, 50 patients were randomly divided into 2 equal groups. Perineural group received bupivacaine (0.5%) assosciated with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone was injected systemically. All patients received equal volumes of 20 milliliters. Results our study revealed that adding 8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block decreased the onset times of motor and sensory blocks and significantly increased their durations. In addition, dexamethasone prolonged the time of analgesia of the plexus block markedly, as shown by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic needs were much lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone. Conclusion addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than injecting dexamethasone intravenously. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously.

The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery: A systematic review and meta-analysis with trial sequential analysis.

Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain. The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24 h in adults undergoing noncardiac surgery. Systematic review and meta-analysis with trial sequential analysis. MEDLINE, EMBASE, CENTRAL from their inception until January 2019. All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded. Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24-h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of -5.6 mg (-7.54 to -3.66, P < 0.001, I = 92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P < 0.001, I = 99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P < 0.001, I = 35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24 h (mean difference, 95% CI) -0.30 (-0.69 to 0.09, P = 0.13, I = 91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P = 0.80, I = 35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P = 0.49, I = 25%, level of evidence moderate). The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24 h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity. CRD42018086846.

Continuous preperitoneal infusion of ropivacaine for postoperative analgesia in patients undergoing major abdominal or pelvic surgeries. A prospective controlled randomized study.

Background and Aims:This study was conducted to compare continuous preperitoneal infusion (CPI) with continuous epidural infusion (CEI) of ropivacaine for pain relief and effect on pulmonary functions after major abdominal and pelvic surgeries.Material and Methods:One hundred patients were randomized into two equal groups. Patients in CPI group (n = 50) received analgesia by continuous infusion of 0.2% ropivacaine, whereas those in the CEI group (n = 50) received continuous epidural infusion of 0.2% ropivacaine. The primary outcome was the first request of analgesia. The secondary outcome was the influence on the pulmonary functions.Results:The time for the first request of analgesia was longer in the CPI group compared with that in the CEI group (7.3 ± 1.6 vs. 4.1 ± 1.1 h with P value = 0.001). The daily dose of morphine was lesser in CPI versus CEI group (11.3 ± 1 against 17.4 ± 0.9 mg). The pulmonary function tests were comparable except peak expiratory flow rate, which was better in CPI (170 ± 5.4) than CEI group (148.1 ± 5.8; with P value = 0.001).Conclusion:Continuous preperitoneal infusion provides a superior analgesic effect than the continuous epidural infusion as regards delayed first request of analgesia, better pain scores, lesser usage of additional analgesics with better respiratory function.

Postoperative analgesic effect of intrathecal dexmedetomidine on bupivacaine subarachnoid block for open reduction and internal fixation of femoral fractures.

One of the drawbacks of subarachnoid block is the short duration of analgesia particularly when adjuvants are not added to local anesthetics agent used. However, dexmedetomidine an α2-adrenergic agent has been found to possess analgesic effect. This study seeks to determine the analgesic efficacy of intrathecal 7.5 μg of dexmedetomidine and its side effects when used for open reduction and internal fixation (ORIF) of femoral fractures. It is a prospective randomized, double-blinded study that was carried out in a Nnamdi Azikiwe University Teaching Hospital, Nnewi in Nigeria. Seventy American Society of Anesthesiologists I or II patients were randomized into two groups of 35 each to receive 3 ml of 0.5% hyperbaric bupivacaine combined with either 7.5 μg of dexmedetomidine in 0.3 ml of normal saline (Group D) or 0.3 ml of normal saline alone (Group S). Patient's outcome measures noted (time to first request of analgesia, proportion of patients with pain score <4 postoperatively using numerical rating scale [NRS], and total analgesic consumed in 24 h.). The patients in Group D had a longer time to first request of analgesia, larger proportion of patients with pain score <4 using NRS in the 2nd h postoperatively and lower amount of total analgesic consumed compared to those in Group S. These differences between the two groups were all statistically significant. Furthermore, there was no difference in the incidences of side effects between the two groups (P > 0.05). However, the patient satisfaction was better in Group D. The addition of 7.5 μg of dexmedetomidine to bupivacaine for subarachnoid block in the management of femoral fractures using ORIF provided better anesthetic profile, particularly prolonged duration of postoperative analgesia without significant side effects.

The Effect of Adding Magnesium Sulfate to Local Anesthetic in Patients Undergoing Middle Ear Surgery.

Background:The use of local anesthesia has been proved to be beneficial in ear surgeries.Aims:This study was conducted to compare between local anesthesia alone and in combination with magnesium sulphate as an adjuvant in ear operations.Materials and Methods:This prospective study included a total of 164 cases prepared for elective ear surgeries were included. They were divided into two equal groups, group C or control group included cases who received local anesthesia alone, and group M which included cases who received local anesthesia in addition to magnesium sulphate. Ear ring block was performed in all cases. Monitoring of blood pressure, heart rate, and oxygen saturation was performed. Post-operative pain was assessed by visual analogue score. The total analgesic time and total analgesic requirement were recorded.Statistical Analysis:IBM's SPSS statistics (Statistical Package for the Social Sciences) for windows (version 25, 2017) was used for statistical analysis of the collected data. Shapiro-Wilk test was used to check the normality of the data distribution. All tests were conducted with 95% confidence interval. P (probability) value < 0.05 was considered statistically significant. Charts were generated using SPSS’ chart builder and Microsoft Excel for windows 2019.Results:The onset of sensory blockade was significantly earlier in the Mg group. Mg group showed a significant decrease in intraoperative and post-operative analgesic consumption. In addition, the first request for analgesia after operation was markedly delayed in the Mg group compared to controls. Regarding intraoperative VAS, it was significantly lower in the Mg group compared to controls at 15-minute reading. Post-operative VAS was significantly lower in Mg group during the first two hours.Conclusion:Addition of magnesium to local anesthesia causes early onset of sensory blockade, delayed call first for analgesia, and better VAS scores during the early post-operative period.

The efficacy of bilateral sphenopalatine ganglion block under general anesthesia in trans-sphenoidal endoscopic hypophysectomy

Background:The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods:thirty patients(ASA I-II)aged 22–55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine(SPGB group)or sterile normal saline(control group). Mean arterial blood pressure was maintained at 60–70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of first request for analgesia, total dose of meperidine consumption in the first 24hours postoperatively, patient’s satisfaction and post-operative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P<0.001), ACS(P<0.01), nitroglycerine consumption(P<0.0001)and emergence time(P< 0.001). At PACU, visual analogue pain score were lower in SPGB at 0,1,6(P<0.001), there were a high difference between two groups in B-endorphin levels(P<0.001)and also in dose of meperidine, % of patients needs analgesia and patients satisfaction(P<0.002), Conclusion:Use of sphenopalatine ganglion block with general anesthesia is a safe and effective technique, it contributes in adequate intra and postoperative analgesia needed for stabilization of hemodynamics with less blood loss, improving the quality of surgical field instead of controlled hypotensive technique during endoscopic endo-nasal trans-sphenoidal hypophysectomy.