First Request For Rescue Analgesia Research Articles

A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy

Objective: To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies. Method: The triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists (grade I-III, weighing >30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2µg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23. Results: Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p>0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p>0.05), and none of the patients experienced any side effect throughout the post-operative stay. Conclusion: The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone. Key Words: Diagnostic laparoscopy, Staging laparoscopy, laparoscopy, Dexmedetomidine, Bupivacaine, Local infiltration, Regional anaesthesia.

Evaluating the Clinical Utility of Brachial Plexus Block for Reducing Opioid Exposure in Pediatric Elbow Fracture Surgery: A Retrospective Cohort Study.

Background and Objectives: Reducing opioid exposure in common pediatric surgeries is of paramount importance. This study aimed to assess the efficacy of regional nerve blocks in reducing opioid exposure while preserving high success rates. Materials and Methods: We conducted a retrospective matched cohort study (1:1) including patients with elbow fractures < 12 years old who underwent treatment with percutaneous pinning. Patients were divided into general-anesthesia (GA) and GA-followed-by-supraclavicular-brachial-plexus-block (GA-SCB) groups. The primary outcome was the number of patients administered postoperative rescue opioids. The secondary outcomes included intraoperative and postoperative opioid administration, the time to first request for rescue analgesia, pain scores, block success rate, block performing time, and block-related complications. Results: In a total of 478 patients, 363 underwent percutaneous pinning, and 86 were cohort-matched (GA: n = 43, GA-SCB: n = 43). On the first postoperative day, 34 (79.0%) patients in the GA group were administered postoperative rescue opioids, compared with 12 (27.9%) in the GA-SCB group (p < 0.001). All the patients in the GA-SCB group were opioid-free during the intraoperative period. No SCB-associated complications were observed. Total opioid consumption was significantly lower in the GA-SCB group than in the GA group until the first postoperative day (GA vs. GA-SCB, 3.2 ± 3.0 mg vs. 0.9 ± 1.8 mg, p < 0.001). Conclusions: SCB application in pediatric patients who underwent elbow fracture surgery significantly reduced opioid exposure and had a high success rate when performed using ultrasound guidance by an expert. Furthermore, the complication risk and surgical delay were minimal.

Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study

BackgroundThere is an association exists between cardiac surgery, performed through median sternotomy, and a considerable postoperative pain.ObjectivesThe aim of the current study is to compare the effects of transversus thoracic muscle plane block (TTMPB) and pecto-intercostal fascial plane block (PIFB) upon postoperative opioid consumption among the patients who underwent open cardiac surgery.MethodsThe present prospective, randomized, comparative study was conducted among 80 patients who underwent elective on-pump cardiac surgery with sternotomy. The subjects were randomly assigned to two groups with each group containing 40 individuals. For the TTMPB group, bilateral ultrasound-guided TTMPB was adopted in which 20 ml of 0.25% bupivacaine was used on each side. In case of PIFB group, bilateral ultrasound-guided PIFB was adopted with the application of 20 ml of 0.25% bupivacaine on each side. The researchers recorded the first time for rescue analgesia, the overall dosage of rescue analgesia administered in the first 24 h after the operation and the postoperative complications.ResultsThe PIFB group took significantly longer time to raise the first request for rescue analgesia (7.8 ± 1.7 h) than the TTMPB group (6.7 ± 1.4 h). Likewise, the PIFB group subjects had a remarkably lower ‘overall morphine usage’ in the first 24 h after the operation (4.8 ± 1.0 mg) than TTMPB group (7.8 ± 2.0 mg).ConclusionBilateral ultrasound-guided PIFB provided a longer time for the first analgesic demand than bilateral ultrasound-guided TTMPB in patients undergoing open cardiac surgery. In addition to this, the PIFB reported less postoperative morphine usage than the TTMPB and increases satisfaction in these patients.Trial registrationThis study was registered at Clinical Trials.gov on 28/11/2022 (registration number: NCT05627869).

The effect of addition of ultra-low dose of naloxone to fentanyl–bupivacaine mixture on the incidence of pruritis after spinal anesthesia for cesarean delivery: Randomized clinical study

Abstract Background and Aims: The use of intrathecal opioids is associated with high risk of pruritis and this may be decreased by adding a low dose of naloxone. This study evaluated the effect of the addition of 20 μg of naloxone to fentanyl–bupivacaine mixture on the incidence of pruritis in pregnant females scheduled for cesarean section (CS). Material and Methods: Eighty pregnant patients scheduled for CS under spinal anesthesia were randomized to receive either 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl (group F) or 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl and 20 μg naloxone (group FN). The incidence, onset, duration, site, and severity of pruritis were measured. Furthermore, the postoperative numerical rating scale (NRS) score, the total tramadol rescue analgesia, and the time for the first request of rescue analgesia were recorded. Results: Compared to the F group, the FN group showed a significant decrease in the incidence of pruritis (P = 0.022), prolongation of the onset of pruritis (P = 0.006), shortening of the duration of pruritis (P = 0.029), and decrease in the severity of pruritis (P = 0.039). Furthermore, the postoperative pain score, the rescue analgesic consumption, and the time for the first request of rescue analgesia were comparable between the two groups (P &gt; 0.05). Conclusions: The addition of an ultra-low dose of naloxone (20 μg) to fentanyl–bupivacaine mixture in spinal anesthesia for pregnant females scheduled for CS significantly reduced the incidence of pruritis without having a significant effect on the postoperative analgesia.

The effect of adding dexmedetomidine or dexamethasone to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section.

Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine-fentanyl mixture on the postoperative analgesia duration, after elective cesarean section. This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine-fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 μg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes. As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine-fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups. The use of dexmedetomidine as an additive to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.

Serratus anterior plane block for postoperative analgesia in modified radical mastectomy

Introduction: Serratus Anterior Plane (SAP) block can be used as part of multimodal analgesia, reducing the need for additional analgesia for 24 h postoperatively. The SAP block (SAPB) is easy to apply with a safe technique and low side effects. This study analyzes serratus anterior plane block as postoperative analgesia in Modified Radical Mastectomy (MRM) surgery by assessing the level of pain, side effects, and complications.&#x0D; Methods: This study was a double-blind randomized control trial (RCT) conducted on patients scheduled to undergo MRM, at Dr. Kariadi Hospital Semarang during August-October 2022. A total of 44 patients were enrolled, and divided into two groups; 22 patients in each group. The treatment group received SAPB and was compared with the control group of morphine 0.1 mg/kg, in terms of the numeric pain rating scale, at 4, 8, 12, and 24 h postoperatively, time and number of analgesic rescue doses, the incidence of PONV and pruritus within 24 h postoperatively. Independent T-test, Mann-Whitney, Chi-square, and Fischer tests were performed to analyze the data. P &lt; 0.05 was considered significant.&#x0D; Results: The mean NRS at 4, 12, and 24 h postoperatively was lower in the SAPB group than in the control group (2.73 ± 0.77 vs. 3.23 ± 0.53; 1.77 ± 0.61 vs. 2.32 ± 0.48, and 1.45 ± 0.59 vs. 2.09 ± 0.61). The difference was statistically significant, e.g., P = 0.017, P = 0.003, and P = 0.001, respectively. Time to the first request of rescue analgesia was prolonged in the SAPB group than in the control group (398.86 ± 140.6 vs. 100.91 ± 10.3; P = 0.000). The mean rescue analgesic dose in the SAPB group was lower than in the control group (3.59 ± 1.56 vs. 8.55 ± 2.4; P = 0.000). The control group showed a higher incidence of PONV (68.2% vs. 18.2%, P = 0.01). There was no significant difference in the groups regarding the frequency of pruritus (P = 0.073).&#x0D; Conclusion: Serratus anterior plane block reduced pain significantly up to 24 h postoperatively compared to the control group. The patients in this group needed rescue analgesia after longer duration and needed lower doses of rescue analgesia. There was lower frequency of PONV than the control group.&#x0D; Abbreviations: MRM - Modified Radical Mastectomy; PONV – Postoperative Nausea and Vomiting; PMPS - Post-Mastectomy Pain Syndrome; PVB – Para Vertebral Block; SAP - Serratus Anterior Plane; VAS - Visual Analog Scale&#x0D; Key words: Serratus Anterior Plane Block; Breast Cancer; Modified Radical Mastectomy&#x0D; Citation: Mochamat, Arifin J, Pramadika T, ManapaCH, Istanto W, Wicaksono SA, Nugroho TE. Serratus anterior plane block for postoperative analgesia in modified radical mastectomy. Anaesth. pain intensive care 2023;27(5):486−490; DOI: 10.35975/apic.v27i5.2297&#x0D; Received: January 05, 2023; Reviewed: January 18, 2023; Accepted: March 31, 2023

The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials

BackgroundDexmedetomidine (DEX) has been thought to be an effective adjuvant to local anesthetics (LAs) in erector spinae plane block (ESPB), however, this method of use is not recorded in the drug instructions. Hence, our meta-analysis will evaluate its efficacy and safety for the first time.MethodsA systematic search of published articles was conducted in the PubMed, Embase, Web of science, and Cochrane Library databases up to July 17, 2022, using specific keywords related to our aims. The time first to request rescue analgesia, number of patient controlled intravenous analgesia (PCIA) presses, rate of rescue analgesia use, postoperative nausea and vomiting (PONV), arrhythmia, and hypotension were calculated by using random-effect models. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42022345488).ResultsNumerous electronic databases were searched and finally 8 studies with a total of 570 patients, 303 in the DEX arm, 267 in the control arm were included. As an adjuvant to LAs, DEX significantly increased the time to first request of rescue analgesia (mean difference [MD] = 8.40, 95% confidence interval [CI] = 4.70–12.10, P < 0.00001), reduced the number of PCIA presses (MD = -4.12, 95% CI = -7.79 to -0.45, P = 0.03) and the rate of rescue analgesia (odds ratio [OR] = 0.33, 95% CI = 0.17–0.65, P = 0.002). Moreover, the combination reduced the risk of PONV (OR = 0.57, 95% CI = 0.36–0.91, P = 0.02). In addition, there was no difference in the incidence of hypotension (OR = 1.01, 95% CI = 0.37–2.74, P = 0.99) and arrhythmia (OR = 0.76, 95% CI = 0.19–3.07, P = 0.70).ConclusionDEX can reduce analgesic requirements after various surgical procedures when used as an adjuvant to LAs for ESPB. Moreover, there was no significant difference between the two groups in terms of safety indicators (arrhythmia, hypotension).

Opioid-sparing post-cesarean analgesia using intravenous diclofenac-acetaminophen combination: A prospective, randomized clinical trial

Background: Current research promotes opioid-sparing analgesia as an approach to enhanced recovery after cesarean (ERAC). In developing countries, non-opioid-based analgesia is routinely practiced in obstetric settings, as opioids are not freely accessible. There are no randomized trials evaluating intravenous diclofenac and acetaminophen for postoperative analgesia following elective cesarean section. Methods: Women scheduled for elective cesarean delivery under subarachnoid block were enrolled if they fulfilled the inclusion criteria. They were randomized to receive either intravenous diclofenac or intravenous diclofenac-acetaminophen combination at the end of surgery and at predefined time intervals during the 24-hour postoperative period. The primary outcome measure of our study was 24-hour rescue analgesic (tramadol) consumption. Secondary outcome measures included time to first request for rescue analgesia, postoperative pain at rest and on movement, episodes of nausea, retching, and vomiting during the 24-hour postoperative period and overall patient satisfaction. Results: The 24-hour rescue analgesic consumption was significantly lesser in the diclofenac-acetaminophen group compared to the diclofenac group (56.25 ± 47.73 mg vs. 92.86 ± 50.83 mg; P = 0.00). Time to first request for rescue analgesia was earlier in the diclofenac group compared to the diclofenac-acetaminophen group (3.96 ± 2.40 h vs. 5.64 ± 3.58 h, P = 0.01). Parturients given a combination of intravenous diclofenac and acetaminophen used 40% less tramadol in the first 24 hours following cesarean section and were more satisfied with their pain management when compared to those given intravenous diclofenac alone. Conclusion: Following cesarean section, intravenous diclofenac-acetaminophen combination provides superior analgesia with significantly lesser opioid consumption and higher patient satisfaction when compared to intravenous diclofenac alone. This combination is effective, easy to administer, opioid-sparing and is compatible with ERAC regimens.

Surgical Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries: A Prospective Interventional Study

Introduction: Pain from lower abdominal surgeries originates from the abdominal wall incision. The Transversus Abdominis Plane (TAP) is a fascial plane between the internal oblique and the transversus abdominis muscle, which contains the nerve bundles. TAP block involves infiltrating this plane with anaesthetic drugs that block the somatic component of postoperative pain. Traditionally, the TAP block is given by anaesthesiologists as a blind procedure or under Ultrasound (US) guidance. In 2010, an innovative surgical TAP block method was developed, where the surgeon gives TAP block under direct vision before closing the abdomen during abdominal surgery. Many studies have recommended surgical TAP block as an intervention for achieving postoperative pain relief. Aim: To evaluate the efficacy of the surgical TAP block technique for postoperative analgesia following lower abdominal surgeries using Visual Analogue Scale (VAS) scores and by comparing the need for rescue analgesia and the total amount of analgesic drugs utilised within the first 24 hours of surgery. Materials and Methods: This hospital-based prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India, from January 2022 to December 2022. The study participants included 108 women undergoing lower abdominal surgeries under spinal or epidural or combined regional anaesthesia and belonging to the American Society of Anaesthesiologists (ASA) physical status classification system ASA I or ASA II or ASA IIE. The study group included 54 women who received surgical TAP block with 20 mL 0.25% bupivacaine and 4 mg of dexamethasone, intraoperatively on either side before closure of the abdomen. Postoperative pain was assessed using VAS at regular intervals within 24 hours of surgery. VAS was also recorded whenever the participants demanded rescue analgesia. The control group included 54 women who received intravenous tramadol 50 mg eight hourly for postoperative pain relief, while the study group received rescue analgesia on demand or if the VAS score was recorded as three or more. The time for the first request for rescue analgesia and the total dose of rescue analgesic required in the first 24 hours after surgery were also recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. For inferential statistics, numerical data were analysed by Chi-square test, and for continuous data, the Student’s t-test was used. A p-value &lt;0.05 was considered statistically significant. Results: The study group had significantly lower postoperative pain VAS scores when compared to the control group at four hours and beyond time intervals. The mean VAS scores at six hours were 1.85 in the study group and 2.35 in the control group (p-value=0.01), at 24 hours it was 2.04 in the study group and 2.24 in the control group (p-value=0.04). The mean time for the first rescue analgesia in the study group and control group was 11 hours 25 minutes and 2 hours 43 minutes, respectively, and the total tramadol consumption was 77.78±46.24 mg and 117.59±36.55 mg, respectively. Both results were statistically significant (p-value&lt;0.001). Conclusion: Surgical TAP block significantly delays the need for rescue analgesia and decreases the total analgesia required in the first 24 hours after surgery. It is an effective, safe, and simple technique for achieving postoperative pain relief.

Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as a Component of Multimodal Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: Multimodal analgesia is the recommended approach for treating post-operative pain after laparoscopic cholecystectomy. The Transversus Abdominis Plane (TAP) block is a recently introduced technique showing promising results. To control visceral and somatic pain adequately and to avoid use of opioids intra-operative diclofenac sodium, combined with TAP block as part of a multimodal approach, may be beneficial. Aim: To evaluate the efficacy of TAP block with or without intraoperative diclofenac sodium aqueous injection for controlling post-operative pain following laparoscopic cholecystectomy. Materials and Methods: A randomised, double-blinded study was conducted from February 2022 to October 2022 at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Forty American Society of Anaesthesiology (ASA) physical status-I and II patients aged 20-50 years scheduled for elective laparoscopic cholecystectomy were divided into two groups of 20 patients each. Group A patients received bilateral Ultrasonography (USG) guided TAP block using 20 mL of 0.125% Bupivacaine on each side of the abdomen at the end of surgery. Group B patients received intravenous injection of diclofenac sodium aqueous 75 mg intravenous, intraoperatively, along with bilateral USG guided TAP block using 0.125% Bupivacaine. The primary outcome was the duration of post-operative analgesia (measured by the first request for rescue analgesia after the end of the operation at a VAS score of 4). Secondary outcomes included the total post-operative analgesic requirement (diclofenac sodium), pain score (VAS) over 24 hours in the post-operative period, and the incidence of complications such as nausea, vomiting, hypotension, and bradycardia. Patient Satisfaction Score (PSS) was recorded for each patient before discharge. Statistical analysis was performed using Statistical Package for Social Sciences(SPSS) version 24.0 software. Continuous variables were expressed as mean and standard deviation, and categorical variables were expressed as percentages. Independent t-tests and chi-square tests were used for between-group comparisons, with a p-value ≤0.05 considered statistically significant. Results: Amongst total 40 patients included, divided into group A(mean age: 32.95±8.74 years, 6 males and 14 females) and group B(31.90±9.16 years, 5 males and 15 females) with 20 patients each, the demographic characteristics such as age, gender, height, and weight were similar in both groups. The duration of post-operative analgesia was longer in Group B (16.32±1.29 hours) than in Group A (7.85±1.04 hours). The total post-operative analgesic requirement was lower in Group B (32.95±20.9 mg) compared to Group A (58.33±17.14 mg). Visual Analogue Scale (VAS) scores were lower in Group B than in Group A. PSS was significantly higher in Group B patients (8.14±1.06) than in Group A patients (6.16±1.38). Conclusion: TAP block, along with intra-operative intravenous diclofenac sodium aqueous, as part of a multimodal regimen, provides superior post-operative analgesia compared to TAP block alone. It is also associated with improved patient satisfaction.

Fentanyl versus midazolam added to bupivacaine for spinal analgesia in children undergoing infraumbilical abdominal surgery: A randomized clinical trial

ABSTRACT Background The addition of fentanyl or midazolam to intrathecal bupivacaine was tested to reduce the occurrence and pain degree in children undergoing infraumbilical surgery under sevoflurane anesthesia with intrathecal analgesia. Methodology Children (6–8 years) were randomized into three groups of 30 patients each with consent from parents. Groups C, F, and M received 0.3 mg/kg of 0.5% bupivacaine + 0.9% NaCl (placebo),0.3 mg/kg of 0.5% bupivacaine + 0.2 µg/kg of fentanyl, and 0.3 mg/kg of 0.5% bupivacaine + 0.5 mg of midazolam, respectively. Assessments included time to first analgesic request, postoperative pain score, the total amount of rescue analgesics, motor and sensory blocks, sedation, family satisfaction, and adverse effects. Results The Children’s Hospital of Eastern Ontario score was higher in the control than in the midazolam and fentanyl groups. The mean time to the first request for rescue analgesia was longer in group M (297.1 ± 10.7 min) than in groups F (219.9 ± 25.4 min) and C (162.7 ± 37.5; P = 0.000). The total analgesic consumption was higher in both control and fentanyl groups (P = 0.044). Family satisfaction was significantly higher in group M (P = 0.013) with no adverse effects. Conclusion In the present study, intrathecal midazolam (0.5 mg) was superior to intrathecal fentanyl (0.2 μg/kg) in increasing the duration of postoperative pain relief with lower postoperative pain scores and less incidences of adverse effects. Consequently, intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not accessible or contraindicated.

Scalp block for postoperative pain after craniotomy: A meta-analysis of randomized control trials.

BackgroundPostoperative pain after craniotomy is an important clinical concern because it might lead to brain hyperemia and elevated intracranial pressure. Considering the side effects of opioid, several studies have been conducted to investigate the effect of local anesthetics, especially the scalp block, on postoperative pain. However, the strength of evidence supporting this practice for postoperative pain after craniotomy was unclear and the best occasion of scalp block was also not identified. Therefore, we conducted a meta-analysis to evaluate the efficacy, safety, and the best occasion of scalp block for postoperative pain after craniotomy.MethodsPubMed, Embase, and the Cochrane Library databases from database inception to October 10, 2021 were searched for all randomized controlled trials evaluating the effect of scalp block on postoperative pain after craniotomy. Data were assessed by StataMP 16 software.ResultsA total of 12 studies were included. A random-effect model was used to analyze all data. Patients under scalp block earned fewer scores than the non-scalp block group in visual analogue scale at the very early period (MD = −1.97, 95% CI = −3.07 to −0.88), early period (MD = −1.84, 95% CI = −2.95 to −0.73) and intermediate period (MD = −1.16, 95% CI = −1.84 to −0.49). Scalp block could also significantly prolong the time of the first request of rescue analgesia and reduce the use of additional analgesics without a significant difference in the incidence of complications. Subgroup analysis showed there was no significant difference in analgesia effect between pre-incision scalp block and post-incision scalp block in all periods.ConclusionScalp block could lead to lower pain intensity scores, more time of the first request of rescue analgesia, and fewer analgesic drugs applied in the first 12 h after craniotomy. There was no significant difference between pre-incision and post-incision scalp block in the occurrence and severity of postoperative pain.

The Lack of Analgesic Efficacy of Nefopam after Video-Assisted Thoracoscopic Surgery for Lung Cancer: A Randomized, Single-Blinded, Controlled Trial.

Nefopam is a centrally acting non-opioid analgesic, and its efficacy in multimodal analgesia has been reported. This study aimed to assess the analgesic efficacy of intraoperative nefopam on postoperative pain after video-assisted thoracoscopic surgery (VATS) for lung cancer. Participants were randomly assigned to either the nefopam or the control group. The nefopam group received 20 mg of nefopam after induction and 15 min before the end of surgery. The control group received saline. The primary outcome was cumulative opioid consumption during the 6 h postoperatively. Pain intensities, the time to first request for rescue analgesia, adverse events during the 72 h postoperatively, and the incidence of chronic pain 3 months after surgery were evaluated. Ninety-nine patients were included in the analysis. Total opioid consumption during the 6 h postoperatively was comparable between the groups (nefopam group [n = 50] vs. control group [n = 49], 19.8 [13.5–25.3] mg vs. 20.3 [13.9–27.0] mg; median difference: −1.55, 95% CI: −6.64 to 3.69; p = 0.356). Pain intensity during the 72 h postoperatively and the incidence of chronic pain 3 months after surgery did not differ between the groups. Intraoperative nefopam did not decrease acute postoperative opioid consumption or pain intensity, nor did it reduce the incidence of chronic pain after VATS.

Comparison of Analgesic Effects of Intravenous and Intraperitoneal Magnesium Sulphate in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study

Background: Postsurgical pain following laparoscopic cholecystectomy is often associated with delayed recovery and discharge from the hospital. Magnesium sulphate as an adjuvant has shown a potential role as an anti-analgesic drug perioperatively. However, the data on the effectiveness and safety of magnesium sulphate delivered via two distinct routes (intravenous and intraperitoneal) for postoperative pain management is scant.&#x0D; Methods: This prospective randomized controlled trial was conducted on 80 adult patients. Group A (n=40) received 30ml intravenous magnesium sulphate(50mg/kg) and 30ml 0.25% bupivacaine intraperitoneal infiltration. Group B (n=40) received 30ml intraperitoneal infiltration of magnesium sulphate(50mg/kg) along with 0.25% bupivacaine and 30ml intravenous 0.9% normal saline infusion. Postoperative pain-free duration, pain scores (visual analog score), need of rescue analgesia, intraoperative hemodynamics and postoperative complications were noted.&#x0D; Results: The Visual analogue scores at 1,2,4 and 6 postoperative hours were 1.75±0.78, 1.33±0.66, 0.60±0.50, 0.45±0.55 in Group B and 2.13±0.61, 1.65±0.62, 1.28±0.88, 0.73±0.51 in Group A respectively (P-value-0.02,0.03,0.00 and 0.02). The time of the first request for rescue analgesia in Group A was 37.09± 5.54 and in Group B 52.00±4.30 (P value-0.00). Mean heart rate, systolic and diastolic blood pressure were significantly lower in Group A compared to Group B (P-value&lt;0.05). Extubation and emergence time was significantly higher in group A compared to Group B (P-value -0.00). The Abbreviated mental test (AMT)-4 cognition scores were similar in both groups while Alert, Voice, Pain and Unresponsive (AVPU) sedation score was higher at the first postoperative hour in Group A (1.30± 0.46) compared to Group B (1.10 ± 0.30) (P value- 0.026).&#x0D; Conclusion: Intraperitoneal magnesium is a safe and efficient means of controlling postoperative pain. Additionally, it decreases the time required for emergence and extubation as compared to intravenous delivery. Intravenous magnesium has better hemodynamic control in perioperative period.

Comparison of the effect of adding midazolam versus fentanyl to intrathecal levobupivacaine in patients undergoing cesarean section: double-blind, randomized clinical trial

BackgroundMany adjuvants are added to prolong the effects of spinal analgesia. We investigated the postoperative analgesic efficacy of the addition of midazolam or fentanyl to intrathecal levobupivacaine in women undergoing cesarean delivery. MethodsEighty patients were randomly assigned to two groups (n = 40). Group M received 10 mg of 0.5% levobupivacaine plus 2 mg of midazolam. Group F received 10 mg of 0.5% levobupivacaine plus 25 μg of fentanyl. Assessments included motor and sensory block, APGAR score, time to first request for analgesia, postoperative pain score, total consumption of rescue analgesics, and adverse effects. ResultsSensory blockade was prolonged in Group M compared with Group F (215.58 ± 27.94 vs. 199.43 ± 19.77 min; p = 0.004), with no differences in other characteristics of the spinal block in intraoperative hemodynamics or APGAR score. The mean time to first request for rescue analgesia was longer in Group M (351.45 ± 11.05 min) than in Group F (268.83 ± 10.35 min; p = 0.000). The median total consumption of rescue analgesics in the first 24 hours postoperatively was 30 mg in Group M vs. 60 mg in Group F (p = 0.003). The median Visual Analog Scale (VAS) scores were lower in Group Ethan in Group F from the 8th to the 12th hour postoperatively, with no differences between the groups at other time points. The incidence of adverse effects was higher in Group F than in Group M. ConclusionIntrathecal midazolam (2 mg) was superior to intrathecal fentanyl (25 μg) in increasing the duration of the sensory blockade and postoperative analgesia with lower postoperative pain scores and decreasing the incidence of adverse effects.

Effect of Dexmedetomidine as an adjuvant in quadratus lumborum block in patient undergoing caesarean section – A randomised controlled study

Study objectiveThis study was conducted to evaluate the effect of Dexmedetomidine as an adjuvant in quadratus lumborum block (QLB) for postoperative pain relief at rest in patients undergoing caesarean section (CS). The primary objective was to compare the time to the first request of rescue analgesia. Secondary objectives were to compare the amount of rescue analgesia, patient satisfaction, Numeric rating scale (NRS), and Ramsay sedation score (RSS) during the first 24 h. DesignA randomised, double-blinded study. SettingThe study was conducted at AIIMS Bhubaneswar from December 2019 to February 2021in the Operating Theatre complex (for the immediate postoperative follow-up) and in the Obstetric Ward (for follow-up at the later time points). PatientsA total of 70 patients were enrolled with singleton term pregnancies scheduled for CS under spinal anaesthesia after written informed consent. InterventionBilateral QLB was given in the recovery area. Group A received 30 ml of 0.25% Bupivacaine and group B received 30 ml 0.25% bupivacaine with Dexmedetomidine 1 μg/kg. They received inj. Paracetamol 15 mg/kg intravenously TDS and Inj. Tramadol 1 mg/kg as rescue analgesia (if Numeric rating scale (NRS) Score ≥ 4). We also compared the rescue analgesia in the first 24 h, patient satisfaction scores, Ramsay sedation score (RSS), and NRS scores at 2, 4, 6, 8, 12, 18, and 24 h. Main resultsThe time to request the first rescue analgesia was significantly prolonged in group B [Mean ± SD (95% CI)] 880 ± 351 (720–1040) min. vs group A 439 ± 208 (368–510) min., p < 0.001). There was a significant decrease in the amount of rescue analgesia [(Inj. Tramadol (1 mg/ kg)] used in the group with dexmedetomidine [group B Mean ± SD (95% CI) (57 ± 18 (49–65) mg. vs group A - 81 ± 25 (73–90)] mg., p < 0.001]. A significant difference was seen in patient satisfaction scores and pain scores between the groups up to 18 h. (p < 0.05) but not in RSS. ConclusionDexmedetomidine can be considered an effective adjuvant for QLB in CS in the absence of intrathecal morphine.

CLINICAL EVALUATION OF EFFICACY AND SAFETY OF TRANSVERSUS ABDOMINIS PLANE BLOCK INJ. LEVOBUPIVACAINE AND INJ. ROPIVACAINE FOR POST OPERATIVE ANALGESIA FOLLOWING LOWER SEGMENT CESAREAN SECTION : A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY

Backgrounds and Aims :Levobupivacaine is a pure S-enantiomer of bupivacaine with similar anesthetic profile and with reduced toxic potential than racemic bupivacaine.This study aims to compare efficacy and safety of Transverse Abdominal Plane block inj. Levobupivacaine Vs. Inj. Ropivacaine for post operative analgesia following lower segment cesarean section. Methods and Material:A prospective, randomized, controlled, double blind clinical study. 60 patients divided in 2 groups by computer generated randomization.60 healthy women undergoing cesarean delivery under spinal anesthesia were randomized into two groups (Group I, Group II). Group I received TAP block with 15 ml of 0.25% ropivacaine while Group II received TAP block with 15 ml of 0.25% levobupivacaine on each side. Postoperatively, time for first request for rescue analgesia and number of women requesting analgesia in 6 h,8 h, 10 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. Statistical analysis used:The data were analyzed with Students t‑test. Results:The duration of analgesia was significantly prolonged in Group I than group II. The VAS score in patients who received Inj. Ropivacaine was significantly lower than who received inj. Levobupivacaine. Patient and surgeon satisfaction score were significantly higher in Ropicavaine than levobupivacaine. Conclusions:0.25% Ropivacaine provided longer duration of analgesia compared to 0.25% Levobupivacaine in TAP Block for postoperative analgesia after lower segment cesarean section.

Nerve block using local anesthetic and dexmedetomidine in patients undergoing functional endoscopic sinus surgery

BackgroundThe main anesthetic goal in the postoperative period of functional endoscopic sinus surgery (FESS) is early and pain-free recovery, with return of protective airway reflex. The aim of this study is to evaluate the role of dexmedetomidine as an adjuvant to regional blocks in patients undergoing functional endoscopic sinus surgery.ResultsGroup bupivacaine + dexmedetomidine (BD) showed statistically significantly lower postoperative pain measurements than group bupivacaine (B), longer time to the first request of rescue analgesia, less patients needing rescue analgesia, and less rescue morphine analgesic requirements. Other measurements were insignificantly different between both groups.ConclusionsDexmedetomidine can be used as an adjuvant to regional nerve block in patients undergoing functional endoscopic sinus surgery. It effectively prolonged postoperative analgesia, decreased postoperative opioid analgesic requirements, and reduced the number of patients needing rescue analgesia.

Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study

Background &amp; objetives: Laparoscopic procedures are usually followed by postoperative pain of variable intensity. The pain occurs due to streching of the visceral organs and peritoneum. We compared the antinociceptive effect of intraperitoneal instillation of bupivacaine with a combination of bupivacaine and dexmedetomidine in laparoscopic surgery. We assessed the quality of analgesia, time to the first request of rescue analgesia and total analgesics required in the first 24 h.&#x0D; Methodology: After institutional ethical committee approval a total of 162 patients were selected, out of which 81 patients were allocated into two groups using table of randomization. Group B received 0.25 % bupivacaine 50 ml with 5 ml normal saline and Group BD received 0.25 % bupivacaine 50 ml plus dexmedetomidine 1 µg/kg diluted in 5 ml of normal saline intraperitoneally.&#x0D; Results: We found a significant difference between mean VAS scores of the two groups in all time points (p &lt; 0.05). There was significant difference between mean time to the first request for analgesia and the mean total dose for analgesic required (p &lt; 0.05) in between both groups.&#x0D; Conclusion: We conclude that intraperitoneal instillation of dexmedetomidine 1 µg kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and analgesic requirement in postoperative period when compared to bupivacaine 0.25% alone.&#x0D; Abbreviations: VAS – Visual analog scale; NS - Normal saline; PACU - post‑anesthesia care unit; HR – Heart rate;&#x0D; Key words: Anesthetics, Local / administration &amp; dosage; Bupivacaine / administration &amp; dosage; Cholecystectomy, Laparoscopic / adverse effects; Dexmedetomidine, Intraperitoneal; Bupivacaine; Visual analogue scale; Pain Measurement; Pain, Postoperative / diagnosis; Pain, Postoperative / etiology; Pain, Postoperative / prevention &amp; control&#x0D; Citation: Shankar S, Gupta BK, Singh MK, Pandey AR, Dwivedi V, Sachan S. Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study. Anaesth. pain intensive care 2022;26(3):347-351. DOI: 10.35975/apic.v26i3.1909&#x0D; Received: August 09, 2021; Reviewed: November 19, 2021; Accepted: December 09, 2021&#x0D;

Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: Randomized controlled study.

Erector spinae plane block (ESPB) in pediatric patients presenting for hip surgery may improve the postoperative analgesia. The study aimed to investigate the effect of ultrasound-guided ESPB on postoperative analgesia after a pediatric hip surgery. Forty children scheduled for hip surgeries were included in this trial and randomly distributed into; Control group, patients received sham ultrasound-guided ESPB at the level of L3 or ESPB group, patients received real ultrasound-guided ESPB at the level of L3 with an injection of 0.4ml/kg of plain bupivacaine 0.25%. The time for the first call of rescue analgesia, intraoperative fentanyl consumption, postoperative morphine consumption, Children's Hospital Eastern Ontario Pain Scale (CHEOPS), and Objective Behavioral Pain score (OPS) were recorded. As compared to the control group, the use of ESPB significantly prolonged the time for first request of rescue analgesia from 170.50±44.066 to 256.50±66.434min (p<0.0001), decreased the intraoperative fentanyl consumption from 1.025±0.379 to 0.775±0.343μg/kg (p=0.035), decreased the postoperative morphine consumption from 0.105±0.036 to 0.065±0.023mg/kg (p=0.0002). Also, it significantly decreased postoperative CHEOPS and OPS scores 2, 4, and 6h after the surgery (p<0.05) with an insignificant difference between the two groups at all other time intervals (p˃0.05). The use of ESPB in pediatric patients undergoing hip surgery prolonged the time for the first call of analgesia, decreased the intraoperative and postoperative opioid consumption, and decreased the postoperative pain.