Improvement Of Postoperative Analgesia Research Articles

Analgesic Efficacy of Dexmedetomidine as Adjuvant to Levo-Bupivacine in Ultrasound Guided Erector Spinae Plan Block for Modified Radical Mastectomy

Background& aim: There are several advantages to properly managing post-masctetomy pain. With single shot interfascial plane blocks, local anesthetic adjuvants enhance analgesia duration. They improve the analgesic impact of local anesthetics. Dexamethasone, magnesium sulphate and dexmedetomidine, are examples of adjuvants with diverse modes of action. This research examined the analgesic effects of dexmedetomidine in women who had undergone a modified radical mastectomy (MRM). Methods and Patients: The research included forty women with histopathologically confirmed breast cancer. They were all scheduled for MRM and were randomly assigned to one of two groups: those who got levobupivacaine alone (group C) or those who received dexmedetomidine plus levobupivacaine (group D) during ultrasound (US)-guided erector spinae plane block (ESPB). The two groups were compared in terms of their hemodynamics, demographics, time until the first request for analgesia, numeric rating scale (NRS) scores, Richmond Agitation & Sedation scale (RASS) scores and total opioid use. Results: There were no statistically significant differences observed between the two groups in terms of baseline data. The set of participants referred to as group D had a statistically significant reduction in heart rate on many instances. Furthermore, it was discovered that group D had a substantial reduction in postoperative NRS ratings and a heightened degree of recovery from sedation, as shown by the RASS. Furthermore, it was noted that group D had a significantly reduced overall analgesic dose (9.12±0.46 vs. 6.24±1.37 mg; p= 0.02) and a prolonged duration until first analgesia (6.21±1.28 vs. 7.13±1.79 hours; p< 0.001). Conclusion: The use of dexmedetomidine in combination with levobupivacaine ESPB has been shown to enhance postoperative analgesia compared to the use of levobupivacaine alone. This improvement in postoperative analgesia leads to enhanced comfort levels for patients. Further research is necessary to corroborate these results via future studies conducted in several places.

Analgesic Efficacy of Quadratus Lumborum Block in Patients Undergoing Nephrectomy: A Systematic Review and Meta-Analysis.

To evaluate the analgesic efficacy of quadratus lumborum block (QLB) in adults undergoing nephrectomy. Systematic review and meta-analysis. Adult patients (≥18 years of age) received nephrectomy under general anesthesia. We searched PubMed, Embase, the Cochrane Library, and Web of Science on January 10, 2022, including randomized controlled trials that evaluated the analgesic efficacy of QLB for patients undergoing nephrectomy. A total of 12 randomized controlled trials (N = 821 patients) were included in the study. Compared with the non-block, single-shot QLB reduced postoperative opioid consumption (mean difference [MD], -8.37 mg intravenous morphine equivalent; 95% confidence interval [CI], -12.19 to -4.54 mg) and pain scores at 2 hours, 6 hours, 12 hours, and 24 hours at rest and during movement after nephrectomy. Single-shot QLB also prolonged the time to first analgesic request (MD, 6.44 hours; 95% CI, 2.23 to 10.65 hours), shortened the length of hospital stay (MD, -0.32day; 95% CI, -0.55 to -0.09day), and decreased the incidence of postoperative nausea and vomiting (risk ratio, 0.48; 95% CI, 0.36 to 0.65). Compared with continuous epidural anesthesia, repeated QLB could provide comparable postoperative analgesic benefits. Single-shot QLB provided a statistically significant but clinically small improvement in postoperative analgesia and recovery for patients undergoing nephrectomy. The QLB would be beneficial as part of multimodal analgesia. Future research might need to determine which approach of QLB is superior for postoperative analgesia after nephrectomy.

Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study

Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb. Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB. Materials and Methods: A prospective, randomized, and triple-blind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 μg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 μg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P<0.001). The duration of post-operative analgesia was also longer in the BD Group compared with the BF Group (549.43±10.56 vs. 403.69±10.84) P<0.001. BF Group had more requirements of analgesic postoperatively. Conclusion: Addition of dexmedetomidine to bupivacaine prolonged the duration of perineural supraclavicular BPB and improvement of post-operative analgesia than fentanyl without significant side effects in patients undergoing upper limb surgeries.

Postoperative Analgesia in Modified Radical Mastectomy Patients After Instillation of Bupivacaine Through Surgical Drains.

Background: In contrast to other breast surgeries, modified radical mastectomy (MRM) with axillary lymph node clearance involves intense tissue dissection, with postoperative seroma formation and pain being the major complaints affecting patients. Among these, 40% of females experience acute postoperative pain, and between 25 to 60% develop persistent chronic postsurgical pain. The rationale of this study was that minimally invasive procedures can result in immediate pain relief in patients undergoing mastectomy, which has been proven to satisfy their needs and lead to early discharge in the local population.Objective: This study determined to find out the efficacy of instilling bupivacaine on wounds by means of surgical drains in controlling pain after MRM.Methodology: This was a randomized control study trial that was carried out in Surgical Unit 1, Ward 3, Jinnah Postgraduate Medical Centre, Karachi, from November 2020 to April 2021. All patients tested negative for coronavirus disease 2019 (COVID-19) by PCR test before randomly allocating them into two groups. Thirty women in Group B received 40 ml of 0.25% injection bupivacaine, and 30 in Group C received no drug. Duration of analgesia was recorded as time in hours when the patient was received after surgery in the post-anesthesia care unit until the patient felt ache and discomfort of > three scores according to the visual analog pain score chart (VAS).Results: The average age was 52.48±4.76 years. The mean period of time during which analgesia was observed was significantly higher in Group B as compared to Group C (10.93±1.84 vs 5.03±1.35 hours, p=0.0005).Conclusion: There is improvement in postoperative analgesia after instilling bupivacaine through surgical drains on wound beds in MRM patients.

Effect of opioid-free anesthesia on postoperative analgesia after laparoscopic gynecologic surgery.

We performed this randomized controlled trial to evaluate the effect of opioid-free anesthesia (OFA) on postoperative analgesia after laparoscopic gynecologic surgery. Seventy-eight patients undergoing laparoscopic gynecologic surgery were randomized to receive either OFA (group OF) or opioid-inclusive anesthesia (group C). Postoperative sufentanil consumption within the first 24 h, Visual Analogue Scale (VAS) for pain, postoperative equivalent milligrams of morphine (EMM), severity of postoperative nausea (PN) and vomiting (PV), prevalence of postoperative nausea and vomiting (PONV), use of antiemetics, time to first passage of flatus were compared by a two-tailed Student's t-test, Wilcoxon rank-sum tests or Fisher's exact tests. Repeated measures ANOVA was used to assess the effect of allocation of groups over time. The median [IQR] sufentanil consumption within 24 h was lower in group OF (4[4.5]) than in group C (6[8], mean difference [MD]=-2, 95% confidence interval [CI] [-4 to 0], P=0.029). The VAS scores at rest and during coughing at 6 h (P=0.009 at rest; P=0.002 during coughing), VAS scores during coughing at 2 h (P=0.013) and 4 h (P=0.008), EMM (P=0.026), severities of PN (P=0.003) and PV (P=0.003), and the mean time to first passage of flatus (P=0.017) was significantly less in group OF than that in group C. The prevalence of PONV (26.3% [group OF], 68.4% [group C], OR=0.31, 95% CI [0.158 to 0.589], P<0.001), use of antiemetics (5.3% [group OF], 28.9% [group C], OR=0.136, 95% CI [0.028 to 0.667], P=0.012) was also significantly different between groups. Compared to opioid-inclusive anesthesia during laparoscopic gynecologic surgery, OFA was associated with significant improvement in postoperative analgesia, reduced PONV incidence prevalence and severity, and faster first passage of flatus.

Comparison of continuous intravenous lidocaine versus transversus abdominis plane block for kidney transplant surgery: a randomized, non-inferiority trial

Background and objectivesTransversus abdominis plane (TAP) blocks are associated with an improvement in postoperative analgesia following kidney transplant surgery. However, these blocks carry inherent risk and require a degree of...

Ретробульбарная блокада при энуклеации глазного яблока у детей с ретинобластомой

Introduction. Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina. Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation. Material and methods. A prospective, randomized, controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) N = 40 and the GA control group (general anesthesia) N = 40. Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7 ± 0.7 μg / kg, which is significantly lower than in the OA group of 10.1 ± 1.9 μg / kg (P &lt;0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (P = 0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (P &lt;0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients. Conclusions. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball in pediatric. Key words: ropivacaine, retrobulbar block, oculocardial reflex, pain, retinoblastoma, enucleation, pediatric patients.

Dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia increases female patients\u2019 global satisfaction degree after thoracoscopic surgery

BackgroundThere are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients’ global satisfaction degree.MethodsOne hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients’ global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery.ResultsCompared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups.ConclusionsDexmedetomidine combined with sufentanil and dezocine increased female patients’ global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients.Trial registrationChinese Clinical Trial Registry number, ChiCTR2000030429. Registered on March 1, 2020.

Intrathecal morphine is associated with reduction in postoperative opioid requirements and improvement in postoperative analgesia in patients undergoing open liver resection

BackgroundOur study aimed to test the hypothesis that the addition of intrathecal morphine (ITM) results in reduced postoperative opioid use and enhanced postoperative analgesia in patients undergoing open liver resection using a standardized enhanced recovery after surgery (ERAS) protocol with multimodal analgesia.MethodsA retrospective analysis of 216 adult patients undergoing open liver resection between June 2010 and July 2017 at a university teaching hospital was conducted. The primary outcome was the cumulative oral morphine equivalent daily dose (oMEDD) on postoperative day (POD) 1. Secondary outcomes included postoperative pain scores, opioid related complications, and length of hospital stay. We also performed a cost analysis evaluating the economic benefits of ITM.ResultsOne hundred twenty-five patients received ITM (ITM group) and 91 patients received usual care (UC group). Patient characteristics were similar between the groups. The primary outcome - cumulative oMEDD on POD1 - was significantly reduced in the ITM group. Postoperative pain scores up to 24 h post-surgery were significantly reduced in the ITM group. There was no statistically significant difference in complications or hospital stay between the two study groups. Total hospital costs were significantly higher in the ITM group.ConclusionIn patients undergoing open liver resection, ITM in addition to conventional multimodal analgesic strategies reduced postoperative opioid requirements and improved analgesia for 24 h after surgery, without any statistically significant differences in opioid-related complications, and length of hospital stay. Hospital costs were significantly higher in patients receiving ITM, reflective of a longer mandatory stay in intensive care.Trial registrationRegistered with the Australian New Zealand Clinical Trials Registry (ANZCTR) under ACTRN12620000001998.

Stocktaking of local anesthetics 2020

For decades local anesthetics have proven to be safe and effective drugs in the clinical practice, crucially promoting the enormous achievements in regional anesthesia. Meanwhile, it is awell-known fact that local anesthetics are much more than just "simple" sodium channel blockers. They also interact with numerous other ion channels and subcellular structures, enhancing nerve blockade and resulting in systemic "alternative" effects, which can sometimes even be clinically used. By the simultaneous administration of various adjuvants (e.g., opioids, corticosteroids and α2-receptor agonists) attempts are made to prolong the time of action of local anesthetics after a single administration in order to achieve the best possible improvement in postoperative analgesia. In this context, ultralong-acting local anesthetics, such as liposomal bupivacaine, which at least theoretically can provide a sensory nerve block for several days, have been developed and clinically introduced. The coming years will show whether these approaches will develop into genuine alternatives to the personnel and cost-intensive continuous nerve blockades.Local anesthetic-induced systemic toxicity is meanwhile rare but still a potentially life-threatening event, frequently resulting from accidental intravascular injection or extensive systemic resorption. Consequently, slow and fractional application of these agents with intermittent aspiration helps to prevent toxic sequelae. If toxic symptoms occur, however, the intravenous infusion of 20% lipid solutions in addition to basic treatment measures can enhance the success of treatment.

Dexmedetomidine and Fentanyl as an Adjunct to Bupivacaine 0.5% in Supraclavicular Nerve Block: A Randomized Controlled Study.

Background:Brachial plexus block is gaining popularity day by day for upper limb surgery. The supraclavicular brachial plexus block may be used for surgical anesthesia alone or in conjunction with general anesthesia.Aims:We intended to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine on onset and duration of block and postoperative analgesia during ultrasonic guided supraclavicular nerve block for upper limb surgeries.Settings and Design:This study design was a prospective randomized controlled double-blinded clinical study.Patients and Methods:Sixty patients with American Society of Anesthesiologists physical status Classes I and II, aged 18–50 years, scheduled for upper limb surgery were randomly divided into three study groups each group contains 20 patients: C Group: receive 0.5 mL/kg up to a maximum of 40 mL volume. The dose of bupivacaine was 1.5 mg/kg. D Group: Bupivacaine as control group + 1 mg/kg dexmedetomidine. F Group: Bupivacaine as control group + 1 mg/kg fentanyl. Patients were observed for onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects.Statistical Analysis Used:One-way ANOVA test and Chi-square test were used.Results:The onset time of sensory and motor blockade was shortened. and the duration of the block was significantly prolonged in the D Group (P < 0.001) and F Group (P < 0.001). The duration of postoperative analgesia was also longer in the D Group 13.5 h compared with the F Group 8.3 h and C Group 7.5 h. Hypotension and bradycardia were recorded in 2 patients in D Group, and nausea and vomiting were recorded in F Group.Conclusions:Addition of dexmedetomidine was better in prolongation of the duration of supraclavicular brachial plexus block and improvement of postoperative analgesia than fentanyl and bupivacaine alone without significant adverse effects in patients undergoing upper limb surgeries.

POSTOPERATIVE ANALGESIA IN ONCOLOGIC HOSPITAL: CURRENT STATUS AND PROSPECTS

Observational study of the postoperative analgesia efficacy with multimodal approach (acetaminophen, NSAIDs, opioids, regional analgesia) in 100 oncological patients has been conducted. On the first day after the surgery maximum pain level was 5 (3-7) points of numeric rating scale (NRS), 38% of patients experienced severe pain (NRS&gt;6 points). After laparo-, thoracoscopic, videoassisted interventions and in cases of epidural analgesia NRS levels were 3 (1-6) and 3 (2-5) points respectively. After the surgeries with high risk of chronic post-surgical pain (thoracic, mammary gland interventions, Phan-nenstiel incision) NRS level was 6 (1-7) points. Patients in this group more often experienced severe pain than in the rest group - 56,7% vs. 32,5% (P.=0.037). Suggesting results of this study and data of current literature the perspectives of further improvement of postoperative analgesia in oncology have been formulated.

Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis.

5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists are the most commonly used drugs for postoperative nausea vomiting (PONV) prophylaxis. Dexamethasone is another antiemetic with proven efficacy in reducing PONV. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the combination of dexamethasone and 5-HT3 antagonist versus a 5-HT3 antagonist alone as prophylaxis of PONV in laparoscopic surgical patients. PubMed, PubMed Central, and CENTRAL databases were searched to identify those randomized trials that compared a 5-HT3 antagonist with the 5-HT3 antagonist and dexamethasone combination for PONV prophylaxis after laparoscopic surgeries. Data from 17 RCTs that evaluated 1402 patients were included. Results from our meta-analysis show that the combination of dexamethasone and a 5-HT3 receptor antagonist is more effective in preventing PONV than the 5-HT3 antagonist alone (odds ratio 0.38, 95% confidence interval [CI] 0.27-0.54; number needed to treat = 6.6), with no statistical heterogeneity (I = 0) among studies. The need for rescue antiemetic is also decreased in patients receiving the combination (odds ratio 0.21, 99% CI 0.10-0.46; number needed to treat = 6), although data are insufficient to detect any significant difference in incidence of adverse effects. In addition, patients in the combination group complained of less pain after 24 hours (Weighted Mean Difference -0.67, 99% CI -1.27 to -0.08). Combination of a 5-HT3 receptor antagonist and dexamethasone is significantly more effective than 5-HT3 antagonist alone in preventing PONV after laparoscopic surgeries, with possible improvement in postoperative analgesia.

Efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting

Objective To evaluate the efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting. Methods Forty-two pediatric patients of both sexes with a large area of burn, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 2-10 yr, weighing 13-36 kg, scheduled for elective tangential excision and skin grafting under combined propofol-remifentanil-sevoflurane anesthesia, were randomly divided into 2 groups (n=21 each) using a random number table: sufentanil group (group Suf) and dexmedetomidine plus sufentanil group (group Dex-Suf). The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained sufentanil 2 μg/kg and granisetron 100 μg/kg in 100 ml of normal saline in group Suf, and contained dexmedetomidine 2.5 μg/kg, sufentanil 1.5 μg/kg, and granisetron 100 μg/kg in 100 ml of normal saline in group Dex-Suf.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of sufentanil 0.1 μg/kg.When Faces Pain Scale score>2, sufentanil 0.1 μg/kg was injected intravenously as rescue analgesic.The consumption of sufentanil was recorded within 48 h after operation.Ramsay sedation scores at static and dynamic (during dressing changes) conditions were assessed after operation.The parents' satisfaction, requirement for rescue analgesics and incidence of adverse reactions such as agitation, nausea and vomiting were recorded after operation. Results Compared with group Suf, Ramsay sedation scores at static and dynamic conditions and patients' satisfaction scores were significantly increased, and the consumption of sufentanil, requirement for rescue analgesics and incidence of agitation, nausea and vomiting were significantly decreased after operation in group Dex-Suf (P<0.05). Conclusion Dexmedetomidine significantly improves postoperative intravenous analgesia with sufentanil in the pediatric patients with a large area of burn after tangential excision and skin grafting, and combination of dexmedetomidine and sufentanil is recommended for this type of pediatric patients. Key words: Dexmedetomidine; Sufentanil; Skin transplantation; Burns; Analgesia, patient-controlled; Child

Comparison between dexmedetomidine and verapamil as an adjuvant to local anesthesia in intravenous regional anesthesia in upper limb orthopedic surgery: a randomized double-blind prospective study

Background The use of intravenous regional anesthesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Objective This randomized double-blind prospective study was designed to compare the effectiveness of adding dexmedetomidine (α2 adrenoceptor agonist) or verapamil (calcium channel antagonist) as an adjunct to lidocaine in upper limb orthopedic surgery. Patients and methods Sixty adult patients scheduled for elective upper limb orthopedic surgery were divided into three groups: the lidocaine group, in which patients received 3 mg/kg of lidocaine 2% diluted with saline to a total volume of 40 ml; the lidocaine dexmedetomidine group, in which patients received 0.5 µg/kg of dexmedetomidine plus 3 mg/kg of lidocaine 2%; and the lidocaine verapamil group, in which patients received 2.5 mg of verapamil plus 3 mg/kg of lidocaine 2%. The onset and duration of sensory and motor block were recorded. Postoperative Visual Analog Score, onset of tourniquet pain, duration of analgesia, and total analgesic requirements at the 12th postoperative hour were monitored. Results Adding dexmedetomidine or verapamil to lidocaine causes faster onset and prolonged recovery of sensory and motor block and improvement of postoperative analgesia, without causing side effects compared with lidocaine alone. Conclusion The use of either verapamil or dexmedetomidine as an adjuvant to lidocaine solution causes equal improvement of the quality of anesthesia in intravenous regional anesthesia of upper limb orthopedic surgeries.

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials.

To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery. We systematically searched six databases up to June 2, 2015 for randomized controlled trials (RCTs) comparing ketamine plus morphine/hydromorphone PCA vs morphine/hydromorphone PCA for postoperative pain in adults. Thirty-six RCTs including 2,502 patients proved eligible, and 22 of these were at low risk of bias. The addition of ketamine to morphine/hydromorphone PCA decreased postoperative pain intensity at six to 72 hr when measured at rest (weighted mean difference [WMD] on a 10-cm visual analogue scale ranged from -0.4 to -1.3 cm) and during mobilization (WMD ranged from -0.4 to -0.5 cm). Adjunctive ketamine also significantly reduced cumulative morphine consumption at 24-72 hr by approximately 5-20 mg. Predefined subgroup analyses and meta-regression did not detect significant differences across subgroups, including a dose-response relationship. There was no significant difference in patient satisfaction scores at 24 and 48 hr. Nevertheless, the addition of ketamine to morphine/hydromorphone PCA significantly reduced postoperative nausea and vomiting (relative risk, 0.71; 95% confidence interval [CI], 0.60 to 0.85; absolute risk reduction, 8.9%; 95% CI, 4.6 to 12.2). Significant effects on other adverse events (e.g., hallucinations, vivid dreams) were not detected, though only a few studies reported on them. Adding ketamine to morphine/hydromorphone PCA provides a small improvement in postoperative analgesia while reducing opioid requirements. Adjunctive ketamine also reduces postoperative nausea and vomiting without a detected increase in other adverse effects; however, adverse events were probably underreported.

Comparative analysis of post operative analgesic requirement in patient undergoing minor oral surgery using buprenorphine with lignocaine versus lignocaine-a double blind study

Aim: The aim of this study is comparative analysis of post operative analgesic requirement in patient undergoing minor oral surgery using 2% Lignocaine with 1:200000 Adrenaline and Buprenorphine versus 2% lignocaine with 1:200000 Adrenaline. Materials and Method: One hundred patients requiring minor oral surgery were included in the study. The patients were randomized by a third party and allocated to one of the two study groups. This allowed the patients and the operators to remain unaware of the group allocations. 1 ml of Buprenorphine Hydrochloride injection I.V which contains an equivalent of 0.3 mg Buprenorphine was withdrawn into a syringe and injected into a 30 ml vial of 2 % Lignocaine with Adrenaline 1:200000. Thus each ml of local anesthetic contained 0.01 mg of Buprenorphine. This solution was labelled and used for the study. Results: The duration of analgesia in Group I was found to be 13.71 ± 7.2 h and Group II was 39.58 ± the average consumption of NSAIDs was found to be 2.88 as compared to Group II mean value of 1.29 (P=0.0001). Conclusion: We concluded that addition of 0.3 mg of Buprenorphine to 30 ml Lignocaine with Adrenaline 1:200000 for minor oral surgery results in significant improvement in postoperative analgesia up to 39 h and markedly reduces the need for excessive analgesic intake. Thus reducing the adverse effects associated with excessive use of NSAIDs. Further studies needs to be done as there is less literature about Buprenorphine added to local anaesthetist. Keyword: Buprenorphine, Hydrochloride, Analgesia

Does Epidural Morphine Loading in Addition to Thoracic Epidural Analgesia Benefit the Postoperative Management of Morbidly Obese Patients Undergoing Open Bariatric Surgery? A Pilot Study

Insufficient data exist regarding postoperative thoracic epidural analgesia for morbidly obese patients undergoing open bariatric surgery. This study evaluated the effectiveness of morphine loading in a postoperative thoracic epidural analgesic regimen of patient-controlled epidural analgesia (PCEA) with levobupivacaine combined with continuously administered epidural morphine in this patient group. In this prospective randomized controlled trial, 48 superobese patients (body mass index of ≥ 50 kg/m(2)) undergoing open bariatric surgery were randomly allocated to three groups of 16 patients each. Postoperatively, all groups received a continuous epidural morphine infusion of 0.2 mg/h with 0.1 % levobupivacaine via PCEA. Group A did not receive intraoperative epidural morphine loading, while groups B and C received an intraoperative 1- and 2-mg morphine bolus, respectively. Levobupivacaine consumption via PCEA (primary outcome), pain scores at rest and on cough, the time to return of bowel function and ambulation, and arterial blood gas levels (secondary outcomes) were recorded. The increase in perioperative morphine administration (groups B and C) led to a significantly prolonged return to normal bowel function and delayed ambulation (P<0.05 to 0.01, respectively), without an improvement in postoperative analgesia or a reduction in local anesthetic consumption. Although the prevalence of obstructive sleep apnea (OSA) was high in all groups, no respiratory depression was observed. Thoracic PCEA with 0.1 % levobupivacaine combined with continuous epidural morphine administration of 0.2 mg/h without morphine loading is an effective postoperative analgesic regimen that provides adequate pain control, early ambulation, and early return of bowel function in superobese patients, particularly those with OSA.

Randomized clinical trial of ropivacaine wound infusion following laparoscopic colorectal surgery

Wound infusions with local anaesthesia have been used with varying success following laparotomy for colonic resections. This trial sought to determine the efficacy of ropivacaine wound infusion following laparoscopic colonic surgery. Forty-eight consecutive patients undergoing elective laparoscopic colorectal resection were randomized to receive either a local anaesthetic wound infusion (ropivacaine 0.5%) or normal saline for a period of 72 h. The primary endpoint was postoperative pain as assessed by analgesic consumption, while secondary endpoints assessed were visual analogue pain scores, respiratory function, gastrointestinal function, length of stay and postoperative complications. There was no difference in mean postoperative analgesic consumption between the two groups over 72 h (143 mEq morphine control vs 94 mEq intervention; p = 0.108). Likewise, there was no difference in daily postoperative analgesic consumption or visual analogue pain scores between the two groups. Patients in the ropivacaine group experienced less reduction in their postoperative forced expiratory volume at 1 s on day 1 (mean difference FEV1 0.4 l; p = 0.015). There was no difference between the two groups with respect to return of gut function and postoperative complications. In this study, local anaesthetic wound infusion with ropivacaine following elective laparoscopic colorectal surgery improves early respiratory function, but does not appear to provide an improvement in postoperative analgesia or other clinically relevant postoperative outcomes.

Efficacy of Buprenorphine Added 2 % Lignocaine 1:80000 in Postoperative Analgesia After Minor Oral Surgery

Recent studies have demonstrated that opioid analgesia cannot be exclusively attributed to effects within central nervous system. Peripheral opioid receptors exist that can be activated by locally applied opioid agonists which mediate analgesic effects that are particularly prominent in painful inflammatory conditions. Patients who present themselves with conditions requiring minor surgery in the maxillo-facial region usually have associated ongoing inflammatory process. The aim of our study was to apply the concept of peripheral opioid analgesia in minor oral surgery and evaluate its effectiveness in managing postoperative pain. The present study was designed to evaluate the efficacy of buprenorphine added lignocaine 2% in providing postoperative analgesia after minor oral surgery. Hundred consenting adult patients who were scheduled to undergo various minor oral surgeries were enrolled in this double blinded study. Patients were randomly assigned into one of the two groups based on whether they received buprenorphine added 2% lignocaine 1:80000 (Group I) or (Group II) lignocaine 2% with adrenaline 1:80000 alone. Visual analog scale method was used for evaluation of the postoperative analgesia. The duration of analgesia in Group I was found to be 36±1.5h and the average consumption of NSAIDs was found to be 1.86 as compared to Group II mean value of 4.4 (P<0.0001). Addition of small amounts of buprenorphine to 30ml lignocaine with adrenaline 1:80000 for minor oral surgery results in significant improvement in postoperative analgesia up to 36h and markedly reduces the need for excessive analgesic intake. Thus reducing the adverse effects associated with excessive use of NSAIDs.