Intraoperative Analgesic Requirements Research Articles

Perioperative Analgesic and Sedative Effects of Cannabidiol in Cats Undergoing Ovariohysterectomy.

The aim of this study was to evaluate the perioperative analgesic and sedative effects of oral CBD in cats undergoing ovariohysterectomy. Twenty-two cats were assigned to receive either oral cannabidiol oil (2 mg/kg, CBD group, n = 12) or placebo oil (0.1 mL/kg, Placebo group, n = 10) 60 min before the premedication. The anesthetic protocol included dexmedetomidine/meperidine, propofol, and isoflurane. Intravenous fentanyl was given to control cardiovascular responses to surgical stimulation. Pain was assessed at 0.5, 1, 2, 4, 6 and 8 h post-extubation using the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite-measure pain scale. Sedation scores were assessed at the same timepoints and at 15 min after the premedication. Morphine was administered as rescue analgesia. Higher sedation scores were recorded in the CBD group at 15 min after premedication (p = 0.041). Intraoperatively, more cats required fentanyl in the Placebo group than in CBD group (p = 0.028). The pain scores did not differ between groups, except at 0.5 h post-extubation when lower scores were detected in the CBD group (p = 0.003-0.005). Morphine was required in 100% of the animals in both groups. CBD increased preoperative sedation and decreased intraoperative analgesic requirements, with minimal evidence of postoperative analgesic benefits over the placebo.

Effect of dexmedetomidine constant rate infusion on the analgesic duration of peripheral nerve blocks in dogs: a randomized clinical study

The aim of this study was to evaluate whether a constant rate infusion of dexmedetomidine could prolong the analgesic effect of peripheral nerve blocks. Twenty client-owned dogs were enrolled and randomly divided into 2 groups. The DEX group received dexmedetomidine infusion at 1 mcg kg−1 h−1, and the NaCl group received an equivalent volume infusion of saline. Infusions were started after securing vascular access and continued for 10 min, after which intravenous (IV) methadone at 0.2 mg kg−1 and propofol to effect were administered. All animals were maintained with isoflurane in 70% oxygen. Sciatic, saphenous and obturator nerve blocks were performed using 0.1 mL kg−1 0.5% ropivacaine/block. Intraoperative fentanyl was administered if the heart rate and/or mean arterial pressure (MAP) increased > 15% from the previous measurement, and vasopressors were administered if MAP was ≤ 70 mmHg. Postoperative pain was assessed every hour using the Glasgow Composite Pain Scale (GCPS) until the first rescue analgesia administration. Postoperative rescue analgesia (methadone (0.2 mg kg−1 IV) and carprofen (2 mg kg−1 IV)) was administered if the pain score was higher than 6/24 or 5/20. Duration of analgesia was defined as the time between the nerve block procedure and initial postoperative rescue analgesia. Ambulation, proprioception, and skin sensitivity were evaluated to assess the duration of the motor and sensory block. A Student T and chi-square test were used to compare groups for duration of postoperative analgesia and intraoperative fentanyl and vasopressor use, respectively (p values ≤ 0.5 considered significant). A greater number of dogs in the NaCl group required fentanyl (5/10 p = 0.03) and vasopressors (8/10, p = 0.02) than did those in the DEX group (0/10 and 2/10, respectively). The duration of postoperative analgesia was significantly longer (604 ± 130 min) in the DEX group than in the NaCl group (400 ± 81 min, p = 0.0005).Dexmedetomidine infusion at 1 mcg kg−1 h−1 delays the time to first administration of rescue analgesia and reduces intraoperative analgesic and vasopressor requirements during Tibial Tuberosity Advancement surgery.

A Comparative Study of Duloxetine with Pregabalin as a Preemptive Analgesic in Lumbar Spine Surgery: A Prospective Randomized Study

Abstract Background: Preemptive analgesia is a method of administration of drugs prior to surgery involving blocking noxious stimuli across the perioperative period. It involves blocking the pain pathway preemptively before injury-induced hypersensitivity manifests. Objective: To compare the analgesic efficacy of duloxetine with pregabalin as preemptive analgesic in lumbar spine surgeries. Design: Randomised, double-blinded, prospective study. Methods: Fifty patients of both sexes between 18-55yrs undergoing elective lumbar spine surgery were randomly allocated into two groups, group P and group D of twenty-five patients each. Group P received 75 mg pregabalin once daily for three days, followed by 150 mg pregabalin daily for the next four days till the day of surgery. Group D received 20 mg duloxetine once daily for three days, followed by 40 mg duloxetine twice daily for the next four days till the day of surgery. Outcome Measure: Both the groups were primarily evaluated in terms of time for request of 1st rescue analgesic and total intraoperative analgesic requirement in terms of fentanyl boluses required; among other parameters. Results: The time for request of 1st rescue analgesic postoperatively was significantly longer in the pregabalin group (396 ± 267.77 min) than in the duloxetine group (218.4 ± 96.9 min), P = 0.003. Pregabalin recipients required considerably less rescue analgesics in terms of dosage, P = 0.006. Also, pregabalin exhibited better postoperative pain control than duloxetine as reflected by NRS comparative scores. No statistical difference was appreciated in terms of intraoperative fentanyl requirement, intraoperative hemodynamic control; nausea and sleepiness. Conclusion: Pregabalin is more efficacious as a preemptive analgesic than duloxetine in lumbar spine surgery.

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

Background: Nowadays, anesthesiologists are evaluating several analgesic adjuncts to minimize opioid use during craniotomy. Some studies have evaluated the analgesic-sparing effect of intravenous infusion of dexmedetomidine and lidocaine on intraoperative hemodynamics and post-operative analgesia. There is a paucity of studies focussing on the intraoperative analgesic requirement. Aims and Objectives: The present study compared dexmedetomidine and lidocaine infusion primarily for their effects on intraoperative fentanyl requirements during craniotomy. Materials and Methods: This study was done on 70 patients aged 18–80 years, the American Society of Anesthesiologists physical status I–II, having Glasgow Coma Scale 15, undergoing craniotomies. Patients were randomly allocated to receive either dexmedetomidine (group A, n=35) at a dose of 0.6 mcg/kg bolus over 10 min followed by 0.6 mcg/kg/h infusion or lidocaine (group B, n=35) at a dose of 1.5 mg/kg bolus over 10 min, followed by 1.5 mg/kg/h infusion till the end of skin suture, respectively. Study drugs were started 10 min before the start of surgery. Intraoperative total fentanyl and propofol consumption, intraoperative hemodynamics, recovery from hypnosis, and time to extubation were recorded. Results: The use of dexmedetomidine resulted in considerably less total fentanyl requirement (245.1 vs. 300.7 mcg, P<0.0001) and total propofol requirement (172.7 vs. 236.7 mg, P<0.0001) compared with lidocaine. Comparatively better hemodynamics were observed with the use of dexmedetomidine at all the points of observation. Conclusion: Dexmedetomidine as an analgesic adjunct can be a better alternative to lidocaine in terms of reduced fentanyl consumption, reduced propofol use and favorable hemodynamics, and early recovery from anesthesia.

The effect of block side on hemodynamic and respiratory parameters in patients who had interscalene block for upper limb surgery.

The administration of interscalene block (ISB) may lead to several hemodynamic effects, likely due to the diffusion of local anesthetic to nearby structures such as carotid sinus baroreceptors. This study aimed to compare hemodynamic and respiratory changes resulting from right and left-sided ISB. A retrospective analysis was conducted on adults who had ultrasound-guided ISB for upper limb surgery between January 2020 and December 2021. All patients had ISB with bupivacaine 0.5% and lidocaine 2% mixture following premedication. Demographic data, arterial blood pressure, heart rate, and peripheral oxygen saturation (SpO2) were measured before and after the block at regular intervals. Block characteristics, surgical and post-anesthesia care unit (PACU) durations, intraoperative analgesic requirements, and side effects were analyzed. A total of 94 patients had ISB for upper limb surgery, 54 for the right and 40 for the left-sided surgeries. Patients' data were analyzed in two groups according to the block side. Increased arterial blood pressure was observed in both groups after the block compared to the control values. Systolic arterial pressure from 10 to 30 minutes, diastolic arterial pressure at the 25th minute, and mean arterial pressure at the 15th, 20th, and 25th minutes were significantly higher on the right-sided blocks. Heart rate, SpO2, analgesic requirements, block characteristics, and PACU durations did not differ between the groups. Ultrasound-guided ISB-applied patients demonstrated increased blood pressure compared to control values. This increase, without concurrent changes in heart rate, was more pronounced in right-sided ISB. These findings indicate that careful hemodynamic monitoring is necessary whenever hypertension should be avoided for the patients.

A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions

: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I & II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.

Effect of preemptive ultrasound-guided TAP block on intraoperative analgesic requirements in patients undergoing laparoscopic gynecological surgeries under general anesthesia: A prospective, randomized controlled study

Background: Pain could lead to an increased consumption of opioids intraoperatively as well as postoperatively with subsequent side effects and prolonged post-operative recovery. Transverse abdominus plain (TAP) block is commonly used for post-operative analgesia. We wanted to study the effect of TAP block, when given as pre-emtive analgesia. Aims and Objectives: The study was conducted to ascertain the benefit TAP block when given before surgical incision. The primary objective was to study the intraoperative fentanyl requirement in patients undergoing Laparoscopic gynecological surgeries. The secondary objectives was to analyze the Intra-operative hemodynamic parameters, time needed to extubate the patient, sedation score, visual analog scale (VAS) scores, and the time of first rescue analgesia. Materials and Methods: Sixty-two eligible female patients posted for total laproscopic hysterectomy or Laproscopic-assisted Vaginal Hysterectomy coming were divided into two groups. Group A – Standard General Anaesthesia with pre-operative TAP block. Group B- Standard General Anaesthesia. Whenever there was 15% rise in heart rate (HR) or mean blood pressure (MBP) above the baseline, 20 mcg bolus of fentanyl was given. Total intra-operative Fentanyl consumption, intraoperative HR and MBP, time needed to extubate, post-operative sedation, VAS score, and time of first rescue analgesia was noted. Results: There was no difference in the demographic profile between two groups. The mean intraoperative fentanyl required was significantly higher in Group B (140.33±12.17 mcg) than in Group A (101.33±5.07 mcg). HR and MBP were lower in Group A throughout the procedure. The mean time of extubation was 5.4 min and 15.77 min in Group A and B. The mean sedation score observed was significantly higher up to 30 min in Group B. Mean Time of first rescue analgesia in Group A was 452.90±110.46 min and Group B was 240±89.13 min. Conclusion: Pre-operative TAP block given in laparoscopic gynecological surgeries decreases intraoperative fentanyl consumption leading to early extubation and causes less sedation in early post-operative period.

Intraoperative Analgesic Requirement using Surgical Plethysmographic Index Guidance in Lumbar Spine Surgeries: A Comparative Study

Context: The surgical plethysmographic index (SPI) has been introduced as a measure of the balance between nociception and anti-nociception. The SPI is proposed for the titration of intraoperative analgesic drugs during general anesthesia. Aims: This study aimed to compare the requirement of intraoperative analgesic consumption between SPI-guided analgesia and conventional analgesia practices, requirement of rescue analgesics and to study recovery time. Subjects and Methods: In this double-blind, randomized control study, 64 patients undergoing lumbar spine surgery were randomly divided into SPI-guided analgesia group (SPI) and conventional practice group (control). In the SPI group, patients received injection fentanyl bolus of 0.5 μg/kg whenever SPI value increased above 50. While in the conventional group, injection fentanyl 0.5 μg/kg was administered according to conventional clinical practice. Statistical Analysis Used: The statistical significance of difference of various categorical variables across two groups was tested using the Chi-square test. For assessing intergroup statistical significance of difference of various continuous measurements, independent sample t-test was used. Results: Intraoperative fentanyl requirement was 119.53 ± 16.48 μg in the conventional group and 142.97 ± 24.78 μg in SPI-guided group (P < 0.05). The difference was statistically significant. The mean recovery time in conventional group was 13.03 ± 1.03 min, and for SPI group, it was 13.53 ± 1.14 min (P > 0.05). Conclusions: We can conclude that SPI guidance may not always help in decreasing the dose of intraoperative opioid consumption. It should be used in combination with hemodynamic parameters. SPI guidance may not affect recovery time.

Thoracic Interfacial Plane Block Versus Thoracic Paravertebral Block for Anesthesia in Gynecomastia Surgery

Background: Gynecomastia is a benign proliferative condition affecting the glandular tissue of the male breast. This study compared the efficacy of ultrasound-guided thoracic interfacial plane block (TIPB) with ultrasound-guided thoracic paravertebral block (TPVB) in providing anesthesia for gynecomastia surgery. Materials and Methods: This prospective randomized open label clinical trial included 90 patients scheduled for elective surgery for idiopathic gynecomastia. Patients were randomly allocated into three equal groups: group C (control group) received bilateral tumescent local anesthesia, group TPVB received bilateral ultrasound guided TPVB, and group TIPB received bilateral ultrasound guided TIPB. We evaluated postoperative analgesic requirements, pain score, and patient’s satisfaction. Results: Intraoperative fentanyl requirement and total diclofenac in the first 24 hours postoperative were significantly lower in both TPVB and TIPB groups compared to control group (P = 0.002 and P < 0.001, respectively). Patient satisfaction was significantly better (P = 0.004) in both TPVB and TIPB groups when compared to control group. In postoperative evaluation, we found both TPVB and TIPB produced significantly lower pain score compared to control group in 2-hours (P < 0.001) and 4-hours (P = 0.001) after the surgery. Mean arterial blood pressure, heart rate, and peripheral oxygen saturation were comparable in all groups, as well as the occurrence of complications. Conclusion: Either TIPB and TPVB may provide effective analgesic property for anesthesia in gynecomastia surgery. This is shown by lower intraoperative analgesic requirements, lower postoperative pain score, and better patient’s satisfaction.

Abstract No.: ABS1074 : Evaluation of efficacy of superficial cervical plexus block for surgeries in head and neck region: A comparative randomised control study

Background and Aims:Superficial cervical plexus block can provide analgesia in head and neck surgeries. This study aimed to evaluate analgesic efficacy of superficial cervical plexus block (SCPB) in various head and neck surgeries, with the primary objectives of assessing time to first rescue analgesic, total dose of rescue analgesics in 24 hours, intraoperative analgesic requirement and associated perioperative complications.Methods:Sixty patients of American Society of Anesthesiologists physical class II,III (30 patients in each group) were included. Group A received general anaesthesia(GA) with systemic analgesia and group B received GA followed by SCPB with injection bupivacaine 0.25% 10ml on each side according to site of surgery. Visual analogue scale(VAS) scores, intra and postoperative analgesic requirement in 24 hours, time of first rescue analgesic demand and peri-operative complications were noted. All quantitative data were analysed by student-t test and qualitative data was analysed by chi-square test.Results:Time of first rescue analgesia was earlier and intraoperative fentanyl requirement and postoperative total rescue analgesic requirement were higher in group A (32.33+_38.39, 38.33+_12.61, 2566.667 + _504.006) than group B(1092+_396.55 minutes, 10.66+_13.11, 833.33+_874.28 ) with p value <0.001 (table 1,2). No significant complication was noted in any patient.Conclusion:SCPB provides better perioperative analgesia and decreases intraoperative as well as postoperative analgesic requirements and associated side effects with no significant perioperative complications in various head and neck surgeries.

A Randomized Control Trial on Comparative Effect of Scalp Nerve Block Using Levobupivacaine Versus Fentanyl on the Attenuation of Pain and Hemodynamic Response to Pin Fixation

Abstract Background: The application of head fixation device and tightening of the pins on the scalp acts as an intense noxious stimulus with an increased hemodynamic response. We aimed at comparing the efficacy of scalp nerve block (SNB) using levobupivacaine against intravenous fentanyl bolus dose followed by continuous intravenous infusion for attenuation of pain and hemodynamic response to pin fixation. Methods: One hundred and eight patients undergoing elective supratentorial craniotomy under general anesthesia were randomly allocated to two groups: Group F received a bolus of intravenous fentanyl (2 μg/kg) followed by continuous maintenance infusion and Group S, in which a bilateral SNB was performed with 20 ml of 0.5% levobupivacaine. Hemodynamic variables and pain scores were the primary outcomes noted. Intraoperative isoflurane and additional fentanyl requirements, emergence time and any side effects were also recorded. Results: The variation in hemodynamics in terms of heart rate (per minute) at pin fixation (Group F [95.88 ± 7.79] and Group S [89.02 ± 5.42]) was significant (P &lt; 0.001). There was a significant change in mean arterial blood pressure (mm Hg) between the groups at pin fixation Group F (104.70 ± 9.18) and Group S (92.88 ± 6.92) (P &lt; 0.001). A significant reduction in pain and intraoperative fentanyl requirements was also seen. Emergence from anesthesia was significantly longer in Group F as compared to Group S (P &lt; 0.001). No group had any significant complication. Conclusion: SNB is a reasonably safe and effective means for smooth control over hemodynamics and lesser intraoperative analgesic requirements compared to the fentanyl infusion in adult patients undergoing supratentorial craniotomies.

Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

Objective: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults. Material and methods: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. Results: Improvement of APD is higher in OP group ( p: 0.001). Improvement of DRF ( p: 0.713) and hydronephrosis ( p = 1.000), success ( p: 0.407) and complication rate ( p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group ( p: 0.001). Conclusion: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

Effect of pregabalin versus midazolam premedication on the anesthetic and analgesic requirements in pediatric day-case surgery: A randomized controlled trial

ABSTRACT Background: This study aimed to compare pregabalin and midazolam premedication in pediatric day-case surgery regarding anesthetic and analgesic requirements.Methods: Sixty patients scheduled for day-case surgery were randomly premedicated orally with either pregabalin (Group P) or midazolam (Group M). Intraoperative anesthetic and analgesic requirements were assessed as primary outcomes. Modified Ramsay Sedation Score (RSS), hemodynamic variables, time to eye opening and time to extubation after discontinuation of general anesthesia were measured. Post-anesthesia care unit (PACU) duration of stay, postoperative Pediatric Anesthesia Emergence Delirium (PAED) scale, and Faces Legs Activity Cry Consolability (FLACC) scale, and post-operative analgesic requirements were assessed as secondary outcomes. The study was pre-registered at the Pan African Clinical Trials Registry (registration number: PACTR201907535888819; date of registration: 22/07/2019).Results: We found no significant differences between the studied groups regarding types and duration of surgery, preoperative modified RSS, and postoperative PAED. The mean ranks of sevoflurane and fentanyl consumptions were significantly lower in group P (p < 0.001). Patients in group P showed significantly lower means of heart rate and arterial blood pressure after induction of anesthesia. Postoperative FLACC pain score showed a significantly lower mean rank in group P. The need for rescue analgesics and the mean ranks of rectal diclofenac and meperidine consumption was significantly lower in group P (p < 0.001). The mean ranks of total paracetamol doses were comparable in both groups (p = 0.090). Group P showed a significantly lower duration of stay in PACU and time to open the eye and to extubate, but significantly higher time to first analgesic requirement.Conclusion: Pregabalin significantly reduced the perioperative anesthetic and analgesic requirements, the PACU duration of stay, and the time to open the eye and to extubate, in comparison to midazolam; therefore, its use as a premedication in pediatric day-case surgery is recommended.

Intraoperative infusion of lidocaine 2% reduces postoperative fentanyl requirements for pain control in renal transplantation surgery

BackgroundIntravenous lidocaine has been shown to be an analgesic and anti-inflammatory medication with modulation of excessive inflammatory response.We investigated the efficacy of intraoperative lidocaine 2% infusion in reducing the postoperative Fentanyl requirements for analgesia in renal transplant recipients. Patients were assigned equally into two groups by computer-generated list compiled before the start of the study. Control group: fentanyl (F) group and study group: lidocaine 2% (L) group. Medication used is either lidocaine in the dose of 2 mg/kg/h and the other syringe contained saline both have been infused by rate of 10 ml/h. Fentanyl induction dose given for the two groups was 1.5 mcg/kg. Both groups have received extra fentanyl according to their intraoperative analgesic requirements, patients in the lidocaine group received the fentanyl induction dose accompanied by lidocaine 2% 1.5 mg/kg as loading dose, followed by maintenance dose of lidocaine 2% infusion 2 mg/kg/h. After transfer to the PACU nursing staff administered fentanyl 0.5 mcg/kg boluses for postoperative pain relief every 10 min up to 2 mcg/kg, the recovery nurse used the pain numerical score to assess pain. The recovery nurse referred the patient to the responsible anesthesiologist covering the recovery unit if he required more than 2 mcg/kg of fentanyl to control postoperative pain. Patient was then transferred to the RTU (renal transplant unit), postoperative pain and fentanyl PCA consumption were followed up during the first 24 h.ResultsOur study detected increased fentanyl consumption in the recovery for the fentanyl group more than the lidocaine group. The request of the first dose of analgesic was significantly longer in lidocaine group than in fentanyl group.ConclusionThe usage of intraoperative lidocaine infusion decreased postoperative fentanyl requirements as analgesic in patients undergoing renal transplantation.Trial registrationRegistration on ANZCTR number ACTRN12618001335280, REGISTERED 08 August 2018.

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial

IntroductionBilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methodsPatients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. ResultsThe intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01), 30 (p < 0.01) minutes, and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). ConclusionWe concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado

IntroductionBilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methodsPatients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 and 30 minutes and 1, 2, 6, 12, 24 and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. ResultsThe intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01) and 30 (p < 0.01) minutes and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). ConclusionWe concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Comparative Evaluation of IV Paracetamol Versus IV Dexmedetomidine in Inpatient Oral and Maxillofacial Surgery: A Double-Blinded Randomized Controlled Study

Reconstructive surgeries following fractures in the maxillofacial region often involve considerable bone manipulation, and paracetamol is a commonly used analgesic medication in both intraoperative and postoperative periods. Dexmedetomidine, an alpha-2 adrenoceptor agonist, has both sedative and analgesic properties with minimal cardiorespiratory effects and has been used primarily for its sedative properties in oral and maxillofacial surgery. To compare the intraoperative analgesic requirements among patients undergoing oral and maxillofacial surgery who receive IV paracetamol versus IV dexmedetomidine. The time to requirement for the first postoperative analgesic dose and safety and adverse events of both medications were also assessed. In total, 64 patients needing primary reconstructive surgery for facial fractures were recruited and divided into two groups for this double-blinded study. Patients were randomized to receive a preinduction dose of either IV paracetamol 1g (Group P) or IV dexmedetomidine 1µg/kg (Group D). Sedation scores (Ramsay sedation scale), maximal interincisal distance and pain scores at maximal mouth opening (visual analogue scale) were assessed in both groups just prior to and after the administration of the study drugs. After induction, Group P and Group D received a maintenance dose of normal saline and dexmedetomidine (0.5µg/kg/h) during the intraoperative period, respectively. Standard noninvasive cardiorespiratory monitoring was done for the entire duration of surgery. Following extubation, postoperative pain scores and the time to request for first analgesic dose in either group were recorded. The time taken to perform the surgery was comparable in both groups. There was a significant difference between the groups in visual analogue scores and interincisal distance after the bolus dose (p < 0.05). Systolic and diastolic blood pressure was significantly lower in Group D at around 150 and 175min of surgery. While the intraoperative fentanyl consumption was comparable in both groups, the time to request for the first analgesic dose in the postoperative period was significantly delayed in Group P (p < 0.05). No adverse cardiopulmonary events were observed in either group. The intraoperative anesthetic and analgesic requirements and hemodynamic stability were comparable in IV paracetamol and dexmedetomidine groups. Dexmedetomidine did not confer any enhanced analgesia effect in the postoperative period. More research examining the role of dexmedetomidine for longer duration inpatient oral and maxillofacial surgery is needed. http://ClinicalTrials.gov (No. CTRI/2017/08/009468).

Effects of Dexmedetomidine Infusion in different Concentrations on Intraoperative and Postoperative Hemodynamic Response and Analgesic Requirement in Laparoscopic Cholecystectomy Patients

Effects of Dexmedetomidine Infusion in different Concentrations on Intraoperative and Postoperative Hemodynamic Response and Analgesic Requirement in Laparoscopic Cholecystectomy Patients

Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Background: This randomised, double-blind study was designed to assess the analgesic efficacy of dexmedetomidine as compared with fentanyl as an adjunct to local anaesthetic in thoracic epidural for upper abdominal surgeries.Methods: Forty adult patients of American Society of Anesthesiologists grade I–II undergoing upper abdominal surgery were randomly allocated into two groups to receive 50 μg fentanyl or 50 μg dexmedetomidine as an adjunct to 10 ml 0.125% bupivacaine via thoracic epidural. Anaesthesia was induced with morphine, propofol and vecuronium and maintained by isoflurane with 60% nitrous oxide in oxygen. In the postoperative period patient-controlled analgesic pumps were used to deliver similar types of mixtures via the epidural catheter. Patients were evaluated for rescue analgesic requirements, haemodynamic stability, postoperative pain, sedation and any adverse events.Results: The groups were comparable regarding intraoperative analgesic requirements, recovery times and postoperative pain s...

Comparison of Ultrasound Guided Transversus Abdominis Plane Block and Caudal Epidural Block for Pain Relief in Children Undergoing Unilateral Inguinal Herniotomy

INTRODUCTION : Transversus abdominis plane block, is an abdominal field block which has emerged as a simple technique for providing post-operative pain relief in lower abdominal surgeries. It has been widely used in adults and its safety has been improved using ultrasound guidance. There was not much information on its efficacy in paediatric surgeries, in comparison to the most preferred caudal block. AIMS AND OBJECTIVES : To evaluate the efficacy of the Ultrasound-guided Transversus Abdominis Plane Block in comparison with the Caudal Epidural Block, for pain relief in paediatric inguinal hernia repair surgeries METHODOLOGY : Sixty patients belonging to the age group 1-7years, weighing 5-20kg undergoing unilateral inguinal herniotomy were randomly allocated into two groups. Group T (n=30) received USG-guided TAP block with 0.5ml/kg of 0.25% bupivacaine and Group C (n=30) received 1ml/kg of 0.25% bupivacaine, after institution of general anaesthesia via ambu LMA. The intra-operative hemodynamics and analgesic requirement were recorded by a blinded investigator. Pain in the post-operative period was assessed using FLACC pain score. Time to first rescue analgesia, cumulative opioid consumption, along with the incidence of side effects were noted in the first 12hrs of the post-operative period. Statistical analysis was performed using SPSSv16. RESULTS : There was significant variation in heart rate and mean arterial pressure from the baseline in the intra-operative period in Group T, which required supplementation with fentanyl. Whereas the intra-operative haemodynamics were stable in Group C. The duration of postoperative analgesia was 8.6hrs +1.84 in Group T, which was significantly more than that of Group C with a post-operative analgesia lasting for 4.57hrs +1.406. The pain scores and the mean opioid consumption were significantly less with Group T than Group C up to 12hrs in the postoperative period. Time to urine voiding was prolonged in Group C when compared to Group T. CONCLUSION : Caudal epidural block provided better intra-operative analgesia than USG guided TAP block for inguinal hernia repair. USG-guided TAP block provided prolonged post-operative pain relief than single shot Caudal epidural block and reduced the mean opioid consumption in the first 12 post-operative hours.