Intravenous Morphine Research Articles

Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial.

Laparoscopic sleeve gastrectomy (LSG) causes significant postoperative pain, necessitating effective multimodal analgesia strategies. This study evaluated the efficacy of the external oblique intercostal block (EOIB) in this context. This prospective, randomized, controlled, single-blind study conducted between April and December 2023 included 60 patients who underwent LSG. Patients were divided into the EOIB (30 ml 0.25% bupivacaine/side) and control (no block) groups. The primary outcome was the cumulative intravenous (IV) morphine milligram equivalent (MME) consumption in the first 24 h postoperatively. Secondary outcomes included 12-h MME consumption, pain scores, intraoperative remifentanil use, rescue analgesia requirements, time to first analgesic request, nausea/vomiting scores, antiemetic use, and American Pain Society Patient Outcome Questionnaire-Revised Turkish Version (APS-POQ-R-TR) scores. The control group had significantly higher median opioid consumption than the EOIB group at 12 (14.4 vs. 5.8 mg; P < 0.001) and 24 h (25.9 vs. 10.6 mg; P < 0.001) postoperatively. The need for rescue analgesics did not differ significantly (43.3 vs. 23.3%: P = 0.1). The EOIB group exhibited significantly higher patient satisfaction (APS-POQ-R-TR score 2.91 vs. 4.42; P < 0.001) and consistently lower pain scores across all time points (P < 0.001) The EOIB group had lower nausea/vomiting scores (P < 0.001), fewer patients requiring antiemetics (16.7% vs. 40%; P = 0.045), longer time to first morphine request (57.5 vs. 25 min; P < 0.001), and lower remifentanil use (850 vs. 1050 μg; P < 0.001). The preoperative EOIB, as a part of multimodal analgesia, provides effective analgesia for acute pain in patients undergoing LSG.

Optimizing Intravenous Patient-Controlled Analgesia for Cancer Pain: A Randomized Controlled Trial on Adjusted Background Infusion Rates.

Patient-controlled analgesia (PCA) has been considered for managing cancer pain; however, limited research has been conducted on optimizing continuous infusion rates with PCA. This study aimed to evaluate the efficacy and safety of a method that optimizes background infusion (BI) alongside PCA for titrating intravenous (IV) morphine in managing cancer-related pain. Forty-four patients with solid tumors who could not manage pain with oral or transdermal opioid analgesics were randomly assigned in a 1:1 ratio to receive IV morphine through PCA or the conventional method. In the PCA group, the BI rate was automatically adjusted on the basis of the frequency and interval of bolus button presses; contrastingly, BI rate in the conventional group was adjusted at the discretion of the medical staff. The primary outcome was the daily number of patient complaints of breakthrough pain (numeric rating scale ≥4). The PCA group reported a significant decrease in breakthrough pain complaints at 24 hours (median, 0 v 3 times/d; P = .012) and a lower proportion of nonresponders at 24 hours (21% v 55%; P = .048) compared with the conventional group. The total daily IV dose of morphine increased in the PCA group and exhibited a significant difference between two groups within 48 hours (median, 76.80 v 44.42 mg/d; P = .036). No uncontrolled opioid-related adverse effects were observed in either group. PCA, with an optimized BI rate, facilitated faster titration of IV morphine than the conventional method, achieving tolerable and rapid pain relief.

Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study

BackgroundChronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic “startle sign”, which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.MethodsWe performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.ResultsOf the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.ConclusionsHere, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.

The Effect of Magnesium Sulfate plus Ketorolac versus Morphine plus Ketorolac on Pain Relief in Patients with Renal Colic: A Double-blind Randomized Clinical Trial

Background: It seems that magnesium sulfate (MgSO4) can be useful in reducing acute pain caused by stone passing through the ureter by reducing ureteral smooth muscle contractions. Aim: This study aimed to evaluate the effect of MgSO4 plus ketorolac versus morphine plus ketorolac on pain relief in renal colic. Methods: The present double-blind randomized clinical trial was performed on 70 patients with renal colic divided into two groups. Patients in the first group received 30 mg intravenous ketorolac plus 5 mg intravenous morphine while patients in the second group received 30 mg/kg MgSO4 plus 30 mg intravenous ketorolac. Then, patients’ hemodynamic parameters and pain scores were evaluated before and 20, 40, and 60 min after the intervention. Results: Within 60 min of administration, systolic blood pressure was significantly reduced in the morphine plus ketorolac group (P &lt; 0.001) while there was no significant change in the MgSO4 plus ketorolac group in this regard (P = 0.576). In addition, the patients’ mean pain scores were not significantly different between the two groups in any of the studied times (P &gt; 0.05). Conclusion: Given that the addition of MgSO4 to ketorolac, as compared with the addition of morphine (as a drug) to ketorolac, has been associated with fewer complications and greater stability of hemodynamic parameters, it can be stated that the use of MgSO4 as an adjunct can be a good choice for further pain relief in patients with contraindications for drug administrations.

Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial

IntroductionBoth the quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block provide effective postoperative analgesia after hip surgery while minimizing the impact on motor function. This study aimed...

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intravenous Patient Controlled Analgesia for Post-Operative Analgesia in Patients Undergoing Lower Abdominal Surgeries under Spinal Anesthesia

Abstract Background poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Aim of the Work to compare the efficacy of TAP block versus PCA with IV morphine to provide prolonged post-operative analgesia; secondary objective is to identify the side effects of both techniques as post-operative analgesia Patients and Methods The study was conducted on 40 randomly chosen patients aged 21 to 70 years in both sexes, American Society of Anesthesiologists (ASA) class I or II scheduled for elective lower abdominal surgeries under spinal anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. Results TAP block is given in the volume of 20 mL bilaterally, it is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect Also TAP block delay using of postoperative additional analgesia, however PCA analgesic effect last longer, less invasive technique and easier to be used while TAP require hand skills and limited to 24 hours analgesia only. Conclusion In lower abdominal surgery, when TAP block is given in the volume of 40 mL, it is as effective as intravenous PCA in pain treatment. Compared with intravenous PCA, TAP block can be considered as a more preferable method because it can avoid the systemic actions of morphine.

Comparison between Pectoral Plane Block (PECS 1 and 2) and Patient Controlled Intravenous Analgesia after Breast Surgeries

Abstract Background Breast cancer has continued to be the most common cancer among women, accounting for 31% of all new cancer cases in the female population. Every/ year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers. Aim of the Work The primary aim of this study is to compare the efficacy of PECS 1,2 block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques, as well as intra-operative analgesia. Patients and Methods A randomized controlled Clinical trial in Ain Shams University Hospitals, Cairo, Egypt (EL Demrdash hospital and Combined operations) for 6 months carried out on women who undergo breast surgeries. Results The Results shows that the VAS score in the PECS group was highly significant lower at the 1st, 2nd and 4th hours postoperative, the time interval for the 1st dose of rescue analgesia was higher in PECS group, there was significant difference regarding heart rate and blood pressure between both groups at 1st, 2nd, 4th and 8th hours postoperative in favor for PECS group, regarding o2 saturation it was significant only after 1 hour postoperative, regarding nausea and vomiting there was significant difference in nausea in favor for PECS block while regarding vomiting it was non- significant, regarding sedation it didn’t occur in neither group so it was not applicable. Conclusion In modified radical mastectomy, PECS block is more effective than intravenous PCA in pain management postoperative, better effect on vital data like heart rate, blood pressure and o2 saturation, it also lowers the analgesic drugs consumption postoperative. Moreover, PECS block is more preferable method because it avoids the systemic side effect of morphine used for PCA like nausea and vomiting. PCA analgesic effect needs time to start its action.

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department

BackgroundUltrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED.MethodsThis open-label randomised controlled trial was conducted in the ED...

Effects of Serratus Anterior Plane Block on Early Recovery from Thoracoscopic Lung Resection: A Randomized, Blinded, Placebo-controlled Trial.

The efficacy of serratus anterior plane block for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of serratus anterior plane block on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection. Patients undergoing minimally invasive anatomic lung resection at a single center were randomized to undergo serratus anterior plane block with 40 ml injectate containing bupivacaine 0.25%, clonidine 100 μg, and dexamethasone 4 mg (serratus anterior plane block group) or sham block with 40 ml normal saline (placebo group) at the conclusion of surgery. The primary outcome was cumulative intravenous morphine equivalents during the first 24 h postoperatively. Secondary outcomes were intravenous morphine equivalents, pain scores at rest and with cough, inspiratory volume on incentive spirometry, incidence of nausea or vomiting during the first 48 h postoperatively, Quality of Recovery-15 score on postoperative day 7, and length of stay. Using the protocol-specified intention-to-treat analysis, the median (interquartile range) intravenous morphine equivalents was 10.6 (5.0 to 27.1) mg in serratus anterior plane block patients (n = 46) versus 18.8 (9.9 to 29.6) mg in placebo patients (n = 46; 32% reduction; ratio, 0.68 [95% CI, 0.44 to 1.06]; P = 0.085). Of the secondary outcomes, only the composite pain with cough scores differed significantly in the serratus anterior plane block group by a coefficient of -0.41 (95% CI, -0.81 to -0.01; P = 0.044). A sensitivity as-treated analysis reported median (interquartile range) intravenous morphine equivalents of 10.0 (5.0 to 27.2) mg in serratus anterior plane block patients (n = 44) versus 19.9 (10.4 to 29.0) mg in placebo patients (n = 48; 36% reduction; ratio, 0.64 [95% CI, 0.41 to 1.00]; P = 0.048). The protocol-specified intention-to-treat analysis demonstrated that serratus anterior plane block did not result in a significant reduction in opioid consumption when added to a multimodal analgesic regimen after thoracoscopic anatomic lung resection. The sensitivity as-treated analysis showed a significant and modest clinical reduction in the primary outcome that warrants further investigation.

FP4.13 - Intravenous morphine negatively affects length of stay following minimally invasive colorectal surgery

Abstract Aim Investigate the impact of intravenous (IV) morphine administered as patient controlled analgesia (PCA) following minimally invasive colorectal resections. Method Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre. Results Our cohort included 38 colorectal resections completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform and 57 consecutive laparoscopic colorectal resections. 7 patients were excluded due to incomplete data. 51/88 (57.9%) of patients underwent a left sided resection and 24/88 (27.3%) had a stoma formed. We observed a median IV morphine dose of 15.5mg (IQR 15.5-43.5mg) and we sub-divided the cohort into those who received &amp;gt;15 mg of IV morphine and &amp;lt;15mg of morphine via PCA. Patients who received &amp;lt;15mg IV morphine were older (median age 75 Vs 67 years; p&amp;lt;0.001). There was no statistical difference in the body mass index, ASA grade, total operative time, or type of minimally invasive resection. The median length of stay was 4 days for the &amp;lt;15mg IV Morphine cases compared to 5 in the &amp;gt;15mg IV Morphine group (p&amp;lt;0.001). As expected, there was a quicker time to first flatus in the &amp;lt;15mg IV Morphine group (median 2 days Vs 3 days; p&amp;lt;0.001) and a shorter time to opening bowels (median 3 days Vs 4 days; p=0.003). There was no statistically significant difference in post-operative complications between the two groups. Conclusions Reducing postoperative IV Morphine dosing following minimally invasive colorectal resections may lead to prompter recovery.

The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis

BackgroundOpen liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection.MethodsA retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects.ResultsA total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001).ConclusionsEpidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance.Trial registrationThe study was registered in the Clinical Trials Registry at www.clinicaltrials.gov/, NCT number: NCT06301932.

Intraoperative landmark-based genicular nerve block versus periarticular infiltration for postoperative analgesia in total knee arthroplasty: a randomized non-inferiority trial

IntroductionGenicular nerve blocks (GNBs) are an emerging technique that have been used as a part of multimodal analgesia for total knee arthroplasty. The efficacy of intraoperative landmark-based GNBs, a recently...

Addition of Dexmedetomidine to Propofol Anesthesia for Middle-Ear Surgeries: A Prospective Randomized Double-Blind Study.

Background Middle-ear surgery commonly performed under a microscope requires a bloodless field provided by hypotensive anesthesia. Our objective wasto study the effects of dexmedetomidine on propofol consumption and intraoperative hemodynamic stability. Methods One hundred adults undergoing elective middle-ear surgery were randomized into two groups. The propofol+dexmedetomidine group (Group PD) received a loading dose of dexmedetomidine 1μg/kg in 10ml normal saline over 10min followed by infusion of the same at 0.5μg/kg/h. Propofol-only group (Group P) received 10ml normal saline over 10min followed by an infusion of the same. General anesthesia was induced with intravenous morphine, propofol, and vecuronium, and maintained with propofol, oxygen, and N2O. During microscope use, we aimed to maintain mean arterial pressure (MAP) within 60-69mmHg. Results There was no significant difference in the mean (SD) consumption of propofol [Group P 8.6 (2.1)mg/kg/h vs Group PD 8.1 (1.5)mg/kg/h, P=0.172]. The induction dose of propofol was significantly less in Group PD [1.8 (0.3) vs 2 (0.4)mg/kg, P<0.001]. Except for the baseline value, the heart rate was significantly lower in Group PD, P<0.001. The time duration during which MAP was within 60-69mmHg was higher in Group P [37.5 (36.8) vs 30.9 (38.3)min] though the difference was not statistically significant. The recovery was delayed in Group PD [25.4 (8.6) vs 17.6 (4.9)min, P<0.001]. Group PD had a significantly better operative field, P=0.0003. Conclusion The addition of dexmedetomidine did not reduce propofol consumption but reduced the induction dose of propofol. Propofol and dexmedetomidine combination provided comparable mean arterial pressure and better operative field but caused delayed recovery.

Negative allosteric modulation of CB1 cannabinoid receptor signalling decreases intravenous morphine self-administration and relapse in mice.

The endocannabinoid system interacts with the reward system to modulate responsiveness to natural reinforcers, as well as drugs of abuse. Previous preclinical studies suggested that direct blockade of CB1 cannabinoid receptors (CB1R) could be leveraged as a potential pharmacological approach to treat substance use disorder, but this strategy failed during clinical trials due to severe psychiatric side effects. Alternative strategies have emerged to circumvent the side effects of direct CB1 binding through the development of allosteric modulators. We hypothesized that negative allosteric modulation of CB1R signalling would reduce the reinforcing properties of morphine and decrease behaviours associated with opioid misuse. By employing intravenous self-administration in mice, we studied the effects of GAT358, a functionally-biased CB1R negative allosteric modulator (NAM), on morphine intake, relapse-like behaviour and motivation to work for morphine infusions. GAT358 reduced morphine infusion intake during the maintenance phase of morphine self-administration under a fixed ratio 1 schedule of reinforcement. GAT358 also decreased morphine-seeking behaviour after forced abstinence. Moreover, GAT358 dose dependently decreased the motivation to obtain morphine infusions under a progressive ratio schedule of reinforcement. Strikingly, GAT358 did not affect the motivation to work for food rewards in an identical progressive ratio task, suggesting that the effect of GAT358 in decreasing opioid self-administration was reward specific. Furthermore, GAT58 did not produce motor ataxia in the rotarod test. Our results suggest that CB1R NAMs reduced the reinforcing properties of morphine and could represent a viable therapeutic route to safely decrease misuse of opioids.

Comparison of low-dose ketamine to methadone for postoperative pain in opioid addicts: a randomized clinical trial.

Postoperative pain can lead to several complications. The effectiveness of different opioids in relieving pain after surgery has been widely studied. However, managing pain in patients with opioid addiction is still challenging. This study aimed to examine the impact of ketamine and methadone on postoperative pain in patients with addiction. This was a non-inferiority randomized clinical trial. All included patients were monitored for morphine use, pain scores, and vital signs every 3 h. The intervention group received 0.5 mg/kg ketamine administered intravenously every 6 h. The control group received 5 mg of methadone intramuscularly every 8 h. The patient received intravenous morphine if their visual analog scale was above 3. All side effects in each group were recorded. Two hundred and twenty patients were included in this study. There were 127 men (57.7%) with an average age of 57.1 ± 19.5 and 93 women (42.3%) with an average age of 57.1 ± 21.0. There were no significant differences in demographic characteristics between the groups. There was no significant difference in the dose or frequency of morphine administration between groups. There was no significant difference between the groups in pain scores and vital signs at different time points. Drug side effects, including delirium and gastrointestinal symptoms, did not differ significantly between the methadone and ketamine groups. Our clinical data support the hypothesis that ketamine is not inferior to methadone in patients with addiction. Future randomize clinical trials are needed to confirm these observations.

Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections.

Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th,and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.

Effect of Fentanyl Compared to Morphine on Pain Score and Cardiorespiratory Vital Signs in Out-of-Hospital Adult STEMI Patients

Objective: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality in Australia. Paramedics treating adults with STEMI in the out-of-hospital environment can use fentanyl or morphine to manage the patient’s pain, although there is little research comparing the efficacy and safety of these drugs. Therefore, the objective of this study was to compare the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in adult STEMI patients in the out-of-hospital environment. Methods: We conducted a retrospective analysis of records of 1902 STEMI cases attended by Queensland Ambulance Service paramedics during the 4-year interval from 2013 to 2016. We compared pain score, blood pressure, respiratory rate, and pulse rate between patients administered intravenous fentanyl and intravenous morphine. We used a two-way mixed effects model (drug, time) to assess for main and interaction effects, and where the interaction effect was significant, applied Mann-Whitney U tests to further analyze between-group differences at each time point. Results: We observed a significant main effect of time on pain score (p &lt; 0.001), respiratory rate (p &lt; 0.05), and pulse rate (p = 0.025), such that these variables all decreased over time. Additionally, we observed a significant drug-time interaction for systolic and diastolic blood pressures (both p &lt; 0.01), such that blood pressures decreased over time in the morphine, but not fentanyl, group. Conclusion: We compared the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in out-of-hospital adult STEMI patients and observed differences in blood pressures only. Morphine appeared to have a depressive effect on systolic and diastolic blood pressure, whereas fentanyl did not. An unanticipated behavioural finding of this research is that, in the absence of a definitive guideline, paramedics appear to use fentanyl when patients may be at risk of developing hypotension.

Comparison of Outcomes of Intravenous Dexamethasone Versus Placebo as Adjunct to Local Anaesthetic Brachial Plexus Block for Upper Limb Surgery

Introduction: Dexamethasone has been tested in combination with different local anesthetics with varying degree of results including increase in intensity and duration of block. Objectives: To compare the outcomes of intravenous dexamethasone versus placebo as adjunct to local anesthetic brachial plexus block for upper limb surgery. Study design: Randomized controlled trial Setting: Department of Anesthesia, pain management and intensive care Holy Family Hospital, Rawalpindi. Study duration: 7th November 2019 till 6th May 2020. Materials &amp; Methods: A total of 10 0 patients of either gender aged 18 to 60 years admitted for upper limb surgery were included. Patients with pregnancy, DM, block failure and contraindication to brachial plexus block were excluded. Patients in group A received a block injection with 30ml of 0.5% bupivacaine along with 2ml of intravenous dexamethasone. Group B patients received 30ml of 0.5% bupivacaine for block injection and 2ml of normal saline intravenously. Block success was confirmed using the sensory and motor examination of the upper limb. Block duration was recorded in hours, opioid consumption was recorded in intravenous morphine equivalents in first 24 hours, visual analogue scores for pain on scale of 0-10 at upper limb at rest was recorded at 8 and 24 hours. Results: In our study, duration of local anesthetic brachial plexus block in dexamethasone and placebo group were 16.12 ± 1.33 hrs and 9.77 ± 1.26 hrs respectively with p-value = 0.0001. Opioid consumption in Morphine Equivalents at 24 hrs in local anesthetic brachial plexus block and placebo group were 16.48 ± 2.60 vs 22.68 ± 3.78 with p-value &lt; 0.0001 respectively. Conclusion: This study concluded that intravenous dexamethasone has better outcomes as compared to intravenous saline as adjunct to local anesthetic brachial plexus block for upper limb surgery.

The Feasibility, Safety and Outcome of Very High-Power Short Duration Radiofrequency Ablation in Pulmonary Vein Isolation: A Real-World Observation Study.

Pulmonary vein isolation (PVI) ablation is the established gold standard therapy for patients with symptomatic drug refractory atrial fibrillation (AF). Advancements in radiofrequency (RF) ablation, have led to the development of the novel contact force-sensing temperature-controlled very high-power short-duration (vHPSD) RF ablation. This setting delivers 90 W for up to 4 seconds with a constant irrigation flow rate of 8 mL/min. The aim of this study was to compare procedural outcomes and safety with conventional radiofrequency ablation. An observational study was conducted with patients who underwent first time PVI ablation between August 2020 and January 2022. The cohort was divided into: (1) vHPSD ablation; (2) High-power short duration (HPSD) ablation; (3) THERMOCOOL SMARTTOUCH™ SF (STSF). The vHPSD ablation group was prospectively recruited while the HPSD and STSF group were retrospectively collected. Primary outcomes were procedural success, PVI duration, ablation duration and incidence of perioperative adverse events. Secondary outcomes were intraprocedural morphine and midazolam requirement. A total of 175 patients were included in the study with 100, 30 and 45 patients in the vHPSD, HPSD and STSF group, respectively. PVI was successfully attained in all vHPSD patients. vHPSD demonstrated significantly reduced time required for PVI and total energy application in comparison to the HPSD and STSF groups (67.7 29.7 vs. 92.9 25.7 vs. 93.6 29.1 min, p 0.0001; 9.87 4.16 vs. 33.9 7.49 vs. 36.0 10.5 min, p 0.0001, respectively). Intravenous morphine and midazolam requirement was lower in the vHPSD group compared to the HPSD and STSF groups (10.2 3.43 vs. 16.1 4.58 vs. 15.3 3.94 mg, p 0.0001; 4.04 3.24 vs. 8.63 5.22 vs. 8.58 4.72 mg, p 0.0001). One cardiac tamponade was observed in both the vHPSD and HPSD groups while the STSF group exhibited an embolic stoke and two pericardial effusions that did not require drainage. In this study, vHPSD demonstrated a comparable safety profile to the other treatment arms. Procedural duration and energy application time was substantially reduced along with sedation requirement notwithstanding the limitations of observational study design, these preliminary findings are promising with respect to periprocedural outcomes and safety of vHPSD however longitudinal outcomes will be essential to assessing the overall efficacy of this novel technology.

A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy

Abstract Background Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery. Aim of the Work The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques. Patients and Methods This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation. Results The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant. Conclusion In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.