Long-acting Local Anesthetic Research Articles

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

758 Pre-Incisional Infiltration of Local Anaesthetic Is Associated with Reduced Intra-Operative Fentanyl Requirements and Lower Pain Scores in Recovery

IntroductionEffective pain management is a pivotal component of day-surgical pathways. Intra-operative regional infiltration of long-acting local anaesthetic (LA) has been shown to be efficacious in reducing post-operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use.MethodPatients undergoing day-case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol-based general anaesthetic. Primary outcomes were intra-operative/post-operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post-operatively). The study ran from October 2019 but was suspended during the COVID-19 pandemic. Non-parametric statistical tests were used.Results25 patients were randomised. Those receiving pre-incisional LA had lower fentanyl requirements intra-operatively (mean; 150mcg vs 186mcg, p < 0.05) but similar requirements post-operatively. Mean pain scores were lower in the pre-incisional LA group at 1 hour (1.2 vs 2.3, p < 0.05) and 3 hours post-operatively (0.7 vs 1.3, p > 0.4).ConclusionsPre-incisional infiltration of LA led to a significantly reduced requirement for intra-operative fentanyl, and significantly lower pain scores at 1 hour post-operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.

Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study.

Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator. Percutaneous peripheral nerve stimulation has been used extensively for chronic pain, but only uncontrolled series have been published for acute postoperative pain. The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption. Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery (e.g., hallux valgus correction), the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption (in oral morphine equivalents) and (2) mean values of the "average" daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days. During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median (interquartile range) of 5 mg (0 to 30) versus 48 mg (25 to 90) in patients given sham treatment (ratio of geometric means, 0.20 [97.5% CI, 0.07 to 0.57]; P < 0.001). During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham (difference, -1.8 [97.5% CI, -2.6 to -0.9]; P < 0.001). Percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery.

In vitro and in vivo evaluation of a lidocaine loaded polymer nanoparticle formulation co-loaded with lidocaine for local anesthetics effect

There is a crucial need for long-acting local anesthetics (LAs) that can be administered as single dose analgesics. However, owing to their low molecular mass, LAs (lidocaine, bupivacaine, procaine, ropivacaine, and benzocaine) display rapid and complete absorption. The goal of the current study (LDC@LPHNs) was to progress and assess lidocaine (LDC) hybrid lipid-polymer nanoparticles (LPHNs) in comparison to LDC-loaded PLGA NPs (LDC@NPs). The morphology, zeta potential, particle size, and drug loading abilities of the newly fabricated materials were examined. The self-assembled LDC@LPHNs combined with PLGA, DSPE-PEG2000, and lecithin were approximately 180 nm in size, were larger than LDC@LPHNs and LDC@NPs and showed a protracted in vitro drug release profile in PBS solution. Additionally, the LDC@LPHNs exhibited improved stability and less in vitro cytotoxicity. Furthermore, in vivo examination of the anesthetic properties in mice models showed that the LDC@LPHNs displayed remarkable protracted analgesic durations, which was further confirmed through histological examinations. These outcomes establish that the LDC@LPHNs could purpose as a potential framework of drug conveyance to address the disadvantages of less stability, quick release of drug, and to extend anesthetic effects with less toxicity.

Pericapsular nerve group block: an overview.

The PENG block is a recently described ultrasound-guided technique for the blockade of the sensory nerve branches to the anterior hip joint capsule. It was described as an analgesic block for the acute pain management after hip fracture, while subsequent studies expanded the original indication. The aim of this narrative review was to summarize the existing knowledge about the PENG block from the anatomical bases and to provide an up-to-date description of the technique, applications and effects. We reviewed the following medical literature databases for publications on PENG block: PubMed, Google Scholar, EMBASE, and Web of science until August 31st, 2020. Data regarding anatomy, indications, drugs and technique were also collected, reported and discussed. From our search result we selected 57 relevant publications. Among them, 36 were case reports or case series and 12 publication were letters or correspondence; no RCT was identified. The main indication is the hip-related analgesia. The most commonly injected drug is a 20ml long-acting local anesthetic. There are some cases of femoral and obturator nerve block, but no major complication such as hematoma/bleeding or needle-related organ injury has been reported yet. The PENG block is a promising technique. Randomized controlled trials of high methodological quality are required to further elaborate the role of this block.

Perineural and intravenous dexamethasone and dexmedetomidine: network meta-analysis of adjunctive effects on supraclavicular brachial plexus block.

Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

Comparative evaluation of levobupivacaine-fentanyl and ropivacaine - fentanyl in epidural anaesthesia in lower limb orthopaedic surgeries in elderly patients

Epidural blockade with levobupivacaine and ropivacaine, the two new long-acting local anaesthetics, have been preferred in elderly due to low cardiac and central nervous system toxicity.A randomized prospective study was conducted on 100 patients having age 60-85 yr of ASA physical status I, II and III admitted for elective lower limb orthopaedic surgeries under epidural anesthesia. Patients were randomly divided into two groups, Group A received epidural levobupivacaine 0.5% (13ml) and Group B received ropivacaine 0.75% (13ml), both with fentanyl 100 µg (2ml). Time of onset, peak level and time to attain peak level of the sensory block &amp; time of regression upto two segment along with duration of analgesia were noted. Onset time and duration of motor block, hemodynamics and adverse effects were also compared in the two groups. Onset time of sensory block in group A was 5.74±0.66 minutes, while it was 5.68±0.62 minutes in group B.Maximum sensory block was attained in 8.58 ± 0.81 minutes in group A and 8.52 ± 0.84 minutes in group B. 134.2±8.10 minutes were taken for two segment regression in group A, while the time taken in group B was 134±10.88 minutes. Motor blockade mean onset time was 20±3.35 minutes and 20.2±3.64 minutes in group A and group B respectively. The mean duration of motor block in group A was 248.4±13.60 minutes and 247.8±13.29 minutes in group B. The mean duration of analgesia was 382±18.63 minutes in group A, while it was 382.4±15.98 minutes in group B. Results were comparable with regards to sensory and motor blockade parameters, hemodynamics and adverse effects. Both 0.5% levobupivacaine and 0.75% ropivacaine with fentanyl as adjuvant are effective and comparable for epidural anaesthesia in elderly patients with regard to sensory and motor block characteristics along with similar hemodynamic profile.

Preparation of ropivacaine-loaded mesoporous bioactive glass microspheres and evaluation of their efficacy for sciatic nerve block

Local anesthetics are mainly used for regional anesthesia and analgesia. However, the duration of action is limited in clinical applications. In the present study, we developed a ropivacaine (RPC)-loaded mesoporous bioactive glass (MBG) microspheres for an extended analgesic duration. First, MBG microspheres were prepared using a template synthesis method. RPC was then loaded into the MBG microspheres through immersion, followed by centrifugation and drying. Finally, the RPC-loaded MBG microspheres were coated with a polylactic acid-b-polyethylene glycol (PLA-PEG) copolymer to obtain RPC-MBG composite microspheres (RPC microspheres). The particle size and zeta potential of the RPC microspheres were 192.3 ± 9.6 nm and −35.6 ± 3.5 mV, with entrapment efficiency (EE) of 88.2 ± 3.2% and low cytotoxicity. In vitro, the release profile of RPC microspheres exhibited a biphasic pattern: an initial release burst within the first hour, followed by subsequent slower and sustained release. After performing a single-shot sciatic nerve block, a fast the anesthetic effect and prolonged analgesic effect were achieved. Given the low cytotoxicity and sustained release, the RPC microspheres developed in this study could be used as a long-acting local anesthetic.

Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Peripheral Nerve Block - Three Prospective Randomized Controlled Studies

Abstract Introduction Peripheral nerve blocks are frequently used as the sole anesthetic technique or as an adjuvant to general anesthesia, However, the duration of sensory nerve block after single doses of long-acting local anesthetics is not consistent enough to avoid the use of postoperative opioids. Many adjuvants have been added to prolong the duration of nerve block, It was recently suggested that, based on current evidence, perineural dexmedetomidine is the most promising adjuvant to extend the duration of long-acting local anesthetics Aim The aim of this work is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in various peripheral nerve blocks. The study will include: supraclavicular brachial plexus block, paravertebral block and femoral nerve block. Patients Adult patients of either sex aged 25 – 60 years, ASA physical status I and II, Elective surgeries appropriate for the nerve block. Methods patients received bupivacaine 0.5% alone in (group I) or bupivacaine 0.5% combined with 100 dexmedetomidine (group II) in peripheral nerve blocks. Motor and sensory block onset times; durations of blockades and analgesia were recorded Results Sensory and motor block onset times were shorter in group II than in group I. Sensory and motor blockade durations were longer in group II than in group I. Duration of analgesia was longer in group II than in group I. Systolic, diastolic arterial blood pressure levels, and heart rate were less in group II. Conclusion In the current study, it was obvious that:(Addition of dexmedetomidine to bupivacaine in supraclavicular nerve block, paravertebral nerve block and femoral nerve block has shortened the onset times of both sensory and motor blocks and significantly prolonged their durations, Dexmedetomidine had also the added effect of sedation with minimal side effects, which makes it a beneficial adjuvant to local anesthetics in peripheral nerve blocks, Addition of dexmedetomidine to bupivacaine prolonged the postoperative analgesia with subsequent consumption of less amount of analgesics and The use of ultrasonography in performing nerve blocks significantly reduced the incidence of complications such as pneumothorax or intra-arterial injection and hence, lowered the incidence of systemic toxicity of local anesthetics).

Clinical Pharmacokinetics and Pharmacodynamics of Levobupivacaine.

Levobupivacaine is a long-acting amide local anaesthetic used in analgesia and anaesthesia. Like other local anaesthetic drugs, levobupivacaine exhibits effects on motor and sensory nerves by inhibiting the opening of voltage-gated sodium channels, and hence propagation of neuronal action potentials. Levobupivacaine is the S(-) stereoisomer of dextrobupivacaine, although both are used commercially in the racemic form bupivacaine. A favourable safety and drug effect profile for levobupivacaine has led to widespread use. Levobupivacaine is generally well tolerated but dose adjustment is important in populations such as paediatrics and the elderly. The pharmacokinetic properties of levobupivacaine are similar to that of bupivacaine; both extensively metabolised in the liver, and excreted in the urine and faeces. In vitro, animal model and human studies confirm a lower risk of cardiac and central nervous system toxicity with levobupivacaine compared with bupivacaine. Clinical trials of relative potency are impaired by the variability in chosen endpoints for sensory and motor function blockade, but clinically significant differences in potency are minor, with most clinical trials showing similar duration and quality of anaesthesia between levo- and racemic bupivacaine. In practice, levobupivacaine is most commonly used in regional anaesthesia, neuraxial anaesthesia and local infiltration analgesia. This review includes an appraisal of evidence from clinical trials of the pharmacokinetic and pharmacodynamic properties of levobupivacaine.

Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

Background Caudal block is the most common anaesthetic technique employed in children for managing perioperative pain of inguino-scrotal surgery. However, despite using longacting local anaesthetics, caudal analgesia lasts relatively shorter. Dexmedetomidine, an alpha-2 agonist, augments local anaesthetic action. Objective To assess the analgesic effect of caudal Dexmedetomidine. Method This is a randomized, double-blinded study conducted on otherwise healthy children (one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia was administered and a laryngeal mask airway was inserted for assisting ventilation. The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/ kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and ventilation were titrated to maintain monitored hemodynamic variables within 15% from baseline values. The primary endpoint comprised the duration of analgesia, defined by a time when postoperative pain score (face, legs, activity, cry, consolability; FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours. Student's t-test and Chi-square test were used for analysis, with p-value less than 0.05 considered as significant. Result Demographic, surgical, and anaesthetic characteristics were similar between the groups. Duration of analgesia was significantly prolonged in group B (group B, 413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for supplement Fentanyl was significantly reduced in group B. Adverse events were comparable between the groups. Conclusion Dexmedetomidine prolongs the duration of analgesia when mixed with caudal Bupivacaine, without increasing adverse events.

Computed Tomography-Guided Percutaneous Infiltrations for Piriformis Syndrome: A Single-Center Retrospective Study.

Piriformis syndrome (PS), first described by Yeoman in 1928, is a general term referring to low back pain, sciatica, and instability. PS has a 6% incidence rate worldwide. In this study, we aim to retrospectively evaluate the effectiveness of computed tomography (CT)-guided percutaneous infiltration in a series of consecutive PS patients who have symptoms that are refractory to conservative therapies. An institutional database search identified 20 such consecutive patients who underwent infiltration with a mixture of long-acting corticosteroid and local anesthetic. Preoperational evaluation included physical examination and magnetic resonance imaging. The correct position of the 22-gauge spinal needle was verified with CT scan after contrast medium injection. Pain measured before the procedure and at 1 wk and 1, 6, and 12 mo after the procedure was compared by means of a numeric visual scale (NVS) questionnaire. The mean pain score before CT-guided percutaneous infiltration was 8.95 ± 1.432 NVS units. This score was reduced to a mean value of 0.85 ± 0.933 units at 1 wk, 0.90 ± 0.852 at 1 mo, 1.10 ± 1.165 at 6 mo, and 1.20 ± 1.399 at 12 mo follow-up (p < 0.001). Two patients of 20 (10%) underwent a second infiltration that was performed at 7 and 10 d after the first, respectively. No complications were observed. CT-guided infiltration seems to be a feasible, efficacious, and safe approach for pain reduction and mobility improvement in patients with symptomatic PS.

The role of clinical pharmacology in enhanced recovery after surgery protocols: a comprehensive review.

Clinical pharmacology has had an enormous impact in the development of anaesthesia practice. Improvement in drugs and the use of long-acting local anaesthetics in peri-pheral nerve blocks have reduced hospital stays and opioid consumption in both the hospital and ambulatory surgery settings. Ambulatory surgery centres are revolutionary because they provide an alternative to hospital-based outpatient services and generally provide favourable patient outcomes. Enhanced recovery after surgery (ERAS) was established in 2001 to improve patient care and increase the number of available ambulatory surgery centres. ERAS protocols arose out of the need to decrease physiological and psychological surgical stress with an emphasis on clinical pharmacology and recovery data. Overall, ERAS aims to reduce unfavourable sequelae, shorten the length of hospital stay, reduce costs, and improve patient recovery. Surgical subspecialties have embraced the philosophy of ERAS, creating unique protocols to meet their patients' needs. There are ERAS guidelines available for nearly every specialty in healthcare, and ambulatory surgery is no exception. The goal of ERAS guidelines is to reduce patient recovery times and improve patient outcomes, with a heavy emphasis on clinical pharmacology data.

Comparative study of two different doses of dexmedetomidine as an adjuvant to bupivacaine in the peripheral nerve block

Background: The duration of analgesia in the brachial plexus block (BPB) with local anesthetics (LAs) only is not sufficient to avoid the requirement of analgesia for breakthrough pain. Dexmedetomidine (DEX) is an upcoming adjuvant with long-acting LA to reduce the requirement of analgesics in the postoperative period. However, there is no documented consensus about the dose of DEX in this regard. Aim: We compared two doses of DEX with LA in the BPB to find out the effectiveness of analgesia and other effects. Materials and Methods: All patients were separated into two groups, namely Group A (0.5 μg/kg DEX added to 20 mL of 0.25% bupivacaine) and Group B (1.0 μg/kg DEX added to 20 mL of 0.25% bupivacaine). Thirty patients in each group were analyzed. The sample size was estimated with a type I error of 0.05 and a power of the study as 80%. Statistical analysis was performed using SPSS (version 13.0) software. Rescue analgesia was decided as injection morphine (0.05–0.15 mg/kg) intramuscularly as indicated. Results: The mean time of onset of sensory analgesia (18.04 ± 3.195 vs. 12.20 ± 1.848 min) and motor blockade (23.7 ± 2.8 vs. 17.3 ± 1.7 min) were comparable (P

Bupivacaine Extended-Release Liposomal Injection Versus Bupivacaine HCl for Early Postoperative Pain Control Following Wrist Operations: A Prospective, Randomized Control Trial

This study evaluated pain control after wrist operations using a long-acting local anesthetic, liposomal bupivacaine, compared with the standard local anesthetic, bupivacaine HCl. Patients undergoing elective carpometacarpal joint arthroplasty and proximal row carpectomy were eligible. Those meeting inclusion criteria were enrolled before surgery and were randomized to receive an intraoperative injection of liposomal bupivacaine or bupivacaine HCl. Primary outcomes included intraoperative and postoperative opioid requirements and pain levels. On the first 4 postoperative days, phone contact assessed pain level by numeric rating scale, number of opioids taken in each 24-hour period, and efficacy of anesthesia and opioid side effects with overall benefit of analgesia score. Postoperative pain scores for 52 patients measured by numeric rating scale demonstrated that liposomal bupivacaine and bupivacaine HCl were similar for pain control. Painscores and opioid use were similar during the first 4 postoperative days. Opioid use on day 1 was slightly lower with liposomal bupivacaine. There were no statistically significant differences in any postoperative outcome between groups. Liposomal bupivacaine and bupivacaine HCl have similar effects in the treatment of early postoperative pain after trapeziometacarpal suspension arthroplasty and proximal row carpectomy. Neither drug demonstrated a clear advantage in this study. Therapeutic II.

Study of Ropivacaine Block to Reduce Post-Operative Pain after Strip Harvesting, and the Relationship of Strip Width to Post-Operative Pain

Introduction: The strip method of follicle harvesting (FUT) has great advantages but post-operative pain and the fear of pain are common complaints of this surgery. The severity of post-operative pain is in direct relation to the width of the strip harvested. It is mandatory to reduce post-operative pain to make this method more acceptable for patients. Objective: Our objective was to determine the effect of strip width and ropivacaine (a long-acting local anaesthetic) infiltration on post-operative pain after strip excision (FUT) surgery. Method: Grading was performed by the authors for the severity of post-operative pain and post-operative sleep disturbance. In Study I (control), the initial data, pain severity, and sleep disturbance was collected from patients on whom a 2cm-wide strip was excised centrally and 1.5cm-wide strip was excised laterally. In the test group, post-operatively, ropivacaine 0.5% was infiltrated below the suture line after 2cm-wide strip excision. In Study II, the strip was excised 1.5cm centrally and 1cm laterally. Again in the test group, ropivacaine infiltration was performed post-operatively while in the control group no ropivacaine was infiltrated. Data was collected and analysed. Observation: There was significant pain in patients where the strip width was 2cm centrally as compared to patients where the strip width was 1.5cm centrally. There was significant reduction of pain in those with strip width 1.5cm centrally and infiltration with ropivacaine was done. Conclusion: The severity of pain is directly proportional to the width of strip harvested. The post-operative infiltration of ropivacaine 0.5% along the suture line significantly reduced post-operative pain.

Haemodynamic Stability After Paracervical Block: A Randomized, Controlled, Double-blind Study Comparing Bupivacaine-Adrenaline With Bupivacaine

(Acta Anaesthesiol Scand. 2018. Doi:10.1111/aas.13259) For gynecologic procedures involving the cervix or uterus, long-acting local anesthetics like bupivacaine, administered via paracervical block, can provide a significant reduction in postoperative pain scores. Adrenaline can be added to local anesthetics to reduce toxicity potential. However, there are few data available regarding the frequency and magnitude of hemodynamic changes in patients when adrenaline is added to local anesthetics. In this randomized controlled trial, the authors examined hemodynamic stability after paracervical block in healthy patients given bupivacaine with and without adrenaline.

Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery. We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded. Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4s) compared with Ropivacaine (104.1 ± 17.7s) with significant differences (p= 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p= 0.001) and postoperative analgesia (p= 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p< 0.001 and p< 0.001 respectively. The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.

Infiltration of bupivacaine into the preperitoneal space and trocar incisions of patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernia: a prospective randomized controlled observational study.

IntroductionAlthough laparoscopic repair of inguinal hernia is associated with reduced postoperative pain, it is not entirely painless. In addition to reducing the need for analgesic medication, postoperative complications, and hospitalization, postoperative pain control enables early return to normal activity.AimTo evaluate the efficacy of bupivacaine instilled into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia.Material and methodsBupivacaine was instilled into the pre-peritoneal space and trocar incisions of the patients in group I (n = 23), whereas it was infiltrated only into the trocar incisions of the patients in group II (n = 21). No local anesthetic was administered to the patients in group III (n = 21). Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4 and 24 h, and the dosage of analgesic medication was noted.ResultsNo significant difference regarding age, gender, body mass index, ASA class, history of abdominal surgery, or smoking was noted between the three groups (p > 0.05). VAS score at 4 h was significantly higher in group III than in groups I and II (p < 0.05). The dosage of analgesic medication was significantly higher in group III than in groups I and II (p < 0.05), with no significant difference between groups I and II (p > 0.05).ConclusionsInfiltration of long-acting local anesthetic into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic TEP repair of inguinal hernia reduces the need for analgesic medication by reducing early postoperative pain.

Dose-response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple-blind trial.

Perineural dexamethasone has a ceiling dose of 4mg for prolongation of analgesia duration after injection of long-acting local anaesthetic for peripheral nerve block, but evidence for doses <4mg is lacking. This randomised controlled triple-blind trial tested the hypothesis that increasing doses of perineural dexamethasone between 1mg and 4mg would prolong the duration of analgesia in a dose-dependent manner. Eighty ASA physical status 1-2 patients scheduled for shoulder arthroscopy under general anaesthesia with ultrasound-guided interscalene brachial plexus block were randomly allocated to receive saline (control), dexamethasone 1mg, 2mg, 3mg and 4mg, together with 20ml ropivacaine 0.5%. Postoperative analgesia consisted of paracetamol, diclofenac and oxycodone on request, using a pre-defined protocol. The primary outcome was the duration of analgesia, defined as the time between the block procedure and the first analgesic request. Secondary outcomes included rest and dynamic pain scores, and analgesic consumption at 2h, 24h and 48h postoperatively. An analysis of the dose-response relationship was performed using multiple comparison procedure-modelling. The median (IQR [range]) duration of analgesia was significantly prolonged in a dose-dependent manner: control 685 (590-860 [453-1272]) min; 1mg 835 (740-1110 [450-1375]) min; 2mg 904 (710-1130 [525-1365]) min; 3mg 965 (875-1025 [730-1390]) min; 4mg 1023 (838-1239 [518-1500]) min (p=0.03). There were no significant differences between the secondary outcomes. Perineural administration of dexamethasone with doses between 1mg and 4mg, combined with ropivacaine for interscalene brachial plexus block, prolongs duration of analgesia in a dose-dependent manner.