Longer Duration Of Analgesia Research Articles

Ultrasound-guided serratus anterior block versus instillation of local anaesthetic through surgical drain in modified radical mastectomy: A randomized controlled study

ABSTRACT Background The primary outcome measure of this study was to compare ultrasound-guided serratus anterior block versus instillation of local anesthetic through the surgical drain in modified radical mastectomy patients as regards the duration of analgesia between the two techniques. Material and methods This prospective, randomized, double-blinded study was conducted on 162 female patients aged 25–50 years, ASA 1, ASA 2, selected for elective unilateral modified radical mastectomy in the Main University Hospital. Group SABP (n = 81) received 20 ml bupivacaine 0.5% in the plan between serratus anterior and latissimus dorsi muscles. Group LA (n = 81) received 40 ml bupivacaine 0.25%, 20 ml in each surgical drain (axillary and chest wall drain). Results The results of the study revealed that the duration of analgesia lasted for 20.8 hr in the SAPB group, while it was 8.14 hourshr in the LA group (P-value ˂0.001). In most postoperative periods, the SAPB group had lower VAS scores at rest and with movement of the ipsilateral arm compared to the LA group. The overall dose and frequency of the consumed rescue analgesic over the first 24 hr in the postoperative period were significantly lower in the SAPB group than in the second group (P-value <0.001). The SAPB group had higher satisfaction scores than the LA group (P-value <0.001). Conclusion It was concluded that the SAPB technique showed superiority over the anesthetic instillation method in controlling acute post-mastectomy pain with a longer duration of analgesia, more patient satisfaction, and less rescue analgesics were consumed.

Comparison of efficacy of butorphanol and nalbuphine as premedicant in patients undergoing elective craniotomy using propofol and desflurane anesthesia – A randomized clinical study

Background: Long duration neurosurgical procedures require the use a relatively longer acting analgesic which will give equianalgesia like a short-acting opioid without needing repeated administration or an infusion. Aims and Objectives: In this study, we investigated and compared the intraoperative analgesic efficacy and post-operative recovery outcome of intravenous (IV) butorphanol and IV nalbuphine in non-emergency craniotomy patients. Materials and Methods: A prospective, randomized, and double-blind study was conducted involving 60 patients of age 18–50 years, randomly assigned into two equal groups receiving either 1 mg butorphanol IV (Group B) or 10 mg nalbuphine IV (Group N) 10 min before induction of general anesthesia. Patients were monitored for changes in blood pressure, heart rate (HR) perioperatively and duration of analgesia, and Ramsay Sedation Score (RSS) postoperatively. The results were recorded and analyzed statistically using Pearson’s Chi-square test for Independence of Attributes/Fisher’s Exact Test and Student’s t-test for continuous variables. Results: Statistically significant fall in HR and mean blood pressure was seen in both groups during intraoperative period, though fall was more in the nalbuphine group. Duration of analgesia was statistically significant in Group B than Group N (249.27±18.33 vs. 240.13±15.70, P=0.043). Sedation was more with nalbuphine as time to achieve RSS 2 was less with butorphanol. Conclusion: Inj. butorphanol and inj nalbuphine both showed satisfactory result in maintaining hemodynamic stability and long duration of analgesia. When compared, butorphanol provided longer duration of analgesia and less post-operative sedation.

Bilateral sphenopalatine ganglion block with adrenaline additive for post-dural puncture headache in orthopedic patients: A randomized controlled trial

ABSTRACT Background Post dural puncture headache (PDPH) is a common condition that occurs following an accidental dural puncture. The work aimed to determine the efficacy and safety of analgesia of sphenopalatine ganglion block (SPB) (lidocaine 4% with adrenaline) for PDPH in orthopedic patients. Methods This randomized prospective open-label-controlled trial was conducted on 60 cases aged 18–60 years, both sexes American Society of Anesthesiologists (ASA) physical status I and II with severe PDPH during seven days after subarachnoid blockage for surgeries of lower limbs. Cases were randomized into two equal groups: Group MT: received medical treatment paracetamol 1 gm/6 hour daily, Group SPB: received SPB by using lidocaine 4% and adrenaline (1/2,000,000). The analgesia was effective if visual analogue scale (VAS) was < 4 in the first 48 hours. Patients with VAS ≥ 4 received diclofenac 75 mg/12 hour if pain was not controlled. Epidural blood patch was used in case of unrelieved pain after 3 days. Results There were significant quicker onset and longer duration of analgesia in group SPB compared to group MT (P = 0.001 and 0.03, respectively). VAS score was insignificantly different at baseline and 48 hours and was significantly lower in group SPB compared to group MT at 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h. The need for EBP was significantly lower in group SPB B than group MT (16.7% versus 46.7%). Conclusions SPB is an effective method for PDPH in orthopedic patients with quicker onset and longer duration of analgesia and lower VAS score compared to medical treatment.

Abstract No.: ABS3221: Comparison of Fentanyl and Dexmedetomidine as adjuvants to 0.2 % Ropivacaine Epidurally in Labour Analgesia

Background & Aims:Childbirth being the most exciting event in the life of a female gets ruined because of cruciating and intolerable labour pain. This study compared quality of labour analgesia by using fentanyl and dexmedetomidine as adjuvants to 0.2% ropivacaine epidurally .Methods:Institutional Ethical Committee approval and patient consent was obtained. 60 enroled patients were divided into 2 groups Group RF: 0.2% ropivacaine + fentanyl 15µg (15ml) Group RD: 0.2% ropivacaine + dexmedetomidine 7.5 µg (15ml) Epidural catheter was inserted at the L2-L3 space and drug was administered. VAS, sensory, motor levels were assessed. Maternal and foetal adverse effects were noted. Maternal satisfaction was evaluated after 24 h. The results were expressed as mean ± standard deviation for continuous variables while frequency and percentage for discrete data. Continuous variables were analysed by using unpaired two-tailed Student t- test. Discrete data was analysed using Chi-square test. P<0.05 considered as statistically significant.Results:The demographical data like age, weight and height were comparable and had no influence on outcome of the study. Quality of analgesia was comparable in both groups (p>0.05) with no patient having poor quality. Early onset and longer duration of analgesia, less epidural top-ups, shorter duration of labour, less incidence of instrumental delivery and adverse effects were observed in Group RD compared with Group RF (p<0.05). Neonatal APGAR score was comparable between the groups.Conclusion:Both fentanyl and dexmedetomidine with 0.2% ropivacaine epidurally provide safe, effective and excellent quality of labour analgesia and equal foetal well-being and neonatal outcomes. Dexmedetomidine as adjuvant prolongs labour analgesia and shortens duration of labour.

Evaluation of postoperative analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound guided adductor canal block in patients undergoing unilateral Total Knee Replacement

The aim of anaesthesia in Total knee replacement (TKR) is to provide adequate analgesia and early ambulation. The recent success of adductor canal block in providing post-operative analgesia and achieving early ambulation has evoked interest in studying the effects of local anaesthetic agents and various adjuvants.This study was a randomized three arm parallel group comparative study conducted in a tertiary care center in India on 135 patients undergoing unilateral total knee replacement under spinal anaesthesia. After completion of the surgery, the adductor canal block was performed with ultrasound guidance at mid-thigh level in all three groups. In group A, 20 ml 0.375% ropivacaine was only used but in group B and C Dexmedetomidine was added to ropivacaine (total volume of 20 ml; 0.375%) at a dose of 0.25 µg/kg and 0.50 µg/kg respectively. The primary outcome of the study was to compare duration of analgesia after the adductor canal block. Duration to rescue analgesia (in hours) was significantly longer [Group A: 15.71±4.87; Group B: 16.44±6.21; Group C: 19.78±5.57 (p=0.014)] and total opioid (24 hours tramadol needed in mg) consumption [Group A: 60.00±13.94; Group B: 52.22±18.80; Group C: 33.33±13.95 (p=0.033)] was significantly lower in Group C. NRS scores both at movement and rest were significantly lesser in Group C at 18 and 24 hours timepoints. Patient satisfaction was significantly higher in Group C with 46.67% patient reporting better than expected peri-operative experience (p=0.022).The addition of dexmedetomidine, 0.5 µg/kg to 0.375% ropivacaine in adductor canal block results in longer duration of analgesia, less 24 hours opioid consumption, better motor strength and better patient satisfaction without any adverse effect after unilateral total knee replacement surgery.

A Comparative Study on the Analgesic Efficacy of Bilateral Suprazygomatic Maxillary Nerve Block Under Ultrasound Guidance with 0.25% Bupivacaine and 0.25% Bupivacaine with Dexmedetomidine in Paediatric Patients Undergoing Cleft Palate Repair - A Randomized Prospective Double Blinded Study

Objective: Cleft palate repair involves surgery on the both hard and soft palate leading to severe pain, intense sympathetic stimulation, and bleeding. In our study we analysed the analgesic efficacy of bupivacaine alone and bupivacaine with dexmedetomidine in ultrasound guided bilateral suprazygomatic maxillary nerve block (SMN) for cleft palate repair. Methods: This study was a randomized prospective double-blinded study. Fourty six children of the ASA class I and II posted for cleft palate repair were randomized into Group A and Group B. In Group A, 23 children had SMN block with 0.15 mL kg-1 of 0.25% bupivacaine with saline and the same procedure was repeated on other side. In Group B, 23 children received SMN block with a volume of 0.15 mL kg-1 of 0.25% bupivacaine with dexmedetomidine 0.5 µg kg-1 on each side. Primary outcomes analysed were pain scores in post operative period by Children and Infants Post-Operative Pain Scale (CHIPPS) and the analgesia duration. Postoperative pain scores were analysed at 30 minutes intervals for 2 hours in Post Anaesthesia Care Unit (PACU) and at every 2 hours interval for 24 hours in the postoperative ward. Results: Group A and B were comparable in demographic variables like age, gender, weight, ASA status, and duration of surgery. Children in Group B had significantly longer duration of analgesia when compared to that of Group A (12±4.73 hours vs 5.41± 3.9 hours) (p=0.003). Children had significantly lower pain scores in Group B at zero min in PACU (p=0.04), after 90 min (p=0.02), at 2 hours (p&lt;0.001), 4 hours (p&lt;0.001), 6 hours (p=0.006) and at 8 hours (p=0.02) when compared to that in Group A. Conclusion: Children who received bupivacaine with dexmedetomidine in SMN block had a longer analgesia duration and lesser postoperative pain scores than children who received bupivacaine alone. Keywords: Maxillary nerve block, Dexmedetomidine, pain scores, postoperative analgesia, rescue analgesia

Effect of Different Doses of Buprenorphine in Combination with Bupivacaine in the Management of Postoperative Analgesia: A Comparative Study.

Background:Longer duration of analgesia, ceiling effect on respiratory depression, and the antihyperalgesia property make buprenorphine a good adjuvant for managing moderate-to-severe postoperative pain.Aims:The aim of this study is to evaluate the onset and duration of postoperative analgesia of three different doses of buprenorphine of 60, 100, and 150 μg given intrathecally along with hyperbaric bupivacaine in patients undergoing lower limb surgeries.Setting and Design:This prospective observational study was carried out in the anesthesia department of a tertiary care hospital.Materials and Methods:The study included 90 patients of either sex, aged 18–60 years, scheduled for elective lower limb surgery under subarachnoid block. Patients were randomly allocated into three groups (30 each) receiving different doses of buprenorphine. In addition, all patients received 3 mL of 0.5% hyperbaric bupivacaine.Statistical Analysis Used:The Chi-square test or Fisher's exact test was used to find out the association between the categorical variables. The association of quantitative variables between the groups was assessed by Kruskal–Wallis test while within the groups was assessed by repeated-measures analysis of variance test.Results:Baseline characteristics such as age, gender, and American Society of Anesthesiologist physical status classification were comparable among the three groups. Sensory block, motor block, and total duration of analgesia were significantly higher with higher doses of buprenorphine. The mean difference in the duration of analgesia was comparable in patients receiving 100 μg (720 min) and 150 μg (825 min) of buprenorphine. Bradycardia as a side effect was only in patients receiving 150 μg of buprenorphine.Conclusion:Risk–benefit of different doses of buprenorphine suggests that 100 μg may be the ideal dose for a better quality of spinal block and maintaining hemodynamic stability.

English

BACKGROUND Studies suggest that clonidine can improve the duration of analgesia, quality of pain control when used with ropivacaine for caudal blocks in children. This study was designed to understand the effects of caudally administered ropivacaine 0.25 % (1ml/kg) alone and ropivacaine 0.25 % (1ml/kg) with clonidine 2 mcg/kg, in children between 2- 10 years. METHODS Sixty children posted for various sub-umbilical surgical procedures were included after written informed consent and ethics committee approval. Children were randomly divided into 2 groups of 30 each: Group R —ropivacaine 0.25 % 1 ml/kg into caudal epidural space and Group RC—ropivacaine 0.25 % 1 ml/kg and clonidine 2 mcg/kg into caudal epidural space. RESULTS The mean age of patients was similar with no statistical difference (4.83 vs 5.36, P = 0.3353). The duration of anaesthesia was significantly longer in the RC group (544.83 minutes vs 268.00 minutes, P &lt; 0.0001). The effect size was very high (Cohen d=23.86). The pain score was comparable up to 1 hour for the two groups. But 2 hours later, the pain scores were significantly lower for the ropivacaine and clonidine groups. The effect on motor blockade was similar in both groups with no motor blockade at 4 hours follow up. 5 cases of urinary retention were seen in the study with no statistically significant difference in terms of complication rate between the two groups. No case of hypotension or bradycardia was seen. There was a significant difference between the two groups in terms of cardiovascular parameters (HR, SBP, DBP) after administration of drugs. CONCLUSIONS The addition of clonidine to ropivacaine for caudal blocks in children was associated with better quality of pain control and a longer duration of analgesia without any additional motor blockade. There was no significant difference seen in terms of complication. KEY WORDS Analgesia Duration, Caudal Analgesia, Clonidine, Pain Control, Ropivacaine.

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

BackgroundSupraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control.MethodsPatients (n = 90) with ASA physical status 1–3 were prospectively randomised to receive; SCB with mepivacine 1%, 25–30 ml (n = 30), SCB with ropivacaine 0.5%, 25–30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups.ResultsThe three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3–3.3) and 2.7 (IQR 1.3–4.2) (p = 0.017) and OEC 30 mg (IQR 10–80) and 85 mg (IQR 45–125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%).ConclusionsThe potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution.Trial registrationNCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).

COMPARATIVE STUDY OF INTRATHECAL FENTANYL WITH HYPERBARIC BUPIVACAINE TO IMPROVE PERIOPERATIVE ANALGESIA IN PATIENT UNDERGOING ORTHOPEDIC SURGERY

Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS, patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures, cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods. Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine, pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if any, in patients undergoing lower limb surgeries. Materials and Methods: After approval from the local ethics committee and with written informed consent from patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients belonging to American Society of Anesthesiologists (ASA)classification I &amp;amp; II, aged between 18-60 years, posted for elective lower limb surgeries, were randomly allocated for the study. Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only. Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex distribution. Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative analgesics. Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic disturbance and better postoperative outcome with/ minimum side effects.

English

BACKGROUND This study compared the characteristics of hyperbaric and hypobaric bupivacaine in patients undergoing unilateral lower limb surgeries under lumbar subarachnoid block with regard to their onset and level of sensory and motor blockades, haemodynamic stability, and recovery profile in terms of analgesic duration and motor recovery. METHODS This is a comparative study. Two groups, each of 36 patients who satisfied American society of Anaesthesiologist (ASA) I &amp; II aged 18 – 65 years, were observed intra operatively and during immediate post-operative period. Group 1 received 2.4 ml of 0.5 % bupivacaine (heavy) with operated limb in dependent position. Group 2 received 4 ml of reconstituted hypobaric bupivacaine 0.3 %, with the operated limb positioned in non-dependent position. Onset, level and duration of motor and sensory block, hemodynamic changes and duration of surgical analgesia were compared between groups. RESULTS The level of sensory block attained in the hypobaric group was at T12 with maximum at T9, in the hyperbaric group it is variable and at higher level. Duration of sensory blockade was less with hypobaric. Motor block of modified Bromage scale 3 after 10 minutes was none in group 2 and 91.7 % in group 1. Significant fall in systolic blood pressure at 15 to 30 minutes and diastolic BP at 15 and 20 minutes was noted in hyperbaric group after subarachnoid block. There was significant percentage of change in systolic blood pressure from 4 to 70 minutes and mean arterial pressure (MAP) from 4 to 90 minutes in hyperbaric group. Duration of surgical analgesia in hypobaric group was longer compared to hyper baric. CONCLUSIONS Intrathecal hypobaric bupivacaine showed better haemodynamic stability and longer duration of analgesia in comparison with hyperbaric bupivacaine in lower limb surgeries. KEYWORDS Anaesthesia, Bupivacaine, Hypobaric, Subarachnoid Block

Tumescent Local Anesthesia in Parotid Abscess - Novel Application of Old Technique

Tumescent local anesthesia (TLA) is a regional anesthetic technique in which the diluted local anesthetic drug (commonly lidocaine) and epinephrine solution in large volume is injected subcutaneously around the site of incision. The main advantages of TLA are excellent bloodless field and longer duration of analgesia because of addition of epinephrine. Although TLA was used in various surgical procedures, there is no literature to date that has reported its use in the parotid region. Hence, we present an interesting case where this old technique found a novel application in avoiding general anesthesia and its sequelae. We also believe that it provides valuable information to doctors of various categories such as surgeons, Anesthesiologists and general practitioners/family physicians.

Comparison of Ropivacaine and Levobupivacaine in Supraclavicular Brachial Plexus Blocks-A Double Blinded Randomized Control Study.

Brachial plexus anaesthesia has been an indispensable tool in the anaesthesiologist's armamentarium. Clinical studies have shown that levobupivacaine and ropivacaine have fewer adverse effects on the cardiovascular and central nervous system making them more advantageous in regional anaesthesia techniques. Less information is available regarding their comparable clinical data. Only a few studies have compared levobupivacaine and ropivacaine for brachial plexus blocks; hence, this study was aimed to compare the analgesic effectiveness and nerve block characteristics of ropivacaine and levobupivacaine in supraclavicular brachial plexus blocks in upper limb surgeries. Patients with American Society of Anaesthesiologists physical status I or II coming for elective upper limb surgeries were included in the study. Total numbers of 62 patients were randomly allocated into two groups, group A and group B. Group A received 25mL of 0.75% ropivacaine, and group B received 25mL of 0.5% levobupivacaine. The duration of analgesia, onset of block, duration of sensory, and motor blockade were studied and compared. The mean duration of analgesia in group ropivacaine was 8.33 hours and in group levobupivacaine was 10.23 hours which was statistically significant. Ropivacaine had a faster sensory onset compared to levobupivacaine (5.22 vs. 6.88 minutes). The duration of sensory and motor blockade was longer with levobupivacaine than ropivacaine (sensory-8.64 vs. 10.29 hours, motor-8.32 vs. 9.8 hours). Levobupivacaine had longer duration of analgesia. The sensory and motor blockade was also longer with levobupivacaine.

Comparative Evaluation of two Doses of Epidural Butorphanol with Bupivacaine for Postoperative Analgesia

Background: Postoperative analgesia is very important to prevent subjective discomfort, early mobilization and shortened hospital stay. Opioids addition to local anesthetics improve the quality of analgesia. Present study was designed to evaluate and compare the duration and efficacy of two different doses of epidural Butorphanol for postoperative analgesia. Patients and Methods: This prospective, randomized double blinded study was conducted on 75 patients in the age group of 20-60 years of either sex, with ASA class I and II scheduled for elective lower limb orthopedic surgeries under combined spinal epidural anesthesia after taking the informed consent and approval from hospital ethical committee. Group allocation, group I (n=25) received epidural 0.25 % bupivacaine, group II (n= 25) patients received 0.25% epidural Bupivacaine and 1 mg Butorphanol, group ΙΙΙ (n= 25) patients received 0.25% epidural Bupivacaine and 2 mg Butorphanol. Postoperatively VAS, sedation score, vitals &amp; side effects were observed. Injections were given on achieving VAS&gt;3. Results: Onset of analgesia was significantly shorter in group III as compare to group II and group I. Duration of analgesia was longest in group ΙII 9.95±0.43 hour which was significantly greater than group I 3.90±0.32 hours and group ΙΙ 6.06±0.26 hours. Postoperative VAS scores at different intervals were lower in group III than group II and group I (group III&lt; group II&lt; group I). Sedation scores were significantly higher in butorphanol group with no major adverse effects. Conclusion: Butorphanol 2 mg with 0.25% bupivacaine appears to be the optimal dose to produce a more rapid onset and longer duration of analgesia with no adverse effects. Keywords: Epidural; Postoperativanalgesia; Butorphanol.

English

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P &lt; 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine

Comparative study between Bupivacaine with Magnesium sulphate v.s. Bupivacaine with Dexmedetomidine in ultrasound guided Transversus Abdominus Plane (TAP) block as postoperative analgesia for pain in Cesarean section

Background: Magnesium sulfate and dexmedetomidine were used as adjuvants to local anesthesia to improve the quality of regional anesthesia. Objectives: To evaluate and compare the effects of magnesium sulfate and dexmedetomidine when added to bupivacaine on the quality of trasversus abdominus plane block (TAPB). Patients and Methods: The study was done at the department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt from November 2019 to October 2020. A total of 50 female patients undergoing elective Cesarean section using post operative transversus abdominus plane (TAP) block were randomly assigned into two groups; Ultrasound-guided transversus abdominus plane (TAP) block was performed using 20 ml 0.25% Bupivacaine. Magnesium sulfate 150 mg (1.5 ml) and dexmedetomidine 0.5 mcg/kg were added in the magnesium sulfate group and dexmedetomidine group, respectively. Time to first analgesia, pain scores at 2/6/12/24/48 hours, hemodynamic data and side effects were recorded. Results: Dexmedetomidine group provided the longest duration of analgesia and the least consumption of postoperative rescue analgesia versus magnesium sulfate group (P = 0.001). Dexmedetomidine group had higher incidences of bradycardia and hypotension. Conclusion: Magnesium sulfate or dexmedetomidine was a useful adjuvant to bupivacaine for transversus abdominus plane block in lengthening the duration of analgesia. Dexmedetomidine provided quicker onset and longer duration of analgesia with lesser consumption of postoperative rescue analgesia; However, it showed a higher incidence of intraoperative hypotension and bradycardia than magnesium sulfate.

Low-Dose Dexamethasone as an Adjuvant for Prolonging the Duration of Brachial Plexus Block with Bupivacaine—a Prospective Randomised Controlled Study

Objectives Dexamethasone, in the dose of 8 mg or higher, has been advocated to be used as an adjuvant to prolong the duration of brachial plexus blocks with local anaesthetics. This study aimed to test the hypothesis that a lower dose of dexamethasone (4 mg) added to bupivacaine would prolong the duration of analgesia in brachial plexus blocks. Methods A randomized double-blind placebo-controlled trial was conducted on patients who underwent supraclavicular brachial plexus blocks using an ultrasound. Patients were randomized to receive 19 mL of 0.5% bupivacaine with dexamethasone (4 mg) (study group) and saline (1 mL) (control group). Primary outcome measure was the duration of analgesia. Onset and duration of sensory, motor blocks, postoperative 24-hour morphine requirements were also recorded. Results A total of 46 patients were studied with 24 patients in the dexamethasone group and 22 patients in the control group. Demographic data, type and duration of surgery were comparable between the groups. Dexamethasone group patients had significantly longer duration of analgesia [Mean (SD): 19.8 (3.8) hours], compared to control group patients [Mean (SD): 14.5 (4.2); p&lt; 0.001]. Morphine requirements over a 24-hour period were not significantly different between the groups. Conclusion Low-dose dexamethasone significantly prolongs the duration of analgesia when used with bupivacaine in supraclavicular brachial plexus blocks, although it does not significantly decrease the overall opioid requirements for 24 hours postoperatively.

9 Impact of Methadone Initiation in Intubated Burn Patients: A Retrospective Review

Abstract Introduction Methadone can be used to wean opiates and reduce length of mechanical ventilation (MV) in critical care and burn patients. The objective of this study was to assess the impact of methadone use on ventilator-free days and clinical outcomes in burned patients requiring MV. Methods This was a retrospective study of adult patients admitted to a burn center for initial management of burn injuries who required MV for at least 48 hours between September 2013 and November 2019. Patients were excluded from the study if they had prior methadone use, total body surface area (TBSA) of less than 5%, or expired within the first 28 days of admission. The primary endpoint was the difference in ventilator-free days among those who received methadone compared to those who did not. Secondary endpoints include length of stay, mortality, sedative agent and average daily dose, analgesic agent and average daily dose, and incidence of delirium. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test, as appropriate. Multivariate regression was used to identify variables for possible association with MV duration. Results A total of 83 patients were included in the study; 52 received methadone and 31 were controls. Patients were generally well-matched between groups, however patients receiving methadone were younger (45.3 vs 56.2 years, p = 0.002) and had a larger TBSA (30.4 vs 19.1%, p = 0.001). Patients who received methadone had fewer ventilator free days of the first 28 (9.5 vs 15.0 days, p = 0.009) and a longer ICU stay (57.2 vs 35.8 days, p = 0.025). There was no difference between groups in terms of mortality, reintubations, and incidence of delirium. Patients who received methadone had longer duration of analgesia (20.7 vs 12.0 days, p = 0.011) and sedation (19.0 vs 12.4 days, p = 0.026) while on MV. Conclusions This study found that methadone use contributed to fewer ventilator-free days and longer ICU stays, which was unexpected but worth discussing. There are several limitations to this study. This study occurred during a time period in which the pain management and sedation strategies of this burn unit were evolving, and strategies may not have been consistent between providers. The study included a small sample size and baseline demographics demonstrated significant differences in age and TBSA between the two groups. Additionally, pain scores were not collected as part of this study, which would have provided better insight into the effectiveness of pain management. The use of methadone as an adjunct for pain control remains undetermined.

Comparison of adjuvant effects of intrathecal magnesium sulfate and dexmedetomidine with hyperbaric bupivacaine

Surgeries involving infraumblical regions are commonly done under spinal anaesthesia. No single adjuvant to bupivacaine found to prolong the duration of analgesia and to reduce its limitations. To compare the block characteristics of intrathecal administration of dexmedetomidine and magnesium sulfate as an adjuvant with bupivacaine in infraumblical surgeries. This is a prospective randomized double-blinded study. Around 90 American Society of Anaesthesiologist physical status I and II patients, scheduled for infraumblical surgeries were enrolled in this study. Patients were randomly assigned into Group B (bupivacaine), Group D (bupivacaine plus dexmedetomidine) and Group M (bupivacaine plus magnesium sulfate). In the operating theatre, baseline values were recorded. Onset and duration of sensory and motor block, time of rescue analgesia were noted. The onset of sensory block was rapid in Group D (2.63 ± 0.66 min) and slow in Group M (6.35 ± 0.87 min) when compared to Group B (2.93 ± 0.785 min) with a statistically significant difference. Motor duration (min) was prolonged in Group D (423.00 ± 12.360) and early in the Group M (165 ± 31.55) when compared to Group B (219.23 ± 14.875). For the surgery, which requires prompt onset and long duration of analgesia,dexmedetomidine can be used as an adjuvant. However, surgical procedures that permit delayed onset block and shorter duration of analgesia,magnesium sulfate can be preferred.

Comparison of Patient-Controlled Epidural Analgesia (PCEA) with Basal Infusion and Programmed Intermittent Epidural Bolus (PIEB) with PCEA in Labour Analgesia – A One-Year Retrospective Study

Introduction: For the past thirty years, patient-controlled epidural analgesia (PCEA) with basal infusion regimen has successfully improved the variable intensity of labour pain due to its advantage in allowing self-titration by the parturient. However, a recent review on programmed intermittent epidural bolus (PIEB) with PCEA regimen proved to be superior compared to PCEA with basal infusion, in terms of higher maternal satisfaction with longer duration of analgesia and lower local anaesthetic consumption. Following the introduction of PIEB at our institution, we did a study to compare maternal satisfaction, mode of delivery and neonatal outcome between these two methods of epidural labour analgesia. Methodology: We conducted a one-year retrospective analysis of data from obstetric analgesia service (OAS) record sheet and hospital information system evaluating outcomes after labour analgesia delivered by PCEA with basal infusion regimen (PCEA + basal infusion) and PIEB with PCEA regimen (PIEB+PCEA). The primary outcome was maternal satisfaction towards their labour analgesia. Other outcome parameters were the mode of delivery and neonatal Apgar scores. Outcomes were compared using independent t-test and Chi-square test. Result: There was no significant difference in maternal satisfaction between the two groups (P=0.398). However, a higher percentage of excellent satisfaction was found in the PIEB + PCEA group compared to that in the PCEA + basal infusion group (PIEB+PCEA 146/172 (84.9%) vs PCEA + basal infusion 138/171 (80.7%) respectively). There was no significant difference in the mode of delivery (P=0.296). However, PIEB+PCEA group had a higher percentage of spontaneous vaginal deliveries (PIEB+PCEA 87/172 (50.6%) vs PCEA + basal infusion 70/171 (40.9%) respectively) and a lower percentage of Caesarean deliveries (PIEB + PCEA 71/172 (41.3%) vs PCEA + basal infusion 87/171 (50.9%) respectively). Despite statistically significant differences found in Apgar scores in 1 minute (P=0.036), there was no significant difference in the scores at 5 minutes (P=0.107). Apgar scores and mean (SD) at 1 minute and 5 minutes for PIEB + PCEA were 7.77(0.85) and 8.91(0.55) respectively, and for PCEA + basal infusion the scores at 1 minute and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA regimen is a newer epidural delivery technique for labour analgesia in our centre, which produced a comparable outcome to PCEA with basal infusion regimen.