Ml Of Bupivacaine Research Articles

A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial

To investigate the possible effects of multisite injection therapy around the shoulder and prospectively compare the pain relief, range of motion (ROM), and functional scores of randomly selected patients with primary frozen shoulder using the American Shoulder and Elbow Surgeons score and the University of California-Los Angeles score after the completion of a standard physiotherapy program. Seventy-six patients with primary frozen shoulder were randomly divided into 2 groups based on the treatment: multisite injection and single injection. In the multisite-injection group, the glenohumeral joint and posteroinferior capsule, subacromial space, posterosuperior capsule, biceps long head, and coracohumeral ligament were injected with a combination of 2 mL of triamcinolone acetonide (40 mg/mL), 4 mL of bupivacaine (0.5%), and 34 mL of saline solution. The glenohumeral joint in the single-injection group was injected with 1 mL of triamcinolone acetonide (40 mg/mL) and 2 mL of bupivacaine (0.5%). Patients in both groups underwent physical therapy using the same protocol. Patients were evaluated for pain (visual analog scale score), functional status, and active and passive joint ROM at 1, 3, and 6 months and 1 year after the injection. The follow-up rate was 82.6%, and significantly lower VAS scores were recorded in all periods in the multisite-injection group compared with the single-injection group (P= .01). In terms of active and passive ROM, the follow-up results were significantly better in the multisite-injection group (P < .05). Significantly higher functional scores were recorded in the multisite-injection group (P < .05). Both treatments were effective in patients with primary frozen shoulder. However, the multisite-injection technique provided better pain palliation, better ROM restoration, and better functional results than the single glenohumeral injection in patients with primary frozen shoulder who were treated with the same physiotherapy regimen. Level I, prognostic comparative study.

Programmed intermittent epidural bolus for labour analgesia during first stage of labour: a sequential allocation trial to determine the effective interval time between boluses of a fixed volume of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 µg·mL-1.

We studied the programmed intermittent epidural bolus (PIEB) time interval between boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 µg·mL-1 to produce effective analgesia in 90% of women (EI90) during the first stage of labour. In a double-blind sequential allocation trial using a biased coin up-and-down design to determine the EI90, the PIEB boluses of 2.5 mL of 0.25% bupivacaine plus fentanyl 8 µg·mL-1 were delivered at varying intervals-60, 50, 40, and 30 min. The primary outcome was the adequate response of the patient to the PIEB regimen, defined as no use of supplemental analgesia for six hours or until the first stage of labour was completed, whichever came first. The secondary outcomes were the upper sensory block level to ice, motor block and hypotension. The isotonic regression with extrapolation approach was used to estimate the EI90. In the 20 women studied, the estimated EI90 was 20 (95% CI, 5.9 to 28.8) min. For the secondary outcomes, we classified women into those assigned to 30 min (16 women) and those assigned to more than 30 min (four women). The median upper sensory block for women in the 30-min group and more than 30 min were T6 (or T5) and T7, respectively. No participants experienced motor block. Hypotension occurred in one patient in the 30-min group. The estimated EI90 for boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 µg·mL-1 was 20 (95% CI, 5.9 to 28.8) min. These results suggest that there is no advantage in using this regimen compared with those reported in the literature using the same dose of bupivacaine in concentrations of 0.0625% and 0.125%. www.clinicaltrials.gov (NCT03735771); registered 7 November 2018.

Mid-axillary transversus abdominis plane block and stress response after abdominal hysterectomy: A randomised controlled placebo trial.

The hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response. To evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia. Randomised, placebo-controlled double-blind study. The current study was conducted at a university hospital from July 2016 to September 2017. Fifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised. After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20 ml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C). Levels of free serum cortisol, metanephrine and normetanephrine at 60 min and 6, 12 and 24 h after surgical incision. Pain scores and opioid consumption during the first 24 h after surgery. There was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6 h in Group T, 23.6 [10.1 to 42.9] P = 0.015 and Group C 23.6 [9.9 to 46.3] P = 0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60 min, 52.8 [33.4 to 193.2] P = 0.001, 6 h, 92.70 [2.4 to 202.6] P = 0.005 and normetanephrine at 60 min 83.44 [28.98 to 114.86] P = 0.004, 6 h 78.62 [36.6 to 162.31] P = 0.0005 and 24 h 80.96 [8.6 to 110.5] P = 0.025. Mean ± SD opioid consumption was similar in both groups: 39.60 ± 14.87 in Group T vs. 43.68 ± 14.93 in Group C (P = 0.338). Mid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia. ClinicalTrial.gov identifier: NCT03443271.

To Study Preloading and Relative Efficacy of Ringer’s Lactate and Pentastarch 6% Prior to Spinal Anaesthesia in Lower Abdominal and Lower Limb Surgeries

Background and Objectives: Hypotension after spinal anaesthesia remains a common and a seriouscomplication. Various method have been recommended for the prevention and treatment of this problem.Preloading has become the cornerstone for prophylaxis of hypotension post spinal anaesthesia. This currentstudy reassessed the efficacy of this volume preloading and also compared the efficacy between Ringer’slactate and Pentastarch 6%.Method: In this study, 60 patients (ASA I &amp; II) presenting for elective lower abdominal and lower limbsurgeries under spinal anaesthesia were allocated into two groups, group P and group R to receive 5 ml/kg of6% Pentastarch and 10 ml/kg of Ringer’s lactate preload respectively. After institution of spinal anaesthesiain a sitting position with 3.8 ml of Bupivacaine 0.5% (heavy) using 23G Quincke spinal needle, patientswere made to assume supine position. The heart rate(HR), systolic blood pressure(SBP) and diastolic bloodpressure(DBP) were monitored intra-operatively every 2 minutes for first 10 minutes and every 5 minutesfor next one hour and every 15 minutes thereafter. Electrocardiogram (ECG) and oxygen saturation(SpO2)were monitored continuously. The amount of ephedrine, used intra-operatively were noted and comparedamong the different groups.Results: The incidence of hypotension in group R was more than that in group P. There were no significantdifference in HR and the SpO2 between the groups. The difference in mean basal SBP and DBP werestatistically insignificant in both groups. Thereafter, the fall in SBP and DBP was more prominent in groupR at all time intervals with a statistically highly significant difference between the two groups (p value&lt;0.001). The amount of ephedrine used in group R was more than that used in group P. There were minimalcomplications like shivering and vomiting which were statistically non–significant . There were no allergicreactions to the fluids used.Conclusion: Volume preloading, still has a substantial role in reducing the incidence and severity ofhypotension in patients operated under spinal anaesthesia. Pentastarch 6% is found to be a better agent forpreloading, as it is safe and effective in preventing spinal-induced hypotension in patients.

Erector spinae plane block versus intraarticular injection of local anesthetic for postoperative analgesia in patients undergoing shoulder arthroscopy: A randomized controlled study

ABSTRACT Background To improve the outcome after shoulder arthroscopy, effective pain control is needed. We aimed to compare the efficacy of ultrasound (US) guided erector spinae plane block (ESPB) versus the intraarticular injection (IAI) of bupivacaine in managing postoperative pain in patients undergoing shoulder arthroscopy. Methods This prospective randomized, double-blind, parallel-controlled trial was conducted on sixty patients aged 18–60 years of either gender, BMI < 40 kg/m2, American Society of Anesthesiologists physical status I–II, posted for elective shoulder arthroscopy. Patients were randomly allocated into two equal groups. Group IA: received IAI using 20 ml of bupivacaine 0.25% done through the surgical port by the surgeon after closure of the shoulder capsule and sham ESBP. Group ES: received US guided ESPB at the T2 level using 20 ml bupivacaine 0.25% after the end of surgery and sham IAI. Results Postoperative visual analogue scale (VAS), heart rate and mean arterial blood pressure were significantly decreased at 30 min, 1 h, 2 h, 8 h, 12 h and 24 h in group ES compared to group IA. VAS increased at 4 h, 6 h in group ES compared to group IA. The time of first postoperative analgesic requirement was significantly increased in group ES compared to group IA. The total diclofenac consumption over 1st 24 hrs postoperatively was decreased in group ES compared to group IA. Conclusion US-guided ESPB controlled postoperative pain effectively in patients undergoing shoulder surgeries with superiority over IAI of bupivacaine.

Evaluation of unilateral ultrasound guided paravertebral block for perioperative analgesia in cancer patients undergoing lower limb sparing surgeries: A prospective randomized controlled trial

ABSTRACT Background Formerly management of malignant tumors of lower limb was mainly through amputation. After advancement in neoadjuvant chemo-radiotherapy, saving the limb through lower limb-sparing surgery became the main line for management. Different regional techniques are used for perioperative pain control in limb-sparing surgeries. One of these techniques is lumbar paravertebral block. It is a regional technique that provides ipsilateral analgesia resulting in somatic and sympathetic blockade in a continuous dermatomal manner. Methods The study included 60 cancer patients scheduled for lower limb sparing surgeries. Patients were randomly allocated into two groups to receive either lumbar paravertebral block Group P with 25 ml of Bupivacaine 0.25%, with adrenaline 1:200,000 or general anesthesia Group C. Results There was a statistically significant decrease in hemodynamics values for Group P compared to Group C at most of the study times. Intraoperative fentanyl consumption was lower in Group P compared to Group C (107.1 ± 22.89 ug versus 233.43 ± 49.29 ug), respectively. VAS scores were lower for Group P compared to Group C with lower postoperative morphine consumption in Group P compared to Group C (8.65 ± 3.57 mg versus 16 ± 3.15 mg) respectively. Conclusion Ultrasound guided paravertebral block can be used as an effective perioperative analgesic modality for cancer patients undergoing lower limb sparing surgeries.

A Randomised Controlled Study of Two Different Doses of Bupivacaine in Ultrasound Guided Axillary Brachial Plexus Block

Introduction: The use of Ultrasound (USG) for needle precision aids in reduction of local anaesthetic volume needed for peripheral nerve blockade. Conventional dosages of 30 to 40 mL of local anaesthetic mixture have been used in peripheral nerve blockades but using a lesser volume will reduce the incidence of local anaesthesia associated systemic toxicity. Aim: To assess the efficacy of two different doses 20 mL and 25 mL of Bupivacaine in USG guided axillary plexus block. Materials and Methods: Sixty patients requiring forearm and hand surgeries were randomised into two groups. Group A received low volume (20 mL of 0.375% bupivacaine) and group B received intermediate volume (25 mL of 0.375% bupivacaine). The quality of anaesthesia in regards to sensory and motor blockade, duration of analgesia, haemodynamic variability and complications were evaluated. Successful block was defined by Vester Anderson’s criteria. Duration of analgesia was measured using Visual Analogue Scale (VAS). Statistical comparison of all continuous variables were assessed utilising Student’s t-test and Mann-Whitney U-test as applicable. Results: No significant difference in onset times were observed as far as sensory and motor blockade was concerned between the two groups A and B with p-values of 0.69 and 0.40, respectively. Group B had significantly longer duration of block in comparison with Group A (p&lt;0.001). Two patients in group A and one patient in Group B required supplemental analgesia with fentanyl boluses. Haemodynamics were stable and no complications were seen in both the groups. Conclusion: Lower volume of Bupivacaine is convincingly prudent for regional blockade under USG guidance than suggested in literature.

Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

EFFICACY OF USG GUIDED FASCIA ILIACA COMPARTMENT BLOCK AS POSTOPERATIVE ANALGESIA IN PROXIMAL FRACTURE FEMUR

Background Fascia iliaca compartment nerve block (FICNB) has been reported to provide effective postoperative analgesia in patients with femur fracture. This study aimed to evaluate the effectiveness of FICNB with Bupivacaine and Dexamethasone for postoperative analgesia in proximal fracture femur. Methods Sixty-four patients of ASA grade 1 to 3, aged 50-80 years scheduled for proximal femur fracture femur were included and randomly assigned to two groups of 32 patients each Group F received ultrasound guided(FICNB) with 0.25% 40ml of Bupivacaine &amp; Dexamethasone 4 mg &amp; Group T received Tramadol 50mg at the end of surgery. Postoperative pain was assessed at 30 minutes, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours and 24 hours using visual analogue scale (VAS). Injection Paracetamol 1gm was given intravenously as rescue analgesia in both the groups when VAS was more than four. Results Both the groups were comparable for demographic parameters. The mean duration of analgesia was 460.31±10.50 minutes in the FICNB group while it was only 263.72±12.85 minutes in the tramadol group, the difference being statistically significant (with a ‘p value’ of 0.001). The total consumption of paracetamol did not show a significant difference in either of the groups in the first 24 hours, the ‘p value’ being 0.406. Conclusion Ultrasound guided FICNB given postoperatively in patients undergoing proximal fracture femur can provide postoperative pain relief for longer duration than Inj. Tramadol.

A Randomized, Double‐Dummy, Emergency Department‐Based Study of Greater Occipital Nerve Block With Bupivacaine vs Intravenous Metoclopramide for Treatment of Migraine

Greater occipital nerve blocks (GONB) are used increasingly to treat acute migraine. We conducted a randomized controlled trial to determine whether GONB was as effective as intravenous metoclopramide for migraine. This was a double-dummy, double-blind, parallel-arm, non-inferiority study conducted in 2 emergency departments (EDs). Patients with migraine of moderate or severe intensity were randomized to receive bilateral GONB with each side administered 3mL of bupivacaine 0.5% or metoclopramide 10mg IV, the putative standard of care. The primary outcome was improvement in pain on a 0-10 scale between time 0 and 1hour later. To reject the null hypothesis that metoclopramide would be more efficacious in relieving pain, we required that the lower limit of the 95% CI for the difference in pain improvement between those randomized to GONB vs those randomized to metoclopramide be >-1.3, a validated minimum clinically important difference. Secondary outcomes included sustained headache relief, defined as achieving and maintaining for 48hours a headache level of mild or none without the use of additional analgesic medication, and the use of rescue medication in the ED. Over a 2.5-year study period, 1358 patients were screened for participation and 99 were randomized, 51 to GONB and 48 to metoclopramide. All of these patients were included in the primary analysis. Patients who received the GONB reported mean improvement of 5.0 (95% CI: 4.1, 5.8) while those who received metoclopramide reported a larger mean improvement of 6.1 (95% CI: 5.2, 6.9). The 95% CI for the between group difference of -1.1 was -2.3, 0.1. Sustained headache relief was reported by 11/51 (22%) GONB and 18/47 (38%) metoclopramide patients (95% CI for rounded difference of 17%: -1, 35%). Of the 51 GONB patients, 17 (33%) required rescue medication in the ED vs 8/48 (17%) metoclopramide patients (95% CI for rounded difference of 17%: 0, 33%). An adverse event was reported by 16/51 (31%) GONB patients and 18/48 (38%) metoclopramide patients (95% CI for (rounded) difference of 6%: -13, 25%). GONB with bupivacaine was not as efficacious as IV metoclopramide for the first-line treatment of migraine in the ED.

A Randomized Controlled Trial: Comparison of 4% Articaine versus 0.5% Bupivacaine for Ambulatory Orthopedic Surgery under Supraclavicular Block.

Background Articaine has been used in many dental and ophthalmic outpatient procedures. In the era of ultrasound-guided regional techniques, we searched for short and potent local anesthetic for patients undergoing ambulatory upper limb procedures. However, studies about articaine efficacy in brachial plexus block are limited. In this study, we compared its safety and efficacy against bupivacaine as a commonly used anesthetic agent for ultrasound-guided supraclavicular brachial plexus block. Methods This randomized prospective study was performed at Ain Shams University Hospital from January to March 2020. A total of 117 patients aged 20 to 60 years, with the American Society of Anesthesiologists physical status I and II, were enrolled in the study. Patients were randomly allocated into two groups: in group A, patients received 30 ml articaine 2%, and in group B, patients received 30 ml of bupivacaine 0.5%. We measured motor and sensory block duration as a primary outcome. Other secondary outcomes such as onset of block, duration of analgesia, patient satisfaction, and time to home discharge readiness were also measured. Results We analyzed data collected from 97 patients. The motor block duration was significantly shorter in group A (165.73 ± 20.33 min) than in group B (220.27 ± 37.73 min). The onset of motor block was faster in group A (8.73 ± 4.33 min), and the postoperative VAS score was lower in group B. Patients in group A achieved an earlier home discharge of 289.67 ± 2.73 min. Conclusion Earlier resolution of articaine block makes it more favorable than bupivacaine for ambulatory surgery. This trial is registered with (NCT04189198).

Analgesic Effect of Intrathecal Fentanyl vs Dexmedetomidine as Adjuvants to Bupivacaine Following Abdominal Surgery for Cancer in Children, a Randomized Trial.

Intrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia. Dexmedetomidine is a fascinating adjuvant with regards to neuraxial anesthesia in children experiencing surgery for abdominal malignancy. After endorsement by the institutional reviewing board (IRB) and guardians' written informed consent, this research was carried out on 60 pediatric malignancy patients scheduled for major abdominal surgery. Children were randomly distributed into three groups (20 patients each): Group C: given 2 mL of bupivacaine 0.5% (0.4 mg/kg) intrathecally, injected gradually over 20 seconds. Group F: the same as group C, plus fentanyl 0.2 μg/kg. Group D: the same as group C, plus dexmedetomidine 0.2 μg/kg. Pain at zero, two, four, six, 12, 18, and 24 hours postoperatively was evaluated by Face, Legs, Activity, Crying, and Consolability (FLACC) score. First analgesic request and postoperative unfavorable effects were recorded for 24 hours postoperatively. A significant decrease was recognized in the mean FLACC score in groups D and F at six, eight, and 12 hours postoperatively, in contrast to group C (P ≤ 0.05). First analgesic request was significantly prolonged in group D (7.67 ± 0.57 hours), in contrast to groups F and C (5.40 ± 1.09 hours and 4.23 ± 3.27 hours, respectively, P < 0.04). Paracetamol utilization was significantly decreased in group D (316.67 ± 28.86 mg), in contrast to group C (391.00 ± 52.00 mg, P < 0.03), without a significant difference between group F (354.44 ± 46.67 mg) and groups D and C (P > 0.05). Adding dexmedetomidine and fentanyl to intrathecal bupivacaine improved postoperative analgesia following abdominal surgery for cancer in children, with better overall analgesia of dexmedetomidine compared with fentanyl.

Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy

Background: Transversus abdominis plane (TAP) blocks provide postoperative pain relief after various abdominal surgeries. Recently, erector spinae plane (ESP) block has obtained vast attention due to its simplicity and usage in truncal procedures. Objectives: This study aims to compare the ultrasound-guided bilateral ESP block versus bilateral TAP block on postoperative analgesia after open total abdominal hysterectomy. Study Design: A prospective, double-blinded, randomized, controlled, clinical trial. Setting: Zagazig University Hospitals. Methods: After ending of surgical procedure and before reversing of the muscle relaxant, 48 women were randomly allocated into 2 equal groups: erector spinae (ES) group received bilateral ultrasound-guided ESP block with 20 mL of bupivacaine 0.375% plus 5 ug/mL adrenaline (1:200000) in each side at the level of T9, and transversus abdominis (TA) group received bilateral ultrasound-guided TAP block with the same volume of bupivacaine plus adrenaline. Results: Visual Analog Scale scores at 30 minutes, 2, 4, 6, 8, 12, 16, 20, and 24 hours were statistically significantly lower in the ES group compared with the TA group. The time for requirement of first morphine was highly statistically significantly prolonged in the ES group (14.81 ± 3.52 hours) compared with the TA group (10.58 ± 2.35 hours). The total amount of morphine consumption in 24 hours postoperatively was statistically significantly decreased in the ES group; P = 0.01. Incidence of postoperative nausea and vomiting was higher but statistically insignificant in the TA group than the ES group. There were statistically significant numbers of unsatisfied patients (4) in the TA group compared with the ES group (no patient). Limitations: Sensorial evaluation of patients was not performed because both blocks had been done under general anesthesia but did not affect outcome. Therefore we recommend further studies comparing between both blocks. Conclusions: Bilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than TAP block after open total abdominal hysterectomy. Key words: Abdominal hysterectomy, transversus abdominis plane block, erector spinae plane block, postoperative analgesia

PS-7-6 Effect of Combined Low Dose Spinal Anesthesia and Caudal Block on Postoperative Pain Outcomes of Penile Prosthesis Surgery

Postoperative pain is a major factor in decreased patient satisfaction after Penile Prosthesis (PP) Surgery. Multiple protocols were developed in order to lower narcotic use, with varying success rates. Therefore, we tried a novel intraoperative anesthesia regimen in 420 cases with age range 35 to 87. The aim of this retrospective study is to assess the effectiveness of combined anesthesia in decreasing postoperative pain and subsequent need for narcotic use in men undergoing PP surgery. Retrospective analysis of data was taken from 420 patients who underwent malleable and inflatable penile prosthesis surgeries from February 2016 to October 2019. Ninety four percent of patients (397 out of 420) suffer from co-morbid conditions, mainly diabetes, hypertension and ischemic heart disease (IHD). Our method involves using spinal anesthesia with 1 ml of Bupivacaine 0.5% at L3-L4 followed by caudal block using 15 ml of Bupivacaine 0.5% at the caudal area through sacral hiatus.

Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block

Objectives: To compare ultrasound guidance (USG) and electrical neurostimulation guidance (ENSG) in axillary brachial plexus block in terms of block performing time, sensory and motor block quality, and patient satisfaction.&#x0D; Methodology: 200 patients undergoing elective carpal tunnel syndrome surgery were randomly assigned to one of two groups; the USG group or the ENSG group. Axillary blocks were performed with a mixture of 15 ml of lidocaine 2% and 15 ml of bupivacaine 0.5% (a total of 30 ml solution). Sensory block was evaluated with a pinprick test and motor block was evaluated via the Bromage scale by a blinded observer.&#x0D; Results: Block performing time was significantly shorter in the USG group than in the ENSG group (P&lt;0.001). The sensory and motor block onset times were significantly shorter and the additional analgesic requirements were significantly lower in the USG group than in the ENSG group (P&lt;0.001).&#x0D; Conclusion: USG is better than ENSG in axillary brachial plexus block in terms of block performing time, block quality and patient satisfaction.&#x0D; Citation: Ozturk O, Bilge A, Tezcan AH, Tezcan HYAH, Ulusoy GR, Gezgin I, Dost B. Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block. Anaesth Pain &amp; Intensive Care 2016;20(1):50-53.

Randomized trial of bupivacaine with epinephrine versus bupivacaine liposome suspension in patients undergoing minimally invasive lung resection

ObjectivesThoracic surgery can cause significant pain, and multiple strategies have been developed to control pain after surgery. We compared 2 bupivacaine formulations given intraoperatively: bupivacaine with epinephrine (1,200,000) or liposomal bupivacaine. MethodsThis was a randomized, open-label study (NCT03560362). Eligible patients were adults scheduled for a minimally invasive lung procedure. Incision sites were injected with bupivacaine with epinephrine or liposomal bupivacaine before incision, and each intercostal space was injected with 1 mL of bupivacaine with epinephrine or liposomal bupivacaine entering the thoracic cavity. Patient-controlled analgesia was initiated in the recovery room. Pain was recorded using a visual analog scale. The primary outcome was the amount of narcotics taken during the postoperative hospital stay. ResultsWe recruited 50 patients; 25 received bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The treatment groups were similar in age, histology, and procedure performed. There were no statistical differences between the treatment groups in the amount of narcotics required during the hospital stay (36.3 mg for bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and 2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital length of stay and complications were also similar. ConclusionsIn a small, randomized study, we did not find significant differences between bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain after minimally invasive lung resection. We currently favor using the less expensive nonliposomal bupivacaine preparations until additional data are available.

Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial.

Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. Randomised, single-blinded trial. Two University-affiliated tertiary care hospitals between April 2016 and May 2017. A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals. The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level. The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg versus 6.7 [3.5 to 10.7] μg kg, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids. The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects. ClinicalTrials.gov ID: NCT02783586.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Chronic Post-Operative Surgical Pain: Review of 20 Cases

Abstract Background: Post-operative surgical pain of at least 2- month duration in absence of clear causes was defined as Chronic Post-operative Surgical Pain syndrome (CPSP). Transversus Abdominis Plane (TAP) block is a new imple-mented regional anaesthetic technique included in the analgesic regimen for many abdominal surgeries to reduce immediate post-operative pain and opioid requirements. Aim of Study: To assess the feasibility and efficacy of US guided TAP block in the management of chronic post-operative surgical pain. Patients and Methods: US-guided TAB block done for 20 patients complaining of chronic lower abdominal pain around 3-months to one-year duration after surgical operation with injection of 20ml of bupivacaine 0.25% and 2ml of methyl prednisolone (40mg/ml). Unilateral injection done for 12 patients & bilateral injections done for 8 patients. Second injection done for 6 patients after 3 months (three unilateral & three bilateral). Patient's pain intensity was assessed by Visual Analogue Score (VAS) before procedure & during follow-up visits for the next six months. Results: Three months after US-guided TAP block; 5 patients with mild degree of pain & 2 out of 10 patients with moderate degree of pain became completely pain free, while other 13 patients acquired relative improvement (5 patients with mild degree of pain and 8 patients with moderate degree of pain). Six months after US-guided TAP block; 6 patients (accepted second injection) improved with mild degree of pain while other 2 patients showed little improvement with still moderate degree of pain. Conclusion: Ultrasound guided TAP block is safe and effective method in management of chronic post-operative surgical pain.

Efficacy of perineural versus systemic dexamethasone in prolonging analgesia after ultrasound guided femoral and sciatic nerve block for patients undergoing below knee surgeries

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective to compare the analgesic efficacy of both, intravenous and perineural administration of dexamethasone during femoral and sciatic nerve block using bupivacaine in patients undergoing below knee surgeries. Patients and Methods In our study, 50 patients were randomly divided into two equal groups: Group A (Perineural Dexamethasone group) [n = 25]: Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous. Group B (Systemic Dexamethasone group) [n = 25]: Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block. Results Our study showed that onset time for sensory block was (25.39 ± 3.79) mins for systemic group and (18.85 ± 4.11) mins in perineural group with a significant statistical difference (P &amp;lt; 0.001) between both groups as the onset of sensory block in perineural group was significantly shorter than the systemic group and the duration of sensory block was (650.00 ± 62.8) mins in systemic group and (718.52 ± 62.06) mins in perineural group. The duration of sensory block was significantly shorter in systemic group than in perineural group with statistically high significant difference between groups (P &amp;lt; 0.001). Onset time for motor block was (30.61 ± 4.89) mins in systemic group and (27.59 ± 3.31) mins in perineural group. Perineural group had shorter time of onset than systemic dexamethasone group with a significant difference between groups (P = 0.013). The duration of analgesia was significantly longer in perineural group than systemic group (P &amp;lt; 0.001) Conclusion Dexamethasone was seen to be a potent adjunct to local anesthetic to prolong post operative analgesia with negligible side effects &amp; better outcome to the perineural route.

Analgesic efficacy of erector spinae block in comparison to thoracic epidural anesthesia in patients undergoing transthoracic esophageal surgical procedure

Background The ultrasound-guided erector spinae plane block is a new regional anesthetic technique providing long-lasting excellent analgesia in addition to hemodynamic stability and minimal rescue analgesic request. Materials and methods Following ethics committee approval, a total of 80 patients aged 36–65 years, American Society of Anesthesiologists physical status I and II undergoing elective transthoracic esophageal surgical procedures were enrolled in this prospective study. The patients were randomized into epidural group: patients who received thoracic epidural anesthesia with injection of 15 ml of bupivacaine 0.25% combined with general anesthesia, followed by 7 ml/h of 0.125% bupivacaine and bilateral erector spinae block group, which were performed with an injection of a total of 15 ml of bupivacaine 0.25% on either side combined with general anesthesia and then 7 ml/h of 0.125% bupivacaine was injected in each catheter 2 h for 24 h postoperatively. The primary end point included postoperative minor complications (hypotension, vomiting, urinary retention) and major complications (mortality). Secondary end points included the extubation time, hospital stay length, pain scores at 4, 8, 12, 18, and 24 h postoperatively, rescue analgesic consumption and patient satisfaction scores. Results Pain scores and the total dose of rescue analgesic were comparable in the two groups. The length of hospital stay was significantly longer in the epidural group compared with the erector group. Satisfaction scores were significantly higher in the erector group compared with the epidural group. There was no significant difference between the study groups regarding time to perform the block, time to extubation, and incidence of postoperative complications except for hypotension which was significantly higher in the epidural group. Conclusion Erector spinae plane block has an outstanding beneficial effect in reducing pain and providing better satisfaction scores with less incidence of complications compared with thoracic epidural anesthesia.