Rib fractures can lead to intense acute pain, chest wall instability, and pulmonary complications in trauma patients, necessitating their admission to critical care units. Furthermore, these lesions represent a source of neuropathic disturbances. The goal was to compare continuous thoracic intervertebral foramen blocks (CTIFBs) to continuous midpoint-to-pleura transverse process blocks (CMTPBs), both guided by ultrasound, for their efficacy in managing acute pain caused by rib fractures. A double-blind, randomized controlled trial. This research was conducted in the Intensive Care Unit (ICU) of San Salvatore Academic Hospital (L'Aquila, Italy) from December 2022 to November 2024. Ninety-six adult trauma patients with rib fractures were randomized to receive either the CTIFB (experimental group; n = 48) or the CMPTB (control group; n = 48). The former block was performed by placing the tip of the needle over and behind the transverse process of the vertebra. In the latter block, the needle tip involved the midpoint between the pleura and transverse process. All patients received an initial bolus of 5 mL of levobupivacaine 0.25% with 4 mg of dexamethasone at each fracture level, followed by a continuous infusion (5 mL/h of levobupivacaine 0.25% with 16 mg of dexamethasone). The primary outcome was the proportion of patients who achieved pain control (Numeric Rating Scale [NRS] score <= 3) by 2 hours after the block. The secondary outcomes included neuropathic disturbances (assessed by von Frey hair and Lindblom tests), respiratory parameters (P/F ratio, spirometry, and diaphragmatic motion), and daily morphine consumption. Success (NRS score <= 3) was achieved in 21/48 patients (44%) in the experimental group and 3/48 patients (6%) in the control group (P < 0.001). Patients in the experimental group showed significant reductions in neuropathic disturbances (F(5,470) = 18.5, P < 0.001) and required less daily morphine (10.1 ± 3.9 mg versus 20.8 ± 4.5 mg, P < 0.001). Both groups demonstrated improved respiratory parameters, but patients in the experimental group showed superior airflow rates by 48 hours (P = 0.004) after the block. The anesthetic procedures were performed under ultrasound rather than fluoroscopic guidance. These techniques may have utility in chronic pain management, requiring fluoroscopy rather than ultrasound. This aspect of our research is not generalizable to chronic pain practice. Additionally, this study had a single-center design, and patients undergoing anticoagulation therapy, an important subgroup of trauma care, were excluded. Those factors might have limited generalizability to other clinical settings. Third, the follow-up period was relatively short, precluding the assessment of long-term outcomes such as chronic pain development or functional recovery. Finally, although improved respiratory parameters were observed, the study was not equipped to detect differences in clinical outcomes such as pneumonia rates or mortality. For patients with rib fractures, the CTIFB offered superior pain management, fewer requests for opioids, and better respiratory function than did the CMTPB. Rib fractures, acute pain, neuropathic disturbances, paravertebral catheters, midpoint transverse process to the pleura, intervertebral foramen, respiratory function, opioid-sparing techniques.

Introduction: Peripheral nerve blocks not only provide surgical anaesthesia but also minimise the stress response, in addition to providing postoperative analgesia. The addition of adjuvants augments the anaesthetic action of the drug and reduces the dose required, thus improving the safety margin. However, no single drug can be considered the optimum local anaesthetic or adjuvant at this time. In the quest to find a better local anaesthetic and adjuvant combination, dexmedetomidine has recently emerged as a promising adjuvant to local anaesthetics during regional anaesthesia procedures. Aim: To study the efficacy of levobupivacaine and ropivacaine with dexmedetomidine as an adjuvant using ultrasound in the Supraclavicular Brachial Plexus Block (SCPB). Materials and Methods: A randomised, double-blinded clinical study was conducted in the Department of Anaesthesiology, Jagjivan Ram Railway Hospital, Mumbai Central, Maharashtra, India from November 2019 to April 2021 on 60 adults aged 21-65 years with American Soceity of Anaesthesiology (ASA) class I and II, scheduled for upper limb surgery. Patients were randomised into two groups, each containing 30 patients. Group A received 20 mL of levobupivacaine 0.5% with 50 mcg of dexmedetomidine, while Group B received 20 mL of ropivacaine 0.75% with 50 mcg of dexmedetomidine. A comparison was made regarding the efficacy in terms of the onset of sensory and motor blockade, duration of sensory and motor blockade, haemodynamics, any adverse effects, and postoperative analgesia. Categorical covariates were compared using the Chi-square test, and continuous covariates were compared using the unpaired t-test. Results: The groups were comparable concerning demographic data and baseline haemodynamic parameters. There was no statistically significant difference when comparing the mean Heart Rate (HR), mean blood pressures, and mean oxygen saturations at different time intervals between the groups. The mean time±Standard Deviation (SD) for the onset of sensory block and motor block in the levobupivacaine group was 19.13±1.87 min and 29.53±2.86 min, respectively; this was statistically faster at 11.26±1.92 min and 7.53±1.35 min in the ropivacaine group (p-value &lt;0.05). The mean duration of sensory and motor block in the levobupivacaine group was 459.83±26.40 min and 539.33±23.77 min, respectively, while it was longer at 878.66±17.46 min and 786.16±17.50 min in the ropivacaine group (p-value &lt;0.05). Conclusion: The use of dexmedetomidine with ropivacaine for SCPB results in a quicker onset and longer anaesthetic effect compared to levobupivacaine. Dexmedetomidine should be utilised as an adjuvant to reduce anaesthesia induction time in SCPB.

Pharmacokinetic modelling and simulation for prolonged infusion of levobupivacaine with or without epinephrine in transversus abdominis plane and erector spinae plane blocks: a randomised controlled trial and analysis of pooled data.

Background: Supraclavicular brachial plexus block provides safe, effective and low-cost anesthesia. There are always efforts to find better and safer local anesthesia along with adjuvant for supraclavicular brachial plexus block. Levobupivacaine has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling bupivacaine. We conducted the study to compare levobupivacaine with clonidine or butorphanol for sensory block, motor block, duration of analgesia, sedation and adverse effects Aims and Objectives: (1) To evaluate the analgesic efficacy of clonidine and butorphanol as an adjuvant to levobupivacaine. (2) To assess the onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog score (VAS) scoring and the requirements of rescue analgesia. Methodology: A prospective randomized study was carried out which included 60 adult patients between the ages of 18-65 years of ASA 1 and 2 who underwent upper limb surgeries. Group A received 30 ml of 0.5% levobupivacaine with 40mcg clonidine and group B received 30 ml of levobupivacaine with 2 mg of butorphanol via supraclavicular approach. Onset, duration of sensory and motor block, duration of analgesia was observed. All patients were observed in post anesthesia care unit and received tramadol injection 100mg IV in 100ml normal saline as soon as they compared of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till the injection of rescue analgesic. Result: Duration of block and analgesia was prolonged in group A compared to group B and it is statistically highly significant. Conclusion: Clonidine as an adjuvant with 0.5% levobupivacaine is more effective in prolonging the duration of sensory and motor block and the duration of analgesia when compared to butorphanol as an adjuvant to 0.5% levobupivacaine.

Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain. After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at P < 0.05. The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL. Adding 0.5 μg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.

Providing postoperative pain management in patients who underwent scrotal surgeries is achieved using several methods, one of which is the ultrasound-guided spermatic cord block (US-SCB). To enhance anesthesia quality and extend analgesia postoperatively, several agents have been added in conjunction with local agents. This study targeted assessing the results of combining neostigmine with levobupivacaine in US-SCB for providing perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery. This double-blind, randomized controlled study was performed for 112 subjects undergoing TESE operation using general anesthesia. They were randomly and equally divided into two groups. All participants received bilateral US-SCB after induction of general anesthesia by 19 mL of levobupivacaine 0.5% combined with 1 mL of neostigmine 500 μg in (group N) or 1 mL of normal saline in (group C). The first analgesic dose request time and the amount of analgesic consumed in the first 24 h were the main points of comparison in both groups. The mean postoperative analgesia duration was noticeably increased in the N group compared to the C group, with a value of 480 ± 41.34 min versus 404 ± 34.14 min, independently (P < 0.001). Moreover, the total amount of postoperative analgesic consumption was remarkably decreased in group N when compared to group C without statistically remarkable divergence concerning complications between both groups. Adding neostigmine to a local anesthetic solution in US-SCB proved to detain the first analgesic request postoperatively with reduced perioperative analgesia consumption, without significant side effects.

Postthoracotomy pain (PTP) is a severe pain complicating thoracic surgeries and its good management decreases the risk of PTP syndrome (PTPS). This randomized controlled study evaluated the efficacy of ultrasound-guided continuous erector spinae plane block (ESPB) with or without dexmedetomidine compared with thoracic epidural analgesia (TEA) in managing acute postoperative pain and the possible emergence of PTPS. Ninety patients with chest malignancies planned for thoracotomy were randomly allocated into 3 equal groups. Group 1: TEA (20 mL of levobupivacaine 0.25% bolus, then 0.1 mL/kg/h of levobupivacaine 0.1%), group 2: ESPB (20 mL of levobupivacaine only 0.1% bolus every 6 hours), and group 3: ESPB (20 mL of levobupivacaine 0.25% and 0.5 μg/kg of dexmedetomidine Hcl bolus every 6 hours). Resting and dynamic visual analog scales were higher in group 2 compared with groups 1 and 3 at 6, 24, and 36 hours and at 8 and 12 weeks. Postthoracotomy pain syndrome incidence was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. The grading system for neuropathic pain score was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. Itching, pruritis, and urine retention were higher in group 1 than in ESPB groups. Ultrasound-guided ESPB with dexmedetomidine is as potent as TEA in relieving acute PTP and reducing the possible emergence of chronic PTPS. However, the 2 techniques were superior to ESPB without dexmedetomidine. Erector spinae plane block has fewer side effects compared with TEA.

Background &amp; Objective: Labor pain relief has been a challenge for the clinicians for centuries. A lot many regimes and therapeutic interventions, including spinal and epidural injections, have been tried with variable effect. We aimed to compare the duration of analgesia and potency of bupivacaine plus fentanyl vs. levobupivacaine plus fentanyl for painless labor.&#x0D; Methodology: We enrolled 70 parturients who requested spinal analgesia in active labor, and randomly divided them into two groups; Group B (35 women) received 2.5 ml of bupivacaine 0.5% plus fentanyl 25 µg, and Group L (35 women) received 2.5 ml of levobupivacaine 0.5% plus fentanyl 25 µg. We assessed motor and sensory block, the efficacy of analgesia, pain scores, adverse effects, and obstetric and neonatal outcomes of both groups.&#x0D; Results: Time to reach maximum sensory block was significantly longer in Group L than in Group B (P = 0.002*). There was a statistically significant increase in the duration of motor blocks in Group B than in Group L (P &lt; 0.05). The median VAS scores were significantly lower in Group L than in Group B after 2 and 3 h after injection. The duration of analgesia was significantly longer in Group L than in Group B (P &lt; 0.05). The two study groups had no differences in the measured obstetric and neonatal outcomes.&#x0D; Conclusion: Levobupivacaine with fentanyl was superior to bupivacaine with fentanyl regarding the duration and potency of analgesia with lower pain scores, high maternal satisfaction, and no adverse obstetric or neonatal outcomes. Therefore, spinal levobupivacaine plus fentanyl was a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.&#x0D; Key words: Bupivacaine; Fentanyl; Levobupivacaine; Labor pain; Spinal Analgesia&#x0D; Citation: Ali WN, Youssef HA, Abbas AM, Roshdy PE, ImbabyASS. Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2023;27(4):478−484; DOI: 10.35975/apic.v27i4.2256&#x0D; Received: July 29, 2022; Reviewed: April 19, 2023; Accepted: April 21, 2023

Background Economic evaluation has become an essential decision-making tool for health systems worldwide. This study was aimed at estimating the difference in the use of healthcare resources, days on sick leave, and costs between patients undergoing a standard-volume versus a low-volume ultrasound-guided interscalene brachial plexus block. Methods This is a post-hoc cost analysis of a double-blind, randomized, and controlled clinical trial. Forty-eight patients undergoing ultrasound-guided interscalene block received either 10 ml or 20 ml of levobupivacaine 0.25%. Analyses involved the public healthcare payer perspective (including visits to general practitioners, nursing staff, physiotherapy facilities, hospital admissions, outpatient diagnostic tests, etc.) and the limited societal perspective, including productivity losses (days on sick leave). Measurements were made at one-month and one-year follow-ups post-intervention. Differences in costs were estimated using two-part models adjusted by the costs incurred in the previous year. Results Subjects in the 10 ml group made greater use of general practitioner visits (mean difference [95% CI]: 3.35 [0.219 to 6.49]; p=0.036) and diagnostic tests (2.43 [0.601 to 4.26]; p=0.009), but less use of physical therapy (-12.9 [-21.7 to -4.06]; p=0.004). Mean (SD) cost differences from the public healthcare payer's perspective were 1,461.34 $ (1,541.62) and 1,024.08$ (943.83) for the 10 ml and 20 ml groups, respectively (p=0.293). From the limited societal perspective, the differences were as follows: 7,036.53$ (8,077.58) and 8,666.56$ (9,841.10), respectively (p=0.937). While there were no differences in the above parameters at the one-month follow-up. Conclusion The volume reduction proposed following interscalene block resulted in meaningful, albeit not statistically significant, clinical benefits and lower costs from a limited societal perspective for shoulder surgery. Thus, healthcare use and days on sick leave are variables to be taken into consideration when calculating the economic impact of surgical procedures.

Backgrounds and objectives: This an attempt to compare the effects of 15ml of levobupivacaine 0.75%, 20 ml of levobupivacaine 0.375% and 30ml of levobupivacaine 0.25% with fixed dosage (75mg) on block characteristics in upper limb surgeries using ultrasound guided supraclavicular block. Materials and methods: Titled “Comparative study of the effects of three different volumes and concentrations of Levobupivacaine on the block characteristics in upper limb surgeries using ultrasound guided supraclavicular block” performed in Department of Anaesthesiology, Chettinad Hospital and Research Institute from March 2020 to April 2021. Group A – 15mL of Levobupivacaine 0.5%, Group B – 20mL of Levobupivacaine 0.375% Group C – 30mL of Levobupivacaine 0.25% Results: Onset of Sensory block: This study observed that mean onset of sensory block was earlier in 15mL was 22±5.25 minutes in comparison 20mL was 29±6.42 minutes and 30mL 37.5±6.17 minutes which is significant. Onset of Motor block: It was observed that mean onset of motor block was earlier in 15mL was 33±6.57 minutes when compared to 20mL was 36±6.87 minutes and 30mL 44±7.67 minutes which is significant. Duration of Analgesia: This study observed the mean Duration of analgesia was longer in 15mL 19.25±2.52 hours when compared to 20mL and 30mL Group having 15.5±1.88 hours and 12±1.94 hours respectively, which is significant. Diaphragmatic involvement: This study observed that the mean diaphragmatic involvement was longer in 15mL 25.6±13.291% when compared to 20 mL and 30mL having 33.76±9.76% and 52.435±12.6% respectively, which is significant. Conclusion:15mL Levobupivacaine of 75mg has an early onset of Sensory and Motor blockade and Prolonged Duration of Analgesia and lesser diaphragmatic involvement compared to 20mL and 30mL.

Introduction: Currently regional technique-thoracic paravertebral block for postoperative analgesia after breast surgery is gaining popularity. Aim of the study is to find out the safety and the analgesic efficacy of 1 ?g/kg dexmedetomidine when added to levobupivacaine 0.25% in paravertebral blocks (PVB) in patients undergoing breast cancer surgery. Methods: Sixty American Society of Anaesthesiologists physical statusI/II patients posted for breast cancer surgery were randomly assigned into two groups of 30 each. Group L received thoracic PVB with 20 mL of levobupivacaine 0.25%. Group LD received thoracic PVB with 20 mL of levobupivacaine 0.25% + 1 ?g/kg dexmedetomidine. Time of first analgesics request, total analgesic consumption, VAS score, hemodynamic, sedation score and side effects in the first 24 hours were recorded. Results: The time of the first rescue analgesic requirement was significantly prolonged in the group LD (8.15 ? 2.21 hours) in comparison to group L (6.34 ? 2.83 hours). The mean total consumption of intravenous tramadol as rescue analgesia in the post-anaesthesia care unit in the first 24 hours postoperatively was significantly decreased in group Levobupivacaine + Dexmeditomidine compared to group Levobupivacaine. Conclusion: The addition of dexmedetomidine 1 ?g/kg to levobupivacaine 0.25% in PVB in patients undergoing breast cancer surgery improves the quality and the duration of analgesia postoperatively.

Ultrasound-guided scalp blocks may revolutionize regional anesthesia for neurosurgery. In this report, we demonstrate that ultrasound-guided scalp blocks can be used effectively for a craniotomy. A 48-year-old patient with a brain tumor at the motor cortex was scheduled for an awake craniotomy. Ultrasound-guided scalp blocks targeting the bilateral supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater auricular, lesser occipital, greater occipital, and third occipital nerves were performed. A total of 29 mL of levobupivacaine 0.3% was used. No additional local anesthetic agent was given for skull pinning, skin incision, or the craniotomy. Postoperatively, the patient remained pain-free, and she was discharged without complications.

BackgroundFor pregnant women who require an emergency cesarean section (CS), extending labor epidural analgesia as quickly as feasible to good quality anesthesia is a critical issue. This indicates the presence of functional labor epidural analgesia and reduces the need for general anesthesia. Addition of magnesium increases anesthetic and analgesic qualities of epidural anesthesia.ObjectivesThe purpose of this trial was to assess the role of adding magnesium sulfate (MgSO4) with levobupivacaine to speed up the conversion of labor epidural analgesia into enough anesthesia for emergency CS.MethodsFifty parturients were randomly assigned to receive 19.5 mL of levobupivacaine 0.5% with either 0.5 mL of normal saline 0.9% (Group I) or 0.5 mL of MgSO4 10% (Group II) after receiving labor epidural analgesia. We documented the onset of block (loss of pinprick to T6), number of patients needing additional analgesia, the time needed for sensory and motor blockade to recover, and the adverse effects.ResultsThe frequency of patients receiving intraoperative supplements was comparable in the study groups (P = 0.491), although the onset of the block was faster in Group II than in Group I (P = 0.000*). Group II took substantially longer to recover from sensory and motor blockade than Group I (P = 0.001* and P = 0.001*, respectively). In both groups, the occurrence of adverse events was similar.ConclusionsAdding 50 mg of MgSO4 to levobupivacaine 0.5% accelerated the epidural top, and both sensory onset and motor blocks period were prolonged as compared to levobupivacaine alone when extending epidural analgesia for emergency CS.

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.&#x0D; Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesiatechnique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.&#x0D; Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Abstract Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.&#x0D; Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.&#x0D; Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.&#x0D; Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.&#x0D; Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Background:The effect of perineural versus intravenous (i.v.) dexamethasone (4 mg) when added to levobupivacaine as an adjuvant has not been well studied.Aims:This study was conducted to compare the analgesic efficacy of perineural and i.v. dexamethasone as an adjuvant to levobupivacaine in infraclavicular brachial plexus (ICBP) block.Settings and Design:This was a prospective, randomized, double-blind study.Materials and Methods:This study was conducted on 68 patients with the ultrasound-guided ICBP block, randomly allocated into two groups (34 each). Four patients had failed block (2 in each group) that was excluded from the study. Group A received 25 mL of levobupivacaine 0.5% and 1 mL of normal saline for the block and i.v. dexamethasone 4 mg. Group B received 25 mL of levobupivacaine 0.5% with 4 mg of perineural dexamethasone for the block. Postoperative vitals and different block characteristics were assessed.Statistical Analysis Used:Student's independent sample t-test and Chi-square test were used for statistical analysis.Results:The duration of motor block and analgesia in Group A was 1245.94 ± 153.22 min and 1310.16 ± 151.68 min, respectively. However, in Group B, the duration of motor block and analgesia was 1768.13 ± 309.86 min and 1743.59 ± 231.39 min, respectively, which was more when compared to Group A (P < 0.001). The Visual Analog Scale score of ≥3 in Group A was 37% and in Group B was 9% (P = 0.008). Four cases had delayed regression of motor block in the perineural group.Conclusions:Perineural dexamethasone significantly prolonged the duration of motor block promoted by levobupivacaine in infraclavicular brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period when compared with the intravenous dexamethasone.

ABSTRACT Background: The control of postoperative pain following major lumbar spine surgeries remains a major challenge for anesthesiologists, and many new strategies and methods have been developed for pain control. This study’s main objective was to evaluate the efficacy of the bilateral ultrasound-guided erector spinae plane block (US-ESPB) as a method for perioperative pain management in patients undergoing lumbar spine surgeries. Methods: This double-blinded prospective randomised controlled study was conducted on 140 patients aged between 18 and 65 years; all were scheduled for elective lumbar spine surgeries. Patients were randomly allocated into one of the two groups: the ESPB group (n = 70) or the control group (n = 70). All patients received bilateral US-ESPB after induction of general anaesthesia, in the ESPB group; 20 mL of levobupivacaine 0.25% were used, while 20 mL normal saline was given to the control group instead. The primary endpoint was the total amount of morphine consumed during the intraoperative and the first 24 postoperative hours. Secondary endpoints included, time to first request of rescue analgesia as well as incidence of adverse effects. Results: The total amount of morphine consumed during the intraoperative and the first 24 postoperative hours was found to be significantly lower in the ESPB group compared to the control group (P < 0.001). Moreover, the time to first analgesic request was significantly longer in patients receiving ESPB as analgesia (P < 0.001). No statistically significant differences were observed between the two groups regarding complications. Conclusion: Bilateral US-ESPB is useful intervention for providing adequate pain management in lumbar spine surgeries.

Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial