Need For Rescue Analgesia Research Articles

Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications. Aim of the Work The present study was designed to assess the analgesic efficacy of ultrasound guided Erector Spinae Plane Block done at the fifth thoracic transverse process level in patients undergoing VATS surgeries for postoperative analgesia. Patients and Methods This prospective randomized clinical study was conducted in Ain Shams University Hospitals. It included a total of 60 adult patients aged 21-60 years, Scheduled for VATS surgeries. Patients were randomly divided into two equal groups 30 patients each. The ESPB group (n = 30): received ESPB after induction of anaethesia, while the Control group (n = 30): received only fentanyl 1- 2 mcg/kg during induction of anesthesia and additional boluses of fentanyl.5 mcg/kg were given according to the patient’s vital data. Results The main finding in this study was that ultrasound guided ESPB provided a good analgesic effect in patients undergoing VATS surgery, it also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to controlled group, Prolonged the time to first request of analgesia, allowed early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting. Conclusion Ultrasound-guided erector spinae plane block was found statistically significantly in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after VATS surgeries, without associated adverse effects as postoperative nausea and vomiting, nerve injury, respiratory depression and hematoma formation.

Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial

Study objectiveWe aimed to assess and compare the analgesic efficacy and adverse effects of intravenous (IV) sub-dissociative-dose ketamine (SDK) to nebulized ketamine in emergency department (ED) patients with acute painful conditions. MethodsWe conducted a prospective, randomized, double-blinded, double-dummy clinical trial in adult patients (ages 18 to 64) with a numerical rating scale (NRS) pain score of >5. We randomized subjects to receive either a single dose of 0.3 mg/kg of IV ketamine or 0.75 mg/kg of nebulized ketamine via a breath-actuated nebulizer. Primary outcome was the difference in pain scores on the NRS between groups at 30 minutes post-medication administration. The secondary outcomes included the need for rescue analgesia, occurrences of adverse events in each group, and the difference in pain scores at 15, 30, 60, 90, and 120 minutes. We calculated a 95% confidence interval (CI) for a mean difference at 30 minutes, with a minimum clinically important difference set at 1.3 points. ResultsWe enrolled 150 subjects (75 per group). Mean pain scores via NRS were 8.2 for both groups at baseline, which decreased to 3.6 and 3.8 respectively at 30 minutes, yielding a mean difference of 0.23 (95% CI -1.32 to 0.857). We observed no clinically concerning changes in vital signs. No serious adverse events occurred in any of the groups throughout the study period. ConclusionWe found no difference between the administration of IV and nebulized ketamine for the short-term treatment of moderate to severe acute pain in the ED with both treatments providing a clinically meaningful reduction in pain scores at 30 minutes.

A Randomized Controlled Study of Epidural Morphine Sulfate-soaked Gelfoam and Morphine Sulfate Instillation in the Management of Postoperative Pain following Lumbar Spinal Fixation Surgery

Abstract Background: Lumbar spinal fixation surgeries play a pivotal role in addressing pain which can be nociceptive, neuropathic, mixed, and nociplastic; however, these surgeries can also cause significant postoperative pain and discomfort, leading to prolonged hospital stays and delayed return to normal activity. Aims and Objectives: The aim of the study was to provide effective postoperative analgesia and to compare the analgesic efficacy by application of Gelfoam-soaked morphine sulfate placed in the epidural space and direct instillation of morphine sulfate in the epidural space in patients undergoing lumbar spinal fixation surgery under general anesthesia. Materials and Methods: A total of 60 patients planned for Lumbar spinal fixation surgeries were selected and sorted into two groups of 30 each after a computer-based randomization. In Group G, a 5 cm × 1 cm piece of absorbable gelatin sponge soaked in 5 mg of morphine sulfate diluted in 0.9% normal saline up to 5 mL was placed in the epidural space. In Group I, 5 mg of morphine sulfate diluted in 0.9% normal saline 5 mL was instilled over the intact epidural space. Pulse rate, mean arterial pressure (MAP), respiratory rate (RR), and peripheral oxygen saturation (SpO2) were observed hourly for the first 6 h, then at 2 hourly intervals till 12 h, and at 4 hourly intervals till 48 h. Postoperatively, pain intensity is assessed by the Visual Analog Scale (VAS) for 24 h, and the time of the first analgesic dose is noted. VAS ranges from 0 (no pain) to 10 (severe pain). Preoperative instructions were given to the patients about the use of VAS. Results: In this study, Group G demonstrated lower postoperative VAS scores and delayed need for rescue analgesia compared to Group I (P < 0.05, P < 0.0001, respectively). Group I had a higher total analgesic requirement (P < 0.0001) and consistently higher heart rates (P < 0.0001) compared to Group G. MAPs were lower in Group G compared to Group I (P < 0.0001). RRs, SpO2, sedation scores, and incidence of nausea and pruritus were similar between the two groups (P > 0.05). Conclusion: Epidural administration of morphine using Gelfoam as a vehicle for sustained release of morphine is a safe and effective method of postoperative analgesia in lumbar spinal fixation surgeries and results in better hemodynamics, prolonged duration of analgesia, and reduced requirement of rescue analgesics, compared to epidural instillation of morphine.

Analgesic effects of pectoserratus plane block and intermediate cervical plexus block for transaxillary endoscopic thyroidectomy: a prospective randomized controlled trial.

Transaxillary endoscopic thyroidectomy (TAET) is favored for its favorable cosmetic outcomes and the preservation of anterior cervical function. Despite these benefits, postoperative analgesia has traditionally relied on pharmacological interventions, and regional anesthetic procedures may be an alternative method. This study aimed to evaluate the efficacy of an ultrasound-guided pectoserratus plane block (PSPB) combined with an intermediate cervical plexus block (ICPB) for TAET. Forty patients undergoing TAET were randomized into two groups: the nerve block group (N.=20) received ultrasound guided PSPB with 20 ml of 0.375% ropivacaine and ICPB with 8 mL of 0.3% ropivacaine, while the control group (N.=20) received no block. The primary outcome was the Visual Analog Scale (VAS) scores for postoperative neck and axillary pain at different time points (1, 6, 12, 24 h) during rest and movement post-TAET. The secondary outcomes included intraoperative remifentanil consumption, incidence of postoperative nausea and vomiting (PONV), number of remedial analgesic requirements, and patient satisfaction postoperatively. Compared to the control group, patients in the nerve block had significantly lower VAS scores of the neck and axilla whether at rest or movement, and 1, 6, 12, and 24 h postoperatively (P<0.0125). The nerve block group showed higher patient satisfaction (P<0.001). No difference was observed in intraoperative remifentanil consumption, need for rescue analgesics, or other adverse effects 48 h postoperatively. Ultrasound-guided PSPB with ICPB significantly alleviated postoperative pain and improved patient satisfaction with TAET.

Ultrasound-guided distal glossopharyngeal nerve block for post-tonsillectomy pain relief in adults: a prospective randomized study.

We aimed to evaluate the safety and efficacy of the novel distal approach of ultrasound (US)-guided glossopharyngeal nerve (GPN) block at the pharyngeal wall for enhancing the quality of analgesia in patients undergoing tonsillectomy. Fifty patients, both male and female, between the ages of 21 and 65, categorized as ASA I-II by the American Society of Anesthesiologists (ASA) and who were scheduled for tonsillectomy, were enrolled in the study. Patients were randomly assigned to receive general anesthesia with either bilateral US-guided distal GPN block (GPN group) or no block (control group). The time for first request of analgesics, postoperative pain scores, the total amount of rescue analgesic medication consumed within a 24-hour period, and the occurrence of any adverse events were all noted. The onset of first analgesic request was significantly prolonged in GPN group than the control group (P=0.013). Pain scores at 30 min, two and six hours postoperative were found to be significantly lower in GPN group than the control group both at rest (adjusted P=0.005, 0.000, and 0.020 respectively) and during swallowing (adjusted P=0.002, 0.000, and 0.015 respectively), with significantly less morphine consumption at 24 hours postoperative in GPN group compared with the control group (P=0.002). No significant postoperative block-related complications were observed. In patients having tonsillectomy, pre-emptive application of US-guided distal GPN block at the pharyngeal wall enhanced the quality of analgesia and decreased the need for rescue analgesics with no major adverse effects.

EFECTIVIDAD DEL BLOQUEO PEC II COMPARADO CON ANALGESIA ENDOVENOSA EN MONODOSIS EN PACIENTES POST MASTECTOMIA POR CÁNCER DE MAMA

Objective: To determine whether in post-mastectomy breast cancer patients, PEC II block plus single-dose intravenous analgesia is more effective than single-dose intravenous analgesia in treating postoperative pain. Methods: An cohort study was conducted between June and September 2022 with 60 breast cancer patients who underwent unilateral mastectomy. Two groups of 30 patients each were formed: one received PECS II Block plus EV Analgesia and the other only EV Analgesia. Inclusion criteria covered patients with ASA physical status 1 or 2, aged 18 to 70 years, and excluded those with drug allergies, serious diseases and those who refused to participate. Results: Patients who received EV Analgesia alone reported higher values of pain measured by the Visual Analog Scale compared to those who received PECS II Block plus EV Analgesia, with significant differences (p = 0.001). In terms of adverse effects, all patients in the PECS II Block and EV Analgesia group experienced no negative effects, while in the EV Analgesia only group, 100% required rescue analgesia, and there were reports of vomiting, headache and nausea. Conclusion: PECS II Block in combination with EV Analgesia proved to be more effective in postoperative pain control in patients undergoing unilateral mastectomy for breast cancer, significantly reducing the need for rescue analgesia and the occurrence of adverse effects compared to EV Analgesia alone.

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.

Comparing Perfusion Index and Visual Analogue Scores for Postoperative Pain Assessment Following Upper Limb Surgeries Under Supraclavicular Brachial Plexus Block: An Observational Study.

Effective pain assessment is crucial to tailor the analgesic regimen post-operatively. Perfusion index (PI) has been reported to be a useful objective assessment tool for monitoring pain. This study aimed to explore the utility of PI in assessing postoperative pain in upper limb surgeries under supraclavicular block and its correlation with visual analogue scale (VAS) scores. This prospective, observational study included 140 patients scheduled for elective upper limb surgeries. PI, VAS scores, heart rate (HR),mean arterial pressure (MAP) and physiological parameters were recorded at baseline and postoperatively. Inj. tramadol was administered when the VAS score exceeded ≥ 4 and the VAS score, PI, HR and MAP were recorded at 5, 10, 15 and 20 minutes after administration. Comparison of normally and non-normally distributed data was done using t-statistics and Mann-Whitney U-test respectively. Pearson correlation was used to establish a correlation between variables and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of PI to determine the onset of pain. There was a significant and moderate correlation between pre-analgesic and post-analgesic PI and VAS score (r = -0.425 and -0.448 respectively, p<0.001), while PI and MAP or PI and HR showed only a weak correlation. A cut-off value of 14.7 for PI showed 76.3% sensitivity and 100% specificity in predicting rescue analgesia requirements. The study supports the use of PI as an objective measure for postoperative pain assessment, with a notable correlation with VAS scores. The identified cut-off value for PI adds to its clinical utility in predicting the need for rescue analgesia.

Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial

ObjectiveReconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). Material and methodsDouble-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. ResultsThe intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ​± ​1.0 vs. 1.3 ​± ​0.6 in the epidural group; p ​= ​0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ​± ​15 vs. 102 ​± ​11 in the epidural group (p ​= ​0.001). ConclusionsEpidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications. Level of evidence2.

Advantages of laparoscopic-assisted ovariohysterectomy versus open ovariohysterectomy for dogs with pyometra not detected in randomized clinical trial.

To compare results for surgery time, perioperative pain, need for rescue analgesia, variables, serum C-reactive protein concentration, and postoperative complications for dogs with pyometra treated with laparoscopic-assisted ovariohysterectomy (LaOVH) versus open-surgery (OS) ovariohysterectomy. 12 client-owned dogs with pyometra between June 1, 2016, and December 31, 2019. Dogs enrolled in this prospective single-center randomized clinical trial had pyometra confirmed by history, physical examination, ultrasonography, and blood work and were randomly assigned to treatment group LaOVH or OS. Differences in results for variables of interest were compared between groups using the Mann-Whitney U test, except the number of dogs requiring rescue analgesia was analyzed using the Fisher exact test. Values of P ≤ .05 were considered significant. 6 dogs were recruited in each group; results for 1 dog in the LaOVH group were excluded from further analysis due to free abdominal fluid detected during surgery. Median surgery time was significantly shorter and median total incision length was longer for the OS group (23 minutes; 106 mm), compared to the LaOVH group (37 minutes; 38 mm). No other results differed significantly between groups. Although fewer patients in the LaOVH group required rescue analgesia, this was not statistically significant. Therefore, our results could not prove previously suggested advantages of LaOVH (eg, less perioperative pain or faster recovery) in dogs with pyometra. Additionally, for the LaOVH group, the median surgical time was approximately 50% longer, an assistant was needed, and specialized equipment was required.

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial.

Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.

Sphenopalatine ganglion block vs greater occipital nerve block in the management of post dural puncture headache in obstetric patients: a randomized clinical trial

Background: With the increased popularity of spinal anesthesia for a variety of surgeries, the anesthesiologists have to face the increased incidence of post dural puncture headache (PDPH). It is especially cumbersome to the obstetric patients. A variety of management techniques have been used. We compared the efficacy of sphenopalatine ganglion block (SPGB) versus greater occipital nerve block (GONB) for the management of PDPH in obstetric cases.&#x0D; Methodology: This prospective, randomized trial, enrolled 120 PDPH cases into two groups. The SPGB group received bilateral SPGB with a 3 ml mixture of 2% lidocaine and 4 mg dexamethasone (in each nostril). In the GONB group, the greater occipital nerves were blocked utilizing a solution of 3 ml mixture of 2% lidocaine and 4 mg dexamethasone on each side. Prior to the procedure, a pain score on numerical pain scale (NPS) was reported. Pain scores were noted at 15 and 30 min, then at 2, 4, 8, 16, and 24 h after the intervention. Need for and cumulative dose of analgesics used were recorded. Complications, patient satisfaction, hospital stay for epidural blood patch (EBP), and hospital discharges were also recorded.&#x0D; Results: Pain perception in upright position at 30 min and at 2, 16, and 24 h, the need for rescue analgesia and the cumulative analgesic dose within 24 h were significantly lower in SPGB group. Bitter taste was significantly more frequently complained by the patients of SPGB group. In the SPGB group, the EBP was not significantly less prevalent. In the SPGB group, patient satisfaction was noticeably greater.&#x0D; Conclusion: The sphenopalatine ganglion block is more effective in relieving PDPH and its associated symptoms than the greater occipital nerve block. Both procedures are easy, safe, more conservative than EBP, and without serious adverse effects. The sphenopalatine ganglion block can be recommended as a first line treatment for PDPH.&#x0D; Abbreviations: ASA: American Association of Anesthesiologists; CI: Confidence Interval; CSF: Cerebral Spinal Fluid; EBP: Epidural Blood Patch; GON: Greater Occipital Nerve; GONB: Greater Occipital Nerve Block; PDPH: Post-Dural Puncture Headache; RR: Relative Risk; SPGB: Sphenopalatine Ganglion Block; NPS: Numerical Pain Scale&#x0D; Key words: Nerve Block; Obstetrical Analgesia; Post-Dural Puncture Headache; Sphenopalatine Ganglion Block&#x0D; Citation: Abdelrazik RA, Toulan HF, Ayoub SNB, Sphenopalatine ganglion block vs greater occipital nerve block in the management of post dural puncture headache in obstetric patients: a randomized clinical trial. Anaesth. pain intensive care 2024;28(1):68-73; DOI: 10.35975/apic.v28i1.2143&#x0D; Received: January 27, 2023; Reviewed: March 02, 2023; Accepted: March 02, 2023

Top 5 Research Studies of the month for Italian Primary Care Physicians: January 2024.

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) A recent high-quality systematic review (SR) of 76 SRs found that, compared to all other lipid-lowering medications, for overall, primary, and secondary prevention the best balance of benefits, harms, and costs is provided by statins. 2) To our surprise, a network meta-analysis of 12 randomized controlled trials (RCTs) concluded that acetaminophen and ketorolac were more effective than morphine in alleviating pain from renal colic and were less likely than morphine to cause adverse effects and the need for rescue analgesia. 3) Proton pump inbibitors (PPI) use in children is associated with an increased risk of developing serious infections as compared with the use other acid-suppressing therapy. It seems prudent to use antacids and histamine 2 receptor antagonists first and reserve PPIs for nonresponders. 4) Overdiagnosis - the identification of, in this case, breast cancer, that would not have caused symptoms in a person's lifetime - seems to increase with age. In a study including more than 50.000 women aged above 70 who underwent mammography screening, the overdiagnosis rate was 31%, 47% and 51% for women aged 70 to 74 years, 75 to 84 years and over age 85, respectively. 5) An RCT among community-dwelling adults conducted in the US found that using a regular cuff on larger-than-average arms can falsely raise blood pressure readings by almost 5 mmHg, and a regular cuff on an especially thin arm can lower readings by 3.6 mmHg.

Bupivacaine liposomal injectable suspension does not provide improved pain control in dogs undergoing abdominal surgery.

To evaluate the difference in postoperative pain scores of dogs undergoing abdominal surgery receiving surgical incision infiltration of saline or bupivacaine liposomal injectable suspension (BLIS). 40 dogs undergoing exploratory laparotomy. Dogs were prospectively enrolled and randomized to receive either BLIS or saline surgical incision infiltration. All dogs received 5.3 mg of BLIS/kg or an equal volume of saline infiltrated in the muscle/fascia, subcutaneous tissue, and intradermal layer during closure. All dogs received a standardized postoperative pain management protocol. Pain assessment was performed at select time points postoperatively by blinded observers with an electronic algometer, short version of the Glasgow Composite Measure Pain Scale (GCMPS), and indirect measures of pain, including systolic blood pressure, heart rate, and serum cortisol levels. At day 0, blood pressure was higher in the saline group (149.6 vs 125.8 mm Hg; P = .006). At day 3, GCMPS was lower in the BLIS group (BLIS = 1, saline = 2, P = .027), though both average GCMPS scores were low and only 10 dogs were available for day 3 assessments (6 BLIS and 4 saline). No other differences in algometer readings, GCMPS scores, other measured parameters, or need for rescue analgesia were present between BLIS and saline groups at any time point. There was no difference in postoperative incisional infection rate or complications. Use of BLIS for exploratory laparotomy did not provide improved pain control over postoperative opioid administration alone. Patients that received BLIS had no increase in short-term complications.

Effectiveness of Postoperative Analgesia with Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia

Objective: To determine the frequency of need for postoperative intravenous analgesia after rectal diclofenac suppository in patients undergoing lower abdominal gynecological or obstetrical surgery under general anesthesiaStudy Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Operation Theater and Postoperative Ward of Sheikh Zayed Hospital, Lahore, Pakistan from January 2021 to July 2021.Methods: A total of 245 women undergoing gynecological and obstetrical surgeries under general anesthesia were enrolled in the study using non-probability consecutive sampling. All the participants were recruited after obtaining informed consent and meeting the inclusion criteria. All subjects had a single 100mg diclofenac suppository inserted rectally after undergoing general anesthesia, and their Visual Analog Scale (VAS) scores for postoperative analgesia were recorded immediately after surgery and again at 1, 6, and 24 hours.Results: The mean age of the patients was 37 years, with a standard deviation of 6.2. The mean VAS (Visual Analog Scale) scores at 1, 6, 12, and 24 hours were 3 (±1.24), 5 (±1.46), 7 (±1.93), and 6 (±2.14), respectively. The need for rescue analgesia was reported in 15.9% of cases at 1 hour, 37.1% at 6 hours, 82% at 12 hours, and 68.2% at 24 hours.Conclusion: The administration of diclofenac via rectal placement led to a notable decrease in Visual Analog Scale scores and a lower incidence of needing additional pain relief within the first 6 hours after surgery.&#x0D; How to cite this: Saeed R, Mahboob A, Ali SM, Latif A, Ammar T, Kakepotto IA. Requirement of Postoperative Analgesia after Per Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia. Life and Science. 2024; 5(1): 120-125. doi: http://doi.org/10.37185/LnS.1.1.515

Thoracotomy Patients Under General Anesthesia: A Comparison on Intra-Operative Anesthetic and Analgesic Requirements, When Combined with Either Epidural Analgesia or Continuous Unilateral Paravertebral Analgesia.

Regional analgesia is effective for post-thoracotomy pain. The primary objective of the study is to compare the intraoperative requirement of isoflurane and fentanyl between general anaesthesia (GA) with epidural analgesia and GA with paravertebral analgesia. A prospective observational comparative study was conducted on 56 patients undergoing open thoracotomy procedures. The patients were divided into two groups of 28 by assigning the study participants alternatively to each group: Group GAE - received thoracic epidural catheterization with GA, and Group GAP - received ultrasound guided thoracic paravertebral catheterization on the operative side with GA. Intraoperative requirement of isoflurane, fentanyl, postoperative analgesia, stress response, need of rescue analgesics and adverse effects were observed and analysed. 25 patients in each group were included in the data analysis. The intraoperative requirement of isoflurane (32.28 ± 1.88 vs 48.31 ± 4.34 ml; p < 0.0001) and fentanyl (128.87 ± 25.12 vs 157 ± 30.92 μg; p = 0.0009) were significantly less in the GAE group than in the GAP group. VAS scores and need of rescue analgesics and blood glucose levels were not statistically significant during the postoperative period (p > 0.05). The incidence of adverse effects was comparable except for hypotension and urinary retention which were significantly higher in the GAE group. GA with epidural analgesia resulted in significant reduction in the intraoperative consumption of isoflurane and fentanyl in comparison to GA with paravertebral analgesia. However, both the techniques were equally effective in the postoperative period.

Effects of Differences in Epidural Needle Entry Point and Angle of Rotation of Needle Hub on the Onset and Duration of Sensory Blockade in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Epidural anaesthesia is a boon for providing prolonged analgesia for postoperative pain relief. The influence of epidural needle insertion on the onset of the block, which has not been studied previously, is significant. Aim: To analyse the effect of epidural needle entry and rotation of the needle on the onset and duration of the block. Materials and Methods: This double-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India from March 2020 to August 2021 on 70 patients undergoing leg and ankle surgeries. They were randomised into Group-ML (midline approach) and Group-PM (paramedian approach). In Group-ML, midline epidural needle entry was followed by catheter insertion. In Group-PM, the needle entry was paramedian, and the bevel was turned 45º towards the surgical site for catheter insertion. A 10 mL of 0.5% bupivacaine was administered. Postoperatively, epidural infusion was initiated using 0.125% bupivacaine with 2 μg/mL fentanyl. The time taken for catheter placement, onset of motor and sensory blockade, maximum sensory level attained, duration of sensory blockade, consumption of local anaesthetics, haemodynamic profile, and the need for rescue analgesia were monitored. Continuous data were analysed using the Student's t-test, and categorical data were analysed using the Chi-squared test with International Business Machines (IBM) statistical product and service solutions software version 27.0 Results: Both groups were comparable with respect to demographics. The mean age in Group-ML was 40.9±25.93 years, while in Group-PM it was 41.028±20.576 years, with a p-value of 0.981. The mean BMI in Group-ML was 24.91±2.998 kg/m2 , while in Group-PM it was 24.96±2.527 kg/m2 , which was statistically insignificant with a p-value of 0.944. A total of 21 males in Group-ML and 28 males in Group-PM participated in the study; the distribution was found to be statistically insignificant with a p-value of 0.067. The time taken for the placement of the epidural catheter was around 288 seconds in Group-ML and 322 seconds in Group-PM, with a p-value of 0.0035. The onset of sensory block was around 17 minutes in Group-ML and 13 minutes in Group-PM, respectively, with a p-value of 0.0001. The duration of sensory block or the time taken for two-segment regression of level was around 102 minutes and 128 minutes in Group-ML and Group-PM, respectively (p-value 0.0001). The rescue analgesic was required in seven patients of Group-ML and none in Group-PM, with a p-value of 0.005. The haemodynamic profile intra and postoperatively and postoperative VAS score were statistically insignificant between the groups. Conclusion: The paramedian approach and epidural catheter insertion with the needle rotated at an angle of 45º towards the surgical side provide a rapid onset of the sensory and motor block with extended duration of the sensory blockade and reduced consumption of local anaesthetics.

Localised 0.2% chlorhexidine irrigation delivery system versus oral antibiotics in reducing postoperative complications in the surgical extraction of impacted mandibular third molar (IMTM). - a randomised controlled trial.

The purpose of the study was to compare the efficacy of the use of 0.2% chlorhexidine irrigation and the oral antibiotics for the prevention of postoperative complication like pain, trismus, swelling and infection after the surgical extraction of IMTM. A randomised, double blinded clinical trial was planned with two equal groups. Patients were randomly divided into two groups using computer-generated codes with an allocation ratio of 1:1. Group I (Control): Standard preoperative and postoperative systemic oral antibiotics and Group II (Study): No systemic antibiotics and Chlorhexidine irrigation local delivery. The primary outcomes evaluated were postoperative pain, mouth opening, swelling and infection. The secondary outcome variables were the number of analgesics and antibiotics taken by the patient in the postoperative period, the satisfaction of the patient and adverse events, were followed up regulary for 7 days postoperatively. A total of 84 patients, divided into two equal groups participated in the study. In intergroup comparison of swelling, the difference was non-significant on postoperative day (POD) 1 and 7, except for POD 3, where it showed significantly lower results in the antibiotic group (p = 0.012). However, there was no significant difference in pain found between both groups at any of the postoperative time points, and the study group had a lesser need for rescue analgesics than the control group. A statistically significant difference in incidence of dry socket was observed (p = 0.03) and gastrointestinal adverse symptoms, but it showed insignificant results for wound dehiscence and pus discharge. Also, patient satisfaction was higher in the study group. both antibiotics and localised delivery demonstrated comparable results in terms of swelling, pain and trismus. However, with lesser adverse events, the localised chlorhexidine delivery with curved tips outperformed the antibiotic group.

Transient Worsening of Pain After Administration of Immune Checkpoint Inhibitors - A Case Series.

Transient pain enhancement or flare pain, is observed following the administration of immune checkpoint inhibitors (ICIs). However, the detailed mechanism of this phenomenon remains unclear. In this report, we present our experience of documenting the course of flare pain following ICI administration in six cases. Six patients with advanced solid tumors received ICI monotherapy between July 2017 and November 2019. Their pain increased within hours of ICI administration despite being stable before ICI administration. We evaluated the changes in the numerical rating scale (NRS) score over 72 h after ICI administration. Four non-small cell lung cancer patients, one gastric cancer patient, and one renal cell cancer patient were included. Four patients experienced an increase in NRS, as evidenced by scores on two or more scales compared to the day before administration, whereas two patients showed an increase only on one scale. The NRS score decreased to almost the same level as that on the day before administration. Flare pain is observed in the same area as the primary site. Most of the pain was alleviated without the need for rescue analgesics, although one patient experienced a 4-point increase in the NRS scale. Flare pain may occur following ICI administration. Healthcare providers should be aware of these events and provide patients with suitable information and coping techniques.

Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries

Introduction: Pain is associated with higher perioperative morbidity in fracture patients. Fascia iliaca compartment block is a simple, inexpensive, and effective method of analgesia for femoral fracture surgeries. Many adjuvants have been used with local anaesthetics to prolong post-operative analgesia.&#x0D; Aims: To assess the effects of dexamethasone as an adjuvant to fascia iliaca compartment block on prolongation of post-operative analgesia in patients undergoing femoral fracture surgeries.&#x0D; Methods: Seventy patients aged, 18-65 years with American Society of Anaesthesiologist-Physical Status I and II, undergoing femoral fracture surgery, were randomly assigned to two groups, n=35 each, who received standard subarachnoid block. Ultrasound guided Fascia iliaca compartment block was given after completion of surgery with 20ml of 0.35% ropivacaine + 2ml normal saline to group one or 20ml of 0.35% ropivacaine + 2ml dexamethasone(4mg/ml) to group 2. Total duration of analgesia and total rescue analgesic requirement in the first post operative day were noted after successful block.&#x0D; Results:The demographic information for the two groups was comparable. The duration of postoperative analgesia was prolonged in patients receiving dexamethasone adjuvant (541 ± 167 vs. 638± 165 mins, p = 0.018; Mean difference -97). Patients receiving dexamethasone adjuvant required significantly less postoperative rescue analgesics for the first 24 hours (tramadol 88 ± 32 vs 65 ± 23 mg, p = 0.001; Mean difference 23).&#x0D; Conclusion: Dexamethasone, added to Fascia Iliaca Compartment Block, as an adjuvant, significantly prolongs the postoperative analgesic effect thereby, reducing the need for rescue analgesic in the first postoperative day.