Onset Of Analgesia Research Articles

Comparison of cardiorespiratory and anaesthetic effect of alfaxalone or propofol in dogs premedicated with acepromazine-buprenorphine

The study compared the cardiorespiratory and anaesthetic effects of alfaxalone or propofol for total intravenous anaesthesia (TIVA) in dogs premedicated with acepromazine-buprenorphine. Six adult Nigerian dogs with mean±S.D. body weight of 11.5±1.6 kg were studied. Acepromazine hydrochloride (0.03 mg/kg) and buprenorphine (0.02 mg/kg) were mixed in the same syringe and administered intramuscularly as premedicants. Following obvious sedation, anaesthesia was induced with bolus intravenous (IV) injection of either 2.0 mg/kg alfaxalone or 4.0 mg/kg propofol over a period of about 30 s. Repeated IV bolus injection of either 1.0 mg/kg alfaxalone or 2.0 mg/kg propofol was administered at 10 minute interval for maintenance of anaesthesia over 90 minutes. Physiological variables were measured and recorded at 15 minute intervals over 90 minutes using a multi-parameter monitor. Onset and duration of analgesia with alfaxalone protocol (2.2±0.4 min and 106.2±4.0 min) were significantly (P<0.05) shorter than those with propofol protocol (4.5±1.4 min and 124.5±3.4 min) respectively. Duration of recumbency with alfaxalone (159.5±18.9 min) and propofol (150.8±5.7 min) were not significantly different. Time to standing and recovery time with alfaxalone (38.2±10.8 min and 76.8±28.4 min) were significantly (P<0.05) longer than those with propofol (14.0±3.8 min and 23.5±6.4 min respectively). There were no significant differences between mean heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), haemoglobin oxygen saturation (SpO2) and rectal temperature (RT) between both protocols. In conclusion, either alfaxalone or propofol appeared to be equally efficacious and safe for induction and maintenance of anaesthesia in healthy dogs premedicated with acepromazine-buprenorphine.

Каудальная анестезия в педиатрической практике

Caudal anesthesia has been used for more than a hundred years. Caudal epidural blockade is the most commonly used regional technique in children and is considered the safest access to the epidural space. This method of anesthesia is used in combination with general anesthesia. With the correct implementation of this anesthetic manual, the risk of complications is small. The technique is used for peri- and postoperative analgesia in children of different ages. The main advantage of the method is high-quality anesthesia during caudal blockade, it is provided in 95–98 % of cases. The level of anesthesia depends on the amount of anesthetic administered; in some cases it may reach the level of the chest. The same advantage is the rapid onset of adequate analgesia and its long-term effect. For successful regional anesthesia in a pediatric patient, it is necessary for the anesthesiologist to know the anatomical and physiological structures of the body, the pharmacology of local anesthetics and the availability of the necessary medical equipment. The research presents a method of using caudal anesthesia as a component of anesthetic support for surgical interventions performed in children. We present the advantages and disadvantages of such anesthesia, indications and contraindications to its use, analyze possible complications, the implementation method.

Topical Traditional Chinese Medicines for Cancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Safe and effective management of cancer-related pain is a worldwide challenge. In the search for treatment options, natural products used in Chinese herbal medicines (CHMs) have received attention in clinical studies for their effects on cancer-related pain. The objective of this systematic review is to evaluate the clinical evidence for topically applied CHMs as adjunctive treatments for cancer pain management. Nine biomedical databases and 4 clinical trial registries were searched for randomized-controlled trials (RCTs) that reported measures of pain and/or quality of life. Risk of bias was assessed using the Cochrane tool. Meta-analysis employed mean difference (MD) with 95% confidence intervals (random effects). Twenty (20) RCTs (1636 participants) met the inclusion criteria. Meta-analyses were grouped based on the comparisons and outcome measures. For pain intensity, there was a greater reduction in the topical CHM group versus placebo (MD -0.72 [-1.04, -0.40]), no difference when compared to tramadol (MD -0.15 [-0.38, 0.08]), and a greater reduction when topical CHMs were combined with conventional analgesic medications (MD -0.67 [-0.93, -0.40]). Analgesic onset time was reduced in the CHM group compared to tramadol (MD -26.02 [-27.57, -24.47] minutes), and for CHMs combined with conventional medications (MD -19.17 [-21.83, -16.52] minutes). When CHMs were combined with analgesic medications, improvements were found for duration of analgesia (MD 1.65 [0.78, 2.51] hours), analgesic maintenance dose (MD -31.72 [-50.43, -13.01] milligrams/day), and quality of life. Addition of topical CHMs to conventional analgesic medications was associated with improved outcomes for pain intensity, some other pain-related outcomes, and measures of quality of life. Limitations included methodological issues in some studies and considerable heterogeneity in some pooled results.

Effectivity of Intravenous Lidocaine in Pain of Neuropathic Origin

Background: In order to accomplish the goals of this research project, lidocaine was administered intravenously (IV) to patients who were experiencing neuropathic pain. The researchers had an interest in gaining a deeper understanding of the connections that exist between effect and concentration, as well as graded and quanta1 dose-response. Study Place: Kulsoom International Hospital Islamabad Study Duration: 6months (Feb 2021 To July 2021) Methods and Materials: Fifteen patients received an intravenous dose of lidocaine at a rate of 8.35 milligrams per minute for a total of one hour. During the course of the study, both venous blood samples and visual analog pain scores were collected at regular intervals of ten minutes for duration of sixty minutes. In addition, blood samples were taken in order to determine the concentrations of lidocaine in the serum as well as the amount of water in the serum both at the start of the analgesia as well as when the patient had reached their maximum level of pain relief. In order to determine the levels of lidocaine, a technique known as gas chromatography was performed. Result: In addition to graded dose-response curves for each participant and the group, a quanta1 dose-response curve was created. Besides graded dose-response curves, this was done. Also done: graded dose-response curves. The dose-response relationship for IV lidocaine showed large pain relief for modest dose changes. Despite moderate dosage increases, this was true. This was when the drug was given. The ED administered 370.0 mg of lidocaine, but the ED administered 415.5 mg (5 min of infusion). Similar to the link between concentration and effect, 0.60 pg/mL of lidocaine significantly reduced pain. It's intriguing that serum lidocaine concentration didn't correlate better with analgesia onset or end than free lidocaine concentration did. Free lidocaine concentration correlated with analgesic effect. Lidocaine concentration in the serum was a stronger predictor of analgesia. Conclusion: This suggests that IV lidocaine's analgesic mechanism may not follow a concentration-effect connection. The evidence shows this. Intravenous lidocaine is significantly stronger than oral. The analgesic response to intravenous lidocaine is a quick "break in pain" over a narrow dosage and concentration range. This was true independent of lidocaine dose. It doesn't matter how much lidocaine is given.

Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients

Abstract
 Background: Patients with chronic renal insufficiency need to have arteriovenous fistula (AVF) for hemodialysis.Ultrasound guided axillary brachial plexus block is a good substitute to general anesthesia or local anesthesia as it causes vasodilatation and minimum hemodynamic derangement, besides offering prolonged postoperative analgesia. We compared three types of local anesthetic solutions; bupivacaine 0.5%, bupivacaine 0.5% plus lidocaine2% and lidocaine 1.5% for onset and duration when used for axillary brachial plexus block.
 Methodology: Sixty-six patients were randomly allocated to one of the three different groups: Group B: patients received 30 ml of bupivacaine 0.5% for the block; Group BL: received 15 ml of bupivacaine 0.5% with 15 ml lidocaine 2% and Group L: received 30 ml of lidocaine 1.5% for the block under US guidance. Onset of sensory and motor anesthesia were registered, and the time to first analgesic demand postoperatively was noted. Statistical analysis of the results was undertaken.
 Results: Results showed that regarding the onset of sensory anesthesia, lidocaine group had the shortest time and the results were statistically significant compared to the other two groups. A statistically non-significant difference was found between Group B and Group BL, where Group BL had shorter time of onset than Group B, e.g., 9.05 ± 1.36 vs. 9.77 ± 0.97 min. The onset of motor block was the earliest in Group BL and the result was considered nonsignificant between Group L and Group B being shorter in Group L; the difference in results was also non-significant between Group BL and Group L. Significantly longer duration of motor and sensory blocks was noted in Group B and compared to the BL and L groups. As regards the timing of first analgesic need, there was statistically significant difference between all groups being longest in Group B (608.68 ± 21.74 min)
 Conclusion: This study revealed that using 30 ml of bupivacaine 0.5% in axillary brachial plexus block with ultrasound guidance in ESRD patients for AVF creation gives much better results than 30 ml of lidocaine 1.5% or a mixture of Abdelhady ISM, et al local anesthetics for axillary brachial plexus block www.apicareonline.com 744 Open access attribution (CC BY-NC 4.0) bupivacaine 0.5% with lidocaine 2% as regards to onset of anesthesia, postoperative analgesia and patient satisfaction.
 Trial Registry: PACTR202208582938205
 Abbreviations: AVF: arteriovenous fistula; BPB: Brachial plexus block; ESRD: End stage renal disease; GA: General anesthesia; NRS: Numeric rating scale; RA: Regional anesthesia
 Key words: Bupivacaine; Lidocaine; Hemodialysis; Brachial plexus block
 Citation: Abdelhady ISM, Ghallab MAA, Zaki MSM, Abdelrahman KAS, Soliman AFH. Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients. Anaesth. pain intensive care 2022;26(6):743−748; DOI: 10.35975/apic.v26i6.2055
 Received: September 14, 2022; Reviewed: October 28, 2022; Accepted: October 31, 2022

Dexmedetomidine v/s clonidine as adjuvants to bupivacaine in supraclavicular brachial plexus block

Background & Objectives: Regional nerve blocks with local anaesthetics provide intra operative anaesthesia as well as postoperative analgesia. Certain drugs like opioids, alpha2 adrenergic agonist, sodium bicarbonate, adrenaline, etc. are used as an adjuvant to local anesthetics. This enchances the analgesic efficacy, reduces the requirement of the local anaesthetics, improves the onset and duration of analgesia. Our study has been undertaken to compare the onset time, duration and analgesic efficacy of clonidine with dexmedetomidine when added as adjuvant to bupivacaine (0.25%) for brachial plexus block by supraclavicular approach. Methodology: 60 patients aged 18-65 years belonging to ASA PS –I &II of both sexes undergoing elective upperlimb surgeries under Brachialplexus block were included in our study. Patients satisfying the inclusion criteria were allotted into 2 groups of 40 each. Group 1: Bupivacaine 0.25% (35 cc) + clonidine 1 mcg/kg. Group 2: Bupivacaine 0.25% (35 cc) +dexmedetomidine 1mcg/kg. Results The mean time for onset of sensory block in group A was (20.23 ±1.104) mins and that observed in group B was (14.83±1.744) mins. The mean time for onset of motor block in group A was (18.43 ±1.135) mins and (12.67±1.539) mins in group B.

Comparative evaluation of sedative and anti-nociceptive effects of epidural romifidine, romifidine-lidocaine, and lidocaine in donkeys (Equus asinus).

Local and regional anesthetic procedures are valuable tools in veterinary practice. Caudal epidural administration of local anesthetic agents is widely reported for surgical interventions of the tail, anus, rectum, vulva, vagina, urethra, and bladder in the standing horse. Epidural analgesia is also obtained using various drugs such as alpha-2 adrenoceptor agonists, dissociative anesthetics, and opioids. The present study evaluates the anti-nociceptive and sedative effects of epidural administration of romifidine, a romifidine-lidocaine combination, and lidocaine alone in donkeys. In a randomized prospective study, twenty-four healthy adult donkeys were assigned to four groups (three experimental and one control; n = 6) received either 50 μg/kg of romifidine, 0.30 mg/kg of lidocaine, combined romifidine (50 μg/kg) and lidocaine (0.30 mg/kg) diluted in 0.9% sterile normal saline solution to a total injection volume of 12 ml, or an equivalent volume of sterile saline epidurally. After epidural injection of each treatment, the onset, degree, and duration of sedation and anatomical extension of anti-nociception were documented. Observations began immediately (time 0) pre-administration and at 5, 15, 30, 45, 60, and 30-min intervals subsequently until 210 min after drug injection. Time to onset of perineal analgesia was documented every minute after the epidural injection by evaluating the animal's response to pinpricks. Only romifidine and romifidine-lidocaine induced mild to moderate sedation. Romifidine, romifidine-lidocaine, and lidocaine induced complete bilateral caudal epidural analgesia with loss of sensation in the perineum, tail, inguinal region, caudal aspect of the upper hind limb, chest areas, and extended distally to the dorsal metatarsal area. Sedation lasted longer (p < 0.05) with romifidine (160 ± 15.4 min) than with romifidine-lidocaine (141.6 ± 13.2 min). Longer-lasting analgesia (p < 0.05) was obtained with romifidine (158.3 ± 9.8 min) and romifidine-lidocaine (165 ± 9.4 min) than with lidocaine (75.8 ± 8 min). Epidural administration of a single dose of romifidine or a combination of romifidine-lidocaine produced mild to moderate sedation and complete anti-nociception in the perineal and inguinal regions of donkeys. The clinical usefulness of epidural romifidine or romifidine-lidocaine combinations to perform obstetric procedures in donkeys needs to be assessed.

TO EVALUATE AND COMPARE THE POSSIBLE ANALGESIC PROPERTIES OF SEVOFLURANE WITH DESFLURANE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMIES UNDER VOLATILE INDUCTION AND MAINTENANCE ANAESTHESIA (VIMA)

Introduction: Sevourane and desurane have been successfully used in labour analgesia. Need more evidence to prove their analgesic properties, intraoperatively and postoperatively, when used in volatile induction maintenance Anaesthesia (VIMA) for laparoscopic cholecystectomy. So, a randomized study single blinded comparative study was carried out. After obtaining appropriate approvals, 50 Method: consenting patients of either gender were randomly, equally allocated to two groups to be anaesthetized with VIMA, using either sevourane and desurane. Monitoring included, in addition to routine multiparametric monitoring, the depth of anaesthesia monitoring using Conox, qCON/qNOX kept between 40-60. Rest of the anaesthesia technique was similar, inclusive of Inj. Fentanyl, in both the groups. Pain was scored using, visual analogue scale (VAS), just before induction (T0), just after extubation (T1), as shifted to Post Anaesthesia Care Unit (PACU) (T2), and on demand of rescue analgesia/2 hours in PACU, whichever came rst (T3). With achievement of adequate modied Aldrete score, adequate rescue analgesia was administered before shifting to the ward. Demographically, pati Results: ents in both the groups were similar. Except for lowering of mean pulse rate intraoperatively as compared to before induction, the haemodynamic parameters remained steadfastly stable, suggesting, potentiation of fentanyl analgesia with appropriate depth of anaesthesia maintained. VAS scores were consistently lower (1-3), at all the timepoints. Recovery although far superior in the desurane group was also adequate even in sevourane group. In face of low VAS, the rescue analgesia, had to be given pre-emptively before shifting to the ward. It appears that, both the IAAs Conclusion: , seem to have signicant intraoperative and postoperative analgesic efcacy. Desurane has rapid onset of analgesia, starting from time of induction. Amongst themselves the efcacy is similar, but recovery in desurane group appears to be faster than sevourane.

The utilization of transperineal ultrasound following fetal heart deceleration after epidural analgesia: a case report

BackgroundWe report a case of fetal heart rate decelerations and relaxation of pelvic muscles and fetal descent using transperineal ultrasound after initiation of epidural labor analgesia.Case presentationA 32-year-old woman, G1P0 with gestational age of 40 weeks, required epidural analgesia when her cervical dilatation was 2 cm. Baseline transperineal ultrasound examination was performed before epidural puncture. The fetal heart rate tracing was normal before the initiation of analgesia. Approximately 10 min after the epidural administration of the loading dose, the patient reported onset of analgesia and the FHR tracing showed variable-decelerations. There was no hypotension or evidence of uterine tachysystole. Transperineal ultrasound was performed again after epidural analgesia took effect. The anteroposterior diameter of the levator hiatus increased from 5.3 to 6.6 cm and angle of progress increased from 116°to 133°. The relaxation of pelvic muscle and rapid descent of fetal head may have contributed to the FHR deceleration. The midwife elevated the fetal head through the vagina with her hand, and the FHR recovered soon thereafter.ConclusionsChanges in fetal heart rate after initiation of neuraxial analgesia are unpredictable. In addition to FHR and tocodynametric monitoring, performing TPU may helpful in distinguishing the reasons for FHR change and initiating corresponding corrective measures.

Fast-acting and injectable cryoneurolysis device

Cryoneurolysis is an opioid-sparing therapy for long-lasting and reversible reduction of pain. We developed a nerve-selective method for cryoneurolysis by local injection of ice-slurry (− 5 to − 6 °C) that induced decrease in nocifensive response starting from about a week after treatment and lasting up to 8 weeks. In this study, we test the hypothesis that injection of colder slurry leads to faster onset of analgesia. Colder slurry (− 9ºC) was injected around the rat sciatic nerve to induce cryoneurolysis. Hematoxylin and Eosin (H&E) staining was used to examine histologic effects on surrounding tissues. Coherent anti-Stokes Raman scattering (CARS) microscopy was used to study effects on myelin sheaths. Functional tests were used to assess changes in sensory and motor function in the treated hind paw. No inflammation or scarring was detected in surrounding skin and muscle tissues at day 7 post slurry injection. Functional tests showed rapid onset reduction in mechanical pain sensitivity starting from day 1 and lasting up to day 98. CARS imaging demonstrated disintegration of myelin sheaths post treatment followed by complete recovery of nerve structure by day 140. In this study we showed that colder slurry (− 9 °C) produces more rapid onset and longer duration of analgesia, while remaining nerve-selective

A comparative study between bier’s block and supraclavicular brachial plexus block for upper limb below elbow surgeries

Background: Present clinical study was conducted to evaluate the onset of analgesia, degree of sensory and motor blockade, duration of analgesia and complications between supraclavicular brachial plexus block and IVRA. Aim: The aim of this study is therefore to determine a superior method between Bier’s block and supraclavicular brachial plexus block for upper limb below elbow surgery. Methods: The study was conducted on patient’s posted for various elective or emergency surgeries of the upper limb below elbow. The subjects were divided into two groups, Group 1 receiving supraclavicular brachial plexus block with 1% lignocaine with adrenaline, 0.6 mg/kg body weight and Group 2 receiving IVRA with 0.5% lignocaine 0.5ml/kg body weight. Patient’s vital parameters were monitored throughout the procedure. A thorough observation was made on onset, quality, duration of analgesia, degree of motor blockade and return of sensation after release of torniquet. Result: onset of analgesia for supraclavicular brachial plexus block is 11.8+/- 1.6 minutes whereas for IVRA it was 3.3+/- 0.8 minutes clearly indicating the early onset of analgesia with IVRA. Conclusion: IVRA appears to be a better alternative with regards to onset, quality of analgesia and degree of motor blockade.

A COMPARATIVE STUDY BETWEEN BIER'S BLOCK AND SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB BELOW ELBOW SURGERIES

Aim: To evaluate the onset of analgesia, degree of sensory and motor blockade, duration of analgesia and complications. Introduction: Brachial plexus block provides a useful alternative to general anaesthesia for upper limb surgeries. Intravenous Regional anaesthesia is a simple method of producing analgesia of the arm or leg by intravenous injection of a local anaesthetic, while the circulation is occluded.Materials And Methods:A prospective, randomised single-blinded study was undertaken in patients posted for upper limb below elbow surgeries. 80 patients aged 15-50 yrs with ASAclass I and II were randomly grouped into two groups. Group 1 – were anaesthetized by supraclavicular brachial plexus block. Group 2 – were anaesthetized by IVRA Results: Group II patients had a faster onset of action, grade I degree of sensory and motor blockade and lesser duration of action. Discussion: The addition of dexamethasone 8mg to bupivacaine 0.5% speeds the onset of sensory and motor blockade also prolongs the duration thus provides better analgesia and reduces the requirements of rescue analgesics. Conclusion: IVRA appears to be a better alternative with regards to onset, quality of analgesia and degree of motor blockade. But the duration of analgesia is little more with Brachial plexus block

Comparison of Dexmedetomidine Versus Fentanyl as an Adjuvent to Epidural Ropivacaine in the Patient Undergoing Lower Limb, Lower Abdomen Surgery

Background: Ropivacaine, the pure S enantiomer of propivacaine, due to its less lipophilicity than bupivacaine does not produce cardiotoxicity or neurotoxicity and causes less motor blockade. Dexmedetomidine the newer selective alpha 2 adrenergic agonist has several advantages when given through epidural route as a neuraxial adjuvant. Aim: To compare 0.75% Inj. Ropivacaine with Inj. Fentanyl and 0.75% Inj. Ropivacaine with Inj. Dexmedetomidine epidurally for the duration of analgesia, hemodynamic changes, degree of motor blockade and occurrence of side effects. Materials and Methods: 60 patients undergoing lower limb, lower abdomen surgeries were randomized to two groups. Group RF (n=30) received 0.75% Inj. Ropivacaine 15 ml with Inj. Fentanyl 1 mcg/kg in 2 ml preparation. whereas Group RD (n=30) received 0.75% Inj. Ropivacaine 15 ml with Inj. Dexmedetomidine 1 mcg /kg in 2ml preparation. Quality of sensory block, motor block, pulse rate, blood pressure, pain assessment and any adverse outcome were noted. Results: Dexmedetomidine fastens the onset of analgesia, prolongs the duration of analgesia thereby reducing the doses of rescue analgesics post operatively, improves the quality of motor blockade without aggravating changes in haemodynamic parameters and has less adverse effects. Conclusion: We conclude that dexmedetomidine serves as a good neuraxial adjuvant when added to 0.75% ropivacaine in epidural anesthesia given for lower limb, lower abdomen surgery.

Efficacy and efficiency of sphenopalatine ganglion block for management of post-dural puncture headache in obstetric patients: a randomized clinical trial

BackgroundThis clinical trial aimed to study the efficacy and efficiency of sphenopalatine ganglion block (SPGB) for the management of post-dural puncture headache (PDPH) in obstetric patients. A prospective randomized clinical trial was carried out on 40 patients with PDPH divided randomly into two equal groups. Paracetamol group (PG): The patients received 1 g of paracetamol three times per day intravenously for 1 day. If adequate pain relief was not achieved, rescue analgesia in the form of intravenous ketorolac was given. Block group (SPGBG): The patients received bilateral SPGB using 3 ml mixture of lignocaine with dexamethasone in each nostril. The pain score, heart rate, and mean arterial pressure were recorded. The onset of analgesia, duration of analgesia, adverse effects, total dose of ketorolac, patient satisfaction, and hospital stay for epidural blood patch (EBP) or hospital discharge after 24 h were also documented.ResultsThe pain perception (numeric rating scale [NRS]) in the block group was generally lower throughout the study showing only highly significant difference till the first 2 h after the block with more rapid onset and longer duration of analgesia. The total dose of rescue analgesic in mg was significantly lower in the block group and hospital stay for EBP was significantly less in the block group with higher patient satisfaction.ConclusionsPDPH can be treated effectively and rapidly with transnasal SPGB, which is a noninvasive, safe, and easy method with a low complication rate.Trial registrationClinicalTrials.gov, NCT04793490. Registered on March 11, 2021; https://clinicaltrials.gov/ct2/show/NCT04793490).

Peribulbar block for retinal surgery comparison among dexmedetomidine, fentanyl, and local anesthesia

Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.

PO126 / #702 CLINICAL OUTCOMES USING A NEW FAST-ACTING SUB-PERCEPTION THERAPY FOR CHRONIC PAIN: A MULTICENTER EUROPEAN OBSERVATIONAL REAL-WORLD STUDY: E-POSTER VIEWING

Traditional Spinal Cord Stimulation (SCS) modalities that achieve sub-perception analgesia (e.g., ∼1-10 kHz, burst SCS) require patients to often wait hours or even days until pain relief is fully realized. A recent study however has demonstrated that quicker analgesic onset is possible using a new sub-threshold-based SCS modality called Fast-Acting Sub-Perception Therapy (FAST).1 While achieving rapid onset of pain relief offers a substantial advantage for patients and providers alike, the magnitude and quality of pain relief in patients using FAST in the real-world clinical setting is also an important consideration.

Fast pain relief in exercise-induced acute musculoskeletal pain by turmeric-boswellia formulation: A randomized placebo-controlled double-blinded multicentre study.

Background:Plant extracts with analgesic properties are seldom considered for treatment of acute musculoskeletal pain due to delay in onset of analgesia. Turmeric (Curcuma longa) and boswellia (Boswellia serrata) extracts are well-studied anti-inflammatory compounds gaining in popularity and used as an alternative to conventional treatments for musculoskeletal pain. This study analyzed the analgesic effect of a formulation of turmeric and boswellia extracts in sesame oil (Rhuleave-K, TBF) in reducing exercise-induced acute musculoskeletal pain in healthy participants.Methods:In this randomized double-blinded placebo-controlled, single-dose, single-day, multicentre study, a total of 232 participants (TBF n = 116; placebo n = 116) having moderate-to-severe exercise-induced acute musculoskeletal pain were randomized in an allocation concealed 1:1 ratio to receive a single dose of 1000 mg of TBF or placebo. The outcome measures were numerical rating scale (NRS), categorical pain relief scale (PRS), onset of analgesia, and short form of McGill questionnaire (SF-MPQ). NRS and PRS were measured from predose to every 30 minutes interval of postdose up to 6 hours at rest, with movement and applying pressure on the affected part. The onset of analgesia was measured from the time of dosage and censored at 6 hours of postdose. The sum of pain intensity difference (SPID6) and total pain relief (TOTPAR6) at 6 hours was, respectively, analyzed from NRS and PRS scores.Results:TBF showed a significant reduction in pain intensity (SPID6rest) with 97.85% improvement in cumulative responder analysis compared with 2.46% in placebo. The onset of pain relief was fast and highly significant in the TBF group with 99% of participants having a mean perceptible pain relief at 68.5 minutes (95% confidence interval, 59.5–77.4) and 96% of participants having a mean meaningful pain relief at 191.6 minutes (95% confidence interval, 176.7–206.4) compared to the placebo group. Highly significant and continuous improvement in pain relief was observed in the TBF group with 93% of participants having ≥ 50% of maximum TOTPAR6 with a number needed to treat of 1.1 at rest.Conclusion:Exercise-induced acute musculoskeletal pain can be effectively relieved by TBF (Rhuleave-K) in about 3 hours signifying its strong analgesic activity.

Comparison of Continuous Infusion of Ropivacaine and Fentanyl With Intermittent Bolus Doses of Ropivacaine and Fentanyl for Epidural Labor Analgesia: A Randomized Open-Label Study

BackgroundThe purpose of this study was to compare the efficacy of continuous epidural infusion with intermittent bolus doses for labour analgesia using ropivacaine 0.2% and opioids.MethodsIn this study, 70 primigravida patients were randomly divided into two groups of 35 each. Both groups received a loading dose of 10ml of 0.2% ropivacaine and 1μg/ml fentanyl in 5ml incremental doses while monitoring blood pressure and heart rate. Subsequently, Group I received a continuous epidural infusion of 0.2% ropivacaine with fentanyl at 10ml/hr, while Group II received 10 ml of 0.2% ropivacaine with fentanyl in bolus form every hour manually, with the first dose given after one hour of the initial loading dose. A rescue bolus dose of 5ml of 0.2% ropivacaine was given in both groups when they complained of breakthrough pain (VAS score >3). An additional 5ml bolus dose was given in both groups at the time of crowning. The blood pressure, heart rate, and severity of pain using the visual analogue scale (VAS) were assessed. Total drug volume utilized, the number of bolus doses, duration of the first and second stage of labour, rate of instrumental delivery and cesarean section, and neonatal Apgar scores were also recorded.ResultsThe total volume of drugs consumed and the number of boluses required for breakthrough pain were both significantly lower in Group II. There was a similar decrease in hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) from baseline in both the groups with no significant difference between them. The onset of analgesia was significantly faster in Group I with both groups achieving optimum analgesia (VAS ≤ 3) within 20 minutes of the loading dose. Maternal motor blockade scores, the duration of the first and second stage of labour, the rate of instrumental delivery, cesarean section, and neonatal Apgar scores, did not show any statistically significant difference between the two groups.ConclusionBoth techniques, i.e. continuous epidural infusion and intermittent epidural boluses are effective for providing labour analgesia. But consumption of drugs and episodes of breakthrough pain was higher in the continuous infusion group (Group I).

Sphenopalatine Ganglion Block versus Conservative Management for Post Dural Puncture Headache in Cesarean Section

Introduction: Post-dural puncture headache is one of the frequently encountered and inevitable post-operative complications of the subarachnoid block. The primary treatment is always considered conservative management in such instances. However, an epidural blood patch remains an invasive gold standard treatment. Sphenopalatine ganglion block is propounded as minimally invasive with prompt and better outcomes. Objective: To assess the efficacy of Sphenopalatine ganglion block (SPGB) when compared to conservative management based on the onset of analgesia and its duration. Methods: This is a prospective study performed on 40 obstetrics patients who underwent Lower segment cesarean section in Lumbini Medical College and Teaching Hospital (LMCTH) who complained of Post dural puncture headache within 7 days. All the parturients are categorized into Group A, those who are treated with sphenopalatine ganglion block, and Group B, where post-dural puncture headache was treated with conservative management. Independent t-tests and Fischer’s test were used for statistical analysis. Results: The patients in group A showed positive outcomes where all of them were relieved of post-dural puncture headache within 10 mins after Sphenopalatine ganglion block (p&lt;0.001) and the mean pain score, based on a numerical pain rating scale was less or equal to 4 for the first 8 hours. Conclusions: Sphenopalatine ganglion block (SPGB) could be used as an effective first-line treatment modality in the management of post-dural puncture headache compared to conservative management.

Increased Spinal Cord Stimulation (SCS) Trial Efficiency and Pain Relief Using Neural Dosing and Precise Targeting of Sub-Perception SCS

Early outcomes in a recently reported real-world, observational case-series utilizing paresthesia as a physiological-based marker for precise targeting of sub-perception stimulation fields, used in combination with neural dosing, demonstrated significant pain relief with rapid onset of analgesia (Metzger C., et al. Expert Review of Medical Devices, 2021). Here, we report real-world observations using a novel SCS therapeutic modality now known as fast-acting sub-perception therapy (FAST) either with or without the use of a customized field shape programming algorithm during the trial period in a single-center, observational case-series.