Pethidine Consumption Research Articles

Preoperative anxiety, postoperative pain tolerance and analgesia consumption: A prospective cohort study.

Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively. This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption. A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded. Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively. The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section

Abstract Background Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. Objective to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine. Results In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value &amp;lt; 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.). Conclusion Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.

Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain: A randomised controlled clinical trial

Background: Total knee replacement (TKR) is a widely used surgical technique for knee disorders. The study is aimed to assess the interspace between the popliteal artery and capsule of the posterior knee (IPACK) block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared to the femoral nerve block (FNB) following TKR. Methods: Under spinal anaesthesia, forty patients undergoing elective unilateral TKR were divided into two groups: FNB, receiving ultrasound-guided FNB, and IPACK Block, receiving ultrasound-guided IPACK block. Ambulation was assessed with the timed up-and-go (TUG) and 10-meter walk tests. Post-surgery, pethidine consumption in 24 hours and VAS scores were recorded. Results: After 24 hours postoperative, TUG showed a mean value of 4.8±1.2 seconds in the IPACK group compared with 8.7±2.1 seconds in the FNB group (p &lt; 0.001). The time needed for a 10-meter walk test was significantly longer in the FNB group (12.1±2.1 seconds) than in the IPACK group (8.3±1.2 seconds) in the first 12 hours postoperative. Similarly, 24 hours postoperatively, values were 6.4±1.2 seconds Vs 10.4±2.1 seconds respectively (p &lt; 0.001). Using the VAS score, the FNB group demonstrated a greater analgesic effect than the IPACK group, while taking less total pethidine (73.8±17.2 mg) compared to 110.0±29.7 mg in the IBACK group. Conclusion: There was delayed ambulation in FNB than in IPACK. The FNB has a better analgesic profile compared to the IPACK block with less total analgesics consumption over 24 hours post-operatively.

The effect of acupressure on pain levels and physiologic indicator in patients undergoing laparoscopic cholecystectomy: A double-blind, randomized clinical trial

BackgroundPostoperative shoulder-tip pain (STP) is a common complication following laparoscopic cholecystectomy (LC). The study seeks to determine whether acupressure can be used as an alternative to medication for pain relief, as medications often come with side effects. This study aims to evaluate the effect of acupressure on pain levels and physiological indicators in patients undergoing LC. Materials and methodsThis double-blind, randomized clinical trial was conducted on 81 patients who underwent LC at Al-Zahra Hospital of Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The patients were divided into two groups: the intervention group, which received acupressure (42 participants), and the control group (39 participants). The selected pressure points were LI11, LI4, SJ5, HT7, P6, and K1. Demographic and clinical data were collected, and the pain level was evaluated using the visual analogue score (VAS). The data was analyzed using SPSS version 16 software with a significance level of p < 0.05. ResultsThe intervention and control groups were homogeneous in terms of age, gender, duration of surgery, and pethidine consumption (p > 0.05). The average VAS significantly decreased in both the intervention and control groups (p < 0.001). The intervention group had a significantly higher reduced score compared to the control group, 30 min and 72 h after applying acupressure (p < 0.001). Significant differences were observed between the two groups in terms of changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and breath rate (BR) (p < 0.05). Conclusionsacupressure can effectively improve STP and physiological indicators in patients undergoing LC. Trial registration noIRCT20150715023216N14 (Registration date: 2023-01-22, https://irct.behdasht.gov.ir/user/trial/68111/view).

Monitored Anesthesia Care (MAC) as an Alternative to General Anesthesia (GA): Prospective Double-Blinded Randomized Controlled Study Comparing Efficacy and Safety of Dexmedetomidine and Ketamine Infusions with Ultrasonography (USG) Guided Pectoral Nerve Block (PECs) for Postoperative Analgesia in Breast Surgery.

PECs blocks are usually combined for breast surgery under general anesthesia (GA) to provide postoperative analgesia rather than primary anesthesia technique. A prospective, interventional, single-center, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was conducted in a tertiary care teaching center after obtaining the Ethics Committee's approval and patients' written informed consent. Forty-eight American Society of Anesthesiologists physical status I/II patients aged 18-60 years, undergoing elective unilateral breast surgery were enrolled. Patients were block-randomized (computer-generated) to two equal groups (24 patients each), with one of them receiving Dexmedetomidine and the other one Ketamine. For concealment, sequentially numbered, sealed, opaque envelopes were used. The study was double-blinded for both the anesthesiologist and outcome assessor anesthesiologist. Obese patients (body mass index > 30), those with infection at block site, coagulopathy and known hypersensitivity to local anesthetics or study medications as well as individuals who refused participation in research were all excluded. The Dexmedetomidine group received a bolus of 0.5 mcg/kg over ten minutes, followed by an infusion of 0.3 mcg/kg/hour, while the Ketamine group received a bolus of 0.5 mg/kg over ten minutes, followed by an infusion of 0.3 mg/kg/hour. Postoperative analgesia was compared using a visual analogue scale (VAS) at regular intervals. When VAS exceeded four, 1 mg/kg intravenous Pethidine was administered as a rescue analgesic. Sub-anesthetic low-dose Ketamine was more effective than low-dose Dexmedetomidine in prolonging PECs block analgesia, which was statistically significant (p value < 0.001). The Ketamine group had lower rescue analgesic Pethidine consumption and longer first-rescue analgesia demand time. There was no significant hemodynamic difference between the study groups. Ketamine was more efficient than Dexmedetomidine for postoperative analgesia.

Effect of intraoperative aminophylline infusion on pain intensity after ureteroscopic lithotripsy: A randomized controlled study

ABSTRACT Background Aminophylline relaxes smooth muscle by inhibiting the phosphodiesterase enzyme and activating protein kinase A, and alleviates inflammation by decreasing the production of leukotrienes. We aimed to assess the effect of intraoperative intravenous (IV) aminophylline on postoperative pain in patients undergoing ureteroscopic lithotripsy. Methods A randomized, placebo-controlled trial was conducted on 50 patients who were scheduled for ureteroscopic lithotripsy under general anesthesia. Patients were divided into two equal groups. Group 1 received 4 mg/kg aminophylline diluted in 100 ml saline 0.9% IV over 20 minutes. Group 2 received saline 0.9% with a similar volume and period as the aminophylline group. Visual analogue scale (VAS) score was recorded at arrival to the post-anesthesia care unit (PACU), 1 h, 2 h, 6 h, 12 h, and 24 h after surgery. Catheter-related bladder discomfort (CRBD) was assessed at PACU arrival, 1 h, 2 h, and 6 h postoperatively. Results VAS measurements at arrival to the PACU, 1 h, 2 h, and 6 h postoperative were significantly lower in group 1 than in group 2 (p < 0.05). Total pethidine consumption in the first 24 hours postoperatively was significantly lower in group 1 (43.04 ± 14.52 mg) than in group 2 (59.32 ± 18.34 mg); p = 0.002. Aminophylline significantly decreased the incidence of moderate-to-severe CRBD at PACU arrival and 1 h after surgery (p = 0.005 and 0.007, respectively). There was no significant variation between both groups regarding side effects. Conclusions In patients undergoing ureteroscopic lithotripsy, intraoperative IV aminophylline infusion reduced postoperative pain and opioid consumption. It also decreased the incidence of early moderate-to-severe CRBD without evidence of intraoperative hemodynamic alterations or postoperative side effects.

Analgesic effects of caudal versus intravenous dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries

Background: Singleshot caudal block provides short lived postoperative analgesia necessitating continued exploration for adjuvants. Aim was to compare the analgesic efficacy between intravenous and caudal dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries. Methods: Following ethical clearance and parental consent, 69 children aged 1-6 years, of American society of anesthesiologists (ASA) physical status classification I and II were randomized into groups A, B and C, of 23 each. All subjects underwent laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen, and had caudal block with 1 ml/kg bupivacaine 0.25%. Additionally, groups B and C received caudal 0.1mg/kg and intravenous preinduction 0.25 mg/kg dexamethasone, respectively. Pain was assessed using FLACC scale. The time to first analgesic request (TTFAR) was defined as the interval from caudal injection until pain score was ≥4; at this point, analgesic was given. Results: All 69 children were completely studied. The mean TTFAR (in minutes) was longest in Group B (485.40±24.50) followed by C (459.60±36.40), and shortest in group A (253.63±71.55), p=0.001, 0.024 and 0.968 for A versus B, A versus C and B versus C respectively, with greatest 24 hours pethidine consumption in Group A relative to groups B and C, p=0.001 and 0.025. Conclusions: Caudal 0.1 mg/kg or intravenous 0.25 mg/kg dexamethasone combined with bupivacaine significantly prolonged postoperative analgesic duration, with comparable analgesic profile between the caudal and intravenous routes, and without adverse effects.

Analgesic Efficacy of Suprascapular Nerve Block versus Combined Suprascapular and Axillary Nerve Block in Patients Undergoing Shoulder Arthroscopy: A Prospective, Randomized, Comparative Study

Abstract Background: Immediate post-operative pain can be severe and is an important outcome measure for patients in shoulder arthroscopic surgeries. Interscalene block is the most widely used and studied technique for post shoulder arthroscopy pain relief and is associated with certain unpleasant adverse effects. Suprascapular nerve block (SSNB) has been suggested as an alternative and safer block. As the suprascapular nerve contributes to 70% of the sensory nerve supply to the shoulder joint, and the axillary circumflex nerve is the other major nerve contributing to 25%; therefore, a combined block of these two nerves should provide more effective pain relief than SSNB alone. Aim: This study aimed to compare the efficacy of combined SSNB and axillary nerve block (ANB) with SSNB alone for analgesia after shoulder arthroscopy in terms of level of pain scores, total analgesic consumption, and patient satisfaction in 24 h. Methods: Forty-one patients posted for shoulder arthroscopy were randomly allocated into two groups, Group S (n = 20) receiving SSNB and Group C (n = 21) receiving combined SSNB and ANB. Visual Analog Scale (VAS) both at rest and during movement at 1, 3, 6, 12, 24 h, and at the time of first demand, total consumption of analgesics in 24 h and patient satisfaction score at 12 and 24 h were noted. Statistical Analysis: The data was analyzed by Student’s t-test, Mann-Whitney U test, and Fisher’s exact test using Graph Pad PRISM 9, a p&lt;0.05 was considered significant. Results: The VAS scores both at rest and during movement were significantly less in Group C at 1, 6, 12 h, and at the time of the first demand of analgesic (p&lt;0.05). Compared to Group S, Group C had a longer pain-free duration (154.3 ± 11.41 min vs. 36.60 ± 6.553 min; P &lt; 0.001) and lesser cumulative consumption of pethidine (300.0 ± 8.894 mg vs. 336.8 ± 13.27 mg; P = 0.0256). The satisfaction level was better in Group C at 12 h (P = 0.002) but comparable to the Group S at 24 h (P = 0.0673). Conclusion: Combined SSNB and ANB provided better pain relief in first 12 h, better patient satisfaction in the first 12 h and decreased overall consumption of analgesics in the first 24 h compared to SSNB alone.

Effect of Ondansetron on Postoperative Pain and Vomiting after Acute Appendicitis Surgery: A Placebo-Controlled Double-Blinded Randomized Clinical Trial.

Common postoperative complications following surgery, particularly acute appendicitis surgery, include postoperative pain and vomiting, which can cause discomfort and delay recovery time. A randomized double-blinded placebo-controlled clinical trial was conducted with 80 cases of acute appendicitis of American Society of Anesthesiologists (ASA) physical status I or II and aged 18-60 y/o scheduled for appendectomy under general anesthesia. Patients were randomly divided into two equal groups: group A received 4 mg of ondansetron IV (2 ml) and group B received 2 ml of normal slain IV (placebo). Pain according to VAS, nausea and vomiting according to clinical symptoms, shivering and sedation according to the Bedside Shivering Assessment Scale (BSAS), and the Ramsay Sedation Scale (RSS) at 2, 6, 12, and 24 hours after surgery were evaluated and compared between the groups. There was a significant decline in the severity of pain only at 2 hours after surgery between the ondansetron and control groups (5.3 ± 1.0 vs. 6.0 ± 1.0; p=0.01), not showing a difference between the groups at 6, 12, and 24 hours after appendectomy. Postoperative nausea and vomiting at 2 (5% vs. 25%; p=0.03) and 6 (7.5% vs. 27.5%; p=0.04) hours after appendectomy in the ondansetron group. At different times, the ondansetron and control groups did not differ in terms of pethidine consumption or sedation. In conclusion, our study found that ondansetron was effective in reducing postoperative vomiting after acute appendicitis surgery. However, it did not show a clinically significant effect on postoperative pain. This trial is registered with IRCT20230722058883N1.

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added.&#x0D; Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score.&#x0D; Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P &lt; 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less.&#x0D; Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids.&#x0D; Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia&#x0D; Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.&#x0D; Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923&#x0D; Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

Analgesic Efficacy of Pre-operative Pregabalin in Dacryocystorhinostomy Surgery: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Dacryocystorhinostomy (DCR) is an effective surgical procedure for addressing lacrimal drainage problems. However, it can be a painful operation that involves incisions both inside and outside the eye, often leading to a high incidence of postoperative nausea and vomiting. Preemptive analgesics can be employed to alleviate this unrelieved pain. Nonetheless, many of the drugs used can induce a wide range of adverse effects. Therefore, the aim of this systematic review and meta-analysis is to assess the current evidence regarding the efficacy of pregabalin in managing postoperative pain following DCR surgery. We conducted a thorough search of five electronic databases, namely, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar, to identify relevant randomized controlled trials (RCTs) published before September 2023. The quality of the included studies was assessed using the Cochrane Risk of Bias tool for RCTs. The outcomes we evaluated included postoperative pain, surgery duration, time to first analgesia, total pethidine consumption, and postoperative nausea and vomiting (PONV). Continues data reported as mean difference (MD), and dichotomous data reported as risk ratio (RR), with 95% confidence interval (CI). A pooled meta-analysis of three RCTs, including 240 patients in both the pregabalin and placebo groups, was conducted. The results revealed that the pooled MD in pain scores was significantly lower in patients treated with pregabalin compared to those receiving a placebo ((MD = -1.35 (95% CI: -1.83 to -0.87, p < 0.00001)). Additionally, the pooled MD of pethidine consumption was significantly lower in patients treated with pregabalin compared to those receiving a placebo (MD = -54.13 (95% CI: -103.77 to -4.50, p = 0.03)). However, there was no statistical significance between both groups in terms of time to first analgesia and duration of surgery (p > 0.05). On the other hand, the pooled RR of PONV was significantly lower in patients treated with pregabalin compared to those receiving a placebo (RR = 0.37 (95% CI: 0.24-0.57, p < 0.001)). This meta-analysis demonstrates that pregabalin is an effective and well-tolerated intervention for reducing postoperative pain and PONV following DCR surgery, without significantly affecting surgery duration or time to first analgesia. These findings support the use of pregabalin in improving patient comfort and outcomes in this surgical context.

Peri-operative Outcomes of Dexmedetomidine as an Additive to Subtenon Block Compared with Intravenous Dexmedetomidine for Patients Undergoing Vitreoretinal Surgery under General Anesthesia

Background: Several medications such as dexmedetomidine can be used as adjuvants with anesthesia to reduce the stress response during surgery resulting in good post-operative outcomes and safe recovery times. Aims: To compare the peri-operative outcomes of subtenon block with or without dexmedetomidine versus dexmedetomidine infusion as adjuvants to general anesthesia in subjects undertaking retinal operations. Design: A prospective randomized double-blind controlled clinical trial Patients and methods: Through the use of sealed opaque envelopes, 120 participants were randomly divided into three groups. Group SB received subtenon bupivacaine and lidocaine and IV infusion of normal saline. Group SD received subtenon bupivacaine, lidocaine, and dexmedetomidine and IV infusion of normal saline, whereas Group DI received subtenon saline and IV infusion of dexmedetomidine. Peri-operative hemodynamics and intra-ocular pressure were measured and recorded. Intra-operative bleeding, recovery times, post-operative sedation and pain scores, first analgesic times, total analgesic requirements, and the incidence of PONV and OCR were also assessed and documented. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The results showed that IV dexmedetomidine has decreased cardiovascular responses to surgery as signified by decreased HR and MAP with a significant drop in IOP measurements before induction and after intubation, in comparison to other groups. Administering dexmedetomidine either or IV in the subtenon block led to a significant reduction in pain scores of the first post-operative six hours, the total pethidine consumption, and the surgical bleeding. Conclusion: When used as a supplement to general anesthesia during retinal surgery, dexmedetomidine is effective at reducing the airway response to tracheal intubation and extubation and maintaining peri-operative hemodynamic stability. Dexmedetomidine is also an efficient method for lowering intraocular pressure, surgical bleeding, and postoperative analgesic consumption with a better recovery profile. It can be administered either through IV infusion or combined with local anesthetics in subtenon block.

Comparative Study between Bupivacaine 0.5% in TAP Block versus Diclophenac Sodium IM for Post-Operative Analgesia after Cesarean Section

Background Cesarean section is one of the commonly performed surgical procedures in the field of obstetrics. It accounts for more than one-fourth of all births worldwide. The most common undesirable outcome following cesarean section is postoperative pain. Failure to treat the pain not only causes distress to the mother but also affects mother‑baby bonding, which, in turn, affects care and breastfeeding of the newborn. Objective The aim of the study is to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus declophinac sodium for postoperative analgesia in patients undergoing cesearean section and reducing nalufine dose. Methods This prospective study was conducted at tertiary care hospital at Ain Shams University hospitals for 6 months from June to December 2020 and performed on total 80 patients who underwent elective cesarean section. Results Our research study revealed that there was statistically significant increase in visual analogue score in diclofenac group than TAP block group explained by removal of effect of spinal anaesthesia and regaining of pain sensation in diclofenac group while persistence of anaesthetic effect of bupivacaine in TAP block group. Our study found that there was statistically significant increase in the time to first request of analgesia in TAP block group than diclofenac group. Also, there was statistically significant decrease in the total consumption of Pethidine (mg) in TAP block group than Diclofenac group. There was no statistically significant difference between Diclofenac group &amp; TAP block group regarding adverse effects post operative nausea &amp; vomiting. Conclusion The analgesic efficacy of the US-guided TAP block after Caesarean delivery compared to the combination of sodium diclofenac with less requirement of rescue analgesic.

Comparative Study of Post-Operative Analgesic Effect between Wound Site Infiltration and Bilateral U/S Guided Transversus Abdominis Plane Block with 0.25% Bupivacaine after Cesarean Section

Abstract Background The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Objectives This study assessed the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to local wound infiltration after cesarean section regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients and Methods The study was conducted on 90 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for cesarean section surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 45 patients each: TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 30 ml at surgical site. Results The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 12 h post-operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores for 12 hours and lower total 12 hours postoperative pethidine consumption after cesarean section under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Intraperitoneal versus Intravenous Dexamethasone Effect on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background Post-operative nausea and vomiting (PONV) is a common unwanted effect in patients undergoing laparoscopic cholecystectomy (LC). This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after laparoscopic cholecystectomy surgeries. Aim of the Work to compare the efficacy of intraperitoneal versus intravenous administration of dexamethasone in reducing the incidence of PONV after LC surgeries. Patients and Methods Ninety patients, American Society of Anesthesiologists physical status I–II, scheduled for laparoscopic cholecystectomy surgery were randomized to receive 8 mg dexamethasone intraperitoneally (IP) (n = 45) or intravenously (IV) (n = 45). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications. Results The incidence of nausea in the IV group was 26.7% (12 patients) and that in the IP group was 6.7% (3 patients) in the first 24 hours post-operatively (P = 0.011). There were no significant differences in the incidence of retching or vomiting, or the need for rescue antiemetics between the 2 groups. In terms of side effects, patients in the IP group had a lower rate of side effects than those in the IV group (6.7% vs. 24.4%, P = 0.020). The mean VAS pain score and total pethidine consumption for the first 24 hours postoperatively were lower in the IP group than in the IV group. However, these differences did not reach statistical significance. Conclusion Intraperitoneal injection of dexamethasone at a dose of 8 mg in patients undergoing Laparoscopic Cholecystectomy surgery reduces significantly the incidence of postoperative nausea, in comparison to the intravenous route.

Evaluation of Ultrasound- Guided Quadratus Lumborum Block for Postoperative Analgesia after Hip Surgery

Abstract Background With improvement of surgical technique, hip surgery became more frequent with increased need for adequate postoperative analgesia The main advantage of quadratus lumborum block (QLB) compared to spinal anaesthesia is the extension of local anesthetic agent beyond the transverses abdominis plane to the thoracic paravertebral space producing extensive analgesia and prolonged action. Aim of the Work to assess the analgesic efficacy of ultrasound-guided (US) trans-muscular QLB compared to spinal anaesthesia during Hip surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods 64 patients were randomly allocated to one of 2 groups (n = 32; each); group QLB received US-guided QLB before induction of spinal anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group Spinal Anaesthesia alone: received Spinal anaesthesia alone, 3.5 ml of 0.5% bupivacaine plus 25 µg fentanyl. QLB results in decreased incidence and severity of postoperative pain resulting in a decrease in incidence and degree of sedation and total opioid requirement. The quadratus lumborum block was more efficient than the spinal anaesthesia alone. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) in QLB group were superior to that for the spinal anaesthesia group. Conclusion patients having preoperative single shot QLB, as an adjuvant to spinal anesthesia, have significant less time for discharge from the postoperative care unit and better postoperative pain control compared to spinal anesthesia alone for hip surgery, in terms of VAS score and total opioid consumption as well as frequency of need.

A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries

Abstract Background Operations rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work This work aims to compare the efficacy of Transversus Abdominis Plane (TAP) Block versus Quadratus Lumborum 2 (QL 2) Block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing lower abdominal surgeries. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this Randomized controlled trial study was conducted in Ain Shams University Hospitals. Forty patients scheduled for elective lower abdominal surgeries were included in this study. The patients' age was ranged from 21 to 65 years and with the American Society of Anesthesiologists (ASA) Class-I and II. At the end of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique to receive either quadratus lumborum block (Group QLB), or TAP (transversus abdominis plane) block (Group TAP), each group constitutes of 20 patients. Results In this study, the effect of quadratus lumborum block and transversus abdominis plane block result of decreased incidence and severity of postoperative pain (VAS) resulting in decrease in incidence and degree of sedation and opioid total requirement. The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique affected the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after lower abdominal surgeries in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

Ultrasound-guided ilioinguinal/iliohypogastric nerve block compared to posterior quadratus lumborum block in patients undergoing inguinal hernia repair

ABSTRACT Background “Ilioinguinal/iliohypogastric nerve block” (IINB) has been described as effective regional anesthetic method for providing analgesia after inguinal hernia operations. Other studies have also reported that the “posterior quadratus lumborum block” (PQLB) is an effective analgesic option for lower abdominal surgeries. Herein, we compared the previous two block techniques for postoperative pain management in adults undergoing unilateral inguinal hernia repair. Methods According to the block technique, 76 adult patients scheduled for inguinal hernioplasty under general anesthesia were randomly enrolled into two groups; the PQLB and IINB groups. The block was performed after skin closure and before patient extubation. Postoperative analgesic profiles were recorded in both groups. Results The PQLB had lower heart rate and mean arterial pressure readings during postoperative assessment compared to the other group. Pain scores showed a significant decline in association with the PQLB during the first postoperative day, which resulted in a significant decline in pethidine consumption (49.17 vs. 70 mg in the IINB group) and better patient satisfaction. The duration to the first analgesic request significantly increased in association with the PQLB (13.25 vs. 8.42 hours in the IINB group). The incidence of nausea and vomiting increased significantly in the IINB group secondary to increased pethidine requirements. Conclusion PQLB is superior to IINB in providing analgesia for patients undergoing inguinal hernia repair.

Comparative study between dexmedetomidine and fentanyl as adjuvants to bupivacaine for postoperative epidural analgesia in abdominal surgeries: A randomized controlled trial

ABSTRACT Background Epidural analgesia is an efficient strategy to relieve postoperative pain after abdominal surgeries. This study aimed to evaluate dexmedetomidine or fentanyl when added to bupivacaine, providing postoperative epidural analgesia after abdominal procedures. Patients and methods Epidural catheter was placed on 75 patients scheduled for lower abdominal procedures under general anesthesia, and they were randomly assigned into three equal groups. Epidural analgesia was activated before the procedure was completed by injection of bupivacaine (0.125%) plus dexmedetomidine or fentanyl or normal saline mixture, according to the study groups. After complete recovery from general anesthesia, the epidural block was evaluated. Then, the infusion started through an elastomeric pump with an infusion rate of 5 ml/hr and continued for 24 hr postoperatively. Group D Dexmedetomidine 1 ml (100 μg) plus normal saline 1 ml were added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group F: 2 ml (100 μg) fentanyl was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group C: Normal saline 2 ml was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Measured outcomes Primary outcomes The onset of sensory analgesia (from the beginning of epidural infusion until scoring 1 on a 3-point scale) and the duration of analgesia (from the start of epidural infusion till the first demand for further pain medication) were observed and recorded. Secondary outcomes Postoperative pain was evaluated using a visual analogue scale (VAS), and the number of patients requesting additional analgesia with pethidine over paracetamol as well as the pethidine consumption during postoperative 24 hr were recorded. The hemodynamic parameters, including heart rate (HR) and mean arterial blood pressure (MAP), were monitored and recorded at baseline, 2, 6, 12, and 24 hr, and any adverse events were properly recorded and managed during the study period. Results The dexmedetomidine group showed an earlier onset and longer duration of analgesia, with a highly significant difference (P-value <0.001) than other groups. The study groups differed significantly concerning pethidine needs and consumption (P-value <0.05). The VAS revealed a considerable decrease in the dexmedetomidine group compared to other groups, with a significant difference (P-value <0.05) at the intervals of (baseline, 12 hr, and 24 hr) and a highly significant difference (P-value <0.001) at the intervals of (2 and 6 hr). Postoperative blood pressure and heart rate measurements in the dexmedetomidine group were lower than in other groups. MAP showed a statistically highly significant difference at 6 and 24 hr (P-value <0.001) and a significant difference after 12 hr (P-value <0.05), while HR showed a statistically significant difference after 6 hr (P-value <0.05) and a highly significant difference at 12 and 24 hr (P-value <0.001). Regarding postoperative adverse events, no statistical difference was detected between groups except in pruritis and dry mouth. Conclusion Dexmedetomidine is preferred to fentanyl when added to epidural bupivacaine to relieve pain after abdominal procedures.

Analgesic effect of sacral erector spinae, penile and caudal block after hypospadias surgery: A randomized single blind controlled trial

ABSTRACT Background Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. Patients and methods This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Results Time to 1st rescue analgesia was significantly delayed in groups C and E than group P (P < 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P (P = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h (p < 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Conclusion Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.