Postoperative Analgesic Requirements Research Articles

Efficacy and safety of preoperative duloxetine in reducing post-laparoscopic surgery pain: a meta-analysis of randomized placebo-controlled trials.

Recent studies suggest that duloxetine administration before non-laparoscopic surgery may reduce postoperative pain and analgesic requirement without increasing adverse event occurrence. To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on preoperative administration of duloxetine versus placebo for postoperative pain relief in adults undergoing laparoscopic surgery, assessing efficacy- and safety-related outcomes. We systematically searched MEDLINE, Embase, and Cochrane Library, covering all records up to July 19, 2024. Inclusion criteria consisted of RCTs comparing preoperative administration of duloxetine versus placebo in adults undergoing laparoscopic surgery and reporting at least one outcome of interest. The random-effects model was used to estimate the mean difference (MD) and risk ratio (RR), along with their respective 95% confidence intervals (95%CIs). We included four RCTs (227 patients). Compared with placebo, duloxetine provided a statistically lower pain scores at 2 (MD -1.04; 95%CI -1.75, -0.33), 4 (MD -1.28; 95%CI -1.77, -0.79), 8 (MD -1.22; 95%CI -1.72, -0.72), 12 (MD -1.64; 95%CI -2.88, -0.41), and 24h (MD -1.05; 95%CI -1.72, -0.39) after surgery. Duloxetine also granted a statistically longer time to first analgesic requirement (MD 128.38min; 95%CI 41.31, 215.46), compared with placebo. Additionally, the duloxetine group had a significantly lower risk of nausea/vomiting (RR 0.48; 95%CI 0.25, 0.90), while there were no significant differences between both groups for the risk of dizziness, headache, and somnolence. Compared with placebo, duloxetine administration before laparoscopic surgery significantly minimized postoperative pain intensity, delayed analgesic requirement, and reduced nausea/vomiting risk.

Effect of inferior alveolar plus buccal nerve block on donor site morbidity at buccal mucosal graft harvest site: A double-blinded, randomized placebo-controlled trial

ABSTRACT Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake. Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration. Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002). Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.

Intrathecal magnesium sulphate as an adjuvant to bupivacaine for infraumbilical surgeries: An updated systematic review and meta-analysis

Background and Aims: Intrathecal anaesthesia is widely used for infraumbilical surgeries due to its effectiveness in providing pain relief during and after the operation. Adding magnesium sulphate (MgSO4) to intrathecal local anaesthetics can prolong analgesia, reduce postoperative analgesic requirements and improve the management of shivering perioperatively. This review aims to investigate the use of intrathecal adjuvant MgSO4 for anaesthesia in infraumbilical surgeries. Methods: We performed a meta-analysis (PROSPERO ID: CRD42023432378) of trials, which included patients who underwent a variety of surgical procedures under spinal anaesthesia with intrathecal MgSO4 as an adjuvant to spinal local anaesthetics. The analysed outcomes included sensory and motor effects and adverse effects. We presented dichotomous outcomes as risk ratios with 95% confidence intervals (CI), while continuous outcomes were measured as mean differences (MDs) with 95% CI. We considered the results significant if the P value was < 0.05. Results: Thirty-two studies (2379 patients) were included. Adding intrathecal MgSO4 to bupivacaine significantly prolonged the time for regression of two segments from the maximum height (MD: 27.18 min; 95% CI: 12.56, 41.79; P = 0.0003), delayed the onset of sensory block to T10 (MD: 1.93 min; 95% CI: 1.10, 2.77; P < 0.0001), prolonged the duration of motor block (Bromage score = 0) (MD: 15.13 min; 95% CI: 4.59, 25.66; P = 0.005) and extended time for first rescue analgesia (MD: 43.80 min; 95% CI: 26.47, 61.14; P < 0.00001). No significant effect for MgSO4 on side effects was observed. Conclusion: Our review underscores intrathecal MgSO4’s benefits in prolonging block duration and improving pain management, but highlights significant heterogeneity, limiting the strength of these findings.

Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.

Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP. A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis. A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27kg/m2 (24-32kg/m2), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381). Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.

Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized clinical trial

BackgroundIn an aging surgical patient population, preventing complications such as oversedation has taken increasing priority in perioperative care. Intraoperative use of virtual reality (VR) may decrease sedative requirements. We hypothesize that the use of immersive VR during total knee arthroplasty (TKA) will lead to decreased propofol requirements, improved patient-reported satisfaction, and reduced postoperative opioid requirements compared to active and usual care controls.MethodsThis is a single-center, randomized clinical trial of older (age > 60) patients undergoing TKA. Participants will be randomized into three groups (2:2:1): VR immersion, music, and sham VR plus usual care. All patients will receive a regional block and spinal anesthesia. Patients in the immersive VR and music groups will use patient-controlled sedation (PCS) with propofol, while those in the sham VR group will act as the standard of care control group and will receive monitored anesthesia care (MAC) with propofol infusion.Statistical analysisAnalyses will be conducted using IBM SPSS Statistics Version 25, considering a two-sided p-value < 0.05 to be statistically significant. The primary outcome is the intraoperative dose of propofol (mg kg−1 min−1). Secondary outcomes include patient satisfaction, post-anesthesia care unit (PACU) length of stay, postoperative pain scores and analgesic requirements, functional outcomes, postoperative delirium, and postoperative neurocognition.DiscussionVR used as a non-pharmacological adjunct to regional and spinal anesthesia during TKA may reduce sedative requirements while maintaining patient satisfaction. If true, this approach to minimizing sedation may impact clinical outcomes including perioperative complications and length of stay for older patients, while maintaining a high degree of patient satisfaction.Trial registrationThis trial was registered on ClinicalTrials.gov on January 29, 2021. The registration number is NCT04748549.

Combination of ultrasound-guided pectoral nerve block I and serratus anterior plane block for attenuation of surgical stress response during modified radical mastectomy: A prospective interventional randomized controlled trial

Background: General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane (SAP) block were used for surgical stress response attenuation and post-operative analgesia. Aims and Objectives: This study aimed to compare the efficacy of combined PECS I and SAP block to intravenous (IV) multimodal analgesia in attenuating surgical stress response and post-operative analgesia in patients who underwent modified radical mastectomy with axillary clearance. The primary objective was to estimate the intraoperative fentanyl requirement to reduce autonomic response due to surgical stimulus. The intraoperative vitals, post-operative numeric rating scale pain score, post-operative analgesic use in the recovery room, and incidence of post-operative nausea vomiting were the secondary objectives. Materials and Methods: Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received IV analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline were noted in the both groups. Intraoperative vitals, post-operative pain score, analgesic requirement, and incidence of post-operative nausea, and vomiting were also recorded in the both groups. Results: Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C (intraoperative fentanyl [mean±SD], 116.11±25.70 μg vs. 134.44±20.07 μg, P=0.023). Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B (SBP reduction [mean±SD], 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P=0.045 and HR reduction [mean±SD], 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P=0.009, respectively). The apparently higher pain scores in the control group were statistically insignificant. Conclusion: A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.

Procedure time-of-day effects on postoperative opioid requirements in children.

Postoperative analgesic requirements in adults follow circadian rhythm patterns with requirements for opioids and local anesthetics highest in the morning. Procedure time of day may also potentially affect circadian rhythm patterns with surgery at night promoting wakefulness during nighttime hours. This disruption may produce a shift in the circadian rhythm and potentially affect when postoperative opioid requirements are highest. We hypothesized that children undergoing surgery at night would have higher postoperative opioid requirements during nighttime hours secondary to a shift in the circadian rhythm with those requirements remaining higher than daytime requirements for the duration of the hospital stay. A retrospective cohort was completed on all children aged 1-18 years undergoing a laparoscopic appendectomy for complicated appendicitis between January 2018 and December 2019. Outcomes were total postoperative morphine equivalents (mg/kg), including total daytime and nighttime postoperative morphine equivalents (mg/kg) in children undergoing surgery during the day and at night. There were 999 children who underwent a laparoscopic appendectomy for complicated appendicitis at Texas Children's Hospital from January 1, 2018 to December 31, 2019. Of these, 758 children underwent the procedure during the day and 241 children at night. The total, daytime, and nighttime median morphine equivalents (mg/kg) for children undergoing an appendectomy during the day were 0.1 (0.0-0.4), 0.0 (0.0-0.2), 0.1 (0.0-0.2), respectively. The total, daytime, and nighttime morphine equivalents (mg/kg) for children undergoing an appendectomy at night were 0.2 (0.0-0.5) (p = -0.01), 0.1 (0.0-0.3) (p = 0.01), and 0.1 (0.0-0.2) (p = 0.03), respectively. All children, irrespective of the procedure time of day, required more morphine equivalents during daytime hours than during nighttime hours. We found that procedure time of day did not impact postoperative opioid requirements in children undergoing a laparoscopic appendectomy for complicated appendicitis. Both children undergoing an appendectomy during the day or at night required more morphine equivalents during daytime hours than during nighttime hours. Surgery at night did not produce a shift in opioid requirements postoperatively from daytime hours to nighttime hours in children undergoing an appendectomy at night.

Pain Level and Analgesic Requirements in Patients Who Underwent Vaginal Pelvic Floor Surgery following General or Spinal Anesthesia

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries. Design: This was a retrospective cohort study. Participants/Materials, Setting, Methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient’s age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004). Limitations: This is a retrospective study, thus the choice of anesthesia may be biased. Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.

A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block.

Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB). Forty patients were randomly allocated to receive a PENG block or FNB and ONB, both combined with wound infiltration (WI). The main outcome was pain, assessed using a Numeric Rating Scale (NRS) 30 minutes after the block, in Post Anesthesia Care Unit (PACU) and in the postoperative 6, 12 and 24 hours. Secondary outcomes included intra and postoperative analgesic requirement, need to increase the level of sedation and postoperative complications. We observed, except for 12 hours post-surgery, higher NRS values for PENG group compared to FNB + ONB group, with a median (IQR) NRS of 3 (2-4) vs. 2 (1-3.25) 30 minutes after the block, 1.5 (0-3.25) vs. 0 (0-1.25) at PACU, 1.5 (0-2) vs. 1 (0-2.25) at 6 hours, 1.5 (0-2) vs. 2 (1-2) at 12 hours, and 2 (0-2) vs. 1.5 (0-2) at 24 hours. Despite this, no result was statistically significant; all P>0.05. No differences were observed as regards other secondary outcomes. Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.

POST-OPERATIVE PORT SITE PAIN AFTER GALL BLADDER RETRIEVAL FROM EPIGASTRIC VS UMBILICAL PORTS IN LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy (LC) is a widely performed procedure for gallstone disease. While epigastric and umbilical ports are commonly used for gallbladder retrieval, their comparative impact on postoperative discomfort, complications, analgesic requirements, and hospital stay remains underexplored. Identifying the optimal port site can improve patient outcomes and safety. Objective: The purpose of the present study was to assess postoperative discomfort, analgesic requirements, complication rates, and duration of hospitalization in patients undergoing LC with gallbladder retrieval either through the epigastric or the umbilical port in order to draw a conclusion on which port site offers better results in terms of patient comfort and safety. Methods: After the ethical approval from the institutional review board, this randomized controlled trial study was conducted at FRPMC PAF hospital from August 2023 to July 2024. Through non-probability consecutive sampling, 100 patients aged 18-65 years, of both gender, diagnosed with gallstones confirmed with ultrasound were included in the present study. Patients with suspected or proven G.B malignancy, coagulation disorder, obstructive jaundice, acute pancreatitis or emergency cases were excluded from the present study. After the informed consent, patients were randomly divided in to two groups: Group A- Epigastric port site (n=50) and Group B- Umbilical port site (n=50). Results: By 12 hours, the epigastric port group had a lower mean pain score of 4.14±3.04 compared to 5.4±3.3 in the umbilical port group (P=0.056). Analgesic requirements were also similar between the groups, with the epigastric port group requiring an average of 93.6±56.6 mg and the umbilical port group 99.96±55.3mg, yielding a p-value of 0.507. Complications were significantly more common in the epigastric port group, with 29 patients (58%) experiencing complications compared to 19 patients (38%) in the umbilical port group, and a p-value of 0.032. Conclusion: The selection of the port in laparoscopic cholecystectomy does not seem to be critical regarding the duration of either surgery or hospitalization; however, an increased complication rate and trends of postoperative pain do underline the importance of port selection.

Impact of Ultrasonography-Guided Transversus Abdominis Plane Block and Local Anesthetic Infiltration in the Surgical Field on Postoperative Analgesic Requirements for Laparoscopic Cholecystectomy Procedures

Impact of Ultrasonography-Guided Transversus Abdominis Plane Block and Local Anesthetic Infiltration in the Surgical Field on Postoperative Analgesic Requirements for Laparoscopic Cholecystectomy Procedures

Comparison of postoperative analgesia requirements between lipoedema and lymphoedema patients undergoing lower limb liposuction

Lymphoedema and lipoedema can present similarly however have different aetiologies and should be considered as distinct clinical entities. Pain is a distinguishing feature of lipoedema. Liposuction can be used in both conditions to reduce bulk and enhance quality of life. Analgesia requirements for cohorts of lipoedema and lymphoedema patients undergoing lower limb liposuction were compared. Requirements for lipoedema cases far exceeded those of lymphoedema cases, in variety, frequency and dosage, suggesting a susceptibility of these patients to perioperative microvascular and sensory damage, thereby propagating their original painful symptoms. Adequate counselling of postoperative expectations, and close consultation with anaesthetic colleagues will improve patient experience and outcome from this procedure.

Effect of total intravenous anesthesia versus sevoflurane anesthesia on intraoperative facial nerve monitoring: a randomized controlled trial.

Intraoperative facial nerve monitoring (IFNM) facilitates effective nerve preservation during ear and head and neck surgeries. Quantitative differences in the timely feasibility of IFNM during total intravenous anesthesia (TIVA) vs sevoflurane anesthesia have not been investigated. We conducted a randomized controlled trial in which 98 patients undergoing ear surgery were allocated to either the TIVA or sevoflurane group. We used quantitative neuromuscular monitoring of train-of-four (TOF) responses to assess achievements of IFNM-feasible conditions, and recorded the TOF count (TOFC) or TOF ratio of T4/T1 (TOFR). The primary outcome was the time interval between a TOFR of 0.25 and 0.75 (recovery index). The most important secondary outcome was the time to reach a TOFR of 0.25. We also recorded the quality of IFNM, intubation condition, patient-ventilator dyssynchrony, surgeon's satisfaction, and postoperative analgesic and antiemetic requirements. Ninety-two patients completed the study. The median [interquartile range] recovery index was significantly shorter in the TIVA group (9 [7-11]min) than in the sevoflurane group (34 [24-53]min), with a difference in medians of 25min (95% confidence interval, 20 to 31; P < 0.001). Before IFNM requests, the time to TOFR of 0.25 was achieved earlier in the TIVA group (34 [29-41]min) than in the sevoflurane group (51 [43-77]min) (P < 0.001). Both groups achieved neuromuscular recovery in time for IFNM without a need for reversal agents. Intraoperative facial nerve monitoring was feasible earlier and faster under TIVA than under sevoflurane anesthesia. We suggest that TIVA may be a preferable choice over sevoflurane to meet a surgeon's request for an earlier IFNM. CRIS.nih.go.kr ( KCT0006676 ); first submitted 7 October 2021.

Comparison of the Effects of Lidocaine Versus Magnesium Infusion on Quality of Recovery After Nasal Bone Fracture Surgery.

Background and Objectives: Postoperative recovery from general anesthesia is a multidimensional process, and patient-centered outcome assessment should be considered an important indicator of recovery quality. This study compared the effectiveness of intraoperative lidocaine and magnesium on postoperative recovery in nasal bone fracture surgery, using the quality of recovery-40 questionnaire (QoR-40) to assess recovery quality and pain intensity. Materials and Methods: A total of 74 patients scheduled for elective closed reduction surgery for isolated nasal bone fracture were assigned to the intraoperative infusions of lidocaine or magnesium. Immediately after anesthetic induction, 1.5 mg/kg lidocaine or 20 mg/kg magnesium was administered over 10 min, followed by a continuous infusion of 2 mg/kg/h lidocaine or 20 mg/kg/h magnesium until the end of the surgery. The primary outcome variable was the QoR-40 survey on postoperative day 1. The secondary outcome variables included postoperative pain intensity, sedation score, the incidence of postoperative nausea and vomiting, and other side effects. Results: The global QoR-40 score at postoperatively 24 h was comparable between the intraoperative lidocaine and magnesium groups. Postoperative pain 30 min after surgery was significantly lower in the lidocaine group than in the magnesium group (p = 0.01), along with lower rescue analgesic consumption (p = 0.003), but pain intensity was not different at other time points (2, 6, and 24 h). The incidence of nausea and vomiting and the sedation score in the post-anesthetic care unit were not significantly different between the two groups. Conclusions: Intraoperative lidocaine and magnesium had no difference in the scores of postoperative QoR-40, but lidocaine was associated with lower postoperative pain scores and analgesic requirement in comparison to magnesium in the closed reduction of nasal bone fractures.

The effect of intravenous lidocaine infusion on subarachnoid anesthesia in patients undergoing total knee replacement: a randomised controlled trial.

Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5mg·kg-1 followed by an infusion of 1.5mg·kg-1·h-1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24h after surgery. The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80min versus 78.21 ± 9.12min;p < 0.001 and 237.14 ± 9.14min versus 215.00 ± 10.12min;p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38min in the lidocaine group and 127.14 ± 23.35min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements.

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries. Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p&lt;0.05 was taken as statistically significant. Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p&lt;0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p&lt;0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038). Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

A COMPARISON OF 0.5% BUPIVACAINE ALONE VERSUS 0.5% BUPIVACAINE WITH VERAPAMIL AS AN ADJUNCT IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: Supraclavicular brachial plexus blocks are commonly performed for surgeries on the upper limb because they are highly effective for both anesthesia during the procedure and pain control afterward. This method targets the entire brachial plexus, making it a popular alternative to general anesthesia, as it minimizes associated risks while offering better pain relief after the surgery. Bupivacaine, a long-lasting local anesthetic, is often preferred for this block, though its pain-relieving effects eventually wear off. Owing to limitations regarding the duration of analgesia, many adjuncts have been tried since time immemorial to enhance the effectiveness of the blocking properties of these local anesthetics. Verapamil, a calcium channel blocker, has emerged as a promising adjunct that can potentially enhance and prolong the effects of Bupivacaine. This study aims to compare the efficacy of 0.5% Bupivacaine alone versus Bupivacaine combined with Verapamil in ultrasound-guided supraclavicular brachial plexus blocks. Methods: A randomized clinical trial was conducted on patients undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Group A received 30 mL of 0.5% Bupivacaine, whereas Group B received 30 mL of 0.5% Bupivacaine with 5 mg of Verapamil. Primary outcomes included the time of onset of sensory and motor blockade and the duration of analgesia for the same, whereas secondary outcomes included post-operative pain scores and hemodynamic stability. Results: The addition of Verapamil to Bupivacaine significantly accelerated the onset of sensory and motor blockade in Group B compared to Group A. Group B also exhibited a significantly prolonged duration of both sensory and motor blockade and reduced post-operative analgesic requirements. Conclusion: Verapamil helps boost the effectiveness of Bupivacaine in supraclavicular brachial plexus blocks, speeding up the onset of its actions and extending its pain-relieving effects. This makes it a useful addition to local anesthetics, making it a valuable adjunct in regional anesthesia.

Comparing the Effects of Infusion and Bolus Doses of Bupivacaine Applied with Infraclavicular Catheter on the Duration and Need of Postoperative Analgesia

Objective: This study aimed to evaluate postoperative analgesia duration, analgesic requirements, and patient satisfaction between continuous infusion and bolus injection techniques using an infraclavicular catheter in patients undergoing forearm surgery. Material and Method: We examined 100 patients which were divided into 2 groups to evaluate the data retrospectively. Bolus Injection Group (B): Patients who received 4 mL of bupivacaine (0.5%) from the catheter if the VAS value was &gt; 3. Continuous Infusion Group (C): Patients who received 20 mg bupivacaine (0.02%) infusion via catheter using an infusion pump in 24 hours. Demographic data, American Society of Anesthesiologists (ASA) score, intraoperative and postoperative hemodynamic data, sensory and motor block onset times, postoperative Visual Analogue Scale (VAS) (1-2-6-12-24th hour), postoperative 24th and 48th hour satisfaction score, obtained from anesthesia and algology follow-up forms, were evaluated. Results: When both groups were compared, VAS6 and VAS24 values of Group C were found to be statistically significantly lower than Group B. Satisfaction scores revealed that significantly more patients in Group C reported being very satisfied compared to Group B. Conclusion: Our findings suggest that continuous local anesthetic infusion via catheter offers more sustainable analgesia compared to bolus administration.

Effects of Intraoperative Lignocaine Infusion on Heamodynamics and Postoperative Analgesic Requirement after Day Case Laparoscopic Surgery

Background:Intravenous lignocaine is an amide local anaesthetic known for its analgesic, anti-hyperalgesic, anti-inflammatory and anti-arrhythmic properties. During perioperative period of laparoscopic surgeries haemodynamic alteration occurs due to laryngoscopy, intubation, and surgical excision, gas insufflation during pneumoperitoneum, inadequate analgesia and inadequate depth of anaesthesia. Intravenous lignocaine is often administered to suppress the haemodynamic response and as an analgesic agent. We aimed to evaluate the effect of intravenous infusion of lignocaine on haemodynamic response and post-operative analgesic requirement. Objectives:The purpose of this study was to evaluate the effect of intravenous infusion of lignocaine on haemodynamic and postoperative analgesic requirements after laparoscopic day case surgeries. Material and method:Four hundred Sixty (460) patients were selected who’s were going to be operated for laparoscopic surgeries (Laparoscopic Cholecystectomy, laparoscopic Hernioplasty, laparoscopic appendicectomy, Diagnostic laparoscopy due to infertility) were grouped into exposed (Group L) who were received lignocaine infusion @1mg/kg/hr and controlled (Group C) who were received placebo. Systematic random sampling was employed. Results:Demographic characteristics were comparable between the groups p&gt;0.05. In lignocaine group intraoperative mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate were significantly lower than control group (p&lt;0.05). Twenty four hour mean VAS score (0 – 10 cm) at immediate recovery, 1st, 2nd, 3rd, 6th, 12th and 24th hour were lower in lignocaine group (p&lt;0.05). The mean time of first analgesic requirement were longer (120 minutes) in lignocaine group compared to 40 minutes in control group (p&lt;0.001) and the mean total tramadol consumption is less in lignocaine group (p&lt;0.001). Conclusion:Intra operative lignocaine infusion causes more haemodynamic stability and decreases postoperative pain score, required longer time for first analgesic requirement and reduced total analgesic consumption in laparoscopic surgeries. J Bangladesh Coll Phys Surg 2024; 42: 312-320

THE RELATIONSHIP OF COVID-19 FEAR WITH PREOPERATIVE ANXIETY AND POSTOPERATIVE ANALGESIC REQUIREMENT IN TOTAL HIP AND KNEE ARTHROPLASTY PATIENTS

It was conducted to determine the relationship between fear of Covid-19 and preoperative anxiety and postoperative analgesic requirement in total hip and knee arthroplasty patients. This descriptive study was conducted with 331 patients scheduled for arthroplasty who were hospitalized in the orthopedic clinic of a hospital in eastern Turkey between March 2022-2023. Fear of covid-19, state anxiety inventory, and visual analogue pain scale were used. The mean age of the patients was 61.9±14.4 years, 52.0% had undergone total knee arthroplasty, and there was no relationship between Covid-19 fear score and state anxiety score. A positive significant correlation was found between opioid requirement and Covid-19 fear score on the first and second days after surgery. A weak positive correlation was found between non-steroidal anti-inflammatory drug (NSAID) requirement and Covid-19 fear score on the zero, first and second days after surgery. A weak negative correlation was found between paracetamol use and Covid-19 fear score on the first and second days. It was determined that the Covid-19 fear experienced by the patients before surgery was not associated with preoperative anxiety and increased the use of analgesics such as NSAIDs and opioids after surgery.