Postoperative Analgesia Research Articles

Impact of Preoperative Aripiprazole on Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Double-blind Placebo-controlled Trial.

Aripiprazole is a second-generation atypical antipsychotic with worldwide clinical approval. Nevertheless, its perioperative antinociceptive application has not been studied. As a result, the purpose of this study was to investigate the analgesic effects of perioperative aripiprazole on reducing postoperative pain, as well as the possible adverse effects. This randomized controlled study enrolled 80 female patients scheduled for laparoscopic hysterectomy who were assigned randomly into 2 equal groups in 1:1; aripiprazole group (n = 40), patients received an aripiprazole 30mg tablet orally 3 hours before surgery and placebo group (n = 40), patients received a placebo tablet 3 hours before surgery. The 24-hour morphine consumption postoperatively was the primary outcome, and the time to the first analgesic request, sedation scores, and the incidence of perioperative adverse events were the secondary outcomes. The mean 24-hour morphine consumption was significantly lower with aripiprazole (2.5 ± 0.5mg) than with placebo (23.7 ± 1.6mg; mean ± SE -21.2 ± 0.3, 95% CI: -21.7 to -20.6, P < 0.001). In addition, the mean time to the first analgesic request was significantly longer with aripiprazole (212.2 ± 14.7min) than with placebo (27.0 ± 2.0min; mean ± SE 185.2 ± 2.3, 95% CI: 180.5 to 189.8, P < 0.001). Furthermore, the aripiprazole group reported higher sedation scores ( P < 0.001). Bradycardia and hypotension were reported more frequently among patients in the aripiprazole group ( P < 0.05). Aripiprazole was effective in reducing pain after laparoscopic hysterectomy. Although self-limited, side effects should be taken into consideration when using the medication perioperatively.

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty: A Randomized Clinical Trial.

This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these. Patients undergoing TKA were randomly assigned to 1 of 3 groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary end point was the Numeric Rating Scale (NRS) score at movement at 24 hours postsurgery. Secondary end points included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion, effective PCNA utilization, and opioid consumption at various postsurgery time points. Of the 94 valid data sets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary end point (H=7.003, P =0.03). Post hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2 to 4]) compared with the ACB group (4 [3 to 5], Bonferroni-adjusted P =0.03). Regarding secondary end points, both the FNB and FTB groups had significantly lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other end points. Continuous FTB provides postoperative analgesia comparable to FNB but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.

Construction of bupivacaine-loaded gelatin-based hydrogel delivery system for sciatic nerve block in mice.

Peripheral nerve blockade (PNB) is a common treatment to relieve postoperative pain. However, local anesthetics alone have a short duration of action and severe side effects during postoperative analgesia. In order to overcome these limitations, the present study reported an injectable hydrogel with a drug slow-release profile for regional nerve blockade. The injectable hydrogel was prepared by crosslinking with gelatin and NHS-PEG-NHS, which was degradable in the physiological environment and displayed sustainable release of anesthetics locally, thus improving the disadvantage of the high toxicity of local anesthetics. In this regard, we conducted a series of in vitro characterizations and proved that the hydrogel has a porous three-dimensional mesh structure with high drug loading capability, and sustainable drug release profile. And cytotoxicity experiments confirmed the good biocompatibility of the hydrogel. It was shown that using the animal sciatic nerve block model, the analgesic effect was greatly improved in vivo, and there was no obvious evidence of permanent inflammation or nerve damage in the block site's sections. This locally slow-release platform, combined with local anesthetics, is therefore a promising contender for long-acting analgesia.

DEVELOPING A ROBOTIC ABDOMINAL WALL RECONSTRUCTION SERVICE IN THE UK – SINGLE CENTRE EXPERIENCE

Abstract Aim A minimally invasive approach (MIS) to complex abdominal wall reconstruction (CAWR) is expanding and offers advantages in enhanced recovery. We report our single-centre experience in the introduction of Robotic CAWR. Methods A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients undergoing CAWR using a MIS approach were included. Data was collected for the following: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and post-operative complications. Results 30 patients underwent MIS CAWR (22 robotic; 8 laparoscopic). Male to female ratio was 18:12. The median age was 59 years (IQR 47–66) and BMI 36 kg/m2 (IQR 32–37). Operations included eTEP retro-rectus Rives-Stoppa (RS) + diastasis plication +/- TAR repair using macroporous polypropylene non-absorbable synthetic mesh. Three patients (10%) had TAR and another 3 (10%) had simultaneous inguinal hernia repairs. The median operating time for RS was 3.3 hours (IQR 3.1–3.5) whilst 7.5 hours (IQR 7.2–7.8) for RS + TAR. The median LOS was 2 days (IQR 1–2). Seven (23%) patients developed post-operative urinary retention requiring catheterization. 1 (3%) patient developed a post-operative chest infection. Twenty-two of 27 (82%) patients undergoing MIS Rives Stoppa required oral post-operative analgesia only. 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement. Conclusion MIS/Robotic CAWR is a safe approach and can be performed in a similar length of time to open procedures. However, LOS is significantly reduced and patients can be successfully managed with oral analgesia.

Intravenous ketorolac versus intravenous dexmedetomidine for postoperative analgesia after hypospadias repair

ABSTRACT Hypospadias repair surgery, though necessary, can be painful after the procedure, especially for children. Effective pain management is essential in all surgeries, but particularly in pediatric procedures. The current study was conducted to evaluate the analgesic efficacy of intravenous ketorolac versus dexmedetomidine after hypospadias repair surgery. Patients and methods A total of 60 children aged between 2 and 7 years old undergoing hypospadias repair under general anesthesia enrolled in the study. Those children were randomly divided into either group Ketorolac (group A) or Dexmedetomidine group (group B). Group (A) included 30 patients who received IV ketorolac in a dose 0.9 mg/kg after intubation for general anesthesia while group (B) included 30 patients who received IV dexmedetomidine in a dose 1 μg/kg after intubation. Pain scores (FLACC), sedation and emergence agitation (EA) scores, 1st analgesic dose, hemodynamics, and any side events were recorded. Results The main finding in this study was that group (B) had significantly lower FLACC at different postoperative times compared to group n(A)with p < 0.05; with exception at 4th and 12th hours. It was found that FLACC was zero in group (B) till the 6th hour postoperatively. All patients in the studied groups had sedation scale was 3 starting from the 4th postoperative hour. Immediate and 2-hour postoperatively, the score was significantly higher among the dexmedetomidine group.Two patients developed EA in group A but non in group B. Conclusion Adjuvant intravenous dexmedetomidine is more effective than intravenous ketorolac in postoperative analgesia children after hypospadias repair surgery under general anaesthesia.

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

(Anesth Analg. 2024;138(1):70–84) Intrathecal opioids are effective for postoperative analgesia following CD, but they also have unpleasant side effects including shivering, nausea, vomiting, respiratory depression, and pruritus. The mechanisms of intrathecal opioid-induced pruritus are largely unknown. It is unknown if ondansetron has an antipruritic effect when administered with neuraxial analgesia. This study is an up-to-date systematic review that addressed the effectiveness of ondansetron for the prevention of pruritus that is associated with intrathecal opioids in women having CD.

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25mg pethidine as a rescue analgesic to patients with VAS ≥4. Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

Continuous Epidural Catheter for Postoperative Analgesia in Children: A Case Report

The management of postoperative pain in children and infants has now become a significant concern. Continuous epidural anesthesia is a proven method for controlling acute pain after surgery. We present the case of thoracic epidural analgesia used for the repair of an extensive burn involving the back and trunk, assisted by a skin graft, in a 6-year-old girl. Department of Pediatric Intensive Care Unit, Children's Hospital of Rabat. In pediatric surgery, postoperative pain awareness is crucial for medical and paramedical teams. Continuous epidural anesthesia, utilizing suitable equipment, is feasible for young children. Its advantages during long procedures are manifold: it eliminates the need for central analgesics, ensuring stable cardiovascular function and a calm awakening post-surgery. Moreover, it provides high-quality analgesia in the postoperative phase, decreasing morbidity and easing care for children. With safe analgesics and advances in locoregional anesthesia, managing postoperative pain in pediatrics has markedly improved.

Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach.

Robotic donor nephrectomy (RDN) has emerged as a safe alternative to laparoscopic donor nephrectomy (LDN). Having previously demonstrated comparable efficacy, this study aims to examine postoperative analgesia use (opioid and non-opioid) in the two groups. We conducted a retrospective review of 300 living donor nephrectomies performed at our center, comparing 150 RDN's with a contemporary cohort of 150 hand-assisted LDN's. In addition to clinical and demographic information, data on postoperative inpatient opioid and non-opioid analgesia (from patient's arrival to the surgical floor after surgery till the time of discharge) was collected. Opioid dosages were standardized by conversion to morphine milligram equivalents (MME). All patients were managed post-operatively under a standardized ERAS pathway for living donor nephrectomy patients. There were no significant differences in donor age, gender, and BMI between RDN and LDN groups. Total post-operative opioid use (MME's) was significantly lower in RDN patients (RDN 27.1 vs. LDN 46.3; P < 0.0001). Breakdown of opioid use with post-operative (POD) day demonstrated significantly lower use in RDN group on POD1 (RDN 8.6 vs. LDN 17.0; P < 0.05), and POD2 (RDN 3.9 vs LDN 10; P < 0.05). RDN patients had a shorter post-operative length of stay (LOS) (RDN 1.69days vs. LDN 1.98; P = 0.0003). There were no differences between groups in non-opioid medication use, complications, and readmission rates. RDN has comparable safety to hand-assist LDN and offers additional benefits of lower postoperative opioid requirement and a shorter hospital LOS.

Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial.

Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway. One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications. No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75-0) vs. 2 (5.25-0) in PACU, 5.5 (7-3) vs. 6 (7-4) at 6 h, 2 (6-0) vs. 3 (5.25-1.75) at 12 h, and 2 (3.75-0) vs. 1 (2-0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes. Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.

A comparative study between postoperative analgesia of suprainguinal fascia iliaca compartment block (SIFI) and lumbar erector spinae plane block (ESPB) in hip arthroplasty

ABSTRACT Background Suprainguinal fascia iliaca (SIFI) block offers efficient pain relief in total hip arthroplasty, although motor blockage is a common complication. Erector spinae plane block (ESPB) is a promising technique with less motor block; in research, we evaluate the efficacy of both blocks regarding analgesia and early mobilization. Patients and method Fifty-six patients who underwent total hip replacement following spinal anesthesia were divided to either treated with ultrasound guided suprainguinal fascia iliaca (SIFI) block or ultrasound guided ESPB at the end of surgery. The primary measure of interest was the pethidine consumed within a 24-hour period following the surgical procedure. Subordinate outcomes were: first rescue pethidine time, pain scores, and onset of ambulation. Post-operative vomiting, nausea, and other adverse events were recorded. Results Fifty-six patients were involved in the study. No significant statistical variances were found in pethidine consumed at 24 hours (p = 0.122) or pain scores and rescue analgesia timing (p = 0.075). ESPB provided an early onset of ambulation with a highly significant divergence (p < 0.001). Conclusion We concluded that ESPB has a similar analgesic, opioid sparing effect to SIFI block after total hip arthroplasty (THA) and provides early onset of ambulation.

Comparative analysis of the course of the perioperative period in patients with diabetes during knee and hip arthroplasties

Background. Hip and knee arthroplasty (HKA) are common surgical interventions. In more than 20 % of patients undergoing HKA, diabetes mellitus is detected, which is one of the risk factors for the development of periprosthetic infection and the occurrence of complications in the perioperative period. The purpose: to determine the features of the course of the perioperative period in patients with diabetes during knee and hip replacement. Materials and methods. A retrospective analysis was performed of the inpatient charts of 50 people who underwent HKA against the background of concomitant diabetes. All participants were divided into two groups: 1) patients with hip arthroplasty; 2) patients with knee arthroplasty. The course of the intraoperative and postoperative periods and the development of complications were analyzed. Results. All patients were aged from 38 to 86 years, had increased weight (body mass index of 26.0–29.4 kg/m2). Among the complications, hypertension was most common (64.0 and 68.0 % in the groups, respectively), nausea and vomiting (32.0 and 28.0 %, respectively), disturbances in the rhythm and depth of breathing (16.0 and 20.0 % respectively) were often observed. The need for analgesia in the postoperative period was registered in 96.0 and 100.0 % of cases, which indicates its insufficient quality. Other clinical and anamnestic indicators, the course of the perioperative period and the development of complications were similar in patients undergoing both hip and knee replacements (p &gt; 0.05). Conclusions. Clinical and anamnestic data, the spectrum of existing concomitant pathology, characteristics of carbohydrate metabolism and its disorders, features of the course of the perioperative period and detected complications were of the same type in patients regardless of the location of the intervention. There was no significant difference in the studied parameters (p &gt; 0.05). Identified complications and insufficient effectiveness of postoperative analgesia dictates the need to find optimal methods of perioperative analgesia during HKA.

0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial

IntroductionIn an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of...

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Objective: This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery. Background: ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear. Methods: This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (&gt;70% of components), length of stay (LOS), readmissions, and 30-day complications. Results: A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P &lt; 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P &lt; 0.001), early regular diet (+15.9%; P &lt; 0.001), and postoperative multimodal analgesia (+6.4%; P &lt; 0.001). High-level ERP adherence was 13.4% higher (P &lt; 0.01) and LOS was 2.0 days shorter (P &lt; 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence. Conclusion: Preoperative education is associated with adherence to ERP components and improved surgical outcomes.

Loco-Regional Ropivacaine Analgesia Via a Surgically Placed Intercostal Catheter after Anatomic Lung Resection: Prospective, Placebo-Controlled, Double-Blind; Randomized Superiority Trial

Abstract Background Even after minimally invasive anatomic lung resection, pain remains a burden for patients. Current guidelines recommend the surgical placement of intercostal catheters at the end of the surgery to promote faster recovery after lung surgery. Aims The aim of this trial was to investigate the analgesic efficacy of continuous loco-regional application of ropivacaine via an intercostal catheter and to establish this method as a possible standard of care in postoperative analgesia management. Methods Between December 2021 and October 2023, we evaluated the efficacy of surgically inserted intercostal catheters. Patients were eligible when undergoing anatomic VATS lung resection under general anesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). Patients received ropivacaine at a concentration of 2 mg/ml or a placebo through an elastomer pump, flow rate of 6-8 ml/h for 72 hours after surgery. The sample size was calculated to find an NRS (numerical rating scale) difference associated with a pain reduction of 1.5 points. Results 14 patients were randomly included in the ropivacaine group and 18 in the placebo group. The patients’ characteristics and preoperative pain scores were similar in both groups. Between the observed groups there was no statistically significant difference in postoperative pain scores and morphine consumption. The NRS score for cough 24 hours postoperatively was 4.9 (±2.2) in the ropivacaine group and 4.3 (±2.4); p=0.474 in the placebo group. In addition, we were unable to determine any influence of the pain management on the relative postoperative pulmonary function. Conclusion Our results suggest that the analgesic efficacy of continuous loco-regionally applied ropivacaine administered through a surgically placed intercostal catheter after surgery does not have a positive effect on postoperative pain scores or morphine requirements. Instead, local analgesia started at the beginning of the procedure and covering several intercostal spaces should be considered.

Evaluating the Efficacy of a Peripheral Nerve Simulator-Guided Brachial Plexus Block in Rabbits Undergoing Orthopaedic Surgery Compared to Systemic Analgesia.

Locoregional anaesthetic techniques are invaluable for providing multimodal analgesia for painful surgical procedures. This prospective, randomised study describes a nerve stimulator-guided brachial plexus blockade (BPB) in rabbits undergoing orthopaedic surgery in comparison to systemic lidocaine. Premedication was provided with intramuscular (IM) medetomidine, fentanyl, and midazolam. Anaesthesia was induced (propofol IV) and maintained with isoflurane. Nine rabbits received a lidocaine BPB (2%; 0.3 mL kg-1), and eight received a lidocaine constant rate infusion (CRI) (2 mg kg-1 IV, followed by 100 µg kg-1 min-1). Rescue analgesia was provided with fentanyl IV. Carprofen was administered at the end of the surgery. Postoperative pain was determined using the Rabbit Grimace Scale (RGS) and a composite pain scale. Buprenorphine was administered according to the pain score for two hours after extubation. Rabbits were filmed during the first two hours to measure distance travelled and behaviours. Food intake and faeces output were compared. Every rabbit in CRI required intraoperative rescue analgesia compared to none in BPB. However, rabbits in both groups had similar pain scores, and there was no difference in the administration of postoperative analgesia. There were no significant differences in food intake or faeces production over 18 h, and no significant differences in distance travelled or behaviours examined during the first two hours. BPB seems superior for intraoperative analgesia. Postoperatively, both groups were comparable.

A Comparative Study to Evaluate Postoperative Analgesia with USG Guided Unilateral Adductor Canal by using Combination of Bupivacaine with Dexamethasone or Morphine After Total Knee Replacement

TKR surgery refer to surgical intervention in the knee joint to replace diseased joint and many studies investigated post operative pain control, Adductor canal block is a newer alterative to femoral block after TKR with better multimodal analgesia and better quadriceps muscle strength, Many studies investigated the prolongation of analgesic duration when adjunct is added to a local anesthetic. A prospective randomized ,double blind, parallel- two group trial. A total of 78 ASA 1 and ASA 2 patients undergoing total knee replacement were included in the study. Seventy eight patients undergoing TKR were randomly allocated into two groups and received block as per the study protocol and the main outcome measure was the duration of postoperative analgesia. The result revealed that at equal volumes Bupivacaine 0.5% with 30mcg/kg of morphine has an advantage over Bupivacaine 0.5% when combined with 8mg of dexamethasone. We conclude that adductor canal block with 0.5% Bupivacaine with 30mcg/kg of morphine has better outcome over conventional intravenous paracetamol analgesia

Comparison of the Analgesic Effect of Pericapsular Nerve Group Block and Lumbar Erector Spinae Plane Block in Elective Hip Surgery.

Background and Objectives: The aim of this study was to compare the effectiveness of pericapsular nerve group (PENG) and lumbar erector spinae plane (L-ESP) blocks, both administered with a high volume (40 mL) of local anesthetic (LA), for multimodal postoperative analgesia in patients undergoing hip surgery. Materials and Methods: This was a prospective, double-blind, randomized study that included 75 adult patients who were divided into three equal groups: control, PENG, and L-ESP. The study compared pain intensity, morphine consumption, time to first morphine request, and postoperative satisfaction between the control group, which received standard multimodal analgesia, and the block groups, which received PENG or L-ESP block in addition to multimodal analgesia. The numerical rating scale (NRS) was used to measure pain intensity. Results: The results showed that the block groups had lower pain intensity scores and morphine consumption, a longer time to the first morphine request, and higher postoperative satisfaction compared to the control group. The median maximum NRS score during the first 12 h was four in the control group, two in the PENG group, and three in the L-ESP group. The control group (21.52 ± 9.63 mg) consumed more morphine than the two block groups (PENG, 11.20 ± 7.55 mg; L-ESP, 12.88 ± 8.87 mg) and requested morphine 6.8 h earlier and 5 h earlier than the PENG and L-ESP groups, respectively. The control group (median 3) had the lowest Likert satisfaction scores, while the PENG group (median 4) had the lowest NRS scores (L-ESP, median 4). Conclusions: The application of PENG or L-ESP blocks with high-volume LA in patients undergoing hip surgery reduces the need for postoperative analgesia and improves the quality of multimodal analgesia.

Effect of remifentanil in clinical anesthesia and postoperative analgesia

Purpose: To investigate the effect of remifentanil in clinical anesthesia and postoperative intravenous analgesia. Methods: A retrospective analysis was conducted on the medical records of 100 patients who received remifentanil for anesthesia and postoperative intravenous analgesia at Zibo Center Hospital, Zibo, China from February 2020 to February 2023. The patients were divided into study and control groups comprising 50 patients in each group. The study group received remifentanil intravenously (8 g/kg) while the control group received fentanyl (3 - 4 μg/kg). Heart rate (HR), mean arterial pressure (MAP), and Bispectral Index (BIS) were monitored 5 min before anesthesia (T1), 10 min after (T2), 40 min after (T3), and 5 min before the end of surgery (T4). The levels of blood glucose (Glu), angiotensin II (Ang II), and cortisol (Cor) were measured at T1, T2, T3, and T4. Analgesic and sedative effects were evaluated 3, 12 and 24 h after surgery using the visual analog scale (VAS) and Ramsay sedation score. Results: At T1, T2, T3, and T4, there were no significant differences in HR, MAP, and BIS between the two groups (p &gt; 0.05), while the levels of Glu, Ang II, and Cor in study group were significantly lower (p &lt; 0.05). At 3, 12 and 24 h after surgery, VAS score in the study group was significantly lower, while Ramsay's analgesia score was significantly higher (p &lt; 0.05). Total effectiveness was significantly higher in the study group (p &lt; 0.05). Recovery time for orientation, spontaneous breathing, awakening, stay in the recovery room, and incidence of adverse reactions were significantly lower in study group (p &lt; 0.05). Conclusion: The use of remifentanil for postoperative intravenous analgesia significantly lowers stress response, sedation and improves recovery time. It is, therefore, effective, and produces lower adverse effects than fentanyl. Large-scale investigation to determine the impact of confounding factors on the outcome of fentanyl/remifentanil combination is required.

Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study.

Prospective, randomized controlled study. To assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy. 88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded. The total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; P < .001), muscle relaxant usage (46.14 + 6.18mg vs 59.32 + 3.97mg; P < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; P < .01), and intra-operative blood loss (233.18 + 66.08mL vs 409.77 + 115.41mL; P < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group's pain score was significantly higher (P < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control (P < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) (P < .001). In patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.