Postoperative Analgesic Consumption Research Articles

A Comparative Study of Ultrasound Guided erector Spinae Plane Block versus Local Anaesthetic Infiltration in Spine Surgeries for Intraoperative and Post-operative Analgesia

Abstract Background: Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA). Aim: This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia. Materials and Methods: Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement. Results: NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site. Conclusion: Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.

EFFICACY OF PERICAPSULAR NERVE GROUP BLOCK AS A MODALITY FOR POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT

The postoperative pain after hip arthroscopy remains a major challenge in the immediate postoperative period. Adequate postoperative analgesia has been associated with increased patient satisfaction and decreased consumption of opioids. We evaluated the efficacy of pericapsular nerve group block (PENG) versus fascia iliaca block (FIB) in reducing post-operative pain and analgesic consumption within the first 24 hours following arthroscopic management of femoroacetabular impingement (FAI).Thirty-nine patients (17 females and 25 males, ages 18–42 years, mean ± SD (27.9 ± 6.2), and mean BMI of 25.13±5.08 kg/m2 were scheduled for primary arthroscopic management of FAI. Included patients were randomized into two groups according to the block used in each. Group (A) 19 patients were included and had FIB and group (B) 20 patients were included and received PENG block. The efficacy of both techniques was clinically and statistically valuated using VAS score and quadriceps muscle power.There was a statically significance difference in the mean at rest between the two groups at all measured time points following surgery (6, 12, 18 and 24 h). Also, in dynamic pain scores (with hip flexion) scores were statistically significant at 24 hours post-operative (P = .001). Total opioid consumption in the first 24 hours postoperative was lower in the PENG group with significant difference of mean 16.5 ±9.9 mg for PENG group versus 27.5±9.6 mg for FIB group (P < .005). Five patients (26.31%) in FIB group had weaker quadriceps muscle power while none in PENG group patients had quadriceps weakness.PENG block might be considered as an ideal regional anesthesia modality for hip arthroscopy. As an alternative to more conventional regional nerve blocks such as a fascia iliaca block. PENG block is easily performed in the preoperative setting, and appears to spare motor function while providing a prolonged sensory pain relief.

Relationship between intraoperative requirement for anesthetics and postoperative analgesic consumption in laparoscopic colectomy: a randomized controlled double-blinded study.

This study investigated the relationship between intraoperative requirement for an inhalational anesthetic (sevoflurane) or an opioid (remifentanil) and postoperative analgesic consumption. The study included 200 adult patients undergoing elective laparoscopic colectomy. In the sevoflurane group, the effect-site concentration of remifentanil was fixed at 1.0 ng/ml, while the inspiratory sevoflurane concentration was adjusted to maintain an appropriate anesthetic depth. In the remifentanil group, the end-expiratory sevoflurane concentration was fixed at 1.0 vol.%, and the remifentanil concentration was adjusted. Pain scores and cumulative postoperative analgesic consumptions were evaluated at 2, 6, 24, and 48 h after surgery. Average end-tidal concentration of sevoflurane and effect-site concentration of remifentanil were 2.0 ± 0.4 vol.% and 3.9 ± 1.4 ng/ml in the sevoflurane and remifentanil groups, respectively. Cumulative postoperative analgesic consumption at 48 h postoperatively was 55 ± 26 ml in the sevoflurane group and 57 ± 33 ml in the remifentanil group. In the remifentanil group, the postoperative cumulative analgesic consumptions at 2 and 6 h were positively correlated with intraoperative remifentanil requirements (2 h: r = 0.36, P < 0.001; 6 h: r = 0.38, P < 0.001). However, there was no significant correlation in the sevoflurane group (r = 0.04, P = 0.691). The amount of intraoperative requirement of short acting opioid, remifentanil, is correlated with postoperative analgesic consumption within postoperative 6 h. It may be contributed by the development of acute opioid tolerance. However, intraoperative sevoflurane requirement had no effect on postoperative analgesic consumption.

Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials.

Dexmedetomidine (DEX) can strengthen the analgesic effects of local anesthetics (LAs) when used as an adjuvant through intrathecal, perineural, and intraperitoneal routes. Many studies have used intraperitoneal instillation of DEX with LAs in laparoscopic cholecystectomy (LC) to relieve postoperative pain. We performed a systematic review and meta-analysis to synthesize evidence of the efficacy and safety of intraperitoneal instillation of DEX as an adjuvant of LAs in patients undergoing LC. A comprehensive literature search of the MEDLINE, PubMed, EMBASE, and Cochrane Library databases was performed to identify randomized controlled trials in which patients received intraperitoneal instillation of DEX combined with LAs during LC. A meta-analysis and sensitivity analysis of the results were conducted. We also performed a subgroup analysis to investigate the source of heterogeneity. The Egger test was used to check for publication bias. Eleven randomized controlled trials involving 890 patients were analyzed. We found that the addition of DEX to LAs significantly decreased pain scores at six postoperative time points (0.5, 1, 2, 4, 12, and 24 h) and significantly prolonged the time to the first analgesic request by patients. In addition, 24-hour postoperative analgesic consumption was decreased in the experimental group, and no significant difference in the incidence of nausea and vomiting was observed. Our findings indicate that intraperitoneal instillation of DEX with LAs can reduce postoperative pain and prolong the time to first request analgesia after LC.

A Novel USG-Guided PEC Block with Ropivacaine and Fentanyl for Postoperative Analgesia in Chest Wall Surgeries: A Randomized Controlled Trial

Background: Perioperative analgesia can be administered through various routes to patients undergoing chest wall surgeries. A recently introduced technique is the ultrasound-guided pectoral nerve block, which aims to alleviate pain effectively. Objectives: The purpose of this study is to investigate and compare the total duration of analgesia and the timing of the first rescue analgesia. Methods: In this prospective, randomized, triple-blind study, 60 adult patients scheduled for elective chest wall surgeries were enrolled. They were randomly divided into two equal groups: Group R received 38 mL of 0.2% ropivacaine and 2 ml of normal saline, and group F received 38 mL of 0.2% ropivacaine and 2 mL of fentanyl (100 mcg). All patients were administered general anesthesia and the PEC1 and PEC2 blocks postoperatively prior to extubation. The primary objective was to assess the total duration of postoperative analgesia, the Numeric Rating Scale (NRS) pain score, and the time to first rescue analgesia in both groups. The secondary outcome was the total consumption of postoperative analgesics. Results: The total duration of analgesia, as well as the consumption of paracetamol and fentanyl postoperatively in group F, were 11.02 ± 2.01 hours, 1.5 ± 0.5 g, and 0 mcg, respectively. In contrast, in group R, these were 8.28 ± 0.51 hours, 2.2 ± 0.8 grams, and 35.1 ± 13.4 mcg, respectively. The NRS scores at rest and during movement in group F were lower compared to group R. Conclusions: Ultrasound-guided PEC1 and PEC2 blocks with fentanyl as an adjuvant to ropivacaine have significantly reduced the requirements for analgesia and pain scores.

Comparison of the effects of ultrasound-guided quadratus lumborum block and erector spinae plane block on postoperative pain in abdominal surgeries: a protocol for systematic review and meta-analysis

IntroductionUltrasound-guided quadratus lumborum block and erector spinae plane block are widely used for postoperative analgesia in adult patients undergoing abdominal surgeries. This protocol aims to compare the analgesic effects between...

Safety and efficacy of general anesthesia versus spinal anesthesia in percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized &gt;20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. Aims and Objectives: The objective of this study was to assess and compare the efficacy and safety of spinal anesthesia (SA) versus general anesthesia (GA) in PCNL. Materials and Methods: A prospective randomized study included eighty-two patients who were enrolled to receive either SA or GA for PCNL. The study assessed patients’ characteristics, vital parameters, requirements for additional analgesia, and patient satisfaction. In addition, intraoperative and post-operative complications were documented. Patients’ satisfaction was also analyzed. Results: In both groups, the vital parameters were consistently maintained at safe levels during the procedures. Patients in the SA group exhibited a lower analgesia consumption on the 1st post-operative day compared to the GA group (P&lt;0.05). Post-operative hypotension was higher in the SA group than in the GA group (17% vs. 7%). Patients in the GA group reported higher patient satisfaction scores than the SA group (mean 4.39+0.59 vs. 3.81+0.64). Conclusion: Both SA and GA are safe and effective in PCNL. SA is associated with fewer complications and reduced postoperative analgesia consumption. However, GA tends to offer higher satisfaction levels for patients. Each method of anesthesia has its own advantages and disadvantages. The final choice between general and SA should be based on the patient’s condition and surgical team preference.

Perioperative oral pregabalin or clonidine in patients undergoing lumbar spine posterior fusion: A randomized controlled trial

ABSTRACT Background Multiple techniques and pharmacological efforts have been tried to control intraoperative hemodynamic fluctuations, reduce perioperative blood loss and severe postoperative pain. This study aimed to assess the perioperative effects of oral premedication with pregabalin or clonidine for lumbar spine posterior fusion under general anesthesia (GA). Outcome measures: Perioperative blood loss, hemodynamics, anesthetics consumption, postoperative pain, and side effects Methods This is a prospective, triple blinded randomized placebo-controlled trial (RCT). Ninety-six adult ASA I-II patients of either sex undergoing lumbar spine posterior fusion were randomly assigned to obtain a placebo (group E), pregabalin 300 mg (group P), or clonidine 200 μg (group C) orally 90 minutes before induction of GA. Trial registration: www.pactr.org with (PACTR201710002416280). Results Preemptive oral pregabalin 300 mg and clonidine 200 μg optimized intraoperative hemodynamics, reduced perioperative blood loss than the placebo group (by 22.2% and 30.7%, respectively), reduced postoperative pain scores, and anesthetic and postoperative analgesic consumption. In addition, they prolonged the duration to the first postoperative analgesic request. There was no major complication in any group. Conclusion Premedication with pregabalin or clonidine reduced perioperative blood loss and optimized intraoperative and postoperative hemodynamics, with the preference for clonidine over pregabalin as well as both reduced postoperative pain scores, analgesic requirements, PONV, and shivering. Sedative drugs should be used in lower doses to avoid oversedation. Pregabalin-associated dizziness and visual disturbance may necessitate extra precautions and patient education.

Effectiveness of ESP Block as Post-Operative Analgesia in Comparison with Opioid Analgesia for Laparoscopic Cholecystectomy

Background: In our country, the role of Erector Spinae Plane Block (ESP) for post-operative analgesia in laparoscopic cholecystectomy has not yet been investigated. As a result, the study was designed to compare the effectiveness of ESP block as post-operative analgesia to opioid analgesia for pain control following Laparoscopic Cholecystectomy. Objectives: The aim of the study was to evaluate the effectiveness of ESP block as post-operative analgesia in comparison with opioid analgesia. Methods: This cross-sectional comparative study was conducted at the department of surgery with collaboration of department of Anaesthesiology in CMH for 6 months of period. Before commencement of the study formal ethical clearance was taken from the Ethical Committee of DGMS Army. Total 60 patients, scheduled for laparoscopic cholecystectomy under general anesthesia were included in this study and randomly divided into two groups (30 patients in each group). total 30 Patients, received both GA and ultrasound guided ESP block were assigned as group E and 30 Patients, received GA and opioid analgesia were in group N. Informed written consent was taken from each subject and ethical measures were followed strictly in whole study. Following data collection, data were analyzed by the SPSS 24. Results: In terms of age, sex, BMI and ASA grading, the two groups had identical demographic features (p&gt;0.05 in all cases). There was no significant difference in pre-operative, post-operative, or recovery room heart rate (p&gt;0.05) or mean arterial pressure (p&gt;0.05). In the recovery room, group E has significantly less pain than group N (3.67±0.802 vs 4.3±0.877; p&lt;0.05). A similar improvement was seen in group E at 6, 12 and 24 hours (p&lt;0.05 in all follow ups). Post-operative analgesic consumption was similarly higher in group N at 1, 12, and 24 hours (p&lt;0.05 in all follow up). Except for nausea, which was more common in group N (p&lt;0.05), complications were similar in both groups. ......

A comparative study of the analgesic efficacy of intraperitoneal instillation of diluted bupivacaine versus non-diluted bupivacaine after laparoscopic cholecystectomy, a prospective single-blinded controlled randomized study

ABSTRACT Intraperitoneal (IP) bupivacaine instillation for postoperative analgesia after laparoscopic cholecystectomy (LC) has been reported in many studies as either diluted or non-diluted, with conflicting results and no standard recommendations. Objective Our study aims to compare the analgesic efficacy of intraperitoneal instillation of diluted versus non-diluted bupivacaine after laparoscopic cholecystectomy. Methods In this prospective, single-blinded, controlled and randomized study, we included 50 patients undergoing LC. They were randomly divided into two groups, with 25 patients each. At the end of surgery, the first group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg), added to 480 ml normal saline, diluted bupivacaine group (DBG) and the second group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg); non-diluted bupivacaine group (NBG). Pain was assessed and recorded using the visual analog scale (VAS) for 24 h. Time to the first analgesic request, total analgesic consumption in 24 h, incidence of negative effects after LC, such as nausea, vomiting and shoulder pain, any side effects due to local anesthetic used as hypotension, bradycardia or respiratory depression and hemodynamic parameters were also recorded. Results Postoperative VAS values were significantly lower in DBG than NBG in the 1st 24 h (P value ≤ 0.003). The duration of analgesia (the 1st time analgesic request) was significantly longer in DBG (20.16 ± 3.52 h) than that in NBG (6.19 ± 2.93 h) (P value = 0.0001). Also, the total amount of postoperative analgesic consumption (tramadol) was less in DBG (7.2 ± 19.9 mg) than NBG (63 ± 31.16 mg) (P value = 0.0001). In relation to negative effects after LC, side effects due to analgesic drugs and hemodynamic parameters, the results were comparable in both groups. Conclusion Intraperitoneal instillation of diluted bupivacaine at the end of laparoscopic cholecystectomy decreases postoperative pain, delays request for rescue analgesia and reduces the amount of analgesics in the 1st 24 h postoperatively, more than non-diluted bupivacaine, with comparable results in incidence-negative effects after LC, side effects due to analgesic drugs and comparable hemodynamic parameters.

Ultrasound-Guided Sciatic Nerve Block vs. Caudal Analgesia in Cerebral Palsy Undergoing Lower Limb Surgeries

Background: Continuous advancements in ultrasound (US)-guided neuraxial and peripheral nerve blocks (PNB) have allowed the safe and successful use of these blocks as adjuvants to general anesthesia in pediatric patients. Objectives: This study was designed to compare the analgesic efficacy of 2 US-guided regional techniques, caudal epidural block (CEB) and subgluteal sciatic nerve block (SNB), in children with cerebral palsy (CP). Methods: The current randomized comparative study was conducted on 30 patients with spastic CP aged 2-12 years who were scheduled for unilateral lower limb multilevel soft tissue corrective surgeries, randomly distributed using a computerized program into 2 equal groups. The CEB group received a US-guided caudal block, and the SNB group received a US subgluteal sciatic nerve block. The time to the first postoperative analgesia requirement (primary outcome), postoperative pain score, total postoperative analgesic consumption, and perioperative complications (secondary outcomes) were assessed in both groups. Results: The duration of postoperative analgesia was significantly longer in patients of the SNB (14.65 ± 3.08 h) than in the CEB group (5.93 ± 1.68 h). The postoperative pain scores recorded at 6th-12th h and the postoperative 24-h rescue analgesic consumption were significantly lower in the SNB compared to the CEB group. Conclusions: Ultrasound-guided subgluteal sciatic nerve block is a safe and effective alternative to US-guided caudal analgesia in pediatric patients with spastic CP scheduled for lower limb surgeries, with longer postoperative analgesia and similar perioperative safety profiles.

A comparison of the continuous supraclavicular brachial plexus block using the proximal longitudinal oblique approach and the interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised, controlled, double-blind trial.

Continuous interscalene brachial plexus block (ISB) is widely used for arthroscopic shoulder surgery, but the incidence of hemidiaphragmatic paresis (HDP) has been reported to reach 100%. Several methods, including injections distal to the C5-C6 nerve roots, have been attempted to reduce the HDP incidence. However, catheter placement distal to the C5-C6 nerve roots interferes with the surgical site. Our primary objective was to describe a new technique, the supraclavicular brachial plexus block (SCB), using the proximal longitudinal oblique approach (PLO-SCB), which can facilitate catheter placement and, when compared with ISB, to test whether this would provide noninferior analgesia and spare the phrenic nerve. Prospective, randomised, double-blind study. Operating rooms, postanaesthesia care unit, and wards. Seventy-six patients aged 20 to 80 years scheduled for arthroscopic shoulder surgery. Patients were randomly assigned to the continuous PLO-SCB ( n = 40) or the continuous ISB ( n = 40) groups. All patients received an initial low-volume single-injection (5 ml 0.75% ropivacaine) followed by a patient-controlled infusion of 0.15% ropivacaine. The primary outcomes were the incidence of HDP and pain scores. Secondary outcomes were respiratory function, postoperative analgesic consumption, sensory and motor function, and complications. The HDP incidence was significantly lower in the PLO-SCB group than in the ISB group at 30 min after block injection: 0% (0 of 38 patients) and 73.7% (28 of 38 patients), respectively ( P < 0.001). Similarly, at 24 h after surgery, the incidences were 23.7% (9 of 38 patients) and 47.4% (18 of 38 patients) in the PLO-SCB and ISB groups, respectively ( P = 0.002). Median [IQR] NRS pain scores at rest measured after surgery in the ISB and PLO-SCB groups were similar: immediately after surgery, 1 [0 to 2] vs. 1 [0 to 1], P = 0.06); at 30 min, 2 [0.25 to 2] vs. 1 [0 to 2], P = 0.065); and at 24 h 2 [0.25 to 3] vs. 1 [0 to 3], P = 0.47, respectively. For major shoulder surgery, compared with continuous ISB, continuous PLO-SCB was more sparing of diaphragmatic and respiratory function while providing noninferior analgesia. Catheter placement via the PLO approach is feasible without interfering with the surgical field. Registered by the Clinical Trial Registry of Korea (Seoul, Korea; KCT0004759, http: cris.nih.go.kr, principal investigator: Hyungtae Kim).

Effects of Pain Beliefs on Postoperative Pain and Analgesic Consumption in Spine Surgery Patients

ABSTRACT PURPOSE: This study evaluates the impact of pain belief on postoperative pain and analgesic consumption in patients undergoing spine surgery. METHODS: This descriptive and cross-sectional study was conducted on 71 patients undergoing spine surgery, who were admitted to the neurosurgery department of a university hospital between January 2021 and April 2022. Descriptive information form, Pain Beliefs Questionnaire, visual analog scale, pain evaluation form, and verbal category scale were used for data collection. RESULTS: Participant mean age was 53 years, and 40.8% underwent spinal disc surgery. A total of 60.2% of the participants experienced moderate postoperative pain, and severe pain was noted during the second postoperative hour, after rest and coughing, which decreased significantly during consecutive hours. Besides, 70.4% of the participants expressed that the level of pain decreased, 43.7% had pain as they expected, 69.0% had intermittent pain, and 53.5% experienced pain at the surgical site. The mean scores obtained from the Organic and Psychological Beliefs subscales of the Pain Beliefs Questionnaire were 4.25 and 4.21, respectively. There was a statistically significant relationship between the Psychological Beliefs and visual analog scale scores after coughing measured in the postoperative 24th and 36th hours. There was also a significant relationship between organic beliefs and working status. There was no statistically significant relationship between analgesic consumption and pain belief. CONCLUSION: Patients undergoing spine surgery experienced moderate pain and had a relatively high level of pain beliefs. Regular evaluation of pain levels and beliefs is required for effective pain management.

Rhomboid intercostal sub serratus plane block – Same bird with different horizons

Sir,We did a case series in five patients undergoing modified radical mastectomy who were given RISS for post-operative analgesia. We noticed that the intraoperative fentanyl consumption as well as the post-operative analgesic consumption was significantly less. The overall quality of life and satisfaction score for routine daily activities like wearing clothes was better in our patients. The importance and efficacy of these blocks are because of the continuity of the interfacial planes across varied anatomical tissues. These planes have various cutaneous as well as sympathetic branches and hence drug given spreads to cover a large dermatomal area. RISS has been proposed to cover lateral cutaneous branches of T2 to T11 that extend medially to cover dorsal rami deep to the errector spinae muscle plane (ESP). The site of injectate is at T5-T6. The dermatomal coverage is 4 cm lateral to the midline anteriorly, posteriorly 4 cm medial to the posterior axillary line, cranially up to serrated posterior superior caudally up to serratus posterior inferior. The advantages of RISS block are that the injection is far from the surgical site and hence the drug does not interfere with the surgical field or cautery if given preoperatively. After induction technically, it is more feasible than serratus plane block or pectoral blocks. Logistically prior catheterization is possible that does not interfere with the sterility of the surgical field. Despite the above advantages, the axillary coverage is inconsistent as it does not cover the intercostobrachial nerve (LCB of second ICN T2). The midline, thoracodorsal nerve, and long thoracic nerve are not covered. Complete analgesia is not provided for latissimus dorsi flap, segmental resection surgeries, lymph node dissections, or radical mastectomies. Dr. Tulgar, first-ever reported of the use of RIB in a patient of MRM and highlighted the superiority of peri-peri-paravertebral blocks apart from previously used ESP and paravertebral blocks for a similar condition. Altiparimak conducted an RCT on 30 MRM patients with axillary lymph node dissection. The patients had enhanced recovery and quality of life scores (QoR-40), especially in terms of pain and emotional status. RISS has proved its non-inferiority as compared to ESP, paravertebral, PEC, and SAP which are closer to neuroaxis, at non-compressible sites and difficult to execute in obese patients. Thus RISS is excellent as a part of MMA for post-operative pain management in MRM patients, who remain comfortable for up to 14 h and have an NRS score &lt;3 was seen in all of our five patients. The dynamic nature of pain was apparent at 14 h in three of the patients who had extensive axillary lymph node dissection. Is the journey of regional anesthesia just the replacement of “pops and clicks” with see it and block it? The renaissance in the era of blocks is visualizing an invention of a new block almost every month. We depend on the facial plane anatomy, its structure, and its relation to the surrounding organs and tissues to precisely disseminate the local anesthetic to its desired location. In this blind sheep race, enthusiasm should not blur our understanding of the basics. We should remember Triple A, improve health, enhance patient outcomes, and decrease the costs. We open the doors for larger studies with more patients, comparing different blocks with RIB/RISS blocks before generalizing the results. CONCLUSIONRhomboid intercostal subserratus plane block is an excellent option for intra and post-operative pain management as a part of multimodal analgesia in MRM patients.

Effect of intraoperative noise on postoperative pain in surgery patients under general anesthesia: evidence from a prospective study and mouse model.

Most patients are in a noisy environment during abdominal surgery under general anesthesia. This study included patients who underwent abdominal surgery under general anesthesia and established an animal model to determine whether intraoperative noise affects postoperative pain. This prospective study included 200 patients who underwent abdominal surgery under general anesthesia. Intraoperative noise and electroencephalograms were continuously recorded, and the mean level and time proportion of noise intensity of greater than 70dB were calculated. Maximum postoperative pain was assessed using a numerical rating scale at 0-12h and 12-24h after surgery, and postoperative analgesia consumption in patients receiving patient-controlled intravenous analgesia was recorded. Postoperative pain intensity and electroencephalogram amplitude were compared between patients with high-noise exposure (time proportion of noise intensity greater than 70dB ≥40%) and low-noise exposure (<40%). Mechanical pain sensitivity was tested in two groups of mice with plantar incisions exposed to 40dB or 70-100dB. The time proportion of noise intensity greater than 70dB was identified as an independent risk factor for postoperative pain intensity ( P <0.001). P ain numerical rating scale 0-12h (4.5±1.5 vs. 3.7±1.3, P =0.001) and 12-24h (3.9±1.5 vs. 3.2±1.1, P =0.004) after surgery in patients with high-noise exposure was significantly higher than in patients with low-noise exposure. The electroencephalogram amplitude of patients with high-noise exposure was significantly lower than that of patients with low-noise exposure ( P <0.05). In the mouse model, mechanical hyperalgesia in the 70-100dB group was significantly greater than that in the 40dB group ( P <0.001). High-level intraoperative noise exposure aggravates the degree of postoperative pain and analgesic needs of patients undergoing abdominal surgery, which may be related to the impact of noise on the neurophysiological activity of the brain and postoperative hyperalgesia.

Analgesic Effectiveness of Dinalbuphine Sebacate in Video-Assisted Thoracoscopic Wedge Resection and Its Effect on Reducing Postoperative Pulmonary Complications: A Retrospective Cohort Study.

Inadequate postoperative analgesia may cause postoperative complications, such as pulmonary complications. This study evaluated the analgesic effectiveness of a single preoperative injection of dinalbuphine sebacate (DS) in patients undergoing video-assisted thoracoscopic wedge resection and assessed whether it can reduce the incidence of postoperative pulmonary complications (PPCs). In this study, the data of 757 patients who underwent VATS wedge resection at a medical center were retrospectively reviewed. The patients were divided into the DS group and the conventional analgesia (CA) group. The following parameters were analyzed: analgesic consumption during hospitalization, the incidence of PPCs, and the postoperative use of oxygen therapy. Compared with the CA group, the DS group had lower nalbuphine, tramadol, parecoxib, acetaminophen, diclofenac, and utraphen consumption during the postoperative period; higher morphine and ketorolac consumption; and comparable fentanyl consumption. Nonetheless, the frequency of requesting pain relief was significantly lower in the DS group. No significant between-group differences were noted in the incidence of PPCs. However, the DS group had fewer requirements for oxygen therapy in the ward, early removal of chest tubes, and shorter length of hospital stay. A single preoperative injection of DS reduced the frequency of salvage analgesic administration and total consumption of certain postoperative analgesics, suggesting the effective pain relief of DS, and it did not increase the incidence of PPCs. Additionally, it reduced the need for postoperative oxygen therapy, which may suggest a better prognosis and smoother postoperative pulmonary recovery for patients.

Effect of addition of different additives: Magnesium sulfate and dexamethasone versus plain bupivacaine in ultrasound-guided erector spinae plane block in pediatrics undergoing repair of inguinal hernia

ABSTRACT Background Erector spinae plane (ESP) block has been evaluated in many studies in pediatric surgeries by the use of postoperative rescue analgesia which is the objective parameter assessing the efficacy of the technique in controlling postoperative pain. Adjuvants were used with ESP block to densify its postoperative analgesia. Magnesium sulfate was used for suppressing somatic, endocrine and autonomic reflexes induced by noxious stimuli during surgery. Dexamethasone is a highly potent glucocorticoid that has been used in different regional anesthesia to prolong the anesthetic effect of the local anesthesia by inducing local vasoconstriction. Methodology Sixty pediatric patients underwent inguinal hernia repair under general anesthesia, and then they were assigned randomly into three groups that received ESP block either with local anesthetic alone or with magnesium sulfate or dexamethasone. Results Our study revealed no statistical significance among the three groups as regards demographic and vital data. Children’s Hospital Eastern Ontario Pain Scale score for postoperative assessment of magnesium sulfate and dexamethasone which were added to bupivacaine in ESP block had a better score than bupivacaine alone with high statistical significance. Also, magnesium sulfate and dexamethasone had a delayed first-dose postoperative rescue analgesia with significant statistical value (P value = 0.002) and total postoperative doses of postoperative rescue analgesia were lesser in magnesium sulfate and dexamethasone groups with marked statistical significance (P value < 0.001). As regards complications, there were minor ones in the form of mild bruising and mild pain at injection site with no statistical significance between the three groups (P value = 0.108). Conclusion In our study, magnesium sulfate and dexamethasone added to bupivacaine in ESP block prolonged the duration of postoperative pain control and decreased the consumption of postoperative analgesia than bupivacaine alone. No major complications were recorded in our study in the three groups which solidify the safety of the technique.

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Introduction: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. Methods: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients’ 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. Results: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p &gt; 0.05). Conclusions: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

Peri-Incisional Infiltration and Intraperitoneal Instillation of Local Anesthetic for Reducing Pain After Laparoscopic Donor Nephrectomy: A Prospective, Randomized, Double-Blind Control Trial

The analgesic efficacy of peri-incisional infiltration and intraperitoneal instillation of ropivacaine in laparoscopic donor nephrectomy has not been clearly established. This randomized, controlled, double-blind trial allocated living donors undergoing left-sided laparoscopic donor nephrectomy to one of the following 4 groups: peri-incisional normal saline (NS) and intraperitoneal NS (group A, n=30), peri-incisional 0.375% ropivacaine and intraperitoneal NS (group B, n=31), peri-incisional NS and intraperitoneal 0.15% ropivacaine (group C, n=31), and peri-incisional 0.375% and intraperitoneal 0.15% ropivacaine (group D, n=32). Pain status was assessed using the visual analog scale at rest and during coughing at 2, 12, 24, and 48 hours postoperatively. Patient-controlled analgesia and additional rescue analgesic consumption were calculated by conversion to an equivalent dosage of morphine. This study did not include prisoners or those individuals who were coerced or paid as study participants. The patient demographics and perioperative outcomes, including operative time, blood loss, and incision length, were comparable between the groups. The pain scores and number of patients who experienced shoulder pain at all postoperative time points did not differ significantly among the 4 groups. Postoperative analgesic consumption was similar in all groups, and there was no difference in the length of hospital stay. Peri-incisional infiltration and intraperitoneal instillation of ropivacaine did not reduce postoperative pain or analgetic consumption.

Transversus abdominis plane block vs quadratus lumborum block for postoperative analgesia in inguinal hernia repair: A systematic review and meta-analysis.

The present review was designed to differentiate between the analgesic value of transversus abdominis plane block (TAP) vs the quadratus lumborum block (QLB) for patients undergoing inguinal hernia surgery. PubMed, CENTRAL, Scopus, Embase, Google Scholar, Open gray, and a clinical trial registry were searched up to 18th February 2023 for randomized controlled trials (RCTs) comparing TAP and QLB for inguinal hernia repair. Six RCTs from India, Turkey, and Norway published between the years 2019 to 2023 were included. Anesthetic agents and dosages were similar for TAP and QLB groups in each study. On meta-analysis, pain scores were not statistically significant different between TAP and QLB at 3-6 h (MD: 0.46 95% CI: -0.11, 1.03 I2 = 86%), 12 h (MD: 1.34 95% CI: -0.12, 2.80 I2 = 97%), and 24 h (MD: 0.38 95% CI: -0.77, 1.53 I2 = 97%). Meta-analysis of total analgesic consumption showed a tendency of reduced analgesic consumption with QLB as compared to TAP but the difference was not significant (SMD: 0.69 95% CI: 0.00, 1.37 I2 = 83%). Data on complications was scarcely available. GRADE assessment of the evidence was low to moderate. Low to moderate-quality preliminary evidence suggests no difference in the analgesic efficacy of TAP and QLB for adult patients undergoing inguinal hernia repair. While there was a tendency for lower postoperative analgesic consumption with QLB, it needs to be verified by future studies.