Postoperative Analgesic Requirements Research Articles

Pre-emptive Analgesic Efficacy of Single-Dose Transdermal Ketoprofen and Diclofenac Patches in Post-operative Pain Management Following Open Treatment of Mandibular Fractures: A Randomized Controlled Study.

Introduction: The present study was deliberated to assess the pre-emptive analgesic efficacy of diclofenac sodium and ketoprofen transdermal patches following open treatment of mandibular fractures.Methods: The present prospective, triple-blind, randomized controlled clinical study was carried out on 50 male patients with a mean age of 30-31 years having bifocal mandibular fractures. The subjects were assigned 1:1 to two groups; group K - ketoprofen group and group D - diclofenac sodium group. Patches were applied according to the group allocation one hour before induction. In the immediate post-operative (PO) phase, pain intensity was recorded using a 10-point Visual analog Scale at 2, 4, 8, 12, and 24 hourly. Statistical analysis was performed using descriptive and inferential statistics using SPSS 27.0 version (IBM SPSS, Armonk, NY) and GraphPad Prism 7.0 version (GraphPad Software, Inc., La Jolla, CA) and p<0.05 is considered a level of significance.Results : The present study demonstrated a statistical difference in mean pain intensity among both groups, with lower pain scores at all time intervals and fewer rescue analgesic consumption in the ketoprofen group.Conclusion: The ketoprofen transdermal patch was found to be superior in comparison to the diclofenac patch in terms of providing optimal post-operative analgesia with a reduced requirement for post-operative rescue analgesics and minimal adverse events.

Emergence agitation in children: A comparison of effect of intravenous midazolam and ketamine

Background- Emergence agitation (EA) is one of the most challenging conditions to manage in pediatric patients undergoing general anesthesia with sevoflurane as it can even lead to physical harm. Various pharmacological interventions are being used in anesthesia to manage this condition. So, the objective of this study is to compare the effects of intravenous midazolam and intravenous ketamine given as premedication, on the incidence and severity of EA and to assess parent separation anxiety and postoperative pain and analgesic requirement in the 2 groups. Methodology- This is a randomized control trial consisting of 70 children aged 3-7years, 35 in each midazolam and ketamine group that received 0.05mg/kg of i.v. inj. midazolam and 1mg/kg of i.v. inj. ketamine respectively, undergoing general anesthesia with sevoflurane. Emotional status of the child assessed and then allocated into either group through a computer-generated programme. A blinded anesthesiologist assessed the incidence and severity of emergence agitation based on WATCHA scale and Children and Infant Postoperative Pain Scale (CHIPPS). Results- The mean WATCHA and CHIPPS scores were lower in ketamine group at all timepoints versus midazolam group (p&lt;0.05 which is statistically significant).

Impact of Spinal/Epidural Anesthesia Versus General Anesthesia on Perioperative Outcomes in Patients Undergoing Lumbar Spine Surgery: An Updated Systematic Review and Meta-analysis.

A systematic review and meta-analysis. To compare impact of different anesthesia techniques on perioperative outcomes in patients undergoing lumbar spine surgery. Both general anesthesia and spinal anesthesia/epidural anesthesia can be used for lumbar spine surgery. There is still much controversy that which anesthesia technique is much more suitable for lumbar spine surgery with less complications, general anesthesia or regional anesthesia. A comprehensive search of the literature was conducted using Excerpta Medica database (EMBASE), PubMed, and Cochrane library for randomized controlled trials and independent reviewers assessed eligibility for included studies. Primary outcomes included incidences of intraoperative hypertension, hypotension, tachycardia, and bradycardia. Secondary outcomes included postoperative analgesic requirement, postoperative nausea and vomiting (PONV), headache, urinary retention, blood loss, and length of hospital stay. Ten randomized controlled trials consisting of 733 adult patients undergoing lumbar spine surgery were included. Spinal anesthesia/epidural anesthesia group had significant lower incidences of intraoperative hypertension [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.08-0.38; P <0.00001; I2 =0.0%] and tachycardia (OR, 0.45; 95% CI, 0.26-0.79; P =0.006; I2 =0.0%), analgesic requirement in postanesthesia care unit (OR, 0.13; 95% CI, 0.08-0.22; P <0.00001; I2 =0.0%), PONV within 24 hours after surgery (OR, 0.27; 95% CI, 0.16-0.46; P <0.00001; I2 =6.0%), and shorter length of postoperative hospital stay (mean difference, -0.28; 95% CI, -0.37 to -0.18; P <0.00001; I2 =32.0%). There were no significant differences in incidences of intraoperative hypotension and bradycardia, PONV in postanesthesia care unit, analgesic requirement, urinary retention, and headache within 24 hours after surgery. Low to moderate quality of evidence revealed that patient undergoing lumbar spine surgery might benefit from spinal or epidural anesthesia.

A review of surgical management of retrosternal goitre in a single tertiary care referral centre in Sri Lanka

Introduction: Retrosternal goitres require surgical removal due to compressive symptoms as well as risk of malignancy. In a majority, the retrosternal part can be removed through the neck incision, while 5-10% requiring a sternotomy. An alternative to sternotomy is thoracoscopy, which is associated with reduced morbidity. Methods: The surgical approach used to resect retrosternal goiters in our unit over a period of two years was evaluated. Results: In fifty four patients out of sixty (90%) with retrosternal extension, resection was feasible from neck. Out of the remaining six, two had median sternotomy while four had thoracoscopy. The operating time, blood loss, post-operative analgesic requirement and hospital stay were less in the thoracoscopy group. Conclusions: Majority of retrosternal goitres can be removed via neck. For those who require access in to chest, thoracoscopy is associated with reduced morbidity and hospital stay, when compared to median sternotomy.

Evaluating the Effect of Duloxetine Premedication on Postoperative Analgesic Requirement in Patients Undergoing Laparoscopic Cholecystectomies: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study.

The aim was to evaluate the effect of oral administration of preoperative duloxetine on postoperative pain and total analgesic requirement in the postoperative period as the primary objective. The secondary objective was to evaluate the perioperative hemodynamic parameters, sedation scores, demographic data, and incidence of side effects (if any) in patients undergoing laparoscopic cholecystectomy. This was a prospective, randomized, double-blind, placebo-controlled study conducted in a tertiary level medical college on 60 patients of either sex posted for laparoscopic cholecystectomies with American Society of Anesthesiologists (ASA) I and II. The patients were divided into 2 groups (n=30), the patients were given duloxetine 60mg capsules and placebo capsules (Becosules) 2 hours before surgery. The total requirement for both first and second rescue analgesics was higher in placebo as compared with duloxetine and was found to be significant ( P <0.05). The difference in mean visual analog scale score was significantly ( P <0.001) higher in placebo as compared with duloxetine at all-time intervals postoperatively 0 minute (7.6±0.7 vs. 4.6±0.8); 15 minutes (5.9±0.8 vs. 4.2±1.0); 30 minutes (4.4±0.5 vs. 3.6±0.9); 4 hours (6.6±0.06 vs. 5.3±1.3); 8 hours (5.2±1.2 vs. 3.9±1.0); and 12 hours (5.1±1.3 vs. 2.3±0.7). The mean arterial blood pressure and heart rate were significantly higher in placebo compared with duloxetine in most of the time intervals in the perioperative period. There was no significant difference in the sedation score between the groups except the 30 minutes and 8 hours postoperative. Preoperative oral duloxetine during laparoscopic cholecystectomy could reduce postoperative pain, postoperative analgesic requirements, and better optimization of hemodynamics without causing major side effects.

Implications of Peri Operative Cannabis Use in Adolescents and Young Adults

<h3>Introduction</h3> Massachusetts legalized cannabis use for both medical and recreational use in 2014. Since then, adolescent recreational and medicinal use of cannabinoids has increased. <h3>Identification of the Problem</h3> There were increased requests by surgical patients post-operatively regarding resuming cannabis use post-operatively. <h3>EBP Question/Purpose</h3> <b>PICO question. Databases utilized.</b> The purpose was to understand best practice regarding post-operative pain management for patients who frequently use cannabis using the PICO question ‘<i>In adolescence and young adults (AYA), does the habitual use of marijuana versus no use increase the need for pain management interventions post-operatively?',</i> and the CINAHL, PubMed, Google Scholar, and Cochrane databases. <h3>Methods/Evidence</h3> The initial search returned 20 articles, which were critically appraised using the Johns Hopkins Evidence-Based Practice Appraisal Tool. One post-operative pain management expert opinion was obtained. In five articles, patients who reported using cannabinoids had higher pain scores, required more narcotics, and exhibited a poorer quality of sleep in the early post-operative period. Three articles found no difference in pain scores, narcotic use or length of stay for post-operative patients reporting cannabis use. These articles focused primarily on the orthopedic population, making it difficult to determine its' effects in other patient populations. Additionally, small sample sizes and older patients make the results difficult to interpret for a pediatric population. Four articles identified the multisystem effects of cannabinoids and its interaction with anesthetic agents, which may lead to serious complications for the patient. <h3>Significance of Findings/Outcomes</h3> There are conflicting findings regarding the use of cannabis as an effective post-operative pain management strategy and no practice change is currently recommended. However, the current available evidence can assist nurses caring for post-operative patients that utilize cannabis. Limited high quality studies were found, possibly due to the lack of federal research funding as cannabis is considered an illegal substance at the federal level. <h3>Implications for perianesthesia nurses and future research</h3> The evidence is useful to educate post-anesthesia care unit (PACU) nurses about how to screen for cannabis use and post-operative care considerations in the PACU setting. Considerations include the importance of eliciting and quantifying a history of cannabis use, consideration of cannabis weaning, additional post-operative nausea, vomiting prophylaxis, anticipated increased post-operative analgesic requirements, and maintaining vigilance for cannabis withdrawal syndrome. Adolescent-specific research is needed.

Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy?

Postoperative pain management is thought to have an effect on patient comfort, morbidity, and mortality after bariatric surgery. Local anesthetic agents are frequently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method. A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupivacaine, no action was taken for the other group. Postoperative analgesia was given to both patient groups with the "patient-controlled analgesia (PCA)" device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non-TAP group (p=0.015, 0.018, 0.04, respectively). According to the PCA device data, the analgesic requirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was required more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar. Laparoscopic TAP block using bupivacaine can be safely administered in morbidly obese patients and reduces postoperative analgesic requirements. Thus, side effects that may develop secondary to the use of analgesics are avoided.

Role of Pregabalin in Reducing Postoperative Analgesic Requirement of Patients Undergoing Knee Arthroscopy Anterior Cruciate Ligament Repair

Objective: To assess the effect of pregabalin in reducing the postoperative requirement of analgesics of patient undergoing knee arthroscopic anterior cruciate ligament repair surgery. Study Design: Prospective randomized control trial. Place and Duration of Study: Department of Anesthesia, Ghurki Trust Teaching Hospital Lahore from 1st June 2021 to 31st December 2021. Methodology: Eighty patients were randomly divided into two groups; group A and group B, each group comprised 40. Group A receive placebo and group B receive pregabalin 150mg once a day for two days after surgery. Pain assessment done with the help of Numeric Rating Scale and rescue analgesia was recorded. Results: The mean age was 31±10.2 years of group A and 33±10.3 year of Group B. There were more males within both groups in comparison to females with a percentage of 77.5% and 85% respectively. The reduction was seen within Group B in comparison of Group A in terms of ASA class, VNRS, and maximum sensory block. Cumulative volume of PCA in ml was also less in group B than group A with a significant difference within 0-6 hours. Conclusions: The use of pregabalin 150mg after surgery for two days significantly reduces the analgesic consumption Keywords: Pregabalin, Postoperative analgesic, Numeric rating scale

Pediatric Patients Undergoing Elective Surgeries Below the Umbilicus: Comparative Study of Caudal Bupivacaine (0.25%) and Caudal Bupivacaine (0.25%) with Ketamine

Background: Caudal block has the potential advantage that, by adding other drugs to the local anaesthetic agent, the duration and effectiveness of the block may be extended. Peripheral nerve blocks and caudal anaesthesia are very benign, nonetheless inordinate attention is compulsory to evade side effects. Aim and objectives: We aimed at this study to compare total postoperative analgesic requirement, anaesthetic, analgesic and sedation qualities. Hemodynamic changes, motor block, adverse effect, and parents’ satisfaction in children who received caudal bupivacaine only versus caudal bupivacaine with ketamine in paediatric patients undergoing surgery below the level of the umbilicus. Methods: Prospective randomized double blind controlled clinical trial conduced at operation room in University Hospital in Faculty of Medicine, October 6 University. Sixty children scheduled for elective surgery below umbilicus were randomly allocated to either: Group A (30 patients) includes the children who take saline caudal bupivacaine with dose of 1 ml/kg, afterward initiation of overall anaesthesia or Group B (30 patients) who following the administration of general anaesthesia, receives caudal bupivacaine 0.25 % in a dose of 1 ml/kg and caudal ketamine preservative free in a dose of 0.5 mg/kg. Hemodynamic alterations, parent satisfaction, postoperative analgesia and sedation characteristics, and side effects were noted. Results: The studied groups showed no statically significant difference regarding demographic data. Motor block statistically was significantly lower in ketamine group. Anaesthesia quality statistically was significantly higher in ketamine group. Regarding hemodynamic state, mean arterial blood pressure (MPA) and heart rate showed a statistically significant difference during and up to 30 minute postoperative (P&lt;0.001), and oxygen saturation showed no statistically significant difference during and after surgery (P&gt;0.05). Sedation score was higher in ketamine group, were lower in ketamine group all were statistically significant. Side effects statistically were non-significantly but less frequent in ketamine group. Total 24-hours analgesia dose statistically was significantly lesser in ketamine group. Parent’s satisfaction statistically was suggestively better in ketamine group. Conclusion: Amalgamation therapy of ketamine with bupivacaine is enhanced decision for post-operative pain controller in children enduring surgery below the umbilical. It increased the duration of analgesia and abridged the necessity for post-operative analgesic supplementation as well.

Comparison of the Effect of Ketamine and Dexmedetomidine Combined with Total Intravenous Anesthesia in Laparoscopic Cholecystectomy Procedures: A Prospective Randomized Controlled Study.

This randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 μg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 μg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.

Analgesic Efficacy of Pre-Operative Oral Pregabalin in Dacryocystorhinostomy Surgery

Background: External dacryocystorhinostomy (DCR) is still considered the golden standard for lacrimal surgery. It is a painful procedure that involves intra- and extra-ocular dissection with a high prevalence post-operative nausea and vomiting (PONV). Aims: This study was designed to evaluate the effects of preoperative oral pregabalin on postoperative pain and analgesic requirements in patients undergoing DCR surgery. Design: A prospective randomized double-blind clinical trial. Patients and methods: 100 American Society of Anesthesiologists (ASA) physical classes I and II patients in an age ranging from 18 to 65 years of either sex, had DCR surgery. Patients were divided randomly into two equal groups (each = 50). In pregabalin group, they received two capsules of pregabalin (one at the night of the surgery, the other at 2 hours before the surgery), while patients in control group received two identical placebo capsules. Hemodynamics were monitored, postoperative VAS scores, the time of first analgesic request, total pethidine requirements, and the incidence of PONV were recorded as well. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The pregabalin group exhibited a significant lower incidence of postoperative pain, pethidine consumption and nausea, without any statistically significant differences regarding hemodynamic parameters in comparison to control group. Conclusion: Preoperative oral administration of pregabalin can be a promising modality for alleviation of postoperative pain and reduction in postoperative opioid consumption.

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N ( P value &lt;.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

Mepivacaine Versus Bupivacaine in Adult Surgical Patients: A Meta-analysis, Trial Sequential Analysis of Randomized Controlled Trials

PurposeEvidence supporting the choice between mepivacaine and bupivacaine is inconclusive. This meta-analysis aims to determine whether mepivacaine can reach a similar effect to bupivacaine after surgeries. DesignA meta-analysis, trial sequential analysis of randomized controlled trials (RCTs). MethodsRCTs were identified in PubMed, EMBASE (Ovid), Medline (Ovid), and Cochrane Library using a controlled vocabulary (MeSH) and keywords. There were no date and language restrictions. We strictly included RCTs comparing mepivacaine with bupivacaine. The primary outcome was motor function recovery time. Secondary outcomes included postoperative analgesic requirement, transient neurologic symptoms (TNS), pain score at 24 hours, length of stay (LOS), duration of analgesia, complications, and patient satisfaction. A trial sequential analysis (TSA) was performed for motor function recovery time, postoperative analgesic requirement, and TNS. FindingsSeven RCTs with a total of 672 patients were included. Return of motor function was quicker in patients who received mepivacaine than in those who received bupivacaine (weighted mean differences [WMD] = -2.23 minutes; 95% confidence intervals [CI], -3.58 to -0.88; P = .02; I2 = 97.08%; TSA adjusted CI -17.52 to -10.9). Postoperative analgesic requirement was significantly more with mepivacaine (risk ratio [RR] = 3.23; 95% CI, 1.37-7.62; P = .01; I2 = 55.11%; TSA adjusted CI 5.73-63.27). Duration of analgesia (WMD = -8.83 hours; 95% CI, -11.75 to -7.90; P < .001; I2 = 0%) and LOS (WMD = -3.95 hours; 95% CI, -4.83 to -3.07; P < .001; I2 = 0%) in group mepivacaine was significantly shorter compared with bupivacaine. There were no differences for TNS (RR = 3.90; 95% CI, 0.94-16.22; P = .062; I2 = 72.23%), postoperative pain score (standard mean differences [SMD] = 0; 95% CI, −0.10 to 0.10; P = .972; I2 = 0%), complications (RR = 1; 95% CI, 0.70-1.43; P = .998; I2 = 0%), and satisfaction (RR = 0.97; 95% CI, 0.85-1.11; P = .40; I2 = 45%) between bupivacaine and mepivacaine. ConclusionsMepivacaine appears to yield a faster return of motor function and shorter LOS compared with bupivacaine. and may be more popular in short-stay and outpatient surgery. However, the results of TSA indicate that more high-quality trials are needed to confirm the true effects.

Anesthetic Depth Monitoring Decreased the Incidence of Postoperative Delirium Assessed in Nursing Delirium Screening Scale in Elective Non-Cardiac Surgical Patients Receiving Intravenous Patient-Controlled Analgesia

Background To identify the impact of processed electroencephalogram (pEEG)-guided anesthesia on postoperative delirium (POD) assessed by NuDESC, postoperative analgesic requirements, and the incidence of postoperative nausea/vomiting (PONV) in the elective non-cardiac surgical patients with intravenous patient-controlled analgesia (IVPCA) in the wards. Methods In this retrospective observational study, the anesthesiologists were free to use M-Entropy™, an pEEG device, to monitor the depth of anesthesia intraoperatively during the period (September 2015 ~ February 2018). Acute pain service team assessed the analgesic/side effects of IVPCA and POD at least twice daily for 3 days postoperatively. POD was screened by Nursing Delirium Screening Scale (NuDESC) (0-10). Pain severity was measured by an 11-point verbal numerical rating scale (0–10). Results A total of 1178 patients (≧60 years) were enrolled and divided to Entropy (749 patients) vs. non-Entropy group (429 patients). Multivariate logistic analysis showed that age (≧70), surgical types (non-joint), intraoperative highest minimum alveolar concentration (MAC) (&lt;0.9MAC) and the POD incidence were independent predictors for group differences (multiple odds ratio and 95% confidence interval: 5.99, 4.34-8.29; 2.01, 1.49-2.72; 6.84, 4.38-10.67; 0.09, 0.04-0.19). The POD incidence in Entropy group (2.2%, 17 patients) was significantly lower than that in non-Entropy group (6.7%, 29 patients) (p &lt;0.001). However, pEEG-guided anesthesia did not affect the phenomenological characteristics of POD. In addition, intraoperative pEEG-guided anesthesia did not reduce total morphine dose of IVPCA, the incidence of PONV and pain severity. Conclusions Processed EEG-guided anesthesia decreased POD incidence assessed in NuDESC in IVPCA patients undergoing elective non-cardiac surgery returning to the common ward. In addition, it did not reduce postoperative pain severity, postoperative analgesic requirements and PONV incidence. More researches are needed to investigate the effects of pEEG-guided anesthesia on POD and other postoperative conditions.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Effect of adding dexmedetomidine to 0.75% ropivacaine in peribulbar block for vitreoretinal surgery.

Peribulbar anesthesia is suitable for vitreoretinal (VR) surgery. Dexmedetomidine has been used in peribulbar block (PBB) to improve akinesia and analgesia. We aimed to study the efficacy of adding dexmedetomidine to 0.75% Ropivacaine in PBB for VR surgery. The primary outcome was the requirement of block supplementation and secondary outcome was post-operative analgesic requirement. 100 adult patients undergoing VR surgery were included in this prospective randomized double-blinded controlled study. The composition of the drug used for PBB in the 3 groups was Group R (8 ml of 0.75% Ropivacaine +0.5 ml normal saline (NS)), Group D25 (8 ml of 0.75% Ropivacaine +25μg Dexmedetomidine) and Group D50 (8 ml of 0.75% Ropivacaine +50 μg Dexmedetomidine). The groups were comparable in terms of patient demographics. The requirement for block supplementation was 16.7% in Group R (5/30), 12.5% in Group D25 (4/32) and 8.8% in group D50 (3/34) (P = 0.64). The mean time to first request for post-operative analgesia was432 ± 362 min in Group R, 572 ± 339 min in Group D25 and 614 ± 394 min for Group D50 (P = 0.26). There was significant difference in the heart rate (P = 0.047), mean arterial pressure (P = 0.012) at 30 min and sedation (RASS) score at 15, 30, 60 (P < 0.001) and 120 (P = 0.019) min between the D50 and group R. Patients undergoing buckling procedures had significantly shorter time to request for analgesia (P = 0.003). Addition of dexmedetomidine does not offer advantage over 0.75% Ropivacaine in PBB for vitrectomy. Its benefit in more painful procedures like scleral buckle needs further validation.

Is Preemptive Oral Tizanidine Effective on Postoperative Pain Intensity after Bimaxillary Orthognathic Surgery? A Triple-Blind Randomized Clinical Trial.

Background:We aimed to investigate the effect of preoperative administration of oral tizanidine on postoperative pain intensity after bimaxillary orthognathic surgery.Methods:All healthy skeletal class III patients who were candidates for bimaxillary orthognathic surgery were enrolled in this triple-blind randomized clinical trial. The study was carried out in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from January 2021 to November 2021. The consecutive patients were randomly divided into tizanidine and placebo groups. One hour prior to anesthesia induction, the tizanidine group received 4 mg Tizanidine dissolved in 10 ml apple juice, whereas the placebo group received an identical glass of plain apple juice. All operations were performed by the same surgical team, under the same general anesthesia protocol. Postoperative pain was measured using the Visual Analogue Scale (VAS) at 3, 6, 12, 18, and 24 hours. For statistical analysis; the significance level was set at 0.05 using SPSS 23.Results:A total of 60 consecutive patients, consisting of 36 females (60%) and 24 males (40%) with an average age of 25.4 ± 6.0 were recruited. An increasing trend was noticed in the amount of perceived postoperative pain from the 3rd till 12th hour, and then decreased afterward. Nevertheless, the average amount of pain was significantly lower in the tizanidine compared to the placebo group, in all the evaluated time intervals (P<0.001). Moreover, there was a significantly higher requirement for postoperative opioid analgesics in the placebo compared to the tizanidine group (P=0.011). Conclusion:The addition of oral tizanidine was effective in reducing postoperative pain following bimaxillary orthognathic surgery. Further studies are necessary for more relevancy.

Intrathecal Nalbuphine and Dexmedetomidine as Adjuvants to Bupivacaine versus Plain Bupivacaine for Orthopedic Surgeries under Subarachnoid Block: A Comparative Study.

In long bone surgeries, the severity of pain is more, demanding good intraoperative anesthesia, and prolonged postoperative analgesia. This is achieved in spinal anesthesia with adjuvants to local anesthetics, which act synergistically. The aim of this study was to compare the efficacy of nalbuphine and dexmedetomidine as adjuvants to bupivacaine versus bupivacaine alone in lower limb orthopedic surgeries under the subarachnoid block (SAB). This is a prospective, randomized, double-blind control study conducted on 60 patients belonging to the American Society of Anesthesiologists physical status Classes I and II, undergoing lower limb orthopedic surgeries under SAB. Sixty patients were divided into three groups by computer-generated randomization. Group A received 2.7 mL of 0.5% hyperbaric bupivacaine with 1.5 mg nalbuphine, Group B received 2.7 mL of 0.5% hyperbaric bupivacaine with 10 μg dexmedetomidine, and Group C received 2.7 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of normal saline (total volume made to 3.2 mL in all groups with normal saline). Time of onset of block, duration of sensory, and motor blocks were noted. Changes in hemodynamic parameters, postoperative first rescue analgesia requirement, and side effects were recorded. Data were analyzed using SPSS 22 version software. P < 0.05 was considered statistically significant. There was no significant difference in the onset of sensory or motor blocks in the three groups. However, the time taken for regression of sensory block was longer in Group B that was statistically significant. Intrathecal dexmedetomidine acts as a better adjuvant with bupivacaine in providing quality anesthesia, prolonged sensory and motor block, and good postoperative analgesia with less incidence of adverse effects compared to nalbuphine and bupivacaine alone.

Effects of Ketamine and Lidocaine Infusion on Acute Pain after Elective Open Abdominal Surgery, a Randomized, Double-Blinded Study.

Background: Most patients suffer from moderate to severe pain after elective laparotomy. They often require opioids to alleviate their pain. Opiates invariably induce certain side effects and, occasionally, dependence. Intraoperative infusion of lidocaine and low-dose ketamine reduces postoperative pain and analgesic requirements. This study aims to evaluate the effects of simultaneous infusion of lidocaine and ketamine during open abdominal surgery on the postoperative pain severity and analgesic consumption. Methods: In this randomized, double-blinded, single-center study that was performed in Iran, 80 patients scheduled for elective open abdominal surgery under general anesthesia were enrolled in two LK and P groups. Group LK (n=40) received lidocaine-ketamine infusion, and group P (n=40) received placebo (normal saline). Both infusions were started thirty minutes after initiation of surgery and were terminated once the surgery was completed. For postoperative pain management, patient-controlled analgesia (PCA), including fentanyl and paracetamol, was administered for both groups. All patients were evaluated for pain visual analogue scale (VAS) and total adjunctive analgesic (diclofenac suppository) consumption within the first 24 hours after the surgery. The data were analyzed using SPSS. P values <0.05 were considered significant. Results: Intraoperative infusion of Lidocaine and Ketamine resulted in desirable postoperative pain control. Patients of LK group demonstrated a significant reduction in the pain score at 1, 6, 12, 18, and 24 hours after termination of surgery (p<0.001). It also resulted in a decreased requirement for postoperative analgesics, as cumulative analgesic consumption was decreased meaningfully in the patients of LK group (p<0.001). Conclusion: Intravenous infusion of lidocaine and ketamine during elective open abdominal surgery reduces pain intensity and analgesic requirements in the first 24 hours postoperatively, without major additional side effects.

Comparative Evaluation of Dexmedetomidine, Ketamine &amp; their Combination for Epidural Analgesia in Orthopedic Surgeries of the lower Limb

Background: Epidural anesthesia is a perioperative pain control treatment that has a variety of applications in anaesthesiology. It could be used as as a primary anaesthetic, although it's most usually utilised as an adjuvant for management of pain. It could be a one-time shot or a continuous infusion for a long-drawn therapeutic intervention. Apart from the potential for significant analgesia, its use minimises the need for other anaesthetics and analgesics, lowering the risk of adverse effects. It has also been proven to lower the level of cortisol, to facilitate the resumption of bowel function, reduce the risk of Pulmonary embolism and deep vein thrombosis in the post-operative phase, while minimizing the duration of institutional stays.&#x0D; Aim: Comparison and Evaluation of the effect of the drugs dexmedetomidine , ketamine &amp; them together as a combination in addition to bupivacaine, as an adjuvant for intermittent epidural top ups for lower limb orthopaedic surgeries .&#x0D; Study Design: Prospective observational study.&#x0D; Place and duration of Study: The study will be conducted over a period of 2 years and 6 months in the department of anaesthesiology, Jawaharlal Nehru medical college and Acharya vinoba bhave rural hospital, wardha.&#x0D; Methodology: Our prospective, comparitive observational study included 90 patients randomly assigned into 3 sets of 30 each, one was administered dexmedetomidine epidurally, one was given ketamine and one was given their combination epidurally [1]. The quality and duration of analgesia provided by all 3 groups were then compared to find out which of them provides better and prolonged pain relief. Along with analgesia, the other parameters assessed were hemodynamic response, sedation and any other side effects.&#x0D; Expected Results: We're attempting to establish the hypothesis that the combination of both the drugs is better than dexmedetomidine or ketamine administered individually. It has been proved in various researches that epidural ketamine prolonged the duration of analgesia, [2] but it was less than epidural dexmedetomidine. We expect that the combination would decrease the postoperative rescue analgesics requirements and less hemodynamic alterations hence providing greater patient satisfaction as compared to the two drugs separately.