Postoperative Opioid Consumption Research Articles

Perioperative Methadone for Spine Surgery: A Scoping Review.

Complex spine surgery is associated with significant acute postoperative pain. Methadone possesses pharmacological properties that make it an attractive analgesic modality for major surgeries. This scoping review aimed to summarize the evidence for the perioperative use of methadone in adults undergoing complex spine surgery. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search was performed using MEDLINE, CINAHL, Cochrane Library, Scopus, Embase, and Joanna Briggs between January 1946 and April 2023. The initial search identified 317 citations, of which 12 met the criteria for inclusion in the review. There was significant heterogeneity in the doses, routes of administration, and timing of perioperative methadone administration in the included studies. On the basis of the available literature, methadone has been associated with reduced postoperative pain scores and reduced postoperative opioid consumption. Though safety concerns have been raised by observational studies, these have not been confirmed by prospective randomized studies. Further research is required to explore optimal methadone dosing regimens, the potential synergistic relationships between methadone and other pharmacological adjuncts, as well as the potential long-term antinociceptive benefits of perioperative methadone administration.

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial.

Video-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS. This is a double-blinded randomized controlled trial. Adult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6h for three cycles. The primary outcome was total analgesic consumption at 24h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48h; analgesic-related side effects at 2, 24, and 48h; quality of recovery at 24h and 48h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3months postoperatively. The study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24h and 48h postoperatively (24h: median difference: - 100µg equivalent intravenous fentanyl [95% confidence interval (CI) - 200 to - 5μg], P = 0.037; 48h: median difference: - 140μg [95% CI - 320 to - 20μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24h post-surgery, with no significant difference at 48h. All pain scores except for coughing at 48h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP. Perioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics.

Decreasing Perioperative Opiate Use During Pancreaticoduodenectomy Using Transversus Abdominus Plane Blocks: A Review of the Literature.

Pancreatoduodenectomy is a highly complex surgical procedure associated with high postoperative morbidity and mortality. Treatment of postoperative pain is crucial to preventing chronic pain and further complications. Opioids are the leading treatment modality for acute postoperative pain for all surgical procedures in the US, contributing to the opioid epidemic, a crisis causing death and lifelong impairment in many patients. Multimodal analgesia techniques, such as the transversus abdominis plane (TAP) block, are suggested to reduce perioperative opioid usage. This exploratory literature review aims to investigate the use of TAP block in postoperative pain and opioid use in patients undergoing pancreatoduodenectomy. A search strategy developed from Cochrane best practice recommendations was applied to a comprehensive search of PubMed, Scopus, and PsycINFO databases, yielding three articles of relevance in patients having pancreatic surgery. Previous research demonstrates TAP block efficacy in decreasing opiate consumption after major abdominal surgery; however, there is a paucity of data regarding opioid consumption in pancreatoduodenectomy patients. Research in relation to TAP block analgesia is varied given the variety of approaches, techniques, and timing of the TAP block procedure. Future research should seek to elucidate the role of TAP blocks in reducing postoperative pain and opioid consumption in pancreatoduodenectomy patients.

Opioid-Sparing Anesthesia Versus Opioid-Free Anesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis.

Patients who undergo laparoscopic bariatric surgery (LBS) are susceptible to postoperative nausea and vomiting (PONV). Opioid-free anesthesia (OFA) or opioid-sparing anesthesia (OSA) protocols have been proposed as solutions; however, differences between the 2 alternative opioid protocols for anesthesia maintenance in obese patients remain uncertain. A network meta-analysis was conducted to compare the impacts of OFA and OSA on PONV. Systematic searches were conducted using Embase, PubMed, MEDLINE, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing OFA and OSA strategies. After screening according to the inclusion and exclusion criteria, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the credibility of the evidence. The main concern of this review was the difference between OFA and OSA in reducing PONV. The primary outcome was any PONV occurrence within 24 hours. Secondary outcomes included postoperative pain intensity, opioid consumption, opioid-related adverse events, and length of hospital stay. Fifteen RCTs involving 1310 patients were identified for a network meta-analysis from 1776 articles that compared OFA, OSA, and traditional opioid-based anesthesia (OBA) strategies in LBS. Twelve RCTs (80%) with 922 participants (70%) were eligible for the occurrence of PONV. These included 199 (22%) patients who received OFA and 476 (52%) and 247 (27%) patients who received OSA and OBA, respectively. OFA was more effective at reducing PONV (relative risks [RR], 0.6, 95% confidence interval [CI], 0.5-0.9, moderate-quality evidence) compared to OSA. No differences were observed in postoperative pain control or opioid consumption between the OFA and OSA strategies (very low-to high-quality evidence). Notably, OFA is associated with a higher risk of bradycardia than OSA (RR, 2.6, 95% CI, 1.2-5.9, moderate-quality evidence). OFA is more effective than OSA in reducing the occurrence of PONV during the early postoperative period of LBS, although it may associate with an increased risk of bradycardia. Patients who received either opioid-alternative strategy demonstrated similar effects in reducing postoperative opioid consumption and alleviating pain intensity.

Opioid-Sparing Nonsteroid Anti-inflammatory Drugs Protocol in Patients Undergoing Intramedullary Nailing of Tibial Shaft Fractures: A Randomized Control Trial.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics commonly used in fracture management. Although previously associated with delayed fracture healing, multiple studies have demonstrated their safety, with minimal risks of fracture healing. Given the current opioid crisis in the United States, alternate pain control modalities are essential to reduce opioid consumption. This study aims to determine whether the combination of oral acetaminophen and intravenous ketorolac is a viable alternative to opioid-based pain management in closed tibial shaft fractures treated with intramedullary nailing. We conducted a randomized controlled trial evaluating postoperative pain control and opioid consumption in patients with closed tibial shaft fractures who underwent intramedullary nailing. Patients were randomized into an NSAID-based pain control group (52 patients) and an opioid-based pain control group (44 patients). Visual analog scale (VAS) scores and morphine milligram equivalents (MMEs) were evaluated at 12-hour postoperative intervals during the first 48 hours after surgery. Nonunion and delayed healing rates were recorded for both groups. A statistically significant decrease in MMEs was noted at every measured interval (12, 24, 36, and 48 hours) in the NSAID group compared with the opioid group (P-value 0.001, 0.001, 0.040, 0.024, respectively). No significant change in visual analog scale scores was observed at 12, 36, and 48 hours between both groups (P-value 0.215, 0.12, and 0.083, respectively). A significant decrease in VAS scores was observed at the 24-hour interval in the NSAID group compared with the opioid group (P-value 0.041). No significant differences in union rates were observed between groups (P-value 0.820). Using an NSAID-based postoperative pain protocol led to a decrease in opioid consumption without affecting pain scores or union rates. Owing to the minimal risk of short-term NSAID use, their role in the perioperative management of tibia shaft fractures is justified, especially when they reduce opioid consumption markedly. Therapeutic Level I.

Effectiveness of Single Intravenous Dexamethasone in Prolongation of Spinal Anesthesia for Postoperative Analgesia in Elective Cesarean Section: A Systematic Review of Randomized Controlled Trials.

The analgesic effectiveness of a single perioperative dose of dexamethasone is not clearly defined. The administration of systemic medication like dexamethasone, opioids, and non-steroidal anti-inflammatory drugs has a positive effect on the prolongation of postoperative analgesia after cesarean section under spinal anesthesia. A single-dose administration of dexamethasone with moderate to high dose reduces postoperative pain, reduces opioid consumption, and prolongs spinal anesthesia after cesarean delivery. The aim of this systematic review was to investigate the effectiveness of single intravenous dexamethasone in prolongation of spinal anesthesia for postoperative analgesia in elective cesarean section. We conducted a search on PubMed, Google Scholar, the Cochrane Library, Hinari, and review articles on the effectiveness of intravenous dexamethasone for extending spinal anesthesia during elective cesarean sections, until June 2023. The searches were conducted by using keyword (IV dexamethasone OR/AND analgesia OR postoperative pain AND cesarean section OR child birth AND prolongation of spinal anesthesia). The articles included describe the analgesic efficacy of dexamethasone for prolongation of spinal anesthesia during cesarean section. A total of 25,384 papers were found using different searching methodologies from different electronic databases. The EndNote reference manager was used to remove duplicates, and 438 articles were selected for screening. Of those, 57 were included for critical evaluation, and 49 were removed with justification. The effectiveness of IV dexamethasone on the prolongation of spinal anesthesia and postoperative analgesia in women undergoing cesarean delivery is the subject of eight RCT studies on 628 parturients that are presented in the chosen journal articles from various countries. Intravenous dexamethasone administration immediately after clamping of the umbilical cord prolongs the duration of spinal block in patients undergoing cesarean sections and has a significant impact on reduction of postoperative pain severity, opioid consumption, and other pain requirements. When high-dose dexamethasone is administered intravenously, it can overcome complications that may arise after severe pain and increase patient satisfaction by extending the duration of postoperative analgesia and sensory block.

Transitional Pain Service: An Update.

Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea ofTransitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possibleinterventionsto adress postoperative pain. Areas of future work in TPS-related research are discussed. Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. Whilesome studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.

Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention.

There is limited evidence for appropriate postoperative opioid prescribing in autologous breast reconstruction. We sought to describe postoperative outpatient prescription opioid use following discharge after deep inferior epigastric perforator (DIEP) breast reconstruction with and without an educational video. Patients undergoing DIEP reconstruction were given a 28-day postoperative pain and medication logbook from August 2022 to June 2023. Our practice implemented an educational video upon discharge on proper opioid consumption. Descriptive statistics on patient characteristics, intraoperative and postoperative opioid consumption, and outpatient prescription opioid use after discharge were compared between the two cohorts. A total of 53 logbooks were completed with 20 patients in the no video cohort and 33 in the video cohort. On average, the days to cessation of opiates was longer in the no video cohort (8.2 vs. 5.1 days, p = 0.003). The average number of oxycodone 5 mg equivalents consumed following discharge was 13.8 in the no video cohort and 7.8 in the video cohort, which was statistically significant (p = 0.01). Overall, the percentage of opioids prescribed that were consumed in the video cohort was 28.3% versus 67.1% in the no video cohort. For patients discharging home after DIEP reconstruction, we recommend a prescription for 12 oxycodone 5 mg tablets. With the use of an educational video regarding proper opioid consumption, we were able to reduce the total outpatient opioid use to 5 oxycodone 5 mg tablets following hospital discharge.

Current evidence of multimodal anesthesia on postoperative outcomes (ICTRP).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (ClinicalTrials.gov).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (Web of Science).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (Ovid MEDLINE).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (Ovid Embase).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (CINAHL).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Current evidence of multimodal anesthesia on postoperative outcomes (Cochrane Library).

Abstract In times of the opioid crisis in the USA and Europe there is a growing interest in reducing peri- and correlated postoperative opioid consumption and prescription. One approach of dealing with the reduction of opioid application is opioid-free anesthesia (OFA). Despite some uncontestable advantages of OFA, it remains a contentious issue. Multimodal anesthesia (MMA) offers a comprehensive and patient-centered alternative to OFA, and could be considered as a change in paradigm. The goal of MMA is to provide superior perioperative pain management while minimizing the risks and limitations associated with opioids. By improving patient satisfaction, amending pain control, diminishing side effects of opiate utilization, accelerating recovery, alleviation of the opioid crisis and optimization of scarce resources multimodal anesthesia has the potential to transform the field of anesthesiology and perioperative medicine. This systematic review is conducted to examine the current evidence of multimodal anesthesia on postoperative outcomes.

Original research: Dexmedetomidine versus ketamine in erector spinae plane block for postoperative analgesia following modified radical mastectomy: A prospective randomized controlled blinded study

ABSTRACT Background A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effectiveness of dexmedetomidine (DEX) versus ketamine as adjuvants to local anaesthetic in erector spinae plane block (ESPB) in MRM. Methods In this randomized controlled trial, 75 women with breast cancer scheduled for MRM were included. All patients underwent ESPB with 30 ml 0.25% bupivacaine and randomized into three equal groups: group A, ESPB group; group B: received 1 µg/kg DEX with the ESPB; and group C: given 0.5 mg/kg Ketamine with the block. Results Compared with group A, VAS score at rest as well as movement were lower considerably in groups B and C (p < 0.05) at 6 h, 12 h, and 24 h. Group B had lower VAS scores at rest at 12 h and 24 h and during movement at 6 h, 12 h, and 24 h (p < 0.05) than group C. In comparison to A Group; B and C Groups required considerably less time to rescue analgesia and consumed significantly fewer total opioids (p < 0.05 and p < 0.001, respectively). In addition, total number of patients who required additional analgesia was markedly reduced in groups B and C compared to group A ;(p < 0.05). Conclusion In MRM surgery, the postoperative opioids consumption and VAS values were lower in both groups DEX and ketamine as an adjuvant to bupivacaine which enhanced the analgesic profile and prolonged ESPB duration compared to ESPB alone, with DEX being superior to ketamine.

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study.

The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24h after laparoscopic sleeve gastrectomy. Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24h. The median [interquartile range] morphine consumption at 24h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12h but were similar at 24h. No block-related complications were observed in any patients. The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. Clinicaltrials.gov identifier: NCT05663658.

The rapid recovery study: Cyclobenzaprine's effect on recovery following joint arthroplasty

IntroductionSkeletal muscle relaxants have previously not been examined in multimodal anesthesia regimens following joint arthroplasty. We sought to evaluate cyclobenzaprine's effect on postoperative opioid consumption as well as surgical recovery following joint arthroplasty. Materials and methodsIn this retrospective cohort study, 471 patients undergoing 554 joint arthroplasty procedures were evaluated. Patients were divided into cohorts who did and did not receive cyclobenzaprine postoperatively, and postoperative opioid consumption and functional recovery measures were recorded in each cohort. ResultsIn the unadjusted model, the cyclobenzaprine cohort experienced a 1.11 increase in pain scores on postoperative day zero (95% CI (0.60, 1.62), p < 0.0001). After adjusting for age, sex, BMI, CCI, perioperative MME, laterality, procedure, anesthesia, pre-op opioid use, pre-operative other controlled substance uses and pre-op benzodiazepine use, the cyclobenzaprine cohort's pain scores were 1.08 units higher at rest (95% CI (0.59, 1.56), p < 0.0001) and 1.25 units higher with activity on postoperative-day-zero (95% CI (0.78, 1.72), p < 0.0001). Both cohorts experienced statistically insignificantly different changes in mobility scores between postoperative day zero and postoperative day one, range of motion at 6 and 12 weeks, and readmission in <90 days. Postoperative morphine milliequivalents were insignificantly different between cohorts after controlling for pain in all models (base model mean ratio: 1.06, 95% CI (0.87,1.29), p = 0.5599) (Full model mean ratio: 1.09, 95% CI (0.91,1.30), p = 0.3608). ConclusionsCyclobenzaprine shows utility in a multimodal anesthetic approach after joint arthroplasty in patients with higher baseline pain.

Analgesic efficacy of classical thoracolumbar interfascial plane block versus modified thoracolumbar interfascial plane block in patients undergoing lumbar disc surgeries: A comparative, randomised controlled trial.

We compared classical (medial) and modified (lateral) thoracolumbar interfascial plane block (TLIP) with only general anaesthesia (GA) using multimodal analgesia in patients undergoing lumbar disc surgeries. In this study, 100 patients aged 18-70 years were randomised to Group cTLIP (conventional TLIP block with 20 mL of 0.25% ropivacaine with GA), Group mTLIP (modified TLIP block with 20 mL of 0.25% ropivacaine with GA), and Group C (only GA using multimodal analgesia). The primary outcome was to assess the total peri-operative opioid consumption in the first 24 h. The secondary outcomes were to assess pain score upon arriving in the post-anaesthesia care unit, time to first analgesic need after surgery, post-operative opioid consumption in 24 h, and incidence of nausea and vomiting. The total peri-operative opioid consumption in Group cTLIP (507.58 (258.55) μg) and Group mTLIP (491.67 (165.39) μg) was significantly lower than that in Group C (1225.4 (237.03) μg); (P < 0.001). However, it was comparable between groups cTLIP and mTLIP (P = 0.767). Pain score was comparable in groups cTLIP and mTLIP. It was significantly lower than Group C (P = 0.001). Rescue analgesia was needed in all (100%) patients of Group C but in only 15.2% of patients of the cTLIP and mTLIP groups. No patient in groups cTLIP and mTLIP complained of nausea and vomiting in the first 24 h, whereas it was significantly higher (61.8%) in Group C (P = 0.001). The analgesic effect of the modified TLIP block was not superior to the conventional TLIP block. Both techniques provided the same intra-operative and post-operative analgesia for lumbar disc surgeries.

Intraoperative clonidine in endometriosis and spine surgery: A protocol for two randomised, blinded, placebo-controlled trials.

A high proportion of patients who undergo surgery continue to suffer from moderate to severe pain in the early postoperative period despite advances in pain management strategies. Previous studies suggest that clonidine, an alpha2 adrenergic agonist, administered during the perioperative period could reduce acute postoperative pain intensity and opioid consumption. However, these studies have several limitations related to study design and sample size and hence, further studies are needed. To investigate the effect of a single intravenous (IV) dose of intraoperative clonidine on postoperative opioid consumption, pain intensity, nausea, vomiting and sedation after endometriosis and spine surgery. Two separate randomised, blinded, placebo-controlled trials are planned. Patients scheduled for endometriosis (CLONIPAIN) will be randomised to receive either 150 μg intraoperative IV clonidine or placebo (isotonic saline). Patients undergoing spine surgery (CLONISPINE) will receive 3 μg/kg intraoperative IV clonidine or placebo. We aim to include 120 patients in each trial to achieve power of 90% at an alpha level of 0.05. The primary outcome is opioid consumption within the first three postoperative hours. Secondary outcomes include pain intensity at rest and during coughing, nausea, vomiting and sedation within the first two postoperative hours and opioid consumption within the first six postoperative hours. Time to discharge from the PACU will be registered. This study is expected to provide valuable information on the efficacy of intraoperative clonidine in acute postoperative pain management in patients undergoing endometriosis and spine surgery.