Prolonged Postoperative Analgesia Research Articles

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: the MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P < 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P < 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P < 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P < 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

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.

Current methods of perioperative analgesia for arthroscopic anterior cruciate ligament reconstruction: a literature review

Arthroscopic knee joint surgery is becoming routine in modern orthopedics. Its advantages include minimal invasiveness, lower infection risk, and early rehabilitation. Despite the minimized surgical trauma, the postoperative period after some arthroscopic operations involving cruciate ligament surgery occurs with relatively severe pain syndrome. This warrants the search for novel pain relief methods for patients that meet all modern trends. This review presents data from randomized clinical studies and meta-analyses on the use of various anesthesias in arthroscopic cruciate ligament repair and discusses methods of prolonged postoperative analgesia. The limited number of studies on this issue and lack of systematic recommendations require prospective studies.

Comparative Study of Dexmedetomidine versus Fentanyl as an adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery

Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery.
 Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software.
 Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group.
 Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.

Comparison of effectiveness of combination of xylocaine and dexmedetomidine with xylocaine alone in biers block of upper limb.

Objective: To evaluate two groups (combination versus xylocaine alone) in terms of onset of motor block, duration of block, and postoperative analgesia following the release of the tourniquet. Study Design: Quasi Experimental study. Setting: Chaudhary Muhammad Akram Teaching & Research Hospital. Period: 01 June 2023 to 30 Nov 2023. Material & Methods: Quasi experimental study design with a sample of total 80 patients divided into two groups of 40 each (xylocaine alone & combination of xylocaine and dexmedetomidine) were selected by using non probability convenient sampling technique. Results: Combining dexmedetomidine with xylocaine in Bier's block for upper limb surgery demonstrated significant advantages. Group B exhibited faster onset (3.8 min), prolong motor block, and prolonged postoperative analgesia (12.4 hrs) compared to group A (xylocaine alone: 5.2 min onset & shorter postoperative analgesia 6.8 hrs). Dexmedetomidine enhanced post-operative pain control, showcasing its effectiveness in improving outcomes for Bier's block procedures. Conclusion: Dexmedetomidine enhances Bier's block with xylocaine, providing faster onset, extended motor block, and superior post-operative analgesia for upper limb surgery.

A comparative study between neostigmine and dexamethasone as an adjuvant to bupivacaine in adductor canal block after knee arthroscopy (RCT)

Background Adjuvants to adductor canal block are used to improve the quality and duration of the block for better analgesia after knee surgeries. This study evaluates and compares the effect of adding dexamethasone and neostigmine to bupivacaine in adductor canal blocks after knee arthroscopy (KA). Methods In this randomized, double-blinded, controlled study, 90 patients scheduled for knee arthroscopy were randomly allocated into three groups to receive adductor canal block after the end of the arthroscopy. The control group received 20 ml bupivacaine 0.5%+2 ml normal saline, the dexamethasone group received 20 ml bupivacaine 0.5%+2 ml dexamethasone (8 mg) and the neostigmine group received 20 ml bupivacaine 0.5%+1 ml neostigmine (500 mcg) +1 ml normal saline. Outcomes: time of first rescue analgesia, sensory blockade duration, total opioid consumption, and visual analog score (VAS). Results Time of first rescue analgesia and Sensory block duration, were longer in dexamethasone and neostigmine groups compared with control group, with no significant difference between dexamethasone and neostigmine groups, however, clinically there was 3 h prolongation in sensory block duration in dexamethasone group. Mean morphine consumption and Visual analog score were lower in dexamethasone and neostigmine groups compared with control group, with no difference between dexamethasone and neostigmine groups, Conclusion Both dexamethasone and neostigmine were effective adjuvants to bupivacaine in ACB with more prolonged postoperative analgesia and less opioid consumption. Though there was no statistically significant difference between both drugs, however, dexamethasone showed some clinical superiority.

A Study to Assess the Efficacy of Ultrasound-guided Bilateral Erector Spinae Plane Block for Total Abdominal Hysterectomy under Spinal Anesthesia: A Prospective Randomized Control Study

Abstract Background: Postoperative discomfort after a total abdominal hysterectomy (TAH) is severe. The Erector spinae plane block (ESPB) is the latest addition to the multimodal pain management regimen, providing both visceral and somatic analgesia. Aim: The aim of this study was assessed the postoperative analgesic efficacy of ultrasound-guided bilateral ESPB for TAH. Materials and Methods: 70 female patients aged 40 to 60 years, American society of anaesthesiology (ASA) physical status class I and II posted for TAH were enrolled. Group ESPB+SA(n=35) received bilateral ESPB using 0.25% ropivacaine hydrochloride 15ml with 0.5µ/kg dexmedetomidine on each side before spinal anaesthesia, while group SA (n=35) received only spinal anaesthesia. Postoperative follow-up for 24 hours.Statistical analysis used: Independent-samples student t-test. Results: The total dose of tramadol injection consumed in the first 24 hours postoperatively in group ESPB+SA was significantly low (110.34mg) as compared to group SA (334.29mg) (P < 0.001). Time for first rescue analgesia was prolonged significantly in group ESPB+SA while it was very short in Group SA(P < 0.001). Postoperatively the mean modified defense and veterans pain rating scale (DVPRS) for pain was lower in group ESPB+SA than in group SA, and the difference was statistically significant (P < 0.001). Similarly, scores for other modified DVPRS components, such as sleep, activity, mood and stress were lower in the ESPB+SA group. Conclusions: Bilateral ultrasound-guided ESPB prior to spinal anaesthesia offers effective and prolonged postoperative analgesia, with significantly lower postoperative tramadol use and a higher satisfaction score in patients undergoing TAH under spinal anaesthesia.

Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries

Introduction: Pain is associated with higher perioperative morbidity in fracture patients. Fascia iliaca compartment block is a simple, inexpensive, and effective method of analgesia for femoral fracture surgeries. Many adjuvants have been used with local anaesthetics to prolong post-operative analgesia.
 Aims: To assess the effects of dexamethasone as an adjuvant to fascia iliaca compartment block on prolongation of post-operative analgesia in patients undergoing femoral fracture surgeries.
 Methods: Seventy patients aged, 18-65 years with American Society of Anaesthesiologist-Physical Status I and II, undergoing femoral fracture surgery, were randomly assigned to two groups, n=35 each, who received standard subarachnoid block. Ultrasound guided Fascia iliaca compartment block was given after completion of surgery with 20ml of 0.35% ropivacaine + 2ml normal saline to group one or 20ml of 0.35% ropivacaine + 2ml dexamethasone(4mg/ml) to group 2. Total duration of analgesia and total rescue analgesic requirement in the first post operative day were noted after successful block.
 Results:The demographic information for the two groups was comparable. The duration of postoperative analgesia was prolonged in patients receiving dexamethasone adjuvant (541 ± 167 vs. 638± 165 mins, p = 0.018; Mean difference -97). Patients receiving dexamethasone adjuvant required significantly less postoperative rescue analgesics for the first 24 hours (tramadol 88 ± 32 vs 65 ± 23 mg, p = 0.001; Mean difference 23).
 Conclusion: Dexamethasone, added to Fascia Iliaca Compartment Block, as an adjuvant, significantly prolongs the postoperative analgesic effect thereby, reducing the need for rescue analgesic in the first postoperative day.

Effect of Intravenous Ketamine Infusion on Hemodynamics of Patients Undergoing Cesarean Delivery after Spinal Anaesthesia: A Randomized, Double-Blind, Controlled Trial.

Hypotension is the most frequent side effect of intrathecal anaesthesia, with an incidence of more than 80%. Following neuraxial anaesthesia, perioperative shivering is a serious complication affecting 40-60% of patients undergoing surgery. This study aimed to determine the effectiveness of low-dose ketamine on blood pressure in patients undergoing cesarean delivery after spinal anaesthesia. We included 126 female patients undergoing cesarean deliveries, American Society of Anesthesiologists (ASA)-(II and III), and aged 21-40 selected from the outpatient clinics of the anaesthesia department. Patients were randomized to two groups; Group K (63 patients), who received 0.3 mg kg-1 of ketamine IV diluted to 10 mL, followed by an infusion of 0.1 mg kg-1 h-1. Group C (Controlled) (63 patients) received 10 mL of normal saline, followed by an infusion of 0.1 mL kg-1 h-1, which started before spinal anaesthesia. Compared with the saline group, the average heart rate, blood pressure, and level of sedation were significantly higher in the ketamine group (P < 0.05). The ketamine group reported a significantly lower incidence of shivering (P < 0.01). The ketamine groups exhibited significantly less mild or severe hypotension (P < 0.05). There was no significant difference between the two groups in terms of nystagmus, diplopia, hallucinations, or neonatal outcomes (P > 0.05). Ketamine decreases the incidence of hypotension and shivering in patients undergoing spinal anaesthesia during cesarean delivery. In addition, it resulted in improved sedation for the mother and prolonged postoperative analgesia without neonatal illness.

Perioperative Analgesia Using an Indwelling Catheter to Deliver an Inferior Alveolar Nerve Block: A Case Report.

A 74-year-old male was diagnosed with osteomyelitis of the left mandible requiring marginal mandibulectomy under general anesthesia. However, the patient's pulmonary function tests demonstrated findings consistent with severe chronic obstructive pulmonary disease, classified as stage III. The consulting pulmonologist explained the increased risk of respiratory complications associated with general anesthesia and advised against its use. Therefore, we opted to perform the surgery under moderate sedation using 0.2% ropivacaine administered via bilateral ultrasound-guided inferior alveolar nerve blocks (UGIANBs) and an indwelling catheter with a pump for continuous perioperative local anesthesia and prolonged postoperative analgesia. This approach delivered excellent local anesthetic effects without any need for rescue medications or complications. Use of UGIANBs along with an indwelling catheter and pump may provide adequate local anesthesia and postoperative analgesia in patients with contraindications for general anesthesia.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p &amp;lt; 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p &amp;lt; 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Ultrasound-Guided Rectus Sheath Block versus Transversus Abdominus Plane Block for Post-Operative Analgesia in Elective Cesarean Section

Abstract Background Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cesarean section, cholecystectomy, prostatectomy, hysterectomy and transplant surgery. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided TAP block versus ultrasound guided rectus sheath block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study eighty patients who received spinal anesthesia were included. Patients were divided randomly into two groups, each group consisted of 40 patients. Group A: Patients in this group received bilateral US guided TAP block at the end of surgery. Group B: Patients in this group received bilateral US guided rectus sheath block at the end of surgery. Results These result met with another study, Ayman Saleh et al which shows the time for first analgesic request (minutes) was significantly increased in TAP when compared to RS block groups (332.50±42.93 vs 220.10±21.51 minutes, respectively). Also, the total analgesic consumption (mg) was significantly reduced in TAP when compared to RS block groups respectively (90.40±27.02 vs 157.00±37.80 mg, respectively). Conclusion Ultrasound-guided TAP block was more effective than ultrasound-guided RS block in patients undergoing cesarean delivery with prolonged postoperative analgesia, less analgesics consumption and less postoperative nausea and vomiting.

Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Congenital Inguinal Hernia Repair

Abstract Background Inguinal hernia is the most common lower abdominal surgery of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. Analgesic techniques in pediatric patients having surgery are often delayed by the inherent difficulties of conducting a large randomized clinical trial in those patients. TAP block and caudal epidural block are two anesthetic techniques that are commonly used in pediatric age group for lower abdominal surgeries. Aim of the Work Compares the efficacy of Dexmedetomidine as an adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for postoperative analgesia in children undergoing congenital inguinal hernia repair especially to provide prolonged post-operative analgesia and decrease opioid consumption. Patients and Methods We conducted a prospective, randomized, controlled and comparative study in Ain shams university hospitals in a period of 6 months including 50 patients divided on 2 groups; group A 25 of them received ultrasound guided transversus abdominis plane block with 0.3 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 2.5-8 years and they were 6 females (24%) and 19 were males (76.0%) and group B 25 patients received caudal epidural block with 0.6 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 3 – 9 years and they were also 4 females (16%) and 21 were males (84.0%). Results In the present study there was statistically significant increase in pain at 1 hr, 2 hrs and 4 hrs in caudal block group and increase in pain score at 12 hrs in tap block group but there was no statistically significant difference found between them at 6 hrs, 18 hrs and 24 hrs. There was statistically significant increase in rescue analgesia in caudal block group at 4 hr with p-value &amp;lt;0.001; also there was statistically significant increase in rescue analgesia in tap block than caudal block at 12 hr with p-value = 0.009 while no statistically significant difference found between both groups at the other times of follow up. Conclusion TAP block was superior to caudal epidural anesthesia in terms of early postoperative pain, less need for rescue analgesia and need for less potent analgesia e.g. Paracetamol and NSAID. Addition of dexmedetomidine to conventional regional anesthetic protocol showed significant reduction of postoperative pain and the need for rescue analgesia.

Efficacy of Perineural versus Systemic Dexamethasone to Prolong Analgesia after Ultrasound Guided TAP Block for Patients Undergoing Lower Abdominal Surgeries

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Aim of the Work to study the effect of adding dexamethasone perineurally &amp; systemicly as an adjuvant to bupivacaine in TAP block. The comparison included the effect on postoperative pain &amp; postoperative analgesic requirement and haemodynamics. Patients and Methods In our study, 52 patients were randomly divided into two equal groups: Group A: Patients who received 2 ml volume of dexamethasone (8 mg) perineurally combined with the 20 ml of bupivacaine of (0.25%) concentration in the block (total 22 ml), followed by injecting 5 ml saline intravenous. Group B: Patients who received 2 ml of dexamethasone (8 mg) intravenously diluted over 3 cm saline in a 5 ml syringe intravenously following injection of the perineural 20 ml bupivacaine (0.25%) combined with 2 ml saline to have the same syringe volume for the block (22 ml) Results Our study showed that addition of dexamethasone to bupivacaine in TAP block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects &amp; better outcome to the perineural route. Conclusion Addition of perineural dexamethasone to bupivacaine in TAP block provided adequate post operative analgesia &amp; patient satisfaction along with reduced numbers of rescue analgesia doses. Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects &amp; better outcome to the perineural route.

Analgesic effect of a lidocaine-ropivacaine mixture for extraction of impacted mandibular third molars: a randomized controlled trial.

The painless postoperative period can be significantly prolonged by using long-acting local anesthetics such as ropivacaine, though these local anesthetics are known for their slower onset of action. To compensate for this, a mixture of short-onset (e.g., lidocaine) and long-acting local anesthetics is used. However, the efficacy of such an anesthetic cocktail has not been elucidated in the field of oral and maxillofacial surgery. To address the research purpose, this prospective randomized controlled trial included 56 patients scheduled for impacted mandibular third molar extraction. All patients received the inferior alveolar nerve block (IANB) using either 2% lidocaine with epinephrine or a 1:1 mixture of 2% lidocaine with epinephrine and 0.75% ropivacaine. Patients anesthetized using the lidocaine-ropivacaine mixture showed significantly prolonged postoperative analgesia and pain control than those anesthetized using lidocaine only. IANB using a lidocaine-ropivacaine mixture can provide prolonged postoperative anesthesia and pain control with extraction of mandibular third molars. This method can be a noteworthy addition to existing methods of local anesthesia for the extraction of mandibular third molars. Trial registration number University Hospital Medical Information Network (No. UMIN000044315).

The effects of two different doses of intravenous dexamethasone on blood glucose concentration intra-operatively and on postoperative pain and emesis in patients undergoing surgery under spinal anesthesia: A double-blind randomized clinical study

Background: Spinal anesthetic techniques are relatively safe and associated with quick and uneventful recovery, but post-operative pain and postoperative nausea and vomiting (PONV) are major concerns after the effect weans off. Steroids by virtue of their anti-inflammatory effect are expected to reduce pain as well as PONV. Aims and Objectives: The study was conducted to evaluate the efficacy of two different doses of intravenous dexamethasone on blood glucose concentration intra-operatively and on post-operative analgesia and emesis for different surgeries under spinal anesthesia. Materials and Methods: This double-blind randomized clinical study was performed on 120 patients aged 20–60 year posted for surgery under spinal anesthesia who were randomly allocated into three groups to receive either normal saline (Group A: 40 pts), intravenous 4 mg dexamethasone (Group B: 40 pts), or iv 8 mg dexamethasone (Group C: 40 pts) immediately after spinal anesthesia. Hemodynamic parameters, respiratory rate, intraoperative blood glucose concentration., severity of post-operative pain, and incidence of PONV was compared among the groups. Results: Patients in Group C had significantly less severe post-operative pain and incidence of PONV (P&lt;0.05). Furthermore, less post-operative rescue analgesia was required in Group C (P&lt;0.05). There was a highly significant rise in intraoperative blood glucose level in Group C as compared to other groups, but it was well below the recommended guidelines (&lt;180 mg/dL). Conclusion: Our study concluded that i.v. dexamethasone 8 mg was more effective, although it caused raised blood glucose concentration intraoperatively, but it also provided prolonged post-operative analgesia, increased time of first rescue analgesic, less incident of post-operative nausea and vomiting, and better patient satisfaction.

A comparative evaluation of intraperitoneal instillation and periportal infiltration of 0.375% ropivacaine with dexmedetomidine and nalbuphine as adjuvants for post-operative analgesia in laparoscopic cholecystectomy

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia. Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC. Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0. Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group. Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.

A prospective randomized study to compare hemodynamic changes and post-operative outcome of intravenous buprenorphine versus epidural buprenorphine in patients undergoing abdominal surgeries under general anesthesia

Background: Post-operative pain following major abdominal surgeries is accompanied with multitude of negative consequences, including increased morbidity, impaired physical function, and slow recovery. Opioids are the gold standard of post-operative pain management. Buprenorphine is a new semi-synthetic opioid and 0.3 mg has shown equipotent effect as 12.5 mg of morphine and 0.125 mg of fentanyl. Aims and Objectives: The aims of this study were to compare the effects of epidural and intravenous buprenorphine and clinically significant differences on perioperative hemodynamic variables, duration, and quality of analgesia and its adverse-effects. Materials and Methods: A total of 60 patients with ASA grade I/II scheduled for elective abdominal surgeries under general anesthesia were randomized into two groups. Group IA received intravenous Inj Buprenorphine 0.3 mg diluted with 10 mL of normal saline and 10 mL NS given epidurally just before the closure of peritoneum; Group EA received epidural Inj Buprenorphine 0.3 mg diluted with 10 mL of normal saline and 10 mL NS given intravenously just before the closure of peritoneum. The post-operative hemodynamic vitals, analgesia, and adverse-effects were assessed at certain intervals over 24 h. Results: In both groups, there was a significant reduction in heart rate and blood pressure as compared to baseline (pre-induction) over first 2 h–3 h following the administration. Group EA has shown to provide satisfactory, prolonged duration of analgesia 22.32 h, and better visual analog scale score as compared to Group IA 18.71 h. Conclusion: Epidural buprenorphine 0.3 mg has proved to provide higher satisfactory post-operative analgesia and considered a better alternative to 0.3 mg intravenous buprenorphine in terms of prolonged post-operative analgesia and acceptable adverse event profile.

A Study of the Clinical Effects of Sequential Combined Spinal Epidural Anesthesia and Spinal Anesthesia in Patients Undergoing Orthopedic Surgeries.

In orthopedic surgeries, there has been an increase in the usage of the neuraxial blockade to provide excellent surgical conditions and prolonged postoperative analgesia. The introduction of the sequential combined spinal epidural anesthesia (SCSEA) technique provides benefits for both spinal anesthesia (SA) and epiduralanesthesia. The focus of this study was to analyze the time needed to attain a desired level of sensory block, to compare the period of sensory block, and to study the intraoperative hemodynamics in the SCSEA and SA groups. The study was conducted on patients admitted for elective lower limb orthopedic surgeries. The sample size for this prospective randomized study is two groups of 67 subjects each. Patients aged between 18 and 65 years, posted for orthopedic surgeries for two to three hours, and of American Society of Anaesthesiologists (ASA) Grades 1 and 2 were included and divided into two groups. Group A patients received SCSEA with an epidural-test dose of 3 ml lignocaine (2%) with adrenaline and spinal bupivacaine (0.5%) of 1.5 ml-7.5 mg + fentanyl .25 mic if the sensory level was below T8. An epidural top-up was given with 2 ml per segment of 0.5% bupivacaine to bring the sensory level to T8. Group B patients received SA with spinal bupivacaine (0.5%) of 3 ml-15 mg + fentanyl .25 mic. Intraoperative hemodynamics, the duration to achieve a sensory level of T8, the time for two-segment regression of sensory block, and the complications that occurred were recorded. The study included a total of 134 subjects with each group having 67 subjects admitted for lower limb surgery. The mean value (SD) of the time taken to attain sensory block in the SCSEA group was prolonged when compared to the SA group (7.15 ± 0.75 and 5.01 ± 0.88). The time for two-segment regression in the SCSEA group was 86.77 ± 3.60and the SA group was 106.4 ± 8.01, which indicated that the SA group has a longer and better sensory block. Substantially, the study shows that the SCSEA group (P< 0.05) has better hemodynamics when compared to the SA group. The SCSEA technique has better intraoperative hemodynamic stability with a longer analgesic effect when compared to SA. SA shows a sudden change in hemodynamics but reveals a greatersensory block.

Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block.

Introduction Currently, peripheral nerve block has shown immense potential with effective patient satisfaction. In the event of upper limb surgeries, the supraclavicular brachial plexus approach under ultrasound guidance renders quick and dense anesthesia. In addition, the clinical utility of adjuvants with local anesthetics elicits a good quality of nerve block with improved duration and inset. So the aim of the present study was tocompare the block characteristics of dexmedetomidine and dexamethasone during supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Materials and methods The present study was conducted on 100 patients aged 20-60 years with the American Society of Anesthesiologists (ASA)-I and ASA-II classification who were scheduled for upper limb surgeries. These patients were divided equally into two groups, namely group D (who received 20mL of 0.5% bupivacaine + 50 mcg (0.5mL) of dexmedetomidine +1.5mL normal saline) and group X (who received 20mL of 0.5% bupivacaine +8mg of dexamethasone), ensuring a total volume of 22mL administered to both groups. The time of onset and duration of the sensory and motor blocks, as well as the quality of intraoperative analgesia, were assessed. Results The addition of dexmedetomidine (50mcg) and dexamethasone (8mg) to 0.5% bupivacaine ensured a faster onset and prolonged duration of the sensory and motor blocks. Additionally, dexmedetomidine resulted in more prolonged postoperative analgesia, a lower mean visual analogscale score in the first 24 hours, and lesser opioid consumption in 24 hours than dexamethasone. Conclusion Dexmedetomidine is superior to dexamethasone as an adjuvant to bupivacaine during supraclavicular brachial plexus block in patients undergoing upper limb surgeries.