Prolonged Duration Of Analgesia Research Articles

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Dexmedetomidine and Dexamethasone as Adjuvants to the Local Anesthetic Mixture in Rhomboid Intercostal and Sub-Serratus Block for Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind, Controlled Trial.

The utilization of adjuvants such as dexamethasone and dexmedetomidine in combination with local anesthetics has proven effective in extending analgesia duration. We aimed to investigate the potential efficacy of combining dexmedetomidine and dexamethasone in rhomboid intercostal and sub-serratus (RISS) block for prolonging postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS). We did this randomized, double-blind, controlled trial in two tertiary-care hospitals. A total of eighty-eight patients undergoing VATS under general anesthesia were enrolled in this study. They were randomly assigned into four groups: ropivacaine (R) group, ropivacaine + dexmedetomidine (RM) group, ropivacaine + dexamethasone (RS) group, or ropivacaine + dexmedetomidine + dexamethasone (RSM) group. The primary outcome measure was the duration of analgesia. Secondary outcomes included Numeric Rating Scale (NRS) scores, cumulative oxycodone consumption, and adverse effects. The RSM group exhibited a significantly prolonged duration of analgesia at 1073.5min (932.0-1283.3) compared to the R group with a duration of 154.5min (80.5-199.3) and the RS group with a duration of 282.0min (195.3-350.0, P < 0 0.001). The cumulative oxycodone consumption during the 0-12hours and 0-24-hours period was significantly reduced in the RSM group compared to the R group (P < 0.05). There was also a lower incidence of nausea at 48hours postoperatively in the RSM group compared to the RM group. However, there were no significant differences between the four groups regarding NRS pain scores. The combination of ropivacaine, dexmedetomidine, and dexamethasone in RISS block significantly prolongs the duration of postoperative analgesia following VATS.

Ultrasound-guided forearm selective nerve block: A bright future on the horizon

Objective: In light of the advancement of modern medicine, anesthesiologists and surgeons are increasingly prioritizing patient comfort in diagnostic and therapeutic procedures. A growing body of research revolves around the utilization of ultrasound-guided forearm selective nerve blocks for surgeries involving the distal upper limb. This review aims to provide an overview of regional anesthesia techniques in forearm, hand, and wrist surgeries, laying a theoretical foundation for the prospects of ultrasound-guided forearm selective nerve blocks in optimizing comfort during diagnostic and therapeutic procedures. Methods: A retrospective review of literature sourced from the PubMed database was conducted to comprehensively evaluate and elucidate the advantages and drawbacks of ultrasound-guided forearm selective nerve blocks, brachial plexus blocks, Bier blocks, and wrist blocks. Additionally, a summary was provided regarding the selection of local anesthetics for ultrasound-guided forearm selective nerve blocks. Results: Overall, ultrasound-guided forearm selective nerve block techniques exhibit several advantages over Bier’s block, brachial plexus block, and wrist block for the majority of forearm, wrist, and hand surgeries. These advantages include reduced anesthesia-related time, prolonged duration of analgesia, and minimal impairment of upper extremity motor function. Consequently, these techniques enhance surgical safety and facilitate postoperative recovery. Furthermore, the addition of dexmedetomidine or dexamethasone to ultrasound-guided selective nerve blocks of the forearm could extend the duration of analgesia. Conclusion: Ultrasound-guided forearm selective nerve block is a straightforward and conducive anesthesia method for distal upper limb surgeries, aligning with the principles of fast surgical recovery and enhanced patient comfort during diagnostic and therapeutic procedures. Given its manifold benefits, widespread promotion and adoption of this technique in clinical practice are warranted.

A Randomized Controlled Study of Epidural Morphine Sulfate-soaked Gelfoam and Morphine Sulfate Instillation in the Management of Postoperative Pain following Lumbar Spinal Fixation Surgery

Abstract Background: Lumbar spinal fixation surgeries play a pivotal role in addressing pain which can be nociceptive, neuropathic, mixed, and nociplastic; however, these surgeries can also cause significant postoperative pain and discomfort, leading to prolonged hospital stays and delayed return to normal activity. Aims and Objectives: The aim of the study was to provide effective postoperative analgesia and to compare the analgesic efficacy by application of Gelfoam-soaked morphine sulfate placed in the epidural space and direct instillation of morphine sulfate in the epidural space in patients undergoing lumbar spinal fixation surgery under general anesthesia. Materials and Methods: A total of 60 patients planned for Lumbar spinal fixation surgeries were selected and sorted into two groups of 30 each after a computer-based randomization. In Group G, a 5 cm × 1 cm piece of absorbable gelatin sponge soaked in 5 mg of morphine sulfate diluted in 0.9% normal saline up to 5 mL was placed in the epidural space. In Group I, 5 mg of morphine sulfate diluted in 0.9% normal saline 5 mL was instilled over the intact epidural space. Pulse rate, mean arterial pressure (MAP), respiratory rate (RR), and peripheral oxygen saturation (SpO2) were observed hourly for the first 6 h, then at 2 hourly intervals till 12 h, and at 4 hourly intervals till 48 h. Postoperatively, pain intensity is assessed by the Visual Analog Scale (VAS) for 24 h, and the time of the first analgesic dose is noted. VAS ranges from 0 (no pain) to 10 (severe pain). Preoperative instructions were given to the patients about the use of VAS. Results: In this study, Group G demonstrated lower postoperative VAS scores and delayed need for rescue analgesia compared to Group I (P &lt; 0.05, P &lt; 0.0001, respectively). Group I had a higher total analgesic requirement (P &lt; 0.0001) and consistently higher heart rates (P &lt; 0.0001) compared to Group G. MAPs were lower in Group G compared to Group I (P &lt; 0.0001). RRs, SpO2, sedation scores, and incidence of nausea and pruritus were similar between the two groups (P &gt; 0.05). Conclusion: Epidural administration of morphine using Gelfoam as a vehicle for sustained release of morphine is a safe and effective method of postoperative analgesia in lumbar spinal fixation surgeries and results in better hemodynamics, prolonged duration of analgesia, and reduced requirement of rescue analgesics, compared to epidural instillation of morphine.

Study of caudal ropivacaine with or without dexmedetomidine for postoperative analgesia in paediatric genitourinary infraumbilical surgery: a double-blinded randomized controlled trial.

Various studies have described the use of Dexmedetomidine with local anaesthetic drugs in caudal blocks for the management of postoperative pain in children. This study was designed to determine the analgesic effect of caudal Dexmedetomidine with Ropivacaine in paediatric genitourinary infraumbilical surgeries. Postoperative analgesic effects of caudal Ropivacaine with or without Dexmedetomidine in paediatric genitourinary infraumbilical were evaluated. This study was a prospective, interventional, comparative study conducted after ethical approval from the institute. Informed expressed consent was taken from each patient's guardians. The sample size was calculated to be 31 in each group. The two groups were randomly assigned and the intervention involved caudal epidural injection with either Ropivacaine combined with Dexmedetomidine or Ropivacaine with Normal Saline. Children receiving Ropivacaine with Dexmedetomidine had a significantly prolonged duration of analgesia compared to those receiving Ropivacaine alone (840.35 ± 149.97 vs. 412.90 ± 93.46 min, P < 0.001). Postoperative rFLACC scores were consistently lower in the Dexmedetomidine group, indicating better pain control (P < 0.05 at 6, 12, and 24 h). Total analgesic consumption was lower in the Dexmedetomidine group (500.67 ± 212.92 vs. 741.75 ± 268.06mg, P < 0.01). No significant differences in adverse effects were observed between the groups. The addition of Dexmedetomidine to Ropivacaine in caudal epidural significantly prolongs analgesia, improves pain control, and reduces analgesic consumption in paediatric genitourinary infraumbilical surgeries.

The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery

Background: Total abdominal hysterectomy (TAH) characterizes as major surgery with increased risk of morbidity. It depends on adequate pain management intra- and postoperatively. Anesthesia management of TAH widely uses a regional approach with the epidural technique which administers a local anesthesia agent into the epidural space.Objective: This study aims to determine the effectiveness of epidural levobupivacaine with fentanyl versus levobupivacaine with dexmedetomidine for epidural anesthesia in patients undergoing TAH.Methods: This is a prospective, single-blinded trial conducted among 20 patients aged 18 to 40 years who underwent elective TAH with American Society of Anesthesiologist (ASA) class I and II status. The control group received epidural levobupivacaine 0.5% with fentanyl as an adjuvant, while the dexmedetomidine group received levobupivacaine 0.5% with dexmedetomidine as an adjuvant. We then compared the degree of pain using a numeric rating scale (NRS) 24 hours after surgery, duration of analgesia, and incidence of postoperative nausea and vomiting (PONV) in both groups.Result: Duration of analgesia was 89.60 + 7.6332 min in group dexmedetomidine, while it was 78.0 + 10.4562 min in group fentanyl, respectively (P &lt; 0.05). The means of NRS was 3.00 + 1.88562 in group dexmedetomidine and 4.80 + 1.1352 in group fentanyl (p=0.019). The incidence of PONV in group dexmedetomidine was three, while in group fentanyl was eight (p=0.025).Conclusion: Dexmedetomidine is preferred over fentanyl when added to levobupivacaine for epidural analgesia in TAH procedures. Dexmedetomidine offers superior quality with a prolonged duration of analgesia, lower NRS values, and a lower incidence of PONV rather than fentanyl.

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

BACKGROUND: Post-operative pain after mastectomy is associated with poor recovery, prolonged hospital stays, and increased liability for chronic persistent pain. AIM: This work aimed to test the analgesic efficacy of adding ketamine to a dexamethasone bupivacaine combination in ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM). METHODS: This randomized, double-blind trial included 60 females aged 20–60 undergoing MRM. They were randomized into two groups: Group DB (n = 30) received SAPB using 30 ml of bupivacaine 0.25% and dexamethasone 4 mg. Group KD (n = 30) received the same block with the addition of ketamine 50 mg. RESULTS: The time to the first analgesic request was significantly delayed in Group KD than in Group DB (p &lt; 0.001). The number of patients requiring morphine and its total consumption during the first 24 post-operative hours in Group KD were significantly less than in Group DB (p = 0.001 and p &lt; 0.001, respectively). Visual Analog Scale scores at rest and movement at 4, 6, 8, 10, 12, and 18 h were significantly lower in Group KD than in Group DB. CONCLUSIONS: Adding ketamine to bupivacaine plus dexamethasone in ultrasound-guided SAPB is associated with better analgesic outcomes in patients undergoing MRM, including prolonged duration of analgesia and decreased post-operative morphine consumption and pain scores at rest and movement.

Comparison of anterior, posterior, and lateral approaches of ultrasound-guided quadratus lumborum block in an adult patient undergoing inguinal hernia surgery: A prospective randomized controlled trial.

Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well. Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery. A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P < 0.001), with better pain scores (P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block. The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients.

Effect of intravenous dexmedetomidine as an adjuvant to brachial plexus block in upper limb orthopedic surgeries – A systemic review and meta-analysis

Brachial plexus block for upper limb orthopedic surgeries has been widely used for surgical anesthesia and post operative analgesia. Various adjuvants are used to prolong the duration of the nerve block. Systemic dexmedetomidine as an adjuvant to local anesthetics has been shown to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in its efficacy. Hence, an updated meta-analysis was planned to assess the efficacy and safety of systemic dexmedetomidine as an adjuvant to local anesthetics in brachial plexus nerve block (BPNB). Objective of the study is to assess the duration of analgesia in patients undergoing upper limb orthopaedic procedures with BPNB and intravenous dexmedetomidine as an adjuvant. Data sources were PubMed, Cochrane, and Google Scholar were systematically searched till July 2023. The meta-analysis included all published studies that investigated the effect of systemic dexmedetomidine on duration of analgesia following BPNB. The data extraction was guided by a predetermined checklist. Analysis was done Using RevMan_5 software, the mean difference for duration of analgesia between the two groups and odds ratio was calculated from the selected studies. The fixed-effects model was used to compare the difference in the duration of analgesia between the two groups. The outcome was prolonged duration of analgesia in patients undergoing upper limb orthopedic procedure where intravenous dexmedetomidine was used as an adjuvant to peripheral nerve blocks. Our meta-analysis currently generates the evidence that intravenous dexmedetomidine administration offers advantages over other drugs in terms of prolonged duration of analgesia.

Comparison of 0.5% Hyperbaric Bupivacaine with Midazolam Versus 0.5% Hyperbaric Bupivacaine Alone Intrathecally: Prospective Observational Study

Context: Neuraxial anesthesia is the preferred choice for infraumbilical surgeries due to its advantages. The incorporation of midazolam alongside local anesthetic drugs in spinal anesthesia has demonstrated positive outcomes. This study was undertaken to assess the effectiveness of midazolam in terms of analgesic and anesthetic efficacy, as well as potential adverse effects, in patients undergoing infraumbilical surgeries. Aims: To compare the analgesic and anaesthetic effect of mixture of midazolam - bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgeries under spinal anaesthesia. Settings and Design: The present study is a prospective, observational study. Methods and Material: Fifty patients posted for elective infra-umbilical surgery were randomly divided into two groups of 25 each for intrathecal drug administration. (n=25). After administration of block, patients were assessed for analgesic and anesthetic effect of the drug. Statistical Analysis used: The study analyzed through the statistical programming software SPSS-22 and it involved the application of the student’s t-test, with a significance threshold set at a P value of &lt;0.05. Results: Analgesic duration of patients in Midazolam Group was signiÞcantly longer compared to Bupivacaine Group for sensory block. More patients in the midazolam group were sedated and easily arousable. Conclusions: This study concludes that the addition of intrathecal preservative-free midazolam to hyperbaric bupivacaine improved intra - operative anaesthesia and prolonged duration of analgesia. Also, it was observed that there was a significant reduction in the consumption of analgesics during the postoperative period in patients undergoing infra-umbilical surgeries without causing any significant haemodynamic changes.

A Comparative Clinical Study to Evaluate the Antinociceptive Efficacy of Intravenous versus Intraperitoneal Dexmedetomidine with Ropivacaine in Patients Undergoing Laparoscopic Cholecystectomy

Background and Aims: Intraperitoneal (IP) local anesthetic administration has become a routine in laparoscopic surgeries. An additive to local anesthetic like alpha-2 agonist such as dexmedetomidine may enhance the efficacy of local anesthetic. Our primary objective was to compare the duration of analgesia and our secondary objectives were to compare the total amount of rescue analgesics in 24 h, hemodynamic changes, and adverse effects after the use of dexmedetomidine intraperitoneally versus intravenously in addition to 0.25% ropivacaine instillation intraperitoneally. Materials and Methods: Eighty patients aged 18–60 years of American Society of Anesthesiologists physical status I and II, undergoing laparoscopic cholecystectomy, were randomly allocated into two groups – Group V (n = 40) received 100 ml normal saline (NS) with 0.7 µg/kg dexmedetomidine over 15 min followed by 30 ml 0.25% ropivacaine intraperitoneally and Group P (n = 40) received 100 ml NS over 15 min followed by 30 ml 0.25% ropivacaine with 0.7 µg/kg dexmedetomidine intraperitoneally soon after removal of gallbladder at the end of surgery. Results: The duration of analgesia was significantly longer in Group V (246.45 ± 27.00 min) as compared to Group P (112.83 ± 11.61 min) (P &lt; 0.0001). The total amount of rescue analgesic consumption in 24 h was significantly reduced in Group V (185.00 ± 73.55 mg) as compared to Group P (225.00 ± 77.63 mg) (P &lt; 0.05). As compared to Group P, patients in Group V had a statistically significant Ramsay Sedation Score. The hemodynamic parameters and side effect profile were comparable in both the groups. Conclusion: IV dexmedetomidine 0.7μg/kg is more efficacious as compared to IP dexmedetomidine along with IP ropivacaine 0.25% in laparoscopic cholecystectomy in terms of prolonged duration of analgesia and decreased requirement of rescue analgesia in 24 h.

Efficacy of intraoperative subanaesthetic dose of ketamine on post-operative analgesia for patients undergoing single level lumbar discectomy under general anesthesia: A placebo control randomized clinical study

Background: Sub-anesthetic ketamine is becoming increasingly popular for opioid sparing analgesic properties. Aims and Objectives: This study was done to determine the efficacy of intraoperative infusion of sub-anesthetic dose of ketamine on post-operative analgesia in single level lumbar discectomy surgeries. Materials and Methods: A prospective, randomized, and control study was carried on 60 patients of American Society of Anesthesiologists I and II aged between 18 and 65 years undergoing single level lumbar discectomy under general anesthesia. After induction of anesthesia, Group A received Ketamine 0.3 mg/kg intravenous (IV) bolus followed by infusion at 4 μg/kg/min and Group B received 0.9% saline bolus dose of similar volume and infusion was started at similar rate. Post-operative pain relief, opioid sparing effect, and side effects if any were recorded. Results: There was significant difference (P&lt;0.001) in post-operative Numeric Rating scores for initial 6 h in Group A patients compared to Group B and prolonged duration of analgesia (8.5 vs. 4.25 h) along with reduced postoperative tramadol consumption. Conclusion: In lumbar spine discectomy, intraoperative ketamine infusion at sub-anesthetic doses produces more effective post-operative analgesia along with opioid sparing effect without any side effects.

Scorpion Venom Component; BmK AGAP Potentiates the Analgesic Effects of Lidocaine During Sciatic Nerve Block

Background: Various analgesic adjuvants, including opioids, have been tested and demon-strated to be clinically beneficial when added to local anesthetics to increase the duration of analgesia with the risk of various adverse effects. This study was designed to test the hypothesis that a scorpion venom component, BmK AGAP, may have a synergistic effect with lidocaine. Methods: We performed partial sciatic nerve ligation on 84 rats to induce a rapid onset and long-lasting mechanical allodynia. An equal volume (600μl) of lidocaine and BmK AGAP were prepared with saline. The rats were randomly assigned to one of seven groups. Group A (n = 12) received saline as the control; Group B (n = 12) received lidocaine alone; Group C (n = 12) received BmK AGAP alone; Group D, E, F and G (n = 12 each) received lidocaine and different concentrations of BmK AGAP combined. The von Frey filaments were used to assess mechanical allodynia in the rats. Results: We observed a decrease in pain intensity and a prolonged duration of analgesia in rats that received BmK AGAP with lidocaine. Conclusion: BmK AGAP with lidocaine decreased pain intensity and increased the duration of analgesia.

Pericapsular nerve group block in hip arthroplasty: A prospective randomized trial.

This study aimed to evaluate the analgesic effect of the ultrasound-guided pericapsular nerve group (PENG) block in hip arthroplasty (HA) surgery. A prospective double-blinded, randomized study. Tertiary institutional clinical care. Fifty patients, more than 50 years old of both genders, were chosen according to the American Society of Anesthesiologists classification, with physical status I-III, and scheduled for unilateral HA surgeries. Patients were randomized to receive either a sham PENG block with 20 mL of normal saline (control group) or a PENG block with 20 mL of bupivacaine 0.25 percent (PENG group). From the onset of the first request for rescue opioid analgesia, preoperative pain scores before and after block (at rest and with a raised straight leg), the incidence of quadriceps weakness after the block, intraoperative fentanyl consumption, post-operative pain scores, and morphine consumption, besides the presence and frequency of adverse events, were recorded. The patients undergoing PENG block with bupivacaine had prolonged durations before the first analgesic request, lower perioperative pain scores, less intraoperative rescue fentanyl, and less post-operative morphine consumption than the control group, with nonsignificant motor weakness after the block and similar adverse events. The PENG block provided effective perioperative analgesia for HA with prolonged duration of analgesia, nonsignificant motor effects, reduced perioperative opioids consumption, and no major side effects.

A study to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine, or morphine through surgical drain for post-operative analgesia in patients undergoing modified radical mastectomy

Background: Local anesthetics have become vital part of multimodal analgesia approach. Instillation of local anesthetics through surgical drain is easier and safer method than conventional nerve blocks. Various local anesthetic drugs and adjuvants have been used for post-operative pain management through surgical drains. Aims and Objectives: This study was conducted to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine or morphine through surgical drain for post-operative analgesia and patient satisfaction in patients undergoing modified radical mastectomy. Materials and Methods: A prospective, randomized, and double-blind study was conducted dividing 75 female patients aged 30–70 years who underwent modified radical mastectomy into three groups: Group (RM) received 40 ml 0.25% ropivacaine with 4.5 mg morphine, group (RD) 40 ml 0.25% ropivacaine with 1 mg/kg dexmedetomidine and group (RF) 40 ml 0.25% ropivacaine with 50 microgram fentanyl, instilled through surgical drains. Results: Visual analog score for pain at rest and movement was significantly lower in group RM as compared to group RD and RF with no significant difference among group RD and RF at different time intervals postoperatively. Patient satisfaction at 24-h postoperatively was significantly better in group RM as compared to group RD and RF (P=0.01) with no significant difference among group RD and group RF. Conclusion: Instillation of ropivacaine with morphine provides good pain relief, prolonged duration of analgesia, and good patient satisfaction in the post-operative period as compared to ropivacaine with dexmedetomidine or fentanyl.

Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Nephrolithotomy.

Background Percutaneous nephrolithotomy (PCNL) is presently the preferred method for managing renal calculi. Visceral pain from the kidney and ureter and somatic pain from the incision site are the primary causes of immediate postoperative pain following PCNL. Poor pain control is associated with unwanted consequences such as patient discomfort, delayed recovery, and prolonged hospital stay.Recently, the erector spinae plane (ESP) block has been used in many thoracic and abdominal surgeries for the control of postoperative pain. In this study, we aimed to assess the effectiveness of the ultrasound-guided ESPblock following PCNL. Methodology This was a prospective, double-blind, randomized controlled study including 60 patients who were scheduled for elective PCNLunder general anesthesia. Patients were randomly divided into two groups. Group E underwent an ultrasound-guided ESP block with 20 mL of the local anesthetic mixture at the T-9 level unilaterally on the side of surgery, and group C was a sham group in which20 mL of normal saline was injected on the side of surgery. Changes in postoperative pain score were the primary outcome, and the duration of analgesia, the total analgesic requirement in 24 hours, and patient satisfaction were the secondary outcomes. Results The demographic data of both groups were comparable. The Visual Analog Scale score was considerably lower in group E than in group C at two, four, six, and eight hours postoperatively. In group E, the mean analgesic duration was substantially longer than that in group C (8.87 ± 2.45 hours vs. 5.67 ± 1.58 hours, respectively). The tramadol requirement was higher in group C (286.67 ± 62.88 mg) than in group E (133.33 ± 47.95 mg) during the 24-hour postoperative period. At 12hours, patient satisfaction was considerably higher in group E than in group C (6.73 ± 0.45 vs. 5.87 ± 0.35, respectively). Conclusions Theultrasound-guided ESP block provided efficient postoperative pain relief, prolonged duration of analgesia, and reduced tramadol intake after PCNL surgery.

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 COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL BUPIVACAINE IN INFRAUMBILICAL SURGERIES

Background Early postoperative mobilization, minimal pain and recovery are desirable features of modern anaesthesia post surgery. Epidural anaesthesia is most commonly used for providing postoperative analgesia. To achieve this, larger volume of local anaesthetics are used epidurally which increased the possibility of local anaesthetic toxicity. To reduce the local anaesthetic toxicity adjuvants to epidural infusion such as opioids, α2 agonists, benzodiazipines are added. Present study is done to evaluate the efcacy of dexmed Objective: etomidine and fentanyl for studying the duration of postoperative analgesia and sedation. Methodology: 80 patients of ASA grade I and II posted for elective lower abdominal and lower limb surgeries were selected for our study.They were premedicated with table tranitidine 150mg and tablet alprazolam 0.25mg night prior to surgery. Baseline parameters of vitals were recorded. Patients were preloaded with Ringer lactate solution of 15ml/kg . Under strict aseptic precautions, epidural catheter was introduced at L3-L4 space and test dose was given using 3ml of 2% Lignocaine with adrenaline followed by SAB given with injection hyperbaric bupivacaine 0.5% 15mg. After 90 min of subarachnoid block they were injected either 25ml of 0.125% bupivacaine with 0.5μg/kg dexmedetomidine or 25 ml 0.125% bupivacaine with 1μg/kg fentanyl epidurally at a rate of 5ml/hour using syringe pump. Rescue analgesia was supplemented with injection morphine 0.1mg/kg through intravenous route. Duration of analgesia , hemodynamic parameters and sedation score were noted. Analgesic effect was noted by visual analogue scale. Patients were observed for side effects Duration of postoperative analgesia, hemodynamic stability Results: and sedation were better with dexmedetomidine than fentanyl. Dexmedetomidine is a better adjuvant to epidural b Conclusion: upivacaine than fentanyl in terms of prolonged duration of analgesia with better sedation and hemodynamic parameters

Peripheral Regional Anesthesia Using Local Anesthetics: Old Wine in New Bottles?

During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. At present, liposomal bupivacaine is the most popular, non-opioid, controlled drug delivery system, but its duration of action, which is still controversially discussed, and its expensiveness have decreased initial enthusiasm. Continuous techniques can be seen as an elegant alternative for providing a prolonged duration of analgesia, but for logistic or anatomical reasons, they are not always the best choice. Therefore, focus has been directed towards the perineural and/or intravenous addition of old and established substances. As for perineural application, most of these so-called 'adjuvants' are used outside their indication, and their pharmacological efficacy is often not or only poorly understood. This review aims to summarize the recent developments for prolonging the duration of regional anesthesia. It will also discuss the potential harmful interactions and side effects of frequently used analgesic mixtures.

EFFECT OF ADDITION OF DEXAMETHASONE TO LEVOBUPIVACAINE ON POST-OPERATIVE ANALGESIA IN ULTRASONOGRAPHY-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INGUINAL HERNIA REPAIR: A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

NTRODUCTION- Postoperative pain is literally a form of acute pain which follows surgical insult with an inammatory reaction and initiation of an afferent neuronal signal bombardment. Due to inadequate management of postoperative pain many patients continue to suffer unnecessarily. Hence it is understood that managing the post operative pain effectively is the need of the hour to reduce postoperative morbidity. AIMS - To evaluate and compare the duration of sensory blockade of 0.25% levobupivacaine with and without dexamethasone in ultrasonography-guided transversus abdominis plane(TAP) block. METHODS-After obtaining approval from Institutional ethical committee, a prospective randomized comparative study was carried out in 60 patients of ASA Grade I &amp; II undergoing inguinal hernia repair under spinal anaesthesia. Patients were randomly divided into 2 groups; Group L(n=30) received 30ml of 0.25% Levobupivacaine with 2ml of Normal saline (NS) while Group D (n=30) received 30ml of 0.25% Levobupivacaine with 8mg Dexamethasone. RESULTS- Patients in group D (8.07±1.34 hr) had prolonged duration of analgesia in comparison to group L (5.33±1.92 hr) (p= 0.000). CONCLUSION- In the inguinal hernia repair surgeries performed under spinal anaesthesia with ultrasonography-guided TAP block, addition of dexamethasone was superior to levobupivacaine alone in providing better and prolonged post-operative analgesia with minimal post-operative nausea and vomiting