Prolonged Duration Of Analgesia Research Articles

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

Abstract Background and Aims: Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well. Material and Methods: 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. Results: A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P &lt; 0.001), with better pain scores (P &lt; 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. Conclusion: 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

Comparison of two different doses of magnesium sulfate as an adjuvant to intrathecal bupivacaine in patients with pre-eclampsia undergoing elective cesarean section: A prospective double-blind randomized study

Background: Intrathecal magnesium sulfate is now emerging as a safe and effective adjuvant for spinal anesthesia (SA). The aim of the present study was to compare the efficacy of two doses of intrathecal magnesium in parturients with pre-eclampsia. Methods: This prospective randomized double-blind study was conducted on 105 parturients undergoing elective cesarean section (CS) who were randomized into three groups of 35 each: Group C, M50, and M75. Group M50 and group M75 received 50 mg of 50% (0.1 ml) and 75 mg of 50% (0.15 ml) magnesium sulfate, respectively. All of the groups received 10 mg of 0.5% heavy bupivacaine with normal saline accordingly to make a total volume of 2.2 ml. The sensory and motor block characteristics, visual analogue scale (VAS) score, post-operative analgesic requirements, hemodynamic parameters, and adverse effects were compared. Results: The sensory and motor block characteristics were significantly delayed in group M75 compared to group M50 and the control group (P < 0.05). VAS scores were significantly high in the control group up to 6 h as compared to group M50 and group M75 (P < 0.05). The time to first rescue analgesia was significantly extended in group M75 (222.86 ± 12.502 min) as compared to group M50 (221.14 ± 13.671 min) and the control group (127.43 ± 11.464 min) (P < 0.05) Conclusion: Intrathecal magnesium sulfate at doses of 50 mg and 75 mg in pre-eclamptic parturients undergoing elective CS results in prolonged duration of analgesia, decreased VAS scores and also delays the first rescue analgesic requirement with a favorable adverse effect profile in terms of decreased incidence of nausea and shivering.

Combined psoas compartment block and sciatic nerve block versus unilateral subarachnoid block as a sole anaesthetic technique for lower limb orthopaedic surgery – A prospective randomised controlled study

: Nerve block as a part on regional anaesthesia extends analgesia time and gives better haemodynamic stability, so comparison of nerve block like psoas compartment block and sciatic nerve block with spinal anaesthesia is our main aim of study. Total 96 patients of tibial surgeries with any gender of ASA grade I, II and III were assigned and randomly divided into two groups:- group P- psoas compartment block plus sciatic nerve block and group S-unilateral subarachnoid block. Parameters compared were onset, peak effect and duration of sensory and motor blockage, haemodynamic parameters, postoperative duration of analgesia and requirement of rescue analgesics post-operatively. Onset of motor and sensory block were faster in group S than group P. There was no significant difference in haemodynamic parameters in both the group. Duration of analgesia in group P was 16.79 ±2.3 hours as compared to group S was 5.57 ±0.49 hours, which was highly significant. Number of rescue analgesic required was significantly less in group P(1.10 ± 0.30) as compared to group S (3.04 ± 0.20) without significant complications in both the groups.Combined psoas compartment block with sciatic nerve block provides prolonged duration of analgesia over subarachnoid block and less numbers of rescue analgesics required postoperatively with good haemodynamic stability.

Comparison of the Analgesic Efficacy of Ultrasound-Guided Superficial Serratus Anterior Plane Block With Deep Serratus Anterior Plane Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Clinical Trial.

Background Acute postoperative pain after breast cancer surgery adversely affects recovery and is an independent predictor of chronic postsurgical pain in these patients. Serratus plane blocks have been found to provide analgesia to the anterior hemithorax. However, trials comparing superficial serratus plane block and deep serratus block in breast cancer surgery patients are sparse. Methodology A total of 74 female patients with American Society of Anesthesiologists physical status I and II scheduled for elective modified radical mastectomy for breast cancer were randomized into two groups. Group A patients received a superficial serratus plane block with 30 mL of 0.25% bupivacaine, and group B patients received a deep serratus plane block with 30 mL of 0.25% bupivacaine. Postoperatively, the Numerical Rating Scale (NRS) score was measured during the immediate postoperative period, after 30 minutes and at one, four, eight, 16, and 24 hours, as well as on the second and third day. After discharge, the NRS scores were recorded in the second and third weeks and then monthly once for three months. All patients received patient-controlled analgesia with intravenous (IV) morphine. The duration of analgesia, pain scores, and 24-hour morphine consumption were also noted. Results In group A, the mean duration of analgesia (hours) was 5.51 ± 1.42, whereas in group B the mean duration of analgesia (hours) was 6.69 ± 1.18 (p < 0.01). NRS scores for pain during rest at 12 and 16 hours and NRS scores for pain during cough at eight, 12, and 16 hours, as well as at the third month were significantly lower in group B. However, morphine consumption was comparable between the groups. Conclusions Deep serratus plane block was associated with better NRS scores for pain on rest and coughing and prolonged duration of analgesia after a modified radical mastectomy. We conclude that the deep serratus plane block provides superior and extended analgesia than the superficial serratus plane block after a modified radical mastectomy.

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery.

PurposeThoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS.Patients and MethodsIn this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1–3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed.ResultsAfter excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) (P value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups.ConclusionIntravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.