Prolonged Postoperative Analgesia Research Articles

Clinical cases of the use of ESPB as a component of combined anesthesia in patients with liver resection operations

This scientific work is devoted to the topical and applied issue of modern anesthesiology – intensive care – rational anesthesia of laparoscopic liver resections. The transformation of surgical access from «open» to minimally invasive – laparoscopic and robot–assisted – encourages anesthesiologists to search for new methods of prolonged postoperative analgesia. The tendency of modern anesthesiology to limit the use of opioids and the popularization of ultrasound technologies expand the scope of application of myofascial blockades in various fields of surgery. The techniques are safe and effective and can be implemented in various groups of patients, in particular in those who has contraindications to neuroaxial block. Currently, the most commonly used method of anesthetic provision is combined anesthesia –general anesthesia and epidural analgesia. It should be remembered about the features of surgical interventions on the liver and the associated risk of developing massive blood loss syndrome, which increases the frequency of post-operative, primarily hemorrhagic complications, after the use of neuroaxial techniques of prolonged analgesia. The sympatholytic effect of local anesthetics with prolonged epidural infusion is well known, in some cases provoking hemodynamic instability, and, as a result, the need for monitoring the patient in the intensive care unit, as well as increasing the length of hospital stay in general. This circumstance contradicts the trend of modern surgery towards rapid and accelerated recovery after surgery. The above together is economically unprofitable and does not meet the requirements of modern protocols. An in-depth analysis of clinical practice led the authors to the idea of using myofascial blocks (in particular, erector spinae plane block), which have positive qualities of neuroaxial techniques, but are characterized by a better safety profile.

Comparative study of intrathecal bupivacaine in combination with nalbuphine and bupivacaine for subarachnoid block in a tertiary care hospital

Introduction: Various adjuvant therapies have been developed to prolong intra and postoperative analgesia. A comparative study was conducted to evaluate the onset, maximum level, and duration of motor and sensory block, as well as the duration of analgesia, side effects like hypotension, bradycardia, sedation, and respiratory depression in patients undergoing elective lower segment caesarean section (LSCS). Methods: The study included 60 patients, divided in to two groups to receive intrathecal hyperbaric bupivacaine (0.5%) in combination with nalbuphine (0.8 mg) (group A) and intrathecal hyperbaric bupivacaine alone (group B). Demographic data, onset of sensory and motor block, regression of motor block, duration of analgesia, hemodynamic changes, and side effects during the procedure were recorded. Results: A statistically significant difference was observed in time of onset of sensory and motor block, and maximum percentage of sensory block was attained in group B (bupivacaine) with 90% of patients. Mean duration of sensory regression to S1 was attained at 120.16 minutes in group A (bupivacaine+nalbuphine). Mean duration of analgesia was attained at 203.33 minutes in group A, and haemodynamic parameters have remained below the baseline value in both the groups. Side effects during the surgery were statistically insignificant. Conclusion: Intrathecal nalbuphine (0.8 mg) is an effective adjuvant to 0.5% hyperbaric bupivacaine in subarachnoid block for patients undergoing elective LSCS. It provides prolonged postoperative analgesia without much side effects and may be used as a better alternative over other opioids.

A Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to 0.5% Hyperbaric Levobupivacaine for Lower Abdominal Surgeries: A Prospective, Double-Blinded, Randomized Controlled Trial.

Background Due to its affordability and ease of application, the subarachnoid block is the most frequently used method for lower abdominal procedures. Levobupivacaine has an onset of sensory and motor blockade comparable to that of bupivacaine and prolongs the duration of analgesia while facilitating quick recovery from motor block. Fentanyl and dexmedetomidine, when used as additives to intrathecal local anesthetic, can extend the duration of sensory and motor blockade and enhance postoperative analgesia. Aims and objectives The purpose of this study is to examine and compare the effectiveness of fentanyl and dexmedetomidine administered as adjuvants to 0.5% hyperbaric levobupivacaine intrathecally in lower abdominal operations with respect to block characteristics, postoperative analgesia as measured by visual analog scale(VAS) scores, hemodynamic changes, and adverse effects. Materials and methods Seventy patients were randomized into two groups of 36 each. Group LF received 15mg of 0.5% hyperbaric levobupivacaine with 25mcg of fentanyl, and Group LD received 15mg of 0.5% hyperbaric levobupivacaine with 10mcg of dexmedetomidine intrathecally. Results Patients in Group LD had a significantly longer duration of sensory and motor block than those in Group LF. In Group LF, the onset of sensory and motor blockade was faster (6.25 ± 1.89 minutes and 9.00 ± 3.24 minutes) compared to Group LD (8.70 ± 1.93 minutes and 10.95 ± 4.03 minutes). The length of sensory and motor blockade in Group LD was longer than in Group LF (308.28 ± 6.36 minutes vs. 232.28 ± 7.01 minutes and 198.20 ± 6.52 minutes vs. 157.45 ± 6.30 minutes, respectively). The total postoperative requirement for analgesics in the initial 24 hours, and the mean VAS scores were lower in Group LD. Conclusion Patients in Group LD experienced a significantly longer duration of sensory and motor block than those in Group LF. The onset of sensory and motor blockade was significantly faster in Group LF than in Group LD. The total postoperative requirement for analgesics in the initial 24 hours and the mean VAS scores were lower in Group LD. This concludes that the use of dexmedetomidine as an adjuvant to 0.5% hyperbaric levobupivacaine during the subarachnoid block provides prolonged postoperative analgesia, reduces total analgesic requirements, and maintains stable hemodynamics, while the use of fentanyl as an adjuvant to hyperbaric levobupivacaine enhances the onset of both sensory and motor blockade.

Study to Compare Epidural Bupivacaine with Buprenorphine and Bupivacaine with Fentanyl for Characteristics of Block and Prolongation of Postoperative Analgesia in Adult Orthopaedic Lower Limb Surgeries

Study to Compare Epidural Bupivacaine with Buprenorphine and Bupivacaine with Fentanyl for Characteristics of Block and Prolongation of Postoperative Analgesia in Adult Orthopaedic Lower Limb Surgeries

A Randomized Controlled Trial to Compare the Analgesic Efficacy of Ultrasound-Guided Fascia Iliaca Compartment Block and Femoral Nerve Block in Patients with Neck of Femur Fracture

ABSTRACT Background and Aims: Regional nerve blocks under ultrasound guidance have heralded the era toward safer anesthetic practices. They provide adequate analgesia during positioning for subarachnoid block in patients posted for hip. We aimed to compare the analgesic efficacy of fascia iliaca compartment block and femoral nerve block for pain during sitting position for subarachnoid block, duration of post-op analgesia, and document any complications. Material and Methods: A randomized double-blind study was conducted in 60 patients undergoing isolated neck of femur fracture surgery under subarachnoid block. They were randomized by a computer-generated randomization table into two groups – group A received a fascia iliaca compartment block and group B received a femoral nerve block. Numeric rating score (NRS) was noted before block, during positioning, and postoperatively for 24 hours. An independent sample t-test and a paired t-test were used for intergroup and intra-group comparisons. Results: The mean NRS before block in group A (7.57 ± 0.50) and group B (7.40 ± 0.49) (P-value = 0.203) was not significant. NRS during positioning in group A (2.10 ± 0.88) was significantly lower than group B (3.33 ± 0.71) (P-value = 0.001*). The mean NRS from the sixth till 20th hour postoperatively was significantly higher in group B compared to group A (P-value <0.05 for all). The mean time to first rescue analgesia was significantly longer in group A (23.57 ± 2.22 hours) compared to group B (11.97 ± 1.73 hours) (P-value = 0.001*). No complications were noted during the study. Conclusion: Fascia iliaca compartment block gives significantly better pain relief during positioning for subarachnoid block and prolonged postoperative analgesia as compared to femoral nerve block.

A Comparative Study between Ultrasound-guided Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Versus Infraclavicular Block Alone

Abstract Background: Peripheral nerve blocks can be used alone as the sole “surgical” anesthetic technique as the initial step in providing prolonged postoperative analgesia. There are studies, where accurate deposition of local anesthetic perineurally has the potential to improve the success rate and reduce the incidence of complications of the infraclavicular block. We hypothesized whether a combined block of the infraclavicular brachial plexus and distal median, radial, and ulnar nerves would accelerate upper extremity anesthesia compared with an infraclavicular block alone. Materials and Methods: This study was a prospective randomized control study conducted among 60 patients undergoing elective and emergency wrist and hand surgeries. A group of 30 patients received an infraclavicular block with 30 mL of a local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine from Group A. Group B received an infraclavicular block with 15 mL of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine along with distal median, radial, and ulnar nerve blockade with 5 mL each of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine. Pain score, assessment of sensory and motor functions, block performance time, and surgical anesthesia were observed. Results: The mean block performance time of Group A was 10.9 ± 1.1 min and Group B was 14.7 ± 0.5 min. The difference between the two groups’ block performance minutes was statistically significant (P < 0.001). The difference in the onset of the sensory block between the two groups was statistically significant (P < 0.001). The mean onset of motor blockade between the two groups was statistically very highly significant (P < 0.001). The mean of Group A was 5.0 ± 0.2 and Group B was 2.1 ± 0.4. Conclusion: From this study, we conclude that using an approximately equivalent dose of local anesthetics, combining ultrasound-guided infraclavicular block with distal median, radial, and ulnar nerve blockade shortens the onset time of sensory and motor block with improved block consistency compared to infraclavicular block alone.

A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery

Background & Objectives: Arthroscopic surgery is a preferred approach for shoulder surgeries due to its documented advantages of early postoperative recovery. However, postoperative pain remains a concern for which different techniques are used. Interscalene block (ISB), using dexmedetomidine (DXM) or dexamethasone (DXA) as adjuvants to local anesthetics (LA), is a common analgesic method. We conducted this comparative study to establish if any one of the adjuvants is better in terms of postoperative analgesia. Methodology: Patients undergoing shoulder arthroscopy were assigned randomly to three groups: Group A (LA alone), Group B (ISB with DXM), and Group C (ISB with DXA). Assessment of intraoperative and postoperative hemodynamics, visual analog scale (VAS) pain scores, time to first rescue analgesic, and rescue analgesic (ketorolac) consumption were recorded. Results: Intraoperative and postoperative heart rate and mean arterial pressure showed no significant differences among the three groups, suggesting comparable hemodynamic control. VAS pain scores were equivalent at 1, 2 and 6 h postoperatively, but at 12, 18 and 24 h, Groups B and C demonstrated significantly lower scores compared to Group A (P < 0.001). Time to first rescue analgesic was prolonged in Groups B and C, indicating improved and longer-lasting analgesia. Groups B and C consumed considerably less ketorolac overall than Group A (P < 0.001). Conclusion: While all three groups exhibited equivalent intraoperative and postoperative hemodynamic control, the addition of dexmedetomidine or dexamethasone to local anesthetics for interscalene block prolonged postoperative analgesia, reduced pain scores at 12, 18 and 24 h, delayed time to first rescue, and decreased total analgesic consumption. Both adjuvants showed advantages over local anesthetics alone, emphasizing their potential in multimodal analgesia for shoulder arthroscopy. Abbreviations: ISB - Interscalene block; DXM - Dexmedetomidine; DXA - Dexamethasone; HR – Heart Rate; MAP – Mean Arterial Pressure; VAS Visual Analog Scale. Trial registry: PACTR202210507488378 Keywords: Analgesia; Analgesia, postoperative; Dexmedetomidine; Dexamethasone; Interscalene block; Pain, postoperative; Shoulder arthroscopy Citation: Nashaat P, Mohamed O, George S, Mohammed A, Samy E. A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery. Anaesth. pain intensive care 2024;28(5):850−858; DOI: 10.35975/apic.v28i5.2566 Received: June 13, 2024; Reviewed: June 20, 2024; Accepted: July 18, 2024

Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study

BackgroundNasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA. ObjectivesThis study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption. Patients and methodsThis double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side. ResultsA significant decrease in the incidence of EA was found in G1 compared to G2 (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h vs. 3 h). ConclusionSPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery. RegistrationNational Clinical Trial Registry, NCT04168879.

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

Abstract Background In arthroscopic knee surgery, managing postoperative pain is crucial for patient outcomes. Dexamethasone, combined with local anesthetics in adductor canal block, offers potential advantages, such as vasoconstriction and anti-inflammatory effects. This approach proves safe, prolongs sensory block duration, delays the need for analgesics, and enhances patient satisfaction, addressing challenges associated with epidural analgesia and femoral nerve block. Overall, it signifies a valuable strategy in anesthesia practice, contributing to prolonged analgesia, reduced opioid use, and faster recovery in knee arthroscopy. Aim of the Work The study aims to assess the effectiveness of perineural dexamethasone combined with bupivacaine in adductor canal block for postoperative pain control following knee arthroscopy with spinal anesthesia. The primary focus is on determining the duration of postoperative analgesia. Secondary objectives involve evaluating the effectiveness of analgesia one day after surgery and assessing opioid consumption. Patients and Methods This randomized, double-blinded controlled trial at Ain Shams University hospitals investigates the efficacy of adductor canal block with dexamethasone in knee arthroscopy under spinal anesthesia. Sixty adult patients are randomly assigned to receive either bupivacaine with dexamethasone (Group A) or bupivacaine with saline (Group B). Primary outcomes include postoperative analgesia duration, and secondary outcomes involve morphine use, patient demographics, surgical time, and complication rates. Ethical considerations and detailed study procedures are outlined, ensuring patient safety and methodological rigor. Results In a randomized study for arthroscopic knee surgery, dexamethasone added to bupivacaine in adductor canal block significantly extended sensory block duration and delayed the time to first analgesic requirement. Visual analog scale scores were lower, and morphine consumption was reduced over 24 hours postoperatively. While systemic effects of dexamethasone were not assessed, consistent with other studies, its addition to local anesthetics in various nerve blocks demonstrated prolonged analgesia. Patient satisfaction was notably higher in the dexamethasone group, likely influenced by increased pain relief duration and reduced side effects. 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.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intravenous Patient Controlled Analgesia for Post-Operative Analgesia in Patients Undergoing Lower Abdominal Surgeries under Spinal Anesthesia

Abstract Background poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Aim of the Work to compare the efficacy of TAP block versus PCA with IV morphine to provide prolonged post-operative analgesia; secondary objective is to identify the side effects of both techniques as post-operative analgesia Patients and Methods The study was conducted on 40 randomly chosen patients aged 21 to 70 years in both sexes, American Society of Anesthesiologists (ASA) class I or II scheduled for elective lower abdominal surgeries under spinal anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. Results TAP block is given in the volume of 20 mL bilaterally, it is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect Also TAP block delay using of postoperative additional analgesia, however PCA analgesic effect last longer, less invasive technique and easier to be used while TAP require hand skills and limited to 24 hours analgesia only. Conclusion In lower abdominal surgery, when TAP block is given in the volume of 40 mL, it is as effective as intravenous PCA in pain treatment. Compared with intravenous PCA, TAP block can be considered as a more preferable method because it can avoid the systemic actions of morphine.

Comparison between Preoperative Ultrasound Guided TAP Block and Caudal Block in Inguinal Hernia Repair in Paediatrics for Intraoperative and Postoperative Analgesia

Abstract Background Inguinal hernia repair is the most common scheduled sub-umbilical surgery done in day case paediatric surgical units. Using optimal analgesic regimens is essential to provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anaesthetic techniques are commonly used to facilitate pain control in paediatric surgical procedures. Aim of the Work To compare the effectiveness and safety of US guided TAP versus caudal block for postoperative analgesia in paediatric patients undergoing Unilateral Inguinal hernia repair. Patients and Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 20 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anaesthesia followed by the block at the beginning of the operation. Results the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in paediatric patients and also demonstrated that both analgesic techniques are safe. Conclusion From our study we can conclude that Ultrasound-guided transversus abdominis plane block and caudal epidural block are effective analgesics in children undergoing inguinal hernia repair surgery, with transversus plane block providing longer analgesic effect and decreased pain scores.

Bupivacaine vs Bupivacaine with Dexmedetomidine for the Caudal Epidural Block as an Adjuvant to General Anesthesia in Lumbosacral Surgeries

Abstract Background A caudal epidural block can be incorporated as a part of multimodal analgesia for lumbosacral spine surgeries. Utilizing a combination of different analgesic modalities, achieving better pain relief, sparing opioids and decreasing their adverse effects, it is a simple and safe technique that can be easily performed under fluoroscopy in the prone position. Using an optimal analgesic regimen provides safe and effective analgesia, reduces postoperative pain, and accelerates recovery from surgery. Aim of the Work to compare the effectiveness and safety of Bupivacaine vs. Bupivacaine and Dexmedetomidine in the fluoroscopy-guided caudal epidural block for postoperative analgesia in patients undergoing lumbosacral surgeries combined with general anesthesia. Patients and Methods The study was conducted on 60 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 30 patients. Results revealed that Fluoroscopy-guided caudal epidural block using Bupivacaine and Dexmedetomidine provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with Bupivacaine only in patients undergoing lumbosacral surgeries and demonstrated that both analgesic techniques are safe. Conclusion Bupivacaine and Dexmedetomidine provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with Bupivacaine alone in patients undergoing lumbosacral surgeries under general anesthesia and also demonstrated that both analgesic drugs are safe.

Comparison between Pectoral Plane Block (PECS 1 and 2) and Patient Controlled Intravenous Analgesia after Breast Surgeries

Abstract Background Breast cancer has continued to be the most common cancer among women, accounting for 31% of all new cancer cases in the female population. Every/ year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers. Aim of the Work The primary aim of this study is to compare the efficacy of PECS 1,2 block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques, as well as intra-operative analgesia. Patients and Methods A randomized controlled Clinical trial in Ain Shams University Hospitals, Cairo, Egypt (EL Demrdash hospital and Combined operations) for 6 months carried out on women who undergo breast surgeries. Results The Results shows that the VAS score in the PECS group was highly significant lower at the 1st, 2nd and 4th hours postoperative, the time interval for the 1st dose of rescue analgesia was higher in PECS group, there was significant difference regarding heart rate and blood pressure between both groups at 1st, 2nd, 4th and 8th hours postoperative in favor for PECS group, regarding o2 saturation it was significant only after 1 hour postoperative, regarding nausea and vomiting there was significant difference in nausea in favor for PECS block while regarding vomiting it was non- significant, regarding sedation it didn’t occur in neither group so it was not applicable. Conclusion In modified radical mastectomy, PECS block is more effective than intravenous PCA in pain management postoperative, better effect on vital data like heart rate, blood pressure and o2 saturation, it also lowers the analgesic drugs consumption postoperative. Moreover, PECS block is more preferable method because it avoids the systemic side effect of morphine used for PCA like nausea and vomiting. PCA analgesic effect needs time to start its action.

Liposomal Bupivacaine in Managing Postoperative Pain Following Shoulder Surgery

To optimize postoperative analgesia following shoulder surgery, current literature recommends multimodal approaches, including the use of regional liposomal bupivacaine (LB), a long-acting local anesthetic. The liposomal formulation of bupivacaine affords it a longer duration of action without a substantial peak plasma concentration; this combined with 3% free bupivacaine provides patients with substantial, prolonged postoperative analgesia following shoulder surgery. The use of LB as part of a multimodal approach to postoperative pain results in diminished use of opioids, reduced pain, and decreased length of hospitalization. Current literature supports these effects following a wide variety of shoulder procedures; however, some studies describe no benefit and list drawbacks including higher costs when electing to use LB instead of comparable, more affordable treatment modalities. In the interest of reducing the number of opioid prescriptions following orthopedic procedures, it is imperative to continue investigating the efficacy of LB as an opioid-sparing pain reducer. Recent literature suggests certain patient populations may be less suitable for implementing this treatment modality; namely those with a history of opioid use, prior surgeries, substantial systemic illness, and existing cardiopulmonary compromise. Patient demographics may be an additional consideration when determining the potential utility of LB to optimize analgesia after shoulder surgery.

Comparing the Efficacy of Landmark-Based Fascia Iliaca Compartment Block and Pericapsular Nerve Group Block for Preoperative Positioning and Postoperative Analgesia in Patients Undergoing Surgery for Hip Fractures: A Randomized Controlled Trial.

Subarachnoid block is the most common anesthetic technique for patients having corrective hip surgeries. However, adequate positioning for a successful subarachnoid block is a major challenge in this particular population of patients, owing to the site of fracture. Regional anesthesia, in the form of nerve blocks, is an effective means of alleviating such constraints and gives an added benefit of prolonged postoperative analgesia. The pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB), under ultrasonography guidance, are a few examples of the commonly performed peripheral nerve blocks in such settings. However, the landmark-based techniques of nerve blockade still hold good in many resource poor settings, given the lack of ultrasonography facilities. To compare the ease of spinal positioning using the patient sitting satisfaction score between the landmark-guided FICBand PENG block. This study was done on 80 patients of the American Society of Anesthesiology (ASA) grade I or II with intertrochantericfractures of the hip joint scheduled for proximal femoral nailing. Patients were allocated into two groups of 40 each through computer generated random numbers, to receive 30 ml of 0.5% ropivacaine via the landmark-guided technique of FICB in Group F and peripheral nerve stimulator assisted landmark-guided PENG block in Group P, 30 minutes prior to spinal positioning. Time to passive leg raise (PLR) to 15 degrees and time to PLR to 30 degrees with a standard goniometer guidance at visual analogue scale (VAS) score < 4 and ease of spinal positioning through the sitting satisfaction score at the 30th minute were assessed. Any adverse effects and events of failure were noted. The duration of postoperative analgesia was measured through the time to the first dose of paracetamol on arrival at the post-anesthesia care unit. Statistical analysis was done using JASP version (0.18.3.0) using the independent samples t-test and significance was taken when p value was < 0.001. The time to PLR to 15 degrees and 30 degrees were achieved faster in the patients who received the PENG block in comparison to the patients who received the FICB, and the average patient sitting satisfaction score was significantly higher in Group P as compared to Group F (p < 0.001). While the overall amount of analgesics used in both groups was similar, the overall period of postoperative analgesia was prolonged in Group F compared to Group P (p < 0.001). The landmark guided PENG block is feasible and superior to the landmark-guided FICB for preoperative positioning and analgesia. The FICB provides a longer duration of postoperative analgesia for patients with intertrochanteric fractures.

Parasacral ischial plane block for lower limb surgeries: A case series

The para-sacral ischial plane block (PIP block) is a novel fascial plane approach targeting the sacral plexus. This technique simplifies the process as direct visualization of the sacral plexus or sciatic nerve is unnecessary. This retrospective case series includes ten patients with American Society of Anesthesiologists (ASA) physical status II-IV, aged over 18 years, undergoing elective or emergency lower limb surgeries such as debridement and below-knee amputation between May 2023 and November 2023. The block was performed in ≤ 6 minutes for all patients. Onset of subjective analgesia was almost immediate in those presenting with pain. Sensory loss occurred within 9 to 12 minutes. Motor block in the sciatic nerve distribution did not reach Grade 2 in any patient. Hemodynamic stability was notably maintained in all high-risk cases. Intraoperative supplementation with ketamine was required for one patient. The PIP block is a quick, easy-to-perform technique that offers satisfactory surgical conditions and hemodynamic stability in high-risk patients undergoing lower limb surgeries. It also provides prolonged postoperative analgesia and early resumption of oral intake with minimal procedural discomfort.

Comparison of the effect of intrathecal fentanyl citrate and magnesium sulfate as adjuvants to hyperbaric levobupivacaine 0.5% for spinal anesthesia in patients undergoing lower limb orthopedic surgeries

Background: Subarachnoid blockade is a safe, reliable, and inexpensive technique that provides surgical anesthesia along with prolonged post-operative analgesia. The quality of subarachnoid block is enhanced by the addition of intrathecal adjuvants, such as fentanyl citrate and magnesium sulfate to hyperbaric levobupivacaine. Aims and Objectives: The aim of this study was to compare the effects of fentanyl and magnesium sulfate as adjuvants to 0.5% hyperbaric levobupivacaine in orthopedic surgeries under subarachnoid block. Materials and Methods: This prospective randomized study included 90 American Society of Anesthesiologists Grade I and II patients aged 18–60 years undergoing orthopedic surgeries. Group LS received 3 mL 0.5% levobupivacaine heavy+0.5 mL normal saline. Group LF received 3 mL 0.5% levobupivacaine heavy+fentanyl 25 μg, and Group LM, 3 mL 0.5% levobupivacaine heavy+magnesium sulphate 50 mg+0.4 mL normal saline. The onset and duration of sensory and motor block and intraoperative hemodynamics were recorded. In the post-operative period, duration of analgesia, Visual Analog Scales scores, and side effects were observed. Results: The onset of sensory block was 4.04±0.74 min in Group LM (P&lt;0.001) as compared to Groups LF (2.01±0.23 min) and LS (2±0.24 min). The onset of motor blockade took 5±1.14 min in the control group, 7.01±0.94 in group LF, and 8.11±1.33 min in group LM (P&lt;0.001). The duration of analgesia in group LS was 183.73±12.08 min, 317±18.6 min in group LF, and 219.43±20.89 in group LM (P&lt;0.001). Conclusion: The addition of fentanyl and magnesium as adjuvants enhanced the quality of subarachnoid block when added to hyperbaric levobupivacaine. The duration of analgesia was longest in fentanyl, followed by magnesium and then control. The incidence of side effects was greatest in fentanyl, followed by control and nil in magnesium.

A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy

Abstract Background Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery. Aim of the Work The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques. Patients and Methods This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation. Results The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant. Conclusion In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.

Comparison of Post-Operative Analgesia of Caudal versus Dorsal Penile Nerve Blocks for Pediatric Patients Undergoing Hypospadias Repair

Abstract Background Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects. Aim of the Work The aim of this study is to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics. Methodology This prospective randomized comparative clinical study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 30 male patient aged (1–8) years, ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Penile block (n = 15) received dorsal penile nerve block by using the subpubic approach technique. Group C: Caudal block (n = 15) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was statistically high significant difference between the two groups in postoperative MAP and HR (p value &amp;lt;0.001) but no statistically significant difference between them in Spo2. FLACC pain scores were significantly lower in group C compared with group P at PACU and 3 hours postoperative (p value &amp;lt;0.001) but no statistically significant difference between them at 6, 9 and 12 hours postoperative. Also, The time for first rescue analgesia was significantly longer in caudal group compared with penile group (P &amp;lt; 0.001) and the total analgesia consumption was also significantly lower (P &amp;lt; 0.001) in group C compared with group P. Postoperative time of ambulation was significantly lower (P &amp;lt; 0.001) in group P compared with group C. Conclusion The current study revealed that Caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with Penile block in pediatric patients undergoing hypospadias repair.

Ultrasound-Guided Pudendal Nerve Block versus Caudal Block for Post-Operative Analgesia in Penile Surgeries in Children

Abstract Background Penile surgeries as hypospadias, urethroplasty and circumcision are of the most frequently performed surgical procedures in the pediatric male population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. This study was to compare the effectiveness and safety of ultrasound (US) guided pudendal nerve block (PNB) versus caudal block (CB) for postoperative analgesia in pediatric male patients undergoing penile surgeries. Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups (20 each group) either receiving ultrasound-guided pudendal nerve block (PNB group) or caudal epidural block (CB group). In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. The two groups were adequately monitored and assessed pre, intra and post-operatively and they were compared regarding demographic data, pre, intra and postoperative hemodynamics, postoperative pain control using objective pain scale (OPS) score, consumption of paracetamol in the 1st 24 hours postoperatively and complications of both anesthetic techniques. Results This prospective randomized controlled single-blind clinical study was performed on total 40 patients of age 3 to 10 years scheduled for penile surgeries. For the primary outcome, there was a statistically significant increase in time to first analgesia in PNB group than CB group with p value &amp;lt; 0.001 while there was a statistically significant increase in total dose of paracetamol in CB group than PNB group with p value &amp;lt; 0.001. For OPS score, there was a statistically significant increase in pain score in CB group than PNB group at 6 h, 12 h and 24 h with p value = 0.02, 0.005 and 0.01, respectively. Conclusion From our study we can conclude that US guided PNB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in pediatric patients undergoing penile surgeries and also demonstrated that both analgesic techniques are safe.