Regional Anesthesia Techniques Research Articles

Ultrasound-Guided Techniques for Postoperative Analgesia in Patients Undergoing Laparoscopic Sleeve Gastrectomy: Erector Spinae Plane Block vs. Quadratus Lumborum Block

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a common bariatric surgery. Regional anesthetic techniques decrease postoperative pain, narcotic analgesic requirements, and opioid-related adverse effects in patients scheduled for bariatric surgery. OBJECTIVES: The research team conducted this clinical trial to assess the effects of bilateral ultrasound (US)-guided erector spinae plane block (ESPB) on postoperative pain scores and postoperative analgesics consumption compared with bilateral US-guided quadratus lumborum block (QLB) in the first 24 hours following LSG. STUDY DESIGN: A randomized, double-blind, prospective, single-center study. SETTING: Ain-Shams University Hospitals. METHODS: Patients: One hundred twenty morbidly obese patients were scheduled for LSG. Intervention: Were randomly assigned to 3 groups (40 each): bilateral US-guided ESPB, bilateral US-guided QLB, or control (C) group. Measurements: The time to first rescue analgesia (ketorolac) was considered as a primary outcome. The time to perform the block, the duration of anesthesia, the time to first ambulation, the visual analog scale (VAS) at rest, VAS at movement, the total nalbuphine consumption (mg), the total requirements of rescue analgesia (ketorolac) over the first 24 hours after surgery and the study safety profile were considered as secondary outcomes. RESULTS: The time to perform the block and the duration of anesthesia were higher in the QLB group compared to other groups, with significant differences between ESPB and C groups (P < 0.001, P < 0.001, respectively). The ESPB and QLB groups were superior to the C group as regards the time to first rescue analgesia, the total dose of rescue analgesia, and the total nalbuphine consumption (P < 0.001, P < 0.001, P < 0.001, respectively). In the C group, VAS-R and VAS-M readings were higher in the first 18 hours after surgery (P < 0.001, P < 0.001, respectively). In the rest 6 hours of 24 hours after surgery, the QLB group had lower VAS-R and VAS-M readings than the C group (P < 0.001, P < 0.001, respectively). More patients in the C group had higher incidences of nausea and vomiting (P = 0.011, P = 0.002, respectively). In the C group, the time to first ambulation, the length of PACU stay, and the hospital stay were higher in comparison to the ESPB and QLB groups (P < 0.001, P < 0.001, P < 0.001, respectively). More patients in the ESPB and QLB groups were satisfied with postoperative pain management protocol (P < 0.001). LIMITATIONS: The lack of postoperative respiratory assessment (e.g., spirometry) precluded the identification of either ESPB or QLB effects on pulmonary functions in such patients. CONCLUSION: Bilateral ultrasound-guided erector spinae plane block and bilateral ultrasound-guided quadratus lumborum block provided adequate postoperative pain control and reduced postoperative analgesic requirements for morbidly obese patients scheduled for laparoscopic sleeve gastrectomy with priority to bilateral erector spinae plane block. KEY WORDS: Obesity, bariatric surgery, ultrasound, erector spinae plane block, quadratus lumborum block, postoperative, pain, analgesia

Analgesic options for anterior approach to scoliosis repair: a scoping review.

The ideal analgesic regimen for the anterior approach to scoliosis repair is not clearly defined. The purpose of the study was to summarize and identify gaps in the current literature specific to the anterior approach to scoliosis repair. A scoping review was conducted in July 2022 utilizing PubMed, Cochrane, and Scopus databases guided by the PRISMA-ScR framework. The database search generated 641 possible articles, 13 of which met all inclusion criteria. All articles focused on the effectiveness and safety of regional anesthetic techniques, while a minority also provided both opioid and non-opioid medication frameworks. Continuous Epidural Analgesia (CEA) is the most well-studied intervention for pain control in anterior scoliosis repair, but other, more novel regional anesthetic techniques offer safe and effective potential alternatives. More research is indicated to compare the effectiveness of different regional techniques and perioperative medication regimens specific to anterior scoliosis repair.

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis.

Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.

Regional Anesthesia Techniques for Shoulder Surgery in High-Risk Pulmonary Patients.

Patients with pre-existing pulmonary conditions are at risk for experiencing perioperative complications and increased morbidity. General anesthesia has historically been used for shoulder surgery, though regional anesthesia techniques are increasingly used to provide anesthesia and improved pain control after surgery. Relative to regional anesthesia, patients who undergo general anesthesia may be more prone to risks of barotrauma, postoperative hypoxemia, and pneumonia. High-risk pulmonary patients, in particular, may be exposed to these risks of general anesthesia. Traditional regional anesthesia techniques for shoulder surgery are associated with high rates of phrenic nerve paralysis which significantly impairs pulmonary function. Newer regional anesthesia techniques have been developed, however, that provide effective analgesia and surgical anesthesia while having much lower rates of phrenic nerve paralysis, thereby preserving pulmonary function.

Anticoagulation and interventional pain treatment has anything changed?

Interventional pain management bears a significant risk of hemorrhagic complications. This risk increases in patientswith coagulation disorders and those taking anticoagulant therapy. The population of the latter is growing, and manynew drugs and new treatment regimens have become widespread in recent years. The latest guidelines on the periproceduraluse of anticoagulant therapy also apply to regional anaesthesia techniques for the treatment of chronicand acute pain. However, despite the existence of guidelines and recommendations, decision-making difficultiescan still be encountered in the practice of interventional pain management. The presentation includes a summaryof existing recommendations for the prophylactic use of anticoagulants and antiaggregants in clinical practice inthe periprocedural period. Also included is a discussion of selected concerns regarding their use in the practice ofinterventional pain management.

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

INCIDENCE OF HYPOTENSION IN LSCS WITH INTRATHECAL FENTANYL –LOW DOSE BUPIVACAINE COMBINATION AND WITH BUPIVACAINE ALONE: OBSERVATIONAL STUDY

Spinal anesthesia is the most common technique of regional anesthesia for cesarean section with minimal maternal and neonatal complications as compared to general anesthesia which is associated with difcult airway and risk of aspiration. However, hypotension during spinal anesthesia for cesarean section is the most common complication associated with nausea and vomiting, altered mental status and risk of aspiration

Wound infiltration or transversus abdominis plane block after laparoscopic radical prostatectomy: a randomized clinical trial.

Regional anesthesia techniques are commonly used for postoperative pain management during laparoscopic surgery. Our aim was to compare the analgesic efficacy of pre-incisional subcutaneous wound infiltration (WI) with that of the transversus abdominis plane (TAP) block as part of a multimodal analgesic approach in laparoscopic radical prostatectomy. In this prospective, double-blinded, randomized controlled clinical trial, 60 patients were assigned to either TAP or WI group. The main outcome was acute postoperative pain control assessed using the mean numeric rating scale (NRS) at the 24 hours postoperatively. The secondary outcomes were opioid requirements, procedure-related complications, overall complications, and length of stay. In this study, 60 patients were randomized: 30 to TAP group and 28 to WI (two were excluded due to conversion to open surgery). We found no significant difference in the median (1Q, 3Q) NRS scores during the 24 h postoperatively neither at rest (TAP, 0 (0, 1) vs. WI, 0 (0, 1), P = 0.812), nor during movement (TAP, 1 (0, 2) vs. WI, 1 (0, 2), P = 0.708). There were no statistical differences in the postoperative intravenous morphine requirements in the TAP vs. WI groups during the same period (1.7 ± 3.1 vs. 1.8 ± 4.1 mg; P = 0.910). Only one patient in the TAP group presented with postoperative nausea and vomiting. Both pre-incisional subcutaneous WI and TAP blockade were associated with very low pain scores as part of a non-opioid multimodal analgesic regimen in laparoscopic radical prostatectomy. This study did not demonstrate the benefits of WI over TAP.

COMPARISION OF DEXAMETHASONE AND MAGNESIUM SULPHATE AS ADJUVANTS TO BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES USING TRANSVERSUS ABDOMINIS PLANE BLOCK

Background:Transversus abdominis plane block is regional anaesthesia technique that provides analgesia to the parietal peritoneum as well as skin and muscles of the anterior abdominal wall.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexamethasone is a potent glucocorticoid,has anti-inflammatory as well as analgesic properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of Bupivacaine with Magnesium sulphate and Dexamethasone using Transversus abdominis plane block. Methods: After approval of ethical committee and informed written consent A total of Sixty ASA grade I and II patients aged between 18-60 years undergoing lower abdominal surgeries were randomnly allocated to receive TAP block and divided into two groups of 30 each . Group BD received 20ml of 0.25% Bupivacaine +2ml(8mg) Dexamethasone , Group BM received 20ml 0f 0.25% Bupivacaine+1ml of 25% Magnesium sulphate(250mg)+1ml of normal saline respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia and side effects were recorded postoperatively. Analgesia was given when VAS score was more than 4. Results: The postoperative visual analogue scale scores was significantly less in group BM.Time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with Bupivacaine reduces postoperative pain scores, prolongs the postoperative analgesia compared with Dexamethasone without any systemic side effects.

Thoracic segmental spinal anaesthesia vs general anaesthesia for laparoscopic cholecystectomy: a comparative study

Background: Regional anaesthesia techniques are now being preferred over General anaesthesia in patients with major medical problems and those at high risk for GA. Thoracic segmental spinal anaesthesia has recently gained popularity because of its safety and efficacy in procedures like laparoscopic cholecystectomy, breast surgeries etc. Methods: A comparative study involving 50 patients of ASA grade I & II of both genders with age group of 25-55 years, weighing between 50-85 kg posted for lap. Cholecystectomy in GGH, Kakinada for a study period of 5 months. 50 Patients were divided into Group A & Group B with 25 patients in each group. After taking informed & written conscent, Group A patients were given Thoracic Segmental Spinal Anaesthesia at T10 level with Inj.0.5% isobaric Levo-bupivacaine 1.75 ml (13.75 mg) with Inj. Fentanyl 0.25 ml (25 mcg) and Group B patients were given GA with fentanyl, propofol, sevoflurane, succinylcholine and vecuronium. Results: conscious patients with less hemodynamic variability, greater duration of post operative analgesia, greater duration for first rescue analgesia were observed in Group A. Whereas greater hemodynamic variability, intubation response, more requirement of intraoperative opioid, less duration of post operative analgesia, lesser time for first rescue analgesia were observed in Group B. Conclusions: TSSA is safe alternative as it provides excellent analgesia. With TSSA, GA can be avoided in patents with comorbidities.

Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques

Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques

Anwendung regionalanästhesiologischer Verfahren zur präoperativen Analgesie bei proximalen Femurfrakturen in der Notaufnahme

Regional anesthesia (RA) techniques such as femoral nerve block (FNB) or fascia iliaca compartment block (FICB) are effective analgesia techniques in the treatment of pain from proximal femoral fractures (PFF). While in Great Britain (GB) these are already frequently used in the emergency department for preoperative analgesia, in the German-speaking D‑A-CH area (Germany, Austria, Switzerland) this seems to occur much less frequently. Therefore, the aim of this study was to survey the type and frequency of RA procedures used and to compare international practice. In the D‑A-CH area as well as in GB, registered emergency departments were contacted and invited to participate in an online survey. The survey included questions on the frequency and type of RA procedures, reasons for non-use, equipment used, person performing the procedure and medications used. The participation rate was 17.4% (142/818 emergency departments). RA procedures for preoperative analgesia in PFF were used in 18.3% (21/115) of hospitals in the D‑A-CH region and in 96.3% (26/27) in GB. The most commonly used block was the FICB in GB at 96.2% (25/26) and the FNB in Germany at 66.7% (14/21). In the D‑A-CH area, RA procedures are primarily performed by anesthesiology specialists 71.4% (15/21), and in GB by emergency department residents 65.4% (17/26). RA procedures are still performed too rarely following PFF in emergency departments in the D‑A-CH area. In international comparison with GB there is potential for improvement.

Impact of COVID-19 pandemic on anesthesia resident’s training program in Cairo University Hospital

ABSTRACT Background The purpose of this study was to evaluate the impact of COVID-19 pandemic on the training process of anesthesia residents in Cairo University Hospital regarding technical skills, operative, and critical care experience. Methods This cross-sectional survey study included two groups of anesthesia residents according to the time of their residency in relation to the pandemic (before-pandemic group [N = 44] and during-pandemic group [N = 42]). The participants were asked to fill out a questionnaire regarding their training. The questionnaire included technical skills experience (regional anesthesia, vascular access, and advanced airway techniques, soft tissue ultrasound), operative and critical care experience, and duration of intensive care unit (ICU) rotation. The quality of training was graded as adequate, moderate, or deficient training according to the number of performed procedure/managed cases. Comparisons of continuous data were done using the Mann–Whitney test, and qualitative categorical was analyzed using the chi-square test. Results All the participants completed the questionnaire. The training in the during-pandemic group was lesser than that in the before-pandemic group for most of the technical skills except for soft tissue ultrasound which was more in the during-pandemic group. The operative experience was less in the during-pandemic group than that in the before-pandemic group. On the other hand, the ICU experience was more in the during-pandemic group than that in the before-pandemic group. Conclusion The COVID-19 pandemic disrupted the training program of anesthesiology residents with regard to elective procedures and produced over-training in critical care subspeciality

Comparison of Postoperative Outcome in Children Undergoing Inguinal Hernia Repair Using Regional With General Versus General Anesthesia Alone: A Single Center Study.

Inguinal hernia repair is one of the most common general surgical procedures. It has been performed under local, regional, or general anesthesia. We hypothesized that using regional plus general anesthesia rather than general anesthesia alone would improve outcomes in neonates and pediatric patients undergoing hernia repair. This is a retrospective cohort study, including all pediatric patients who underwent inguinal hernia repair from 2015-2021. We divided patients into two groups. The first group was labeled "general anesthesia" (GA), while the second group was labeled "combined general and regional anesthesia" (GA+RA). We compared both groups in terms of demographic data, intraoperative outcome variables, and postoperative outcome variables. 212 children fulfilled the study criteria, with 57 in the GA group and 155 in the GA+RA group. Demographic and preoperative data were comparable between both groups except for age, which was 60.3±49.4 months in the GA group versus 26.7±33.13 months in the GA+RA group (p<.0001). Outcome variables demonstrated statistically significant improvement in postoperative pain occurrence, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation in the GA+RA group in comparison to the GA group with P values of 0.031, 0.02, 0.005, and 0.02, respectively. Using regional and general anesthesia techniques rather than general anesthesia alone is associated with a decrease in postoperative pain, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation. Further studies are still warranted to validate our conclusions.

Sacral Erector Spinae Plane Block As the Main Anesthetic Method for Parasacral Reconstructive Surgeries: A Single-Center Retrospective Cohort Feasibility Study.

Study objective Sacral erector spinae plane block (ESPB) is a regional anesthesia technique defined for the blockade of the posterior branches of the sacral nerves. In this study, we aimed to retrospectively evaluate our sacral ESPB applications as an anesthetic methodin patients who underwent parasacral and gluteal reconstructive surgery. Methodology The design of our study is a retrospectivecohortfeasibility study. This study was conducted at a tertiary university hospital, and patient files and electronic data systems were used to obtain data for analysis. In total, the data of 10 patients who underwentparasacral or gluteal reconstructive surgery were evaluated. Main results During reconstructive procedures for sacral pressure ulcers and lesions in the gluteal region, the sacral ESP block was utilized.Small doses of perioperative analgesics/anesthetics were required, but moderate or deep sedationor conversion to general anesthesia was not required. Conclusion Sacral ESP block is a viable regional anesthetic technique in reconstructive surgeries of the parasacral and gluteal regions.

Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.&#x0D; AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.&#x0D; MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.&#x0D; RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.&#x0D; CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

Practical strategies for the prevention and management of chronic postsurgical pain

Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.

A COMPARATIVE STUDY OF CLONIDINE AS ADJUVANT TO ROPIVACAINE AND ROPIVACAINE ALONE IN EPIDURAL ANESTHESIA FOR LOWER LIMB SURGERIES

Introduction:Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Due to similar analgesic properties, lesser motor blockade and decreased cardiotoxic tendency ropivacaine is increasingly used instead of bupivacaine now a days. Clonidine has been frequently used as an adjunct to local anesthetics because it improves the quality of anesthesia, reduces the dose requirement of the anesthetic agent and provides a more stable cardiovascular course. Aims And Objectives: 1. To evaluate effect of ropivacaine alone in epidural anaesthesia for lower limb surgeries. 2. To evaluate effect of clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. 3. To compare effect of ropivacaine alone and clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. Material And Method: The study was conducted in the department of Anaesthesiology, GGS Medical College, Faridkot, after approval by Hospital Ethical Committee. Written informed consent was obtained from each patient. The total of 90 patients were allocated into 2 groups of 45 patients each:1.Group R (n=45) - 19 ml of 0.75% ropivacaine + 1 ml of normal saline (20 ml) 2.Group RC (n=45)-19 ml of 0.75% ropivacaine + 75μg of clonidine diluted to 1 ml (20 ml). The onset time for sensory and motor block, the maximum level of sensory block , duration of analgesia and side effects were recorded. The demographic prole were comparable in terms Results: of age, sex, weight which was statistically nonsignicant in both the groups. Clonidine group (RC) had rapid onset of sensory and motor blockade (p=0.001) and prolonged duration analgesia (p=0.001). There was no statistically signicant difference in HR, SBP, DBP, MAP monitored at various intervals between the two groups. Conclusion: The use of Clonidine as an adjuvant to Ropivacaine for epidural anaesthesia produces early onset of sensory and motor blockage and prolonged the duration of analgesia as compared to ropivacaine alone, with minimal changes in haemodynamic parameters and adverse effects.

496 Erector Spine Plane Block Improves Analgesia After Minimally Invasive Awake Spine Surgery

INTRODUCTION: There is an emerging interest in lumbar spine surgery under spinal anesthesia (SA). Bilateral lumbar erector spinae plane (ESP) blocks are also described as a useful regional anesthetic technique to reduce post-operative pain after lumbar surgery. METHODS: A retrospective chart review was performed analyzing time in OR, first pain score in PACU after spinal wore off, pain scores throughout POD0, opioid requirements, PONV requiring rescue agent, and length of stay in patients that underwent spine surgery under SA before our practice adopted ESP blocks for back surgery versus patients that received an ESP block. For patients that received an ESP block, the injection was performed after skin closure above the level of the surgical intervention. Under ultrasound guidance, the erector spinae muscle layer was visualized and the block was performed with 15 ml of 0.5% bupivacaine mixed with 15 ml of liposomal bupivacaine (30 ml of local anesthetic per side). RESULTS: There was no significant difference in age, sex, ASA class, and BMI. Perioperative opioid use on POD0 was more than double in those not receiving a block (p = 0.0032). First pain score in recovery following conclusion of the spinal was greater than those who had received the intervention, p = 0.0209. Median length of stay in days was the same with a larger range in the non-intervention group. Incidence of nausea/vomiting was decreased in the group receiving ESP blocks. CONCLUSIONS: An ESP block can be used as an adjunct for minimally invasive spine surgery for enhancing recovery. Preliminary data suggests there is a trend for lower incidence of PONV as well as average pain scores on POD0 and a significant decrease in perioperative opioid use, increased same-day discharges, and improved pain scores upon conclusion of SA.

Motor Blockade After Erector Spinae Plane Block for Lumbar Spinal Surgery: A Case Report

BACKGROUND: Regional anesthetic techniques, including the erector spinae plane block (ESPB), decrease pain scores while reducing opioid consumption. Given their high safety profile and analgesic efficacy, ESPBs offer an alternative to neuraxial anesthetic techniques for perioperative analgesia. CASE REPORT: Transient unilateral dense L3 motor weakness occurred as a complication of the ESPB performed intraoperatively for an L2-L5 laminectomy and L2-L3 discectomy at the L3 level. The motor weakness was concerning for spinal cord injury and confounded the postoperative neurologic examination. CONCLUSIONS: Lesson learnt from this case suggests the lumbar ESPB should be performed preoperatively in awake patients to avoid confounding physical exam findings in the postoperative anesthesia care unit; this also reduces the need for further emergent imaging and workup. During a lumbar ESPB, a local anesthetic should be deposited at the tip of the transverse process, and not breach the intertransversarii muscle and ligament to favor the dorsal spread and sparing of ventral rami motor fibers. KEY WORDS: Erector spinae plane block, ultrasound, regional anesthesia, spine surgery