Postoperative Analgesic Request Research Articles

Dexmedetomidine versus labetalol for induced hypotension during functional endoscopic sinus surgery: a randomized, double-blind study

Background & Objective: Functional endoscopic sinus surgery (FESS) is a surgical procedure for treating sinus diseases. Bleeding is a common concern during FESS, so maintaining hemodynamic stability and ensuring quality surgical field visibility is crucial for achieving the best outcomes. The present study compared the time taken to achieve target mean arterial pressure (MAP) when using dexmedetomidine or labetalol during FESS and assessed the quality of the surgical field to establish the better choice of the two. Methodology: The study was conducted as a prospective, randomized, double-blinded clinical study. Sixty patients classified as American Society of Anesthesiologists grade I or II, undergoing FESS under general anesthesia, were divided into two groups, each with 30 patients. Group D patients received dexmedetomidine and Group L received labetalol. The study aimed to maintain the mean arterial pressure (MAP) between 60-70 mmHg. The operative field visibility was assessed using the Fromme and Boezaart scoring system. Emergence time and postoperative first analgesic request time were also recorded. Results: The time taken to achieve target MAP (60-70 mmHg) was less in Group D (15.1 ± 0.2 min) than in Group L (18.2 ± 0.5 min), and it was statistically significant (P < 0.05). Although insignificant, lower MAP were observed in the Group D than Group L. A significantly lower heart rate was observed at defined intervals in Group D than in Group L. The visibility of the surgical field in both groups has comparable results. The first analgesic request time was considerably longer in Group D (52.2 ± 1.9) compared to Group L (10.2 ± 2.1) (P < 0.05). Conclusion: Dexmedetomidine provided better hemodynamic stability and operative field visibility than Labetalol during FESS. Abbreviations: FESS - Functional endoscopic sinus surgery; MAP - Mean arterial pressure; EtCO2 - end-tidal carbon dioxide Keywords: Dexmedetomidine; Labetalol; Controlled Hypotension; Mean Arterial Pressure Citation: Gupta S, Yadav I, Saxena A, Bagla RK, Nazir N. Dexmedetomidine versus labetalol for induced hypotension during functional endoscopic sinus surgery: a randomized, double-blind study. Anaesth. pain intensive care 2024;28(4):652−657; DOI: 10.35975/apic.v28i4.2507 Received: May 19, 2024; Reviewed: June 08, 2024; Accepted: June 08, 2024

A comparative study of respiratory effects of erector spinae plane block versus paravertebral plane block for women undergoing modified radical mastectomy

BackgroundInadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM.MethodsThis prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine.ResultsRespiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects.ConclusionBoth ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups.ClinicalTrials.gov IDNCT03614091 registration date on 13/7/2018.

Comparative Study between Dexmedetomidine and Nitroglycerin as a Hypotensive Agent and Their Effects on Bleeding in Functional Endoscopic Sinus Surgery

Abstract Background Rhino-sinusitis is commonly treated with FESS. However, there can be serious complications associated with this procedure during peri-operative period like orbital cellulitis, optic nerve injuries, meningitis, etc. Their incidence increases with excessive bleeding during surgery. So Controlled hypotension is used reducing arterial blood pressure 30-40% below its normal range. Objective Primary aim: Comparing Dexmedetomidine and Nitroglycerine for inducing controlled hypotension in patients undergoing FESS with recording total intraoperative fentanyl consumption and recording of total local vasoconstrictor used by the surgeon. Secondary aim: Assessment of time to full recovery after extubation with recording of time to first analgesic used after recovery and its total dose for the first 24 hours. Materials and Methods In this study we compare Demedetomidine and Nitroglycerine in achieving hypotensive anaesthesia. The study is conducted in Anesthesiology Department, Faculty of medicine, Ain shams University. The study period is 6 months. The sample size is 50 patients divided in two groups randomly (Group I and Group II). Each group has 25 patients. Group I received Demedetomidine. Group II received Nitroglycerine. Results we find that the mean HR was significantly lower in Group I compared to Group II at all the times of measurements. The MAP was significantly lower in Group I compared to Group II after infusion of study drugs, after induction of anesthesia, after intubation and 5 min after intubation. However, the desired MAP for intra-operative induced hypotension could be achieved in all the two groups. Also we find that intra-operative Fentanyl requirement is significantly reduced in the Dexmedetomidine group as compared to the other group. The patients in group I had a longer time to full recovery. We also observe a significant delay in the first postoperative analgesic request in group I as compared to group II. It has been shown that perioperative analgesic requirements are significantly reduced with intra-operative use of Dexmedetomidine infusion. The patients in the Dexmedetomidine group had significantly higher sedation scores compared to group II. The incidence of postoperative shivering was significantly lower in the Dexmedetomidine group. The most frequent reported side-effect with Dexmedetomidine is dry mouth, which can be easily managed. Conclusion Dexmedetomidine provided better hemodynamic stability and comparable operative field visibility to nitroglycerine during FESS. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation.

Use of Dexmedetomidine versus Nitroglycerine to Provide Hypotensive Anesthesia in ENT Surgeries (Functional Endoscopic Sinus Surgery)

Abstract Background controlled (deliberate/induced) hypotension is a technique by which the arterial blood pressure is lowered in a controllable manner to reduce surgical blood loss and improve the operative field visibility. There are pharmacological and nonpharmacological techniques for inducing hypotension. The nonpharmacological methods for deliberate hypotension include positioning and positive pressure ventilation to control venous return. Aim of the Work to evaluate the efficacy of dexmedetomidine (DEX) as a hypotensive agent in comparison to nitroglycerin (NTG) in FESS regarding the bloodless field, reduction of mean arterial blood pressure, decrease inhalational anesthetic requirements (MAC), decrease perioperative opioid requirements, increase the time to first postoperative analgesic request and recovery profile and increase hemodynamics stability. Patients and Methods we conducted this study on 20 patients who were planned to perform functional endoscopic sinus surgery and were randomly distributed into 2 equal groups: 10 patients received dexamedotomidine and equal number of patients received nitroglycerine. Serial measurements of mean arterial blood pressure and heart rate were obtained and records between both groups were compared. Results There were statistically significant differences between both groups regarding heart rate as mean values of heart rate were lower among dexamedotomidine group. There were no statistically significant differences between both groups regarding mean arterial blood pressure values at different time points during the operation. Regarding the period after stopping infusion, mean values of heart rate and blood pressure were lower among dexamedotomidine group than nitroglycerine group after 5 minutes and after 10 minutes and the differences had statistically significant differences. Regarding postoperative period, both groups were comparable regarding heart rate and blood pressure immediately postoperative. Conclusion From the results of this study, we could conclude that both Dexmedetomidine and Nitroglycerin can be effectively used in induced hypotensive anesthesia for ENT surgery as FESS. Both groups were comparable with intra operative MAP with no statistically significant differences. This study also show that Dexmedetomidine has added advantages as better haemodynamic stability than Nitroglycerin (No rebound HTN, no tachycardia). Has sedative and analgesic effect, reduce requirement of anesthetic agents and perioperative analgesia. Postoperative recovery score (Time to reach modified Aldert score more than nine significantly higher. Postoperative complication as nausea and vomiting is less.

A Comparative Study of Fixed-Dose Dexmedetomidine and Propofol Infusions on Intraoperative Desflurane Consumption During Bispectral Index-Guided Laparoscopic Surgeries: A Randomized Controlled Study.

Background Desflurane is an excellent but expensive volatile anesthetic agent. Dexmedetomidine and propofol may decrease intraoperative desflurane consumption. This study aimed to compare the desflurane-sparing effect of dexmedetomidine and propofol in patients undergoing laparoscopic surgeries under bispectral index (BIS)-guided general anesthesia (GA). Methods Sixty-two adult patients, ASA (American Society of Anesthesiologists) physical status I or II, of either sex, aged between 18 and 60 years, were randomly allocated into group D or group P. Only group D patients received an intravenous (IV) bolus of dexmedetomidine (1 mcg/kg) over 15 minutes before induction. In both groups, GA was induced following the standard protocol with propofol infusion (0.5 mg/kg/min) until the BIS value dropped below 60. For maintenance, group D and group P patients received IV dexmedetomidine infusion (0.5 mcg/kg/h) and propofol infusion (50 mcg/kg/min), respectively. In both groups, desflurane dial concentration was adjusted between 3 and 8% to maintain the BIS within the range of 45-55. An hourly bolus of IV fentanyl (0.5 mcg/kg) and a half-hourly bolus of IV vecuronium (0.02 mg/kg) were administered. The total amount of desflurane consumed, duration of pneumoperitoneum, extra aliquots of propofol used during maintenance, number of boluses of IV atropine, fentanyl, and esmolol, time to attain Ramsay Sedation Score of 2 after extubation, time to first postoperative analgesic request at Numerical Rating Scale (NRS) score ≥ 4, time to reach a Modified Aldrete Score of ≥9, and incidence of any side effects were recorded. All the data were analyzed and compared using appropriate statistical tests, and a p-value of <0.05 was considered significant. Results The final data analysis was performed on 60 patients. The mean desflurane consumption was clinically higher in group P patients than in group D, but the difference was statistically insignificant (p-value > 0.05). The mean induction dose of propofol was significantly less in group D than in group P (p-value < 0.05). After extubation, the difference in time to the first analgesic request (NRS ≥ 4) between the groups was statistically significant (p-value < 0.05). Group D patients had a residual intraoperative analgesic effect. Conclusion The effects of dexmedetomidine and propofol infusions on desflurane consumption in laparoscopic surgeries are comparable, with minimal effects on intraoperative hemodynamics and postoperative recovery profiles.

Perioperative oral pregabalin or clonidine in patients undergoing lumbar spine posterior fusion: A randomized controlled trial

ABSTRACT Background Multiple techniques and pharmacological efforts have been tried to control intraoperative hemodynamic fluctuations, reduce perioperative blood loss and severe postoperative pain. This study aimed to assess the perioperative effects of oral premedication with pregabalin or clonidine for lumbar spine posterior fusion under general anesthesia (GA). Outcome measures: Perioperative blood loss, hemodynamics, anesthetics consumption, postoperative pain, and side effects Methods This is a prospective, triple blinded randomized placebo-controlled trial (RCT). Ninety-six adult ASA I-II patients of either sex undergoing lumbar spine posterior fusion were randomly assigned to obtain a placebo (group E), pregabalin 300 mg (group P), or clonidine 200 μg (group C) orally 90 minutes before induction of GA. Trial registration: www.pactr.org with (PACTR201710002416280). Results Preemptive oral pregabalin 300 mg and clonidine 200 μg optimized intraoperative hemodynamics, reduced perioperative blood loss than the placebo group (by 22.2% and 30.7%, respectively), reduced postoperative pain scores, and anesthetic and postoperative analgesic consumption. In addition, they prolonged the duration to the first postoperative analgesic request. There was no major complication in any group. Conclusion Premedication with pregabalin or clonidine reduced perioperative blood loss and optimized intraoperative and postoperative hemodynamics, with the preference for clonidine over pregabalin as well as both reduced postoperative pain scores, analgesic requirements, PONV, and shivering. Sedative drugs should be used in lower doses to avoid oversedation. Pregabalin-associated dizziness and visual disturbance may necessitate extra precautions and patient education.

Perioperative duloxetine improves postoperative outcomes after anterior talofibular ligament repair for chronic lateral ankle instability for patients with depression: A prospective randomized clinical trial

BackgroundRecent studies have indicated that depression is associated with persistent postoperative pain and decreased satisfaction following foot and ankle surgery. This study aimed to evaluate the effect of perioperative duloxetine on postoperative outcomes of anterior talofibular ligament (ATFL) surgical repair for chronic ankle instability (CAI) in patients with depression. We further sought to evaluate patients’ satisfaction and side effects related to duloxetine. Material and methodsPatients undergoing ATFL repair were screened for depression preoperatively with the Patient Health Questionnaire (PHQ-9). Among 249 patients who underwent arthroscopic or open surgical Brostrom repair of the ATFL, 120 patients were identified as being “possibly depressed” and were included in the study. Sixty patients were randomly assigned to the duloxetine group (one day preoperatively and for 6 weeks postoperatively), and the other sixty were randomized to the placebo group. Painkillers and opioid consumption, pain scores, and patient satisfaction were recorded at 12, 24, 48, and 72hours postoperatively and at follow-up visits 1, 3, and 6 months after surgery. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 3, 6, 12 and 24 months postoperatively. Duloxetine-related side effects such as nausea/vomiting and fatigue were also recorded. ResultsThe patients in the duloxetine group reported a significantly longer time to rescue analgesic and reduced opioid requirements (including celecoxib, pregabalin, acetaminophen, and tramadol). The patients experienced decreased pain intensity and greater satisfaction with their pain management at 24, 48, 72h and 1 and 3 months after surgery (p<0.05). The duloxetine group also had significantly better clinical and functional outcomes at 3 and 6 months of follow-up compared to the placebo group (p<0.05). The occurrence and rate of symptoms of duloxetine side effects were not significant. DiscussionDepression is an important factor to consider and address because its presence before surgery can predict poor postoperative outcomes, including more severe postoperative pain, persistent postoperative pain, and increased consumption of painkillers and opioids. ConclusionPerioperative administration of duloxetine following ATFL repair for CAI in patients with depression increased the time to first postoperative rescue analgesic request and reduced both opioid consumption and postoperative pain. This approach also led to a high level of patient satisfaction. In addition, duloxetine improved the quality of recovery without leading to significant side effects. Level of evidenceI; prospective randomized controlled trial.

Effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia in lower abdominal surgery, Randomized controlled trial

BackgroundThe purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia.MethodsTwo hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects.ResultsThe Dexa group had significantly delayed onset of 2 dermatomes regression (P < 0.001) compared to the control group. Additionally, the Dexa group had significantly longer duration of both sensory block (P = 0.01) and motor block (P < 0.001). The Dexa group had significantly longer duration until the first postoperative analgesic request (P < 0.001) and a lower incidence of side effects compared to the control group.ConclusionAlthough the intravenous administration of dexamethasone had a limited effect on the duration of hyperbaric bupivacaine spinal anesthesia, it improved postoperative VAS scores compared to the control group and decreased overall postoperative analgesic consumption. Therefore, it can be considered a valuable addition to postoperative multimodal analgesia strategies, aiming to minimize total analgesic consumption.Clinical trial registrationID: NCT04778189 (2/3/2021).

Dexmedetomidine Versus Clonidine as Additives for Spinal Anesthesia: A Comparative Study.

Postoperative pain management is vital to improve patient care. Successful postoperative pain relief is currently achieved only through NSAIDs and narcotics. We compared dexmedetomidine and clonidine as additives to hyperbaric levobupivicaine 0.5% for the sub-arachnoid block (spinal anesthesia) concerning the onset time, duration of the block, hemodynamic changes, level of sedation intraoperatively and postoperatively and time taken for the first postoperative analgesic request and frequency. This prospective, double-blind study enrolled 60 patients who underwent lower abdominal surgeries and were eligible for a sub-arachnoid block. They were allocated randomly to one of the two groups. Group D received intrathecal dexmedetomidine 5 µg and 0.5% hyperbaric levobupivicaine 15 mg. Group C received intrathecal clonidine 50 µg and 0.5% hyperbaric levobupivicaine 15 mg. Patients who received dexmedetomidine had a longer duration of the block (2-segment regression: 135 ± 15 min vs. 130 ± 20 min, S1 segment regression: 305 ± 50.4 min vs. 290 ± 47.2 min, Bromage 0: 285 ± 60 min vs. 280 ± 45 min), delayed first rescue analgesia request (700 ± 160 min vs. 506 ± 112 min), reduced frequency of rescue analgesics (1 vs. 2), and desired level of sedation (1.3 ± 0.46 vs. 0.4 ± 0.01) when compared to those receiving clonidine. There were insignificant differences between the groups in intraoperative hemodynamic parameters, such as minimal bradycardia and minimal hypotension. Though dexmedetomidine had an early onset, there was no statistically significant difference compared to clonidine. Comparing dexmedetomidine and clonidine as additives in the sub-arachnoid block, the group who received dexmedetomidine had similar onset, prolonged duration of blockade, delayed first rescue analgesia demand, reduced frequency of analgesics, and desired sedation with similar minimal hemodynamic changes such as bradycardia and hypotension.

Comparison of Analgesic effect of Dexmeditomidine and Paracetamol as Adjuvant with Lignocaine Hydrochloride for Intravenous Regional Anesthesia

Objective: To compare and evaluate the analgesic effect of Dexmeditomidine and Paracetamol as adjuvant with lignocaine hydrochloride following upper limb surgeries. Study Design: Quasi-experimental study Place and Duration of Study: Combined Military Hospital, Rawalpindi, Allied Hospital, Faisalabad, Fauji Foundation Hospital, Rawalpindi Pakistan Methodology: Sixty ASA physical status I and II patients undergoing upper limb surgery were included in this study. Patients were divided into three groups (n=20) in each group. Regional anesthesia was achieved with 3mg/kg of Lignocaine hydrochloride(L) (02%) in Group A (n=20). Group B received 3 mg/kg of Lignocaine hydrochloride plus Dexmedetomidine (D/L) 0.5 μg/kg. Group C (n=20) received 3 mg/kg of lignocaine hydrochloride plus 300 mg of paracetamol (P/L). Onset and recovery time of Sensory and motor blocks and post-operative pain using visual analogue score was evaluated. Results: Group B showed significantly less sensory block onset time and motor block onset time as compared with Group Aand Group C. Similarly, sensory block recovery time and motor block recovery time were significantly more in Group B compared to other groups. visual analogue score was significantly less in Group B in comparison with Group A and C. First postoperative analgesic request time was significantly longer in the Group B than in Group C. Conclusion: It was concluded that Dexmedetomidine/Lignocaine hydrochloride provides better analgesia compared to paracetamol/Lignocaine hydrochloride in intravenous regional anesthesia.

The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis.

The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL. The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols. There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404). Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.

Adding Ketamine to Epidural Morphine Does Not Prolong Postoperative Analgesia After Lumbar Laminectomy or Discectomy.

Epidural opioids provide effective postoperative analgesia after lumbar spine surgery. Ketamine has been shown to reduce opioid-induced central sensitization and hyperalgesia. We hypothesized that adding ketamine to epidural opioids would prolong the duration of analgesia and enhance analgesic efficacy after lumbar spine surgery. American Society of Anesthesiologists physical status class I to II patients aged between 18 and 70 years with normal renal function undergoing lumbar laminectomy were recruited into this single-center randomized trial. Patients were randomized to receive either single-dose epidural morphine (group A) or epidural morphine and ketamine (group B) for postoperative analgesia. The primary objective was to compare the duration of analgesia as measured by time to the first postoperative analgesic request. Secondary objectives were the comparison of pain scores at rest and movement, systemic hemodynamics, and the incidence of side effects during the first 24 hours after surgery. Fifty patients were recruited (25 in each group), of which data from 48 were available for analysis. The mean±SD duration of analgesia was 20±6 and 23±3 hours in group A and group B, respectively ( P =0.07). There were 12/24 (50%) patients in group A and 17/24 (71%) patients in group B who did not receive rescue analgesia during the first 24-hour postoperative period ( P =0.07). Pain scores at rest and movement, systemic hemodynamics, and postoperative complications were comparable between the groups. The addition of ketamine to epidural morphine did not prolong the duration of analgesia after lumbar laminectomy.

The analgesic efficacy of subcutaneous nalbuphine compared with epidural analgesia in abdominal surgeries: A randomized controlled trial

Background: Analgesia represents a cornerstone for the perioperative management of patients undergoing open abdominal surgery. Epidural analgesia (EPA) is a standard method for pain control in 50%-60% of major abdominal surgeries. Nalbuphine -a synthetic opioid agonist/ antagonist- has equianalgesic properties to morphine but without the undesirable side effects of the pure agonists. Objective: We compared the perioperative analgesic efficacy of subcutaneous nalbuphine and epidural analgesia in abdominal surgeries. Methods: 130 adult patients of both sexes with American Society of Anesthesiologists physical status class I or II aged 20-60 years were randomized into two equal groups. After induction of general anesthesia, the epidural was activated with 18 ml of bupivacaine 0.25% + 2 ml fentanyl (100 Mcg) in group (I), while in a group (II) subcutaneous nalbuphine (0.15 mg/kg) was injected. The time for the first postoperative analgesic request was recorded as the primary endpoint. The cumulative analgesics consumption within the first 24 postoperative hours and drug-related side effects were the secondary outcomes. Results: The time for the first postoperative analgesia request was significantly longer in group II than in group I (10.8 ± 1.34 vs 3.29 ± 0.72 hours) (p &lt; 0.05). There was a significant reduction in postoperative analgesic requirements in group II compared with group I. Group II patients had significantly more sedation levels than group I (p &lt; 0.05). Conclusion: Under the conditions of this study, subcutaneous nalbuphine showed a superior analgesic profile than epidural analgesia for open abdominal surgeries.

Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia

ABSTRACT Background Anesthesia for repair of tracheal stenosis considered as a challenging that needs to optimize the immediate postoperative period and preventing unwise use of postoperative opioid. This study was designed to evaluate the analgesic efficacy of adding dexmedetomidine to levobupivacaine for blocking the superficial cervical plexus for tracheal reconstruction. Methods Eighty patients, underwent elective surgical repair of upper tracheal stenosis and reconstruction. Patients were randomly allocated into two groups and received ultrasound guided bilateral superficial cervical plexus block. Group L received 10 ml of 0.5% Levobupivacaine. Group D received 10 ml of 0.5% Levobupivacaine and 0.5 µg⁄kg dexmedetomidine in each side. The total postoperative analgesic consumption, postoperative pain severity and the time to the first analgesic requirement were evaluated in all patients. Results Total postoperative fentanyl consumption decreased in group D (76.75 ± 9.57 µg) versus (176.75 ± 22.66 µg) in group L with p value ≤ 0.001 and time to first analgesic requirement was longer in group D (20.70 ± 5.42 hours) versus (8.35 ± 2.55 hours) in group L. Moreover, increased plasma cortisol level during surgery and after recovery in group L compared with group D with p value ≤ 0.001. Conclusion : Addition of dexmedetomidine to levobupivacaine for bilateral superficial cervical plexus block considered as an effective and safe block that significantly reduced total postoperative opioid consumption and prolonged time to first postoperative analgesic request with achievement of good quality of analgesia.

Efficacy of peritonsillar infiltration of levobupivacaine-dexamethasone versus levobupivacaine-dexmedetomidine in children undergoing tonsillectomy surgery

Purpose We evaluated the quality of analgesia produced by peritonsillar infiltration of levobupivacaine with either dexamethasone or dexmedetomidine in children undergoing tonsillectomy surgery. Patients and methods Patients scheduled for tonsillectomy were randomly allocated into three groups with 27 patients in each group. Group L received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine, while group D received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexamethasone 0.5 mg/kg and group X received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexmedetomidine 1 μg/kg (with infiltration of 2.5 ml in each tonsil in all groups) with the first postoperative analgesic request as the primary outcome. Results Postoperative time to first analgesic paracetamol request was prolonged in group D (19.51±2.34 h) compared with group L (4.15±0.53 h) and group X (15.74±2.29 h). Face, leg, activity, cry, consolability (FLACC) Behavioral Pain Assessment score at rest and during swallowing decreased in group D compared with group L and group X. Total postoperative analgesic consumption decreased in group D (581.48±165.7 mg) compared with group L (1303.51±90.10 mg) and group X (680.50±160.67 mg). Conclusions We concluded that peritonsillar infiltration of levobupivacaine when mixed with either dexamethasone or dexmedetomidine for patients undergoing tonsillectomy produced prolonged analgesia; however, dexamethasone was superior to dexmedetomidine with more prolonged time to first paracetamol request and prolonged late postoperative pain relief.

The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center

IntroductionThe novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and...

Circadian effects on neural blockade of levobupivacaine and fentanyl intrathecal administration for caesarian section.

Circadian variations in biological rhythms affect the pharmacological properties of many anaesthetic agents, suggesting circadian patterns of local anaesthetics' activity in labour pain analgesia, with important differences among diurnal and nocturnal phases.

Effect of Bupivacaine at Gallbladder Fossa and Port Site Vs Port Site Alone on Postop Analgesia in Lap Cholecystectomy

Aim: To evaluate the effect of bupivacaine at gallbladder fossa and port site vs port site alone on postoperative pain in patients undergoing laparoscopic cholecystectomy. Methodology: After approval from ethical committee, 82 patients fulfilling the inclusion criteria were selected from department of General Surgery (West Surgical Ward), Mayo hospital Lahore. Demographic profile i.e. name, age, gender was recorded. All the patients were randomly divided into 2 groups. Results: The group statistics revealed that the visual analogue scale (VAS) was analyzed within the durations of 3, 6, 12 and 24 hours along with postoperative analgesia request. VAS at 3 hours showed that mean±SD of group 1 was 6.66±1.575 whereas group 2 showed relatively less values in mean±SD i.e. 4.0±1.162. VAS at 6 hours showed that mean±SD of group 1 was 6.2±1.04 whereas group 2 showed relatively less values in mean±SD i.e. 3.8±0.97. VAS at 12 hours showed that mean±SD of group 1 was 5.8±1.01 whereas group 2 showed relatively less values in mean±SD i.e. 3.7± 0.89. VAS at 24 hours showed that mean±SD of group 1 was 5.3±0.89 whereas group 2 showed less values in mean± SD i.e. 3.3±0.69. Post-operative analgesia duration in group 1 was also recorded, the mean±SD hours of group 1 was 3.49±1.26, whereas for group 2, the mean±SD hours were 6.4±1.70. Independent sample t test is applied between VAS pain score at 3, 6, 12 and 24 hours between the group 1 and 2, and 1st request for the post-operative analgesia is recorded. The p value is &lt;0.05 which is significant statistically. Conclusion: Adequate post-operative pain control provides early post-surgical mobilization, shortened hospital stay and increased patient satisfaction. This also reduces requirement of postoperative opioid analgesics. Keywords: Laparoscopic cholecystectomy, postoperative pain, bupivacaine

The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial.

BackgroundAcute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders.MethodsIn this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups.ResultsThe pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001).ConclusionsHigh intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.

A comparative study of dexmedetomidine–propofol and fentanyl-propofol on perioperative haemodynamics, propofol requirement and post-operative recovery profile in patients undergoing elective abdominal surgeries - A prospective randomised double-blind study

Background: Dexmedetomidine is gaining popularity for its sympatholytic, sedative and haemodynamic stabilising properties, without significant respiratory depression.Methods: A prospective randomised double-blind study was conducted on 60 patients belonging to American Society of Anesthesiologists (ASA) Grade I and II undergoing elective abdominal surgeries who were randomised to receive either dexmedetomidine (Group D-P) or fentanyl (Group F-P) 10 Min prior to induction. Induction was done with midazolam along with propofol in 20 mg aliquots until bispectral index (BIS) value drops below 60. Infusion of one of the study drugs was continued along with propofol infusion which was titrated to maintain BIS around 40–60. Vecuronium to provide muscle relaxation and bolus doses of fentanyl were given whenever additional analgesia was needed. Intra-operative propofol, vecuronium and additional fentanyl requirement, time from discontinuation of anaesthetic drugs to extubation, time from the end of surgery to achieve a Ramsay sedation score of 2 and to the first post-operative analgesic request were recorded. Post-operatively, patients were monitored till 24 h for any adverse events.Results: A significant decrement in heart rate was observed in the D-P group in comparison to the fentanyl group. The D-P group was found to have required less propofol for induction, limited additional fentanyl requirement, less time required for extubation and a delay in request for first post-operative analgesia which was statistically significant.Conclusions: Propofol–dexmedetomidine provides better haemodynamic stability with lesser intraoperative propofol and fentanyl requirement, early cognitive recovery and longer postoperative analgesia when compared to propofol–fentanyl.