Required Rescue Analgesia Research Articles

A prospective comparitive study of transdermal patches for post operative pain management in laprotomy surgeries: efficacy and rescue analgesic requirements

A prospective comparitive study of transdermal patches for post operative pain management in laprotomy surgeries: efficacy and rescue analgesic requirements

The effect of intravenous lidocaine infusion on subarachnoid anesthesia in patients undergoing total knee replacement: a randomised controlled trial.

Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5mg·kg-1 followed by an infusion of 1.5mg·kg-1·h-1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24h after surgery. The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80min versus 78.21 ± 9.12min;p < 0.001 and 237.14 ± 9.14min versus 215.00 ± 10.12min;p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38min in the lidocaine group and 127.14 ± 23.35min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements.

Effects of pericapsular nerve group block on early postoperative cognitive function in older people undergoing hip arthroplasty: a randomized controlled clinical trial.

Pericapsular nerve group (PENG) block has emerged as a reliable analgesia technique for hip arthroplasty (HA). However, the effects of PENG block on perioperative neurocognitive disorder (PND) after HA has not yet been assessed. The present study aimed to investigate the effects of PENG block on early postoperative cognitive function in older people undergoing hip arthroplasty. Sixty older patients undergoing HA under spinal anesthesia were randomly assigned to group P (n = 30) receiving PENG block with ropivacaine and patient-controlled intravenous analgesia (PCIA) pump with sufentanil after surgery or group C (n = 30) only receiving PCIA pump with sufentanil after surgery. The primary outcome was the Mini-Mental State Examination (MMSE) score at 7 days postoperatively. Secondary outcomes consisted of the incidence of PND 7 days postoperatively, the static VAS pain scores at 6, 12, 24, and 48h postoperatively; cumulative sufentanil consumption and the requirement of rescue analgesia during the 0-24h period after surgery; quality of recovery-15 (QoR-15) scale scores at 24h postoperatively; and the plasma levels of high mobility group box protein 1 (HMGB1) preoperatively and 1day after surgery, and adverse events. After surgery, the PENG block group had higher MMSE score than the control group at 7 days postoperatively (27.0 ± 1.8 vs. 26.1 ± 1.7, P = 0.048), with a mean difference of 0.9 (95%CI, 0.1-0.9). The incidence of PND at 7 days postoperatively was 6.7% in group P, lower than that of 30% in group C (P = 0.044). In group P, the static VAS scores at 6, 12, and 24h postoperatively were significantly lower than those in group C (all P < 0.05). Compared with group C, the cumulative sufentanil consumption and the number of patients required rescue analgesia during the 0-24h period after surgery were significantly lower in group P (all P < 0.05). The scores of QoR-15 scale were higher in group P at 24h postoperatively than those in group C (P < 0.05). Patients in group P showed lower plasma levels of HMGB1 than group C at 1day after surgery (P < 0.05), and the rate of complications didn't differ between both groups. Older people undergoing HA receiving a PENG block for perioperative analgesia experience improved early postoperative cognitive function, reduced postoperative pain, higher quality of recovery, and less postoperative inflammatory response. Chictr.org.cn identifier ChiCTR2200061055 (Date of registry: 15/06/2022, prospectively registered).

A Comparative Analysis of Intravenous Clonidine and Dexmedetomidine for Hemodynamic Stability and intraoperative bleeding in Lumbar Spine Surgeries

Lumbar spine surgeries are complex procedures often associated with challenges in maintaining hemodynamic stability and controlling intraoperative bleeding, which are crucial for optimizing patient outcomes. Clonidine and dexmedetomidine both are α2-adrenergic agonists with sedative and analgesic properties, known for their potential to attenuate sympathetic responses and stabilize hemodynamics. However, their comparative efficacy in lumbar spine surgeries remains underexplored. METHODOLOGY This study was carried out in 40 patients, ASA grade1 and 2, undergoing lumbar spinal instrumentation requiring laminectomy. The patients were randomly allocated into two groups (20 each) using the computer generated random number table. Group C received 2 µg/kg of clonidine diluted in 10 ml of normal saline, given slowly intravenous infusion over 10 min before induction of general anaesthesia. Group D received 1 µg/kg of dexmedetomidine diluted in 10 ml normal saline, given slow intravenous infusion over 10 minutes before induction of general anaesthesia. Heart rate, systolic, diastolic, and mean arterial pressure were monitored before intubation as the baseline and after intubation, 15, 30, and 60 minutes after starting the surgery, and after extubation. The amount of intraoperative blood loss was estimated based on the volume of blood in the suction bottle and the number of the blood-soaked gauze pads (20 mL for a completely blood-soaked gauze and 50 mL for a completely blood-soaked long gauze). OBSERVATION No statistically significant difference was found on comparing the two drugs in terms of Baseline characteristics, Mean Arterial Pressure and the amount of blood loss. However Dexmedetomidine group had a higher reduction in Heart Rate as compared to the Clonidine Group. CONCLUSION In conclusion, both the alpha2 agonist drugs; intravenous clonidine and dexmedetomidine represent valuable options for achieving stable hemodynamics as well as decreases the intraoperative surgical bleeding in lumbar spine surgeries. Total opioid requirements for intraoperative and rescue analgesia in postoperative period were decreased in both the groups.

Effectiveness of ultrasound-guided ilioinguinal and iliohypogastric nerve block in pediatric inguinal hernia surgery: a systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

Effect of pericapsular nerve block on the quality of recovery after shoulder arthroscopy.

Shoulder arthroscopy, a standard orthopedic procedure, often results in severe postoperative pain, leading to high opioid consumption and delayed recovery. Various analgesic methods, including peripheral nerve blocks, manage this pain. The pericapsular nerve group block is a relatively new technique whose efficacy in shoulder surgeries has yet to be extensively studied. This study aimed to assess the impact of the pericapsular nerve group block on postoperative recovery quality following shoulder arthroscopy, as measured by the Quality of Recovery-15 score. A randomized, prospective, controlled, multicenter study was conducted with 60 patients undergoing unilateral shoulder arthroscopy. Participants were allocated to either Group P (patients receiving the pericapsular nerve group block and multimodal analgesia) or Group C (patients receiving only multimodal analgesia). The primary outcome measured was the Quality of Recovery-15 score 24 hours post-surgery. Secondary outcomes included postoperative numeric rating scale scores, the requirement for rescue analgesia, time to first rescue analgesia, postoperative complications, the necessity for antiemetics, and patient satisfaction. The median Quality of Recovery-15 score was significantly higher in Group P compared to Group C (120±10 vs. 89±11; P<0.001). Additionally, Group P exhibited lower pain scores at rest and during movement, a decreased need for rescue analgesia, and an extended duration before the first rescue analgesia was required. Postoperative nausea and vomiting were less common in Group P, and patient satisfaction scores were notably higher in this group. The pericapsular nerve group block significantly enhances postoperative recovery quality, reduces pain and opioid consumption, and improves patient satisfaction without significant complications.

Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl transdermal patch in the management of postoperative pain after lower limb surgery

Background: Postoperative pain represents a significant medical issue that needs immediate attention. Despite advancements in pain management, managing postoperative pain remains challenging. Transdermal drug delivery systems (TDDS) offers a straightforward, reliable, non-invasive, and patient-friendly approach for alleviating post-surgical pain. Hence, this study was planned to evaluate the analgesic efficacy of buprenorphine and fentanyl transdermal patch in the management of post-operative pain after lower limb surgery. Methods: In this prospective, randomised study, 82 adult patients of either sex undergoing elective lower limb surgery were randomly allocated into two groups- Group A (Transdermal Buprenorphine 20 mg patch) and Group B (Transdermal Fentanyl 50 mcg patch). Postoperative pain was assessed by 10-point Visual Analogue Scale (VAS) every 6 hours following surgery on the first day and then daily for next 4 days. All patients were also monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status. Statistical analysis was carried out using student t-test and Chi-square test. A p-value &lt;0.05 was considered significant. Results: The mean pain intensity scores were found to be significantly different (p&lt;0.0001) between the two groups, with VAS scores consistently lower in Buprenorphine group as compared to Fentanyl group. Also, Buprenorphine group had the lowest demand for rescue analgesic, with 58.5% of patients requiring two administrations and 36.6% needing only one. Patients belonging to Fentanyl group exhibited higher occurrence of nausea (46.3%), vomiting (46.3%) and pruritus (31.7%). Conclusions: Our study concludes that transdermal patch of buprenorphine demonstrates superior efficacy and safety profile as compared to fentanyl patch for post-operative pain management in lower limb surgeries.

Transversus Abdominis plane block to manage post operative pain in canine mastectomy

The aim of this study was to assess effectiveness of transversus abdominis plane block as part of a multimodal anaesthetic protocol in controlling perioperative nociception/ pain in dogs that underwent mammary tumour excision. The study included twelve dogs belonging to different breeds and ages. The dogs were classified according to the American Society of Anaesthetists (ASA) classification of physical status, based on their pre-anaesthetic evaluations and were divided into two groups: I and II, each with six dogs. Dogs in both groups received dexmedetomidine for premedication and diazepam-propofol for induction. Group I dogs were subjected to Transversus abdominis plane (TAP) block and Group II dogs were given butorphanol. Pain score was assessed using the Glasgow Composite Measure Pain Scale (GCMPS-SF) at one hour post-operatively. The pain score was significantly lower in Group I. None of the dogs in Group I required rescue analgesia. TAP block proved beneficial in mitigating nociception and postoperative pain in dogs undergoing mammary tumour excision. Keywords: Mammary tumour resection, TAP block, post-operative pain

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

Evaluation of lateral sagittal infraclavicular block according to inferior vena cava collapsibility index (VCI-CI): An observational study.

Depending on the total amount of fluid, changes occur in the amount of fluid in the peripheral area. The aim of this study was to observe the differences caused by hemodynamic changes after lateral sagittal infraclavicular block (LS-ICB) according to the inferior vena cava collapsibility index (VCI-CI). In this prospective, observational study (Clinical Trial Number: NCT05968105), patients undergoing elective hand and wrist surgery with LS-ICB were classified according to VCI-CI, with Group 1 defined as inferior vena cava (VCI) diameter < 1.5 cm and VCI-CI > 50% and Group 2 defined as VCI diameter > 1.5 cm and VCI-CI < 50%. Groups were compared for demographic characteristics, defined durations, rescue analgesics, and complications. Continuous hemodynamic parameters and pulsed wave Doppler were evaluated within groups. Demographic characteristics and time periods were comparable between the groups. Hemodynamic parameters and pulsed wave Doppler measurements showed no significant differences. However, while Group 1 remained consistent, Group 2 exhibited differences in axillary artery diastolic diameter and axillary artery contractility index. A significant statistical difference was observed in Group 1 for the perfusion index at 30 minutes and postoperatively, whereas Group 2 remained consistent. The dosage and number of patients requiring rescue analgesics were similar across both groups, and no complications were reported. Blood flow increased after LS-ICB without a corresponding increase in axillary artery diameter. Group 1 showed a tendency toward a lower perfusion index in the postoperative period.

Assessment of ultrasound-guided intercostal nerve block for acute herpes zoster and its' possible prophylaxis for postherpetic neuralgia: a retrospective and case-controlled trial.

This study aimed to compare the intercostal nerve block (ICNB) and thoracic paravertebral block (TPVB) for acute herpes zoster-associated pain (ZAP) and possible prophylaxis for post-herpetic neuralgia (PHN). This study enrolled 128 patients with ZAP. Their records were stratified into standard antiviral treatment (AVT) plus US-guided TPVB (the TPVB group), AVT plus US-guided ICNB (the ICNB group) or AVT alone (the control group). Herpes zoster (HZ)-related burden of illness (HZ-BOI) within the post-procedural 30 days was defined as the primary endpoint, determined by a composite of pain severity and follow-up duration. Procedure time, rescue analgesic requirement, PHN incidence, health-related quality of life and side effects were also recorded. Significantly lower HZ-BOI-AUC30 was reported in the TPVB and ICNB groups as compared to the control group, with a mean difference of 57.5 (P < 0.001) and 40.3 (P = 0.003), respectively. However, there was no difference between the TPVB and ICNB groups (P = 0.978). Both TPVB and ICNB reported significantly greater improvements in PHN incidence, EQ-5D-3L scores and rescue analgesic requirements during follow-up, as opposed to the control AVT. Shorter procedure time was observed in ICNB as compared to TPVB (16.47 ± 3.39 vs. 11.69 ± 2.58, P < 0.001). Both US-guided TPVBs and ICNBs were effective for ZAP, and accounted for possible prophylaxis for PHN, as compared to AVT alone. The ICNB approach could be recommended as an alternative to conventional TPVB with a better consumed procedure time and side effect profile.a.

To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A Randomized Prospective Comparative Study.

The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. A randomized controlled, double-blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.

Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial.

Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section. We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia. A single-centre, double-blind, randomised trial. Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital. Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group. After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side). The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications. The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ± 6.67 points vs. 87.10 ± 9.84 points, respectively; P < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ± 2.21 mg in the TFP block group and 22.21 ± 3.04 mg in the TAP block group ( P < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects. TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption. Clinicaltrials.gov (NCT05999981). http://links.lww.com/EJA/B6 .

Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in paediatric idiopathic scoliosis patients undergoing posterior spine fusion surgery: a randomized controlled trial.

Major spinal surgery causes severe pain. We examined the ability of erector spinae plane block (ESPB) to alleviate pain after posterior spinal fusion (PSF) in paediatric scoliosis patients. Seventy-two patients who underwent PSF were randomized into a preoperative ultrasound-guided ESPB group or a no-block control group. The composite primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score in the first 24h after surgery and the number of parent-controlled intravenous analgesia (PCIA) boluses administered 24h after surgery. The secondary outcomes included the NRS score, opioid consumption, rescue analgesia, adverse events, and quality of recovery. The AUC-NRS at rest was 62 (13) in the ESPB group and 89 (13) in the control group (P < 0.001). There were 15 (5) 24-h PCIA boluses administered in the ESPB group and 30 (7) in the control group (P < 0.001). Compared with those in the control group, the NRS scores at rest were lower in the ESPB group at 0, 3, 6, and 9h postoperatively, and the NRS scores during movement were lower in the ESPB group at 0, 3, 6, 9 and 12h postoperatively. The ESPB group showed a lower need for PCIA than did the control group at 0-6, 6-12, 12-18 and 1-24h postoperatively. In the ESPB group, fewer patients required rescue analgesics, and patients exhibited a higher quality of recovery. Preoperative ESPB improves postoperative analgesia in paediatric scoliosis patients who underwent PSF. ChiCTR2300074505. August 8, 2023.

Can Rhomboid Intercostal Block Be an Alternative to Paravertebral Block in Video-Assisted Thoracoscopic Surgery? A Randomized Prospective Study.

Rhomboid intercostal block (RIB) is a new interfascial plane block. RIB is a simple and clinically effective technique. Paravertebral block (PVB) is offered as a first-line regional anesthesia technique for thoracoscopic surgeries. In this study, we aim to compare the analgesic efficacy of RIB to PVB in video-assisted thoracoscopic surgeries (VATSs). This is a prospective randomized study with 84 patients aged 18-75 and ASA I-III, undergoing VATS for primary lung cancer. The study was approved by an ethical committee and registered under clinicaltrials.org. With informed consent, patients were randomized to receive ultrasound-guided RIB or PVB at T5-level with 20 mL of %0.25 bupivacaine preoperatively. Surgeries were performed under general anesthesia. Postoperatively, patient-controlled IV fentanyl analgesia was prescribed, delivering 10 μg boluses upon request with 10 min of a lock-out period. Patients received paracetamol 1 g IV three times a day and tramadol 50 mg IV for breakthrough pain. The postoperative Numeric Rating Scale (NRS) for pain, total opioid consumption, and rescue analgesic requirements were recorded postoperatively at 1, 3, 6, 12, and 24 h. There were no significant differences in 24 h total opioid consumption between the RIB and PVB groups [PVB: 48.5 (39.5-55) mcg; RIB: 48.6 (40.2-65) mcg; p = 0.258], nor in rescue analgesic requirements [PVB: seven patients (20%); RIB: seven patients (17.1%); p = 0.570]. NRS pain scores were also similar between the groups, with no significant difference in overall pain control efficacy (p = 0.833). RIB is comparable to PVB in analgesic efficacy for VATS and can be considered as an alternative analgesic modality.

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department

BackgroundUltrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED.MethodsThis open-label randomised controlled trial was conducted in the ED...

Pre-emptive Nebulized Ketamine Versus Lidocaine for Post-tonsillectomy Pain Management in Children: A Comparative Study.

Background Tonsillectomy is associated with significant pain, and postoperative pain control is often unsatisfactory. There have been several methods adopted to treat postoperative pain, but none of the methods were effective, with patients continuing to undergo severe postoperative pain. Hence, our study aimed to compare the efficacy of pre-emptive nebulized ketamine versus pre-emptive nebulized lidocaine with a control group receiving nebulized saline for pain control in children undergoing tonsillectomy. Methods In this prospective randomized clinical trial, 105 patients with American Society of Anesthesiologists(ASA) Ⅰ and Ⅱ undergoing tonsillectomy were enrolled and randomized into three groups, group K, group L, and group C, with 35 patients in each group, wherein pre-emptive nebulized ketamine, lidocaine, and saline were given to each group of patients, respectively. Faces Pain Scale-Revised (FPS-R), sedation scale scores, and the usage of rescue analgesia were noted postoperatively for the first six hours. Hemodynamic parameters were noted before and after nebulization.The primary objective was to determine the number of patients requiring rescue analgesia as an indicator of postoperative pain control. Results In this randomized clinical trial, pre-emptive nebulized ketamine significantly reduced the need for rescue analgesia compared to lidocaine and saline (p<0.05). Only 14.3% (n=5) of patients in the ketamine group required rescue analgesiacompared to 85.7% (n=30) in the lidocaine group and 91.4% (n=32) in the control group. Nebulized ketamine given pre-emptively is an effective strategy for reducing postoperative pain in pediatric tonsillectomy. Conclusion Pre-emptive nebulized ketamine was found to be effectivewhen compared with lidocaine nebulization in reducing postoperative pain in children undergoing tonsillectomy.

Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries.

Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia. A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed. The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant (p-value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant (p-value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups. Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management.

Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis

BackgroundRemimazolam is a novel ultra-short-acting benzodiazepine that has been recently introduced as an alternative to propofol for general anesthesia. While both agents have been compared in terms of safety and efficacy, their relative effects on postoperative quality of recovery (QoR) remain unclear. Therefore, this meta-analysis aimed to compare the effects of remimazolam and propofol on subjective QoR in surgical patients who underwent general anesthesia.MethodsMedline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to May 28, 2024 to identify randomized controlled trials comparing remimazolam and propofol in terms of postoperative QoR. The Cochrane risk-of-bias tool (RoB 2) was used to assess study quality. QoR score on postoperative day (POD) 1 (primary outcome), QoR scores on PODs 2–3, QoR dimensions, time to loss of consciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using random-effects meta-analyses.ResultsThis meta-analysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR-15 (10 studies) or QoR-40 (3 studies) questionnaire. The pooled results indicated no significant difference in the QoR scores on POD 1 (standardized mean difference: 0.02, 95% confidence interval [CI]: − 0.20, 0.23, P = 0.88, I2 = 73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no significant differences were observed in QoR dimensions, length of postanesthesia care unit (PACU) stay, and time to extubation as well as in the risks of agitation and postoperative nausea and vomiting. Patients administered remimazolam exhibited slower anesthetic induction (mean difference (MD): 32.27 s) but faster recovery of consciousness (MD: − 1.60 min) than those administered propofol. Moreover, remimazolam was associated with a lower risk of rescue analgesia requirement in the PACU (risk ratio: 0.62, 95% CI: 0.43, 0.89, P = 0.009, I2 = 0%) but not in the ward.ConclusionRemimazolam is a potential alternative to propofol for general anesthesia as it offers similar QoR to the latter and has advantages in terms of consciousness recovery and immediate postoperative analgesia requirement.

Bilateral Ultrasound-Guided External Oblique Intercostal Block Vs. Modified Thoracoabdominal Nerve Block Through Perichondrial Approach for Postoperative Analgesia in Patients Undergoing Laparoscopic Sleeve Gastrectomy Surgery: A Randomized Controlled Study.

The objective of the present study was to evaluate morphine consumption and pain scores 24h postoperatively to compare the effects of a bilateral External Oblique Intercostal (EOI) block with those of a Modified Thoracoabdominal Nerve Block Trough Perichondrial Approach (M-TAPA) block in laparoscopic sleeve gastrectomy (LSG). Fifty-eight patients aged between 18 and 65years of with American Society of Anesthesiologists class II-III were included in this randomized, double-blinded study. Patients were assigned into two groups either EOI block or M-TAPA block. The primary outcome was cumulative morphine consumption within the first postoperative 24h. Secondary outcomes were numerical rating scale (NRS) scores at rest and during activity, QoR-15 Patient Questionnaire scores, incidence of postoperative nausea and vomiting (PONV), number of patients requiring rescue analgesic and antiemetics drugs, and complications. There was no statistically significant difference between the groups in terms of morphine consumption in the first 24h (EOI block; 10.74 ± 3.94mg vs. M-TAPA block; 11.67 ± 4.66mg, respectively). In addition, no significant difference between the two groups in the NRS and PONV scores, total QoR-15 scores, and the number of patients requiring rescue analgesics and antiemetics. EOI block and M-TAPA block showed similar effectiveness for morphine consumption within 24h postoperatively and in pain scores in LSG.