Required Rescue Analgesia Research Articles

The analgesic effect of ultrasound-guided cervical erector spinae block in arthroscopic shoulder surgery: a randomized controlled clinical trial

BackgroundErector spinae plane block (ESPB) is a novel fascial plane block technique that can provide effective perioperative analgesia for thoracic, abdominal and lumbar surgeries. However, the effect of cervical ESPB on postoperative analgesia after arthroscopic shoulder surgery is unknown. The aim of this study is to investigate the analgesic effect and safety of ultrasound-guided cervical ESPB in arthroscopic shoulder surgery.MethodsSeventy patients undergoing arthroscopy shoulder surgery were randomly assigned to one of two groups: ESPB group (n = 35) or control group (n = 35). Patients in the ESPB group received an ultrasound-guided ESPB at the C7 level with 30 mL of 0.25% ropivacaine 30 min before induction of general anesthesia, whereas patients in the control group received no block. The primary outcome measures were the static visual analogue scale (VAS) pain scores at 4, 12, and 24 h after surgery. Secondary outcomes included heart rate (HR) and mean arterial pressure (MAP) before anesthesia (t1), 5 min after anesthesia (t2), 10 min after skin incision (t3), and 10 min after extubation (t4); intraoperative remifentanil consumption; the Bruggrmann comfort scale (BCS) score, quality of recovery-15 (QoR-15) scale score and the number of patients who required rescue analgesia 24 h after surgery; and adverse events.ResultsThe static VAS scores at 4, 12 and 24 h after surgery were significantly lower in the ESPB group than those in the control group (2.17 ± 0.71 vs. 3.14 ± 1.19, 1.77 ± 0.77 vs. 2.63 ± 0.84, 0.74 ± 0.66 vs. 1.14 ± 0.88, all P < 0.05). There were no significant differences in HR or MAP at any time point during the perioperative period between the two groups (all P > 0.05). The intraoperative consumption of remifentanil was significantly less in the ESPB group compared to the control group (P < 0.05). The scores of BCS and QoR-15 scale were higher in the ESPB group 24 h after surgery than those in the control group (P < 0.05). Compared to the control group, fewer patients in the ESPB group required rescue analgesia 24 h after surgery (P < 0.05). No serious complications occurred in either group.ConclusionsUltrasound-guided cervical ESPB can provide effective postoperative analgesia following arthroscopic shoulder surgery, resulting in a better postoperative recovery with fewer complications.Trial registrationChictr.org.cn identifier ChiCTR2300070731 (Date of registry: 21/04/2023, prospectively registered).

Comparison of the efficacy and safety of transdermal buprenorphine patch to conventional analgesics after operative fixation of extra capsular fracture of proximal femur

IntroductionProximal femur fractures are common among older individuals and pose challenges in achieving effective post-operative analgesia. Age-related co-morbidities limit the selection of analgesics in this population. This study aimed to compare the safety and effectiveness of transdermal buprenorphine (TDB) patch with traditional analgesics after fixation of an extracapsular fracture of the proximal femur. MethodologyA prospective randomized controlled study was conducted over a 2-year period, involving 60 patients who underwent surgery for extra capsular intertrochanteric fracture fixation. The patients were randomly assigned to two groups by random envelope method. Group A received an intravenous formulation of paracetamol and tramadol for the initial 48 h, followed by an oral formulation. Group B received a transdermal buprenorphine (TDB) patch delivering 5 mcg/hour immediately after surgery, which continued for 2 weeks postoperatively. During the 14-day monitoring period, patients' pain scores were assessed using the Visual Analog Scale (VAS) at rest and during movement. The primary objective was to maintain a VAS score of 4 or lower. Rescue analgesics were administered if the VAS score reached 6. The secondary objectives included evaluating the quantity of rescue analgesics required and monitoring for any adverse effects or complications. ResultsPain scores at rest and during movement were significantly lower in Group B at all-time points (p-value 0.0006 - ≤ 0.0001), and the requirement for rescue analgesia was also significantly lower in this group. The administration of the TDB patch did not result in any significant adverse effects. ConclusionTDB patch is secure and offers better compliance and analgesia than other analgesics in the postoperative period whilst treating proximal femur extra capsular fracture.

The Effect of Different Propofol-Ketamine Combinations on Emergence Delirium in Children Undergoing Adenoidectomy and Tonsillectomy Surgery

PurposeEmergence delirium (ED) after sevoflurane anesthesia remains a serious issue in children. We aimed to compare different ratios of propofol-ketamine combinations to determine a better option for preventing ED. DesignA prospective, randomized clinical trial. MethodsIn this study, 112 children aged between 3 and 12 years who underwent adenoidectomy and tonsillectomy were recruited. Propofol 1 mg kg−1 + ketamine 1 mg kg−1 (1:1 ratio), propofol 1.5 mg kg−1 + ketamine 0.75 mg kg−1 (2:1 ratio), propofol 2 mg kg−1 + ketamine 0.66 mg kg−1 (3:1 ratio), and propofol 3 mg kg−1 were applied at induction of anesthesia for Groups I, II, III, and IV, respectively. Fentanyl 1 mcg kg−1 and rocuronium 0.6 mg kg−1 were applied at induction, and anesthesia was maintained with sevoflurane and O2/N2O mixture for all participants. Intravenous morphine 0.1 mg kg−1 was applied for postoperative analgesia in the last 10 minutes of surgery. ED was defined as a Watcha score of ≥3. Demographics, hemodynamics, extubation time, Watcha scores, the Face, Legs, Activity, Cry, and Consolability scores, length of stay in the postanesthesia care unit (PACU), rescue analgesic requirement, and postoperative complications were recorded. FindingsED was significantly higher at 10 and 20 minutes in Group IV. Eighteen children experienced ED in PACU, (3, 2, 2, and 11 children in Groups I, II, III, and IV, respectively). Face, Legs, Activity, Cry, and Consolability scores were significantly different at all times. Rescue analgesics were required by 3 children (10.7%) in Group I, 2 (7.1%) in Group II, 2 (7.1%) in Group III, and 10 (35.7%) in Group IV (P = .012). The PACU stay was 21.9 ± 6.4 in Group I, 18.7 ± 6.3 in Group II, 16.7 ± 5.8 in Group III, and 17.4 ± 5.8 in Group IV. Nystagmus was observed in three children in Group I. ConclusionsTo addition of ketamine to propofol during the induction of sevoflurane anesthesia can reduce the ED and analgesic requirements in children. A propofol-to-ketamine ratio of 3:1 provided better postoperative recovery with less pain and ED, without prolonging the PACU length of stay.

A Comparison of Analgesic and Recovery Profiles of Ketamine, Lignocaine, and Dexmedetomidine (KeLiDex) Versus Fentanyl-Based Anesthesia in Laparoscopic Nephrectomies: A Randomized, Single-Blind, Pilot Study.

In the search for opioid-free anesthesia, notable numbers of drugs, singly or in combinations, have been tested with variable results. However, most of the drugs used are not as strong as opioids. Even if some non-opioid drugs are potent enough, they cause significant untoward effects, necessitating the use of lower effective dosages of multiple drugs as a substitute. The present pilot study evaluated low-dose combinations of ketamine, lignocaine, and dexmedetomidine (KeLiDex) against fentanyl-based anesthesia for analgesia and recovery profiles in laparoscopic nephrectomies. Twenty patients (10 in each group) randomly received KeLiDex or fentanyl infusion as an analgesic component for balanced general anesthesia. Entire patients also received paracetamol and quadratus lumborum block-2. Anesthesia depth, neuromuscular blockade, and reversal were standardized. Intraoperative hemodynamic variation, time to extubation after reversal (T-tEAR) administration, postanesthesia care unit (PACU) discharge readiness assessed using modified Aldrete score, sedations using Richmond Agitation Sedation Scale, postoperative pain, and rescue analgesia consumptions were compared using different validated scales. P-value <0.05 was considered significant. The KeLiDex group had a significantly lower heart rate (HR) between 45-90 minutes and at the time of reversal. Mean arterial pressure (MAP) (mean ± standard deviation (SD)) differed significantly at only a 60-minute interval (KeLiDex group 80.90 ± 9.50 versus fentanyl group 92.60 ± 16.13 mmHg, p-value 0.041). The Friedman test for change in HR and MAP over time within each group was also insignificant. The mean ± SD of T-tEAR was 6.37 ± 2.13 in KeLiDex, and 8.18 ± 2.92 minutes in the fentanyl group, p-value 0.27. Sedation scores, Modified Alderette scores, pain scores, and rescue analgesic requirements were also comparable. KeLiDex could effectively control hemodynamics and pain both at rest and in movements in line with fentanyl-based anesthesia for laparoscopic nephrectomies. Further, recovery from the anesthesia, sedation, and PACU discharge readiness were similar.

Is a Failed Spinal Attempt Associated With a Worse Clinical Course Following Primary Total Hip and Knee Arthroplasty?

BackgroundSpinal anesthesia (SA) is the preferred anesthesia modality for total joint arthroplasty (TJA). However, studies establishing SA as preferential may be subject to selection bias given that general anesthesia (GA) is often selectively utilized on more difficult, higher-risk operations. The optimal comparison group, therefore, is the patient converted to GA due to a failed attempt at SA. The purpose of this study was to determine risk factors and outcomes following failed SA with conversion to GA during primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). MethodsA consecutive cohort of 4,483 patients who underwent primary TJA at our institution was identified (2,004 THA and 2,479 TKA). Of these patients, 3,307 underwent GA (73.8%), 1,056 underwent SA (23.3%), and 130 patients failed SA with conversion to GA (2.90%). Primary outcomes included rescue analgesia requirement in the postanesthesia care unit (PACU), time to ambulation, pain scores in the PACU, estimated blood loss, and 90-day complications. ResultsRisk factors for SA failure included older age and a higher comorbidity burden. Failure of SA was associated with increased estimated blood loss, rescue intravenous opioid use, and time to ambulation when compared to the successful SA group in both THA and TKA patients (P < .001). The anesthesia modality was not associated with significant differences in PACU pain scores. The 90-day complication rate was similar between the failed SA and GA groups. There was a higher incidence of postoperative pain prompting unplanned visits and thromboembolism when comparing failed SA to successful SA in both THA and TKA patients (P < .05). ConclusionsIn our series, patients who had failed SA demonstrated inferior outcomes to patients receiving successful SA and similar outcomes to patients receiving GA who did not have an SA attempt. This emphasizes the importance of success in the initial attempt at SA for optimizing outcomes following TJA.

Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis.

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = -1.99 [95% CI -3.01 to -0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = -1.34 [95% CI -2.29 to -0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile.

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations.

To compare the effects of magnesium sulphate on the total dose of intravenous morphine consumption postoperatively following limb amputations along with rescue analgesia requirement, pain scores and side effects. This prospective, triple-blinded, randomised controlled study was conducted from October 2021 to May 2022 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised of patients scheduled for limb amputations. They were randomised into 2 equal groups. The anaesthesia protocol was uniform for all patients. Intervention group A was administered 30mg/kg loading dose and 10mg/kg/hr maintenance dose of magnesium sulphate intravenously, while patients in control group B received the same amount of plain isotonic saline. Morphine consumption, including that used for rescue analgesia and patient-controlled analgesia, was measured for 24 hours postoperatively. Numeric rating scale was used for the evaluation of postoperative pain in both groups at 15min, 1h, 2h, at discharge from the post-anaesthesia care unit and at 12h and 24h in the ward. Data was analysed using SPSS 23. Of the 24 patients enrolled, the study was completed by 20(83.33%). There were 10(50%) patients in group A; 8(40%) males and 2(20%) females with mean age 24.8±14.14 years and mean surgery time 130.5±47.86 minutes. There were 10(50%) patients in group B; 8(40%) males and 2(20%) females with mean age 23.2±7.4 years and mean surgery time 117±23.85 minutes (p>0.05). Total morphine used over 24 hours in group A was 16±3.1 mg compared to 29.6±11.2 mg in group B (p<0.05). The time for first use of patient-controlled analgesia after arriving in the postanaesthesia care unit was significantly delayed in group A (72.2±24.95 minutes) compared to that in group B (25±26.68 minutes) (p<0.05). Pain scores were significantly higher in the group B at 15min compared to group A (p<0.05), but not at the rest of the time points (p>0.05). Intravenous magnesium sulphate proved to be effective in lowering postoperative opioid requirement following limb amputations.

Ultrasound guided quadratus lumborum block versus interlaminar epidural block for analgesia in pediatric abdominal surgery: a randomized controlled trial

BackgroundAlthough the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB.MethodsPatients were randomly allocated into two equal groups: Group E(n = 29): received EB; Group QL(n = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request.ResultsOur study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups(P > 0.05).ConclusionQLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries.Clinical trial registration numberPACTR202203906027106.

Perioperative epidural catheter analgesia as a component of a multimodal analgesic approach in a dog with thoracic hemivertebrae and kyphosis undergoing thoracic vertebral stabilisation

AbstractA 4‐year‐old, male, neutered French bulldog weighing 13.5 kg presented with urinary and faecal incontinence, progressive, non‐painful paraparesis and pelvic limb proprioceptive ataxia. Magnetic resonance imaging revealed a T12 constrictive myelopathy in association with multiple thoracic vertebral malformations, and mildly impinging thoracic intervertebral disc protrusions. Additionally, there was a sacral axial defect and degenerative lumbosacral stenosis. Surgical treatment comprised bilateral dorsal vertebral stabilisation of T9–T13. This case report summarises the peri‐anaesthetic management, which included an ‘in‐plane’ ultrasound‐guided placement of an epidural catheter at the level of L3–L4 and advancement cranially to T12 as a component of a multimodal analgesic regimen. Following the cessation of postoperative epidural bupivacaine administration, the patient remained comfortable without requiring rescue analgesia, and was discharged within 24 hours of surgery. At the latest recheck 5 months after surgery, the dog's neurological status remained static. This technique and application remain unexplored in existing veterinary literature.

Intrathecal Analgesia Versus Thoracic Epidural Analgesia for Thoracic Surgery

Introduction: Thoracic surgery is associated with severe postoperative pain involving parietal, visceral, and projected components. Potent analgesia at rest and during movement over an extended period is crucial. Thoracic epidural analgesia is considered the gold standard, but intrathecal analgesia may represent a promising alternative. This study aimed to evaluate the ability of intrathecal analgesia to provide comparable pain relief to thoracic epidural analgesia for thoracic surgery. Methods: This prospective, descriptive study was conducted over 12 months. Adult patients undergoing elective thoracic surgery were included after obtaining written informed consent. Patients were randomly allocated to receive either thoracic epidural analgesia (Epidural group, n=40) with a loading dose of 10 ml 0.1% bupivacaine + 10 mcg sufentanil followed by continuous infusion, or intrathecal analgesia (Intrathecal group, n=23) with a single injection of 500 mcg morphine + 10 mcg sufentanil. Standardized general anesthesia and postoperative care protocols were applied. Primary outcomes included intraoperative hemodynamics, postoperative pain scores (NRS 0-10), rescue analgesic requirements, patient satisfaction, and adverse effects. Results: The incidence of intraoperative hypotension was higher in the Epidural group (30% vs 8.7%, p=0.04). Postoperative pain scores were initially lower in the Intrathecal group, but the difference was not significant beyond 18 hours. Rescue morphine requirements were significantly higher in the Epidural group during the first 12 postoperative hours. Overall patient satisfaction was higher in the Intrathecal group (82.6% vs 62.5%, p=0.03). The incidence of nausea/vomiting and pruritus was significantly higher in the Intrathecal group. Discussion: Thoracic epidural analgesia was associated with a higher risk of intraoperative hypotension, likely due to the extended sympathetic blockade. Intrathecal analgesia provided superior early postoperative ....

Efficacy of bilateral erector spinae block for intraoperative and post-operative analgesia in lumbar decompression surgeries: A prospective randomized controlled trial

Background: Lumbar surgery is known to cause severe pain in the post-operative period. Modalities to reduce pain in the perioperative period include opioids, non-steroidal anti-inflammatory drugs, neuraxial blocks, and erector spinae block (ESB). Aims and Objectives: In this study, we aimed to evaluate whether ESB could reduce perioperative pain, opioid consumption, and muscle relaxant consumption. Materials and Methods: Fifty patients scheduled for lumbar decompression spine surgery were randomly allocated to two groups, the erector spinae plane (ESP) group (n=25) and the control group multimodal analgesia group (n=25). Intraoperative hemodynamics, muscle relaxant requirement, opioid consumption post-operative visual analog score, and rescue analgesia were evaluated. Results: Compared with the control group, heart rate (91.24±14.86 and 90.20±14.26) (77.12±11.96 and 77.44±11.96) arterial blood pressures (87.12±8.45 mmHg) (85.25±7.25) (78.73±5.56 and 79.64±5.95) were higher during surgical incision and 1st-time interval than in ESP group, respectively. The visual analog scale scores were higher in the control group than in the ESP group during all measurements of time. The requirement for rescue analgesia was more in the control group compared to the ESP group. Post-operative analgesia lasted for 15–18 h. Conclusion: Ultrasound-guided ESP block is a simple and safe technique which provides effective intraoperative, and post-operative analgesia and patient satisfaction with reduced opioid and muscle relaxant consumption.

Comparative Study of 0.5% Bupivacaine, 0.5% Ropivacaine, and 0.75% Ropivacaine With Fentanyl as a Continuous Intraoperative Epidural Infusion on Post-operative Analgesia.

Introduction Persistent postoperative pain leads to impaired patient recovery and delays in discharge of patients. The aim was to compare the efficacy of 0.5% bupivacaine to two varying concentrations of ropivacaine, specifically 0.5% and 0.75%, along with fentanyl as a continuous epidural infusion in providing adequate pain relief for patients subjected to infraumbilical surgeries. Materials and methods A prospective randomized comparative study was carried out on 150 patients and was divided into three groups, namely group B, group R, and group RP. Group B indicates (0.5% bupivacaine), group R means (0.5% ropivacaine),and finally, group RP means (0.75% ropivacaine); the three groups had 50 patients each. Group B was administered an epidural infusion of bupivacaine at a concentration of 0.5%, group R was given 0.5% ropivacaine, and group RP was treated with 0.75% ropivacaine; all three groups included 40 mcg fentanyl. The duration of the motor and sensory blockade and the time needed for the first rescue analgesia after the stoppage of epidural infusion were assessed in all three groups.The data were statistically analyzed using the ANOVA, "post hoc Tukey," and chi-square tests. Results Comparison of the duration of motor and sensory blockade among all three groups showed that group RP (0.75% ropivacaine with 2 mcg/cc fentanyl)had the longest duration of 328.8 and 406 minutes, and the difference was statistically significant (p < 0.001). Comparison of the time of stoppage of epidural infusion to the requirement of first rescue analgesia showed that the group that received 0.75% ropivacaine with 40 mcg fentanyl had the highest value of 258.6 minutes and was statistically significant (p < 0.001). Conclusion Epidural intraoperative infusion of 0.75% ropivacaine with fentanyl offers better postoperative pain relief as compared to both 0.5% bupivacaine and 0.5% ropivacaine with fentanyl.

A Randomized Controlled Study of Epidural Morphine Sulfate-soaked Gelfoam and Morphine Sulfate Instillation in the Management of Postoperative Pain following Lumbar Spinal Fixation Surgery

Abstract Background: Lumbar spinal fixation surgeries play a pivotal role in addressing pain which can be nociceptive, neuropathic, mixed, and nociplastic; however, these surgeries can also cause significant postoperative pain and discomfort, leading to prolonged hospital stays and delayed return to normal activity. Aims and Objectives: The aim of the study was to provide effective postoperative analgesia and to compare the analgesic efficacy by application of Gelfoam-soaked morphine sulfate placed in the epidural space and direct instillation of morphine sulfate in the epidural space in patients undergoing lumbar spinal fixation surgery under general anesthesia. Materials and Methods: A total of 60 patients planned for Lumbar spinal fixation surgeries were selected and sorted into two groups of 30 each after a computer-based randomization. In Group G, a 5 cm × 1 cm piece of absorbable gelatin sponge soaked in 5 mg of morphine sulfate diluted in 0.9% normal saline up to 5 mL was placed in the epidural space. In Group I, 5 mg of morphine sulfate diluted in 0.9% normal saline 5 mL was instilled over the intact epidural space. Pulse rate, mean arterial pressure (MAP), respiratory rate (RR), and peripheral oxygen saturation (SpO2) were observed hourly for the first 6 h, then at 2 hourly intervals till 12 h, and at 4 hourly intervals till 48 h. Postoperatively, pain intensity is assessed by the Visual Analog Scale (VAS) for 24 h, and the time of the first analgesic dose is noted. VAS ranges from 0 (no pain) to 10 (severe pain). Preoperative instructions were given to the patients about the use of VAS. Results: In this study, Group G demonstrated lower postoperative VAS scores and delayed need for rescue analgesia compared to Group I (P &lt; 0.05, P &lt; 0.0001, respectively). Group I had a higher total analgesic requirement (P &lt; 0.0001) and consistently higher heart rates (P &lt; 0.0001) compared to Group G. MAPs were lower in Group G compared to Group I (P &lt; 0.0001). RRs, SpO2, sedation scores, and incidence of nausea and pruritus were similar between the two groups (P &gt; 0.05). Conclusion: Epidural administration of morphine using Gelfoam as a vehicle for sustained release of morphine is a safe and effective method of postoperative analgesia in lumbar spinal fixation surgeries and results in better hemodynamics, prolonged duration of analgesia, and reduced requirement of rescue analgesics, compared to epidural instillation of morphine.

Fentanyl versus Magnesium Sulfate with 0.5% Ropivacaine in Adductor Canal Block for Knee Surgeries

Abstract Background: Adductor canal block (ACB) is an emerging technique for postoperative analgesia following knee surgery. ACB technique is relatively easy and is performed under ultrasound guidance. Aims: This study aimed to compare the efficacy of fentanyl and magnesium sulfate as adjuvants with 0.5% ropivacaine in ACB for patients undergoing knee surgeries. Adverse events if any were also noted. Materials and Methods: The study was conducted on 100 patients aged 40–80 years posted for knee surgeries. They were divided into two groups of 50 each: Group ropivacaine with fentanyl (RF) and Group ropivacaine with magnesium (RM). Group RF received 30 mL of 0.5% ropivacaine with 50 μg of fentanyl. Group RM received 30 mL of 0.5% ropivacaine with 125 mg of magnesium sulfate. Both the groups were compared on the basis of time for the first rescue analgesia given after the block. The results were analyzed using the SPSS software. Results: The mean time of the first rescue analgesia was 8.40 ± 0.85 h in Group RF and 10.63 ± 1.10 h in Group RM, which was higher and statistically significant (P = 0.002). Rescue analgesia was given more frequently in Group RF (5.77±3.84) compared to group RM (3.20±1.27) and this was statistically significant (P = 0.000). There were no significant adverse events noted in both the groups. Conclusion: Both the adjuvants, when added to ropivacaine, prolong the duration of blockade and reduce the requirement of rescue analgesia without causing significant adverse effects, but magnesium sulfate has an extra edge over fentanyl in terms of longer duration of postoperative analgesia.

A Prospective Randomized Clinical Study to Assess and Compare the Efficacy of Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Abdominal Hysterectomy Under General Anaesthesia

Abstract Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P &lt; 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P &lt; 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P &lt; 0.0001). No significant hemodynamic changes or side effects were observed (P &gt; 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

Effect of an increased dose of intrathecal fentanyl on cesarean delivery anesthesia at a Texas level IV maternal care center

Background We hypothesized that increasing our intrathecal fentanyl dose for cesarean delivery from 10 µg to 15 µg would result in fewer patients receiving a rescue analgesia intervention. Methods Patients who had a cesarean delivery from February 15, 2021 to February 14, 2023 and received a single injection spinal or combined spinal-epidural anesthetic for cesarean delivery were eligible for inclusion. We defined a rescue analgesia intervention as administration of local anesthetic through an epidural catheter, administration of systemic anesthetic adjuvant medication, or conversion to general anesthesia. Results A total of 520 and 556 patients received 10 µg and 15 µg of intrathecal fentanyl for cesarean delivery, respectively, of which 154 (29.6%) and 122 (21.9%) patients required rescue analgesia interventions, respectively (P = 0.004). The odds ratio for receiving a rescue analgesia intervention was 0.668 (95% confidence interval 0.507 to 0.880; P = 0.004) for patients who received 15 µg of intrathecal fentanyl compared to 10 µg. Conclusion Following implementation of an increased dose of intrathecal fentanyl, patients who received 15 µg of intrathecal fentanyl for cesarean delivery were approximately 33% less likely to require a rescue analgesia intervention during cesarean delivery compared to patients who received 10 µg.

Comparison of the Efficacy of Sterile Silicone Studs Versus Lidocaine for the Attenuation of the Hemodynamic Response to Skull Pin Insertion: A Randomized Controlled Trial

BackgroundSkull pin insertion causes hypertension and tachycardia that adversely affects cerebral hemodynamics. We compared the efficacy of sterile silicone studs (SS) and pin site infiltration with lidocaine in attenuation of the sympathetic response to skull pin insertion. MethodsOne hundred and twenty adult patients undergoing supratentorial craniotomy under general anesthesia were randomized to receive either medical-grade sterile SS (Group SS) or 2 ml of 2% plain lidocaine infiltration at each pin site (Group LO). The primary objective was the comparison of the hemodynamic (heart rate [HR] and mean arterial pressure [MAP]) response to skull pin insertion at baseline and 0, 1, 2, 3 and 5 minutes of skull pin insertion. The secondary objectives were to assess the requirement of rescue analgesia (fentanyl), complications like pin-site bleeding, and the surgeon satisfaction score. ResultsThe HR in Group LO was significantly greater at 0, 1, 2, 3 and 5 mins post pin insertion as compared to Group SS (P <0.05). The MAP was also significantly higher in Group LO at 0, 1, 2, and 3 mins post pin insertion (P = 0.001, 0.01, 0.034 and 0.042 respectively) as compared to Group SS. The number of patients requiring fentanyl [17/60 (28.3%) v/s 40/60 (66%), P=0.001] was lower in Group SS. The incidence of pin site bleeding was also lower in Group SS along with a greater surgeon satisfaction score. ConclusionSterile SS appears to be more effective than lidocaine infiltration in attenuating the hemodynamic response to skull pin insertion with minimal adverse effects. Further multi-centre studies are necessary to conclusively establish the safety and efficacy of sterile SS.

Evaluation of Ketamine in Premedication on Postoperative Rescue Analgesia Requirement in Cats Undergoing Ovariohysterectomy

Feline ovariohysterectomy is a routine surgery that may cause neglected pain. This work evaluated, in a prospective, comparative, randomized and blind study, the ketamine in comparison to morphine in preanesthetic medication on postoperative analgesia requirement in cats undergoing ovariohysterectomy. Thirty healthy female cats were divided into morphine group (MG, n = 15) and ketamine group (KG, n = 15). Cats received intramuscular dexmedetomidine (10 µg/kg), and either ketamine (5 mg/kg) or morphine (0.3 mg/kg) as premedication. The anesthesia was induced with propofol and maintained with isoflurane in oxygen. Sedation and analgesia were evaluated using the GRINT, and UNESP-Botucatu scales, respectively, immediately after extubation, and hourly for 6 hours following the ovariohysterectomy. Rescue analgesia was performed with morphine (0.1 mg/kg) when pain scores were ≥ 8 on the UNESP-Botucatu scale. The side effects were observed after surgery, including mydriasis in all animals from both groups, dysphoria in 80% of the KG group and in 20% of the MG, sedation in fourteen (93.33%) animals of the MG group, but not in the KG group (p &lt;0.001). In the KG group, 13 animals required only one rescue analgesia (86.66%), while 11 animals in the MG group (73.33%) required multiple and consecutive rescue analgesia. The need for rescue analgesia in the MG group was 5.34 times higher than in the KG group (p &lt;0.05). This study suggests a reduced need for analgesic opioids in the treatment of postoperative pain. Keywords: Analgesia. Feline. Opioid. Pain. Sedation. Resumo A ovariohisterectomia felina é uma cirurgia de rotina que pode causar dor negligenciada. Este trabalho avaliou, em um estudo prospectivo, comparativo, aleatório e cego, a cetamina em comparação com a morfina na medicação pré-anestésica sobre necessidade de analgesia pós-operatória em gatas submetidas à ovariohisterectomia. Trinta gatas saudáveis foram divididas em grupo morfina (MG, n = 15) e grupo cetamina (KG, n = 15). Os gatos receberam dexmedetomidina intramuscular (10 µg/kg) e cetamina (5 mg/kg) ou morfina (0,3 mg/kg) como pré-medicação. A anestesia foi induzida com propofol e mantida com isoflurano em oxigênio. A sedação e a analgesia foram avaliadas pelas escalas GRINT e UNESP-Botucatu, respectivamente, imediatamente após a extubação e a cada 6 horas após a ovariohisterectomia. A analgesia de resgate foi realizada com morfina (0,1 mg/kg) quando os escores de dor foram ≥ 8 na escala UNESP-Botucatu. Os efeitos colaterais foram observados após a cirurgia, incluindo midríase em todos os animais de ambos os grupos, disforia em 80% do grupo KG e em 20% do MG, sedação em quatorze (93,33%) animais do grupo MG, mas não no grupo KG. Grupo KG (p &lt;0,001). No grupo KG, 13 animais necessitaram de apenas uma analgesia de resgate (86,66%), enquanto 11 animais do grupo MG (73,33%) necessitaram de analgesia de resgate múltipla e consecutiva. A necessidade de analgesia de resgate no grupo MG foi 5,34 vezes maior do que no grupo KG (p &lt; 0,05). Este estudo sugere uma menor necessidade de opióides analgésicos no tratamento da dor pós-operatória. Palavras-chave: Analgesia. Felino. Opióide. Dor. Sedação.

Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial

Study objectivesThe study aimed to compare the analgesic effect of USG-guided PENG (Peri capsular nerve group) block with Intravenous Nalbuphine hydrochloride (IVN) in patients with hip fracture coming to the emergency department (ED). The purpose was also to monitor the adverse effects and rescue analgesic requirements in both treatment modalities. MethodsThe study was an open-label randomised controlled trial (RCT) comparing PENG block versus IVN in treating patients with femoral head and neck fractures, as well as pubic rami fracture of the hip (HF). The participants in the PENG group received a USG-guided PENG block by injection of 25 ml of 0.25% bupivacaine, whereas the IVN group received 0.15 mg/kg of nalbuphine. An emergency physician with expertise in ultrasound-guided nerve blocks performed the PENG blocks. The primary outcome was to measure the improvement of the NRS (Numerical rating scale) score at 30 min in both static position (Patient-chosen position for the best comfort) and dynamic position (15-degree passive affected lower limb elevation). Secondary outcomes were to measure static and dynamic NRS pain scores at 2 h, 4 h, and 6 h after intervention in both groups. The requirement for rescue analgesia, adverse events and any block-related complications were also recorded. ResultsA total of 60 patients with HF were included in the final analysis. The static and dynamic NRS score was significantly lower in the PENG group compared to the IVN group at 30 min, 2 h, 4 h, and 6 h post-intervention. In the PENG group, the static NRS score was improved by 5.73 ± 1.17, while In the IVN group, the static NRS score was just improved by 2.13 ± 0.97 at 30 min. In the same duration, the Dynamic NRS score in the PENG group was improved by 6.13 ± 1.38, while In the IVN group, it improved just by 2.43 ± 1.28. Rescue analgesia was required in 50.0% of patients in the IVN group but none in the PENG group. Further, no block-related complications or adverse events were observed in the patients of the PENG group. ConclusionThe study provides evidence that the ultrasound-guided PENG block has a better analgesic effect and has fewer adverse events than IV opioids in patients with HF.

The potentiating effect of intravenous dexamethasone upon preemptive pudendal block analgesia for hypospadias surgery in children managed with Snodgrass technique: a randomized controlled study

IntroductionEvidence regarding the potentiating effects of intravenous dexamethasone on peripheral regional anesthesia in children is sparse. The objective of the current study was to investigate the potentiating effect of intravenous dexamethasone upon pudendal block during surgical correction of hypospadias using Snodgrass technique.MethodsThe study consisted of a monocentric, randomized controlled, double-blinded study. Patients were randomized to receive either intravenous dexamethasone 0.15 mg.kg− 1 (D group) or a control solution (C group). Both groups received standardized anesthesia including a preemptive pudendal block performed after the induction of anesthesia. The primary outcome was the proportion of patients needing rescue analgesia. Secondary outcomes were other pain outcomes over the first 24 postoperative hours.ResultsOverall, 70 patients were included in the study. Age were 24 [24; 36] and 26 [24; 38] months in the D and C groups, respectively (p = 0.4). Durations of surgery were similar in both groups (60 [30; 60], p = 1). The proportion of patients requiring rescue analgesia was decreased in the D group (23% versus 49%, in D and C groups respectively, p = 0.02). The first administration of rescue analgesia was significantly delayed in the D group. Postoperative pain was improved in the D group between 6 and 24 h after surgery. Opioid requirements and the incidence of vomiting did not significantly differ between groups.ConclusionAssociating intravenous dexamethasone (0.15 mg.kg− 1) to pudendal block during hypospadias surgery improves pain control over the first postoperative day. Further studies are needed in order to confirm these results.ClinicalTrials.gov IdentifierNCT03902249.A. What is already knowndexamethasone has been found to potentiate analgesia obtained with regional anesthesia in children.B. What this article addsintravenous dexamethasone was found to improve analgesia with a preemptive pudendal block during hypospadias surgery.C. Implications for translationresults of this study indicate that intravenous dexamethasone could be used as an adjunct to pudendal block.