Requirement Of First Dose Research Articles

English

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P < 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine

Role of intraperitoneal instillation of bupivacaine after laparoscopic cholecystectomy for post-operative pain management: a randomized controlled trial

Background: Intra peritoneal (IP) local anaesthesia (LA) is a simple, cheap and safest method of providing post-operative (post-op) analgesia after laparoscopic cholecystectomy (LC). In this research, the role of intraperitoneal (IP) instillation of bupivacaine on post-op pain was studied. Post-op pain at 6, 12 and 24 hours was assessed using numeric rating scale. The degree of ambulation postoperatively at 6 and 24 hours and the requirement of analgesics was taken into account. The length of hospital stay was also a factor.Methods: A total of 76 patients during January 2018 to December 2018, undergoing LC, fitting the inclusion criteria were included randomly and divided in to two groups, bupivacaine group (B) and control group (A) based on a pre-generated random number sequence by the principal investigator. The surgical outcome was compared based on multiple parameters and the primary outcome measures were the post-op pain and analgesic requirement.Results: Degree of ambulation at 6 hours was significantly better in group B, compared to group A (p=0.008). The requirement of first dose of rescue analgesia was found to be within 6 hours (post-op) in 34 patients of group A (89.47%) as compared to 13 patients of group B (34.21%), was found to be statistically significant (p<0.001). There was statistically significant (p=0.002) difference with respect to length of hospital stay between the two groups.Conclusions: In our study we found that IP bupivacaine (0.5%) is an effective, economical, safe method of post-op pain management with better post-op recovery.

Effect of intravenous paracetamol for post-operative pain relief after tonsillectomy - A study of 70 cases

INTRODUCTION: Tonsillectomy is one of the commonest surgical procedures performed in the field of otorhinolaryngology. The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The provision of adequate analgesia after tonsillectomy presents the anaesthesiologist with difficulties, as this is a painful procedure and may be associated with significant bleeding into the airway. As evidence continues to accumulate concerning the role of central sensitisation in post operative pain, many researchers have followed methods to prevent central neuropathic changes from occurring, through the utilization of pre-emptive analgesic techniques. Effective preventive analgesic technique may not only be useful in reducing the acute pain, but also chronic post surgical pain and disabilities. Paracetamol is an effective analgesic and an antipyretic agent. The efficiency and tolerability for intravenous Paracetamol are well established. It has a favourable safety profile and it is the most commonly prescribed drug for the treatment of mild to moderate pain. The objective of the present study is to evaluate the post operative analgesia, the haemodynamic profile and the side effects of IV Paracetamol. AIM OF THE STUDY: 1. To evaluate the efficacy of Intravenous Paracetamol as a pre-emptive analgesic in relieving the post operative pain. 2. To study the hemodynamic variables during the post-operative period. 3. To establish the safety of Intravenous paracetamol in patients. MATERIALS AND METHODS: Study Design: Prospective, randomized, double blinded, comparative study. Double blinding was done by taking appropriate dose of intravenous paracetamol calculated in mg/kg and was added to a solution of normal saline to make a volume of 100 ml. This was labelled as drug A. Plain 100 ml of normal saline was labelled as drug B. Neither the person administering the drug nor the person observing the patient in the post operative period did not know the drug. Study Population: After obtaining the institutional ethical committee approval and written informed consent from the parent/guardian, 70 ASA I physical status patients undergoing tonsillectomy were selected between the age group of 6-16 years and weighing between 10-30 kg. Sample Size: 35 patients in the paracetamol group (P group) and 35 in the control group (N group). Probability sampling: All the70 patients were randomised in two groups and the entire patients stood an equal chance of getting into any group. Data collection: 1. Age, Sex, Weight, 2. Pre operative and intra operative pulse rate and blood pressure, Spo2, 3. Duration of surgery, 4. Sedation score using Ramsays Sedation Scale, 5. Visual analogue pain scale at the end of surgery, 1h 2h, 3h, 4h, 5h, 6h. 6. Post operative complications such as: • Drug intolerance, • Nausea and vomiting, • Epigastric pain, • Bleeding, Exclusion Criteria: 1. Upper and lower respiratory tract infections, 2. Cardiac valvular abnormalities, 3. Abnormal bleeding and clotting time, 4. Obstructive sleep apnea, 5. Known history of allergy to paracetamol, 6. Past history of jaundice, 7. Patients on aspirin, 8. Any other concurrent antipyretic, analgesic or anti inflammatory Medications. OBSERVATION AND RESULTS: Data were analysed using SPSS version 13.0 computer software at level of significance p = 0.05. Numerical variables were presented as mean and standard deviation (SD) and categorical variables were presented as frequency (%). Unpaired Student ‘t’ test was used for between-group comparisons between categorical variables. Time to first analgesic administration was analysed by the Kaplan–Meier survival analysis. SUMMARY: 1. Intravenous Paracetamol achieved significant post operative pain relief up to 6 hours. 2. Intravenous Paracetamol delayed the requirement of first dose of rescue analgesic for a mean duration of 6 hours in the post-operative period. 3. Intravenous Paracetamol had a better haemodynamic profile in the post-operative period. 4. Intraveous Paracetamol had a smooth and better post-operative recovery profile rendering a calm, co-operative and tranquil patient. 5. Intravenous Paracetamol did not exhibit any adverse effects in the patients. CONCLUSION: 1. Intravenous Paracetamol can be used as an effective analgesic for providing pre-emptive analgesia. 2. Intravenous Paracetamol provides excellent post operative pain relief. 3. Intraveous Paracetamol has a better hemodynamic profile. 4. Intraveous Paracetamol is safe for use in patients.

Effect of intravenous paracetamol for post-operative pain relief after tonsillectomy - A study of 70 cases

INTRODUCTION: Tonsillectomy is one of the commonest surgical procedures performed in the field of otorhinolaryngology. The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The provision of adequate analgesia after tonsillectomy presents the anaesthesiologist with difficulties, as this is a painful procedure and may be associated with significant bleeding into the airway. As evidence continues to accumulate concerning the role of central sensitisation in post operative pain, many researchers have followed methods to prevent central neuropathic changes from occurring, through the utilization of pre-emptive analgesic techniques. Effective preventive analgesic technique may not only be useful in reducing the acute pain, but also chronic post surgical pain and disabilities. Paracetamol is an effective analgesic and an antipyretic agent. The efficiency and tolerability for intravenous Paracetamol are well established. It has a favourable safety profile and it is the most commonly prescribed drug for the treatment of mild to moderate pain. The objective of the present study is to evaluate the post operative analgesia, the haemodynamic profile and the side effects of IV Paracetamol. AIM OF THE STUDY: 1. To evaluate the efficacy of Intravenous Paracetamol as a pre-emptive analgesic in relieving the post operative pain. 2. To study the hemodynamic variables during the post-operative period. 3. To establish the safety of Intravenous paracetamol in patients. MATERIALS AND METHODS: Study Design: Prospective, randomized, double blinded, comparative study. Double blinding was done by taking appropriate dose of intravenous paracetamol calculated in mg/kg and was added to a solution of normal saline to make a volume of 100 ml. This was labelled as drug A. Plain 100 ml of normal saline was labelled as drug B. Neither the person administering the drug nor the person observing the patient in the post operative period did not know the drug. Study Population: After obtaining the institutional ethical committee approval and written informed consent from the parent/guardian, 70 ASA I physical status patients undergoing tonsillectomy were selected between the age group of 6-16 years and weighing between 10-30 kg. Sample Size: 35 patients in the paracetamol group (P group) and 35 in the control group (N group). Probability sampling: All the70 patients were randomised in two groups and the entire patients stood an equal chance of getting into any group. Data collection: 1. Age, Sex, Weight, 2. Pre operative and intra operative pulse rate and blood pressure, Spo2, 3. Duration of surgery, 4. Sedation score using Ramsays Sedation Scale, 5. Visual analogue pain scale at the end of surgery, 1h 2h, 3h, 4h, 5h, 6h. 6. Post operative complications such as: • Drug intolerance, • Nausea and vomiting, • Epigastric pain, • Bleeding, Exclusion Criteria: 1. Upper and lower respiratory tract infections, 2. Cardiac valvular abnormalities, 3. Abnormal bleeding and clotting time, 4. Obstructive sleep apnea, 5. Known history of allergy to paracetamol, 6. Past history of jaundice, 7. Patients on aspirin, 8. Any other concurrent antipyretic, analgesic or anti inflammatory Medications. OBSERVATION AND RESULTS: Data were analysed using SPSS version 13.0 computer software at level of significance p = 0.05. Numerical variables were presented as mean and standard deviation (SD) and categorical variables were presented as frequency (%). Unpaired Student ‘t’ test was used for between-group comparisons between categorical variables. Time to first analgesic administration was analysed by the Kaplan–Meier survival analysis. SUMMARY: 1. Intravenous Paracetamol achieved significant post operative pain relief up to 6 hours. 2. Intravenous Paracetamol delayed the requirement of first dose of rescue analgesic for a mean duration of 6 hours in the post-operative period. 3. Intravenous Paracetamol had a better haemodynamic profile in the post-operative period. 4. Intraveous Paracetamol had a smooth and better post-operative recovery profile rendering a calm, co-operative and tranquil patient. 5. Intravenous Paracetamol did not exhibit any adverse effects in the patients. CONCLUSION: 1. Intravenous Paracetamol can be used as an effective analgesic for providing pre-emptive analgesia. 2. Intravenous Paracetamol provides excellent post operative pain relief. 3. Intraveous Paracetamol has a better hemodynamic profile. 4. Intraveous Paracetamol is safe for use in patients.

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Comparison of pregabalin with gabapentin as preemptive analgesic in lumbar spine surgery.

Background and Aims:Analgesic effect of gabapentin and pregabalin is well-defined in the treatment of neuropathic pain. Postoperative pain after lumbar spine surgery limits the function of patients in the postoperative period, for which the search for ideal analgesic goes on. The aim of the present study was to compare pregabalin and gabapentin as a pre-emptive analgesic in elective lumbar spine surgeries.Material and Methods:In this randomized prospective study, 75 patients were allocated into three groups of 25 each. Group G, group PG, and group P received two capsules of gabapentin 300 mg each, two capsules of pregabalin 150 mg each, and two multivitamin capsules, respectively, with sip of water 1 hour before the expected time of induction of anesthesia. Time for requirement of first dose of rescue analgesia, reduction in postoperative pain score and total dose of rescue analgesic used in first 24 hours postoperatively, and side effects were compared.Result:Time for requirement of first dose of rescue analgesic in PG group was 180.12 min and in G group was 104.16 min, which was statistically significant. Both G and PG group had lower visual analogue scale (VAS) score in comparison to P group, which was statistically significant. Consumption of rescue analgesic was less in G and PG group in comparison to P group. Amount of rescue analgesic requirement were low in PG group in comparison to G group (P < 0.001).Conclusion:Though both study drugs had produced prolonged postoperative analgesia compared to placebo, pregabalin had better analgesic profile in postoperative period than gabapentin.

Ultrasonography-guided articular branch of femoral nerve and anterior obturator nerve block for perioperative pain in hip surgery

Background: We present a novel block of the articular branch of the femoral nerve (ABFN) and anterior obturator (AO) nerve for perioperative analgesia during various hip surgeries. Materials and Methods: In this prospective audit, 30 patients underwent hip surgeries such as hemiarthroplasty, percutaneous femoral nailing, and dynamic hip screwing performed by the same surgeon under subarachnoid block (SAB) that was performed by the same anesthesiologist using 10–15 mg of bupivacaine 0.5% (heavy). Pain management after hip surgery used to be provided by using epidural analgesia or intravenous (IV) analgesia. During this study, we performed ultrasonography (USG)-guided block to ABFN and AO with injection ropivacaine (0.2%) 35 mL (20 + 15 mL) with 8 mg dexamethasone just before spinal anesthesia in operation theatre. Pain scores were compared using Numeric Pain Rating Scale at pre-procedure, followed by 0, 4, 8, and 12 h after the block and the requirement of first dose of IV analgesics. Results: Pain scores were significantly lower in these patients in the first 12 h of the surgery along with less requirement of IV analgesics. The onset of blocks start within 3–5 min, and patients were more comfortable in sitting position while performing SAB. Discussion: Blocking ABFN and AO nerve provides superior analgesia during perioperative period in hip surgeries and decreases the requirements of IV analgesics and provides effective analgesia in patients while performing SAB in sitting position.

Efficacy of Dexmedetomidine in two Different Doses as an Adjuvant to Lignocaine in Patients Scheduled for Surgeries under Axillary Block.

The effect of adding dexmedetomidine (α2-adrenoceptor agonist) to local anaesthetics in brachial plexus blocks has been evaluated, however there has been no consensus regarding the ideal dose of dexmedetomidine. Without ultrasound axillary block has been considered as the safest approach for brachial block. To evaluate the efficacy of two doses of dexmedetomidine (0.5 μg/kg and 1 μg/kg) as an adjuvant to lignocaine in patients undergoing forearm surgeries under axillary brachial plexus block. This prospective randomized controlled study was conducted on 104 adult patients, American Society of Anaesthesiologists (ASA) physical status 1 or 2. They were randomized and given following drug formulations, Group L (n=35) received 23 ml of 2% lignocaine with adrenaline + 7 ml of saline, Group LD0.5 (n=34) received 23 ml of 2% lignocaine with adrenaline + 0.5 μg/kg of dexmedetomidine diluted in saline to make a volume of 7 ml, Group LD1 (n=35) was given 23 ml of 2% lignocaine with adrenaline + 1 μg/kg of dexmedetomidine diluted in saline to make volume of 7 ml, the total volume of drug being 30 ml in each group and concentration of lignocaine 1.5%. The duration of postoperative analgesia and demand for rescue analgesia were the primary outcomes and block characteristics taken as secondary outcome. Sensory and motor block onset times were shorter in Group L than in group LD0.5, LD1 (p < 0.05). Sensory and motor blockade durations were longer in Group LD1, LD0.5 than Group L (p<0.01). Duration of analgesia was longer in Group LD1 than in group LD0.5 and least in Group L (p<0.05). Dexmedetomidine (0.5 μg/kg and 1 μg/kg) as an adjuvant in axillary brachial plexus increases the duration of postoperative analgesia and delays the requirement of first dose of analgesic in a dose dependent manner and 1 μg/kg seems to be the near ideal dose of dexmedetomidine as an adjuvant in axillary block.

Comparative Study of Intravenous Dexmedetomidine versus Paracetamol for Postoperative Pain Relief in Laparoscopic Surgery

Background: Acute pain in the perioperative setting is detrimental to post operative outcome and adequate analgesia leads to better outcome. Methods: Sixty ASA I/II patients between 18- 65 years undergoing laparoscopic cholecystectomy and appendicectomy were included and randomly divided into 2 groups. ASA III/IV patients, previous opioid and alpha 2 agonist treatment and patients requiring extensive surgical dissection were excluded. Group D received IV Dexmedetomidine 1?g/kg over 10 min followed by 0.2-0.7 ?g /kg/hr and Group P received IV Paracetamol 15 mg/kg prior to extubation. Patients were monitored for hemodynamics and VAS score was assessed after extubation till 24 hours. Rescue analgesia (IV tramadol 1 mg/kg) was given and the time interval till the requirement of first dose of rescue analgesia was recorded. Results: In group D, 12 patients required rescue analgesia as compared to 4 Patients in group P (40% vs13.3%; P=0.02). VAS scores were similar in both groups with group P showing trend towards low score. Median time at which the first dose of rescue analgesia was administered in group P was longer (134.42 + 12.67 vs 82.76 + 9.38 min; P=0.001). Incidence of bradycardia and hypotension was higher in group D (20% vs 3.3%; P=0.04). Conclusion: Paracetamol is a superior to Dexmedetomidine for analgesia in short surgical procedures and should form a part of multimodal analgesia. Keywords: Dexmedetomidine, Paracetamol, Laparoscopic surgery, Analgesia

Comparision of Caudal Bupivacaine with Additives Fantanyl or Ketamine for Post-Operative Pain Relief in Children: A Randomized Controlled, Double Blinded Study

Background and Aims: Ensuring adequate analgesia in the post-operative period is an indispensable part of a balanced anesthesia technique with increasing scope of day care surgery and emphasis on early discharge. In children undergoing infra-umbilical and lower limb surgeries, caudal block is a reliable and safe technique that can be used with general anesthesia for intra and post-operative analgesia. The present study was designed to compare the analgesic efficacy of ketamine and fentanyl as additives to bupivacaine given caudally in children undergoing lower abdominal and lower limb surgery. Materials and Methods: A total of 60 children aged 1-5 years undergoing lower abdominal and lower limb surgery were included in this randomized, controlled, double-blind study. Three groups of 20 each were assigned to receive caudal block with bupivacaine 0.25% 0.5 ml/kg alone (group A) or along with 1 ml/kg fentanyl (group B) or 0.5 mg/kg ketamine (group C). Assessment of post-operative pain was done using the Objective Pain Scale. Requirement of rescue analgesia and side effects were also noted. Results: Children who received ketamine with bupivacaine caudally (group C) had the longest duration of post-operative analgesia [Group A vs. Group C: 150 min (p=0.32) vs. 180 min (p=0.00)] and requirement of first dose of analgesia in groups A, B and C ranged from 183±16.5 min, 350±2.5 min and 594±148.12 min respectively. The mean number of doses of rescue analgesia that patients received in 24 hours in group A, B and C were 6.0, 1.63 and 1.40 respectively. Conclusion: Caudally administered Ketamine in the dose of 0.5 mg/kg with bupivacaine provides prolonged post-operative analgesia in comparison to fenatnyl 1 ?g/kg with bupivacaine with minimal side effects. Keywords: Ketamine, fentanyl, bupivacaine, children

A comparison between intravenous paracetamol plus fentanyl and intravenous fentanyl alone for postoperative analgesia during laparoscopic cholecystectomy.

Purpose:our study compared the effect of fentanyl alone with fentanyl plus intravenous Paracetamol for analgesic efficacy, opioid sparing effects, and opioid-related side effects after laparoscopic cholecystectomy.Materials and Methods:eighty patients undergoing laparoscopic cholecystectomy were randomized into two groups, who were given either an IV placebo or an IV injection of 1g paracetamol just before induction. Both groups received fentanyl during induction and IM diclofenac for pain relief every 8 hourly for 24 h after surgery. The postoperative pain relief was evaluated by a visual analog scale (VAS) and consumption of fentanyl as rescue analgesic in the postoperative period for 24 h after surgery was measured. The incidence of PONV and sedation scores was also measured in the postoperative period.Results:the mean VAS score in first and second hour after surgery was less in the group receiving IV Paracetamol (3.3±0.4* vs. 5.2±0.9; 3.1±0.4* vs. 4.3±0.3); the fentanyl consumption over first 24 h was also less in the group receiving IV paracetamol (50±14.9 vs. 150±25.8). The time requirement of first dose of rescue analgesic in the postoperative period was also significantly prolonged in the group receiving IV paracetamol (76±24.7 vs. 48±15.8). There was no difference in the sedation scores and in the incidence of PONV in the two groups.Conclusion:The study demonstrates the usefulness of intravenous paracetamol as pre-emptive analgesic in the treatment of postoperative pain after laparoscopic cholecystectomy.

Effect of Scalp Block on Postoperative Pain Relief in Craniotomy Patients

The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol IV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P < 0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P < 0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.

EMLA® Cream Versus Dorsal Penile Nerve Block for Postcircumcision Analgesia in Children

We conducted a prospective, randomized, double-blinded trial comparing preoperative application of EMLA® cream and sodium chloride solution dorsal penile block (n = 31) with placebo cream and bupivacaine dorsal penile nerve block (n = 32) for postcircumcision analgesia. Pain was assessed using modified Children’s Hospital of Eastern Ontario Pain Scale and the duration of block by the time to requirement of first dose of postoperative analgesic. There was no difference in Children’s Hospital of Eastern Ontario Pain Scale between the two groups, but bupivacaine dorsal penile nerve block resulted in longer analgesia (P = 0.003). There were no local or systemic complications related to either technique, and there was a very small incidence of vomiting. We conclude that preoperative application of EMLA® cream is an effective and simple method to produce postcircumcision analgesia with a very small incidence of adverse effects.