Postoperative Analgesic Requirements Research Articles

Comment on "Postoperative Outcomes and Analgesic Requirements of Single-Port vs Multi-Port Robotic Assisted Radical Cystectomy" by Fang, et al.

Comment on "Postoperative Outcomes and Analgesic Requirements of Single-Port vs Multi-Port Robotic Assisted Radical Cystectomy" by Fang, et al.

Evaluating the safety of bipolar nephrostomy tract cauterization “BNTC” towards a safe tubeless percutaneous nephrolithotomy: a randomized controlled trial

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section

Abstract Background Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. Objective to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine. Results In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value < 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.). Conclusion Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.

Analgesic Effect of Intrathecal Nalbuphine versus Intrathecal Fentanyl as Adjuvant to 0.5% Bupivacaine for Cesarian Section under Spinal Anaesthesia

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective To assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl. Methods This randomized comparative clinical trial was conducted in Ain Shams University Hospitals’ operating rooms on 48 patients undergoing cesarean section within a period of six months after approval of ethical committee of Faculty of Medicine, Ain Shams University. Results This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine. It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine. Conclusion Either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 μg) combined with Bupivacaine improves intraoperative analgesia and prolongs post- operative analgesia in cesarean section. There was statistically significant difference between them, intrathecal nalbuphine had a prolonged duration of post-operative analgesia, lesser amount of rescue analgesia needed and fewer side effects than intrathecal fentanyl.

A Comparative Study between Ultrasound Guided Ilioingunial/Iliohypogastric Nerve Block versus Transversus Abdominis Plane Block in Patients Undergoing Unilateral Oblique Inguinal Hernia Repair

Abstract Background Combined ilioinguinal-iliohypogastric (IIN/IHN) block and transversus abdominis plane (TAP) block are used under ultrasound (USG) visualization for postoperative pain control in patients undergoing unilateral inguinal hernia repair surgery. Patients and Methods This study compares USG-guided TAP versus IIN/IHN block for post-operative analgesia efficacy in adults undergoing inguinal hernia surgery, among 60 patients randomized into group A received IIN+IHN blocks by using levobupivacaine 0.25% 20 ml and group B received TAP block by using levobupivacaine 0.25% 20 ml after induction of general anesthesia. Results There is highly statistically significant increase mean of ilioinguinal /illiohypogastric block (II/IH) group compared to TAP block group according to time to rescue analgesia (min) (p < 0.001). Conclusions USG-guided IIN/IHN block delays the need for rescue analgesia and reduces the postoperative analgesic requirement compared to USG-guided TAP block.

Comparison of Post-Operative Analgesia of Caudal versus Dorsal Penile Nerve Blocks for Pediatric Patients Undergoing Hypospadias Repair

Abstract Background Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects. Aim of the Work The aim of this study is to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics. Methodology This prospective randomized comparative clinical study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 30 male patient aged (1–8) years, ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Penile block (n = 15) received dorsal penile nerve block by using the subpubic approach technique. Group C: Caudal block (n = 15) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was statistically high significant difference between the two groups in postoperative MAP and HR (p value <0.001) but no statistically significant difference between them in Spo2. FLACC pain scores were significantly lower in group C compared with group P at PACU and 3 hours postoperative (p value <0.001) but no statistically significant difference between them at 6, 9 and 12 hours postoperative. Also, The time for first rescue analgesia was significantly longer in caudal group compared with penile group (P < 0.001) and the total analgesia consumption was also significantly lower (P < 0.001) in group C compared with group P. Postoperative time of ambulation was significantly lower (P < 0.001) in group P compared with group C. Conclusion The current study revealed that Caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with Penile block in pediatric patients undergoing hypospadias repair.

Ultra-Sound Guided Quadratus Lamborum Block Using Dexamethasone and Bupivacaine versus Dexmedetomidine and Bupivacaine for Post-Operative Analgesia after Labaroscopic Cholecystectomy

Abstract Background The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using regional anethesia. Transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after lower abdominal surgeries. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution. Objective To assess the analgesic effect of addition dexamethasone or Dexmedetomidine with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing laparscopic abdominal surgeries in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients undergoing laparscopic abdominal surgeries were included in the study, and were divided into two groups (n = 10; each); group A and B . Where in group A patients(n = 10) received 20 ml bupivacaine 0.5% plus 100 μg Dexmedetomidine diluted in 5ml 0.9% NaCl (the total volume injected in all patients is 25 ml), and group B patients (n = 10) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl . Results The thesis proved that the addition of either Dexmedetomidine or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for laparscopic abdominal (cholecystectomy) surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexmedetomidine showing better results. Conclusion The addition of either 100 μg Dexmedetomidine diluted in 5 ml 0.9% NaCl or 8 mg dexamethasone to 20 ml bupivacaine 0.25% in ultrasound guided quadratus lumborum block for laparscopic abdominal surgery prolonged the duration of analgesia significantly and decreased the postoperative analgesic requirement. Hence, our study suggests that either Dexmedetomidine or dexamethasone may be a useful alternative as an adjuvant to long-acting local anesthetics for quadratus lumborum nerve block with Dexmedetomidine showing better results.

Ultrasound-Guided Pudendal Nerve Block versus Caudal Block for Post-Operative Analgesia in Penile Surgeries in Children

Abstract Background Penile surgeries as hypospadias, urethroplasty and circumcision are of the most frequently performed surgical procedures in the pediatric male population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. This study was to compare the effectiveness and safety of ultrasound (US) guided pudendal nerve block (PNB) versus caudal block (CB) for postoperative analgesia in pediatric male patients undergoing penile surgeries. Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups (20 each group) either receiving ultrasound-guided pudendal nerve block (PNB group) or caudal epidural block (CB group). In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. The two groups were adequately monitored and assessed pre, intra and post-operatively and they were compared regarding demographic data, pre, intra and postoperative hemodynamics, postoperative pain control using objective pain scale (OPS) score, consumption of paracetamol in the 1st 24 hours postoperatively and complications of both anesthetic techniques. Results This prospective randomized controlled single-blind clinical study was performed on total 40 patients of age 3 to 10 years scheduled for penile surgeries. For the primary outcome, there was a statistically significant increase in time to first analgesia in PNB group than CB group with p value < 0.001 while there was a statistically significant increase in total dose of paracetamol in CB group than PNB group with p value < 0.001. For OPS score, there was a statistically significant increase in pain score in CB group than PNB group at 6 h, 12 h and 24 h with p value = 0.02, 0.005 and 0.01, respectively. Conclusion From our study we can conclude that US guided PNB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in pediatric patients undergoing penile surgeries and also demonstrated that both analgesic techniques are safe.

A comparative evaluation of intraperitoneal bupivacaine alone and bupivacaine with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy.

Intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, α2 agonists such as Dexmedetomidine have been found to reduce postoperative pain following laparoscopic cholecystectomy. The study was designed to compare the better drug among Bupivacaine alone and Bupivacaine with Dexmedetomidine with respect to their analgesic efficacy and safety profile. in patients undergoing laparoscopic cholecystectomy. The study was carried out on sixty patients of the American Society of Anaesthesiologists (ASA) physical status I-II of either sex with ages ranging from 18 to 60 years posted for elective laparoscopic cholecystectomy under General Anaesthesia, equally divided into two groups, randomly allocated to one of the Groups using the table of randomization. Group B received Intraperitoneal Bupivacaine 40 ml 0.25% +5 ml normal saline and Group BD received Intraperitoneal Bupivacaine 40 ml 0.25% + Dexmedetomidine1 μg/kg diluted in 5 ml Normal saline. The mean heart rate and blood pressure (systolic, diastolic and mean) readings were significantly lower in Group BD than in Group B. The mean duration of analgesia in our study was longer in Group BD (7.5 ± 0.73 hours) when compared to Group B (5.9 ± 0.55 hours) with p-value & 0.0001 and CI 1.27 to 1.9, which was statistically significant. However, the post-operative analgesic requirement (rescue/demand) in Group B was clinically earlier and statistically significant as compared to Group BD. Postoperative VAS score ≥3 was considered the benchmark for providing rescue analgesia in the form of injection of Diclofenac 75 mg IV. In our study, we observed the pain scores via VAS/NRS at 30 min, 1 h, 2 h, 4 h, 6 h, 8 h, 10 h, 12 h, 14 h, 16 h, 18 h, 20 h, 22 h and 24 h postoperatively. A comparison of pain scores from 30 min to 10hrs postoperatively showed a significant difference in both Groups with Group B having significantly higher VAS scores and lower VAS scores with Group BD. Our study suggests that there is a shorter duration of action of 0.25% Bupivacaine alone as compared to 0.25% Bupivacaine + Dexmedetomidine. Since the laparoscope is still inside the abdominal cavity the drugs are easy to administer with no adverse effects and with a good safety profile because of the visualization of drug deposition in the right place. Intraperitoneal instillation of Bupivacaine with Dexmedetomidine for postoperative analgesia was very promising as a part of multimodal analgesia in laparoscopic cholecystectomy.

Agony of Choice: Caudal Block versus Ilioinguinal/Iliohypogastric Nerve Block in Unilateral Orchidopexy.

Objective: This prospective study aimed to compare the efficacy of caudal block (CB) and ilioinguinal/iliohypogastric nerve block (IINB) for providing additional analgesia during unilateral orchidopexy. Methods: Seventy-one boys aged <48 months, classified as ASA I/II, were assigned into CB (n = 37) and IINB (n = 34) groups. Outcome measures included intra- and postoperative analgesic requirements, pain scores, and administration duration. Additional intraoperative analgesia was administered for a 10% increase in heart rate, while postoperative pain was assessed using the Children's and Infants Postoperative Pain Scale (CHIPPS), with scores >4 prompting supplementary analgesia. Monitoring was extended for 24 h post-surgery. Results: CB significantly reduced the need for intraoperative (p < 0.001) and early postoperative (p = 0.008) analgesia compared to IINB. However, the CB group exhibited a slightly higher but non-significant analgesic requirement on the ward. No clinically relevant side effects were observed in either group. Conclusions: Both CB and IINB are effective and safe methods for providing regional analgesia during orchidopexy. CB demonstrates superior efficacy intraoperatively and in the early postoperative period, while IINB may offer advantages in the later recovery phase. However, additional analgesia is often required for orchidopexy, especially in outpatient settings.

Liposomal Bupivacaine Versus Bupivacaine and Dexamethasone Intercostal Nerve Blocks for Robotic Thoracic Surgery: A Randomized Clinical Trial.

Introduction For peripheral nerve blocks, using either the liposomal formulation of bupivacaine or plain bupivacaine with epinephrine and dexamethasone as an adjuvant has been shown to improve postoperative pain scores. In a single-blinded, randomized controlled study of patients undergoing robotic-assisted thoracoscopic surgery, we determined if bupivacaine with epinephrine and dexamethasone was noninferior to liposomal bupivacaine mixed with plain bupivacaine when administered intraoperatively as an intercostal nerve block (INB). Methods A total of 34 patients undergoing robotic-assisted thoracoscopic surgery were randomized to receive one of two injectate mixtures during their intraoperative INB. Group LB was administered 266 mg of 13.3 mg/mL liposomal bupivacaine with 24 mL of 0.5% plain bupivacaine, while Group BD was given 42 mL of 0.5% bupivacaine with epinephrine and 8 mg of dexamethasone. The primary outcomes were mean postoperative numerical pain ratings and mean postoperative opioid analgesic requirements. Secondary outcomes included adjuvant pain medication consumption, hospital length of stay, and total opioid use in oral morphine equivalents. Results Group LB exhibited no significant difference in pain scores (p = 0.437) and opioid analgesic requirement (p = 0.095) within the 72-hour postoperative period when compared to Group BD. The median total postoperative opioid requirement was 90 mg in Group LB, compared to 45 mg in Group BD. There were no significant differences in the use of postoperative adjuvant pain medications (gabapentin, p = 0.833; acetaminophen, p = 0.190; ketorolac, p = 0.699). Hospital length of stay did not differ between the groups. Conclusions INBs with the addition of dexamethasone as an adjuvant to 0.5% bupivacaine with epinephrine provided noninferior postoperative analgesia compared to liposomal bupivacaine mixed with plain 0.5% bupivacaine.

Pudendal nerve block decreases narcotic requirements and time spent in post-anesthesia care units in patients undergoing primary inflatable penile prosthesis implantation.

Efforts to minimize narcotic usage following inflatable penile prosthesis (IPP) implantation are vital, considering the current opioid epidemic in the United States. We aimed to determine whether pudendal nerve block (PNB) utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. A single-institution, retrospective study was conducted on patients who underwent primary IPP implantation between December 2015 and June 2022. PNB usage and intra- and post-operative outcomes were analyzed using multivariate binary logistic regression. 449 patients were included, with 373 (83.1%) in the PNB group. Median time (minutes) spent in the post-anesthesia care unit (PACU) (1499 [119-198] vs. 235 [169-322], p < 0.001) was significantly lower in the PNB group. There were no significant differences in intra-operative and PACU morphine milligram equivalents or post-operative safety outcomes between groups. However, fewer patients in the PNB group called for pain medications post-operatively (10.2% vs 19.7%, p = 0.019). Multivariate analysis revealed a significantly decreased operative time (B -6.23; 95%CI -11.28, -1.17; p = 0.016) and decreased time in recovery (B: -81.62; 95%CI: -106.49, -56.76, p < 0.001) in the PNB group. PNB decreases post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation and thus may represent an attractive, non-opioid adjunct.

Use of Anal Fistula Plug for Treatment of Fistula-in-ano: A Novel Technique?

Abstract Background: Fistula-in-ano is a chronic phase of anorectal suppuration characterized by purulent discharge. The conventional gold standard fistulotomy opens the entire track to heal with secondary intention. Anal fistula plug (AFP) is one of the newer modalities where the track is debrided from within and plugged with a biodegradable material made of porcine small intestinal submucosa. Materials and Methods: A total of 100 patients were enrolled in a randomized prospective study into two groups: conventional fistulotomy (CF) group and AFP group with 50 patients in each arm. The demography and surgical outcomes were assessed for postoperative pain, discharge and recovery, and failure. Results: All 100 patients included in the study had a history of anorectal suppuration which led to the residual anal fistula. Postoperative pain and analgesic requirements were equal in the two groups. The recovery period and return to work were shorter in the AFP group, and this difference was statistically significant. The success rate was 100% in the CF group as compared to 76% in the AFP group. There was no significant complication, failure, or recurrence in the CF group as against allergy (1), extrusion of plug (2), and failure/recurrence (9) in the AFP group. Conclusion: Our study shows that the application of bioprosthetic plugs may be an alternative option in a select group of patients. AFP has also shown to have a faster recovery with less morbidity and comparable success rates.

Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study

Objective: The aim of this comparative study was to evaluate the efficacy and safety of ultrasound-guided caudal anesthesia compared to blind caudal anesthesia for subumbilical surgery in pediatric patients. Methods: This prospective study included pediatric patients undergoing subumbilical surgery in the Department of Pediatric Surgery. Patients were divided into two groups: the ultrasound-guided caudal anesthesia group and the blind caudal anesthesia group. Primary outcomes assessed included the success rate of block placement, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications. Results: A total of 40 patients were included in the study, with 20 patients in the ultrasound-guided group and 20 patients in the blind group. The success rate of block placement was significantly higher in the ultrasound-guided group compared to the blind group (p &lt; 0.001). The ultrasound-guided group also demonstrated faster onset of sensory and motor blockade (p &lt; 0.05) and longer duration of analgesia (p &lt; 0.05) compared to the blind group. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p &lt; 0.001). No significant differences in perioperative complications were observed between the two groups. Conclusion: Ultrasound-guided caudal anesthesia was found to be more effective and reliable than blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided a higher success rate of block placement, faster onset and longer duration of sensory and motor blockade, reduced postoperative analgesic requirements, and comparable safety profile. Ultrasound guidance should be considered as the preferred technique for caudal anesthesia in this patient population.

A COMPARATIVE STUDY OF EFFECT OF DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO 0.2% ROPIVACAINE FOR ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INFRAUMBILICAL SURGERIES

Background: The relief of pain and suffering is, and always has been, one of the primary concerns of mankind and one of the prime factors that has influenced the course of history of medicine. Transversus abdominis plane (TAP) block is a regional anaesthetic technique which blocks the abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscle. Aim: To compare the efficacy of Dexmedetomidine and dexamethasone as an adjuvant to 0.2%ropivacaine in ultrasound guided transverses abdominis plane block in infra umbilical surgeries in terms of, 1. Time to initial postoperative pain. 2. Time to initial rescue analgesia. 3. Quality of block.. 4. Total postop analgesic consumption. 5. Patient satisfaction with regard to pain relief. 6. Post-operative nausea and vomiting. Materials And Methods: We included 80 patients of age between 18-60 years of American Society of Anesthesiologists status (ASA)I and II scheduled for elective infraumbilical surgeries in our study. We randomly allotted these patients into two groups namely Group A and Group B of each. Patients in Group APatients who received transversus abdominis plane block with - 18ml Ropivacaine 0.2%+ 2 ml Dexamethasone 8mg. Patients in Group B received transversus abdominis plane block with-18ml Ropivacaine 0.2%+ 2 ml Dexmedetomidine .This TAP block was given soon after the surgery is completed. The duration of block and regression of sensory block, time for rescue analgesia, degree of sedation, hemodynamic parameters, post operative analgesia and adverse effects were noted. Result: The two groups were comparable on the basis of duration of surgery, site of surgery, ASA and BMI. Heart rates and mean arterial pressure were compared and it was found to be significantly lower in group B compared to group A until initial 5 hours. In our study we found that the visual analogue score at rest and on coughing between groups A and B was statistically insignificant. However, the time to first rescue analgesia (330 mins vs 240 mins) and total analgsic consumption in the 24 hours period post operatively was significantly lesser for group A compared to group B. Ramsey sedation score was significantly higher in group B compared to group A until 8 hourspost operatively. Nausea and vomiting in 3 cases of group A , and 2 cases in group B. No other significant side effects were noted. Conclusion: USG-guided TAP block is an effective and safe adjunct for postoperative analgesia in infra umblical surgeries. Addition of dexamethasone as an adjuvant prolongs the duration and reduces post-operative analgesic requirement in patients significantly more than dexmedetomidine whereas dexamethasone provides better control of the heart rate and mean arterial pressure.

Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.

Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and analgesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Study included 88 patients aged 18-60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentanyl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Both groups had similar demographic characteristics. The opioid-free group required lesser analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 ± 28.2 vs. 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associated with decreased PONV.

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.

The impact of preoperative anxiety on pain and analgesia consumption in women undergoing vaginal hysterectomy with general anesthesia and spinal anesthesia.

To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia. A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity. The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia. Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial.

Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) andlaparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.

Randomized control study to evaluate the effect of adding Dexmedetomdine to levobupivacaine in femoral sciatic block in total knee replacement

Background In recent years there has been an increasing interest in the practice of regional anesthesia especially peripheral nerve blocks for surgical anesthesia and postoperative analgesia. Imaging guidance for nerve localization helps the promise of improving block success with fewer complications. Among the imaging modalities available nowadays, ultrasonography seems to be the most suitable for regional anesthesia. One the most significant advantage of ultrasound (US) technology is the availability to provide anatomic examination of the area of interest. Aim The aim of this study is to evaluate the additive effect of dexmedetomidine to levobupivacaine in femoral sciatic block in total knee replacement regarding the onset and duration of both sensory and motor blockade, postoperative analgesia requirements. Patients and methods After ethical approval, 60 patients aged 45–65 years old, with an American Society of Anesthesiologists (ASA) physical class I and II who underwent total knee replacement using combined femoral-sciatic nerve block, were included in this prospective, randomized, controlled, double-blinded study. Patients were randomly assigned to receive levobupivacaine alone (group B) or dexmedetomidine 100 µg added to levobupivacaine (group BD) [n=30 patients for each group] for combined femoral-sciatic nerve block. Results This study showed that the addition of dexmedetomidine 100 µg to levobupivacaine during ultrasound-guided combined femoral-sciatic nerve block for total knee replacement was associated with, −20% shorter onset times for sensory and motor block, −25% faster time for surgical readiness, and longer duration of sensory and motor block (+45% and +40%, respectively) and +50% longer duration of analgesia. Conclusion Addition of dexmedetomidine to levobupivacaine during combined femoral-sciatic nerve block for total knee replacement was associated with faster onset of sensory and motor block, decrease intraoperative and postoperative requirements of analgesia and longer duration of motor block than levobupvicaine alone.