Pain Management Techniques Research Articles

Pain Management Methods and Techniques in Lumbar Disc Surgery: A Narrative Review Study

Background and Aim: This study examines the complex field of pain treatment related to lumbar disc disorders in a narrative review. Methods and Materials/Patients: Our search strategy involved utilizing specific terms, including ‘pain management,’ ‘lumbar disc surgery,’ ‘methods,’ and ‘techniques.’ We formulated a search query using Boolean operators: (‘Pain management’ OR ‘analgesia’) AND (‘lumbar disc surgery’ OR ‘spinal surgery’) AND (‘techniques’ OR ‘procedures’ OR ‘approaches’ OR ‘methods’) AND ‘narrative review.’ A systematic search was conducted across reputable medical databases including PubMed, MEDLINE, and Cochrane Library. Filters were applied to refine search results based on publication type and date, with a focus on material published within the past two decades to ensure the inclusion of current, high-quality literature. Results: This study synthesized information from several sources, demonstrating the changing methods used to address pain in lumbar disc disorders. The article explored the historical background of medical treatments, emphasized both contemporary surgical and non-surgical methods, and investigated the predicted factors that affect the results. The study investigated the range of surgical incidents and examined the clinical factors to be taken into account for treatments. The value of efficient pain treatment in alleviating chronic back pain and maximizing patient results was emphasized. Conclusion: In conclusion, this review underscores the paramount importance of comprehensive management of lumbar disc pain. It stresses that effective pain control not only alleviates immediate suffering but also plays a pivotal role in ensuring positive surgical experiences, enhancing patient outcomes, and promoting long-term well-being.

Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis.

The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid-based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. We systematically reviewed and meta-analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3. Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg-1; 95% CI -3.15 to -0.66 μg.kg-1; p = .003; I2 = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I2 = 0%). No significant differences were found in the remaining outcomes. Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS. CRD 42024526961.

Conceptual Study on the Effect of Palasha Gudavarti in Post-operative Pain Management of Anorectal Surgeries

Post-operative pain management is a crucial component of recovery, particularly following anorectal surgeries, where pain can significantly hinder healing. The prevalence of postoperative pain after 24 hours of surgery is 55.3%, after 48 hours is 34.7 % and of moderate to severe post-operative pain is 13 % after 24 hours, and 11.7% after 48 hours1 .Ano rectal pathology amenable to ambulatory surgery includes anal fissures, warts, fistulas, hemorrhoids,abscess and small neoplasms. Quick recovery after ano rectal surgery can be successful only with effective post-operative pain control. Acharya Sushruta recommends the use of Yashtimadhu siddha ghritha application over the operated area2 . Additionally , he advocates the application of shoolahara dravyas and vatahara dravyas processed with ghritha to the surgical site for effective pain relief. Planning a cost effective, reliable, time tested and technically simple management is the need of this modem era. The present study explores the possible analgesic, anti-inflammatory, and wound-healing properties of Palasha Gudavarti, offering an alternative approach to conventional pain management techniques.

Role of Adjuvants in Enhancing the Efficacy and Duration of Anesthesia Blocks: A Comprehensive Review.

Anesthesia blocks are integral to modern pain management, offering targeted and effective relief for various surgical and procedural interventions. These techniques, including regional and peripheral nerve blocks (PNBs), involve the administration of local anesthetics to specific body areas, either through epidural, spinal, or direct nerve injections. While effective, incorporating adjuvants, substances added to local anesthetics, can significantly enhance their efficacy and prolong their duration. Adjuvants such as opioids, corticosteroids, alpha-2 agonists, and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to amplify analgesic effects, reduce the need for general anesthesia, and improve postoperative outcomes. This review explores the role of adjuvants in optimizing anesthesia blocks, examining their mechanisms of action, clinical benefits, and safety considerations. Adding adjuvants can lead to enhanced pain control, reduced dosage of local anesthetics, and fewer systemic side effects. By integrating adjuvants into anesthesia practice, clinicians can achieve more precise and sustained pain management, tailoring approaches to individual patient needs and specific procedural demands. This comprehensive review highlights current evidence on using adjuvants, their impact on anesthesia block effectiveness, and future research directions. Understanding the role of adjuvants is crucial for improving patient outcomes and advancing pain management techniques in various surgical settings.

A Case Series of Deep Subgluteal Block: A New Block Targeting the Missed Portion of the Hip for Analgesia After Total Hip Replacement

The study aimed to evaluate the effectiveness of deep subgluteal block (DSGB) for pain relief after posterolateral-approached total hip replacement. The cadaver study and observational case series assessed the spread and outcomes of ultrasound-guided DSGB. Results showed low postoperative pain scores, minimal opioid requirements, and no complications related to DSGB. Anatomical dissection revealed effective spread of the injected substance. These findings suggest that DSGB could be a promising regional analgesic technique for postoperative pain management after posterolateral-approached total hip replacement.

Pediatric Gabapentin Use in Postoperative Pain following Craniotomy: A Scoping Review

Management of postoperative pain following craniotomy can be dealt with in several forms. Treatment options range from conventional protocols involving opioid narcotics, NSAIDS, non-opioid pain management, and non-pharmacological management. Due to the massively publicized opioid crisis in the United States and in other countries there is a call for alternative methods for pain management. Of the alternative pain management techniques, gabapentin has been used in acute postoperative settings due to its anticonvulsant properties and pain management capabilities. This drug has been extensively used in the adult population, but its use in the pediatric population is uncommon. This scoping review aims to identify the lack of documented postoperative use in the pediatric population, specifically following craniotomy. It will aim to emphasize the need for further exploration of the use of gabapentin in a postoperative setting and accentuate gabapentin’s theoretical benefit as an alternative medication for pain management. This article will also discuss the potential of Gabapentin as either an opioid alternative or in combination with non-opioid analgesics for postoperative pain management in pediatric populations. Execution of this through the use of multiple scholarly databases yielded 229 articles. Of these 229 articles 227 were excluded, two articles met inclusion criteria, unfortunately these did not directly utilize Gabapentin for pain relief, leaving the research regarding this topic to be non-existent.

Comparison of Dye Spread Pattern and Nerve Involvement between Suprainguinal and Infrainguinal Fascia Iliaca Blocks with Different Injectate Volumes: A Cadaveric Evaluation.

Background and Objectives: Fascia iliaca compartment block (FICB) is an effective and relatively safe technique in perioperative pain management for hip surgery. However, blockade of the obturator nerve (ON) using this technique remains controversial. This study aimed to compare dye spread patterns and nerve involvement in the suprainguinal FICB (S-FICB) and infrainguinal FICB (I-FICB) approaches using different volumes of dye. Materials and Methods: Following randomization, 6 S-FICBs and 6 I-FICBs were performed on the left or right sides of 6 unembalmed cadavers. For each block, 30 mL or 60 mL of dye solution was injected. The extent of dye spreading and the staining pattern in the lumbar plexus branches were investigated using anatomical dissection. Results: Twelve injections were successfully completed. The lateral femoral cutaneous nerve (LFCN) and femoral nerve (FN) were consistently stained in all injections. Extended dye spread toward lumbar plexus branches was observed volume-dependently in S-FICBs. However, I-FICBs with an increased volume only showed dye spreading in the caudad direction limited to within the fascia iliaca. When 30 mL of dye was used, the ON was not stained with either approach. A stained ON was only observed in S-FICBs when 60 mL of dye was used. Conclusions: In this cadaveric evaluation, the ON was not stained in either FICB approach with the volume of injectate commonly used in clinical practice. The S-FICBs but not I-FICBs using a high volume of injectate resulted in extended spreading to the lumbar plexus branches.

Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients

BackgroundAcute pain due to rib fractures causes significant in-hospital morbidity and impacts patients’ quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however,...

Comparison of Continuous Thoracic Epidural Analgesia Versus Bilateral Erector Spinae Plane Block for Pain Management in Coronary Bypass Surgery.

Background Effective pain control is vital for patients undergoing heart surgery. Utilizing a multimodal approach to analgesia is essential, as poor pain management can result in hemodynamic and systemic complications. This study aimed to compare perioperative pain management techniques in patients undergoing coronary artery bypass grafting (CABG), specifically evaluating continuous thoracic epidural analgesia and ultrasound-guided bilateral erector spinae block. Methods This randomized comparative study was conducted at a tertiary care centreover a period of six months, with approval from the institute's ethics committee. A total of 24 patients undergoing CABG under general anesthesia participated in the study. They were randomly assigned to either the continuous thoracic epidural analgesia (TEA) group (Group A) or the ultrasound-guided bilateral erector spinae plane (ESP) block group (Group B) using a simple randomization method. The study assessed intraoperative intravenous opioid requirements for maintaining stable hemodynamics, as well as postoperative resting and coughing Visual Analog Scale (VAS) scores and peak inspiratory spirometry. Results Twelve patients from each group completed the study, with comparable demographics (age, gender). Both groups exhibited similar resting and coughing VAS scores at 0, 3, 6, and 12 hours postoperatively (p > 0.05). However, at 24, 36, and 48 hours, Group A had significantly higher VAS scores compared to Group B (p < 0.05). Group A maintained an overall mean VAS score of 4 or less during rest and coughing. Peak inspiratory spirometry results were consistent between both groups (p > 0.05). Conclusion The ultrasound-guided bilateral erector spinae block provided pain control comparable to thoracic epidural analgesia, making it a viable alternative for perioperative pain management. This is particularly beneficial for CABG patients where early postoperative anticoagulant therapy is crucial for graft patency. Effective pain management also contributes to faster recovery in coronary artery bypass grafting.

COGNITIVE MUSCULAR THERAPY FOR LOW BACK PAIN

PurposeCognitive Muscular Therapy (CMT) is a new treatment for low back pain which integrates psychological techniques for pain management alongside training to improve postural control. Rather than focus on postural alignment or strength, CMT aims to improve the regulation of postural tone (low-level activity which supports the body against gravity). This is achieved by teaching patients an awareness of compensatory paraspinal activation, which can be triggered by overactivity of the abdominal muscles.The aim of this study was to understand whether CMT could reduce symptoms associated with low back pain and improve paraspinal muscle activation.Methods and resultsFifteen patients with chronic low back pain received seven weekly sessions of CMT from a physiotherapist. Clinical data was captured at baseline and two weeks after the intervention using the Roland-Morris questionnaire and the pain catastrophising scale. Activation of the erector spinae muscle during walking was also measured at baseline and after the final intervention session. Change data were analysed using paired t-tests.There was a 75% reduction (p&lt;0.001) in the Roland-Morris score from a mean (SD) of 9.3(2.9) to 2.3(2.6), along with a 78% reduction in pain catastrophising (p&lt;0.002) from 16.6(13) to 3.7(4.8). Activation of the contralateral erector spinae muscles reduced by 30% (p&lt;0.01) during the contralateral swing phase of walking.ConclusionIn this small sample, CMT delivered large clinical improvements and reduced activation of the low back muscles during walking. Larger randomised trials are now required to confirm whether CMT could outperform existing physiotherapy treatments for chronic back pain.Conflict of interestNo conflicts of interestSource of fundingUniversity of Salford

A comparative study of levobupivacaine 0.25% with dexmedetomidine and dexamethasone as adjuvant in caudal block for pediatric patients undergoing infraumbilical surgeries

Background: The caudal epidural block is one of the most commonly used regional techniques for post-operative pain management in pediatric age group patients undergoing infraumbilical surgeries. Adjuvants use increase the duration of analgesia and decrease local anesthetic dose requirement, thereby decreasing the risk of toxicity. Aims and Objectives: The aim of the present study was to compare the prolongation of the duration of analgesia, hemodynamic parameters, and side effects if any, provided by the addition of dexmedetomidine (DEX) or dexamethasone as an adjuvant to levobupivacaine in the caudal block. Materials and Methods: A total of 60 patients with the American Society of Anesthesiologists grade I/II scheduled for elective infraumbilical surgeries were randomly allocated into two groups of 30 each. Group 1 received levobupivacaine 0.25% 1 mL/kg+DEX 1 mcg/kg and Group 2 received levobupivacaine 0.25% 1 mL/kg+dexamethasone 0.1 mg/kg for caudal block. The duration of analgesia, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2. Post-operative face, leg, activity, cry, consolability, (FLACC) pain scores were significantly lower in Group 1 when compared with Group 2. The mean duration of analgesia was prolonged in Group 1 at 824.23±53.53 min than in Group 2 with a mean duration of analgesia 480.50±31.66 min which was statistically significant (P&lt;0.005). Adverse events were comparable between the two groups and were statistically not significant (P&gt;0.05). Conclusion: The addition of DEX to levobupivacaine in caudal block significantly prolongs the duration of analgesia in post-operative period in comparison to the addition of dexamethasone with levobupivacaine. It also provides more hemodynamic stability during the intraoperative and post-operative period, lower FLACC pain scores, and is associated with minimal side effects.

Recent Advances In Interventional Pain Management

Introduction: Due to limited access to therapy, 60 million individuals worldwide suffer from chronic pain, with a frequency of 20–25% in some nations. Low- and middle-income countries (LMICs) are disproportionately affected by this condition. The yearly cost of diabetes, cancer, and heart disease—including medical expenses, lost productivity, and disability programs—is less than that of pain complaints. Pain management techniques, the most recent discoveries in pain research, and the most recent advancements in pain therapy technology can work together to reduce the prevalence of chronic pain and lessen the financial burden that comes with pain syndrome. Objective: To determine the extent to which the latest technological developments in interventional pain management to personalized treatment techniques according to patient complaints and conditions. The scope of technological development here is not only pain intervention techniques but also advances in understanding the pathophysiology of pain, nerve and tissue regeneration, as well as the modalities of technology used for pain interventions. Review: By conducting literature searches including journals, systematic reviews, library surveys, and case reports from the last 10 years on the latest interventional pain management techniques and serial cases. Summary: Many new minimally invasive pain intervention techniques have been developed and used in the treatment of chronic pain within the past 10 years. The necessity for standardization of processes, safety, efficacy, cost, and accessibility to new technology and techniques are among the issues and debates surrounding technical advancements and strategies for managing chronic pain. Intervention pain management techniques have grown in importance as a less intrusive method of treating chronic pain. For optimal outcomes, used in conjunction with other pain management modalities such as medication, physical therapy, cognitive behavioral change therapy, and others.

Integrating an Interventional Pain Management Curriculum in Hospice and Palliative Medicine Fellowship Training: A Feasibility Study.

Pain is a common symptom for patients with cancer. Hospice and Palliative Medicine (HPM) physicians are expected to be experts in both pharmacologic and non-pharmacologic treatment of pain for this patient population. Insufficient knowledge of non-pharmacologic, interventional approaches to pain management is a barrier to providing optimal care. This study assesses the feasibility and effectiveness of an interventional pain management curriculum on HPM fellow knowledge at a single institution. The primary objective was to implement an interventional pain management curriculum for HPM fellows' and secondly to measure its effects on their knowledge and confidence in interventional pain management approaches. We executed an interventional pain management curriculum for HPM fellows. The curriculum consisted of 6 fifty-minute virtual lectures. Anonymous pre- and post-curriculum surveys were used to assess curricular impact. Post-course surveys showed a significant increase in HPM fellows' knowledge and confidence in interventional pain management techniques. An interventional pain management curriculum for HPM fellows is a feasible and promising intervention to significantly impact fellows' knowledge and confidence in non-pharmacologic treatment of cancer pain.

Postoperative pain management following minimally invasive abdominal cancer surgeries -An audit.

There is limited data comparing pain management following various minimally invasive oncological surgeries (MIOS). This retrospective audit was planned to determine the severity of pain and to study the analgesic modalities offered to these patients. Secondary objectives included studying opioid requirements, non-opioid analgesics, their side effects, and the influence of comorbidities on the choice of pain modalities. Following approval and registration of trial (CTRI/2018/10/016220), data were collected retrospectively from adult patients who underwent elective MIOS for abdominal tumors from August 2017 to July 2018. Pain scores (PS) on the day of surgery, and the average, worst PS, and the morphine equivalent (ME) dose in the perioperative period was recorded. Emergency surgeries and thoracic-abdominal MIOS were excluded. The association between the type of surgery, pain modalities, and PS were compared using Chi-square test. ME dose consumption of patients and type of surgery were compared using ANOVA with Bonferroni's correction. Out of the 349 patients' data that were analyzed, 76% had mild, 22% had moderate, and 2% had severe pain after surgery. Port site infiltration was done in 27% of cases and epidural analgesia in 46 patients (13%). PS and opioid consumption (ME = 5.7 ± 5.2 mg) was significantly higher following pelvic surgeries when compared to other urological and diagnostic MIOS. American Society of Anesthesiologists Physical Status did not affect PS or choice of pain management technique. Most of the patients experience mild pain at movement in the immediate postoperative period, pelvic MIOS (abdominoperineal resection/exenteration surgeries) have higher PS and opioid consumption than other MIOS.

Interventional pain management practices in Pakistan: The role of Physical Medicine and Rehabilitation (PMR).

Chronic pain represents a complex, multifaceted challenge that surpasses the prevalence of commonly encountered disorders such as diabetes mellitus and hypertension. This condition exerts a substantial burden on healthcare systems due to its pervasive impact. While pain interventions and procedures constitute a crucial facet, they alone do not constitute a comprehensive solution. Nevertheless, the strategic and precise application of these procedures by well-trained and proficient physicians offers patients a swift route to resuming their normal activities, sparing them from protracted reliance on medications. Within the realm of Physical Medicine and Rehabilitation (PM&R), Interventional Pain Management (IPM) adopts a multidisciplinary rehabilitative approach, addressing all dimensions of pain syndromes. This approach culminates in enhanced functional outcomes and an improved quality of life. This concise review underscores the significance of this integrated approach, shedding light on various pain procedures routinely employed for diagnostic and therapeutic purposes. Within this context, we briefly explore the application of ultrasound and C-arm guided procedures. In conclusion, this review underscores the imperative nature of embracing a multidimensional approach to pain management, essential for seamlessly incorporating interventional pain management techniques into the broader domain of rehabilitation medicine.

Insight Into the Clinical Practices of US-Based Surgical Nongovernmental Organizations

IntroductionA growing sector of humanitarian surgical nongovernmental organizations (NGOs) is providing care in low- and middle-income countries. Minimal data exists regarding this extremely heterogeneous community. This study aims to describe the demographics and clinical practices of surgical NGOs. We hypothesize there are identifiable attributes of such organizations which correlate with success. MethodsA survey was sent to 83 US-based surgical NGOs directly providing general or subspecialty surgical care in low- and middle-income countries. Further information was obtained from organizations’ websites. Descriptive statistics were performed to analyze organizational attributes and define protocol-driven practices. ResultsThirty NGOs (36%) responded, averaging 20 ± 11 y of operation. Annually, US humanitarian surgical organizations performed a wide range of operations (10-15,000) with 52% performing fewer than 200 operations per year. Sixty-seven percent of responders were classified as strongly protocol-driven. Only twenty percent reported deviation from standard US practice occurs often or very often, most commonly in pain management (18%), preoperative workup (16%), and operative technique (16%). ConclusionsTo our knowledge, this is the first effort to describe the characteristics and clinical practices of the humanitarian surgical sector. There exists a wide scope of clinical practice among responding surgical NGOs, however mostly consistent with US standards, with a prevalance of protocol-driven clinical approach. Developing consensus-based protocols may help standardize and improve quality of care for surgical NGOs.

HARNESSING ANCIENT WISDOM: PAIN MANAGEMENT IN KATIGRAHA THROUGH MARMA CHIKITSA

Background: The Ayurvedic treatment known as Marma Chikitsa stimulates Marma points to treat pain and enhance general health. The effectiveness of Marma Chikitsa in treating Katigraha, a disorder marked by stiff-ness, limited mobility, and low back discomfort, is investigated in this study. Methods: Traditional Ayurvedic texts, PubMed, and Google Scholar were searched for relevant material. Results: To reduce pain and promote healing, Marma Chikitsa concentrates on stimulating particular spots, especially Katikataruna and Kukundara Marma. These locations line up with important anatomical features related to low back discomfort. Natural anal-gesia is thought to be produced by the therapy's release of endogenous opioids and anti-inflammatory chemicals. Comparative research suggests that Marma Chikitsa provides a non-invasive, side-effect-free substitute for tradi-tional anti-inflammatory and analgesic medications, which frequently have limits on their effectiveness and pos-sible negative effects. Discussion: Marma Chikitsa's holistic method, which emphasizes the equilibrium of Pra-na (life force), works very well for treating Katigraha. This therapy treats the underlying imbalances that lead to chronic pain disorders in addition to providing instant pain relief. Marma Chikitsa may improve pain manage-ment techniques and provide patients with low back pain with a full remedy if it is included into contemporary medical methods. Conclusion: Marma Chikitsa offers a viable substitute for treating Katigraha, integrating both short-term analgesia and long-term recovery. To confirm its effectiveness and make it easier for conventional medical practices to incorporate it, further empirical research and clinical trials are required. This might lead to better patient outcomes in pain treatment.

Effect of Intra-Operative Erector Spinae Plane Block on Post-Operative Consumption of Opioids after Video-Assisted Thoracoscopic Surgeries (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Although VATS is less painful than an open thoracotomy, patients may still feel severe pain and restricted mobility during the first few postoperative hours. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Objective to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing VATS for postoperative analgesia. Patients and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 30 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Patients were randomly divided into two equal groups, 15 each, according to the inclusion and exclusion criteria. Group A (n = 15): Received fentanyl 1-2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation in addition 40 ml bupivacaine 0.25% (20ml on each side) as a single level bilateral injection for ESPB. Group B (n = 15) (the controlled group): Received only fentanyl 1- 2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing VATS also reduced the total amount of postoperative morphine consumption in comparison to controlled group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake. Conclusion Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after VATS, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB slightly decreased the rate of PONV. This might be because the use of ESP might have decreased the use of intraoperative opioids.

Erector Spinae Plane Block versus Patient Controlled Analgesia for Postoperative Analgesia in Patient Undergoing Urologic Surgeries with Lumbar Incision

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Aim of the Work The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA. Patietns and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients‟ consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake. Conclusion Ultrasound-guided unilateral ESPB reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients‟ satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids.

Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications. Aim of the Work The present study was designed to assess the analgesic efficacy of ultrasound guided Erector Spinae Plane Block done at the fifth thoracic transverse process level in patients undergoing VATS surgeries for postoperative analgesia. Patients and Methods This prospective randomized clinical study was conducted in Ain Shams University Hospitals. It included a total of 60 adult patients aged 21-60 years, Scheduled for VATS surgeries. Patients were randomly divided into two equal groups 30 patients each. The ESPB group (n = 30): received ESPB after induction of anaethesia, while the Control group (n = 30): received only fentanyl 1- 2 mcg/kg during induction of anesthesia and additional boluses of fentanyl.5 mcg/kg were given according to the patient’s vital data. Results The main finding in this study was that ultrasound guided ESPB provided a good analgesic effect in patients undergoing VATS surgery, it also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to controlled group, Prolonged the time to first request of analgesia, allowed early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting. Conclusion Ultrasound-guided erector spinae plane block was found statistically significantly in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after VATS surgeries, without associated adverse effects as postoperative nausea and vomiting, nerve injury, respiratory depression and hematoma formation.