Analgesic Time Research Articles

Dexmedetomidine is an Excellent Additive to Local Anaesthesia for Postoperative Analgesia in Bilateral Third Molar Teeth Extraction Surgery

Background: We led this study to investigate the effect of injection of Dexmedetomidine as an additive to Lidocaine in the inferior alveolar nerve for patients undergoing lower bilateral impacted tooth extraction regarding postoperative pain, duration of postoperative analgesia, the over-all quantity of analgesia demanded in the first 24 h postoperatively, and the surgeon and the patient satisfaction. Patients and methods: Sixty patients were included, so that 30 patients were in the Dexmedetomidine group and the other 30 in the Adrenaline group. The inferior alveolar nerve block was done bilaterally after general anaesthesia using Lidocaine with Dexmedetomidine or Adrenaline. The primary outcome was analgesia quality (pain intensity, the duration of postoperative analgesia, and the patient's whole demanded amount of analgesia), the haemodynamic parameters, patients and surgeon’s satisfaction as secondary outcomes. Results: The mean postoperative analgesia time in Group (D) is 362.3±12.3 min, which is higher than Group (A) 231.4±13.1 min. 83.3% of the Group (D) received no analgesics, and 16.7% received one dose, while in the Group (A), 50% received two doses, 33.3% received one dose, and 16.7% received no doses. The VAS score was lower for Group (D) than Group (A) except for zero, where there was no difference between them. The satisfaction was higher in Group (D) than the Group (A) for both the patients and the surgeons. Conclusion: Adding 12.5μ/ml of Dexmedetomidine is an excellent additive to Lidocaine in Inferior alveolar nerve block regarding analgesia quality, patient and surgeon satisfaction in bilateral third molar teeth surgery.

Randomised control trial to evaluate post-operative analgesia efficacy of USG guided transverse abdominis plane (TAP) block with ropivacaine (0.5%) in unilateral hernia surgery by total requirement of diclofenac as post-operative analgesia drug

Background: Inguinal hernia repair is a common surgical procedure. Chronic pain occurs in 5-10% after the inguinal hernia repair. This study is aimed to evaluate post-operative analgesia efficacy of ultrasound guided transverse abdominal plane (TAP) block in unilateral hernia surgery. Aims and Objective: The present study aimed to evaluate the post-operative pain scoring at ½, 2,4,6,12,18 and 24 hours duration on basis of pain intensity using Visual Analogue Scale (VAS). Total requirement of analgesic drug in first 24 hours. To compare time for first rescue analgesia. Material and Method: A total of 80(n=80) patients of ASA I and II grade in the age group of 20 to 65 years undergoing unilateral hernia surgery. They were randomized into two groups. Lumbar puncture was done at L3-L4 space through a standard 25 G quincke spinal needle in sitting position of patient. Drug 0.5% hyperbaric bupivacaine 3.5 ml was administered intrathecally as a single dose in all patient. Study group: Patients received TAP block with Ropivacaine (0.5%) 20 ml after completion of surgery. Control group: Patients not received TAP block and was given injection diclofenac on demand for postoperative analgesia. The primary outcome was measured as patient-reported pain intensity using VAS. Results: VAS score was significantly lower in study group post‑operatively at all time intervals(P<0.0001). The 24‑h diclofenac consumption was significantly less in study group compared to control group (93.7±32.88mg vs. 204.3±44.89 mg, P< 0.0001). Time for first rescue analgesia was significantly more in study group as compared to control group (635.66±312.2 minutes vs. 210±140.7 minutes, p<0.0001).Conclusion: TAP block provided excellent post‑operative analgesia in the first 24 h.

TO COMPARE THE EFFECTS OF ROPIVACAINE(1.8mg/kg) WITH FENTANYL (50μg) AND ROPIVACAINE (1.8mg/kg) WITH CLONIDINE (75μg) FOR INTRAVENOUS REGIONAL ANAESTHESIA (IVRA) FOR UPPER LIMB AND LOWER LIMB SURGERIES

Introduction: Intravenous Regional Anaesthesia (IVRA) is indicatedfor short surgical procedures of upper extremity(below elbow) and of lower extremity (below knee). The aim of this randomised double-blind controlled study was to investigate the effects of adding Injection Clonidine as adjuvant to Injection Ropivacaine and Injection Fentanyl as adjuvant to injection Ropivacaine for IVRA in patients undergoing upper limb (below elbow) and lower limb (below knee) surgeries. Sixty adult ASA I and II patients Material and methods: of either sex in the age range of 20 to 60 years were randomly divided equally into 2 groups of 30 each. Group A received Injection Ropivacaine(0.75%) 1.8 mg/kgwith Injection Clonidine75µg/kg and Group B received Injection Ropivacaine (0.75%) 1.8 mg/kg with Injection Fentanyl 50 µg/kg. Results: Sensory onset showed high statistically signicant difference with Group A having earlier onset at 28.50 19.96 seconds as compared to Group B at 238 111.95 seconds (P&lt;0.0001). Comparison of peak sensory showed high signicant statistical difference with Group A having earlier onset at 194 223.21 seconds as compared to Group B at 720 217.19 seconds (P&lt;0.0001). The sensory wearoff between both the groups were highly signicant statistically showing Group A at 1150 ± 486.19 seconds as compared with Group B 184 ± 112.45 seconds (P&lt;0.0001). The Visual Analogue Score in post operative ward just after completion of surgery show Group B having higher VAS score as compared with Group A.The time for rescue analgesia was prolonged in Group A as compared with Group B. Conclusion: Adding Clonidine to Ropivacaine improved the quality of anaesthesia and post-operative analgesia in Intravenous Regional Anaesthesia as compared to when Fentanyl was added to Ropivacaine.

Comparative study of caudal tramadol and caudal dexmedetomidine as an adjuvant with ropivacaine in paediatric infraumbilical surgeries

Background and Aims: Caudal anaesthesia is one of the most commonly used regional anaesthetic technique in providing peri- and post-operative analgesia. It can serve as the sole anesthetic or can be an adjuvant to general anaesthesia. The aim of this study was to compare the clinical efficacy of the caudal block of 0.25% Ropivacaine with Tramadol or Dexmedetomidine as an adjuvant in paediatric infraumbilical surgeries. Methods: In this prospective, randomised, double-blinded comparative study, sixty children of either gender, in the age group of 1-8 years and scheduled for elective infra umbilical surgeries were randomly divided into two groups of thirty each. Children in Group D received a caudal epidural injection of 1ml/kg 0.25% ropivacaine with 2µg/kg dexmedetomidine while Group T received a caudal epidural injection of 1ml/kg ropivacaine with 2mg/kg tramadol. The primary outcome variable was the duration of time to rescue analgesia. The secondary outcome variables were onset of action, residual motor block, sedation score and adverse effects. Results: Results were statistically analysed using student’s t- test. Mean time of rescue analgesia in group D was 718.00 ± 100.06 min i.e. 11 hours 58 minutes and in group T was 467.33± 68.94 min i.e. 7 hours 47 minutes. (P<0.001). Pain scores measured at regular intervals post operatively were lower in D group as compared to T group. Rescue analgesia requirement was more in group T as compared to group D. Haemodynamic changes and side effects were comparable between the groups Conclusion: Caudal dexmedetomidine with Ropivacaine provides longer duration of post-operative analgesia as compared to caudal Tramadol with Ropivacaine.

Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method.

Until now, little is known about the benefit of laparoscopic total gastrectomy (LTG) after neoadjuvant chemotherapy (NACT). This study was designed to compare the safety and efficacy of the LTG versus the open total gastrectomy (OTG) approach after NACT treatment in patients with advanced gastric cancer (AGC). This study involved a cohort of 145 patients with AGC who underwent total gastrectomy after NACT at our centre between April 2013 and August 2018 including 24 cases of LTG and 121 OTG. The baseline characteristics were matched based on 1:2 balanced propensity score-matching method. Sixty-nine marched cases were finally analysed (23 LTG vs. 46 OTG). All patients underwent R0 resection. Compared to the OTG group, the LTG group had a longer surgery duration (P<0.001), but a shorter incision length (P<0.001) and less intravenous patient-controlled analgesia (IV-PCA) time after surgery (P=0.027). No statistical differences were observed in terms of blood loss, retrieved lymph nodes (LNs), resection margin, length of stay, postoperative pain intensity, and complications (P>0.05). LTG had comparable safety and histological findings to OTG after NACT in the perioperative period; however, LTG is less invasive and patients can benefit from less IV-PCA use. Further research is needed to investigate long-term effects. Gastric cancer (GC); neoadjuvant chemotherapy (NACT); safety; laparoscopic technique.

Comparison of Ultrasound-Guided Transversus Abdominis Plane Block and Caudal Epidural Block for Pain Relief in Children Undergoing Infraumbilical Surgeries.

Background:Caudal epidural block combined with general anesthesia remains a popular choice of anesthesia for both supraumbilical and infraumbilical surgeries. More recently transversus abdominis plane block performed under ultrasound guidance is being described as an effective technique for postoperative analgesia for lower abdominal surgeries. The present study aims to compare the efficacy of ultrasound –guided TAP block and caudal epidural for paediatric infraumbilical surgeries.Aims and Objectives:To compare the duration and efficacy of postoperative pain relief between TAP block and caudal epidural block in children undergoing lower abdominal surgeries.Methods:Fifty children of age group 2-7 years undergoing lower abdominal surgeries were randomized to groups T and C. All patients were given general anesthesia as per standardized anesthesia protocol. Group T were given ultrasound guided TAP block with 0.5 ml.kg-1 of 0.2% Ropivacaine. Group C were given 1 ml.kg-1 of 0.2% ropivacaine as caudal block. All the children were assessed using FLACC scale. Their vitals, pain scores, duration of postoperative analgesia and requirement of supplemental analgesics were noted.Results:Rescue analgesic requirement was significantly less in Group T compared to Group C. Mean postoperative analgesia time was significantly more in Group T (342 mins) as compared to Group C (198 mins).Conclusion:Ultrasound guided TAP block provides better postoperative analgesia after loer abdominal surgeries in children.

A Comparative Study on the Postoperative Analgesic Effects of the Intraperitoneal Instillation of Bupivacaine Versus Normal Saline Following Laparoscopic Cholecystectomy.

BackgroundLaparoscopic cholecystectomy is widely performed, and postoperative pain is an important factor in patient morbidity during recovery. Various modalities for postoperative pain relief have been proposed, with varying levels of success such as intravenous or intramuscular non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, regional anesthesia techniques such as epidurals and nerve blocks. The study was aimed to evaluate the efficacy of intraperitoneal instillation of bupivacaine and normal saline on postoperative analgesia, postoperative nausea, and vomiting after laparoscopic cholecystectomy.MethodsThis prospective, controlled, and randomized study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients, aged 18-50 years, who were scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were classified randomly into two groups with an equal number of participants: Group B received intraperitoneal instillation of 30 ml of plain bupivacaine 0.5% and Group N received 30 ml of normal saline. Postoperative pain was recorded using the visual analog scale (VAS) for 24 hours after surgery. Postoperative shoulder pain, nausea, vomiting, and the time taken to request rescue analgesia were noted.ResultsPatients receiving intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first six hours postoperatively (P = 0.04); moreover, the time taken to request rescue analgesia requirement was prolonged (P = 0.04). Side effects, such as nausea and vomiting, were similar between the two groups (P = 0.1 and p = 0.09, respectively) while shoulder pain was significantly lower in the bupivacaine group (P = 0.04).ConclusionBupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia. It also reduces the incidence of shoulder pain but does not decrease postoperative nausea and vomiting.

Combined spinal‐epidural versus spinal anesthesia comparison of efficacy in terms of analgesia and motor and sensory blockade

Background: This study was conducted on patients to compare efficacy in terms of motor and sensory blockade and prolonged time of analgesia between spinal and combined spinal epidural methods of anesthesia.Methods: This prospective study was conducted on 60 adult patients of either sex belonging to ASA grade I and II, from June 2014 to June 2016 at Maharishi Markendeshwar institute of medical sciences and research, Mullana in the department of anesthesia.Results: The patients were randomly allocated into two groups of 30 each as defined in text, by a computer-generated number. Proper statistical methods were applied and results obtained. results were statistically significant p&lt;0.05.Conclusions: The Combined spinal epidural technique has been described in the medical literature for use in general surgery, orthopedics, trauma surgery of a lower limb, and urological and gynecological surgery. With this technique, surgical anesthesia is established rapidly, saving 15-20 minutes compared with epidural anesthesia. Patients who received the combined technique had more intense motor blockade than those who received epidural anesthesia alone.

Comparison of adjuvant effects of intrathecal magnesium sulfate and dexmedetomidine with hyperbaric bupivacaine

Surgeries involving infraumblical regions are commonly done under spinal anaesthesia. No single adjuvant to bupivacaine found to prolong the duration of analgesia and to reduce its limitations. To compare the block characteristics of intrathecal administration of dexmedetomidine and magnesium sulfate as an adjuvant with bupivacaine in infraumblical surgeries. This is a prospective randomized double-blinded study. Around 90 American Society of Anaesthesiologist physical status I and II patients, scheduled for infraumblical surgeries were enrolled in this study. Patients were randomly assigned into Group B (bupivacaine), Group D (bupivacaine plus dexmedetomidine) and Group M (bupivacaine plus magnesium sulfate). In the operating theatre, baseline values were recorded. Onset and duration of sensory and motor block, time of rescue analgesia were noted. The onset of sensory block was rapid in Group D (2.63 ± 0.66 min) and slow in Group M (6.35 ± 0.87 min) when compared to Group B (2.93 ± 0.785 min) with a statistically significant difference. Motor duration (min) was prolonged in Group D (423.00 ± 12.360) and early in the Group M (165 ± 31.55) when compared to Group B (219.23 ± 14.875). For the surgery, which requires prompt onset and long duration of analgesia,dexmedetomidine can be used as an adjuvant. However, surgical procedures that permit delayed onset block and shorter duration of analgesia,magnesium sulfate can be preferred.

Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound\u2010guided supra\u2010inguinal fascia iliaca compartment block

BackgroundFascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA).MethodsAs a case series study, 28 patients (≥ 65 years old) with THA were received a modified in-plane ultrasound-guided supra-inguinal (S-FICB) as an analgesic adjunct to evaluate the analgesic effectiveness and the local anesthetic diffusion with magnetic resonance imaging (MRI). A combination of propofol and sufentanil was administered to conduct target-controlled infusion.ResultsThe pain scores were 1 (0–4), 2 (1–5), 3 (1–6) and 3 (1–6) at 4, 8, 12, and 24 h. The cumulative opioids were 8 (8–12), 18 (16–32), 28 (24–54) and 66 (48–104) mg of i.v. morphine equivalents at 4, 8, 12, and 24 h. The patient-controlled analgesia (PCA) times were 0 (0–1), 1 (0–2), 2 (0–5) and 5 (3–8) at 4, 8, 12, and 24 h. In lateral, anterior and medial part of thigh, the sensory blockade in 28 patients was 23 (82 %), 21 (75 %) and 19 (68 %) at 5 min; 28 (100 %) at 10 and 20 min. Motor blockade of femoral nerve (FN) and obturator nerve (ON) was present in 13 (46 %) and 3 (11 %) patients at 5 min, 24 (86 %) and 9 (32 %) at 10 min, 26 (93 %) and 11 (39 %) at 20 min. Injectate permeated to the FN and extended superiorly over the surface of iliac muscle (IM) and pectineus muscle (PM) in all patients.ConclusionsThe modified S-FICB has provided an effective postoperative analgesic adjunct after THA with the satisfactory blockade of femoral (FN), obturator (ON) and sciatic (SN) nerves, especially for ON, when compared with the existing techniques.

A Comparative Study of Intrathecal Low dose Isobaric and Hyperbaric Levobupivacaine in Ambulatory Perianal Surgeries: A Prospective, Double Blind Study

Background: Perianal surgeries can be conveniently performed under saddle block . We intended to compare intrathecal low dose isobaric and hyperbaric levobupivacaine and study their efficacy in perianal surgeries under saddle block on ambulatory basis. Methods: In this prospective, randomised controlled, double blind trial involving 20 patients in each group were randomised into two groups, Group I and Group H. Group I received 1ml of 0.5% levobupivacaine(5 mg) + 0.16 ml of Normal Saline ( total volume-1.16 ml) and Group H : 1 ml of 0.5% levobupivacaine (5 mg) + 0.16 ml of 50% dextrose (total volume-1.16 ml). Duration for ambulation being the primary criteria, we also noted maximum cephalic spread, time to reach maximum height of sensory blockade, 2 segment regression, duration of motor and sensory blockade, time for voiding and time for rescue analgesia . Appropriate statistical tests were used for final analysis. P value less than 0.05 was considered statistically significant. Results: There were no significant differences between the two groups in terms of the maximum height of sensory blockade and 2 segment regression that was achieved and request for first rescue analgesic. Duration of motor blockade, time to full recovery of sensory block and first voiding were all statistically significantly shorter in group H than group I. Conclusions: We conclude that hyperbaric levobupivacaine is superior to isobaric form while being closer to ideal choice of anaesthetic agent on ambulatory basis required for perianal anaesthesia while both the concentrations are similar in their safety profile.

Comparison between Ultrasound Guided Peritubular Infiltration and Paravertebral Block for Postoperative Pain Relief in Percutaneous Nephrolithotomy

Background: Percutaneous Nephrolithotomy is most advanced and preferred technique for Renal calculi but associated with pain and discomfort in postoperative period. Aim of our study is to compare analgesic efficacy of peritubular infiltration with paravertebral block under Ultrasound guidance for postoperative pain relief. Methods: In this prospective randomised study total 60 adult patients were allocated in two equal groups (A, B). After undergoing surgery under general anaesthesia group A patients received peritubular infiltration of 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg and group B patients received 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg in Paravertebral space T11, T12, L1 under ultrasound guidance. Postoperatively hemodynamic variables, VAS, Dynamic VAS, mean time for 1st demand of analgesia and total consumption of inj.tramadol were noted in both groups. Results: At 4, 8, 12 hrs VAS, Dynamic VAS scores were lower in group B compared to group A(p&lt;0.005). Hemodynamic variables were comparable between groupsand demand for first rescue analgesia time were higher in paravertebral block group compared to peritubular infiltration group and total consumption of tramadol were low in paravertebral block. Conclusion: Paravertebral block under ultrasound guidance is an effective analgesia for PCNL in postoperative period compared to peritubular infiltration.

Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique.&#x0D; Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale).&#x0D; Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group.&#x0D; Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia.&#x0D; Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia&#x0D; Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39.&#x0D; DOI: 10.35975/apic.v25i1.1434&#x0D; Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

Effects of transcutaneous electrical acupoint stimulation on perioperative immune function and postoperative analgesia in patients undergoing radical mastectomy: A randomized controlled trial.

Radical mastectomy may lead to suppression of cellular immune function in patients with malignant tumors. Transcutaneous electrical acupoint stimulation (TEAS) is widely used in clinical practice. However, there have been relatively few studies on the effects of TEAS on postoperative analgesia and immune function. The present study aimed to evaluate the effects of TAES on postoperative pain and immune function in patients undergoing radical mastectomy. A total of 65 patients were enrolled and allocated to either receive TEAS or sham TEAS. TEAS was implemented on bilateral Hegu (LI4), Neiguan (PC6) and Zusanli (ST36) acupoints simultaneously for 30 min before induction of anesthesia at 4 and 12 h post-operation. The primary outcomes included visual analogue scale (VAS) scores at 4 h (T1), 12 h T2), 24 h (T3) and 48 h (T4) post-operation, and serum levels of IL-2, IL-4, IFN-γ and the IL-2/IL-4 ratio at 30 min before TEAS (T0), T1, T2, T3 and T4. Secondary outcomes included the cumulative time of rescue analgesia within 48 h post-surgery, as well as the incidence of postoperative nausea and vomiting (PONV) and pruritus. Compared with the sham TEAS group, postoperative VAS scores at T2 and T3, the total consumption of opioids in the patient-controlled analgesia (PCA) pump, pressing times of the PCA pump and the incidences of PONV and headache were significantly lower in the TEAS group. The serum levels of IFN-γ at T3 and T4, and the serum levels of IL-2 and the IL-2/IL-4 ratio at T2, T3 and T4 were higher in the TEAS group compared with the sham TEAS group. By contrast, the serum levels of IL-4 were lower at T2, T3 and T4 in the TEAS group compared with the sham TEAS group. The results indicated that TEAS could improve postoperative analgesia, reduce postoperative consumption of opioids and alleviate postoperative side effects. Simultaneously, TEAS was able to reverse decreased serum levels of IL-2 and IFN-γ, reduce the level of IL-4 and restore the balance of Th1/Th2, thereby partially attenuating perioperative immune function depression in patients with breast cancer. The current trial was registered prior to participant enrollment at www.chictr.org.cn (Clinical Trial no. ChiCTR1800017768).

Application of Remifentanil in Analgesia and Sedation of Mechanically Ventilated Patients in Intensive Care Unit

To observe the analgesic and sedative effect of remifentanil in patients with mechanical ventilation in intensive care unit and to explore the application value of remifentanil in intensive care unit patients with mechanical ventilation. 164 patients were randomly divided into remifentanil combined with dexmedetomidine group (R group), sufentanil combined with dexmedetomidine group (S group) where 82 patients in each group. The patients in the two groups were assessed with the pain observation instrument of intensive care (critical care pain observation tool) for analgesia score and the sedative effect was assessed with the Ramsay scale. The vital signs during the treatment, the time for patients to achieve satisfactory analgesia and sedation, the time for mechanical ventilation, the time for intensive care unit hospitalization and the occurrence of adverse reactions were recorded respectively. Both groups of patients can achieve satisfactory analgesic and sedative effect. Critical care pain observation tool score of patients in the two groups was significantly lower than that before treatment (p<0.05), the percentage of Ramsay assessment grade 3-4 of patients in the R group was significantly higher than that in the S group. Heart rate, map of mean arterial pressure and autonomic respiratory rate of patients in the two groups were significantly lower than that before treatment (p<0.05). There was no significant difference in heart rate between the two groups (p>0.05), map of mean arterial pressure of patients in the R group was significantly higher than that in the S group immediately after treatment (p<0.05); respiratory rate in R group was significantly lower than that in S group (p<0.05). The time of analgesia and sedation (min), mechanical ventilation (H) and intensive care unit hospitalization (H) in group R were significantly shorter than that in group S (p<0.05). The number of hypotension patients in R group was more than that in S group and delirium and agitation were lower than those in S group (p<0.05). Remifentanil combined with dexmedetomidine can rapidly achieve the goal of analgesia and sedation, improve vital signs and shorten the time of satisfactory analgesia and sedation, mechanical ventilation, hospital stay and no serious adverse reactions.

Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis.

BackgroundWe aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm.MethodsWe searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals.ResultsWe included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL.ConclusionLPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

A study to evaluate the effect of low dose Intrathecal dexmedetomidine as adjuvant to low dose bupivacaine (H) Spinal Anaesthesia in elderly patients undergoing Infraumbilical Surgery

Background: Elderly patients pose a serious challenge to anaesthesia not only because of associated co-morbidities but also due to physiological changes during aging. Therefore lower doses of local anesthetics along with Intrathecal a2-adrenoceptor agonists have been shown to decrease the required doses of local anesthetics and are devoid of major side effects. Hence this study evaluates spinal anaesthesia characteristics in elderly patients. Methods: 120 Patients aged more than 60 years belonging to ASA I,II and III physical status and posted for infraumbilical surgeries were randomized into 2 groups, Group B(Bupivacaine) and Group BD (Bupivacaine + Dexmedetomidine) .Under aseptic conditions lumbar puncture was performed in sitting position at L3-4 / L4-5 interspace and 2.1 ml of study agents were administered. Group B received 10mg of 0.5% hyperbaric Bupivacaine and Group BD received 10mg of 0.5% hyperbaric Bupivacaine and 5mcg of Dexmedetomidine. In all cases monitoring of Blood pressure, ECG, Oxygen saturation and Respiratory rate was done at regular intervals intra-operatively. Sensory block and motor blocks were assessed periodically. Results: There were no clinically and statistically significant changes in heart rate and blood pressure and the mean max fall in HR, SBP, DBP and MAP. However, it was observed that there was a statistically significant (P<0.001) decrease in the time of onset of sensory block and motor block in Group BD(1.68±0.96 and 2.42±1.12) when compared to Group B(2.24±0.81 and 3.33±1.06) . Duration of analgesia and the time for first rescue analgesia was prolonged in Group BD (P<0.001). There were no side effects except for mild sedation in Group BD. Conclusion: Addition of Dexmedetomidine 5 mcg to intrathecal Bupivacaine(H) in elderly patients causes minimum hemodynamic changes, prolongs sensory and motor block.

Comparison of two ultrasound-guided approaches for the fascia iliaca compartment block in patients with a proximal femur fracture

Background: Fascia iliaca compartment block (FICB) is a popular block in patients with hip injuries. It gives good postinjury analgesia and helps in positioning for neuraxial blockade before the surgery. Aims and Objectives : The study aims to compare two approaches (parallel versus perpendicular) of ultrasound (USG)guided FICB in patients undergoing proximal femur fracture surgeries. The primary objective was to compare the time to do ultrasonic imaging, time to perform the FICB, and total block time. The secondary objective was to compare the time to loss of sensation, first rescue analgesia, pain score and occurrence of adverse events. Materials and Methods: Fiftyone patients were allocated into two groups in this prospective observational study. In parallel group (Group A) (n = 25), the USG probe was kept parallel to the inguinal ligament, and in the perpendicular group (Group B) (n = 26), a probe was placed perpendicular to the inguinal ligament. Both groups received equal doses of the drug. The time to achieve ultrasonic imaging, time to perform the block, total block time, loss of sensation within the distribution of lateral cutaneous nerve and the femoral nerve was noted. Time to first rescue analgesia, pain score and adverse events were also noted. Results: Group A approach was quicker to perform than the perpendicular approach (5.1 ± 0.7 vs. 7.3 ± 1.2 min) (P < 0.0001). The imaging time of Group A was shorter than Group B (3.2 ± 0.3 vs. 5.3 ± 0.7 min) (P < 0.0001). The success rate of sensory loss of lateral cutaneous nerve was quicker and better with Group B (88% vs. 100%). No statistical differences were noted in postoperative pain score, time of rescue analgesia, the incidence of complications, and the patient's satisfaction score between the two groups. Conclusion: The perpendicular approach of USGguided FICB may offer a better blocking effect of lateral cutaneous nerve and longer duration of block time, but the parallel approach offers better and quicker ultrasonic imaging.

The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial.

Introduction:Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not.Methods:A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB.Results:Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05).Discussion:When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction.Conclusion:We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

Comparative Study between Intrathecal Morphine and Nalbuphine Added to Hyperbaric Bupivacaine 0.5% in Elective Cesarean Delivery

Background: Many additives have been used to improve spinal anesthesia; morphine and nalbuphine are commonly used drugs. Objective: This work aimed to compare intrathecal morphine and different doses of nalbuphine in elective cesarean section (CS). Patients and Methods: This double-blinded, randomized controlled study was done on 150 patients, American Society of Anesthesiologist (ASA) grade I to II undergoing elective CS. Patients underwent spinal anesthesia 3 ml with 10 mg hyperbaric bupivacaine 0.5 % with the addition of a 1 ml volume (morphine or nalbuphine) according to the group; Group M: 150 μg morphine, Group N1: 1 mg nalbuphine, and Group N2: 2 mg nalbuphine. Results: Intraoperative and postoperative hemodynamics, respiratory rate, SPO2 and Apgar score were insignificantly different in all groups. Postoperative VAS was significantly decreased in group M and was insignificantly different between group N1 and group N2. Postoperative BROMAGE was significantly higher in group M. Time of rescue analgesia was significantly increased in group M and was insignificantly different between group N1 and group N2. Postoperative nausea and vomiting (PONV) was insignificantly different in all groups, and pruritus was significantly decreased in group N1. Conclusions: As additives to hyperbaric bupivacaine in the spinal block, morphine was superior to nalbuphine in decreasing VAS and increased time for rescue analgesia by prolonged sensory block. Increasing the dose of nalbuphine up to 2 mg did not increase the analgesic effect. Nalbuphine is superior to morphine in decreasing pruritus, and both drugs have similar effects on neonatal APGAR score and hemodynamics