Analgesic Time Research Articles

Efficacy of a Novel Face-to-Face Lateral Position (Partha’s Technique) in Children to Aid Identification of Caudal Space during Single Dose Caudal Epidural Anaesthesia for Elective Infraumblical Surgeries- A Feasibility Study

Introduction: A single-dose of caudal epidural block accounts for 30-40% of paediatric regional anaesthesia. For infraumblical procedures, it is administered with or without general anaesthesia. The traditional patient position for assisting caudal blocks in children is lateral, with the child's back facing the anaesthesiologist. For caudal epidural block, a novel face-toface orientation of the anaesthesiologist with respect to the child in lateral position was used. Aim: To determine whether a novel face-to-face position of the anesthesiologist and the child is feasible in identification of the caudal epidural space during administration of caudal epidural anaesthesia following general anaesthesia in paediatric patients undergoing elective infraumblical surgery. Materials and Methods: This prospective feasibility study was conducted from November 2020 to November 2021 on 15 children belonging to American Society of Anaesthesiologists (ASA) 1, who were scheduled for elective infraumblical procedures under general anaesthesia, with single dose caudal epidural anaesthesia. While performing caudal block, a novel face-toface orientation of the anaesthesiologist and patient was used. The following variables were recorded: first pass success rate, number of attempts, block performance time, block failure rate, performer satisfaction score, duration of postoperative analgesia, and complications. Results: There were eight males and seven females. The mean age of the population was 6.6±2 years and the mean weight was 20.6±3.4 kilograms. The first pass success rate was 86.6% (13/15) with overall success rate of 100%. Number of attempts for successful block were 1.2±0.5. Block performance time and duration of postoperative analgesia were 31.8±12.1 seconds and 176±31.8 minutes respectively. Performer’s satisfaction score was excellent in 86.6% (13/15) and good in 13.4% (2/15). No incidence of block failure and complications were noted. Conclusion: The novel face-to-face position in child ergonomics with respect to anaesthesiologist during caudal epidural block performance is a feasible and effective method in children undergoing elective infraumblical procedures.

Effect of Fentanyl and Dexmedetomidine as Additives to 0.5% Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block for Elective Upper Limb Surgeries: A Randomised Clinical Trial

Introduction: Supraclavicular brachial plexus block is a superior alternative to general anaesthesia for upper limb surgeries, and use of ultrasound makes it safe and efficient in implementation. Ropivacaine, having significantly higher threshold for cardiotoxicity and neurotoxicity and more potent blocker of A and C fibres, renders good sensory blockade and lesser motor. Hence, to overcome this, additives are added. Aim: To evaluate the block characteristics with addition of either fentanyl or dexmedetomidine to 0.5% ropivacaine for supraclavicular brachial block. Materials and Methods: This randomised double-blinded clinical trial, was conducted on 50 patients posted for upper limb surgeries under supraclavicular brachial plexus block were randomly allocated to either receive 30 mL of 0.5% ropivacaine with 50g fentanyl (Group RF) or 30 mL of 0.5% ropivacaine with 50g dexmedetomidine (Group RD).The time for onset of sensory block and motor block were noted. Intraoperative hemodynamics were monitored in all the patients. Postoperatively Visual Analog Scale (VAS) scoring for pain, the time for rescue analgesia and the duration of sensory and motor blockade were noted. Results: Both groups were comparable with respect to age, gender and American Society of Anaesthesiologists (ASA) grading. The onset of both sensory (p-value 0.008) and motor block (p-value 0.0005) was faster in Group RD compared to Group RF which was highly significant statistically. The duration of sensory (p-value 0.0005) and motor block (p-value 0.0005) was longer in Group RD compared to Group RF which was highly significant statistically. The requirement for rescue analgesia was lesser in Group RD since the mean VAS score was persistently low which was statistically significant (p-value <0.01) compared to Group RF. Conclusion: The blockade improved better with addition of dexmedetomidine than fentanyl to 0.5% ropivacaine. There were no increased incidence for side effects.

Effectiveness of bilateral erector spinae plane block on intraoperative requirement of fentanyl in patients undergoing cardiac surgery: a randomized controlled interventional study

Background and objectives Erector spinae plane block (ESPB) is a newly defined and effective interfacial plane block. Cardiac surgeries are performed mainly via a median sternotomy leads to significant postoperative pain. Multiple studies have confirmed that ESPB is effective in cardiothoracic and abdominal surgeries. This study aimed to compare the efficacy of ESPB in two groups (group A and group B) for the intraoperative requirement of fentanyl (entropy index guided), hemodynamic variables, need of first rescue analgesia in the postoperative period, and side effects.Settings and design The study was designed as a prospective, randomized, control, hospital-based interventional study.Patients and methods A total of 60 patients, 18–65 years old of either sex who underwent cardiothoracic surgery by midline sternotomy under general anesthesia, were divided into either group A (n=30), which received ultrasound-guided bilateral ESPB by 25 ml 0.5% ropivacaine with dexmedetomidine 0.5 μg/kg with general anesthesia), or group B (n=30), which received general anesthesia without block.Statistical analysis used To observe the difference in quantitative variables between both groups Student’s t test/analysis of variance test was performed. The Fisher’s exact or χ2 test was used to establish the association between qualitative variables.Results The median requirement of fentanyl (μg/kg/h) in group A and group B was 1.97 (1.43–2.83) and 2.55 (1.55–3.19). This difference was statistically nonsignificant (P=0.348). The mean time of first rescue analgesia in group A and group B was 10.9±8.6 and 7.1±4.4 h, respectively (P<0.05). Demographically both groups were comparable.Conclusions ESPB produced safe and effective analgesia in the postoperative period following cardiac surgery.

Comparison between Plain Ropivacaine, Ropivacaine with Buprenorphine and Ropivacaine with Clonidine for Intrathecal use in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Ropivacaine is an amide local anaesthetic agent. The lower limb surgeries involves the great somatic pain. By using these adjuvants such as buprenorphine and clonidine with local anaesthetic agent to know the effective intraoperative and postoperative analgesia. Aim: To compare the anaesthetic characteristics in terms of quality of blockade when intrathecal ropivacaine with buprenorphine and ropivacaine with clonidine as adjuvant. Materials and Methods: The present study was a doubleblinded randomised control trial in which a total of 75 subjects were divided into three groups, with 25 per group-group R (Inj. Ropivacaine 0.75%-3 mL with 0.2 mL sterile water), group RB (0.2 mL Buprenorphine with Inj. Ropivacaine 0.75% 3 mL), and group RC (0.2 mL Clonidine with Inj. Ropivacaine 0.75% 3 mL). Onset and duration of blocks were observed. Haemodynamic parameters, and pain score were monitored intraoperatively and postoperatively. Data was entered in MS excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. The p-value &lt;0.05 were considered as statistically significant. Results: The onset time of sensory and motor blockade for group RC was significantly more in comparison to R and RB groups (sensory block-5 minutes 50 seconds vs 3 minutes 39 seconds vs 3 minutes 50 seconds); and (motor block-6 minutes 52 seconds vs 4 minutes 39 seconds vs 4 minutes 74 seconds). Group RC had significantly longer duration of sensory block than R and RB groups (327 minutes 88 seconds vs 166 minutes 60 seconds (167 minutes) vs 222 minutes 44 seconds). Conclusion: Ropivacaine with clonidine showed significantly more duration of sensory block, motor block and time for first rescue analgesia with haemodynamic stability than ropivacaine and ropivacaine with buprenorphine.

Comparing the intraoperative and postoperative analgesic effect of transabdominal block versus caudal block in children undergoing laparoscopic appendectomy

Background: Laparoscopic appendectomy is commonly performed in children. Regional anesthesia in children is complementary to general anesthesia, which allows conscious postoperative analgesia and reducing hospital stay. Caudal anesthesia and transverses abdominis plane (TAP) block is commonly used in children because it is easy to practice and provides effective analgesia during surgery. However, its efficacy in laparoscopic appendectomy is not tested much.Aim: The aim of this study is to evaluate the analgesic efficacy of caudal block and TAP block, when used as pre-emptive analgesia using ropivacaine in terms of opioid consumption, postoperative visual analog score (VAS), duration of analgesia, time for rescue analgesia, postoperative nausea, and vomiting and other side effects following elective laparoscopic appendectomy.Methodology: The study design was a prospective, double-blinded, comparative randomized trial on children undergoing laparoscopic appendectomy. Sixty patients between 12 and 18 years were included in the study. They were allocated into any one of two groups of 30 patients each, employing computer-generated randomization. Group I: receive ultrasound-guided caudal block using 0.2% ropivacaine 1 mL/kg. Group II: receive ultrasound-guided TAP block using 0.2% ropivacaine 1 mL/kg.Results: Total intraoperative consumption of opioid fentanyl in Group I is 14.83 ± 18.78 compared to 25.50 ± 17.88 in Group II, which is statistically significant P = 0.028*. VAS score was significantly lower in Group II compared to Group I, P < 0.001**.Conclusion: Caudal block is effective for intraoperative management, whereas TAP block is effective for postoperative management in children undergoing laparoscopic appendectomy.

Effects of the new fasting standard on sedation in the pediatric emergency room.

This study compared adherence to the fasting-time guidelines of the International Committee for the Advancement of Procedural Sedation (ICAPS) and the North American Society of Anesthesiologists (ASA) and complication rates in pediatric patients requiring procedure sedation and analgesia during treatment in the emergency room (ER). This retrospective, single-center study was performed between 2016 and 2020, and enrolled patients who received procedural sedation and analgesia in the ER with the fasting times recommended in the ICAPS and ASA guidelines. In total, 857 patients were included. The most frequent indication for procedural sedation and analgesia was fracture reduction in 420 patients (49.0%). Ketamine, the most commonly administered drug, was given to 710 patients (82.8%). Adherence to the ICAPS guidelines was higher (P < 0.01), with 772 (95.7%) and 351 (41.0%) patients, respectively, adhering to the ICAPS and ASA recommendations for food and drink fasting times. Complications occurred in 130 patients (15.2%), including SpO2 <90% in 75 patients (8.7%) and vomiting in 20 patients (2.3%). No serious complications, such as aspiration, cardiac arrest, or death, occurred. The complication rate between the two groups did not differ significantly, with 50 (14.2%) and 127 (15.5%) patients experiencing complications according to the ICAPS and ASA guidelines, respectively (P = 0.586). The fasting recommendations of the ICAPS guidelines, which propose risk stratification to determine the appropriate fasting time for procedural sedation and analgesia, are more tolerable to patients and the rate of adverse events did not appear to be different from that experienced when following the ASA guidelines.

Postoperative Analgesic Efficacy of Transverse Abdominis Plane Block versus Port Site Local Infiltration in Laproscopic Gynaecological SurgeriesA Randomised Clinical Trial

Introduction: Pain relief postoperatively has advantages related to better patient satisfaction in terms of early ambulation and discharge and also better cardiovascular stability, decreased infections, neurological complications, prevention of thromboembolic phenomenon, and chronic pain syndrome. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are the most commonly used drugs in pain management. Transverse Abdominis Plane (TAP) block is a regional analgesic technique, which provides analgesia of the anterolateral abdominal wall and hence can be used to provide analgesia for cesarean section, hernia repairs, hysterectomies, cholecystectomy. Aim: To compare the effectiveness of bilateral TAP block versus port sites local anaesthetic infiltration to relieve postoperative pain in laparoscopic gynaecological surgeries. Materials and Methods: This single-blinded randomised controlled study conducted at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The clinical trial was conducted on 80 patients belonging to American Society of Anesthesiologists (ASA) I and II posted for elective laparoscopic gynaecological surgeries. Patients were randomly allocated into two groups with 40 patients in each group. Group T (TAP block) received 0.6 mL/ kg of 0.25% bupivacaine for bilateral ultrasound guided TAP block and group O (port sites local infiltration) received 0.6 mL/ kg of 0.25% bupivacaine for port sites infiltration. At the end of surgery, patients received either TAP block or port site infiltration as per the group allocated and then extubated. Postoperative pain intensity using Visual Analogue Scale (VAS) score were recorded at the time of shifting as 0 hr and then every 2 hrs, 4 hrs, 6 hrs, 8 hrs, 12 hrs, 24 hrs. The mean time for first rescue analgesia and total number of rescue analgesic given in first 24 hrs were noted. Haemodynamic parameters and side-effects with study drug were noted. For inferential statistics, numerical data was analysed by Chi-square test and for categorical data student’s t-test was used. A p-value &lt;0.05 was considered as statistically significant. Results: Demographic parameters in both groups were comparable. There was no significant difference in VAS score up to 4 hours in between two groups. But mean VAS score was significantly low in group T when compared to group O at 6 hours (2.2±0.4 vs 2.7±0.5), 8 hours (2.7±0.4 vs 3.2±0.7) and 12 hours (3.3±0.5 vs 3.6±0.5). The time to receive rescue analgesic was longer in TAP block group (13.7±1.5 vs 10.6±1.64 hrs) when compared to port sites local infiltration group. And total number of rescue analgesia received was low in TAP block group (70% recieved single dose) when compared to port sites local infiltration group (80%received two doses). Conclusion: The TAP block and port sites infiltration in patients undergoing laparoscopic gynaecological surgeries are used for effective postoperative analgesia as part of multimodal analgesia, which reduces the use of other analgesics like NSAIDS and opioids. However, TAP block provides superior and prolonged pain relief when compared to port sites local infiltration.

Comparing the efficacy of ultrasound-guided supraclavicular brachial plexus block with or without intercostobrachial nerve block for forearm surgeries – An observational study

Background: Supraclavicular block is a commonly used block for regional anesthesia in forearm surgeries. The rationale behind this study is to prove that ultrasound (USG)-guided supraclavicular block is sufficient to provide adequate analgesia and eliminates the need for an intercostobrachial (ICB) block for forearm surgeries. Aim: We aimed to find whether there is any additional advantage in performing ICB block along with supraclavicular brachial plexus block in forearm surgeries. Methods: In this study, 110 patients undergoing elective forearm surgeries under USG-guided supraclavicular block were observed. A block solution of 30 ml was made and 20 ml was given as supraclavicular block. Group ICB, received an additional 10 ml ICB nerve block (ICBN) and group Non-ICB who did not receive an additional block. The outcomes assessed were intraoperative and postoperative tourniquet pain scores, hemodynamic changes, the onset of sensory and motor block, sensory and motor scoring, postoperative rescue analgesia time, and patient satisfaction. Data were analyzed using SPSS 25.0 version. Results: The mean intraoperative and postoperative pain scores in the group ICB was 0.76 ± 1.677 and in the non-ICB was 0.69 ± 1.439 and was no significant. Furthermore, there was no statistically significant difference between the immediate and late postoperative pain scores between the two groups. Conclusion: Our study has concluded that a sole USG-guided supraclavicular block provides adequate anesthesia of the operated forearm. Additional blocking of the ICBN does not affect the incidence or course of tourniquet pain.

Total or Near-total Thyroidectomy in treatment of Thyroid Cancer.

Objectives:To observe the clinical efficacy on total or near-total thyroidectomy in the treatment of thyroid cancer.Methods:Ninety-four patients with thyroid cancer treated in Meiris Branch of the First Affiliated Hospital of Qiqihar Medical College from June 2018 to June 2020 were selected as subjects. According to different surgical methods, they were divided into observation group and control group, with 47 patients in each group. The control group was treated with total thyroidectomy, while the observation group received near-total thyroidectomy. The two groups were both followed up for one year. The therapeutic effect, surgery-related indexes (surgical duration, intraoperative bleeding volume, postoperative analgesia time and postoperative 24-h VAS score), the incidence of complications three months after surgery, and the serum levels of relevant indexes [parathyroid hormone (PTH), calcium ion (Ca2+) and signal transducer and activator of transcription 3 (STAT3)] before and 14 d after surgery were compared between the two groups. The difference in quality of life [the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)] between the two groups one year after surgery was observed.Results:During the one year follow-up, there was no death in both groups. The total efficacy of the observation group was higher than that of the control group (0.05). The surgical duration, postoperative analgesia time and postoperative 24-h VAS score of the observation group were higher than those of the control group (p<0.05). However, no statistically significant difference was found in intraoperative bleeding volume between the two groups (p> 0.05). Three months after surgery, the total incidence of postoperative complications in the observation group was higher than that in the control group (p< 0.05). Fourteen days after surgery, the levels of PTH, Ca2+ and STAT3 in the two groups were lower than those before surgery, and the levels in the observation group were lower than those in the control group (p< 0.05). One year after surgery, cognitive, emotional, role, social and physical scores in the observation group were all lower than those in the control group, without statistically significant differences (p> 0.05).Conclusion:Total thyroidectomy is effective in the treatment of thyroid cancer, but has many postoperative complications. Clinicians need to choose the appropriate surgical method according to the actual condition of patients.

The comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine

Introduction: Spinal anaesthesia provided by bupivacaine may be to short for providing postoperative analgesia. This study is conducted for the understating and calculation of the efficacy of intrathecal fentanyl and intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine with regards to the onset duration of sensory and motor blockade. Material & Method: 200 patients were taken with difference age group and classified into two groups. Both group consist 100 patients and given spinal anaesthesia using bupivacaine 0.5%, heavy 2.5 ml with either fentanyl 25µg (group A) or 5µg of preservative free dexmedetomidine (group B). Result: During sedation we take proper measurement of major vital organ such as taken pulse rate, respiratory rate, blood pressure, and arterial oxygen saturation were obtained. After operation patient analgesia time were recorded.

Comparison of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane Block versus Local Infiltration of Port Site with Bupivacaine in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia

Introduction: Patients undergoing laparoscopic cholecystectomy have moderate post-operative pain in the early post-operative period. There are several modalities to manage pain in the postoperative period. Subcostal transversus abdominis plane block is one of the effective methods for pain management. The objective of our study was to compare the analgesic efficacy of subcostal transversus abdominis block versus local infiltration at the port site with bupivacaine in patients undergoing Laparoscopic cholecystectomy under general anesthesia. Methodology: This is a prospective randomized study of 60 patients of age group 18 – 60 years of either gender, of ASA PS I and II scheduled for laparoscopic cholecystectomy under general anesthesia and were randomly divided into two groups. At the end of the surgery 20ml of 0.25% bupivacaine was administered with ultrasound guided subcostal transversus abdominis plane block bilaterally in group T and local infiltration at the port sites in group L. Visual analogue scale at 0, 2, 6, 12 and 24 hours at rest, time of rescue analgesia and opioids consumption were recorded. Results: Both the groups were comparable with each other to assess pain scores and analgesic requirements. Group T had less pain at rest (&lt;0.001) on visual analogue scales and also less analgesic and opioids consumption compared to group L (&lt;0.001), which were found to be statistically significant. Conclusion: Subcostal transversus abdominis plane block is beneficial, effective and reliable method in providing post-operative analgesia in patients after laparoscopic cholecystectomy compared to local infiltration at port sites.

Intravenous Acetaminophen Does Not Provide Adequate Postoperative Analgesia in Dogs Following Ovariohysterectomy.

Simple SummaryAcetaminophen is the most commonly used pain relief (analgesic) agent in humans worldwide and its use is becoming more frequent in dogs. However, limited evidence supports this use. This study aimed to investigate the analgesic effect of acetaminophen when administered as an intravenous injection post-operatively in female dogs. A total of 34 dogs were randomly divided into two groups and either administered acetaminophen or saline intravenously immediately after desexing. The dogs had their pain levels evaluated at 10, 20, 40, 60, 120, and 180 min after awakening from general anesthesia and the pain levels between groups were compared. Concurrently, the dogs had blood collected at 2, 5, 10, 40, and 80 min following injection of the acetaminophen. The blood was analyzed to quantify the levels of acetaminophen in the body. This study found that acetaminophen was no better than saline in providing analgesia in dogs following surgery. This study suggests that acetaminophen used alone may not be an appropriate post-operative analgesic agent for desexing procedures.(1) Objective: To investigate the analgesic effects of intravenous acetaminophen after intravenous administration in dogs presenting for ovariohysterectomy. (2) Methods: 14 ASA I client-owned female entire dogs. In this randomized, blinded, clinical study, dogs were given meperidine and acepromazine intramuscularly before induction of anesthesia with intravenous propofol. Anesthesia was maintained with isoflurane in oxygen. Intravenous acetaminophen 20 mg/kg or 0.9% NaCl was administered postoperatively. Pain assessments were conducted using the Glasgow Pain Scale short form before premedication and at 10, 20, 60, 120, and 180 min post-extubation or until rescue analgesia was given. The pain scores, times, and incidences of rescue analgesia between the groups was compared. Blood was collected before and 2, 5, 10, 20, 40, and 80 min after acetaminophen administration. Acetaminophen plasma concentration was quantified by liquid chromatography-mass spectrometry. The acetaminophen plasma concentration at the time of each pain score evaluation was subsequently calculated. (3) Results: There was no significant difference in pain scores at 10 min, highest pain scores, or time of rescue analgesia between groups. In each group, 3 dogs (43%) received rescue analgesia within 20 min. (4) Conclusions: Following ovariohysterectomy in dogs, there was no detectable analgesic effect of a 20 mg/kg dosage of intravenous acetaminophen administered at the end of surgery.

Can Ultrasound-Guided Regional Anesthesia Techniques For Tracheostomy Be An Alternative To General Anesthesia?

Introduction The cervical plexus block (CPB) has been used for a long time for both analgesia and anesthesia in carotid endarterectomy and thyroid operations. To be unfamiliar with the technique and its perceived difficulty, potential risks, and possible adverse effects such as intravascular injection has limited broader use before the practical use of ultrasound. We hypothesize that the cervical plexus block can provide adequate anesthesia in tracheostomy cases and provide excellent anesthesia comfort when combined with a translaryngeal block. Methods This double-blinded, randomized 29 patients undergoing primary tracheostomy operation to receive either CPB (Group S) or CPB with translaryngeal block (Group ST). The primary outcome was cumulated analgesic consumption during the first 24 postoperative hours. Secondary outcomes were as follows: pain related to incision, patient tolerance as assessed by tracheostomy cannula comfort score, cough and gag, pain at rest, nausea and vomiting, and time to first analgesic demand. Results The patient tolerance for tracheostomy was higher in Group ST than Group S. The median tracheostomy cannula comfort score was 4.0 in Group S. In contrast, the median score was significantly lower in group ST (P<.001). The cough and gag reflex scores were significantly lower in Group ST than Group S (1.0 vs 4.0, P<.001). Conclusion This trial supported the hypothesis that the CPB combined with the translaryngeal block yields excellent anesthesia for tracheostomies. The technique we briefly described, in a way, is the equivalent of awake fiberoptic intubation to awake tracheostomy with minimal sedation adjusted according to airway patency.

EFFICIENCY OF ANESTHESIA DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE BREAST

The purpose of the study – to perform a comparative analysis of anesthesia effectivenessduring reconstructive surgery on the mammary glands.Material and methods. 120 women undergoing aesthetic intervention were divided intoanesthesia groups: intravenous anesthesia with propofol; inhalation with sevoflurane,combined with opioids; combined anesthesia with PECS-block.Results. It has been found that the group of combined anesthesia with PECS- block required the least time for analgesia (p&lt;0,05). The greatest depth of medication sleepwas in the group of propofol, the smallest - in the combination of general anesthesia withPECS-block (p &lt;0,05).It was verified that the largest number of patients with unstable hemodynamics wasin the group of propofol (33,3%), and the smallest number - in the group of combinedanesthesia with opioids (6,7%). Predisposition to tachycardia has been reported withthe use of propofol and the combination of sevoflurane with opioids. Bradycardic type ofsinus rhythm was observed in the group of combined anesthesia with PECS-block.Conclusions. In reconstructive interventions on the mammary glands, combinedinhalation anesthesia with sevoflurane in combination with opioids or single-stage PECSI block is promising.

A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia.

BackgroundThe epidural analgesia technique is effective for labor analgesia and combinations of various local anesthetics with lipophilic opioids like fentanyl are used. However, fentanyl can cause an increased incidence of pruritus, urinary retention, nausea, vomiting, giddiness, shivering, and respiratory depression. Dexmedetomidine and clonidine are selective alpha 2 agonists with analgesic properties and have been used via the neuraxial route with local anesthetics for the same without the side effects of fentanyl. Thus, the primary objective was to assess and compare the analgesic efficacy of the two-drug combinations by the visual analog scale (VAS) score.MethodsFifty-four primigravida women were randomly allocated in two groups of 27 each and were given an initial bolus of 10 mL of 0.125% levobupivacaine with dexmedetomidine 0.5 ug/kg in Group A and with clonidine 1 μg/kg in Group B. Subsequently, each patient received a background infusion rate of 10 mL/h, a bolus dose of 5 ml, and a lock-out interval of 10 min via a patient-controlled-analgesia (PCA) pump. The blood pressure, heart rate, and severity of pain using VAS were assessed. Durations of the stages of labor, rate of instrumental delivery, and cesarean section, side effects, maternal sedation, and neonatal Apgar scores were also recorded.ResultsVAS scores in both the groups progressively decreased to <3 by 15 min with significant differences at five, 10, 15, and 120 min being lower in group A. Onset of analgesia and time for maximum analgesia was significantly shorter in group A. There was a significant decrease in hemodynamic parameters from baseline in both groups. The fall in heart rate was significantly greater in Group A and at almost all the time intervals after baseline, diastolic blood pressure (DBP) was also lower in group A. Maternal motor blockade scores, the intensity of maternal sedation, the incidence of maternal complications, the duration of the first and second stage of labor, the rate of instrumental delivery and cesarean section, total analgesic dose and PCA bolus requirement, and neonatal Apgar scores did not show a significant difference between the two groups.ConclusionBoth dexmedetomidine and clonidine provide hemodynamically stable labor with a fall in heart rate and maternal blood pressure in the initial hours. Dexmedetomidine has the advantage of faster onset of analgesia and time for maximum analgesia.

Comparison of the Analgesic Effects of Ultrasound Guided Pectoral Nerve Block Type II and Erector Spinae Plane Block in Breast Cancer Surgery

Objectives: To compare the effect of ultrasound guided Pectoral Nerve Block 2 (PECs 2) and Erector Spinae Plane Block (ESP) for post op analgesia in patients undergoing Breast cancer surgery Methods: This observationally planned study included 40 patients over the age of ages of 18 who are of American Society of Anesthesiologists (ASA) I-III and scheduled for elective surgery due to breast malignancy were included in the study. PECs 2 block was applied to the patients after the induction of general anesthesia in Group 1 and ESP block was applied to the patients after the induction of general anesthesia in Group 2. In the postoperative period, visual analog scale (VAS) values, nausea, vomiting and sedation score values and analgesic doses used by all patients in the post-operative period were recorded. Results: Intraoperative and postoperative opioid consumption was statistically significantly lower in the PECs block group than in the ESP group. Postoperative analgesia time was longer in the PECs group. The number of patients requiring rescue opioid in the post-operative period was statistically significantly lower in the PECs group. There was no difference between the groups in terms of complications, mobilization time, time of discharge, postoperative nausea-vomiting (PONV) and terms of sedation. Conclusions: In patients who underwent breast surgery for malignancy, we found that the ultrasound (US) guided PECs 2 block achieved more effective postoperative analgesia compared to ESP block.

Comparison of Analgesic Efficacy of Nalbuphine Versus Tramadol as Adjuvant to Local Anaesthetic in Caudal Block in Children

Objective: To compare the mean time of first analgesia with nalbuphine versus tramadol as adjuvant to bupivacaine for caudal block in children. Patients and Methods: In this randomized clinical trial, a total number of 60 children who were planned for caudal block after infra-abdominal surgeries having age 3-12 years were included. A caudal block was performed under general anaesthesia immediately after surgery for postoperative analgesia. Tramadol 2mg/kg body weight was given caudally to individuals in group A. Group B patients had 0.125 percent bupivacaine with 0.1mg/kg nalbuphine caudally. Time of requirement of first analgesia was noted in all patients. Paracetamol 10 mg/kg was given as rescue analgesic in all patients. Results: Mean age of patients was 8.30±3.03 years. Mean weight of patients was 23.33±6.92 Kg. There were 26 (43.33%) female patients and 34 (56.67%) male patients. There were 50 (83.33%) children who were having ASA status I, and remaining 10 (16.67%) children were having ASA status II. Mean pain score was 3.53±1.43 in tramadol group and 1.86±1.25 in Nalbuphine group (p-value &lt;0.001. Mean time of first rescue analgesia was significantly prolonged in Nalbuphine group, mean time was 6.13±1.07 hours in Nalbuphine group versus 4.03±1.03 hours in tramadol group (p-value &lt;0.001). Conclusion: Single dose of nalbuphine as an adjunct to bupivacaine is superior as compared to tramadol in reducing the post-operative pain, it also significantly prolongs the duration of analgesia in children. Keywords: Caudal Block, Nalbuphine, Tramadol, Post-operative pain, Time of first rescue analgesia.

Identifying the Minimal Effective Dose of Dexmedetomidine Infusion for Post-Operative Pain Control in Laparoscopic Cholecystectomy Patients

Objective: To compare the frequency of need of rescue analgesia and time of first rescue analgesia) of two different doses 0.2 μg/kg/h and 0.4 μg/kg/h of IV dexmedetomidine in patients undergoing laparoscopic cholecystectomy (LC). Material and Methods: A total number of 68 patients planned for LC under general anesthesia were included from January-2020 to January-2021. The patients were randomly divided into two groups; group D1 patients received dexmedetomidine 0.2 μg/kg/h i.v and group D2: received dexmedetomidine0.4 μg/kg/h i.v. After shifting the patient in recovery unit, the need of rescue analgesia and time of first rescue analgesia was noted for each patient. Results: Mean age of patients was 42.64±13.54 years. There were 47 (69.12%) females and 21 (30.88%) male patients. Rescue analgesia was needed by 16 patients (47.1 %) in group D1 and 07 patients (20.6 %) in group D2. The time of first rescue analgesia was 167.50±11.64 minutes in groups D1 and 263.44±19.03 minutes in group D2 (p-value of &lt;0.001). Conclusion: Dexmedetomidine in an infusion dosage of 0.4 µg/kg/hour is helpful in providing adequate postoperative analgesia. Keywords: Rescue analgesia, dexmedetomidine, laparoscopic cholecystectomy.

Comparison of patient and surgeon satisfaction in patients undergoing knee arthroscopy with peripheral nerve block versus spinal anesthesia

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p &lt;0.01) and surgeon (p = 0.022; p &lt;0.05) satisfaction rates, these being lower in the group with SFNB comparable to patients with spinal anesthesia. There was a statistically significant difference between the first analgesic requirements of the patients according to the groups (p = 0.001; p &lt;0.01). The first analgesic requirement of the patients who received SFNB was later than in the case of patients who received spinal anesthesia. Conclusions. Patient and surgeon satisfaction with SA was significantly higher than SFNB. The peripheral nerve blocks are inadequate for patient and surgeon satisfaction for knee arthroscopy compared to SA.

Transversus Abdominis Plane (TAP) Block: A Comparative Study between Levobupivacaine versus Levobupivacaine plus Ketamine in Abdominoplasty.

Purpose We conducted this study to explore the hypothesis that the addition of ketamine to levobupivacaine in ultrasound-guided Transversus Abdominis Plane (TAP) block would result in a better and prolonged duration of postoperative analgesia for patients undergoing abdominoplasty. Material and Methods. This randomized prospective study was conducted on 50 patients who were scheduled for abdominoplasty. TAP block was performed bilaterally for all patients either with levobupivacaine 0.5% 15 ml plus ketamine 0.5 mg/kg in a total volume of 20 ml in the LK group (n = 25) or with levobupivacaine 0.5% 15 ml plus 5 ml normal saline in a total volume of 20 ml in the L group on each side. Results Visual analogue scale (VAS) was significantly lower in the LK group in resting condition at 6, 12, and 16 h postoperatively compared to the L group. On movement, the VAS was significantly lower at 4, 6, 8, 12, 16, and 24 h postoperatively in the LK group compared to the L group. The time for first rescue analgesia was longer in the LK group (18.7 ± 4.8 h) than that in the L group (6.5 ± 2.4 h) with the reduced total amount of rescue morphine in the LK group (1.14 ± 2.2 mg) versus the L group (5.86 ± 3.6 mg). Only six patients in the LK group requested rescue morphine, whereas nineteen patients requested rescue morphine in the L group. Conclusions In TAP block, adding ketamine 0.5 mg/kg enhanced the analgesic efficacy of levobupivacaine 0.5% in patients undergoing abdominoplasty and reduced the required analgesics postoperatively.