Time For First Rescue Analgesia Research Articles

Bilateral erector spinae plane block by multiple injection for pain control in pseudomyxoma peritonei surgery: a single-blind randomized controlled trial

ObjectiveCurrently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP.MethodsFifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB.ResultsThe Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P < 0.001), 4 (2.4 ± 1.5 vs. 3.7 ± 1.0, P = 0.001), and 6 h (2.7 ± 1.1 vs. 3.8 ± 1.4, P = 0.004) post-extubation during rest. Similarly, the VAS scores in Group E were significantly lower than those in Group C at immediate post-extubation (3.0 ± 1.4 vs. 4.6 ± 1.2, P < 0.001), and at 2 (3.8 ± 1.7 vs. 4.9 ± 1.4, P = 0.019), 4 (3.5 ± 1.3 vs. 5.3 ± 1.5, P < 0.001), and 6 h (3.9 ± 1.8 vs. 4.9 ± 1.3, P = 0.004) post-extubation during movement. In Group E, the intraoperative remifentanil administration (2319.3 ± 1089.5 vs. 2984.6 ± 796.1, P = 0.017) and the amount of rescue analgesia within 2 h post-extubation (0 vs. 4, P = 0.037) were significantly less than in Group C, and the first rescue analgesia time was shorter as well (231.4 ± 147.5 vs. 668.8 ± 416.7, P < 0.001).ConclusionCompared to general anesthesia alone, bilateral multiple-injection ESPB with 0.2% ropivacaine can enhance analgesia and reduce opioid administration in patients with PMP. However, the duration of analgesia with ESPB is relatively short due to the low concentration of the local anesthetic used.Trial registrationChinese Clinical Trial Registry, ChiCTR2300069504, 20/03/2023.

Comparison Of Ketorolac Versus Ibuprofen For Postoperative Pain Management In Total Abdominal Hystrectomy Surgeries

Background - Postoperative pain management is crucial for ensuring patient comfort and promoting faster recovery. Pharmacological interventions, such as NSAIDs, play an essential role in reducing pain intensity while minimizing opioid-related side effects. Ketorolac, a potent NSAID, and ibuprofen are both commonly used for pain relief. This study focuses on comparing the efficacy of these two drugs for pain management in total abdominal hysterectomy surgeries. Aim -To assess and compare the effects of intravenous ketorolac and intravenous ibuprofen on postoperative pain management in total abdominal hysterectomy patients. Materials and Methods: A randomized single-blind study was conducted on 30 patients, divided into two groups (Group K: ketorolac, Group I: ibuprofen). Various parameters, including VAS pain scores, sedation, time for rescue analgesia, and the number of rescue analgesics, were compared. Participants: 30 patients undergoing total abdominal hysterectomy, randomized into two groups (Group K: ketorolac, Group I: ibuprofen). Inclusion Criteria: Patients between 18 and 65 years of age undergoing elective surgery, ASA grade I or II. Exclusion Criteria: Patients with NSAID hypersensitivity, coagulation disorders, bronchial asthma, hepatic or renal failure, and peptic ulcers. Methodology: Patients received lumbar subarachnoid block, followed by either 30 mg of ketorolac or 800 mg of ibuprofen postoperatively. Rescue analgesics were provided if needed. Results: The postoperative pain scores were significantly lower in the ibuprofen group. Time for first rescue analgesia and the total number of rescue analgesics required were also lower in the ibuprofen group

Comparative Study between Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. Aim of the Work The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB). Results The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group II from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs. Conclusion Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.

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

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

The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery

Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Results Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.

Efficacy of quadratus lumborum block as a relatively new analgesic technique in patients undergoing open inguinal hernia surgical repair

Study objective To determine the analgesic efficacy of ultrasonographic guided transmuscular graduatus lumborum block (QLB) in patients undergoing open inguinal hernia surgery. Design Prospective randomized double-blinded study. Methodology and interventions This prospective randomized double-blinded study was carried out at Sohag University hospital, after local research ethical committee approval and obtaining informed written consent from all patients participating in the study or their guardians. A total of 50 patients (ASA grade I to II) were posted for open inguinal hernia surgery. All patients underwent the operation under general anesthesia. Then patients were randomly divided into two equal groups: group A (QLB group, N=25): were underwent a transmuscular QLB approach, after wound dressing with a single shot of a total volume of 20 ml of mixture (10 ml bupivacaine 0.5% and10 ml normal saline). Group B (control group N=2): patients received only general anesthesia with conventional intravenous analgesia. Measurements Pain intensity between groups was compared using the Visual Analog Score (VAS), furthermore, analgesic consumption (morphine and ketorolac) and additional rescue analgesic requirements were also calculated. Results Postoperative VAS scores at rest and during movement were significantly lower in group (QLB) A than the control group B at 1, 5, 7, 8, 9, 10, and 12 h, the time of first rescue analgesia was significantly delayed in QLB group (15.8±3.94 h) than the control group (8.5±4.29 h). Number of patients required morphine was significantly different between both groups. Number of patients required ketorolac was significantly lower in QLB group than in the control group. Total morphine and ketorolac requirements were significantly lower in group A (2.5±0.71 mg, 75±25.1), respectively than those consumed by the control group B (4.7±0.49, 126±23.24), respectively. Conclusions QLB significantly improves the analgesic quality in patients undergoing inguinal hernia repair compared to the standard intravenous analgesia regimen.

Comparison of ultrasound-guided erector spinae plane block with ultrasound-guided pericapsular nerve group block for paediatric hip surgery: A randomised, double-blinded study.

Postoperative pain after hip surgeries in children could be classified as severe, requiring combined intra- and postoperative opioid analgesia with regional blocks. This study was carried out to investigate ultrasound-guided pericapsular nerve group (PENG) block versus ultrasound-guided erector spinae plane (ESP) block for pain management after paediatric hip surgery. The primary objective was to assess the time of the first request for morphine rescue analgesia. In this randomised study, 56 children scheduled for elective unilateral hip surgery were distributed randomly to ESP and PENG groups. Intraoperative haemodynamics, fentanyl consumption, postoperative pain measurement, morphine consumption, time of first rescue analgesia, adverse effects and parents' satisfaction score were studied. The primary outcome was the time of the first request for morphine rescue analgesia. The Chi-square test, Student's t-test and the Mann-Whitney U test were used, where applicable, to compare the groups. The time to first rescue analgesia was significantly longer in Group ESP than in Group PENG (P < 0.001), with significantly higher postoperative morphine consumption in Group PENG than in Group ESP (P = 0.04). The pain scores of Group ESP were lower than those of Group PENG at 2 and 4 h postoperatively (P = 0.006 and P < 0.001, respectively). At 8 h postoperatively, the score was significantly higher in Group ESP than in Group PENG (P = 0.005). Other outcomes were comparable between both groups (P > 0.05). ESP and PENG could be both effective for intraoperative and postoperative analgesia in paediatric hip surgeries, but the ESP block prolonged the time of first rescue analgesia more than the PENG block.

A Randomized Comparative Study of Ultrasound-guided Femoral Nerve Block Versus Fascia Iliaca Compartment Block for Reducing Pain Associated with Positioning for Spinal Anesthesia in Patients with Proximal Femur Fracture

Abstract Context: Peripheral nerve blocks are widely accepted as the gold standard for providing perioperative and postoperative analgesia in lower limb surgeries. Aims: This study aimed to determine which block is better in terms of onset of action among ultrasound-guided femoral nerve block (USG FNB) and ultrasound-guided fascia iliaca compartment block (USG FICB) for positioning for spinal anesthesia in patients operated for proximal femur fracture and find the total duration of analgesia, total consumption of rescue analgesics, and complications. Settings and Design: This was a prospective, randomized, comparative, interventional, single-blinded study. Subjects and Methods: Patients in Group A (n = 43) were administered USG FNB with 15 mL of 0.25% bupivacaine and patients in Group B (n = 43) were administered USG FICB with 30 mL of 0.25% bupivacaine. The primary objective was to find out which nerve block was better in reducing pain associated with a sitting position for spinal anesthesia, and the secondary objective was to find the difference in the mean time of first rescue analgesia. Statistical Analysis: Data analysis was done using the Student’s t-test and Chi-square tests. Results: Before block administration, patients in Group A had a Visual Analog Scale (VAS) score of 7.65 ± 0.75, and patients in Group B had a VAS score of 7.79 ± 0.74 (P = 0.389). The primary objective was to achieve VAS &lt; 3. It was 3 min in Group A and 5 min in Group B (P = 001). The secondary objectives were the duration of postoperative analgesia in Group A was 330.58 ± 28.16 min and in Group B was 482.33 ± 19.89 min (P &lt; 0.001). The mean value of tramadol consumption in 24 h in both the study groups was comparable (P = 1.000). The anesthesiologist satisfaction score, patient satisfaction score, and proportion of side effects in both study groups were comparable. Conclusion: USG FICB is more efficacious. Although the onset of action delays by 2 min, it provides longer postoperative analgesia compared to USG FNB.

QUALITY AND EFFICACY OF GENERAL ANESTHESIA VERSUS SEGMENTAL THORACIC SPINAL ANESTHESIA IN MODIFIED RADICAL MASTECTOMY SURGERY: A SINGLE-CENTER OBSERVATIONAL STUDY

Objective: Surgical resection remains the most important treatment modality for breast cancers. Recent research suggests that the choice of anesthesia technique might also have a role in the recurrence of the disease. We compared quality and efficacy of the conventional general anesthesia technique with segmental thoracic spinal (STS) anesthesia technique used in modified radical mastectomy. Methods: 60 American Society of Anesthesiologists II/III patients were divided into two groups Group C (Control group) and Group S (Study group). Group C patients were induced with standard anesthesia regimen while Group S patients were given STS at T4–T5 inter space with 1.5 mL of 0.5% hyperbaric levobupivacaine along with 15 µg of fentanyl with conscious sedation. Hemodynamics, pain score, time for first rescue analgesia, experience of anesthesiologist, surgeon, and patients were recorded. Results: Time for induction in group S is significantly longer (Group C 17.4±3.8 vs. 36.2±7.2 min, in Group S). The duration of surgery (56±13.6 min vs. 76.4±15.9 min) was also significantly longer, while reversal period was shorter in Group S (9.2±6.2 and 6.3±5.7 min). Modified Aldrete’s recovery score achieved quickly in Group C (16.8±4.9 vs. 29.7±9.8 min), but postoperative analgesia was better in Group S as first rescue analgesic sode required after 6.2±1.9 h in Gr. S while in Gr. C time duration was 4.9±1.3 h. Length of stay in hospital was more in Group S, (Group C 45.4±4.8 vs. Group S 56.3±8.5 [h]) while ease and comfort of surgeon anesthesiologist and patient satisfaction score were more in Group C. Conclusion: STS anesthesia is feasible for breast carcinoma surgeries but it is easier for surgeon and anesthesiologist to manage patient under general anesthesia. STS anesthesia has advantage in terms of early post-operative analgesia and will definitely be helpful in cases where patient is not fit for general anesthesia.

A comparative study between neostigmine and dexamethasone as an adjuvant to bupivacaine in adductor canal block after knee arthroscopy (RCT)

Background Adjuvants to adductor canal block are used to improve the quality and duration of the block for better analgesia after knee surgeries. This study evaluates and compares the effect of adding dexamethasone and neostigmine to bupivacaine in adductor canal blocks after knee arthroscopy (KA). Methods In this randomized, double-blinded, controlled study, 90 patients scheduled for knee arthroscopy were randomly allocated into three groups to receive adductor canal block after the end of the arthroscopy. The control group received 20 ml bupivacaine 0.5%+2 ml normal saline, the dexamethasone group received 20 ml bupivacaine 0.5%+2 ml dexamethasone (8 mg) and the neostigmine group received 20 ml bupivacaine 0.5%+1 ml neostigmine (500 mcg) +1 ml normal saline. Outcomes: time of first rescue analgesia, sensory blockade duration, total opioid consumption, and visual analog score (VAS). Results Time of first rescue analgesia and Sensory block duration, were longer in dexamethasone and neostigmine groups compared with control group, with no significant difference between dexamethasone and neostigmine groups, however, clinically there was 3 h prolongation in sensory block duration in dexamethasone group. Mean morphine consumption and Visual analog score were lower in dexamethasone and neostigmine groups compared with control group, with no difference between dexamethasone and neostigmine groups, Conclusion Both dexamethasone and neostigmine were effective adjuvants to bupivacaine in ACB with more prolonged postoperative analgesia and less opioid consumption. Though there was no statistically significant difference between both drugs, however, dexamethasone showed some clinical superiority.

Comparison of Post Operative Analgesic Efficacy of Dexamethasone as an Adjuvant with Ropivacaine 0.25% and Plain Ropivacaine 0.25%, Using Ultrasound Guided Tap Block after Total Abdominal Hysterectomy: A Randomized Controlled Trial

Introduction: Following abdominal surgery, transversus abdominis plane (TAP) block, a peripheral nerve block, can be a useful supplement to multimodal postoperative analgesia. The aim was assessment of postoperative analgesic effectiveness of 0.25% ropivacaine with 4 mg of dexamethasone on each side and 0.25% ropivacaine alone in the management of postoperative pain following total abdominal hysterectomy (TAH). Materials and Methods: Sixty adult patients planned for elective TAH with ASA Grades I–II under general anesthesia participated in this prospective, randomized, double-blinded study. Patients of Group A were given 20 mL of 0.25% ropivacaine on both the sides and Group B patients were given 20 mL of 0.25% ropivacaine with dexamethasone 4 mg on each side. The primary objective of this study was a comparison of Visual Analog Scale (VAS) scores between the groups and comparison of mean time of first rescue analgesia. The secondary objectives of this study were a comparison of hemodynamic parameters, postoperative analgesic requirement, patient satisfaction, and incidence of side effects. Results: VAS shows no discernible variation in 1 and 4 h after administration of block in Groups A and B. However, a significant difference appeared in VAS 8 h (P = 0.007), VAS 12 h (P = 0.000), and VAS 24 h (P = 0.000) after the administration of block between Groups A and B. The median time for first rescue analgesia was 2.75 h (interquartile range [IQR] = 1 h) and 5.8 h (IQR = 1.6 h) in Groups A and B, respectively, which was highly significant. Conclusion: We concluded that, after abdominal hysterectomy, dexamethasone added to ropivacaine TAP block tends to prolong postoperative analgesia and decrease the need for analgesics.

A Study to Assess the Efficacy of Ultrasound-guided Bilateral Erector Spinae Plane Block for Total Abdominal Hysterectomy under Spinal Anesthesia: A Prospective Randomized Control Study

Abstract Background: Postoperative discomfort after a total abdominal hysterectomy (TAH) is severe. The Erector spinae plane block (ESPB) is the latest addition to the multimodal pain management regimen, providing both visceral and somatic analgesia. Aim: The aim of this study was assessed the postoperative analgesic efficacy of ultrasound-guided bilateral ESPB for TAH. Materials and Methods: 70 female patients aged 40 to 60 years, American society of anaesthesiology (ASA) physical status class I and II posted for TAH were enrolled. Group ESPB+SA(n=35) received bilateral ESPB using 0.25% ropivacaine hydrochloride 15ml with 0.5µ/kg dexmedetomidine on each side before spinal anaesthesia, while group SA (n=35) received only spinal anaesthesia. Postoperative follow-up for 24 hours.Statistical analysis used: Independent-samples student t-test. Results: The total dose of tramadol injection consumed in the first 24 hours postoperatively in group ESPB+SA was significantly low (110.34mg) as compared to group SA (334.29mg) (P &lt; 0.001). Time for first rescue analgesia was prolonged significantly in group ESPB+SA while it was very short in Group SA(P &lt; 0.001). Postoperatively the mean modified defense and veterans pain rating scale (DVPRS) for pain was lower in group ESPB+SA than in group SA, and the difference was statistically significant (P &lt; 0.001). Similarly, scores for other modified DVPRS components, such as sleep, activity, mood and stress were lower in the ESPB+SA group. Conclusions: Bilateral ultrasound-guided ESPB prior to spinal anaesthesia offers effective and prolonged postoperative analgesia, with significantly lower postoperative tramadol use and a higher satisfaction score in patients undergoing TAH under spinal anaesthesia.

Comparison of two different doses of preemptive gabapentin on postoperative pain relief and morphine requirement after mastectomy: A randomized study

Abstract Background and Aims: Gabapentin (GBP) has been found to decrease the pain scores and analgesic requirements following total abdominal hysterectomy, spinal surgery, and ear, nose, and throat surgery. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. This study compares the effect of two different doses of preemptive GBP on morphine requirement and postoperative pain relief in patients undergoing mastectomy. Methods: This randomized comparative trial included 70 patients scheduled for unilateral mastectomy. They were divided into two groups. Group 1 received 800 mg oral GBP and Group 2 received 1200 mg oral GBP 2 h before surgery. After surgery, we recorded the pain score at different time points using the Visual Analog Scale (VAS) at rest. Patients were also asked about possible side effects of the premedication drug. Patients received morphine 0.1 mg/kg intravenous on demand. The time of first rescue analgesia was recorded along with the total rescue analgesic requirement in the first 24 h. Results: In our study, the mean VAS score, postoperatively at 2, 4, 12, 24 h in Group 2, was less than Group 1 but the difference was not statistically significant (P = 0.9, 0.1, 0.8, 0.4, respectively) Patients of Group 1 demanded rescue analgesia earlier (5.8 ± 3.4 h) than Group 2 (9.6 ± 5.9 h). The total 24 h morphine consumption in Group 1 (10.97 ± 4.01 mg) was higher than Group 2 (6.71 ± 5.02 mg). No significant side effects were observed during the perioperative period. Conclusion: We conclude that GBP in higher doses, when used preemptively, provides a greater degree of analgesia with opioid-sparing effect.

Comparison of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy - A randomised, double-blind, controlled study.

Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same. This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02-20.32) h and 16.3 (21.8) (95% CI: 8.17-24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery.

Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial

ABSTRACT Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair. Methods This randomized double-blinded study was performed on 75 male children undergoing hypospadias repair under CB. Patients were randomized into three equal groups. All received 0.5 ml/kg bupivacaine 0.25% caudally plus 1 ml volume containing either dexmedetomidine 1 μg/kg in Group D, 0.5 mg/kg ketamine in Group K or 50 mg of MgSO₄ in Group M. Results Time of first rescue analgesia was significantly delayed in group D (8.2 ± 3.45 h) than in group K (5.8 ± 2.85 h) and group M (3.7 ± 1.51 h) (P value = 0.007 vs. <0.001) and in group K than in group M (P value = 0.027). Heart rate and mean arterial blood pressure measurements after block and 60 min intraoperative reduced significantly in group D than in K and Group M. At 6 h and 12 h, FLACC scores were considerably lower with Group D compared to Group K, and Group M, and ketamine group compared to Group M at 4 h. The total amount of pethidine consumed 24 hours postoperatively was significantly lower in Group D than in Group K and Group M. Conclusions Dexmedetomidine as an additive to the CB significantly prolonged time to first analgesia required and decreased total rescue opioid consumption compared to ketamine and MgSO₄.

USEFULNESS OF FASCIA ILIACA COMPARTMENT BLOCK WITH INJECTION BUPIVACAINE AND DEXAMETHASONE AS ADJUVANT IN PATIENTS UNDERGOING HIP FRACTURE SURGERIES UNDER SPINAL ANESTHESIA

Objectives: The objectives of our study are to study the effectiveness of fascia iliaca block for positioning during spinal anesthesia and to compare the duration of post-operative analgesia using bupivacaine alone and bupivacaine with dexamethasone as an adjuvant. Methods: This was a prospective randomized study done at a general hospital. Fifty patients aged 18 years and above of ASA Grades II and III undergoing hip fracture surgeries (proximal femur nailing, DHS, and hemiarthroplasty) were included in the study to receive the fascia iliaca compartment block (FICB). Group A (25 patients) received 38 mL of 0.25% bupivacaine with 2 mL normal saline and Group B (25 patients) received 38 mL of 0.25% bupivacaine with 2ml dexamethasone (8 mg). Relief of pain for positioning during spinal anesthesia was assessed by recording the visual analog score, 30 min after the FICB. In both groups, the post-operative analgesia was recorded from the time of giving spinal anesthesia to the time for first rescue analgesia which was given when VAS was 4 or more. Results: There was a significant prolongation in the post-operative analgesia in Group B patients who received FICB with bupivacaine and dexamethasone in comparison to Group A in which bupivacaine alone was used. However, the VAS score after 30 min of FICB, for positioning for spinal anesthesia and the patient satisfaction score was similar in both groups. Conclusion: FICB is effective for providing adequate positioning for spinal anesthesia and the addition of dexamethasone (8 mg) to bupivacaine for FICB significantly prolonged the duration of the block and increased the time to first rescue analgesia as compared to using bupivacaine alone.

Efficacy and Safety of Bilateral Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ObjectivesThis study conducted a meta-analysis basing on the available evidences from randomized controlled trials (RCTs), with the aim of assessing the efficacy and safety of bilateral ultrasound-guided erector spinae plane block (US-ESPB) for post-operative analgsia in patients receiving spine surgery. MethodsThe PubMed, EMBASE and CENTRAL were searched by two reviewers independently, to identify the RCTs evaluating the efficacy of US-ESPB for pain management in patients undergone spine surgery. During performing the meta-analyses, the mean difference (MD) and 95% confidence interval (95%CI) were selected for continuous data, while risk ratio (RR) and 95%CI were selected for dichotomous variables. ResultsA total of 25 RCTs, including 1917 patients (873 in ESPB group and 874 in control group), were eligible for inclusion. ESPB was associated with significant lower pain intensity at 0, 2, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group at rest. During movement, ESPB was associated with significant lower pain intensity at 0, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group. Significantly reduced opioid consumption (MD = -6.29, 95%CI: -8.16∼ -4.41, p<0.001***), prolonged time for first rescue analgesia (MD = 7.51, 95%CI: 3.47∼11.54, p<0.001***), fewer patients needing rescue analgesia (RR = 0.34, 95%CI: 0.28∼0.43, p<0.0001***), improved patients’ satisfactory (MD = 1.34, 95%CI: 0.88∼1.80, p<0.001***), and shorter length of hospital stay (MD = -0.38, 95%CI: -0.50∼-0.26, p<0.001***) were demonstrated after applying of ESPB. Additionally, ESPB was associated with decreased risks of any adverse event (RR = 0.51, 95%CI: 0.43∼0.60, p<0.001***) and PONV events (RR = 0.39, 95%CI: 0.31∼0.49, p<0.001***). ConclusionUS-ESPB is an effective adjunctive technique with good tolerability for multimodal analgesia in the management of pain in patients undergoing spine surgery.

COMPARISON OF BILATERAL USG-GUIDED ERECTOR SPINAE BLOCK VERSUS CONTROL GROUP FOR INTRAOPERATIVE HEMODYNAMIC STABILITY AND POST-OPERATIVE ANALGESIA IN SPINE SURGERIES UNDER GENERAL ANESTHESIA

Objectives: The aim of the study was to compare the intraoperative hemodynamics and post-operative analgesia after using bilateral erector spinae block (ESB) and conventional techniques during spinal surgeries. The study also aims at comparison of analgesics consumption in patients during post-operative period. Methods: One hundred adults aged 18–80 years with American Society of Anaesthesiology physical status I/II scheduled for elective lumbar spine surgeries (two levels) under general anesthesia (GA) were divided into two groups. Group A received erector spinae plane block (ESPB) along with GA and Group B received GA only. Injection Paracetamol 1 g intravenously was given as rescue analgesia. Intraoperative hemodynamics, visual analog score at rest and at movement in 24 h postoperatively, first rescue analgesia, total dose of analgesics in first 24 h postoperatively, and intraoperative opioid dose requirement were compared in both the groups for 7 days. Results: Intraoperative hemodynamics in ESPB group were found to be more stable than the control group. There was a significant low VAS score in Group A compare to Group B at rest and on movement (p&lt;0.001). The time for first rescue analgesia was prolonged in group ESPB as compared to control group (p&lt;0.05). The total dose of analgesia required in first 24 h was significantly lower in patients of ESP group 25±41.96 mg 82.5 than patients in control group ±22.73 mg. Conclusion: Ultrasound-guided bilateral ESB provides profound intraoperative hemodynamic stability with perioperative analgesia in comparison to conventional GA technique. The present study concluded that ESP block decreased the opioid requirement in both intraoperative and post-operative period.

Comparative study between ketamine-bupivacaine versus bupivacaine with intravenous ketamine infusion in supraclavicular brachial plexus block during upper limb surgeries

Background Theb only drawback of using local anesthetics alone for supraclavicular brachial plexus block is that postoperative analgesia lasts for a shorter period. To block brachial plexus quickly and completely, different adjuvants, including opioids, dexmedetomidine, dexamethasone, midazolam, and ketamine, had been used with local anesthetics. Aim of the study was to compare the efficacy of adding ketamine to bupivacaine versus intravenous ketamine infusion with supraclavicular brachial plexus. Methods Sixty studied cases planned to undergo unilateral elective upper limb surgeries using ultrasound-guided supraclavicular brachial plexus block were separated into two groups: group 1: 20 ml bupivacaine 0.5% plus ketamine (1 mg/kg) with a maximum dose of 100 mg; (the total volume is 30 ml), with the infusion of 100 ml normal saline at a rate of 100 ml/h and group 2: 20 ml bupivacaine (0.5%) plus 10 ml saline; (the total volume is 30 ml) with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline at a rate of 100 ml/h, that was stopped 5 min before the end of surgery. Results Visual Analog Scale (VAS), heart rate and mean arterial pressure were significantly lower at 12 h postoperatively in group 1. The onset of sensory, motor block, duration of sensory and motor block were significantly lower in group 1 compared with group 2. The time of first rescue analgesia was significantly delayed in group 1 compared with group 2. Total ketorolac requirements were significantly lower in group 1. Conclusions Using ketamine bupivacaine in supraclavicular brachial plexus block in upper limb surgeries is effective in improving the onset of brachial plexus block and prolonging the time of brachial plexus block with no hemodynamic changes.

A randomised, prospective, double blind study of intraperitoneal instillation of 0.25% bupivacaine with clonidine versus 0.25% bupivacaine with dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the standard and most accepted technique for Cholecystectomies due to lesser postop pain and short recovery time.The origin of abdominal and shoulder pain after laparoscopic procedures has led to the use of intra peritoneal instillation of local anaesthetic agent to reduce postoperative pain. To assess the efficacy and quality of postoperative analgesia between the study groups using Visual Analogue Scale (VAS) score at various time intervals along with side effects if any.: 60 patients belonging to ASA 1 and 11 categories posted for Laparoscopic Cholecystectomy were given General Anaesthesia. After completion of surgery, before removing the trocar, anaesthetic study solution was sprayed on the surface of liver, gall bladder bed, right sub-diaphragmatic space, and port sites in Trendelenburg position. Volume and dilution of two drugs were same in both groups. Bupivacaine (0.25%) 50 mL; Dexmedetomidine (1 µg/kg) (BD) or Clonidine (1 µg/kg) (BC) was used. VAS score, Heart rate and BP measured at various time intervals and the time of first rescue analgesia noted.: VAS of BD group was 5.27 ± 0.64 to 3.70 ± 0.837 from 1 hour to 6 hour post extubation, when compared to BC group of 6.03 ± 0.669 in 1 hour reduced to 4.17 ± 0.699 at 6 hour post extubation. Dexmedetomidine combination significantly reduced the total dose of rescue analgesic required in 24 hours as compared to Clonidine combination.