Local Anesthetic Research Articles

Effect of adding sodium bicarbonate 8.4% to local anesthesia on pain during upper canine infiltration.

Alkalization of local anesthetics may have an impact on alleviating the injection pain by buffering these solutions with sodium bicarbonate. The present study aimed to evaluate the pain during local anesthetic buccal infiltration for the maxillary canines after adding sodium bicarbonate 8.4% during local anesthesia. A buffered 2% lidocaine with 1:80,000 epinephrine and sodium bicarbonate 8.4% was used for one site, and an unbuffered 2% lidocaine with 1:80,000 epinephrine was used for the other site at the same appointment. Two groups of volunteers (15 male and 15 female) participated. Each participant received 0.6 mL of the anesthetic solution. Injection discomfort was assessed using a visual analog scale. 73% and 93% of patients in group 1 experienced pain in sites A and B, respectively, during the injection, whereas 80% and 100% of patients in group 2 experienced pain in sites A and B, respectively, during the injection. Both groups showed a significant difference in pain scores between the two injected sites (P ˂ 0.01). Upper canine infiltration anesthesia with buffered lidocaine and epinephrine with sodium bicarbonate has less pain during injection than when unbuffered lidocaine with epinephrine is used.

Comparing the effects of three local anaesthetic agents on cardiac conduction system - A randomised study.

This study aimed to compare the effects of three local anaesthetic (LA) agents, namely bupivacaine, levobupivacaine, and ropivacaine, on the cardiac conduction system as assessed by corrected QT (QTc) and P wave dispersion (PWD) intervals in lower limb orthopaedic surgeries and to find the most suitable LA agent that can be used for a long duration. The study included 75 patients with American Society of Anesthesiologists physical status I and II of either gender in the age group of 18-65 years undergoing elective lower limb orthopaedic surgeries under epidural anaesthesia. These were allocated to groups B (bupivacaine), L (levobupivacaine), and R (ropivacaine). We observed blood pressure, heart rate, respiratory rate, PWD, and QTc intervals from baseline value through Holter monitoring, pain assessment by visual analogue scale, and demand and total volume of LA consumed by patient-controlled analgesia devices. The repeated measures of ANOVA were carried out to find the effect of time and time-to-group interaction among the groups across the periods. On intergroup comparison of QTc and PWD, no significant difference among groups was observed, but on intragroup analysis, a statistically significant increase in QTc and PWD from baseline was observed for each of groups B, L, and R at all time intervals. However, the mean increase in QTc and PWD recorded for Group B was higher than in groups L and R. Bupivacaine has the maximal tendency to prolong QTc and PWD. All three agents showed comparable haemodynamic effects and time to onset of sensory and motor blockade.

High-Dose Compound Betamethasone Used in Local Infiltration Analgesia Does Not Increase Reinfection Rates Following Periprosthetic Joint Infection Treatment

BackgroundCocktails containing glucocorticoids for local infiltration analgesia (LIA) are highly advocated and effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA. MethodsA retrospective study was conducted on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of re-infection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared. ResultsDuring minimum 2-year follow-up, there was no significant difference in the re-infection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the first 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). For knees, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery (P < 0.001). Furthermore, within the first 72 hours post-surgery, the CB group required less additional opioid analgesics than the non-CB group (P < 0.05). ConclusionsA LIA with a high-dose CB reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

Abstract Background In arthroscopic knee surgery, managing postoperative pain is crucial for patient outcomes. Dexamethasone, combined with local anesthetics in adductor canal block, offers potential advantages, such as vasoconstriction and anti-inflammatory effects. This approach proves safe, prolongs sensory block duration, delays the need for analgesics, and enhances patient satisfaction, addressing challenges associated with epidural analgesia and femoral nerve block. Overall, it signifies a valuable strategy in anesthesia practice, contributing to prolonged analgesia, reduced opioid use, and faster recovery in knee arthroscopy. Aim of the Work The study aims to assess the effectiveness of perineural dexamethasone combined with bupivacaine in adductor canal block for postoperative pain control following knee arthroscopy with spinal anesthesia. The primary focus is on determining the duration of postoperative analgesia. Secondary objectives involve evaluating the effectiveness of analgesia one day after surgery and assessing opioid consumption. Patients and Methods This randomized, double-blinded controlled trial at Ain Shams University hospitals investigates the efficacy of adductor canal block with dexamethasone in knee arthroscopy under spinal anesthesia. Sixty adult patients are randomly assigned to receive either bupivacaine with dexamethasone (Group A) or bupivacaine with saline (Group B). Primary outcomes include postoperative analgesia duration, and secondary outcomes involve morphine use, patient demographics, surgical time, and complication rates. Ethical considerations and detailed study procedures are outlined, ensuring patient safety and methodological rigor. Results In a randomized study for arthroscopic knee surgery, dexamethasone added to bupivacaine in adductor canal block significantly extended sensory block duration and delayed the time to first analgesic requirement. Visual analog scale scores were lower, and morphine consumption was reduced over 24 hours postoperatively. While systemic effects of dexamethasone were not assessed, consistent with other studies, its addition to local anesthetics in various nerve blocks demonstrated prolonged analgesia. Patient satisfaction was notably higher in the dexamethasone group, likely influenced by increased pain relief duration and reduced side effects. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg) dexamethasone to (0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Pain Scoring in Uterine Evacuation for Incomplete Abortion Using Isolated Paracervical Block vs Combined Paracervical and Intrauterine Lignocaine Instillation: A Randomized Clinical Trial

Abstract Background Nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone. Objective To compare efficacy of paracervical block alone versus combined paracervical block and intrauterine lidocaine installation in pain management of first trimesteric incomplete abortion. Patients and Methods A total of 80 women with first trimesteric incomplete miscarriage were admitted to the emergency department for uterine evacuation at Ain Shams University Maternity Hospital, in the period from September 2021 to September 2023 and underwent uterine evacuation using either paracervical block or combined paracervical block and intrauterine lidocaine instillation then pain score was obtained using visual analogue scale. Pain score was done 10 minutes after injection of local anaesthetic, 5 minutes after starting procedure and 1 hour postevacuation. Results It also showed that there was no statistically significant difference between both groups regarding need of opioids and time interval till opioids need. Exploring other factors that might have affected the success or failure of procedure in the study population it was found that age, parity were significant predictors such that the younger the age, the less the parity the more likely failure of procedure. Also being previous section was linked more to success than failure. Conclusion The combination of intrauterine lidocaine and paracervical block has no additive effect on conventional paracervical block in reducing the pain during uterine evacuation for incomplete abortion, but successful evacuation resulted in lower pain score and reduced needs for opioid.

Labelling of Fluids in the Sterile Field During Orthopaedic Surgery: A Quality Improvement Initiative.

Background Intraoperative safety protocols, including proper labelling of syringes, are critical to patient safety in surgical settings. While the Royal Pharmaceutical Society and the Royal College of Anaesthetists provide clear guidelines to prevent medication errors, ensuring consistent compliance with labelling protocols in the fast-paced and complex environment of orthopaedic surgery can still present practical challenges. The absence of proper labelling, combined with the use of multiple fluids such as normal saline, disinfectants, and local anaesthetics, increases the risk of adverse outcomes due to fluid misidentification. This quality improvement project aimed to assess current labelling practices in a district general hospital, identify barriers to compliance, and develop a cost-effective solution. Methodology The project was conducted in three orthopaedic theatres over two audit cycles. During the first audit cycle, 30 procedures were observed to assess compliance with labelling guidelines. Compliance was defined as the labelling of all syringes containing fluids present in the sterile field. Following this, an intervention was introduced, using surgical marker pens and sterile stickers for fluid labelling, along with a mandatory "tactical pause and check" and an awareness campaign. Two months later, a second audit of 34 procedures was conducted to evaluate the effectiveness of the intervention. Results In the first audit cycle, only three out of 30procedures (10%) were compliant with labelling guidelines. Following the intervention, compliance increased dramatically to 32 out of 34 procedures (94%). The results were statistically significant (p < 0.05) as determined by Fisher's exact test. The use of sterile stickers and marker pens proved to be a simple and cost-effective solution that did not interfere with the sterile environment or increase costs. Conclusions This study demonstrates that a low-cost intervention using sterile stickers and surgical marker pens can significantly improve compliance with fluid labelling guidelines in orthopaedic surgery, thereby enhancing patient safety. While the intervention was successful, future research should explore more sustainable solutions, such as pre-printed sterile labels, and evaluate the long-term impact of such interventions across various surgical settings. Continuous education and regular audits will be essential in maintaining high compliance rates.

Ropivacaine and magnesium sulfate in sciatic nerve block at the popliteal level: randomized double-blind study.

Following surgical procedures, over 80% of patients experience acute pain, with half of them expressing dissatisfaction with pain relief. The modern approach to surgical treatment and pain management increasingly relies on implementing multimodal analgesia, which includes the use of adjuvants in addition to long-acting local anesthetics (such as ropivacaine). This double-blind randomized study evaluated the analgesic effect of magnesium sulfate added to ropivacaine in the sciatic nerve block at the popliteal level for bunion correction surgery. In this double-blind study, fifty patients were enrolled and randomized in a 1:1 ratio to receive ropivacaine and MgSO<inf>4</inf> 200 mg or ropivacaine and physiological solution. The primary endpoint was the duration of sensory block. A statistically significant difference was observed in the onset time for sensory block (9.2 minutes vs. 21.8 minutes, P<0.001) and its duration (18.2 hours vs. 13.9 hours, P<0.001) between the two groups. Between 12 and 24 hours postoperatively, the maximum NRS pain scores in the magnesium group were lower than those in the control group (IQR [range]) 2 (2-3.8 [0-6.5]) vs. 6.7 (5.6-7.9 [2.7-9.2], P<0.001). The need for additional opioids after 12-24 hours was significantly higher in patients in the physiological solution group compared to those in the magnesium group. Our results suggest that magnesium added to the local anesthetic extends sensory block duration, reduces postoperative pain, improves the quality of analgesia, decreases the need for additional opioids. Further studies are needed to confirm these preliminary findings.

Dexmedetomidine and Dexamethasone as Adjuvants to the Local Anesthetic Mixture in Rhomboid Intercostal and Sub-Serratus Block for Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind, Controlled Trial.

The utilization of adjuvants such as dexamethasone and dexmedetomidine in combination with local anesthetics has proven effective in extending analgesia duration. We aimed to investigate the potential efficacy of combining dexmedetomidine and dexamethasone in rhomboid intercostal and sub-serratus (RISS) block for prolonging postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS). We did this randomized, double-blind, controlled trial in two tertiary-care hospitals. A total of eighty-eight patients undergoing VATS under general anesthesia were enrolled in this study. They were randomly assigned into four groups: ropivacaine (R) group, ropivacaine + dexmedetomidine (RM) group, ropivacaine + dexamethasone (RS) group, or ropivacaine + dexmedetomidine + dexamethasone (RSM) group. The primary outcome measure was the duration of analgesia. Secondary outcomes included Numeric Rating Scale (NRS) scores, cumulative oxycodone consumption, and adverse effects. The RSM group exhibited a significantly prolonged duration of analgesia at 1073.5min (932.0-1283.3) compared to the R group with a duration of 154.5min (80.5-199.3) and the RS group with a duration of 282.0min (195.3-350.0, P < 0 0.001). The cumulative oxycodone consumption during the 0-12hours and 0-24-hours period was significantly reduced in the RSM group compared to the R group (P < 0.05). There was also a lower incidence of nausea at 48hours postoperatively in the RSM group compared to the RM group. However, there were no significant differences between the four groups regarding NRS pain scores. The combination of ropivacaine, dexmedetomidine, and dexamethasone in RISS block significantly prolongs the duration of postoperative analgesia following VATS.

Myoclonic Jerks in an Ex-Preterm Undergoing Hernia Surgery Under Combined Spinal Caudal Block: Is It Time to Revisit the Test Dose?

Abstract Myoclonic jerks, while often benign, can indicate underlying issues such as inadvertent intrathecal or intravascular injection of the local anesthetic. In preterm infants, whose physiological responses are often more unpredictable and sensitive, the risk of complications from regional anesthesia may be heightened. We present the management of a possible local anesthetic systemic toxicity in an ex-preterm infant scheduled for an elective left inguinal herniotomy.

Atropine Prophylaxis before Spinal Anesthesia in Young and Middle Age Males Undergoing Inguinal Hernia Repair

Abstract Background Spinal Anesthesia is a common type of anesthesia used during many surgical procedures. This regional technique can be accomplished by administering an intrathecal dose of hyperbaric local anesthetic solution. The local anesthetic within the subarachnoid space can block sensory, motor and sympathetic pathways. One of the most common complications associated with spinal anesthesia is hypotension with or without bradycardia that can increase risk of perioperative cerebral and cardiovascular events. Aim of the Work to find out the effectiveness of prophylactic administration of intravenous atropine for attenuation of spinal anesthesia induced hypotension in inguinal hernia repair surgeries. Patients and Methods Therefore, A randomized controlled clinical trial was found to be the most suitable design in order to achieve the study objectives. A total of 40 patients males included in the study, aged 15-60 years, and were divided equally into two groups: Group 1 received intravenous injection of 0.01 mg /kg atropine sulphate one minute before spinal anesthesia and fluid preloading 500 ml Ringer solution. Group 2 received the same volume of normal saline intravenous bolus. Results Prophylactic intravenous atropine sulphate 0.01 mg /kg intravenous one minute prior to spinal anesthesia in inguinal hernia repair surgeries was effective in reducing spinal anesthesia induced hypotension, incidence of hypotension was lower in atropine exposed group compared to placebo group. The incidence of ephedrine use and number of boluses of fluids were lower in atropine exposed group compared to placebo group. Conclusion among patients who received spinal anesthesia with bupivacaine for elective inguinal hernia repair, prophylactic intravenous atropine sulphate 0.01 mg /kg prior to spinal anesthesia reduced spinal anesthesia induced hypotension and reduced ephedrine use.

Ultrasound-Guided Quadratus Lumborum Block Using Bupivacaine and Verapamil versus Bupivacaine as Postoperative Analgesia in Abdominal Surgeries

Abstract Background Postoperative pain control is significant challenge in medical practice, and insufficient postoperative pain control can increase the incidence of many postoperative complications. Regional anesthesia can efficiently alleviate postoperative pain, avoid opioid- related side effects and decrease the risk of developing postoperative chronic pain. Ultrasound-guided quadratus lumborum block (QLB) is a posterior abdominal wall block. It was proved to reduce postoperative opioid consumption. In recent years, the practice of adding adjuvants to local anesthetics in nerve blocks emerged to decrease dose of anesthetics and prolong time of analgesia. Among such adjuvants is verapamil which showed efficacy in prolongation of the action of local anesthetics in several studies when used in supraclavicular brachial plexus block. Objective To evaluate the analgesic effect of quadratus lumborum block (QLB) with and without the addition of verapamil in the postoperative period after abdominal surgeries. Methods Twenty patients scheduled for abdominal surgeries under general anesthesia were recruited in this prospective randomized comparative clinical study from Ain Shams University hospitals, Cairo, Egypt within a period of 6 months and were divided into two groups. Results This study showed that there was no statistically significant difference between both groups according to demographic data, age, sex, ASA and BMI, with p-value (P = 0.611; P = 0.371; P = 1.000 and P = 0.869) respectively. There was statistically significant higher mean value of heart rate “beat/min” after 2 hrs. and after 4 hrs. in control group was 82.20±9.58 and 87.50±10.61 comparing to verapamil group was 70.40±9.83 and 75.00±11.42, respectively, with p-value (p = 0.014 and p = 0.021). While, the rest have insignificant difference, with p- value (p &amp;gt; 0.05). Statistically significant higher mean value of MAP (mmHg) in control group was 86.90±6.44 and 87.00±6.78 comparing to verapamil group was 76.60±6.48 and 80.90±5.76, respectively, with p-value (p = 0.002 and p = 0.044). While, there rest have insignificant difference, with p-value (p &amp;gt; 0.05). An increase in median of VAS score in the two groups over the periods from the after 1hr, but the most increase in the control group comparing to verapamil group; as there was a statistically significant difference between groups according to VAS score at after 6 hr., after 12 hrs. and After 18 hrs., with p-value (p &amp;lt; 0.05). Need of analgesia was statistically significantly faster in control group was 5.80±2.39 compared to verapamil Group was 13.20±6.20, according to time of 1st rescue analgesia “hrs.”, with p-value (p = 0.002). Statistically significant higher mean value of total morphine (mg) in control group was 18.50±4.12 compared to verapamil group was 11.50±3.37, with p-value (p &amp;lt; 0.001). Conclusion The study showed that the addition of verapamil to bupivacaine in QLB improved the qualities of the block which was proved by longer time before rescue analgesia, lower VAS scores and lower morphine (mg) consumption in verapamil group compared to control group.

A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy

Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P&lt;0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.

Needling Technique (with or without Cryotherapy) versus Cryotherapy Alone in Treatment of Multiple Plantar Warts

Abstract Background Plantar warts are common benign tumors caused by human papilloma virus (HPV) infection of the epidermal cells with an estimated annual incidence of 14%. Needling, a novel therapeutic approach, stimulates the immune system resulting in clearance of even untreated lesions, in several patients. Introduction of human papilloma virus infected keratinocytes into the subcutaneous layer may facilitate a desired immune response. On the other hand, Cryotherapy, an inexpensive and simple traditional provider administered procedure using liquid nitrogen in a spray or cryoprobe, is frequently used in many countries as a first line of treatment of plantar warts. Objective To evaluate the efficacy and safety of immunotherapeutic modality (needling) versus locally destructive modality (cryotherapy), as well as combination of both immunotherapeutic modality and locally destructive modality (cryotherapy) in treatment of multiple plantar warts. Methods This is a randomized therapeutical prospective clinical study included 60 patients aged from 19 to 55 years with planter warts (&amp;gt;2) who haven't received treatment for the condition within the previous month, divided into 3 groups, 20 patients per group, one group subjected to needling procedure, another group subjected to cryotherapy and the third group subjected to a combination treatment of both needling and cryotherapy. Results Regarding patients' satisfaction, there was a statstical significant difference between the 3 studied groups as regard patients' satisfaction (median/range), being higher in cryotherapy and combined treatment groups than in needling group. This is the rapid effect of cryotherapy in warts treatment which shows higher scores in the 8th week. Also, not all patients are satisfied with needling since it is not commonly used as cryotherapy, which makes patients question its efficacy especially when used alone. As it is a painful procedure that has to be performed with local anesthetic which consumes a lot of time. Regarding reported side effects of our study, patients of needling group experienced pain, mild bleeding and mild infection. While patients of cryotherapy group experienced pain, blistering, infection and high recurrence rates. Patients of the combination treatment group experienced pain, mild bleeding and blistering. Conclusion Combining cryotherapy (locally destructive method) and needling (immunotherapeutic method) provides promising results as it combines benefits of cryotherapy, being rapid, safe and shows rapid response together with benefits of needling, being an immuno-stimulant that provides effective, long lasting, minimally invasive, low-cost treatment with excellent safety profile and low recurrence rates for treatment of plantar warts.

Safety of oral mucosal punch biopsy and other oral biospecimen collections in clinical research

ObjectiveOral punch biopsies are frequently used for analysis of lesions since they are minimally invasive, easily performed and assist in diagnosis. Despite broad usage, recent changes in risk classification characterize oral punch biopsies as “greater than minimal risk” for institutional review board purposes. We performed a retrospective review of oral sampling in clinical trials to determine the safety of punch biopsies and other biospecimen collection methods in our oral cancer surveillance program. Study DesignPunch biopsies of 3- and 4-mm were collected following topical and local injection anesthetic. Hemostasis was achieved using pressure and silver nitrate cautery. Other specimens were collected according to standard collection guidelines. Safety and adverse events were determined through consultation with clinical investigator guidelines and were graded with the NCI Common Terminology Criteria for Adverse Events v5. ResultsIn total, 579 samples were collected, 339 of which were oral punch biopsies. There were no adverse events above NCI CTCAE grade 1 for any biospecimen collection. ConclusionThese results support the safety profile of oral punch biopsies and saliva collection. Additionally, these results align with previous research on punch biopsy safety and demonstrate fewer bleeding events. Based on the results and prior research, we believe that punch biopsies should be considered a minimal risk procedure.

A Comparative Controlled Study of Preoperative Skin Infiltration with Bupivacaine-Dexmedetomidine versus Bupivacaine-Magnesium for Pain Control Analgesia in Para Umbilical Hernia regarding Their Perioperative Analgesic Effect

Abstract Background Postoperative pain and opioid-related adverse drug events are still among the principal factors affecting the rapid recovery and discharge of patients undergoing surgery. Wound pain at rest and on movement is one of the main sources of postoperative pain. In addition, skin traction stimulation, which can be caused by respiratory movement and the daily activities of patients after surgery, further aggravates the severity of wound pain, resulting in restlessness and insomnia and even inducing serious symptoms such as wound tear and infection. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. The technique of wound infiltration analgesia has been shown to play an active role in relieving postoperative pain and reducing opioid consumption. Aim of the Work Comparing the effectiveness of pre-incision skin infiltration with bupivacaine- dexmedetomidine mixture versus bupivacaine-magnesium mixture for elective para umbilical hernia repair. Patients and Methods A Prospective randomized, double blinded controlled study was conducted in Ain Shams university hospital on 75 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. They will be randomly divided into three groups. Method of randomization using computer generated number list using opaque sealed envelopes. Patients will be enrolled in group B for bupivacaine alone, group D for bupivacaine-dexmedetomidine and group M for bupivacaine-magnesium. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of pain conduction in C-fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia. Conclusion Dexmedetomidine is found to be an effective adjuvant to bupivacaine for local wound infiltration analgesia in terms of effective analgesic duration, need for rescue analgesic and better pain scores in the immediate postoperative period, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.

Prophylactic preoperative administration of oral gabapentin versus metoclopramide for prevention of opioid induced pruritis in spinal anesthesia.

Abstract Background Spinal opioids have become a mainstay of clinical pain management in labor, in perioperative care, and in chronic pain management. Spinal opioids are frequently co- administered with local anesthetics to provide analgesia requiring lower doses of each agent, thus minimizing most undesirable side effects. Most opioid-induced side effects such as nausea, vomiting, and respiratory depression are more commonly observed following systemic administration.8 By contrast, pruritus is more commonly observed following intrathecal or epidural administration, particularly in obstetric patients. Aim of the Work to compare the efficacy of gabapentin versus metoclopramide for prevention of intrathecal opioids induced pruritus. Patients and Methods This study is a double blinded prospective randomized controlled clinical trial. This study conducted at Ain Shams University Hospital. The period of the study is a 6 months. 62 adult patients undergoing elective operations under spinal anesthesia at Ain Shams University hospital. Results The demographic data (age, gender, and ASA physical status) was statistically non- significant. The mean age was 35.1 years old in Group G and 36.8 years old in Group M with a P value of 0.569. The female-to-male ratio was 63.1 % in Group G and 82.3% in Group M with a P value of 0.607. In Group G, 71 % were of ASA 1 physical status and 29 % of ASA 2 physical status while in Group M, 67.7% were of ASA 1 physical status and 32% of ASA 2 physical status with a P value of 0.783. The whole incidence of pruritus in the two groups was 31.5%, (48.8% in group G and 45.2% in group M). There is no statistically significant difference, with a p-value 0.799. As for the severity, both drugs showed reduction of VAS score from the first hour after intrathecal fentanyl injection. Gabapentin showed to be more potent in decreasing the severity of pruritus as 2 patients only needed rescue treatment compared to 5 patients from metoclopramide group (but insignificant difference with p value 0.341). The overall incidence of nausea was 17.7% (22.58 in Gabapentin group and 12.9% in metoclopramide group). As for the incidence of vomiting, the whole incidence was 11.29% (16.13% in Gabapentin group and 6.45% in metoclopramide group). There was no statistically significant difference with a p-value 0.118 for nausea and p-value 0.374 for vomtitng. Conclusion The results of the study showed that Gabapentin is as effective as Metoclopramide in prevention of opioid induced pruritus in spinal anesthesia. But, Gabepentin improved to be slightly more effective in reducing the severity of pruritus than Metoclopramide.

Comparison between Ultrasound Guided Quadratus Lumborum Block and Caudal Block in Children Undergoing Lower Abdominal Surgeries

Abstract Background Caudal epidural anesthesia is a widely used popular technique for postoperative analgesia. The caudal approach of the epidural space is done through the sacral hiatus. A success rate of 96% was reported, however it can cause complications such as needle trauma, infection, hematoma, inadvertent subarachnoid or intravascular injection of local anesthetic. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. The quadratus lumborum block is also known as the abdominal truncal block. Ultrasound-guided quadratus lumborum block is a technique that was developed to provide visceral and somatic analgesia during abdominal procedures, and it can provide perioperative analgesia for all age groups, including pediatric patients undergoing abdominal surgery. Aim of the Work The aim of this study was to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing lower abdominal surgeries under general anesthesia. Patients and Methods This prospective randomized controlled double-blind study was carried out on eighty patients between 6-12 years old and undergoing lower abdominal surgeries. Patients were equally categorized into two groups which are quadratus lumborum block group (40 patients) received general anesthesia followed by ultrasound- guided Quadratus Lumborum block (0.3 ml/Kg of 0.25% Bupivacaine) and caudal block group (40 patients) received general anesthesia followed by caudal block (0.5 ml/Kg of 0.25% Bupivacaine). Results VAS score measurements showed no statistically significant difference at baseline, after 1 hr, 18h and 24h postoperative, while VAS score measurements were significantly lower in QLB group than Caudal block group after 2h, 4h, 6h and 12h postoperative. Intraoperative HR and MAP measurements were insignificantly different between both groups. Postoperative HR and MAP measurements were insignificantly different at baseline, after 18h and 24h. Postoperative HR2 measurements were significantly lower in QLB group than Caudal block group after 1h, 2h, 4h, 6h, 12h, 18h and 24h. Time to first analgesic request was significantly higher in QLB group than caudal block group. Total paracetamol consumption was significantly lower in QLB group than caudal block group. Hospital stay was insignificantly different between both groups, also hypotension was reported to be significantly lower in QLB group than caudal block group. There were few cases that experienced postoperative nausea and vomiting in both groups but there was no statistically significant difference in PONV between the two groups. Conclusion Performing QLB (anterior approach) is recommended for pediatric analgesia in lower abdominal surgeries as it is more effective in decreasing total paracetamol consumption, pain scores, and prolonging postoperative analgesia time more than caudal block.

Effect of Addition of Hyaluronidase as an Adjuvant to Lidocaine and Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Abstract Background Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post- operative pain control. Objective The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block. Methods This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month). Results There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 ± 47.97 mins, group B: 610.5 ± 57.9 mins) and motor (group A: 660.5 ± 47.29 mins, group B: 625.5 ± 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 ± 48.74 mins, group B: 618 ± 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 ± 1.56 mg). Conclusion This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block ….etc), the difference between the two groups was also significant statistically.

Comparison of Ultrasound Guided Bilateral Rectus Sheath Block versus Local Wound Infiltration for Post Operative Analgesia in Patients undergoing Laparotomy with Midline Incision

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 56 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline expolaratory surgery. in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 28 patients each: Results Patients receiving RSB block had significantly lower pain scores at rest for 24 hr after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration of local anaesthetic. Conclusion U/S-guided rectus sheath block is more effective analgesic technique than local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.

Effective regional anesthesia for pediatric surgical care

This review highlights the significant role of pediatric regional anesthesia in optimizing perioperative care and improving surgical outcomes. We examine common local anesthetics, adjuvant medications, and techniques. Safety, efficacy, adverse events, and controversies are addressed while spotlighting the broad utility of regional anesthesia to contribute to better outcomes and quality of life for pediatric surgical patients and their families.