Total Analgesic Requirement Research Articles

Comparison of analgesic efficacy of shoulder block versus interscalene block for postoperative analgesia in arthroscopic shoulder surgeries: A randomised trial.

Background and Aims:Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like phrenic nerve palsy. Shoulder block (ShB) is a relatively recent diaphragm sparing alternative for analgesia in these cases.Methods:This prospective randomised trial was conducted in 70 adult patients posted for arthroscopic Bankart repair surgery. Patients were randomly assigned into two groups: interscalene block [Group ISB (n = 35): 0.5% bupivacaine 10 ml] or shoulder block [Group ShB (n = 35): 0.5% bupivacaine (suprascapular block 10 ml and axillary block 10 ml)] using ultrasound and nerve stimulator. The primary aim of our study was to compare the ISB with ShB for visual analogue score (VAS) in recovery area (zero hour). Time for block performance, VAS, time to first rescue analgesia, total analgesic requirement, patient satisfaction and complications were recorded.Results:VAS was significantly higher in ShB group at 2 and 4 h (P = 0.001 and 0.000) while it was significantly higher in ISB group at 12 h (P = 0.013). The time to first analgesic request was significantly prolonged in ISB group as compared to ShB group (8.22 h vs. 4.69 h; P = 0.002) but total analgesic requirement and patient satisfaction at 24 h were similar. Complications like dyspnoea, ptosis and motor weakness were seen only with ISB group.Conclusion:Both ShB and ISB blocks have similar efficacy in terms of postoperative pain scores, cumulative analgesic requirements and patient satisfaction. However, considering the various undesirable effects associated with ISB, like phrenic nerve blockade, prolonged upper limb weakness and the occurrence of rebound pain, shoulder block may be preferred for arthroscopic shoulder surgeries.

Effect of Wound Infiltration with Bupivacaine after Laparoscopic Cholecystectomy – A Randomized, Controlled Trial

Background and Objective: Adequate post-operative pain management can improve surgical outcome. Patients undergoing surgery can be affected socially, psychologically, economically with undertreated pain. We aimed to evaluate the effect of 0.25% bupivacaine infiltration on postoperative pain, analgesic requirement, satisfaction level, hospital discharge and quality of life after laparoscopic cholecystectomy.
 Methodology: Fifty eight patients undergoing laparoscopic cholecystectomy were enrolled and randomized in two groups – placebo and intervention. Patients were infiltrated with 10 ml 0.25% bupivacaine in intervention and 10 ml 0.9% normal saline in placebo group. Post-operative pain was managed with morphine using Patient Controlled Analgesia (PCA). Pain intensity was assessed on the matrix of visual analogue scale and verbal rating scale up to 12 post-operative hours. This study also assessed its effect on analgesic requirements, hospital stay, patient satisfaction level after 24hours, pain score on discharge, time taken to return to job and quality of life (on 15th and 30th post-operative day).
 Results: It was revealed 0.25% bupivacaine can lower post-operative pain up to six post-operative hour of performing laparoscopic cholecystectomy. Total analgesic requirement was also reduced (p= 0.0003) with decreased side effect like vomiting (p= 0.0002). However, satisfaction and quality of life were not affected by bupivacaine infiltration in this study.
 Conclusion: 0.25% Bupivacaine infiltration offered more effective management of postoperative analgesia with decreased analgesic requirement and less incident of vomiting. But it was not effective after long duration in terms of satisfaction level, hospital discharge, time to return to job or quality of life.

Analgesic effect of continuous adductor canal block versus continuous femoral nerve block for knee arthroscopic surgery: a randomized trial

Background and objectivesAnterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR. MethodIn this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion). ResultsThe time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p < 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p < 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p < 0.001). ConclusionThe findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.

The Comparison of Balloon and Camera Dissection of the Preperitoneal Space in Totally Extraperitoneal Repair Hernia Repair. Our Initial Experience!

Purpose. To perform totally extraperitoneal repair of a hernia, it is essential to create a working space for the placement of instruments. In this study, we aimed to compare balloon dissection (BD) and camera or telescopic dissection (CD) with respect to the surgical outcomes, without considering the cost-effectiveness. Methods. Forty consecutive, healthy, unilateral inguinal hernia patients who underwent Totally Extraperitoneal Repair hernia repair were randomized into 2 groups according to whether they received BD or CD. The perioperative demographic characteristics were recorded. All the operations were video recorded from the beginning to the end of each procedure. The virtually constructed periods of the procedures were evaluated by another surgeon who watched each video. The time spent for each period, the severity score assigned by the surgeon, the total operation time, the peritoneal laceration rate, the presence of early and late postoperative pain, the number of postoperative visits, the total analgesic requirements, and the complications were recorded. Results. The demographic properties of the patients, the perioperative and postoperative complications, and the severity scores in the BD and CD groups were statistically similar. The total operating time and the time from the dissection of the peritoneum to the reduction of the hernia sac were significantly longer in the CD group. Post-discharge analgesic consumption, Visual Analog Scale scores, and the number of visits were similar between the groups. Conclusions. The dissection of the working space in the preperitoneal area can be achieved using camera dissection without the risk of common complications associated with balloon dissection, particularly balloon rupture.

Effect of perioperative intravenous lignocaine infusion on postoperative pain in laparoscopic cholecystectomy

Background and Aims: Postoperative pain delays recovery after laparoscopic cholecystectomy which is done as a daycare surgery. Opioid analgesia carries adverse effects like nausea, vomiting and respiratory depression which can affect postoperative recovery. Our aim was to compare lignocaine infusion with saline infusion as perioperative ERAS measure for postoperative analgesia in laparoscopic cholecystectomy. Method: After obtaining ethical clearance, 40 patients undergoing laparoscopic cholecystectomy were randomised by computer generated codes in to two groups A and B. In group B two subjects were moved out of study, so two in group A were also excluded to make the two groups equal. Group A received saline and group B received 2mg/kg/h lignocaine infusion intravenously which were stopped at the end of the surgery. Postoperative pain was assessed by NRS score at definite time intervals 0 (admission to postoperative anesthesia care unit), 2nd, 4th, 6th, 8th, 10th, 12th and 24th hours. Time at which first rescue analgesia was requested, total analgesic requirements, mean NRS score and side effects were noted. Results: At every time interval, patients in lignocaine group had delayed time to request for rescue analgesia, less analgesic requirements and mean NRS. (P value &lt;0.05). No side effects or signs of toxicity were noted in lignocaine group. Conclusion: Perioperative lignocaine infusion is an efficient, safe and cost-effective armamentarium in implementing ERAS in laparoscopic cholecystectomy.

Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy- A RCT

Introduction: Abdominal Hysterectomy (AH) is one of the most common surgeries performed in gynaecology and is associated with a medium to high pain level. Newly discovered peripheral blocks such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block have gained immense popularity as an adjunct to regional and general anaesthesia for postoperative pain management and reducing analgesic requirements. Aim: To compare the analgesic efficacy of QL block with TAP block in patients undergoing total AH. Materials and Methods: This was a double-blinded Randomised Clinical Trial (RCT). The study population comprised of 105 patients posted for elective total AH under spinal anaesthesia. They were randomly allocated into three groups of 35 patients each. Group Q received bilateral QL block with 40 mL of 0.25% bupivacaine divided on either side, Group T received bilateral TAP block with 40 mL of 0.25% bupivacaine divided on either side and in Group C no block was given. Patients were monitored for Visual Analogue Scale (VAS) scores at 0, 15 minutes, 30 minutes, 1st, 2nd, 6th, 12th and 24th hour postoperatively, time for first analgesic requirement, total analgesic requirement in 24 hours and patient satisfaction score after 24 hours and also adverse effects, if any. Data were analysed using Statistical Package For The Social Sciences (SPSS) version 16 (Chicago, IL, USA) with independent t-test and Chi-square test as appropriate. The p&lt;0.05 was considered statistically significant. Results: There were significantly lower VAS scores in group Q than group T at 2nd and 6th hour with p-value of 0.003 and 0.001, respectively. The time for first analgesic was early in group C with mean value of 1.37±0.74 hours and it was 4.63±0.97 hours in group T and 7.77±1.51 hours in group Q. The total analgesic requirement was lesser in group Q when compared to group C and T. Patient satisfaction score was comparable between group Q and T (p=0.97). No significant difference in complications among the three groups was observed (p=0.51). Conclusion: QL block is a better postoperative analgesic technique than TAP block for postoperative analgesia in hysterectomy patients.

A clinical comparison between 0.375% levobupivacaine and 0.375% levobupivacaine with 1 ug/Kg dexmedetomidine in brachial plexus block by supraclavicular approach for upper limb surgeries

Introduction: Dexmedetomiodine is a selective α2 agonist drug. This study aimed to assess the onset and duration of sensory and motor block and postoperative analgesia in the first 12 hours after surgery after adding Dexmedetomidine with 0.375% Levobupivacaine for brachial plexus block. Material and Method: 100 patients aged 18-60 years of ASA Grade I & II posted for upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups with 50 patients in each. Group L and L+D received 35cc of 0.375% injection Levobupivacaine and 35cc of 0.375% Levobupivacaine with 1 µg/kg of injection Dexmedetomidine respectively through nerve stimulator guided supraclavicular block. Onset and duration of sensory and motor block, time to first and total analgesic need were noted postoperatively for 12 hours.Results: Sensory and motor block onset time was significantly lower in the Group L+D than Group L (p=0.001). Duration of sensory and motor block was significantly longer in the Group L+D than Group L (p=0.001). The time to the first analgesic requirement was longer in Group L+D than Group L (p=0.001). The total analgesic requirement was significantly lower in Group L+D than Group L (p=0.001).Heart rate and systolic and diastolic blood pressure was significantly lower after drug administration in group L+D than group L.Conclusion: Dexmedetomidine added to Levobupivacaine causes early onset and increased duration of sensory and motor block and prolonged period of postoperative analgesia in supraclavicular brachial plexus block. Therefore, Dexmedetomidine seems to be a good alternate adjuvant.

Assessment of supraclavicular brachial plexus block with or without dexamethasone as an adjuvant to 0.5% levobupivacaine

Background: Brachial plexus block is an excellent method for attaining optimal operating conditions for upper limb surgeries by producing complete muscular relaxation, maintaining haemodynamic stability and the associated sympathetic block. The present study was conducted to assess supraclavicular brachial plexus block with or without dexamethasone as an adjuvant to 0.5% levobupivacaine. Materials and methods: 50 patients of 18-60 years were allocated in two groups of 25 each. In group I, patients received 30 ml of 0.5% isobaric levobupivacaine with 2 ml of isotonic sodium chloride. In group II patients received 8mg (2ml) dexamethasone in addition to 30ml of 0.5% isobaric levobupivacaine. Results: Group I had 15 males and 10 females and group II had 12 males and 13 females. The mean duration of surgery was 62.4 minutes in group I and 63.2 minutes in group II, onset of sensory blockade was 10.4 minutes in group I and 8.1 minutes in group II, onset of motor blockade was 15.4 minutes and 13.2 minutes, duration of sensory blockade was 658.2 minutes and 925.6 minutes, duration of motor blockade was 572.4 minutes and 764.2 minutes and total analgesic requirement was 22 and 1 in in group I and in group II respectively. The difference was significant (P< 0.05). Conclusion: Dexamethasone found to reduce the time to onset of sensory and motor blockage and prolongs the duration of analgesia.

Effect of Single Preoperative Dose of Duloxetine on Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy under Spinal Anesthesia.

Background:Women undergoing hysterectomy present a unique set of challenges to the anesthesiologist in terms of postoperative pain management. This study was conducted to see the effect of single-dose perioperative duloxetine 60 mg on postoperative analgesia following abdominal hysterectomy under spinal anesthesia.Materials and Methods:This prospective randomized placebo-controlled study was conducted on 64 patients scheduled to undergo elective abdominal hysterectomy under spinal anesthesia. The patients were divided into two groups of 32 in each, Group D received duloxetine 60 mg 2 h preoperatively and Group P received placebo 2 h preoperatively. Postoperatively, the patients were evaluated by an independent observer for pain on rest and during cough at 0 (arrival at postanesthesia care unit), 2, 4, 6, 12, and 24 h. In addition, the postoperative analgesic requirements and adverse effects were noted.Statistical Analysis Used:Independent t-test/Mann–Whitney U-test was used to compare the pain score between two groups.Results:The demographic data were comparable between both the groups. The mean Visual Analogue Scale scores assessed postoperatively at rest and during cough which were not statistically significant between the two groups. The rescue analgesic consumption in Group D (0.97 ± 0.86) and Group P (1.25 ± 0.76) was comparable and statistically not significant. The total analgesic requirement between duloxetine (4.94 ± 0.84) and placebo (1.25 ± 0.76) group was comparable and statistically not significant. The incidence of nausea vomiting and somnolence was higher in Group D.Conclusion:We conclude that patients receiving a single dose of 60 mg duloxetine as premedication before hysterectomy under spinal anesthesia are no better than placebo on postoperative pain during the first 24 h.

Dexmedetomidine infusion on subarachnoid block with bupivacaine in inguinal herniorrhaphies - A prospective study

Background: Dexmedetomidine (D) is alpha-2 agonist that acts as an anaesthetic and analgesic substitute. The goal of this study was to see how intravenous (I.V.) dexmedetomidine affected the length of sensory and motor block, postoperative analgesia, sedation degree, and side effects. Aims: To assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess side effects. Materials and methods: Prospective study was done under the for a period of 11 months. In 80 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named B and BD using computer generated randomization. The enrolled patients were divided into 2 groups each 40 patients to receive either 0.5 µg/kg dexmedetomidine intravenous bolus over 10 min (Group BD) or saline infusion (Group B) prior to subarachnoid block with 0.5% hyperbaric bupivacaine 12.5 mg Results: Numerical pain rating scale scores were significantly lower in group BD. Total analgesic requirement was significantly less in group BD. Time to request for first analgesic dose was longer in group BD as compared to group B. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. Hemodynamic parameters and incidence of side effects were similar in both the groups. Conclusion: Premedication with single dose of intravenous dexmedetomidine 0.5 µg/kg prior to subarachnoid blockade with 0.5% hyperbaric bupivacaine hastens the onset and increases duration of sensory and motor block, with maintenance of stable hemodynamics and arousable sedation in Inguinal Herniorrhaphies.

The effect of perioperative magnesium sulphate on the total anesthetic and analgesic requirement in neck surgery

Background: The major perioperative goal is to provide adequate depth of anaesthesia along with optimum perioperative analgesia. One of the IV adjuvant that has been shown potential in pre-emptive analgesia is magnesium sulphate. This study was designed to assess the effect of perioperatively administered IV magnesium sulphate on anaesthetic and analgesic requirements. Materials And Methods: Sixty patients of ASA class 1, 2, 18-65 years of age scheduled for neck surgeries were randomly divided in to two groups. Group M received 40 mg/kg, magnesium sulphate in 100ml normal saline as loading dose over 20min followed by 8 mg/kg/hour as infusion till the end of the surgery during total intravenous anaesthesia with propofol, fentanyl and atracurium in neck surgeries. Group C received 100 ml normal saline as loading dose over 20min and thereafter continuous infusion of same volume of normal saline as received by group M. We observed total requirement of inj.propofol and inj.atracurium intraoperatively and duration of postoperative analgesia in both the groups. Results: The mean VAS score was consistently high in Group C than group M during first 24 hours which was statistically significant (p&lt;0.05). The mean duration of total analgesia was significantly higher in group M. And total requirement of propofol and atracurium in control group were significantly higher compared to group receiving Mgso4.Conclusion: Perioperative use of magnesium sulphate as preloading and infusion shows reduced analgesic and anaesthetic drugs requirements in neck surgeries.

Efficacy of preincisional versus post incisional unilateral ultrasound-guided transversus abdominis plane block in patients undergoing appendectomy under subarachnoid block

Background: Transversus abdominis plane (TAP) block produces effective postoperative analgesia and reduces postoperative opioid consumption after abdominal surgeries. It could be instituted preoperatively or postoperatively. Objectives: This study determined which period of institution of TAP block is more efficacious in postoperative analgesia in patients undergoing open appendicectomy. Patients and Methods: Eighty patients undergoing open appendicectomy were randomized, of which eight were excluded for various reasons (these were; three for protocol violations, four declined further participations, while one for prolonged surgery). A total of 72 patients received SAB, of which half received (n = 36) TAP block with 20 ml of 0.375% plain marcaine before skin incision (preoperative TAP block group) while the other half (n = 36) received same volume and concentration of TAP block at the end of surgery (postoperative TAP block group). Pain was evaluated postoperatively at rest and on movement by numerical rating scale (NRS) over 24 h. Results: Pain scores were significantly lower in the preoperative TAP block group than in the postoperative TAP block group, especially in the first 6 h (P < 0.001) postoperatively; although, both demonstrated lower pain score. Furthermore, total analgesic consumption (paracetamol and tramadol) was significantly higher in the postoperative TAP block group (P = 0.001 and P = 0.002). Conclusion: Preoperatively, administered TAP block increases time to first analgesic request, provides a longer duration of analgesia and reduces total analgesic requirement in comparison to postoperative TAP block in patients undergoing open appendicectomy.

Desflurane versus total intravenous anesthesia in improving the postoperative outcome for the patient undergoing spinal fixation

Background Total intravenous anesthesia (TIVA) and volatile inhalation anesthesia are both standardized techniques for lumbar laminectomy and discectomy procedures. Objective To compare TIVA versus desflurane anesthesia in improving postoperative recovery for patients undergoing spinal fixation. Patients and methods This prospective, double-blind, randomized study was carried out on 60 patients undergoing spinal fixation. Patients were randomized into two equal groups: group D received desflurane anesthesia, and group T received TIVA technique. Induction was done by propofol, fentanyl, and rocuronium. Anesthesia was maintained using desflurane in oxygen air mixture in group D. Still, anesthesia was maintained by intravenous infusion of propofol and dexmedetomidine in group T. Intraoperative vital signs, recovery time, postoperative nausea and vomiting, visual analog score, postanesthetic care unit stay time, total first 24 h postoperative analgesic needs, and serum cortisol and interleukin 6 preoperative and postoperative were assessed. Results TIVA group had lower intraoperative heart rates and mean arterial blood pressure. TIVA group also had a faster recovery time, shorter postanesthetic care unit stays, lower postoperative visual analog score for pain assessment, lower total analgesic requirements, and lower incidence of nausea and vomiting. Conclusions TIVA provided better postoperative recovery with fewer postoperative adverse effects and analgesia need.

Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block versus Ultrasound Guided Transversus Abdominis Plane Block for Lower Abdominal Surgeries: A comparative Clinical Study

Background: Effective pain relief is of utmost importance to anyone undergoing surgery. Postoperative pain relief increases patient comfort and satisfaction. This is best accomplished with a multi-modal approach. Recent trends in minimally invasive surgery and improved recovery protocols have addressed pain treatment in light of these goals. Aim of the work: Comparison between ultrasound-guided Ilioinguinal and Iliohypogastric nerve block with ultrasound-guided transversus abdominis plane block regarding postoperative analgesia in patients scheduled for lower abdominal surgeries. Patients and methods: Seventy patients of ASA I or II, aged 21-50 years, who planned for elective open lower abdominal surgeries were included. They signed an informed consent and were randomly classified into two groups: [Group I] scheduled for Ilioinguinal and Iliohypogastric nerve block, and [Group II] scheduled for transversus abdominis plane block guided by ultrasound. Postoperative pain assessment was conducted by numerical rating score. Results:In inguinal hernia repair, pain score at rest was significantly reduced in the TAP group when compared to Group-I at 30 minutes till the seventh hour postoperatively and at 12 up to 15 hours postoperatively. Also, in the CS group, the pain score was significantly decreased in TAP block when compared to nerve block at 90, 105 minutes, and from 4 up to seventh postoperative hours. With movement, pain scores were significantly lower at the 4, 5, 6, 7, 8, 9, 10, and 11 -hours in group II in inguinal hernia. It was significantly decreased at the 90 minutes to 2 -hours in group II in the CS subgroup. The total analgesic requirements were significantly lower in group II. Conclusion: Ultrasound-guided TAP block tended to be more effective than Ultrasound-guided II/IH nerve block in lowering postoperative pain scores and decreasing the need for rescue analgesia in lower abdominal surgeries.

Efficacy of adding Dexmedetomidine in Fascia Iliaca Compartment Block to provide analgesia for positioning femur fracture patients before spinal anesthesia

Background: fascia iliaca compartment block (FICB) has been used to provide analgesia and facilitate positioning for spinal anesthesia in fracture femur patients with the problem of delayed onset of action. Aim of the study was to assess effectiveness of dexmedetomidine as adjuvant to FICB with bupivacaine to facilitate positioning for spinal anesthesia in fracture femur patients with decrease time to sensory block as primary outcome. Methods: in this prospective double blinded randomized controlled study, 60 patients, ASA I-III, aged 50-70 years, underwent femur fracture surgeries under spinal anesthesia were included. Patients were randomly assigned into two equal groups according to drug injected in FICB; Control group received 40ml 0.25% bupivacaine, and Dexmedetomidine group received dexmedetomidine 80µg in 40ml 0.25% bupivacaine. Twenty minutes after FICB, spinal anesthesia was given. Time to sensory block, fentanyl requirements, and pain during positioning were compared. Postoperative; time to first analgesic request, Pain score and total analgesic requirements were compared. Results: Time to sensory block was significantly shorter and pain during positioning for spinal anesthesia was significantly lower in Dexmedetomidine group, but there were no differences regarding fentanyl requirements. Postoperatively, Pain score was significantly lower after 6 and 8 hours in Dexmedetomidine group, time to first analgesic request was longer, and total analgesic requirements was less in Dexmedetomidine group. Conclusion: Addition of dexmedetomidine to bupivacaine in FICB is effective in enhancing onset and decreasing severity of pain during positioning for spinal anesthesia in fracture femur patients, with added postoperative analgesic effect.

COMPARATIVE STUDY OF PREEMPTIVE ORAL GABAPENTIN WITH PREGABALIN FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY UNDER SUBARACHNOID BLOCK

Introduction:Pain management is important for early mobilization and well-being of the surgical patient.So we compared pregabalin and gabapentin as preemptive analgesic for post operative pain management in patients undergoing abdominal hysterectomy under subarachnoid block. Material and methods:In this randomized controlled double blinded study , 60 elective patients posted for abdominal hysterectomy were randomly divided into two groups of 30 patients each. Group G900 received 900 mg Gabapentin and group P300 received 300 mg Pregabalin, administered orally 1 hour prior to administration of spinal anesthesia.VAS scores ,first rescue analgesic time,total analgesic requirement, and any adverse effects in first 24 hours postoperatively were compared. Results:Mean total analgesic dose and mean no. of doses in first 24 hour post-operatively were significantly lower while time to first rescue analgesic was significantly more in pregabalin compare to gabapentin. Conclusion:Preemptive pregabalin is more effective for postoperative pain relief compared to gabapentin.

Oral Gabapentin versus Pregabalin for Postoperative Pain Relief in Elective Cesarean Section Patients under Spinal Anesthesia

Background: Pain after Cesarean delivery is the main postoperative complain in parturients, pregabalin and gabapentin have been shown to decrease acute postoperative pain in parturient. Objective: The aim of the study was to compare gabapentin and pregabalin as oral premedication in patients for elective cesarean section under spinal anesthesia for postoperative pain relief and the need to rescue analgesia. Methods: This study was carried out at Obstetric Operating Rooms, Zagazig University Surgical Hospitals. The study included 54 consenting women aging 20–40 yrs old with uncomplicated pregnancies that were scheduled to undergo elective Cesarean section delivery under spinal anesthesia. They were randomly allocated into three equal groups. Group (P) received 300 mg pregabalin, group (G) received 900 mg gabapentin, and control group (C). The study medication given orally one hour before the anticipated time of the surgical incision, and data measured included visual analogue scale (VAS), the total doses of analgesia, the incidence of post-operative nausea and vomiting (PONV) and the level of sedation. Results: The VAS was comparatively low in patients of group P as compared to G and C groups (P value < 0.05). Total analgesic requirement of pethidine in first 24 h was significantly lower in groups P as compared to groups G & C (P value < 0.001). We found that there was statistically significant increase in the sedation scores of the patients in P group as compared to G & C groups. Conclusion: Pregabalin 300 mg was more effective than gabapentin300 mg in reducing post Cesarean section pain, opioid consumption, nausea, and vomiting.

Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block.

In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy. Between January 2016 and January 2019, a total of 63 pediatric patients (37 males, 26 females; mean age 34.8±26.8 months; range, 2 to 96 months) who underwent corrective congenital heart surgery for atrial septal defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children"s Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded. The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6±1.3 vs. 9.4±2.1 h; 23±2.6 vs. 30±7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3±0.5 mg vs. 1.1±0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0±2.2 mg vs. 9.0±3.4 mg, respectively) (p<0.0001). Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.

Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laparoscopic cholecystectomy is commonly performed as a day care procedure for treating symptomatic gallstones. Suitability of patient discharge from the inpatient facility depends upon adequacy of postoperative pain control. Among the various modalities for pain relief, intraperitoneal local anaesthetic has become an important approach. In this study we aimed at comparing the post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients after laparoscopic cholecystectomy. The objective of this study was to determine which adjuvant drug was superior to the other in terms of prolonging the analgesic effects of levobupivacaine in post-operative period of laparoscopic cholecystectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 90 patients undergoing laparoscopic cholecystectomy were selected. They were divided into three groups: Group L- received 50 ml of 0.25% levobupivacaine; Group LT- received 0.25% of levobupivacaine and tramadol 2 ml (50 ml total); group LF- received 0.25% levobupivacaine plus fentanyl 2 ml (50 ml total). Postoperative pain was assessed using visual analogue scale.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The combination of levobupivacaine fentanyl and levobupivacaine tramadol&lt;strong&gt; &lt;/strong&gt;was superior to plain levobupivacaine for reducing postoperative pain. No significant difference was found between Group LT and LF with respect to first analgesic and total analgesic requirement. However significant difference was found between LF and L; and between LT and L.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Levobupivacaine should be used along with adjuncts either tramadol or fentanyl.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Intra-articular ultra-low-dose naloxone for postoperative analgesia after knee arthroscopy

Background Naloxone has been used at low doses to enhance the analgesic effect; however, this application remains less well defined. It was added to local anesthetics for intrapleural, axillary brachial plexus block, and peribulbar anesthesia with good results but was not used before as an adjuvant in intra-articular injection. The aim of this prospective double-blinded randomized controlled study is to assess the effect of intra-articular ultra-low-dose naloxone when added to bupivacaine on postoperative pain after knee arthroscopy, with time to first analgesic request as the primary outcome and total analgesic requirement, severity of pain, and side effects as secondary outcomes. Patients and methods In all, 80 patients who underwent knee arthroscopic meniscectomy under general anesthesia were randomly allocated into two groups (40 patients each): the naloxone group received 100 ng naloxone added to 20 ml 0.25% bupivacaine, and the control group received 20 ml 0.25% bupivacaine. General anesthesia was standardized for all patients. At the end of surgery, the study solution was injected intra-articularly through the arthroscope. Visual analog scale was recorded at 1, 2, 4, 6, 8, 12, 18, and 24 h. An intravenous dose of 20 mg pethidine was given if visual analog scale greater than or equal to 3 or on patient request. The time to first analgesic request, total analgesic consumption, and side effects were recorded. Results The time to first analgesic request was significantly longer, and the total analgesic consumption was significantly lower in the naloxone group compared with the control group. Pain score was significantly higher after 6 and 8 h in the control group compared with the naloxone group. No side effects were reported. Conclusion Intra-articular ultra-low-dose naloxone enhanced postoperative analgesic effect of bupivacaine after knee arthroscopy without adverse effects.