Total Analgesic Dose Research Articles

COMPARISON OF LEVOBUPIVACAINE WITH TWO DIFFERENT ADJUVANTS (DEXAMETHASONE VS. DEXMEDETOMIDINE) IN ULTRASONOGRAPHY-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR UNILATERAL INGUINAL HERNIORRHAPHY: A RANDOMIZED DOUBLE-BLINDED CONTROL TRIAL

Objectives: Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in patients undergoing intraabdominal surgery. This study was aimed to compare the post-operative analgesia, hemodynamic variables, sedation, and adverse effects of levobupivacaine with two different adjuvants (dexamethasone and dexmedetomidine) in USG-guided TAP block for patients undergoing unilateral inguinal herniorrhaphy under subarachnoid block. Methods: A double-blind randomized control study, conducted on 96 patients, allocated in three groups of 32 each. Patients in group C received 0.25% levobupivacaine (20 mL) with normal saline (2 mL), group D1 received 0.25% levobupivacaine (20 mL) added with 0.1 mg/kg dexamethasone (2 mL) and group D2 received 0.25% levobupivacaine added with 0.5 mcg/kg dexmedetomidine diluted in NS (2 mL). Pain was assessed using Visual Analog Scale (VAS). The time for request of first analgesia (TFA), total number and total dose of rescue analgesic in 24 h were recorded. Statistical analysis was done using unpaired Student’s t-test and ANOVA. Results: At 12 and 24 h >30% of patients had VAS ≥4 in control group while it was <10% in groups D1 and D2 (p<0.001). TFA was earliest in control group (6.10±0.96 h) as compared to group D1 (7.26±1.22 h) and group D2 (7.49±1.02 h) (p<0.001). The total number and total dose of analgesic given were higher in the control group than other two groups (p<0.001). However, it was comparable between groups D1 and D2 (p<0.05). Conclusion: Dexamethasone and dexmedetomidine when added as an adjuvant to levobupivacaine for TAP significantly prolonged the duration of post-operative analgesia as compared to levobupivacaine alone, however, it was found to be comparable between adjuvant groups.

Randomized Comparative Study of Analgesic Effects of Ilioinguinal and Iliohypogastric Nerve Block with Levobupivacaine (0.25%) versus Diclofenac Suppository in Pediatric Patients Undergoing Inguinal Herniotomy under General Anesthesia

Context: Pain management intraoperatively and postoperatively in the pediatric age group is a matter of concern. On the one hand, children are poorer at precisely conveying the extent of pain all the while being more susceptible to pain-related complications such as laryngospasm. On the other hand, children are less suited to use of potent opioids due to associated complications which can often lead to catastrophe. Therefore, a multimodal approach is desirable to optimize pain management in children. A nerve block is a highly effective and popular modality nowadays. In this single-blinded, parallel group, monocentric, and randomized protocol study, we have compared the efficacy of pain control achieved in the use of nonsteroidal anti-inflammatory drugs as analgesic versus iliohypogastric ilioinguinal (IIIH) nerve block in herniotomy in pediatric age group. Materials and Method: The parallel-group prospective study recruited 104 participants who were randomly allocated into two groups of 52 each, such that both groups received 1 mcg/kg fentanyl and sevoflurane during induction of GA. For analgesia, Group 2 was given diclofenac suppository intraoperative after induction of GA. Group 1 was given IIIH nerve block under nerve stimulator guidance for perioperative analgesia. Both groups were studied for the following parameters which included: time to get the 1st dose of rescue analgesic, total dose of rescue analgesic, visual analog scale (VAS) score, and hemodynamic parameters. Results: We observed that Group 1 showed a statistically significant difference in the form of longer duration of analgesia after surgery (9.67 ± 1.80 h vs. 6.35 ± 0.84 h) and lower total dose of rescue analgesic requirement (69.23 ± 2 [22.77] vs. 106.23 ± 2 [21.49]) while having a better hemodynamic profile and lower cumulative VAS score (7.71 ± 1.39 vs. 12.04 ± 1.72). Conclusion: Based on the above findings, we deduce that preincisional nerve stimulator-guided IIIH block by levobupivacaine (0.25%, 0.3 ml/kg) and rectal diclofenac (2 mg/kg) is both safe approaches to provide postoperative analgesia in pediatric inguinal herniotomy under general anesthesia. However, nerve stimulator-guided IIIH nerve block by levobupivacaine is a safe and better choice as it provides more intense analgesia for a longer duration compared to diclofenac suppository in the immediate postoperative period.

Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with gradeIII hemorrhoids.

Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for the treatment of internal hemorrhoids. ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study investigated the midterm outcomes of AM surgery in patients with hemorrhoids. Patients with gradeIII hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution. Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed. The median number of ALTA injection procedures was 3 (range 1-4), and the median total injection dose was 19 mL (range 7-32 mL). The median number of mucopexy procedures was 2 (range 1-4). The median postoperative pain score (0 = no pain at all, 10 = worst pain imaginable) at rest or during defecation were ≤2. The total dose of analgesics administered during the first two weeks after surgery was 1 (range 0-25). Six patients (5.3%) showed postoperative complications: five showed Clavien-Dindo (C-D) grade I and one showed C-D grade IIIa complications. Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively. Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year. AM surgery is an effective non-excisional surgery with satisfactory mid-term results for gradeIII hemorrhoids, and is associated with lower complication rates, postoperative analgesic requirements, and higher patient satisfaction.

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<0.001). The time for first rescue analgesia was prolonged in group ESPB as compared to control group (p<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.

A Comparative Study to Evaluate the Effectiveness of Perioperative Multi Modal Analgesia with Ultrasound Guided Bilateral Subcostal TAP Block for Post-Operative Analgesia in Patients undergoing Elective Laparoscopic Cholecystectomy under General Anaesthes

Background: Laparoscopic cholecystectomy is usually performed as a day care procedure for diseases involving the gall bladder. Pain in the immediate post-operative period is due to multiple factors and hence different modalities of pain relief are used. The present study was conducted to study the effectiveness of Peri-operative Multi-Modal Analgesia with ultrasound guided bilateral subcostal TAP block for Post-operative analgesia in 60 patients undergoing elective laparoscopic cholecystectomy.
 Methods: In this hospital based, randomized prospective interventional study patients were randomly allocated into 4 groups of 15 in each group, Group B received Bilateral Ultrasound guided Subcostal TAP Block with 20 ml of 0.25% Bupivacaine, Group P received Tab Pregabalin tablet 150 mg, Group D received Inj Dexamethasone 8 mg IV and Group C was the control group. The hemodynamic changes like heart rate, blood pressure, saturation was monitored both intra and post operatively. The post-operative VAS scoring, duration of analgesia, time for first rescue analgesic and the total dose of analgesics in 24 hours were noted.
 Results: The VAS Scores indicated that Group B> P> D> C provided better analgesia to the patients with a P Value of < 0.01. Group B took the longest mean duration (6.8± 1.15 hours) to take the 1st rescue analgesic and least mean total dose of rescue analgesic in 24 hours followed by Group P, Group D and Group C which was statistically significant.
 Conclusion: USG guided B/L TAP Block was superior to other modalities in providing postoperative analgesia for patients undergoing laparoscopic cholecystectomy.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value < 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value < 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Analgesia after Caesarean Section

Background and Aim: Effective postoperative analgesia after caesarean section is crucial for early ambulation and quality of life. Quadratus lumborum (QL) block is gaining wide acceptance for pain control after lower abdominal surgery. The current work aimed to compare between transversus abdominis plane (TAP) block and Quadratus Lumborum Block (QLB) in patients undergoing elective cesarean delivery (CD) under spinal anesthesia.
 Patients and Methods: The study included 200 patients who were divided randomly into two equal groups according to the type of anesthetic blocks (Ultrasound guided QLB and TAP block). All underwent cesarean delivery using Pfannenstiel incision and subarachnoid anesthesia with 0.25% bupivacaine. Preoperatively all women were assessed clinically and by laboratory investigations. The visual analogue scale (VAS) was the proper method for postoperative pain assessment. Women demographics and preoperative hemodynamics were recorded. After the procedure, hemodynamics and pain assessment was continued on regular intervals. The time for first analgesic request, the total dose of analgesics and any complications were documented.
 Results: QLB group had significantly lower pain score at 4 and 6 hours, and from 10 hours till the end of assessment duration. Both groups were comparable after surgery and at 2 hours. The heart rate and respiratory rate were significantly lower in the QLB than the TAB group. However, values were in normal range. The time for the first analgesic request was significantly longer in QLB than TAP block (458.79±39.68 vs 262.75±30.92 minutes. The total dose of analgesics was significantly lower in QLB than TAPB. The somatic pain reported by 17% and 45% in QLB and TAPB groups respectively.
 Conclusion: The Quadratus lumborum block was a safe, reliable, and effective option for postoperative pain relief after elective caesarean delivery. QLB was superior than the TAP block for pain control and both were comparable as the rate of complications.

Comparison of Patient-Controlled versus Continuous Epidural Analgesia in Adult Surgical Patients: A Systematic Review.

The advantages of PCEA over CEA have been demonstrated in obstetric patients. Whether a similar benefit applies to surgical patients is unclear. Embase, PubMed, and Cochrane Library were searched, enabling a systematic review of studies comparing PCEA and CEA in adult surgical patients (PROSPERO: CRD42018106644). The study quality was assessed using the Cochrane risk-of-bias tool (RoB2). The primary outcome was pain scores on postoperative day one (POD1). Secondary outcomes were 24 or 48 h epidural or intravenous total analgesic dose, systemic analgesics, manual top-ups, side effects, and patient satisfaction. Six randomized controlled trials with high heterogeneity of study characteristics were identified with a moderate risk of bias. Two studies showed significantly reduced resting pain scores on POD1 in PCEA compared with CEA patients (36-44%, p < 0.05). Four studies found comparable pain scores between these groups. PCEA use reduced epidural medication (28% to 40% reduction, p < 0.01) in four studies. One study found a 23% reduction (p < 0.001) of top-ups in PCEA; intravenous morphine use by PCEA patients was reduced (0.16 vs. 3.45 mg per patient, p < 0.05) in one study. PCEA patients were more satisfied with analgesia (p < 0.001) in two studies. Nausea and vomiting were reduced in PCEA (p = 0.01). Regarding the reduction in pain scores, the effects of PCEA were not significant or clinically not relevant. However, regarding the amount of epidural drug use, the amount of required rescue systemic analgesics, patient satisfaction, and the number of required top-ups, PCEA had advantages over CEA in surgical patients.

Efficacy of Intraperitoneal 0.2% Ropivacaine With Dexmedetomidine Versus 0.2% Ropivacaine With Ketamine in Laparoscopic Surgeries: A Randomized Controlled Trial.

Effective pain management modalities are the armamentarium for enhanced recovery in laparoscopic surgeries. Intraperitoneal instillation of local anaesthetics with adjuvants is advantageous in minimizing pain. So, we designed this study with the aim to compare the analgesic effectiveness of intraperitoneal ropivacaine with adjuvants like dexmedetomidine versus ketamine for postoperative analgesia. The objective of this study is to assess the total duration of analgesia and total rescue analgesic dose requirements in the first 24 hours postoperatively. A total of 105 consenting patients for elective laparoscopic surgeries were enrolled and divided into three groups by computer-generated randomization as follows: Group 1: 30 ml of 0.2% ropivacaine with ketamine 0.5 mg/kg diluted to 1 ml; Group 2: 30 ml of 0.2% ropivacaine with dexmedetomidine 0.5 mcg/kg diluted to 1 ml; Group 3: 30 ml of 0.2% ropivacaine with 1 ml of normal saline. The postoperative visual analogue scale (VAS) score, total duration of analgesia, and total analgesic dose were calculated and compared among the three groups. The postoperative analgesic duration after intraperitoneal instillation of Group 2 was longer as compared to Group 1. The total analgesic requirement was lower in Group 2 as compared to Group 1, and the p-value was significant (p ≤ 0.001) for both parameters. Demographic parameters and VAS scores among the three groups were not statistically significant. We conclude that intraperitoneal instillation of local anaesthetics with adjuvants is effective for postoperative analgesia in laparoscopic surgeries, and ropivacaine 0.2% with dexmedetomidine 0.5 mcg/kg is more effective when compared to ropivacaine 0.2% with ketamine 0.5 mg/kg.

Bilateral diz protezi yapılan hastalarda postoperatif analjezi için standart intravenöz hasta kontrollü analjezi dozu yeterli olur mu?

The aim of this study is to investigate whether patients undergoing one-stage bilateral total knee arthroplasty and those undergoing unilateral total knee arthroplasty differed in their responses to a standard intravenous patient-controlled analgesia protocol. Data from patients with the physiological status I-III according to American Society of Anesthesiologists, aged 18-99 years, undergoing one-stage bilateral or unilateral total knee arthroplasty under spinal anesthesia between January 2014 and December 2017 and offered a standard intravenous patient-controlled analgesia with morphine were retrospectively reviewed. Demographic data, Visual Analogue Scale scores and postoperative complications were examined. The total dose of analgesics consumed, analgesia demands, doses delivered and the ratio of delivered doses to demands in 0- 24 hours and 24-48 hours after surgery available in the patient-controlled analgesia pump monitoring forms were recorded. &#x0D; Records about 68 patients who had one-stage bilateral total knee arthroplasty and 124 patients who had unilateral total knee arthroplasty were accessed. The analgesia demands and analgesic doses delivered and utilized by the patients with one-stage bilateral total knee arthroplasty were significantly higher in 0-24 hours and 24-48 hours after surgery. Side-effects of the analgesia were similar in both groups. Visual Analogue Scale scores in 24-48 hours after surgery were higher in the patients with unilateral total knee arthroplasty. &#x0D; Although the patients with one-stage total knee arthroplasty received significantly higher doses of morphine, side-effects due to this opioid did not differ significantly. This showed that the standard intravenous patient-controlled analgesia protocol utilized was reliable and effective in both patient groups.

Ultrasound-guided Techniques for Perioperative Analgesia in Pediatric Lower Abdominal Surgeries: Quadratus Lumborum Block with Bupivacaine versus Caudal Bupivacaine and Neostigmine

BACKGROUND: Ultrasound-guided regional anesthesia techniques for perioperative analgesia in pediatric patients scheduled for lower abdominal surgeries can be achieved either by quadratus lumborum block (QLB) or caudal block (CB). Neostigmine was co-administered with caudal bupivacaine to shorten the onset and extend the duration of analgesia. OBJECTIVES: This study aimed to compare between 2 ultrasound-guided techniques used for perioperative analgesia (QLB with bupivacaine vs. CB with bupivacaine/neostigmine) regarding the total amount of rescue analgesic (acetaminophen mg/kg) used for pain relief at 24 hours postsurgery in pediatric patients undergoing lower abdominal surgeries in a developing country and to discuss existing barriers during the implementation of both techniques. STUDY DESIGN: A randomized, double-blind, prospective, single-center study. SETTING: Ain-Shams University Hospitals METHODS: Eighty pediatric patients scheduled for lower abdominal surgeries under general anesthesia were randomly allocated to receive either ultrasound-guided QLB using bupivacaine or ultrasound-guided CB using a bupivacaine/neostigmine mixture. The total amount of rescue analgesic (acetaminophen mg/kg) 24 hours postsurgery was considered as the primary outcome while the time to first rescue analgesia, pain score, postoperative nausea and vomiting, bradycardia, hypotension, and urinary retention were considered as secondary outcomes. RESULTS: In the QLB group, the time to first rescue analgesia was longer whereas the total analgesic dose (mg/kg) was lower than the CB group (P &lt; 0.001, P = 0.007, respectively). While, on the other hand, in CB group, the time to perform the block was shorter and Parents Satisfaction Score 24 h postsurgery was lower than the QLB group (P &lt; 0.001, P &lt; 0.001, respectively). Side effects were infrequent and comparable between the study groups. LIMITATIONS: First, the researchers did not assess the dermatomal level before or after the operation in either group. Second, the investigators should have noticed the first voiding time to demonstrate accurately the incidence of urine retention. Third, a cost-effectiveness analysis of perioperative costs (drugs, staff, resources being used) of these regional anesthesia techniques when applied in an ambulatory setting should have been done, which would be helpful for those in resource-limited settings. CONCLUSIONS: Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries can be safely and effectively achieved by QLB with bupivacaine and a CB with a bupivacaine/neostigmine mixture with priority given to CB, especially in resource-limited settings. KEY WORDS: Quadratus lumborum, caudal, bupivacaine, neostigmine, ultrasound, pediatric, postoperative, pain

Initiation of an Enhanced Recovery After Cesarean Delivery Protocol in a University Hospital in Serbia: A randomized comparison with existing management

Background: Enhanced Recovery After Surgery (ERAS) programs have been introduced in many areas of clinical practice in recent years, to improve the patient’s recovery, increase patient satisfaction and shorten length of hospital stay. This study investigated feasibility of an ERAS protocol after cesarean delivery in a system where long-acting neuraxial opioids are not available. Materials and Methods: 200 parturients were randomly assigned to either an enhanced recovery group (E) or a control group (C) receiving standard care. After delivery, parturients in group E received ultrasound guided quadratus lumborum block. On the day of surgery, both groups received intravenous analgesia. On the first post-operative day, patients in group E transitioned to oral analgesics, while group C continued intravenous analgesia. On the second post-operative day, both groups received oral analgesics. Data collected included total dose of analgesics used in the first 24 hours; pain scores at rest and with movement; patient satisfaction; and length of hospital stay. Six weeks after surgery, parturients received a questionnaire for postpartum depression assessment. Results: Group E reported better pain control with lower pain scores in all times (at rest and with movement), which was statistically significant, as was patient satisfaction. Conclusion: Enhanced recovery protocols after cesarean delivery can improve postoperative recovery in low- and middle-income countries where long-acting neuraxial opioids may not be available. Protocols need to be individually tailored for each institution in coordination with the health care system.

Comparison of General Anaesthesia and Epidural Anaesthesia in Lumbar Microdiscectomies- A Prospective Comparative Study

Introduction: Lumbar Microdiscectomy (LMD) is most commonly performed under General Anaesthesia (GA). Regional techniques are being used more widely now, with Epidural Anaesthesia (EA) being safer than Spinal Anaesthesia (SA). Regional anaesthetic methods are being used increasingly, with EA being less harmful than spinal with respect to cardiac and neurological complications. Aim: To compare the intraoperative and postoperative outcomes of GA and EA in single level lumbar microdiscectomies. Materials and Methods: This prospective comparative study was conducted at a single tertiary care centre between April 2014 to April 2018 and Study was conducted among 40 patients who were posted for single level lumbar microdiscectomies. The patients underwent surgery under group GA and group EA. Intraoperatively, parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Surgical Onset Time (SOT), Surgical Time (ST), Total Operating room Time (TOT) and postoperatively Visual Analog Scale (VAS) for pain, the Total Analgesic Dose (TAD) of fentanyl, Postoperative Nausea and Vomiting (PONV) and the level of satisfaction with regard to pain relief (4-point Likert scale) for the first 24 hours were compared. The data were analysed using Statistical Package for Social Sciences (SPSS) version 18 software. Mean, percentage, student’s t-test, χ2 test, Mann-whitney test and appropriate statistical tests were used. Results: A total of 40 patients were enrolled in the present study with rather similar demographic characteristics in both groups. The SOT was significantly more in the EA group (24.30±2.958 min) when compared to the GA group (14.05±2.259) minutes. However, the ST and TOT did not show much of a difference. Intraoperatively, group GA showed significantly high HR and MAP values when compared to group EA (p&lt;0.001). Postoperatively, VAS for pain and the TAD of fentanyl were found to be significantly lesser in the EA group, when compared to GA group. The incidence of Postoperative Nausea and Vomiting (PONV) was less in EA group. The level of satisfaction with regard to pain relief at the end of first 24 hours was more among patients in EA group. Conclusion: The present study concludes that, EA may be used as an alternative to GA in single level lumbar microdiscectomies.

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 µg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groupsRP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 µg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 µg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p&lt;0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

A comparison of efficacy of parenteral and perineural dexmedetomidine with 0.25% ropivacaine for post-thyroidectomy analgesia using bilateral superficial cervical plexus block.

Opioids are conventionally used for post-thyroidectomy pain, regional anesthesia is becoming popular due to its feasibility and efficacy in minimizing use of opioids and hence its side effects. This study compared analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) using perineural and parenteral dexmedetomidine with 0.25% ropivacaine in thyroidectomy patients. In this double-blind study, 60 American Society of Anesthesiologists (ASA) physical status I and II thyroidectomy patients, aged 18-65 years were randomized into two groups. Group A (n = 30) received BSCPB with 0.25% ropivacaine, 10 mL on each side with dexmedetomidine 0.5 μg/kg IV infusion. Group B (n = 30) received 0.25% ropivacaine plus dexmedetomidine 0.5 μg/kg, ten mL on each side. Duration of analgesia by measuring pain visual analog scores (VAS), total dose of analgesic requirement, Haemodynamics parameters and adverse events were recorded for 24 h. Categorical variables were analyzed using Chi-square test and continuous variables were computed as mean with standard deviation and analyzed using independent sample t-test. Mann-Whitney U test was used for analysis of ordinal variables. Time to rescue analgesia was longer in Group B (18.6 ± 3.27 h) as compared to Group A (10.2 ± 2.11 h) (P < 0.001). Total analgesic dose required was also found to be lesser in Group B (50.83 ± 20.37 mg) as compared to Group A (73.33 ± 18.27 mg) (P < 0.001). No significant hemodynamic changes or side effects were observed in both groups; (P > 0.05). Perineural dexmedetomidine with ropivacaine in BSCPB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement.

The analgesic efficacy of ultrasound-guided thoracic paravertebral block in pulmonary tumor ablation surgery: a prospective single-arm study.

Local thermal ablation is a rapidly developing minimally invasive treatment for lung tumors. This technique has the advantages of less trauma, ease and convenience of the operation, fast recovery, and fewer complications. Thoracic paravertebral block (TPVB) has been demonstrated can provide sufficient pain relief with high safety. This study aimed to evaluate the efficacy of TPVB for anesthesia management during the ablation surgery of lung tumors. In our study, a total of 30 patients undergoing Local thermal ablation surgery were enrolled. All patients received TPVB anesthesia before CT positioning starting. Analgesics and rescue drugs were used according to the patient's condition during operation. The main observation and assessment outcome were intraoperative and postoperative Visual Analog Scale (VAS) score. Other outcomes were total dose of analgesics and rescue drugs, incidences of adverse events, and the patients' and surgeons' satisfaction degrees. All patients successfully received ablation surgery under TPVB anesthesia. None of the patients were switched to general anesthesia. There were no statistically differences were found between the preoperative VAS score (0.54±1.12) and the intraoperative VAS score (0.58±1.15) (P>0.05). No adverse events occurred and no rescue drugs were used during operation. The satisfaction scale of both patients and surgeons was 3 points or above, and all patients were discharged from the hospital. TPVB is an effective and safe anesthesia management technique which can provided adequate pain relief in local thermal ablation therapy for lung tumors. This discovery could provide a better anesthesia protocol for anesthetists in lung tumors ablation surgery, especially when patients have a poor cardiopulmonary function and combined with serious underlying diseases.

Efficacy of femoral periarterial block in preventing thigh tourniquet pain: a randomized controlled trial.

Tourniquet pain, described as a dull, tight, poorly localized aching sensation, is common in conscious patients. Although various pain-reduction methods have been implemented, none are completely effective. Femoral periarterial block (FAB) has been shown to attenuate tourniquet-induced hypertension in patients undergoing general anesthesia. We aimed to test the feasibility of FAB in inhibiting thigh tourniquet pain in orthopedic patients under conscious sedation. Forty-two patients (aged 18-64 years and ASA I-II) scheduled for below-knee orthopedic surgeries with an anticipated tourniquet duration of more than 40 min were recruited and received FAB (Group 1) or not (Group 2). The primary outcome was the occurrence of tourniquet pain. The onset time and severity of the tourniquet pain were recorded. Total doses of sedatives and analgesics administered intraoperatively and hemodynamic changes were documented. The occurrence of local anesthetic systemic toxicity was recorded. Kaplan-Meier time-to-event curves indicated an improved tourniquet tolerance and delayed pain onset. Tourniquet pain occurrence was lower in Group 1 than in Group 2 (30% vs. 95.5%, P=0.02). Tourniquet pain onset was delayed in Group 1 (80[67,84] min vs. 58[51.5,60] min, P<0.01). Fewer patients in Group 1 experienced severe pain (3(15%) vs. 18(81.8%), P<0.01), and less hemodynamic changes (2(10%) vs. 12(54.5%), P<0.01). Local anesthetic systemic toxicity was absent. FAB, applied with regional anesthesia in patients undergoing below-knee orthopedic surgeries, could reduce thigh tourniquet pain, stabilize blood pressure and heart rate, and prolong tourniquet duration.

Efficacy and efficiency of sphenopalatine ganglion block for management of post-dural puncture headache in obstetric patients: a randomized clinical trial

BackgroundThis clinical trial aimed to study the efficacy and efficiency of sphenopalatine ganglion block (SPGB) for the management of post-dural puncture headache (PDPH) in obstetric patients. A prospective randomized clinical trial was carried out on 40 patients with PDPH divided randomly into two equal groups. Paracetamol group (PG): The patients received 1 g of paracetamol three times per day intravenously for 1 day. If adequate pain relief was not achieved, rescue analgesia in the form of intravenous ketorolac was given. Block group (SPGBG): The patients received bilateral SPGB using 3 ml mixture of lignocaine with dexamethasone in each nostril. The pain score, heart rate, and mean arterial pressure were recorded. The onset of analgesia, duration of analgesia, adverse effects, total dose of ketorolac, patient satisfaction, and hospital stay for epidural blood patch (EBP) or hospital discharge after 24 h were also documented.ResultsThe pain perception (numeric rating scale [NRS]) in the block group was generally lower throughout the study showing only highly significant difference till the first 2 h after the block with more rapid onset and longer duration of analgesia. The total dose of rescue analgesic in mg was significantly lower in the block group and hospital stay for EBP was significantly less in the block group with higher patient satisfaction.ConclusionsPDPH can be treated effectively and rapidly with transnasal SPGB, which is a noninvasive, safe, and easy method with a low complication rate.Trial registrationClinicalTrials.gov, NCT04793490. Registered on March 11, 2021; https://clinicaltrials.gov/ct2/show/NCT04793490).

A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal.

Background:This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar.Methods:This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used.Results:Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I.Conclusion:Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.