Total Analgesic Dose Research Articles

The Analgesic Efficacy of the Single Erector Spinae Plane Block with Intercostal Nerve Block Is Not Inferior to That of the Thoracic Paravertebral Block with Intercostal Nerve Block in Video-Assisted Thoracic Surgery.

This monocentric, single-blinded, randomized controlled noninferiority trial investigated the analgesic efficacy of erector spinae plane block (ESPB) combined with intercostal nerve block (ICNB) compared to that of thoracic paravertebral block (PVB) with ICNB in 52 patients undergoing video-assisted thoracic surgery (VATS). The endpoints included the difference in visual analog scale (VAS) scores for pain (0–10, where 10 = worst imaginable pain) in the postanesthetic care unit (PACU) and 24 and 48 h postoperatively between the ESPB and PVB groups. The secondary endpoints included patient satisfaction (1–5, where 5 = extremely satisfied) and total analgesic requirement in morphine milligram equivalents (MME). Median VAS scores were not significantly different between the groups (PACU: 2.0 (1.8, 5.3) vs. 2.0 (2.0, 4.0), p = 0.970; 24 h: 2.0 (0.8, 3.0) vs. 2.0 (1.0, 3.5), p = 0.993; 48 h: 1.0 (0.0, 3.5) vs. 1.0 (0.0, 5.0), p = 0.985). The upper limit of the 95% CI for the differences (PACU: 1.428, 24 h: 1.052, 48 h: 1.176) was within the predefined noninferiority margin of 2. Total doses of rescue analgesics (110.24 ± 103.64 vs. 118.40 ± 93.52 MME, p = 0.767) and satisfaction scores (3.5 (3.0, 4.0) vs. 4.0 (3.0, 5.0), p = 0.227) were similar. Thus, the ESPB combined with ICNB may be an efficacious option after VATS.

A Comparative Study to Evaluate the Efficacy of Dexmedetomidine and Clonidine to Accentuate the Perioperative Analgesia of Caudal 0.25% Isobaric Levobupivacaine in Pediatric Infraumbilical Surgeries

BackgroundCaudal block is an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. It enables early ambulation and periprocedural hemodynamic stability. These are important advantages over general anesthesia, notably in preterm babies and in children with cardiopulmonary comorbidities. In this study, we aimed to compare the effect of dexmedetomidine and clonidine to accentuate the perioperative analgesia of 0.25% isobaric levobupivacaine in pediatric caudal anesthesia.MethodologyA prospective double-blind randomized control study was conducted on 60 patients with the American Society of Anesthesiologists (ASA) physical status I, between the ages of one to six undergoing infraumbilical abdominal surgery under caudal anesthesia in the Department of Anaesthesia, Sardar Patel Medical College, Bikaner. Patients were randomly allocated to the following three groups of 20 each: group L, 1 mL/kg of levobupivacaine 0.25%; group LD, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of dexmedetomidine; and group LC, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of clonidine. Intraoperative and postoperative hemodynamic parameters were recorded for 24 hours. Patients’ pain scores, sedation scores, and Bromage scores were recorded. In our study, the main observation was the duration of analgesia and the total analgesic requirement for 24 hours.ResultsThere was a significant difference in the duration of analgesia among the three groups (p < 0.001). Group LC had the highest duration of analgesia of 492.00 (50.01) minutes, followed by group LD 486.00 (54.71) minutes, and the lowest in group L 291.00 (40.25) minutes. There was a significant difference between the three groups in terms of the total dose of analgesics in 24 hours (p < 0.001), with the median total dose of analgesics being the highest in Group L. Three groups differed significantly in terms of motor block, which was limited to up to 180 minutes in groups LC and LD with no residual motor block.ConclusionsThe addition of α2 agonists such as clonidine or dexmedetomidine at a dose of 0.5 µg/kg as an adjuvant to caudal levobupivacaine (0.25%) at 1 mL/kg significantly prolongs the duration of opioid-free analgesia in children undergoing infraumbilical abdominal surgeries without prolonging the motor blockade and any side effects. Moreover, dexmedetomidine does not offer a significant advantage over clonidine regarding the analgesia duration.

EFFECTIVENESS OF FASCIA ILIACA COMPARTMENT BLOCK FOR POST OPERATIVE ANALGESIA AFTER SURGERY FOR FEMUR BONE FRACTURE

Background:Multimodal analgesia is given to alleviate postoperative pain in fracture neckfemur.Present study is done to assess the effectiveness of fascia iliaca compartment block for post operative analgesia after surgery for femur fractures. Aims &amp; Objectives: 1) To study effect on pain at rest and with movement 2) To study duration of post operative analgesia with fascia iliaca compartment block 3) TO study post operative analgesic requirement Methods: Afer approval from institution review board committee, this prospective randomised observational study was conducted at our institute after taking informed consent from each patient. Total 60 adult patients (ASA I/II) aged 18 to 70 years, of either sex undergoing femur bone fracture surgery under subarachnoid block were included. Sub arachnoid block was performed in the sitting posture under strict aseptic precautions in theL2-L3 or L3-L4 space using 23G Quincke needle with 3.5ml of 0.5%Bupivacaine (hyperbaric, dextrose 80mg/ml) in all patients. Patients were randomly divided in two groups, Group A (n=30): The FICNB group was received ultrasound guided fascia iliaca compartment block with 0.25% bupivacaine 30ml at the end of the operation. Group B (n=30): were managed without FICNB Hemodynamic variables like heart rate, non invasive blood pressure, saturation of oxygen, were recorded after the block. The analgesia provided by either of the modes was assessed by using Visual analogue scale scores at 5 mins,10 mins,15 mins,20 mins,25 mins,30 mins,40 mins,50 mins,1, hr,then hourly upto,12 hour,then 2 hourly upto 24 hour. Postoperative hemodynamic monitoring was done and depicated in tabular form. Patients were watched for adverse effects of drugs and complications of procedure itself.The duration of postoperative analgesia was compared between the 2 groups using visual analogue scale and in terms of first rescue analgesic and total analgesic dose requirement with inj. diclofenac sodium75 mg.The data were studied using mean values and mean ± SD and then compared using unpaired ttest. p value &lt;0.05 was considered significance Results:The result obtained in study At 1hr Mean VAS in group A was 2.23 ±0.43 and in group B it was 4.93±0.25 At 7hr Mean VAS in group A was 2.96 ± 0.18 and in group B it was 4.9±0.31 At 12hr Mean VAS in group A was 4.66±0.80 and in group B it was 3.83±0.38 At 14hr Mean VAS in group A was 1.86±1.25 and in group B it was4.93±0.25 Post-operative VAS at rest and moment were significantly higher in group B, compared to group A (p&lt;0.001). After 24 hr statistically significant difference was not observed in mean VAS between group B and group C. The mean consumption of analgesic was 137.5±28.42 mg diclofenac in Group A and 295±19.03 mg diclofenac in group B.

Evaluation of Effectiveness of Preemptive Intravenous Analgesics versus Postoperative TAP Block in Unilateral Inguinal Hernioplasty—A Prospective Randomized Double-Blind Clinical Trial

Abstract Aim The aim of this study was to compare the extent of analgesia in terms of duration of analgesia and requirement of postoperative analgesics with preemptive analgesia and transversus abdominis plane (TAP) block in patients undergoing inguinal hernioplasty. Materials and Methods Ninety male patients aged between 18 and 65 years of American Society of Anesthesiologists grades I and II undergoing open inguinal hernioplasty were randomly allocated to three comparable groups of 30 each. Control group (group C) received normal saline; preemptive group (group P) received inj. paracetamol, inj. diclofenac, and inj. Lignocaine; and TAP group (group T) received TAP block with 20 mL of 0.25% bupivacaine at the end of surgery. Parameters recorded were verbal numerical rating scale (VNRS) at rest at 4, 12, 24, and 48 hours and VNRS on movement at 12, 24, and 48 hours; heart rate and mean arterial pressure at 0, 4, 12, and 48 hours; time for first analgesic request; and total doses of analgesics consumed at 24 hours. Results Demographic data were comparable. VNRS on movement and number of doses of analgesics consumed at 24 hours were statistically less in group T (4.80 ± .761 hours); time for first request of analgesia was longer and this group had better patient satisfaction scores compared with other groups. Conclusion Both groups P and T provided better VNRS scores compared with group C. TAP block provided better VNRS scores on movement at 24 hours, lesser analgesic requirement, and better patient satisfaction score compared with other groups.

A comparative study between ultrasound-guided serratus anterior plane block and conventional IV analgesics for post-operative pain management in modified radical mastectomy

BackgroundSurgery is the first line of treatment for early, localized, or operable breast cancer and it is associated with severe post-operative pain. Although opioids have been the mainstay for managing post-operative pain, they have undesirable side effects. A variety of methods, including thoracic epidural, paravertebral, and intercostal blocks have been used to manage breast surgery pain; however, each of these blocks has some drawbacks. Serratus anterior plane block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. This study compares between the effect of serratus anterior plane block and conventional IV analgesia on post-operative pain after modified radical mastectomy.ResultsPost-operative pain scores were significantly lower in the SAPB group in the first 8 h compared to the control group (P < 0.05), the time to the first rescue analgesic was significantly longer in the SAPB group with a mean 354 min compared to the control group; the mean is 17.8 min, the total dose of rescue analgesic was significantly lower in the SAPB group with a mean 50 mg in the first 24 h compared to a mean of 212.5 mg in the control group. The patient’s satisfaction scores were higher, the incidence of post-operative nausea and vomiting was significantly lower among the SAPB group compared to the control group. No other complications were recorded in either group.ConclusionsThe serratus anterior plane block can be used as one of the modalities in managing the pain of patients undergoing MRM surgery. This procedure was effective in reducing the need for post-operative opioids usage, better patient satisfaction with fewer side effects as post-operative nausea and vomiting. It is simple and easy-to-learn technique.

Efficacy of Methylprednisolone and Etoricoxib Combination to attenuate Post-operative Pain and Nausea/Vomiting in Laparoscopic Surgeries

Abstract Background and Aims:Pain and PONV (postoperative nausea and vomiting) are common complaints in the period following surgery. A multimodal approach targeting the reduction of postoperative pain with an opioid-sparing analgesic along with an antiemetic medication would minimize opioid consumption and its associated side effects. We evaluated the efficacy of methylprednisolone 125 mg IV taken along with oral 120 mg etoricoxib on postoperative pain and PONV in patients undergoing laparoscopic surgeries Material and methods:A prospective, randomized, double-blind study was conducted on 70 patients aged between 18 and 60 years with ASA grade 1 and 2 posted for elective laparoscopic surgeries. The test group was given a combination of methylprednisolone 125mgIV (given just before induction)&amp; etoricoxib120mg oral (given 1 hr before surgery). (Group A, n=35) while control group received normal saline IV and a placebo per oral(Group B, n=35). Duration and quality of analgesia was assessed by visual analogue scale (VAS) score at 2,4,6,8,10,12,16,20 and 24hr as primary objective. Total dose of rescue analgesic(injection Fentanyl 50 mcg) in first 24 hours, peri-operative hemodynamic change and post op nausea vomiting (PONV) were observed as secondary objective. Result:Demographic profiles were comparable. Duration of postoperative analgesia was significantly prolonged(p&lt;0.05) in Group A(7.57±1.04hrs) as compared to Group B(3.05±0.5hrs). Group A showed a significant reduction in postoperative fentanyl consumption in the form of rescue analgesic(p&lt;0.05). Group A also showed significant reduction in the incidence of PONV(p&lt;0.05). Conclusion:We conclude that single-dose administration of methylprednisolone IV along with oral etoricoxib has better analgesic efficacy in comparison to placebo for patients undergoing laparoscopic surgeries.

The effect of type 2 diabetes mellitus on early postoperative cognitive functions

Background/Aim: Postoperative cognitive dysfunction (POCD) is an important problem that is encountered perioperatively and has a complex pathophysiology. Diabetes mellitus (DM) can cause adverse effects on cognitive functions, such as memory dysfunctions, psychomotor retardation, slower information processing, impairment of complex motor functions, deterioration of verbal rationality, and attention deficit. We assume that DM will have a triggering effect on POCD. Mild cognitive dysfunction caused by diabetes mellitus may increase the risk of POCD. For this purpose, we aimed to investigate the effect of type 2 DM on early POCD. Methods: Fifty literate patients who ranked 1-2 on the American Society of Anesthesiologists (ASA) scale were included in our prospective case-control study. They ranged in age from 35 to 70. All were scheduled for elective laparoscopic cholecystectomy at the İstanbul Training and Research Hospital. Patients were divided into two groups: the diabetes mellitus group and the control group. The DM group consisted of 25 patients who had been diagnosed with type 2 DM and had been on regular oral antidiabetic medication or insulin for at least five years. To examine the patients neuropsychologically, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) Test were conducted one day before the surgery. The MMSE and MoCA were repeated at the 4th and 24th hours postoperatively. The patients were monitored to record their depth of anesthesia, peak heart rate, mean arterial pressure, oxygen saturation, end-tidal carbon dioxide value, and expiratory sevoflurane concentration prior to perioperative intubation and every five minutes after intubation until the end of the operation. The state of postoperative pain and total analgesic dose used for the patients were also recorded. Results: Demographic data in both groups were similar in terms of age, gender, body mass index, and duration of surgery (P > 0.05 for each). Perioperative depth of anesthesia, hemodynamic data, and postoperative pain scores were similar in both groups (P > 0.05 for each). While there was initially no significant difference between the groups in terms of preoperative cognitive function, compared with the control group, the DM group had significantly lower values of MMSE and MoCA at the postoperative 4th (P = 0.014 and P = 0.014) and 24th hour (P = 0.026 and P = 0.01) . Conclusion: Our study shows that the early postoperative cognitive functions of diabetic patients are affected more than non-diabetic patients in laparoscopic surgery. MMSE and MoCA tests are appropriate for screening type 2 diabetic patients. Thus, complications can be prevented in diabetic surgical patients by detecting cognitive dysfunction in the early stages, so that appropriate treatment can be initiated.

A randomised prospective single-blind pilot study to compare the analgesic efficacy of thoracic epidural block and erector spinae plane block in breast cancer surgery.

Background and Aims:Thoracic epidural analgesia (TEA) is an effective analgesic technique for breast surgery, although it has many associated complications. Ultrasound (US)–guided erector spinae plane (ESP) block requires less technical expertise, is safe and may be an alternative to TEA. We aimed to compare the efficacy of TEA with US-guided continuous ESP block for post-operative analgesia in patients undergoing modified radical mastectomy (MRM) surgeries.Methods:Sixty-six female patients of age group 18–65 years, and American Society of Anesthesiologists (ASA) physical status I and II, undergoing MRM surgeries were recruited. Patients received TEA in Group Ep and US-guided ESP block in Group Er, before induction of general anaesthesia. Both the groups received 0.2% ropivacaine 15 mL, followed by 5 mL.h-1 infusion for 24 h. The primary outcome was the duration of analgesia. Secondary outcomes were total doses of rescue analgesics in 24 hours and visual analogue scale (VAS) scores at 0 h, 1 h, 2 h, 4 h, 8 h, 12 h, and 24 h.Results:The mean duration of analgesia was 21.72 ± 4.73 hours in Ep group and 20.60 ± 5.77 hours in Er group (P = 0.39). The total dose of rescue analgesics in the postoperative period was comparable between both the groups. There was no significant difference in VAS scores between the groups over 24 h.Conclusion:US-guided ESP block can be used as safe and easy to perform alternative analgesic technique over thoracic epidural analgesia for peri-operative pain management in breast cancer surgeries.

Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal.

Introduction Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient's quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.

Comparison between dexmedetomidine versus magnesium sulfate infusions for mitigating emergence agitation in obese adults undergoing nasal surgery

BackgroundEmergence agitation is a potentially serious post-anesthetic event occurring in the early phase of recovery from general anesthesia, characterized by anxiety, disorientation, violent, and irrational behavior. Many agents have been used as prophylaxis with varying degrees of success. The purpose of this study was to compare the efficacy and safety of dexmedetomidine to magnesium sulfate in mitigating emergence agitation. Patients were randomly allocated to one of three groups of 35 each. Dexmedetomidine group (D group) received intraoperative Dex 0.7 μg/kg/h infusion (no loading dose). The magnesium sulfate group (M group) received intraoperative magnesium sulfate 20 mg/kg/h infusion (no loading dose). The control group (C group) received equal volume of saline infusion as placebo.ResultsThe total incidence of emergence agitation was significantly lower in group D, 5.6% and group M, 8.5% compared to control group, 54.2%. The median time to extubation was significantly longer in group D than C and M groups (13, 7, and 8, respectively) and was not significantly different between group C and M. During recovery, the number of patients who experience pain was significantly lower in D and M groups compared to patients in control group (P < 0.002). The total dose of rescue analgesic was also significantly lower in D and M group versus control group (P < 0.001).ConclusionsDexmedetomidine and magnesium sulfate infusion are both equally effective in reducing the incidence of emergency agitation in obese adults undergoing nasal surgery. Extubation time and post-operative anesthesia care time were rather longer in dexmedetomidine than other groups.Trial registrationRegistered with ClinicalTrials.gov Identifier: NCT04531371

Abstract No.: ABS1074 : Evaluation of efficacy of superficial cervical plexus block for surgeries in head and neck region: A comparative randomised control study

Background and Aims:Superficial cervical plexus block can provide analgesia in head and neck surgeries. This study aimed to evaluate analgesic efficacy of superficial cervical plexus block (SCPB) in various head and neck surgeries, with the primary objectives of assessing time to first rescue analgesic, total dose of rescue analgesics in 24 hours, intraoperative analgesic requirement and associated perioperative complications.Methods:Sixty patients of American Society of Anesthesiologists physical class II,III (30 patients in each group) were included. Group A received general anaesthesia(GA) with systemic analgesia and group B received GA followed by SCPB with injection bupivacaine 0.25% 10ml on each side according to site of surgery. Visual analogue scale(VAS) scores, intra and postoperative analgesic requirement in 24 hours, time of first rescue analgesic demand and peri-operative complications were noted. All quantitative data were analysed by student-t test and qualitative data was analysed by chi-square test.Results:Time of first rescue analgesia was earlier and intraoperative fentanyl requirement and postoperative total rescue analgesic requirement were higher in group A (32.33+_38.39, 38.33+_12.61, 2566.667 + _504.006) than group B(1092+_396.55 minutes, 10.66+_13.11, 833.33+_874.28 ) with p value <0.001 (table 1,2). No significant complication was noted in any patient.Conclusion:SCPB provides better perioperative analgesia and decreases intraoperative as well as postoperative analgesic requirements and associated side effects with no significant perioperative complications in various head and neck surgeries.

English

BACKGROUND Adequate pain management has a great importance for smooth postoperative recovery, early hospital discharge and early rehabilitation. In this study, we compare the analgesic effect and possible side effects of different routes of magnesium sulphate administration in cases of spinal anaesthesia for knee arthroscopy. METHODS This is an experimental prospective randomized control study. 196 patients undergoing knee arthroscopy were divided into 4 groups (49 each): Group A: Given bupivacaine intrathecally during spinal anaesthesia. Group B: Given magnesium sulphate 50 mg with bupivacaine intrathecally. Group C: Given magnesium sulphate IV 10 min after intrathecal injection (30 mg/kg MgSo4). Group D: Given magnesium sulphate intra-articular route, 10 min before the end of surgery (800 mgSo4 diluted in 12 ml normal saline (0.9 % NaCl). Operative time in minutes, VAS at rest and after procedure, time lapse before first analgesic dose after surgery, total dose of rescue analgesics used, pulse rate, mean arterial pressure and side effects were observed and analysed. RESULTS In regards to the lapse of time between end of surgery and first rescue analgesic given, total doses of tramadol used during the 24 hours after the procedure were significantly better in patients given intra-articular magnesium sulphate than other groups (P = 0.001). Patients of Group C who received IV magnesium sulphate were significantly better than patients who were given intrathecal magnesium sulphate in relation to time taken from end of surgery until first analgesic dose. VAS at rest and during the period of first 24 hours followed by surgery was statistically significant in patients who received intra-articular magnesium sulphate (p- 0.001). CONCLUSIONS Intra-articular administration of magnesium sulphate was observed to be superior to other routes of administration or not using at all. Next to intra-articular route, intravenous magnesium sulphate was found to be superior to intrathecal route in providing post operative analgesia in arthroscopy patients. KEY WORDS Analgesia, Knee Arthroscopy, Pain, Magnesium Sulphate, Intrathecal, Intra-articular

Ultrasound-guided infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for hand and forearm surgeries

Background Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia. Objective To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements. Patients and methods This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm. Results The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C. Conclusion Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.

Postoperative Analgesic Effect of Morphine Added to Ropivacaine for Fascia Iliaca Compartment Block following Femoral Fracture Surgeries: A Randomized Controlled Trial

Background: Fascia iliaca compartment block (FICB) following femoral fracture surgery provides effective analgesia. Reports of morphine added to ropivacaine for peripheral nerve blocks are limited. We designed this study to investigate the effects of morphine as an adjuvant to ropivacaine in FICB for femoral fracture surgery. Methods: Seventy patients undergoing spinal anaesthesia for femoral fracture surgery were randomized to undergo ultrasound aided FICB with ropivacaine alone (n = 35) or in combination with morphine (n = 35). FICB was performed postoperatively with 20 ml of 0.375% ropivacaine plus 2 ml normal saline or 20 ml of 0.375% ropivacaine plus 2 ml (1 mg/ ml) morphine. Primary outcome parameter was the duration of analgesia. Secondary outcome parameters were total doses of rescue analgesics, sedation scores, Numeric Rating Scale (NRS) scores for pain and patient satisfaction. Results: Demographic data were similar between the two groups. Patients receiving morphine adjuvant had longer duration of postoperative analgesia (541 ± 167 vs 634 ± 164 mins, p = 0.01; Mean difference -92.71; 95% CI: -171.95 – -13.47). Requirement of postoperative rescue analgesics for the first 24h was significantly lesser (tramadol 77 ± 25 vs 62 ± 22 mg, p = 0.01; Mean difference 14.28 ;95% CI: 2.95 – 25.63) in patients receiving morphine adjuvant. Postoperative NRS scores and sedation scores were comparable between the two groups. Conclusion: Morphine as an adjuvant to ropivacaine for FICB significantly prolongs the duration of postoperative analgesia.

Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty

Purpose: This study aimed to compare the effectiveness of ultrasound-guided femoral and anterior sciatic (FAS) nerve blocks and genicular (G) nerve blocks as preventive analgesia methods after total knee arthroplasty.&#x0D; Materials and Methods: Fifty patients, aged 55–80 years were divided into two groups preoperatively. Patients in the FAS group (n=25) received 20 mL solutions (10 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 9 mL saline) in both femoral and sciatic blocks. Patients in the G group (n=25) received 5 mL solutions (2 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 2 mL saline) for each nerve. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesic requirement, total analgesic dose, and postoperative complications during the first 24 h were recorded.&#x0D; Results: VAS scores at postoperative 0, 1, and 6 h and the total amount of tramadol consumed 24 h were lower in the FAS group than in the G group. There was no requirement for additional analgesia in the first 24 h in the FAS group; however, 9 patients required additional analgesia in the G group. &#x0D; Conclusion: USG FAS nerve blocks were superior to the genicular nerve blocks in TKA. Additionally, the genicular block doesn’t cause motor block. A genicular block can be considered as an alternative with this regard.

A COMPARISON OF POST-OPERATIVE ANALGESIA WITH INTRAOPERATIVE PECTORAL NERVE BLOCK VERSUS CONVENTIONAL TECHNIQUE IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED STUDY

Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects.

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

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

Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

BackgroundTwo-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited.MethodsFrom January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups.ResultsClinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274).ConclusionOur data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

GENERAL ANESTHESIA VERSUS CONSCIOUS SEDATION WITH LOCOREGIONAL ANESTHESIA IN S-ICD IMPLANTATION: A MONOCENTRIC RETROSPECTIVE ANALYSIS

GENERAL ANESTHESIA VERSUS CONSCIOUS SEDATION WITH LOCOREGIONAL ANESTHESIA IN S-ICD IMPLANTATION: A MONOCENTRIC RETROSPECTIVE ANALYSIS

Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri

Aim This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri. Materials and methods This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6th and 24th hours, and the final pathology reports were recorded. Results There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24th hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24th hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group. Conclusion vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24th h VAS score.