Total Fentanyl Consumption Research Articles

Development of a multivariable predictive model for postoperative nausea and vomiting after cancer surgery in adults

Background and objectivesPredicting postoperative nausea and vomiting risk is the cornerstone for deciding prophylaxis. Apfel's score does not define how long a person must be abstinent from smoking to be considered a non-smoker, and the use of intraoperative spinal opioids as a risk factor for predicting postoperative nausea and vomiting is also not addressed. The aim of this study was to quantify predicting postoperative nausea and vomiting risk by an ordinal smoking status and the use of intraoperative opioids (systemic or neuraxial), and to develop a new predictive model. MethodsPatients scheduled for cancer surgery were prospectively evaluated for predicting postoperative nausea and vomiting in the first 24h after surgery. ResultsOf 2014 initially included patients, 185 participants were excluded. Smoking status classification was associated with predicting postoperative nausea and vomiting incidence rates of 14.1%, 18.1%, 24.7%, 29.4% and 33.9% for smokers, patients who stopped smoking up to 1 month prior to surgery, one to 6 months prior, more than 6 months prior or patients who never smoked, respectively, which was significant in the multiple comparisons analysis (adjusted p=0.015). The multiple comparisons-adjusted hypothesis tests for association with predicting postoperative nausea and vomiting for sex, age, previous predicting postoperative nausea and vomiting, chemotherapy-induced nausea, and ordinal smoking status had p-values of <0.001. The type of surgery (p=0.04), total fentanyl consumption (p=0.04), both intraoperative and postoperative, were significant predictors. A new model was developed and showed higher discriminative power than Apfel's score (AUC 67.9% vs. 63.7%, p<0.001). ConclusionSmoking status showed a significant and linear impact on predicting postoperative nausea and vomiting incidence, and we developed a new model that uses unambiguous smoking and opioid predictors.

The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery

Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (μg) in the dexketoprofen group, and 490.00 ± 408.98 (μg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups’ demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.

Erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy: a randomized controlled study original study.

Background: Abdominal hysterectomy is associated with marked postoperative pain and morbidity, but effective postoperative analgesia provides early recovery and ambulation.Aim: We intended to assess the efficacy of bilateral erector spinae plane block (ESPB) on postoperative analgesia in females undergoing abdominal hysterectomy under general anesthesia.Settings and Design: The design was a prospective, randomized, controlled, single-blind clinical study.Patients and Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status classes Ι to ΙΙΙ were scheduled for elective abdominal hysterectomy under general anesthesia, patients were randomly allocated into two equal groups. ESPB patients received ultrasound-guided ESPB at T9 vertebrae level with 20 ml bupivacaine 0.5%. Control group patients did not receive a block. Total fentanyl consumption in the first 24 h and visual analogue scale (VAS) score for pain were evaluated postoperatively. Unpaired Student’s t-tests, chi-square tests, and Z tests were used to compare groups.Results: No significant differences were recorded between the groups regarding age, weight, ASA physical status, or surgery duration, Total fentanyl consumption in the first 24 h was significantly higher in the control group than the ESPB group (P=0.003; 485±20.39 mcg vs 445±67.49 mcg, respectively), VAS for pain was significantly higher in the control group for the first 12 h postoperatively.Conclusions: Bilateral ESPB provided effective postoperative analgesia and markedly decreased postoperative fentanyl consumption in patients undergoing an abdominal hysterectomy.

Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: Comparison with desflurane anesthesia - a randomised trial.

Background:As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery.Methods:Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patient-controlled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded.Results:The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P = .002, P = .133, P = .161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375 μg vs 485 μg, P = .032, 414 μg vs 572 μg, P = .033, and 421 μg vs 479 μg, P = .209, respectively), less cumulative fentanyl consumption at postoperative 48 hours (790 μg vs 1057 μg, P = .004) and 72 hours (1210 μg vs 1536 μg, P = .004), and total fentanyl consumption (1393 μg vs 1704 μg, P = .007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects.Conclusion:Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery.

Pretreatment of ankle nerve block provides better postoperative analgesia than peri-incisional local anesthetic infiltration in hallux valgus correction surgery.

Adequate postoperative analgesia after hallux valgus (HV) correction surgery improves early mobilization and decreases hospital stay. Peripheral nerve block and peri-incisional local anesthetic (LA) infiltration are both widely used for pain management in orthopedic surgeries. The aim of this study was to compare the analgesic effects between the ankle block and peri-incisional infiltration technique in patients undergoing HV correction surgery. Ninety patients scheduled for hallux valgus correction surgery were randomly allocated into three groups. In group N, patients were pretreated with tibial and peroneal nerve blocks with 8-10 mL of 0.25% bupivacaine before surgery. In group P, patients received the same LA for peri-incisional infiltration preoperatively. In group C, patients underwent surgery without regional analgesic pretreatment. All patients had intravenous fentanyl patient control analgesia as part of multimodal postoperative pain management. Fentanyl consumption, rest and moving pain scale, and adverse effects were evaluated at postoperative 6 h (Poh6), Poh12, Poh 24, and Poh36, respectively. Patients receiving bilateral feet surgeries were excluded in this study. Seventy-five patients were enrolled into final analysis. The patients in group N expressed lower resting and moving pain scores at Poh6, but the pain scores turned similarly among the three groups following Poh12 and then. The total fentanyl consumption was significantly less in group N than in group P. The postoperative activities and mood disturbance were not significantly different between groups after Poh12 and then. We conclude that ankle block is better than peri-incisional LA infiltration in HV correction surgery in pain relief and fentanyl consumption.

Intraperitoneal instillation of lornoxicam–levobupivacaine versus tramadol–levobupivacaine in patients undergoing laparoscopic cholecystectomy under general anesthesia

Background Intraperitoneal local anesthetic administration is used for reducing postoperative pain after laparoscopic surgery, this study aimed to compare intraperitoneal instillation of lornoxicam–levobupivacaine versus tramadol–levobupivacaine on the quality of postoperative analgesia for elective laparoscopic cholecystectomy. Patients and methods After ethical approval, 90 (30/group) patients scheduled for elective laparoscopic cholecystectomy were randomly allocated to receive intraperitoneal instillation of either 25 ml of normal saline for patients in group S, 20 ml of levobupivacaine 0.5% combined with 5 ml of lornoxicam (16 mg) for patients in group L or to receive 20 ml of levobupivacaine 0.5% combined with 5 ml of tramadol (100 mg) for patients in group T. Postoperative pain-free period, visual analog pain scores, pulmonary functions and cumulative fentanyl consumption were recorded. Results Postoperative pain-free period showed significantly longer duration in group L and group T in comparison to group S with 6.86 h in group L and 6.90 h in group T versus 1.33 h in group S at 95% confidence interval, also total fentanyl consumption decreased in group L and group T in comparison to group S. Pulmonary functions were decreased in all groups but with less decrease in group L and group T in comparison to group S. Conclusion Addition of either lornoxicam or tramadol provided safe, effective, less affection of pulmonary functions and good quality of analgesia when added to levobupivacaine without any significant differences between both groups for intraperitoneal administration.

Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study.

Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated. Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri-articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient-controlled analgesia pump during the 48-h post-operative period. A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post-operative day 2 than femoral nerve block alone (p < 0.05). C-reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post-operative day 3 (p < 0.01). There was no difference between the two groups, post-operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index. The addition of local infiltration of analgesia to femoral nerve block promoted post-operative pain relief and the recovery of knee ROM in the early post-operative period. This combination is an effective method for post-operative pain management after TKA. Randomized controlled trial, Level I.

High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study.

The purpose of this study was to determine whether intraoperative infusion of remifentanil induces acute tolerance to opioids, and compare the postoperative pain and opioid consumption by the effect site concentrations of remifentanil. One hundred and ninety-eight patients undergoing gastrectomy were randomly assigned to maintain target effect site concentrations of remifentanil at 0 (Group 1, n = 39), 2 (Group 2, n = 40), 4 (Group 3, n = 39), 8 (Group 4, n = 40), or 12ng/ml (Group 5, n = 40) during operation. Postoperative pain intensities and fentanyl requirement were recorded at postoperative 2, 6, 24, and 48h. Fentanyl requirement for postoperative 2h was significantly greater in Group 5 compared to Group 1 (376 ± 116 vs. 283 ± 129µg, P = 0.03). However, there were no differences in fentanyl requirements among the groups after postoperative 2h. Also, total fentanyl consumption for 48h was similar in all groups (Group 1; 3106 ± 629, Group 2; 2970 ± 705, Group 3; 3017 ± 555, Group 4; 3151 ± 606, and Group 5; 2984 ± 443 µg, P = 0.717). Pain scores at rest and during deep breathing were comparable in all groups at the time of each examination. Intraoperative infusion of remifentanil with 12ng/ml of effect site concentration in patients undergoing gastrectomy increases early postoperative fentanyl requirement. Acute opioid tolerance would be developed by higher concentration of remifentanil than dosage of common anesthetic practice.

Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study

A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy. A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention. An intravenous patient-controlled analgesia (PCA) device was used to deliver fentanyl in both groups. Using the Visual Analog Scale (VAS), the patients' pain was assessed at intervals of 1, 6, 12 and 24 hours after entering the recovery room. Intravenous acetaminophen was administered as a rescue analgesic if the pain exceeded 3 on the VAS. A total amount of fentanyl consumed, the time to first PCA request, a total amount of acetaminophen consumption and possible adverse effects were evaluated. The pain scores assessed at the time intervals were not significantly different between the two groups (p>0.5). The total consumption of fentanyl was significantly lower in the SAB group than in the CTL group (p=0.0001). Duration of the time to first PCA request was remarkably longer in the SAB group than in the CTL group (p=0.0001). The total amount of acetaminophen consumed was notably higher in the CTL group than in the SAB group (p=0.001). None of the patients experienced side effects. Undertaking serratus anterior block following mastectomy can reduce pain scores and lower opioid usage.

Does a single-dose preemptive intravenous ibuprofen have an effect on postoperative pain relief after septorhinoplasty?

PurposeSeptorhinoplasty is a surgical procedure widely employed by otolaryngologists and plastic surgeons. The purpose of this study was to investigate the effects of a single pre-emptive dose of iv ibuprofen on postoperative pain and opioid consumption in patients undergoing septorhinoplasty. Material and methods50 patients scheduled for septorhinoplasty were included in this prospective, randomized, double-blinded study. Control group (n = 25) was administered 100 mL iv saline solution 30 min preoperatively, while Ibuprofen group (n = 26) received 800 mg ibuprofen iv. in 100 mL saline solution. Intravenous fentanyl was administered with a Patient Controlled Analgesia device after surgery for postoperative pain management. Postoperative pain was evaluated using a Visual Analogue Scale (VAS) with 0 representing no pain and 10 the worst pain possible. ResultsVAS scores at 10, 20, and 30 min and at 1, 2, 4, 8, 12 and 24 h were lower in the ibuprofen group than in the control group (p < 0.05). Total fentanyl consumption was lower in the ibuprofen group compared to the placebo group (148.8 ± 86.4 mcq vs 338.00 ± 81.00 mcq), respectively. ConclusionWe suggest that the pre-emptive use of iv ibuprofen at a dosage of 800 mg 30 min before septorhinoplasty will be beneficial in reducing opioid consumption and pain scores.

Effect of perioperative intravenous lidocaine infusion on postoperative analgesia and recovery following laparoscopic cholecystectomy--a randomized, controlled, triple blind trial

Objective This randomized controlled study was conducted to assess the effect of perioperative intravenous lidocaine infusion on pain, bowel function, and levels of serum IL-6, IL-8 and IL-1ra in patients subjected to larparoscopic cholecystectomy. Methods Eighty patients undergoing laparoscopic cholecystectomy were randomly allocated to receive intravenous infusion of lidocaine (bolus injection of 1.5 mg/kg lidocaine for induction of anesthesia, then a continuous infusion of 2 mg·kg-1·h-1 until the end of surgery) or an equal volume of saline. Anesthesia and multimodal perioperative analgesia were standardized. Pain scores (VAS), consumption of opioid drugs, time to first flatus, and time to first bowel movement were measured after surgery. The levels of serum IL-6, IL-8 and IL-1ra were also measured at scheduled times within 48 h. Results Seventy-one of eighty recruited patients finished the survey. The two groups of patients showed similar demographic profile. Lidocaine infusion significantly reduced pain intensity 2 h and 6 h after surgery (P<0.05) and total fentanyl consumption 24 h after surgery [lidocaine (98±16) μg vs placebo (187±20) μg, P<0.05]. Time to first flatus passage and time to first bowel movement were also significantly shorter in patients received lidocaine(P<0.05). The post-operative levels of serum IL-6 and IL-8 in the lidocaine group were lower than those in the control group. Conclusions This study suggests that perioperative infusion of lidocaine improves postoperative recovery and attenuates the excessive release of serum IL-6 and IL-8 following laparoscopic cholecystectomy. Key words: Intravenous lidocaine; Postoperative recovery; Immunocompetance

Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study.

The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery. Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n=20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n=20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC+T, n=20) received BSCPB with 0.25% bupivacaine plus tizanidine 6mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24h. Compared with Group C, rest and swallowing pain scores in Group SC and Group SC+T were statistically lower at all postoperative time points (p<0.05). Fentanyl consumption was lower in Group SC and Group SC+T than in Group C at time periods 0-4 and 4-8h (p<0.05). Fentanyl consumption was lower in Group SC+T than in Group SC at 0-4h (p=0.006). Total fentanyl consumption was higher in Group C than in the other groups (p<0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC+T than in the other groups (p<0.05). Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache. The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).

Subarachnoid versus intravenous dexmedetomidine and fentanyl for minimizing stress response in laparoscopic cholecystectomy

Background The magnitude of stress response depends on several factors such as duration and intensity of surgical trauma, patient's age, surgical method, anesthetic technique, blood loss, and postoperative pain. Aim of the work The aim of this work was to study the effect of intravenous versus intrathecal dexmedetomidine and fentanyl on stress response during laparoscopic cholecystectomy. Patients and methods Sixty patients fulfilling the inclusion criteria who were undergoing laparoscopic cholecystectomies were randomly assigned to receive either intravenous fentanyl and dexmedetomidine (group I) or intrathecal fentanyl and dexmedetomidine (group II). Mean arterial blood pressure and heart rate were recorded before induction of anesthesia (T0), 5 min after intubation (T1), 30 min after start of surgery (T2), at skin closure (T3), 6 h postoperatively (T4), and 24 h postoperatively (T5). The number of patients who required intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients who required intravenous morphine at the end of surgery were recorded. Visual analogue scale and total postoperative morphine consumption (mg) at the end of surgery (M0), and at 6, 12, 18, and 24 h (M1, M2, M3, and M4, respectively) were recorded. Blood interleukin-6, cortisol, and glucose were measured before anesthesia (F0) and after recovery (F1). Postoperative complications were recorded. Results Heart rate and mean arterial blood pressure were statistically lower in group II at T2 and T3. The number of patients requiring intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients requiring intravenous morphine at the end of surgery were statistically lower in group II. Visual analogue scale and postoperative morphine consumption (mg) were statistically lower in group II at M0 and M1. Blood cortisol and blood glucose level were statistically lower in group II at F1. There were no statistical differences as regards complications. Conclusion Apart from lowering heart rate and BP, intrathecal dexmedetomidine and fentanyl was superior to intravenous dexmedetomidine and fentanyl, wherein it lowered pain score and analgesic consumption with attenuation of stress response.

Effect of Pregabalin on Preoperative Anxiety and Postoperative Pain in Spine Surgery: A Randomized Controlled Study

Abstract Background Pregabalin is a gabapentinoid which has been shown to possess analgesic and anxiolytic properties. The present study aimed to assess the efficacy of a single dose of pregabalin on postoperative pain and preoperative anxiety in patients undergoing lumbar spine surgery. Materials and Methods Sixty adults posted for elective lumbar laminectomy and discectomy were randomly assigned to one of the three groups; Group C received placebo capsules, Group PI received pregabalin 150 mg, and Group P2 received pregabalin 300 mg capsules, 2 h prior to induction of anesthesia. The levels of anxiety and pain were assessed with respective 100 mm visual analog scale (VAS) score. Postoperative fentanyl consumption and occurrence of side effects were recorded. All patients were observed for 8 h, postoperatively. Results There was a significant reduction in preoperative anxiety in both pregabalin groups as compared to control group (p = 0.001). VAS score for pain (at rest and during movement) was significantly decreased at all time intervals in both PI and P2 groups as compared to control (p &lt; 0.05). Fentanyl consumption in the postoperative period was significantly reduced in pregabalin groups as compared to control (p = 0.001). The level of sedation was higher in P2 group in the first 4 h (p &lt; 0.05). The occurrence of postoperative nausea and vomiting was more in control group as compared to the pregabalin groups (p = 0.018). The incidence of dizziness and blurring of vision was significantly more in P2 group. Conclusion Single preoperative dose of pregabalin 150 or 300 mg was effective in reducing preoperative anxiety, postoperative pain and total fentanyl consumption in patients undergoing lumbar laminectomy and discectomy. However, the incidence of postoperative side effects such as sedation, dizziness and visual blurring was more in patients who received pregabalin 300 mg.

Peri-operative Rectus Sheath Fentanyl-levobupivacaine Infusion vs. Thoracic Epidural Fentanyl Levobupvacaine Infusion in Patients Undergoing Major Abdominal Cancer Surgeries with Medline Incision

Background and Objectives: The gold standard for acute postoperative pain management in major abdominal surgeries is thoracic epidural analgesia (TEA) and this was proved by a lot of studies, systematic reviews and metaanalyses. However, TEA is sometimes contraindicated and may cause serious risks. Rectus Sheath Block (RSB) is effective for the abdominal surgeries with midline abdominal incisions as local anesthetics will be injected within the posterior rectus sheath bilaterally leading to intense pain relief for the middle anterior wall extending from the xiphoid process to the symphysis pubis. The aim of the study was to assess intra and post-operative RSB versus intra and post-operative TEA, in patients undergoing elective major abdominal cancer surgery with midline incisions. Methods: This randomized, blinded, was registered at www.clinicaltrials.gov at no.: “NCT03460561” and was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Egypt. One hundred adult patients, (ASA grade II and III), scheduled for major elective abdominal cancer surgery with Medline incision, were randomly divided into two groups, (50 patients each); TEA group: patients in this group received TEA with standard GA and intra-operative analgesia was started before skin incision by injecting epidural bolus dose of 0.1 ml/kg of (0.125% levo-bupivacaine+fentanyl 2 μg/ml). Postoperative analgesia was provided through PCEA by injecting a bolus dose of 3 ml then continuous infusion of 0.1 ml/kg of mixture of (0.0625% levo-bupivacaine+fentanyl 2 μg/ml) for 48 hours postoperative. RSB group: patients in this group received standard GA plus ultrasound (U/S) guided rectus sheath block by a volume of 20 mL of (0.25% levo-bupivacaine+fentanyl 30 μg) in saline on either side. Before end of surgery and before closure of abdominal wall, bilateral surgically placed catheters in rectus sheath plane aiming to provide post-operative analgesia using the following; 20 mL of (0.125% levo-bupivicaine+Fentanyl 30 μg) every 12 hours in to each catheter for 48 hours. Perioperative hemodynamics (MAP and HR) were recorded. Postoperative pain was assessed over 48 hour post operatively using (VAS). Total fentanyl consumption, Peak expiratory flow rate (PEFR), postoperative and side effects of the drugs and duration of ICU and hospital stay were recorded. Results: We found a significant reduction in VAS pain scores (at rest and during cough) in both group at all postoperative period but fentanyl consumption was significantly lower in TEA group. Also we found a significant reduction in intra-operative hemodynamics (mean arterial pressure and heart rate) in TEA group in comparison to RSB group while there was minimal statistically significant reduction in postoperative MAP and heart rate. The incidence of other postoperative complications such as sedation, nausea and vomiting were comparable in both groups. Conclusion: Rectus sheath block was not inferior to thoracic epidural analgesia in reduction of pain intensity after major abdominal cancer surgeries, and associated with hemodynamic stability along the 48 hours postoperative without procedure related adverse events or decreasing PEFR.

Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section.

Background and Aims:Magnesium is a physiological antagonist of NMDA receptor and a calcium channel blocker. This study was designed to test the analgesic effect of magnesium sulfate (MgSO4) when added to epidural anesthesia in mild pre-eclampsia.Material and Methods:Sixty parturients with mild pre-eclampsia were allocated randomly to two equal groups. The Placebo group received 20 ml levobupivacaine hydrochloride 0.5% plus 5 ml isotonic saline 0.9% using two separate syringes. The Magnesium group received the same amount of local anesthetic plus 5 ml of 10% MgSO4(500 mg) using two separate syringes. The primary outcome was pain free period. While, the secondary outcomes were the onset of motor block and the time needed to achieve complete motor block. The analgesic profile was evaluated by visual analog scale (VAS) during rest or motion, the time to first request for analgesia, and the total analgesic consumption.Results:The pain-free period was significantly longer in the Magnesium group (311.3 ± 21.4) compared to placebo group (153.1 ± 22.18). The total postoperative consumption of fentanyl was significantly lower in the Magnesium group (42.4 ± 5.3) than that in the placebo group (94.4 ± 9.9), with a P value 0. 01. Both the onset time of motor block and the time needed to achieve complete motor block were significantly shorter among the Magnesium group (4.4 ± 1.4 and 8.2 ± 0.4, respectively), with a P value of 0. 01.Conclusion:The addition of 500 mg MgSO4 to epidural anesthesia fastens both sensory and motor blockade and improves postoperative analgesic profile.

Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for perioperative analgesia in thoracotomy

Background:Thoracotomy needs adequate powerful postoperative analgesia. This study aims to compare the safety and efficacy of ultrasound (US)-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) for perioperative analgesia in cancer patients having lung lobectomy.Patients and Methods:This clinical trial involved 90 patients with lung cancer scheduled for lung lobectomy randomly divided into three groups according to the type of preemptive regional block. Group TPVB received US-guided TPVB. In Group SAPB, US-guided SAPB was performed. The patients of the control Group received general anesthesia alone. The outcome measures were postoperative visual analog scale (VAS) score, intraoperative fentanyl consumption, time of first rescue analgesic, total dose postoperative analgesic, and drug-related adverse effects.Results:Analgesia was adequate in TPVB and SAPB groups up to 24 h. VAS score was comparable in TPVB and SAPB groups and significantly lower compared to control group up to 9 h postoperatively. At 12 and 24 h, TPVB group had significantly lower VAS score relative to SAPB and control groups. Total intraoperative fentanyl consumption was significantly lower in TPVB and SAPB Groups compared to control group. The majority of TPVB Group cases did not need rescue morphine, while the majority of control group needed two doses (P < 0.001). The hemodynamic variables were stable in all patients. Few cases reported trivial adverse effects.Conclusion:Preemptive TPVB and SAPB provide comparable levels of adequate analgesia for the first 24 h after thoracotomy. TPVB provided better analgesia after 12 h. The two procedures reduce intraoperative fentanyl and postoperative morphine consumption.

Comparison of Two Different Volumes of Ropivacaine Used in Nerve Stimulator Guided Inter-scalene Block for Arthroscopic Shoulder Surgery - A Randomized Controlled Trial.

Background:This study was conducted to compare the analgesic efficacy of 10 ml versus 20 mL of 0.5% ropivacaine in nerve stimulator guided interscalene brachial plexus block, in patients undergoing arthroscopic shoulder surgery.Methods:A total of 70 American Society of Anesthesiologists physical status classes 1 and 2 patients, aged 18–65 years, undergoing unilateral arthroscopic shoulder surgery, were randomized into two groups. Group A received single shot inter-scalene block with 20 mL of 0.5% ropivacaine whereas Group B received the same with 10 mL. The primary outcome was difference in the total postoperative fentanyl consumption over 24 h. Secondary outcomes were difference in block onset, intra-operative hemodynamic parameters, intra-operative fentanyl consumption, duration of effective analgesia, visual analogue scale (VAS) scores at various time intervals, duration of motor block, and incidence of hemidiaphragmatic (HD) palsy.Results:Total 24 h fentanyl consumption was significantly higher in Group B (558 ± 112 mcg) compared to Group A (296 ± 88 μg). Block onset was slower in Group B than Group A. There was no difference in intra-operative fentanyl consumption. Postoperative VAS scores were significantly higher in Group B compared to Group A, at 6 h and thereafter. Duration of motor block was significantly shorter in Group B (6.25 ± 1.25 h) compared to Group A. HD palsy was seen in all the cases in both the groups.Conclusion:Single shot nerve stimulator guided interscalene block with 10 ml of 0.5% ropivacaine was inferior to 20 mL of 0.5% ropivacaine with respect to postoperative analgesic efficacy.

Duloxetine as an Analgesic Reduces Opioid Consumption After Spine Surgery: A Randomized, Double-Blind, Controlled Study.

Multimodal analgesia is widely advocated for the control of perioperative pain in an effort to reduce the use of opioid. Duloxetine is a selective inhibitor of serotonin and norepinephrine reuptake with efficacy for chronic pain conditions. The primary objective of this study was to evaluate the efficacy of two 60 mg oral doses of duloxetine in terms of fentanyl consumption during the postoperative period in patients undergoing elective spine surgery. This study was prospective, double-blind, randomized, and placebo controlled. Patients received either 60 mg duloxetine or an identical placebo 1 hour before surgery and again the following morning. The study participants were allocated into 2 groups: Group C (control) participants received the placebo and Group D (duloxetine) participants received 60 mg duloxetine. The total consumption of fentanyl 48 hours after surgery was measured. Secondary end points were pain scores and the presence or absence of adverse effects, such as headache, nausea, vomiting, itching, dizziness, and drowsiness. Demographic characteristics did not differ between groups. There was a significant difference in fentanyl consumption in the first 24 hours between Groups C and D (mean difference, 223.11±39.32 µg; P<0.001). Fentanyl consumption also differed between Groups C and D after 48 hours (mean difference, 179.35±32.55 µg; P<0.000). The pain scores over 48 hours did not significantly differ between groups. The incidence of side-effects was similar in both groups. Duloxetine was effective as an adjunct for postoperative analgesia and reduced opioid consumption.

A comparative study between intraoperativelow-dose ketamine and dexmedetomidine, as an anaesthetic adjuvant in lumbar spine instrumentation surgery for the post-operative analgesic requirement

Abstract Background: Spinal instrumentation and fusion surgery presents the anaesthesiologist with multiple issues like intraoperative blood loss, hemodynamic changes, prolonged surgery etc, but the most probing aspect is analgesia. While both ketamine and dexmedetomidine as adjuvants have shown to decrease intraoperative anaesthetics and post operative analgesic consumption but there are no comparative studies. The primary aim of this study was comparison of post-operative analgesic requirements for 1st 24 hours after surgery when either of the drugs was used as adjuvants. Methods: Adult patients aged 18-60 years, of either sex, and ASA status I or II scheduled for elective lumbar spine instrumentation (of 2 or more spinal levels) surgery were enrolled for the study. Patients were randomised into one of the 3 treatment regimens ketamine/group K (0.5mg/kg bolus followed by 250 mcg/kg/h infusion), dexmedetomidine/ group D (0.5mcg/kg bolus followed by 0.5 mcg/kg/h infusion) or the placebo/ group S (saline/placebo). The study drugs were started after turning the patient prone. Data were recorded for intraoperative hemodynamics, anesthetic consumption (inhalational agent and opioids), emergence through RAS scale (Riker sedation agitation scale), PCA (patient controlled analgesia)-fentanyl use and VAS (visual analog scale) score in the 1st 24 hours after surgery. Appropriate statistical analysis was done. Results: A total of 42 patients (14 in each group) were enrolled. The total PCA fentanyl consumed in first 24 hours of surgery was maximum with the group-S (1366.6±382.6 mcg) in compared with group- D (1035.4±391.8 mcg) and group- K (1164.9±503.6 mcg) (P=0.13). The post extubation RAS score was lower in group-K (3.7±0.6) when compared with group-D (4±0.4) and group-S (4.5±0.9) (P=.009). Total intraoperative sevoflurane and fentanyl consumption showed no difference (P=0.19 and P=0.28). VAS score at rest was higher at baseline with group-S (P=0.009). The ICU stay was comparable (group-D: 1.4±0.5 d, group-K: 1.5±0.5 d, group-S: 1.9±0.5 d) among the groups. Hospital stay was also comparable (P=0.09). Conclusion: In patients undergoing lumbar instrumentation surgery, opioid consumption, VAS scores, PCA pump bad demands, inhalational agent consumption, hospital stay were comparable when either ketamine or dexmedetomidine was used as intraoperative anesthetic adjuvants.