Total Pethidine Consumption Research Articles

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section

Abstract Background Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. Objective to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine. Results In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value < 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.). Conclusion Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.

Effect of intraoperative aminophylline infusion on pain intensity after ureteroscopic lithotripsy: A randomized controlled study

ABSTRACT Background Aminophylline relaxes smooth muscle by inhibiting the phosphodiesterase enzyme and activating protein kinase A, and alleviates inflammation by decreasing the production of leukotrienes. We aimed to assess the effect of intraoperative intravenous (IV) aminophylline on postoperative pain in patients undergoing ureteroscopic lithotripsy. Methods A randomized, placebo-controlled trial was conducted on 50 patients who were scheduled for ureteroscopic lithotripsy under general anesthesia. Patients were divided into two equal groups. Group 1 received 4 mg/kg aminophylline diluted in 100 ml saline 0.9% IV over 20 minutes. Group 2 received saline 0.9% with a similar volume and period as the aminophylline group. Visual analogue scale (VAS) score was recorded at arrival to the post-anesthesia care unit (PACU), 1 h, 2 h, 6 h, 12 h, and 24 h after surgery. Catheter-related bladder discomfort (CRBD) was assessed at PACU arrival, 1 h, 2 h, and 6 h postoperatively. Results VAS measurements at arrival to the PACU, 1 h, 2 h, and 6 h postoperative were significantly lower in group 1 than in group 2 (p < 0.05). Total pethidine consumption in the first 24 hours postoperatively was significantly lower in group 1 (43.04 ± 14.52 mg) than in group 2 (59.32 ± 18.34 mg); p = 0.002. Aminophylline significantly decreased the incidence of moderate-to-severe CRBD at PACU arrival and 1 h after surgery (p = 0.005 and 0.007, respectively). There was no significant variation between both groups regarding side effects. Conclusions In patients undergoing ureteroscopic lithotripsy, intraoperative IV aminophylline infusion reduced postoperative pain and opioid consumption. It also decreased the incidence of early moderate-to-severe CRBD without evidence of intraoperative hemodynamic alterations or postoperative side effects.

Analgesic Efficacy of Pre-operative Pregabalin in Dacryocystorhinostomy Surgery: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Dacryocystorhinostomy (DCR) is an effective surgical procedure for addressing lacrimal drainage problems. However, it can be a painful operation that involves incisions both inside and outside the eye, often leading to a high incidence of postoperative nausea and vomiting. Preemptive analgesics can be employed to alleviate this unrelieved pain. Nonetheless, many of the drugs used can induce a wide range of adverse effects. Therefore, the aim of this systematic review and meta-analysis is to assess the current evidence regarding the efficacy of pregabalin in managing postoperative pain following DCR surgery. We conducted a thorough search of five electronic databases, namely, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar, to identify relevant randomized controlled trials (RCTs) published before September 2023. The quality of the included studies was assessed using the Cochrane Risk of Bias tool for RCTs. The outcomes we evaluated included postoperative pain, surgery duration, time to first analgesia, total pethidine consumption, and postoperative nausea and vomiting (PONV). Continues data reported as mean difference (MD), and dichotomous data reported as risk ratio (RR), with 95% confidence interval (CI). A pooled meta-analysis of three RCTs, including 240 patients in both the pregabalin and placebo groups, was conducted. The results revealed that the pooled MD in pain scores was significantly lower in patients treated with pregabalin compared to those receiving a placebo ((MD = -1.35 (95% CI: -1.83 to -0.87, p < 0.00001)). Additionally, the pooled MD of pethidine consumption was significantly lower in patients treated with pregabalin compared to those receiving a placebo (MD = -54.13 (95% CI: -103.77 to -4.50, p = 0.03)). However, there was no statistical significance between both groups in terms of time to first analgesia and duration of surgery (p > 0.05). On the other hand, the pooled RR of PONV was significantly lower in patients treated with pregabalin compared to those receiving a placebo (RR = 0.37 (95% CI: 0.24-0.57, p < 0.001)). This meta-analysis demonstrates that pregabalin is an effective and well-tolerated intervention for reducing postoperative pain and PONV following DCR surgery, without significantly affecting surgery duration or time to first analgesia. These findings support the use of pregabalin in improving patient comfort and outcomes in this surgical context.

Peri-operative Outcomes of Dexmedetomidine as an Additive to Subtenon Block Compared with Intravenous Dexmedetomidine for Patients Undergoing Vitreoretinal Surgery under General Anesthesia

Background: Several medications such as dexmedetomidine can be used as adjuvants with anesthesia to reduce the stress response during surgery resulting in good post-operative outcomes and safe recovery times. Aims: To compare the peri-operative outcomes of subtenon block with or without dexmedetomidine versus dexmedetomidine infusion as adjuvants to general anesthesia in subjects undertaking retinal operations. Design: A prospective randomized double-blind controlled clinical trial Patients and methods: Through the use of sealed opaque envelopes, 120 participants were randomly divided into three groups. Group SB received subtenon bupivacaine and lidocaine and IV infusion of normal saline. Group SD received subtenon bupivacaine, lidocaine, and dexmedetomidine and IV infusion of normal saline, whereas Group DI received subtenon saline and IV infusion of dexmedetomidine. Peri-operative hemodynamics and intra-ocular pressure were measured and recorded. Intra-operative bleeding, recovery times, post-operative sedation and pain scores, first analgesic times, total analgesic requirements, and the incidence of PONV and OCR were also assessed and documented. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The results showed that IV dexmedetomidine has decreased cardiovascular responses to surgery as signified by decreased HR and MAP with a significant drop in IOP measurements before induction and after intubation, in comparison to other groups. Administering dexmedetomidine either or IV in the subtenon block led to a significant reduction in pain scores of the first post-operative six hours, the total pethidine consumption, and the surgical bleeding. Conclusion: When used as a supplement to general anesthesia during retinal surgery, dexmedetomidine is effective at reducing the airway response to tracheal intubation and extubation and maintaining peri-operative hemodynamic stability. Dexmedetomidine is also an efficient method for lowering intraocular pressure, surgical bleeding, and postoperative analgesic consumption with a better recovery profile. It can be administered either through IV infusion or combined with local anesthetics in subtenon block.

Evaluation of Ultrasound- Guided Quadratus Lumborum Block for Postoperative Analgesia after Hip Surgery

Abstract Background With improvement of surgical technique, hip surgery became more frequent with increased need for adequate postoperative analgesia The main advantage of quadratus lumborum block (QLB) compared to spinal anaesthesia is the extension of local anesthetic agent beyond the transverses abdominis plane to the thoracic paravertebral space producing extensive analgesia and prolonged action. Aim of the Work to assess the analgesic efficacy of ultrasound-guided (US) trans-muscular QLB compared to spinal anaesthesia during Hip surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods 64 patients were randomly allocated to one of 2 groups (n = 32; each); group QLB received US-guided QLB before induction of spinal anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group Spinal Anaesthesia alone: received Spinal anaesthesia alone, 3.5 ml of 0.5% bupivacaine plus 25 µg fentanyl. QLB results in decreased incidence and severity of postoperative pain resulting in a decrease in incidence and degree of sedation and total opioid requirement. The quadratus lumborum block was more efficient than the spinal anaesthesia alone. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) in QLB group were superior to that for the spinal anaesthesia group. Conclusion patients having preoperative single shot QLB, as an adjuvant to spinal anesthesia, have significant less time for discharge from the postoperative care unit and better postoperative pain control compared to spinal anesthesia alone for hip surgery, in terms of VAS score and total opioid consumption as well as frequency of need.

A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries

Abstract Background Operations rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work This work aims to compare the efficacy of Transversus Abdominis Plane (TAP) Block versus Quadratus Lumborum 2 (QL 2) Block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing lower abdominal surgeries. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this Randomized controlled trial study was conducted in Ain Shams University Hospitals. Forty patients scheduled for elective lower abdominal surgeries were included in this study. The patients' age was ranged from 21 to 65 years and with the American Society of Anesthesiologists (ASA) Class-I and II. At the end of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique to receive either quadratus lumborum block (Group QLB), or TAP (transversus abdominis plane) block (Group TAP), each group constitutes of 20 patients. Results In this study, the effect of quadratus lumborum block and transversus abdominis plane block result of decreased incidence and severity of postoperative pain (VAS) resulting in decrease in incidence and degree of sedation and opioid total requirement. The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique affected the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after lower abdominal surgeries in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

Intraperitoneal versus Intravenous Dexamethasone Effect on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background Post-operative nausea and vomiting (PONV) is a common unwanted effect in patients undergoing laparoscopic cholecystectomy (LC). This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after laparoscopic cholecystectomy surgeries. Aim of the Work to compare the efficacy of intraperitoneal versus intravenous administration of dexamethasone in reducing the incidence of PONV after LC surgeries. Patients and Methods Ninety patients, American Society of Anesthesiologists physical status I–II, scheduled for laparoscopic cholecystectomy surgery were randomized to receive 8 mg dexamethasone intraperitoneally (IP) (n = 45) or intravenously (IV) (n = 45). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications. Results The incidence of nausea in the IV group was 26.7% (12 patients) and that in the IP group was 6.7% (3 patients) in the first 24 hours post-operatively (P = 0.011). There were no significant differences in the incidence of retching or vomiting, or the need for rescue antiemetics between the 2 groups. In terms of side effects, patients in the IP group had a lower rate of side effects than those in the IV group (6.7% vs. 24.4%, P = 0.020). The mean VAS pain score and total pethidine consumption for the first 24 hours postoperatively were lower in the IP group than in the IV group. However, these differences did not reach statistical significance. Conclusion Intraperitoneal injection of dexamethasone at a dose of 8 mg in patients undergoing Laparoscopic Cholecystectomy surgery reduces significantly the incidence of postoperative nausea, in comparison to the intravenous route.

Analgesic effect of sacral erector spinae, penile and caudal block after hypospadias surgery: A randomized single blind controlled trial

ABSTRACT Background Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. Patients and methods This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Results Time to 1st rescue analgesia was significantly delayed in groups C and E than group P (P < 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P (P = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h (p < 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Conclusion Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.

Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial

Background &amp; Objectives: Hip arthroscopy is a minimally invasive technique that has been widely used to treat a variety of hip joint diseases. However, severe postoperative pain usually follows these surgeries, necessitating the use of multimodal pain control strategies. Regional blocks like femoral nerve block (FNB) and fascia iliaca compartment block (FICB) allow for better postoperative analgesia while using less parenteral opioids. The purpose of this study was to evaluate and compare the efficacy of ultrasound guided FNB versus ultrasound guided FICB for postoperative analgesia. &#x0D; Methodology: A total of 60 patients, planned for hip arthroscopy, aged 21−65 y, of either sex and ASA I−II were randomly divided into two groups: Group FICB (n= 30), in which FICB with 40 mL levobupivacaine 0.25% was done after induction of general anesthesia (GA) and Group FNB (n = 30) in which FNB with 20 mL levobupivacaine 0.25% was done after induction of GA. Time to the first analgesic use was the primary outcome, whereas total pethidine consumption as rescue analgesic in the first 24 h postoperatively, VAS scores, and the assessment of postoperative early ambulation were the secondary outcomes.&#x0D; Results: Patients in the Group FICB experienced a significantly shorter time to ambulation compared to Group FNB; 17.2 ± 2.1 vs. 19.8 ± 2.1 h respectively (P &lt; 0.001). There were no significant differences between the two groups regarding time to first analgesic requirement (pethidine), total pethidine consumption, and the VAS scores. No cases of drug allergy were reported in both groups.&#x0D; Conclusion: Both fascia iliaca compartment block and femoral nerve block were effective in reducing postoperative pain; however, fascia iliaca compartment block was superior regarding early ambulation.&#x0D; Abbreviations: FNB: Femoral Nerve Block; FICB: Fascia Iliaca Compartment Block; GA: General Anesthesia; US: Ultrasound; VAS: Visual Analog Scale&#x0D; Key words: Hip arthroscopy; Fascia iliaca compartment block; Femoral Nerve Block; Pain; Pain Management; Postoperative pain&#x0D; Citation: Alasnsary AM, Elgouhary MO, Rashed MM, Ali MM. Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial. Anaesth. pain intensive care 2022;27(1):23−30; DOI: 10.35975/apic.v27i1.2120&#x0D; Received: September 10, 2022; Reviewed: November 05, 2022; Accepted: November 16, 2022

Sodium Bicarbonate-Based Warm Saline Versus Warm Saline for Peritoneal Irrigation in Diagnostic Hysteroscopy-Laparoscopy: A Prospective Randomized Controlled Trial

ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice. ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice. Keywords: Laparoscopy, Pain, VAS, Sodium bicarbonate, PONV.

Quadratus lumborum block (transmuscular approach) versus transversus abdominis plane block (unilateral subcostal approach) for perioperative analgesia in patients undergoing open nephrectomy: a randomized, double-blinded, controlled trial

Study objectivePatients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications. MethodsThis was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20–60 years, with ASA I and II, and a body mass index ≤ 30kg.m-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n=16) received USG transmuscular QLB; Group B (n=16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n=16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30min and 1,2,4,6, and 12hours postoperatively. The time of first analgesic request was also recorded. ResultsIntraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69±27.35 and 190.31±44.48, respectively) than in Group C (347.50±63.64) (p<0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31±6.68, 84.06±4.17mg, and 152.19±43.43mg, respectively) (p<0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75±52.39min, 202.50±72.25min, and 37.50±13.42min, respectively) (p<0.001). VAS score was significantly lower in Groups A and B than in Group C at 30min and 1, 2, 4, and 6hours postoperatively. ConclusionTransmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.

The Impact of Adding Magnesium Sulfate to Bupivacaine versus Bupivacaine Alone in Fascia Iliaca Compartment Block in Burn Patients Undergoing Skin Grafting Procedures; Comparative Study

Purpose: The purpose of the study is to evaluate the analgesic effect of adding magnesium sulfate to bupivacaine in Fascia Iliaca Compartment Block (FI-CB). Patients and Methods: Ninety-six burn patients scheduled for skin-grafting procedures were allocated into two equal groups. After induction of general anaethesia, forty-eight patients received US guided FICB using 35 ml bupivacaine 0.25% + 5 ml isotonic sodium chloride solution with a total volume of 40 ml. The other forty-eight patients received 35 ml bupivacaine 0.25% + 250 mg of magnesium sulfate with a total volume of 40 ml. Results: Total postoperative pethidine consumption in the first 24 h post-operative showed a highly statistically significant decrease in the magnesium group in comparison to the bupivacaine group. Conclusion: Adding magnesium sulfate to bupivacaine in FICB in skin grafting procedures decreased the pain scores post-operative, delayed the first request of analgesia and reduced the total analgesic consumption in the first 24 h post-operative without any significant side effects.

Comparative study between paracetamol versus paracetamol and pregabalin combination for postoperative analgesia in hip surgeries

Abstract Introduction Pregabalin has been used for treatment of chronic pain, but recently it has been introduced in treatment of acute postoperative pain. Aim of Study This study is conducted to evaluate the postoperative analgesic effect of paracetamol and pregabalin combination versus paracetamol after hip surgeries. Methods The study was done on 20 randomly chosen patients after approval of the medical ethical committee of Ain Shams University. Patients were divided randomly into two groups, each group consisted of 10 patients.After preoperative assessment and obtaining baseline vital data all patients received spinal anaesthesia. Group I received paracetamol 1gm intravenous immediately postoperatively and every 6 hours for 24 hours. Group II received the same as group I plus two doses of oral pregabalin 300mg in the recovery room and 12 hours later. The two groups were assessed postoperatively and they were compared regarding demographic data, postoperative pain control, sedation, total pethidine consumption, hemodynamics and side effects. Results In pregabalin group (group II), pain scores and total pethidine consumption were significantly lower and sedation scores were higher than group II. Heart rate and arterial blood pressure were lower in group II but without clinical significance. Conclusions This study revealed that combination of paracetamol and pregabalin as multimodal analgesia is better than paracetamol alone in postoperative analgesia, and decreasing use of opioids without significant effect on hemodynamics but with increased incidence of side effects such as somnolence, dizziness and blurred vision.

Ultrasound Guided PECS II Block versus Thoracic Epidural in Modified Radical Mastectomy for Post-Operative Pain Relief

AbstractBackground: Breast cancer is women's most common malignancy and has steadily increased incidence over the past decade. Despite recent breast cancer surgery advances, this procedure is often associated with postoperative pain, nausea, and vomiting, contributing not only to increased patient discomfort, but also to extended hospital stays and associated costs. A significant risk factor for the development of chronic pain following breast surgery is acute postoperative pain due to insufficient or ineffective pain control.Aim of Study: Assess the effectiveness of ultrasound guided PECS block to thoracic epidural blockage in breast cancer surgery to minimize postoperative pain, analgesic requirements and complications.Patients and Methods: After Ethical Committee at Al-Zahraa University Hospital accepted, 50 female patients, age from 42-67 years, were included in the study with ASA physical status I-II patients scheduled for unilateral modified radical mastectomy and axillary lymph node dissection, randomly blind assigned, split two different groups of 25 patients in each, Thoracic epidural block (TEB group); patients were received a single shot of 15ml of 0.25% bupivacaine between T4 and T5 vertebrae. PECS group: Ultrasound-guided PECS block, the patients were received 0.25% of 10ml bupi-vacaine injected at fiscal plain between the pectoral s major and minor muscles (PECS I) also 0.25% of 20ml of pectoral-minor injection above the Serratus anterior muscle (PECS II). Primary outcome in the form of post-operative visual analogue scale (VAS) to assess pain in density. Secondary outcome in the form heart rate (HR), mean blood pressure (MBP) intra operative fentanyl consumption and, first request of analgesia, total amount of pethidine/24 hrs. were recorded and other any post-operative complication were assessed.Results: The patients of TEB group, the mean heart rate and the mean MAP were highly significant decrease than PECS group. Intra operative fentanyl consumption as statis-tically significant decrease in PECS group compared with TEB group. VAS pain scores was high statistically significant decrease immediately and at 4 hrs. post-operative in PECS group than TEB group. The time for the first request for pethidine was highly significantly longer in the PECS group than in TEB group. Amount of pethidine at 24 hrs. was high significant lower in PECS group in comparison with TEB group. Complications recorded as hypotension and bradycardia post-operative nausea and vomiting (PONV) occurrence in TEB group.Conclusion: PECS blocks provided superior post-operative analgesia, low pain scores and less total pethidine consumption in the early postoperative period and maintained hemodynamic stability compared to TEB.

Comparative Clinical Study between Preoperative Oral Administration of Paracetamol, Celecoxib and Pregabalin on Postoperative Pain in Gynecological Laparoscope

Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively.

Comparative study between the effect of opioid-free anesthesia versus opioid-based anesthesia in morbid obese patients

Introduction Multimodal techniques for pain management involve using two or more analgesic drugs with different mechanisms of action working in synergy. These drugs may be given by either the same or different routes of administration preoperatively, intraoperatively, and/or postoperatively [1]. By targeting different pain pathways within the central and peripheral nervous systems, the use of multiple agents with different mechanisms of action allows for lower doses of individual agents, which in turn results in a lower risk of adverse effects. Aim We have conducted this study to compare the effect of opioid-free anesthesia (OFA) with opioid-based anesthesia (OA) on postoperative pain relief as a primary outcome and hemodynamic variables, including mean arterial blood pressure (MAP), heart rate (HR) and oxygen saturation%, total pethidin consumption 24 h postoperatively, and postoperative complications developed in postanesthetic care unit (PACU), such as hypoxia, shivering, nausea, and vomiting as secondary outcomes in morbid obese patients. Patients and methods A total of 40 patients (morbidly obese) aged 25–50 years with BMI of at least 35, having ASA status II scheduled for laparoscopic cholecystectomy were divided into two groups in a randomized controlled fashion: group 1 was the OA group (n=20), which received general anesthesia with propofol, muscle relaxant (rocuronium), and fentanyl as the main anesthetic adjuvant and analgesic, and group 2 was the OFA group (n=20), which received general anesthesia with propofol, muscle relaxant (rocuronium), dexmedetomidine, magnesium sulfate, and lidocaine as anesthetic adjuvant and analgesic. Hemodynamic variables such as MAP, HR, and oxygen saturation% were recorded preoperatively, postintubation, and every 15 min till the end of surgery. Postoperative visual analog scale done immediately postoperatively, and at 2, 6, 12, and 24 h postoperatively; total pethidine consumption in 24 h postoperatively; and postoperative complications developed in PACU such as hypoxia, shivering, nausea, and vomiting were also recorded for each patient. Results There were no differences between the two groups regarding demographic data. There was a statistically significant decrease in HR in OFA group compared with OA group from 15 min after induction to 15 min postoperatively and a statistically significant decrease in MAP in group II (OFA) compared with group I (OA) from 30 min after induction to 90 min postoperatively in PACU. Visual analog scale for pain postoperatively was lower in nonopioid group than opioid group. The postoperative pethidine consumption was significantly lower in OFA versus OA. Postoperative complications like nausea, vomiting, shivering, and hypoxia were significantly higher in the OA group. Conclusion OFA provides postoperative pain relief and intraoperative hemodynamic stability without significant associated adverse effects compared with OA.

Clinical Comparative study between subcutaneous Continuous Analgesia versus continuous transversus abdominis plane block post caesarian section

Background: post cesarean section pain is associated with a variety of unfavorable post-operative consequences; affect both mother and the newborn, especially the first 48 h after delivery. The pain can be improbable, disrupting mother/child bonding and also affects mental, chest, heart problems, and prolong the hospital stays. Aim of the Work: to compare the efficacy and safety of bilateral continuous transversus abdominis plane (TAP) block versus continuous wound infiltration for pain relief after surgery. Patients and Methods: this study was conducted on forty patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective CS were enrolled in this controlled study. Information about the study was explained comprehensively both orally and in written form to the patients. All patients gave written informed consents prior to their inclusion in the study. Results: there was no difference between TAP block & CWI as regarding pain during rest but TAP block was more effective during movement than CWI, opioid consumption was much less in TAP group than in CWI group and the time of first analgesia request was earlier in CWI group than in TAP group. Conclusion: both TAP block & CWI provided post-operative analgesia but USG TAP block increased the time to first analgesic request, reduces the total pethidine consumption with hemodynamic stability and decreases the incidence of adverse effects in patient undergoing caesarian section compared to continuous wound infiltration.

Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine.

Background:The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine.Purpose:The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery.Methods:This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes.Results:In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively.Conclusions:Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.

Efficacy of forearm intravenous regional anesthesia through comparison of concentration and volume of lidocaine at a dose of 2 mg/kg for hand and wrist surgeries

Aim This study aimed to evaluate the efficacy of intravenous regional anesthesia (IVRA) as regards volume versus concentration of lidocaine in surgeries. Patients and methods The study enrolled 46 patients of ASA physical status I and II, aged 18-65 years, undergoing IVRA using lidocaine 2% at a dose of 2 mg/kg plus fentanyl 1 mg/kg diluted with a volume of 25 ml normal saline [the concentration group (group C, n = 23)], or 2 mg/kg lidocaine 2% plus fentanyl 1 mg/kg diluted with a volume of 40 ml normal saline [the volume group (group V, n = 23)]. The total supplemental systemic fentanyl intraoperatively and rescue pethidine consumption during the first 4 h postoperatively were recorded. The success rate of the IVRA block was also recorded. First and second tourniquet pain times, as well as times of onset and recovery of sensory and motor block, were calculated. Visual analogue scale score for evaluation of the pain resulted from the surgical stimulation was recorded. The side effects of the drugs and complications of the technique were also recorded. Results Intraoperative supplemental fentanyl dose was significantly higher in group V compared with group C. The total pethidine consumption during the first 4 postoperative hours showed nonsignificant difference between patients of the two groups, with a mean of 48.27 ± 9.75 mg in group C versus 52.42 ± 13.83 mg in group V. Hemodynamic parameters such as heart rate and mean arterial pressure were comparable in the two groups. The time to first call of analgesia was significantly prolonged ( P Conclusion IVRA with lidocaine at a dose of 2 mg/kg in 25 ml volume of normal saline represented an effective block and reduced the second tourniquet pain, increased the second tourniquet tolerance, and significantly decreased intraoperative supplemental fentanyl in comparison with the same dose in 40 ml volume of normal saline.

Effect of preemptive intravenous ketorolac and bupivacaine infiltration on post operative pethidine consumption - a comparative study

Background: Preemptive analgesia significantly reduces postoperative analgesic requirement. Multi modal approach for preemption has greater range of benefit and its use in treating postoperative pain has gaining popularity. Objectives: To observe the effect of preemptive bupivacaine infiltration and intravenous ketorolac on postoperative pethidine consumption in single and multiple preemptive techniques. Methods: One hundred and twenty patients of ASA physical status I&amp;II requiring lower abdominal surgery under general anaesthesia were randomly allocated in four groups. Gr- A received bupivacaine infiltration and ketorolac injection, Gr-B received intravenous Ketorolac injection, Gr-C bupivacaine infiltration and Gr- D received nothing regarded as Control group. Data were analyzed by student’s t test, ANOVA and chi-square test as appropriate. Results: Patients characteristics, duration of surgery, haemodynamic status were comparable in four groups. Pain intensity in VAS was significantly reduced in Gr-A (p&lt;0.00) than other three groups. Total pethidine consumption was also reduced significantly in Gr-A (p&lt;0.05). Conclusion: Preemptive analgesics using in multiple modes gives better postoperative analgesia and patient comfort and less postoperative complications. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18155 Journal of BSA, 2010; 23(1): 25-29