Opioid saving strategy: bilateral single-site thoracic paravertebral block in right lobe donor hepatectomy

Postoperative analgesia after hepatectomy remains a challenge, mainly because of limited therapeutic index of the conventional opioids. The aim of this study is to evaluate the efficacy of bilateral single-site thoracic paravertebral block for the management of postoperative pain following right lobe donor hepatectomy [RLDH] using a prospective, randomized and controlled study design. Twenty four adult patients, aged 18-50 years, ASA-I-II, of both sexes scheduled for right lobe donor hepatic resection, were enrolled in this study. Patients were randomly allocated into 2 equal groups of 12 patients each. Before induction of general anesthesia, all patients received bilateral single-site thoracic paravertebral injection at the level of T7-8 in the sitting position. Patients of Group B were injected with 25 mL of bupivacaine 0.25% with epinephrine 1:200.000 on each side. Patients of Group P were injected with 25 mL of 0.9% NaCl [placebo]. General anesthesia was standardized in all patients. Postoperative pain score, analgesic requirements and the incidence of postoperative nausea and vomiting Bilateral single-site thoracic paravertebral block significantly decrease the pain visual analogue score parameters. Total morphine consumption in the first 24 hours postoperatively was decreased by more than 50% in Group B [21.76 +/- 6.8 mg compared to 44.12 +/- 9.2 mg in Group P].There was significant prolongation in time to rescue analgesia [104.08 +/- 2.04 mm in Group B, and 31.5 +/- 6.14 mm in Group P]. Postoperative nausea and vomiting was significantly less in the active Group B when compared to the controlled Group P. Bilateral single-site thoracic paravertebral block is easy, safe and efficient technique for postoperative pain management in patients undergoing right lobe donor hepatectomy

Effect of preoperative hydration on postoperative nausea and vomiting

Postoperative nausea and vomiting [PONV] remains one of the most common postoperative complications, causing discomfort, patient dissatisfaction, delayed discharge and increased costs. Our aim: Was to determine whether preoperative IV rehydration with a balanced salt solution would decrease the incidence of PONV in patients at increased risk for these symptoms. Sixty female patients [physical status ASA class I and II] presenting for laparoscopic cholecystectomy were included in the study and were instructed to fast from the previous midnight. Patients were randomly assigned to either a control group [group 1] or a high infusion group [group 2] according to the volume of fluid infused preoperatively. Patients of control group [group 1] didn't receive pre-operative fluid bolus, whereas patients of the high infusion group [group 2] received pre-operative fluid bolus of Ringer's solution in a volume of 1.5 mL kg[-1] h[-1] of fasting time. This volume was completely administered in group 2 before induction of anesthesia, over approximately 30 min, in the preoperative holding area. The incidence of PONV, was assessed by a blinded investigator during the stay in post anesthesia care unite [PACU], and at 6, 12 and after 24 hrs postoperatively. Post-operative adverse effects [thirst, pain and drowsiness], and the need for supplemental antiemetic and analgesic therapy were also recorded during stay in PACU and for 24 hrs. The incidence of PONV and the need for anti-emetics were significantly reduced in the high volume infusion group at all time intervals. The high volume infusion group also had decreased postoperative thirst, drowsiness, and pain scores and required less supplemental analgesia. Preoperative hydration effectively reduces the incidence of PONV, antiemetic and analgesic requirements in patients with increased risk of PONV

Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery- granisetron alone vs granisetron combined with dexamethasone / droperidol

Laparoscopic bariatric surgeries are associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of granisetron either alone or in combination with droperidol or dexamethasone, for the prevention of post operative nausea and vomiting [PONV] in patients undergoing laparoscopic bariatric surgeries. In a randomized, double-blind, placebo-controlled trial, 120 patients received either Granisetron 1 mg, Granisetron 1 mg plus Droperidol 1.25 mg, Granisetron 1 mg plus Dexamethasone 8 mg or Placebo [saline], intravenously immediately before induction of anesthesia. Perioperative anesthetic care was standardized in all patients. Patients were then observed for 24 hours after administration of the study drugs. The incidence of PONV was 30% with granisetron alone, 30% with granisetron plus droperidol, 20%, with granisetron plus dexamethanone, and 67% with placebo [P < 0.05; overall Fisher's exactprobability test]. The incidence of adverse events was not different among the 4 groups. Graniserton is effective and safe drug for reducing the incidence of PONV in patients undergoing bariatric surgeries, and becomes highly effective when combined with dexamethasone

Bilateral superficial cervical plexus block alone or combined with bilateral deep cervical plexus block for pain management after thyroid surgery

Patients undergoing thyroid surgery need postoperative pain management. Bilateral superficial cervical plexus block [BSCBs] has been shown to improve postoperative analgesia. The objective of this study was to assess its analgesic efficacy in the first 24 hours after thyroid surgery alone and when combined with bilateral deep cervical plexus block [BDCBs]. We performed a prospective randomized and controlled study that compared 3 equal parallel groups, 12 patients each: Group A, received [BSCBs] before surgery and under general anaesthesia with 10 ml of bupivacaine 0.5% and epinephrine 1:200.000 in each side. Group B received [BSCBs] as in group A with [BDCBs] with 5 ml bupivacaine 0.5% and epinephrine 1:200,000 at the level of C3. Group C: received general anaesthesia without any block. Postoperative pain was assessed by the use of a 0-10 numeric rating scale. All patients received paracetamol every 6 hours. Morphine was administered following a standardized protocol if the numeric rating scales was 4 or higher. The main outcome variables were the proportion of patients given morphine during the 24 hours postoperatively, pain intensity scores, and total morphine consumption. There was no significant difference among the 3 groups as regards their demographic data. Both groups A and B were significantly superior to the controlled group C as regards percentage of patient required morphine, pain scores and postoperative morphine consumption. In comparison between groups A and B, there was no significant difference between the 2 groups as regards the main outcome variables. [P < 0.05]. Bilateral deep cervical plexus block does not add significant analgesic efficacy or has a narcotic saving strategy when combined with bilateral superficial cervical plexus block for pain control after thyroid surgery

Propacetamol versus placebo for management of acute postoperative pain after elective tonsillectomy in children

The analgesic efficacy and safety of propacetamol, an injectabie prodrug of acetaminophen, was assessed versus placebo after elective tonsillectomy operation in children. Using a double-blind, randomized parallel group design, 70 children aged 6-12 years were included to evaluate the effect of a single iv infusion of 40 mg/kg propacetamol versus a single infusion of 100 ml normal saline [placebo] given at the recovery room. Analgesic efficacy was assessed on pain scores rated on a four-points verbal scale, a five-points visual scale [faces] and a four-points pain relief verbal scale; before administration [TO] and 0.25, 0.5, 1, 2, 3, 4, 5 and 6 hours after the infusion. The global efficacy was rated on a five-point scale at the end of the study. Rescue medication was allowed freely and the time for re-medication as well as the occurrence of any side effects was recorded. Propacetamol was statistically superior to placebo on all assessment criteria. The global final efficacy evaluation demonstrated 12 patients in the propacetamol group with good and very good scores compared to only one patient in the placebo group. Rescue medication was used in 40% of patients in the propacetamo! group versus 83% in the placebo group. No serious side effects were recorded in both groups and pain at the infusion arm was noticed in 4 patients with propacetamol and 2 patients in the placebo group [P> 0.05]. We concluded that, although propacetamol 40 mg/kg infusion may provide greater pain relief than placebo in children after tonsillectomy operation without any significant adverse effects, it is better to be used as a complementary drug to other analgesics in the treatment of moderate to severe postoperative pain

Analgesic efficacy and opioid saving strategy of etoricoxib [an oral cyclooxygenase 2 selective inhibitor] in postoperative pain relief after gynecological laparotomy

Non-opioid analgesics are often used to supplement opioids for the management of postoperative pain This study examined the opioid-spanng effectiveness, analgesic efficacy and tolerability of preoperative administration of the oral cyclooxygenase 2 selective inhibitor, etoricoxib. in gynecological iaparotomies. 60 patients ASA physical status 1 and 11 were randomly assigned into 2 equal groups [A and B]. 30 patients each All patients received Midazolam 10-15 mg orally on call to OR. only group A received tablet Etoricoxib 120 mg 1 hour before surgery In the OR. all patients started crystalloid infusion, standard monitoring Induction of anaesthesia was achieved with Fentanyl 2 mg/kg. piopofoi 2 mg/kg and rocuronium 0.6 mg/kg. Anaethesia was maintained with Sevoflurane 1-2% in nitrons oxide achieved maintenance and oxygen [ratio 2:1] with mechanical ventilation to maintain end expiratory CO., between 35-40 mmhig After trachea! extubation. patients were transferred to the PACU where postoperative analgesia was provided by PCA morphine. SpO HR MAP. VAS Sedation score, total amount of morphine and Ondansteron consumption in the first 24 hours after surgery were recorded and analyzed. There were no significant difference between the two treatment groups as regards the demographic data and the base line haemodynamic parameters. In the postoperative period SpO2 in group A was significantly higher than in group B. and there was no significant difference between the two treatment groups as regard HR and MAP VAS and Sedation score were significantly higher in group B than in group A. Total morphine consumption was 36 3% less in group A in comparison to group B with a significantly less Ondansteron consumption in group A in comparison to group B Administration of etoricoxib with PCA morphine resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirements, lower pain scores and less opioid side effects

Spinal ropivacaine in fast-track TURP

The addition of fentanyl to spinal ropivacaine anaesthesia has been shown to improve the quality of block, increase duration of sensory block, and provide postoperative analgesia without affecting motor function. in a randomized controlled, double blind study, we examined the efficacy and the adverse effects of three different regimen of spinal anesthesia Forty-five patients scheduled for transuretherai resection of the prostate [TURP] under sudarachnoid anesthesia. Patients were randomly assigned to Group I [G I] hyperbaric bupivacaine 10 mg. Group II [G II] 15 mg heavy ropivacaine, and Group III [G III] ropivacaine 10 mg with 20 micro g fentanyl. Evaluation of the block and side effects were performed after spinal anaesthesia. Three patients in bupivacaine group, three patients in ropivacaine group and one patient in fentanyl group required sedative / analgesic supplementations. Patients of fentanyl group showed significant prolonged sensory block and significant decrease in the motor block. Time to walk was significantly shortened in fentanyl group, it was 150 mm versus 197 and 162 mm in bupivacaine and ropivacaine groups respectively. The visual analogue score for pain at 3, 6 and 12 hours after jntrathecal anaesthesia in G II and III were significantly less than G I. No patient experienced respiratory depression, hypoxemia. hypotension or bradycardia dunng the postoperative penod Pruritus was reported in 12 patients [80%] of fentanyl group, but it was mild and did not necessitate medical treatment. Shivering was significantly less in the patients of fentanyl group. Intratnecal ropivacaine 10 mg plus 20 micro g fentanyl resulted in sufficient analgesia comparable to 15 mg ropivacaine or 10 mg bupivacaine with better analgesia and discharge criteria for fast-track TURP

Propofol versus remifentanil patient controlled sedation for awake craniotomy during epileptic surgeries

Anaesthesia for neurosurgical procedures, specificaity craniotomies requiring patient participation presents a challenge to both the neuroanaesthesiologist and the neurosurgeon Despite the popularity of general anaesthesia for these procedures, there has been a renewed interest in this technique of awake craniotomy due to its definite advantages m specific patient populations. This study evaluate two anaesthetic regimens for propofoi and remifentanil for awake craniotomy in epileptic surgeries. Total drug administered, incidence of complications, sedation score and patient satisfaction were assessed in 20 patients, randomely assigned into 2 equal groups, aged 18-55 years undergoing awake craniotomy for epileptic surgeries. Sedation was induced vis propofol patient controlled sedation in group I and via remifentanil patient controlled sedation in group II. five patients in the remifentanil group versus two patients in propofol group experienced nausea and /or vomiting. Respiratory rate depression, desturation were more frequent in remifentanil group while pain and hypotension were more frequent in propofoi group Both groups achieved a good level of sedation and patient satisfaction. Propofol and remifentanil are almost ideal drugs for conscious sedation during avjake craniotomy

Single-site versus multiple-sites percutaneous thoracic paravertebral block in breast surgery

Alternative forms of anaesthesia in breast surgery have been sought to reduce the untoward effects of general anaesthesia. Unilateral paravertebral nerve blockade has been reported to produce excellent afferent nerve block that overcomes all the disadvantages of general anaesthesia. The aim of the present study was to compare single-site and multiple-sites techniques of thoracic paravertebral block in breast surgery. After written informed consent, sixty women [ASA I, II] were enrolled in this prospective study, randomly allocated to receive either a single-site paravertebral block at the level of T4 [30 women] or multiple-sites paravertebral block at the levels from T1 to T6 [30 women]. The end points of the study were failure rate, complications, haemodynamic parameters, and the post operative analgesic profiles [visual analogue score and opioid requirements]. Failure rate was 6.67% in both groups and without any complications after the block. There was obvious haemodynamic stability in all the way through intra and postoperative periods in all patients with no significant difference between the two studied groups. The two techniques used in this study resulted in low visual analogue scores and low opioid supplementations in the postoperative period with no significant difference between the two groups. Single-site paravertebral block is as multiple-sites paravertebral block as regards efficacy, haemodynamic stability, and post operative analgesic effect in unilateral breast surgery without axillary dissection