Ultrasound Guided Fascia Iliaca Compartment Block Using Either Bupivacaine Or Bupivacaine With Dexmedetomidine For Postoperative Analgesia In Patients With Femur Fractures.

Background: Femur fractures are extremely painful due to the lowest pain threshold of the periosteum among the deep somatic structures. Perioperative Fascia Iliaca Compartment Block (FICB), when administered using a local anesthetic agent, bupivacaine, can reduce morbidity by providing satisfactory pain relief. Dexmedetomidine, an alpha-2 agonist, is known to prolong the local anesthetic effects without causing any significant side effects. We compared analgesic duration of ultrasound guided FICB with bupivacaine alone and bupivacaine with dexmedetomidine for postoperative analgesia. A prospective, randomized, double blinded study was conducted on 50 patientsMaterials And Method: aged 18 to 65 years undergoing femur fracture surgeries. Patients were divided into 2 groups of 25 each. Both groups received USG guided FICB. Group A received 28 ml 0.25% bupivacaine and 2 ml normal saline (NS). Group B received 28 ml 0.25% bupivacaine and 30 mcg dexmedetomidine in NS. Pain scores were assessed every 5 minutes until 15 minutes post FICB, during positioning for subarachnoid block and every 2 hours until 24 hours post-operatively. Total duration of analgesia, cumulative analgesia requested in 24 hours, Ramsay sedation and patient satisfaction scores were recorded. Results: The mean duration of analgesia in Group A was 419.4 ± 115.35 minutes (95%CI: 374.2 – 464.6) and in Group B was 656.6 ± 137.99 minutes (95%CI: 602.5 –710.7), p <0.001. Mean VAS score during positioning for SAB in Group A was 1.60 ± 0.50 and in Group B was 0.96 ± 0.68. USG guided FICB with dexmedetomidine is superior inConclusion: providing prolonged post-operative analgesia in comparison to bupivacaine alone

Effect of Wrist-Ankle Acupuncture on Postoperative Analgesia after Total Knee Arthroplasty / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of wrist-ankle acupuncture (WAA) in pain and functional recovery after total knee arthroplasty (TKA).@*METHODS@#From June to September 2020, 94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group (47 cases) and the sham WAA group (47 cases) by a random number table, receiving real or sham WAA treatment, respectively. The primary outcome measure involved the visual analogue scale (VAS) scores at rest and in motion. The secondary outcomes involved the range of motion (ROM) of the knee joints, straight-leg raising time, postoperative weight-bearing time, sufentanil consumption within 48 h of patient-controlled analgesia (PCA) pump, length of hospital stay, and postoperative complications.@*RESULTS@#The VAS scores on the 3rd, 5th, and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group (P<0.01). The ROM on the 1st, 2nd, and 3rd PODs was significantly higher in the WAA group than that of the sham WAA group (P<0.01). In comparison to the sham WAA group, the sufentanil consumption within 48 h of PCA pump was significantly less in the WAA group (156.3 ± 12.2 µg vs. 128.8 ± 9.8 µg, P<0.01). There was no significant difference in active straight-leg raising time, postoperative weight-bearing time, length of hospital stay, and postoperative complications between the two groups (P>0.05).@*CONCLUSIONS@#WAA could alleviate post-TKA pain, improve knee joint function, and reduce the sufentanil consumption within 48 h of PCA pump. WAA is a safe and effective treatment in the perioperative analgesic management for TKA.

Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block

Abstract Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N (P value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Colorectal Surgery

Background: Transmuscular Quadratus Lumborum Block (TQLB) is a newer modality for postoperative pain management. But, its efficacy after laparoscopic colorectal surgery is little researched. The aim of our trial was to access the analgesic efficacy of TQLB in colorectal surgery.Methods:This study was done in 64 patients posted for colorectal surgery who were divided into two groups of 32 each. TQLB was given bilaterally in group RQ with 20 ml of 0.375% ropivacaine and in group SQ with 20 ml saline. Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary endpoint. Secondary endpoints were total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications.Results:The time required for first analgesic demand was 3.9� 0.8hrs in RQ group and 0.1� 0.2 hrs in group SQ which was statistically significant. The total paracetamol consumption in 24 hours was1.2� 0.4 gm in group RQ and 2.9� 0.7gm in group SQ ,the difference being remarkable.Conclusion:Transmuscular quadratus lumborum block can produce quality analgesia after laparoscopic colorectal surgery. TQLB not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

Comparison of Analgesic Effects of Levobupivacaine (0.25%) versus Bupivacaine (0.25%) using Ultrasound Guided Transversus Abdominis Plane Block in Total Abdominal Hysterectomy under General Anesthesia — An Interventional Study

Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.

Meta-analysis of the effectiveness and safety of parecoxib sodium for gynecological surgery and postoperative analgesia / 中国药房

OBJECTIVE To systematically evaluate the effectiveness and s afety of parecoxib sodium for gynecological surgery postoperative analgesia ，and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ， Embase，the Cochrane Library ，CNKI，VIP，Wanfang data and SinoMed during the inception to Feb. 16th，2021，randomized controlled trials （RCT） about parecoxib sodium （trial group ） versus 0.9％ sodium chloride injection （control group ） for gynecological surgery and postoperative analgesia were collected. After screening literatures ，extracting data and evaluating the quality of literatures with modified Jadad scale ，Meta-analysis，sensitivity analysis and publication bias analysis were performed by using RevMan 5.3 software. RESULTS A total of 14 RCT were included ，involving 1 120 patients. The results of Meta-analysis showed that visual analogue scale （VAS）score at 4 h after operation [MD ＝－1.65，95％CI（－2.48，－0.82），P＝0.000 1]，VAS score at 6 h after operation [MD ＝－1.03，95％CI（－1.60，－0.45），P＝0.000 5]，VAS score at 12 h after operation [MD ＝－0.98， 95％CI（－1.38， －0.59），P＜0.000 01]，the proportion of postoperative analgesia requirements [OR ＝0.14，95％CI（0.04， 0.50），P＝0.003] and the dosage of morphine [MD ＝ －17.75， com 95％CI（－20.93，－14.56），P＜0.000 01] in trial group were significantly lower than control group. There was no statistical significance in the incidence of nausea between 2 groups [OR＝ 0.68，95％CI（0.43，1.08），P＝0.10]. The results of sensitivity analysis showed that the above results were basically stable. The results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS Parecoxib sodium is effective and safe for gynecological surgery and posto perative analgesia.

Intravenous lidocaine infusion for the treatment of acute pain in the pediatric intensive care unit: case series / Infusión de lidocaína endovenosa para el tratamiento de dolor agudo en la unidad de cuidado intensivo pediátrico: serie de casos

Abstract Introduction: The use of intravenous lidocaine infusion has increased over the past decade as part of a multimodal approach to analgesia in adults; however, information about its safety and tolerability in the pediatric population is limited. Methods: Acute pain management using lidocaine infusion in eleven patients treated in the pediatric intensive care unit. Results: Five cases of postoperative abdominal pain and six cases of non-operative abdominal pain. Two cases were cancer patients affected by neutropenic colitis. Analgesic control achieved was good. Conclusion: Lidocaine infusions are apparently a safe option for the management of acute pain, either post-operative or not, in the pediatric population.

Resumen Introducción: El uso de la infusión de lidocaína endovenosa ha aumentado en la última década como parte de un enfoque analgésico multimodal en los adultos; sin embargo, se dispone de información limitada sobre su seguridad y tolerabilidad en la población pediátrica. Métodos: Se presentan once casos de manejo de dolor agudo con lidocaína en infusión tratados en unidad de cuidado intensivo pediátrico. Resultados: Cinco casos fueron postoperatorio abdominal y seis casos tenían dolor abdominal no postoperatorio. Dos pacientes tenían cáncer y cursaban con colitis neutropénica. El control analgésico alcanzado fue bueno. Conclusión: Las infusiones de lidocaína parecen ser una opción segura para el manejo del dolor agudo ya sea posquirúrgico o no en la población pediátrica.

Analgesia posoperatoria en la videolaparascopía de urgencia mediante irrigación de bupivacaína intraperitoneal / Posoperative analgesia in emergency videolaparoscopy through intraperitoneal bupivacaine irrigation

Introducción: La videolaparascopía es un procedimiento frecuente en los servicios de urgencias de cirugía general. El dolor agudo después de estas intervenciones es de naturaleza compleja y requiere un tratamiento analgésico efectivo. Objetivo: Determinar la utilidad del empleo de bupivacaína intraperitoneal en el alivio del dolor posoperatorio en la videolaparascopía de urgencia. Métodos: Se realizó un estudio longitudinal prospectivo y analítico en 80 pacientes mayores de 18 años, anunciados para videolaparoscopía bajo anestesia general orotraqueal en el servicio de urgencias del HMC: Dr. Luis Díaz Soto, desde septiembre de 2016 hasta septiembre de 2018. Los pacientes fueron divididos aleatoriamente en dos grupos de 40 cada uno. Al grupo 1 se aplicó lidocaína transdérmica preincisional en las incisiones de piel y, al término de la cirugía, se irrigaron ambos hemidiafragmas con bupivacaína al 0,25 por ciento. Al grupo 2 se le administró dosis preincisional de analgésicos endovenosos solamente. Resultados: Predominó significativamente el sexo femenino sin diferencia entre grupos. La analgesia posoperatoria fue mejor en el grupo 1 estadísticamente significativa a las 4, 8 y 12 horas. Los requerimientos de analgesia de rescate fueron menores en el grupo 1 (p=0,0024). No se reportaron efectos adversos. Conclusiones: La administración de lidocaína transdérmica preincisional y la instilación de bupivacaína intraperitoneal al final de la videolaparoscopía de urgencia, reduce significativamente el dolor en las primeras horas de posoperatorio. Su aplicación es sencilla, fácil y segura sin evidencias de efectos adversos(AU)

Introduction: Videolaparoscopy is a frequent general surgery procedure in emergency services. Acute pain after these interventions is complex in nature and requires effective analgesic treatment. Objective: To determine the usefulness of intraperitoneal bupivacaine in the relief of postoperative pain in emergency videolaparoscopy. Methods: A prospective, analytical and longitudinal study was carried out in eighty patients older than eighteen years old, announced for videolaparoscopy under orotracheal general anesthesia in the emergency department of Hospital Militar Central Dr. Luis Díaz Soto, from September 2016 to September 2018. The patients were randomly divided into two groups of forty individuals each. Group 1 was applied pre-incisional transdermal lidocaine on skin incisions and, at the end of surgery, both hemidiaphragms were irrigated with bupivacaine 0.25 percent. Group 2 received pre-incisional doses of intravenous analgesics only. Results: The female sex predominated significantly, without difference between the two groups. Postoperative analgesia was better in group 1, insofar it was statistically significant at four, eight and twelve hours. Rescue analgesia requirements were lower in group 1 (p=0.0024). No adverse effects were reported. Conclusions: The administration of pre-incisional transdermal lidocaine and the instillation of intraperitoneal bupivacaine at the end of emergency videolaparoscopy significantly reduces pain during the first hours after surgery. Its application is simple, easy and safe, without evidence of adverse effects(AU)

Analgesia preventiva versus analgesia postoperatoria con paracetamol + ketorolaco en colecistectomía laparoscópica / Preventive versus postoperative analgesia with paracetamol + ketorolac in laparoscopic cholecystectomy

Resumen: Introducción: La analgesia preventiva es la administración de un fármaco o realización de una intervención capaz de inhibir o bloquear la respuesta dolorosa con la finalidad de prevenir el dolor asociado a un procedimiento quirúrgico. Objetivo: Identificar si existen diferencias en el control del dolor postoperatorio utilizando analgesia preventiva versus analgesia postoperatoria, manejado con paracetamol + ketorolaco en pacientes sometidos a colecistectomía laparoscópica electiva. Material y métodos: Ensayo clínico controlado, comparativo, aleatorizado, longitudinal, unicéntrico, prospectivo, homodémico, doble ciego; con 70 pacientes divididos en dos grupos. En el grupo 1 que recibió analgesia preventiva se usó paracetamol + ketorolaco y en el grupo 2 se utilizó el mismo esquema de manera postquirúrgica inmediata. Se midió tensión arterial, frecuencia cardíaca, escala verbal numérica del dolor y presencia de efectos secundarios de los fármacos en distintos momentos. Prueba estadística T de Student con significancia estadística de p < 0.05. Resultados: A los 60 minutos la tensión arterial diastólica en el grupo 1 tuvo diferencia de medias -4.20 con p = 0.027 y la escala verbal numérica presentó diferencia de medias de -0.71 y p = 0.002. A las cuatro horas la tensión arterial diastólica mostró diferencia de medias de -3.5 y p = 0.033. Las náuseas se constataron en 2.9% para el grupo 1 y 8.6% para el grupo 2. Conclusiones: Existe una mejor respuesta al dolor en aquellos pacientes que reciben un esquema de analgesia preventiva en comparación a los que se les administra un esquema de analgesia postquirúrgica inmediata.

Abstract: Introduction: Preventive analgesia is the administration of a drug or performance of an intervention capable of inhibiting or blocking the painful response in order to prevent the pain associated with a surgical procedure. Objective: To identify whether there are differences in postoperative pain control using preventive analgesia versus postoperative analgesia, managed with paracetamol + ketorolac in patients undergoing elective laparoscopic cholecystectomy. Material and methods: Controlled clinical trial, randomized, longitudinal, unicentric, prolective, homodemic, double blind; 70 patients divided into two groups. group 1 received preventive analgesia using paracetamol + ketorolac and group 2 same scheme in an immediate postsurgical manner. Bloodpressure, heartrate, numerical verbal scale of pain and presence of side effects of drugs at different times were measured. Student's t-test with statistical significance of p < 0.05. Results: At 60 minutes the diastolic blood pressure in group 1 had difference of means -4.20 with p = 0.027 and numerical verbal scale presented difference of means of -0.71 and p = 0.002. At four hours diastolic bloodpressure showed difference of means of -3.5 and p = 0.033. Nausea was reported in 2.9% for group 1 and 8.6% for group 2. Conclusions: There is a better response to pain in those patients who receive a preventive analgesia scheme compared to those who are administered an immediate post-surgical analgesia scheme.

The need for opioid in the postoperative analgesia of dogs undergoing hemilaminectomy due to intervertebral disc extrusion

ABSTRACT: The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.

RESUMO: O objetivo deste estudo foi avaliar a analgesia pós-operatória de protocolos com e sem o opioide metadona em cães com extrusão de disco intervertebral submetidos à descompressão cirúrgica. Dezesseis cães paraplégicos com presença de nocicepção foram submetidos à hemilaminectomia/fenestração de disco e distribuídos aleatoriamente em dois grupos. No Grupo I (G1), o protocolo analgésico consistiu em metadona, meloxicam e dipirona e, no Grupo II (G2), por meloxicam e dipirona. Os pacientes foram avaliados de maneira cega por dois avaliadores, com base na escala visual analógica (EVA) e na escala simplificada composta de dor de Glasgow (CMPS-SF). As avaliações ocorreram a cada 2 horas durante as primeiras 24 horas de pós-operatório e, por mais 24 horas, a cada 4 horas. Não houve diferença estatística entre os grupos avaliados em relação à escores de dor e nem a necessidade de resgate analgésico. Ambos os protocolos promoveram analgesia nas 48 horas iniciais de pós-operatório, demonstrando não haver a necessidade do uso de opioide em cães submetidos à hemilaminectomia e fenestração de disco.

The need for opioid in the postoperative analgesia of dogs undergoing hemilaminectomy due to intervertebral disc extrusion / A necessidade de opioide na analgesia pós-operatória de cães submetidos à hemilaminectomia devido à extrusão do disco intervertebral

The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.(AU)

O objetivo deste estudo foi avaliar a analgesia pós-operatória de protocolos com e sem o opioide metadona em cães com extrusão de disco intervertebral submetidos à descompressão cirúrgica. Dezesseis cães paraplégicos com presença de nocicepção foram submetidos à hemilaminectomia/fenestração de disco e distribuídos aleatoriamente em dois grupos. No Grupo I (G1), o protocolo analgésico consistiu em metadona, meloxicam e dipirona e, no Grupo II (G2), por meloxicam e dipirona. Os pacientes foram avaliados de maneira cega por dois avaliadores, com base na escala visual analógica (EVA) e na escala simplificada composta de dor de Glasgow (CMPS-SF). As avaliações ocorreram a cada 2 horas durante as primeiras 24 horas de pós-operatório e, por mais 24 horas, a cada 4 horas. Não houve diferença estatística entre os grupos avaliados em relação à escores de dor e nem a necessidade de resgate analgésico. Ambos os protocolos promoveram analgesia nas 48 horas iniciais de pós-operatório, demonstrando não haver a necessidade do uso de opioide em cães submetidos à hemilaminectomia e fenestração de disco.(AU)

Single Shot Paravertebral Block - A Novel Approach for Post-Operative Analgesia in Breast Surgeries

Advancements in diagnostic sciences have led to increased frequency in detection of cases of breast cancer. After confirmation, majority of these patients undergo definitive surgeries commonly Modified Radical Mastectomy or Lumpectomy under general anaesthesia. In addition to inadequate pain control there is increased incidence of nausea and vomiting during first 24 hrs. of the post-operative period with GA. Parenteral narcotic used routinely in postoperative period further increases nausea and vomiting. The large number of patients hospitalized annually for breast cancer surgeries results in heavy costs and long hospital stays. Regional anaesthesia using prep-incisional paravertebral block (PVB) maybe an ideal alternative to GA alone for breast cancer surgery. Benefits include prolonged postoperative pain relief, reduction in postoperative nausea and vomiting and has potential for early discharge. It results in unilateral sensory, motor and sympathetic blockade with additional advantages of lower side effect profile, early mobilization and fewer contraindications. We wanted to study the efficacy of paravertebral block for postoperative pain relief in breast surgeries. METHODSA prospective, randomized, comparative study involving 60 adult female patients posted for Ca breast surgery was conducted. One group received pre-incisional PVB with GA (group A) and another received GA alone (group B). The efficacy of analgesia and PONV were assessed using Visual Analogue Scale and Numeric Rating Score respectively at T1, 2, 3, 4, 5, 6, 12, 24, 48 hours. Fentanyl 2 mic / Kg as rescue analgesic and ondansetron 0.1 mg / Kg as antiemetic were given at VAS >/= 4 and NRS >/= 2. Total opioid and antiemetic consumption was noted. RESULTSTotal VAS and NRS scores of Group A was significantly lower than Group B. Also significantly reduced consumption of analgesic and antiemetic was observed in Group A. ∑VASA = (3.37 + 2.76) while ∑ VASB = (19.23 + 3.32) while, Group A ∑NRS = (0.47 + 0.67) and Group B ∑NRS = (5.27 + 1.34). CONCLUSIONSPVB provides significant pain relief with decreased incidence of PONV and has the additional advantage of lesser consumption of opioids and antiemetics in the immediate postoperative period.

Analgesia multimodal una alternativa para el paciente quirúrgico / Multimodal analgesia: an alternative for the surgical patient

Introducción: El dolor posterior a una intervención quirúrgica, es un síntoma frecuentemente observado, no cumple una función útil y el peligro de no tratarlo aumenta la morbilidad y mortalidad posoperatoria. Objetivo: Destacar la importancia de la analgesia multimodal en el control del dolor agudo posoperatorio. Métodos: Revisión en la literatura impresa tanto nacional como internacional, sobre la analgesia y la modalidad multimodal y además, se hizo búsqueda en Internet. En los artículos revisados se obtuvieron distintos aspectos clínicos de la analgesia multimodal y de sus protocolos. Resultados: En la actualidad para mitigar el dolor y alcanzar la máxima expresión en la analgesia posoperatoria se han desarrollado diferentes modalidades analgésicas, aunque de todas ellas solo ha alcanzado mayor grado de recomendación, la analgesia multimodal porque es capaz de conseguir con su efecto sinérgico y con pequeñas dosis, una mejor potencia para producir analgesia y menos efectos adversos. Consideraciones finales: La analgesia multimodal logra un control adecuado del dolor agudo posoperatorio, disminuye las complicaciones posoperatorias y la necesidad de analgesia de rescate, pero todo esto depende del protocolo de analgesia multimodal propuesto, la vía de administración de los fármacos elegidos, sus dosis y el cumplimiento de los intervalos de aplicación(AU)

Introduction: The pain after surgery is a frequently observed symptom, it is not a useful function and the danger of not treating it increases postoperative morbidity and mortality. Objective: To highlight the importance of multimodal analgesia in the control of acute postoperative pain. Methods: It was made a review in the printed literature both national and international on the multimodal analgesia, and in addition, a search in Internet. In the reviewed articles there were obtained different clinical aspects of multimodal analgesia and its protocolization. Results: Nowadays, in order to mitigate the pain and achieve the maximum expression in the postoperative analgesia, there have been developed different analgesic modalities, although of all of them it only has achieved a greater degree of recommendation, the multimodal analgesia because it is capable of achieving with its synergetic effect and with small doses, a better power to produce analgesia and fewer adverse effects. Conclusions: The multimodal analgesia achieved adequate control of acute postoperative pain, decreasing the inherent complications of this state and the need of rescue analgesia. All of the above depends on the proposed protocol of multimodal analgesia, the route of administration of the chosen drugs, their doses and the compliance of the application intervals(AU)

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

Epidural analgesia has been the gold standard, preferred technique for providing postoperative analgesia in lower abdominal, lower limb, pelvic and vascular surgeries. Combination of local anaesthetic agents when used along with opioids, as an adjuvant in epidural analgesia, was found to be effective and synergistic. Ropivacaine is associated with less central nervous system toxicity and cardiotoxicity, and produces less motor blockade. Nalbuphine is an opioid with mixed kappa (κ) agonist and mu (µ) antagonistic properties, when mixed with other opioids, attenuates the µ opioid effect and enhances the κ opioid effect. We wanted to compare the post-surgical analgesic efficacy of epidural nalbuphine (10 mg) when added as an adjuvant to epidural ropivacaine (0.2%-9 ml) in patients undergoing lower abdominal surgeries. Primary objective was to compare the duration of postoperative analgesia and number of rescue analgesics required in 24 hours. Secondary objectives were to compare postoperative haemodynamic variation, quality of analgesia, Visual Analogue Score and side effects if any in both the groups.METHODSIt was prospective observational study conducted after obtaining ethical committee clearance. Sixty patients of ASA class I & II, fulfilling inclusion criteria posted for elective lower abdominal surgeries preferably abdominal hysterectomies divided into two groups, each comprising of 30 patients; group R- Ropivacaine- 0.2% - 9 ml with 1 ml normal saline and group R+N - 0.2%- 9 ml with nalbuphine 1 ml - 10 mg, under spinal anaesthesia with epidural catheter insertion. Parameters like duration of analgesia, number of rescue analgesia, quality of analgesia by patient rated quality of pain management, haemodynamic variation was assessed. Assessment of pain was done by VAS scale, side effects like sedation was assessed by modified Ramsay sedation scale.RESULTSNo demographic variation was found in any group. Mean duration of analgesia was found more in group R+N. Number of rescue analgesia was reduced in group R+N with improved quality of analgesia which was statistically significant. Mean HR was significant in group R+N. No change was noted in SBP, RR, SpO2 in either group. DBP and MAP showed statistically significant difference at 30, 60 min and 15, 30, 60 min respectively. None of the patients in either group had sedation; one episode of vomiting was noted in group R+N with statistically non-significant results.

Comparative study of intrathecal fentanyl, tramadol, clonidine mixed with bupivacaine for peri and post operative pain relief in lower limb and lower abdominal surgery

Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions:Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions: Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.

Evaluación del bloqueo del cuadrado lumbar transmuscular ecoguiado en pediatría / Efficacy of ultrasound-guided transmuscular quadratus lumborum block in children

OBJECTIVES:Transmuscular quadratus lumborum block (TQLB) is a novel regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. The present study evaluated its efficacy on pain intensity and analgesic consumption in children undergoing low abdominal surgery. METHODS: The study included forty patients, aged 1 to 6 years, scheduled for low abdominal surgery (hernia repair or orchiopexy) under general anaesthesia. They were enrolled in two groups: TQLB block plus systemic analgesia (group 1; n = 20) wound infiltration done by the surgeon plus systemic analgesia (Group 2; n = 20). All blocks were performed by the same anesthesiologist under general anaesthesia before surgery. Both groups received the same systemic analgesia protocol. Analgesic consumption (ibuprofen) within the first 24 postoperative hours, pain intensity scores (FLACC scale) at 60 minutes, 2, 6 and 24 hours after surgery, time in which the first analgesia was required, satisfaction levels of the parents (0-10), adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. RESULTS: We found differences between both groups in ibuprofen consumption (80 mg 185 mg; p < 0.05) and pain scores (FLACC) within the first 24 postoperative hours at each interval (p < 0.05 for every point in time analyzed). Time in which the first analgesia was required was longer for the TQLB group (18 10 hours; p < 0.05). Satisfaction levels of the parents were also higher in the first group (p < 0.05). Adverse events related to medication and time to hospital discharge showed similar results. Further investigation comparing the TQLB with different approaches of QLB or conventional TAP block could be interesting and is required in a near future.

INTRODUCCIÓN: El bloqueo del cuadrado lumbar transmuscular (TQL) es una técnica de anestesia regional ecoguiada que demostró ser efectiva en cirugía abdominal abierta y laparoscópica como parte de un esquema multimodal de analgesia postoperatoria. La presente investigación evaluó su eficacia en cirugía de hernia inguinal y testículo no descendido en población pediátrica (de 1-6 años de edad). MATERIALES Y MÉTODOS: El estudio fue diseñado como un ensayo clínico controlado, aleatorizado en 2 ramas: grupo protocolo bloqueo TQL (Grupo 1; n = 20) grupo protocolo infiltración local por cirujano (Grupo 2; n = 20), simple ciego que incluyó a 40 pacientes pediátricos sometidos a una cirugía de hernia inguinal u orquidopexia unilateral. Todos los bloqueos fueron realizados bajo anestesia general antes del inicio de procedimiento quirúrgico. Ambos grupos recibieron el mismo esquema de analgesia endovenosa y oral postoperatoria. Consumo de analgésicos durante las primeras 24 horas (mg de ibuprofeno), intensidad de dolor con escala FLACC a tiempo 1, 2, 6 y 24 horas postoperatorias, tiempo transcurrido a la primera administración de ibuprofeno, escala de satisfacción parental (0-10) e incidencia de náuseas y vómitos fueron evaluados y registrados. Se consideró como significativa una p < 0,05. RESULTADOS: El consumo promedio de ibuprofeno en las primeras 24 horas fue de 80 mg para el grupo bloqueo TQL y de 185 mg para el segundo grupo, diferencia estadísticamente significativa (p < 0,05). El tiempo transcurrido a la primera administración de ibuprofeno fue mayor en el grupo TQL (18 10 horas), p < 0,05. Las escalas de dolor por FLACC a los 60 y 120 minutos y a las 6 y 24 horas. postcirugía fueron menores comparadas con el grupo de infiltración local por el cirujano (p < 0,05 en cada punto de análisis). Las escalas de satisfacción parental mostraron puntajes más elevados para el grupo que recibió el bloqueo TQL (p < 0,05). No se hallaron diferencias significativas en la incidencia de episodios de náuseas y/o vómitos en las primeras 24 horas. postoperatorias (p > 0,2). No se reportaron complicaciones asociadas al bloqueo. CONCLUSIONES: Este estudio muestra que el bloqueo TQL aporta beneficios adicionales respecto al plan de analgesia estándar empleado en cirugía de hernia inguinal unilateral u orquidopexia, disminuyendo el requerimiento de analgésicos y la intensidad de dolor en las primeras 24 horas postoperatorias, así como también incrementando la satisfacción de los cuidadores respecto al estado postoperatorio del niño. Sería interesante llevar a cabo nuevas investigaciones comparando esta técnica con otros abordajes del bloqueo de cuadrado lumbar y con el cuestionado bloqueo TAP convencional.

Progress in Development of Long-acting Delivery Systems for Local Anesthetics and Its Application in Postoperative Analgesia / 中国药学杂志

Patients require proper pain relief after surgery. Local anesthetics are widely used to control postoperative pain, but their clinical application is limited due to short duration of action. In decades of research, the long-acting delivery systems have been applied to local anesthetics, with the purpose of locally and continuously release drugs to prolong the action of drugs and reduce the side effects. The study of local anesthetics long-acting delivery systems has laid foundation for clinical postoperative analgesia.This paper reviewed the research status of long-acting drug delivery systems for local anesthetics, and discussed the advantages and existing problems.

The value of acupuncture-moxibustion in enhance recovery after surgery / 中国针灸

Enhance recovery after surgery (ERAS) is an emerging discipline aiming to reduce perioperative stress response and postoperative complications and promote better and faster recovery of patients. In this study, the potential value and feasibility of acupuncture in ERAS is discussed from three aspects: acupuncture can reduce the demand of perioperative analgesic drugs, improve the postoperative gastrointestinal function, and prevent and treat postoperative complications. The combination of acupuncture and ERAS can better promote the rehabilitation of patients, complement the advantages of acupuncture and ERAS, and promote the development of acupuncture and ERAS.