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Background: The study was to compare intrathecal isobaric ropivacaine and hyperbaric bupivacaine in terms of onset of sensory block, maximum height of sensory block, total sensory duration, onset of motor block, degree of motor block and duration of motor block, quality of anesthesia. Methods: The 100 cases of ASA II undergoing elective lower segment caesarean section were taken for the study and divided into two groups. Group B patients received 2 ml of hyperbaric bupivacaine intrathecally. Group R patients received 2ml of isobaric ropivacaine intrathecally. Patients were evaluated for onset and duration of sensory block, onset and duration of motor block, maximum height of sensory block, quality of anaesthesia, time to request for analgesia, hemodynamic parameters and side effects if any were studied. Results: There were no significant differences between the two groups in mean time to onset of sensory block. Maximum sensory height attained in group B ranged between T4 and T6, where as in group R, it ranged between T2 and T6 which was clinically and statistically highly significant (p<0.001). Total duration of sensory block in group B and in group R, which is not significant (p=0.068). Mean time onset of motor block was 4min in group B and 8 min in group R, (p<0.001). Duration of motor block was 155.20±14.95 min in group B and 94.10±8.31 min group R, which is clinically and statistically significant (p<0.001). Conclusions: Ropivacaine 15 mg (2 ml of 0.75% isobaric ropivacaine) provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to bupivacaine.
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Resumen: Es frecuente que, durante el postoperatorio inmediato, el anestesiólogo se enfrente a pacientes con dolor posterior a una colecistectomía laparoscópica. La nebulización de anestésicos locales en la cavidad abdominal durante la cirugía laparoscópica parece ser un procedimiento prometedor para reducir el dolor en el postoperatorio, y de esta manera disminuir la cantidad de analgésicos y opioides administrados a los pacientes. Presentamos el caso de una mujer de 35 años de edad que fue sometida a una colecistectomía laparoscópica, a la cual se nebulizó ropivacaína en la cavidad abdominal al término de ésta, con lo que se redujo notablemente el dolor en el postoperatorio hasta el egreso de la paciente.
Abstract: It is common for the anesthesiologist to cope with patients in the immediate postoperative period with moderate to severe amount of pain after laparoscopic cholecystectomy. The nebulization of local anesthetics in the abdominal cavity during laparoscopic surgery seems to be a promising procedure to reduce pain in the postoperative period thus reducing the number of analgesics and opioids administered to patients. We present the case of a 35-year-old woman who underwent a laparoscopic cholecystectomy, nebulizing ropivacaine in the abdominal cavity at the end of it, significantly reducing postoperative pain until the patient's discharge.
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Background: Many prior studies have utilized thoracic or lumbar spinal anesthesia with isobaric/hyperbaric bupivacaine or Ropivacaine and opioids for laparoscopic cholecystectomy and have reported variable results. our study is centered around addressing the occurrence of intraoperative right shoulder pain and its potential impact on the need for conversion to general anesthesia.Methods: This is a prospective comparative case series study in which 70 patients scheduled for elective laparoscopic cholecystectomy were. Patients in Group R received 1 ml (1 mg) of Hypobaric Ropivacaine 0.1% at T10-11 followed by 25 mcg fentanyl, and 5 mg Isobaric Ropivacaine 0.5% whereas patients in Group B received 1.5 ml (7.5 mg) Isobaric levo Bupivacaine 0.5% and 25 mcg fentanyl at T8-T10. Patients in both the groups were compared for incidence of shoulder tip pain and Hemodynamic stability.Results: Both techniques achieved satisfactory anaesthesia quality, with similar results in surgical anaesthesia onset. Average surgical duration was 45-75 minutes with average of 60 mins with longer durations in two cases common to both the groups. In group R there was there was no bradycardia or hypotension recorded more than 10% of preinduction vitals. Whereas in group B 2 patients had bradycardia and hypotension more than 10% of preinduction vitals. Conclusions: The T10-11 technique using low-dose (6 mg) hypobaric ropivacaine and isobaric Ropivacaine appears to be superior in terms of shoulder tip pain, and hemodynamic stability compared to the T8-T10 technique using isobaric levo-Bupivacaine alone in higher dose.
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Objective:To explore the effects of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy.Methods:A prospective study was conducted on 120 obese patients who underwent laparoscopic sleeve gastrectomy at the Puren Hospital Affiliated to Wuhan University of Science and Technology from July 2020 to July 2022. According to the random number table method, all patients were divided into a control group, a low concentration group, and a high concentration group, with 40 cases in each group. All three groups underwent ultrasound-guided transverse abdominis plane block after general anesthesia induction. The control group was injected with physiological saline, while the low concentration group and high concentration group were injected with 0.25% and 0.50% ropivacaine, respectively. Stress response indicators before and after surgery in three groups [adrenaline (E), cortisol (Cor), free thyroxine (FT4), and C-reactive protein (CRP)], hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR)], glucose and lipid metabolism indicators [fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hour PBG), glycated hemoglobin (HbA 1c), total cholesterol (TC), and triglycerides (TG)] and Visual Analog Scale (VAS) score were compared before and after surgery. Results:On the 1st day after surgery, the levels of E, Cor, FT4, CRP, FBG, 2-hour PBG, HbA 1c, TC, and TG in the high concentration group were lower than those in the control group and low concentration group (all P<0.05); 15 minutes after anesthesia and 2 hours after surgery, the MAP and HR of the high concentration group were higher than those of the control group and the low concentration group (all P<0.05); At 6, 12, and 24 hours after surgery, the VAS score of the high concentration group was lower than that of the control group and the low concentration group (all P<0.05); There was no statistically significant difference in the incidence of airway reactions during anesthesia induction among the three groups ( P>0.05). Conclusions:In laparoscopic sleeve gastrectomy, administering 0.50% concentration of ropivacaine ultrasound-guided plane block of the transverse abdominis muscle has a strong postoperative analgesic effect, which can improve E, Cor, FT4, and CRP levels, and is worthy of clinical application.
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Objective:To investigate the effects of low-dose ropivacaine combined with sufentanil on the onset time of anesthesia and postoperative rectal traction reflectance in patients undergoing mixed hemorrhoid surgery.Methods:A total of 96 patients who underwent mixed hemorrhoid surgery at the General Hospital of the Southern Theater Command of the Chinese People′s Liberation Army from January 2020 to June 2021 were selected. They were randomly divided into a control group and an observation group using a random number table method, with 48 cases in each group. The control group was anesthetized with low-dose ropivacaine; The observation group was anesthetized with low-dose ropivacaine combined with sufentanil. The anesthesia effect, hemodynamic changes, pain score, bleeding score, postoperative rectal traction reflectance, and incidence of adverse reactions were compared between two groups of patients.Results:Compared with the control group, the observation group had a shorter onset time of anesthesia ( P<0.05) and a longer duration of anesthesia maintenance ( P<0.05). Before surgery, there was no statistically significant difference in heart rate and mean arterial pressure between the two groups of mixed hemorrhoid patients (all P>0.05); After surgery, both groups of patients had an increase in heart rate, a decrease in mean arterial pressure, and a more significant change in the control group (all P<0.05). Before surgery, there was no statistically significant difference in Visual Analogue Scale (VAS) scores and bleeding scores between the two groups of mixed hemorrhoid surgery patients (all P>0.05); After 1 day of surgery, the VAS score and bleeding score of both groups of patients were significantly reduced (all P<0.05), and the observation group showed a more significant decrease (all P<0.05). The postoperative recovery rate of anal contraction in the observation group was higher than that in the control group ( P<0.05), and the rectal traction reflectance was lower than that in the control group ( P<0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group (χ 2=4.667, P<0.05). Conclusions:The combination of low-dose ropivacaine and sufentanil has a definite anesthetic effect on patients undergoing mixed hemorrhoid surgery. It can improve the onset time of anesthesia and postoperative rectal traction reflectivity, alleviate patient pain, and has high safety.
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Objective:To explore the effect of ultrasound-guided femoral nerve block with dexmedetomidine combined with ropivacaine on the pain of patients after knee arthroscopy combined with high tibial osteotomy(HTO).Methods:A total of 97 patients who underwent the treatment of HTO combined with knee arthroscopy in the Ankang central hospital from 2021 to 2022 were selected,and they were divided into the observation group(46 cases)and the control group(51 cases)based on the random number table method.All patients received anesthesiology with ultrasound-guided femoral nerve block.For anesthesia,the observation group used ropivacaine combined with dexmedetomidine,and the control group only used ropivacaine.The visual analogue scale(VAS)scores of them were assessed respectively at rests before surgery,and 3h,6h and 12h after surgery,and the times that patients pressed the button of patient controlled analgesia(PCA)within 4 time intervals included the postoperative 0-6h(T1),6-12h(T2),12-18h(T3)and 18-24 h(T4)were recorded.In addition,the doses of oral opioid drug within postoperative 24 h,48 h and 72 h also were recorded,and the relevant adverse reactions of anesthesiology after surgery were recorded.Results:The pain levels at postoperative 3h,6h and 12h in the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=2.181,3.113,3.073,P<0.05),respectively.The oral dosage of opioids within 24h,48h and 72h after surgery in observation group were significantly less than those in the control group,and the differences were statistically significant(t=6.356,9.778,11.284,P<0.05),respectively.The times of pressing PCA button within T1 and T2 intervals after surgery in observation group were also significantly lower than those in control group,and the differences were statistically significant(t=5.033,2.184,P<0.05),respectively.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,and the difference was statistically significant(x2=4.562,P<0.05).Conclusion:In the surgical anesthesia of knee arthroscopy combined with(HTO),the early analgesic effect of femoral nerve block with dexmedetomidine combined with ropivacaine is significant,and the oral dosage of opioids of patient decreases after surgery,and the risk of occurring adverse reaction that is relative to anesthesia after surgery is less.
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Objective To investigate the effects of different concentrations of morphine in combination with ropivacaine on proliferation,migration,invasion and cell cycle in MDA-MB-231 breast cancer cells.Methods MDA-MB-231 breast cancer cells were inoculated on the culture plate for 24h and randomly divided into 8 groups:Control group(C),ropivacaine 400μg/ml group(R),morphine 3μg/ml group(LM),morphine 30μg/ml group(MM),morphine 300μg/ml group(HM),ropivacaine 400μg/ml group+ morphine 3μg/ml group(R+LM),ropivacaine 400μg/ml+ morphine 30μg/ml group(R+MM),and ropivacaine 400μg/ml+ morphine 300μg/ml group(R+HM).After treaments of MDA-MB-231 breast cancer cells for 24h,these proliferation,migration,invasion and cell cycle were evaluated.Results When using morphine alone,the proliferation inhibitive effect was positively correlated with the concentration of morphine.The proliferation was significantly inhibited by morphine of LM,MM,HM group(P<0.05).When using ropivacaine alone,the proliferation was significantly inhibited(P<0.05).When using morphine combined with ropivacaine,the high concentration morphine group has a synergistic effect with ropivacaine group on proliferation inhibition(P<0.05).When using morphine alone,the migration rate decreases sequentially with the increase of morphine concentration.The migration rate was significantly inhibited by morphine of LM,MM,HM group(P<0.05).When using ropivacaine alone,the migration rate was inhibited(P<0.05).When using morphine combined with ropivacaine,the low and medium concentration morphine group have a synergistic effect with ropivacaine group on migration rate(P<0.05).When using morphine alone,the number of cell invasion was decreased with the concentration of morphine increasing(P<0.05).The MM and HM groups inhibited cell invasion ability.When using ropivacaine alone,the invasiveness of cells was also inhibited(P<0.05).When using morphine combined with ropivacaine,the medium and high concentration morphine groups have a synergistic effect with ropivacaine group on inhibiting cell invasion ability(P<0.05).When using morphine alone,the cell cycle progression was inhibited into G2/M Phase(P<0.05).When using ropivacaine alone,the cell cycle progression was inhibited into G2/M phase(P<0.05).The combination of low concentration morphine and ropivacaine has synergistic effect on arresting at G0/G1 and S phase(P<0.05).Conclusion Morphine combined with ropivacaine inhibits the Proliferation,migration and invasion of MDA-MB-231 breast cancer cells in a dose-dependent manner.
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OBJECTIVE To investigate the effects of 0.2% chloroprocaine combined with ropivacaine on epidural labor analgesia and median effective concentration （EC50） of ropivacaine. METHODS Totally 67 parturients who scheduled for vaginal delivery and required epidural labor analgesia were collected from our hospital from July to October 2023 and randomly divided into RL group （33 cases） and R group （34 cases）. The concentration of ropivacaine was determined by modified Dixon sequential method. RL group was given 0.2% Chloroprocaine hydrochloride injection+Ropivacaine hydrochloride injection+0.4 μg/mL Sufentanil citrate injection； R group was given Ropivacaine hydrochloride injection+0.4 μg/mL Sufentanil citrate injection. EC50 of ropivacaine， analgesic effect during delivery， total dosage of analgesic drugs， analgesic satisfaction score， the incidence of adverse reactions， delivery status， and Apgar score of newborns were observed in two groups. RESULTS EC50 of ropivacaine， onset time， remedial analgesia rate， the incidence of perineal distension and breakthrough pain and total dosage of analgesic drugs of RL group were significantly lower than R group， and analgesic satisfaction score was significantly higher than R group （P＜0.05）. There was no statistical significance in the incidence of adverse reactions such as numbness， weakness， and chills in the lower limbs， or the duration of labor， amount of bleeding， mode of delivery， and Apgar score of newborns between 2 groups （P＞0.05）. CONCLUSIONS For epidural labor analgesia， 0.2% chloroprocaine combined with ropivacaine can reduce EC50 of ropivacaine， improve analgesia effect and have good safety.
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Abstract Objective: This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). Methods: A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. Results: Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. Conclusions: For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
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ObjectiveThis study aims to explore the effect of ultrasound-guided superficial parasternal intercostal plane block on the quality of recovery and postoperative analgesia in patients undergoing sternotomy cardiac surgery. MethodsA total of 64 patients undergoing sternotomy cardiac surgery were selected for this study. They were randomly divided into two groups： one group received a superficial parasternal intercostal plane block with ropivacaine （the ropivacaine group）， while the other was given normal saline （the normal saline group）. The primary outcome was the Quality of Recovery-15 （QoR-15） score on postoperative day 1 in both groups， accompanied by a comparative analysis of the pain score and opioid usage. ResultsCompared with the normal saline group， the ropivacaine group exhibited a significantly higher QoR-15 score on postoperative day 1［（89.60±13.24） vs （81.18±12.78）， P=0.012］. The numerical rating scale at rest was significantly lower［（3.03±0.72） vs （4.26±0.93）， P<0.001］， and the numerical rating scale during coughing was also significantly reduced ［（4.40±0.89） vs （5.44±1.05）， P<0.001］. Concurrently， the cumulative morphine equivalent consumption during the initial 24 h postoperatively was significantly lower in patients who were administered the ropivacaine ［14.15 （4.95～30.00） mg vs 40.50 （19.25～68.18） mg， P=0.002］， and there was also a notable decrease in the rescue analgesia ［0.00 （0.00～0.00） mg vs 0.00 （0.00～100.00） mg， P=0.007］. ConclusionUltrasound-guided superficial parasternal intercostal plane block can significantly enhance the overall quality of recovery in patients undergoing sternotomy cardiac surgery on postoperative day 1. The technique contributes to improved postoperative analgesic effects and a reduction in opioid usage， thereby facilitating early postoperative recovery.
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Objective To investigate the effect of ropivacaine on biological behavior of gastric cancer BGC-823 cells and AMP activated protein kinase(AMPK)/nuclear factor E2-related factor 2(Nrf2)signaling path-way.Methods Gastric cancer BGC-823 cells were cultured in vitro.When BGC-823 cells were cultured to log-arithmic growth phase,they were divided into control group(routine culture),cisplatin group(medium con-taining 5 mg/L cisplatin),and low-level(medium containing 25 mg/L ropivacaine),medium-level(medium containing 50 mg/L ropivacaine),and high-level(medium containing 100 mg/L ropivacaine)ropivacaine groups.The cells were cultured for 48 h.Cell counting kit-8(CCK-8)was used to detect the survival rate of BGC-823 cells.Transwell chamber assay was used to detect the invasion ability of BGC-823 cells.The apopto-sis rate of BGC-823 cells was detected by flow cytometry.The mRNA levels of AMPK and Nrf2 in BGC-823 cells were detected by real-time fluorescence quantitative PCR(qPCR).The protein levels of AMPK and Nrf2 in BGC-823 cells were detected by Western blot.Results Compared with the control group,the survival rate,invasion number,AMPK and Nrf2 mRNA and protein levels of BGC-823 cells in the cisplatin group and the low-level,medium-level and high-level ropivacaine groups were decreased(P＜0.05),while the apoptosis rate was increased(P＜0.05).Compared with the cisplatin group,the survival rate,invasion number,AMPK and Nrf2 mRNA and protein levels of BGC-823 cells in the low-level,medium-level and high-level ropivacaine groups were increased(P＜0.05),while the apoptosis rate was decreased(P＜0.05).Compared with the low-level ropivacaine group,the survival rate,invasion number,AMPK,Nrf2 mRNA and protein levels of BGC-823 cells in the medium-level and high-level ropivacaine groups were decreased in oder(P＜0.05),while the apop-tosis rate was increased in oder(P＜0.05).Conclusion Ropivacaine could inhibit the survival and invasion of BGC-823 cells and promote the apoptosis of BGC-823 cells,which may be related to the inhibition of AMPK/Nrf2 signaling pathway.
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Objective To explore the efficacy of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block(ESPB)in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods A total of 119 lung cancer patients who underwent thoracoscopic radical resection of pulmonary carcinoma at the First Affiliated Hospital of Henan Polytechnic University from October 2020 to October 2022 were selected and randomly divided into the observation group(n=59)and the control group(n=60),with 3 patients excluded from the observation group and 4 patients excluded from the control group.Finally,56 patients were included in each group.Patients in the control group received ultrasound-guided ESPB with ropivacaine,while patients in the observation group received ultrasound-guided ESPB with both ropivacaine and dexmedetomidine.The pre-anesthesia preparation,anesthesia induction,and anesthesia maintenance were the same for patients in both groups,and patients in both groups used patient-controlled intravenous analgesia to relieve pain after surgery.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups after entry(T1),successful block(T2),skin incision(T3),and end of surgery(T4),as well as the visual analogue scale(VAS)scores at rest and activity 6,12,24,and 48 hours after surgery were recorded.The amount of analgesic medication used,the number of analgesia pump presses,and the incidence of delirium and adverse reactions were compared between the two groups 48 hours after surgery.Results The MAP and HR of patients in the two groups at T2 and T3 were significantly higher than those at T1 and T4(P＜0.05).However,there was no significant difference in MAP and HR between the two groups at T4 and T1(P＞0.05),and there was also no significant difference in MAP and HR between the two groups at T2 and T3(P＞0.05).The patients in both groups showed no significant difference in MAP and HR at T1(P＞0.05),while at T2,T3,and T4,the MAP and HR in the observation group were significantly lower than those in the control group(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 12,24,and 48 hours postope-ratively compared to 6 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 24 and 48 hours postoperatively compared to 12 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores in both resting and active states 48 hours after surgery compared to 24 hours after surgery(P＜0.05).There was no significant difference in VAS scores at both rest and activity 6 hours after surgery between the two groups(P＞0.05).At 12,24,and 48 hours after surgery,the patients in the observation group had lower VAS scores in both resting and active states compared to the control group(P＜0.05).Compared with the control group,the observation group used fewer analgesic drugs and pressed analgesia pumps less 48 hours after surgery(P＜0.05).The incidence of overall adverse reactions within 48 hours after surgery was 5.36％(3/56)and 8.93％(5/56),respectively;there was no significant difference in the incidence of overall adverse reactions between the two groups(x2=0.135,P＞0.05).The incidence of delirium within 48 hours after surgery in the control and observation groups was 14.29％(8/56)and 3.57％(2/56),respectively.The incidence of delirium in the observation group was significantly lower than that in the control group(x2=3.953,P＜0.05).Conclusion The use of ropivacaine combined with dexmedetomidine for ultrasound-guided ESPB in elderly patients undergoing thoracoscopic radical surgery for lung cancer can maintain perioperative hemodynamic sta-bility,improve analgesic effect,and reduce the dosage of analgesic drugs,the number of analgesia pump presses,and the inci-dence of postoperative delirium.
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AIM:To evaluate the clinical efficacy and safety of pneumoperitoneum-free single-hole endoscopy combined with ropivacaine local infiltra-tion anesthesia in pregnancy with ovarian tumor.METHODS:Twenty-eight pregnant women with ovarian tumor were randomly divided into two groups:observation group(n=16)and control group(n=12).The first time out of bed,ventilation time,postoperative hospital stay,non-invasive blood pressure,heart rate(HR),respiratory fre-quency(RR)and blood oxygen saturation(SpO2)were compared between the two groups.Pain score,Ramsay sedation score,SAS anxiety score,postoperative complications,patient satisfaction and recovery quality scale QoR15 were evaluated at 6,24 and 48 hours after operation.RESULTS:There was no significant difference in postopera-tive hospital stay,Ramsay score,RR,SpO2 and the incidence of complications between the two groups(P>0.05),but the time of getting out of bed and ventilation time were shortened,the scores of non-invasive blood pressure,HR,pain and anxiety in the observation group were lower than those in the control group,and the scores of patient satisfac-tion and QoR15 in the observation group were bet-ter than those in the control group(P<0.05).CON-CLUSION:The application of pneumoperitoneum-free single-hole endoscope combined with ropiva-caine local infiltration anesthesia in pregnancy with ovarian tumor can reach satisfactory clinical re-sults,including reducing postoperative pain and anxiety,which is worth popularizing.
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Background: Randomised controlled study aimed to compare low thoracic segmental spinal anesthesia (TSSA) and conventional lumbar spinal anesthesia (LSA) in percutaneous nephrolithotomy (PCNL). Methods: Sixty adult patients undergoing elective PCNL were randomly assigned to two groups: T (TSSA) and L (LSA). Group T received TSSA (isobaric ropivacaine 0.75% 2.5 ml with dexmedetomidine 6mcg) at T10-T12, while Group L received LSA (hyperbaric ropivacaine 0.75% 4 ml with dexmedetomidine 6mcg) at L2-L4. Primary objectives of our study was to evaluate the feasibility and safety of TSSA for PCNL and to compare hemodynamic changes, block onset, and duration, and adverse effects. Secondary objectives were time to rescue analgesia, patient, and surgeon satisfaction. Data was analyzed using SPSS. Results: All patients underwent surgery successfully under neuraxial anesthesia. Group T exhibited more stable hemodynamics with a significantly lower hypotension incidence compared to Group L (3.33% vs. 26.66%, p=0.03). Onset of sensory and motor block was quicker in the TSSA group (p<0.001) upper. Sensory block levels were T6 for both groups, but lower level in TSSA was levels L2 and L3, while LSA impacted all segments below T6. No neurological complications occurred, particularly in Group T, which had higher satisfaction scores from surgeons and patients. Conclusions: TSSA is a safe and effective option for PCNL, providing better hemodynamic stability with lesser incidence of and reducing intra-operative hypotension compared to conventional LSA.
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Background: Various adjuvants have been added to improve the quality of the supraclavicular brachail plexus block and prolong postoperative analgesia. The aim of the present study was to compare the onset and duration of sensory and motor blockade provided by dexmedetomidine and fentanyl as adjuvants to ropivacaine in such block. Methods: In this study 60 patients with American Society of Anesthesiologists grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group A received 30 mL of 0.5% ropivacaine with 1 µg kg-1 dexmedetomidine, and group B received 30 mL of 0.5% ropivacaine with 1 µg kg-1 fentanyl for supraclavicular brachial block. The onset and duration of sensory and motor block and adverse events during the perioperative period were noted. Results: The onset of sensory and motor blockade was 13.47±1.73 min and 22.87±2.27 min respectively in the dexmedetomidine group and 14.80±2.20 min and 24.33±2.63 min respectively in the fentanyl group which was statistically significant (P<0.05). The duration of the sensory blockade was significantly higher in the dexmedetomidine group as compared with fentanyl (826±58.29 vs 592±51.62 minutes, p< 0.0001). Conclusions: Dexmedetomidine provides faster onset of sensory and motor block with longer duration of block as compared with fentanyl when used as an adjuvant with ropivacaine in supraclavicular brachial plexus block without any significant side effects.
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Background: Breast cancer is the most common cancer in women, comprising approximately 25% of all cases. Failure to provide effective pain control is associated with poor quality of recovery & chronic postsurgical pain after breast surgery. According to a recently published PROSPECT guideline, pectoral nerve (PECS) blocks seem to be an effective alternative to PVB for postsurgical pain management in breast surgery. In order to relieve post-operative pain in patients undergoing MRM, in this study we compared the efficacy of modified pectoral nerve block versus erector spinae plane block for breast cancer surgeries. Methods: A comparative study was conducted among 80 female patients of age 25-65 years scheduled for modified radical mastectomy surgery with ASA class I and II after obtaining approval from ethical committee. Written informed consent was obtained and research process were explained to the patients. They were randomly allocated into two groups of 40 each. Group 1: was assigned to receive 0.2% Ropivacaine 25ml for Erector spinae block and Group 2: Was assigned to receive 0.2% ropivacaine 25 ml for modified pectoral nerve block, p value <0.05 was considered statistically significant. Results: In patients receiving modified pectoral nerve block (PEC 2) there was considerably lesser opioid consumption, Ionger duration of analgesia and lesser postoperative pain score as compared to patients receiving erector spinae block (ESP) for modified radical mastectomy surgeries. Conclusions: Modified Pectoral nerve block is a potential analgesic technique in breast surgeries since it has less perioperative opioid consumption, proIonged duration of anaIgesia, Iesser postoperative pain score when compared to Erector Spinae block.
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Background: Paravertebral block can be given for pain management after modified radical mastectomy (MRM). Although many additives to ropivacaine in PVB have been tried for post-operative analgesia, none has been found ideal. Aims and Objectives: We have compared the duration of analgesia in PVB using adjuvant like dexmedetomidine with ropivacaine after MRM. Materials and Methods: Sixty female patients posted for MRM and axillary dissection were split into two groups. Group R administered ultrasound-guided PVB with 20 ml ropivacaine 0.5% and Group RD administered 20 ml of 0.5% ropivacaine with dexmedetomidine 1 mcg/kg. After confirming PVB, surgery was done under general anesthesia in all patients. Time for 1st analgesia requirement was the main objective of our trial. Other objectives were to record visual analog scale scores and total analgesic need. Results: Post-operative analgesia duration was increased in the group RD (7.11 ± 1.42 h) in contrary to Group R (3.68 ± 1.85 h). Total paracetamol consumption post-operative 24 h was decreased in Group RD (1.63 ±0.89 g) in contrary to Group R (2.74 ± 0.76 g). Conclusion: Dexmedetomidine in PVB provides prolonged pain relief after MRM.
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Background: Although an increasing number of anesthesiologists are using peripheral nerve catheters for postoperative analgesia, single shot blocks are still more common. Ropivacaine has become the most commonly used long-acting local anesthetic, and the duration of analgesia has been estimated to be 8 to 14 hours. Methods: The study was conducted from February 2020 to October 2021 after obtaining approval from the institutional ethics committee. The study was a prospective observational study. Results: Hemodynamic changes in patients who received dexmedetomidine in combination with Ropivacaine had a favorable reduction in both heart rate and blood pressure without causing any major side effect. Comparison of postoperative MAP (mmHg) in two groups at various intervals of time was observed and found to be statistically significant (p value of <0.05). Comparison of postoperative heart rate (beats/min) among two groups at various intervals of time was statistically significant (p value of <0.05). Conclusions: We can conclude that preoperative inter-scalene block given reduces the analgesic requirement intraoperatively as well postoperatively. And the hemodynamic changes in patients who received dexmedetomidine in combination with ropivacaine had a favorable reduction in both heart rate and blood pressure without causing any major side effect.
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Abstract Background Postdural puncture headache (PDPH) is a common complication of neuraxial techniques which delays patients' discharge. Sphenopalatine ganglion block (SPGB) is a safe bedside technique with comparable efficacy to Epidural Blood Patch, the gold-standard treatment. There is no evidence on the ideal timing for SPGB performance. We aimed to evaluate the difference between early versus late SPGB concerning efficacy, symptom recurrence and hospital length of stay. Methods We present an observational study with 41 patients diagnosed with PDPH who were submitted to SPGB with ropivacaine 0,75%. The study sample (n = 41) was divided in two groups: an early (less than 24 hours after diagnosis) and a late (more than 24 hours after diagnosis) SPGB group. Pain was evaluated 15 minutes after the block and follow up occurred daily until patients were discharged. Patients' demographic characteristics, neuraxial technique, timing of SPGB, qualitative pain relief and post-SPGB length of stay were registered and analyzed with SPSS statistics (v26) software. Results Early SPGB resulted in a significant reduction in length of stay (p = 0,009) and symptom recurrence (p = 0,036), showing equally effective pain relief, compared to late SPGB. Conclusions SPGB was equally effective in both groups. Data showed that early SPGB reduces length of hospital stay and symptom recurrence, which potentially allows early resumption of daily activities and a reduction in total health costs.
Subject(s)
Humans , Post-Dural Puncture Headache/therapy , Sphenopalatine Ganglion Block/methods , Pain , Blood Patch, Epidural/adverse effects , Pain Management , RopivacaineABSTRACT
OBJECTIVE To explore the efficacy and safety of intra-articular injection of ropivacaine combined with alfentanil for postoperative analgesia in patients who underwent knee arthroscopic surgery. METHODS A total of 60 patients who underwent knee arthroscopic surgery were collected from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from March to September in 2022， and then divided into trial group and control group with random number table method， with 30 cases in each group. The control group received intra-articular injection of 0.25% ropivacaine 50 mg， and the trial group received intra-articular injection of 0.25% ropivacaine 50 mg+alfentanil 0.15 μg/kg.The first postoperative remedial analgesia time， the total amount of postoperative remedial drugs， numerical rating scale at rest （NRS-R） scores， numerical rating scale at movement （NRS-M） scores， heart rate， mean arterial blood pressure， and pulse oxygen saturation during exercise at different monitoring time points after surgery， the incidence of adverse drug reactions such as hypotension， respiratory depression， nausea， and vomiting after surgery were compared between 2 groups. RESULTS Compared with the control group， the first postoperative remedial analgesia time was significantly longer in the trial group， and the total amount of postoperative remedial drugs was significantly reduced （P＜0.001）. The trial group had lower NRS-R and NRS-M scores at each monitoring time point， with statistically significant differences （P＜0.001）， and there was an interactive effect between time and groups （P＜0.001）. The changes in heart rate， mean arterial blood pressure， and pulse oxygen saturation of patients in the trial group were relatively small， with no statistically significant differences （P＞0.05）， and there was no interactive effect between time and groups （P＞0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups， such as postoperative hypotension， respiratory depression， nausea， vomiting （P＞0.05）. CONCLUSIONS The intra- articular injection of ropivacaine combined with alfentanil shows good efficacy and safety for post-knee arthroscopic analgesia， and significantly prolongs the analgesic duration of ropivacaine.