Ultrasound guided abdominal field blocks improve postoperative pain relief in cesarean delivery: a prospective randomized controlled study

Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions

Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine [n=30] or no block [n=30]. Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery [after the skin sutures] bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side [to maximal dose of 3 mg/kg] and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively

Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours [157 +/- 50.709 vs 386.67 +/- 29.16 mg] and also the visual analogue pain scores at 2 [2 vs 8], 4 [2 vs 8],6 [2 vs 8],12 [4 vs 7] and 24 [4 vs 7] hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks

Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery

Evaluating effect of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia

Background and Aims: Intravenous dexmedetomidine is being increasingly used in perioperative setting including as an adjunct to local anesthetic in various regional techniques with an intent to either improve the block quality, increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolonged postoperative analgesia and reduced post-anesthesia shivering. We aimed to study the effect of intravenous dexmedetomidine on spinal anesthesia with hyperbaric 0.5% bupivacaine

Methodology: One hundred American Society of Anesthesiologists [ASA] physical status I and II patients undergoing orthopaedic surgeries under spinal anesthesia were randomized into two groups of 50 each. After giving spinal anesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine, patients in Group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in Group C received an equivalent quantity of normal saline. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score [RSS], duration of analgesia and side effects of dexmedetomidine were assessed

Results: The time taken for regression of sensory block to S1 dermatome and Bromage 0 motor block was increased significantly by addition of dexmedetomidine. Time to first requirement of analgesic in postoperative period was more in Group D compared to Group C. Sedation was more in patients of Group D compared to Group C [P < 0.001]

Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia

Ultrasound guided rectus sheath block in management of pain in laparoscopic tubal ligation

Background and objectives: Laparoscopic tubal ligation [LTL] is a day care surgery and requires a small supraumbilical incision for the umbilical port. Pain after LTL is more than diagnostic laparoscopy. We aimed to examine the efficacy and benefits of a preemptive ultrasound guided single injection rectus sheath block [RSB] in providing improved early on postoperative pain scores in comparison to general anesthesia alone

Methodology: Sixty patients underwent elective LTL, were randomly allocated by a computer generated list into two groups: the ultrasound guided rectus sheath block group - the Group R, received a bilateral RSB using 20 ml of 0.25% bupivacaine on either side after initiation of anesthesia and earlier than the surgical incision; and general anesthesia group - the Group G, received general anesthesia alone. Intravenous tramadol was also given and its time was recorded. Pain was measured by verbal analogue score [VAS]. Sedation score [from 0 awake to 5 unarousable] was used to record sedation level. Any adverse events were recorded. Statistical Analysis was done with the help of SPSS software version 15. Mann-Whitney U-test, t-test, Pearson ?[2] test and Fisher's exact test was used for analysis of different variables. Statistical significance was set at 5%

Results: The rectus sheath block with bupivacaine compared with control group reduced verbal analogue scores. Tramadol requirements in the first 12 postoperative hours were also lower. The frequency of nausea and sedation was reduced in the Group R. There were no complications accredited to the rectus sheath block

Conclusion: Ultrasound guided rectus sheath block, as a part of multimodal analgesic regimen, provides superior analgesia up to 12 postoperative hours after voluntary laparoscopic tubal ligation

Ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery

Aims and objectives: To study the effect of ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery

Methodology: Thirty American Society of Anesthesiologists [ASA] physical status I and II patients undergoing clavicular surgery, ages 20-60 years were selected. All routine non- invasive monitors were applied and IV line was secured. Ultrasound guided superficial cervical plexus block and interscalene brachial plexus block were given. Injection dexmedetomidine 1 microg/kg infusion over 10 min was started. Block efficacy was evaluated. Any complication or side effects were noted. Sedation was assessed using Ramsay sedation score. Perioperative hemodynamics were charted. Duration of motor block was noted as time of shoulder abduction 3cm from time of block. Duration of analgesia was noted as time for first demand of analgesic from time of block

Results: All the thirty patients allowed clavicular surgeries under combined interscalene brachial plexus and superficial cervical plexus block. No major complications and side effects were noted

Conclusion: USG guided combined superficial cervical plexus and interscalene brachial plexus block are effective for clavicular surgery without any major complication and may be used in place of general anesthesia or blocks by other techniques