Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations.

OBJECTIVE: To compare the effects of magnesium sulphate on the total dose of intravenous morphine consumption postoperatively following limb amputations along with rescue analgesia requirement, pain scores and side effects. METHODS: This prospective, triple-blinded, randomised controlled study was conducted from October 2021 to May 2022 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised of patients scheduled for limb amputations. They were randomised into 2 equal groups. The anaesthesia protocol was uniform for all patients. Intervention group A was administered 30mg/kg loading dose and 10mg/kg/hr maintenance dose of magnesium sulphate intravenously, while patients in control group B received the same amount of plain isotonic saline. Morphine consumption, including that used for rescue analgesia and patient-controlled analgesia, was measured for 24 hours postoperatively. Numeric rating scale was used for the evaluation of postoperative pain in both groups at 15min, 1h, 2h, at discharge from the post-anaesthesia care unit and at 12h and 24h in the ward. Data was analysed using SPSS 23. RESULTS: Of the 24 patients enrolled, the study was completed by 20(83.33%). There were 10(50%) patients in group A; 8(40%) males and 2(20%) females with mean age 24.8±14.14 years and mean surgery time 130.5±47.86 minutes. There were 10(50%) patients in group B; 8(40%) males and 2(20%) females with mean age 23.2±7.4 years and mean surgery time 117±23.85 minutes (p>0.05). Total morphine used over 24 hours in group A was 16±3.1 mg compared to 29.6±11.2 mg in group B (p<0.05). The time for first use of patient-controlled analgesia after arriving in the postanaesthesia care unit was significantly delayed in group A (72.2±24.95 minutes) compared to that in group B (25±26.68 minutes) (p<0.05). Pain scores were significantly higher in the group B at 15min compared to group A (p<0.05), but not at the rest of the time points (p>0.05). CONCLUSIONS: Intravenous magnesium sulphate proved to be effective in lowering postoperative opioid requirement following limb amputations.

A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy.

Objectives: To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies. METHODS: This triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists grade I-III, weighing >30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2µg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23. RESULTS: Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p>0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p>0.05), and none of the patients experienced any side effect throughout the post-operative stay. CONCLUSIONS: The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone.

A Novel Experience Of Ultrasound-Guided Erector Spinae Plane Block With Sedation In Breast Cancer Surgery: A Case Report.

We report the anaesthetic management of a breast cancer patient, at a high risk for undergoing general anaesthesia, using a single-shot ultrasound-guided Erector Spinae Plane Block (ESPB) with monitored sedation. Targetted at T4, 20 mL of 0.375% bupivacaine provided complete surgical anaesthesia in 15 minutes. Concurrent sedation was administered with target controlled infusion of propofol with entropy monitoring throughout the procedure. The surgery lasted 90 minutes and the patient remained pain free and haemodynamically stable throughout. At the end of the surgery, the patient received 1 g of paracetamol intravenously, and did not require any further analgesics other than routinely administered paracetamol until her discharge from the hospital. On top of the successful execution of our plan, this case was especially interesting as her postoperative analgesia remained completely opioid-free.

Pain experienced by patients during epidural insertion using 16-gauge versus 18-gauge epidural needles.

OBJECTIVE: To compare the intensity of insertion-site pain between epidural catheterisation with 16-gauge needle and with 18-gauge needle at various time points, and the number of attempts taken to locate the epidural space while using either of the needles. METHODS: This single-blind prospective study was conducted from August 2019 to January 2020 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised of adult patients of either gender with American Society of Anaesthesiologist grade I-III requiring thoracic epidural for elective abdominal procedures. The patients were divided into two groups using simple randomised sampling with group A receiving 16-gauge and group B receiving 18-gauge epidural. The intensity of insertion-site pain was noted at the time of insertion, at 24 hours and one week after the insertion. The number of attempts taken to locate the epidural space was also noted for the two groups. Data was analysed using SPSS 23. RESULTS: Of the 135 patients enrolled, 126(93.3%) completed the study. There were 63(50%) subjects in group A; 30(47.6%) males, 33(52.3%) females, overall mean age 46.81±10.94. The remaining 63(50%) subjects were in group B; 22(34.9%) males, 41(65%) females, overall mean age was 44.89±11.10 (p>0.05). Pain scores did not differ significantly on comparative analysis between groups (p>0.05). Similarly, number of patients requiring 2 or more attempts for successful epidural catheter insertion was not significantly different between the groups (p>0.05). CONCLUSIONS: The difference in pain scores or number of attempts for 16-guage or 18-guage groups were not significant.