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Background and Aims: Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain. Methods: After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at P < 0.05. Results: The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL. Conclusion: Adding 0.5 µg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.
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Background and Aims: Pain associated with rib fractures is challenging to manage. This pilot trial aimed to assess the efficacy of erector spinae plane block (ESPB) compared with thoracic epidural analgesia (TEA) for controlling pain associated with multiple rib fractures. Methods: This randomised, single-blinded, controlled pilot study was conducted on trauma patients who had three or more rib fractures and had been admitted at a tertiary care centre. The study was conducted after receiving ethical approval and trial registration. Patients were randomised into two groups: TEA and ESPB, from February 2019 to February 2020. In the ESPB group, a unilateral or bilateral catheter was inserted in the erector spinae space, and an infusion of 0.125% bupivacaine was started. In the TEA group, the thoracic epidural catheter was inserted, and 0.125% bupivacaine infusion was started. Rescue analgesia using intravenous morphine (0.1 mg/kg) was administered if the Visual Analogue Scale (VAS) score was >3 for 48 hours postoperatively. The primary endpoint was total morphine consumption after administration of ESPB and TEA in patients with a rib fracture. Results: Forty patients completed the study, with 20 in each group. Total morphine consumption by patients in the ESPB group was 5.38 ± 2.6 mg per 48 hours, and by those in the TEA group was 5.22 ± 2.11 mg per 48 hours (P = 0.883). Thirty minutes after starting the infusion, mean arterial pressure (MAP) was 64.8 ± 2.1 mmHg in the ESPB group and 57.2 ± 1.3 mmHg in the TEA group (P = 0.00001). Conclusion: Total morphine consumption was not statistically different in this pilot trial among the two groups. ESP block may provide similar analgesia with better haemodynamic stability compared to TEA in patients with multiple traumatic rib fractures.
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BACKGROUND: Hemodynamic changes are the most common predicted response after laryngoscopy and intubation during general anesthesia. We compared the efficacy of buprenorphine with fentanyl to attenuate this stress response. METHODS: One hundred and thirty patients of either sex between the age group of 18-70 years, admitted for the routine surgical procedure under general anesthesia were enrolled in this double blind, randomized, clinical study. Patients were randomly assigned into two equal groups (60 patients in each group): group F received fentanyl 2 µg/kg, and group B received buprenorphine 2.5 µg/kg; both via intravenous route. Each group received a total volume of 10 mL by adding normal saline to the total drug volume, given over 60 seconds, 5 minutes before intubation. Thereafter patients were induced using routine balanced anesthesia technique, and the hemodynamic parameters were observed at baseline (0 minute), 1, 3, and 5 minutes after the administration of the study drug and again at 1, 3, 5, 7, and 10 minutes after intubation. Continuous variables were presented as mean with an 80% confidence interval, and a t-test was applied for comparing the difference of means between two groups after we checked the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way analysis of variance was performed to compare the outcome variables between the two groups. RESULTS: In both groups, mean arterial blood pressure (MAP) and heart rate (HR) were statistically insignificant up to 5 minutes after study drug, thereafter mean HR and MAP at 1, 3, 5, 7, and 10 minutes after intubation, were statistically significant between the two groups, and P value was less than 0.05. CONCLUSIONS: The dose of 2.5 µg/kg buprenorphine is an effective alternative to fentanyl 2 µg/kg for attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation without causing any hemodynamic adverse effect.