Post-thoracotomy pain relief: Thoracic paravertebral block compared with systemic opioids

BackgroundWe evaluated the safety and efficacy of thoracic paravertebral block as a method of pain relief after thoracotomy in comparison with systemic opioids.Study designRandomized controlled trial.MethodsWe scheduled 40 patients divided into two groups to receive either 20 ml bupivacaine (0.5%) incremental injections for intra and postoperative analgesia via a catheter inserted in the thoracic paravertebral space. The other 20 patients received systemic morphine for postoperative analgesia. We recorded postoperative Visual Analog Scale pain score, total morphine consumption, time to first analgesic request, changes in pulmonary functions and side effects.ResultsVisual analogue scale (VAS) at rest was lower in the paravertebral group at all measurement points except at 16, 20 and 24 h postoperatively. Pain on coughing showed significant difference (P value < 0.05) at 8 and 16 h but not at 24 h. Post-operative consumption of morphine was 36 (22–42) mg in the control group versus 9 (2–22) mg in the paravertebral block group (PVB) (P value = 0.003). Total bupivacaine dose used in the PVB group in the first 24 h was 300–420 mg. For time to first analgesic request it was significantly longer in the morphine group than the paravertebral block group. VAS at first analgesic request was not statistically different between the two groups.There was no significant difference between the two groups as regards to peak expiratory flow rate (PEFR) preoperatively, after 12 h or 24 h.There was a significant reduction in the incidence of side effects in the TPVB group compared to morphine group concerning vomiting and pruritus.no local anesthetic toxicity was reported.ConclusionWe conclude that thoracic PVB provides effective post thoracotomy analgesia supported by lower VAS pain scores at rest and on coughing compared to intravenous morphine with significant less incidence of side effects.     

Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation

Study ObjectiveThe aim of this study was to evaluate the analgesic efficacy and safety of pectoralis-serratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain.DesignA prospective randomized controlled study.SettingTertiary center, university hospital.PatientsSixty-four adult women, American Society of Anesthesiologists physical status classes I, II, and III, scheduled for unilateral modified radical mastectomy with axillary evacuation.InterventionsPatients were randomized to receive either pectoralis-serratus interfascial plane block, PS group (n = 32), or thoracic paravertebral block, PV group (n = 32).MeasurementsTwenty-four-hour morphine consumption and the time to rescue analgesic were recorded. The pain intensity evaluated by visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24 hours postoperatively was also recorded.Main ResultsThe median (interquartile range) postoperative 24-hour morphine consumption was significantly increased in PS group in comparison to PV group (PS vs PV), 20 mg (16-23 mg) vs 12 mg (10-14 mg) (P < .001). The median postoperative time to first analgesic request was significantly shorter in PS group compared to PV group (PS, 6 hours [5-7 hours], vs PV, 11 hours [9-13 hours]) (P < .001). The intensity of pain was low in both groups in VAS 0, 2, and 4 hours postoperatively. However, there was significant reduction in VAS in PV group compared to PS group at 8, 16, and 24 hours postoperatively.ConclusionsPectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block.     

Ultrasound guided transversus abdominis plane block in pediatric patients undergoing laparoscopic surgery

ObjectiveTo assess safety and effectiveness of ultrasound-guided TAP block in children undergoing laparoscopic surgery for undescended testis.Subjects and methodsThis randomized controlled trial involved 108 children, 3–7 years old, randomly allocated into one of two equal groups; TAP Group and Control Group. All children received general anesthesia using propofol 1.5–2.5 mg/kg, atracurium 0.5 mg/kg and fentanyl 2 μg/kg. TAP Group received 0.5 ml/kg of ropivacaine 0.375% bilaterally under ultrasound guidance and control group received regular analgesics. Quality of analgesia was assessed using Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and Objective behavioral pain score (OPS). The primary outcome measures were hemodynamic parameters and degree of pain. Secondary outcome measures were intraoperative fentanyl requirement, postoperative rescue analgesia (time and dose), complications, hospital stay and degree of satisfaction of patients and their parents.ResultsTAP block group had significantly lower intraoperative fentanyl dose (p < 0.001), significantly longer time to first postoperative request of analgesic (p < 0.001), lower analgesic dose during the first postoperative 24 h (p < 0.001) and lower pain scores along the whole 24 postoperative hours. Mean arterial pressure and heart rate were within the clinically accepted range in the two groups. Parents’ satisfaction was significantly higher (p < 0.001) in the TAP block group.ConclusionTAP block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing laparoscopic surgery for undescended testis.     

Analgesic efficacy of pregabalin in acute postmastectomy pain: placebo controlled dose ranging study

Study objectiveWe hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption.DesignProspective randomized controlled clinical trial.SettingPostanesthesia care unit.PatientsOne hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation.InterventionsPatients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg.MeasurementsThe assessment parameters were the postoperative analgesic effect using visual analog scale (VAS) pain scores, the subsequent 24-hour morphine consumption, and the systemic adverse effects of pregabalin doses.Main resultsThe VAS score at rest and movement was significantly decreased only in group P300 and group P150 in comparison to group P0 and group P75 at 0 hour (P < .01).The median (interquartile range) consumption of morphine in the first postoperative 24 hours was significantly decreased in group P300 in comparison to group P0 and group P75 (P300 vs P0: 6.5 [5-6.5] vs 20.5 [15.8-20.5] [P < .001]; P300 vs P75: 6.5 [5-6.5] vs 20 [14-20] [P < .001]), but there was no significant difference between group P300 and group P150. In addition, there was a significant decrease in consumption of morphine in group P150 in comparison to group P0 and group P75 (P150 vs P0: 7 [5-7] vs 20.5 [15.8-20.5] [P < .001]; P150 vs P75: 7 [5-7] vs 20 [14-20] [P < .001]). There were statistical significant increase in dizziness and blurred vision in group P300 in comparison to other groups (P < .05).ConclusionsA single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM.     

Preemptive use of epidural magnesium sulphate to reduce narcotic requirements in orthopedic surgery

Background and objectivesAs pain is one of the most common problems challenging the anesthetist, and as regional anesthesia is a safe, inexpensive technique with the advantage of prolonged postoperative analgesia. Also, we all know that Magnesium is the fourth most plentiful cation in the body with antinociceptive properties arising from being the natural physiological calcium antagonist and the antagonism to N-methyl-d-aspartate (NMDA) receptor. Thus, the study is a prospective, randomized, double-blind study designed to evaluate analgesic efficacy of magnesium sulphate when added to epidural bupivacaine in patients undergoing orthopedic surgery in the lower limb.MethodsAfter approval of the ethical committee and informed written consent 60 patients ASA I and II, undergoing orthopedic surgery in the lower limb were enrolled to receive either bupivacaine 0.5% or bupivacaine 0.5% plus magnesium sulphate 50 mg as an initial bolus dose followed by a continuous infusion of 10 mg/h as intraoperative epidural analgesia. Postoperatively, all patients were equipped with a patient-controlled epidural analgesia device. Heart rate, mean arterial pressure, oxygen saturation, respiratory rate, pain assessment using a visual analogue scale (VAS), sedation score, the first time patient ask for analgesics and postoperative fentanyl consumption were recorded.ResultsVAS was significantly less in the magnesium group during 15 and 30 min intra-operatively and in the first and third hour post-operatively. The postoperative rescue analgesia, as well as the PCEA fentanyl consumption, was significantly reduced in the magnesium group.ConclusionCo-administration of epidural magnesium provides better intraoperative analgesia as well as the analgesic-sparing effect on PCEA consumption without increasing the incidence of side-effects.     

Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study

IntroductionWe hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery.MethodsAfter Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150 mg or 300 mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24 h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded.ResultsCompared with placebo or pregabalin 150 mg, the use of a preoperative dose of pregabalin 300 mg resulted in significantly lower cumulative morphine consumption at 24 h (mean dose: placebo 12.9 mg [95% CI 11.6 to 14.2]; pregabalin 150 mg 11.9 mg; [95% CI 10.7 to 13.1]; pregabalin 300 mg 6 mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300 mg resulted in lower pain scores at 4 h and 6 h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300 mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300 mg group (6.7%) experienced short-term poor latching-on for breastfeeding.ConclusionIn our study, preoperative administration of pregabalin 300 mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.     

Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy

AimTo evaluate efficiency of dexmedetomidine compared to fentanyl as supplements to low-dose levobupivacaine spinal anesthesia in patients undergoing knee arthroscopy.Materials and methodsSixty adult patients (ASA I or II) scheduled for knee arthroscopy were randomized to receive plain levobupivacaine (4 mg) plus dexmedetomidine (3 μg) in group D or fentanyl (10 μg) in group F.ResultsDexmedetomidine shortened time to surgery (P = 0.002), time to highest sensory level (P = 0.001), and time to highest Bromage score (P < 0.001). The highest sensory level was comparable in both groups (P = 0.969), but the duration of sensory block was significantly longer in group D (P = 0.009). The highest Bromage score was 2 in both groups. This score was attained in significant higher number of patients in group D (P = 0.038) that showed better muscular relaxation (P = 0.035). At the end of surgery, a residual motor block (Bromage score 1) was observed in significant higher number of patients (P = 0.033) and time to ambulation was significantly longer in group D (P = 0.001). There was no difference in the number of patients bypassed post-anesthesia care unit (PACU) (P = 0.761) or time to hospital discharge (P = 0.357) between groups. The pain free period was more prolonged (P < 0.001), and the visual analog scale (VAS) for pain was lower at the 2nd, 4th, 6th, and 8th postoperative hours (P < 0.001, <0.001, 0.013, 0.030 respectively) in group D.ConclusionDexmedetomidine is a good alternative to fentanyl for supplementation of low-dose levobupivacaine spinal anesthesia for knee arthroscopy.     

The effect of gabapentin premedication on pain and anxiety during cataract surgery under peribulbar block

BackgroundThe principal goal of sedation during eye surgery is to keep the patient calm and comfortable without depression of the protective airway reflexes or affecting the hemodynamics. The aim of the present study was to evaluate the effect of oral gabapentin premedication on anxiety and pain during cataract surgery done under peribulbar block.Material and methodsIn this double blinded placebo controlled study, 60 patients scheduled for cataract surgery under peribulbar block were randomly allocated into two groups. In the gabapentin group (n = 30), patients were premedicated 2 h before peribulbar block by 1200 mg oral gabapentin capsules. In the placebo group (n = 30), patients were premedicated 2 h before peribulbar block by oral placebo capsules. Verbal pain score (VPS), sedation score, verbal anxiety score (VAS), respiratory rate, oxygen saturation, heart rate, blood pressure and side effects were recorded.ResultsVPS was low in the gabapentin group versus the placebo group after the block till discharge (P < 0.01). VAS for anxiety was low in the gabapentin group versus the placebo group 1 h after premedication till discharge (P < 0.01). The heart rate and blood pressure were high in the placebo group versus the gabapentin group from arrival to the operating room till discharge. No side effects were recorded.ConclusionPremedication with 1200 mg oral gabapentin reduces anxiety and pain during cataract surgery done under peribulbar block without producing side effects.     

Efficacy of preoperative melatonin versus pregabalin on perioperative anxiety and postoperative pain in gynecological surgeries

BackgroundWe compared the efficacy of melatonin and pregabalin on perioperative anxiety and postoperative pain in patients undergoing laparoscopic gynecological surgeries.MethodsIn this randomized double-blind study, 40 patients, 25–35 yr undergoing gynecological surgeries were divided into 2 equal groups to receive either melatonin capsule 6 mg (Group M), or pregabalin capsule 150 mg (Group P) 1 h before induction of general anesthesia. Our primary outcome was preoperative acute anxiety level 1 h after drug administration, 1, 6, and 12 h after operation. The secondary outcomes were postoperative visual analog scale (VAS) for pain, analgesic consumption, sedation level using the inverted observer’s assessment of alertness/sedation scale (OAA/S) scale, and incidence of adverse effects.ResultsThe anxiety scores decreased significantly >50% after premedication in both groups compared to baseline values (p < 0.01) with no statistically significant difference between the two groups (30.4 ± 4.5 in group M versus 31.7 ± 4.2 in group P, p > 0.05). Postoperative VAS for pain, time for first analgesic demand and number of patients requiring postoperative analgesia did not differ between groups, and the sedation score was higher in melatonin group compared to pregabalin group 1 h after drug (3.45 ± 0.7 versus 1.95 ± 0.6, p < 0.001, respectively) and at all the subsequent readings postoperatively with equal incidence of adverse effects in both groups.ConclusionOral melatonin 6 mg or pregabalin 150 mg administered 1 h before operation had reduced perioperative anxiety and postoperative pain in patients undergoing gynecological surgeries, without untoward sedative effects in the pregabalin group compared to melatonin group.     

Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery

AimThe study conducted aims to assess the efficacy, time to first analgesic request, and postoperative inflammatory response after adding dexamethasone to local anesthetic mixture for a peribulbar block in posterior segment eye surgery.Patients and methodsA double-blind randomized study was carried out on 50 ASA I and II patients scheduled for elective posterior segment surgery (vitreoretinal). Patients were allocated randomly into two groups, 25 patients in each group. Group I received equal volumes of 10 ml of a l:1 mixture of bupivacaine 0.5% and saline, supplemented with 4 mg dexamethasone in 1 ml saline and group II received the same local anesthetic mixture (total volume 10 ml) without adding dexamethasone. The duration and onset of motor block, time to first analgesic request, postoperative inflammatory response, and other side effects such as nausea and vomiting were assessed.ResultsPatients receiving peribulbar block were significantly pain free by end of surgery (0 h) (P < 0.05) and throughout the postoperative period in the dexamethasone group at 2 and 6 h postoperatively. The number of patients requiring rescue analgesics was significantly lower with dexamethasone bupivacaine block (P < 0.05). The incidence of postoperative nausea and vomiting was significantly less in the first group (I) in comparison to the other group (II) (P < 0.05) and lastly the level of C reactive protein postoperatively was found to be significantly less in the dexamethasone group than the other one (P < 0.0001).ConclusionAdding dexamethasone to bupivacaine in peribulbar block appears to be a safe and clinically superior adjuvant with less postoperative pain, inflammatory response in patients undergoing posterior segment eye surgery.     

Comparación de ibuprofeno y ketorolaco intravenosos para analgesia postoperatoria en niños tratados mediante cirugía de la zona inferior del abdomen: estudio aleatorizado,controlado y de no inferioridad

BackgroundNon-steroidal anti-inflammatory drugs are often used as part of multimodal analgesia to control postoperative pain. This randomized, controlled, double-blinded, non-inferiority study aimed to compare the postoperative analgesic effects of intravenous ibuprofen versus ketorolac in children undergoing open unilateral lower abdominal surgery. The authors hypothesized that postoperative analgesia produced by intravenous ibuprofen would be non-inferior to that of intravenous ketorolac.MethodsSixty-six children aged 2 to 8 years who were scheduled to undergo unilateral lower abdominal surgery, were recruited. Patients in the ibuprofen group received 10 mg/kg/6 h intravenous ibuprofen. Patients in the ketorolac group were given 0.5 mg/kg/6 h intravenous ketorolac. The primary outcome measure was 24-h postoperative morphine consumption. The secondary outcome measures were postoperative pain score, the incidence of early postoperative fever and the incidence of ibuprofen and ketorolac adverse effects including pain during drug infusion, vomiting, epigastric pain and allergic reaction.ResultsFifty-nine patients completed the study (30 ibuprofen, 29 ketorolac). There was no significant difference (P= .305) in the mean (SD) 24-h postoperative morphine consumption (μ/kg) between intravenous ibuprofen, 16.00 (5.31), and ketorolac, 14.65 (4.61). The reported pain scores were similar in both groups. The incidence of postoperative fever was significantly lower (p = 0.039) in the ibuprofen group (3%) than the ketorolac group (20%). The incidence of adverse effects was similar in both ibuprofen and ketorolac groups.ConclusionsIntravenous ibuprofen can be used as an alternative to ketorolac for postoperative analgesia in children undergoing unilateral lower abdominal surgery because both drugs similarly provide safe and effective postoperative analgesia.     

Low dose ketorolac infusion improves postoperative analgesia combined with patient controlled fentanyl analgesia after living donor hepatectomy – Randomized controlled trial

BackgroundHepatectomy elaborates significant post-operative pain. Opioids represent cornerstone for post-operative analgesia in such cases. This study examined the therapeutic effect and outcome of adding low dose ketorolac tromethamine infusion to PO intravenous patient controlled fentanyl analgesia IV-PCA.Patients and methodsSixty right lobe donors were randomized into either fentanyl or ketorolac groups (30 patients each). Patients in both groups received fentanyl (2 μg/ml) solution in normal saline as IV-PCA with background infusion in a rate adjusted to deliver 0.25 μg kg h^?1 and boluses of 10 ml with a lock-out time of 20 min. They received 15 mg ketorolac IV bolus in ketorolac group and similar placebo injection in the control. Patients in both groups received a continuous intravenous infusion of 240 ml normal saline solution that is either free in the FENT group or containing 60 mg ketorolac in ketorolac group, adjusted to a rate of 0.2 ml kg h^?1. Visual analogue score (VAS) and hemodynamic profile were recorded at 1, 6, 12, 24, 36 and 48 h while laboratory results were recorded after 48 h and 7 days post-operatively.ResultsVAS was significantly lower in ketorolac group compared to fentanyl group from 6 to 36 h post-operatively while sedation score was significantly higher in fentanyl group compared to fentanyl–ketorolac group between 12 and 36 h post-operatively. Fentanyl consumption was significantly lower in ketorolac group at 24 (318.7 ± 66 vs 468.3 ± 79) and 48 (211.5 ± 59 vs 369.1 ± 68) h. Hemodynamic data and laboratory parameters were comparable in both groups. Nausea had a significantly higher incidence in FENT compared to KETR groups while other complications (vomiting and blood loss) were homogenous in both groups.ConclusionAdding ketorolac to IV PCA fentanyl improved the analgesic state and reduced the dose of fentanyl used without adding any side effects or risks to donors subjected to right lobe hepatectomy.     

Can systemic lidocaine be used in controlled hypotension? A double-blinded randomized controlled study in patients undergoing functional endoscopic sinus surgery

IntroductionFunctional endoscopic sinus surgery (FESS) is one of the operations that need controlled hypotension. Many drugs were successfully used in this purpose, e.g., magnesium sulfate, esmolol, and volatile anesthetics. Hypotension was observed to occur after submucosal injection of lidocaine. Based on this observation, it was hypothesized in this double-blinded randomized controlled study that lidocaine may be effective in producing controlled hypotension.MethodsForty-eight ASA I–II adults planned to undergo FESS were given a standard general anesthetic after which they were divided into 2 equal groups to receive either lidocaine infusion in a dose of 1.5 mg/kg/h (group L, n = 24) or equal volumes of normal saline (group C, n = 24). Primary outcome was the surgical field rating score (0–5 points). Secondary outcomes included hemodynamic parameters, extubation time, end-tidal sevoflurane concentrations, fentanyl consumption, and postoperative visual analog pain scores (VASs).ResultsBoth groups were similar regarding hemodynamic parameters. Surgical field scores were significantly lower in group L than in group C at all intraoperative time points (P < 0.05). Extubation time was significantly longer in group C than in group L [group C: 12.4(2.3) min and group L: 9.1(3) min, P = 0.03]. Intraoperative fentanyl dose was significantly higher in group C than in group L [group C: 172(37) mcg and group L: 149(34) mcg, P = 0.03]. End-tidal sevoflurane concentrations were significantly lower in group L than in group C at most intraoperative time points (P < 0.05). Postoperative VAS pain scores in the PACU were higher in group C than in group L (P < 0.05).ConclusionThis study showed the ability of intravenous lidocaine infusion of 1.5 mg/kg/h to produce controlled hypotension in patients undergoing FESS and the superiority of this technique over placebo to achieve favorable surgical field scoring.     

Clonidine versus fentanyl as adjuvants to bupivacaine in peribulbar anesthesia

BackgroundPeribulbar anesthesia is widely practiced as a safe local block for cataract eye surgeries. Fentanyl has been used as an adjuvant to local anesthetics, prolonging their duration of action. Clonidine has been shown to increase the duration of analgesia and anesthesia produced by local anesthetics.Aim of the studyThe aim of this study was to compare the effect of fentanyl versus that of clonidine when used as adjuvants to bupivacaine in peribulbar block.MethodologyNinety patients, ASA physical status I–III, scheduled for cataract operations, under peribulbar block, were enrolled in the study and randomly assigned into 3 equal groups. Group F (n = 30) received a mixture of bupivacaine, hyaluronidase, and fentanyl; Group C (n = 30) received a mixture of bupivacaine, hyaluronidase, and clonidine; and in the control Group B (n = 30), a mixture of bupivacaine, hyaluronidase, and saline was used for peribulbar block. The onset, duration of globe anesthesia, akinesia, and lid akinesia were recorded. Intraoperative and postoperative patient comfort, first time to analgesic request, and any recorded complications due to drugs used were all assessed.ResultsGroups C and F showed significantly faster onset and longer duration of globe anesthesia, akinesia, lid akinesia, and the time to first analgesic request when compared to Group B (p < 0.001). The onset, of lid akinesia was significantly faster in Group C compared to Group B (p < 0.01). Group C showed a significantly longer duration of lid akinesia and globe akinesia compared to Group F (p < 0.01).ConclusionThe addition of either clonidine or fentanyl to the local anesthetic during peribulbar block results in a faster onset and longer duration of the block with a longer period of postoperative analgesia. The addition of clonidine was found to prolong the duration of the block more than fentanyl.     

Effect of tramadol on fentanyl induced cough: A double-blind,randomized, controlled study

BackgroundTramadol has NMDA antagonist effect and reported to have antitussive effect. The aim of this study to assess the effect of preoperative i.v. tramadol compared to placebo on the incidence and severity of fentanyl induced cough.MethodIn a prospective, randomized, double-blind study, 100 patients ASA I, age 18–50 years old, scheduled for elective laparoscopic surgeries under general anesthesia. Patients were randomly allocated to one of two groups: Tramadol group received i.v. tramadol 1 mg/kg in 100 ml saline and control group received 100 ml saline over 15 min before induction of anesthesia. The incidence and severity of cough was assessed following injection of fentanyl 2 μg/kg. The postoperative analgesic requirements, nausea, and vomiting were also recorded.ResultsThe incidence of FIC was significantly less in tramadol treated group being [10 (20%)], compared to control group being [19 (38%)] (p < 0.05). Regarding the grade of FIC; 7 out of 10 in tramadol group and 12 out of 19 in control group showed mild form, 3 out of 10 in tramadol group and 4 out of 19 in control group showed moderate form and 3 out of 19 in control group with no patients in tramadol group showed severe form. The postoperative analgesic requirements was significantly less in tramadol group (p < 0.05) with no significant difference in postoperative nausea and vomiting between the two groups.ConclusionTramadol 1 mg/kg i.v. infusion 15 min before induction of anesthesia reduced the incidence and severity of cough after fentanyl injection 2 μg/kg with reduction of postoperative analgesic requirements and without changes in postoperative nausea and vomiting compared to placebo.     

Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico

Background and objectivesThe primary aim of this study is to assess the effect of ultrasoung‐guided erector spinae block on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of erector spinae plane block on intraoperative fentanyl need and postoperative pain scores.MethodsPatients between 18‐70 years old, ASA I‐II were included in the study and randomly allocated into two groups. In Group ESP, patients received bilateral US‐ESP with 40 ml of 0.25% bupivacaine at the level of T7, while in Group Control, they received bilateral US‐ESP with 40 ml of saline before the induction of anesthesia. Then a standard general anesthesia procedure was conducted in both groups. NRS scores at the postoperative 15th, 30th, 60th minutes, 12th and 24th hours, intraoperative fentanyl need and total postoperative tramadol consumption were recorded.ResultsThere were 21 patients in Group ESP and 20 patients in Group Control. Mean postoperative tramadol consumption was 100 ± 19.2 mg in Group ESP, while it was 143 ± 18.6 mg in Group Control (p < 0.001). The mean intraoperative fentanyl need was significantly lower in Group ESP (p = 0.022). NRS scores at the postoperative 15th, 30th min, 12th hour and 24th hour were significantly lower in ESP group (p < 0.05). According to repeated measures analysis, NRS score variation over time was significantly varied between two groups (F[1,39] = 24.061, p < 0.0005).ConclusionsBilateral US‐ESP block provided significant reduction in postoperative opioid consumption, intraoperative fentanyl need and postoperative pain scores of patients undergoing laparoscopic cholecystectomy.     

Effect of pregabalin on postoperative pain after shoulder arthroscopy

BackgroundPostoperative pain is difficult to be managed with the use of opioids analgesia alone, so multimodal pain management is a method to improve postoperative analgesia with minimal side effects. Pregabalin has an analgesic and opioid sparing effects in postoperative analgesia. The objective of the present study was to evaluate the effect of premedication with pregabalin on postoperative analgesia in patients undergoing shoulder arthroscopy.MethodsEighty patients ASA I-II and aged 18–60 years undergoing elective shoulder arthroscopy were randomized to receive two doses of either placebo or pregabalin 300 mg 12 h and 1 h before surgery. Anesthesia was induced with thiopental (3–5 mg/kg) and atracurium (0.5 mg/kg) and maintained with isoflurane with O₂. Patients were studied at 1, 4, 8, 12 and 24 h postoperatively for Visual Analogue Scale (VAS), nalbuphine consumption (was given when VAS > 4), satisfaction score and side effects of pregabalin.ResultsThe VAS scores of the pregabalin group were significantly lower than the control group at 1, 4 and 8 h after surgery. The total nalbuphine consumption at 24 h postoperatively of pregabalin group (33.8 + 6.89) was highly significant lower than the control group (46.4 + 5.72) (p < 0.001). There were no significant differences between groups in somnolence-dizziness and nausea-vomiting. The satisfaction score was higher in the pregabalin group.ConclusionA 300 mg pregabalin administered 12 h and 1 h preoperatively is a safe and effective method in management of pain after shoulder arthroscopy.     

Efficacy of Intravenous Paracetamol and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective,Randomized, Double-Blind,Placebo-Controlled Clinical Trial

ObjectivesEffective postoperative pain management after lumbar disc surgery reduces complications and improves postoperative care. The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study is to evaluate the effects of IV paracetamol and ibuprofen on postoperative pain, morphine consumption and side effects of morphine in patients who underwent lumbar disc surgery.Materials and methodsSeventy-five patients aged 18-85 years scheduled for lumbar disk surgery with a single level laminectomy included in this study. All patients received morphine with an IV patient-controlled analgesia device during the first postoperative 24 hour. The patients were divided randomly and double-blinded into three groups (control, paracetamol and ibuprofen). The demographic characteristics and procedure data, VAS score, cumulative morphine consumption, opioid-related side effects were recorded.ResultsThere was no significant difference regarding to demographic characteristics, comorbidities, and durations of anesthesia and surgery. There was a significant difference between all groups regarding to total morphine consumption (P < 0.001). IV ibuprofen significantly reduced the total morphine consumption in comparison with control and paracetamol (P < 0.001). Repeated measures ANOVA showed in all periods of the study that VAS score was significantly lower in ibuprofen (P < 0.001), but not in paracetamol (P = 0.394) in comparison with control. There was no difference between groups regarding postoperative heart rate, mean arterial pressure, nausea-vomiting, pruritus and urinary retention.ConclusionsThis study showed that pain scores and morphine consumption, but not the side effects of patient-controlled analgesia during 24 hours after the lumbar disk surgery, were significantly reduced by IV ibuprofen as a supplemental analgesic when compared with controls and paracetamols.     

Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia: a double-blind,dose-comparison,placebo-controlled randomized trial

BackgroundThe analgesic benefit of TAP (transversus abdominis plane) blocks for cesarean delivery pain remains controversial. We compared the analgesic efficacy of two doses of local anesthetic for TAP blocks after cesarean delivery.MethodsSixty women having cesarean delivery under spinal anesthesia were randomized to receive ultrasound-guided TAP blocks using either high-dose ropivacaine (3 mg/kg), low-dose ropivacaine (1.5 mg/kg) or placebo. Patients received intrathecal 0.75% bupivacaine 10–12 mg, fentanyl 10 μg and morphine 150 μg and standard multimodal analgesia. The primary outcome was the difference in pain with movement using a numeric rating scale at 24 h. Other outcomes included time to first request for analgesia, pain scores at 6, 12, 36, 48 h and at 6 and 12 weeks, opioid consumption, adverse effects, quality of recovery, and satisfaction.ResultsThere were no differences between groups in the primary outcome. Mean ± SD pain scores (0–10) with movement at 24 h were: high-dose ropivacaine 3.6 ± 1.5, low-dose ropivacaine 4.6 ± 2.1 and placebo 4.1 ± 1.7. With respect to secondary outcomes, the mean ± SD pain scores at 6 h were lower in the high-dose group 2.0 ± 1.8 compared to the low-dose 3.4 ± 2.7 and placebo groups 4.2 ± 2.0 (P = 0.009). Pain scores at 12 h were also lower in the high-dose group 2.2 ± 2.0 compared to the low-dose group 4.1 ± 2.7 and placebo group 4.0 ± 1.3 (P = 0.011). There was no difference in other outcomes between groups.ConclusionsNeither high- or low-dose TAP blocks as part of a multimodal analgesia regimen including intrathecal morphine improved pain scores with movement at 24 h after cesarean delivery when compared to placebo TAP blocks. High-dose TAP blocks may improve pain scores up to 12 h after cesarean delivery.     

Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery

BackgroundFunctional Endoscopic sinus surgery (FESS) is a delicate and time consuming procedure; it is performed routinely under general anesthesia. Hypotensive techniques should be employed for best visualization of operative field. Gabapentin is a structural analog of gamma amino butyric acid. The aim of this study was to determine the analgesic efficacy of gabapentin and its role in deliberate hypotension during and after FESS.MethodsEighty patients ASA physical status I–II patients were scheduled to undergo elective FESS under general anesthesia. Patients were randomly assigned to one of two groups using a computer-generated table. Patients in the control group (40 patients) received oral placebo capsules and the study group (40 patients) patients received oral gabapentin (Conventin 400 mg; Evapharma Egypt) 1.2 g 1 h before surgery. Intraoperative, mean arterial blood pressure, infusion rates of the hypotensive agent (sodium nitroprusside) were recorded at 15 min interval. Assessments of pain, opioid usage, and side effects were performed at 1 h interval after arrival in the PACU.ResultsGabapentin group patients required significantly lower (p value <0.05) infusion rates and total doses of hypotensive agent (sodium nitroprusside) than the placebo group patients at all measured intervals. Postoperative assessment of pain scores revealed that gabapentin group recorded significantly lower mean values of VAS than the control group (p value <0.05).ConclusionOral gabapentin, 1200 mg decreased dose requirements of intraoperative hypotensive agent (sodium nitroprusside) and postoperative morphine. In addition, patients receiving gabapentin had suffered less from opioid side effects (nausea, vomiting and urinary retention) than those receiving placebo.