Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery

Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery.ObjectivesThe objectives of this study were designed to detect the effects of addition of dexmedetomidine to bupivacaine on the quality of blind fascia iliaca compartment block and its possible side effects in children undergoing fracture femur surgery.MethodsThis study was conducted on 28 children (2–6 years of age), scheduled for fracture femur surgery. Children were randomly allocated to receive either 0.25% bupivacaine 1 ml kg^?1 (B group), or 0.25% bupivacaine 1 ml kg^?1 with dexmedetomidine 2 μg kg^?1 (BD group). Anesthesia was maintained with sevoflurane 1–1.5 minimum alveolar concentration. Intraoperative sevoflurane concentration, hemodynamic, postoperative emergence delirium, sedation scores and pain scores were recorded. Duration of surgery and emergence time were recorded. Postoperative complications such as (nausea and vomiting, respiratory depression, purities, hypotension and bradycardia) were reported.ResultsCompared to the group B, patients received bupivacaine–dexmedetomidine for fascia iliaca compartment block had lower intraoperative sevoflurane concentration, higher sedation score, longer duration of postoperative analgesia, less use of rectal paracetamol for the first 24 h postoperatively and less number with postoperative agitation. No patients developed postoperative respiratory depression, purities, hypotension or bradycardia.ConclusionThe present study concluded that the combined use of bupivacaine–dexmedetomidine for fascia iliaca compartment block in children provided significant reduction of end-tidal sevoflurane concentration, remarkable hemodynamic stability, significant postoperative analgesia with lower postoperative analgesics requirements without any undesirable complications.     

Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery

Background and objective: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. Patients and Methods: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. Results: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. Conclusions: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques.     

Levobupivacaine patient controlled analgesia: Epidural versus blind fascia iliaca compartment analgesia – A comparative study

This study was designed to compare the analgesic efficacy of levobupivacaine patient controlled analgesia epidural versus patient controlled analgesia with fascia lliaca compartment block. In patients undergoing fixation of fracture neck femur.MethodsSixty patients ASA II&III undergoing fixation of fracture neck femur were randomly allocated into two groups (n = 30).Group EEpidural group given levobupivacaine 0.25% 15 ml before induction of general anesthesia, followed by postoperative PCEA with levobupivacaine (0.125%).Group FFascia iliaca block group given levobupivacaine 0.25% 30 ml through the catheter before induction of general anesthesia, followed by postoperative patient controlled fascia illiaca analgesia with levobupivacaine (0.125%).Severity of postoperative pain at rest in 24 h using VAS, number of patients required additional analgesia (tramadol) in 24 h, doses of postoperative 24 h tramadol consumed, postoperative mean arterial blood pressure and heart rate were recorded.ResultsThe severity of postoperative pain was statistically significantly less in E group, number of patients required tramadol in 24 h were statistically significantly less in E group than F group, postoperative tramadol consumed was statistically significantly less in E group than F group.ConclusionPCEA with levobupivacaine (0.125%) was associated with satisfactory analgesia than patient controlled analgesia with fascia iliaca block in patients undergoing fixation of fracture neck femur.     

Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery

Study objectiveWe conducted this study to compare the efficacy of caudal epidural block (CEB) vs ultrasonography-guided transversus abdominis plane (TAP) block for providing postoperative pain relief in children scheduled for lower abdominal surgery. Whereas the primary objective was to compare the duration of postoperative analgesia, the secondary objectives included comparative assessment (TAP vs CEB) of quality of pain relief in the first 24 hours postoperatively and rescue analgesia requirements.DesignRandomized-control, prospective, observer-blinded, 2-arm, single-center comparison.SettingOperating room, postoperative recovery area.PatientsEighty-children, aged 2-6 years, of American Society of Anesthesiologists physical status I/II scheduled to undergo unilateral lower abdominal surgery under general anesthesia.InterventionsThe recruited children were randomly allocated to receive under general anesthesia either CEB (group C, 0.75 mL/kg of 0.25% bupivacaine) or ultrasonography-guided administration of TAP block (group T, 0.5 mL/kg of 0.25% bupivacaine).MeasurementsIntraoperative: heart rate and noninvasive blood pressure; postoperative: pain profile, including duration of postoperative analgesia, quality of pain relief, and rescue analgesia requirements.Main resultsThe median duration of postoperative analgesia was significantly greater in children who received CEB than those who were administered TAP block (group C: 362.5 minutes [172.5-693.75] vs group T: 210 minutes [108.75-362.5]; P < .05). No difference was found in the incidence of postoperative pain up to 6 hours from the point of initiation of assessment (group C: 47.2% vs group T: 55.9%; P > .05). The children who received CEB experienced greater incidence of pain in the 6- to 24-hour postoperative interval than those administered TAP block (group C: 75% vs group T: 44.1%; P < .05). Although there was no difference in the rescue analgesia requirements, the number of children not requiring any rescue analgesia in the first 24 hours postoperatively was significantly higher in the TAP group (group C: n = 2 vs group T: n = 8; P < .05).ConclusionsIn children undergoing lower abdominal surgery, CEB provides a significantly prolonged duration of postoperative analgesia when compared with ultrasonography-guided TAP block.     

Postoperative continuous transversus abdominis plane block vs continuous wound infusion of levobupivacaine in females undergoing open gynecologic procedures

IntroductionTransversus abdominis plane (TAP) block is used as a part of multimodal analgesia in decreasing pain of lower abdominal wall incision. Local anesthetic instillation of wounds through subcutaneous or subfascial catheters is used to treat postoperative pain in different types of surgery. The aim of this randomized controlled trial was to study the opioid-sparing effect of these two techniques (if any) compared to placebo in women undergoing gynecologic procedures through transverse lower abdominal incisions.MethodsSeventy-eight ASA I–III patients planned to undergo gynecologic procedures through a transverse lower abdominal incision were randomly divided into three equal groups: Control (C) group (n = 26), Continuous Wound Infusion (CWI) group (n = 26), and continuous transversus abdominis plane block (TAP) group (n = 26). After standardized general anesthetic and before extubation, the patients were given the allocated treatment. A morphine patient-controlled analgesia (PCA) was started postoperatively alongside with the local anesthetic (or placebo) infusion. Cumulative dose of morphine PCA in the first postoperative 48 h was the primary outcome. Secondary outcomes included visual analog pain score (VAS) at rest and on movement and complications of morphine PCA.ResultsThe cumulative dose of morphine PCA in the first postoperative 48 h was higher in control group than in groups CWI and TAP (P < 0.001). However, no significant difference was found between groups CWI and TAP. No significant differences were found among the three groups regarding VAS during rest but TAP group showed less pain scores than groups C and CWI on movement. The three groups were similar regarding morphine side effects.ConclusionContinuous bilateral TAP block and CWI can decrease PCA morphine consumption in the first postoperative 48 h when compared to placebo in women undergoing gynecologic surgery through transverse lower abdominal incision. Continuous TAB block might give better analgesia with movement than CWI.     

Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

BackgroundDexamethasone has anti-inflammatory properties that can affect postoperative analgesia when added to caudal bupivacaine.MethodsSeventy-two geriatric patients scheduled for elective total hip replacement under ultrasound guided caudal anesthesia were randomized blindly into two groups: Group BD received caudal isobaric bupivacaine 0.25% (20 ml) and dexamethasone 8 mg (2 ml) and Group BS received caudal isobaric bupivacaine 0.25% (20 ml) and normal saline (2 ml). Postoperative analgesia was assessed by recording time to first rescue analgesia and the analgesic doses (paracetamol and meperidine hydrochloride) required during the first 24 h postoperatively as a primary outcome. Secondary outcomes were the time taken to the onset of sensory analgesia at T10, time to the onset of complete motor block, VAS pain score at rest and on movement at 1, 2, 4, 6, 8, 12 and 24 h, and postoperative adverse events.ResultsGroup BD had a significantly longer time to first rescue analgesia [402 (63) vs 213 (53)] min and significantly lower doses of paracetamol [3389 (728) vs 2833 (697)] mg meperidine hydrochloride [78 (30) vs 142 (28)] mg than Group BS. VAS scores were significantly lower in Group BD than Group BS both at rest and on movement respectively at 4, 6, 8, 12 and 24 h.ConclusionAdding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.     

超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者围术期镇痛的研究

目的:研究超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期疼痛控制及术后并发症的影响。方法:选择2021年1月至2021年9月收治的老年髋部骨折手术患者127例,按照镇痛方法不同分为连续髂筋膜间隙阻滞组(F组)和静脉镇痛对照组(C组)。其中F组62例,男19例,女43例;年龄66~95(82.4±7.2)岁;股骨颈骨折25例,股骨转子间骨折37例。C组65例,男18例,女47例;年龄65~94(81.4±8.7)岁;股骨颈骨折29例,股骨转子间骨折36例。观察两组患者围术期不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS)、简易精神状态评价量表(minimental state examination,MMSE)评分、警觉-镇静评分(observer''s assessment of alertness/sedation,OAA/S)、改良Bromage评分、术后并发症及患者住院期间情况。结果:F组实施阻滞后30 min、麻醉摆放体位时,术后6、24、48 h的静息及运动VAS低于C组(P<0.05)。F组术前12 h,术后1、3 d的MMSE评分及术后3 d的OAA/S评分高于C组(P<0.05)。F组不良反应发生率、需要额外镇痛人数低于C组(P<0.05)。F组围术期镇痛满意度及住院时间均优于C组(P<0.05)。两组患者在各时间点患肢Bromage评分及术后30 d死亡率比较,差异无统计学意义(P>0.05)。结论:超声引导下连续髂筋膜间隙阻滞可为老年髋部骨折患者提供安全、有效的围术期镇痛效果,改善术后认知功能,减少术后并发症,从而缩短住院时间,提高住院期间生活质量。     

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.     

Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective,randomized, double-blinded clinical trial

BackgroundTransversus abdominis plane (TAP) block is a peripheral nerve block that reduces postoperative pain, nausea, vomiting and the need for postoperative opioids following various types of abdominal surgery. The primary aim of the present study was to evaluate the effects of TAP block on postoperative analgesia and opioid consumption in living liver donors in whom a right “J” abdominal incision was used.MethodsThis prospective, double-blinded, randomized controlled study was conducted with 50 living liver donors, aged 18–65 years, who were scheduled to undergo right hepatectomy. Patients who received ultrasonography-guided subcostal TAP block were allocated into Group 1, and patients who did not receive TAP block were allocated into Group 2. The TAP blocks were performed bilaterally at the conclusion of surgery using 1.5 mg 1 kg^− 1 bupivacaine diluted with saline to reach a total volume of 40 mL. For each patient, morphine consumption, pain scores at rest and movement, sedation scores, nausea, vomiting and the need for antiemetic medication were assessed at 0, 2, 4, 6, 12 and 24 h postoperatively by researchers who were blinded to the study groups.ResultsMorphine consumption was significantly lower in Group 1 than in Group 2 at the 2nd, 6th and 24th hours (P < 0.05). The mean total morphine consumption values after 24 h were 40 mg and 65 mg in Groups 1 and 2, respectively. The TAP block significantly reduced postoperative visual analog scale pain scores both at rest and during movement at 0, 2, 4, 6, and 24 h postoperatively (P < 0.05).ConclusionsThe TAP block reduced 24-h postoperative morphine consumption and contributed to analgesia in living liver donors who underwent upper abdominal wall incisions.     

Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block

IntroductionTo compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement.Material and methodsA prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30 mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6 ml/h for 48 h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48 h after surgery.ResultsA total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48 h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose.ConclusionsThe use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48 h) compared to isolated femoral block.     

Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

BackgroundPectoral nerve block (Pecs) is a novel interfascial plane block which can provide analgesia after breast surgery while paravertebral block (PVB) is widely used for this purpose. We evaluated the difference between the two techniques in regard to morphine consumption and analgesic efficacy after modified radical mastectomy (MRM).MethodsSixty patients undergoing elective MRM were randomly allocated into either PVB with 15–20 ml of levobupivacaine 0.25% at the level of fourth thoracic vertebra or Pecs block with 10 ml of levobupivacaine 0.25% injected inbetween pectoralis major and pectoralis minor muscle and another 20 ml levobubivacaine 0.25% inbetween pectorlis minor and serratus anterior muscle. Primary outcome measure was morphine consumption in the first 24 h while secondary outcome measures included pain scores, intraoperative fentanyl consumption as well as postoperative nausea and vomiting (PONV).ResultsPostoperative morphine consumed at 24 h was significantly lower in Pecs group [21 (20–25) mg] than in PVB group [28 (22–31) mg], (p = 0.002). Time for first request of morphine was longer in Pecs group [175 (155–220) min] than in PVB group [137.5 (115–165) min], (p < 0.001). Numerical rating score (NRS) at rest was lower in Pecs group compared with PVB group at 1 h, 6 h and 12 h (p < 0.001) but at 18 h and 24 h it was lower in PVB group compared with Pecs group (p = 0.008 and <0.001 respectively). During movement, NRS was significantly lower at 1st hour in Pecs group (p < 0.001) while at 18 h and 24 h it was significantly lower in PVB group (p < 0.001). PONV was comparable between both groups.ConclusionPecs block reduced postoperative morphine consumption in the first 24 and pain scores in the first 12 h in comparison with PVB after mastectomy.     

Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during endoscopic trans-nasal resection of pituitary adenoma

BackgroundThis study was conducted to investigate the anaesthetic, vasodilator, and post-operative analgesic sparing effect of bilateral sphenopalatine ganglion block (SPGB) in patients undergoing endoscopic endo-nasal trans-sphenoidal surgery.MethodsThirty adult patients of ASA (I, II), aged 20–60 years, were randomly allocated to either the block group or the non-block group (n = 15, for each). After establishment of general anesthesia with sevoflurane and 100% oxygen, the patients received bilateral SPGB with 1.5 ml of either 0.5% bupivacaine (block group) or 0.9% NaCl (non-block group). Intra-operative mean arterial pressure (MAP) was maintained at 60–65 mmHg by using nitroglycerine. End-tidal sevoflurane concentration required to maintain bispectral index values (40–50) throughout the operation was recorded. Nitroglycerine and propranolol consumption, blood loss, recovery profile, perioperative catecholamines, post-operative pain and meperidine consumption were evaluated.ResultsBlock group showed significant decrease in sevoflurane and nitroglycerine consumption, blood loss, emergence time and time needed to achieve ?9 Aldrete score, P < 0.0001. All patients in non-blockade group (100%) were supplemented by nitroglycerine to achieve the target MAP versus 9 patients (60%) in the block group (P < 0.01). Propranolol administration was necessary in 9 patients (60%) in the non-block group versus 3 patients (20%) in the block group, P < 0.05. At PACU, visual analogue pain score and number of patients received meperidine analgesia were significantly less in the block group versus non-block group, P < 0.0001 and P < 0.001, respectively. Intra- and post-operative plasma epinephrine and nor-epinephrine levels were significantly higher in the non-block group than the block group, P < 0.05.ConclusionBilateral SPGB has anaesthetic, vasodilator and analgesic sparing effect when combined with general anaesthesia during endoscopic endo-nasal trans-sphenoidal resection of pituitary adenoma.     

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.     

Efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block after laparoscopic sleeve gastrectomy: A double blind,randomized, placebo controlled study

IntroductionPain control in the morbidly obese can be especially challenging because of increased sensitivity to opioid-induced respiratory depression. The subcostal transversus abdominis plane block is associated with a large area of spread (T7-L1). The aim of the study was to test the hypothesis that US-guided TAP blocks can reduce opioid consumption during the first 24 h after of laparoscopic sleeve gastrectomy in comparison with port site local anesthetic infiltration and systemic analgesia.MethodSixty-three ASA II/III adult patients listed for elective laparoscopic sleeve gastrectomy were randomly allocated in one of three groups: Group I (OSTAP) received bilateral OSTAP block. Group II (Local) received local anesthetic infiltration at trocar port sites. Group III (Control) placebo group received TAP block and port site infiltration by same volumes of sterile normal saline. Twenty-four hours postopetrative morphine consumption, the dose of fentanyl (μg) required during surgery, equivalent morphine dose in the recovery unit (PACU) and first morphine dose were recorded. The quality of analgesia is assessed by Visual Analogue Scale for 24 h at rest and movement.ResultsThe mean opioid consumptions in PACU showed significant difference between the three groups, P = 0.02. The mean 24 h morphine consumption showed statistically significant difference between groups (P value < 0.001). Significant differences were found between both OSTAP and Local groups with control group (P < 0.001) and also between OSTAP and Local groups (P = 0.02). Pain score of OSTAP group was significantly lower than local infiltration group at 6 and 4 h at rest and movement respectively. OSTAP group had faster extubation time than other groups. Postoperative nausea and vomiting were not significant between groups. No signs or symptoms of local anesthetic systemic toxicity or complications were detected.ConclusionOblique subcostal TAP block is a good alternative for providing analgesia during the postoperative period. The block is easily performed using ultrasound guidance. It is safe, provides effective analgesia with significant morphine-sparing effect with reduced side-effects of opioids.     

Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: A comparison between the out-of-plane versus the in-plane approaches

BackgroundThe optimal method of ultrasound-guided femoral nerve block (in-plane vs. out-of-plane) has not been established. We tested the hypothesis that the incidence of needle-nerve contact may be higher with out-of-plane than with in-plane needle insertion.MethodsForty-four patients with hip fracture (American Society of Anaesthesiologists physical status I–III) were randomized to receive the femoral block with an out-of-plane approach (needle inserted at a 45–60° angle 1 cm caudal to the midpoint of the ultrasound probe just above the femoral nerve) or with an in-plane technique (needle inserted 0.2–0.4 cm from the side of the probe lateral to the femoral nerve). Data collected included depth of needle insertion, response to nerve electric stimulation, and distribution of the injected volume in relation to the nerve (anterior vs. posterior, the latter assuming needle-nerve contact). The sensory block onset was tested at 20 min and block recovery and any neurologic symptoms were evaluated at 24 h.ResultsThe incidence of needle-nerve contact was significantly higher with the out-of-plane approach (14/22 patients [64%]) than with the in-plane approach (2/22 patients [9%]) (p < 0.001) (OR = 17.5, 95% CI: 4–79). The rate of paraesthesia on crossing the fascia iliaca was similar in the two groups. All blocks uneventfully regressed; and no patient developed neurologic symptoms.ConclusionsUnder the conditions of our study, needle-nerve contact during femoral nerve block occurs frequently with the out-of-plane approach. An in-plane approach results in an equally effective femoral block and less incidence of needle-nerve contact.     

Comparison of femoral nerve block and fascia iliaca block for analgesia following reconstructive knee surgery in adolescents

Study ObjectiveTo compare the femoral nerve block with the fascia iliaca block for postoperative analgesia in adolescents undergoing reconstructive knee surgery.DesignRandomized, single-blinded study.SettingFull-service pediatric medical center.Patients23 ASA physical status I and II patients, aged 8 to 16 years, undergoing anterior cruciate ligament (ACL) repair.InterventionsPatients received either fascia iliaca or femoral nerve block prior to reconstructive surgery.MeasurementsPain scores by visual analog scale (VAS; 0-10) and morphine use were routinely recorded through to discharge from the hospital. Pain scores were assessed on days 1 and 2 at home post-discharge.Main resultsThere was no difference between the femoral nerve block and the fascia iliaca nerve block in VAS pain scores or postoperative morphine consumption.ConclusionEither the femoral nerve block or the fascia iliaca block, followed by patient-controlled analgesia with morphine, provides efficacious analgesia for adolescents undergoing ACL reconstruction.     

Anesthesia management with ultrasound-guided thoracic paravertebral block for donor nephrectomy: A prospective randomized study

Study objectiveTo determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy.DesignProspective randomized controlled study.SettingPrivate foundation university hospital; November 2014 to June 2015.PatientsThirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n = 14) or Group M (morphine, n = 16).InterventionsIn Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively.MeasurementsIntraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Horner's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression.ResultsIntraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P < .001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P.ConclusionsContinuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications.     

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.     

Intrathecal vs intravenous magnesium as an adjuvant to bupivacaine spinal anesthesia for total hip arthroplasty

BackgroundThe aim of this study was to investigate the effect of intravenous infusion vs intrathecal magnesium sulfate during spinal anesthesia on postoperative pain, analgesic consumption, and intraoperative blood loss on patients undergoing total hip arthroplasty surgery.MethodsIn this prospective randomized controlled study, 75 adult patients, ASA physical status I and II scheduled for total hip arthroplasty, were included and randomized into three groups. Patients in Group I (control) received spinal anesthesia with hyperbaric bupivacaine and fentanyl. In Group II (IT Mg), 50 mg of magnesium sulfate was added to bupivacaine and fentanyl. In Group III (IV Mg), after induction of spinal anesthesia as in group I, a bolus dose of i.v. magnesium sulfate 40 mg kg^?1 was injected over 10 min, followed by continuous infusion of 15 mg kg^?1 h^?1 till the end of surgery. Arterial blood pressure, heart rate, electrocardiography, and O₂ saturation were continuously monitored. Onset, duration of sensory and motor block, and postoperative pain scores were assessed. Serum magnesium concentrations were checked before induction of anesthesia, immediately after surgery, at 6 h and 24 h after surgery. Total analgesic consumption and intraoperative blood loss were calculated.ResultsThere were no significant differences between the study groups in terms of onset time and maximum sensory level achieved, as well as onset and duration of motor block. Postoperative pain scores and 24 h analgesic consumption were lower in group II and III with insignificant differences between them. Intraoperative blood loss was significantly lower in group III. Postoperative Mg levels were higher in group III, without significant side effects.ConclusionsBoth i.v. infusion and intrathecal injection of Mg sulfate improved postoperative analgesia after total hip replacement. In addition, i.v. infusion of Mg sulfate reduced intraoperative blood loss.