The analgesic efficacy of continuous fascia iliaca block vs. continuous psoas compartment block after hip surgery: A comparative study

BackgroundBoth psoas compartment block and fascia iliaca compartment block have been shown to be reliable blocks for postoperative pain relief for procedures involving the hip joint. This study evaluated the efficacy of continuous psoas compartment block with continuous fascia iliaca block for postoperative analgesia after hip surgery.MethodsIn randomized blinded study Forty, ASA I–III patients aged 30–75 years, with BMI less than 40, scheduled for hip surgery, were divided to one of two groups. Group P: continuous psoas compartment block (n = 18) and group F: continuous fascia iliaca block (n = 19). Standard general anesthesia was induced after finishing the block technique. After recovery 30 ml of 0.125% levobupivacaine was injected through the catheter to all patients. Postoperative 24 h meperidine consumption, patient satisfaction, visual analogue scale pain scores at (1, 6, 12, 18, and 24 h) postoperative, postoperative hemodynamics (HR and MAp), evidence of sensory and motor blockades, and incidence of adverse effects were recorded.ResultsThere was no significant difference between the two groups in 24 h postoperative meperidine requirements, postoperative VAS, patient satisfaction, postoperative hemodynamics, and distribution of sensory and motor block of (femoral, lateral femoral cutaneous, and obturator nerves). The epidural anesthesia occurred in two patients in psoas group (11%).ConclusionBoth continuous fascia iliaca block and continuous psoas compartment block were comparable in providing safe and effective analgesia after hip surgery.     

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.     

Efeitos de cetamina e midazolam sobre a incidência de agitação pós‐anestesia com sevoflurano em crianças submetidas ao bloqueio caudal: estudo randomizado

Background and objectivesEmergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.Methods62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg⁻¹, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg⁻¹, midazolam 0.03 mg kg⁻¹ and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.Results and conclusionsModified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow‐up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.     

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.     

Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients: a randomized study

BackgroundThe effect of dexmedetomidine on the potency of bupivacaine for transversus abdominis plane (TAP) block in pediatric patients has not been investigated.Study objectiveThe primary objective of this study was to assess the effectiveness of dexmedetomidine to decrease the concentration of bupivacaine needed for analgesia for ultrasound-guided TAP block in a pediatric patient undergoing hernia repair or hydrocelectomy.DesignThis is a randomized, double-blind, up-down, dose-finding study.SettingOperating room.PatientsSixty American Society of Anesthesiologists I and II patients aged 1-4 years scheduled for elective unilateral herniorrhaphy or hydrocelectomy.InterventionsPatients were randomly assigned to 1 of the 2 groups: group B (0.125% bupivacaine, 1 mL/kg) TAP block or group BD (0.125% bupivacaine plus 2 μg/kg dexmedetomidine, 1 mL/kg) TAP block.MeasurementsThe response of each child was observed for 60 seconds after skin incision and evaluated as ‘unsuccessful’ when skin incision caused a change in hemodynamic parameters (heart rate and mean blood pressure) 20% more than the preincision values. If the response was determined to be unsuccessful, the concentration of bupivacaine administrated to the next patient was increased by 0.02%. If it was successful, the concentration of bupivacaine administrated to the next patient was decreased by 0.02%.ResultsThe minimum local anesthetic concentration of bupivacaine was 0.0839% (0.0137) in the B group and 0.0550% (0.0169) in the BD group. The difference was statistically significant (t = 7.165, P = .0001). The total postoperative analgesic dosage of morphine was significantly higher in the B group (0.17 ± 0.04 mg/kg) than the BD group (0.11 ± 0.02 mg/kg, P = .001).ConclusionsThe addition of 2 μg/kg of dexmedetomidine reduced the minimum local anesthetic concentration of bupivacaine used for a TAP block and improved postoperative analgesia in children undergoing surgery for inguinal hernia repair or hydrocelectomy.     

Effects of intrathecal bupivacaine–fentanyl versus bupivacaine–dexmedetomidine in diabetic surgical patients

BackgroundDiabetes mellitus is the most common endocrine disorder encountered during anesthesia. Experimental researches showed that the functional μ opioid receptors in the dorsal horn of spinal cord in diabetics are either reduced or impaired in their function. This prospective study was postulated to differentiate between the effects of either opioid like fentanyl versus nonopioid like dexmedetomidine agents added to spinal bupivacaine in diabetic patients.MethodsSixty diabetic patients of either sex were submitted for elective lower limb orthopedic surgery. Patients were randomly allocated into three equal groups (each group 20 patient): bupivacaine group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 0.5 mL of normal saline, bupivacaine–fentanyl group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 25 μg fentanyl in 0.5 mL of normal saline and bupivacaine–dexmedetomidine group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5%, plus 10 μg dexmedetomidine in 0.5 mL of normal saline. Duration and quality of sensory and motor block were assessed.ResultsThe duration of sensory and motor block as well as duration of effective analgesia was significantly longer in the bupivacaine–dexmedetomidine group as compared with both bupivacaine–fentanyl and control bupivacaine groups.ConclusionAddition of intrathecal dexmedetomidine to heavy bupivacaine 0.5% was more advantageous than fentanyl with special regard to its analgesic properties in diabetic surgical patients.     

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Background and objectivesEven a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short‐term sedation in the intensive care unit but also is an alpha 2 agonist sedative.Method60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre‐induction loading dose of 50 mg kg⁻¹ over 10 min and maintained at 15 mg kg⁻¹ h⁻¹; in Group D, dexmedetomidine was given at 1 mcg kg⁻¹ 10 min before induction and maintained at 0.6 mcg kg⁻¹ h⁻¹. Intraoperatively, the haemodynamic and respiratory parameters and 6‐point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11‐point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted.ResultsGroup D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters.ConclusionsDue to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.     

Comparação de fentanil e dexmedetomidina como adjuvante à bupivacaína para raquianestesia unilateral em cirurgia de membros inferiores: estudo randômico

Background and objectivesOne of the disadvantages of unilateral spinal anesthesia is the short duration of post‐operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery.MethodsIn this double‐blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5 μg of dexmedetomidine, 25 μg of fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24 h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90 min.ResultsThe duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169 min) and BD (92 and 166 min) groups than the BS (84 and 157 min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24 h after surgery, than the BS (1.6) group.ConclusionsThe addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.     

The effects of caudal or intravenous dexmedetomidine on postoperative analgesia produced by caudal bupivacaine in children: a randomized controlled double-blinded study

Study ObjectivesThe aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 μg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries.DesignA randomized controlled double-blind study.SettingUniversity-affiliated teaching hospital.PatientsSeventy-five American Society of Anesthesiologists I children, aged 1 to 6 years.InterventionPatients were randomly allocated to 3 groups. All patients received 1 mL/kg caudal 0.25% bupivacaine. In addition, those in group B (n = 25) received 10-mL IV saline, those in group B-D_cau (n = 25) received 1 μg/kg caudal dexmedetomidine and 10-mL IV saline, and those in group B-D_IV (n = 25) received 1 μg/kg IV dexmedetomidine in 10-mL saline.MeasurementsIntraoperative mean blood pressure, heart rate, peripheral oxygen saturation, end-tidal sevoflurane, and bispectral index as well as postoperative pain and behavior scores and time to first analgesia were assessed.Main resultsGroup B-D_cau had a significantly longer time to first rescue analgesia than groups B-D_IV and B, with mean (SD) values of 14.4 (7.5), 9.18 (2.7), and 6.6 (2.5) hours, respectively (P < .05). Fewer patients in group B-D_cau (n = 16) required rescue analgesia during the first 24 hours postoperatively compared to group B (n = 24) and group B-D_IV (n = 20) (P < .05).Groups B-D_cau and B-D_IV had lower pain and behavior scores than Group B. Eight patients Group B had agitation compared to 2 in Group B-D_IV and 0 in Group B-D_cau. Four patients in Group B-D_IV developed bradycardia and hypotension during surgery.ConclusionsCompared to IV administration, caudal administration of dexmedetomidine during caudal bupivacaine anesthesia provided prolonged postoperative analgesia and a greater analgesic sparing effect without significant side effects. This suggests a greater role of neuraxial compared to that of peripheral α-2 adrenoceptors in pain processing.     

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.     

Dexmedetomidine improves intraoperative conditions and quality of postoperative analgesia when added to epidural in elective cesarean section

IntroductionThis study was designed to evaluate the effect of adding dexmedetomidine to regular mixture of epidural drugs for pregnant women undergoing elective caesarian section with special emphasis on their sedative properties, ability to improve quality of intraoperative, postoperative analgesia and neonatal outcome.MethodsFifty women of ASA physical status I or II at term pregnancy were enrolled randomly to receive either plain bupivacaine plus fentanyl (BF group) or plain bupivacaine plus mixture of fentanyl and dexmedetomidine (DBF group). Incidence of hypotension, bradycardia, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores and side effects were recorded.ResultsNo difference in the times taken for block to reach T4 sensory level, to reach the highest level of sensory block and interval between first neuraxial injection and onset of surgery between the groups. Onset of postoperative pain was significantly delayed in the DBF group (P = 0.001), the need for supplementary fentanyl was significantly less in DBF group (P = 0.03), and no significant difference was obtained between both groups regarding neonatal Apgar scores as well as the incidence of hypotension, bradycardia, nausea, vomiting and duration of motor blockade between the groups. DBF group had significantly less incidence of shivering (P = 0.03).ConclusionAdding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects.     

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.     

Dexmedetomidine is an effective adjuvant to subtenon block in phacoemulsification cataract surgery

BackgroundResearches to find a better adjuvant in regional anesthesia are still continued until now.Dexmedetomidine prolongs anesthesia and analgesia of local anesthetics in various neural blocks as well as the onset of sensory and motor block. The objective of the present study was to evaluate the effect of adding dexmedetomidine to local anesthetics on the sensory and motor block of the subtenon block in patients undergoing phacoemulsification cataract surgery.MethodsSixty patients of American Society of Anaesthesiologists (ASA) grade I–III, aged between 18 and 70 years, scheduled for phacoemulsification cataract surgery were randomly assigned to two equal groups. Group C (control group) received 2 ml of a mixture of 2% lidocaine and 0.5% bupivacaine and Group D (dexmedetomidine group) received 2 ml of a mixture of 2% lidocaine and 0.5% bupivacaine plus dexmedetomidine (0.5 μg/kg). Onset and duration of sensory and motor block was recorded. Pain during administration of anesthesia and during surgery was graded using the verbal analogue scale and recorded. Intraocular pressure, hemodynamic, and sedation parameters were recorded before and after surgery.ResultsOnset of both sensory and motor block was significantly decreased in group D (P < 0.001, P = 0.004 respectively), and duration of sensory and motor block was more prolonged in group D than in group C (P < 0.001, P = 0.961). Pain during administration of anesthesia was significantly lower in group I compared with group II, and more patients in group I compared with group II were pain free, without a significant difference between the two groups. Intraocular pressure was significantly decreased in group D (P < 0.001). More sedation score was observed in group D (P = 0.022). Heart rate and mean arterial blood pressure were insignificantly decreased in group D more than in group C.ConclusionDexmedetomidine is a safe and effective adjuvant to subtenon block in phacoemulsification cataract surgery.     

Bloqueio PECS I para analgesia pós‐operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado,duplo‐cego,controlado por placebo

Background and objectivesPECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population.MethodsThis was a randomized, double‐blind, placebo‐controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg^‐1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 − 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05).ResultsIn the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 − 5.56; mean 95% CI), 3.75 (3.13 − 4.37), 3.79 (2.93 − 4.64), and 2.29 (1.56 − 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 − 5.60), 4.00 (3.50 − 4.49), 3.93 (3.12 − 4.73), and 2.29 (1.56 − 3.01), respectively.ConclusionsPECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.     

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.     

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.     

Pharmacokinetics of bupivacaine after bilateral ultrasound-guided transversus abdominis plane block following cesarean delivery under spinal anesthesia

BackgroundTransversus abdominis plane block is an effective method of post-cesarean analgesia. There are no data available about plasma bupivacaine levels after this block in adults. This study aimed to assess bupivacaine pharmacokinetic parameters after ultrasound-guided transversus abdominis plane blocks following cesarean delivery under spinal anesthesia.MethodsA prospective observational study in parturients undergoing elective cesarean delivery under hyperbaric bupivacaine spinal anesthesia was conducted. After surgery, patients received bilateral transversus abdominis plane block (50 mg bupivacaine each side). Venous blood samples were collected immediately before performing the block and at 10, 20, 30, 45, 60, 90, 120, 180, 240, 720 and 1440 minutes. High performance liquid chromatography was used to measure total plasma bupivacaine concentrations. Mean bupivacaine area under the curve (AUC) was calculated from 0 to 24 hours.ResultsData were collected from 17 parturients. Mean age and body mass index were 31 ± 6 y and 30 ± 4 kg/m² respectively. Mean plasma bupivacaine concentration before the block was 171 ng/mL. Mean peak concentration was 802.36 ng/mL (range 231.8 to 3504.5 ng/mL). Mean time to peak concentration was 30 min and mean area-under-the-curve (0–24 h) was 4505.4 h.ng/mL. Mean elimination half-life was 8.75 h. Three subjects had concentrations above the quoted toxic threshold and mild symptoms suggestive of neurotoxicity were reported by two subjects, but no treatment was required.ConclusionSingle-dose bilateral transversus abdominis plane block using 100 mg of bupivacaine, after spinal anesthesia for cesarean delivery, can result in toxic plasma bupivacaine concentrations.     

Analgesic effects of intrathecal tramadol in patients undergoing caesarean section: a randomised,double-blind study

BackgroundIntrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery. The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section.MethodsEighty full-term parturients scheduled for elective caesarean section were randomly divided into two groups. In the fentanyl group, patients received intrathecal 0.5% bupivacaine 10 mg with fentanyl 10 μg; in the tramadol group, patients were given the same dose of bupivacaine with tramadol 10 mg. Sensory and motor block characteristics, duration of postoperative analgesia, maternal side effects, and neonatal outcome were compared.ResultsOne patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis. Median [interquartile range] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [240–360] min and 260 [233–300] min respectively (P = 0.02). The incidence of shivering was lower in patients who received tramadol (5%) than those who had fentanyl (32%) (P = 0.003). Apgar scores, umbilical cord acid–base measurement and neurologic and adaptive capacity scores were comparable between the two groups.ConclusionCompared to intrathecal fentanyl 10 μg, tramadol 10 mg, as an adjunct to bupivacaine for subarachnoid block for caesarean section, showed a longer duration of analgesia with a reduced incidence of shivering.     

Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial

BackgroundThe transversus abdominis plane block (TAP) has been described for pain management following abdominal surgery in adults, but there are only few reports on its use in pediatrics. The aim of this study was to evaluate the analgesic effect of ultrasound guided TAP block in patients scheduled for open appendectomy versus an active comparator (wound infiltration).MethodsForty-four children aged 4–16 years (ASA 1–2) were enrolled. Patients were randomized into two groups (22 in each). Patients in group (T) were assigned to receive ultrasound guided TAP block using 0.4 ml/kg of bupivacaine 0.25%, and those in group (L) were assigned to receive local infiltration by the surgeon. Maximum pain scores, the time to the first analgesic requirement and the number of analgesic requirements were recorded over 48 h.ResultsThe ultrasound guided TAP block increased the mean time to the first analgesic requirement (10.4 ± 1.5 h) in comparison with the local infiltration group (5.4 ± 1.5). The cumulative number of doses of analgesic was significantly lower in TAP group than in local infiltration group (3.7 ± 1.1 versus 5.3 ± 2.1) and the Pain Scale score was significantly lower in the TAP group over the study period. Besides, there were no complications attributable to the ultrasound guided TAP block.ConclusionUltrasound-guided TAP block with (0.4 ml/kg) 0.25% bupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after appendectomy in children.     

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.