Online ISSN: 2515-8260

Keywords : analgesia


A comparative study of local anaesthetics ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Ashim Saikia, Dr. Sangeeta Deka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1863-1871

Background: Caudal blocks have been shown to reliably block dermatomes below the level of the umbilicus (T10–S5) in children <20 kg (∼6 yr of age).  Caudal epidural anaesthesia involves accessing the epidural space through the sacrococcygeal ligament via the sacral hiatus at the base of the sacrum. The aim of this study was to compare the effects of ropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. The group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. In this study we assessed demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Modified Bromage Scale) immediately after surgery and at 1, 2 and 3 hours post operatively.
Results: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points – 1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr (P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
Conclusion: The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

A comparative study of ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Sangeeta Deka .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5330-5339

Background: Caudal epidural anaesthesia blocks dermatomes below the level of the umbilicus  in children.
Objectives:This study intends to compareropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Materials and methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. Group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. We assessed the demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Bromage Scale)immediately after surgery and at 1, 2 and 3 hours post operatively.Data analysis was performed using one way ANOVA test.P value less than 0.05 was considered significant.
Results and conclusion: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points –1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr(P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

Ultrasound guided erector spinae plane block versus transversus abdominis plane block for postoperative analgesia in patient undergoing cesarean section: A randomized controlled study

Shabir Ahmad Langoo, Fehmeedah Banoo, Summaira Jan, Rubiyaa Ghulam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1303-1312

Background: This study compared the analgesic efficacy of the bilateral erector spinae plane
(ESP) with that of the bilateral transversus abdominis (TAP) postoperative delivery with
selected surgery.
Methods: Sixty mothers scheduled for caesarean section under random surgery were
randomly assigned to receive an ESP block or a TAP block. The ESP group received USG
guided block with 20 mL 0.2% of ropivacaine at the T9 level corresponding to T10 transverse
process e at the end of surgery. The TAP group received an ultrasound-guided TAP block
containing 20 mL of 0.2% ropivacaine at the end of delivery. The main effect was the
duration of analgesia achieved by each block. Measures of the second outcome were
postoperative pain severity, complete diclofenac use, patient satisfaction.
Results: The median duration (interquartile) block was longer in the ESP group than in the
TAP group (12 hours [10-14] vs 8 hours [8-10], p <0.0001). In the first 24 hours, the median
rate of analog pain observed at rest was lower in the ESP group. Intermediate diclofenac use
in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg
[100-150] vs 100 mg [75-100, p = 0.003]).
Conclusion: Compared with the TAP block, ESP block provides effective pain relief, has a
long lasting analgesic action, increases duration of first analgesic need, is associated with
minimal diclofenac use, and can be used in multimodal analgesia and opioid -sparing
medication after surgery.

Comparative study of low dose subarachnoid bupivacaine (9 mg) with different dose combinations of fentanyl versus standard dose bupivacaine (12 mg) in parturients undergoing caesarean section

Ashok Rout, Sunny Eapen, Dewendra J Gajbhiye, P Ansuman Abhisek, Pradeep Kedar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1499-1506

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Comparison of Analgesic Effect of Fentanyl and Clonidine Added Intrathecally with Bupivacaine in LSCS

Firasath, Abhinaya, Raja Shekar Reddy Motkar, Khaja Layeeq Ur Rahman

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 6094-6103

Background:Hyperbaric bupivacaine 0.5% (l0mg) with fentanyl 15mcg(0.3ml) and (2)
Hyperbaric bupivacaine 0.5% (10mg) with clonidine 45mcg. Objectives: The study
compared the onset and duration of action of intrathecal hyperbaric bupivacaine 0.5
percent and fentanyl 15mcg (group-I) to intrathecal hyperbaric bupivacaine 0.5 percent
and clonidine 45 mcg (group-II) in spinal anaesthesia in LSCS. The combination of
bupivacaine with fentanyl or clonidine assists anesthesiologists in alleviating
intraoperative discomfort by delivering superior analgesia to patients without extending
recovery.
Materials and Methods: The study included 80 female patients with ASA grade I (n=40
in each group). The time of onset of sensory and motor block, duration of analgesia, 2-
segment regression, intraoperative discomfort, hemodynamic stability, time to
micturition, visual analogue score, and postoperative analgesic requirements were all
evaluated.
Results: In group II, the onset of sensory and motor block was substantially later than
in group I (p0.001). Hemodynamic alterations did not differ between groups (p>0.05).
Intraoperatively, 1 patient reported pruritis, and 2 patients had postoperative urinary
II78.506.12min and groupII-—121.284.09 min) and regression of sensory level to L2
dermatome (group-I - 142.206.73 min and group II 166.405.79 min) were significantly
longer in group II (p0.001). The duration of analgesia in group II was 210.186.79
minutes, whereas in group II it was 323.5610.53 minutes, which is significant (p0.001).
The VAS scores in group II were considerably lower after 3 hours (p0.05), 6 hours
(p0.001), and 12hours (p0.001).
Conclusion: The addition of intrathecal clonidine 45 mcg to hyperbaric bupivacaine in
spinal anaesthesia gives greater analgesia with less perioperative discomfort, a longer
duration of analgesia, and a reduction in postoperative analgesic requirements.

Assess the analgesic efficiency of rectal diclofenac after caesarean section

Dr. Harsh Kasliwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 337-342

Background: Pain management following caesarean section still remains a challenge in our
environment. Diclofenac suppository is an effective adjunct analgesic for post-operative pain
control. Over the last two decades the number of caesareans being performed has increased
dramatically. High quality postoperative analgesia is important because the new mother has
to recover from major intra-abdominal surgery while also caring for her newborn baby. Many
options are available but tailoring the method to the individual can be problematic because it
has been difficult to predict the severity of postoperative pain or the individual response to a
regimen.

A Comparative Study Of Caudal Bupivacaine And Bupivacaine-Midazolam Mixture For Post-Operative Analgesia In Children Undergoing Genitourinary Surgery

Dr. Devendra Singh Khurana, Dr. Vinod Kumar Singh Senger, Dr. Vishal Gajbhiye, Dr. Sachin Gajbhiye

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1734-1743

Introduction: Adequate pain control remains a major challenge after ambulatory surgery. Midazolam as adjunct to local anaesthetics in caudal epidural analgesia has been found effective with minimal adverse effects.
Objective: The study was carried out to evaluate the analgesic efficacy of caudal bupivacaine and midazolam in children undergoing genitourinary surgeryfor post operative analgesia and to study the side effects and complications of bupivacaine and midazolam.
Subjects and methods: Sixty children, aged2-12 were randomly selected from routine cases of pediatric genitourinary surgery in NSCB Medical college and Hospital, Jabalpur.Group B receive 0.25% bupivacaine 0.5ml/kg [n=30] and group BM receive combination of 0.25% bupivacaine 0.5ml/kg with 50 microgm/kg midazolam[n=30].Throughout the study period heart rate,arterial BP, respiratory rate were monitored. Postoperative pain was assessed by MODIFIED TODDLER PRESCHOOLER POST OPERATIVE PAIN SCALE [TPPPS].Rescue analgesia was given when pain score was 4 or more than 4. Sedation was evaluated by four point sedation score.
Results: Lowest pain score were observed in BM group. The mean duration of postoperative analgesia in group  B was 7.6+1.5hrs and in group BM was 10.43+0.95 hrs’ which was statistically significant[p<0.05]. There was no significant changes in HR,BP and respiratory rate in both groups. The incidence of nausea and vomiting were equal in both groups. No respiratory depression,motor paralysis or urinary retention in both groups during the period of study.
Conclusion- Caudal administration of bupivacaine , midazolam mixture prolongs postoperative analgesia compare to bupivacaine alone without causing any adverse effects and complications.

Anaesthesia for the elderly patients and Techniques: preoperative assessmentand evaluation, Peri and Postoperative care of the elderlypatients’painmanagement

Arunachala D Edukondalu,Yamuna Devi .V.R ,E.Prabhakar Reddy

European Journal of Molecular & Clinical Medicine, 2019, Volume 6, Issue 1, Pages 103-113

Elderly person of 80 years of age and older presents a specific challenge to anesthetists,
who needs toacquire and maintain skill and expertise in the management of such patients.
Departments should havea lead clinician with an interest in the care of the elderly.
Development in anesthesia and operative techniques hasconsiderably reduced morbidity
and mortality in the elderly patients.Several anesthetic techniques have been used for
elderly patientsincluding general anesthesia, regional anesthesia, intravenoussedation and
monitored anesthesia care. However, anesthesiarelatedmortality in these patients is still
high. All elderly patientsundergoing surgical procedures require a preprocedural
evaluationto assess the risks of anesthesia and procedure and to manageproblems related
to the preexisting medical conditions, monitoringpatients during intraprocedural and
postprocedural periods aswell as postprocedural management. This article considers
theage-related physiological changes, preprocedure assessmentand preparation, anesthetic
techniques, intraoperative care andpostoperative care. Age does not obtund the perception
of pain. Acute and chronic pain management teams should be available totreat the elderly.
Prophylaxis for Thrombo embolic disease should initiated to prevent further complications.