Online ISSN: 2515-8260

Keywords : postoperative analgesia


Comparison of Analgesic Effect of a Single Dose of PerineuralRopivacaine With and Without Dexamethasone on Ultrasound-Guided Femoral Nerve Block After Total Knee Arthroplasty

Dr. Rajmohan Rao Tumulu, Dr. Dilshad Kauser, Dr. Sunil Kumar Swain, Pranay Kumar Tumulu, Tanisha Garg, Mohammed Amer Mohiuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4696-4701

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

A COMPARATIVE STUDY BETWEEN EPIDURAL BUPRENORPHINE vs TRAMADOL FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

Dr.IshratBano, Dr.GiridharJanampetBekkam, Dr. B. Chandrika .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1536-1541

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj. Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

A COMPARATIVE STUDY BETWEEN EPIDURAL BUPRENORPHINE vs TRAMADOL FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES.

Dr.Ishrat Bano, Dr.Giridhar Janampet Bekkam, Dr. B. Chandrika, .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3048-3054

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj.Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

A prospective randomised comparative study of intrathecal nalbuphine versus intrathecal fentanyl as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries under subarachnoid block

Dr. M Sreya Santhoshi and Dr. Vishwa Saineer

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2091-2099

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.

A clinical study of post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Nandini CV, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1431-1435

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

INTRATHECAL HYPERBARIC BUPIVACAINE WITH VARYING DOSES OF BUPRENORPHINE AS AN ADJUVANT FOR POSTOPERATIVE ANALGESIA AFTER CAESAREAN SECTION

Dr Thatipamula Nagapraveen, Dr Vuppu Bhavani, Dr Neela Sandeep Kumar, Dr Pakala Swathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5952-5961

Introduction:Postoperative analgesia after cesarean section poses unique clinical challenges
to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.
Aims: The aim of this study was to compare the efficacy of two doses of buprenorphine (45
μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in
caesarean section.
Materials and methods: This was a prospective, randomized, double-blind controlled study.
Ninety ASA physical status Class II parturients posted for elective caesarean section. The
computer-generated simple random sampling procedure was used to allocate the subjects into
three Groups A, B, C of 30 each.
Results: Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and
quality of postoperative analgesia without producing any major side effect. The maximum
duration of analgesia and hence decreased analgesic requirement were obtained with 60 μg
buprenorphine. Addition of buprenorphine did not have any adverse outcome on the baby as
assessed by Apgar score.
Conclusion:Addition of buprenorphine to hyperbaric bupivacaine provides postoperative
analgesia after cesarean section without significant maternal and neonatal side effects.

Dexmedetomidine Infusion in Patients Undergoing Elective Laparoscopic Cholecystectomy under General Anesthesia: Postoperative Analgesia and Complications

Dr. Prashantha Kumar HM, Dr. UshaSaha, Dr. RadhikaAgarwala

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1906-1911

LC combines the benefit of complete removal ofgall bladder with the advantage of limited
abdominal incisions, early recovery, shorter hospital stay and less postoperative complication.
Laparoscopic cholecystectomy can be associated with severe complications in the form of
arrhythmias,sudden intraoperative cardiovascular collapse, severe pulmonary edema and
postoperative thromboembolic phenomenon. All patients underwent a thorough
preanaesthetic check-up. Written informed consent was obtained from each patient after
explaining the procedure in a language that the patient understood. Patients were randomly
allocated into 2 groups of 40 each. Mean time to first analgesic in Group D was 4.38 ± 0.86
hrs and in Group C was 2.50 ± 0.68 hrs. On comparing, time to first analgesia was
significantly longer in Group D both statistically and clinically. Nausea and Vomiting was
noted in 5 patients in Group D and 14 patients in Group C. This incidence though statistically
not significant was clinically significant.