Online ISSN: 2515-8260

Keywords : Post-operative analgesia


Study of additive effects of butorphanol with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries

Anusha Balasubramanian, S A Mohamed Arif, Jagan Govindasamy

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3329-3334

Brachial Plexus block either alone or as a part of an anaesthetic sequence is useful as it provides complete relaxation of muscles of upper extremities. Present study was aimed to study additive effects of butorphanol with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, comparative study in patients aged 18–58 years, of both gender, with body mass index (BMI) <25 kg/m2, of American Society of Anesthesiologists (ASA) physical status I to II, scheduled for elective forearm and hand surgeries, Patients fit for surgery, were randomly allocated into two groups using as Group BB (1 mg of butorphanol) & group B (bupivacaine only).
Results: In present study, general characteristics such as age (year), gender (male/female), ASA (I/II), weight (kg), height (cm) & mean duration of surgery (min) were comparable among both groups & difference was not statistically significant. Time taken for procedure (min) & onset of sensory blockade (min) were comparable in both groups and difference was not statistically significant. Butorphanol when added to levobupivacaine in supraclavicular brachial plexus block had early onset of motor block, improves the quality of block, prolonged the duration of sensory and motor blockade as compared to levobupivacaine alone, and difference was statistically significant.  Prolonged the duration of analgesia and late requirement of rescue analgesia as compared to levobupivacaine alone, and difference was statistically significant.
Conclusion: Butorphanol added with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of block, better analgesia, good hemodynamic stability and profound and longer analgesia

Evaluation Of Post-Operative Analgesic Effect Of Combined Use Of Fentanyl And Neostigmine As An Adjunct To Bupivacaine In Lower Abdominal Surgeries

Rashmee D. Palwade, A. S. Tarkase, Usha O. Giri, Vrushali Rajgire, Devanand Pawar .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3896-3902

Spinal anaesthesia requires a small volume of drug to produce profound sensory and motor blockade but has limited duration of action. An adjunct to local anaesthetic produces a better-quality regional block.The present study was aimed to evaluate the study and tolerability of combined use of intrathecal neostigmine and fentanyl as an adjunct to bupivacaine for postoperative analgesia in patients posted for abdominal surgeries under spinal anaesthesia. Material and Methods: Present study was single-center, prospective, comparative, observational study, conducted in patients of age group of 20-60 years, of either gender, ASA grade I/II, Elective patients undergoing Lower Abdominal Surgeries. 60 patients were divided by computer assisted randomization table into 2 groups of 30 subjects each as GROUP B (BUPIVACAINE Group) & GROUP C (COMBINED Fentanyl Neostigmine Group). Results: There was no significant difference in age distribution, gender distribution & ASA grade in two groups. (p>0.05). The mean duration of sensory block was found to be 194.16 ±21.43 minutes in group C while 153.03 ±19.19 minutes in group B, difference was statistically highly significant. (P <0.0001). The mean duration of motor block was found to be 197.18 ±21.78 minutes in group C while 169.26 ± 19.38 minutes in group B, difference was statistically highly significant. (P <0.0001) There was no difference when two groups were compared statistically for complications. (p>0.05) post-operative analgesia remained for longer duration in Group C, 7.40 ± 1.21 hours as compared to 5.32 ± 1.21hours in Group B, difference was statistically significant (P <0.05). Conclusion: Spinal neostigmine added to bupivacaine and fentanyl provided a significantly longer surgical analgesia and insignificant adverse effects who had lower abdominal surgery under spinal anaesthesia.

Effect of addition of 8 mg of dexamethasone to 15 ml of 0.25% levobupivacaine in ultrasound guided adductor canal block for postoperative analgesia in patients undergoing knee surgeries

Dr. Priyadharshini S., Dr. Subbulakshmi Sundaram, Dr. T. Santhosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3463-3472

Background: Adductor canal block (ACB) has recently been considered as a promising method for providing analgesia after knee surgeries with sensory blockade. ACB blocks the sensory innervation of the knee via the saphenous nerve [1]. ACB preserves quadriceps muscle strength better than Femoral Nerve Block, minimizing weakness during knee extension and thus functional recovery is improved within the first 24 hrs post‑operative period and the risk of developing Deep Vein Thrombosis is reduced [1]. Addition of Dexamethasone to local anaesthetics improves the quality and duration of peripheral nerve block [2]. We evaluated the effect of adding dexamethasone to levobupivacaine on the duration of postoperative analgesia in patients undergoing knee surgery using ultrasound-guided adductor canal block.
Methods: The study was a prospective double blinded randomized comparative study. Sixty patients scheduled for knee surgery were randomly allocated into two groups to receive adductor canal block. The control group L received 15 mL levobupivacaine 0.25% + 2 mL normal saline, and the dexamethasone group D received 15 mL levobupivacaine 0.25% + 2 mL dexamethasone (8 mg). Measurements included duration of sensory blockade, hemodynamic stability, visual analog score, time to first analgesic requirement and analgesic consumption.
Results: Postoperative analgesia was better in Group D patients. The mean VAS score increased with time and the magnitude of increase was more in the Group L than in group D. Duration of analgesia was significantly prolonged in Group D (14 ± 2.25 hours) when compared to Group L (10.57 ± 1.65 hours) with significant P value (<0.05). There was no significant difference between two groups in terms of age, sex, ASA grading and type of surgery. Both the groups maintained hemodynamic stability, which was statistically insignificant (P value >0.05).

Efficacy of pregabalin as premedication for postoperative analgesia in inguinal hernia surgery

Dr. Navveen PM, Dr. SK Srinivasan, Dr. Sittaramane S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3481-3487

Aim: This study is aimed to determine the efficacy of preoperative administration of oral pregabalin 150mg against the administration of a placebo for postoperative analgesia in patients undergoing Inguinal Hernia Surgery under Spinal anesthesia.
Methodology: A Prospective Randomized Double Blinded Control Study was conducted among 60 patients posted for elective Inguinal hernia surgery and were divided into equal groups. Group C received placebo and Group P received Tab. Pregabalin 150mg which was administered 30 min before surgery. Visual Analogue Score was used to determine the pain at rest during postoperative period. The time of requirement of rescue analgesia during postoperative period was also assessed.
Result: VAS at rest was significantly reduced in Group P (p<0.05). Duration of analgesia was significantly prolonged in Group P when compared to Group C (p<0.05). Time of first rescue analgesic was administered in Group Panda in Group C was noted and the mean was found to be more in the pregabalin group than in the control group (p<0.05). Rescue analgesic consumption in 24hours during postoperative period was significantly decreased in Group P (p<0.05).
Conclusion: We observed that the postoperative analgesia was definitely of a longer duration with the Group Pwhen compared to Group C and decreased requirement of parenteral analgesics in Group P. It is concluded that Tab. Pregabalin 150mg has significant postoperative analgesia when compared to placebo

Comparison of lumbar epidural analgesia using 0.25% bupivacaine (10ml) and 0.2% ropivacaine (10ml) for post-operative analgesia in abdominal surgeries

Dr. C Aravind Sekaran, Dr. Subbulakshmi Sundaram, Dr. Sittaramane S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3488-3497

Introduction: The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Post-operative epidural analgesia provides better static and dynamic pain relief. Ropivacaine is less neuro and cardiotoxic when compared to Bupivacaine with minimal motor blockade thus facilitating early post-operative mobilization.
Aims and Objectives: To Compare Lumbar Epidural Analgesia using 0.25% Bupivacaine (10ml) and 0.2% Ropivacaine (10ml) for post-operative analgesia in abdominal surgeries.
Materials and Methods: A Randomized Comparative Study was conducted on Sixty (60) adult patients of either sex divided in to two equal groups with age group 20-65 years with physical status ASA I, II undergoing abdominal surgeries. At the end of surgery when the patient complained of pain Group B received 10ml of 0.25% bupivacaine and Group R received 10ml of 0.2% ropivacaine as post-operative analgesia.
Results: Both the group B (236.40 ± 29.55 minutes) and group R (244 ± 27.95 minutes) produced almost same duration of post-operative analgesia, but hemodynamic instability was seen with Group B (53.3% reported hypotension and 13.3% reported nausea) along with delay in recovery of motor activity.
Discussion: Group B shows statistical significance with Group R in (HR, SBP, DBP) in first 60 minutes required vasopressor. Group B shows statistical similarity with Group R (P value >0.05) in (HR, SBP, DBP) after 60 minutes, RR, SPO2, onset and duration of analgesia, VAS score, Patient satisfaction score. Group R has less complications than Group B, hence proves statistically significant (P value <0.05).
Conclusion: Post-operative analgesia with 0.2% Ropivacaine provides excellent pain relief with hemodynamic stability and early post-operative ambulation

EVALUATION OF INTRATHECALDEXMEDETOMIDINE FOR SPINAL ANAESTHESIA FOR PERIANAL AMBULATORY SURGERIES

Dr JaladKapoor, Dr Avdhesh Kumar Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1187-1191

Background:Ambulatory anorectal surgery is an appealing approach for patients and physicians due to its increased efficiency and decreased surgical costs. The present study was conducted to evaluate intrathecaldexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries.
Materials & Methods:50 adult patients presenting for perianal surgeries were divided into 2 groups of 25 each. Group I patients received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of distilled water and group II received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of distilled water. The parameters such as time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic wasassessed.
Results: The mean weight in group I was 64.7 kg and in group II was 63.4 kg, height was 156.8 cm in group I and 157.3 cm in group II, ASA grade I was seen in 15 in group I and 16 in group II and grade II was seen in 10 in group I and 9 in group II.  The difference was non- significant (P>0.05). The mean duration of surgery was 26.5 minutes in group I and 28.2 minutes in group II. The mean duration of sensory block in group I was 430.6 minutes in group I and in group II was 318.6 minutes, duration of motor block was 324.8 minutes in group I and 230.6 minutes in group II and time to ambulation was 314.2minutes in group I and 216.1 minutes in group II. The difference was significant (P< 0.05). Side effects were shivering seen in 1 in group II, bradycardia 1 in group I, hypotension 1 in each group and Nausea/vomiting 1 in group I and 2 in group II. The difference was significant (P< 0.05).
Conclusion: Intrathecaldexmedetomidine provides prolonged post-operative analgesia.

Comparative evaluation of tramadol via two different routes for post-operative analgesia after inguinal herniorrhaphy

Dr. Prerna Attal, Dr. Taninder Singh, Dr. Ranika Manhas, Dr. Sunayna Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2294-2300

Aims: To compare the duration of analgesia and side effects of tramadol via two different routes i.e intravenous and rectal administration.
Settings and Design: The study design was Prospective, randomized, single blind and hospital based.
Methods and Material: Sixty adult patients of ASA grade I and II posted for inguinal hernia surgery were randomized to receive either rectal suppository of tramadol 100mg (n=30) Group R or I.V. tramadol 50 mg (n=30) Group I. Pain measurement was performed using visual analogue scale (VAS). Rescue analgesia was given when the VAS was >3 in the postoperative period up to 24 hrs. Side effects like nausea, vomiting, were recorded during the same period.
Statistical analysis used: All data was analysed using the Chi square test and Z-test.
Results: Duration of analgesia was prolonged and requirement of rescue analgesic was less with the suppository group. Nausea and vomiting were also lower with the suppository group.
Conclusions: Rectal suppository of tramadol as well as intravenous tramadol are effective for postoperative analgesia after inguinal herniorraphy, but rectal tramadol is better alternative than I.V. tramadol as it has longer duration of pain relief and lesser incidence of nausea and vomiting.

Comparison of the analgesic efficacy of ultrasound-guided transversus abdominis plane (tap) block versus local infiltration during laparoscopic surgeries in paediatric patients

Amit Kumar Srivastava, Abhishek Kumar Patel, Sarvjeet Verma, Archana Aggarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5065-5069

Introduction: Regional anaesthesia has proved to be an essential aspect of modern
paediatric anaesthesia which issues support for the superior and long-lasting analgesia
without the risk of respiratory depression. The transversus abdominis plane (TAP)
block is a type of regional anaesthetic technique which was first elaborated in the
literature as an anatomical landmark technique in the year 2001 by Rafi. Hence this
study is aimed to research whether USG guided TAP block was superior to local
infiltration for intra and postoperative analgesia for paediatric laparoscopic surgeries.
Materials and Methodology: 100 children in the age group of 3–12 years, posted for
elective laparoscopic hernia repair, orchidopexy, appendicectomy or cholecystectomy
were enrolled in the study. All the study participants were basically divided into two
groups like Group – T receiving TAP block and Group – L receiving local infiltration.
Results: The postoperative pain scores were reported to be significantly lower in Group
T at 10 and 30 min, 1 and 2 hours than in Group L as tabulated in table 2. After 2 h, the
pain scores were similar in the two groups. The necessity for rescue analgesia was also
significantly lower in the TAP block group (10/50) when compared with the local
infiltration group (37/50; P < 0.001). The intraoperative heart rates were significantly
lower in TAP block group at port placement, 30 and 60 min compared with the local
infiltration group.
Conclusion: This is to be conclude that TAP block is proven to be superior to local
infiltration for intra and immediate postoperative analgesia in paediatric laparoscopic
surgeries. We recommended the inclusion of TAP block as a routine in the part of
multimodal analgesia for these surgeries in paediatric patients.

A study on side effects of post-operative analgesia with intravenous paracetamol versus dexmedetomidinein patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Deepak Vijaykumar Kadlimatti, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1425-1430

Several theories have been proposed, the most consistent being that it acts in a similar fashion to NSAIDs by the inhibition of the cyclo-oxygenase pathways. However, paracetamol lacks both the peripheral anti-inflammatory and anti-platelet response seen with NSAIDs28. More recently, it has been suggested that paracetamol may also be linked with both direct and indirect stimulation of the cannabinoid, nitric oxide synthase, and serotonergic pathways. Patients satisfying the inclusion criteria were selected during the study period from the operation register on a daily basis. After obtaining a written informed consent, sixty patients were recruited for this study. They were allocated into two groups of 30 each. 10 patients in group D and 08 patients in group P complained of nausea, none of the patients in either group had vomiting, bradycardia, and hypotension