Online ISSN: 2515-8260

Keywords : Postoperative Pain


Comparative Study of Pre-Operative Ultrasound Guided Transversus Abdominis Plane Block Versus Post-Operative Ultrasound Guided Transversus Abdominis Plane Block on Perioperative Hemodynamic Status and Post-Operative Analgesic Requirement in Patients Undergoing Laparoscopic Abdominal Surgeries

Bhanushree G, Priyanka Krishnamurthy, P K Dileep, Soumya Rohit

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2781-2789

Background:Although abdominal laparoscopic surgery is known for less pain compared with that of laparotomy, many patients still complain considerable post-operative pain. Pneumoperitoneum affects several homeostatic systems leading to alteration in cardiovascular, pulmonary physiology and stress response. The benefits of an adequate analgesia include a reduction in stress response of surgery, reduction in   perioperative morbidity and effective pain control can also facilitate rehabilitation and accelerates recovery from surgery.
Materials and Methods: This is a Randomized control study and single blind study conducted at Done in Hospitals attached to Bangalore Medical College and Research Institute, Bangalore over 10 months -from November 2019 to September 2020. Patients undergoing laparoscopic abdominal surgeries admitted to hospital.  Group I (n=40) –will receive ultrasound guided transversus abdominis plane block prior to surgical procedure (starting with skin incision). Group II(n=40) –will receive ultrasound guided transversus abdominis plane block after surgery (following skin suture and closure).
Results: The two groups were comparable in terms of age, sex, weight, ASA grading, mean duration of surgery, mean duration of anesthesia and mean duration of insufflations. The two groups were comparable in terms of intraoperative EtCO2 and respiratory rate. Comparison of heart rate at regular intervals with basal heart rate, P value was significant from 45 minutes to 90 minutes in both the groups. Comparison of SBP at regular intervals with basal SBP, the difference was not statistically significant from 30 minutes to 75 minutes in group I, while the difference was statistically significant in group II. In comparison of DBP at regular intervals with basal DBP, the difference was not statistically significant at intervals of 45 to 90 minutes in both the groups. In comparison of MAP at regular intervals with basal MAP, the difference was not statistically significant at intervals from 30 to 90 minutes in both the groups (Table 4).
Conclusion: For patients undergoing laparoscopic surgery, preoperative TAP block was recommended for duration of surgery <180 min for lower consumption of intraoperative opioids, while postoperative TAP block was better than preoperative manipulation for duration of surgery >180 min, which might obtain lower postoperative pain score, less postoperative analgesics, and higher satisfaction score.

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.

Comparison of the Effect of Adding Dexmedetomidine versus Midazolam to Intrathecal Bupivacaine on the Post-Operative Analgesia

Dr Ravi Shrivastav, Dr Sachin Kumbhare, Dr Arpit Khandelwal, Dr. Hemant Vanjare

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1225-1232

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Injectable pethidine vs diclofenac as an analgesic for lower limb orthopedic surgeries as postoperative analgesics

Dr. Pavankumar P,Dr.Harish Naik S

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2858-2861

Background: Postoperative pain may be a significant reason for delayed discharge from
hospital, increased morbidity and reduced patient satisfaction. Nowadays opioids are the
mainstay in the treatment of acute postoperative pain. Pethidine is an opioid.But opioids
produce side effects like nausea, vomiting, sedation, pruritis, respiratory depression.
Diclofenac is a non-selective NSAIDs with good tissue permeability. NSAIDs are particularly
Effectiveincasesofsomaticinflammatorypain.
Objectives: We conducted this study to compare the efficacy of Injection pethidine and
Injection diclofenac as an analgesic for post-operative patients undergoing Hysterectomy.
Methods: This was an open-label prospective study that included 60 female patients
undergoing lower limb orthopedic surgeries aged 20 years and above. Randomly allocated 30
patients were given Pethidine 50 mg IM three times a day and the rest 30 patients were given
Diclofenac 75mg IV two times a day. Post-operative pain scores were recorded using the
Visual Analog Scale (VAS) at 6,12,24and 48 hrs. Statistical analysis was done using unpaired
t-test.
Results: The mean pain score was found less in the diclofenac group compared to the
pethidine group at all intervals by VAS (p<0.05). Nausea and dizziness were more commonly
reportedinthepethidinegroup.
Conclusion: Diclofenac provides effective and better analgesia in acute post-lowerlimb
orthopedic surgery pain than pethidine with fewer adverse effects.

EFFICACY OF FLAPLESS DENTAL IMPLANTS- A SYSTEMATIC REVIEW

Dr. J. ANGELIN FIONA; Dr. ANITHA BALAJI; Dr. BAGAVAD GITA

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 2010-2023

Dental implant placement using flapless surgery is minimally invasive technique which improves blood supply compared with flapped surgery. Objectives: The aim of this systematic review was to evaluate the clinical parameters following implant surgery in healed sites, using 2 procedures: flapped vs flapless surgery. A detailed electronic search was carried out in the PubMed/Medline, Scholar Library databases. The focused question was, what is the efficacy of flapless surgery compared to the flapped approach?” .All the studies included with a prospective controlled design were considered separately, depending on whether they are being conducted on animals or humans. The following data were recorded in all studies: number of implants, failures, location (maxilla, mandible), type of rehabilitation (partial or single), follow up and flap design. The variables selected for comparison in animal studies were : flap design, gingival index, mucosal height, recession and probing pocket depth. In humans studies the variables were as follows: flap design, plaque index, gingival index, recession, probing pocket depth, papilla index and keratinized gingiva. Results: Ten studies were included, of which 2 are excluded because of irrelevance, out of which 6 where human studies and 2 were animal studies. Results obtained showed that human studies proved that the flapless implant approach proved to be efficient over flapped approach whereas the animal studies showed no significant differences between the two.