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Background and Aims: To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies. Methods: A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann–Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0). Results: Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group. Conclusions: As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA. [ABSTRACT FROM AUTHOR]

Context: Preoperative anxiety in surgical patients imposes stress and dissatisfaction. It results in altered neuroendocrine response and various perioperative complications. Aims: This study was conducted to determine the changes in anxiety level and need for information about the anesthetic and the surgical procedures at three different time points before surgery and evaluate the correlating factors. Settings and Design: A prospective observational study in a university hospital. Materials and Methods: Five hundred adults, American Society of Anesthesiologists Physical Status Class 1 and 2 patients were included in this study. Level of anxiety and need for information were assessed with the Amsterdam Preoperative Anxiety and Information Scale at three time points before the surgery: Evening before surgery in the ward (T1); on the day of surgery, in the preoperative holding area (T2); and in the operating room, after being positioned on the operating table (T3). T-test was applied to compare the mean between two groups, and the Chi-square test for independence of association between two categorical variables. Mann–Whitney–Wilcoxon test was applied to test the equality of distribution between two groups. Kruskal–Wallis test was applied for one-way analysis for comparing median score, and Friedman test was applied for two-way analysis of comparing score among three time points. Results: Total anxiety score recorded was significantly different over the time period (P = 0.023), with an increasing trend over the time. Need for information did not change significantly over time period. Conclusions: Preoperative anxiety continues to increase from ward to operation table. The factors responsible are nonmodifiable. [ABSTRACT FROM AUTHOR]