Search

Background: Opioids continue to remain the primary analgesics in children undergoing ophthalmic surgery, and their use may be associated with adverse effects like vomiting and respiratory depression. Topical anesthesia avoids these adverse effects and also complications of regional blocks. We designed this study to verify whether topical anesthesia with lignocaine gel is a feasible alternative to intravenous (IV) fentanyl for pediatric cataract surgery., Methods: One hundred ASA I and II children aged 3-12 years, scheduled for cataract surgery were included in this study. After induction of anesthesia, children were randomized to Group F (fentanyl), who received 2 mcg.kg(-1) IV fentanyl for analgesia and Group G (lignocaine gel), who received 2% lignocaine gel applied over the cornea of the operative eye. Anesthesia was maintained with isoflurane and oxygen in nitrous oxide. All children received intramuscular ketorolac. Intraoperative supplementary analgesia was provided with 0.5 mcg.kg(-1) IV fentanyl to manage increases in heart rate or blood pressure of 20% above baseline. In the postoperative period, Aldrete score and objective pain score were assessed. Rescue analgesia was provided with fentanyl in the postanesthesia care unit and syrup ibuprofen in the ward., Results: Significantly more children in group F (8/48) required intraoperative supplementary fentanyl as compared with group G (1/48) (P = 0.0291). In the PACU, 7/48 children of group G needed fentanyl as compared with 5/48 children in group F. Time to reach Aldrete 10 was significantly longer in group F (P = 0.01)., Conclusions: Topical lignocaine gel is an effective analgesic and may be used as an adjunct to fentanyl during cataract surgery in children.

Background: Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation. Aims: We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures. Settings and Design: 100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups. Materials and Methods: In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg-1.h-1 and in Group C i.v. fentanyl at 1μg.kg-1.h-1 along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse. Statistical Analysis: Continuous variables between the groups were compared by the independent t-test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value. Results: Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg-1 compared to group S 0.79 (±0.53) μg.kg-1. Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S. Conclusion: Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative pain following laparoscopic donor nephrectomy (LDN) is significant and no suitable analgesic technique is described. Opioid analgesia in standard doses is often suboptimal and associated with numerous adverse effects. Transversus abdominis plane (TAP) block has been evaluated in various laparoscopic procedures. Intrathecal morphine (ITM) has been seen to provide long-lasting analgesia of superior quality in laparoscopic colorectal procedures. Methods: The present study was undertaken to evaluate the analgesic efficacy of single-dose ITM 5 μg/kg for LDN. After ethics approval, 60 adult patients scheduled for LDN were randomised to receive intravenous fentanyl, ultrasound-guided TAP block or ITM for postoperative analgesia. Postoperative 24-h patient-controlled analgesia (PCA) fentanyl consumption, visual analogue scale (VAS) score and intraoperative fentanyl and muscle relaxant requirements were compared. Statistical analysis was performed using appropriate statistical tests by using Stata 11.1 software. Results: Haemodynamic stability at pneumoperitoneum and in the post anaesthesia care unit was significantly better in patients receiving ITM. Intraoperative rescue fentanyl requirement (P = 0.01) and postoperative fentanyl requirement until 24 h (P = 0.000) were significantly lower in the morphine group. Postoperative VAS at rest and on movement was significantly lower in the morphine group at all points of assessment (P = 0.000). Conclusion: ITM 5 μg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl. [ABSTRACT FROM AUTHOR]

Background and Purpose: A unilateral paravertebral (PVB) block with catheter can provide extendable analgesia without physiological changes. The objective of this study was to assess the efficacy of PVB bupivacaine for providing perioperative pain relief in adults undergoing percutaneous nephrolithotomy (PCNL) under general anesthesia. Methods: Fifty American Society of Anesthesiologists Grade I, II patients, aged 18 to 65 years, were included in this prospective, randomized, controlled, observer blinded trial. PVB group patients received preinduction 20 mL of 0.5% bupivacaine in the T9-10 paravertebral space and a catheter in addition to general anesthesia. Control group patients received only general anesthesia. All patients received intravenous fentanyl (2 μg/kg on induction, 0.5 μg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol every 6 hours. Postoperative pain was assessed using the visual analog scale (VAS) (0-10 cm) at rest and movement by a blinded observer at 0, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Data of 48 patients were analyzed. Intraoperative fentanyl requirement was higher in the control group (2.74±0.75 μg/kg [95 % confidence interval (CI) 2.42, 3.05]) than the PVB group (2.07±0.26 μg/kg [95 % CI 1.96, 2.18]), ( P=0.0001). Time to first postoperative analgesic requirement was longer in the PVB group (120 min [30-570]) than the control group (30 min [0-180]), ( P=0.0000). The VAS on rest (0, 1, 2, and 12 h) and movement (all time points) were significantly lower in the PVB group. Postoperative fentanyl consumption was lower in this group (175 μg [25-475]) compared with the control group (525 μg[(150-1275]), ( P=0.0000). Conclusions: Unilateral PVB block with catheter provided effective perioperative analgesia for PCNL. [ABSTRACT FROM AUTHOR]

Background: Pain after laparoscopic inguinal hernia surgery can be moderate to severe, interfering with return to normal activity. The study aimed to assess the efficacy of bilateral ultrasound-guided (USG) transversus abdominis plane (TAP) block for relieving acute pain after laparoscopic hernia repair as T10-L1 nerve endings are anesthetized with this block.Methods: Seventy-one American Society of Anesthesiologists I to II patients, aged 18 to 65 years, undergoing unilateral/bilateral laparoscopic hernia repair were randomized to port site infiltration (control, 36) and TAP block groups (35). All patients received general anesthesia (fentanyl 2 μg/kg intravenously at induction, 0.5 μg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol 6 hourly. Postintubation, TAP group received bilateral USG TAP block (15-20 mL 0.5% ropivacaine, maximum 3 mg/kg) with 18-G Tuohy needle. Control group had 20 to 30 mL 0.5% ropivacaine infiltrated preincision, at port sites from skin to peritoneum. Postoperative patient-controlled analgesia fentanyl was provided for 6 hours; pain was assessed using 0- to 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 24 hours and telephonically at 1 week and 3 months.Results: Demographic profile of the 2 groups was comparable. Significantly more number of patients required intraoperative fentanyl in the control group (24/36) than in the TAP group (13/35); VAS at rest was lower in TAP than control patients in postanesthesia care unit at 0, 2, 6, and 24 hours (median VAS TAP group: 0, 0, 0, and 0; control: 10, 20, 10, and 10; P= .002, P= .001, P= .001, and P= .006, respectively); P< .01 was considered statistically significant. TAP group had significantly lower VAS on deep breathing at 6 hours and on knee bending and walking at 24 hours and lesser patient-controlled analgesia fentanyl requirement. No significant difference in pain scores was observed at 1 week and 3 months.Conclusion: TAP block reduced postoperative pain up to 24 hours after laparoscopic hernia repair. [ABSTRACT FROM AUTHOR]