Search

Background: The erector spinae plane block (ESPB) is a modern interfascial block method to reduce postoperative pain. Dexmedetomidine (DEX), when utilized as an adjuvant to bupivacaine, is believed to enhance analgesia and prolong the period of various anesthetic strategies. Objective: This study aimed to estimate the impact of adding different doses of DEX to ultrasound-guided ESPB (UG-ESPB) on postoperative analgesia following laparoscopic sleeve gastrectomy (LSG). Patients and Methods: A prospective double-blinded randomized study included 72 patients, aged 20-60 years, ASA II-III, undergoing LSG under general anesthesia. Patients were divided into 3 groups: Group A (control group) received ESPB with 20 ml of 0.25% bupivacaine, group B received ESPB with 20 ml of 0.25% bupivacaine + DEX 0.5 µg/kg and group C that received ESPB with 20 ml of 0.25% bupivacaine + DEX 1 µg/kg. Bilateral UG-ESPB was provided before the surgery at the T7 vertebral level. Intraoperative total fentanyl requirements, postoperative pain, hemodynamic parameters, and patient satisfaction were evaluated. Results: Groups B and C had significantly delayed time to the first analgesic requirement and decreased total ketorolac and morphine consumption compared to group A. Intraoperative fentanyl requirements were similar across groups. Ramsay sedation scores were higher in groups B and C. Side effects like bradycardia, hypotension, and nausea were not significantly different among groups. Conclusions: Adding DEX (0.5 or 1 µg/kg) to bupivacaine in UG-ESPB for LSG significantly enhanced analgesic outcomes, provided higher sedation scores, and maintained better hemodynamic parameters without increasing intraoperative fentanyl requirements or postoperative complications. This makes it a valuable adjunct in pain management protocols, with the 1 µg/kg dose showing superior results. [ABSTRACT FROM AUTHOR]

Background: Myofascial plane block has recently replaced central neuraxial analgesia as the preferred method of effective, opioid-sparing pain treatment. The use of external oblique intercostal (EOI) nerve blocks to treat postoperative pain has increased recently because they can relieve pain in the upper midline and upper lateral abdominal wall. Objectives: To evaluate the effect of external oblique intercostal plane block (EOIPB) on the postoperative pain that was evaluated by visual analogue pain scale (VAS) as a primary objective. Time to first rescue analgesia, 24 hours' postoperative consumption of analgesia, perioperative hemodynamics, postoperative anesthetic care unit (PACU) stay, patient satisfaction, and postoperative complications were the secondary objectives. Patients and Methods: This prospective and randomized controlled study was conducted on fifty patients with ASA I and II, aged ≥ 20 to ≤ 70 years, scheduled for upper abdominal surgeries. Patients were divided equally into two groups, group (A) Patients received US-guided EOIB with 20 ml of 0.25% bupivacaine on each side after induction, and group (B) Patients received postoperative morphine on patient request. Results: The EOIPB group showed a significantly lower VAS score than the control group at 0 time, 1h, 2h, 4h, 8h and 12h postoperatively (p<0.001), but there was no significant difference at postoperative 24h between the two groups (p>0.05). Postoperative 24-hour morphine consumption was significantly lower in the EOIPB group than in the control group (9.8±2.4 (6-15) mg vs. 19.4±2.7 (15-25) mg respectively, P<0.001). Similarly, the time until the first required analgesia was significantly longer in EOIPB group (8.1 ±0.8(7-9) vs. 4.1 ±0.8(3-5) in hours, respectively, P<0.001). Conclusion: We concluded that EOIPB resulted in decreased postoperative pain, morphine, and fentanyl usage while increasing patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Pain remains a significant challenge for cancer patients. Upper abdominal cancer patients often experience severe visceral pain, profoundly impacting their quality of life. In such cases, minimally invasive pain interventions like celiac plexus neurolysis may be necessary to alleviate the debilitating pain and improve overall wellbeing. Objective: Our study aimed to evaluate the effectiveness of various volumes of 70% alcohol (40 ml, 30 ml, 20 ml) for neurolytic celiac plexus block in alleviating pain associated with upper abdominal tumors. Patients and Methods: at the Anesthesia, ICU and Pain Management Department of Al Menoufia University Hospital, and the Pain Therapy Unit at Tanta Cancer Center, spanning one year. Ninety patients of both sexes who were suffering from non-resectable upper abdominal tumors were enrolled in the study. Results: Visual Analog Scale (VAS) scores exhibited a significant decrease for 12 months in all groups with the degree of relief being directly proportional to the volume of the neurolytic agent. Additionally, there was a noteworthy reduction in tramadol requirements observed up to 12 months in both Group I and group II, and up to 5 months only for Group III. Furthermore, Quality of Life Questionnaire-Core 30 (QLQ-C30) scores were markedly decreased in Group III compared to other two groups, but it was better in group I than in group II from 4th month onward. Conclusion: Administration of 40 ml and 30 ml of 70% alcohol yielded significant outcomes compared to the use of 20 ml of 70% alcohol. Furthermore, the use of 40 ml of 70% alcohol demonstrated superior results when compared to 30 ml in terms of the duration of pain relief, opioid consumption, and overall QOL improvement. [ABSTRACT FROM AUTHOR]