Efficacy of Perineural versus Systemic Dexamethasone to prolong analgesia after Supraclavicular Nerve Block in patients undergoing Wrist Arthroscopy

Abstract Background Poorly controlled acute pain after surgery is associated with a varity of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Wrist arthroscopy is a very common surgery and performed as a day case surgery and need good postoperative analgesia. Many adjuvant drugs are added to bupivacaine to prolong the duration of sensory block like opioids and dexamethasone. Objective The aim of this thesis was to study the effect of adding both perineural & systemic dexamethasone as an adjuvant to bupivacaine in supraclavicualr nerve block. The comparison included the the effect on hemodynamics, postoperative pain & postoperative analgesic requirement. Methods In our study, 40 patients were randomly divided into two equal groups: Group #1 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) & 2 ml normal saline was injected IV. Group #2 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml normal saline) & 2 ml Dexamethasone ‘8 mg’ was injected IV. Results Our study showed that addition of 8 mg dexamethasone to bupivacaine in supraclavicular nerve block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects however, slight better outcome for the perineural route. Conclusion Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects with slightly better outcome to the perineural route.

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A PROSPECTIVE RANDOMISED COMPARITIVE DOUBLE BLIND STUDY TO DETERMINE THE DURATION OF ANALGESIA OF BUPRENORPHINE AND DEXAMETHASONE AS ADJUNCTS TO BUPIVACAINE IN SCIATICO-POPLITEAL AND SAPHENOUS NERVE BLOCK FOR BELOW KNEE SURGERIES.

10.36106/gjra/5700599 ◽

2020 ◽

pp. 1-3

Author(s):

Renjith I ◽

Renu Devaprasath ◽

Geo Navin Jude ◽

T. S. Ambujam

Keyword(s):

Side Effects ◽

Nerve Block ◽

Normal Saline ◽

Motor Block ◽

Sensory Block ◽

Saphenous Nerve ◽

Double Blind Study ◽

Double Blind ◽

The Mean ◽

Mean Time

BACKGROUND: Adjuvants to local anaesthetics improve the block properties and reduce opioid consumption. This study compared combination of local anaesthetic bupivacaine with buprenorphine and dexamethasone in ultrasound guided sciatico-popliteal and saphenous nerve block for below knee surgeries. STUDY DESIGN:A prospective, double-blind, randomized, comparative study. MATERIAL AND METHODS: 82 patients posted for elective or emergency below knee surgeries were randomly divided into 2 groups. Group X received 25ml block solution made up of 2mg/kg of 0.5% bupivacaine with 2mcg/kg buprenorphine and normal saline and group Y received 25ml block solution made of 2mg/kg of 0.5% bupivacaine with 0.1mg/kg dexamethasone and normal saline. Onset of sensory block, onset of motor block, duration of analgesia, hemodynamic parameters, and side effects were noted in each group. RESULTS: The mean time of onset of sensory block was earlier in group X (6.730±1.871 min) as compared to group Y (11.340±3.038min). The mean time of onset of motor block was also rapid in group X (9.000±2.121 min) than in group Y (13.020±2.286min). The mean total duration of analgesia was longer in group Y (1098.000±169.216) as compared to group X (794.070±145.084). There was no signicant difference in the mean duration of motor block between the groups. Both the groups were hemodynamically stable, and no signicant side effects were noted. CONCLUSIONS: Onset of sensory and motor blockade was faster in the buprenorphine group, however duration of analgesia was much longer in the dexamethasone group without any signicant side effects.

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Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1697220 ◽

2004 ◽

Vol 37 (02) ◽

pp. 105-109 ◽

Cited By ~ 4

Author(s):

V. Gaonkar ◽

Swati R. Daftary

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Pain Relief ◽

Nerve Block ◽

Postoperative Analgesia ◽

Cleft Lip ◽

Randomized Study ◽

Hemodynamic Stability ◽

Cleft Lip Repair ◽

Recovery From Anesthesia

ABSTRACTIn this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline.The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively.We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

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No Enhancement of Sensory and Motor Blockade by Neostigmine Added to Mepivacaine Axillary Plexus Block

Anesthesiology ◽

10.1097/00000542-199907000-00014 ◽

1999 ◽

Vol 91 (1) ◽

pp. 78-83 ◽

Cited By ~ 42

Author(s):

Herve Bouaziz ◽

Xavier Paqueron ◽

Marie Lorraine Bur ◽

Michel Merle ◽

Marie Claire Laxenaire ◽

...

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Motor Block ◽

Saline Solution ◽

Hand Surgery ◽

Sensory Block ◽

Group 3 ◽

Group 2 ◽

Plexus Block ◽

Group 1

Background Intrathecal neostigmine induces analgesia but also several side effects. Recently, 500 microg neostigmine administered intraarticularly was shown to produce postoperative analgesia without side effects. The authors' goal was to determine whether 500 microg neostigmine added to mepivacaine in axillary plexus block prolongs postoperative analgesia. In addition, they wanted to determine the incidence of side effects in patients undergoing hand surgery. Methods Sixty-nine outpatients scheduled for carpal tunnel syndrome repair with axillary plexus block were randomly assigned to one of three groups that received saline solution in the axillary plexus and subcutaneously (group 1), 500 microg neostigmine in the axillary plexus and saline solution subcutaneously (group 2), or saline solution in the axillary plexus and 500 microg neostigmine subcutaneously (group 3). Sensory and motor block in the four hand nerve distributions were assessed every 5 min for 30 min The duration of the sensory and motor blocks were assessed after operation. Side effects were also recorded. Results Neostigmine had no effect on sensory and motor block in any of the four nerve distributions, nor did it increase the median duration of sensory block (215 min; range, 120-330 min) compared with group 1 (247 min; range, 190-287 min) or group 3 (236 min; range, 160-280 min). Motor block was slightly shorter (P = 0.045) in group 3 (190 min; range, 135-285 min) compared with group 1 (218 min; range, 145257 min) and group 2 (215 min; range, 105-343 min). Gastrointestinal side effects occurred in 30% of patients in both neostigmine groups but not in group 1 (P < 0.05). Conclusions This study suggests that 500 microg neostigmine added to mepivacaine in axillary plexus block does not prolong postoperative sensory block, but it does cause a relatively high incidence of side effects. These two findings raise doubts about the use of neostigmine associated with local anesthetics for plexus neural block.

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Comparison of bupivacaine and bupivacaine plus magnesium sulphate infiltration for postoperative analgesia in patients undergoing lumbar laminectomy: A prospective randomised double-blinded controlled study

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.139102 ◽

2014 ◽

Vol 01 (03) ◽

pp. 183-187 ◽

Cited By ~ 6

Author(s):

Praveen Donadi ◽

Srilata Moningi ◽

Ramachandran Gopinath

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Postoperative Analgesia ◽

Normal Saline ◽

Magnesium Sulphate ◽

Controlled Study ◽

Surgical Trauma ◽

Analgesic Consumption ◽

Paravertebral Muscles ◽

Chi Square Analysis

AbstractBackground: Laminectomy is associated with considerable postoperative pain. Providing analgesia locally in the area of surgical trauma, with minimal systemic side effects, is an attractive option and has become an integral part of multimodal analgesia. The objective of this study was to assess and compare the effectiveness and safety of local infiltration of bupivacaine and bupivacaine plus magnesium sulphate for postoperative analgesia in patients undergoing lumbar laminectomy. Materials and Methods: Sixty adult patients of the American Society of Anaesthesiologists (ASA) class 1 and 2 were randomly allocated into two groups, comprising 30 patients in each group. After the completion of lumbar laminectomy, the study drug was locally infiltrated into the paravertebral muscles on either side. Group bupivacaine with magnesium (BM) was given 20 ml of 0.25% bupivacaine with 500 mg of magnesium sulphate (constituted with normal saline); and Group bupivacaine (B) was given 20 ml of 0.25% bupivacaine constituted with normal saline. Postoperative visual analogue scale (VAS) pain scores at 1, 2, 4, 6, 8, 12 and 24 hours; rescue analgesia, the time to first analgesic consumption, degree of overall patient satisfaction and side effects were recorded. Comparison of continuous data between groups was done using independent T-test. Comparison of nominal data was done using Chi-square analysis and ordinal data using Mann-Whitney test. A P value less than 0.05 was considered significant. Results: Time to first analgesic consumption was significantly longer in BM group (7.78 ± 1.350 hours) compared to B group (4.62 ± 0.997 hours) (P < 0.0001). The consumption of Tramadol was significantly higher in B group (202.5 ± 76.9 mg) compared to BM (117.5 ± 63.4 mg) (P < 0.0001). The degree of overall satisfaction with postoperative pain management on a 4-point satisfaction scale was better in BM group (2.77 ± 0.626) compared to B group (2.0 ± 0.587) (P < 0.001). Conclusion: Wound infiltration with bupivacaine and magnesium sulphate provided better pain control and analgesic effect was more significant, providing effective and safe postoperative analgesia in patients undergoing laminectomy surgeries.

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Intra-articular dexmedetomidine and clonidine for postoperative analgesia in arthroscopic knee surgery

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164833 ◽

2016 ◽

Vol 3 (1) ◽

pp. 103

Author(s):

Rabinarayan Dhar ◽

Satya Prasanna Nayak

Keyword(s):

Postoperative Pain ◽

Total Dose ◽

Postoperative Analgesia ◽

Normal Saline ◽

Knee Surgery ◽

Analgesic Requirement ◽

Arthroscopic Knee Surgery ◽

Group I ◽

Group Ii ◽

Arthroscopic Knee

Background: Many drugs have been used for postoperative pain management which is a common and distressing symptom after knee arthroscopy. But no single ideal intra-articular drug has been found. This study was done to assess the efficacy of intra-articular dexmedetomidine and clonidine for postoperative pain relief in patients undergoing arthroscopic knee surgeries.Methods: Fifty patients of American Society of Anaesthesiologists of grade I/II, aged 20-70 years posted for arthroscopic knee surgery were randomly divided into groups I (clonidine group) and group II (dexmedetomidine group). 25 patients in group I received 1 µg/ kg of clonidine diluted to 20 ml in normal saline and group II patients received 1 µg/kg of dexmedetomidine diluted to 20 ml in normal saline via intra-articular route at the end of the surgery. Visual analogue score (VAS), time to give the first dose of analgesia and total dose of analgesic required in first 24 hours was evaluated in each group.Results: VAS score was lower and time to first analgesic requirement was greater in Group II in comparison to Group I which was statistically significant. Total dose of analgesic used in Group II patients was significantly less compared to patients in Group I which was statistically significant. Conclusions: Intra-articular dexmedetomidine is more effective in providing prolonged postoperative analgesia after arthroscopic knee procedures and reduces the total dose of analgesic required postoperatively compared to clonidine.

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Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site - Case Series

Acta Medica Marisiensis ◽

10.1515/amma-2015-0055 ◽

2015 ◽

Vol 61 (3) ◽

pp. 241-244

Author(s):

Lazar Alexandra ◽

Szederjesi Janos ◽

Copotoiu Sanda Maria ◽

Simon Noemi Szidonia ◽

Badea Iudita ◽

...

Keyword(s):

Pain Management ◽

Side Effects ◽

Brachial Plexus ◽

Postoperative Analgesia ◽

Postoperative Period ◽

Case Series ◽

Postoperative Pain Management ◽

Perineural Catheter ◽

Plexus Block ◽

Systemic Drug

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

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Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

Annals of Cardiac Anaesthesia ◽

10.4103/aca.aca_15_18 ◽

2018 ◽

Vol 21 (3) ◽

pp. 333 ◽

Cited By ~ 26

Author(s):

PS Nagaraja ◽

KarthikNarendra Kumar ◽

RavikumarNagashetty Kalyane ◽

NaveenG Singh ◽

Madhu Krishna ◽

...

Keyword(s):

Cardiac Surgery ◽

Pain Management ◽

Postoperative Pain ◽

Nerve Block ◽

Postoperative Pain Management

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Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

Reproductive Medicine Gynaecology & Obstetrics ◽

10.24966/rmgo-2574/100056 ◽

2021 ◽

Vol 5 (4) ◽

pp. 1-6

Author(s):

Tanudeep Kaur ◽

Keyword(s):

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Pain Relief ◽

Emotional Experience ◽

Postoperative Pain Management ◽

Economic Benefits ◽

High Dose ◽

Postoperative Patient ◽

Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

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Intermittent Subcutaneous Morphine for Postoperative Analgesia Following Coronary Artery Bypass Grafting

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44277.13837 ◽

2020 ◽

Author(s):

CN Namitha ◽

Manjunath R Kamath ◽

Ananda Bangera ◽

M Gopala Krishnan ◽

B Amith Kiran

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Side Effects ◽

Postoperative Pain ◽

Coronary Artery Bypass ◽

Postoperative Analgesia ◽

Artery Bypass ◽

P Value ◽

Bypass Grafting ◽

Artery Bypass Grafting

Introduction: An effective postoperative pain management is of utmost importance following cardiac surgery. Various agents, routes and modes are available for the treatment of postoperative pain. Subcutaneous route of administration is an easy and effective method of postoperative analgesia with improved patient satisfaction and lesser side effects compared to intravenous route. Aim: To evaluate the efficacy of Subcutaneous Morphine (SCM) as postoperative analgesia following Coronary Artery Bypass Grafting (CABG). Materials and Methods: This study was designed as a retrospective analytical survey from June 2015 to June 2017. Medical records of all patients over 18 years of age who underwent coronary artery bypass grafting were reviewed. Patients belonging to ASA PS I, II and III, patients above 18 years of age and those posted for coronary artery bypass grafting were included in the study. Patients were divided into two groups: SCM group and Paracetamol (PCT) group, depending on the primary analgesia they received. The two groups were compared using Student’s t-test for normally distributed continuous data or non-parametric tests if the data were not normally distributed. Categorical data were compared by Fisher’s-exact test. The p-values <0.05 were considered statistically significant. Results: A total of 102 records were reviewed, out of which 49 patients received SCM and 53 patients had received PCT as their primary postoperative analgesia. It was observed that PCT group required more additional analgesia (intravenous fentanyl/ tramadol) than SCM group which was statistically significant with p-value of <0.001 and the duration of Cardiac Intensive Care Unit (CICU) stay was more in PCT group with p-value of 0.001. Postoperative side effects were significantly more in PCT group. Conclusion: SCM can be effectively administered intermittently for postoperative analgesia following CABG with similar haemodynamic stability and minimal side effects as compared to intermittent intravenous PCT.

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