Effectiveness of Subconjunctival 0.5% Bupivacaine for Postoperative Analgesia after Intravitreal Silicon Oil Removal Surgery

Background. Intravitreal silicon oil removal surgery can cause mild-to-moderate postoperative pain and discomfort in most patients. Postoperative pain can be managed by using many methods, including a local anesthetic drug. One of the common local anesthetic drugs is 0.5% bupivacaine. The application techniques also vary, such as subconjunctival application. It was a good alternative for postoperative analgesia in the ophthalmic surgery because of its minimal risks and complications. The purpose of this research was to measure the effectiveness of subconjunctival 0.5% bupivacaine for postoperative analgesia in silicon oil removal surgery. Method. This was a double-blind randomized clinical study in patients undergoing elective intravitreal silicon oil removal surgery at Cipto Mangunkusumo Hospital. Thirty consecutive patients, enrolled from October 2016 to February 2017, were randomized to receive subconjunctival 0.5% bupivacaine or subconjunctival placebo (0.9% NaCl) at the end of the surgery. The primary outcome was the pain score 24 hours after surgery, using a 100 mm Visual Analogue Scale (VAS). Intravenous injection of tramadol 50 mg was given if the VAS >4. Secondary outcomes were the time to first analgesic requirement and the incidence of nausea/vomiting. Statistical analysis was conducted to measure the difference between 24 h pain score in the bupivacaine group (B) and that in the placebo group (NS). Result. The overall 24 hours’ postoperative pain score was significantly different between the bupivacaine group and the placebo group (p=0.001). In the 24 hours after surgery, there were only five patients needing additional analgesia in the placebo group. The time to first analgesic requirement was significantly different between the two groups (p=0.042). Nausea/vomiting only happened in the placebo group with proportions 6% and 3%, respectively. Conclusion. Subconjunctival 0.5% bupivacaine was effective for postoperative analgesia in intravitreal silicon oil removal surgery.

Download Full-text

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

QJM ◽

10.1093/qjmed/hcab086.076 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mona Ismail Mohammed Fadl Eldemirdash ◽

Raouf Ramzy Gadalla ◽

Neveen Gerges Fahmy ◽

Yahia Mamdouh Hassan Maky

Keyword(s):

Pain Score ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Epidural Block ◽

Hypospadias Repair ◽

Success Rates ◽

University Hospitals ◽

Analgesic Requirement ◽

Rescue Analgesia ◽

Randomized Clinical Study

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P < 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P>0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P < 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P < 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

Download Full-text

Epipleural surgical block and ultrasound-guided erector spinae plane block for analgesia in VATS

10.1510/mmcts.2021.031 ◽

2021 ◽

Keyword(s):

Postoperative Pain ◽

Thoracic Surgery ◽

Postoperative Analgesia ◽

Local Anesthetic ◽

Erector Spinae ◽

Ultrasound Guided ◽

Additional Method ◽

Video Tutorial ◽

Erector Spinae Plane Block ◽

Severe Postoperative Pain

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.

Download Full-text

Preoperative Intradermal Acupuncture Reduces Postoperative Pain, Nausea and Vomiting, Analgesic Requirement, and Sympathoadrenal Responses

Anesthesiology ◽

10.1097/00000542-200108000-00015 ◽

2001 ◽

Vol 95 (2) ◽

pp. 349-356 ◽

Cited By ~ 173

Author(s):

Naoki Kotani ◽

Hiroshi Hashimoto ◽

Yutaka Sato ◽

Daniel I. Sessler ◽

Hideki Yoshioka ◽

...

Keyword(s):

Postoperative Pain ◽

Abdominal Surgery ◽

Postoperative Analgesia ◽

Rating Scale ◽

Acupuncture Group ◽

Double Blind Study ◽

Analgesic Requirement ◽

Bladder Meridian ◽

Intravenous Morphine ◽

Intradermal Acupuncture

Background In a controlled and double-blind study, the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm from the spinal vertebrae (bladder meridian) provide satisfactory postoperative analgesia. Methods The authors enrolled patients scheduled for elective upper and lower abdominal surgery. Before anesthesia, patients undergoing each type of surgery were randomly assigned to one of two groups: acupuncture (n = 50 and n = 39 for upper and lower abdominal surgery, respectively) or control (n = 48 and n = 38 for upper and lower abdominal surgery, respectively). In the acupuncture group, intradermal needles were inserted to the left and right of bladder meridian 18-24 and 20-26 in upper and lower abdominal surgery before induction of anesthesia, respectively. Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine. Consumption of intravenous morphine was recorded. Incisional pain at rest and during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale. We also evaluated time-dependent changes in plasma concentrations of cortisol and catecholamines. Results Starting from the recovery room, intradermal acupuncture increased the fraction of patients with good pain relief as compared with the control (P < 0.05). Consumption of supplemental intravenous morphine was reduced 50%, and the incidence of postoperative nausea was reduced 20-30% in the acupuncture patients who had undergone either upper or lower abdominal surgery (P < 0.01). Plasma cortisol and epinephrine concentrations were reduced 30-50% in the acupuncture group during recovery and on the first postoperative day (P < 0.01). Conclusion Preoperative insertion of intradermal needles reduces postoperative pain, the analgesic requirement, and opioid-related side effects after both upper and lower abdominal surgery. Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery.

Download Full-text

Using intravenous acetaminophen in the reduction of opioids in spinal cord surgeries by patient-controlled analgesia

International Surgery Journal ◽

10.18203/2349-2902.isj20185012 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3883

Author(s):

Vadoud Nourouzi ◽

Ali Mohammadian ◽

Khatereh Isazadehfar ◽

Sona Rasouli

Keyword(s):

Spinal Cord ◽

Placebo Group ◽

Postoperative Pain ◽

Pain Relief ◽

Pain Score ◽

Postoperative Recovery ◽

Opioid Use ◽

Hospitalization Period ◽

Significant Difference ◽

Pain Pump

Background: Proper management of postoperative pain results in improved quality of patient's' life, early postoperative recovery, reduced hospitalization period and decreased treatment costs. Regarding significant efficacy and higher pain relief functions, opioids are amongst the best pain relief drugs. However, use of theses narcotics as pain killers is somehow controversial. Current study investigated the effects of IV acetaminophen in reduced use of opioids in surgeries of spinal cord by PCA method.Methods: Current double blinded clinical trial study performed upon 86 patients of 20-70 years of age who candidate for spinal CD implant with ASA class I or II. Patients randomly divided into two groups of IV Acetaminophen therapy (N=43) and placebo group (N=43) and each group were put equally under general anesthesia in which both received pain pump containing Fentanyl during recovery. Patients were examined regarding pain score, amount of opioid use and request for extra narcotics and the related complications including nausea, vomiting, dizziness, allergy, gastrointestinal bleeding and Ileus every 6 hours for 24 hours and the obtained results were recorded.Results: Regarding VAS, pain was significantly lower during 24 hours of study in IV Acetaminophen group (p<0.05). Mean use of opioid via pain pump was significantly lower in IV Acetaminophen group compared with placebo group (p=0.00). Request for extra doses of narcotics was higher in placebo group while regarding demand for extra pain relief, there was no significant difference between both groups. Regarding other results, no significant difference observed between both study groups.Conclusions: Results of the study indicated that use of a combination of IV acetaminophen along with opioids would be much more effective than use of narcotics alone in postoperative pain control of CD implant surgery of spinal cord and that leads to lower pain score and decreased use of opioids and its related complications.

Download Full-text

Effects of Gabapentin on Postoperative Pain and Total Analgesic Requirement After Laparoscopic Cholecystectomy

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1718 ◽

2019 ◽

Vol 12 (2) ◽

pp. 925-929

Author(s):

Zaffar Abbas ◽

Amina Bashir ◽

Zaffar Abbas

Keyword(s):

Laparoscopic Cholecystectomy ◽

Placebo Group ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Analogue Scale ◽

Analgesic Requirement ◽

Matching Placebo ◽

Pain Scores ◽

Group A ◽

To Receive

The aim of this study is to determine the effect of preoperative use of gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. Sixty adult patients listed for laparoscopic cholecystectomy were randomly allocated to two groups of 30 each to receive gabapentin 600 mg p.o. or a matching placebo 2 hours before surgery. Postoperative pain was monitored using 100 mm visual analogue scale (0 for no pain and 100 for worst imaginable pain) at 1, 2, 6, 12 and 24 hours. Diclofenac 75 mg IM was used as rescue analgesic and total analgesic requirement (mg/24hr) in first 24 hours following surgery was recorded. Postoperative pain scores and total analgesic requirement was significantly less in gabapentin group compared to placebo group. A single 600 mg dose of gabapentin given preoperatively decreased postoperative pain and total analgesic requirement following laparoscopic cholecystectomy. Preemptive use of gabapentin can be used to treat postoperative pain caused by laparoscopic cholecystectomy.

Download Full-text

Comparison of the Effect of Different Dosages of Celecoxib on Reducing Pain after Cystocele and Rectocele Repair Surgery

The Open Anesthesia Journal ◽

10.2174/2589645802014010030 ◽

2020 ◽

Vol 14 (1) ◽

pp. 30-34 ◽

Cited By ~ 7

Author(s):

Sepideh Vahabi ◽

Arash Karimi ◽

Siavash Beiranvand ◽

Mahmoudreza Moradkhani ◽

Khatereh Hassanvand

Keyword(s):

Clinical Trial ◽

Placebo Group ◽

Postoperative Pain ◽

Pain Score ◽

Analogue Scale ◽

Satisfaction Score ◽

Rectocele Repair ◽

Scale Method ◽

The Third ◽

Different Doses

Background: Administration of celecoxib reduces pain and inflammation and is associated with greater patient satisfaction. Objective: This study was designed to evaluate the efficacy of two different doses of oral celecoxib for reducing postoperative pain. Methods: This randomized clinical trial was performed on 90 patients undergoing cystocele and rectocele repair under spinal anesthesia. Patients were randomly divided into 3 groups: the first group received 200 mg/day celecoxib, the second group received 400 mg/day celecoxib and the third group was placebo. The pain was measured at 8, 16 and 24 hours after surgery using the VAS (Visual Analogue Scale) method. If the pain score was greater than 5, pethidine 1 mg/kg was prescribed. Pain score at 8, 16 and 24 hours, the need for pethidine, side effects and satisfaction score were recorded during the first 24 hours after surgery. Results: The pain score at postoperative 8 hours was 7.7, 3.9, and 8.1 in the 200 mg/day celecoxib, 400 mg/day celecoxib, and placebo group, respectively (p<0.001). Furthermore, the need for pethidine was significantly less in 400 mg/day group and with the greatest satisfaction score, p<0.01, respectively. Conclusion: Our study concludes that 400 mg/day of celecoxib can be effective against postoperative pain, following the cystocele and rectocele repair, as compared to 200 mg/day and placebo groups. Unwanted use of opioids can be avoided with economically cheaper and safer drugs.

Download Full-text

Bilateral Transversus Abdominis Plane Block versus Epidural analgesia for Postoperative Pain Relief in Lower Abdominal Surgery

QJM ◽

10.1093/qjmed/hcaa039.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

N M Aly ◽

S M Talaat ◽

M A Menshawi ◽

E R Mohammed

Keyword(s):

Blood Pressure ◽

Postoperative Pain ◽

Abdominal Surgery ◽

Epidural Analgesia ◽

Postoperative Analgesia ◽

Local Anesthetic ◽

Epidural Block ◽

Tap Block ◽

Caudal Analgesia ◽

Internal Oblique

Abstract Background epidural and caudal analgesia have been considered the gold-standard techniques after abdominal surgery for adults and children, respectively. The techniques consist of injecting the local anesthetic within the epidural space, between the ligamentumflavum and the dura mater. Depending on the surgical site and the level of injection, cervical, thoracic, or lumbar nerve roots are blocked after their emergence from the neural foramen. Epidural and caudal analgesia have technical drawbacks with epidural local anesthetic associated with hypotension secondary to the sympathetic blockade.In the last decade, a new abdominal truncal block, called the tranversusabdominis plane (TAP) block, was described consisting of local anesthetic injection between the internal oblique and transversusabdominis muscle. This block provides analgesia by blocking the 7th to 11th intercostal nerves (T7–T11), the subcostal nerve (T12), and the ilioinguinal nerve and iliohypogastric nerve (L1–L2). Aim of the Work to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block to provide postoperative analgesia after abdominal surgery. Methods sixty patients undergoingLower Abdominal Surgery were randomly divided into 2 equal groups by Closed Envelope Method. patients scheduled for Lower Abdominal surgery were assessed preoperatively in the form of evaluation of their medical history, their laboratory investigations and for fulfilling the above inclusion criteria.Patients Preparation was done by 2 mg Dormicum IV injection as a sedation preoperatively. After obtaining baseline vital signs, All patients received GA; sevoflurane was used for induction and maintenance of anesthesia, IV cannula was inserted and laryngeal mask airway (LMA) to secure the airway.Patients were divided randomly into two groups, each group consists of 30 patients. Group A: Patients in this group received Epidural analgesia, patients were placed in sitting position, Epidural block was administered under sterile conditions with a 18 G Touhy needle using a standard loss of resistance technique. After negative aspiration, 1ml/kg of 0.25% bupivacaine was injected. Group B: Patients in this group received US guided TAP block on the same side of surgery, patients were placed in supine position, linear US probe (high frequency probe 10–12 MHz) connected to a portable US unit (SonoSite, USA) was placed in the mid-axillary plane midway between the lower costal margin and the highest point of iliac crest. After skin disinfection, a 23-G 50-mm needle with an injection line was inserted in plane with the probe. Once the tip of the needle was placed in the space between the internal oblique abdominal muscle and transverses abdominis muscle, and after negative aspiration, 0.5 ml/kg 0.25% bupivacaine was injected. The following parameterswas assessed and recorded Hemodynamic monitoring, Assessment of postoperative painUsing visual analogue scale score, Any case of failed block was recorded, Doses of analgesics required intraoperatively and during the first 2 hours postoperatively were recorded. In case of failed block, 1 mic/kg Fentanyl IV was given. Complications During and after the procedurewere recorded. Results There was no significant differences regarding Demographic data, Heart Rate, SPO2 and duration of surgerybetween both groups. There were significant difference between both group regarding systolic blood pressure, Diastolic blood pressure, visual analogue score, need of analgesic, mobilization postoperative, pain on coughing and hospital stay Conclusion The current study revealed that Epidural block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements compared with Ultrasound guided TAP Block in patients undergoing lower abdominal surgery. Both analgesic techniques are safe.

Download Full-text

A Comparison of Analgesic Effect between Preoperative and Postoperative Transversus Abdominis Plane (TAP) Blocks for Different Durations of Laparoscopic Gynecological Surgery

Scientific Programming ◽

10.1155/2021/6668496 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Meiyu Wei ◽

Ming Liu ◽

Jie Liu ◽

Haitao Yang

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Postoperative Analgesia ◽

Postoperative Nausea And Vomiting ◽

Transversus Abdominis ◽

Gynecological Surgery ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Postoperative Pain Score ◽

Duration Of Surgery

Aim. This study aims to compare the postoperative analgesia between preoperative and postoperative ultrasound-guided transversus abdominis plane (TAP) blocks for different durations of laparoscopic gynecological surgery. Methods. A total of 120 patients, ASA I-III, 18–65 years of age, were divided randomly into 2 groups: preoperative TAP group (pre-TAP group) and postoperative TAP group (post-TAP group). Patients in the pre-TAP group (n = 60) and post-TAP group (n = 60) received bilateral TAP blocks of 0.375% ropivacaine, 40 mL, preoperatively and postoperatively, respectively. Duration of surgery, postoperative pain score, consumption of analgesics, and postoperative nausea and vomiting (PONV) during the first 24 h postoperatively were recorded. Results. For all the patients in the two groups, similar analgesia was obtained with no statistical difference. The same results were found in duration of surgery <180 min. Meanwhile, patients undergoing surgery >180 min in the post-TAP group obtained lower postoperative pain score, lower analgesics consumption, and higher satisfaction score than those in the pre-TAP group. Conclusion. Postoperative TAP block could offer better postoperative analgesia than preoperative TAP block for patients undergoing surgery >180 min. No difference was found in analgesia effect between preoperative TAP block and postoperative TAP block for patients undergoing surgery <180 min.

Download Full-text

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

QJM ◽

10.1093/qjmed/hcaa039.038 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A E Mohammed ◽

A A Abdellatif ◽

H Shokry ◽

A A N H Refaat

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Nerve Block ◽

Postoperative Analgesia ◽

Normal Saline ◽

Sensory Block ◽

Postoperative Pain Management ◽

Wrist Arthroscopy ◽

Analgesic Requirement ◽

Group 2

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.

Download Full-text

Dexmedetomidine Added to Bupivacaine versus Bupivacaine in Transincisional Ultrasound-Guided Quadratus Lumborum Block in Open Renal Surgeries: A Randomized Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/271 ◽

2020 ◽

Vol 3;23 (6;3) ◽

pp. 272-281

Author(s):

Marwa A.K. Elbeialy

Keyword(s):

Postoperative Pain ◽

Adverse Effects ◽

Postoperative Analgesia ◽

Renal Surgery ◽

Analgesic Requirement ◽

New Approach ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Vas Scores ◽

Open Renal Surgery

Background: General anesthesia (GA) is the preferred anesthetic modality for open renal surgeries to ensure a patent airway while the patient is in the lateral decubitus position. However, these surgeries are usually accompanied by severe postoperative pain with increased requirements for multimodal pain management strategies. Regional blocks provide better postoperative pain control with less systemic opioid consumption. Objectives: The aim of this study was to describe the ultrasound (US)-guided transincisional quadratus lumborum block (TiQLB) as a new approach, and to compare the addition of dexmedetomidine to bupivacaine versus bupivacaine alone for TiQLB in combination with GA regarding postoperative analgesia and adverse effects in open renal surgery. Study Design: A prospective, randomized, double-blind, controlled trial. Setting: Ain Shams University Hospitals. Methods: Eighty patients who were scheduled for an elective open renal surgery, aged 20 to 65 years, of either gender, and American Society of Anesthesiologists physical status I to II were enrolled in the study. They were randomly allocated into 2 equal groups: group dexmedetomidine-bupivacaine (DB) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% plus 1 μg/kg dexmedetomidine, and group bupivacaine (B) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% only. The primary outcome was the total morphine consumption among both groups, whereas the secondary outcomes were the Visual Analog Scale (VAS) scores and the time to first analgesic requirement during the first 24 hours. Postoperative side effects, such as sedation, nausea, vomiting, shivering, pruritus, bradycardia, hypotension, and respiratory depression, were also recorded. Results: Patients in the DB group experienced lower total morphine consumption and lower VAS scores when compared with patients in the B group (P < 0.001). Time to first analgesic requirement was prolonged in patients in the DB group (18.6 ± 2.4 hours) in comparison to patients in the B group (7.3 ± 1.1 hours). Ten minutes after the block there was a significant reduction in mean blood pressure and heart rate in the DB group than in the B group. Regarding postoperative adverse effects, sedation scores were higher in the DB group than in the B group, postoperative nausea, vomiting, and shivering were significantly higher in the B group than in the DB group. Bradycardia was significantly more frequent among the DB group. Although nonsignificant, pruritus was more frequent in the B group than in the DB group. No cases of respiratory depression were reported in both groups. Limitations: The used technique US-guided TiQLB could be performed in open renal surgeries only. Conclusions: The new approach US-guided TiQLB was effective and easy to be performed. Adding dexmedetomidine to bupivacaine in TiQLB was associated with potent and prolonged postoperative analgesia with fewer postoperative adverse effects. Key words: Quadratus lumborum block, dexmedetomidine, open renal surgery, postoperative pain, bupivacaine

Download Full-text