scholarly journals Combined Opioid Free and Loco-Regional Anesthesia Enhances the Quality of Recovery in Sleeve Gastrectomy Done Under ERAS Protocol: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Mohamed Ibrahim ◽  
Ali M Elnabtity ◽  
Ahmed Hegab ◽  
Omar A. Alnujaidi ◽  
Osama El Sanea
Keyword(s):  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Oral Fluid ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
P Value ◽  
Rescue Analgesia ◽  
Quality Of Recovery ◽  
Eras Protocol

Abstract Background: There is still debate as to whether opioid-free anaesthsia (OFA) may offer additional benefit over multimodal analgesia to better achieve the goals of ERAS(Enhanced recovery after surgery) in bariatric surgery.Patients and method: Patients in the OFA group (n=51) were pre-medicated with IV dexmedetomidine 0.1 µg.kg-1 then induced with propofol (2 mg. kg-1) -ketamine (0.5 mg. kg-1) mixture and maintained on dexmedetomidine 0.5µg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1. Patients in the MMA(Multimodal analgesia) group (n= 52) were induced using IV propofol 2 mg. kg-1, and fentanyl 1 µg. kg-1. Cisatracurium (0.15 mg.kg-1) was given to all patients for muscle relaxation. Ultrasound-guided bilateral oblique subcostal transverse abdominis plane (OSTAP) block was performed in all patients. The postoperative quality of recovery at 6 and 24 hours was measured as a primary outcome. Postoperative pain control; subsequent opioid consumption; time to ambulate; time to tolerate oral fluid; and time to readiness for discharge were measured as secondary outcomes Results: The total QoR-40 (quality of recovery-40) scores at 6 hours were significantly higher in the OFA group (184.84 versus 180.69 in the MMA group with an estimated difference in mean of -4.15, 95% CI, -5.78 to -2.5, and P ˂0.001. The OFA group tolerated oral fluid intake earlier (194.94, 95% CI, 162.59 to 227.30) versus (273, 95% CI, 223.65 to 322.27) for the MMA group (p value=0.009). Readiness for discharge was significantly quicker in the OFA group (447.49, 95% CI, 409.69 to 485.29 versus 544.56, 95% CI, 503.08 to 586.04 in the MMA group, P-value =0.001). The post-anesthesia care unit (PACU) (0 Hour) and the floor 2 and 6-hour numerical rating scales (NRS) for pain were significantly higher in the MMA group. The OFA group needed less opioid rescue analgesia in the PACU and at 24-hours (P value= 0.003 and 0.014; respectively).Conclusion: Combined Opioid free and loco-regional anesthesia provides better early recovery with reduced postoperative pain intensity, and opioid consumption when compared to multimodal analgesia; and is better suited to achieve the goals of ERAS protocol.Clinical trial number: registration number NCT04285255.

Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial

2020 ◽  
Vol 45 (4) ◽  
pp. 277-282 ◽  
Author(s):  
Başak Altıparmak ◽  
Melike Korkmaz Toker ◽  
Ali Ihsan Uysal ◽  
Özcan Dere ◽  
Bakiye Uğur
Keyword(s):  
Postoperative Analgesia ◽  
Radical Mastectomy ◽  
Opioid Consumption ◽  
Control Group ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Quality Of Recovery ◽  
Pain Scores

Background and objectivesMastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia.MethodsPatients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I–II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room.ResultsThe descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4–7 mg) in group R and 10 mg (IQR 8–13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups.ConclusionsIn the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery.Trial registration numberACTRN12619000879167.

scholarly journals The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiyu Geng ◽  
Hui Bi ◽  
Dai Zhang ◽  
Changji Xiao ◽  
Han Song ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Controlled Trial ◽  
Bowel Function ◽  
Multimodal Analgesia ◽  
Study Group ◽  
Gynecological Surgery ◽  
Quality Of Recovery ◽  
Enhanced Recovery Protocol ◽  
The Impact

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

scholarly journals Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

2018 ◽  
Vol 28 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Lauren K. Dunn ◽  
Marcel E. Durieux ◽  
Lucas G. Fernández ◽  
Siny Tsang ◽  
Emily E. Smith-Straesser ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Rating Scale ◽  
Psychological Intervention ◽  
Opioid Consumption ◽  
Anxiety And Depression ◽  
Opioid Use ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
The Impact

OBJECTIVEPerception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODSPatients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTSOne hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).CONCLUSIONSCatastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

Comparison of post-operative analgesic effect between Pregabalin and Gabapentin given as premedication drugs for patients undergoing laproscopic cholecystectomy

2021 ◽  
Vol 8 (2) ◽  
pp. 179-184
Author(s):  
Arun Kumar Balasubramanian ◽  
Rasikapriya Madhanagopal ◽  
Priyanka S Gowda ◽  
Brindha Rathnasabapathy ◽  
R Shankar
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Adverse Events ◽  
Multimodal Analgesia ◽  
Dose Requirement ◽  
College Hospital ◽  
Rescue Analgesia ◽  
Entire Study ◽  
The Difference

Currently most of the anesthetist prefer the usage of multimodal analgesia technique to improve the degree of pain relief without inducing any side effects. Pregabalin and gabapentin when given in higher doses reduces the preoperative anxiety and induce sedation without causing undesirable side effects.To compare and evaluate the effects of premedication drugs Pregabalin or Gabapentin versus placebo for attenuation of postoperative pain among patients undergoing laparoscopic cholecystectomy under general anaesthesia.A prospective comparative study was conducted for a period of 6 months in the department of anesthesiology of our medical college hospital. A total of 90 patients posted for elective laproscopic cholecystectomy in the age group between 20 and 60 years were taken as our study subjects. The entire study subjects were randomized into three groups of 30 each. Group B subjects received 3 tablets of Beplex forte (as placebo), Group G subjects received 3 tablets of Gabapentin 300mg (total 900mg) and Group P subjects received 3 tablets of Pregabalin 50mg (total 150mg). Post-operatively degree of pain, requirement for rescue analgesia, sedation score and adverse events occurred was monitored and analysed between the three groups. Pain score was less in the pregabalin group at all intervals compared to gabapentin and placebo group and the difference was found to be statistically significant. Maximum amount of tramadol requirement as a part of rescue analgesia was seen in the placebo group followed by gabapentin group and minimal dose requirement was needed for pregabalin group and the difference was found to be statistically significant. The occurrence of adverse events such as somnolence and dizziness was almost similar in all the three groups whereas the incidence of nausea and vomiting was less in pregabalin group compared to gabapentin and placebo group. Pregabalin can be effectively used as a part of the multimodal analgesic to prevent acute postoperative pain among patients undergoing elective laproscopic cholecystectomy.

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

2021 ◽  
Vol 15 (10) ◽  
pp. 2622-2624
Author(s):  
Haq dad Durrani ◽  
Rafia Kousar ◽  
Ejaz Iqbal ◽  
Muhammad Abdul Aziz ◽  
Syed Aushtar Abbas Naqvi ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Subcutaneous Tissue ◽  
Difficult Problem ◽  
P Value ◽  
Trial Methodology ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Significant Difference

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy

2021 ◽  
Vol 11 (1) ◽  
pp. 5-8
Author(s):  
Neha Singh ◽  
Parnandi Bhaskar Rao ◽  
Anirudh Elayat
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Laparoscopic Hysterectomy ◽  
Multimodal Analgesia ◽  
Total Laparoscopic Hysterectomy ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Quadratus Lumborum

Aim: Laparoscopic procedures are now preferred over open surgeries, and total laparoscopic hysterectomy is becoming increasingly popular. Quadratus lumborum (QL) block is an evolving technique for abdominal surgeries that blocks T5–L1 nerve branches. Methods: We used a combination of anterior and posterior QL block given bilaterally in two patients and evaluated perioperative opioid consumption, postoperative pain score and patient satisfaction. Results: There was reduced perioperative opioid consumption along with postoperative visual analog scale for pain over the first 24 h. Both patients appreciated the level and standard of pain relief. Conclusion: QL block is promising as a part of multimodal analgesia for laparoscopic abdominal surgeries. Further studies are needed to determine the best possible combination of different approaches to QL block.

Cost-efficacy of Rofecoxib versus  Acetaminophen for Preventing Pain after Ambulatory Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 931-937 ◽  
Author(s):  
Tijani Issioui ◽  
Kevin W. Klein ◽  
Paul F. White ◽  
Mehernoor F. Watcha ◽  
Gary D. Skrivanek ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Pain ◽  
Confidence Interval ◽  
Analgesic Efficacy ◽  
Additional Patient ◽  
Controlled Study ◽  
Quality Of Recovery ◽  
Analgesic Medication

Background Nonsteroidal antiinflammatory drugs are commonly administered as part of a multimodal regimen for pain management in the ambulatory setting. This randomized, double-blinded, placebo-controlled study was designed to compare the analgesic effect of oral rofecoxib, a cyclooxygenase-2 inhibitor, and acetaminophen when administered alone or in combination prior to outpatient otolaryngologic surgery. Methods A total of 143 healthy outpatients undergoing elective otolaryngologic surgery were assigned to one of four study groups: group 1 = control (500 mg vitamin C); group 2 = 2 g acetaminophen; group 3 = 50 mg rofecoxib; or group 4 = 2 g acetaminophen and 50 mg rofecoxib. The first oral dose of the study medication was taken 15-45 min before surgery, and a second dose of the same medication was administered on the morning after surgery. Recovery times, side effects, and the need for rescue analgesics were recorded. Follow-up evaluations were performed at 24 and 48 h after surgery to assess postdischarge pain, analgesic requirements, nausea, and patient satisfaction with their postoperative pain management and quality of recovery. Peak pain scores and the need for rescue analgesic medication were used as the endpoints for estimating efficacy of the study drugs, while cost to achieve complete satisfaction with analgesia was used in the cost-effectiveness analysis. Results Premedication with rofecoxib (50 mg) was significantly more effective than either placebo or acetaminophen (2 g) in reducing the peak postoperative pain, the need for analgesic medication, and improving the quality of recovery and patient satisfaction. Moreover, the addition of acetaminophen failed to improve its analgesic efficacy. An expenditure for rofecoxib of 16.76 US dollars (95% confidence interval, 7.89 to 21.03 US dollars) and 30.24 US dollars (95% confidence interval, 5.25 to 54.20 US dollars) would obtain complete satisfaction with pain control in one additional patient who would not have been satisfied if placebo or acetaminophen, respectively, had been administered prior to surgery. Conclusions Rofecoxib, 50 mg administered orally, decreased postoperative pain and the need for analgesic rescue medication after otolaryngologic surgery. The addition of 2 g oral acetaminophen failed to improve its analgesic efficacy.

scholarly journals EFFICACY OF USG GUIDED FASCIA ILIACA COMPARTMENT BLOCK AS POSTOPERATIVE ANALGESIA IN PROXIMAL FRACTURE FEMUR

2020 ◽  
pp. 10-13
Author(s):  
Kulkarni Sanhita J. ◽  
Sahasrabuddhe Saumil S ◽  
Joshi Pradnya S ◽  
Bhale Pramod V ◽  
Sasturkar Vasanti M ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Femur Fracture ◽  
Proximal Femur Fracture ◽  
P Value ◽  
Ultrasound Guided ◽  
Total Consumption ◽  
Rescue Analgesia ◽  
Fracture Femur ◽  
Significant Difference

Background Fascia iliaca compartment nerve block (FICNB) has been reported to provide effective postoperative analgesia in patients with femur fracture. This study aimed to evaluate the effectiveness of FICNB with Bupivacaine and Dexamethasone for postoperative analgesia in proximal fracture femur. Methods Sixty-four patients of ASA grade 1 to 3, aged 50-80 years scheduled for proximal femur fracture femur were included and randomly assigned to two groups of 32 patients each Group F received ultrasound guided(FICNB) with 0.25% 40ml of Bupivacaine & Dexamethasone 4 mg & Group T received Tramadol 50mg at the end of surgery. Postoperative pain was assessed at 30 minutes, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours and 24 hours using visual analogue scale (VAS). Injection Paracetamol 1gm was given intravenously as rescue analgesia in both the groups when VAS was more than four. Results Both the groups were comparable for demographic parameters. The mean duration of analgesia was 460.31±10.50 minutes in the FICNB group while it was only 263.72±12.85 minutes in the tramadol group, the difference being statistically significant (with a ‘p value’ of 0.001). The total consumption of paracetamol did not show a significant difference in either of the groups in the first 24 hours, the ‘p value’ being 0.406. Conclusion Ultrasound guided FICNB given postoperatively in patients undergoing proximal fracture femur can provide postoperative pain relief for longer duration than Inj. Tramadol.

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