scholarly journals Intrathecal Dexmedetomidine, Ketamine, and their Combination Added to Bupivacaine for Postoperative Analgesia in Major Abdominal Cancer Surgery

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E829-E839
Author(s):  
Ahmad MA El-Rahman
Keyword(s):  
Postoperative Analgesia ◽  
Academic Medical Center ◽  
Small Sample ◽  
Cancer Surgery ◽  
Morphine Consumption ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background: Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P < 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone. Key words: Intrathecal, ketamine, dexmedetomidine, lower abdominal cancer surgery

scholarly journals Efficacy and Safety of Dexmedetomidine Added to Caudal Bupivacaine in Pediatric Major Abdominal Cancer Surger

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 393-400
Author(s):  
Ahmed H. Othman
Keyword(s):  
Postoperative Period ◽  
Small Sample Size ◽  
Academic Medical Center ◽  
Small Sample ◽  
Cancer Surgery ◽  
Rescue Analgesia ◽  
Group I ◽  
Caudal Analgesia ◽  
Significant Difference ◽  
Group B

Background: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties. Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. Study Design: A randomized double-blind trial. Setting: Academic medical center. Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 µg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale. Adverse effects were recorded and treated. Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations: This study is limited by its small sample size. Conclusion: Addition of dexmedetomidine (1 µg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance. Key words: Dexmedetomidine, caudal block, pediatric cancer surgery

scholarly journals Comparitive evaluation of different concentrations of alcohol in ultrasound guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies

2021 ◽  
Vol 8 (4) ◽  
pp. 492-500
Author(s):  
Manish Kumar Singh ◽  
Pragya Verma ◽  
Sarita Singh ◽  
Gyan P Singh ◽  
Hemlata Verma
Keyword(s):  
Quality Of Life ◽  
Morphine Consumption ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii ◽  
Upper Abdominal

Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%).This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48).Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups.

Effects of Electroacupuncture on Intraoperative and Postoperative Analgesic Requirement

2002 ◽  
Vol 20 (2-3) ◽  
pp. 56-65 ◽  
Author(s):  
Chin-Keng Sim ◽  
Pei-Chang Xu ◽  
Hwee-Leng Pua ◽  
Guojing Zhang ◽  
Tat-Leang Lee
Keyword(s):  
Early Postoperative Period ◽  
Morphine Consumption ◽  
Control Group ◽  
Analgesic Requirement ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
The Difference ◽  
Sparing Effect ◽  
Postoperative Morphine

Acupuncture has been shown to be effective in experimental and clinical acute pain settings. This study aims to evaluate the effect of preoperative electroacupuncture (EA) on intraoperative and postoperative analgesic (alfentanil and morphine) requirement in patients scheduled for gynaecologic lower abdominal surgery. Ninety patients were randomly assigned to one of three groups: Group I (control group) –received placebo EA for 45 minutes before induction of general anaesthesia (GA); Group II –preoperative EA instituted 45 minutes before induction of GA; Group III – 45 minutes of postoperative EA. The Bispectral Index monitor was used intraoperatively to monitor the hypnotic effect of anaesthetic drugs, and alfentanil was titrated to maintain the blood pressure and pulse rate within ±15% of basal values. Postoperative pain was managed by intravenous morphine via a patient-controlled analgesia (PCA) device. Patients in Group II (0.44 ± 0.15μg/kg/min) received less alfentanil than those in Group III (0.58 ± 0.22μg/kg/min) (p=0.024), but not significantly less than those in Group I (0.51 ± 0.21μg/kg/min) (p=0.472). Postoperative morphine consumption was numerically lower in Group II compared with the other groups; however, the difference was statistically significant only during the period of 6–12 hours between Group II [0.03 (0.05) mg/kg] and Group I [0.10 (0.11) mg/kg] (p=0.015), and Group II and Group III [0.08 (0.10) mg/kg] (p=0.010). The 24-hour cumulative morphine consumption for Group II (0.52 ± 0.19mg/kg) was less than that for either Group I (0.68 ± 0.38mg/kg) or Group III (0.58 ± 0.27mg/kg), but the difference did not reach significance. In conclusion, preoperative EA leads to a reduced intraoperative alfentanil consumption, though this effect may not be specific, and has a morphine sparing effect during the early postoperative period.

scholarly journals Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

2017 ◽  
Vol 5 (10) ◽  
pp. 4588 ◽  
Author(s):  
Tauqeer Anjum Mir ◽  
Aabid Hussain Mir ◽  
Tantry Tariq Gani ◽  
Abida Yousuf ◽  
Sheikh Irshad Ahmad
Keyword(s):  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
P Value ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Group I ◽  
Group Ii ◽  
The Difference

Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. In this study, we have compared bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing lower abdominal surgeries under spinal anaesthesia.Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoing various lower abdominal surgeries were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. Quality of analgesia was assessed by visual analogue scale (VAS), categorical pain scoring system and frequency of rescue analgesia given and duration was assessed with the time at which first rescue analgesia was given. Side effects of clonidine such as sedation, bradycardia and hypotension were also noted. The hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were noted for both the groups.Results: Demographic characteristics like age, weight, sex, ASA class and type of surgeries were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. Categorical pain scoring system also showed statistically better scores in group II than group I. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. The mean number of doses of rescue analgesia in group I for the first 24 hours was 1.37 ± 0.89 and in group II was 0.60 ± 0.62 with a p-value of 0.0003 and the difference was statistically significant. Group II patients showed more sedation scores than group I patients (p-value <0.05). None of the patients had any episode of bradycardia or hypotension.Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in tranverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.

Effect of intrathecal morphine before and after laminectomy on intraoperative surgical stress response and post-operative pain: A prospective randomized study

2020 ◽  
Vol 16 (1) ◽  
pp. 15-22
Author(s):  
Amany Faheem Abd El Salam Omara, MD ◽  
Asmaa Fawzy Amer, MD
Keyword(s):  
General Anesthesia ◽  
Surgical Stress ◽  
Intrathecal Morphine ◽  
Morphine Group ◽  
Rescue Analgesia ◽  
Group Iii ◽  
General Anesthesia Group ◽  
Group I ◽  
Anesthesia Group ◽  
Group Ii

Study objective: Intrathecal administration of morphine.Design: A prospective, randomized, controlled study.Setting: Operating room.Patients: Ninety patients of American Society of Anesthesiologists physical statuses I and II undergoing lumbar laminectomy.Interventions: Pre-emptive versus post-operative intrathecal morphine injection, compared to a control group.Main outcome: The visual analog score at the time of discharge and 2, 4, 6, 8, 10, 12, 18, and 24 h later, serum cortisol level, the number of patients needing post-operative rescue analgesia, its duration, and the total amount required. Main results: Morphine sulfate consumption as rescue analgesia over 24-h postoperatively was significantly higher in general anesthesia group (Group I) than in pre-emptive intrathecal morphine groups (Group II) [p = 0.001] and then postoperative intrathecal morphine group (Group III) [p = 0.001], and it was higher in Group III than Group II [p = 0.001]. There was a greater need for post-operative rescue morphine in general anesthesia group (Group I) than in the other two groups, and it was greater in post-operative intrathecal morphine group (Group III) than in pre-emptive intrathecal morphine group (Group II). At 30 min after surgical incisions and at 1 and 24 h after surgery, serum cortisol levels were significantly higher in general anesthesia group (Group I) [p = 0.001] and in post-operative intrathecal morphine group (Group III) [p = 0.001] than in pre-emptive intrathecal morphine groups (Group II), with no significant difference between general anesthesia group (Group I) and post-operative intrathecal morphine group (Group III) [p = 0.704, 0.263, and 0.943, respectively].Conclusion: Pre-emptive intrathecal morphine analgesia is an effective technique for controlling surgical stress response and post-lumbar laminectomy pain.

scholarly journals Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries

2020 ◽  
Vol 5 (1) ◽  
pp. 109-113
Author(s):  
Prachi Singh ◽  
Sandeep Kumar Yadav ◽  
Sumit Kumar ◽  
Manoj Tripathi ◽  
Deepak Malviya
Keyword(s):  
Statistical Analysis ◽  
Pain Perception ◽  
Study Drug ◽  
Surgical Excision ◽  
Rescue Analgesia ◽  
Randomised Study ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Arthroscopic Knee

Background: The post-operative pain in knee arthroscopy procedures can be attributed to irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection1.  In the recent years, new interest has focused on the cholinergic system that modulates pain perception and transmission. The present study is designed to compare the efficacy of intra- articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following arthroscopic surgeries.Subjects and Methods:Prospective, Interventional, Randomised study was conducted over 90 patients scheduled for elective arthroscopic knee surgery, who were randomly allocated into three equal groups of 30 patients each. Group I-Bupivacaine with Neostigmine, Group II-Bupivacaine with Fentanyl and Group III-Bupivacaine alone. The study drug combinations were administered Intra-articularly at the conclusion of surgery. Hemodynamic variables and Pain were observed immediately after completion of surgery (Baseline) and thereafter at fixed intervals. The duration of effective analgesia was measured from the “baseline” until the first use of rescue analgesic. The number of rescue analgesics given in 24 hours were also recorded. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software.Results:Requirement for first analgesia was significantly earlier in Group III (146.00±71.66 minutes) as compared to Group II (236.00±111.34 minutes) and Group I (648.00±228.55 minutes). Majority of patients of Group I (90.0%) required rescue analgesia only once while in was twice in Group II (90.00%) and thrice in Group III (86.67%).Conclusion:Intra-articular administration of Neostigmine in combination with Bupivacaine provided a better post-operative analgesic effect with a lower incidence of side effects and lesser requirement of rescue analgesia.

scholarly journals Comparative Study between Ultrasound-Guided Fascia Iliaca Block Versus Adductor Canal Block for Postoperative Analgesia in Patients undergoing Knee Surgeries

2021 ◽  
pp. 214-224
Author(s):  
Soliman Ramadan Naser ◽  
Sameh Mohammed Refaat ◽  
Nagat Sayed El Shmaa ◽  
Sabry Mohammed Amin
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Control Group ◽  
Ultrasound Guided ◽  
Adductor Canal Block ◽  
Group Iii ◽  
Adductor Canal ◽  
Group I ◽  
Group Ii ◽  
Fascia Iliaca Block

Background: Peripheral nerve block may provide effective unilateral postoperative analgesia following knee and hip surgeries with a lower incidence of opioid-related and autonomic side-effects, less motor block. Fascia iliaca block (FIB) and adductor canal block (ACB) have been shown to be a successful technique for postoperative pain relief after knee surgeries. The aim of our study was to compare the effect of ultrasound guided FIB versus ultrasound guided ACB for postoperative analgesia in patients undergoing knee surgeries. Methods: Our randomized controlled trial was conducted over 105 patients aged between 18 and 65 years, (ASA) class I and II undergoing knee surgeries. Patients divided into three groups: Group I control (C): Patients received spinal anesthesia alone. Group II (FIB): Patients received spinal anesthesia with postoperative ultrasound guided FIB. Group III (ACB): Patients received spinal anesthesia with postoperative ultrasound guided ACB. Results: Both FIB and ACB provided better pain control compared to control group. The need for first dose of supplemental analgesic was earlier in the control group than FIB and ACB groups postoperatively. Additionally, the total 24-h pethidine consumption was highest in the control group compared to fascia FIB and ACB groups. FIB was shown to reduce the strength of the quadriceps muscle, which resulted in delayed early postoperative mobilization and influencing patient satisfaction. There was statistically significant increase in heart rate and mean arterial blood pressure in group I as compared to group II and group III at 6hrs and 12hrs postoperatively. Conclusions: Both FIB and ACB provide excellent postoperative analgesia after knee surgeries, however the ACB is superior to FIB because it has no prolonged muscle weakness and FIB did.

scholarly journals Effect of Intravenous Dexamethasone in Combination with Caudal Analgesia on Post Operative Pain Control after Herniotomy in Children

2020 ◽  
Vol 35 (2) ◽  
pp. 145-149
Author(s):  
Md Jahirul Islam ◽  
Ismat Jahan ◽  
Aminul Islam
Keyword(s):  
Adverse Effects ◽  
Postoperative Analgesia ◽  
Control Group ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Dexamethasone Group ◽  
Group I ◽  
Caudal Analgesia ◽  
Group Ii

Background: Dexamethasone has a powerful anti-inflammatory action and has demonstrated reduced morbidity after surgery. Objectives: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudalblock on postoperative analgesia in children. Methods: This study was a randomized, double blind clinical trial, in which 77 children of ASA I and II, aged 3-10 years, undergoing elective unilateral herniotomy operation, was allocated in a double blind manner. Control Group I consist of 39 patients and Dexamethasone Group II consists of 38 patients. Group II received i.v. Dexamethasone 0.5 mg/Kg (Maximum 20 mg) and Group I received the same volume of i.v. saline after induction of anaesthesia. After inhalation induction of general anaesthesia, children received either dexamethasone 0.5-1 mg/Kg (maximum 20 mg) (n=39) or the same volume of saline (n=38) i.v. A caudal anaesthetic block was then performed using 1.5 ml/kg of Bupivacaine 0.25% in all patients. After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. Results: Significantly, fewer patients in the dexamethasone group required fentanyl for rescue analgesia (7.9% vs38.5%, p<0.05) in the post-anaesthetic care unit or acetaminophen (23.7% vs 64.1%) after discharge compared with the control group. The time to first administration of oral acetaminophen was significantly longer in the dexamethasone group (646 vs 430 min). Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Conclusion: Intravenous dexamethasone 0.5-1 mg/Kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia with out adverse effects in children undergoing herniotomy. DS (Child) H J 2019; 35(2) : 145-149

scholarly journals Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

2017 ◽  
Vol 5 (2) ◽  
pp. 623
Author(s):  
Kanhya Lal Gupta ◽  
Amit Gupta ◽  
. Neeraj
Keyword(s):  
Postoperative Analgesia ◽  
Normal Saline ◽  
Lower Limb ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
The Difference ◽  
Preservative Free

Background: Spinal Anaesthesia is a well-known technique of performing lower limb orthopaedic surgeries. It has a shorter duration of action and early arising postoperative pain due to which various adjuvant needs to be added and their roles are being evaluated in various studies. Intrathecal opioids act synergistically with local anaesthetics and thus intensifying the sensory block without having any effect on sympathetic blockage. The main aim of present study is to investigate and evaluate the effectiveness of intrathecal nalbuphine (preservative free) as an adjuvant and also the efficacy of nalbuphine for postoperative analgesia and its complications if there are any.Methods: A total of 60 patients were included in this study belonging to ASA I and ASA II score with normal coagulation profile. Patients were randomly divided into 2 groups of 30 patients each. Group I receiving 3 ml of hyperbaric bupivacaine 0.5%+1.0mgm of nalbuphine (preservative free) injection made in 0.5 ml normal saline intrathecally. Group II received 3 ml of hyperbaric bupivacaine 0.5%+0.5 ml injection Normal saline intrathecally. The following criteria were noted. The onset of sensory blockade and complete motor blockade highest level of sensory blockade, duration of sensory blockade, duration of motor and duration of effective analgesia were recorded. Any hemodynamic alterations were also noted.Results: The mean time for the onset of sensory blockage was 56 sec in Group I and 59 sec in Group II (control). The difference were statistically insignificant (p>0.05). The mean onset of motor blockage was 106 sec in Group I and 208 sec in Group II (control). The difference was statically insignificant. The peak onset time in Group I and Group II was 372 sec and 220 sec respectively (p>0.05). Two segment regression times for sensory blockage was prolonged in Group I (118.20±8.56 min) compared to Group II (104.56±15.20 mins).Conclusions: The duration of postoperative analgesia was 6-8 hours in Group I compared to 3-4 hours in Group II (p value= 0.0001, statistically significant).

scholarly journals Optimization of postoperative analgesia after adenoidectomy in children

2017 ◽  
Vol 8 (2) ◽  
pp. 277-282
Author(s):  
M. A. Georgiyants ◽  
M. B. Pushkar ◽  
O. V. Vysotska ◽  
A. P. Porvan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Analgesia ◽  
Group Iii ◽  
Group I ◽  
Pain Scales ◽  
Group Ii ◽  
Fentanyl Group

It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41) those who received propofol in combination with fentanyl; group II (n = 40) those who received sevoflurane in combination with fentanyl; group III (n = 36) those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces») and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain intensity on the «Faces» scale. A very strong correlation between «cortisol – BIS index» was observed during the traumatic moment of operation and unidirectional positive correlations were seen both between ΔBIS-index «intubation-the traumatic moment of operation» and between the level of cortisolemia (Δcortisol before surgery – the traumatic moment of operation, Δcortisol extubation – the 1st day after the surgery and Δcortisol before surgery – the 1st day after the surgery) and the intensity of postoperative pain by the «Faces» and Oucher scales. The around-the-clock prescribed administration of ibuprofen at dose 10 mg/kg after adenoidectomy provided effective postoperative analgesia. At the 1st hour after the operation lower pain intensity was revealed in patients using propofol in combination with fentanyl by both pain scales. We believe that propofol is able to influence the level of cortisol and assume that due to minimal changes in the level of cortisol during the perioperative period, propofol can reduce the intensity of postoperative pain. 

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