scholarly journals A Randomised, Double Blinded Study on Comparison of Intrathecal Morphine and Clonidine as Adjuvant for Post-caesarean Analgesia

2020 ◽  
Author(s):  
Susmita Ghosh ◽  
Sankar Roy ◽  
Bidyut Bikas Gharami ◽  
Arunava Biswas ◽  
Dipasri Bhattacharya ◽  
...  
Keyword(s):  
Side Effects ◽  
Caesarean Section ◽  
Postoperative Analgesia ◽  
P Value ◽  
Time Interval ◽  
Morphine Group ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Blinded Study ◽  
Double Blinded

Introduction: Caesarean section is a common obstetric operation which requires adequate and safe postoperative analgesia sometimes using morphine or clonidine to provide comfort to the mother and ease in handling the new born. Aim: To compare the adjuvant effect of morphine and clonidine when co-administered intrathecally with 0.5% bupivacaine heavy during caesarean section. Materials and Methods: A randomised double-blinded study was conducted on 90 parturient were randomly divided into three groups, during March to November 2011, receiving intrathecal 100 mcg morphine, 75 mcg clonidine and 0.5 mL normal saline along with 2.5 mL of 0.5% bupivacaine respectively. The quality and duration of postoperative analgesia and any side effects were assessed at fixed time interval. APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score of foetus was also done to assess their wellbeing. Statistical analysis was done using Analysis of Variance (for continuous variables like Blood Pressure, heart rate, etc.,) and chi-square test (for discrete variables like VAS score, side effects, etc.,). Results: Postoperative VAS score at different time were much lower in the morphine group as compared to clonidine group (p-value<0.001) at 2,8,24-hour interval postoperative period. The time required for 1st rescue analgesia was longer in morphine (14±7.33 hours) as compared to clonidine (7±1.02 hours) (p<0.001). The total dose of rescue analgesic required in 24 hours was less (p<0.001) in morphine (75±48.25 mg) group. Hypotension bradycardia and sedation (p-value 0.028) were more in clonidine group as compared to morphine group. Conclusion: Low dose morphine is better as an adjuvant than clonidine during spinal anaesthesia for relieving pain following caesarean section.

scholarly journals Epidural Ropivacaine and Dexmedetomidine with that of Epidural Ropivacaine and Fentanyl for Postoperative Analgesia in Lumbar Spine Surgeries- A Randomised Double-Blinded Study

2021 ◽  
Author(s):  
G Prashanth ◽  
Sulochana Dash ◽  
Sudeep Mohapatra ◽  
Nupur Moda
Keyword(s):  
Lumbar Spine ◽  
Postoperative Analgesia ◽  
Analgesic Efficacy ◽  
Sedation Score ◽  
Categorical Variables ◽  
P Value ◽  
Epidural Administration ◽  
Rescue Analgesia ◽  
Blinded Study ◽  
Double Blinded

Introduction: Epidural with opioids as adjuvants are the most common agents of choice for postoperative analgesia in spine surgeries which promote early ambulation, increased patient satisfaction and improved outcome. Recently, epidural administration of α2 agonists in combination with local anaesthetics in low doses offers new dimensions in the management of postoperative pain. Aim: To compare the analgesic efficacy, sedation score and haemodynamic stability of Epidural Ropivacaine and Fentanyl (RF) with that of Ropivacaine and Dexmedetomidine (RD) in the postoperative period in lumbar spine surgeries. Materials and Methods: This was a randomised, double-blinded study conducted on 120 patients at IMS and SUM Hospital, Bhubaneswar, Khordha, India. Haemodynamic parameters, Visual Analogue Score (VAS), sedation score, time to 1st dose of rescue analgesics requirement and complications were observed. The study consisted of group RF that received ropivacaine and fentanyl and group RD that received ropivacaine and dexmedetomidine, with 60 patients in each group. Continuous variables were analysed with the unpaired t-test and categorical variables were analysed with Chi-square Test and Fisher-Exact test. Statistical significance was taken as p <0.05 Results:ThemeanageofparticipantsingroupRDwas39.73±7.192 years and in group RF was 40.67±7.434 years (p-value 0.872). Heart rate was in lower range in RD group throughout the study and was statistically significant with a p-value <0.05. VAS score was lower, sedation score was higher and time to 1st dose of rescue analgesia were longer in RD group compared to group RF (p<0.005). Complications like hypotension (33.3%), bradycardia (20%) were more common in group RD while nausea, vomiting (16.67%) and pruritis (10%) were noted in group RF. Conclusion: Dexmedetomidine seems to be a better neuraxial adjuvant with good postoperative analgesic efficacy, better patient comfort and hemodynamic stability compared with that of fentanyl.

scholarly journals A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

Pain medicine ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 25-29
Author(s):  
Kishore Kumar N. ◽  
Sandeep Kadam
Keyword(s):  
Adverse Effect ◽  
Postoperative Analgesia ◽  
Rescue Analgesia ◽  
Pediatric Age Group ◽  
Respiratory Parameters ◽  
Caudal Anaesthesia ◽  
Significant Difference ◽  
Blinded Study ◽  
Group B ◽  
Double Blinded

Background: caudal anaesthesia has short­term effect. Alpha­2 adenoreceptors when used as adjuvant to local anaesthetic in children prolongs analgesic duration. The study is aimed to assess the efficacy of addition of dexme­detomidine with Bupivacaine in caudal block for extending postoperative analgesia and its safety profile in pediatric infra­umbilical surgeries.Method: the prospective interventional longitudinal double blinded study was conducted on 60 patients randomly divided into two groups by simple lottery method: group B who received (0.25 %) bupivacaine 1 ml/kg plus 1 ml nor­mal saline (NS), and those in group BD who received (0.25 %) bupivacaine 1 ml/kg plus 0.5 μg/kg dexmedetomidine in 1 ml NS. Post­surgery, both groups were compared in R studio v1.2.5001. Association between the adverse effect and other variables (age, gender, type of surgery, groups) were assessed by Multiple linear regression.Results: in group BD, duration of analgesia prolonged significantly (P < 0.05). In group BD, FLACC score at initial four hours and at 12th hour was significantly less (P < 0.05). Group B was more likely to receive high number of rescue analgesia (P = 0.0005; OR = 11.769). No significant difference was observed concerning hemodynamics, respiratory parameters and adverse effect between both groups (P > 0.05). Conclusion: in children, dexmedetomidine when used along with bupivacaine prolongs postoperative analgesia du­ration, without any significant side effects.

scholarly journals Comparison of perioperative magnesium sulphate infusion with placebo for postoperative analgesia.

2019 ◽  
Vol 26 (11) ◽  
pp. 1937-1941
Author(s):  
Ranna Mussrat ◽  
Afifa Zahoor ◽  
Muhammad Ahmad Khan ◽  
Shakeel Ahmad
Keyword(s):  
Abdominal Surgery ◽  
Magnesium Sulfate ◽  
Postoperative Analgesia ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

Adequate control of post-operative pain is very essential to reduce discomfort and early recovery after surgery. Role of adjuvant drugs along with conventional analgesic drugs have gained popularity in recent years, out of which MgSO4 is one of them. Objectives: To compare mean duration of postoperative analgesia between perioperative infusion of magnesium sulfate versus placebo in patients undergoing upper abdominal surgery. Study Design: Randomized Controlled Trial. Setting: Nishtar Medical University/Hospital Multan. Period: March-2018 to Dec-2018. Material and Methods: A total number of 100 patients admitted for upper abdominal surgery in the Department of Surgery, Nishtar Hospital Multan were included in this analysis. Group A received 50 mg/kg i/v of MgSO4 in 0.9% N/S at induction and 15 mg/kg MgS04 per hour, 6 hours postoperatively. While group B received 100 ml of 0.9% N/S at induction and 500 ml of 0.9% N/S 6 hours postoperatively. Post-op pain score was noted at 01 and 06 hours after surgery. Time for requirement of first rescue analgesia was also noted. Results: Mean post-op pain (VAS score) after 01 hour of surgery was 2.7+0.43 in MgSO4 group versus 4.1+0.82 in control group (p-value <0.001). VAS score after 06 hours was 1.9+0.31 in MgSO4 group versus 2.3+0.63 in control (p-value <0.001). Time of first rescue analgesia was prolonged in MgSO4 group; 105.9+12.7 minutes versus 67.8+15.3 minutes in control group with p-value <0.001. Conclusion: Magnesium sulfate increases the duration of postoperative analgesia and can be used as an adjunct since this molecule is inexpensive, relatively harmless, and the biological basis for its potential anti-nociceptive effect is promising.

scholarly journals COMPARISON OF EFFICACY OF LEVOBUPIVACAINE IN TRANSVERSE ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING CAESAREAN SECTION: A DOUBLE BLINDED, RANDOMIZED STUDY

2020 ◽  
pp. 1-3
Author(s):  
Praveen S ◽  
Shashank M
Keyword(s):  
Caesarean Section ◽  
Postoperative Analgesia ◽  
Randomized Study ◽  
Local Anaesthetics ◽  
Tap Block ◽  
Rescue Analgesia ◽  
Transverse Abdominis ◽  
Group A ◽  
Group B ◽  
Double Blinded

Background: Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. When used as an adjuvant to local anaesthetics, it prolongs the duration of analgesia. The aim of this study was to determine the effect of dexamethasone as an adjuvant to levobupivacaine in TAP block given to patients who underwent caesarean section. Materials & Methods: 70 patients posted for caesarean section under spinal anaesthesia were included in the study and divided into two groups. Group A received bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone(8mg). Group B received bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl in a TAP block performed with ultrasonography. The time needed for the first rescue analgesia in the postoperative period was recorded. 24hr tramadol consumption & VAS was recorded. Results: Time for first analgesic administration (tramadol) was prolonged significantly in Group A (mean ± SD- 12.24 ± 1.22hrs) as compared to Group B (mean ± SD ‑ 8.37± 1.07 hrs), P < 0.0001. Tramadol requirement for 24hrs in Group A was 115.71± 16.89 mg and for Group B was 198.57± 22.64 mg, which was statistically significant (P < 0.0001). VAS was noted at 2, 4, 6, 8, 12, 18 and 24 h. VAS was greatly reduced in group A for the first 8–10 h post‑operatively as compared to patients in group B. CONCLUSIONS: Dexamethasone when used as an adjuvant to levobupivacaine in TAP block, enhances the duration of block & decreases opioid consumption in the post- caesarean section patients.

scholarly journals A prospective randomized study to compare tramadol and morphine for postoperative analgesia in spine surgeries using intravenous patient controlled analgesia

2017 ◽  
Vol 5 (8) ◽  
pp. 3350
Author(s):  
Tasaduq Javed ◽  
Basharat Ahad ◽  
Pushpinder Singh ◽  
Riyaz Ahmad
Keyword(s):  
Postoperative Analgesia ◽  
Rating Scale ◽  
Randomized Study ◽  
Numeric Rating Scale ◽  
Nausea And Vomiting ◽  
P Value ◽  
Patient Controlled Analgesia ◽  
Morphine Group ◽  
Rescue Analgesia ◽  
Unique Challenge

Background: Spine surgeries particulary spine fusion surgeries provide a unique challenge with respect to postoperative analgesia as the choices to provide analgesia are limited. Uses of NSAIDS and neuroaxial anaesthesia for post-operative analgesia in spine surgeries have been controversial. Patient controlled analgesia with opioids is commonly used and morphine remains the gold standard. The aim of this study was to compare tramadol with morphine for postoperative analgesia in spine surgeries using iv patient controlled analgesia.Methods: A total of 80 adult patients of ASA grade I and 2 undergoing spine surgeries and divided into two groups i.e. morphine group M and tramadol group T with 40 patients in each group were included in the study. pain assessment was done by NRS (numeric rating scale) upto 48 hours postoperatively other parameters like nausea/vomiting and sedation were also noted. Both groups received boluses initially to control pain. Group M patients received 1mg i.v demand dose of morphine with lock out time of 10-15 minutes and in Group T patients PCA device was set to deliver 20mg i.v demand dose of tramadol with lock out time of 10-15 minutes. A bolus of 25mcg fentanyl was given as rescue analgesia in both groups by the nurse if required. No background infusion or four-hour maximal limit was set on PCA pumps.Results: Pain scores remained on lower side in both the groups, though slightly better with morphine and the difference was statistically significant at 4 hours, 12 hours and 24 hours. The total NRS mean value (0-48 hours) of morphine and tramadol is 3.270 and 3.629 with p value of 0.015 which is statistically significant. 7 patients in morphine group received rescue analgesia while it was received by 15 patients in tramadol group with p value of 0.78 which is statistically insignificant. Nausea and Vomiting was encountered more frequently in the tramadol group. Mean mobilization time in patients of tramadol group was 21.72 hours and that of morphine group was 17.10 hours with p value of 0.00 which is highly significant.Conclusions: Morphine and tramadol when used in PCA mode provide adequate pain relief post operatively after spine surgeries with morphine showing slightly better analgesia profile and significantly less nausea and vomiting than tramadol.  

scholarly journals Comparative study of diclofenac suppository with tramadol suppository in addition to acetaminophen for post caesarian analgesia

2020 ◽  
Vol 9 (4) ◽  
pp. 1372
Author(s):  
Reetu Hooda ◽  
Prachi Pathak ◽  
Rahul Chavhan
Keyword(s):  
Caesarean Section ◽  
Elective Caesarean Section ◽  
P Value ◽  
Breastfeeding Initiation ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Rectal Suppository ◽  
Group A ◽  
Group B

Background: Pain after emergency and elective caesarean section may adversely affect patient’s recovery and breastfeeding initiation. The aim of present study was to compare the analgesic efficacy of diclofenac suppository-intravenous acetaminophen (APAP) combination, tramadol suppository-intravenous APAP combination and intravenous APAP alone for postoperative pain relief after caesarean section.Methods: We designed a randomized double-blind control study. Three hundred parturient scheduled for caesarean section were randomized to receive diclofenac rectal suppository (100 mg), tramadol rectal suppository (100 mg) or glycerin rectal suppository in Group A, B and C respectively (100 parturient in each group). All the women routinely received 1000 mg acetaminophen intravenously. Assessment of pain was done using a visual analogue scale (VAS) at 0, 1, 6, 12, 18 and 24 hours. injection Pentazocine 0.3 mg/kg IV was given as rescue analgesia when VAS score > 30.Results: The mean VAS score was significantly higher in Group C as compared to Group A and Group B (p value < 0.001). This suggests better efficacy of multimodal treatment as compared to monotherapy. Group A as compared to Group B showed better efficacy in term of VAS score at 12 and 18 hours (p = 0.05, p = 0.02 respectively).Conclusions: We found that when controlling for socio-demographic characteristics, combination of either diclofenac or tramadol suppository with acetaminophen has significantly better results when compared with monotherapy of acetaminophen alone in post-operative analgesia after caesarean section. However, the combination of diclofenac suppository has proved to be superior in comparison to tramadol suppository.

scholarly journals Intermittent Subcutaneous Morphine for Postoperative Analgesia Following Coronary Artery Bypass Grafting

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.

scholarly journals Effect of Dexamethasone as an Adjuncton Efficacy of Ropivacaine in Caudal Block forPostoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

2021 ◽  
Author(s):  
Veena Patodi ◽  
Kavita Jain ◽  
Mukesh Choudhary ◽  
Surendra Kumar Sethi ◽  
Neena Jain ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Controlled Study ◽  
P Value ◽  
Single Shot ◽  
Caudal Block ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Paediatric Patients ◽  
Haemodynamic Changes

Introduction: Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in single-shot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. GroupR (n=40) administered 0.2% ropivacaine (1 mL/kg) while GroupRD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC ≥4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to GroupR (440.38±76.44 min); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

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