A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

The Global Publication Trend and Research Development of Nerve Block: A Visualisation Analysis Between 1997 and 2021

Background: Nerve block is used as a clinical technique for relieving pain during the surgical period as well as in postoperative analgesia and chronic pain. Although great progress has been recently made regarding nerve block techniques, there is still room for further medical and technical improvement. Here, we analysed the trends in nerve block research and compared contributions from different countries, institutions, journals, and authors. Methods: We extracted all studies concerning nerve block published between 1997 and 2021 from the Web of Science database. Microsoft Excel and VOSviewer were employed to collect publication data, analyse publication trends, and visualize relevant results. Results: A total of 6,437 publications with 111,612 citations were identified between 1997 and 2021. The United States contributed the greatest number of publications (2010), whereas China ranked second (518). The Regional Anesthesia & Pain Medicine journal had published the most papers concerning nerve block. Harvard University and Mariano ER were the most productive institution and author, respectively, in the field. Keywords were categorized into five clusters: the association between nerve block and anaesthesia or analgesia, local anaesthetic drugs for nerve block, nerve block techniques, nerve block for postoperative analgesia, and nerve block for oral local anaesthesia. Management-related research was a heavily researched topic in the field. Conclusions: We concluded that the United States contributed the most studies, and developing countries, led by China, are also encouraging study in this area. The exploration of new drugs in the fields of nerve block, multi-modal analgesia after surgery, treatment of chronic pain, analgesia for thoracic and abdominal surgeries, and analgesic interventions in oral therapy is considered as a potential focus for future research.

Analgesia Nociception Index-Guided Remifentanil versus Standard Care during Propofol Anesthesia: A Randomized Controlled Trial

The clinical benefits to be expected from intraoperative nociception monitors are currently under investigation. Among these devices, the Analgesia Nociception-Index (ANI) has shown promising results under sevoflurane anesthesia. Our study investigated ANI-guided remifentanil administration under propofol anesthesia. We hypothesized that ANI guidance would result in reduced remifentanil consumption compared with standard management. This prospective, randomized, controlled, single-blinded, bi-centric study included women undergoing elective gynecologic surgery under target-controlled infusion of propofol and remifentanil. Patients were randomly assigned to an ANI or Standard group. In the ANI group, remifentanil target concentration was adjusted by 0.5 ng mL−1 steps every 5 min according to the ANI value. In the Standard group, remifentanil was managed according to standard practice. Our primary objective was to compare remifentanil consumption between the groups. Our secondary objectives were to compare the quality of anesthesia, postoperative analgesia and the incidence of chronic pain. Eighty patients were included. Remifentanil consumption was lower in the ANI group: 4.4 (3.3; 5.7) vs. 5.8 (4.9; 7.1) µg kg−1 h−1 (difference = −1.4 (95% CI, −2.6 to −0.2), p = 0.0026). Propofol consumption was not different between the groups. Postoperative pain scores were low in both groups. There was no difference in morphine consumption 24 h after surgery. The proportion of patients reporting pain 3 months after surgery was 18.8% in the ANI group and 30.8% in the Standard group (difference = −12.0 (95% CI, −32.2 to 9.2)). ANI guidance resulted in lower remifentanil consumption compared with standard practice under propofol anesthesia. There was no difference in short- or long-term postoperative analgesia.

Reduction of leakage from insertion site during continuous femoral nerve block with catheter-through-needle versus catheter-over-needle technique for postoperative analgesia after total knee arthroplasty: a randomized controlled trial

Background Continuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A different type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare the incidence of leakage from the catheter insertion site during CFNB while using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA). Methods This prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN or CON groups. All patients in both groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine (a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 h postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups. Results The CON group had a significantly lower incidence and degree of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes. Conclusions Use of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage. Trial registration The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

Effectiveness of Postoperative Pain Management By Multimodal Analgesia Without Epidural Analgesia After Laparoscopic Colon Cancer Surgery: A Prospective Cohort Study

Background:Although epidural analgesia has been recommended for its strong analgesic effect for postoperative analgesia management, the increasing number of patients undergoing anticoagulant or antiplatelet therapy to treat cerebrocardiovascular diseases cannot receive epidural analgesia given the risk of serious complications, including epidural hematoma. We aimed to evaluate the analgesic effects of multimodal analgesia involving intravenous patient-controlled analgesia (IV-PCA), and repeated scheduled acetaminophen administration, and block as local anesthesia, to establish postoperative analgesia management method replacing epidural analgesia in laparoscopic colectomy.Methods:We enrolled patients undergoing laparoscopic surgery for colorectal cancer at our hospital. The primary outcome was days of postoperative hospital stay. The efficacies of multimodal and epidural analgesia were compared. The secondary outcomes were the pain assessment and safety.Results:We registered 48 patients; among them, 40 patients were eligible. The mean postoperative hospital stay was 9.00 days (95% CI = 8.19 to 9.39, p < 0.0001). There were relatively high pain scores from postoperative day (POD) 0-1, which subsequently decreased and reach their lowest value at POD 4-5.Conclusions:Multimodal analgesia with IV-PCA and repeated scheduled acetaminophen administration could provide a safe and effective analgesic effect after laparoscopic colectomy and may be a postoperative analgesia management alternative to epidural analgesia.

Evaluation of Analgesia Effect after Ultrasound-Guided Laparoscopic Renal Surgery

Kidney surgery involves placing the kidney in the iliac fossa of the lower abdomen on the right or left side. Studies have found that most kidney patients experience moderate to severe pain after surgery. The stress response caused by postoperative pain, especially visceral pain, not only aggravates the patient’s pain and irritability and aggravates the original complications but may also harm the early recovery of renal function and affect the survival of the kidney. Therefore, adequate postoperative analgesia for renal patients is essential. This paper combines ultrasound-guided laparoscopic technology to improve the postoperative analgesia effect of renal surgery and compares the data with experimental research methods. Through experimental research, it can be seen that the method proposed in this article has a certain effect, and ultrasound-guided laparoscopic technology can be used in follow-up clinical research to improve the analgesic effect of renal surgery.

Comparative Randomised Study between Bupivacaine with Clonidine and Ropivacaine with Clonidine Used Caudally for Postopertaive Analgesia in Paediatric Hypospadias Surgery

Background: This study was conducted to compare and evaluate the caudal epidural clonidine when mixed with ropivacaine and bupivacaine in prolonging postoperative analgesia in children of Indian genotype undergoing hypospadias surgery, as well as compare the intraoperative haemodynamics using caudal bupivacaine with clonidine vs ropivacaine with clonidine. The study was also aimed at studying the side effects and the duration of post-operative pain relief of bupivacaine with clonidine v/s ropivacaine with clonidine. Methods: This is a prospective randomised comparative study that was carried out in the Department of Anaesthesiology, KEM Hospital, Pune, over 12 months (from October 2016 to September 2017), among 56 children having an ASA Grade of II, aged between 1 to 8 years admitted for hypospadias surgery. The data gathered was cleaned using Microsoft Excel, before statistical analysis was done. Results: It was observed that caudal epidural analgesic duration was more in the bupivacaine clonidine group than in the ropivacaine clonidine group. The sedation score was higher at the second hour in the bupivacaine clonidine group. The HR and mean arterial pressure values were found to be notably higher in the ropivacaine clonidine group than those in the bupivacaine clonidine group. Intraoperatively and postoperatively, there was a decrease in pulse rate and MAP but at no time did the value reach the criteria for intervention. Other side effects like postoperative vomiting, nausea, motor blockade, respiratory distress not observed in any group. Conclusion: Bupivacaine 0.25 % 0.5 ml per kg with clonidine 1 microgram / kg via caudal route increased the duration of postoperative analgesia with no adverse effects as compared to ropivacaine 0.25 % with clonidine 1 microgram/ kg. Hence clonidine is more efficient in increasing postoperative analgesia when added with Bupivacaine as compared to ropivacaine in Indian genotype in hypospadias surgery.