Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia

Hemorrhage is a leading cause of battlefield and civilian trauma deaths. Several pain medications, including fentanyl, are recommended for use in the prehospital (i.e., field setting) for a hemorrhaging solider. However, it is unknown whether fentanyl impairs arterial blood pressure (BP) regulation, which would compromise hemorrhagic tolerance. Thus, the purpose of this study was to test the hypothesis that an analgesic dose of fentanyl impairs hemorrhagic tolerance in conscious humans. Twenty-eight volunteers (13 females) participated in this double-blinded, randomized, placebo-controlled trial. We conducted a pre-syncopal limited progressive lower-body negative pressure test (LBNP; a validated model to simulate hemorrhage) following intravenous administration of fentanyl (75 µg) or placebo (saline). We quantified tolerance as a cumulative stress index (mmHg•min), which was compared between trials using a paired, two-tailed t-test. We also compared muscle sympathetic nerve activity (MSNA; microneurography) and beat-to-beat BP (photoplethysmography) during the LBNP test using a mixed effects model (time [LBNP stage] x trial). LBNP tolerance was not different between trials (Fentanyl: 647 ± 386 vs. Placebo: 676 ± 295 mmHg•min, P=0.61, Cohen's d = 0.08). Increases in MSNA burst frequency (time: p<0.01, trial: p=0.29, interaction: p=0.94) and reductions in mean BP (time: p<0.01, trial: p=0.50, interaction: p=0.16) during LBNP were not different between trials. These data, the first to be obtained in conscious humans, demonstrate that administration of an analgesic dose of fentanyl does not alter MSNA or BP during profound central hypovolemia, nor does it impair tolerance to this simulated hemorrhagic insult.

Utility of bilateral superficial cervical plexus block in thyroidectomy patients for post-operative analgesia

Background: Thyroidectomy is painful procedure hence multimodal analgesia is required. Superficial cervical plexus block can be used for analgesia in thyroid surgeries. USG guided cervical plexus block administration is safe and latest technique as a part of multimodal analgesia for thyroid surgery.Methods: After obtaining consent 60 ASA grade I-II adult patients undergoing elective thyroid surgery were included and randomly divided into two groups (group B)-0.25% bupivacaine and (group S)-normal saline. Induction and maintenance under general anesthesia carried out as per standard protocol. After Induction USG guided block was administered with the drug solution as per allocated group. After surgery, patients were extubated and shifted to recovery room. Vital parameters were monitored. Patients were asked about their pain based on the 11-point numerical rating scales (NRS) score. The NRS score and other variables were documented at 3rd hour, 6th hour, 12th hour, and 24th hour at wards after the end of surgery. Time since the end of surgery to the first analgesia request was documented together with total analgesia consumed in the first 24 hours. If NRS score was ≥4 inj. Tramadol iv in incremental doses of 25 mg was given until pain relieved.Results: Time to first dose of analgesia was higher in group B compared to group S. Total analgesic dose of tramadol during first 24 hours was lower in group B compared to group SConclusions: bilateral superficial cervical plexus block can be used as a part of multi-modal analgesia in patients of thyroidectoy.

A prospective randomized comparative study of rapidly absorbing polyglactin 910 versus chromic catgut for episiotomy repair at tertiary care hospital Bikaner, Rajasthan

Background: The aim of our study was to compare rapidly absorbing polyglactin 910 with chromic catgut as a suture material for episiotomy repair, in relation to post episiotomy complications and maternal morbidity.Methods: This prospective, randomized, comparative study of rapidly absorbing polyglactin 910 versus chromic catgut for episiotomy repair was conducted in the department of obstetrics and gynaecology, PBM hospital, associated with Sardar Patel medical college Bikaner, Rajasthan.Results: RAPG-910 was associated with significantly lesser analgesic dose requirement for pain relief than chromic catgut. Use of chromic catgut was associated with a higher incidence of hematoma formation, wound gaping, need of re-suturing of wound and need of re-admissions for management of post-episiotomy complications than RAPG-910 although, the difference was statistically insignificant. RAPG-910 was associated with better wound condition & healing as compared to chromic catgut.Conclusions:To conclude, rapidly absorbing polyglactin 910 was better than chromic catgut in relation to post episiotomy complications and maternal morbidity with a significantly lesser incidence and severity of post episiotomy pain, lesser dose of analgesia required, lesser wound gaping and infection, better wound healing, faster suture reabsorption.

A study to compare the analgesic efficacy of intra-articular Levobupivacaine, Fentanyl and Clonidine following arthroscopic knee surgery

Arthroscopic knee surgery can produce pain postoperatively which can be very distressing. Many drugs, in various ways, have been tried to overcome this pain. But none found to be most effective. So we have done a study for correlating with the analgesic levobupivacaine efficiency, fentanyl, & clonidine into intra-articular therapy associated with arthroscopic surgeries. This study was conducted from Nov 2019 to April 2020, in which 90 patients undergoing arthroscopic surgery of knee split in 3 classes of 30 each. (L,F,C). Class L was injected 10 millilitre in levobupivacaine of 0.26% e, where Class F was injected 50 mcg fentanyl, and Class C was injected 50 mcg of clonidine in intra-articular therapy after surgery. Time of first analgesia request, no of the analgesic dose required and total rescue analgesic required in postoperative 24 hours were assessed. The pain was assessed using a visual analogue scale. Demographic characteristics were similar among all the three Class. Time for the need of 1st analgesic request in Class L was 381.57 ± 24.63 min, in Class F was 328.67 ± 20.42 min and in Class C was 238.47 ± 21.93 minutes.(p<0.06) The overall amount of doses of analgesic needed was fewer in Class L (1.21 ± 0.57) in comparison to Class F (1.95 ± 0.42) and Class C (2.12 ± 0.34). (p<0.05) A total dose of paracetamol used was reduced in Class L correlated with Class F and C in 1st 24 hrs postoperatively. (p<0.05) Class F & C has a highest average score of VAS at various time points in 1st 24 hrs correlated with Class L.(p<0.05) Intra-articular levobupivacaine obtained better control of pain in the postoperative period with a delayed time of need of 1st analgesic dose and reduced the need of a total dose of rescue analgesic in comparison to intra-articular clonidine and fentanyl.

COMPARATIVE STUDY OF PREEMPTIVE ORAL GABAPENTIN WITH PREGABALIN FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY UNDER SUBARACHNOID BLOCK

Introduction:Pain management is important for early mobilization and well-being of the surgical patient.So we compared pregabalin and gabapentin as preemptive analgesic for post operative pain management in patients undergoing abdominal hysterectomy under subarachnoid block. Material and methods:In this randomized controlled double blinded study , 60 elective patients posted for abdominal hysterectomy were randomly divided into two groups of 30 patients each. Group G900 received 900 mg Gabapentin and group P300 received 300 mg Pregabalin, administered orally 1 hour prior to administration of spinal anesthesia.VAS scores ,first rescue analgesic time,total analgesic requirement, and any adverse effects in first 24 hours postoperatively were compared. Results:Mean total analgesic dose and mean no. of doses in first 24 hour post-operatively were significantly lower while time to first rescue analgesic was significantly more in pregabalin compare to gabapentin. Conclusion:Preemptive pregabalin is more effective for postoperative pain relief compared to gabapentin.

Machine learning techniques for computer-based decision systems in the operating theatre: application to analgesia delivery

This work focuses on the application of machine learning techniques to assist the clinicians in the administration of analgesic drug during general anaesthesia. Specifically, the main objective is to propose the basis of an intelligent system capable of making decisions to guide the opioid dose changes based on a new nociception monitor, the analgesia nociception index (ANI). Clinical data were obtained from 15 patients undergoing cholecystectomy surgery. By means of an off-line study, machine learning techniques were applied to analyse the possible relationship between the analgesic dose changes performed by the physician due to the hemodynamic activity of the patients and the evolution of the ANI. After training different classifiers and testing the results under cross validation, a preliminary relationship between the evolution of ANI and the dosage of remifentanil was found. These results evidence the potential of the ANI as a promising index to guide the infusion of analgesia.

Sciatic obturator femoral technique versus spinal anesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator: A randomised trial

Background Peripheral nerve block is an ideal choice for lower limb surgery because of the peripheral site of the surgical procedure and the ability to block pain pathways at multiple levels. The aim of this study was to assess the efficacy and safety of SOFT (sciatic-obturator-femoral nerve block technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixatorMethods This study was conducted over 107 patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7.5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, time of first analgesic dose, visual analogue scale scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic, paresthesia observed within 48 hours of the block.Results The duration of soft block and time to first analgesic dose in SOFT group was significantly longer (p<0.001). The incidence of headache (p=0.028) and back pain (p=0.012) was significantly higher in spinal group. There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and parathesia. Pain scores were significantly lower in SOFT group at 3,6,12 hours postoperative (p<0.001).Time to the first effect was significantly longer in SOFT (P<0.001).Conclusion Our results showed that SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing elective fixation of tibial fractures using Ilizarov external fixator.

Sciatic-obturator-femoral technique versus spinal anesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator: A randomized trial

Background Peripheral nerve block is an ideal choice for lower limb surgery because of the peripheral site of the surgical procedure and the ability to block pain pathways at multiple levels. The aim of this study was to assess the efficacy and safety of SOFT block (sciatic-obturator-femoral nerve block technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixatorMethods This study was conducted over 107 patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7.5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, time of first analgesic dose, visual analogue scale scores, incidence of adverse events as back pain, postural -puncture headache, vomiting, systemic toxicity from local anesthetic, parathesia observed within 48 hours of the block.Results The duration of soft block and time to first analgesic dose in SOFT group was significantly longer (p<0.001). The incidence of headache (p=0.028) and back pain (p=0.012) was significantly higher in spinal group. There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and parathesia. Pain scores were significantly lower in SOFT group at 3,6,12 hours postoperative (p<0.001).Conclusion SOFT block is a feasible technique for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing fixation of tibial fractures using Ilizarov external fixator.