European Journal of Molecular & Clinical Medicine

Postoperativeanalgesia remains a cornerstone in management of patients undergoing inguinal hernia repair. This study evaluates the analgesic efficacy of traditional wound site infiltration and recent ultrasound guided TAP block using VAS score. Sixty patients were divided into two Groups. Patients in Group 1 were given ultrasound guided TAP block with 20ml of 0.25% bupivacaine and patients in Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine as per the discretion of anaesthesiologist. Postoperative parameters like VAS score, time to first rescue analgesia, total analgesic consumption, adverse events and hemodynamic parameters were assessed.
Methods: Sixty patients who met the inclusion criteria posted for elective unilateral inguinal hernia surgeries were divided into two Groups Group1 received ultrasound guided TAP block with 20ml of 0.25% bupivacaine and Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine. Postoperatively patients were shifted to post-operative ward and monitored for post-operative pain using VAS score at various postoperative intervals; 2, 4, 6, 12, 18, 24 hours and secondary parameters such as duration of analgesia, time to first rescue analgesia, total analgesic consumption and adverse events were also recorded.
Results: VAS scores recorded at various post-operative intervals, total analgesic consumption were significantly lower in USG-TAP block Group compared to WSI Group which was significant statistically. The mean time requirement for rescue analgesia was shorter in the WSI Group (3.67h) than the USG-TAP block (6.43h) and was statistically significant.

Background: Laparoscopic cholecystectomy is the preferred surgical technique for uncomplicated cholecystectomy. Recommended approach for post operative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS followed by adjunctive use of opioids to treat more acute pain symptoms. Present study was aimed to compare intravenous paracetamol versus intravenous diclofenac for postoperative pain relief in elective laparoscopic cholecystectomy.
Material and Methods: Present study was prospective double blinded Randomised controlled study, conducted patients between 18 - 65 years, ASA physical status I/II, posted for laparoscopic cholecystectomy. 80 cases were randomly divided as Group A (75 mg Diclofenac: 40 cases) & Group B (1 gm Paracetamol: 40 cases).
Results: In present study difference in VAS score in group A & group B at all points was statistically not significant except at 6 Hours where difference in VAS score in both group was statistically significant (P value 0.02). After comparing the Visual Rating Scale (VRS) scores of both groups to assess postoperative pain, it was found that VRS score in group A was higher than group B at 15 minutes, 30 minutes & 6 hours and was statistically significant. It was found that 26 (65%) of patients in group A required rescue analgesic whereas 18(45%) in group B required rescue analgesic. However, the difference observed was statistically not significant (P= 0.072). It was found that 3 (7.5%) of patients in group B experienced an adverse effect whereas 6 (15%) in group A had an adverse effect. The difference was statistically not significant. (P=0.061).
Conclusion: Paracetamol is considered superior to diclofenac in laparoscopic cholecystectomy as paracetamol gives better & prolonged analgesia than Diclofenac as evidenced low VAS & VRS score and also lesser requirement of rescue analgesia.

Levobupivacaine has also been evaluated as a less toxic substitute for bupivacaine and has been found to produce a quantitatively similar neural blockade. So far few data are available concerning the use of levobupivacaine in children. Ropivacaine, a recently introduced bupivacaine analogue drug, is less neurotoxic and cardiotoxic than bupivacaine. Ropivacaine is less lipophilic; hence, it is less likely to penetrate large myelinated motor fibers, resulting in a relatively reduced motor blockade and longer postoperative analgesia and has a greater degree of motor sensory differentiation, which could be useful when motor blockade is not desired. In this randomized, prospective, double blind, single hospital study ninety (90) paediatric patients aged 1 to 10 years undergoing lower abdominal surgery were enrolled. Twenty three patients were excluded as they did not meet the inclusion criteria and seven patients refused to participate.This study was conducted on 60 patients undergoing lower abdominal surgeries. The mean postoperative duration of analgesia was 321.37 ± 24.25 minutes in group L and 309.75 ±23.68 minutes in group R. The difference in the mean duration of analgesia was statistically insignificant (p -value was > 0.05 at all specified intervals).

Background: In lower limb orthopedic surgeries there is significant postoperative pain, which is difficult to treat with oral or intravenous analgesics resulting in adverse endocrine, metabolic and inflammatory responses. Morphine, Pethidine, Fentanyl, and other opioids fall under the Narcotics Act whereas nalbuphine does not. So, the accessibility of Nalbuphine is not as major a concern in several hospitals in India as that of morphine and other such opioids. Present study was aimed to compare the effectiveness of 0.8mg nalbuphine with 20 mcg fentanyl as an adjuvant to hyperbaric bupivacaine in lower limb orthopedic surgeries. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of either gender, age group of 18-60 years, belonging to ASA CLASS 1 and 2, With BMI < 30, undergoing elective orthopedic lower limb surgery. Patients were allocated in Group N- Received intrathecal 0.8 mg Nalbuphine & 3 ml 0.5 % H bupivacaine & Group F- Received intrathecal 20 mcg Fentanyl & 3 ml 0.5 % H bupivacaine.

Introduction: Femur fractures cause moderate to severe pain which requires effective analgesia both preoperatively and postoperatively, poor pain management can have serious physiological and psychological consequences.
Aim: To compare the postoperative analgesic efficacy between 0.25% Bupivacaine and 0.2% Ropivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries under epidural anaesthesia.
Materials and Methodology: This is a randomized clinical study conducted at a tertiary care centre, after receiving approval from institute’s ethical committee. 60 patients posted for femur surgeries under epidural anesthesia were divided into groups of 30 each. Postoperatively ultrasound guided fascia iliaca block using 0.25% bupivacaine 20 ml for group B and 0.2% Ropivacaine 20 ml was given to group R and are compared. The time from fascia iliaca compartment block to first requirement of analgesia for both the groups calculated.
Results: Demographic characteristics and BMI are statistically similar between both the groups. The mean time for duration of analgesia for bupivacaine group was 307.83±34.43 minutes and that of Ropivacaine group was 262.67±31.39 minutes. So, the mean duration of post-operative analgesia of the Bupivacaine group was more than that of Ropivacaine group which was statistically significant. Both the groups maintained hemodynamic stability.
Conclusion: We observed that the postoperative analgesia was definitely of a longer duration with the Bupivacaine group when compared to Ropivacaine group. So, it is concluded that 0.25% Bupivacaine is better in providing prolonged satisfactory postoperative analgesia as compared to 0.2% Ropivacaine when both are used as postoperative analgesia.

Background- The Transversus Abdominis Plane (TAP) Block is a method used for regional anaesthesia. It offers analgesia during lower abdominal surgery, especially when parietal wall pain is a significant source of discomfort. Through the local anaesthetic deposition between the Transversus Abdominis muscle and internal oblique muscle, it permits sensory blockage of the lower abdominal wall's skin and muscles. In a hospital-based, prospective observational study we assessed the effectiveness of unilateral TAP Block with bupivacaine for postoperative analgesia in hernia repair.
Material & Methods - The following procedure was used on 100 patients having elective unilateral inguinal hernioplasty surgery: TAP Block with bupivacaine (n = 50 in the study group) and without TAP Block (n = 50 in the control group). At the conclusion of the spinal anesthesia-induced surgery, the study group underwent a unilateral TAP Block on the surgical side using 20 ml of 0.25% bupivacaine. In the post-anesthesia care unit, each patient was evaluated 30 minutes, 2, 4, 6, 12, 18, and 24 hours after surgery. The amount of time needed to administer the first dosage of rescue analgesia, the vas score, and the total amount of diclofenac used were evaluated in each group, and comparisons were made using a student t-test.
Result: The difference between the mean analgesia duration in the study group and control group—669.66± 346 min 220.33 ± 139.24 minutes, respectively—was shown to be statistically significant. The VAS score in the control group was consistently higher than in the study group. Diclofenac was consumed in a total dose of 95 mg in the study group and 202.5 mg in the control group, indicating a substantial decrease in diclofenac consumption in the study group.
Conclusions- When utilised in patients undergoing inguinal hernioplasty, TAP Block with 0.25% bupivacaine offered powerful and longer duration of analgesia, with little any need for diclofenac. There were no side effects linked to TAP Block or the medications being tested

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj. Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj.Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

Introduction:Postoperative analgesia after cesarean section poses unique clinical challenges
to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.
Aims: The aim of this study was to compare the efficacy of two doses of buprenorphine (45
μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in
caesarean section.
Materials and methods: This was a prospective, randomized, double-blind controlled study.
Ninety ASA physical status Class II parturients posted for elective caesarean section. The
computer-generated simple random sampling procedure was used to allocate the subjects into
three Groups A, B, C of 30 each.
Results: Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and
quality of postoperative analgesia without producing any major side effect. The maximum
duration of analgesia and hence decreased analgesic requirement were obtained with 60 μg
buprenorphine. Addition of buprenorphine did not have any adverse outcome on the baby as
assessed by Apgar score.
Conclusion:Addition of buprenorphine to hyperbaric bupivacaine provides postoperative
analgesia after cesarean section without significant maternal and neonatal side effects.

LC combines the benefit of complete removal ofgall bladder with the advantage of limited
abdominal incisions, early recovery, shorter hospital stay and less postoperative complication.
Laparoscopic cholecystectomy can be associated with severe complications in the form of
arrhythmias,sudden intraoperative cardiovascular collapse, severe pulmonary edema and
postoperative thromboembolic phenomenon. All patients underwent a thorough
preanaesthetic check-up. Written informed consent was obtained from each patient after
explaining the procedure in a language that the patient understood. Patients were randomly
allocated into 2 groups of 40 each. Mean time to first analgesic in Group D was 4.38 ± 0.86
hrs and in Group C was 2.50 ± 0.68 hrs. On comparing, time to first analgesia was
significantly longer in Group D both statistically and clinically. Nausea and Vomiting was
noted in 5 patients in Group D and 14 patients in Group C. This incidence though statistically
not significant was clinically significant.