Indian Journal of Anaesthesia最新文献

Fascial plane blocks (FPBs) have rapidly expanded from regional anaesthesia adjuncts to versatile analgesic tools across perioperative, emergency, and chronic pain settings. Building upon the anatomical and mechanistic foundations outlined in Part A, this Part B translates theory into practice by presenting a region-wise, surgery specific, and scenario-focused synthesis of FPB applications. We outline evidence based block selection for thoracic, abdominal, hip, pelvic, and limb procedures, while integrating their roles in trauma care, rib and clavicle fractures, and acute pain management. Practical ultrasound-guided "tips for success", landmark-based fallback strategies, and dosing considerations are consolidated into user-friendly clinical tables. Safety optimisation, including volume management, toxicity prevention, catheter techniques, and adjuvant use, is discussed with an emphasis on real-world feasibility. Persistent challenges such as sensory analgesia mismatch, variable spread, inconsistent visceral coverage, and operator dependency are critically evaluated to guide future innovation. By bridging anatomical insights with pragmatic decision making, this review empowers clinicians to adopt a "right FPB for the right surgery" approach and standardise FPB practice across diverse patient populations.

Background and aims: Open inguinal hernia repair often causes significant postoperative pain. While the transversus abdominis plane block (TAPB) is widely used, the transmuscular quadratus lumborum block (QLB) may offer broader analgesia, but evidence is limited. This RCT evaluated whether QLB is non-inferior to TAPB in terms of duration of analgesia, opioid use, and pain scores in adults undergoing unilateral open inguinal hernia repair.

Methods: This randomised trial was conducted in 70 patients, aged 18-60 years, of either gender, undergoing unilateral open inguinal hernia surgery under spinal anaesthesia. Patients were randomly assigned to receive either a transmuscular QLB or TAPB at the end of the procedure. The primary outcome was duration of analgesia; secondary outcomes included total opioid consumption in 24 h, visual analogue scores (VAS) at various intervals, haemodynamic parameters, and complications. Non-inferiority was tested using a one-sided t-test with predefined margins; P < 0.05 was considered significant.

Results: QLB was found non-inferior to TAPB for the time of the first rescue analgesic request [mean difference (MD): 31.5] [standard deviation (SD): 360.4] [95% confidence interval (CI): -40.3, 103.4]; non-inferiority margin: -60 min)], and total tramadol consumption at 24 h [(MD: -11.4) (SD: 150.6) (95% CI: -41.4, 18.0); non-inferiority margin: 25 mg)]. There was no significant difference in postoperative VAS scores and haemodynamic parameters between the two groups.

Conclusion: Transmuscular QLB was non-inferior to TAPB for postoperative analgesia in unilateral open inguinal hernia repair, though results should be interpreted cautiously due to residual spinal anaesthesia and variability.

Background and aims: Laparoscopic cholecystectomy (LC) presents anaesthetic challenges such as haemodynamic instability and postoperative complications. Remimazolam (RMZ), a novel ultra-short acting benzodiazepine, has emerged as a promising alternative to the standard propofol, with a potentially superior safety profile. This study aimed to compare the efficacy and safety of RMZ with propofol for anaesthesia during LC.

Methods: A systematic review and meta-analysis were conducted to synthesise evidence from randomised controlled trials (RCTs). A search of PubMed, Web of Science, Scopus, and Google Scholar through May 2025 was conducted. We pooled dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and 95% confidence intervals (CIs).

Results: Six RCTs involving 452 patients were included in the analysis. Compared to the control group, RMZ was associated with a significantly longer anaesthesia onset time (MD: 13.26, 95% CI: 0.47, 26.05, P = 0.04), recovery time (MD: 2.72, 95% CI: 0.44, 5.01, P = 0.02), and postanaesthesia care unit (PACU) stay (MD: 5.54, 95% CI: 0.86, 10.22, P = 0.02). However, RMZ significantly reduced the incidence of injection pain (RR: 0.03, 95% CI: 0.01, 0.15, P < 0.001), and no significant differences were observed in surgery duration (P = 0.30), extubation time (P = 0.14), or the incidence of hypotension (P = 0.15), bradycardia (P = 0.13), or postoperative nausea and vomiting (P = 0.67).

Conclusion: With uncertain evidence, RMZ significantly prolonged anaesthesia onset time, recovery time, and time to PACU discharge compared to control in patients undergoing LC. Still, RMZ improved patient comfort through significantly decreased incidence of injection pain and is associated with a comparable haemodynamic safety profile to propofol.

The external oblique intercostal plane block (EOIPB) is a novel, ultrasound guided regional anaesthesia technique targeting the fascial plane between the external oblique and external intercostal muscle. This scoping review aimed to comprehensively map current evidence on EOIPB, covering its anatomical basis, techniques, clinical applications, efficacy, and safety. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic search of PubMed, Scopus, and Cochrane databases was conducted for articles published between January 2019 and July 2025. Eligible studies encompassed clinical trials, observational studies, case series, case reports, cadaveric investigations, and relevant clinical correspondences involving EOIPB for surgical or chronic pain related indications. Forty-two studies involving 1610 patients were included, with EOIPB performed in 765 cases. The block was most commonly administered at the sixth rib between the midclavicular and anterior axillary lines using an in-plane sagittal approach, providing consistent T6-T10 dermatomal coverage. EOIPB demonstrated opioid-sparing effects, lower pain scores, and improved recovery across various surgical settings. It was found to be comparable or superior to other regional techniques, such as the transversus abdominis plane block, erector spinae plane block, and wound infiltration. Catheter-based EOIPB facilitated prolonged analgesia and proved useful within enhanced recovery after surgery protocols. Reported complication rates were low. Overall, EOIPB is a promising regional anaesthesia technique, offering safe, effective, and versatile analgesia for upper abdominal and lower thoracic surgeries. Further high-quality comparative studies and standardisation of techniques are warranted to establish its definitive role in perioperative care.

Background and aims: Regional anaesthetic techniques are widely used for postoperative analgesia in paediatric hip and femur surgeries. Caudal blocks, while effective, require precise anatomical knowledge and can be time-consuming with potential complications. The suprainguinal fascia iliaca block (FICB) offers a potentially simpler and safer alternative. This study aimed to compare the analgesic efficacy of ultrasound guided caudal block and suprainguinal FICB in children undergoing hip surgery.

Methods: This randomised, double-blind study included 60 paediatric patients aged 2-8 years undergoing unilateral hip surgery. Participants were assigned to either Group A (caudal block) or Group B (suprainguinal FICB). The primary outcome of this study was to compare the postoperative pain intensity using the FLACC (Face, Legs, Activity, Cry, Consolability) scale assessed at 4 h postoperatively. The secondary outcomes were to assess pain scores at additional time intervals (30 minutes, 2, 6, 12, and 24 h), evaluate the time first to rescue analgesia, and compare the total number of analgesic doses administered within the first 24 h postoperatively. Data were analysed using SPSS Version 22.0 and compared using Student's independent samples t-test.

Results: At 4 h postoperatively, FLACC scores were comparable between both groups (P > 0.05), indicating no significant difference in peak pain intensity. FLACC scores at additional time intervals (30 minutes, 2, 6, 12, and 24 h) were also statistically similar. However, the time to first rescue analgesic was significantly longer in Group B (14.3 h) than in Group A (10.0 h; P = 0.043), suggesting more prolonged analgesia in the FICB group. Although not statistically significant, the average number of rescue doses was slightly higher in Group A (2.32) compared to Group B (2.00).

Conclusion: Suprainguinal FICB provides analgesia comparable to caudal block, with a longer duration before requiring rescue analgesia.