Indian Journal of Anaesthesia最新文献

Background and aims: Central sensitisation (CS) is a key mechanism contributing to chronic low back pain (CLBP), influenced by demographic, metabolic, and psychological factors. This study aimed to evaluate the association between CS and variables such as age, gender, body mass index (BMI), vitamin D levels, psychological distress (anxiety, depression, kinesiophobia), and pain intensity in individuals with CLBP.

Methods: A cross-sectional observational study was conducted at a tertiary care centre between January and December 2023. Adults aged 18 years or older with CLBP (lasting at least 3 months) were included. Participants were assessed using the Central Sensitisation Inventory (CSI), Numerical Rating Scale (NRS), Tampa Scale for Kinesiophobia, BMI, and serum vitamin D levels. Individuals with neurological or psychiatric disorders or those on medications affecting pain modulation were excluded. Statistical analysis was performed using non-parametric tests and Spearman's correlation to explore associations between CSI scores and demographic, metabolic, and psychological variables. P value < 0.05 was considered statistically significant.

Results: The mean age of participants was 41.3 years. Females had significantly higher CSI scores than males (P < 0.001). CSI scores differed significantly across age groups (P = 0.024), with the highest scores observed in participants under 20 years of age. Weak correlations were observed between CSI scores and both BMI and vitamin D levels. BMI showed a weak positive correlation with CSI scores (ρ = 0.182, P = 0.036), while vitamin D levels showed a weak negative correlation with CSI scores (ρ = -0.181, P = 0.038). No significant associations were found between CSI scores and anxiety, depression, kinesiophobia, or pain intensity.

Conclusion: CS in CLBP is associated with age, gender, BMI, and vitamin D levels, but not psychological distress or pain intensity. These findings highlight the importance of personalised, multidimensional pain assessment and management approaches.

Background and aims: Adequate pain management is crucial for postoperative recovery in paediatric patients. This study aimed to evaluate the analgesic efficacy of ultrasound (US)-guided modified thoracoabdominal nerve block through perichondrial approach (mTAPA) block in paediatric patients undergoing upper abdominal surgeries.

Methods: This randomised controlled trial included 40 paediatric patients aged between 2 and 8 years scheduled for unilateral upper abdominal surgeries. Patients were randomised into two groups: Group I received general anaesthesia (GA) with US-guided mTAPA block (0.5 mL/kg of 0.2% ropivacaine), while Group II received GA only. Intravenous fentanyl 0.5 µg/kg was utilised for perioperative pain management. The primary outcome was to assess intraoperative opioid consumption, whereas secondary outcomes were postoperative pain scores, 24-h opioid consumption, and adverse effects such as nausea and vomiting. The independent Student t-test compared quantitative, normally distributed data, while the Mann-Whitney U test compared quantitative, discrete data. A P value of <0.05 was considered statistically significant.

Results: Patients in Group I had a statistically lower intraoperative median fentanyl consumption of 10.0 µg [range: 0-20, interquartile range (IQR): 0-10] versus 20 µg (range: 5-48, IQR: 20-27) in Group II (P = 0.001). There was a significant reduction in the number of patients requiring rescue opioid top-ups (32.5% vs 50%) and postoperative pain scores (till 16 hours) in Group I. The median time to rescue analgesia was significantly higher in Group I than Group II (P = 0.001). No significant side effects were observed in either group.

Conclusion: Ultrasound-guided modified thoracoabdominal nerve block through perichondrial approach as an adjunct to general anaesthesia provides effective analgesia by significantly reducing opioid consumption in paediatric patients undergoing upper abdominal surgeries through a unilateral subcostal incision.

Background and aims: Distal motor-sparing nerve blocks are increasingly popular for knee arthroplasty pain. Genicular nerve ablation, initially proposed for knee osteoarthritis, is also currently used for postoperative pain management. We hypothesised that superior postoperative analgesia can be achieved by combining genicular nerve block with adductor canal block (ACB) by reducing 24-hour opioid consumption.

Methods: Fifty patients were assigned to Group I (ultrasound-guided ACB with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone and ultrasound-guided superomedial (SM), superolateral (SL), and inferomedial (IM) GNB with 5 mL of 0.25% ropivacaine and 2 mg of dexamethasone at each location and Group II (ultrasound-guided ACB with 20 mL of 0.25% ropivacaine, 4 mg dexamethasone, and ultrasound-guided three-location GNB with 15 mL of 0.9% saline). The outcomes measured were 24-hour morphine consumption, pain scores over 24 hours, and the time to rescue analgesia. The continuous data were analysed using an unpaired t-test or the Mann-Whitney U test, and the Chi-square test was used to analyse the categorical variables.

Results: The mean total consumption of morphine (mg) was 5.96 [standard deviation (SD): 2.73] in Group I and 15.52 (SD: 2.67) in Group II, with a mean difference of 9.56 [95% confidence interval (CI): -4.66, -2.39] (P < 0.001, Cohen's d = 3.54). In Group II, the mean time for first rescue analgesia was 20.73 (SD: 7.28) hours, whereas it was 24.00 (SD: 0.00) hours in Group I, with a mean difference of -3.27 (95% CI: -11.33, 4.783) (P = 0.034, Cohen's d = 0.45). Pain severity at rest was substantially lower in Group I at 6 hours (P = 0.020), 12 hours (P = 0.003), and 24 hours (P = 0.002). Pain score with movement in Group I was considerably lower at 6 hours (P = 0.008) and 12 hours (P < 0.001).

Conclusion: Combining genicular block with ACB provided superior postoperative analgesia and reduced opioid consumption compared to ACB alone.

Background and aims: Compression-only cardiopulmonary resuscitation (CPR) has been shown to be as effective as conventional CPR, and oxygen supplementation during compression-only CPR may be beneficial. The study aimed to compare the arterial oxygen levels achieved while supplementing oxygen through high flow nasal cannula (HFNC) during compression-only CPR and bag-mask ventilation (BMV) during conventional CPR in simulated cardiac arrest scenarios on a high-fidelity simulator.

Methods: The study included a simulated cardiac arrest created on a human patient simulator (HPS). The simulation included two sets of scenarios. In Simulation A, cardiac arrest was simulated on HPS, and compression-only CPR was provided by AutoPulse, and oxygen supplementation was provided using HFNC. In Simulation B, chest compression was provided by AutoPulse, and BMV was supplemented with oxygen at 15 L/min at a compression-to-ventilation ratio of 30:2. Both simulation scenarios were evaluated for three different starting PaO₂ values: 100 mmHg, 80 mmHg, and 60 mmHg. The change in PaO₂ and PAO₂ values was recorded every minute for 6 minutes. Statistical analysis was conducted using SPSS Statistics (Version 24.0; IBM, Armonk, NY), and P < 0.05 was considered statistically significant.

Results: In Simulation A, at a starting PaO₂ of 100 mmHg, there was an increase in the PaO₂ at the 2^nd minute, which was sustained till the 6^th minute. PaO₂ values were persistently higher at all time points as compared to Simulation B (P < 0.001). At a starting PaO₂ of 80 mmHg, there was no change in PaO₂ in Simulation A as compared to a sustained fall in Simulation B (P < 0.001). At the starting PaO₂ of 60 mmHg, a decrease in PaO₂ was observed in both Simulation A and Simulation B (P = 0.57).

Conclusion: In a simulated setting, compression-only CPR with HFNC results in better PaO₂ levels compared to conventional CPR with BMV.

Peripheral nerve blocks (PNBs) in coagulopathic patients are typically avoided due to the risks of bleeding and potential nerve compression. This case series explores the use of perineural fresh frozen plasma (FFP) to enhance local haemostasis in such settings. Five patients with an international normalised ratio of > 1.8, requiring urgent surgery, received PNBs with perineural FFP after haematology consultation. Seven ultrasound-guided blocks were performed, with FFP injected perineurally and along the needle tract, followed by systemic FFP 20 minutes later. All procedures were completed under PNB without conversion or need for additional analgesia. One patient developed a localised haematoma post-supraclavicular block, resolving after perineural FFP. No neurological deficits, major bleeding, or infections were observed. These preliminary results suggest that perineural FFP may reduce bleeding complications in high-risk patients, though further research is needed. Until validated, its use should remain investigational and be undertaken with multidisciplinary oversight and strict adherence to aseptic technique and ultrasound guidance.

Background and aims: This study aimed to systematically evaluate the effectiveness and safety of dural puncture epidural (DPE) and combined spinal epidural (CSE) for labour analgesia in parturients.

Methods: Searches were performed in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and CBM Database up to June 2025 to identify randomised controlled trials (RCTs) investigating the application of DPE and CSE techniques for labour analgesia in parturients. Data from eligible studies were pooled to calculate the combined standardised mean difference (SMD) or risk ratio (RR).

Results: Eleven studies with 1461 parturients were included. DPE had higher visual analogue scale (VAS) pain scores at 10 min [SMD: 0.60; 95% confidence interval (CI): 0.24, 0.95; P = 0.001; I ² = 76%] compared to CSE but fewer parturients requiring physician top-up boluses (RR = 0.64; 95% CI: 0.46, 0.88; P = 0.006; I ² = 11%). It also showed significantly lower incidences of abnormal foetal heart rate patterns (RR = 0.27; 95% CI: 0.16, 0.44; P < 0.001; I ² = 0%), pruritus (RR = 0.27; 95% CI: 0.14, 0.53; P < 0.001; I ² = 54%), and maternal hypotension (RR = 0.36; 95% CI: 0.15, 0.89; P = 0.030; I ² = 74%). No significant intergroup differences were found in first-stage labour duration, neonatal Apgar scores, or adverse reactions. The trial sequential analysis suggested the need for further data.

Conclusion: Compared with CSE, although DPE has a slower onset of analgesia, it may provide more reliable analgesic effects and result in lower incidence rates of adverse reactions in both parturients and foetuses. Substantial heterogeneity in some outcomes, driven by clinical heterogeneity including dose variations and limited studies, warrants cautious interpretation.

Background and aims: Monitoring oxygen saturation (SpO₂) during general anaesthesia using pulse oximetry is mandatory, though it may not always reflect the actual oxygenation status. Arterial blood gas (ABG) analysis remains the gold standard for measuring the partial pressure of oxygen (PaO₂), but it is invasive and limited by complications. This study aims to validate five existing equations for predicting PaO₂ from SpO₂ and, if applicable, to derive and validate a new equation in adult patients undergoing surgeries under general anaesthesia.

Methods: A prospective cohort study was conducted on adult patients undergoing general anaesthesia and requiring ABG measurements at several time points intraoperatively. Using SPSS software, a Bland-Altman analysis was performed to assess the agreement between derived and measured PaO2 values using five existing equations. Regression analysis was then performed to develop a new equation for predicting PaO₂, which was validated in a second cohort.

Results: During the initial phase, 150 ABG samples were collected from 83 patients. Bland-Altman analysis revealed weak agreements with all existing equations. A new logarithmic equation, El-Khatib's equation (PaO₂ = 10^-25.6 × SpO₂ ^13.9), was derived. The validation phase involved 150 ABG samples from 65 patients, demonstrating strong agreement with El-Khatib's equation (systematic bias of 13 mmHg, limits of agreement: -189 to 214 mmHg).

Conclusion: Five existing equations for predicting PaO₂ from SpO₂ revealed weak agreement in adult patients under general anaesthesia. El-Khatib's equation demonstrated strong potential for predicting PaO₂, providing a reliable non-invasive alternative for determining PaO₂ in clinical practice.