Indian Journal of Anaesthesia最新文献

Background and aims: Post-spinal hypotension (PSH) is a common complication of neuraxial anaesthesia in high risk cesarean delivery (CD). This systematic review and network meta-analysis evaluate the comparative efficacy and safety of prophylactic intravenous infusions of norepinephrine, phenylephrine, and ephedrine to prevent PSH in this population.

Methods: Randomised controlled trials comparing intravenous prophylactic norepinephrine, phenylephrine, and ephedrine in high risk CD and reporting maternal or fetal outcomes were considered. Two reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. A frequentist network meta-analysis was carried out. Heterogeneity was inspected with I² and Q statistics, and treatment ranking was estimated by P-scores. Sensitivity and subgroup analyses were performed to examine clinical modifiers such as preeclampsia and bolus versus infusion strategies.

Results: Eighteen trials involving 3331 participants were included. Administration of vasopressors reduced the incidence of PSH compared with placebo or no treatment [odds ratios (OR): 1.5; 95% confidence interval (CI) 1.12, 1.67; I²: 10.5%]. Norepinephrine and phenylephrine were superior to ephedrine. There was greater cardiac stability and less bradycardia and nausea with norepinephrine. In preeclamptic and in infusion treated patients, vasopressors were more effective, yet the advantage of norepinephrine was not consistently statistically significant. Neonatal outcomes such as APGAR scores and umbilical artery pH did not differ significantly between agents (OR: 1.1; 95% CI: 0.8, 1.5; P = 0.15).

Conclusion: Both norepinephrine and phenylephrine are effective for the prevention of PSH in high-risk cesarean delivery receiving neuraxial anaesthesia, with norepinephrine offering more favourable maternal safety and tolerability. These findings justify the use of norepinephrine and phenylephrine over ephedrine in this patient population.

Background and aims: Real-time ultrasonography has shown good correlation in evaluating gastric emptying in previous studies. The present study aimed to examine gastric content and volume using ultrasound in neurosurgical patients admitted in the intensive care unit (ICU) and compare it with non-neurosurgical patients and assess correlation between gastric emptying and intracranial pressure.

Methods: Forty adult patients of either gender admitted in the ICU on mechanical ventilation and receiving enteral nutrition via nasogastric tubes were included in the study and allocated into two groups: Group I (n = 20): Neurosurgical patients; Group II (n = 20): Non-neurosurgical patients with chest pathology. All patients were given 300 ml of water through a ryle's tube and ultrasound-guided gastric volume was assessed at baseline (before feed, T₀) and 15 minutes (T1), 1 hour (T2), 2 hours (T3), and 4 hours (T4) after the feed. Gastric volume and gastric emptying rate (GER) were calculated using appropriate formulas. Ocular ultrasound was performed to record optic nerve sheath diameter (ONSD) in all patients.

Results: There was no significant difference between the two groups in baseline values of gastric volume as well as at T1 and T2, while there was a significant difference between the two groups at T3 and T4. The mean value of GER in group I was 33.80 ± 13.29%, and that in group II was 58.24 ± 9.80% (P < 0.001). There was significant negative correlation between ONSD and GER (Pearson's correlation coefficient: -0.6; P value < 0.001).

Conclusion: Mechanically ventilated patients in the ICU who had neurosurgical pathology exhibited delayed gastric emptying as compared to non-neurosurgical patients.

Background and aims: Percutaneous nephrolithotomy (PCNL), although minimally invasive, causes moderate to severe pain after surgery. In regional anaesthesia techniques, such as the erector spinae plane block (ESPB) and costotransverse foramen block (CTFB), local anaesthetic reaches the paravertebral space, focussing on the dorsal rami and intercostal nerves. The aim of this study was to assess the postoperative analgesic efficacy of triple level ultrasound guided ESPB versus triple level ultrasound guided CTFB in patients undergoing PCNL surgery under general anaesthesia. In this study, three injections of study drug at three consecutive levels (triple-level) were given, anticipating adequate craniocaudal spread.

Methods: In this randomised, double-blind, parallel group trial, 50 adults set to undergo PCNL with general anaesthesia were randomised to two groups: Group I (ESPB, n = 25) and Group II (CTFB, n = 25). Before anaesthesia, patients received an ultrasound guided triple level block with 0.375% ropivacaine (7 mL at each of the T10, T11, and T12 levels, for a total of 21 mL) on the operative side. The statistical analyses were performed using SPSS version 23.0, employing the independent t-test, Mann-Whitney U test, paired t-test, and Chi-square test.

Results: The median cumulative morphine use over 24 hours was 7 mg in both groups {ESPB: interquartile range (IQR) 4-11.75 mg; CTFB: IQR 3-11 mg} (P = 0.267).

Conclusion: Postoperative analgesia provided by triple level ESPB was not inferior to triple level CTFB and thus can be used as an effective analgesic technique for PCNL surgeries.

Quadratus lumborum blocks extend abdominal wall analgesia by engaging thoracoabdominal and lumbar pathways, yet outcome variability persists because fascial continuities, neural trajectories, and sonographic-anatomic correlations are emerging. This narrative review synthesises foundational anatomy, cross-sectional relationships, and ultrasound correlations to explain injectate spread and to guide precise techniques. Drawing on cadaveric dissections, radiologic studies, and live sonoanatomy, we map the three-dimensional interplay of muscles, fascial planes, and nerves across the T12-L1 transition. These insights clarify why anterior/transmuscular approaches more reliably reach paravertebral and lumbar plexus corridors, whereas superficial or lateral techniques chiefly provide somatic flank coverage. We also dispel common misconceptions propagated by oversimplified schematics. Framing the quadratus lumborum block within a continuous fascial network-linking thoracolumbar, transversalis, psoas, and endothoracic fascia-supports more accurate target selection, rational volume planning, and improved safety. The review offers a practical framework for matching block variants to surgical indication, enhancing reproducibility, and achieving more predictable, opioid-sparing analgesia clinically.

Background and aims: Laparoscopic sleeve gastrectomy (LSG) is effective for treating obesity but frequently causes significant postoperative pain. This meta-analysis evaluated the efficacy and safety of the external oblique intercostal plane block (EOIB) in reducing pain, opioid use, and adverse effects after LSG.

Methods: This PROSPERO-registered review (CRD420251072075) searched seven major databases for comparative studies of EOIB versus placebo or other analgesic techniques in adults undergoing LSG. Primary outcomes were pain scores at rest and movement at 6, 12, and 24 h. Secondary outcomes included cumulative opioid consumption in Morphine Milligram Equivalents (MME) in the first 24 h, time to first rescue analgesia, complications or side effects like incidence of postoperative nausea and vomiting (PONV), and block related adverse events. Pooled effect sizes were calculated using a random effects model, with heterogeneity assessed via I².

Results: Four randomised controlled trials (n = 265, 2024-2025) met inclusion criteria. EOIB significantly reduced pain at rest at 6 h [standardised mean difference (SMD) -0.69, I² = 0%], 12 h (SMD -0.56, I² = 59%), and 24 h (SMD -0.66, I² = 82%), with a pooled effect across all time points (SMD -0.62, I² = 63%). Pain at movement was significantly reduced overall (SMD -0.45, I² = 74%), with a notable effect at 12 h (SMD -0.59, I² = 76%). EOIB decreased 24 h opioid consumption by an average SMD of -1.65 (I² = 93%) and lowered the proportion of patients needing rescue analgesics by 41% [risk ratio (RR) 0.59, I² = 0%]. No significant differences were observed for time to first rescue analgesia (SMD 0.57, I² = 93%) or PONV (RR 0.85, I² = 37%). No block-related complications were reported.

Conclusion: This meta-analysis suggests that EOIB is a promising analgesic technique for patients undergoing LSG. It effectively reduces early postoperative pain and overall opioid consumption in the first 24 h. While no block-related complications were reported, larger, multicenter trials are necessary to confirm its efficacy, establish a definitive safety profile, and determine its role in multimodal pain management for bariatric surgery.

Background and aims: There is limited comparative data on sensory-motor block dynamics following single-point drug delivery between ultrasound guided supraclavicular brachial plexus block and costoclavicular brachial plexus block. This study aimed to compare the efficacy of sensory-motor blockade after single-point subfascial injections at these two anatomical locations.

Methods: Following institutional ethics approval, 50 patients undergoing upper limb surgery at or below the elbow were randomised to receive a single-point injection of 20 mL of a 1:1 mixture of 2% lignocaine (with 1:200,000 epinephrine) and 0.5% bupivacaine in either the supraclavicular fossa (Gp-SC) or the costoclavicular space (Gp-CC). A blinded observer assessed the sensory-motor function of the musculocutaneous, median, ulnar, and radial nerves by using a 3-point scale. Scores were combined into a total composite score (TCS), assessed every 5 minutes for up to 40 minutes or until a TCS of 0 was achieved. Continuous variables were analysed using an unpaired Student's t-test; categorical data were analysed using the Chi-square test.

Results: Gp-CC had significantly lower TCS values than Gp-SC at all intervals except 5 minutes. Complete sensory-motor blockade at 40 minutes was more frequent in Gp-CC (92%) versus Gp-SC (60%, P < 0.001). Incomplete blockade was largely due to sparing of the ulnar (4% vs 36%, P = 0.004), median (8% vs 36%, P = 0.019), and radial nerves (0% vs 20%, P = 0.025).

Conclusion: A single-point subfascial injection of local anaesthetic at the costoclavicular space produces a more complete sensory-motor blockade of all four major terminal nerves of the brachial plexus than at the supraclavicular fossa.

Background and aims: Post-caesarean pain significantly impacts maternal recovery. The erector spinae plane (ESP) and quadratus lumborum block (QLB) are regional analgesic techniques used for postoperative pain management; however, their comparative effectiveness remains uncertain. The objective was to compare the efficacy of ESP and QLB regarding post-caesarean pain intensity, opioid consumption, time to first analgesic request, and the incidence of nausea and vomiting.

Methods: A systematic review and meta-analysis of randomised controlled trials comparing ESP and QLB in women undergoing caesarean section was conducted according to PRISMA guidelines (PROSPERO ID: CRD42024612438). The electronic databases PubMed, Embase, Cochrane Library, and Scopus were searched. Effect sizes were estimated using a random-effects model, and trial sequential analysis (TSA) was performed to assess the robustness of the evidence.

Results: Six studies involving a total of 466 patients were included. No significant differences were observed between ESP and QLB in postoperative pain scores measured by the Numeric Rating Scale at 12 hours [mean difference (MD): 0.10; 95% confidence interval (CI): -0.14, 0.35; P = 0.40] and 24 hours (MD: -0.34; 95% CI: -0.74, 0.07; P = 0.10). The time to the first analgesic request was significantly longer in the QLB group (MD: 1.40 hours; 95% CI: 0.42, 2.38; P = 0.005). Opioid consumption within the first 24 hours was comparable between the two techniques (P = 0.93), as was the incidence of nausea and vomiting (P = 0.50). TSA did not confirm firm evidence for differences in opioid consumption, pain intensity at 24 hours, or time to first rescue analgesia, and the results remained inconclusive.

Conclusion: ESP and QLB provide comparable analgesia, though current evidence remains inconclusive. Larger multicentre trials are warranted to confirm these findings.