Indian Journal of Anaesthesia最新文献

Background and aims: Despite the benefits of Enhanced Recovery After Surgery (ERAS) guidelines, there are still hesitations in implementing them. In this study, we compared the ERAS guideline-based multimodal analgesia protocol (ERAS-MMA) with patient-controlled morphine analgesia (PCA-Morphine) for single-level lumbar fusion surgeries. The primary objective was the length of hospital stay. The secondary objectives were the postoperative mobilisation time, time to start oral feeds, pain scores, complications, and re-admissions.

Methods: This is a double-blinded, randomised controlled study, conducted on 60 participants who were randomised into two groups. Group T received the ERAS-MMA, and Group C received PCA-Morphine. An unpaired t-test was used to compare the continuous variables. The Mann-Whitney U test was used to compare discrete data. Regression analysis was used to identify the true effect of ERAS-MMA on the length of stay.

Results: The difference in the mean length of the hospital stay was significant [Group T vs Group C, 4226.02 (Standard Deviation (SD): 522.21) min vs 7144.12 (SD: 592.11) min), P < 0.001]. Multiple linear regression model analysis showed that ERAS-MMA reduced the stay duration by 2 days (B = - 2871.8, P < 0.001) compared to the control group. Postoperative pain, opioid consumption, time to initiate oral feeds, time to mobilisation, and complications were less in Group T. There were no re-admissions in either group.

Conclusion: Implementing ERAS-MMA for patients undergoing single-level spine fusion surgery significantly contributes to lesser hospital length of stay, faster time to oral feeding and mobilisation, lower opioid use with better pain scores, and reduced complications.

Background and aims: Endotracheal intubation (ETI) in the intensive care unit (ICU) carries significant risks. Peri-intubation care bundles have been shown to reduce severe complications associated with ETI, but they are not routinely implemented due to equipment, drug shortages, and changes in local policies. Therefore, we developed an intubation bundle and assessed its impact on complications.

Methods: This study was carried out over 18 months with adult patients requiring ETI in the ICU. The intubation practices and complication rates were evaluated during the pre-implementation phase (Phase I). The ETI bundle was developed based on an analysis of these complications and existing guidelines, and the ICU team was trained on its application. Afterwards, complications during ETI were documented in the post-implementation phase to evaluate the impact of the intubation bundle (Phase II). P values < 0.05 were considered statistically significant.

Results: The number of patients with major complications decreased significantly after the introduction of the bundle (45% vs 29%, P < 0.001). Critical haemodynamic instability (HI) was the primary complication, and the use of a bundle was associated with a significant reduction (39% vs 19%, P < 0.001). Additionally, by implementing the bundle led to significant improvements in intubation practices, such as airway assessment by the MACOCHA score, optimisation of patient positioning, and the presence of two intubators.

Conclusion: Our study demonstrates that implementing an intubation bundle in ICU settings makes ETI practices safer by decreasing the incidence of life-threatening complications.

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.