Pub Date : 2024-04-11DOI: 10.4103/joacp.joacp_412_22
Balaji Kannamani, S. Panneerselvam, P. Rudingwa, A. S. Badhe, K. Govindaraj, Srivats Ramamoorthy
The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis. A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland–Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume. The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39). In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.
{"title":"Comparison of ultrasonographic measurement of gastric antral volume and pH with or without pharmacological acid aspiration prophylaxis in low-risk surgical patients – A randomized clinical trial","authors":"Balaji Kannamani, S. Panneerselvam, P. Rudingwa, A. S. Badhe, K. Govindaraj, Srivats Ramamoorthy","doi":"10.4103/joacp.joacp_412_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_412_22","url":null,"abstract":"\u0000 \u0000 \u0000 The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis.\u0000 \u0000 \u0000 \u0000 A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland–Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume.\u0000 \u0000 \u0000 \u0000 The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39).\u0000 \u0000 \u0000 \u0000 In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"39 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_155_23
Sunil Rajan, N. Sasikumar, Jacob Mathew, SherjinDev S. Raveendran
{"title":"Nasal endotracheal intubation in a patient with difficult airway under ultrasonographic guidance","authors":"Sunil Rajan, N. Sasikumar, Jacob Mathew, SherjinDev S. Raveendran","doi":"10.4103/joacp.joacp_155_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_155_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_434_22
Deepak Kumar, P. Talawar, Mridul Dhar, Qumar Azam, D. Tripathy, Deepak Singla, Gaurav Jain, Sangadala Priyanka, Deepali Jamgade, Rekha
The upper thoracic (T2) erector spinae plane block (UT-ESPB) has been proposed as an alternative to interscalene brachial plexus block for postoperative analgesia in shoulder surgery. The current study was conducted to evaluate the same. Patients scheduled for shoulder surgery under general anesthesia (GA) received ultrasound-guided UT-ESPB. The outcomes measured were diaphragmatic movements, block characteristics, and quality of recovery at 24 h. A total of 43 patients were recruited. The incidence of phrenic nerve palsy was 0%. The sensory level achieved by the maximum number of patients at the end of 30 min was C7-T5 level, and none had a motor block. Forty-two percent of patients did not require rescue analgesia till 24 h postoperative. In the rest of the patients, the mean (SD) duration of analgesia was 724.2 ± 486.80 min, and the mean postoperative requirement of fentanyl was 98.80 ± 47.02 mg. The median pain score (NRS) during rest and movement is 2 to 3 and 3 to 4, respectively. The median quality of recovery score at the end of 24 h after the block was 14 (15–14). The upper thoracic ESPB resulted in a sensory loss from C7-T5 dermatomes without any weakness of the diaphragm and upper limb. However, the block was moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery in patients undergoing proximal shoulder surgeries under GA. Further studies are required to establish its role due to its poor correlation with sensory spread.
{"title":"The efficacy of ultrasound-guided upper thoracic erector spinae plane block for postoperative analgesia in proximal shoulder surgery and its effect on phrenic nerve function: A prospective exploratory study","authors":"Deepak Kumar, P. Talawar, Mridul Dhar, Qumar Azam, D. Tripathy, Deepak Singla, Gaurav Jain, Sangadala Priyanka, Deepali Jamgade, Rekha","doi":"10.4103/joacp.joacp_434_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_434_22","url":null,"abstract":"\u0000 \u0000 \u0000 The upper thoracic (T2) erector spinae plane block (UT-ESPB) has been proposed as an alternative to interscalene brachial plexus block for postoperative analgesia in shoulder surgery. The current study was conducted to evaluate the same.\u0000 \u0000 \u0000 \u0000 Patients scheduled for shoulder surgery under general anesthesia (GA) received ultrasound-guided UT-ESPB. The outcomes measured were diaphragmatic movements, block characteristics, and quality of recovery at 24 h.\u0000 \u0000 \u0000 \u0000 A total of 43 patients were recruited. The incidence of phrenic nerve palsy was 0%. The sensory level achieved by the maximum number of patients at the end of 30 min was C7-T5 level, and none had a motor block. Forty-two percent of patients did not require rescue analgesia till 24 h postoperative. In the rest of the patients, the mean (SD) duration of analgesia was 724.2 ± 486.80 min, and the mean postoperative requirement of fentanyl was 98.80 ± 47.02 mg. The median pain score (NRS) during rest and movement is 2 to 3 and 3 to 4, respectively. The median quality of recovery score at the end of 24 h after the block was 14 (15–14).\u0000 \u0000 \u0000 \u0000 The upper thoracic ESPB resulted in a sensory loss from C7-T5 dermatomes without any weakness of the diaphragm and upper limb. However, the block was moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery in patients undergoing proximal shoulder surgeries under GA. Further studies are required to establish its role due to its poor correlation with sensory spread.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"138 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_414_22
Deepak Modi, Manbir Kaur, Govind Singh, P. Bhatia
{"title":"Occult foreign body in bronchus masquerading clinically as malignant hyperthermia","authors":"Deepak Modi, Manbir Kaur, Govind Singh, P. Bhatia","doi":"10.4103/joacp.joacp_414_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_414_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"56 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140729888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_346_22
G. Chilkoti, Anju Gupta, Pallavi Bhandari, M. Mohta
Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.
{"title":"Techniques of detecting recurrent laryngeal nerve palsy in patients undergoing thyroid surgery: Pearls and pitfalls","authors":"G. Chilkoti, Anju Gupta, Pallavi Bhandari, M. Mohta","doi":"10.4103/joacp.joacp_346_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_346_22","url":null,"abstract":"\u0000 Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"89 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_391_22
Pierre Grassin, Richard Descamps, J. Bourgine, Jean Lubrano, A. Fiant, Véronique Lelong-Boulouard, J. Hanouz
Perioperative lidocaine infusion has many interesting properties such as analgesic effects in the context of enhanced recovery after surgery. However, its use is limited in liver surgery due to its hepatic metabolism. This prospective, monocentric study was conducted from 2020 to 2021. Patients undergoing liver surgery were included. They received a lidocaine infusion protocol until the beginning of hepatic transection (bolus dose of 1.5 mg kg−1, then a continuous infusion of 2 mg kg−1 h-1). Plasma concentrations of lidocaine were measured four times during and after lidocaine infusion. Twenty subjects who underwent liver resection were analyzed. There was 35% of preexisting liver disease before tumor diagnosis, and 75% of liver resection was defined as “major hepatectomy.” Plasmatic levels of lidocaine were in the therapeutic range. No blood sample showed a concentration above the toxicity threshold: 1.6 (1.3–2.1) mg ml−1 one hour after the start of infusion, 2.5 (1.7–2.8) mg ml−1 at the end of hepatic transection, 1.7 (1.3–2.0) mg ml−1 one hour after the end of infusion, and 1.2 (0.8–1.4) mg ml−1 at the end of surgery. Comparative analysis between the presence of a preexisting liver disease or not and the association of intraoperative vascular clamping or not did not show significant difference concerning lidocaine blood levels. Perioperative lidocaine infusion seems safe in the field of liver surgery. Nevertheless, additional prospective studies need to assess the clinical usefulness in terms of analgesia and antitumoral effects.
{"title":"Safety of perioperative intravenous lidocaine in liver surgery – A pilot study","authors":"Pierre Grassin, Richard Descamps, J. Bourgine, Jean Lubrano, A. Fiant, Véronique Lelong-Boulouard, J. Hanouz","doi":"10.4103/joacp.joacp_391_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_391_22","url":null,"abstract":"\u0000 \u0000 \u0000 Perioperative lidocaine infusion has many interesting properties such as analgesic effects in the context of enhanced recovery after surgery. However, its use is limited in liver surgery due to its hepatic metabolism.\u0000 \u0000 \u0000 \u0000 This prospective, monocentric study was conducted from 2020 to 2021. Patients undergoing liver surgery were included. They received a lidocaine infusion protocol until the beginning of hepatic transection (bolus dose of 1.5 mg kg−1, then a continuous infusion of 2 mg kg−1 h-1). Plasma concentrations of lidocaine were measured four times during and after lidocaine infusion.\u0000 \u0000 \u0000 \u0000 Twenty subjects who underwent liver resection were analyzed. There was 35% of preexisting liver disease before tumor diagnosis, and 75% of liver resection was defined as “major hepatectomy.” Plasmatic levels of lidocaine were in the therapeutic range. No blood sample showed a concentration above the toxicity threshold: 1.6 (1.3–2.1) mg ml−1 one hour after the start of infusion, 2.5 (1.7–2.8) mg ml−1 at the end of hepatic transection, 1.7 (1.3–2.0) mg ml−1 one hour after the end of infusion, and 1.2 (0.8–1.4) mg ml−1 at the end of surgery. Comparative analysis between the presence of a preexisting liver disease or not and the association of intraoperative vascular clamping or not did not show significant difference concerning lidocaine blood levels.\u0000 \u0000 \u0000 \u0000 Perioperative lidocaine infusion seems safe in the field of liver surgery. Nevertheless, additional prospective studies need to assess the clinical usefulness in terms of analgesia and antitumoral effects.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"213 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_436_22
Vaishali Singla, S. Palta, R. Saroa, Robin Kaushik, Avneet Singh
Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25–60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet. We hypothesize that the addition of tramadol to ropivacaine for SAM block may reduce morphine consumption in the post-operative period in patients undergoing elective MRM surgeries. The primary aim of the study was to compare cumulative post-operative morphine consumption over 24 h in patients receiving SAM block with or without tramadol. The secondary aims were to observe adverse events related to the procedure or medications. The other parameters recorded were non-invasive blood pressure (NIBP), pulse rate, respiratory rate, and nausea or vomiting. Patients scheduled to undergo MRM were randomly allocated by block randomization into two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) with tramadol 100 mg while the control group (Group P) received a SAM block with 18 ml of 0.25% ropivacaine and 2 ml of saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h post-operatively. Cumulative morphine consumption over 24 h in the post-operative period was less in the group T (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg; P 0.001). Time to the first analgesic requirement was more in group T (10.44 ± 5.04 h vs 6.11 ± 2.73 h; P < 0.001). Pain scores were significantly lower in the group T at all time points. Tramadol, when used as an adjuvant to ropivacaine for SAM block reduces post-operative pain scores in the first 24 h and prolongs the time of first morphine requirement.
改良根治性乳房切除术（MRM）会导致严重的术后急性疼痛，25%-60%的患者可能会发展为慢性疼痛综合征。事实证明，前锯肌 (SAM) 阻滞对接受乳腺癌根治术的患者来说是一种极佳的镇痛选择。虽然许多辅助剂被用于延长镇痛时间，但曲马多在 SAM 中的作用尚未得到研究。我们假设，在罗哌卡因中加入曲马多用于 SAM 阻滞，可能会减少接受 MRM 手术的择期患者术后的吗啡用量。本研究的主要目的是比较接受SAM阻滞时添加或不添加曲马多的患者术后24小时内的吗啡累积消耗量。次要目的是观察与手术或药物相关的不良事件。记录的其他参数包括无创血压（NIBP）、脉搏、呼吸频率、恶心或呕吐。 计划接受 MRM 的患者通过整群随机法被随机分配到两组。研究组（T 组）接受 0.25% 罗哌卡因（18 毫升）和曲马多 100 毫克的 SAM 阻滞，而对照组（P 组）接受 18 毫升 0.25% 罗哌卡因和 2 毫升生理盐水的 SAM 阻滞。分别在术后 30 分钟、1 小时、4 小时、8 小时、12 小时和 24 小时对患者的疼痛评分、镇痛需求、首次镇痛请求时间、血液动力学变量和任何副作用进行评估。 T 组在术后 24 小时内的累积吗啡消耗量较少（3.06 ± 1.53 毫克 vs 4.34 ± 1.53 毫克；P 0.001）。T 组患者首次需要镇痛药的时间更长（10.44 ± 5.04 小时 vs 6.11 ± 2.73 小时；P < 0.001）。在所有时间点上，T 组的疼痛评分都明显较低。 曲马多作为罗哌卡因的辅助药物用于SAM阻滞时，可降低术后头24小时的疼痛评分，并延长首次吗啡需求时间。
{"title":"Role of tramadol as an adjuvant in ultrasound-guided serratus anterior muscle block for modified radical mastectomy - A randomized control trial","authors":"Vaishali Singla, S. Palta, R. Saroa, Robin Kaushik, Avneet Singh","doi":"10.4103/joacp.joacp_436_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_436_22","url":null,"abstract":"\u0000 \u0000 \u0000 Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25–60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet. We hypothesize that the addition of tramadol to ropivacaine for SAM block may reduce morphine consumption in the post-operative period in patients undergoing elective MRM surgeries. The primary aim of the study was to compare cumulative post-operative morphine consumption over 24 h in patients receiving SAM block with or without tramadol. The secondary aims were to observe adverse events related to the procedure or medications. The other parameters recorded were non-invasive blood pressure (NIBP), pulse rate, respiratory rate, and nausea or vomiting.\u0000 \u0000 \u0000 \u0000 Patients scheduled to undergo MRM were randomly allocated by block randomization into two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) with tramadol 100 mg while the control group (Group P) received a SAM block with 18 ml of 0.25% ropivacaine and 2 ml of saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h post-operatively.\u0000 \u0000 \u0000 \u0000 Cumulative morphine consumption over 24 h in the post-operative period was less in the group T (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg; P 0.001). Time to the first analgesic requirement was more in group T (10.44 ± 5.04 h vs 6.11 ± 2.73 h; P < 0.001). Pain scores were significantly lower in the group T at all time points.\u0000 \u0000 \u0000 \u0000 Tramadol, when used as an adjuvant to ropivacaine for SAM block reduces post-operative pain scores in the first 24 h and prolongs the time of first morphine requirement.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"39 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140732067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_375_23
A. Tejedor, Lana Bijelic, Marta García
Opioid-free anesthesia (OFA) provides adequate analgesia minimizing opioids. OFA has not been evaluated in laparoscopic radical prostatectomy (LRP). Our aim was to evaluate OFA feasibility and its effectiveness in LRP. A quasi-experimental retrospective study of 55 adult patients undergoing LRP was performed from September 2020 until December 20223. Predefined protocols for either opioid-based anesthesia (OBA; with continuous remifentanil infusion) or OFA (continuous lidocaine, dexmedetomidine, and ketamine infusion) were followed. In both groups, wound infiltration was performed before skin incision. Primary outcome was postoperative pain management (numerical rating scale [NRS]) in the first 24 postoperative hours. Secondary outcomes were opioid consumption, start to sitting and ambulation, postoperative complications, and length of hospital stay. OFA protocol patients had better median pain scores during movement at 1, 18 and 24 h, that is, 1 (interquartile range [IQR] 0–3) versus 2.5 (IQR 0–4), P = 0.047; 0 (IQR 0–1) versus 1 (IQR 0–2), P = 0.017; and 0 (IQR 0–0.25) versus 1 (IQR 0–2), P = 0.013, respectively. At 6 and 12 h, there were no statistically significant differences, that is, 0.5 (IQR 0–2) versus 1 (IQR 0–2), P = 0.908 and 1 (IQR 0–2) versus 0.5 (IQR 0–2), P = 0.929, respectively. Lower morphine requirements were recorded in the first 18 and 24 postoperative hours, that is, 0 (IQR 0–0) versus 1 (IQR 0–2.75) mg, P = 0.028 and 0 (IQR 0–2) versus 1.5 (IQR 0–3) mg, P = 0.012, respectively. Start to sitting and ambulation occurred earlier in the OFA group (P = 0.030 and P = 0.002, respectively). Linear regression showed that ambulation was independently associated with the analgesic technique (P = 0.034). Only one patient had postoperative nausea and vomiting (PONV) and belonged to the OBA group. There was no difference in total complications or the length of stay. In this study, OFA strategy was found to be safe, feasible, and provided adequate analgesia, minimizing the use of postoperative opioids, and was independently associated with earlier ambulation.
{"title":"Feasibility of opioid-free anesthesia in laparoscopic radical prostatectomy: A retrospective, quasi-experimental study","authors":"A. Tejedor, Lana Bijelic, Marta García","doi":"10.4103/joacp.joacp_375_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_375_23","url":null,"abstract":"\u0000 \u0000 \u0000 Opioid-free anesthesia (OFA) provides adequate analgesia minimizing opioids. OFA has not been evaluated in laparoscopic radical prostatectomy (LRP). Our aim was to evaluate OFA feasibility and its effectiveness in LRP.\u0000 \u0000 \u0000 \u0000 A quasi-experimental retrospective study of 55 adult patients undergoing LRP was performed from September 2020 until December 20223. Predefined protocols for either opioid-based anesthesia (OBA; with continuous remifentanil infusion) or OFA (continuous lidocaine, dexmedetomidine, and ketamine infusion) were followed. In both groups, wound infiltration was performed before skin incision. Primary outcome was postoperative pain management (numerical rating scale [NRS]) in the first 24 postoperative hours. Secondary outcomes were opioid consumption, start to sitting and ambulation, postoperative complications, and length of hospital stay.\u0000 \u0000 \u0000 \u0000 OFA protocol patients had better median pain scores during movement at 1, 18 and 24 h, that is, 1 (interquartile range [IQR] 0–3) versus 2.5 (IQR 0–4), P = 0.047; 0 (IQR 0–1) versus 1 (IQR 0–2), P = 0.017; and 0 (IQR 0–0.25) versus 1 (IQR 0–2), P = 0.013, respectively. At 6 and 12 h, there were no statistically significant differences, that is, 0.5 (IQR 0–2) versus 1 (IQR 0–2), P = 0.908 and 1 (IQR 0–2) versus 0.5 (IQR 0–2), P = 0.929, respectively. Lower morphine requirements were recorded in the first 18 and 24 postoperative hours, that is, 0 (IQR 0–0) versus 1 (IQR 0–2.75) mg, P = 0.028 and 0 (IQR 0–2) versus 1.5 (IQR 0–3) mg, P = 0.012, respectively. Start to sitting and ambulation occurred earlier in the OFA group (P = 0.030 and P = 0.002, respectively). Linear regression showed that ambulation was independently associated with the analgesic technique (P = 0.034). Only one patient had postoperative nausea and vomiting (PONV) and belonged to the OBA group. There was no difference in total complications or the length of stay.\u0000 \u0000 \u0000 \u0000 In this study, OFA strategy was found to be safe, feasible, and provided adequate analgesia, minimizing the use of postoperative opioids, and was independently associated with earlier ambulation.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"13 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_331_23
Neha Garg, Rudranil Nandi, S. Banerjee, Aditi Gupta
{"title":"Awake video laryngoscopy as a rescue airway maneuver after a failed awake flexible bronchoscope-guided intubation: A case report","authors":"Neha Garg, Rudranil Nandi, S. Banerjee, Aditi Gupta","doi":"10.4103/joacp.joacp_331_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_331_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"180 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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