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BACKGROUND AND AIMS: The pain following total abdominal hysterectomy (TAH), a very commonly performed gynaecological surgery, is usually taken care of by various opioids, non-opioids, regional and peripheral nerve blocks. Erector spinae plane block (ESPB) under ultrasound guidance is a relatively new approach for postoperative analgesia in thoracic and abdominal surgeries. Ultrasound availability and expertise to use it is a limitation at times. The primary aim of this study was to determine the analgesic efficacy of ESPB using peripheral nerve stimulation (PNS) technique in patients undergoing TAH. METHODS: A total of 60 American Society of Anesthesiologists physical status I and II female patients were posted for abdominal hysterectomy after obtaining ethical committee clearance in a tertiary care centre. Group I (n = 30) received spinal anaesthesia, whereas Group II (n = 30) received ESPB under peripheral nerve stimulator (PNS) guidance with 20 mL of 0.375% ropivacaine before spinal anaesthesia. Post-operative pain intensity reported using the Visual Analogue Scale (VAS) was considered as the primary outcome. The haemodynamic variables, total duration before the first rescue analgesia, total consumption of tramadol, level of satisfaction regarding analgesia and any complications were considered as secondary outcomes. The data were recorded in an excel sheet, and analysis was performed using the Statistical Package for the Social Sciences version 23.0. RESULTS: VAS score was significantly lower (P < 0.001) in Group II at 0, 1, 2, 3, 4, 6, 12, 18 and 24 h post-operatively. The total dose of rescue analgesia was significantly reduced in the ESPB group. CONCLUSION: PNS-guided ESPB is effective in relieving pain in patients undergoing TAH.
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BACKGROUND: Percutaneous nephrolithotomy (PCNL) a minimally invasive method for the removal of renal calculi and is associated with significant pain in postoperative period. Conventionally, intravenous opioids, local anesthetic infiltration, and regional blocks (intercostal/paravertebral blocks) have been tried with less efficacy to control postoperative pain. The present study is conducted to assess the effectiveness of erector spinae plane block (ESPB) performed under fluoroscopy guidance for postoperative analgesia during PCNL. SUBJECTS AND METHODS: After obtaining ethical clearance, the study was conducted on 61 American Society of Anaesthesiologists (ASA) I and II patients aged between 18-65 years admitted for PCNL. Group I (n = 30) did not receive ESPB while Group II (n = 31) received ESPB under fluoroscopy guidance and 20 ml of 0.375% ropivacaine was administered after PCNL. Patient-reported pain intensity using visual analogue scale (VAS) was considered as a primary outcome. The hemodynamic variables (heart rate, systolic, diastolic, and mean blood pressure) was considered as a secondary outcome. Statistical analysis was performed using Student's t-test and Mann-Whitney U test. Data analysis was performed using the Statistical Package for the Social Sciences version 23.0. RESULTS: Postoperatively VAS score was significantly lower in Group II at 0, 1, 2, 3, 4, 6, 12, 18, and 24 hours after PCNL (P < 0.001). Dose of rescue analgesia significantly decreased in Group II compared to Group I. CONCLUSION: ESPB performed under fluoroscopic guidance is a simple and effective technique and it provides significantly better postoperative pain relief.
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OBJECTIVES: This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. METHODS: This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 µg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. RESULTS: There was a significant reduction in mean heart rate at 3-5 minutes in both treatment groups compared to the control group (P <0.050), as well as lower increases in mean arterial pressure at 1-3 minutes (P <0.050). However, at 2-4 minutes, there was a significantly greater decrease in mean systolic blood pressure in the NTG group compared to both the lignocaine and control groups (P <0.050). Moreover, a greater decrease in mean rate pressure product response at 1-5 minutes was observed in the NTG group compared to the lignocaine and control groups (P = 0.001). CONCLUSION: The NTG spray was more effective than lignocaine in attenuating blood pressure increases and rate pressure product during elective laryngoscopy and intubation.