Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial

Abstract Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. Results The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.

Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial.

BACKGROUND: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. METHODS: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg-1 loading, 2 mg.kg-1.h-1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg-1 loading, 0.6 µg.kg-1.h-1 infusion) (Group 2), lidocaine (1.5 mg.kg-1 loading, 2 mg.kg-1.h-1 infusion), and dexmedetomidine infusions (1 µg.kg-1 loading, 0.5 µg.kg-1.h-1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg-1.h-1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. RESULTS: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. CONCLUSION: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Purpose: To evaluate the postoperative analgesic and adverse effects of three doses of dexamethasone, administered epidurally in combination with lignocaine, in dogs undergoing ovariohysterectomy (OVH). Methods: Twenty-four female dogs undergoing ovariohysterectomy were pre-medicated with acepromazine and general anaesthesia was induced and maintained with propofol. Animals were randomly allocated into four groups of six. The control group was given lignocaine 2% (LI) and the treatment groups were given lignocaine with either 2 mg dexamethasone (LIDEX2), 4 mg dexamethasone (LIDEX4) or 8 mg dexamethasone (LIDEX8) administered at the lumbosacral epidural space. Duration of postoperative analgesia, first analgesic rescue, motor blockade, heart rate, blood pressure, respiratory rate, and rectal temperature were evaluated. Results: The duration of postoperative analgesia was 19.5 (SD 6) hours for LIDEX8 (p=0.001), 10 (SD 2) hours for LIDEX4 (p=0.002), 4 (SD 2) hours for LIDEX2 (p=0.074) treatments compared with values for the LI control treatment 2.2 (SD 1.6) hours. All treatments had significant cardiovascular and respiratory alterations but they were within acceptable range in these clinically healthy female dogs. Conclusion: Dexamethasone added to epidural lignocaine significantly extends the postoperative analgesia after ovariohysterectomy in female dogs.(AU)

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Abstract Purpose: To evaluate the postoperative analgesic and adverse effects of three doses of dexamethasone, administered epidurally in combination with lignocaine, in dogs undergoing ovariohysterectomy (OVH). Methods: Twenty-four female dogs undergoing ovariohysterectomy were pre-medicated with acepromazine and general anaesthesia was induced and maintained with propofol. Animals were randomly allocated into four groups of six. The control group was given lignocaine 2% (LI) and the treatment groups were given lignocaine with either 2 mg dexamethasone (LIDEX2), 4 mg dexamethasone (LIDEX4) or 8 mg dexamethasone (LIDEX8) administered at the lumbosacral epidural space. Duration of postoperative analgesia, first analgesic rescue, motor blockade, heart rate, blood pressure, respiratory rate, and rectal temperature were evaluated. Results: The duration of postoperative analgesia was 19.5 (SD 6) hours for LIDEX8 (p=0.001), 10 (SD 2) hours for LIDEX4 (p=0.002), 4 (SD 2) hours for LIDEX2 (p=0.074) treatments compared with values for the LI control treatment 2.2 (SD 1.6) hours. All treatments had significant cardiovascular and respiratory alterations but they were within acceptable range in these clinically healthy female dogs. Conclusion: Dexamethasone added to epidural lignocaine significantly extends the postoperative analgesia after ovariohysterectomy in female dogs.

[To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine]. / Avaliação do efeito de dexmedetomidina na prevenção da dor relacionada à injeção de propofol e comparação com o efeito da injeção de lidocaína.

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2mcg/kg diluted in 5mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2mg/kg diluted in 5mL normal saline. IV line was secured with 20G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70mm Hg for 1min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10s. After 10s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine / Avaliação do efeito de dexmedetomidina na prevenção da dor relacionada à injeção de propofol e comparação com o efeito da injeção de lidocaína

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2 mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2 mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2 mcg/kg diluted in 5 mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2 mg/kg diluted in 5 mL normal saline. IV line was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70 mm Hg for 1 min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10 s. After 10 s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

JUSTIFICATIVA E OBJETIVO: A dor relacionada à injeção de propofol é um problema comum. Métodos diferentes são usados para diminuí-la, mas com sucesso limitado. O objetivo deste estudo foi avaliar o efeito da dexmedetomidina (0,2 mcg kg-1) na prevenção da dor relacionada à injeção de propofol e compará-lo com lidocaína (0,2 mg kg-1). MÉTODO: Depois da permissão do Comitê de Ética Institucional, a assinatura do termo de consentimento informado foi obtida de todos os participantes deste estudo prospectivo e randomizado. Sessenta pacientes com estado físico ASA I-II, idades entre 20-60 anos, de ambos os sexos e programados para cirurgias eletivas sob anestesia geral foram randomicamente alocados em dois grupos: Grupo I (dexmedetomidina) recebeu injeção de dexmedetomidina (0,2 mcg kg-1) diluída em 5 mL de solução salina normal e Grupo II (lidocaína) recebeu injeção de lidocaína (0,2 mg kg-1) diluída em 5 mL de solução salina normal. O acesso IV foi obtido com uma cânula de calibre 20G e a oclusão venosa aplicada no antebraço com o uso de um torniquete pneumático e inflado a 70 mm Hg durante um minuto. Os medicamentos em estudo foram injetados, o torniquete foi liberado e, em seguida, 25% da dose calculada de propofol foi administrada por via intravenosa durante 10 segundos. Após 10 segundos de injeção, a intensidade da dor foi avaliada com o uso da escala de McCrirrick e Hunter e, em seguida, o restante do propofol e um agente bloqueador neuromuscular foram administrados. A intubação endotraqueal foi feita e a anestesia mantida com O2, N2O e isoflurano em ventilação com pressão positiva intermitente, com o circuito de Bain e uso de vecurônio como relaxante muscular. RESULTADOS: Os dados demográficos mostraram que não houve diferença estatisticamente significante entre os dois grupos. Não houve diferença estatisticamente significante entre os dois grupos em relação à dor relacionada à injeção de propofol. Não houve efeitos adversos, como edema, dor e pápula no local da injeção nos dois grupos.

To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine.

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2 mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2 mcg/kg diluted in 5 mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2mg/kg diluted in 5 mL normal saline. IV line was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70 mm Hg for 1 min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10s. After 10s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate

INTRODUCTION AND OBJECTIVE: Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: 66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2% topical diltiazem or 2 mL of 0.2% topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion of the probe, during biopsy and at the end of the procedure. RESULTS: The pain scores due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine were significantly lower compared to the placebo group (p < 0.001). There were no significant differences in the pain scores between the patients receiving diltiazem compared to those receiving nitroglycerine. Higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine compared to those receiving diltiazem. CONCLUSION:Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal prostatic biopsy. Diltiazem is safer compared to nitroglycerine.