Comparison of Intravenous Ondansetron and Dexamethasone for Preventing Propofol-Induced Pain During Laparoscopic Cholecystectomy: A Double-Blind, Randomized Study.

Background Propofol is the most common induction agent used in current anesthesia practice. Patients receiving propofol injections commonly experience varying degrees of pain, creating an unpleasant anesthesia experience. Methods Seventy-two patients, aged between 18 and 70, scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomized into two groups. Group D received 8 mg of dexamethasone, and Group O received 8 mg of ondansetron intravenously before induction. After five seconds, mid-arm venous occlusion was applied for one minute using a tourniquet. Propofol (0.5 mg/kg) was administered intravenously over five seconds, and patients rated the injection pain over the next 15 seconds. The primary outcome was pain intensity using the Verbal Rating Scale during propofol injection. Secondary outcomes included intraoperative hemodynamic changes and postoperative nausea and vomiting (PONV). Normally distributed variables were compared using the Student's t-test, non-normally distributed variables using the Mann-Whitney U-test, and qualitative data using the chi-square or Fisher's exact test. Statistical significance for the study was set at p < 0.05. Results In Group D, 30 out of 36 patients (83.3%) experienced no pain, while four patients (11.1%) reported mild pain, two patients (5.6%) reported moderate pain, and no patients (0.0%) reported severe pain. In contrast, in Group O, only 15 out of 36 patients (41.6%) experienced no pain, with 12 patients (33.3%) experiencing mild pain, seven patients (19.4%) experiencing moderate pain, and two patients (5.6%) experiencing severe pain. Overall, six out of 36 patients in Group D (16.7%) experienced some level of pain, compared to 21 out of 36 patients in Group O (58.3%), a statistically significant difference (p < 0.05). Regarding postoperative nausea, 16 out of 36 patients in Group Dexamethasone (44.44%) experienced nausea, whereas 23 out of 36 patients in Group Ondansetron (63.88%) reported this symptom, with the difference being statistically significant (p = 0.0372). Additionally, postoperative vomiting occurred in nine out of 36 patients in Group Dexamethasone (25%), compared to 18 out of 36 patients in Group Ondansetron (50%), with this difference also reaching statistical significance (p= 0.026). Conclusions Intravenous dexamethasone before propofol administration reduces injection pain and PONV in laparoscopic cholecystectomy more effectively as compared to ondansetron.

Comparative Study of Levobupivacaine Versus Levobupivacaine With Dexmedetomidine as an Adjuvant in Transversus Abdominis Block for Postoperative Pain Relief in Abdominal Hysterectomy Patients: A Randomized, Double-Blind Study.

Background Adjuvants have been discovered to prolong the analgesic impact of local anesthetics (LA), while the transversus abdominis plane (TAP) block offers sufficient postoperative pain relief after various abdominal procedures. Nevertheless, the impact of the given LA will determine the duration of the TAP block. Thus, in this investigation, we aimed to estimate the analgesic impact of combining dexmedetomidine (DEX) with levobupivacaine in the TAP block for patients having an infraumbilical incision for an abdominal hysterectomy while under spinal anesthetic. Aim This study aimed to determine the analgesic effect of DEX (0.5 mcg/kg) to 20 ml of 0.25% levobupivacaine on each side in the TAP block in patients undergoing total abdominal hysterectomy (TAH). Materials and methods Two groups of 30 patients each, with ASA grades 1 and 2, were randomly selected from patients. Group N, comprising 30 patients, had a bilateral TAP block using 2 mL of normal saline and 20 mL of 0.25% levobupivacaine. Group D (n = 30 patients) was given DEX at a dose of 0.5 mcg/kg (2 mL) in addition to 20 mL of 0.25% levobupivacaine given bilaterally. The TAP block was administered just after skin closure. Time of the initial analgesic dose administration; total fentanyl doses utilized as rescue analgesia; pain scores (numerical rating scale (NRS)) at 2, 4, 6, 8, 12, and 24 hours; and pre- and postoperative cortisol levels were also noted. For each group, 1 gram IV paracetamol was administered every eight hours. Drugs used for rescue analgesia (RA) were diclofenac 75 mg IV stat and fentanyl 1 mcg/kg. Results and discussion In addition to Group N having lower NRS scores at rest, Group D had a considerably longer time for initial rescue analgesia than Group N. There was also a significant decrease in the total fentanyl consumption and postoperative serum cortisol levels in Group D in contrast to Group N. Conclusion Potential adjuvant DEX prolongs postoperative analgesia in patients experiencing abdominal hysterectomy when used alongside LA in TAP.

Comparative Study between Intrathecal 0.5% Isobaric Levobupivacaine, 0.5% Isobaric Ropivacaine, and 0.5% Hyperbaric Bupivacaine in Elective Lower Segment Cesarean Section: A Randomized Clinical Study.

Background: Neuraxial anesthesia in obstetrics began with the spinal block by Oskar Kreis in 1900. The technique of subarachnoid blockade has been refined since then and various drugs have been used to provide analgesia and anesthesia for infraumbilical surgeries. Materials and Methods: This study was conducted because of newer options available, such as an intrathecal drug with appropriate sensory and motor blockade and minimal haemodynamic changes that can be used in the lower segment cesarean section safely. Ninety patients were randomly divided into three groups including 30 patients in each group. Group B, Group L, and Group R, each receiving 2.2 mL of 0.5% hyperbaric bupivacaine, 0.5% isobaric levobupivacaine, and 0.5% isobaric ropivacaine, respectively. All groups were compared concerning sensory block, motor block, hemodynamic stability, and complications if any. Results: The onset of sensory block at T8, two-segment regression time from the highest block, time of regression to L1, total duration of analgesia, onset and total duration of motor block were comparable between Group B and L (P > 0.05), but both these groups were statistically significant with Group R (P < 0.05). Hypotension was observed among all the groups; however, the incidence was minimum in Group R. Conclusion: 12 mg of isobaric ropivacaine and 12 mg of isobaric levobupivacaine, compared to 12 mg hyperbaric bupivacaine (2.2 mL of 0.5% each), when administered intrathecally provides adequate anesthesia for cesarean section. The lesser duration of motor block in ropivacaine compared to the other two drugs could be beneficial for early ambulation, also the incidence of hypotension was lower in Group R.