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KOPS AWARD ABSTRACTS: PAIN
Year : 2020  |  Volume : 64  |  Issue : 13  |  Page : 35-40  

KOPS Award Abstracts: Pain


Date of Web Publication6-Feb-2020

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DOI: 10.4103/0019-5049.277903

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How to cite this article:
. KOPS Award Abstracts: Pain. Indian J Anaesth 2020;64, Suppl S1:35-40

How to cite this URL:
. KOPS Award Abstracts: Pain. Indian J Anaesth [serial online] 2020 [cited 2020 Feb 21];64, Suppl S1:35-40. Available from: http://www.ijaweb.org/text.asp?2020/64/13/35/277903




   Abstract ID: ISAP309: “Comparison of effectiveness of erector spinae plane block and transversus abdominis plane block in inguinal hernia repair for post operative analgesia-a prospective randomised single blinded study” Top


Sajna.S, Edward Johnson.

Kanyakumari Government Medical College.

Background and aims: Patients undergoing hernioplasty suffer significant post operative pain and distress. Transversus abdominis plane (TAP) block is one of the well known approaches to provide effective postoperative analgesia. The ESP block is a recently described regional anaesthetic technique which when applied to low thoracic region was reported to provide extensive, potent analgesia in inguinal hernia surgeries. We aimed to compare the effectiveness of ultrasound guided TAP block and ESP block in inguinal hernia repair for postoperative analgesia.

Methods: This single blinded, prospective, randomised study was done after institutional review board approval and written informed consent and in accordance with the principles outlined in the declaration of Helsinki. The study was registered with Clinical trials registry – India (CTRI no:CTRI/ 2019/ 10/021766).64 patients aged 18-60yrs belonging to ASA classes I/II scheduled for elective inguinal hernia repair under spinal anaesthesia were randomly allocated into two equal groups-groups E and T.GroupE received ESPblock at T9 level and GroupT received TAPblock with 20ml 0.25% Bupivacaine at the end of surgery..Demographic data,duration of surgery,block success/failure,duration of analgesia, postoperative consumption of analgesic (Tramadol)for 24hrs and complications if any were recorded. Pain intensity between groups compared using Numerical Rating Score (NRS) score. The continuous variables were presented as mean ± SD and were compared using student's t test.The categorical variables presented as absolute numbers and percentage and were compared using Chi-square test. The p value of ≤0.05 was considered statistically significant.

Results:Demographic characters and duration of surgery were comparable between groups.Mean duration of analgesia in GroupE was longer(460.8 ± 47.5 min)compared to GroupT(282.00 ± 39.2 min)which is statistically significant(p< 0.001).When average NRS scores for 24h were compared,mean NRS score was higher in group T at all time points at rest and on movement/coughing,but there was a statistically significant difference only at 3h (p< 0.05). The mean postoperative 24 h tramadol requirement was less in Group E (128.0± 45.8mg) than in Group T (185.2± 45.6mg) with a p value <0.001. None of the patients developed block related complications.

Conclusion: Ipsilateral ultrasound guided Erector Spinae Plane block as a component of multimodal analgesia provides prolonged postoperative analgesia with reduced opioid analgesic requirement in patients undergoing hernioplasty.

REFERENCES:

  1. Evaluation of Ultrasound Guided Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Randomized,Controlled,Prospective Study.Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer.2019 Anaesthesia: Essays and Researches.
  2. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med 2018;43:567-71



   Abstract ID - ISAP226: To study the efficacy of bilateral ultrasound guided erector spinae plane block for postoperative analgesia in donor laparoscopic nephrectomy surgery. Top


Anushree R T, Divya Vasudevan, Jayashree Simha, Radhika Magizhan

Manipal Hospital, Bangalore

Back ground and aims: Laparoscopic living donor nephrectomy is the most commonly performed procedure during renal transplantation. There are many regional techniques described for providing analgesia. Our study was conducted to evaluate the efficacy of bilateral ultrasound guided erector spinae block for postoperative analgesia in laparoscopic donor nephrectomy surgery.

Methods: A prospective randomized control study was conducted with 42 patients belonging to American Society of Anaesthesiologists classes I and II scheduled for laparoscopic donor nephrectomy surgery under general anaesthesia. They were recruited into two groups, Group B (block) received bilateral ultrasound guided erector spinae block before extubation with 0.2% ropivacaine 20ml on each side at T8 level and supplemented with intravenous patient controlled analgesia with fentanyl. Group C (control) received only intravenous PCA fentanyl. The mean fentanyl consumption was recorded for 24hours postoperatively. Other parameters like NRS, sedation, incidence of nausea and vomiting, requirement of additional analgesic and patient satisfaction were recorded and compared between the groups using student t test and chi square test.
Table 1: Postoperative analgesic requirement and incidence of PONV

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Results: Total fentanyl consumption postoperatively at 24hours in group B (ESPB) was 219 ± 158 mcg as compared to group C(control) 745 ± 291 mcg(p<0.001). There was no difference in NRS scores between the groups. Requirement of additional analgesics, incidence of nausea and vomiting were lower in group B than group C (p<0.05). Patients in group B were less sedated and better satisfied with postoperative pain management.

Conclusion: Ultrasound guided bilateral erector spinae block can be used as an effective analgesic regimen postoperatively in laparoscopic donor nephrectomy surgery

REFERENCES:

  1. 1. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z, Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial.J Clin Anesth. 2018 Sep;49:101-106.
  2. Serkan Tulgar, Onur Selvi, and Mahmut Sertan Kapakli, “Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries: Case Series,” Case Reports in Anesthesiology, vol. 2018, Article ID 3947281, 3 pages, 2018.



   Abstract ID: ISAP318: Dexmedetomidine as an adjuvant to 0.75% ropivacaine in ultrasound guided brachial plexus block using supraclavicular parasagittal approach for upper limb orthopedic surgeries: A randomized prospective clinical study. Top


Mahima K.B, Karthik G.S, Rangalakshmi S, Sudheer

Rajarajeswari Medical College and Teaching Hospital, Bangalore

Background and aims: Ropivacaine has been used for brachial plexus block because of its safety profile. Dexmedetomidine is one of the adjuvant added to ropivacaine. Aim was to compare and assess the effectiveness of adding dexmedetomidine to 0.75% ropivacaine in supraclavicular brachial plexus block using parasagittal approach.



Methods: A prospective single blinded randomized comparative clinical study was conducted involving Forty patients of ASA GRADE I and II between the ages of 20-60 years, scheduled for elective upper limb orthopedic surgeries under supraclavicular brachial plexus block, were assigned into two groups. Group RN received 25ml of 0.75% ropivacaine along with 1ml of normal saline while Group RD received 25ml of 0.75% of ropivacaine along with 1mcg/kg dexmedetomidine diluted to 1ml.Sensory, motor blockade & analgesic efficacy was determined. Student t-test was used for demographic and hemodynamic data analysis. Unpaired t-test was used for evaluation of data which included onset, duration of sensory and motor blockade along with duration of analgesia. The results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant.

Results: Group RD had rapid onset of sensory and motor blockade (7.4 ±1.02 min vs 9.9 ±1.16 min & 10.25 ±1.13 min vs 13.28 ±1.22 min). Duration of analgesia (484.78 ±15.52 min vs 646.82 ±21.56 min) was also prolonged.



Conclusion: Adding dexmedetomidine to Ropivacaine provided rapid onset and longer duration of sensory and motor blockade along with superior post-operative analgesia.

REFERENCES:

  1. Searle A, Niraj G. Ultrasound-guided brachial plexus block at the supraclavicular level: A newparasagittal approach. Int J Ultrasound Appl Technol Perioper Care 2010;1:19-22.
  2. Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth 2015;9:148-54.



   Abstract ID: ISAP452: Comparison between ropivacaine and ropivacaine with dexmedetomidine via ultrasound guided erector spinae block for post operative analgesia in patients undergoing modified radical mastectomies: A prospective randomized study Top


Umadri Singh, Karthik G S, Rangalakshmi S, Sudheer R

Rajarajeswari Medical College and Hospital, Bangalore

Background and aims: Usg guided erector spinae plane block for modified radical mastectomy has been described for providing post operative analgesia. This study was devised to assess the additive efficiency of dexmedetomidine, a highly selective α2-adrenergic receptor (α2-AR) agonist, to ropivacaine in ultrasound guided erector spinae block in terms of the duration of analgesia.

Methods: 40 females belonging ASA 1 or 2 posted for MRM were randomly allocated into two groups in this randomized blinded trial. Group R received unilateral usg guided erector spinae block with 20ml of 0.5% injection Ropivacaine and 1 ml of saline Group RD received 20ml of 0.5% ropivacaine with 1mcg/kg of dexmedetomidine (reconstituted as 1 ml) followed by GA. The primary objective of study was to determine the Duration of analgesia along with postoperative diclofenac consumption. Student t-test was used for demographic and haemodynamic data analysis. Unpaired t-test was used for evaluation of data which included duration of analgesia. The results were statistically significant if p value <0.05. P value <0.001 was considered highly significant.

Results: The duration of analegesia was significantly prolonged in group RD patients (668+/- 36.6 mins vs 966.6+/- 46.2) Postoperative diclofenac consumption was found to be significantly less in patients receiving dexemedetomidine with ropivacaine.



Conclusion: Addition of dexmedetomidine to ropivacaine in usg guided erector spinae block reduced the analgesic requirement in post operative period.

REFERENCES:

  1. Singh S, Kumar G, Akhileshwar. Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomised control study. Indian J Anaesth 2019;63:200-4
  2. Nair AS, Seelam S, Naik V, Rayani BK. Opioid-free mastectomy in combination with ultrasound-guided erector spinae block: A series of five cases. Indian J Anaesth. 2018;62(8):632–634.314-18



   Abstract ID: ISAP582: Comparative evaluation of peng block [pericapsular nerve group block] v/s fascia iliaca block[fib] for positioning and post operative analgesia prior to spinal anaesthesia for hip surgeries: Prospective randomized controlled trial Top


Ashwin A B, Shankar K, Rangalakshmi S

Rajarajeshwari Medial College and Hospital, Bangalore

Background & aims: Extreme pain does not allow ideal positioning for central neuraxial block procedures. Adequate pain relief before spinal anaesthesia will increase patient's cooperation. Blockade of nerves supplying the anterior capsule by pericapsular nerve group [PENG] block facilitates positioning. We evaluated the analgesic efficacy of ultrasound guided PENG block versus FIB for positioning and post operative pain in hip surgeries.

Method: After ethical committee clearance and informed consent, 60 ASA I and II patients undergoing hip surgeries were randomised into 2 groups. [N=30]. Group P [PENG BLOCK] - 30ml of Inj. ropivacaine 0.375% + 0.25 mcg/kg dexmedetomidine.

Group F [FASCIA ILIACA BLOCK} - 30ml of Inj. ropivacaine 0.375% + 0.25 mcg/kg dexmedetomidine. “Pain scores after the block”, during positioning and post-operative period, opioid consumption and side effects if any were recorded. Statistical analysis done using student t test, chi-square test.P value < 0.05 was considered significant.

Results: Demographic profile was comparable. VAS scores during positioning was significantly lower in PENG block group[P value <0.05] with good quality of patient positioning and better patient satisfaction score as compared to FIB. Duration of post operative analgesia were comparable between the two groups.



Conclusion: In Hip fractures, PENG block produces more effective analgesia for position and postoperative pain than Fascia iliaca block without any significant side effects.

REFERENCES:

  1. Girón-Arango L, Peng PW, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018 Nov 1;43(8):859-63.
  2. Gopal ND, Krishnamurthy D. A clinical comparative study of fascia iliaca compartment block with bupivacaine and bupivacaine with dexmedetomidine for positioning and duration of postoperative analgesia in fracture femur under spinal anesthesia. Anesthesia, essays and researches. 2018 Apr;12(2):528.



   Abstract ID: ISAP588: Shoulder block versus interscalene block for postoperative analgesia in arthroscopic shoulder surgery. Top


Shruthi.M, Suman Saini

Vardhman Mahavir Medical College and Safdarjung Hospital. N Delhi

Background and Aims: Arthroscopic shoulder surgery, though minimally invasive, is associated with severe intraoperative and postoperative pain. Interscalene brachial plexus block [ISB] frequently used technique for shoulder surgeries provide anaesthesia of the proximal brachial plexus roots. Associated with many infrequent but potentially serious complications. Price suggested “Shoulder block” (ShB)-involving blockade of peripheral nerves Suprascapular nerve and Axillary nerve block. The aim was to compare the efficacy and duration of analgesia provided by Shoulder block versus Interscalene block using visual analogue scale (VAS).

Methods: In a randomized, prospective study,70 patients (35 in each group) aged 18-60 years, ASA 1and 2, posted for elective unilateral shoulder arthroscopy surgery were divided to receive either ISB+ GA (10ml of 0.5% bupivacaine) or ShB+ GA (suprascapular nerve & axillary nerve block – 10ml of 0.5%bupivacaine). The nerve block was guided by both ultrasound and nerve stimulator. Pain was evaluated at 0, 2, 4, 6, 12 and at 24hrs using VAS. The time to first rescue analgesia, total analgesic requirement for 24hrs postoperatively, patient satisfaction and any complications were recorded.

Results: VAS scores at 4h (p value 0.018) in ShB and at 12hr (p value0.008) in ISB was statistically significant. Total analgesic requirement was same in both the groups but requirement was earlier in shoulder block(4.69hr) compared to interscalene block(8.2hr). Patient satisfaction at 24hrs was similar in both groups. Block time was longer in shoulder block(9.8min) compared to interscalene block(3.8min). Block complications-dypsnea, ptosis seen in ISB.

Conclusion: Shoulder block is equally efficacious as Interscalene block in terms of requirement of analgesia and patient satisfaction with less side effects and complications. Shoulder block is a good alternative to interscalene block.

References

  1. Price DJ. The shoulder block: a new alternative to interscascalene brachial plexus blockade for the control of postoperative shoulder pain. Anesth Analg 2007;35:575-81.
  2. Pitombo PF, Barros RM, Matos MA, Modolo NSP. Selective supra-scapular and axillary nerve block provides adequate analgesia and minimal motor block; comparison with interscalene block. Rev Bras Anesthesiol 2013;63:45-58.



   Abstract ID: ISAP445: Erector spinae block is better than surgical transverse abdominis plane block in reducing opioid requirement in patients undergoing major abdominal surgery Top


Aswathy M N, Hanuman Srinivasa Murthy, Jalaja Koppa Ramegowda, DwarakaNath Reddy V

Department of Anaesthesiology and Surgical Gastroenterology, Manipal Hospitals, Bangalore

Background and aims: Multimodal and opioid sparing analgesic techniques are used to facilitate early postoperative recovery1. Ultrasound guided erectorspinae block (ESB) is gaining popularity in treating postoperative pain following major surgeries. We studied the postoperative opioid and non-opioid analgesic requirements following bilateral ESB or surgical transverse abdominis plane block (STAPB) (performed by surgeons during closure of the abdominal wound) in patients undergoing major abdominal surgeries.

Methods: After obtaining hospital ethics committee approval, data of 82 patients who underwent major open abdominal surgeries over the last one year was collected from the computerised data bank. Demographic parameters, indication and type of surgery, technique of analgesia, number of patients requiring postop opioid analgesia (Fentanyl patch, subcutaneous morphine), non-opioid rescue analgesia (Paracetomol, Ketorolac) and duration of hospital stay were noted. These patients were divided into 1. Patients receiving bilateral ESB with 20 ml of 0.2% Ropivacaine on each side 2. Patients receiving 30-40 ml of 0.2% Ropivacaine for STAPB.
Figure 1: Depicts the number of patients requiring postoperative analgesics in each group.

Click here to view


Results: 41 patients received ESB and 41 patients received STAPB. Demographic parameters and type of surgery were comparable between the groups. Twentysix (62%) patients and 34 (82%) patients required opioid analgesics in ESB and STAPB groups respectively (p=0.03). Statistically significant number of patients in STAPB group required a combination of both opioid and non opioid drugs. The duration of stay in the hospital was 7.5±3.2 days and 7.9±3.5 days in ESB and STAPB groups respectively.

Conclusion: After open abdominal surgery, significantly lesser number of patients required opioid and non opioid analgesics after receiving ultrasound guided erector spinae block compared to TAP block given by the surgeons under direct vision.

REFERENCES:

  1. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. Chou, Roger et al. The Journal of Pain, Volume 17,Issue 2,131 – 157
  2. Erector spinae plane block in abdominal surgery: Case series: Juan Carlos Luis-Navarro et al. Indian journal of anaesthesia.2018Jul;62(7):549-554



   Abstract ID: ISAP 451: Comparison of spank block versus ipack block when added to adductor canal block for pain control and knee rehabilitation after total knee arthroplasty: A prospective randomized control trial. Top


Sireesha L, Abhiruchi Yeshwant Patki, Shibani Padhy, Durga Padmaja

Nizam's Institute of Medical Sciences

Background & Aims: Pain management in total knee arthroplasty minimizes postoperative pain and improves functional outcomes. Adductor canal block (ACB) provides analgesia to peripatellar and intra-articular aspects of knee joint without any motor weakness, but it does not provide analgesia to posterior knee, which is decreased by addition of IPACK block (interspace between popliteal artery and capsule of knee joint) and SPANK block (sensory posterior articular nerves of knee). Our objective was to compare effect of SPANK block and IPACK block when combined with adductor canal block for analgesia and immediate postoperative rehabilitation in TKR.

Methods: After institutional ethics committee approval, 86 patients of ASA grade I and II posted electively for total knee replacement surgeries were randomly allocated into groups I and S. Group I received ropivacaine 0.25% 15cc into adductor canal plus 15cc for IPACK block and group S received ropivacaine 0.25% 15cc in adductor canal plus 15cc in SPANK block. Postoperative VAS score assessed at 0, 6, 12, 18, 24, 48hrs intervals. Time for first rescue analgesia, 24hr opioid consumption, success of early ambulation, quadriceps muscle strength assessed at 8hrs, POD 1,2

Results: Mean VAS score was significantly less in IPACK plus ACB group at Day1(3.2 ± 1.75) compared to SPANK plus ACB group(4.86 ± 1.64) p value <0.001. In-hospital rehabilitation metrics like TUG test, ability to perform SLR and number of steps walked were similar in two groups

Conclusion: ACB plus IPACK could contribute to greater decrease in posterior knee pain and opioid consumption when compared to ACB plus SPANK block while providing comparative early in-hospital rehabilitation.


   Abstract ID: ISAP835: Effect of platelet rich plasma in osteoarthritis knee Top


Satyendra Tripathi, Apurva Agarwal, Manoj Chaurasiya, Ashok Verma

Insitute: GSVM Medical College

Back ground & Aims: This study aims to evaluate the effectiveness of intra-articular injection of platelet rich plasma (PRP)in reducing pain and improving physical function, in osteoarthritis.





Method: Prospective longitudinal study comprising of 100 patient& divided into 3groups according to kellgren & lawrence grading of osteoarthritis of knee and followed up for period of 1 year (january18 to october 19). All patient were treated with intraarticular PRP injection(C-arm guided) in affected knee at 4weeks apart. VAS (Visual analog scale), KOOS (knee injury&osteoarthritis outcome score)used for clinical evaluation.Data analysed using SPSS software 22.0.

Result: Demographic characters were matched in all patients. Outcome were almost similar for grade 1&2 though intensity of pain showed significant improvement even in grade3(p<0.05).

Conclusion: PRP injection is a cost effective minimal invasive method& no side effect with high significant improvement in grade1 &2 osteoarthritis and significant improvement in grade 3 osteoarthritis.

REFERENCES:

  1. Patel S, Dhillon MS, Aggarwal S ,Marwaha N, Jain A. Treatment with platelet rich plasma is more effective than placebo for knee osteoarthritis: a prospective ,double blind , randomized trial. Am J Sports Med . 2013 feb;41(2):356 64
  2. Sampson S, Reed M, Silvers H, Meng M, Mandelbaum. Injection of Platelet-Rich Plasma in Patients with primary and secondary knee osteoarthritis : Pilot study. American Journal Physical medicine & rehabilitation 2010;89:961-969



   Abstract ID: ISAP193: Comparative study between radio frequency abalation and percutaneous ballooning in trigeminal neuralgia. Top


Punyashree M, Madivanan M, Rajeev Kumar Dubey, Anil Kumar Paswan .

Background and Aims: Trigeminal neuralgia (TN) is a neuropathic pain condition affecting the face. It has a significant impact on the quality of life and physical function of patient's prevalence of 4 per 100,000 in the general population.1 It commonly affects patients aged over 50 years and occurs more frequently in women than men with a ratio of 1.5:1 to 2:1, respectively. The study aimed to assess effectiveness of percutaneous balloon compression (PBC) and radiofrequency ablation (RFA) in the management of drug resistant idiopathic trigeminal neuralgia.

Methods: The retrospective data in this study belong to 40 patients with idiopathic drug-resistant TN who underwent RFA or PBC for pain management and analyzed from 12 months data

Results: VAS score in both groups are comparable results. Recurrence of pain in the PBC group was comparable to that in the available literature, but the recurrence rate in the RFA group was comparatively higher. The complications in PBC were higher, but they were transient and improved with time.

Conclusion: In patients with drug-resistant idiopathic TN, BC and RFA are effective treatment modalities with comparable results

REFERENCES:

  1. Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124(Pt 12):2347–2360. [PubMed] [Google Scholar]
  2. Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol. 1990;27:89–95. doi: 10.1002/ana.410270114. [PubMed] [CrossRef] [Google Scholar]





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