European Journal of Cardiovascular Medicine

Purpose: The purpose of the study was to evaluate the postoperative analgesia produced by low-dose Intrathecal Morphine as an adjuvant to 0.5% Hyperbaric Bupivacaine spinal anaesthesia and its side-effect profile in Lower Segment Cesarean patients. Methods: It was a prospective observational study conducted in 150 patients who underwent Cesarean section delivery under general anaesthesia. The duration of the study was one year, and it was conducted in a tertiary care hospital in the UAE. Result: This study included 150 participants. Postoperative VAS pain scores averaged 0.21 in the study population. Low-dose ITM provided postoperative analgesia for all 150 patients. The average 24-hour pruritus score was 0.01.   The study group's mean PONV grade was 1.01.  The first postoperative day was nausea-free for 88% of 132 participants. 149 patients (99.3%) had a respiratory rate exceeding 10/minute. The study population averaged 16.7 breaths per minute.  149 individuals (99.3%) had SpO2 above 92%. The study group averaged 98.1% SpO2. Our patients experienced no respiratory depression. The study group's average MAP was 81 mmHg, 100% of 150 patients had MAP values < 60 mmHg. Conclusion: The study concludes that the addition of 0.075 mg of Intrathecal Morphine is an excellent adjuvant to 12.5 mg of 0.5% Hyperbaric Bupivacaine spinal anaesthesia with the lowest side-effect profile in Lower Segment Cesarean patients for spinal anaesthesia and also recommends the use of I.V Ondansetron 8 mg immediately after spinal anaesthesia as an antiemetic prophylaxis to have a comparatively lower incidence of PONV postoperatively. This prophylactic ondansetron also tends to significantly reduce the frequency of hypotensive episodes which allowed us to use reduced doses of vasopressor infusions as well.

Background: To determine the effect of single dose of intravenous dexamethasone (0.15 mg/kg) given at the time of induction of general anaesthesia for tonsillectomy in paediatric patients on post-operative nausea vomiting, pain and quality of oral intake. Materials And Methods: After ethical committee approval and parental consent, 64 children of ASA physical status I or II, aged 6 –16 years, scheduled for elective tonsillectomy with or without adenoidectomy, were randomly assigned to one of two groups to receive, at the time of induction of anaesthesia, either a single dose of intravenous dexamethasone (0.15 mg/kg) diluted in normal saline to total volume of 5 ml or an equal amount of normal saline. The post-operative pain scores were assessed at different time intervals post-operatively using objective pain scale and visual analogue score. Post-operative nausea and vomiting scores were assessed 30 mins, 3 hours, 6 hours, 12 hours, 24 hours post-operatively using Bellville PONV score. Quality of oral intake was assessed 3 hours post-operatively. Results: The demographic data were comparable between two groups. Post-operative pain scores and post-operative nausea and vomiting scores were significantly less in the dexamethasone group (study group) at different time intervals (p value<0.05). The number of patients who received rescue analgesia in study group and control group were 5 out of 32 and 13 out of 32 respectively (p=0.034). The need of rescue anti emetic in study group and control group were 25% and 46.9% respectively (p=0.048). At 3 hours post operatively, 21.9% in study group and 6.3% in control group had excellent quality of oral intake (p=0.022). Conclusion: Single intravenous dose of 0.15 mg/kg of dexamethasone given following induction of general anaesthesia in paediatric patients undergoing elective tonsillectomy with or without adenoidectomy reduces incidence of post-operative nausea and vomiting, provides better and prolonged post-operative pain relief and results in better quality of oral intake without side effects.

Background:   In modern era of medical science, patients’ post-anaesthesia recovery has improved mainly because of better monitoring, measures taken intra-operatively to avoid post-operative complications, and better immediate post-anaesthesia care. The present study aimed to know the incidence of postoperative nausea and vomiting, hypothermia and worst pain score in post-surgical patients in recovery room. Materials and Methods: This study was carried out after approval from institutional review board. This is a prospective observational study, conducted on the post-operative patients in the post anaesthesia recovery room in Tata Memorial Hospital, Mumbai for a period of two months. Data was collected from 1,007 patients out of 1,191 elective surgical procedures carried out. Incidence of postoperative nausea and vomiting (PONV), postoperative pain and hypothermia were assessed in the post-operative recovery room. Result: With the cut off value of 35°C, the incidence of hypothermia at ICU admission was 31.4%. There was significant correlation between duration of anaesthesia and hypothermia (p=0.04). Incidence of hypothermia in surface surgeries i.e. breast, head and neck, bone and soft tissue services was 26.3% (162/617) and in cavity surgeries i.e. gastrointestinal, genitourinary, gynaecology and thoracic surgeries was 39.5% (154/390) and in children <12 years was 35.5% (11/31). 6.6% of patients (66/1007) had nausea and 2% (20/1007) had vomiting on ICU admission. There is also no correlation between severe nausea and vomiting with the use of intraoperative antiemetic, duration of anaesthesia. 9.8 % (99/1007) had moderate to severe pain on admission to ICU, 12.1 % (122/1007) after one hour of admission and 2% had severe pain during ICU stay. There was no significant correlation between intra- operative analgesia and post-operative pain score. The study didn’t find any correlation with hypothermia, PONV and worst pain increasing the duration of ICU or hospital stay or affecting the outcome as the p value was >0.05. Conclusion: Incidence of hypothermia in ours study is similar as compared to previous studies. The incidence of severe pain is similar in cancer patients but lower than the patients undergoing general surgical procedures. Rate of re-admission and PONV in a post-surgical patient is very low in our ICU compared to other studies. We need to take further steps in improving the temperature monitoring, to control severe postoperative pain and PONV. Despite of pharmacological advances and known risk factors the incidences of postoperative complications is still higher.

Background: Following pain, Postoperative nausea and Vomiting (PONV) is most frequent complaint in the postoperative period. Currently various 5HT3 receptor Antagonists used widely in the prevention and treatment of PONV. Second generation 5HT3 receptor  palonosetron¹¹ is new Drug in the market and we would like to compare it with  most commonly used 5HT3 receptor Antagonists Ondansetron. Materials And Methods: This prospective, randomized, double- blind study was conducted over a period of one year at Subbaiah Institute of Medical Sciences, Shimoga. 80 patients belonging to ASA 1 and 2, admitted for elective laparoscopic gynecological surgeries under General anesthesia, were randomized into 2 groups. Group O received 4mg Ondansetron and Group P received 75 mcg Palonosetron prior to induction of anesthesia. Incidence of the occurrences of nausea, retching, and vomiting were observed and  was  recorded at time interval between 0-2^nd  ,2^nd -6^th hrs  and 6^th  -24 hrs in the post operative period. Need for rescue drug, side effects of the study medicine were also observed. The statistical analysis was done by using SPSS version 25.0. Discrete data between the two groups were compared with Student T test. Result: During the time interval between 0-2 hrs 27.5% patients in group O had nausea where as 25% patients experienced nausea in group P which is not statistically significant as p value is 0.799. During the time interval between 2- 6 hours 42.5% in group O had nausea where as in group P 17.5% experienced nausea and it was statistically significant(P<.015). From 6- 24 hrs 35% in group O and 5% in group P had nausea and this difference was (p value 0.001) statistically significant. Conclusion: After analysing the results from our study, we conclude that Palonosetron 75 mcg is more efficacious than Ondansetron 4 mg in preventing PONV in patients undergoing laparoscopic gynecological surgeries.

Postoperative nausea and vomiting (PONV) is a common complication affecting patients undergoing surgery, with significant implications for recovery and patient satisfaction. This study aimed to investigate the incidence, risk factors, and management strategies for PONV among patients undergoing general anesthesia at SRM Medical College Hospital, Bhawanipatna, Odisha. A retrospective cohort study was conducted involving 130 patients who underwent various surgical procedures. Data on demographic factors, surgical details, anesthetic techniques, and incidence of PONV were collected from medical records. The overall incidence of PONV was found to be 30.8%, with mild, moderate, and severe cases observed in 37.5%, 50.0%, and 12.5% of affected patients, respectively. Significant predictors of PONV included a history of motion sickness (OR 2.5, 95% CI 1.1-5.7, p=0.028), previous PONV episodes (OR 3.2, 95% CI 1.5-6.9, p=0.012), laparoscopic procedures (OR 2.1, 95% CI 1.0-4.4, p=0.041), longer surgery durations (OR 1.8, 95% CI 1.2-2.6, p=0.006), and the use of volatile anesthetics (OR 2.5, 95% CI 1.3-4.8, p=0.007) and opioids (OR 1.9, 95% CI 1.1-3.4, p=0.024). Prophylactic antiemetics were partially effective, with a 25% incidence rate despite widespread use (76.9%). These findings underscore the need for tailored perioperative care strategies to minimize PONV and improve patient outcomes.

Background: Postoperative nausea and vomiting (PONV) significantly affect patient recovery following general anesthesia, particularly in breast surgery patients. Objective: To compare the effects of sugammadex versus neostigmine–glycopyrrolate on PONV incidence and severity in patients undergoing breast surgery under general anesthesia. Method: In this double-blind randomized controlled trial at Indira Gandhi Institute of Medical Sciences, 84 eligible breast surgery patients were randomly assigned to two groups receiving either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg) with glycopyrrolate (0.01 mg/kg) for neuromuscular blockade reversal. PONV was assessed at defined intervals post-extubation using a 4-point scale over 12 hours. Data on PONV episodes, need for rescue antiemetics, and adverse events were collected and statistically analyzed using mean ± standard deviation (SD), percentages, and p-values. Result: The sugammadex group demonstrated a significantly lower PONV incidence of 15% ± 4.2 compared to 35% ± 5.1 in the neostigmine group. The mean PONV scores were 0.8 ± 0.4 for sugammadex versus 1.5 ± 0.6 for neostigmine. The requirement for rescue antiemetics was 10% in the sugammadex group versus 28% in the neostigmine group. Statistical analysis revealed this reduction was significant (p=0.03). Calculations showed a relative risk reduction of 57% with sugammadex, supported by a 95% confidence interval. The standard deviation values indicate consistent performance within each group, reinforcing the robustness of the findings. Conclusion: Sugammadex substantially reduces the incidence and severity of PONV compared to neostigmine–glycopyrrolate, suggesting its preferable use in breast surgery patients.

Introduction: Its widely known that sensory blockade of the brachial plexus with local anaesthetics for perioperative analgesia leads to stable haemodynamics intraoperatively, smoother emergence from general anaesthesia and decreased need for supplemental analgesics or suppositories in the Post-operative period. The current study aimed at determining the efficacy of dexamethasone as an adjuvant to bupivacaine for Post-operative analgesia following sensory blockade of the brachial plexus in children. Materials and Methods: The study was divided into two groups of 30 each, group BD receiving dexamethasone (0.1mg/kg) as an adjunct to bupivacaine 0.125% and group B receiving bupivacaine alone. The duration of analgesia was taken as time from completion of the block to the patient receiving rescue analgesia, the haemodynamics were measured until 180 minutes after surgery, the incidence of Post-operative Nausea and Vomiting (PONV) was measured. Results: The duration of analgesia in the group BD was 26.1±12.4 hours and was significantly higher as compared to the group B, in which it was 12.9±10.3 hours (p<0.05). The pulse rate measured Post-operatively between both groups at 20 minutes (p-value 0.534), 60 minutes (p-value 0.788), 120 minutes (p-value 0.804) and 180 minutes (p-value 0.428) showed no statistical significance. Likewise, the mean blood pressure measured between the two groups at 20 minutes, 60 minutes, 120 minutes and 180 minutes Post-operatively showed no significance. There was no significant difference in incidence of PONV in both groups with p-value of 0.524. Conclusion: Dexamethasone as an adjuvant to local anaesthetic in brachial plexus blocks significantly, prolongs duration of analgesia in children undergoing upper limb surgeries.

Background: The perioperative period is critical in the long-term prognosis of breast cancer patients. The use of regional anesthesia, such as paravertebral block (PVB), could be associated with improvements in long-term survival after breast cancer surgery by modulating the inflammatory and immune response associated with the surgical trauma, reducing opioid and general anesthetic consumption, and promoting cancer cells death by a direct effect of local anesthetics. Methods: A systematic literature search was conducted for studies of patients who received PVB for breast cancer surgery. The Jadad score and Ottawa-Newcastle scale were used to assess the methodological quality of randomized controlled trial and observational retrospective studies, respectively. Only high-quality studies were considered for meta-analysis. The selected studies were divided into 3 groups to determine the impact of PVB on (a) recurrence and survival, (b) humoral response, and (c) cellular immune response. Results: We identified 100 relevant studies. The main outcome was  to compare opioid consumption at the first 24 h after surgery. For secondary objectives, we aimed to compare pain scores after surgery, intraoperative opioid consumption, the incidence of PONV and block-related adverse events. Conclusions: Our study indicates that there are no data to support or refute the use of REGIONAL BLOCKS for reduction of cancer recurrence or improvement in cancer-related survival. However, its use is associated with lower levels of inflammation and a better immune response in comparison with general anesthesia and opioid-based analgesia.

Aim: In this study, we aim to examine the efficacy of supra-inguinal FIB compared to anterior QLB in the management of postoperative pain in patients undergoing open hip surgeries. Materials and methods: This was a randomised prospective study conducted in Department of Anesthesia for a period of one year in 80 patients posted for hip surgeries done under subarachnoid block. All male and female of age between 40-60 years scheduled for open hip surgeries with ASA status I-III are included in study. Assessment of VAS score during patient positioning for neuraxial blockade, VAS score, nausea and vomiting, patient satisfaction in postoperative period were noted. Results: The total morphine consumption in 24 hours was significantly lower in the group receiving supra-inguinal F with a mean consumption of morphine 5.8 ± 0.8 mg compared to 7.2 ± 1.91 mg which is significant. The VAS during positioning the patient showed a significant difference between the groups, 3.9 ± 2.6 in the supra-inguinal F compared to 5.3 ± 2.7 in the anterior Q group which is significant. Patients receiving F had better perioperative analgesia profiles overall, patient satisfaction showed no significant difference between groups. Side effects including respiratory depression and itching were not reported in either group, and PONV scores were not significantly different between groups. Conclusions: Supra-inguinal Group-F provides prolonged postoperative analgesia compared to anterior Group Q in patients undergoing hip surgery.

Background: Pain after thyroid surgery is typically of moderate intensity and short duration. NSAIDs may be ineffective for adequate analgesia and increase post-operative bleeding risk. Opioid analgesics cause postoperative nausea, vomiting and postoperative respiratory depression. The block offers effective preemptive analgesia for thyroid surgeries perioperatively. OBJECTIVE: To compare the postoperative analgesic efficacy in Ultrasound v/s Landmark technique for bilateral superficial cervical plexus block. METHODS: After ethical committee approval, double-blind clinical study was conducted on 46 Patients aged 18 to 65 years, ASA I & II, undergoing elective thyroid surgery after meeting inclusion and exclusion criteria. Study Drug: Inj. 0.25% Bupivacaine 12ml + 2mg Dexamethasone on each side- total volume 25ml. Group A- Ultrasound ultrasound-guided superficial cervical plexus block (n=23). Group B- Landmark-guided superficial cervical plexus block (n=23). Intra-op hemodynamics, time of rescue analgesia, nausea, vomiting, pain while swallowing, and patient’s vital parameters like HR, SBP, DBP, MBP noted at induction, incision, end of resection, extubation and VAS scores at 0,2,4,8, 12,16,20,24 hours. CONCLUSION :The study concluded that Ultrasound-guided bilateral superficial cervical plexus blocks resulted in lower VAS scores, reduced need for additional analgesics, more stable intra-operative haemodynamics, and lower incidence of PONV compared to Landmark technique.

Background: Postoperative nausea and vomiting (PONV) are among the most common complaints that can occur after general anaesthesia.¹ PONV is defined as any nausea, retching or vomiting that occurs within first 24 hours postoperatively.² Nausea is a subjective unpleasant sensation which is associated with awareness of the urge to vomit.¹ Retching is defined as rhythmic and spasmodic contraction of respiratory muscles like diaphragm, chest wall muscles and abdominal muscles without expulsion of any gastric contents.¹ Vomiting is defined as forceful expulsion of gastric contents through mouth which is brought about by powerful and sustained contraction of abdominal muscles, opening of the gastric cardia and descent of diaphragm.¹ Corticosteroids like dexamethasone has shown to have a potent antiemetic activity. The first trial which suggested the role of dexamethasone in preventing PONV was published in 1993. The precise mechanism of antiemetic efficacy is still unknown. A common theory is prostaglandin antagonism. It may also inhibit the synthesis and release of 5-HT by depleting its precursor tryptophan or prevent the activation of its receptors in gastrointestinal tract through its anti-inflammatory properties. Moreover, it also releases endorphins and synergizes with other antiemetic drugs by sensitizing their receptors.³ Dexmedetomidine is highly selective alpha-2 receptor agonist. It is having sympatholytic, sedative, analgesic and opioid sparing properties. Intravenous dexmedetomidine also has 4 efficacies in improving perioperative hemodynamic stability and postoperative analgesia. It decreases the incidence of PONV by various mechanisms. It decreases the intraoperative consumption of anaesthetics and opioids, which decreases the risk of PONV. PONV may be triggered by high catecholamines concentration and dexmedetomidine decreases the sympathetic tone, so it decreases the risk of PONV. It also has direct antiemetic effect by activating the alpha-2 receptors. Minor side effects like hypotension and bradycardia can occur with dexmedetomidine. It has been widely studied in patients undergoing laparoscopic surgeries for premedication, anaesthetic adjuvant, attenuation of hemodynamic response to pneumoperitoneum, prevention of postoperative side effects like PONV, shivering and pain. Methods The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, randomised double blinded manner after obtaining approval from the institutional ethical committee and patient’s written, informed consent. From April 2021 – May 2022, the study included 70 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists (ASA) physical status of I-II with scheduled for elective laparoscopic cholecystectomy under general anaesthesia. Results The incidence of post operative nausea and vomiting was found to be statistically comparable between two groups except at 12h after the surgery. The patients who received dexmedetomidine reported no incidence of PONV after 12 and 24 hours of surgery while 11.4% and 8.6% of patients who received dexamethasone experienced nausea and vomiting. 7) The severity of post operative nausea and vomiting was found to statistically comparable between two groups except at 6h after the surgery. Patients who received dexamethasone experienced more severe PONV at 6 h after the surgery than who received dexmedetomidine.  Conclusion We conclude that dexmedetomidine 1 µg/kg given intravenously over 10 minutes after induction of anaesthesia and before skin incision prevent the postoperative nausea and vomiting similar to the 8 mg dexamethasone given intravenously after induction and before skin incision in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Dexmedetomidine is superior than dexamethasone in preventing PONV at 12 and 24 h of the surgery, decreasing the severity of PONV at 6 hours of the surgery, relieving early postoperative pain, maintaining the intraoperative hemodynamic stability and a smooth recovery from the anaesthesia.