Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Apr 2018
Comparison of dermatomal sensory block following ultrasound-guided transversus abdominis plane block by the lateral and posterior approaches: A randomized controlled trial.
Ultrasound (US)-guided transversus abdominis plane (TAP) block is used as a part of a multimodal analgesic regimen in the postoperative period. Lateral approach TAP block (LTAP) has been widely used for postoperative analgesia after lower abdominal surgeries. Posterior approach TAP block (PTAP), which is achieved by more posterior blockade of the anterior ramus of the spinal nerve, also provides profound postoperative analgesia after transverse lower abdominal incision. We investigated the dermatomal sensory block following LTAP and PTAP under US guidance. ⋯ PTAP produced a sensory block that involved a greater number of dermatomes and involvement of more cephalad dermatome blocked to sharp touch, compared with LTAP under US guidance.
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J Anaesthesiol Clin Pharmacol · Apr 2018
Dexmedetomidine for prevention of early postoperative catheter-related bladder discomfort in voluntary kidney donors: Prospective, randomized, double-blind, placebo-controlled trial.
Catheter-related bladder discomfort (CRBD) has started to gain recognition as a problem in early postoperative care. Dexmedetomidine reduces bladder contractility via M3 muscarinic receptor antagonism and α-2 receptor agonism, apart from its concomitant therapeutic benefits, such as sedation and sympatholysis, in a postoperative period. We, therefore, evaluated the efficacy of dexmedetomidine in reducing incidence and severity of CRBD. ⋯ Dexmedetomidine 1 μg/kg administered IV to patients 30 min before extubation reduces the incidence and severity of CRBD in early postoperative settings with no adverse effects.
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J Anaesthesiol Clin Pharmacol · Apr 2018
ReviewPharmacogenomics of analgesics in anesthesia practice: A current update of literature.
The field of pharmacogenomics seeks to understand how an individual's unique gene sequence can affect their response to certain drugs. It is particularly relevant in anesthesia when the interindividual response to pain medication is essential. Codeine and tramadol are prodrugs metabolized by CYP2D6, polymorphisms of which can cause dangerous or even fatal levels of their metabolites, or decrease the level of metabolites to decrease their analgesic effect. ⋯ Certain haplotypes of COMT have been demonstrated to have an effect on opioid requirements. The OPRM1 gene codes for the mu-opioid receptor, and there is conflicting data regarding its effect on analgesia and opioid requirements. Overall, there is a fair amount of conflicting data in the above topics, suggesting that there is still a lot of research to be done on these topics, and that pain perception is multifactorial, likely including many common genetic variants.
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J Anaesthesiol Clin Pharmacol · Apr 2018
Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia.
Adductor canal block (ACB) is now an established component of multimodal analgesia for knee replacement surgery and is slowly replacing femoral nerve block (FNB). It is also gaining popularity for providing pain relief in knee arthroscopies including anterior cruciate ligament reconstruction surgery (ACLR). Data is lacking from the Indian subcontinent on comparing ACB to the traditional FNB for ACLR. Hence, we conducted the present study to compare ACB and FNB in ACLR under general anesthesia. ⋯ ACB preserves quadriceps motor strength while providing analgesia comparable to FNB in patients undergoing ACLR. However, patient satisfaction score is better with FNB than ACB.
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J Anaesthesiol Clin Pharmacol · Apr 2018
Comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries.
Dexmedetomidine has been demonstrated to be safe and efficacious in prolonging the duration of peripheral nerve blocks. This study was designed to compare the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries. ⋯ Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects.