ISA JAIPUR NATIONAL AWARDS

AIRWAY

ABS0078

Evaluation of ultrasonography-guided indices to assess difficult airway in obese patients: A prospective observational study

Chhavi Goel, Rajat Garg, Lokvendra Singh Budania

Kalpana Chawla Government Medical College, Karnal

Email: drchhavigoel@gmail.com

Background and Aims: Ultrasonography has extended itself into airway assessment.^[1,2] This study assessed the ultrasonography (USG) indices for predicting airway difficulties in obese patients and associated them with clinical parameters (Cormack- Lehane grades).

Methods: This prospective observational research was done over four months. Eight ultrasound parameters, namely skin-to-hyoid distance, tongue thickness, skin-to-midpoint of vocal cords, pre-epiglottic space, skin-to-thyroid isthmus, hyomental distance, anterior soft tissue thickness at the suprasternal notch and thyromental distance were related to clinical assessment.

Results: Out of the 40 cases examined, 29 airways were predicted to be challenging during an ultrasound examination, and 19 were found challenging during clinical intubation [Table 1].

Table 1.

Comparison of ultrasonographic indices (cut-off, specificity, sensitivity) with previous studies

Parameters observed	Study cut-off (cm)	Previous studies cut-off mean (standard deviation) (cm)	Easy Intubation (n)	Difficult intubation (n)	Specificity (%)	Sensitivity (%)
Tongue thickness	4.48	6.2	12	22	45.5	88.6
Skin to hyoid	0.29	1.38 (0.17)	14	20	65.6	48
Skin to mid-point of vocal cords	1.46	1.24 (0.12)	13	21	60.3	89.6
Pre-epiglottic space	0.56	0.87 (0.17)	17	18	74.2	77
Anterior soft tissue thickness at suprasternal notch	1.23	1.26 (0.28)	13	23	60.3	88.7
Skin to thyroid isthmus	0.65	1.07 (0.28)	25	9	78	14.7
Thyromental distance	7.2	6.4	21	15	61.4	80
Hyomental distance	7.24	5.12 (0.48)	17	18	61.5	65.7

Conclusion: Ultrasonography measurements of skin to the midpoint of vocal cords, anterior soft tissue thickness at suprasternal notch, pre-epiglottic space, hyomental distance in mid-extended position, and thyromental distance were found to be clinically correlated with difficult intubation in obese patients.

Keywords: Airway difficulties, airway indices, ultrasonography

References:

1. Singh S, Ohri R, Singh K, Singh M, Bansal P. Comparison of Different Ultrasound Parameters for Airway Assessment in Patients Undergoing Surgery under General Anaesthesia. Turkish J Anaesth Reanim 2021; 49: 394-9.

2. Yadav U, Singh RB, Chaudhari S, Srivastava S. Comparative study of preoperative airway assessment by conventional clinical predictors and ultrasound-assisted predictors. Anesth Essays Res 2020;14:213-8.

ABS0151

Haemodynamic changes using video laryngoscope versus Macintosh direct laryngoscope during oral endotracheal intubation in controlled hypertensive patients: A randomised interventional study

Ram Kishan Vyas, Sunita Meena, Mamta Sharma, Anupama Gupta

SMS Medical College, Jaipur

Email: ram.nokha1990@gmail.com

Background and Aims: Hypertensive patients demonstrate a relatively more significant rise in catecholamine concentration and increased sensitivity during laryngoscopy and endotracheal intubation.^[1,2] This study aimed to compare the haemodynamic changes using a video laryngoscope versus a Macintosh direct laryngoscope during endotracheal intubation.

Methods: This prospective randomised interventional study was conducted on 140 well-controlled hypertensive patients of either gender, aged 30-60 years of American Society of Anesthesiologists physical status ll, who were randomly allocated into two groups (70 in each group). In group A, ClearVue®video laryngoscope(CVL) was used to visualise the larynx for endotracheal intubation, and in group B, Macintosh direct laryngoscope(MDL) was utilised. Statistical analysis was performed using the Chi-square test and Fisher’s exact test. A P value ≤ 0.05 was taken as statistically significant.

Results: There was a statistically significant increase in systolic, diastolic and mean blood pressures at intubation (P<0.001), 1 min (P<0.001), 2 min (P<0.001), and 3 min (P<0.001) after intubation in the MDL group as compared to CVL group. The time to intubate was significantly greater in the CVL group [44.51 (16.62 s] as compared to the MDL group [32.73 (10.79 s] (P<0.001). There was no significant difference in the incidence of intraoperative and postoperative airway complications.

Conclusion: The choice between video laryngoscopes and Macintosh direct laryngoscopes can impact haemodynamic changes during oral endotracheal intubation in controlled hypertensive patients. Video laryngoscopes offer advantages in improved glottic visualisation, potentially reduced manipulation, and fewer haemodynamic changes.

Keywords: Endotracheal intubation, direct laryngoscopy, haemodynamic, videolaryngoscopy

References:

1. Nishiyama T, Higashizawa T, Bito H, Konishi A, Sakai T. Which laryngoscope is the most stressful in laryngoscopy: Macintosh, Miller, or McCoy? Masui 1997;46:1519–24.

2. Xue FS, Zhang GH, Li XY, Sun HT, Li P, Li CW, et al. Comparison of hemodynamic responses to orotracheal intubation with the Glidescope video laryngoscope and the Macintosh direct laryngoscope. J Clin Anesth 2007; 19: 245–50.

ABS0273

Miller and Macintosh blade for laryngoscopy in adult patients: A randomised cross-over trial of

Chandhana V, Santhosh MCB, Shivakumar G

Mandya Institute of Medical Sciences, Mandya

Email: chandana.v09@gmail.com

Background and Aims: Optimal laryngoscopy should provide a good view of the glottis and room to pass the tracheal tube easily.^[1,2] This study aimed to compare the laryngoscopic view and ease of tracheal intubation between Miller and Macintosh blades in adults.

Methods: This randomised cross-over trial included 60 patients (30 in each group) who received general anaesthesia for elective surgical procedures and had no comorbidities. Clearance was obtained from the institutional ethics committee. Group I had laryngoscopy and intubation, first with Miller, then with Macintosh blade in the same patient. Group II had laryngoscopy and intubation, first with Macintosh, then with Miller blade. The laryngeal view was assessed based on Cormack-Lehane grading. Ease of intubation was evaluated according to the following grades: 1- easy; 2- assistance to pull right corner of mouth; 3- multiple attempts and stylet; 4- failed intubation.

Results: Miller blade showed Cormack-Lehane grade 1 laryngoscopic view in 93.3% of patients compared to 53.3% in Macintosh blade (P< 0.05, Figure 1). Concerning ease of intubation, no significant association was found between the two blades (P>0.05, Figure 2).

Figure 1.

Comparison of Cormack-Lehane grade with two Laryngoscopes

Figure 2.

Comparison of ease of intubation with two laryngoscopes

Conclusion: Our study found that the Miller blade provides a better laryngoscopic view than the Macintosh blade in adult patients.

Keywords: Cormack and Lehane grading, Macintosh blade, Miller blade

References:

1. Nalini KB, Gopal A, Iyer SS, Chanappa NM. A Comparative Crossover Randomized Study of Miller and Macintosh Blade for Laryngoscopic View and Ease of Intubating Conditions in Adults. Archives of Anesthesiology and Critical Care 2021;7:58-62.

2. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105–11

ABS0353

Fibreoptic intubation using i-gel® versus Ambu AuraGain: A randomised study.

Smrutirani Mund, Malaya Kumar Patel, Sapan Jena

VIMSAR, Burla

Email: smrutiranimund22@gmail.com

Background and Aims: Difficult airways can be managed by supraglottic devices(SAD), video laryngoscopes, fibreoptic bronchoscope surgical methods, etc.^[1,2] In our study, we compared fibreoptic intubation through i-gel® and Ambu AuraGain.

Methods: This study randomly allocated 90 patients of 18-65 years, American Society of Anesthesiologists physical status I and II, and Mallampati grades I and II (45 in each group). After general anaesthesia, the airway was secured with i-gel® and Ambu AuraGain sizes 3 and 4, per the group and patient profile. Fibreoptic intubation was performed using a 6.5 mm or 7 mm internal diameter sized endotracheal tube through size 3 and size 4 SAD, respectively. The primary outcome measure was to determine success rates and time for ETT insertion in terms of SAD insertion time and intubation time, and secondary outcomes were the number of attempts, haemodynamic changes and any complications.

Results: The mean time (in seconds) for ETT insertion through Ambu AuraGain was 18.58 ± 4.27, and through i-gel was 26.80 ± 2.25. SAD insertion time was comparable in both groups[Figure 1]. The first attempt success rate was 40/45 in group A and 30/45 in group G. All baseline parameters were comparable(P> 0.05). Minor complications were comparable, and no significant complications were seen in any patients of either group.

Figure 1.

Comparison of insertion and intubation times in seconds.

Conclusion: Fibreoptic intubation through Ambu AuraGain is better than i-gel® regarding intubation time and the number of attempts.

Keywords: Ambu AuraGain, fibreoptic intubation, supraglottic airway devices

References:

1. Mihara T, Asakura A, Owada G, Yokoi A, Ka K, Goto T. A network meta-analysis of the clinical properties of various types of supraglottic airway device in children. Anaesthesia 2017; 72: 1251-64.

2. Myatra SN, Ahmed SM, Kundra P, Garg R, Ramkumar V, Patwa A, et al. The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit. Indian J Anaesth 2016;60:922-930.

ABS0448

Prediction of difficult laryngoscopy by ultrasound-guided quantification of anterior cervical soft tissue and its correlation with Cormack-Lehane classification in adults: A prospective cross-sectional study

Ankit Srivastava, Gokul Prasath A, Sunil Kumar Arya, Shahbaz Ahmad

BRD Medical College, Gorakhpur.

Email: ankgeneration33@gmail.com

Background and Aims: Ultrasound can measure anterior soft tissue thickness to anticipate a difficult airway.^[1,2] This study aimed to find the correlation between preoperative sonographic airway assessment parameters and Cormack-Lehane (CL) grade at laryngoscopic view in adults.

Methods: After approval from the ethics committee and informed written consent from patients, the proposed prospective cross-sectional study was conducted on 150 patients, aged 18-65 years, of American Society of Anesthesiologists physical status I and II, undergoing elective procedures requiring endotracheal intubation. A detailed preoperative airway assessment (mouth opening, neck movements, modified Mallampati class, thyromental distance, etc) was done. Ultrasonographic evaluation of anterior neck soft tissue thickness was done using Sonosite Edge II in the preoperative area and correlated with Cormack Lehane grade at the laryngoscopic view. The intubation difficulty score was calculated for various CL grades.

Results: All three ultrasonographic parameters in the present study had a significant association with the CL grade (P<0.001), and among them, DSAC (anterior neck soft tissue thickness at the level of anterior commissure of vocal cords) had the highest sensitivity (93.7%) in predicting difficult laryngoscopy and intubation. The mean intubation difficulty scale (IDS) was progressively increasing with increasing CL grade (P<0.001)[Figures 1, 2]. The mean intubation duration (s) was progressively increased with increasing CL grade (P<0.001).

Figure 1.

Comparison of mean intubation difficulty scale (IDS) between the Cormack-Lehane (CL) Grades

Figure 2.

Comparison of the mean distance from skin to anterior commissure of vocal cords (DSAC) between the Cormack-Lehane (CL) grades

Conclusion: Ultrasonography can predict difficult airways by measuring the thickness of the soft tissue in the anterior neck. An increase in the DSAC(anterior commissure of vocal cords) correlates with increasing intubation difficulty.

Keywords: Cormack-Lehane, laryngoscopy, ultrasonography

References:

1. Singh S, Ohri R, Singh K, Singh M, Bansal P. Comparison of different ultrasound parameters for Airway Assessment in patients undergoing surgery under General Anaesthesia. Turk J Anaesthesiol Reanim 2021;49:394-400.

2. Srinivasarangan M, Akkamahadevi P, Balkal VC, Javali RH. Diagnostic accuracy of ultrasound measurements of anterior neck soft tissue in determining a difficult airway. J Emerg Trauma Shock 2021;14:33.

ABS0522

Effect of preoperative continuous positive airway pressure administration in reducing perioperative hypoxic events in patients with obstructive sleep apnoea: A randomised prospective controlled study

Akshitha Jayakumar, Srinivas HT, Archana KN, Arjun BT

JSS Academy Of Higher Education And Research, Mysuru.

Email: dr.akshithajk@gmail.com

Background and Aims: Obstructive sleep apnoea (OSA) with its concurrent comorbidities is associated with increased peri-operative cardiopulmonary morbidity. Continuous positive airway pressure (CPAP) has been beneficial in treating OSA.^[1,2]This study evaluated the effect of pre-emptive preoperative CPAP in undiagnosed OSA patients in reducing the incidence of perioperative hypoxic events.

Methods: Sixty American Society of Anesthesiologists physical status I/II patients posted for elective surgeries under general anaesthesia with STOP-BANG SCORE ≥ 3 were selected for the prospective control study. Patients were randomly allocated into two groups of thirty each. Group 1 was administered CPAP in the preoperative room for thirty minutes using a Phillips Dreamstation Auto-CPAP machine at 10cmH₂O via face mask, while group 2 was not administered CPAP. Oxygen saturation(SpO₂), heart rate, blood pressure, and end-tidal-carbon dioxide were monitored and compared between the two groups perioperatively for up to twenty-four hours. Any fall in saturation of more than 5% from baseline or values less than 90% for ten seconds was considered a hypoxic event.

Results: Oxygen saturation was significantly higher in the CPAP group than in the non-CPAP group during intubation. (Mean SpO₂: CPAP group-96.43±1.61, non-CPAP group-94.4±3.26, P value: 0.008) None of the CPAP patients developed hypoxaemia, but five patients of the non-CPAP group had hypoxic events within the first ten minutes of extubation (Mean SpO₂, CPAP: 97.9±1.2, non-CPAP: 95.6±5.67, P value:0.0463), with one patient requiring re-intubation [Table 1]. The number of hypoxic events in the non-CPAP group was statistically significant (P value: 0.0172). No significant haemodynamic differences were observed.

Table 1.

Comparison between the groups

	CPAP	Non-CPAP	P
Intubation difficulty scale score	4.23±1.36	4.16±1.23	0.855
Need for a second attempt for intubation	6 (20%)	6 (20%)	1
Mean intubation time (s)	25±6.4	24±6.0	0.549
Mean SpO2 (%)
During intubation	96.8±1.74	95.13±3.25	0.029
Intraoperative	98.75±0.85	98.34±1.42	0.543
After extubation	97.9±1.21	95.6±5.67	0.046
Post anaesthesia care unit (PACU) for 24 h	97.41±1.05	97.31±1.72	0.310
Hypoxic events
During intubation	1 (3.33%)	6 (20%)	0.0444
Intraoperative	0	0	1
After extubation	0	5 (16.67%)	0.0195
PACU till 24 h	0	0
Reintubation	0	1 (3.33%)
End-tidal carbon dioxide (mmHg)
Intubation-5 min	35.03±2.68	37.36±3.3	0.0083
Intraoperative	34.92±0.99	35.51±2.19	0.288
Heart rate (per min)
Intraoperative	83.07±5.97	83.24±5.06	0.405
Postoperative	84.42±4.87	8.07±5.11	0.382
Mean arterial pressures (mmHg)
Intraoperative	97.22±4.117	97.50±4.39	0.576
Postoperative	96.47±3.36	95.52±4.78	0.384

CPAP: Continuous positive airway pressure; SpO₂: peripheral oxygen saturation

Conclusion: The implementation of risk stratification of obese and overweight patients using the STOP-BANG Questionnaire, along with supplementation of CPAP preoperatively to high-risk patients, can help in the prevention of perioperative hypoxic events.

Keywords: Continuous positive airway pressure, obstructive sleep apnoea, oxygen saturation

References:

1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006–14.

2. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population review on the epidemiology of sleep apnea. J Thorac Dis 2015;7:1311–22.

ABS0549

Applicability of Cameron Tracheostomy Scoring System for oral cancer patients undergoing surgery.

Dwideep Chandra P, Rajesh HC, Vishal Rao

Comtrust Charitable Trust Eye Hospital.

Email: dr.dwideep@comtrustacademy.edu.in

Background and Aims: Oral cancer ranks as the eleventh most prevalent cancer worldwide, with a significant burden in the Indian subcontinent.^[1,2] This study aimed to retrospectively analyse the airway management and factors influencing elective tracheostomy decisions in oral cancer patients.

Methods: The study was conducted after receiving ethical clearance from the institutional ethics committee. Phase I involved 93 patients who underwent elective resection of oral cavity tumours for retrospective analysis using the Cameron scoring system. In phase II, 57 patients with American Society of Anesthesiologists physical status I, II, or III undergoing the same procedure were included after applying inclusion and exclusion criteria.

Results: Airway difficulty was assessed using parameters like neck extension, mouth opening, Mallampati, and Cormack-Lehane (CL) grading. Around 87.3% had adequate neck extension, 82.7% had adequate mouth opening, and 54.7% had a difficult airway, marked by Mallampati scoring of 3 or 4. CL grading showed that 19.3% had a difficult direct laryngoscopic airway. Tracheostomy decisions were based on clinical judgment rather than scoring systems. About 74% of patients had their airway secured by direct laryngoscopy, with additional aids used in a minority of cases. Surgical factors such as mandibulectomy, glossectomy, neck dissection, and reconstruction influenced airway management decisions. Elective tracheostomy was performed in 10% of cases, with longer intensive care units and hospital stays. Cameron’s score did not correlate with this study’s decision to perform elective tracheostomy. An ideal cutoff score of ≥8 was suggested for Indian patients based on postoperative complications.

Conclusion: The Cameron tracheostomy score may need modification for the local context. An ideal cutoff score of ≥8 was proposed for elective tracheostomy decisions in Indian patients.

Keywords: Airway management, Cameron score, oral cancer, tracheostomy

References:

1. Ong S-K, Morton RP, Kolbe J, Whitlock RML, McIvor NP. Pulmonary complications following major head and neck surgery with tracheostomy: A prospective, randomised, controlled trial of prophylactic antibiotics. Arch Otolaryngol Head Neck Surg 2004;130:1084– 1087.

2. Kruse-Lösler B, Langer E, Reich A, Joos U, Kleinheinz J. Score system for elective tracheotomy in major head and neck tumour surgery. Acta Anaesthesiol Scand 2005;49:654- 9.

ABS0605

Comparative study of the efficacy of intratracheal dexmedetomidine and ropivacaine with intratracheal budesonide and ropivacaine in reducing incidence and severity of postoperative sore throat after general anaesthesia: A prospective double-blinded randomised control trial

Harsh, Bibha Kumari

Indira Gandhi Institute of Medical Sciences

Email: drharshpatna@gmail.com

Background and Aims: Postoperative sore throat (POST) is common after extubation.^[1,2] This study compared the incidence of POST between group D (dexmedetomidine and ropivacaine) and group B (budesonide and ropivacaine).

Methods: One hundred and thirty-two patients were enroled in the study, evenly distributed in two groups, 66 in group D and 66 in group B, allocated according to a generated random number table, keeping the anaesthetist and recorder unaware of the patient’s group. Following three minutes of positive pressure ventilation, all patients received 7ml of medication applied to the glottis. The study recorded changes in intraoperative haemodynamics at various time points. The severity of POST and haemodynamic changes were also monitored at specific intervals, including 0 hours, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours after extubation.

Results: Group D exhibited a significantly lower overall sore throat incidence than group B, particularly at ‘0h’ (13.63% versus 30.30%, P=0.034, Table 1). The severity of sore throat in group D at ‘0 h’ was notably milder (66.67% grade 1, 33.3% grade 2), contrasting with group B’s distribution (30% grade 1, 50% grade 2, 20% grade 3) with statistical significance (P=0.024, Table 2). Additionally, the severity score differences persisted at 2h and 4h (P=0.001 and P=0.034, respectively).

Table 1.

Incidence of postoperative sore throat in the groups

Time	Group D (n=66)	Group B (n=66)	P
0 h	9 (13.6%)	20 (30.3%)	0.034
2 h	9 (13.6%)	18 (27.3%)	0.083
4 h	8 (12.1%)	13 (19.7%)	0.341
6 h	7 (10.6%)	9 (13.6%)	0.791
12 h	6 (9.1%)	8 (12.1%)	0.778
24 h	6 (9.1%)	7 (10.6%)	1.000

Table 2.

Severity of postoperative sore throat in the groups

Time	Grades	Group D	Group B	P
0 h	0	57	46	0.024
	1	6	6
	2	3	10
	3	0	4
2 h	0	57	48	0.001
	1	9	5
	2	0	10
	3	0	3
4 h	0	58	53	0.034
	1	8	6
	2	0	5
	3	0	1
6 h	0	59	57	0.140
	1	7	5
	2	0	4
12 h	0	60	58	0.778
	1	6	8
24 h	0	60	59	1.000
	1	6	7

Conclusion: Dexmedetomidine and ropivacaine decreased the incidence and severity of postoperative sore throat compared to budesonide and ropivacaine at all intervals, with significant results at 0 h, 2 h, and 4 h.

Keywords: Dexmedetomidine, intratracheal, postoperative sore throat

References:

1. Niu J, Hu R, Yang N, He Y, Sun H, Ning R, et al. Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial. BMC Anesthesiol 2022;22:144.

2. Thomas D, Bejoy R, Zabrin N, Beevi S. Preoperative ketamine nebulisation attenuates the incidence and severity of postoperative sore throat: A randomized controlled clinical trial. Saudi J Anaesth 2018;12:440-445.

ABS0931

Comparative efficacy of NO-DESAT and THRIVE for peri-oxygenation in patients with anticipated difficult airway: A prospective randomised study

Rajit Kemprai, Rashmi Salhotra, RS Rautela, Ruchi Kapoor

UCMS and GTB Hospital, Delhi.

Email: rajkemp21@gmail.com

Background and Aims: Perioxygenation is advised to increase the apnea interval in difficult airway situations.^[1,2] This study compares the efficacy of preoxygenation with a simple nasal cannula (NO-DESAT) with a high-flow nasal cannula (THRIVE) in adult patients with anticipated difficult airways.

Methods: This prospective randomised study was conducted after written informed consent and approval from the institutional ethics committee. Forty American Society of Anesthesiologists physical status I/II/III adult patients with anticipated difficult airways and required general anaesthesia for surgical procedures were randomly allocated to two groups. Group N received preoxygenation with a facemask and nasal oxygen through a simple nasal cannula(NO-DESAT), while group T received peri-oxygenation with THRIVE. Arterial blood gas samples were drawn before and after pre-oxygenation and after intubation. The primary outcome was partial pressure of oxygen(PaO₂) after intubation. Secondary outcomes included pH, partial pressure of carbon dioxide(PaCO₂), patient comfort, and oxygen consumption.

Results: The PaO₂ at the end of intubation in group N was 315.43±90.78 mm Hg versus 298.92±74.23 mm Hg in group T (p=0.926). The pH was significantly higher in group N compared to group T after intubation (P=0.019). The PaCO₂ and patient comfort were comparable. The estimated oxygen consumption during peri-oxygenation was higher in group T (378.6±56.2 L) compared to group N (119.24±26.7 L, P<0.001).

Conclusion: NO-DESAT was more effective than THRIVE for peri-oxygenation in patients with anticipated difficult airways, providing similar oxygenation with significantly lower oxygen consumption.

Keywords: Nasal cannula, peri-oxygenation

References:

1. Mir F, Patel A, Iqbal R, Cecconi M, Nouraei SA. A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia. Anaesthesia 2017;72:439-443.

2. Rajan S, Joseph N, Tosh P, Kadapamannil D, Paul J, Kumar L. Effectiveness of transnasal humidified rapid-insufflation ventilatory exchange versus traditional preoxygenation followed by apnoeic oxygenation in delaying desaturation during apnoea: A preliminary study. Indian J Anaesth 2018;62:202-207.

ABS0979

Comparative evaluation of the influence of head rotation on oropharyngeal leak pressure of LMA-Protector and i-gel® in paralysed, anaesthetised patients: A randomised comparative study.

Gauri Sharma, Jaspal Singh Dali, Rashmi Virmani, Megha Soni

ESIC MCH, Faridabad

Email: gaurisharmamgm@gmail.com

Background and Aims: The sealing effectivity of a supraglottic airway device (SAD) is measured as oropharyngeal leak pressure (OPLP).^[1,2] This study aimed to evaluate and compare the influence of head rotation on OPLP of LMA-Protector with i-gel® in paralysed, anaesthetised patients.

Methods: Following institutional ethics committee approval and trial registration, this study was conducted on patients scheduled for elective laparoscopic cholecystectomy. After obtaining informed consent, they were randomly allocated into the L and I groups. Ten minutes following induction of pneumoperitoneum, OPLP was recorded with a head position at neutral (0°) and at 30° and 60° rotation. The insertion characteristics of both SADs and postoperative morbidity were also compared.

Results: OPLP was higher in the LMA-Protector than in the i-gel® at 60° head rotation (P= 0.041). Insertion was easier (P= 0.012) and faster (P= 0.002) with i-gel® than LMA-Protector [Table 1]. The incidence of blood stains on SAD after removal was higher with LMA-Protector (P <0.001). Pain on swallowing was also more significant for LMA-Protector (P=0.006) than i-gel®.

Table 1.

Oropharyngeal leak pressures (OPLP) in the groups

OPLP (cmH2O)	Group I	Group L	P
	Mean±standard deviation (SD)	Mean±SD
Neutral	24.63±2.94	25.87±2.24	0.073
30°	24.60±2.55	24.83±2.95	0.744
60°	23.50±2.85	25.03±2.82	0.041
P (within the group)
Neutral - 30°	0.929	0.004
Neutral - 60°	0.012	0.029
30-60°	0.023	0.415

Conclusion: Protector offered better OPLP than i-gel® at 60° head rotation; however, i-gel® provided easy, quick insertion with less postoperative morbidity than LMA-Protector.

Keywords: Airway, anaesthesia, head and neck, laryngeal mask, position

References:

1. Chaki T, Tachibana S, Kumita S, Sato H, Hamada K, Tokinaga Y, et al. Head rotation reduces oropharyngeal leak pressure of the i-gel and LMA® Supreme™ in paralysed, anesthetised patients: a randomised trial. Anesth Analg 2021;132:818-826.

2. Park SH, Han SH, Do SH, Kim JW, Kim JH. The influence of head and neck position on the oropharyngeal leak pressure and cuff position of the three supraglottic airway devices. Anesth Analg 2009;108:112–7.

ABS1142

Real-time transtracheal ultrasonography and waveform capnography to detect endotracheal intubation: A prospective observational study

Harshitha K, Neha Gupta, Reshma BM, Harsoor SS

Dr B R Ambedkar Medical College And Hospital, Bangalore.

Email: dr.harshithakrishna95@gmail.com

Background and Aims: Transtracheal ultrasonography (USG) is now emerging as a promising tool for rapid endotracheal tube(ETT) placement assessment.^[1,2] We aimed to measure the time required to detect the correct placement of ETT by transtracheal USG and waveform capnography.

Methods: After obtaining the institutional ethics committee approval and trial registration, this prospective, observational study was conducted on 100 patients, aged 18 to 80 years, of American Society of Anesthesiologists physical status I and II, undergoing elective surgeries under general anaesthesia with endotracheal intubation. Correct placement of ETT by transtracheal USG was done by visualising an “empty oesophagus sign” (single bullet sign), whereas oesophageal intubation yielded a “double trachea sign”. The appearance of 6 square waveforms in capnography was considered a confirmation of the correct placement of ETT. Two different observers noted the time taken by both methods in seconds.

Results: The time taken to confirm the correct placement of ETT by ultrasonography was 19.82±5.14s (95% confidence interval(CI), (18.8 - 20.84) and for capnography, was 32.69±5.73s(95% CI,31.55 - 33.83) (P<0.001), with a mean difference of -12.87s (95% CI,-13.61 to -12.069, P<0.001) with Pearson’s correlation coefficient r value of 0.822(95% CI,0.746 - 0.877, P<0.001)[Figure 1, Table 1].

Figure 1.

Correlation between time taken to confirm tube position by ultrasonography versus time taken by capnography

Table 1.

Sensitivity, specificity and predictive value of ultrasonography

Parameters	Value	95% CI
		Lower limit	Upper limit
Sensitivity	97.9%	92.7%	100.0%
Specificity	100.0%	29.2%	100.0%
Positive predictive value	100.0%	96.2%	100.0%
Negative predictive value	60.0%	14.7%	94.7%

Conclusion: Transtracheal ultrasonography is a faster, equally accurate, and safe technique for confirming the correct placement of ETT and can be an excellent alternative to capnography.

Keywords: Capnography, endotracheal intubation, trachea, ultrasonography

References:

1. Kuppusamy A, Mirunalini G, Koka MV, Ramamurthy B. Comparison of real-time ultrasound with capnography to confirm endotracheal tube position in patients in critical care units—A cross-sectional study. Bali J Anaesthesiol 2022; 6:43- 8.

2. Roy PS, Joshi N, Garg M, Meena R, Bhati S. Comparison of ultrasonography, clinical method and capnography for detecting correct endotracheal tube placement A prospective, observational study. Indian J Anaesth 2022;66:826-31.

ACUTE PAIN / PERIOPERATIVE PAIN

ABS0037

Comparative evaluation of continuous pericapsular nerve group block and continuous suprainguinal fascia iliaca block in hip surgery

Wasim Zafar, Sushil Krishnan

Max Super Speciality Hospital

Email: wasim.zfr@gmail.com

Background and Aims: Hip arthroplasties require appropriate pain relief for early rehabilitation.^[1,2] This study compared continuous ultrasound-guided pericapsular nerve group (PENG) block and continuous suprainguinal fascia iliaca block (SFIB) for post-operative analgesic efficacy after total hip arthroplasties.

Methods: A total of 48 patients undergoing hip surgeries were included in this study. At the end of the surgery, the patients in group A underwent ultrasound-guided PENG block with catheter placement and bolused with 25 ml 0.2% ropivacaine along with single shot lateral femoral cutaneous nerve(LFCN) block with 10 ml of 0.2% ropivacaine. Group B patients underwent ultrasound-guided SFIB with catheter placement, bolused with 35 ml of 0.2% ropivacaine. Both groups received 0.2% ropivacaine infusion at 4ml/h for the next 36 hours.

Results: The mean total analgesic consumption [1.54 mg] in the PENG group was significantly less than the SFIB group [5.52 mg][Table 1]; the mean static numerical verbal rating scale (nVRS) pain scores were significantly less in the PENG group at all time points; however, dynamic nVRS pain score was significantly lower only at 12 h [1.71 versus 2.54] in the PENG group. Finally, the PENG group’s patient satisfaction score was significantly lower [3.33 versus 2.79].

Table 1.

Total tramadol consumption comparison in two groups

Group	n	Mean	Standard deviation	P
Tramadol (mg)
Group A	24	15.42	27.50	<0.001
Group B	24	55.21	39.33

Conclusion: PENG block is superior to the SFIB in hip surgeries regarding total analgesic consumption and pain relief in the early postoperative period.

Keywords: Anaesthesia, fascia iliaca block, hip fractures, pericapsular nerve group block

References:

1. Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. A retrospective case series of pericapsular nerve group (PENG) block for primary versus revision total hip arthroplasty analgesia. Cureus 2020;12:e8200.

2. Zhang XY, Ma JB. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J Orthop Surg Res 2019;14:33.

ABS0224

Analgesic efficacy of bilateral sphenopalatine ganglion block in functional endoscopic sinus surgeries and reconstructive nasal surgeries: A randomised double-blinded study

Parijaat Mukherjee, Vasantha Kumar KR, Prashantha G Raj

Adichunchanagiri Institute of Medical Science, BG Nagara.

Email: drparijaatmukherjee@gmail.com

Background and Aims: Postoperative pain is common in functional endoscopic sinus surgeries(FESS) and reconstructive nasal surgeries. Bilateral sphenopalatine ganglion block can be an effective regional anaesthetic technique for post-operative analgesia.^[1,2] The study aimed to assess the analgesic effect, quality, and duration of bilateral sphenopalatine ganglion block analgesia as a sole analgesic.

Methods: Institutional ethics committee approval and written informed consent were obtained. We conducted a randomised double-blinded study categorised into two groups with 30 patients undergoing FESS and reconstructive nasal surgeries. General anaesthesia was induced at the end of the surgery before neuromuscular block reversal. A bilateral sphenopalatine ganglion block was given with the help of ultrasonography(USG) to interventional group(A) with a mixture of 0.25% ropivacaine and dexamethasone 4mg, 7.5ml on each side, whereas the control A group A (A b A) A did A not A receive A anything A. Both groups received fentanyl 1µg/kg and paracetamol 1gm intravenously. Visual analogue scale (VAS) scores were evaluated soon after extubation 0,2,4,6,8,10,12,16,20,24,30,36,42 and 48h postoperatively in all patients.

Results: Both groups had no significant difference in VAS scores at 0 or 2h. Interventional group (A) had statistically significantly lower scores (P <0.00) from 4h onwards till 48h than the control group (B). No adverse events were noted, with minimal postoperative analgesic requirement in group (A) (P <0.001).

Conclusion: USG-guided bilateral sphenopalatine block is a safe and effective procedure that provides sustained postoperative analgesia in FESS and nasal reconstructive surgeries and is superior in terms of the quality of analgesia when compared to fentanyl and paracetamol.

Keywords: Endoscopy, general anaesthesia, paranasal sinus surgery, sphenopalatine ganglion block

References:

1. Hwang JH, Liu TC, Hsu MC. Sphenopalatine ganglion block before removal of nasal packing. Laryngoscope 2003; 113:1423-4.

2. Peterson JN, Schames J, Schames M, King E. Sphenopalatine ganglion block: a safe and easy method for managing orofacial pain. Cranio 1995;13:177-81.

ABS0340

Comparative evaluation of quadratus lumborum versus subcostal transversus abdominis block for postoperative analgesia in laparoscopic cholecystectomy: A randomised comparative study.

Ruchi Goyal, Lalit Gupta

Maulana Azad Medical College, Delhi

Email: ruchigoyal403@gmail.com

Background and Aims: Effective perioperative analgesia optimises patient outcomes in laparoscopic cholecystectomy, promoting early recovery, ambulation, and discharge.^[1,2] The primary objective of our study was to compare the efficacy of ultrasound-guided subcostal transversus abdominis plane(TAP) block and posterior quadratus lumborum (QL) block in laparoscopic cholecystectomy.

Methods: We conducted a randomised comparative study involving 80 patients scheduled for elective laparoscopic cholecystectomy. These patients were randomly allocated into two groups, each consisting of 40. The first group received a posterior QL block, while the second group received a subcostal TAP block. Pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 hours were assessed and recorded for all patients. Data analysis was performed on 76 patients (38 patients in each group), as four patients were excluded due to an intraoperative change in procedure.

Results: The time (in hours) to the first postoperative request for rescue analgesia was significantly longer in the QL block group (mean =13.18, standard deviation(SD)=1.4) compared to the TAP block group (mean=8.05, SD=0.70). The total analgesic requirement was significantly higher in the TAP block group. However, the two groups had no significant difference in pain scores at 0, 1, 2, 4, and 12 hours. Patient satisfaction scores at 24 hours were significantly higher (P=0.032) in the QL block group compared to the TAP group.

Conclusion: Posterior QL block provides superior postoperative analgesia for patients undergoing laparoscopic cholecystectomy compared to the subcostal TAP block.

Keywords: Cholecystectomy, nerve block, perioperative pain

References:

1. Baytar Ç, Yılmaz C, Karasu D, Topal S. Comparison of ultrasound-guided subcostal transversus abdominis plane block and quadratus lumborum block in laparoscopic cholecystectomy: a prospective, randomised, controlled clinical study. Pain Res Manag 2019;2019:2815301.

2. Dai J, Lin S, Cui X, Xu Z, Zheng R, Wu D. The effects of ultrasound-guided QLB and TAPB combined with opioid-free anaesthesia (OFA) on the clinical efficacy of the patients undergoing abdominal surgery. Heliyon 2023;9:e20878.

ABS0354

Superficial cervical plexus block with interscalene brachial plexus block versus superficial cervical plexus block with clavipectoral fascia block for postoperative analgesia in patients posted for mid-point clavicle surgery: A randomised comparative study.

Chilla Anusha, Shivakumar G, Divakar S R

Mandya Institute of Medical Sciences, Mandya

Email: anushareddypediatrics@gmail.com

Background and Aims: Clavicle surgeries are being performed under regional techniques. ^[1,2]We aimed to compare the duration of postoperative analgesia in superficial cervical plexus block with interscalene block versus superficial cervical plexus block with clavipectoral fascia block for postoperative analgesia in patients posted for clavicle surgery.

Methods: Seventy adult patients with clavicle fractures were divided randomly into two groups (1 and 2). They were administered superficial cervical plexus block with interscalene brachial plexus block(ISB+SCPB) or superficial cervical plexus block with clavipectoral fascia block(CPB+SCPB), respectively. Patients were monitored for block efficacy anaesthesia and analgesia adequacy at the surgical site. Side effects and haemodynamic parameters were also monitored.

Results: ISB+SCPB provides excellent anaesthesia for clavicle fixation. Compared to CPB+SCPB, the sensory and motor effects for ISB+SCPB were achieved in an average of five and nine minutes, respectively[Tables 1,2]. The sensory analgesic effect lasted an average of 12 hours, providing an added advantage of immediate post-operative pain relief with CPB+SCPB. No acute complications related to block or surgical complications were noted.

Table 1.

Sensory and motor block onset and duration of analgesia by groups

	Clavipectoral fascia block	Interscalene block	P
Sensory block onset	6.5 (0.5)	4.9 (0.6)	0.04
Motor block onset	10.8 (0.7)	8.9 (0.7)	0.02
Duration of analgesia	12.5 (1.1)	5.9 (0.5)	0.01

Table 2.

Bromage score by groups

	Clavipectoral fascia block	Interscalene block	P
1	34 (97.1)	2 (5.7)	<0.001
2	1 (2.9)	33 (94.3)
Total	35 (100)	35 (100)

Conclusion: USG-guided CPB+SCPB is an excellent regional anaesthesia technique that provides safe and precise postoperative analgesia for clavicle surgeries without adverse effects.

Keywords: Clavipectoral fascia block, interscalene block, superficial cervical plexus block

References:

1. Xu G, Su P, Cai B, Liu Y, Jiang D, He Y, et al. Ultrasound-guided superficial cervical plexus block combined with clavipectoral fascial plane block or interscalene brachial plexus block in clavicle surgery: a single-centre, double-blind, randomised controlled trial. J Clin Monit Comput 2023;37:985-992.

2. Gupta N, Gupta V, Kumar G, Gupta V, Gupta DK. Comparative evaluation of the efficacy of interscalene block vs interscalene block and superficial cervical plexus block for fixation of clavicular fractures. International Journal of Contemporary Medical Research 2019; 6:C11-C13.

ABS0364

Hypnosis as a tool for reducing pre-operative anxiety in patients undergoing total knee replacement: A randomised study

Yamini Arora, Padma Puppala, Gurpreet Kaur, Charanjeet Kaur

Max Super Specialty Hospital, Mohali

Email: yaminiaro@gmail.com

Background and Aims: Preoperative anxiety occurs in 11 - 80% of adult patients. Anxiety can affect both patient physiology and drug pharmacology. Of late, there is an increased interest in non-pharmacological methods like clinical hypnosis for alleviating anxiety owing to their safe nature.^[1,2] This study aimed to assess the effect of hypnosis in managing pre-operative anxiety.

Methods: We did a randomised study to examine the effect of clinical hypnosis on preoperative anxiety scores in the setting of knee replacement. Subjects were randomised into two groups: a hypnosis group (n =40) and a “standard of care” control group (n=40). Anxiety was measured pre-intervention and before entering the operating room using the state-trait anxiety inventory scores. Additional parameters studied were postoperative pain scores, analgesic requirement, and incidence of nausea, vomiting, and sleep disturbance. A P value < 0.05 was considered significant.

Results: The control group had more increase in preoperative anxiety levels (change = 3.25) when compared to the hypnosis group(change =-0.04) (P=0.018)[Figures 1,2]. Maximum pain scores were higher in the control group (4.15 ±1.81) as compared to the Hypnosis group (3.33±1.65) on postoperative day 1 (p=0.03). The demand for higher analgesics (diclofenac or a combination of diclofenac and morphine) was higher in the control group (P=0.0026). The two groups had no significant difference in the incidence of nausea, vomiting and sleep disturbance.

Figure 1.

Usage of analgesics by the two groups

Figure 2.

Average anxiety scores of patients in the two groups at the time of admission and in the pre-operative area.

Conclusion: The use of clinical hypnosis for managing pre-operative anxiety in patients is a viable option with the additional benefits of a better post-operative pain profile and lesser requirements of pain medications.

Keywords: Clinical hypnosis, postoperative pain, pre-operative anxiety

References:

1. Saadat H, Drummond-Lewis J, Maranets I, Kaplan D, Saadat A, Wang SM, et al. Hypnosis reduces preoperative anxiety in adult patients. Anesthesia & Analgesia 2006;102:1394-6.

2. Chen PY, Liu YM, Chen ML. The effect of hypnosis on anxiety in patients with cancer: A meta-analysis. Worldviews on Evidence-Based Nursing 2017;14:223-36.

ABS0541

Portal blocks for relief of postoperative pain in patients undergoing Caesarean section- new frontiers in pain management.

Niyaz Abdul Salam, Ravi Kerur

Jawaharlal Nehru Medical College, Belagavi

Email: niyazsalam7@gmail.com

Background and Aims: Portal blocks consist of subcutaneous infiltration of local anaesthetic agents and additives at specific points.^[1,2] The objective of this study was to evaluate the efficacy of portal blocks for postoperative pain management, patient satisfaction, and haemodynamic effects in women undergoing caesarean section.

Methods: After obtaining consent from 60 patients posted for cesarean section, they were randomised into two groups. Group A received conventional analgesics: intravenous(IV) paracetamol 1gm 8^th hourly and tramadol 50 mg IV 12^th hourly. Group P received portal block postoperatively when numerical rating scale(NRS) scores were (documented postoperatively for six hours, then 24 and 48 hours) ≥7. The portal block consisted of lignocaine 0.25% 8ml+ 1ml triamcinolone 40mg +1 ml clonidine 30μg with 4ml mixture administered at 2cm above and below the umbilicus. Rescue analgesia with paracetamol 1gm IV and tramadol 50mg IV was given when the NRS score was≥7 despite the block.

Results: The call for rescue analgesics was the least in group P and highest in group A during the first 24 hours[Figures 1,2]. The depreciation of pain after onset was the fastest in group P, with a maximal decrease seen 1 hour after block administration with subsequent gradual decline. At the same time, the rate of depreciation of pain in group A was much slower during the first 24 hours.

Figure 1.

Showing numerical rating scale(NRS) score in group A

Figure 2.

Showing numerical rating scale(NRS) score in group P

Conclusion: Portal blocks can be used for effective relief of postoperative pain in patients undergoing cesarean section as a sole agent or with the requirement of minimal IV analgesics.

Keywords: Caesarean section, portal blocks, postoperative pain

References:

1. Derry S, Straube S, Moore RA, Hancock H, Collins SL. Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Cochrane Database Syst Rev 2012; 1:CD009107.

2. Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res 2019; 19: 68.

ABS0563

Opioid-free anaesthesia versus opioid-containing anaesthesia in laparoscopic cholecystectomy on quality of recovery: A comparative study in a tertiary care centre

Md Mudassir Alam, Swati, Takallum Khatoon, Swarnika Singh

Indira Gandhi Institute of Medical Sciences

Email: nurej17@gmail.com

Background and Aims: We hypothesised that an opioid-free (OFA) combination of dexmedetomidine, lignocaine and ketamine would be equally effective to opioid-containing anaesthesia (OCA) in providing perioperative analgesia.^[1,2] The primary objective was to compare the quality of recovery at 24 h in patients.

Methods: Sixty-six patients undergoing laparoscopic cholecystectomy were allocated into two groups using computer-generated random numbers, and group allocation was concealed in an opaque envelope. Group OFA received intravenous(IV) ketamine 0.2mg/kg bolus with IV dexmedetomidine 0.5μg/kg over 10 min before induction of anaesthesia, followed by infusion till the end of surgery. Group OCA received IV fentanyl 2μg/kg/h before induction, followed by infusion for analgesia. The primary objective was that the Quality of recovery score (QoR 15) was assessed at 24h in the postoperative period. The pain score was compared at 1, 2, 4, 8, 12, and 24 h in the postoperative period. Haemodynamics were noted in both the intraoperative and postoperative periods.

Results: Compared to OCA, the group which received opioid-free anaesthesia had a significantly better QoR 15 score at 24 h (140.21±5.61 versus 144.69±3.32, P=0.002 confidence interval -6.74 to -2.213) and significantly lower pain score at most observed time points. The 24-hour rescue analgesia requirement was comparable in both groups. Haemodynamic parameters remained similar in both the intraoperative and postoperative periods.

Conclusion: Opioid-free anaesthesia provides a better quality of recovery compared to opioid-containing anaesthesia in laparoscopic cholecystectomy. OFA also provided better postoperative pain control with no haemodynamic imbalance.

Keywords: Laparoscopic cholecystectomy, opioid, postoperative pain, quality of recovery

References:

1. Eidan A, Ratsch A, Burmeister EA, Griffiths G. Comparison of opioid-free anesthesia versus opioid-containing anesthesia for elective laparoscopic surgery (cofa: lap): a protocol measuring recovery outcomes. Methods Protoc 2020;3:58.

2. Gupta L, Agarwal J, Saxena KN. Opioid-free anaesthesia: The problem and the solutions. Indian J Anaesth. 2022; 66 (Suppl 2): S91-S94

ABS0624

Postoperative analgesic effect of ultrasonography-guided quadratus lumborum block in patients undergoing infra umbilical surgery

Ankita Singh, Santosh Kumar Sharma, Sunil Kumar Arya, Shehbaz Ahmad

BRD Medical College, Gorakhpur

Email: drsinghankita1111@gmail.com

Background and Aims: Quadratus lumborum (QL) block has several advantages for postoperative analgesia following spinal anaesthesia over other truncal blocks in certain lower abdominal surgeries.^[1,2] This study aimed to observe the postoperative analgesic efficacy of ultrasonography(USG)-guided bilateral QL block in patients undergoing infra umbilical surgery using a numeric rating scale (NRS) for pain at rest.

Methods: The study was conducted on 77 patients of either gender, aged 18-65 years, of American Society of Anesthesiologists physical status I and II, scheduled for elective infraumbilical abdominal surgery under spinal anaesthesia after approval from the ethics committee and obtaining written consent. Randomisation was done using the chit-and-box method, and the patients were divided into two groups. Group S(n=35) received spinal anaesthesia with 15mg 0.5% hyperbaric bupivacaine, and Group Q(n=35) was administered spinal anaesthesia with 15mg 0.5% hyperbaric bupivacaine and USG-guided bilateral QL3 block with 20ml 0.375% ropivacaine on each side.

Results: The mean value of NRS during movement was significantly lower in group Q than in group S(1.4 +/- 0.6 versus 3.6 +/-0.9; P=0.0001). Mean fentanyl consumption (μg/kg) was considerably lower in group Q than in group S. Mean time to first rescue analgesia (hours) was significantly higher in group Q than in group S(0.9+/-4.2 versus 6.1+/-2.3; P<0.001). No complications were reported in patients from either group.

Conclusion: In patients undergoing infraumbilical surgery, bilateral QL block effectively decreases postoperative pain and analgesic consumption and increases patient satisfaction.

Keywords: Numeric rating scale, postoperative analgesia, quadratus lumborum

References:

1. Venugopal P, Lingaiah A, Mridula KR, Bandaru S. Types of various day-care surgeries: A study from South India. Intl Assn Amb Surg 2015;21:10-13.

2. Akerman M, Pejčić N, Veličković I. A review of the Quadratus Lumborum Block and ERAS. Front Med (Lausanne) 2018; 5:44.

ABS0784

Comparison of ultrasound-guided novel sacral erector spinae block and caudal block for postoperative analgesia in paediatric patients undergoing hypospadias repair

Teena Bansal

PGIMS Rohtak

Email: aggarwalteenu@rediffmail.com

Background and Aims: Caudal block is most frequently used in children for postoperative pain management; however, its disadvantage is its short duration. Sacral erector spinae plane block (ESPB) can potentially block the pudendal nerve and may prove a better alternative.^[1,2]

Methods: This prospective, randomised, double-blinded study included 50 children aged 2-7 years. After general anaesthesia, group I (n=25) was given sacral ESPB(Figure) with 1 ml/kg of 0.25% bupivacaine and group II (n=25)was given a caudal block with 0.5 ml/kg of 0.25% bupivacaine. The primary objective was time first to rescue analgesia. The secondary objectives were pain assessment and postoperative analgesic consumption in 24 hours. Pain was assessed using the FLACC scale every 15 minutes up to 1 hour, every half an hour up to 2 hours, every 2 to 12 hours, and at the 18th and 24th hours. At FLACC score ≥4, rescue analgesia was given (15mg/kg paracetamol intravenously).

Figure 1.

Ultrasound image of sacral erector spinae block

Results: The mean time to first rescue analgesia in group I was 21.30 ± 3.06 h, and in group II, 9.36 ± 1.70 h (P=0.001). The FLACC score was significantly higher (P> 0.05) in group II at the 8th, 12th, 18th, and 24th hours. Mean postoperative paracetamol consumption was 310.50 ± 72.69 mg in group I and 615.60 ± 137.51 mg in group II (P=0.001).

Conclusion: Sacral ESPB resulted in a significantly longer time to rescue analgesia than caudal block. It is a better alternative to caudal block for postoperative analgesia in paediatric patients undergoing hypospadias repair.

Keywords: Caudal block, sacral erector spinae block, ultrasound

References:

1. Aksu C, Gurkan Y. Sacral erector spinae plane block with longitudinal midline approach: could it be the new era for paediatric postoperative analgesia? J Clin anesth 2019; 59: 38-9.

2. Oksuz G, Arslan M, Bilal B, Gisi G, Yavuz C. Ultrasound-guided sacral erector spinae block for postoperative analgesia in pediatric angioplasty surgeries. J Clin anesth 2019; 60: 88.

ABS0911

Comparative study of intrathecal morphine as an adjuvant to hyperbaric ropivacaine (0.75%) and plain hyperbaric ropivacaine (0.75%) in lower limb orthopaedic surgeries: A double-blinded randomised controlled study.

Shivani Meena, Sarvesh, Prateek

BPS Government Medical College, Sonipat

Email: meenashivani118@gmail.com

Background and Aims: Morphine as an intrathecal adjuvant can reduce the analgesia requirement. However, minimal research has been done when combined with hyperbaric ropivacaine.^[1,2] Therefore, we conducted this study to evaluate the blockade characteristics and analgesic requirement when low-dose morphine is used as an adjuvant with hyperbaric ropivacaine in lower limb orthopaedic surgeries.

Methods: After approval from the institutional ethics committee and registration in the clinical trial registry of India (CTRI/2023/04/052091), 40 American Society of Anesthesiologists physical status I and II grade patients undergoing lower limb orthopaedic surgery under spinal blockade were divided into two groups. Group R received 3ml of 0.75% hyperbaric ropivacaine, and group RM received 3ml of 0.75% hyperbaric ropivacaine with 200μg morphine, respectively. The onset and duration of sensory and motor blockade, two-segment regression time, visual analogue scale scores for pain and incidence of adverse effects were compared.

Results: The addition of morphine significantly reduced the onset of sensory blockade and the requirement for analgesia [Table 1]. The total duration of motor blockade was prolonged significantly, and urinary retention was present in ropivacaine with morphine, which was not statistically significant.

Table 1.

Study parameters

VARIABLES	Group RM	Group R	P
Onset of sensory block (min)	210	192	0.046
Onset of motor block (min)	420	396	0.033
Time to reach maximum level of sensory block (min)	21	18.6	0.031
Two segment sensory regression (min)	90	88	0.014
Total duration of motor block (min)	330	210	0.037
Time for first rescue analgesia (min)	720	189	0.068
Urinary intention	4/20	0

Conclusion: Morphine as an adjuvant provides a longer duration of analgesia as compared to ropivacaine alone.

Keywords: Adjuvant, morphine, ropivacaine

References:

1. Oğün CO, Kirgiz EN, Duman A, Okesli S, Akyürek C. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth 2003;90:659-64.

2. Wong JO, Tan TD, Leung PO, Tseng KF, Cheu NW, Tang CS. Comparison of the Effect of Two Different Doses of 0.75% Glucose-Free Ropivacaine for Spinal Anesthesia for Lower Limb and Lower Abdominal Surgery. The Kaohsiung Journal of Medical Sciences 2004;20:423-30.

ABS1096

Comparative study of nerve stimulator versus ultrasonography guided pericapsular nerve group block for positional comfort during the central neuraxial block in patients with a femur fracture

Suhas H N, Srinivasalu D

Vijayanagar Institute Of Medical Sciences, Ballari

Email: suhas9887@gmail.com

Background and Aims: One constraint in patients with a fractured femur is difficulty positioning for central neuraxial block due to severe pain. ^[1,2] This study aimed to compare the efficacy of guided ultrasonography (USG) and nerve-stimulator-based pericapsular nerve group (PENG) blocks.

Methods: After institutional ethics committee approval, trial registration and informed consent, a double-blinded randomised controlled study was conducted in 50 patients aged 50-80 years of the American Society of Anesthesiologists physical status I, posted for hip surgeries under the central neuraxial block. Patients were allocated into two groups. Groups A and B received 20 ml of 0.75 % ropivacaine with USG-guided and nerve stimulator-based PENG blocks, respectively. After 30 min, pain was assessed at rest, 15-degree passive limb elevation using the numerical rating scale(NRS) pain intensity score. The comfort during sitting for spinal anaesthesia was evaluated by the ease of giving a sitting position (EOSP) score, and the time taken to provide spinal anaesthesia was recorded.

Results: NRS score at rest after giving PENG block was 1.92±1 in group A and 3.00±0.91 in group B, P<0.001. Scores at 15-degree passive limb elevation were 2.92±1 in group A and 3.92±0.95 in group B, P<0.001. During position for spinal anaesthesia, the scores were 3.08±1.04 in group A and 4.20±1.12 in group B, P<0.001. The time taken to perform spinal anaesthesia in group A was 2.56±0.96 min and in group B, 3.32±1.24 min, P<0.034. The EOSP score of group A was 1.88±0.6, and group B was 1.144±0.59, P=0.009.

Conclusion: At equal concentrations, 0.75% ropivacaine provides better analgesia and positioning with ultrasound-guided PENG block than nerve stimulator-guided PENG block.

Keywords: Nerve stimulator, pericapsular nerve group, ropivacaine, ultrasound

References:

1. Jadon A, Sinha N, Chakraborty S, Singh B, Agrawal A. Pericapsular nerve group block (PENG): A feasibility study of landmark-based technique. Indian J Anaesth 2020;64:710-3.

2. Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. A retrospective case series of pericapsular nerve group (PENG) block for primary versus revision total hip arthroplasty analgesia. Cureus 2020;12: e8200.

ABS1135

Comparative study of postoperative analgesia after intrathecal hyperbaric ropivacaine with fentanyl and ropivacaine hyperbaric with dexmedetomidine in lower abdominal surgeries: A randomised controlled trial

Suprita Suresh Naik, Parimala, Srinivasalu

Vijayanagara Institute Of Medical Sciences, Ballari

Email: supritanaik08@gmail.com

Background and Aims: Spinal anaesthesia is the most widely used technique for infra-umbilical surgeries. Hyperbaric ropivacaine reduces cardiotoxicity and neurotoxicity with improved sensory and motor block. Adjuvants are added to prolong the postoperative analgesia.[1,2] This study aimed to compare the duration of analgesia.

Methods: After ethics committee clearance and informed consent, considering inclusion and exclusion criteria, 62 patients of the American Society of Anesthesiologists, with physical status I and II and aged 18-60 years, were allocated to two groups. Group D and group F received 2.5ml of 0.75% ropivacaine heavy with either dexmedetomidine 5μg (in 0.5ml saline) or fentanyl 25μg(0.5ml) intrathecally, respectively. Duration of postoperative analgesia, onset of sensory and motor blockade, 2-segment regression, duration of sensory and motor blockade, haemodynamics, and adverse effects were compared.

Results: Duration of analgesia was 174.10±47.78 min in group D and 134.13 ±29.03 min in group F [P< 0.001]. Time of onset of sensory blockade was 1.94 ±0.68 min in group D and 2.32±0.94 min in group F [P= 0.069]. The time of onset of the motor blockade in group D was 1.81±0.54 min. In group F was 2.97±0.80 min [P<0.001], duration of sensory blockade was 254.17 ±56.33 min in group D and 201.40 ±32.97 min in group F [P<0.001], duration of the motor blockade was 226.03 ±51.34 min in group D versus 156.40 ±35.94 min in group F [P<0.001], two segment regression time was 80.81±5.35 min in group D versus 65.87±4.98 min in group F min[P<0.001].

Conclusion: Dexmedetomidine at a dose of 5μg added to hyperbaric ropivacaine prolonged postoperative analgesia and provided prolonged sensory and motor blockade. No significant adverse effects were seen with these drugs.

Keywords: Dexmedetomidine, fentanyl, intrathecal, ropivacaine heavy

References:

1. Shashikala TK, Sagar SS, Ramaswamy P, Hudgi VV. Comparing effects of intrathecal adjuvants fentanyl and dexmedetomidine with hyperbaric ropivacaine in patients undergoing elective infra umbilical surgeries: a prospective, double-blind, clinical study. Anaesth, Essays Res 2019;13:654-62.

2. Ravipati P, Isaac GA, Reddy PN, Krishna L, Supritha T. A comparative study between intrathecal isobaric Ropivacaine 0.75% plus Dexmedetomidine and isobaric Ropivacaine 0.75% plus fentanyl for lower limb surgeries. Anaesth, Essays Res 2017;11:621-26.

ABS1141

Preoperative ultrasound-guided supra-inguinal fascia iliaca compartment block versus pericapsular nerve group block as an analgesic technique for positioning elderly patients with hip fracture: A randomised comparative trial

Priyanka Chawla, Pratibha Panjiar, Tahir Ahamad Masoodi, Kharat Mohd Butt

Hakeem Abdul Hameed Centenary Hospital

Email: priyanka22ster@hotmail.com

Background and Aims: Supra-inguinal fascia iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block effectively relieved pain in geriatric patients with hip fractures.^[1,2]This study aimed to assess their efficacy in ease of positioning for spinal anaesthesia and compare their perioperative analgesic effects.

Methods: This prospective randomised, double-blinded study was conducted on 60 patients randomly divided to receive either USG-guided S-FICB or PENG block. The primary outcome measure was the ease of spinal positioning (EOSP) score. The secondary outcome measures were numerical rating scale (NRS) pain scores at rest and movement pre-procedure and 30 minutes post-procedure, sitting angle using goniometer, time to perform spinal anaesthesia, analgesic consumption postoperatively in the first 24 hours and patient satisfaction scores. P <0.05 was considered significant.

Results: The PENG group’s EOSP score was significantly better (P=0.001)(Table 1). Analgesic requirement postoperatively in the first 24 hours was less in patients who received PENG block and was clinically significant (P=0.001). Pre-procedure and 30-minute post-procedure NRS at rest and on movement did not vary significantly in the two groups. No significant difference was seen in the sitting angle degree, time to perform spinal anaesthesia or patient satisfaction scores.

Table 1.

Groupwise distribution according to ease of spinal positioning (EOSP)

	Ease of spinal positioning				Total
	0	1	2	3
Group
S-FICB
n	0	0	10	20	30
%	0.00%	0.00%	33.3%	66.6%	100.0%
PENG
n	0	0	4	26	30
%	0.00%	0.00%	13.33%	86.66%	100.0%
Total
n	0	0	14	46	60
%	0.00%	0.00%	23.33%	76.66%	100.0%
P	-	-	0.001	0.001

Conclusion: The ease of sitting position during spinal anaesthesia in elderly patients with fractured hips was better in patients who received PENG block than S-FICB. The postoperative analgesic requirement was lesser in patients who received PENG block. However, the NRS pain scores in patients receiving S-FICB and PENG were similar.

Keywords: Anaesthesia, fascia, femoral nerve, hip fractures, nerve block, pain management, spinal

References:

1. Jadon A, Mohsin K, Sahoo RK, Chakraborty S, Sinha N, Bakshi A. Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial. Indian J Anaesth 2021;65:572-578.

2. Madabushi R, Rajappa GC, Thammanna PP, Iyer SS. Fascia iliaca block versus intravenous fentanyl as an analgesic technique before positioning for spinal anaesthesia in patients undergoing surgery for femur fractures- a randomised trial. J Clin Anesth 2016;35:398-403.

ABS0401

Postoperative analgesia for percutaneous nephrolithotomy with erector spinae plane block: An observational study.

S Sonika, Tejesh CA

MS Ramaiah Medical College, Bangalore

Email: sonika.shivakumar@gmail.com

Background and Aims: Although percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure, it can be associated with significant postoperative pain. ^[1,2]The objective of the present study was to evaluate the role of erector spinae plane block in providing postoperative analgesia following PCNL.

Methods: After ethics committee clearance and informed consent, 53 patients of either gender aged 18-70 years satisfying inclusion criteria undergoing unilateral PCNL under general anaesthesia were enrolled. Ultrasound-guided erector spinae plane block was given at T10 level with 20mL of 0.25% bupivacaine at the end of surgery. Paracetamol 1gm was given intravenously at the end of surgery and after 8 hours. Time to first rescue analgesia, analgesic consumption, and pain assessed by visual analogue scale (VAS) scores at rest and on movement were noted during the first 24 hours.

Results: Erector spinae plane block could be administered in all patients. The majority of the procedures were completed with a single infra-costal puncture. Fifty per cent of patients did not require rescue analgesia during the first 24 hours postoperatively. Of those requiring rescue analgesia, 84% required a single dose of tramadol 50mg to maintain VAS<4 [Table 1]. Most patients had a VAS score of <4 at different time points during the first 24 hours [Table 2].

Table 1.

Analgesic parameters in patients receiving erector spinae plane block

Parameters	Values
Patients requiring tramadol within first 24 h (Yes/No)‡	26 (49.1%)/27 (50.9%)
The median time of tramadol request (minutes)	215
Complications
Nausea	2
Vomiting	4

Data presented as ^‡number (%)

Table 2.

Visual analogue scale (VAS) scores at different time points

Time	VAS at rest		VAS on movement
	Score <4	Score ≥4	Score <4	Score ≥4
30 min	42 (79.2%)	11 (20.8%)	41 (77.4%)	12 (22.6%)
1 h	38 (71.7%)	15 (28.3%)	35 (66.0%)	18 (34.0%)
2 h	42 (79.2%)	11 (20.8%)	35 (66.0%)	18 (34.0%)
4 h	39 (73.6%)	14 (26.4%)	31 (58.5%)	22 (41.5%)
6 h	39 (73.6%)	14 (26.4%)	36 (67.9%)	17 (32.1%)
12 h	47 (88.7%)	6 (11.3%)	45 (84.9%)	8 (15.1%)
24 h	52 (98.1%)	1 (1.9%)	52 (98.1%)	1 (1.9%)

Conclusion: Erector spinae plane block at T10 level provides good pain relief during the first 24 hours postoperatively as part of multimodal analgesia in patients undergoing PCNL.

Keywords: Erector spinae plane block, percutaneous nephrolithotomy, postoperative analgesia

References:

1) Sarkar S, Jena SS, Nayak P, Mitra JK. Postoperative pain relief following lumbar erector spinae plane block in patients undergoing percutaneous nephrolithotomy: A randomised controlled trial. Urology 2022; 160: 69-74.

2) Gultekin MH, Erdogan A, Akyol F. Evaluation of the efficacy of the erector spinae block for postoperative pain in patients undergoing percutaneous nephrolithotomy- A randomised controlled trial. J Endourol 2020; 34: 267-272.

ABS0778

Comparison of the efficacy of adductor canal block versus intra-articular infiltration analgesia using ropivacaine-morphine combination for postoperative analgesia after arthroscopic knee surgery: A randomised controlled study

Rajat, Mumtaz Hussain, Alok Kumar Bharti

IGIMS, Shimla

Email: kumardrrajat@gmail.com

Background and Aims: Arthroscopic knee surgery often involves post-operative pain, hindering early patient rehabilitation.^[1,2] This randomised controlled study compared the effectiveness of ultrasound-guided adductor canal block (ACB) and intra-articular infiltration (IAI) with ropivacaine-morphine combination for postoperative analgesia in arthroscopic knee surgeries.

Methods: Of the 100 enrolled patients undergoing arthroscopic knee surgeries, 50 were randomly assigned to receive either ultrasound-guided ACB or IAI. Both groups received a combination of 20 ml of 0.5% ropivacaine and 5mg of morphine. Post-operative pain management followed a predefined protocol with intravenous tramadol. The primary outcome measured postoperative analgesia using the numeric rating scale (NRS) [0, no pain and 10, worst pain imaginable] at 2, 4, 6, 12, and 24 hours after the operation. Secondary outcomes included the time of first rescue analgesia, total analgesic consumption, and adverse effects of analgesics.

Results: The NRS pain scores were comparable in both groups at all time intervals, except at 12 hours, where a statistically significant difference was observed[Table 1]. The ACB group recorded a score of 2.28[95% confidence interval(CI): 1.82, 2.74], compared to the IAI group: 2.94[95% CI: 2.53, 3.35](P=0.033). However, no significant difference was observed between the groups during the first rescue analgesia, total analgesic consumption, and adverse effects.

Table 1.

Postoperative numerical rating scale (NRS) score (0-10)

	ACB Group	IAI Group	P value
NRS 2hr Post Operative	0.04 (0.00, 0.10)	0.06 (0.00, 0.15)	0.704
NRS 4hr Post Operative	0.26 (0.08, 0.44)	0.40 (0.18, 0.62)	0.328
NRS 6hr Post Operative	0.76 (0.50, 1.72)	1.04 (0.68, 1.40)	0.207
NRS 12hr Post Operative	2.28(1.82, 2.74)	2.94 (2.53, 3.35)	0.033*
NRS 18hr Post Operative	1.1(0.76, 1.44)	1.64(1.26, 2.02)	0.075
NRS 24hr Post Operative	1.1(0.76, 1.44)	1.64(1.26, 2.02)	0.373

Conclusion: ACB and IAI techniques show similar effects on postoperative analgesia following arthroscopic knee surgeries, with the only significant difference observed in the 12-hour NRS score.

Keywords: Adductor canal block, arthroscopic knee surgery, intra-articular infiltration

References:

1. Stebler K, Martin R, Kirkham KR, Lambert J, De Sede A, Albrecht E. Adductor canal block versus local infiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial. Br J Anaesth 2019;123:e343-e349.

2. Luo ZY, Yu QP, Zeng WN, Xiao Q, Chen X, Wang HY, et al. Adductor canal block combined with local infiltration analgesia with morphine and betamethasone shows superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomised controlled trial. BMC Musculoskelet Disord 2022;23:468.

ABS1153

Efficacy of ultrasound-guided paravertebral block and erector spinae block using levobupivacaine for postoperative analgesia in percutaneous nephrolithotomy surgeries: A prospective, randomised comparative study

Ashwani Kristipati, Karthik GS

Rajarajeswari Medical College and Hospital, Bangalore

Email: ashwanikristipati@gmail.com

Background and Aims: Percutaneous nephrolithotomy surgeries can increase patient morbidity.^[1,2] This study aimed to compare the efficacy of ultrasound-guided paravertebral block versus erector spinae block using levobupivacaine for postoperative analgesia in these surgeries under general anaesthesia.

Methods: This study was registered in the clinical trial registry of India (CTRI/2023/07/055193), where fifty patients under American Society of Anesthesiologists (ASA) physical status I and II were randomly assigned into two groups of twenty-five each. Under ultrasound guidance, groups E and PV received erector spinae and paravertebral blocks, respectively, using 25 ml of 0.25% levobupivacaine, each at T8 level, before extubation. Patients were evaluated postoperatively for the duration of analgesia, which was assessed using a visual analogue scale(VAS). Pain assessment was done 20 minutes after extubation, which was considered to be zero time. When the VAS score was more than or equal to 4, paracetamol 1gm was given intravenously as a rescue analgesic.

Results: Both groups were statistically comparable in their demographic parameters. The duration of analgesia was comparable in both groups (746 +/- 58.3 versus 768 +/- 68.6 min) with a P value of 0.863[Table 1]. Similarly, VAS scores and total analgesic requirements were comparable in both groups [Table 2]. Haemodynamic stability was maintained in both groups. No adverse effects were noted in either of the groups.

Table 1.

Duration of analgesia and total analgesic requirement

Variable	Group E	Group PV	P
Duration of analgesia (min) (From zero time)	746 (58.6)	768 (68.6)	0.863
Total rescue analgesic requirement (Paracetamol in gm	2.0 (1.6)	2.2 (1.4)	0.526

Table 2.

Visual analogue scale (VAS) score

VAS score (post-operative)	Group E	Group PV	P
4 h	1.86 (0.62)	1.78 (0.70)	0.126
8 h	2.06 (0.4)	2.1 (0.62)	0.235
12 h	5.72 (0.32)	5.6 (0.8)	0.562

Conclusion: Erector spinae and paravertebral blocks using levobupivacaine 0.25% are equally efficacious in providing adequate postoperative analgesia in patients undergoing percutaneous nephrolithotomy surgeries following general anaesthesia.

Keywords: Analgesia, erector spinae block, levobupivacaine, paravertebral block, percutaneous nephrolithotomy, postoperative

References:

1. Elewa AM, Faisal M, Sjöberg F, Abuelnaga ME. Erector spinae plane block versus paravertebral block in analgesic outcomes following breast surgery. BMC Anesthesiol 2023;23:19.

2. Premachandra A, Wang X, Saad M, Moussawy S, Rouzier R, Latouche A, et al. Erector spinae plane block versus thoracic paravertebral block for preventing acute postsurgical pain in breast cancer surgery: A prospective observational study compared with a propensity score-matched historical cohort. PLoS One 2022;17:e0279648.

DAYCARE / AMBULATORY ANAESTHESIA

ABS0038

Effects of dexmedetomidine on myalgia due to succinylcholine administration in electroconvulsive therapy patients.

Bhavna Sriramka

IMS and SUM Hospital, Bhubaneswar

Email: bhavna.sriramka@gmail.com

Background and Aims: Electroconvulsive therapy(ECT) can cause myalgia due to fasciculations and convulsions.^[1,2] This study aimed to determine the effects of dexmedetomidine on the incidence of fasciculations and myalgia due to succinylcholine administration in ECT patients.

Methods: Sixty patients undergoing ECT were enroled in this study. Patients were allocated blindly to two groups. In the dexmedetomidine group (group D) (n=30), dexmedetomidine 0.25 ug/kg was administered intravenously over 10 minutes before ECT. The same volume of normal saline was administered in the control group (group C) (n=30). ECT was performed after 30 seconds of administration of succinylcholine. Fasciculation and myalgia were recorded at the thirtieth-minute post-procedure and the postoperative 6, 12, and 24^th hour.

Results: The severity and incidence of fasciculation were better in group D than in group C (P=0.025). At the thirtieth minute, the incidence and severity of myalgia were significantly higher in group C (P=0.016), and the same was true at 6 hours (P=0.012) and 12 hours (P=0.02)[Table 1].

Table 1.

Incidence of myalgia among the groups

Myalgia	Group D	Group C	P
No	28	15	0.016
Mild	2	15
Moderate to Severe	0	0

Conclusion: Dexmedetomidine infusion(0.25ug/kg) before succinylcholine administration may help diminish the incidence of succinylcholine-induced myalgia in the early post-procedure period of ECT.

Keywords: dexmedetomidine, myalgia, succinylcholine

References:

1. Celebi N, Canbay O, Cil H, Ayaz A. Effects of dexmedetomidine on succinylcholine-induced myalgia in the early postoperative period. Saudi Med J 2013;34:369-73.

2. Rasmussen KG, Petersen KN, Sticka JL, Wieme LJ, Zosel JH, Marienau ME, et al. Correlates of myalgia in electroconvulsive therapy. J ECT 2008;24:84-7.

ABS0517

Assessment of optimum time interval between premedication with dexmedetomidine and electroconvulsive therapy for effective attenuation of hyperdynamic response

Neha Panse, Noopur Singh

Smt. Kashibai Navale Medical College and Hospital

Email: drnehaghule@gmail.com

Background and Aims: Acute hyperdynamic responses to electroconvulsive therapy (ECT) may increase the risk of cardiovascular complications in vulnerable patients. ^[1,2] The current study aimed to estimate the most effective time interval between dexmedetomidine administration and electroconvulsive therapy delivery. A secondary aim was to study the recovery times and side effects, if any.

Methods: Seventy-five patients were enroled and randomly allocated to receive 0.5 μg/kg dexmedetomidine intravenously, 5min, 15min and 30 min before ECT under short-acting general anaesthesia. Heart rate (HR) and mean arterial pressure (MAP) were recorded immediately after the administration of dexmedetomidine (T1), and 0, 1, 3, 5, 10, 20 and 30 min after the electrical stimuli ended (T2, T3, T4, T5, T6, T7, T8). In addition, the peak HR after ECT, seizure duration, recovery time, and incidence rates of post-ECT adverse effects (agitation, headache and nausea) were also recorded.

Results: HR and MAP in group B were significantly lower than in groups A and C from T2 to T7. In addition, peak HR was significantly lower in group B than in groups A and C. Seizure length was shorter and dampened in group A, while that in groups B and C was comparable and as per expectations. Time to spontaneous breathing was similar in the three groups, while time for eye-opening and obeying commands was delayed in group A than in groups B and C. The incidence rates of post-ECT agitation and headache were clinically higher in groups A and C than in group B.

Conclusion: Fifteen minutes is the optimum time interval for effective attenuation of HR, MAP and peak HR responses to ECT using dexmedetomidine without altering seizure duration or delaying recovery. A very short or long interval fails to prevent the acute hyperdynamic response.

Keywords: dexmedetomidine, electroconvulsive therapy, hyperdynamic response

References:

1. Sannakki D, Dalvi NP, Sannakki S, Parikh DP, Garg SK, Tendolkar B. Effectiveness of dexmedetomidine as premedication before electroconvulsive therapy: a Randomized controlled cross-over study. Indian J Psychiatry 2017;59:370-374.

2. Parikh DA, Garg SN, Dalvi NP, Surana PP, Sannakki D, Tendolkar BA. The outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomised controlled crossover trial. Ann Card Anaesth 2017; 20: 93- 99.

ABS0568

Efficacy of preoperative oral maltodextrin versus glucose in reducing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anaesthesia: A randomised controlled double-blinded study

Sonia Elizabeth Jacob, Girish BK.

JSS Medical College And Hospital, Mysuru

Email: sonia.jacobm95@gmail.com

Background and Aims: Postoperative nausea and vomiting(PONV) is the second most common complaint following general anaesthesia despite using multiple strategies to prevent and treat PONV. ^[1,2] This study aimed to compare the efficacy of oral preoperative carbohydrate loading with glucose and maltodextrin in reducing PONV.

Methods: Sixty-nine patients of the American Society of Anesthesiologists, physical status I-II, undergoing elective laparoscopic cholecystectomy under general anaesthesia were randomised into three groups. Group M received 50 mg of oral maltodextrin in 100 ml of water, group G received 50 mg of oral glucose in 100 ml, and group C received 100 ml of plain water 2 hours before surgery. After confirming blood sugars < 180mg/dl before surgery, they underwent routine induction and intervention. Their blood sugars and other parameters were monitored intraoperatively and postoperatively. Post extubation, they were evaluated for PONV scores and comfort levels.

Results: The analysis of variance(ANOVA) showed that there was a significant difference. The Bonferroni Post hoc test used to compare groups in pairs showed that the pairwise group comparison of C - M had a P value <0.05[Figure 1].

Figure 1.

Mean postoperative nausea and vomiting(PONV) scores in the groups

Conclusion: Patients who consumed the carbohydrate solution were found to be more comfortable compared to the control group postoperatively, with slightly less PONV in patients taking oral maltodextrin over glucose

Keywords: Glucose, maltodextrin, nausea, post-operative, vomiting

References:

1. Yilmaz N, Çekmen N, Bilgin F, Erten E, Özhan MÖ, Coşar A. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. J Res Med Sci 2013;18:827-32.

2. Rajan S, Rahman AA, Kumar L. Preoperative oral carbohydrate loading: Effects on intraoperative blood glucose levels, postoperative nausea and vomiting, and intensive care unit stay. J Anaesthesiol Clin Pharmacol 2021;37:622-627.

ABS0707

Recovery profile of cognitive functions in patients undergoing laparoscopic cholecystectomy under desflurane versus sevoflurane-based general anaesthesia: A randomised double-blinded comparative study

Ankita, Nidhi Arun, Annu Choudhary

IGIMS

Email: vermaankita72@gmail.com

Background and Aims: Desflurane has low solubility in blood and body tissues, which causes a very rapid induction and anaesthesia emergence. ^[1,2] This study compared the recovery profile of cognitive functions in patients undergoing laparoscopic cholecystectomy under desflurane or sevoflurane-based general anaesthesia(GA).

Methods: A prospective, randomised, double-blinded study was conducted on patients posted for laparoscopic cholecystectomy under GA. After obtaining approval from the ethical committee and informed written consent, 60 patients were enrolled for this study. After the selection of the patient, the baseline cognitive function of the patient was recorded at the bedside under these six domains: Attention and concentration, language, memory, praxis, gnosis, and executive function. In the post-anaesthesia care unit, the cognitive test was reassessed 30 minutes, 90 minutes, and 150 minutes after the stoppage of the agent.

Results: The attention and concentration, language, memory, praxis, gnosis, executive function and total scores were comparable between groups. When scores were compared at 30 minutes, 90 minutes, and 150 minutes after recovery, there was no significant difference in the cognitive function scores between the two groups at these time intervals. The P values at 30 minutes, 90 minutes, and 150 minutes after recovery were 0.71, 0.13, and 0.80, respectively(Table 1). No statistically significant difference was observed in the patient’s heart rate, blood pressure, and oxygen saturation at 30 minutes, 90 minutes, and 150 minutes after recovery.

Table 1.

Comparison of cognitive scores between the groups

Total Score	Mean (standard deviation)		P
	Group 1	Group 2
Baseline	55.27 (3.86)	55.5 (3.76)	0.813
30 min	46.23 (6.65)	46.83 (5.82)	0.711
90 min	52.37 (4.58)	54.03 (3.7)	0.126
150 min	55.17 (3.58)	55.4 (3.71)	0.805
P (within the group)	<0.001	<0.001

Conclusion: Though desflurane has been associated with faster emergence from anaesthesia compared to sevoflurane, the cognitive function recovery profile is similar in both groups with no significant difference in the postoperative changes in heart rate, blood pressure and oxygen saturation.

Keywords: Cognition, desflurane, recovery, sevoflurane

References:

1. Callaway JK, Jones NC, Royse CF. Isoflurane induces cognitive deficits in the Morris water maze task in rats. Eur J Anaesthesiol 2012;29:239–245.

2. Carr ZJ, Torjman MC, Manu K, Dy G, Goldberg ME. Spatial memory using active allothetic place avoidance in adult rats after isoflurane anaesthesia: a potential model for postoperative cognitive dysfunction. J Neurosurg Anaesthesiol 2011; 23: 138–145.

ABS0709

A comparative study of three supraglottic airway devices, i-gel, Proseal LMA and Blockbuster LMA, in adult patients during short surgical procedures under general anaesthesia

Amrita Kumari, Arvind Kumar

IGIMS

Email: amritaj734@gmail.com

Background and Aims: Newer laryngeal mask airways (LMAs) have purported benefits for positive pressure ventilation during general anaesthesia.^[1,2]This study compared the insertion characteristics of Blockbuster LMA with i-gel and Proseal LMA.

Methods: In this study, 120 patients aged 18-60 years and of American Society of Anesthesiologists physical status I and II underwent general anaesthesia. They were divided into three groups: I-gel® (group-I), Proseal LMA (group-P), or Blockbuster LMA (group-B). Following standard monitoring and anaesthesia induction (propofol 2 mg/kg, succinylcholine 2mg/kg), LMAs were inserted. Primary objectives included comparing insertion attempts and time. Secondary objectives assessed the ease of insertion, ventilation adequacy, haemodynamic changes, and adverse effects.

Results: The number of insertion attempts in group I was significantly less than in groups B and P(1.60±0.54 versus 1.73±0.70 versus 1.8±0.41 P=0.202). The mean time for insertion was less in group I (24.30±9.2 s) compared to group B (24.5±3.91 s) and group P (29.50±14.65 s). Haemodynamic variables were comparable (P>0.05). The incidence of complications in patients Group I was higher (27.5%) compared to Group P (10%) and Group B (18.5%).

Conclusion: i-gel®, LMA Proseal and Blockbuster LMA are safe for spontaneous and positive pressure breathing during GA. i-gel® requires less time for insertion compared to other LMAs. Ease of insertion and perioperative haemodynamics were comparable among all LMAs.

Keywords: General anaesthesia, i-gel®, laryngeal mask airway, supraglottic airway devices

References:

1. Selvin CC, Singariya G, Bihani P, Kamal M, Paliwal N, Ujwal S. Comparison of oropharyngeal leak pressure of I-gel®TM and BlockbusterTM laryngeal mask airway in anaesthetised pediatric patients. Anesth Pain Med (Seoul) 2023;18:51-6.

2. Kumar KR, Soni L, Sinha R, Muthiah T, Patel N, Shende DK, et al. Comparison of Ambu AuraGain and BlockBuster laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anaesthesia: A prospective randomised controlled study. Paediatr Anaesth 2023;33:474-80.

ABS0935

Can segmental spinal anaesthesia and dexmedetomidine aid pain-free early ambulation in lower abdominal surgeries?

Prakash Kumar Sharma, Rajiv Lakhotia, Nishat Nasar, Hemant Singh

Hind Institute of Medical Sciences, Lucknow

Email: 07.prakash@gmail.com

Background and Aims: Segmental spinal anaesthesia is known for its relative haemodynamic stability and early ambulation.^[1,2] We intended to explore the relative benefits of dexmedetomidine versus fentanyl as adjuvants in segmental spinal anaesthesia.

Methods: Twelve American Society of Anesthesiologists physical status I and II patients who underwent lower abdominal surgeries with thoracic segmental spinal at the T9-T10 level were included in the study after consent. Patients were divided into three groups (A - ropivacaine, B- ropivacaine with fentanyl, and C -ropivacaine with dexmedetomidine). Local anaesthetics were administered at T9-T10 level, and sensory testing was done at 3,5,7,9 min to observe the level of the dermatomal blockade and, after that, every 10 min till the time of two-segment regression. Post-operative haemodynamic and visual analogue score data were collected, and the time of first micturition was observed.

Results: The duration of analgesia was significantly higher in the dexmedetomidine group (mean 7.2 h) than in the fentanyl group (mean 6 h) and the control group (mean five h). Heart rate was observed to be lesser in the dexmedetomidine group. The time for micturition was prolonged with adjuvants, with the risk of urinary bladder atony.

Conclusion: Thoracic segmental spinal anaesthesia offers the benefits of early ambulation and relatively stable haemodynamics. Dexmedetomidine, as an adjuvant, provides a prolonged duration of analgesia with a delayed micturition reflex.

Keywords: Ambulation, dexmedetomidine, intrathecal, segmental

References:

1. LE Imbelloni Spinal anaesthesia for laparoscopic cholecystectomy: Thoracic versus Lumbar Technique. Saudi J Anaesth 2014;8:477-83.

2. Van Zundert AAJ, Stultiens G, Jakimowicz JJ, van den Borne BE, van der Ham WG, Wildsmith JA. Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth 2006;96:464-66.