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372: Effect of addition of clonidine to local anesthetic mixture for peribulbar block in vitreoretinal surgery
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Free Papers
•
Postoperative Pain Management
372. Effect of addition of clonidine to local anesthetic mixture for peribulbar block in vitreoretinal surgery Yazbek-karam1,2,
Barakat1,
nader1,
369. Pain relief after episiotomy using pudendal block
Karam1,
V. D. E. Abi H. E. Habib1, C. Abou chacra1,3, M. Aouad1,2, G. Cherfane1,3 1Anesthesia Department, Rizk Hospital, Beirut, Lebanon, 2Anesthesia Department, American University of Beirut, Beirut, Lebanon, 3Ophtalmology Department, Rizk Hospital, Beirut, Lebanon
Background: The addition of clonidine to local anesthetics has been shown to prolong analgesia and akinesia in peribulbar block for cataract surgery. Vitreoretinal surgery, unlike cataract surgery, is a long procedure requiring frequently intraoperative sedation or supplementation when performed under regional anesthesia. Also, postoperative pain can be significant.The purpose of this study is to evaluate the efficacy of clonidine peribulbar anesthesia in perioperative analgesia for patients undergoing vitreoretinal surgery. Methods: A randomized double-blind study included 40 patients divided into 2 groups. Patients in control group received peribulbar anesthesia with 10 ml of a mixture of 0.5% bupivacaıne and lidocaine 2%, 150 UI hyaluronidase, with 1 ml normal saline. Patients in clonidine group received the same mixture with 1ml of 50 g clonidine. The outcome measures included the occurrence of intraoperative pain, the need for supplemental block or need for sedation, the time to first analgesic requirement, the VAS at first rescue analgesic, the number of analgesic requirements during the first 24 hours, and patient satisfaction. Results: Demographic data and duration of surgery were comparable between the 2 groups (Table 1). A lower number of patients in the clonidine group required postoperative analgesics. Also, the time to first analgesic requirement and the total analgesic requirements were significantly less in the clonidine group. Patients’ satisfaction was similar in the two groups.
Y. Aissaoui, R. Bruyere, D. Bry, A. Moudden, C. Girard, J. Goulet, E. Valle Dauvissat, I. Andres, B. Rumennap, P. Rodriguez, C. Miller Service D’anesthesiologie, Centre Hospitalier D’Auxerre, Auxerre, Bourgogne, France Background: Pain from episiotomy or from tearing of perineal tissues is often poorly treated and may be severe. This prospective randomised double blind study was performed to investigate the efficacy of unilateral pudendal block for pain relief after episiotomy. Methods: 40 women who gave birth vaginally with episiotomy were randomised to receive nerve stimulator guided pudendal block with 15 ml of either ropivacaine 0.75% (ropivacaine group) or normal saline (placebo group). The block was achieved after episiotomy repair. Pain was assessed at rest at 3, 6, 12, 24, 48 hours after episiotomy on a 100 mm visual analog scale (VAS). The maximum pain scores while sitting and sitting were also recorded. All women received acetaminophen orally 1g ⫻ 4/day. Rescue analgesia consisted of niflumic acid suppositories 700mg ⫻ 2 / day which were administered if VAS was ⱖ 40 mm. Results: Patients in ropivacaine group reported significantly lower pain scores than those in placebo group at rest at 6, 12, 24, 48 h (p⬍0.05) (Fig 1). They also reported better analgesia while sitting and walking (p⬍0.05) (Fig 2). Rescue analgesia was required by only 3 patients (15%) in ropivacaine group vs 17 patients (85%) in placebo group (p⬍0.001). Conclusion: This study demonstrated that pudendal block was effective in reducing pain after episiotomy within the first 48 hours after birth.
Conclusion: The addition of 50 g of clonidine to a mixture of bupivacaine 0.5% and lidocaine 2% for peribulbar anesthesia in vitreoretinal surgery resulted in a significant prolongation of the duration of postoperative analgesia.
Table 1
Male/female Weight (kg) Age (years) Duration of Surgery (min) Patients requiring intraop supplementation (%) Patients requiring postop supplementation (%) Time to first analgesic (hours) Median VAS at first analgesic (range) Median number of analgesic supplementation postop (range)
Control Group N ⫽ 20
Clonidine Group N ⫽ 20
18/2 70.5 ⫾ 11.2 62.3 ⫾ 22.6 61.7 ⫾ 8.1
16/4 71.5 ⫾ 12.2 56 ⫾ 21.7 65.2 ⫾ 9.1
5 (25)
2 (10)
18 (90)
12 (60)
6.5 ⫾ 3.2
13.4 ⫾ 4.9
7 (4–8)
6 (4–8)
1.5 (0–3)
1 (0–2)
P
Fig 1: Evolution of VAS at rest
NS NS NS NS NS 0.028 ⬍0.001 NS
Fig 2: VAS while sitting and walking 0.003
Legend: Ropivacaine group: white box plot, Placebo group: grey box plot
Free Papers
•
Postoperative Pain Management
372. Effect of addition of clonidine to local anesthetic mixture for peribulbar block in vitreoretinal surgery Yazbek-karam1,2,
Barakat1,
nader1,
369. Pain relief after episiotomy using pudendal block
Karam1,
V. D. E. Abi H. E. Habib1, C. Abou chacra1,3, M. Aouad1,2, G. Cherfane1,3 1Anesthesia Department, Rizk Hospital, Beirut, Lebanon, 2Anesthesia Department, American University of Beirut, Beirut, Lebanon, 3Ophtalmology Department, Rizk Hospital, Beirut, Lebanon
Background: The addition of clonidine to local anesthetics has been shown to prolong analgesia and akinesia in peribulbar block for cataract surgery. Vitreoretinal surgery, unlike cataract surgery, is a long procedure requiring frequently intraoperative sedation or supplementation when performed under regional anesthesia. Also, postoperative pain can be significant.The purpose of this study is to evaluate the efficacy of clonidine peribulbar anesthesia in perioperative analgesia for patients undergoing vitreoretinal surgery. Methods: A randomized double-blind study included 40 patients divided into 2 groups. Patients in control group received peribulbar anesthesia with 10 ml of a mixture of 0.5% bupivacaıne and lidocaine 2%, 150 UI hyaluronidase, with 1 ml normal saline. Patients in clonidine group received the same mixture with 1ml of 50 g clonidine. The outcome measures included the occurrence of intraoperative pain, the need for supplemental block or need for sedation, the time to first analgesic requirement, the VAS at first rescue analgesic, the number of analgesic requirements during the first 24 hours, and patient satisfaction. Results: Demographic data and duration of surgery were comparable between the 2 groups (Table 1). A lower number of patients in the clonidine group required postoperative analgesics. Also, the time to first analgesic requirement and the total analgesic requirements were significantly less in the clonidine group. Patients’ satisfaction was similar in the two groups.
Y. Aissaoui, R. Bruyere, D. Bry, A. Moudden, C. Girard, J. Goulet, E. Valle Dauvissat, I. Andres, B. Rumennap, P. Rodriguez, C. Miller Service D’anesthesiologie, Centre Hospitalier D’Auxerre, Auxerre, Bourgogne, France Background: Pain from episiotomy or from tearing of perineal tissues is often poorly treated and may be severe. This prospective randomised double blind study was performed to investigate the efficacy of unilateral pudendal block for pain relief after episiotomy. Methods: 40 women who gave birth vaginally with episiotomy were randomised to receive nerve stimulator guided pudendal block with 15 ml of either ropivacaine 0.75% (ropivacaine group) or normal saline (placebo group). The block was achieved after episiotomy repair. Pain was assessed at rest at 3, 6, 12, 24, 48 hours after episiotomy on a 100 mm visual analog scale (VAS). The maximum pain scores while sitting and sitting were also recorded. All women received acetaminophen orally 1g ⫻ 4/day. Rescue analgesia consisted of niflumic acid suppositories 700mg ⫻ 2 / day which were administered if VAS was ⱖ 40 mm. Results: Patients in ropivacaine group reported significantly lower pain scores than those in placebo group at rest at 6, 12, 24, 48 h (p⬍0.05) (Fig 1). They also reported better analgesia while sitting and walking (p⬍0.05) (Fig 2). Rescue analgesia was required by only 3 patients (15%) in ropivacaine group vs 17 patients (85%) in placebo group (p⬍0.001). Conclusion: This study demonstrated that pudendal block was effective in reducing pain after episiotomy within the first 48 hours after birth.
Conclusion: The addition of 50 g of clonidine to a mixture of bupivacaine 0.5% and lidocaine 2% for peribulbar anesthesia in vitreoretinal surgery resulted in a significant prolongation of the duration of postoperative analgesia.
Table 1
Male/female Weight (kg) Age (years) Duration of Surgery (min) Patients requiring intraop supplementation (%) Patients requiring postop supplementation (%) Time to first analgesic (hours) Median VAS at first analgesic (range) Median number of analgesic supplementation postop (range)
Control Group N ⫽ 20
Clonidine Group N ⫽ 20
18/2 70.5 ⫾ 11.2 62.3 ⫾ 22.6 61.7 ⫾ 8.1
16/4 71.5 ⫾ 12.2 56 ⫾ 21.7 65.2 ⫾ 9.1
5 (25)
2 (10)
18 (90)
12 (60)
6.5 ⫾ 3.2
13.4 ⫾ 4.9
7 (4–8)
6 (4–8)
1.5 (0–3)
1 (0–2)
P
Fig 1: Evolution of VAS at rest
NS NS NS NS NS 0.028 ⬍0.001 NS
Fig 2: VAS while sitting and walking 0.003
Legend: Ropivacaine group: white box plot, Placebo group: grey box plot