Anaesthesia, Pain & Intensive Care

How to promote genuine research culture in medical institutions: the role and responsibilities of the institutional heads

2025-04-08T03:13:28-06:00

The term “Global Health” has been widely used in literature over the last decade. In its broader sense, global health is all about tackling health gaps cross the world considering different disciplines, regions, socio-economic status and cultural perspectives to find solutions. There are great differences in perceptions across the globe, and what is appropriate in one place might not be in another. Koplan et al define “Global health” is a field of study, research and practice that places a priority on achieving equity in health for all people.¹

How can artificial intelligence (AI) transform ultrasonography for regional anesthesia and pain management?

2025-04-08T03:13:28-06:00

Ultrasound is a well-recognized tool for regional anesthesia and tailored pain management. It offers real-time imaging of patient’s anatomy and provides guideline for needle insertion with precision. Though, its accuracy highly relies on operator’s skill and experience. The incorporation of Artificial Intelligence (AI) into ultrasound modality has transformed the field by upgrading the explication of images including tumor detection, segmentation and classification by inculcating the Convolution Neural Networks (CNNs) which is a type of deep learning.

Blockbuster LMA versus Baska Mask in pa-tients undergoing laparoscopic cholecystec-tomy: a randomized clinical trial

2025-04-08T03:13:28-06:00

Objectives: This study compared the performance and safety of the Blockbuster Laryngeal Mask Airway (LMA) and the Baska Mask (BM) in patients undergoing laparoscopic cholecystectomy (LC).

Methodology: In this randomized open-label trial, 140 individuals between the ages of 18 and 60 years, underwent elcetive LC. Patients were chosen at random to receive either the Blockbuster LMA (Group L) or the Baska Mask (Group B).

Results: The groups exhibited comparability in terms of insertion time, number of attempts, and success rate. Group B had a statistically significant reduction in gastric tube insertion time (P = 0.005). Oropharyngeal leak pressure (OLP) was significantly higher in Group B, both just after insertion (P < 0.001) and at 30 min (P = 0.002). Hemodynamic parameters and peak airway pressure (PAP) were insignificantly different between the groups. Postoperative complications (pain, difficulty swallowing, cough, and blood on the device) were insignificantly different between the groups.

Conclusions: The BM exhibited a more effective oropharyngeal seal and facilitated the insertion of the stomach tube in comparison to the Blockbuster LMA, while both devices exhibited comparable insertion characteristics, hemodynamic profiles, and postoperative complications in patients undergoing LC.

Keywords: Laparoscopic cholecystectomy; Blockbuster LMA; Baska Mask; Supraglottic airway devices; Oropharyngeal leak pressure

Citation: Mohamed RM, Eid AA, Anwar AG. Blockbuster LMA versus Baska Mask in patients undergoing laparoscopic cholecystectomy: a randomized clinical trial. Anaesth. pain intensive care 2025;29(2):155-161. DOI: 10.35975/apic.v29i2.2698

Received: July 30, 2024; Reviewed: August 12, 2024; Accepted: August 12, 2024

Comparison of intubating conditions between induction with target-controlled infusion (TCI) of remifentanil and propofol with or without a topical lignocaine spray in elective surgery for adults

2025-04-08T03:13:28-06:00

Background & objective: Intubation without muscle relaxants is indicated in certain situations. The aim of this study was to compare intubating conditions without muscle relaxants between a combination of induction using target-controlled infusion (TCI) remifentanil and propofol with a topical lignocaine spray and TCI remifentanil and propofol alone in elective surgery.

Methodology: Sixty patients, aged 18 to 65 years with ASA I and II classification, were randomized into two groups: the RPL group (n = 30), which received 10 puffs of 10% lignocaine spray over the glottic area before induction followed by TCI remifentanil 4 ng/ml and TCI propofol 4 µg/ml for induction, and the control group (n = 30), which received 10 puffs of topical spray of normal saline before a similar technique of induction. The intubating conditions were assessed using a C-Mac video laryngoscope. Hemodynamic changes and the percentage of patients who required rescue muscle relaxants were recorded.

Results: The RPL group showed a significantly higher percentage of easy laryngoscopic procedures (96.7% vs. 56.7%; P < 0.01) and open vocal cord positions (86.7% vs. 56.7%; P = 0.028) than the control group. However, there were no significant differences in overall intubating conditions, requirements for rescue muscle relaxants, or hemodynamic changes between the two groups.

Conclusion: A combination of TCI remifentanil and TCI propofol with a topical lignocaine spray facilitated better intubating conditions without muscle relaxants compared to this combination without topical lignocaine.

Abbreviations: Ce_t: effect-site concentration, Cp_t: target plasma concentration, ETT: Endotracheal tube, LOC: loss of consciousness, NS: Normal saline, TCI: Target-controlled infusion,

Keywords: Muscle Relaxants; Remifentanil; Propofol; Lignocaine; Vocal Cord

Citation: Khan SN, Wan Hassan WMN, Seevaunnatum P, Mazlan MZ, Hassan MH. Comparison of intubating conditions between induction with target-controlled infusion (TCI) of remifentanil and propofol with or without a topical lignocaine spray in elective surgery for adults. Anaesth. pain intensive care 2025;29(2):163-169. DOI: 10.35975/apic.v29i2.2699

Received: August 10, 2024; Reviewed: September 26, 2024; Accepted: September 26, 2024

Ultrasound guided pectoral nerve block with or without ultrasound guided transversus thoracic plane block in modified radical mastectomy; a randomized controlled trial

2025-04-08T03:13:29-06:00

Background & objective: For managing acute postoperative pain is multimodal analgesia, including regional blocks. None of the regional techniques can block the whole breast innervation. Combining different blocks may address the inadequacy of existing methods. This study compared the perioperative analgesic efficacy of US-guided transversus thoracis muscle plane block (TTPB) combined with pectoralis nerve (PECS II) block versus PECS II block alone in patients subjected to modified radical mastectomy (MRM).

Methodology: This prospective randomized clinical trial involved 34 female patients scheduled for MRM under general anesthesia (GA). Patients were randomized into two equal groups: Combined Group (n=17) received TTPB and PECS II block, and PECS Group (n=17) received PECS II block 30 minutes before inducing GA. The primary outcome measure was the total postoperative opioid requirements. Secondary outcomes were postoperative pain, duration of analgesia, hemodynamic stability, and sedation.

Results: The total postoperative morphine consumption was significantly lower (P < 0.001), the duration of analgesia was significantly longer (P < 0.001), and the sedation score was significantly higher (P = 0.034) in the combined group than in the PECS Group . The pain scores were significantly lower in the combined group between 2 and 12 h. Both techniques showed hemodynamic stability, with lower heart rate and blood pressure in the combined group.

Conclusion: Adding TTPB to the PECS II block was superior to the PECS II block alone for patients undergoing MRM. The combined block reduced postoperative pain and morphine consumption. The patients were more well-sedated with improved hemodynamics.

Abbreviations: GA: general anesthesia, MRM: modified radical mastectomy, PECS II block: pectoralis nerve block, TTPB: transversus thoracis muscle plane block.

Keywords: Ultrasound; Transversus Thoracic; Pectoral Nerve Block; Modified Radical Mastectomy; Analgesia

Citation: Abed SM, Soliman AM, Elrawas MM, Elsheikh SAE, Abdallah AA, Tabashy RH, Kamel MA. Ultrasound guided pectoral nerve block with or without ultrasound guided transversus thoracic plane block in modified radical mastectomy; a randomized controlled trial. Anaesth. pain intensive care 2025;29(2):170-176. DOI: 10.35975/apic.v29i2.2700

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Comparative study between perineural versus intravenous dexamethasone in prolonging the analgesic effect of supraclavicular plexus nerve block in upper limb surgeries

2025-04-08T03:13:29-06:00

Background & Objectives: Dexamethasone is well known to potentiate the efficacy and the duration of local anesthetic drugs. The anesthetists have used this combination in spinal and epidural analgesia with satisfaction. We evaluated the efficacy of intravenous (IV) dexamethasone vs perineural administration in reducing postoperative pain in adults having supraclavicular brachial plexus blocks (BPB) for elective procedures involving the upper limbs.

Methodology: This prospective randomized, double blind study involved 44 patients aged 18 to 60 y, both sexes, posted for elective upper limb cancer (synovial sarcoma, liposarcoma, melanoma, squamous cell carcinoma and osteosarcoma) surgeries under supraclavicular block, with an expected tourniquet time less than 120 min. Patients were divided into two equal groups: Perineural Dexamethasone group: 2 mL of dexamethasone (8 mg) combined with 28 mL of bupivacaine 0.25% concentration perineurally, along with 2 mL of normal saline as an IV placebo and systemic dexamethasone group: normal saline 2 mL was combined with 28 mL of bupivacaine 0.25% perineurally, and dexamethasone 2 mL (8 mg) was administered IV.

Results: Onset time for sensory and motor block were significantly higher in systemic than perineural groups (P < 0.05). Duration of sensory blocks and duration of analgesia of the block were significantly lower in system than perineural groups (P < 0.05). There was significant difference between the two groups as regards the number of patients who needed a second dose of morphine (P = 0.030). Total morphine doses were significantly different between both groups. The duration of motor block was insignificantly different between both groups.

Conclusions: When compared to its IV counterpart, perineural dexamethasone offers a prolonged duration of motor block, sensory block, and postoperative analgesia in ultrasound-guided supraclavicular brachial plexus block.

Abbreviations: BPB: brachial plexus blocks, IV: intravenous, PACU: post-anesthesia care unit

Keywords: Cancer; Perineural; Intravenous; Dexamethasone; Dysarthria; Pain; Supraclavicular Plexus Nerve Block; Upper Limb Surgeries; VAS

Citation: Kamel MA, Abdelmonem AS, KamalGM, El Awady G, Soliman AM. Comparative study between perineural versus intravenous dexamethasone in prolonging the analgesic effect of supraclavicular plexus nerve block in upper limb surgeries. Anaesth. pain intensive care 2025;29(2):178-184. DOI: 10.35975/apic.v29i2.2701

Received: January 19, 2025; Reviewed: February 15, 2025; Accepted: February 15, 2025

Comparing intrathecal dexmedetomidine versus midazolam in orthopedic cancer surgeries: a prospective randomized controlled trial

2025-04-08T03:13:29-06:00

Background & objectives: The anesthetists have been trying various adjuvants with local anesthetic agents for spinal anesthesia to prolong the duration of analgesia and to reduce the associated side effects. This study was aimed to evaluate the effect of dexmedetomidine versus midazolam when added to the intrathecal bupivacaine.

Methods: Seventy-five adult patients, 20 to 70 y of age, scheduled for orthopedic cancer procedures under the spinal anesthesia, were enrolled in this research trial. Selected patients were randomly divided into three equal groups; Group D (Dexmed Group): 25 patients received spinal anesthesia with 0.5% bupivacaine 3.5 mL plus dexmedetomidine 5 μg in saline 0.5 mL; Group M (Midazolam Group) 25 patients received 0.5% bupivacaine 3.5 mL plus midazolam 2 mg in 0.5 mL normal saline, and the third group Group C (Control Group) comprising of 25 patients received 0.5% bupivacaine 3.5 mL plus 0.5 mL normal saline. The primary outcome of this study was duration of the sensory block. Secondary outcomes were duration of the motor block.

Results: We employed two segments of time. The median duration of the dexmedetomidine group was 132 min, which is statistically significant compared to the midazolam group (119 min) and the control group (98 min). The motor block was also significantly prolonged in the Dexmed Group compared to the midazolam group and the control group. However, dexmedetomidine and midazolam groups showed significant hypotension compared to the control group.

Conclusion: Dexmedetomidine has a longer sensory and motor block effect than midazolam, when added to the spinal bupivacaine; both dexmedetomidine and midazolam groups have longer duration than the control group. Dexmedetomidine can be recommended for prolonged orthopedic cancer surgeries, due to its prolonged postoperative analgesia despite the associated hypotension.

Abbreviations: GABA: gamma-aminobutyric acid. gamma-aminobutyric acid, MAP: mean arterial pressure.

Keywords: Intrathecal Dexmedetomidine; Intrathecal Midazolam; Hyperbaric Bupivacaine; Spinal Anesthesia, Hypotension

Citation: Zedan M, Elwasseef M, Shaker EH, Mohamed Turki DA, Kamel MA. Comparing intrathecal dexmedetomidine versus midazolam in orthopedic cancer surgeries: a prospective randomized controlled trial. Anaesth. pain intensive care 2025;29(2):185-193. DOI: 10.35975/apic.v29i2.2702

Received: September 24, 2024; Reviewed: October 26, 2024; Accepted: January 25, 2025

Effects of sugammadex on deep neuromuscular blockade reversal in laparoscopic colorectal resection: a prospective observational study

2025-04-08T03:13:29-06:00

Background & objective: Sugammadex can provide a rapid recovery from deep neuromuscular blockade induced by aminosteroid non-depolarizing paralytics and has recently been recommended as a routine reversal agent for neuromuscular blockade induced by rocuronium or vecuronium. This study aims to investigate the efficacy and safety of sugammadex on the reversal of rocuronium-induced deep neuromuscular blockade in patients undergoing laparoscopic colorectal resection.

Methodology: This was a prospective observational study on 59 patients who had scheduled laparoscopic colorectal resection surgery in a national teaching hospital in Vietnam. The primary outcome was the time to reach a train-of-four ratio of 0.9. Secondary outcomes included the incidence of deep neuromuscular blockade at the end of the surgery and the incidence of residual neuromuscular blockade in the post-anesthesia care unit (PACU).

Results: The average time to reach a train-of-four (TOF) ratio of 0.9 was 4.0 min (ranging from 1.5 to 8.9 min). It took 4.2 min and 3.7 min to fully recover of neuromuscular function in the 4 mg/kg and the 2 mg/kg groups, respectively. At the end of the surgery, 62.7% of patients remained under a deep level of neuromuscular blockade. There was no incidence of residual paralysis recorded in the PACU. Older age and higher ASA classification appeared to be associated with prolonged time to reach a TOF ratio of 0.9 following reversal by sugammadex.

Conclusions: Sugammadex provided a rapid recovery from deep blockade induced by rocuronium in laparoscopic colorectal resection patients and there was no event of residual blockade in the PACU.

Keywords: Sugammadex; Deep Neuromuscular Blockade; Laparoscopic Colorectal Resection; Residual Neuromuscular Blockade

Citation: Phan VTN, Nguyen DT, Phi HT. Effects of sugammadex on deep neuromuscular blockade reversal in laparoscopic colorectal resection: a prospective observational study. Anaesth. pain intensive care 2025;29(2):194-201. DOI: 10.35975/apic.v29i2.2703

Received: July 30, 2024; Reviewed: October 26, 2024; Accepted: February 04, 2025

Effect of lung recruitment on atelectasis in lung-healthy patients undergoing laparoscopic cholecystectomy

2025-04-08T03:13:29-06:00

Background: Recruitment maneuvers are standard practice for mitigating aeration disturbances. The literature has described a variety of recruitment techniques. In order to evaluate the efficacy of various lung recruitment maneuvers on the incidence of atelectasis in adults undergoing laparoscopic cholecystectomy surgery with lung ultrasound, the present trail was conducted.

Methodology: A randomized controlled trial was conducted on 93 patients, divided equally into three groups: Control group: The parameters were maintained throughout the procedure without any modifications. Sustained inflation group: After abdominal deflation, sustained inflation was applied by adjusting the APL valve to 40 cmH₂O on spontaneous mode and holding the bag for 30 sec. Stepwise PEEP increasing group: The PEEP was gradually increased by 2 cmH₂O every 5 breathing cycles until it reached 12 cmH₂O, and it was maintained until extubation, with a maximum airway pressure of 40 cmH₂O.

Results: There was a statistically significant increase in the incidence of atelectasis after abdominal deflation with significantly reduced after application of recruitment maneuver. The sustained inflation group showed more significant improvement than the stepwise PEEP increasing group.

Conclusion: lung recruitment maneuvers can reduce the incidence of atelectasis in adults undergoing laparoscopic cholecystectomy surgery. The sustained inflation group was associated with better results.

Keywords: Atelectasis; Cholecystectomy; Laparoscopic; Recruitment Maneuver

Citation: Sultan WA, Metwally AA, Shiha HG, Saeed A. Effect of lung recruitment on atelectasis in lung-healthy patients undergoing laparoscopic cholecystectomy. Anaesth. pain intensive care 2025;29(2):202-209. DOI: 10.35975/apic.v29i2.2704

Received: October 16, 2024; Reviewed: October 26, 2024; Accepted: December 25, 2024

Single intravenous bolus vs. continuous infusion of tranexamic acid to reduce blood loss in transurethral resection of prostate: a prospective randomized double-blind study

2025-04-08T03:13:29-06:00

Background and objective: Intraoperative a single bolus of tranexamic acid may be inadequate to prevent bleeding in the early postoperative period. We compared the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate (TURP).

Methods: A total of 50 patients electively posted for TURP, were randomly assigned to receive either a single bolus dose of tranexamic acid 10 mg/kg (Group A), or a bolus of tranexamic acid 10 mg/kg followed by an infusion of tranexamic acid @1 mg/kg/h till 4 h postoperatively (Group B). Perioperative blood loss and the amount of blood transfused were the primary outcome. Postoperative hemoglobin and hematocrit levels, incidence of deep vein thrombosis and any convulsions were the secondary outcomes.

Results: There was no significant difference among patients in both groups regarding intraoperative and postoperative blood loss at 6 h and 48 h postoperatively. However, the postoperative blood loss at 24 h was significantly higher among patients in Group A (P = 0.014).

Conclusion: Tranexamic acid used as intravenous bolus followed by infusion continued in the postoperative period is more effective in reduction of perioperative blood loss in comparison to single bolus in transurethral resection of prostate.

Abbreviations: TURP: transurethral resection of prostate, TXA: tranexamic acid, Hct: hematocrit, DVT

Key words: Antifibrinolytics, blood loss, transurethral resection of prostate, tranexamic acid.

Citation: Ghaly Tawadros SI, Kamal MM, Mohammed EA, Khairy MA. Single intravenous bolus vs. continuous infusion of tranexamic acid to reduce blood loss in transurethral resection of prostate: a prospective randomized double-blind study. Anaesth. pain intensive care 2025;29(2):210-216. DOI: 0.35975/apic.v29i2.2705

Received: November 10, 2024; Reviewed: February 03, 2025; Accepted: February 05, 2025

Low dose hyperbaric bupivacaine 0.5% in transurethral resection of the prostate with three different doses of intrathecal dexmedetomidine: a randomized double-blind trial

2025-04-08T03:13:29-06:00

Objectives: The objective of this research endeavor was to assess the efficacy of three distinct intrathecal concentrations of dexmedetomidine (ITD) in conjunction with 0.5% hyperbaric bupivacaine in TURP.

Methods: This study employed a randomized, double-blind design, ninety patients who were admitted for TURP participated. Six (Group A), eight (Group B), or ten (Group C) patients were administered µg ITD diluted in a solution consisting of 0.5 mL saline 0.9%- and 1.5-mL hyperbaric bupivacaine 0.5%.

Results: An absence of statistically significant variation was noted at the outset latencies of sensory block and motor block between groups A and B. Nevertheless, when comparing Group C to groups A and B, the onset latency was diminished considerably (P < 0.05). Significantly prolonged was the duration of first rescue analgesia in groups C and B than in Group A, and in Group C than in Group B (P < 0.05). Significantly reduced postoperative total morphine consumption and NRS scores at 6h, 8h, and 12h were observed in groups C and B, respectively, compared to Group A and Group B (P < 0.05).

Conclusions: When combined with hyperbaric bupivacaine, 10 µg of ITD significantly prolongs analgesia duration, sensory block, and motor blockade in TURP. This prolongation is accompanied by a reduction in the necessity for postoperative analgesics, and the incidence of adverse effects is not significantly different from lower dosages.

Keywords: Transurethral Resection of the Prostate; Dexmedetomidine; Hyperbaric Bupivacaine; Dose

Citation: Mohamed RM, Fathy SM, Anwar AG. Low dose hyperbaric bupivacaine 0.5% in transurethral resection of the prostate with three different doses of intrathecal dexmedetomidine: a randomized double-blind trial. Anaesth. pain intensive care 2025;29(2):217-225. DOI: 10.35975/apic.v29i2.2707

Received: May 22, 2024; Reviewed: January 26, 2025; Accepted: February 15, 2025

The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients

2025-04-08T03:13:30-06:00

Background: The fast expanding demographic segment of the elderly population has resulted in an increase in the people aged 65 y and above, needing surgical treatments. This change has posed special medical problems including need of surgical management, while preventing postoperative complications. We compared the postoperative cognitive injury in older adults between total intravenous anesthesia (TIVA) and inhalational anesthesia. It lays the groundwork for anesthesiology and perioperative care research and clinical choices in elderly.

Methodology: With exclusions for cognitive disabilities and neurologic disorders, participants of ≥ 65 y of age, scheduled for elective surgery, were randomly assigned to TIVA or inhalational anesthesia groups. Preoperative exams were carried out, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) cognitive tests. While the inhalation group got inhalational sevoflurane or desflurane with opioids, TIVA group received propofol and remifentanil IV. The incidence of Postoperative Cognitive Dysfunction (POCD) was the main outcome; while secondary outcomes included hospital stay, any complications, anesthesia and surgery durations and three-month mortality.

Results: On days 1 and 3 postoperative cognitive scores (POCS) dropped dramatically; on day 7 in both TIVA and inhalational anesthesia groups, they rose again. On day 1, TIVA group patients demonstrated better cognitive scores than the inhalational group. On days 3 and 7, no appreciable changes were noted. By day 7, both groups showed notable cognitive improvement over preoperative levels.

Conclusion: Though by day seven they recover, both TIVA and inhalational anesthesia cause cognitive problems following surgery. Early after surgery, TIVA enhances cognitive ability; but both techniques have identical long-term results. Our results imply that to improve cognitive recovery, elderly surgical patients require specially tailored anesthetic management.

Abbreviations: MMSE: Mini-Mental State Examination, MoCA: Montreal Cognitive Assessment, POCD: Postoperative Cognitive Dysfunction, TIVA: total intravenous anesthesia,

Keywords: Total Intravenous Anesthesia; Inhalational Anesthesia; Postoperative Cognitive Dysfunction; Elderly Patients; Cognitive Recovery

Citation: Saeed AA, Al-Jenabi ZK. The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients. Anaesth. pain intensive care 2025;29(2):226-231.

DOI: 10.35975/apic.v29i2.2708

Received: September 02, 2024; Reviewed: October 23, 2024; Accepted: January 01, 2025

Analgesic efficacy of ultrasound guided anterior femoral cutaneous nerve block (AFCNB) plus femoral triangle block (FTB) vs. adductor canal block (ACB) in total knee arthroplasty

2025-04-08T03:13:30-06:00

Background& objective: Femoral Triangle Block (FTB) offers an efficient pain relief in total knee arthroplasty (TKA), except the anteromedial cutaneous region which may not be completely anesthetized by solely utilizing FTB. Therefore, adding the Anterior Femoral Cutaneous Nerve Block (AFCNB) to the FTB could provide complete pain relief. Adductor Canal Block (ACB) is a common technique to provide analgesia after total knee arthroplasty. In the current study, we assessed and contrasted the effectiveness of ultrasound (US) guided AFCNB plus FTB versus ACB regarding analgesia and early mobilization after TKA.

Methodology: Sixty patients who had total knee arthroplasty were randomly assigned into two equivalent groups; Group A which obtained AFCNB in Combination with FTB or Group B which received ACB before the beginning of the surgery. After completion of the desired block, spinal anesthesia was given under complete aseptic conditions. The primary outcome was comparison of the time to first request of the post-operative rescue pethidine in the case of visual analogue scale (VAS) score above 3. Secondary outcomes were the total amount of rescue pethidine used, VAS scores and time to ambulation. Immediate postoperative complications of the given nerve blocks and the adverse effects of the used drugs were recorded and managed accordingly.

Results: Sixty participants successfully finished the study. No significant statistical differences between both groups were noted at the time of request of the first post-operative rescue pethidine (P = 0.159). Additionally, there was no statistical difference concerning postoperative VAS between the two groups except at 8 hours and 20 hours where Group A showed a statistically significant lower VAS than Group B (P = 0.039 and 0.005 respectively). However, Group A consumed a statistically significant smaller total amount of pethidine than Group B (P = 0.030). Conversely, Group B showed a shorter duration than Group A regarding ‘Timed Up and Go’ test (TUG) at 12 hours and 24 hours post operatively with a high statistically significant difference between them (P< 0.001 in both). Incidence of complications and adverse effects of the used drugs was comparable between the two groups without significant difference.

Conclusion: We concluded that AFCNB in combination with FTB provided better analgesic and pethidine-sparing effects compared to ACB after TKA. However, ACB provided better preservation of motor function and provided early ambulation.

Abbreviations: ACB: Adductor canal block, AFCNB: Anterior Femoral Cutaneous Nerve Block, FTB: Femoral Triangle Block, TKA: Total knee arthroplasty, VAS: visual analogue pain scale

Keywords: Anterior Femoral Cutaneous Nerve Block; Femoral Triangle Block; Adductor Canal Block; Anesthesia; Total Knee Arthroplasty

Citation: Mohamed ElRazzaz MHS, Kamel Youssif GF, Wahba SS, Mohamed SA, Mohamed AM. Analgesic efficacy of ultrasound guided anterior femoral cutaneous nerve block (AFCNB) plus femoral triangle block (FTB) vs. adductor canal block (ACB) in total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):232-241.

DOI: 10.35975/apic.v29i2.2709

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

A comparative study between the analgesic effect of adductor canal block with or without IPACK block after total knee arthroplasty

2025-04-08T03:13:30-06:00

Background & objectives: Ensuring adequate post-operative pain management, especially after orthopedic procedures, is a crucial component of patients' well-being. Following total knee arthroplasty (TKA), the degree of pain underscores the need for effective analgesic measures to alleviate the adverse effects of pain. Utilizing multimodal analgesia has been recognized as an ideal approach for managing acute pain following TKA. This approach encompasses various strategies, including preemptive analgesia, neuraxial blockade, peripheral nerve blocks, as well as narcotic and non-narcotic analgesics.

This prospective research compared the efficacy of the combination of IPACK (Interspace between Popliteal Artery and the Capsule of the Posterior Knee) block and Adductor Canal Block (ACB) for postoperative pain following TKA, with a particular focus on posterior knee pain. The study compared the effectiveness of this technique with opioid analgesics administered after spinal anesthesia alone or with ACB used independently.

Methodology: The research was a prospective, double-blinded, randomized controlled trial, comprising 60 patients undergoing knee surgeries. The patients were assigned into three groups at random: Group A received solely spinal anesthesia without any peripheral nerve blocks; Group B underwent ultrasound guided ACB after spinal anesthesia, and Group C was administered a blend of ACB and IPACK block under ultrasound guidance at the commencement of the surgery. Postoperatively, pain levels were evaluated using VAS scores. If the VAS score exceeded 4, 50 mg of intravenous pethidine was used as a primary rescue analgesic to lower the VAS score to below 3.

Results: Demographic data and preoperative hemodynamic parameters (heart rate and mean arterial blood pressure) were equivalent in both groups. Postoperatively, HR at 4, 8, 12 and 24 h and MAP at 12 and 24 h were significantly different (P < 0.001). Time to first rescue analgesia, total narcotics intake and VAS scores were significantly different at 4, 8, 12 and 24 h (P < 0.001).

Conclusion: In patients undergoing TKA, postoperative analgesia of combined ACB and IPACK was more effective than that of ACB block alone regarding hemodynamic changes, pain scores, doses of pethidine required for pain relief and postoperative mobilization.

Keywords: Adductor Canal Block; IPACK; Knee Arthroplasty; Knee Capsule; Nerve Block

Citation: Taha Abdelghaffar MR, Nemr MM, Mohamed Mabrouk MH, Elgendy HMA, Abdulmageed AM. A comparative study between the analgesic effect of adductor canal block with or without IPACK block after total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):242-247. DOI: 10.35975/apic.v29i2.2710

Received: October 10, 2024; Reviewed: October 31, 2024; Accepted: December 28, 2024

Intra–abdominal hypertension in critically ill patients after emergency abdominal surgery: incidence, risk factors, and patient outcome

2025-04-08T03:13:30-06:00

Background and Objectives: Intra-abdominal hypertension (IAH) is frequently encountered in patients undergoing major emergency abdominal surgery and is associated with adverse outcomes in the intensive care unit (ICU). This study aims to evaluate the prevalence, risk factors, and outcomes of IAH in a surgical ICU setting.

Methodology: This prospective observational study was conducted at the Center for Anesthesia & Surgical Intensive Care, Bach Mai Hospital, from April 2023 to September 2023. We included adult patients who underwent emergency major abdominal surgery and were in the surgical ICU for more than 48 h. Intra-abdominal pressure (IAP) was measured via a urinary bladder catheter upon ICU admission, and subsequently at 24 and 48 h. IAH was classified according to the World Society of the Abdominal Compartment Syndrome guidelines from 2013. The incidence of IAH and treatment outcomes, including the number of days on mechanical ventilation and the 28-day mortality rate, were recorded. Odds ratios (OR) and 95% CI were calculated to assess the effect size of perioperative risk factors.

Results: Among 92 patients, 38 were diagnosed with IAH. The majority of these patients had IAH grade I, (31.5%), with no cases of grade IV observed. multivariable Logistic-regression analysis revealed several risk factors for IAH included septic shock (odds ratio [OR]; 95% confidence interval [CI]: 3.31; 1.34–8.01), peritoneal fluid (5.28; 1.33–21.05), massive fluid resuscitation (6.93; 1.38–34.80), intra-abdominal infection (7.19; 2.58–20.04), and coagulopathy (3.73; 1.55–8.94). Patients with IAH had a significantly longer duration of mechanical ventilation and ICU length of stay (P = 0.009 and P = 0.049, respectively). The 28-day mortality rate was markedly higher in the IAH group compared to the non-IAH group (34% vs. 5.6%, P = 0.000). A strong correlation was observed between IAH and 28-day mortality, with each 1 mmHg increase in IAP associated with a 5.3-fold increase in mortality rate.

Conclusion: IAH is common among patients undergoing major emergency abdominal surgery and is linked to prolonged ICU stay, extended mechanical ventilation, and increased 28-day mortality. Key risk factors for IAH include septic shock, intra-peritoneal fluid collections, massive fluid resuscitation, intra-abdominal infection, and coagulopathy.

Abbreviations: ACS: Abdominal compartment syndrome, BMI: body mass index, ICU: Intensive Care Unit , IAH: Intra-abdominal hypertension, IAP: Intra-abdominal pressure, RRT: renal replacement therapy

Keywords: Intra-Abdominal Hypertension; Risk Factors; Outcome; Emergency Abdominal Surgery

Citation: Nguyen TT, Kham VV, Giang NT, Quoc LM, Quyen VT, Ho HS. Intra–abdominal hypertension in critically ill patients after emergency abdominal surgery: incidence, risk factors, and patient outcome. Anaesth. pain intensive care. 2025;29(2):248-253. DOI: 10.35975/apic.v29i2.2712

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Combination of interleukin-6 and C-reactive protein levels as predictive biomarkers for early diagnosis of community-acquired pneumonia in ICU patients

2025-04-08T03:13:30-06:00

Background & objective: Pneumonia is a leading cause of morbidity and mortality globally, accounting for 15.2% of deaths in Malaysia in 2023. Community-acquired pneumonia (CAP) poses diagnostic challenges due to the non-specificity of clinical presentations and inconsistencies in imaging interpretation. This study evaluates the diagnostic utility of biomarker interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT), individually and in combination, to improve the diagnosis of CAP in critically ill patients.

Methodology: This prospective cohort study was conducted in an intensive care unit. Adult patients admitted with dyspnea and respiratory failure were recruited, with 33 patients classified as CAP by standardized definition, and 42 as non-CAP. Biomarker levels were assessed in both groups, and diagnostic performance was evaluated with optimum cutoff levels.

Results: Individually, IL-6, CRP and PCT showed poor diagnostic accuracy (AUC < 0.7). The IL-6 and CRP combination achieved the highest AUC (0.759, sensitivity 78%, specificity 67%). The IL-6 and PCT combination provided the highest sensitivity (91%) and negative predictive value (85%), aiding in ruling out CAP.

Conclusion: Combined biomarker evaluation enhances diagnostic accuracy for community-acquired pneumonia, providing a basis for early treatment. These findings warrant further multicenter validation to confirm their clinical applicability in community-acquired pneumonia diagnosis.

Abbreviations: CAP: community-acquired pneumonia, CRP: C-reactive protein, IL-6: interleukin-6, PCT: procalcitonin, ICU: intensive care unit

Keywords: Biomarker; Interleukin-6; C-Reactive Protein; Procalcitonin; Community-Acquired Pneumonia; Dyspmea; Respiratory Failure

Citation: Ramly NF, Wah LK, Nanyan S, Abdul Ghani MR, Ab Rashid I. Combination of interleukin-6 and C-reactive protein levels as predictive biomarkers for early diagnosis of community-acquired pneumonia in ICU patients. Anaesth. pain intensive care 2025;29(2):254-260. DOI: 10.35975/apic.v29i2.2713

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Combined adductor canal block and infiltration in the space between popliteal artery and posterior capsule of the knee block (IPACK) versus combined genicular nerve block and IPACK in total knee arthroplasty

2025-04-08T03:13:30-06:00

Background & objective: Total knee arthroplasty (TKA) causes postoperative discomfort hindering recovery. Effective analgesia aids early rehabilitation and reduces falls. We compare the effectiveness of the conjunction of ACB + IPACK blocks versus GNB + IPACK blocks in providing postoperative pain relief and early recovery following TKA.

Methodology: 40 participants were randomly allocated to two comparable sets received either combined ACB by 10 mL bupivacaine 0.25% and IPACK block by 20 mL of bupivacaine 0.25% or combined GNB using a total of 15 mL bupivacaine 0.25% and IPACK block using 20 mL of bupivacaine 0.25%. Time to first rescue analgesic dose, postoperative pain using NRS, total nalbuphine consumption, and risk of falls using Timed Up and Go (TUG) test on the consecutive two days after surgery were evaluated.

Results: The GNB+IPACK group experienced a delayed time to the first rescue analgesic dose, lower total nalbuphine intake, reduced pain scores, earlier mobilization and decreased fall risk on the first and second postoperative days compared to the ACB+IPACK group with significant P-values.

Conclusion: Combined GNB + IPACK blocks provided superior analgesia, reduced opioid consumption, better motor sparing, earlier ambulation, and decreased falls compared to ACB+IPACK blocks in postoperative TKA patients.

Abbreviations: IPACK: the space between the popliteal artery and the posterior capsule of the knee

Keywords: Adductor Canal Block; Analgesia; Genicular Nerve Block; IPACK; Regional anesthesia; Total Knee Arthroplasty; Opioids

Citation: Abdelrahman Elkfafi SM, Ahmed Ghallab MA, Fawzy HM, Samir GM, Hashim RM. Combined adductor canal block and infiltration in the space between popliteal artery and posterior capsule of the knee block (IPACK) versus combined genicular nerve block and IPACK in total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):261-269. DOI: 10.35975/apic.v29i2.2714

Received: July 30, 2024; Reviewed: October 26, 2024; Accepted: February 04, 2025

Ultrasound guided assessment of internal jugular vein parameters for prediction of postinduction hypotension in cirrhotic patients

2025-04-08T03:13:30-06:00

Background & objective: Liver cirrhosis has been associated with an elevated risk of perioperative complications and the development of post-induction hypotension (PIH). The purpose of this research was to determine how well changes in the internal jugular vein) IJV (diameter and area can predict post-induction hypotension in cirrhotic patients.

Methodology: A prospective study was conducted in 96 cirrhotic patients, undergoing general anesthesia for surgery, at Department of Anesthesia, Menoufia University hospitals, from October 2023 to September 2024. IJV diameter, area, collapsibility index in supine and Trendelenburg positions and IJV change rate measurements were recorded. A decrease in mean arterial pressure (MAP) by more than 20% of the baseline was defined as ‘hypotension’. A persistent hypotension for ≥ 2 min was defined as ‘prolonged hypotension’. If MAP was reduced by over 40% from the baseline value, it was considered as ‘severe hypotension’.

Results: Hypotension occured in 68% of the participants studied. There was no statistically significant difference between hypotensive and non-hypotensive groups regarding age, sex and baseline mean blood pressure. Δ IJV maximum diameter, ΔIJV minimum diameter, ΔIJV -A, ΔIJV-CI with cut-off point (≥ 0.14, ≤ 0.10, ≥ 0.22, ≥ 0.21 respectively) and sensitivity and specificity of (81% and 97%/ 67% and 77% / 100% and 90% / 78% and 90% respectively) in prediction of hypotension

Conclusion: The ultrasound guided measurement of IJV parameters demonstrated a good diagnostic accuracy during both the supine and Trendelenburg position for predicting postinduction hypotensive response especially, the change rate of IJV area.

Keywords: Internal Jugular Vein; Ultrasonographic Measurement; Hypotension; General Anesthesia; Induction

Citation: Afify NA, Fathi YE, Ghanem MA, Mowafy NI, Bahgat NM. Anaesth. pain intensive care; 2025;29(2):270-277. DOI: 10.35975/apic.v29i2.2715

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Predictors of weaning failure from mechanical ventilation in post-cardiac surgery patients

2025-04-08T03:13:30-06:00

Objectives: This research endeavors to pinpoint the variables that foretell failure to wean from mechanical ventilation (MV) among individuals who have experienced cardiac surgery, aiming to mitigate the hazards linked to prolonged stays in the intensive care unit (ICU).

Methodology: The investigation was conducted in the ICU for post-cardiac surgery patients at Ain Shams University Hospital. The study included 80 patients who had undergone cardiac surgery and were subsequently on MV.

Results: Successful extubation was achieved in most patients enrolled in the study. Intraoperative complications were common among participants, with pacemaker wire insertion being the most frequent, followed by ventricular fibrillation. The most frequently performed surgical procedure was coronary artery bypass grafting (CABG), with mitral valve replacement (MVR) being the second most common. Most patients exhibited mild to moderate tracheal secretions. Significant differences were observed between successfully weaned patients and those who failed extubation. Specifically, the failed extubation group demonstrated significantly higher Charlson Comorbidity Index scores, a greater prevalence of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVS), and significantly lower mean blood pressure (MBP) and PaO₂/FiO₂ ratios.

Conclusion: The study's results indicate that several independent factors are linked to a higher probability of unsuccessful weaning from MV. These factors include a Sequential Organ Failure Assessment (SOFA) score of 6 or above, a Comorbidity Index exceeding 3, severe tracheal secretions, a respiratory rate to tidal volume ratio (RR/TV) of 57 or higher, and minute ventilation of 13.5 L/min or more.

Abbreviations: ACC: aortic cross-clamp, CABG: coronary artery bypass grafting, COPD: chronic obstructive pulmonary disease, ECC: extracorporeal circulation, MV: mechanical ventilation, MVR: mitral valve replacement

Keywords: Cardiac Surgery; Mechanical Ventilation; Weaning Failure

Citation: Mohamed Ali MAK, Mohamed NMK, Elgendy HM, Mohamed AlAwady DES, Sayed HM. Predictors of weaning failure from mechanical ventilation in post-cardiac surgery patients. Anaesth. pain intensive care 2025;29(2):278-283. DOI: 10.35975/apic.v29i2.2716

Received: February 04, 2025; Revised: February 13, 2025; Accepted: February 15, 2025

Plasma L-FABP as a superior biomarker for detecting and characterizing cardiorenal syndrome in acute heart failure: comparative insights with hs‐troponin T and NT‐proBNP

2025-04-08T03:13:31-06:00

Background & Objective: The interplay between cardiac and renal dysfunction poses a major diagnostic and therapeutic challenge in acute heart failure (AHF). While high‐sensitivity troponin T (hs-TnT) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) are valuable for cardiac assessment, they offer limited insights into renal injury. We evaluated the performance of plasma liver‐type fatty acid–binding protein (L‐FABP) in distinguishing acute cardiorenal syndrome (CRS) from AHF and its correlation with renal function.

Methods: A case-control study was conducted with 90 participants categorized as controls (n=30), AHF (n=30), and acute CRS (n = 30). Clinical and laboratory data were obtained, including echocardiographic parameters, serum creatinine, estimated glomerular filtration rate (eGFR), and biomarker levels (L‐FABP, hs-TnT, NT‐proBNP). Plasma L-FABP, hs-TnT, and NT-proBNP levels were measured and correlated with renal and cardiac functions. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of biomarkers in differentiating acute CRS from AHF.

Results: Plasma L‐FABP levels were markedly elevated in CRS compared to both AHF and controls (P < 0.001). L‐FABP demonstrated a stronger correlation with serum creatinine (r = 0.84) and an inverse relationship with eGFR (r = −0.55) relative to the other biomarkers. In ROC analyses, L‐FABP showed the highest discriminatory power (AUC = 0.968) in differentiating CRS from AHF, exceeding hs-TnT (0.958) and NT‐proBNP (0.913). Multiple regression analysis revealed that only L‐FABP remained a significant independent predictor of current renal impairment (P = 0.001).

Conclusion: Plasma L‐FABP offers superior diagnostic accuracy and correlates more closely with renal dysfunction than conventional cardiac markers in AHF and CRS. Integrating L‐FABP into routine evaluation may enhance early risk stratification and guide targeted therapeutic interventions for patients at risk of worsening kidney injury.

Abbreviations: AHF: Acute heart failure, CRS: cardiorenal syndrome, hs‐TNT: high‐sensitivity troponin T, L-FABP: liver‐type fatty acid–binding protein

Keywords: Acute Heart Failure; AHF; CRS; hs-Tnt; NT-Probnp; Plasma L-FABP

Citation: Alredha RD, Farman HA. Plasma L-FABP as a superior biomarker for detecting and characterizing cardiorenal syndrome in acute heart failure: comparative insights with hs‐troponin T and NT‐proBNP. Anaesth. pain intensive care 2025;29(2):284-293. DOI: 10.35975/apic.v29i2.2717

Received: September 27, 2024; Reviewed: October 24, 2024; Accepted: January 01, 2025

Perception and knowledge of breast cancer: evaluating educational gaps among Saudi Arabian female medical students

2025-04-08T03:13:31-06:00

Background & objective: Breast cancer continues to rank among the leading causes of mortality for women globally. Though a serious disease, breast cancer is poorly understood worldwide, including in Saudi Arabia.

To evaluate female medical students' understanding of breast cancer risk factors, symptoms, and signs.

Method: This prospective study was conducted over nine months in the College of Medicine, Northern Border University, involving 198 female medical students. A questionnaire adapted through modification from the Breast Cancer Awareness Measure, version 2, was used for this study to collect data. The SPSS used for analysis was version 29.

Results: Medical students’ knowledge of breast cancer symptoms and signs is diverse. As an example, 59.2% of respondents correctly identified a lump or thickening in the breast and 67.3% recognized that a lump or thickening under the armpit may be a warning sign, while 40.8% and 32.7%, correspondingly, were uninformed. Awareness of the risk factors among the different years of the study revealed some interesting trends with significant associations like the history of breast cancer (P = 0.003), relative to breast cancer (P = 0.031), early menarche (P = 0.005), and hormone replacement therapy (P = 0.021). Only 18.69% were very confident in noticing changes in breasts while 40.91% had never done self-examination.

Conclusion: The female Saudi medical students demonstrated knowledge in some aspects of breast cancer; however, knowledge and practice gaps were still large. These results strengthen the evidence of a continuing need for education to develop better knowledge and proactive health behaviors regarding breast cancer.

Key words: Breast Cancer; Risk Factors; Medical Students; Saudi Arabia

Citation: Mehmood Y. Perception and knowledge of breast cancer: evaluating educational gaps among Saudi Arabian female medical students. Anaesth. pain intensive care 2025;29(2):294-299. DOI: 10.35975/apic.v29i2.2718

Received: January 28, 2025; Revised: February 04, 2025; Accepted: February 05, 2025

Ultrasound guided quadratus lumborum block versus ultrasound guided erector spinae plane block for postoperative analgesia in laparoscopic abdominal surgeries

2025-04-08T03:13:31-06:00

Background: Postoperative pain after laparoscopic abdominal surgeries can be severe. Despite multimodal analgesia protocols, administration of high doses of opioids is often required hindering early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery (ERAS) setting. A prospective randomized clinical comparative double blinded study was conducted at Ain Shams University Hospitals.

We evaluated and compared the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided posterior Quadratus Lumborum Block (QLB II) in laparoscopic abdominal surgeries.

Methodology: This study was carried on 82 adult patients undergoing laparoscopic surgeries allocated randomly into 2 equal groups ESPB group and QLB II group. The first time to rescue analgesia was reported as a primary outcome. The secondary outcomes include opioid consumption intraoperative, the time of the performance of the block, visual analogue scale (VAS) at rest, at cough and during deep inspiration and total dose of rescue analgesia.

Results: No significant difference recorded between both groups regarding demographic data, first time to rescue analgesia, opioid consumption intraoperative, VAS score and total dose of postoperative analgesia. However, the duration of block procedure was significantly shorter in ESPB group relative to QLB II group (14.2 ± 1.6 min vs 25.3 ± 2.8 min, P < 0.001).

Abbreviations: ERAS: Early Recovery after Surgery, ESP: erector spinae plane, QLB: Quadratus Lumborum Block, VAS: visual analogue scale

Conclusion: Both quadratus lumborum plane block and erector spinae plane block can control postoperative pain after laparoscopic abdominal surgeries; however, erector spinae plane block provided more time saving during its performance.

Keywords: analgesia; ERAS; Erector spinae block; Laparoscopic; Postoperative pain; Quadratus lumborum block; Ultrasound; VAS score

Citation: Boeith AA, Hafez AF, Kamal F, Kamal Eldin DM, Abdelwareth M. Ultrasound guided quadratus lumborum block versus ultrasound guided erector spinae plane block for postoperative analgesia in laparoscopic abdominal surgeries. Anaesth. pain intensive care 2025;29(2):300-306. DOI: 10.35975/apic.v29i2.2592

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

A comparative prospective study on efficacy of premedication with intravenous paracetamol vs 6% hydroxy ethyl starch for reduction of propofol induced local pain

2025-04-08T03:13:31-06:00

Background & objective: A wide variety of approaches have been tried to reduce propofol-induced pain including physical and pharmacological methods. As there are very few studies on this topic, we decided to conduct a study to compare the effectiveness of pretreatment with i.v. paracetamol with that of 6% hydroxy ethyl starch (HES) to reduce pain induced by propofol injection.

Methodology: The prospective comparative observational study was conducted on patients who belonged to American Society of Anesthesiologists (ASA) class I and II and were to undergo general anesthesia. A total of 60 patients were distributed into two groups; Group HES patients received 100 mL hydroxy ethyl starch (HES) intravenously, and Group P received 100 mL inj. paracetamol IV before the propofol injection. We evaluated the pain on the injection of propofol using verbal rating scale (VRS) and noticed any associated behavioral signs. Hemodynamix parameters and the Perfusion Index (PI) were monitored.

Results: Pain experienced by the HES group expressed in terms of VRS score was comparatively higher with early onset of pain (at 1 sec) whereas participants in IV paracetamol started experiencing pain at 4 sec. There was no significant difference between both groups in terms of Heart Rate (HR) Systolic Blood Pressure (SBP), Mean Arterial Pressure ( MAP), and Perfusion Index (PI).

Conclusion: The present study found that IV paracetamol is more effective in reducing the propofol-induced local pain compared to hydroxy ethyl starch solution IV. Hence it is preferable as a pretreatment to provide pain relief to the patients.

Abbreviations: COX: cyclooxygenase , HES: hydroxy ethyl starch, MAP: Mean Arterial Pressure, PI: Perfusion Index, VRS: verbal rating scale

Keywords: Analgesia; Injection; Propofol; Paracetamol; Premedication; Pain Management

Citation: Shivakumar G, Kiran AV, Ramegowda DS, Halagatti C. A comparative prospective study on efficacy of premedication with intravenous paracetamol vs 6% hydroxy ethyl starch for reduction of propofol induced local pain. Anaesth. pain intensive care 2025;29(2):307-311. DOI: 10.35975/apic.v29i2.2453

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Impact of adductor canal block vs. femoral nerve block for postoperative analgesia in total knee arthroplasty

2025-04-08T03:13:31-06:00

Background: Patients undergoing Total Knee Arthroplasty (TKA) benefit from peripheral nerve blocks as a part of multi-modal analgesia. Femoral Nerve Block (FNB) and Adductor Nerve Block (ACB) are very common blocks used in postoperative analgesia. We compared the impact of the two nerve blocks on the postoperative analgesia in total knee arthroplasty under spinal anesthesia.

Method: This prospective double blind randomized controlled trial evaluated 60 patients, ASA PS I and II, randomized either to receive a single shot ACB (Group A, n = 30) or FNB (Group B, n = 30) for postoperative analgesia following TKA in reducing postoperative morphine consumption. Both groups also received infiltration of the local anesthetic by the operating surgeon. Total morphine consumption during first 24 h postoperatively, and pain scores at rest and on flexion of the knee joint at 6, 12, 18 and 24 h were recorded in both groups.

Results: Mean morphine consumption at 24 h in Group A and B was 3 mg and 2.75 mg respectively. There was no difference statistically (P = 0.994). Mean pain scores at rest and on knee flexion at specified intervals of 6, 12, 18 and 24 h were statistically not different. Time to initial ambulation in Group A and B was 238.3 and 406.6 min (P = 0.015), and it was significantly prolonged in Group B.

Conclusion: The results of this study conclude that adductor nerve block is an effective pain relief technique with comparable opioid sparing effect and with minimal quadriceps weakness and decreased time to early initial ambulation when compared to femoral nerve block, as a part of multimodal analgesia, in knee arthroplasty under spinal anesthesia. It offers good patient satisfaction and early ambulation.

Abbreviations: ACB: Adductor Nerve Block, FNB: Femoral Nerve Block, NRS: Numerical Rating Scale, PACU: Post Anesthesia Care Unit, PCA; Patient Controlled Analgesia, TKA: Total Knee Arthroplasty,

Citation: Venkatesan S, Mallik M, Mohammed S, Narayan P, Adeel S. Impact of adductor canal block vs. femoral nerve block for postoperative analgesia in total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):40-46. DOI: 10.35975/apic.v29i2.2721

Received: July 30, 2024; Reviewed: August 12, 2024; Accepted: August 12, 2024

Comparative study of the effects of volume-controlled ventilation vs. pressure-controlled volume guaranteed ventilation in patients with obesity during laparoscopic surgery

2025-04-08T03:13:31-06:00

Background & objective: The anesthetists have been experimenting with different modes of mechanical ventilation during general anesthesia. The objective of this study was to evaluate the efficacy of Pressure Controlled Ventilation-Volume Guaranteed (PCV-VG) mode in comparison to volume-controlled ventilation (VCV) mode in obese patients undergoing laparoscopic surgery in the Trendelenburg position, with a focus on their lung compliance and Oxygenation Index (OI).

Methodology: This randomized controlled clinical trial involved 64 obese patients of both sexes, with a Body Mass Index (BMI) of ≥30 kg/m², and classified as American Society of Anesthesiologists (ASA) class I or II. The participants were randomly assigned to one of the two groups: the study group (Group P) using PCV-VG and the control group (Group V) using VCV. Hemodynamic and respiratory parameters were monitored.

Results: The arterial oxygen partial pressure (PaO₂) and lung compliance were significantly higher in Group P compared to Group V (P < 0.05). Conversely, the peak pressure (P peak) and plateau pressure (Pplat) along with the mean pressure (P mean) as well as the OI were significantly lower in Group P compared to Group V (P < 0.05).

Conclusion: PCV-VG significantly improves lung compliance and oxygenation while maintaining lower peak and plateau pressures, with comparable hemodynamic stability and PaCO₂ levels.

Abbreviations: BMI: Body Mass Index, OI: Oxygenation Index, PCV-VG: Pressure Controlled Ventilation-Volume Guaranteed, PIP: Peak Inspiratory Pressure, PRVC- pressure-regulated volume-controlled, V_T: tidal volume, VCV: volume-controlled ventilation

Keywords: Volume-Controlled Ventilation; Pressure-Controlled Ventilation Volume-Guaranteed; Trendelenburg Position; Obesity; Airway Pressures

Citation: Soliman AM, El Seidy MI, Taha SS, El Agamy AES, Youssef AM. Comparative study of the effects of volume-controlled ventilation vs. pressure-controlled volume guaranteed ventilation in patients with obesity during laparoscopic surgery. Anaesth. pain intensive care 2025;29(2):318-324. DOI: 10.35975/apic.v29i2.2722

Received: September 02, 2024; Reviewed: October 23, 2024; Accepted: January 01, 2025

Comparative study between cervical medial branch radiofrequency ablation versus radiofrequency plus superficial cervical plexus block in treatment of the cervical facet and cervical spondylosis pain

2025-04-08T03:13:31-06:00

Background & objective: Neck pain is one of the common problems due to long office hours and improper posture. While most of the pain originates from the muscles and is usually self-limiting, chronic pain which is resistant to treatment is very common especially with the cervical spondylosis. It is the most common progressive disorder in the aging cervical spine and may produce direct neurological damage or ischemic changes and, thus, lead to spinal cord disturbances.

Cervical facet medial branch radiofrequency ablation (RFA) is a minimal procedure for the pain originating from the cervical facets. The procedure is very safe and needs no hospital stay with a success rate over 80% of the patients. We compared the efficacy in the pain relief between RFA of the medial branch of the cervical facet alone vs combined with superficial cervical plexus block (SCPB).

Methodology: We used Power Analysis and Sample Size Software (PASS 15) (Version 15.0.10) for sample size calculation, setting confidence level at 90%, margin of error + 0.10. A total of 53 patients, seeking treatment for bilateral cervical spondylosis pain were included in the study conducted between March 2024 and June 2024. All of them received RFA on both sides; and after 2 weeks they received superficial cervical plexus block on one side. Numeric pain scale (NPS) was used to assess the pain at 1 and 6 months after the procedure. Patient Global Impression of Change (PGIC) score was also measured. Primary outcome was to measure the efficacy of the standard RFA in managing the cervical facet pain; secondary outcome was to assess any additive value of SCP block.

Results: Neck pain significantly reduced on both sides after radiofrequency ablation of cervical facet medial branch after 1 month and after 6 months (P < 0.001), with no significant added effect of superficial cervical plexus block. PGIC was compared between both sides. Significant improvement was detected in both sides after treatment. However, the difference between the groups was not statistically significant.

Conclusion: Radiofrequency alone can provide sufficient pain relief in patients with chronic neck spondylosis pain with no significant added effect of superficial cervical plexus block.

Keywords: Neck pain, Radiofrequency, Cervical plexus block, Spondylosis, Chronic pain

Citation: Daniel SH, Zakhary LE, El-Komos PM. Comparative study between cervical medial branch radiofrequency ablation versus radiofrequency plus superficial cervical plexus block in treatment of the cervical facet and cervical spondylosis pain. Anaesth. pain intensive care 2025;29(2):325-330. DOI: 10.35975/apic.v29i2.2583

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Anesthetic management of a parturient with Ebstein anomaly palliated with Fontan procedure

2025-04-08T03:13:31-06:00

Women of childbearing age with surgically palliated congenital heart disease (CHD) have become increasingly common as survival rates of CHD improve. We describe a 33-year-old female with a history of Ebstein anomaly (EA), status post fenestrated lateral tunnel Fontan procedure, at gestational week 37 who presented for induction of labor and was found to have a fetal breech presentation. Cesarean section with general anesthesia was indicated after failure to progress in labor with epidural analgesia. As surgically treated EA has led to increased survivability, further discussion on the anesthetic management of this growing obstetric patient population was necessary.

Abbreviations: CO: cardiac output; CTPA: computed tomography pulmonary angiography; CHD: congenital heart disease; EA: Ebstein anomaly; LPA: left pulmonary artery; LT: lateral tunnel; PVR: pulmonary vascular resistance; RA: right atrium; SVC: superior vena cava; TTE: transthoracic echocardiogram; VR: venous return.

Keywords: Ebstein Anomaly; Congenital Heart Disease; Anesthesia; Fontan Procedure

Citation: Schmitt K, Tafalla J, Wells R, Rinehart J. Anesthetic management of a parturient with Ebstein anomaly palliated with Fontan procedure. Anaesth. pain intensive care 2025;29(2):341-344. DOI: 10.35975/apic.v29i2.2724

Received: July 18, 2023; Reviewed: December 03, 2023; Accepted: January 01, 2023

Integration of robotics in healthcare management: a narrative review

2025-04-08T03:13:31-06:00

Background: Rapid advancements in robotics have addressed concerns including a dwindling workforce and the need for technological integration, resulting in major advances in patient care. Combining concepts from engineering, physics, and mathematics, robotics has developed from industrial applications in the 1960s to medical applications in the 1980s. These days, robots assist with a variety of medical tasks, such as surgery, patient monitoring, and rehabilitation. Notwithstanding their revolutionary potential, particularly in domains such as pharmacy automation and telepresence, the assimilation of robotics into nursing care has not received enough attention. The numerous uses and effects of robotics in patient care are reviewed in this study, with a focus on how they might improve productivity, lower error rates, and enable independent living for the old and disabled.

Objective: To provide a narrative review of integration of Robotics in health care management to provide individualized and effective healthcare solutions.

Method: A systematic search of MEDLINE/PubMed and Google Scholar databases, then thoroughly reviewed the articles, focusing on those published in the last 5 years.

Conclusion: Robotics integration in healthcare is revolutionizing minimally invasive procedures, medicine administration, and improved mobility for patients. Robotics-assisted rehabilitation enhances the results of physical and cognitive treatment while helping the aged and disabled. While robotic process automation (RPA) boosts productivity and lowers errors in administrative work and pharmacy operations, telepresence robots enable remote patient connection. As robots’ technology develops, more individualized and effective healthcare solutions could be possible.

Abbreviations: ASD: autism spectrum disorder, EMR: Electronic Medical Record, AI: artificial intelligence, IoMT: Internet of Medical Things. RPA: robotic process automation, UN: United Nations, UV-C: ultraviolet-C lighting, WHO: World Health Organization

Keywords: Robotics; Health Care Management; Patient Care; Robotic-Assisted Surgery; Robotics-assisted rehabilitation; Pharmacy Automation

Citation: Irshad A, Farooq N, Kiran Q, Farooq A, Munir S, Kafeel S. Integration of robotics in healthcare management: a narrative review. Anaesth. pain intensive care 2025;29(2):331-336. DOI: 10.35975/apic.v29i2.2723

Received: February 04, 2025; Reviewed: February 13, 2025; Accepted: February 14, 2025

Building holistic health using Quran-based spiritual therapy application media for chronic disease patients in intensive care units

2025-04-08T03:13:32-06:00

Background & objective: In the implementation of "Aplikasi Terapi Al-Quran (ATAQ)" (in English: Al-Quran Therapy Application) in the ICU, Kendari City Hospital, Indonesia, it is realized that each patient with chronic disease is a unique person, who certainly has a different response to their disease and to ATAQ. This study aimed to explore the meaning felt by patients with chronic disease after implementing ATAQ.

Methodology: This case series is part of a research project on ATAQ testing, involving 3 patients in the ICU. After all patients received an explanation and gave their consent, spiritual therapy using ATAQ was carried out every morning and evening and continued for 3 months. During the therapy process, in-depth interviews were conducted about the important meaning felt by each patient about the changes that occurred in him/her after undergoing spiritual therapy using ATAQ. In addition, observations were also made on the patient's condition. The data obtained were analyzed thematically, then presented narratively.

Results: The results of the study on the three patients were as follows. The first patient looked fresher. He promised to be disciplined in performing prayers, which were previously not routinely done, could sleep soundly every night, the feeling of tightness decreased, but the stomach pain was still felt. In the last days, he stated that he was much calmer and his mind was more open. The second patient also looked fitter with a radiant red face. He felt that his sleep quality had improved, his anxiety had decreased, he could accept his illness, the pain had decreased slightly, and his appetite had improved. On the last day, he expressed his gratitude. The third patient was initially not interested in ATAQ. After discussing, the patient finally agreed to undergo therapy using ATAQ. He felt calmer and always cried with emotion every time he underwent therapy, felt more comfortable and peaceful, and regretted having previously refused therapy.

Conclusion: With spiritual therapy using ATAQ, patients with chronic diseases feel healthier holistically; both physically, socially, mentally, and spiritually; so, they can adapt better to their condition.

Abbreviations: ‘ATAQ’: Aplikasi Terapi Al-Quran; ICU: Intensive care unit

Keywords: Patients; Chronic Diseases; Holistic Health; Quran-Based Spiritual Therapy; Intensive Care Unit

Citation: Rosyanti L, Nugroho HSW, Hadi I. Building holistic health using Quran-based spiritual therapy application media for chronic disease patients in intensive care units. Anaesth. pain intensive care 2025;29(2):337-340.

DOI: 10.35975/apic.v29i2.2725

Received: July 30, 2024; Reviewed: October 26, 2024; Accepted: February 04, 2025

Managing carbon dioxide embolism in hepatobiliary laparoscopic surgery: a case report

2025-04-08T03:13:32-06:00

Laparoscopic surgery has become a cornerstone of modern medicine, emerging as one of the most frequently performed procedures in the most of the world. It serves as a minimally invasive technique used for a range of diagnostic and therapeutic interventions, including cholecystectomy, hysterectomy, and tissue biopsies. It needs insufflation of the carbon dioxide (CO₂) peritoneal cavity to offer space in the abdominal cavity. Veress needle technique being one of the most commonly used, which may injure abdominal contents and blood vessels. This case report is about the inadvertent intrahepatic entry of the Veress needle.

Keywords: Cholecystectomy; Laparoscopic surgery; Veress needle

Citation: Jiang M, Rajan GR. Managing carbon dioxide embolism in hepatobiliary laparoscopic surgery: a case report. Anaesth. pain intensive care 2025;29(2):345-349. DOI: 10.35975/apic.v29i2.2727

Takayasu’s arteritis, discovered in a young lady presenting with stroke; a case report

2025-04-08T03:13:32-06:00

Takayasu Arteritis (TA) affects major arteries in the body and it is a rare vasculitis that causes inflammation and leads to loss of pulse and raised blood pressure. In our case, stroke lead to an accidental diagnosis of TA. Moreover, physical symptoms such as problems with maintaining balance and the muscular strength have never been reported in previous case studies, especially in patients presenting with stroke. A 24-year-old female patient was brought to the emergency room in unconscious state and was diagnosed with right-sided ischemic stroke. On diagnostic imaging, her right common carotid artery and left subclavian artery were found to be more than 90% blocked. She was discharged after three days. Her control over maintaining her balance decreased even more with closed eyes and feet together, on manual perturbation approaches directed from right and left sides. Additionally, her left lower limb had reduced muscular strength than her left upper limb.

There are high chances of experiencing frequent falls and reduced muscular strength in this population group, that could hinder their day-to-day activities.

Keyword: Takayasu Arteritis; Balance Impairments; Muscle; Stroke; Doppler Ultrasound

Citation: Perveen W, Sajjad Y, Ilyas U, Naeem R. Takayasu’s arteritis, discovered in a young lady presenting with stroke; a case report. Anaesth. pain intensive care 2025;29(2):350-353. DOI: 10.35975/apic.v29i2.2728

Received: February 04, 2025; Revised: February 13, 2025; Accepted: February 15, 2025

Regional anesthesia for axillary lymph node excisional biopsy in a patient with anterior mediastinal mass

2025-04-08T03:13:32-06:00

Regional blocks for the anterolateral chest wall are challenging in regard to the anatomical basics and innervation, the limitation of available evidence, lack of credible guidelines, and wide discrepancy in the existing practice among the health practitioners across the countries. Despite the challenges, recently new fascial plane blocks have been used more often as analgesic techniques. In very few occasions these techniques have been reported in literature as surgical blocks in certain cases where general anesthesia was not favorable or advisable. We present a challenging case in which the scheduled surgery had to be postponed due to high risk if done under general anesthesia, as she was concurrently suffering from multiple comorbidities and needed much status optimization. At the same time, her procedure was time sensitive to diagnose her medical illness and initiate the proper management.

Keywords: Regional Anesthesia; Pain Management; Fascia Plane Block; Nerve Block

Citation: Al Misnid O. Regional anesthesia for axillary lymph node excisional biopsy in a patient with anterior mediastinal mass. Anaesth. pain intensive care 2025;29(2):354-357. DOI: 10.35975/apic.v29i2.2729

Received: February 11, 2025; Reviewed: February 14, 2025; Accepted: February 16, 2025

Caudal anesthesia for anorectal surgery in a rare case of syringomyelia in a day-surgery clinic

2025-04-08T03:13:32-06:00

Syringomyelia is a rare neurological disease that is characterized by a degenerated and cystic spinal cord. General or spinal anesthesia can cause development of or exacerbation of syringes in these patients, and the optimal anesthetic method for use in patients with syringomyelia remains unclear. Here, we present the case of a patient with syringomyelia in whom caudal anesthesia was used for anorectal surgery in a day-surgery clinic. Surgery was concluded successfully, without any neurological complications associated with syringomyelia. This case demonstrates that caudal anesthesia may be an option for non-obstetric surgery in patients with syringomyelia, if it is performed by experienced medical staff.

Keywords: Arnold Chiari Malformation; Ambulatory Surgical Procedures; Caudal Anesthesia; Hemorrhoids; LAST; PDPH; Syringomyelia; Valsalva Maneuver; Water-Hammer Effect

Citation: Lee H, Lee HK. Caudal anesthesia for anorectal surgery in a rare case of syringomyelia in a day-surgery clinic. Anaesth. pain intensive care 2025;29(2):358-361. DOI: 10.35975/apic.v29i2.2730

Received: October 08, 2024; Reviewed: December 24, 2024; Accepted: December 26, 2024

Airway management dilemma in a patient with carcinoma of the tongue and retrosternal goiter: a case report

2025-04-08T03:13:32-06:00

Difficulty in intubation can be addressed if the otolaryngologist performs tracheostomy under local anesthesia. However, it becomes a dilemma when the tracheostomy is anticipated to be difficult due to the presence of retrosternal thyroid enlargement and when the procedure is requested to be done under general anesthesia. We performed airway management in a 72-year-old woman with double challenges of carcinoma of the left lateral border of the tongue and retrosternal thyroid enlargement for tracheostomy and gastrostomy under general anesthesia. We avoided oral intubation and anticipated potential obstructing airway, difficulty in ventilation, and potentially difficult tracheostomy, that limited the choice of our plan towards awake nasal intubation under monitored anesthesia care with dexmedetomidine and target-controlled infusion of remifentanil.

Keywords: Carcinoma; Tongue; Thyroid; Intubation; Tracheostomy

Citation: Alwyn Lee CY, Wan Hassan WMN, Mahamarowi NH, Azzeri AA. Airway management dilemma in a patient with carcinoma of the tongue and retrosternal goitre: a case report. Anaesth. pain intensive care 2025;29(2):362-365. DOI: 10.35975/apic.v29i2.2726

Received: October 10, 2024; Reviewed: October 16, 2024; Accepted: October 26, 2025

Response to: ‘Arthritis cannot break my spirit’

2025-04-08T03:13:32-06:00

Citation: Nugroho HSW. Response to: ‘Arthritis cannot break my spirit’ (Correspondence). Anaesth. pain intensive care 2025;29(2):366-367; DOI: 10.35975/apic.v29i2.2731

Received: February 24, 2025; Accepted: February 28, 2025

Anesthesia for electroconvulsive therapy in a unique patient population: pregnancy

2025-04-08T03:13:32-06:00

Citation: Tuncer B, Arici MB, Kaya H, Erkiliç E, Öztürk L. Anesthesia for electroconvulsive therapy in a unique patient population: pregnancy (Correspondence). Anaesth. pain intensive care 2025;29(2):368-270; DOI: 10.35975/apic.v29i2.2644

Received: January 28, 2025; Revised: February 21, 2025; Accepted: February 21, 2025