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Comparative study on the efficacy of ultrasound guided clavipectoral fascial plane block versus interscalene brachial plexus block combined with superficial cervical plexus block in clavicle surgeries- a randomized clinical trial

2026-08-18T11:43:25Z

Title: Comparative study on the efficacy of ultrasound guided clavipectoral fascial plane block versus interscalene brachial plexus block combined with superficial cervical plexus block in clavicle surgeries- a randomized clinical trial Authors: Unnithan arya gopinathan Abstract: AIMS AND OBJECTIVES AIM: This study aims to compare the Efficacy Of ultrasound-guided clavipectoral Fascial Plane Block versus Interscalene Brachial Plexus Block Combined With Superficial Cervical Plexus Block Posted For Clavicle Surgery PRIMARY OBJECTIVES: • To assess the success rate of the block • Ultrasonographic assessment of hemi diaphragmatic paresis by using sigh test • Modified Bromage scale to assess the upper limb function SECONDARY OBJECTIVES: • Assessment of pain by using the VAS score • Time for the first rescue analgesia • Look for side effects, including local anaesthetic systemic toxicity and Horner syndrome METHODS: A Total of 60 patients with unilateral clavicle fractures of ASA I & II, age between 18 to 55 who underwent elective internal fixation of clavicle fractures in our hospital, willing for proposed blocks were included in this study. Randomization was done by a computer-generated randomized table Group C: Superficial Cervical Plexus Block and Clavipectoral Fascial Plane Block (S.C.P.B. and C.P.B.) in 30 patients Group I: Superficial Cervical Plexus Block and Interscalene Brachial Plexus Block (S.C.P.B. and I.S.B.P.) in 30 patients 10 Docusign Envelope ID: D8185B3F-E09C-4406-9E88-92889FB5AACA After informed consent, the blocks were given as per the standard protocol by the same anaesthetist under ultrasound guidance. Group C (SCPB AND CPB): Group I (SCPB AND ISBP): S.C.P.B. with 7ml of 0.5% Ropivacaine C.P.B. with 20ml of 0.5% Ropivacaine S.C.P.B. with 7ml of 0.5% Ropivacaine I.S.B.P. with 20ml of 0.5% Ropivacaine At the beginning of the surgery, all patients were administered 0.05 mg/kg of midazolam. The primary objectives were measured as the effect of the block was obsseved at 30 min in three areas: the sternoclavicular joint, mid-clavicle and acromioclavicular joint, Modified Bromage scale (M.B.S.) to assess upper limb movement function and Visual Analog Score(VAS). The diaphragmatic movement was evaluated by real-time M mode using ultrasonography of the hemidiaphragm, and adverse reactions like local anaesthetic systemic toxicity, pneumothorax and haemothorax were also noted. RESULTS: The study compared the Clavipectoral Fascial Plane Block with Superficial Cervical Plexus Block (Group C) and the Interscalene Brachial Plexus Block with the Superficial Cervical Plexus Block (Group I) across multiple parameters. Both groups were demographically similar in age (32.83 ± 10.77 vs. 34.57 ± 9.58 years, p = 0.347) and height (1.673±0.053m vs. 1.684 ± 0.043m , p = 0.382), but Group C had a significantly higher weight (76.53 ± 6.12 vs. 69.80 ± 7.34 kg, p = 0.00005) and BMI (27.33 ± 1.28 vs. 24.67 ± 2.84, p = 0.00003). Analgesic outcomes favoured Group C, with a longer duration of analgesia (23.23 ± 1.96 vs. 14.23 ± 1.33 hours, p < 0.001) and lower VAS pain scores at 6 hours (0.00 ± 11 Docusign Envelope ID: D8185B3F-E09C-4406-9E88-92889FB5AACA 0.00 vs. 0.87 ± 0.97, p < 0.001), 12 hours (0.87 ± 1.01 vs. 2.80 ± 0.61, p < 0.001), and 24 hours (2.93 ± 0.94 vs. 6.63 ± 0.81, p < 0.001), demonstrating superior and prolonged pain relief. Respiratory function was better preserved in Group C, as diaphragmatic excursion at 30 minutes was significantly greater (5.79 ± 0.52 vs. 2.96 ± 0.60 cm, p < 0.001), with a lower percentage decrease (95.57%±4.25 vs. 50.21% ± 10.60, p < 0.001), suggesting reduced risk of respiratory impairment in Group C. Sensory blockade was effective in both groups, with no significant differences in block success scores across the sternoclavicular (2.77 ± 0.43 vs2.60 ± 0.50 ,p = 0.171) , midclavicular (3.00 ± 00 vs. 2.90 ± 0.31, p = 0.083), and acromioclavicular (2.93 ± 0.25 vs. 2.87 ± 0.35, p = 0.398) regions. However, Group I resulted in significant motor blockade (MBS 2.47 ± 0.57 vs. 0.00 ± 0.00, p < 0.001), whereas Group C preserved motor function. Additionally, Group I was associated with hemidiaphragmatic paresis (13%)and Horner syndrome (2%), complications that were absent in Group C. CONCLUSION: The results indicate that Clavipectoral Fascial Plane Block had superior analgesic efficacy, with a significantly longer duration of pain relief and lower VAS scores at all time points compared to the Interscalene Brachial Plexus Block combined with Superficial Cervical Plexus Block Additionally, Clavipectoral Fascial Block was associated with no incidence of hemi diaphragmatic paresis or Horner syndrome, making it a safer alternative for patients at risk of respiratory complications.

Opioid-free versus opioid based anaesthesia for laparoscopic cholecystectomy- a randomized clinical trial.

2026-08-18T11:40:32Z

Title: Opioid-free versus opioid based anaesthesia for laparoscopic cholecystectomy- a randomized clinical trial. Authors: Thaskin Abstract:  AIM To compare the effect of Opioid-free multimodal analgesic regimen over conventional general anesthesia with opioids for post operative pain relief in patients posted for laparoscopic cholecystectomy.  BACKGROUND Laparoscopic cholecystectomy is the standard surgical procedure for cholelithiasis and Gall stone diseases. Although this procedure is thought to be generally painless and require a shorter hospital stay, they can nonetheless result in significant Pain, particularly in the first four hours after procedure. Opioids have been the primary mode of analgesia in the perioperative period with a number of associated side effects like delirium, constipation, nausea, vomiting, sedation, physical dependence, muscle rigidity, tolerance, respiratory depression etc. The preference of Multimodal opioid-free analgesia over opioids have been seen to be associated with intraoperative hemodynamical stability, early return of the bowel function, earlier mobilization of the patient, reduced length of hospital stay along with reduce in the severity of postoperative pain thereby reducing risk of chronic postoperative pain.  METHODOLOGY Informed consent was taken before the surgery. Patients kept nil by mouth 6 hours prior surgery. 10 | P a g e Docusign Envelope ID: 8F437D08-9D11-4DD8-B075-F17F1CE04AE6 All the patients were educated on Visual Analogue Scale and its scoring system. They were evaluated with a detailed history, general and systemic examinations in the preoperative room. Airway assessment and systemic examinations were done. Randomization was done and patients in the study were assigned into two Groups viz., Group A- Opioid free Anaesthesia and Group B - Conventional opioid group. In the preoperative room, Preloading was done with IV crystalloids 10ml/kg. IV Dexamethasone 8 mg was administered to all patients. Baseline parameters were monitored and Group A patients were administered IV paracetamol 15 mg/kg preoperatively. Patients in both the groups were pre oxygenated with 100% O2 for 3 min and then premedicated. Induction was done using IV propofol 2.5mg/kg until the endpoint of loss of eyelash reflex is obtained, along with Lignocaine 1.5 mg/kg (bolus dose) and 1.5mg/kg of succinyl Choline. Endotracheal intubation was done, Atracurium 0.5 mg/kg was administered as loading dose and then in incremental doses as needed along with Nitrous oxide, oxygen and sevoflurane 1%. Additionally, During the maintenance phase, Group A patients received Lidocaine 1.5mg/kg as slow intravenous infusion for an hour and Magnesium 2 g (bolus dose) over 10-15 minutes. Pre-incisional infiltration using 20 ml of 0.25% Bupivacaine (5 ml in each port) and intraperitoneal instillation of 20 ml of 0.25% Bupivacaine was given in the gall bladder bed, after gall bladder has been taken out. In the conventional Opioid group, a similar induction protocol was followed, along with 2 mcg/kg bolus dose of Fentanyl was given and later 0.5mcg/kg IV fentanyl to reduce the intraoperative rise of blood pressure. Intra-abdominal pressure was maintained between 12-15 mmHg during 11 | P a g e Docusign Envelope ID: 8F437D08-9D11-4DD8-B075-F17F1CE04AE6 pneumoperitoneum, and end-tidal CO₂ was kept below 35 mmHg. Intraoperative hemodynamic parameters were recorded. Residual neuromuscular blockade was reversed with IV neostigmine 2.5mg and IV Glycopyrrolate 0.5mg and tracheal extubation was done, after meeting the extubation criteria. At the end of surgery, all the patients received 1g paracetamol intravenously. Postoperatively, pain scores were assessed at 0, 2, 4, 6, 12, and 24 hours using the Visual Analogue Scale (VAS). Rescue analgesia with IV paracetamol was provided for VAS >4, and tramadol was administered for severe pain (VAS 8-10). The primary outcomes included postoperative pain scores, total analgesic consumption and the time to first analgesic request.  RESULTS Demographic Characteristics:  The mean age of patients (years) in Group A (OFA) was 46.21 ± 15.497 years, while in conventional opioid group, it was 41.09 ± 13.957 years. The difference was not statistically significant, ensuring comparability between the groups.  The mean weight of patients in Group A was 68.62 ± 13.298 kg, while in Group B, it was 63.32 ± 12.579 kg. This difference was also not statistically significant (p = 0.096). Intraoperative Hemodynamic Stability:  The mean systolic blood pressure (SBP) was higher in Group A (123.65 ± 5.672 mmHg) compared to Group B (119.50 ± 5.720 mmHg) 12 | P a g e Docusign Envelope ID: 8F437D08-9D11-4DD8-B075-F17F1CE04AE6  No significant differences were observed in diastolic blood pressure (DBP), heart rate (HR), or mean arterial pressure (MAP) between the two groups (p > 0.05), suggesting comparable intraoperative hemodynamic stability. Postoperative Pain (VAS Score Comparison): At 0, 2, 4, and 24 hours postoperatively, the OFA group demonstrated significantly lower pain scores compared to the conventional group (p < 0.05), indicating superior early postoperative pain control. Duration of Analgesia: The mean duration of analgesia was significantly longer in the OFA group (11.35 ± 7.639 hours) compared to the Opioid group (4.26 ± 2.050 hours) (p < 0.001). This indicates prolonged postoperative pain relief in patients receiving opioid-free anesthesia. Postoperative Analgesic Consumption:  A higher percentage of patients in the OFA group (24%) did not require postoperative analgesics, whereas all patients in the Opioid group required pain management.  A greater proportion of patients in the OFA group (71%) required only a single dose of paracetamol, compared to the opioid group. 13 | P a g e Docusign Envelope ID: 8F437D08-9D11-4DD8-B075-F17F1CE04AE6  None of the patients in the OFA group required combination of paracetamol and tramadol 50 mg, whereas 21% of patients in the conventional group required the additional opioid analgesia for pain relief. Postoperative Adverse Effects:  The incidence of nausea and vomiting was higher in the conventional opioid group (n=5) compared to the OFA group (n=0), though this difference did not reach statistical significance (p = 0.053).  Shoulder tip pain, commonly associated with residual carbon dioxide, was significantly more prevalent in the Opioid group than the OFA group. (p = 0.0115).  Other adverse effects, such as generalized pruritus and shivering, were reported only in the conventional opioid anesthesia group but were not statistically significant. • CONCLUSION Opioid-free anesthesia provided effective postoperative pain relief, reduced analgesic requirements, and lowered adverse effects when compared to the conventional opioid-based anesthesia. This multimodal opioid-free approach may offer a safer alternative for pain management in laparoscopic cholecystectomies.

To compare the effectiveness of real-time ultrasound guided spinal anaesthesia versus pre procedural ultrasound guided spinal anaesthesia in obese parturients: a randomized control trial

2026-08-18T11:36:49Z

Title: To compare the effectiveness of real-time ultrasound guided spinal anaesthesia versus pre procedural ultrasound guided spinal anaesthesia in obese parturients: a randomized control trial Authors: Suman hiremath Abstract: BACKGROUND: Spinal anesthesia is the preferred technique for elective cesarean sections. However, standard landmark-guided approaches can be challenging in obese parturients due to difficulty in identifying anatomical landmarks, leading to multiple attempts and increased complication risks. Neuraxial ultrasound-guided (USG) techniques offer a promising solution by enhancing procedural accuracy and efficiency. AIM: The Aim of our study is to compare the effectiveness of real-time ultrasound-guided (RUS) spinal anesthesia versus pre-procedural ultrasound-guided (PPUS) spinal anesthesia in obese parturients posted for elective cesarean sections. METHODOLOGY: A total of 80 obese parturients (BMI >30 kg/m2, ASA II-III) who were scheduled for elective cesarean sections were randomized into two groups: Group PPUS and Group RUS. Primary outcomes included the number of attempts, needle passes, and time taken for successful dural puncture. Secondary outcomes included intervertebral space identification time, successful analgesia time, and hemodynamic stability. Statistical analysis was performed using SPSS v20, with p<0.05 considered significant. 10 Docusign Envelope ID: EC662210-CC2F-4FA0-832C-C62D38F6813A RESULTS : The Group RUS demonstrated significantly fewer attempts (1.7±0.6 vs. 4.5±1.0, p<0.05) and needle passes (2.1±1.0 vs. 5.7±1.3, p<0.05) compared to the Group PPUS . The mean time for intervertebral space identification was shorter in the Group RUS (60.3±25.6 vs. 160.8±45.2 seconds, p<0.05), as was the time for successful lumbar puncture (93.6±30.0 vs. 249.2±63.3 seconds, p<0.05). Both groups achieved a 100% success rate in spinal anesthesia. CONCLUSION : Both Group RUS and Group PPUS techniques are effective for spinal anesthesia in obese parturients. However, RUS was significantly betteri technique in reducing the number of attempts, needle passes, and procedural time, making it a more efficient and precise.

A prospective randomized controlled trial to study the advantage of implementation of enhanced recovery after surgery (eras) in acute pain management during elective caesarean delivery.

2026-08-18T11:24:26Z

Title: A prospective randomized controlled trial to study the advantage of implementation of enhanced recovery after surgery (eras) in acute pain management during elective caesarean delivery. Authors: Sankarnarayanan R Abstract: BACKGROUND AND AIMS: Indeed, giving birth to a child represents a profound joy for woman. But for those mothers whose choose to deliver by Cesarean section either by choice or maternal and fetal conditions, the happiness is short-lived due to various reasons. Post operative pain, sedation, other complications such as Shivering, nausea and vomiting prevents the mother from actively engaging with the newborn to hold, to feed which is not only a concern for the mother, but is also detrimental for the well-being of new born. To address these short comings associated with following traditional routine protocols in cesarean delivery, we decided to study the adaptation of Enhanced Recovery After Elective Cesarean section. The study aims to evaluate the impact of an Enhanced Recovery After Surgery (ERAS) protocol on the postoperative outcomes of patients undergoing elective cesarean delivery. METHODOLOGY: After the fulfillment of the inclusion criteria, patients were explained about the study and enrolled into the study after obtaining the written informed consent. Randomized into group EP or RP. Patients underwent thorough Pre-anaesthetic evaluation with detailed history, airway examination, systemic examination. Patient was explained about the protocols and sensitized about Visual analogue scale. Routine blood investigations were done. Patients randomized into group EP were encouraged to drink clear liquids two hours before surgery, whereas patients in group RP were kept nil by mouth for 6 hours. 14 Docusign Envelope ID: 833A84C4-8009-45BD-A545-F3C56FEE92E7 In preoperative holding area, patient details were checked, and a 20G iv cannula was secured. Before shifting the patient to operating room, the forced air warmers, fluid warmers and ultrasound machines were kept ready. Patients were monitored with ASA standards for intraoperative monitoring. Before positioning the patient for subarachnoid block, a bolus dose of Phenylephrine 100 mcg was given. Fluid warmers and forced air warmers were turned on. Ath the end of the surgery, bilateral Tap were given using ultrasound guidance. All the patients were followed up un till the time of discharge. Results: Among the 50 patients in each group, 5 patients in Group EP and 17 patients in Group RP had experienced shivering during intraoperative period. There is a significant decrease in intraoperative shivering in group EP (p<0.005). In Group EP, 10 patients out of total 50 patients had hypotension intraoperatively. In Group RP, 32 patients out of total 50 patients had Hypotension intraoperatively. The patients in Group RP had higher incidence of intraoperative Hypotension compared to Group EP. Postoperative pain was evaluated in patients 24 hours post-surgery at rest using the Visual Analog Scale (VAS). The mean VAS score in Group EP (1.76 ± 0.8221, P<0.005) was significantly lower than that in Group RP (2.96 ± 0.9467, P<0.005). Postoperative pain was evaluated in patients 24 hours post-surgery at motion using the Visual Analog Scale (VAS). The mean VAS score in Group EP (2.46 ± 0.8134, P<0.005) was significantly lower than that in Group RP (3.78 ± 0.8873, P<0.005). The number of patients required opioids at 24 hours in Group EP and Group RP was 2(4%) and 25 (50%) respectively. The number of patients required opioids in Group EP is significantly lower than that in Group RP with a P value less than 0.005. The Satisfaction VAS in Group EP (6.18 ± 0.8965) is significantly higher than that of in Group Rp (4.76 ± 0.6247) with a P value lesser than 0.005. The total length of stay (days) in hospital in Group EP (3.76 ± 0.7969) is significantly lower than that of in Group RP (4.68 ± 0.7126) with a P value of lesser than 0.005. 15 Docusign Envelope ID: 833A84C4-8009-45BD-A545-F3C56FEE92E7 The postoperative length of stay (Days) in hospital in Group EP (3.04 ± 0.7273) is significantly lower than that of in Group RP (3.94 ± 0.7117) with a P value lesser than 0.005. CONCLUSION The adaptation of Enhanced Recovery After Cesarean section protocol for perioperative care in elective cesarean delivery, showed better outcomes with maternal pain management, reduced intraoperative complications such as Hypotension and shivering, reduced opioid consumption, early mobilization, reduced length of stay and significantly better satisfaction among the patients. Thus, ERAS protocol can be continued to be a part of standard management for individuals undergoing cesarean delivery at our institution.