Epidural fentanyl decreases the minimum local analgesic concentration of epidural lidocaine

Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration （MLAC） of lidocaine is not known. We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults. Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions： lidocaine, or lidocaine plus fentanyl 1 pg/ml, 2 pg/ml, or 3 pg/ml. The first patient in each group was administered 1% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments. Efficacy was assessed using a visual analog pain scale, and accepted if this was 〈10 mm on a 100 mm scale within 30 minutes. The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery, respectively. Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785% （95%C/0.738-0.864）. A significant dose-dependent reduction was observed with the addition of fentanyl： the MLAC of lidocaine with fentanyl at 2 pg/ml was 0.596% （95%C/0.537-0.660） and 0.387% with fentanyl at 3 pg/ml （95%C/0.329-0.446, P 〈0.001）. Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects. （Chi CTR-TRC-11001559）

Perineural dexamethasone does not enhance the analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block during laparoscopic cholecystectomy

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is an adjunct therapy to provide effective postoperative analgesia in abdominal surgical procedures. Dexamethasone is a supplement agent that can improve the efifcacy of local anesthesia. However, information about its additive effect is limited. This study aimed to compare the an-algesic efifciency using ultrasound-guided TAP block with and without perineural dexamethasone for patients who under-went laparoscopic cholecystectomy. METHODS: Sixty patients who underwent laparoscopic cho-lecystectomy were randomly divided into three groups: group I, controls; group II, TAP; and group III, TAP+perineural dexamethasone supplement. The requirement of additional analgesia and the ifrst-time request of rescue-analgesia were recorded after operation and the numerical rating scale was evaluated at speciifc intervals. RESULTS: Compared to group I, the ifrst-time requirement of rescue-analgesia in groups II and III was signiifcantly delayed (403.0±230.9, 436.0±225.3 vs 152.3±124.7,P<0.01). Compared with those in group I, patients in groups II and III were associ-ated with lower numerical rating scale pain scores (P<0.01) and less postoperative analgesic consumption (P<0.01). There&nbsp;was no signiifcant difference in the variables mentioned above between groups II and III (P>0.05). CONCLUSION: Perineural dexamethasone has no additive/synergistic effect with subcostal TAP block on analgesic efif-cacy for the patients undergoing laparoscopic cholecystectomy.