Chilkoti GT, Dixit P, Tawar N
… +3 more, Mishra BK, Saxena AK, Tiwari S
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088191
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BACKGROUND AND AIMS: The opioid receptor mu receptor 1( gene codes the human μ-opioid receptor, which is a major target for opioids. The A118G polymorphism leads to inter-individual variation in the susceptibility to po...BACKGROUND AND AIMS: The opioid receptor mu receptor 1( gene codes the human μ-opioid receptor, which is a major target for opioids. The A118G polymorphism leads to inter-individual variation in the susceptibility to postoperative nausea and vomiting (PONV). This study explored the A118G gene polymorphism and inter-individual differences in PONV induced by postoperative IV tramadol in patients undergoing femur fracture surgery. MATERIAL AND METHODS: The present prospective observational study was conducted following IEC approval, prospective CTRI registration, and written informed consent. Patients of ASA PS I/II undergoing femur fracture surgery under subarachnoid block were included. Fifty patients of ASA I and II, aged 18-60 years, of either sex, undergoing isolated femur fracture surgery and receiving IV tramadol postoperatively were included. Two milliliters venous sample was withdrawn for gene polymorphism study preoperatively. Incidence of PONV and comparison of PONV score, total rescue antiemetic consumption, postoperative NRS pain score, and total analgesic consumption were compared between different genotypes in the first 24 h postoperatively. RESULTS: The prevalence of the wild homozygous allele (AA) was 56%, and mutant-G alleles, i.e., AG and GG, were 36% and 8%, respectively. PONV incidence was significantly higher in the AA allele than in mutant-G alleles i.e. 89% vs 7%; odd's ratio is 0.214 ( value = 0.000097), reflecting the protective role of the G allele in patients' predisposition to PONV. Patients with AA allele of A118G required significantly more rescue antiemetic in the first 24h postoperatively. CONCLUSION: A significantly lower incidence of PONV and lower consumption of rescue antiemetics was observed among patients with mutant G alleles of A118G.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088188
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BACKGROUND AND AIMS: Bone and soft tissue (BST) cancer surgeries of extremities and pelvis have a high incidence of postoperative neuropathic pain (NP) due to extensive soft tissue dissection and breach of internervous p...BACKGROUND AND AIMS: Bone and soft tissue (BST) cancer surgeries of extremities and pelvis have a high incidence of postoperative neuropathic pain (NP) due to extensive soft tissue dissection and breach of internervous planes. The primary aim of this study is to assess the incidence of NP in patients undergoing BST tumor surgery and establish its predisposing factors. MATERIAL AND METHODS: This prospective observational study assessed the incidence of NP after BST surgery at a tertiary care cancer center from April 2021 to June 2022. Postoperatively, NP follow-up was done with PainDETECT Questionnaire (PD-Q). Pain severity was assessed with Numerical Rating Scale, and Brief Pain Inventory was applied to look for interference of NP with active daily life. Preoperative and intraoperative data were analyzed to find the association with the NP. The association with causative factors was done using Mann-Whitney U test for continuous measures and Pearson's Chi-squared test/Fischer's test for categorical variables. RESULTS: Of total 278 patients, the incidence of NP was 23.5% (n = 65) at the third postoperative day, 12.6% (n = 35) at 1 month, and 3.6% (n = 10) at 3 months. We found a significant correlation of NP with age ( = 0.05), preoperative ongoing treatment for NP ( = 0.01), preoperative pain severity ( = 0.005), type of surgery ( < 0.001), region operative ( = 0.01), intraoperative nerve handling ( < 0.01), and reconstruction component ( = 0.02). CONCLUSIONS: The incidence of postoperative NP is high [23.5%] in young adults, patients with pre-existing NP controlled with medication, preoperative pain severity, reconstructive component of surgery, and nerve handling. Certain surgeries like amputation, pelvis tumors, and plastic reconstructions are associated with a higher incidence of NP.
Roy S, Gupta N, Bharti SJ
… +5 more, Garg R, Mishra S, Bhoriwal S, Bhatnagar S, Kumar V
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088187
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BACKGROUND AND AIMS: Managing acute postsurgical pain following midline exploratory laparotomy in colorectal cancer patients involves various approaches, such as central neuraxial blockade, patient-controlled intravenous...BACKGROUND AND AIMS: Managing acute postsurgical pain following midline exploratory laparotomy in colorectal cancer patients involves various approaches, such as central neuraxial blockade, patient-controlled intravenous analgesia with opioids, and bilateral continuous paravertebral block. However, each of these modalities carries its disadvantages. The Quadratus Lumborum Block's role in delivering adequate analgesia in abdominal surgical cases has recently gained prominence across different patient populations, including adults, pediatrics, and pregnant patients. This study aims to compare the analgesic and perioperative effects of continuous bilateral quadratus lumborum block [CQL (II)] (using the QL2 approach) with continuous epidural block [Epi]. MATERIAL AND METHODS: In this noninferiority randomized controlled trial, all eligible patients, aged 18 to 80 undergoing exploratory laparotomy for colorectal cancer surgery, falling within the American Society of Anesthesiologists (ASA) Physical Status Class I, II, and III, who voluntarily provided written informed consent were randomly assigned to the CQL (II) or the Epi group using computer-generated randomization. Due to the presence of invasive catheters, both patients and investigators could not be masked regarding group allocation. Separate anesthesiologists performed the block procedures, operating room anaesthesia management, and postoperative pain follow-up. RESULTS: No significant disparities in age, height, weight, BMI, gender, and ASA physical status between the two groups. The upper limit of the 95% confidence interval (1.63) crosses the noninferiority margin (1.0), indicating that the NRS score at rest after 24 hours of surgery is inferior in the CQLII group compared to the Epi group. Among other postoperative outcomes, sleep quality ( value = 0.0015), patient satisfaction score ( value = 0.0000), total postoperative rescue fentanyl use ( value = 0.0005), and postoperative time for first activity out of bed ( value = 0.016) were significantly better in the Epi group. CONCLUSIONS: The continuous bilateral quadratus lumborum block failed to demonstrate noninferiority to the epidural block in providing similar NRS scores at rest at 24 hours and other postoperative outcomes.
Kaur K, Sharma P, Vashishth S
… +5 more, Kumar P, Yadav M, Bhardwaj A, Bhatia V, Singhal SK
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088185
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BACKGROUND AND AIMS: The present study aimed to compare the success rate of fiberoptic-guided intubation, using Intubating laryngeal mask airway (ILMA) versus intubating laryngeal tube suction disposable (ILTS-D). MATERI...BACKGROUND AND AIMS: The present study aimed to compare the success rate of fiberoptic-guided intubation, using Intubating laryngeal mask airway (ILMA) versus intubating laryngeal tube suction disposable (ILTS-D). MATERIAL AND METHODS: This prospective randomized study was conducted on 100 patients of either sex aged 18-60 years, belonging to the American Society of Anesthesiologists physical status I-II, with 50 patients in each group (group I -patients were intubated through ILMA, and group II - patients were intubated through ILTS-D). The primary objective was to compare the ease of fiberoptic-guided tracheal intubation, time taken for intubation, and number of attempts. Secondary objectives included assessing the success of supraglottic device (SAD) placement, oropharyngeal seal pressure, and hemodynamic changes, and adverse effects like sore throat, trauma, nausea, etc. RESULTS: The insertion time of the SAD was 10.44 ± 4.26 and 9.08 ± 3.79 s for groups I and II, respectively. Mean insertion time for ETT (Endotracheal tube) placement (seconds) was 39.68 ± 9.48 s in group I and 50.12 ± 7.78 s in group II, which was found to be statistically significant between the groups ( ≤ 0.001). The ETT was placed in the first attempt in 78% and 44% patients in group I and group II, respectively ( = 0.001). CONCLUSION: Our study concluded that ILMA demonstrated superiority over ILTS-D when used as conduits for fiberoptic-guided tracheal intubation.
Bagri V, Manickam A, Parameswari A
… +2 more, Kumar V, Ramesh BS
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088184
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BACKGROUND AND AIMS: Pain management strategies in pediatric penile surgery are an essential component of anesthetic care that directly influences maternal-child comfort in the postoperative period. While caudal analgesi...BACKGROUND AND AIMS: Pain management strategies in pediatric penile surgery are an essential component of anesthetic care that directly influences maternal-child comfort in the postoperative period. While caudal analgesia remains the standard technique, ultrasound-guided regional techniques, particularly the pudendal nerve block, have emerged as viable alternatives. This study explores the analgesic efficacy of ultrasound-guided pudendal block versus caudal blockade using clonidine as an adjuvant in children undergoing penile surgeries. MATERIAL AND METHODS: This prospective, randomized, comparative study included 60 children aged 6 months to 6 years scheduled for penile surgery. Children were randomly assigned to either Group A (Caudal Block) or Group B (Ultrasound-Guided Pudendal Nerve Block) and received 0.2% ropivacaine with clonidine (1 mcg kg) as an adjuvant. A blinded observer assessed the FLACC scale, the number of rescue analgesia doses within 24 hours, and the duration of analgesia. The primary outcome was the difference in rescue analgesia requirements. RESULTS: There was no significant difference in rescue analgesia requirements between the groups (P 0.92). Eleven patients (36.7%) in both the groups did not require any rescue analgesia within 24 hours postextubation. The median time to first rescue analgesia was 11.5 hours (6-24) in Group A and 12.3 hours (6.5-24) in Group B (P- 0.72). The FLACC scores were comparable between groups. CONCLUSIONS: The pudendal nerve block provides analgesia comparable to caudal block in terms of rescue analgesia requirements and duration of analgesia when clonidine is added with local anesthetics.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088183
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BACKGROUND AND AIMS: As the aging Indian population expands, anesthesiologists will increasingly encounter frail surgical patients. We aimed to study the prevalence of frailty, its association with sarcopenia, and its im...BACKGROUND AND AIMS: As the aging Indian population expands, anesthesiologists will increasingly encounter frail surgical patients. We aimed to study the prevalence of frailty, its association with sarcopenia, and its impact on postoperative outcomes among older patients (>65 years) undergoing lower limb orthopedic surgeries. MATERIAL AND METHODS: Frailty was assessed using the Clinical Frailty Score (CFS), and values were compared with ultrasound-guided quadriceps muscle thickness measurements for sarcopenia, after normalizing for body mass index (BMI) and body surface area (BSA). A comparison of perioperative characteristics and postoperative outcomes with frailty was made using Spearman's correlation and the Chi-square test. An ROC curve was plotted to evaluate the validity of the normalized quadriceps muscle thickness value in diagnosing frailty. RESULTS: The proportion of frailty in our study population was 80.1% with a significant association for sarcopenia (Spearman's correlation coefficient -0.182 and -0.237 for quadriceps muscle thickness normalized for BMI and BSA, value < 0.001), age (72.35 (64.2, 80.5) versus 68.76 (64.97,72.55) years, = 0.001), ASA classification ( < 0.001), and surgical type ( = 0.006). Compared to the nonfrail, patients with frailty had higher rates of postoperative ICU admission ( = 0.003), increased lengths of ICU ( = 0.005) and hospital stay ( = 0.005), and more postoperative complications (39.4% vs 12.9% patients, ( = 0.001), OR 3.061 (1.636-5.730)). CONCLUSION: Frailty occurs in a large percentage of older orthopedic patients and significantly impacts postoperative outcomes.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088181
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Bronchoscopy is the primary tool for evaluating the histopathology of endobronchial carcinoid tumors. Carcinoids are rare neuroendocrine neoplasms found chiefly in young adults, with a low tendency to metastasize. They c...Bronchoscopy is the primary tool for evaluating the histopathology of endobronchial carcinoid tumors. Carcinoids are rare neuroendocrine neoplasms found chiefly in young adults, with a low tendency to metastasize. They can be located in the bronchus, either centrally or peripherally. Central bronchial tumors are usually symptomatic. This article describes the successful general anesthesia management of two cases of bronchial carcinoid for bronchoscopic debulking of the tumors with laser heat therapy. The patients improved symptomatically after debulking. Periods of oxygen desaturation occurred, but there were no airway complications.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088180
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BACKGROUND AND AIMS: Acute trauma pain often remains inadequately treated despite opioid therapy. Low-dose ketamine has emerged as a promising adjunct analgesic that may enhance morphine effectiveness while reducing opio...BACKGROUND AND AIMS: Acute trauma pain often remains inadequately treated despite opioid therapy. Low-dose ketamine has emerged as a promising adjunct analgesic that may enhance morphine effectiveness while reducing opioid requirements. This systematic review assessed the efficacy and safety of morphine combined with low-dose ketamine versus morphine alone for acute trauma analgesia. MATERIAL AND METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, comprehensive searches were conducted across six databases (2006-2024) for studies comparing morphine-ketamine combination versus morphine monotherapy in acute trauma patients. Six eligible randomized controlled trials (RCTs) ( = 708) were included. Meta-analysis was performed using RevMan 5.4 software with random-effects modeling. RESULTS: Six RCTs involving 708 patients from emergency departments and prehospital settings were analyzed. Morphine-ketamine combination demonstrated superior analgesic efficacy with significantly lower final pain scores (mean difference (MD): -0.26; 95% confidence interval (CI): -0.40 to -0.12; = 0.0003). Subgroup analysis by ketamine dose indicated the most pronounced and statistically significant pain reduction at 0.3 mg/kg (MD: -0.30; 95% CI: -0.48 to -0.12; = 0.001), while lower doses showed similar trends. Significant pain reduction occurred at 30 min after sensitivity analysis (MD: -0.64, < 0.00001) and sustained through 60 min (MD: -0.32, < 0.0001). The combination reduced total morphine consumption by 2.93 mg ( = 0.07). Overall, adverse events increased (odds ratio: 2.37, = 0.05), but specific events-nausea, vomiting, and hallucinations-showed no significant differences between groups. No serious adverse events occurred. CONCLUSION: Low-dose ketamine as a morphine adjunct improves acute trauma pain control, shows a trend toward reduced opioid requirements, and maintains an acceptable safety profile, supporting its clinical implementation in emergency settings.
Kaur K, Vikash, Manohar M
… +5 more, Kumar P, Bhardwaj A, Tripathi A, Yadav M, Bansal A
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088174
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BACKGROUND AND AIM: The present study aimed to compare the success rates of intubation using AIROD and gum elastic bougie (GEB) in simulated difficult airway. MATERIAL AND METHODS: This prospective randomized study was c...BACKGROUND AND AIM: The present study aimed to compare the success rates of intubation using AIROD and gum elastic bougie (GEB) in simulated difficult airway. MATERIAL AND METHODS: This prospective randomized study was conducted on 100 patients of either sex aged 18-60 years, belonging to ASA physical status I-II, with 50 patients in each group. Group A patients were intubated using AIROD, and Group G patients were intubated using GEB. The primary objective of the study was to compare the first-attempt success rates of endotracheal intubation using the two devices. The secondary objectives were to compare the success of introducer placement, the total time required for successful intubation, the ease of intubation, the need for optimization maneuvers, and the incidence of device-related complications. RESULTS: The placement of introducer was successful in 98% and 100% patients in groups A and G, respectively. The mean insertion time of endotracheal tube (ETT) placement was 28.33 ± 12.77 and 35.06 ± 11.45 sec for groups A and G, respectively, which was found to be statistically significant between the groups ( = 0.001). The ETT was placed in the first attempt in 90% patients in group A and 84% in group B, respectively ( = 0.357). In 2% patients, failure to insert the introducer was noted in group A compared to none in group G. CONCLUSIONS: Our study concludes that AIROD offers a modest but meaningful advantage over GEB, providing easier insertion, improved glottic visualization, and a significantly shorter intubation time, while maintaining a comparable safety profile.