Bangladesh Journal of Pain

Efficacy of Suprascapular-Axillary Nerve Block versus Interscalene Brachial Plexus Block for Postoperative Pain Management in Shoulder Surgery

2026-06-26T10:06:54+00:00

Background: Shoulder surgeries are commonly associated with significant postoperative pain. Adequate pain management is essential for optimal patient outcomes. Conventionally, interscalene brachial plexus block is used for shoulder surgery, but it is associated with potential complications, such as phrenic nerve palsy, direct intrathecal injection. The combined suprascapular-axillary nerve block technique may offer a safe alternative with a more targeted analgesic effect, potentially reducing complications and allowing early recovery. The main objective was to compare the analgesic efficacy of combined suprascapular-axillary nerve block with interscalene brachial plexus block for postoperative pain management in shoulder surgery.
Methods: This prospective, randomized controlled trial was carried out in the Orthopedics operation theatre, Bangladesh Medical University. Sixty patients scheduled for elective shoulder surgery were enrolled. Participants were randomized into two groups: Group SA received combined suprascapular axillary nerve block and Group I received interscalene brachial plexus block. Postoperative pain scores were assessed using the Visual Analogue Scale (VAS) immediately at recovery, 4h, 8h, 12h, and 24h. Time to rescue analgesic, opioid consumption, respiratory rate and hemodynamic parameters were recorded and patient satisfaction were assessed on a 5-point Likert scale after 24 hours.
Results: Postoperative pain intensity by Visual Analogue Scale (VAS) score was higher in Group SA compared to Group I at 8 hours (3.07±0.82 vs 3.50±0.63, p=0.04) & at 24 hours pain remained lower in the group SA compared to the group I (1.57±0.62 vs 1.90±0.40, p=0.010), both was statistically significant, at other point of VAS scores are non-significant. Time of first rescue analgesic request was longer in Group I compared to Group SA (495 minutes vs.352.5 minutes, p=0.559), but difference was not statistically significant and postoperative 24-hour morphine consumption were similar in both groups. Hemodynamic parameters remained stable and comparable throughout the perioperative period but at 24 hours postoperatively, the group I showed a significantly higher MAP than the group SA (90.0±5.72 vs. 84.83±12.39 mmHg, p=0.003). The respiratory rate remained stable and comparable between both groups. Patient satisfaction scores did not differ significantly between the groups.
Conclusion: Suprascapular-axillary block is comparable to interscalene brachial plexus block in providing effective postoperative pain relief following shoulder surgery.

Effectiveness of Rectus Sheath Block on Postoperative Analgesia in Scheduled Midline Laparotomy under General Anaesthesia

2026-06-26T10:49:01+00:00

Background: Midline laparotomy, a widely performed surgical procedure, is associated with significant postoperative pain that may delay recovery, prolong hospital stay and also lead to adverse surgical outcomes. As a part of multimodal analgesia, Rectus Sheath Block (RSB) may be a simple effective alternative that minimize postoperative complications and promote earlier recovery. The Objective of this study was to evaluate the effectiveness of RSB on postoperative pain relief in scheduled midline laparotomy under General Anaesthesia.

Methods: This study was carried out from July 2024 to July 2025 in the General Surgery and MIS operation theatre (OT) in the department of Anaesthesia, Analgesia & Intensive Care Medicine, Bangladesh Medical University. Participants were randomly allocated into two groups: Group-R received ultrasound-guided rectus sheath block (RSB) with 0.3 mL/kg of 0.25% bupivacaine on each side of abdomen before surgical incision while Control Group- C received same volume of Normal Saline as placebo. Postoperative pain intensity was assessed by visual analogue scale (VAS), measured immediately in the postanaesthesia care unit (PACU) and at 3, 6, 12, and 24 postoperative hours. Rescue opioid analgesia as Morphine (0.05 mg/kg IV) was given when pain intensity by VAS ≥4. First analgesic request time (minutes), total Morphine consumption (mg) in 24 hours, frequency of postoperative vomiting, perioperative haemodynamic parameters (HR, SBP, DBP, MAP and SpO2) and patient’s satisfaction (based on a questionnaire graded on 5-Points Likert scale) were recorded.

Results: A total of 60 patients were included in this interventional study based on the selection criteria. Immediate postoperative pain score in the PACU were significantly lower in Group-R (VAS 6.10 ± 1.38) compared to Group-C (VAS 7.11 ± 1.24), p = 0.0045. Pain scores at other time points (3, 6, 12 and 24 hours) were comparable between both groups. Time to first analgesic request in minutes was significantly longer in Group-R (121 ± 10.3 minutes) than in Group-C (36 ± 6.8 minutes), p < 0.001. Total Morphine consumption in 24 hours in mg was lower in Group-R compared to Group-C (13.83±2.89 vs 15.70±2.70, p = 0.012), frequency of vomiting was reduced in Group-R (13.3% vs 23.33%) though not statistically significant, p = 0.317. Haemodynamic parameters (HR, SBP, DBP, MAP and SpO2) remained stable and comparable throughout 24 hours of the perioperative period. patient’s satisfaction scores did not differ significantly (10% vs 3.3%, p = 0.3) between both groups but more patients were unsatisfied in Group-C compared to Group-R with a statistical significance (13.3% vs 36.7%, p = 0.03).

Conclusion: RSB administered prior to surgical incision provides effective immediate postoperative pain relief following scheduled midline laparotomy under General Anaesthesia.

Role of Low Dose Intravenous Ketamine for Postoperative Pain Relief Following Laparoscopic Cholecystectomy

2026-06-26T11:19:20+00:00

Background: Laparoscopic cholecystectomy provides faster recovery but postoperative pain still remains a persistent challenge. Many patients experience visceral, somatic, or referred pain despite multimodal analgesic strategies, which are often limited by side effects and inconsistent efficacy. In this context, low-dose intravenous ketamine has emerged as a promising preemptive option, with the potential to reduce pain intensity, delay analgesic demand, and enhance overall recovery. The main objective of this study was to evaluate effectiveness of low dose intravenous ketamine for postoperative pain relief in laparoscopic cholecystectomy.
Materials and methods: This quasi-experimental study was carried out over one year at the Department of Anaesthesia, Analgesia and Intensive Care Medicine of Bangladesh Medical University, Dhaka, following ethical approval. A total of 90 patients aged 18–60 years undergoing laparoscopic cholecystectomy under general anesthesia were enrolled. Participants were divided into two groups. Group K who received low dose intravenous ketamine & Group NS received normal saline as placebo. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 0, 1, 2, 6, 12, and 24 hours. Rescue analgesia with IV
pethidine (1 mg/kg) was given for VAS ³4. Outcomes included pain scores, time to first analgesic, total opioid requirement, haemodynamic parameters, and patient satisfaction.
Result: Postoperative pain intensity was significantly lower in the Group K at recovery (1.3±1.3 vs.1.8±1.4,p<0.05), at 1 hour (1.8±1.3 vs.2.5±1.7,p<0.05), and at 2 hours (2.0±1.4 vs.5.1±1.6,p<0.05), but differences diminished at later time points. Heart rate remained similar at most intervals, though significant differences were noted intraoperatively at 90 minutes (73.7±4.5 vs.68.7 ±4.3,p<0.05) and postoperatively at 1 hour (80.9±8.4 vs.90.3±11.6,p<0.05). Systolic blood pressure was stable pre and intraoperatively, but maintained significantly lower values at 1 hour (113.2±10.5vs.129.0±10.0,p<0.05) and at 2 hours(111.9±10.6 vs.130.7±12.6,p<0.05) postoperatively in Group K. Diastolic and mean arterial pressures were similar both preoperatively and intraoperatively, yet Group K again showed significantly lower MAP values at 1 hour(79.4±9.0vs.2.7±11.7,p<0.05) and at 2 hour s(79.6±9.3 vs. 94.0±10.4,p<0.05) postoperatively. Adverse effects did not differ significantly between groups. Group K showed, significantly prolonged the time to first analgesic demand, reduced total opioid consumption, and extended analgesia duration, although patient satisfaction scores were nearly identical across groups.
Conclusion: Low dose intravenous ketamine, reduces the postoperative pain scores, delayed first analgesic demand and reduced opioid consumption.

Effects of Dexmedetomidine & Fentanyl as Adjuncts to Bupivacaine for Postoperative Analgesia in Subarachnoid Block of Urological Surgeries

2026-06-26T11:41:33+00:00

Background: Spinal anesthesia is preferred for its quick action, reliability, and fewer complications, aiding in faster recovery and enhanced postoperative outcomes in elective urologic surgeries. Adjuvants like fentanyl and dexmedetomidine enhance spinal anesthesia, improving analgesia duration and hemodynamic stability. This study aims to compare the analgesic efficacy, hemodynamic profile, and adverse effects of dexmedetomidine and fentanyl.
Methods: Adult patients aged 18-50 years, ASA physical statuses I and II, undergoing elective urological surgery were selected for the study. Sixty patients were enrolled following inclusion and exclusion criteria and divided into two groups. One group received 0.2 ml (10 mcg) fentanyl with 1.8ml hyperbaric bupivacaine while the other group received 0.2ml (5mcg) dexmedetomidine with 1.8 ml hyperbaric bupivacaine. The patients in post-operative period received analgesics when VAS score was equal or more than 4. By maintaining the standard operative procedure heart rate and blood pressure were measured at 5 min,10 min,15 min, 30 min, 45 min, 60 min, 75 min, 90 min, 105 min, 120 min, 6-hour, 12 hour and 24 hours. After completing the surgery VAS at first analgesic request, duration of analgesia was also recorded. VAS at 0-hour, 1 hour, 3-hour, 6-hour, 12-hour and 24-hour was also recorded respectively. Patients were monitored for side effects e.g. nausea, bradycardia, hypotension, pruritus, shivering.
Results: Combining dexmedetomidine with bupivacaine yielded superior analgesic effects in urological surgery patients compared to bupivacaine and fentanyl. Dexmedetomidine reduced postoperative pain scores (p=0.002) and analgesic like paracetamol (p<0.001) or pethidine (p<0.001) requirement. It prolonged analgesia (p<0.001) and caused less side effects like nausea (p=0.011). Up to 120 minutes, SBP, DBP, MAP, HR were stable in experimental group while it was elevated in control group.
Conclusion: Addition of dexmedetomidine with bupivacaine for urological surgeries under subarachnoid block resulted in superior analgesia for a longer duration without demand for additional analgesia & fewer side effects (nausea, hypotension, bradycardia, pruritus, shivering) compared to fentanyl with bupivacaine.

Thoracic Segmental Spinal Anaesthesia for Laparoscopic Cholecystectomy: A Quasi- Experimental Study

2026-06-26T12:18:09+00:00

Background: Laparoscopic surgery is normally performed under general anaesthesia but regional techniques have been emerging and found beneficial. This regional anaesthesia technique could be a potential alternative to GA. This technique also supports green anaesthesia by reducing use of volatile agents. The main objective of this study is to evaluate the effectiveness of thoracic segmental spinal anesthesia in laparoscopic cholecystectomy.
Methods: This is a nonrandomized clinical trial. Patients aging 18-50 years with American Society of Anesthesia (ASA) class I or II undergoing elective laparoscopic cholecystectomy were included. The patients were given thoracic segmental spinal anaesthesia at the level of T9-T10 with 1 mL (5 mg) of 0.5% isobaric bupivacaine and 0.25 mL (25 mcg) fentanyl. Adequacy of block was assessed by clinical examination. Their vital parameters (HR, BP, SpO2) were recorded at regular interval. The satisfaction of both patients and surgeons were assessed by 5 points Likert scale.
Results: The average patient age was 41.9 ±4.9 years, with females comprising 20 (66.7%) and males 10 (33.3%). Most patients 18 (60%) were classified as ASA Class I, while 12 (40%) were Class II. Height, weight, and BMI showed moderate variability, indicating a relatively uniform group. Sensory blocks typically ranged from T4 to L2. Heart rate, SBP, DBP, and SpO2 were significantly affected during surgery, initially declining and later rising toward completion. The average duration of surgery was 40.2 ±6.4 minutes and duration of pneumoperitoneum was 29.6 ±5.5 minutes. The motor block lasted 67.3 ± 7 minutes, while sensory block was 100.1 ± 4.7 minutes. Postoperative pain was mild at 2 hours but reached its peak at 8 hours. The need for conversion to general anaesthesia was 2 (6.7%). However, perioperative complications such as bradycardia was 9 (30%), analgesic requirement was 6 (20%) and shoulder pain was 5 (16.7%). Both patients and surgeons reported high satisfaction, with a smaller group expressing neutrality or dissatisfaction.
Conclusions: Thoracic segmental spinal anaesthesia provides a reliable sensory and motor blockade and it could be an effective alternative technique for laparoscopic cholecystectomy surgery.

Symposium on ‘Lower Back Pain: Understanding the Science, Challenging the Myths, and Empowering Our Practices’

2026-06-26T12:48:08+00:00

Over six hundred million people globally are suffering from lower back pain (LBP), with 80% affected at some point in their lives. In Bangladesh, the age-standardized prevalence rate of LBP is 19.4%. This highlights LBP as a major public health issue impacting quality of life, workforce productivity, and healthcare costs. A multidisciplinary symposium was held on 26th November 2025 at Ibrahim Cardiac Hospital and Research Institute Organization, Dhaka, Bangladesh, to discuss effective management strategies for LBP, involving experts from various medical fields. The symposium aimed to raise awareness among practitioners about the challenges of LBP, evaluate current practices, identify treatment gaps, and propose collaborative prevention strategies for acute and chronic cases, emphasizing the need for interdisciplinary approaches to LBP management.

Multidisciplinary management of lower back pain in low-middle income countries (LMICs), modelled on Bangladesh

2026-06-26T09:08:15+00:00

Cases of LBP are expected to rise to an estimated 843 million by 2050, with Africa and Asia accounting for a significant share, as populations in these regions are growing and people are living longer (though this modelling should be interpreted with caution due to the absence of primary data, especially from LMICs). This editorial summarizes the considerations necessary to develop a rational and practical guideline for LBP treatment in Bangladesh that takes into account peer-reviewed medical evidence and the restrictions of health care delivery in a resource-poor setting.