Background and Aims: Dural puncture epidural (DPE) has been shown to improve labor analgesia over epidural (EPL), with fewer side effects than a combined spinal-epidural (CSE). However, there is some debate regarding the superiority of DPE over EPL and CSE. Therefore, we aimed to compare the effects of EPL, DPE, and CSE without intrathecal opioids on the epidural local anesthetic (LA) consumption and occurrence of side effects in early labor. Material and Methods: We randomly assigned parturient to one of the 3 groups; EPL, DPE, or CSE. EPL and DPE groups received a 10 mL loading dose of 0.1% bupivacaine with fentanyl 2 μg/mL. CSE group received intrathecal 2.5 mg bupivacaine (without opioids). Labor analgesia was maintained in all patients via patient-controlled epidural analgesia (PCEA). The primary outcome was the mean hourly consumption of epidural LA. Results: The mean hourly consumption of epidural LA anesthetic was significantly lower in CSE (9.55 mL), compared with the EPL (11 mL), and DPE (10.5 mL), P < 0.01; but no significant difference was seen between EPL and DPE. Compared with EPL and DPE, CSE achieved faster time to complete analgesia defined as a numeric rating pain scale (NRPS) ≤1 and sensory block, lower NRPS in the first hour and higher frequencies of complete analgesia. There were no differences between groups in terms of physician top-up boluses, the occurrence of side-effects, mode of delivery, Apgar scores, and maternal satisfaction. Conclusion: Compared with EPL and DPE, CSE without intrathecal opioids, had a less epidural LA consumption, faster onset of analgesia, with no difference in the incidence of side effects. Trial Registration: This study was registered at www.clinicaltrials.gov (NCT03980951).

Background and Aims: Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA. Material and Methods: Prospective, randomized, double-blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, n = 35) or control (CT group, N = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well. Results: The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, P < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2–12] vs. 3 [0–8] h, P < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) μg/kg/min; P = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups. Conclusion: Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.

Background and aims Deep neuromuscular blockade (NMB) is known to improve surgical conditions, compared to moderate neuromuscular blockade (NMB), which is expected to improve postoperative quality of recovery (QOR). However, it is unknown whether deep NMB improves postoperative QOR in ambulatory gynecologic laparoscopy. Therefore, we compared the effects of deep and moderate NMB on postoperative QOR in ambulatory gynecologic laparoscopy. Methodology We included 80 female in this study. They were randomized into 2 equal groups: deep NMB (dNMB) and moderate NMB (mNMB) at constant pneumoperitoneum pressure of 12 mmHg. The primary outcome was QOR-40 at 24 h, and the secondary outcomes were duration of surgery, surgical rating scale (SRS) score, time to home discharge readiness, pain scores, and tramadol consumption. Results The SRS scores were significantly higher in dNMB group, compared with mNMB. Mean (95% CI) SRS scores in deep NMB were 4.55 (4.52-4.58) versus 4.15 (4.11-4.19) in moderate NMB, p = 0.03. However, there was no significant difference between the two groups in the QoR-40 scores, and other secondary outcomes. Conclusion We found no difference between deep and moderate NMB on postoperative QOR after ambulatory gynecologic laparoscopy. Therefore, deep NMB during ambulatory gynecologic laparoscopy may be unnecessary, at least in non-obese patients. Trial registration This study was registered at www.clinicaltrials.gov (NCT04105764).

Background Total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric cochlear implants (CIs) surgery as it does not suppress the electrical stapedial reflex threshold (ESRT). However, high doses of remifentanil exacerbate postoperative pain and increase opioid consumption. Intravenous lidocaine reduces pain and opioid requirement. This study investigated the effect of intravenous lidocaine on perioperative opioid consumption and ESRT in pediatric CIs. Results The mean (95% CI) remifentanil consumption was significantly lower in lidocaine group than in placebo group [0.57 (0.497–0.643) vs 0.69 (0.63–0.75)] μg/kg/min, P = 0.016. The mean (95% CI) propofol consumption was significantly lower in lidocaine group than in placebo group [155.5 (146–165) vs 171 (161–181) μg/kg/min, P = 0.02. MBP and HR were significantly lower after surgical incision, laryngeal mask airway (LMA) removal, and at PACU admission in the lidocaine group compared with the placebo group. The PACU pain score was significantly lower in the lidocaine group compared to the placebo group. The mean (95% CI) pethidine consumption in PACU was significantly lower in the lidocaine group than in the placebo group 7.0 (6.17–7.83) vs. 8.9 (7.84–9.96) mg, P = 0.012. There were no differences between groups regarding ESRT response. Conclusions Intravenous lidocaine infusion reduced perioperative opioid requirements without altering the ESRT in pediatric CIs. Trial registration Clinical registration number: NCT04194294.