Shweta Dhiman

Background: This study aims to compare the effects of two perioperative dexamethasone regimens on duration of analgesia after upper limb surgery under supraclavicular brachial plexus block (SBPB). Patients and Methods: Between October 2024 and August 2025, this double-blind, randomized-controlled study included a total of 48 patients who were in the American Society of Anesthesiologists (ASA) Class I-III and underwent elective unilateral osseous surgery of the forearm or hand under ultrasound-guided SBPB with 30 mL of 0.5% ropivacaine. The patients were randomized in 1:1 ratio to oral dexamethasone (OD) group to receive 12 mg OD 2 h before the block and intravenous dexamethasone (ID) group to receive 8 mg of ID at the time of block. The primary outcome was the duration of analgesia. Secondary outcomes included duration of motor block, pain scores at 6, 12 and 24 h, additional postoperative analgesic consumption over the first 24 h and the Quality of Recovery-15 (QoR-15) at 24 h. Results: Of the patients, 31 were male and 17 were female with a mean age of 34.31 ± 14.15 (range, 18 to 60) years. The mean duration of analgesia was 10.50 ± 3.30 h in group OD and 14.92 ± 3.40 h in group ID ( p < 0.001). The mean duration of motor block was 9.33 ± 3.12 h in group OD and 12.75 ± 3.40 h in group ID ( p = 0.001). Pain scores at 6, 12 and 24 h after surgery and additional analgesic requirements were higher in group OD ( p < 0.001). The QoR-15 scores were higher in group ID at 24 h ( p < 0.001). Conclusion: These findings indicate that the ID regimen in SBPB with ropivacaine resulted in prolonged analgesia and motor blockade, lower pain scores, reduced analgesic consumption, and improved quality of recovery compared to the OD regimen.

A BSTRACT: Background: Pain assessment in children is often inconsistent despite its recognition as the “fifth vital sign.” Untreated perioperative pain has adverse physiological and psychological effects. Although validated tools exist, their use in clinical practice remains limited. This survey evaluated the knowledge of anesthesiology residents towards pediatric pain assessment. Materials and Methods: A prospective, cross-sectional survey was conducted using a validated 15-item questionnaire (Cronbach’s α = 0.82). The study was approved by the Institutional Review Board and registered with the Clinical Trial Registry of India (CTRI/2023/06/053717). The questionnaire was distributed electronically to anesthesiology residents (6 months–6 years of anesthesia experience, including ≥3 months in pediatric anesthesia) across teaching hospitals in North India. Results: Of 480 surveys circulated, 210 (43.7%) were returned. While 183 (87.1%) respondents reported awareness of pediatric pain assessment tools, knowledge was incomplete. Only 47% identified that the Face, Legs, Activity, Cry, Consolability scale is not a self-report tool. Most (85.7%) recognized that tool selection depends on age, cognition, and institutional protocols, but only 27.1% correctly noted that observational measures are inappropriate in older children capable of self-reporting. Just 24.3% knew that facial expressions are the most studied behavioral indicator of neonatal pain. Although 90% acknowledged the importance of documentation, responses indicated a gap between theoretical awareness and practical application. Conclusion: Anesthesiology residents possess partial but insufficient knowledge of pediatric pain assessment. Standardized training and institutional adoption of validated tools are needed to bridge the knowledge–practice gap and improve perioperative pain management in children.

Objectives: This study aims to compare the incidence of respiratory adverse events following removal of ProSeal laryngeal mask airway (PLMA) after total intravenous anesthesia (TIVA) with propofol and inhalational anesthesia with sevoflurane in healthy children undergoing lower limb, lower abdominal, or genitourinary surgery under general anesthesia with caudal analgesia. Patients and methods: This randomized, parallel-group, double-blind trial was conducted with children with American Society of Anesthesiologists physical status Class I or II between August 01, 2023, and September 30, 2024. Children were randomly allocated to the TP group (TIVA with propofol) to receive induction and maintenance with total intravenous anesthesia with propofol or the IS group (inhalation with sevoflurane) to receive induction and maintenance of anesthesia with sevoflurane. The primary outcome was the incidence of any respiratory event (coughing, biting of device/teeth clenching, oxygen desaturation, breath holding, laryngospasm, bronchospasm, or upper airway obstruction) during emergence from anesthesia and PLMA removal. Secondary outcomes were prevalence of individual respiratory events, airway hyperreactivity scores, emergence times, incidence of emergence agitation, duration of postanesthesia care unit stay, postoperative nausea and vomiting, hemodynamic parameters, and peripheral oxygen saturation during emergence. Results: A total of 86 children (70 males, 16 females; mean age: 4.265±2.23 years; range, 6 months to 7 years) were enrolled in the study, with 43 in both groups. A respiratory event occurred in 15 patients in the IS group (34.8%) and four patients in the TP group (9.30%; p=0.004). There was no difference in the occurrence of individual events. Airway hyperreactivity scores were higher in the IS group (p=0.032). Emergence time was quicker and emergence agitation and excessive salivation were more common in the IS group. Time to postanesthesia care unit discharge, postoperative nausea and vomiting and, hemodynamic parameters before and after PLMA removal were comparable. Conclusion: The incidence and severity of adverse respiratory events during emergence from anesthesia was more frequent in the sevoflurane group.

Objectives: This study aims to determine whether ultrasoundguided pudendal nerve block (USG-PNB) provides improved postoperative analgesia compared to caudal epidural block (CEB) in children undergoing hypospadias repair. Patients and methods: This prospective, randomized, parallel-group, double-blind comparative trial included 40 male children (mean age: 5.92±2.73 years; range, 2 to 12 years) with American Society of Anesthesiologists physical status I or II who were scheduled to undergo hypospadias repair under general anesthesia between March 2023 and January 2024. Participants were randomly allocated (1:1) to either the PNB group, receiving ultrasound-guided PEB (0.3 mL/kg ^-1 of 0.25% bupivacaine), or the CEB group, receiving CEB (1 mL/kg ^-1 of 0.25% bupivacaine) following induction of anesthesia. The primary outcome was the proportion of patients requiring additional analgesia within the first 24 h after surgery. Secondary outcomes included postoperative pain scores and total 24-h analgesic consumption. Results: In the first 24 postoperative hours, 80% of children in the PNB group required rescue analgesia compared to 15% in the CEB group (pConclusion: In pediatric patients undergoing hypospadias repair, CEB provided longer-lasting postoperative analgesia, reduced analgesic requirements, and greater surgeon satisfaction compared to USG-PNB. Although previous studies have reported favorable outcomes with nerve stimulator-guided PNB, only limited evidence supports improved analgesia with USG-PNB. Since bilateral blockade is required, and the block is technically challenging when performed with ultrasound alone, the success rate may be enhanced by combining ultrasound with nerve stimulator guidance. In our view, USG-PNB should be reserved for high-volume centers with substantial expertise in this technique to ensure reliable analgesia, optimize operating room efficiency, and conserve theatre time.