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Journal of Anaesthesia and Pain
Published by Universitas Brawijaya
ISSN : 27223167     EISSN : 27223205     DOI : http://dx.doi.org/10.21776/ub.jap
Core Subject : Health,
Health Professions Medicine & Pharmacology
Journal of Anaesthesia and Pain is a peer-reviewed and open-access journal that focuses on anesthesia and pain. Journal of Anaesthesia and Pain, published by Anesthesiology and Intensive Therapy Specialist Program of Medicine Faculty, Brawijaya University. This journal publishes original articles, case reports, and reviews. The Journal s mission is to offer the latest scientific information on anesthesiology and pain management by providing a forum for clinical researchers, scientists, clinicians, and other health professionals. This journal publishes three times a year. Subjects suitable for the Journal of Anaesthesia and Pain are all subjects related to anesthesiology and pain management.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 129 Documents
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Comparative Study of Epidural Block with Combined Femoral and Sciatic Nerve Block in Adults for Lower Limb Surgery using Bupivacaine with Fentanyl Gulia, Abhity; Kohli, Pramod; Pandey, Maitree
Journal of Anaesthesia and Pain Vol 5, No 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.03

Abstract

Background: Combined femoral and sciatic nerve blocks for lower limb surgery have been shown to be as effective as epidural blocks for intraoperative anesthesia and postoperative analgesia. This study compared the analgesic effect of epidural and the combined femoral and sciatic nerve block for lower limb surgeries in adults.Methods: This randomized controlled study included 60 patients who underwent lower limb surgery, divided into two groups to receive epidural (Group E, n = 30) or combined femoral and sciatic nerve block (Group PNB, n = 30). The duration of sensory and motor block, intraoperative hemodynamics, duration of postoperative analgesia, and adverse effects were assessed. Data was analyzed using McNemar’s test with α = 0.05.Result: There are no intraoperative hemodynamic changes in group PNB. The sensory block lasted 18.81 ± 1.78 hours, and postoperative analgesia for 17 ± 1.87 hours in group PNB. Whereas in group E, the sensory blockade lasted for 6.54 ± 0.87 hours and postoperative analgesia for 5.13 ± 1.13 hours (p = 0.000). The duration of the motor blockade in group E was 4.48 ± 1.02 hours. No motor blockade was seen in group PNB. No nausea, vomiting, hypotension, numbness, or urine retention were noted in group PNB. In group E, hypotension was noted at 15, 30, and 45 minutes, with 33.3% having nausea and 13.3% postoperative vomiting.Conclusion: Femoral and sciatic nerve block provide similar surgical conditions for lower limb surgeries with better hemodynamic stability, earlier ambulation, and longer duration of postoperative analgesia than epidural.
Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol 5, No 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Abstract

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 µg, administered as 10 cm³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 µg, in a total volume of 50 cm³ at a rate of 3 cm³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of α=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 ± 0.36) compared to the intermittent bolus (0.91 ± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 ± 0.00) compared to the intermittent bolus (1.29 ± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.
Comparison of Efficacy of Bolus Dosages of Norepinephrine, Phenylephrine, and Ephedrine in Treating Post-Spinal Hypotension During Elective Cesarean Section: A Randomized Double-Blinded Controlled Trial Ganeshnavar, Anilkumar Sangappa; Endigeri, Archana; Chitti, Prashant Kumar Reddy; Nair, Vinduja; Konappanavar, Chaitra
Journal of Anaesthesia and Pain Vol 5, No 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.04

Abstract

Background: Phenylephrine and ephedrine are widely used to manage spinal-induced hypotension after cesarean section. Norepinephrine is an alternative vasopressor that maintains the heart rate. This study compared the efficacy and safety of bolus administration of norepinephrine, phenylephrine, and ephedrine for treating post-spinal hypotension during elective cesarean section.Methods: This prospective, randomized, double-blind controlled trial included patients between 20–45 years of age undergoing elective cesarean section; they were randomized into three groups receive norepinephrine 6 µg (Group A, n = 45), phenylephrine 100 µg (Group B, n = 45), or ephedrine 6 mg (Group C, n = 45) boluses after a 20% drop in blood pressure. The primary objective was to compare the efficacy (total doses required) and safety (maternal complications) of treating post-spinal hypotension. Secondary objectives assessed neonatal outcomes using fetal arterial blood gas and Apgar scores. Mean differences were analyzed using one-way analysis of variance at a 95% confidence level (α = 0.05).Result: The total number of drug boluses required to treat maternal hypotension was significantly lower in group A (1.78 ± 0.74) than in groups B (1.93 ± 0.69) and C (2.38 ± 0.81) (F = 7.89; p < 0.001). Tachycardia occurred more frequently in group C (37.8%) than in groups A (15.6%) and B (26.7%) (p = 0.001). The incidence of bradycardia was higher in group B (24.4%) than in groups A (20%) and C (6.7%) (p = 0.001). Maternal complications were comparable between the groups, with no significant differences in neonatal outcomes.Conclusion: Norepinephrine is a potent drug with a better hemodynamic profile than phenylephrine and ephedrine.
Comparison of Analgesic Effects of Nalbuphine and Buprenorphine on Caudal Ropivacaine in Children Undergoing Infraumbilical Surgeries Kaur, Navdeep; Chinnappa, Jithendra; Iyer, Sadashivan S; Suresh, Govindswamy; Turai, Ashwini
Journal of Anaesthesia and Pain In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Introduction:Caudal anaesthesia is the most commonly performed regional anaesthesia in children. Opioids are the most commonly used additives to Local Anesthetics. Synthetic Opioid Agonist- Antagonists like Nalbuphine and Buprenorphine provide advantage of prolonging duration and quality of analgesia without risk of respiratory depression.OBJECTIVE OF THE STUDYTo study the effects of caudal nalbuphine or buprenorphine on postoperative analgesia produced by caudal Ropivacaine in children undergoing infraumbilical surgery.Materials and Methods Following Institutional Ethical Committee Clearance 54 ASA grade I and II children, aged 1-10 years scheduled for elective infra umbilical surgeries under General Anaesthesia with Caudal Epidural were randomly allocated using Computer Generated Random Number Tables into 3 groups R (Ropivacaine 0.2% 1ml/kg), RN (0.2% Ropivacaine with0.1mg/kg Nalbuphine) and RB (0.2% Ropivacaine with 3mcg/kg Buprenorphine). The time taken for first analgesic was noted and was compared between the groups.RESULTS A Total of 54 patients were enrolled for the study. Both the nalbuphine and buprenorphine provided good analgesia in the post operative period compared to plain ropivacaine group ( p<0.05) with higher incidence of side effects in group RB. CONCLUSIONAddition of Nalbuphine(0.1mg/kg) to caudal ropivacaine provides comparable duration of analgesia with caudal Buprenorphine and ropivacaine (3mcg/kg)with lesser incidence of side effects. KEYWORDSNalbuphine,  Ropivacaine, Buprenorphine, Caudal Epidural CTRI TRIAL REGISTERATION CTRI/2017/08/009445                                             
Comparison of Analgesic Effects of Nalbuphine and Buprenorphine on Caudal Ropivacaine in Children Undergoing Infraumbilical Surgeries Kaur, Navdeep; Chinnappa, Jithendra; Iyer, Sadasivan Shankar; Suresh, Govindswamy; Turai, Ashwini
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Caudal anesthesia is the most commonly performed regional anesthesia in children. Nalbuphine and buprenorphine provide the advantage of prolonging the duration and quality of analgesia without the risk of respiratory depression. The study compares the analgesic effects of nalbuphine versus buprenorphine on caudal ropivacaine. Method: Randomized, double-blind study on 54 patients aged 1-10 years scheduled for elective infraumbilical surgeries, randomly assigned to three groups. Group R (n = 17, receive ropivacaine 0.2% 1 ml/kg), group RN (n = 17, receive 0.2% ropivacaine with 0.1 mg/kg nalbuphine), and group RB (n = 17, receive 0.2% ropivacaine with 3 µg/kg buprenorphine). The time taken for the first rescue analgesic, children and infants postoperative pain scale (CHIPPS), sedation scores, motor blockade, and side effects were noted every 30 minutes in the postoperative room. Data were analyzed using students’ unpaired t-test, ANOVA, Yates' and Fisher’s chi-square tests, with α = 0.05 and 95% confidence intervals (CI). Result: Time to rescue analgesia was 15.54 ± 7.74 hours in RN, 17.96  ±  5.56 hours in RB, and 11.25  ± 8.85 hours in R group. Most patients had a CHIPPS score of 1 in all 3 groups. Motor blockade was not present in all groups (p = 0.650). All three groups were comparable in sedation scores (2, tranquil and oriented) (p = 0.650). There were no significant difference in the side effects between groups (p = 0.060).     Conclusion: Both nalbuphine and buprenorphine prolong the duration of postoperative analgesia when combined with caudal ropivacaine, compared to solely caudal ropivacaine.
Efficacy of Opioid-Free Anesthesia vs Opioid Anesthesia in Postoperative Outcome of Patients Underwent General Anesthesia Ananda, Pratama; Anggraeni, Novita; Sari, Valencia Ayu
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Opioids are widely used narcotic analgesics in perioperative settings. However, it has a series of postoperative side effects. Opioid-free anesthesia (OFA) is an anesthetic technique that avoids the use of opioids intraoperatively to minimize their side effects. This study aimed to compare the postoperative outcome and side effects between OFA and opioid anesthesia. Methods: This is a randomized comparative experimental study in adults undergoing elective surgery under general anesthesia. We enrolled 30 patients and divided them into Group A (treatment) (n = 15), who were given ketamine at 0.25-0.5 mg/kg repeated every 30 minutes and 2% lidocaine at 1-1.5 mg/kg followed by maintenance doses. Group B (control) (n = 15) received fentanyl at 1-5 µg/kg/hour. Postoperative outcome (pain intensity) using the Wong-Baker FACES® Pain Rating Scale and side effects of opioids, including postoperative hypoxia, ileus, delirium, and postoperative nausea and vomiting (PONV), were observed. The data between groups were analyzed using the Wilcoxon, chi-square, unpaired t-test, Fisher’s exact, and Mann-Whitney test with α = 0.05. Result: Moderate to severe postoperative pain was observed to be higher in the control group than in the treatment group (88.9% vs 11.1%) (p = 0.020). Incidence of hypoxia, ileus, delirium, nausea, and vomiting in group A (p = 0.003; p = 0.030; p = 0.042; p = 0.001, respectively) was higher compared to group B. Conclusion: The use of OFA results in better postoperative pain control and a lower incidence of postoperative opioid-related side effects, i.e., postoperative hypoxia, ileus, delirium, and PONV.  
Diabetes Insipidus in Severe Traumatic Brain Injury Patient: A Case Report Zaelany, Allief Ilman; Fatoni, Arie Zainul
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Traumatic brain injury (TBI) contributes to significant morbidity and mortality. It leads to neuronal and vascular damage that can disrupt the function of the hypothalamus and pituitary gland, sometimes resulting in diabetes insipidus (DI). This study aims to examine DI as a complication of severe TBI and seeks to emphasize the importance of appropriate diagnosis, intervention, and monitoring to reduce the risk of mortality from TBI with DI. Case: We present a case of a severe TBI patient who had a traffic accident, resulting in subdural hematoma (SDH), subarachnoid hemorrhage (SAH), and ala magna fracture of the sphenoid bone. On the fourth day of treatment (the second day in the ICU), the patient experienced DI, characterized by a urine output rate of 4.2 cm3/kg/hour and hypernatremia (147 mmol/l). The patient was treated with fluid resuscitation and desmopressin. Symptoms improved after eight days of treatment, characterized by a urine output rate of 2.8 cm³/kg/hour and a serum sodium level of 159 mmol/l. This showed significant clinical improvement. On the tenth day, urine output returned to normal, with a lower serum osmolality, and the patient was discharged from the hospital. Conclusion: DI, as a severe complication of TBI, has the potential to increase mortality. This case underscores the importance of early detection, appropriate treatment, and ongoing monitoring to improve prognosis and reduce the risk of death associated with DI after traumatic brain injury (TBI).
Supraclavicular Block in Neglected Closed Fracture of the Intercondylar Humerus Imunu, Naim Ismail; Siswagama, Taufiq Agus
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: The supraclavicular block is used in upper extremity surgery, offering the advantages of easy access, reliability, and low risk, with the added benefit of ultrasound guidance to enhance safety and effectiveness. The aim of this case study was to evaluate the effectiveness and role of the supraclavicular block with ultrasound as the primary anesthetic and analgesic technique in the surgical management of neglected closed intercondylar humeral fractures. Case: A 57-year-old woman presented with an intra-articular fracture of the distal third of the left humerus according to the osteosynthesefragen and the orthopedic trauma association (AO/OTA) classification, type C2, with soft tissue swelling on the dorsal aspect of the left elbow. The patient had diabetes and hypertension, American Society of Anesthesiologists (ASA)  III, and a BMI of 27.8 kg/m2. The patient received a supraclavicular block with 0.5% ropivacaine and 10 mg dexamethasone in a total volume of 20 cm3. Needle placement was performed using ultrasound. During surgery, the patient received dexmedetomidine 0.3 µg/kg/hour plus intermittent fentanyl. Postoperatively, the patient was given ketorolac 3 x 30 mg and paracetamol 500 mg orally three times a day. One day after the procedure, the patient's numerical rating scale at rest was approximately 0 to 1, and a score of 1-2 was recorded during movement. Conclusion: A supraclavicular block, ultrasound-guided, with ropivacaine 0.5% can improve the accuracy and effectiveness of local anesthetic administration. This technique is helpful for patients with excess body mass because the brachial plexus is located superficially in the supraclavicular region
Anesthesia Management and Intensive Care in Cesarean Section on a Woman with Placenta Accreta with Placenta Accreta Index (PAI) Score of ≥ 6: A Case Report Prasetyo, Denny; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Placenta accreta spectrum (PAS) is the leading cause of peripartum hysterectomy. PAS often results in massive postpartum haemorrhage, requiring careful perioperative planning and multidisciplinary coordination. This case report aims to discuss the anesthesia management and intensive care provided to a patient who underwent cesarean section (CS) with a placenta accreta index (PAI) score of ≥6.Case: This case involves a 32-year-old multipara with a history of three previous CS. The patient was scheduled for CS due to breech presentation and suspected total placenta previa/accreta with a PAI score of ≥ 6. A combined spinal-epidural (CSE) was chosen as anesthesia management. During surgery, the patient experienced severe bleeding (3,000 mL) with hypotension (blood pressure 81/44 mmHg) and bradycardia (heart rate 60 beats per minute). Central iliac artery balloon occlusion (CIABO) was performed by a radiologist for temporary blood flow occlusion. Resuscitation included 3,000 mL crystalloids, 1,000 mL colloids, and 1,200 mL blood product. A baby girl was delivered (Apgar 7–9). The patient remained stable in the intensive care unit and was transferred to the regular ward the following day.Conclusion: Comprehensive perioperative planning and multidisciplinary coordination in managing PAS are important. Despite severe intraoperative hemorrhage and hemodynamic instability, the use of combined spinal-epidural anesthesia, prompt fluid and blood resuscitation, and intensive monitoring ensured a favorable outcome. Postoperative lactate value and early transfer from the ICU to the regular ward indicate successful management.
Comparison of Fentanyl and Tramadol on Pain Sensitivity in Rat Model of Traumatic Barin Injury Deswita, Rinda; Jasa, Zafrullah Khany; Rahmi, Rahmi
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Traumatic Brain Injury (TBI) is intracranial tissue damage caused by mechanical processes originating from outside that cause structurally and functionally brain damage. After TBI, these animals often exhibit exaggerated responses to otherwise mild pain stimuli, a condition mimicking chronic pain observed in human TBI patients.Methods: This laboratory experimental study used a pretest-posttest control group design. A traumatic brain injury (TBI) rat model was created using the Feeney weight drop method. Rats received intravenous fentanyl or tramadol every 8 hours for three days. Pain thresholds were measured before and at 1, 6, 24, and 72 hours, and 7 days after TBI.Results: Pain sensitivity peaked at 6 and 24 hours post-trauma, with the control group showing a significant drop in Von Frey test scores. In contrast, the fentanyl and tramadol groups showed gradual improvement from 6 hours, with stable recovery by 72 hours. By day 7, both treatment groups returned to near-baseline sensitivity, while the control group remained impaired. Statistical analysis showed a significant difference between control and intervention groups (p < 0.05). Conclusion: Both fentanyl and tramadol improved pain sensitivity in the early phase after TBI and restored thresholds close to baseline state before TBI while the control group did not.  

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