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BACKGROUND AND AIMS: Pre-emptive analgesia is initiated before surgery in order to prevent the establishment of central sensitization during intra-operative and early post-operative period. Multimodal analgesia relates a balanced approach to treat post-operative pain by combining multiple therapeutic agents and regional techniques. This study was conducted to evaluate the post-operative analgesic efcacy and safety of intravenous water based diclofenac sodium with or without pre-emptive intravenous ketamine in patients undergoing total abdominal hysterectomy under spinal anaesthesia. METHODS: This was a prospective, randomized, double blinded controlled comparative tertiary hospital based study. Three groups of 30 patients each, i.e., receiving diclofenac with and without pre-emptive ketamine and control group were enrolled. The time of rst analgesic request, total analgesic requirement in rst 24h, intra-operative and post-operative vitals, any side effects and complication were recorded. RESULTS: Statistically signicant differences were observed in post-operative mean VAS scores between T30m to T24h, mean time of requirement of rst dose of rescue analgesia request was longer in patients in group DK (373±9.39 min.), as compared to group NS (179.13±5.95min.) and group D (228.30±7.97min.), post-operative requirement of analgesia in rst 24h was lower in group DK (1.27±0.45) as compared to group NS (2.86±0.44) and group D (1.67±0.55), and quality of analgesia among the three groups (p=0.001). CONCLUSION: Pre-emptive use of ketamine with intravenous diclofenac sodium as a part of multimodal analgesia regimen render the patient pain-free in immediate post-operative period and minimize the demand of rescue analgesic.

Background Caudal block is an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. It enables early ambulation and periprocedural hemodynamic stability. These are important advantages over general anesthesia, notably in preterm babies and in children with cardiopulmonary comorbidities. In this study, we aimed to compare the effect of dexmedetomidine and clonidine to accentuate the perioperative analgesia of 0.25% isobaric levobupivacaine in pediatric caudal anesthesia. Methodology A prospective double-blind randomized control study was conducted on 60 patients with the American Society of Anesthesiologists (ASA) physical status I, between the ages of one to six undergoing infraumbilical abdominal surgery under caudal anesthesia in the Department of Anaesthesia, Sardar Patel Medical College, Bikaner. Patients were randomly allocated to the following three groups of 20 each: group L, 1 mL/kg of levobupivacaine 0.25%; group LD, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of dexmedetomidine; and group LC, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of clonidine. Intraoperative and postoperative hemodynamic parameters were recorded for 24 hours. Patients' pain scores, sedation scores, and Bromage scores were recorded. In our study, the main observation was the duration of analgesia and the total analgesic requirement for 24 hours. Results There was a significant difference in the duration of analgesia among the three groups (p0.001). Group LC had the highest duration of analgesia of 492.00 (50.01) minutes, followed by group LD 486.00 (54.71) minutes, and the lowest in group L 291.00 (40.25) minutes. There was a significant difference between the three groups in terms of the total dose of analgesics in 24 hours (p0.001), with the median total dose of analgesics being the highest in Group L. Three groups differed significantly in terms of motor block, which was limited to up to 180 minutes in groups LC and LD with no residual motor block. Conclusions The addition of α2 agonists such as clonidine or dexmedetomidine at a dose of 0.5 µg/kg as an adjuvant to caudal levobupivacaine (0.25%) at 1 mL/kg significantly prolongs the duration of opioid-free analgesia in children undergoing infraumbilical abdominal surgeries without prolonging the motor blockade and any side effects. Moreover, dexmedetomidine does not offer a significant advantage over clonidine regarding the analgesia duration.