Levobupivacaine hydrochloride 625mg/500ml / Fentanyl 1mg/500ml infusion bags

BackgroundSerratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) are widely used regional anesthesia techniques for postoperative analgesia and are generally considered safe and effective. However, the comparative efficacy remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB in adult patients undergoing thoracic and breast surgeries.MethodsA comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google Scholar up to February 28, 2025. Primary outcomes included time to first analgesic request (TFAR), 24-h total analgesic consumption (TAC) postoperatively, and 24-h postoperative pain scores at rest. Secondary outcomes comprised pain scores at various postoperative timepoints, intraoperative fentanyl consumption, length of hospital stay, patient satisfaction with analgesia, and incidence of complications. A random-effect model was applied for the meta-analysis.ResultsTwenty-eight 28 RCTs comprising 1796 patients were included. No significant differences were found between SAPB and TPVB in TFAR (mean difference [MD] = -0.68 h, 95% confidence interval [CI]: -1.55 to 0.18, P = 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, P = 0.334), other postoperative pain scores, length of hospital stay, patient satisfaction, or incidence of postoperative nausea and vomiting (risk ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, P = 0.310). Despite statistically significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73 mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, P = 0.005) did not exceed the minimal clinically important difference (MCID) of 10 mg. SAPB also resulted in greater intraoperative fentanyl consumption (MD = 13.85 mcg, 95%CI: 3.86 to 23.84, P = 0.007) but a significantly lower incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, P = 0.006). Subgroup analyses showed that TPVB provided superior, but non-clinically significant, opioid-sparing benefits in thoracic procedures (3.38 mg) and when compared to superficial SAPB (3.11 mg).ConclusionSAPB offers comparable analgesic efficacy to TPVB, with a more favorable safety profile but slightly higher opioid consumption. However, the increased opioid use does not exceed the MCID. Therefore, SAPB is a clinically effective and safe alternative to TPVB for perioperative regional analgesia in thoracic and breast surgeries.

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BackgroundUnilateral spinal anesthesia has gained increasing attention in recent years. Emerging evidence suggests that it provides comparable analgesia to conventional bilateral spinal anesthesia while reducing adverse effects, and its efficacy and safety compared to bilateral spinal anesthesia remains controversial.ObjectiveThis systematic review and meta-analysis aims to evaluate and compare the efficacy and safety of unilateral versus bilateral spinal anesthesia.DesignSystematic reviews and meta-analysis of randomized controlled trials (RCTs).Data sourcesA systematic search was conducted across PubMed, EMBASE, and Cochrane Library from inception to December 10, 2024.Eligibility criteriaIncluded studies were randomized controlled trials involving adult patients (≥18 years) undergoing surgery under spinal anesthesia, comparing unilateral versus bilateral spinal anesthesia for efficacy and adverse effects. Studies that focused exclusively on either unilateral or bilateral spinal anesthesia were excluded. The comparator group used the same local anesthetic as the experimental group, with no restrictions on adjuncts (e.g. fentanyl, morphine).ResultsNineteen randomized controlled trials including 1191 patients met the inclusion criteria. Compared with bilateral spinal anesthesia, unilateral spinal anesthesia has a longer onset of sensory blockade (MD = 2.58, 95% CI: 0.93 to 4.22, p = 0.002), a shorter duration of sensory blockade (MD = -27.83, 95% CI: -39.25 to -16.42, p CI: 0.31 to 0.52, p CI: 0.07 to 0.56, p = 0.002), and post-dural puncture headache (RR = 0.44, 95% CI: 0.23 to 0.81, p = 0.009). No statistically significant differences were observed in bradycardia and urinary retention. Collectively, these findings support unilateral spinal anesthesia as a strategy that may enhance perioperative safety while maintaining adequate anesthetic efficacy in appropriately selected patients.ConclusionsUnilateral spinal anesthesia may offer a favorable balance between anesthetic efficacy and safety compared with bilateral spinal anesthesia, although its clinical utility may depend on surgical duration and patient characteristics.

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BACKGROUND Kidney transplantation (KT) is frequently associated with substantial postoperative pain, while opioid use in these patients increases the risk of adverse outcomes. Peripheral nerve blocks (PNBs) have been proposed as opioid-sparing strategies; however, evidence in kidney transplant recipients remains inconsistent, likely due to heterogeneity in block techniques, variability in perioperative analgesic regimens, and differences in study design and methodological rigor. This systematic review and meta-analysis aimed to evaluate the impact of PNBs on postoperative analgesia in kidney transplant recipients. MATERIAL AND METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science was conducted through April 2025 following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting 24-h postoperative opioid consumption in adult kidney transplant recipients were included. The primary outcome was cumulative opioid use within 24 hours after surgery, expressed as intravenous morphine or fentanyl. RESULTS Twelve studies met the inclusion criteria, of which 10 contributed to the quantitative synthesis. Pooled analysis showed that PNBs significantly reduced 24-h morphine consumption compared with control analgesia (pooled mean difference=-16.20 mg of intravenous morphine equivalents, 95% confidence interval -24.66 to -7.74; P=0.0002). Heterogeneity was high (I²=99%), but no study reported higher opioid use or increased adverse events in the PNB groups. CONCLUSIONS PNBs appear to be an effective opioid-sparing adjunct for postoperative analgesia in kidney transplant recipients. However, the available evidence remains limited, and further well-designed comparative trials are needed to define their role within multimodal analgesic strategies in this population.

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ObjectiveTo evaluate the effect on maternal pain of local anesthetic wound infiltration for intra-cesarean delivery analgesia in patients who also received intrathecal opioids.Data sourcesScopus, PubMed, and Cochrane Central Register of Controlled Trials were searched from the inception of each database to August 2023.Study eligibility criteriaAll randomized controlled trials (RCTs) comparing the use of local anesthetic wound infiltration at the time of cesarean delivery versus no such infiltration in patients who also received intrathecal opioids. The primary outcome was pain scores at 24 h with movement. Secondary outcomes included pain scores at 12, 48, 72 h with movement and at rest, opioid consumption at 48 h, length of hospitalization, and side effects.Study appraisal and synthesis methodsResults were summarized as mean difference (MD) or risk ratio (RR) with associated 95% confidence intervals. Quality of studies was evaluated by Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I2).ResultsEight RCTs (n = 762) comparing local anesthetic wound infiltration to no infiltration during cesarean delivery met inclusion criteria. Local anesthetic (usually with ropivacaine, bupivacaine, or levobupivacaine) wound infiltration was associated with significantly lower pain scores with movement compared to no infiltration (MD, -9.07 (-14.62, -3.53) (I 2 = 5%) at 48 h. Additional outcomes showed decreased but not statistically different pain scores at rest: 24 h (MD, -2.57 [-7.79, 2.65]), 48 h (-3.98 [MD, -8.18, 0.23]), and 72 h (MD, -4.28 [-9.56, 1.00]). Analysis of morphine consumption equivalents at 48 h showed a significant decrease in the wound infiltration group (MD, -3.09 [-4.46, -1.72], I 2 = 46%). Side effects were similar in both groups (nausea, vomiting, pruritus, and sedation).ConclusionSingle-dose local anesthetic wound infiltration-of levobupivacaine, ropivacaine, or bupivacaine-administered subfascial at the time of cesarean delivery with intrathecal opioids is associated with reduced postoperative morphine consumption. The pain intensity scores at rest or with movement at 24 h postoperatively are decreased yet not significantly different, but significantly decreased at 48 h with movement and maternal side effects are comparable.

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BackgroundLaparoscopic cholecystectomy (LC) is the gold standard for gallstone disease, but postoperative pain remains a challenge. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique; however, its comparative efficacy versus established methods such as transversus abdominis plane block (TAPB), port-site infiltration (PSI), or no block (NB) is not fully clarified.Materials and methodsThis meta-analysis followed PRISMA and AMSTAR guidelines. Thirty-six randomized controlled trials (RCTs) published between 2018 and 2025, including adult patients who had LC were analyzed. ESPB was compared with TAPB (12 RCTs), PSI (5 RCTs), and NB (24 RCTs) with respect to pain scores, opioid consumption, time to rescue analgesia, intraoperative fentanyl use, and postoperative nausea and vomiting (PONV). Fixed- or random-effects models were used according to heterogeneity (I 2 threshold 50%).ResultsESPB significantly reduced postoperative pain at rest and on movement compared with NB at all time points, with the greatest effect observed at 1-2 hours (MD: -1.82; P ConclusionsESPB provides superior analgesia with reduced opioid consumption after LC, with additional benefits of prolonged pain relief and lower PONV rates. It should be considered an effective component of multimodal pain management in this setting.

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BackgroundBreast cancer surgeries remain the cornerstone of treatment for early-stage disease. Nonetheless, a substantial proportion of patients experience moderate-to-severe acute or chronic postoperative pain, adversely affecting quality of life and functional recovery. Regional anesthetic techniques have emerged as effective strategies for perioperative pain control. This study compares the erector spinae plane block (ESPB) and the thoracic paravertebral block (PVB) in breast cancer surgeries.MethodsFour databases were systematically searched for randomized controlled trials (RCTs) using ESPB and PVB in breast cancer surgeries. Primary extracted outcomes include post-operative morphine consumption, analgesia duration, resting and dynamic pain scores. Methodological quality was assessed using the ROB-2 tool, while data were pooled using the R software, Version 4.4.2.ResultsNineteen RCTs reporting on 1527 patients were included. Postoperative morphine consumption, PONV incidence, and intraoperative fentanyl use were comparable in both groups. Similarly, pain scores at rest and movement reported no significant differences. The two techniques also demonstrated similar results regarding the number of patients requiring rescue analgesia and analgesia duration. ESPB was associated with a significant, however clinically negligent, shorter surgery duration compared to PVB [MD -0.04, 95% CI; -0.07 to 0.00, P = 0.023].ConclusionESPB and PVB provide comparable analgesic efficacy and perioperative outcomes in breast cancer surgeries. ESPB may offer a shorter surgical duration, supporting its use as a simpler yet equally effective alternative to PVB, however this must be taken cautiously.

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IntroductionNewer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes.Methodshttp://www.Clinicaltrialsgov , Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis.ResultsA total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 - 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 - 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 - 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 - 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 - 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 - 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score ConclusionsTo conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue.

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