{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:41:55Z","timestamp":1786653715281,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"\n Background and Aims:<\/jats:title>\n Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in \u2018opioid-free\u2019 and \u2018opioid-based\u2019 TCSA.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into \u2018opioid-free\u2019 (bupivacaine alone) and \u2018opioid-based\u2019 (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02\u20130.05 mg\/kg), ketamine (0.25 mg\/kg) and dexmedetomidine (bolus dose of 1 \u00b5g\/kg IV over 10 min followed by 0.2\u20130.7 \u00b5g\/kg\/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student\n t<\/jats:italic>\n -test, Mann-Whitney and Fisher\u2019s exact tests.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The \u2018opioid-based\u2019 group performed significantly better compared with the \u2018opioid-free\u2019 group concerning pain scores at rest at 0 h (\n P<\/jats:italic>\n = 0.023), 18 h (\n P<\/jats:italic>\n = 0.023) and 24 h (\n P<\/jats:italic>\n = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (\n P<\/jats:italic>\n = 0.012) and maintenance (\n P<\/jats:italic>\n = 0.031)], postoperative rescue fentanyl requirement (\n P<\/jats:italic>\n = 0.018) and patient satisfaction (\n P<\/jats:italic>\n = 0.032) at the cost of increased postoperative nausea and vomiting (\n P<\/jats:italic>\n = 0.049).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The \u2018opioid-based\u2019 TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the \u2018opioid-free\u2019 group in patients undergoing major abdominal surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_729_23","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T07:08:02Z","timestamp":1708585682000},"page":"280-286","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial"],"prefix":"10.4103","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3417-6560","authenticated-orcid":false,"given":"Priyanka","family":"Sangadala","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9931-2316","authenticated-orcid":false,"given":"Praveen","family":"Talawar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0346-1374","authenticated-orcid":false,"given":"Debendra K.","family":"Tripathy","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Chhatisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8552-7861","authenticated-orcid":false,"given":"Ashutosh","family":"Kaushal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4847-4120","authenticated-orcid":false,"given":"Amit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1896-0555","authenticated-orcid":false,"given":"Nirjhar","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,2,22]]},"reference":[{"key":"R1-20260504","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1177\/1756287218795427","article-title":"Radical cystectomy in frail octogenarians in thoracic continuous spinal anaesthesia and analgesia: A pilot study","volume":"10","author":"Castellani","year":"2018","journal-title":"Ther Adv Urol"},{"key":"R2-20260504","doi-asserted-by":"crossref","first-page":"261","DOI":"10.23736\/S0375-9393.19.13896-5","article-title":"Thoracic continuous spinal anaesthesia for high-risk comorbid older patients undergoing major abdominal surgery: One-year experience of an Italian geriatric hospital","volume":"86","author":"Spannella","year":"2020","journal-title":"Minerva Anestesiol"},{"key":"R3-20260504","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.sopen.2020.07.002","article-title":"Continuous thoracic spinal anaesthesia with local anaesthetic plus midazolam and ketamine is superior to local anaesthetic plus fentanyl in major abdominal surgery","volume":"2","author":"Vincenzi","year":"2020","journal-title":"Surg Open Sci"},{"key":"R4-20260504","first-page":"CD010108","article-title":"Neuraxial blockade for the prevention of postoperative mortality and major morbidity: An overview of Cochrane systematic reviews","volume":"2014","author":"Guay","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"Suppl 2","key":"R5-20260504","doi-asserted-by":"crossref","first-page":"ii46","DOI":"10.1093\/bja\/aev376","article-title":"Impact of including regional anaesthesia in enhanced recovery protocols: A scoping review","volume":"115","author":"McIsaac","year":"2015","journal-title":"Br J Anaesth"},{"key":"R6-20260504","first-page":"198","article-title":"Safety and effectiveness of adding fentanyl or sufentanil to spinal anaesthesia: Systematic review and meta-analysis of randomised controlled trials","volume":"73","author":"Fonseca","year":"2023","journal-title":"Braz J Anesthesiol"},{"key":"R7-20260504","doi-asserted-by":"crossref","first-page":"317","DOI":"10.4103\/ija.IJA_769_18","article-title":"Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy","volume":"63","author":"Bansal","year":"2019","journal-title":"Indian J Anaesth"},{"key":"R8-20260504","doi-asserted-by":"crossref","first-page":"765","DOI":"10.4103\/ija.IJA_387_18","article-title":"Continuous spinal anaesthesia: A retrospective analysis of 318 cases","volume":"62","author":"Beh","year":"2018","journal-title":"Indian J Anaesth"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_729_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:41:24Z","timestamp":1786650084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_729_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,22]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_729_23","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,22]]},"assertion":[{"value":"2023-07-31","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}