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Research Article
Cardio-renal and Metabolic Comorbidity Clusters in
High-Risk Diabetic Patients Selected for Ankle Block Anesthesia: A Retrospective Correlational Analysis
Tasnuva Tanzil
,
Md. Mazharul Islam*,
Md. Mostafa Al Bani
Issue:
Volume 14, Issue 2, December 2026
Pages:
115-126
Received:
10 May 2026
Accepted:
22 May 2026
Published:
3 July 2026
Abstract: Patients with diabetic foot often have multiple cardio-renal and metabolic comorbidities, which increase perioperative risk, especially in resource-limited settings where ankle block anesthesia is commonly used. The aim of the present study was to identify clusters of these comorbidities in high-risk diabetic patients undergoing foot surgery with ankle block anesthesia and to study correlations among key clinical parameters relevant to perioperative risk. A retrospective correlational study was performed on 71 adult diabetic patients who underwent foot surgery with ankle block anesthesia at Diabetic General Hospital, Chattogram, Bangladesh. Demographic and clinical data, encompassing biochemical, haematologic, renal, and cardiac parameters, were obtained from hospital records. Spearman's rank correlation, principal component analysis (PCA), and hierarchical clustering were used to find patterns of multimorbidity. There were strong links between renal and metabolic variables. Serum creatinine (SC) exhibited a robust inverse correlation with estimated glomerular filtration rate (eGFR), whereas bicarbonate showed a negative correlation with creatinine, indicating a potential link between metabolic acidosis and renal dysfunction. Positive correlations between electrolytes, albumin, and hemoglobin signify homeostatic equilibrium. PCA identified two principal axes-metabolic-electrolyte integrity and renal dysfunction-that encompassed the majority of the variance. Hierarchical clustering delineated three distinct physiological groupings. These results emphasize the necessity for thorough preoperative assessment and multidisciplinary management to enhance perioperative outcomes in this high-risk population. Prospective studies are necessary to enhance risk assessment methodologies.
Abstract: Patients with diabetic foot often have multiple cardio-renal and metabolic comorbidities, which increase perioperative risk, especially in resource-limited settings where ankle block anesthesia is commonly used. The aim of the present study was to identify clusters of these comorbidities in high-risk diabetic patients undergoing foot surgery with a...
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Case Report
Ultrasound-Guided Thoracic Paravertebral Block for Uniportal VATS Sublobar Resection: A Case Report
Shizhu Lin*
Issue:
Volume 14, Issue 2, December 2026
Pages:
127-130
Received:
14 June 2026
Accepted:
29 June 2026
Published:
17 July 2026
Abstract: Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. Despite the numerous advantages of video-assisted thoracoscopic surgery (VATS) in thoracic surgery, postoperative pain continues to pose a significant challenge, contributing to pulmonary complications and delayed recovery. Given the limited efficacy and notable adverse effects of systemic opioids, opioid-sparing multimodal analgesic strategies—including regional nerve block techniques such as the paravertebral block—have gained increasing attention for optimizing postoperative pain management and enhancing recovery. Objective: This case report aims to illustrate the clinical application and analgesic efficacy of an ultrasound-guided single-injection TPVB, combined with a preoperative nonsteroidal anti-inflammatory drug (NSAID), as a component of an opioid-sparing multimodal regimen in a patient undergoing VATS sublobar resection. Methods: A 36-year-old female underwent VATS sublobar resection of a right upper lobe nodule. To achieve opioid-sparing multimodal analgesia, the anesthesiologist implemented a regimen consisting of an intravenous NSAID (flurbiprofen axetil 50 mg) administered 30 minutes before the end of surgery, followed by an ultrasound-guided thoracic paravertebral block (TPVB) with 25 mL of 0.25% ropivacaine injected as a single shot postoperatively. Conclusions: A single-injection thoracic paravertebral block (TPVB) represents a highly effective component of a multimodal analgesic strategy, offering profound and opioid-sparing analgesia for thoracic surgical procedures.
Abstract: Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. Despite the numerous advantages of video-assisted thoracoscopic surgery (VATS) in thoracic surgery, postoperative pain continues to pose a significant challenge, contributing to pulmonary complications and delayed recovery. Given the limited efficacy an...
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Research Article
Dose-Response Evaluation of Intrathecal Dexmedetomidine with Low-Dose Hyperbaric Levobupivacaine for Geriatric Urological Surgery: A Randomized Double-Blind Trial
Issue:
Volume 14, Issue 2, December 2026
Pages:
131-144
Received:
26 June 2026
Accepted:
8 July 2026
Published:
24 July 2026
Abstract: Background: The ideal intrathecal adjuvant in elderly patients should prolong postoperative analgesia while maintaining hemodynamic stability and facilitating smooth recovery. This study compared three doses of intrathecal dexmedetomidine combined with low-dose hyperbaric levobupivacaine in geriatric patients undergoing elective urological surgery. Methods: In this prospective, randomized, double-blind study, 66 ASA I-II patients aged 60-82 years were allocated into three groups (n=22 each). All patients received 2.2 ml of 0.5% hyperbaric levobupivacaine with dexmedetomidine 5 µg (Group A), 7.5 µg (Group B), or 10 µg (Group C). The primary outcome was duration of postoperative analgesia. Secondary outcomes included onset and duration of sensory and motor blockade, Visual Analogue Scale (VAS) scores, rescue analgesic consumption, sedation scores, hemodynamic parameters, and adverse events. Preoperative geriatric assessment included Activities of Daily Living, Mini-Mental State Examination, and Clinical Frailty Scale. Results: Baseline demographic and geriatric assessment parameters were comparable among groups. Group C demonstrated significantly faster sensory block onset (1.08±0.42 min) and longer postoperative analgesia (181.37±9.79 min) than Groups A and B (p < 0.001). Postoperative VAS scores and rescue analgesic requirements were significantly lower in Group C. Sedation scores were slightly higher in the early postoperative period in Group C; however, hemodynamic and respiratory parameters remained stable, with no significant increase in adverse effects. Conclusion: Intrathecal dexmedetomidine improved spinal anaesthesia quality in a dose-dependent manner. A 10 µg dose provided superior postoperative analgesia with reduced analgesic requirement and acceptable safety in elderly patients undergoing urological surgery.
Abstract: Background: The ideal intrathecal adjuvant in elderly patients should prolong postoperative analgesia while maintaining hemodynamic stability and facilitating smooth recovery. This study compared three doses of intrathecal dexmedetomidine combined with low-dose hyperbaric levobupivacaine in geriatric patients undergoing elective urological surgery....
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Research Article
Intravenous Ondansetron, Nefopam, and Paracetamol for Prevention of Post-Spinal Shivering During Caesarean Section: A Randomized, Controlled, Double-blind Study
Iheanyi Ihunanya Anokwute*,
Alex Maduakolam Oham,
Ebe Kalu,
Chukwuma Grant Madubuko,
Olumide Samuel Agunbiade,
Timothy Okechukwu Ogbuagu
Issue:
Volume 14, Issue 2, December 2026
Pages:
145-153
Received:
25 July 2026
Accepted:
6 August 2026
Published:
24 August 2026
Abstract: Background: Shivering is a common complication of spinal anaesthesia, with an incidence of approximately 50%-60%, and is associated with increased perioperative morbidity. Although several pharmacological agents have been investigated for its antishivering prophylaxis, each has inherent limitations, and the optimal prophylactic agent remains a subject of ongoing debate. This study compared the anti-shivering efficacy of prophylactic intravenous paracetamol, ondansetron, and nefopam in obstetric patients undergoing spinal anaesthesia. Methods: Eligible obstetric patients were randomly allocated into four groups: Group P (paracetamol, n = 16), Group O (ondansetron, n = 16), Group N (nefopam, n = 16), and Group C (normal saline, n = 16). The primary outcome was the incidence of post-spinal shivering. Secondary outcomes included the severity of shivering, incidence of nausea, vomiting, hypotension, and perioperative haemodynamic variables. Continuous variables were analysed using one-way analysis of variance (ANOVA), while categorical variables were analysed using the chi-square test. A p-value of <0.05 was considered statistically significant. Results: No patient in the nefopam group developed shivering. The incidence of shivering was significantly lower in the ondansetron and nefopam groups than in the control group (p < 0.001), with nefopam demonstrating complete prophylaxis. Patients who developed shivering in the ondansetron group predominantly experienced mild-to-moderate shivering, whereas those in the paracetamol and control groups mainly exhibited moderate-to-severe shivering, with the difference being statistically significant. The incidence of nausea, vomiting, hypotension, and the perioperative trends in heart rate, mean arterial pressure, and peripheral oxygen saturation were comparable across all study groups. Conclusion: Prophylactic intravenous nefopam demonstrated the greatest efficacy in preventing post-spinal shivering in obstetric patients undergoing spinal anaesthesia, followed by ondansetron and paracetamol. Nefopam may therefore be considered a superior prophylactic agent for the prevention of post-spinal shivering in this patient population.
Abstract: Background: Shivering is a common complication of spinal anaesthesia, with an incidence of approximately 50%-60%, and is associated with increased perioperative morbidity. Although several pharmacological agents have been investigated for its antishivering prophylaxis, each has inherent limitations, and the optimal prophylactic agent remains a subj...
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Research Article
Anesthetic Management in Laparoscopic Surgery for Cholecystectomy at Brazzaville University Teaching Hospital, Republic of Congo
Mpoy Emy Monkessa Christ Mayick*,
Niengo Outsouta Gilles,
Elion Ossibi Pierlesky,
Bayoundoula Ghislaine,
Bokoba-nde Ngala Marina Aurole,
Tiafumu Konde Arnaud Christ,
Tsouassa Wa Ngono Bienvenu Giresse,
Elombila Marie,
Otiobanda Gilbert Fabrice
Issue:
Volume 14, Issue 2, December 2026
Pages:
154-161
Received:
7 August 2026
Accepted:
18 August 2026
Published:
8 September 2026
Abstract: Laparoscopic cholecystectomy has been considered the "gold standard" for the surgical treatment of symptomatic gallstone disease because it numerous advantages. However, this surgical technique presents specific anesthetic challenges. The aim of study was to describe the anesthetic management of laparoscopic cholecystectomies at the Brazzaville University Teaching Hospital (BUTH). This was a retrospective, cross-sectional study conducted from January 1, 2023 to April 30, 2025, at BUTH. All patients aged 15 years and older who underwent laparoscopic cholecystectomy were included. The epidemiological, anesthetic, surgical variables and outcomes were analyzed using Excel 2016 software. Fifty-eight patients underwent laparoscopic cholecystectomy. The mean age was 34.1 ± 14.3 years (range: 15 – 72 years). The sex ratio was 0.3. Symptomatic gallstones (96.5%) were the main indication for surgery. Comorbidities were present in 63.8% of cases, including homozygous sickle cell disease in 72.9%. Symptomatic gallstone disease (96.5%) was the primary indication for surgery. Difficult intubation, as predicted by the Mallampati score, was reported in 8.6%. Patients were classified as ASA 2 (67.2%). An Apfel score ≥ 2 was reported in 45 patients (77.6%). Antibiotics were administered to 89.6% of patients and domined by cefuroxime. All patients underwent surgery under general anesthesia with orotracheal intubation. Capnography was monitored in five patients (8.6%). Hypotension (27.58%) and severe bradycardia (8.62%) were the observed anesthetic complications. Four patients (6.9%) required conversion to laparotomy. The mean duration of abdominal insufflation was 79.9 ± 47.0 minutes and the mean duration of anesthesia was 145.5 ± 53.0 minutes. Postoperative complications were present in four patients with sickle cell disease (6.9%): one bone vaso-occlusive crisis, two respiratory infections and one pneumothorax associated with subcutaneous emphysema, requiring admission to the intensive care unit with an unfavorable outcome. Conclusion: Anesthesia for laparoscopic cholecystectomy is feasible at the BUTH for symptomatic gallstones, even in patients with sickle cell disease. Improved intraoperative monitoring could reduce the risk of postoperative complications.
Abstract: Laparoscopic cholecystectomy has been considered the "gold standard" for the surgical treatment of symptomatic gallstone disease because it numerous advantages. However, this surgical technique presents specific anesthetic challenges. The aim of study was to describe the anesthetic management of laparoscopic cholecystectomies at the Brazzaville Uni...
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