ABSTRACT
Epidural blockade is becoming one of the most useful and versatile procedures in modern anaesthesiology. What is unique is its application to clinical practice, as it can be placed virtually at any spinal level of vertebral column that allows considerable flexibility. Epidural steroid injections through lumbar transforaminal route to treat pain in lower back where radiculopathy is also associated with, are used widely. It has been reported that these procedures in lumber spine are effective clinically for improved physical function in patients as well as relief of pain of short- and long-term duration. We wanted to determine as to whether there is a difference in the efficacy between nonparticulate (e.g. dexamethasone phosphate) and particulate (e.g. triamcinolone acetate) steroids in Lumbar Epidural via transforaminal approach for acute radicular pain in lumber region and adverse effects of the drugs if any. METHODS66 patients, 33 in each group, with dexamethasone phosphate 8 mg or triamcinolone acetate 40 mg for lumbar transforaminal approach epidural steroid injection, were randomized. Observation was done through visual analog scale, short McGill pain questionnaire, revised Oswestry Disability Index before intervention and a month later. RESULTSA difference which was significant statistically in the visual analog score (2.85 ± 0.83 in group T, 5.76 ± 0.75 in group Dx), McGill Pain Questionnaire (3.73 ± 1.15 in group T, 6.55 ± 0.51 in group Dx) and Oswestry Disability Index (18.67 ± 7.13 in group T, 35.83 ± 5.10 in group Dx ) was found in both but was more in triamcinolone group. CONCLUSIONSEfficacy is more in particulate (triamcinolone) than non-particulate (dexamethasone) in epidural injection through lumbar transforaminal with no drug related complication, performed for radiculopathy in lumbar region.
ABSTRACT
The Transverses Abdominis Plane (TAP) block is a relatively new regional technique which is often used for sensory blockade of the lower abdominal wall mainly for post-operative pain relief. It causes sensory blockade mainly because of injection of local anaesthetic between the internal oblique and the transverse abdominis muscle. TAP block was performed using a blind landmark technique in the lumbar petit triangle. Nowadays USG guided TAP block is being performed in many centers. TAP block is known to improve postoperative pain, reduce the opioid demand, and also reduce the time to rescue analgesia in patients undergoing lower abdominal surgeries. In our study, we have used TAP block as a main anaesthetic technique in patients posted for unilateral inguinal hernia repair under elective conditions. TAP Block in this study was given with 0.5 % bupivacaine. Duration of anaesthesia / analgesia, effectiveness of block, period of block, cardiac stability and haemodynamic stability were studied. METHODSA prospective observational study was conducted on 30 randomly selected individuals posted for elective inguinal hernia repair who belonged to American Society of Anaesthesiologists classification 1 and 2; age group between 20 and 70 years; satisfying all inclusion and exclusion criteria. All the patients received 0.5 % bupivacaine for TAP block, dose not more than 2.5 mg / Kg body weight. RESULTSWe have found that TAP block gives good anaesthesia for patients posted for inguinal hernia repair with good haemodynamic stability. With inj. Bupivacaine 0.5 % having an onset of anaesthesia at about 7.45 + / - 2.32 minutes (p value < 0.001). The block was complete and effectively elevated nociceptive stimuli. The block lasted till the end of surgery in all cases, with no complications. CONCLUSIONSTAP block other than being the main anaesthetic technique for lower abdominal surgery, also provides good post-operative analgesia with minimal post-operative analgesic requirement with less haemodynamic variations.
ABSTRACT
Electroconvulsive therapy (ECT) is a standard procedure in the modern psychiatric armamentarium. It involves, application of electric stimulus for a brief time in psychiatric patients to induce generalized seizure. ECT is utilized for treating various severe, treatment-resistant or refractory psychiatric disorders, schizophrenia and major depressive disorder (MDD). During ECT, severe disturbances can be noted in the cerebrovascular and cardiovascular system. Various anaesthetic drugs used in modified ECT can prevent these disturbances. We wanted to compare induction time, alteration of hemodynamics, seizure duration, and recovery time by using intravenous etomidate and intravenous propofol for induction of anaesthesia in modified electroconvulsive therapy.METHODSSixty patients were included in this prospective and comparative study. Patients of age group of 18–60 years of either sex, who had been posted for ECT therapy were randomly divided into two groups. Group E received Inj. Etomidate at 0.2 mg/Kg IV and Group P received Inj. Propofol 1% at 1.5 mg/Kg for induction of anaesthesia. Patients were monitored for various haemodynamic parameters such as heart rate, blood pressure at basal, after induction, and 1 min, 2 min, 3 min, 5 min, 10 min and 20 min following ECT. Induction time, seizure duration, quality of anaesthesia and recovery time from anaesthesia were also noted.RESULTSInduction of anaesthesia is faster with propofol (40.30 ± 3.65 sec) than with etomidate (48.63 ± 3.29 sec). Longer seizure duration was found with etomidate (58.90 ± 11.91 sec) induction in comparison to propofol (22.16 ± 5.48 sec) induction. Propofol group had more stable hemodynamic parameters compared to etomidate group following ECT. Propofol group (7 ± 1.43 min) achieved consciousness earlier than those of etomidate group (8.60 ± 1.16 min) following induction.CONCLUSIONSPropofol had the advantage of smooth induction, stable hemodynamic parameters, and rapid recovery as compared to etomidate. However, it was associated with shorter seizure duration. Etomidate had longer seizure duration which results in better clinical outcomes over propofol. However, it was associated with greater incidence of myoclonic jerks during induction.