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
Bupivacaine as local anaesthetic has cardiovascular and neurological toxic effects; ropivacaine on the other hand is known to have fewer side effects. Its safety and some its ability to reduce intra ocular pressure has led to its widespread usage. The aim of our study was to compare the efficacy of inj. Ropivacaine 0.75 % + hyaluronidase 50 IU / mL with inj. bupivacaine 0.5 % + hyaluronidase 50 IU / mL in cataract surgeries under regional anaesthesia. MethodsWe evaluated 60 patients who were posted for small incision cataract surgeries. They were randomly divided by drawing chits in to 2 groups according to the anaesthetics used (ropivacaine / bupivacaine). Evaluation of these patients was done on the basis of sensory onset, motor onset using akinesia score, requirement of rescue analgesic, and time of motor and sensory offset of the local anaesthetic. ResultsInj. ropivacaine 0.75 % showed greater reduction in IOP (p < 0.05). Other parameters such as motor block, sensory block, akinesia score, and requirement of rescue analgesia were comparable between the two groups (p > 0.05). ConclusionsIn patients posted for intra ocular / cataract surgeries, ropivacaine 0.75 % and bupivacaine 0.5 % are comparable, with ropivacaine having better haemodynamic profile and also reduces intra ocular pressure.
ABSTRACT
Syngnathia is a rare disorder characterized by bony fusion of maxilla and mandible which can be unilateral, or bilateral.1,2,3,4 Only 24 cases have been reported since 1936. Airway management in case of surgery for syngnathia varies from observation or sedation only, up to full airway control. It is a formidable task for anaesthetist to manage anticipated difficult intubation.Management of difficult airway is challenging task for anaesthesiologist. We present a case of 5 yr. old female with syngnathia with a bony fusion of maxilla and mandible on right side. Multidisciplinary approach is used to manage the airway with step wise anticipation of each complication. Child is premedicated with oral promethazine, nebulisation given, followed by FOB by maintaining spontaneous ventilation in the child.
ABSTRACT
Labour analgesia is the emerging technique in obstetric anaesthesia. There are various ways to provide painless labour to a mother. The best technique is epidural analgesia and providing a mother with good analgesia without a motor block is best done by ropivacaine and analgesia can be prolonged with addition of adjuvants. We wanted to compare efficacy, safety, quality of analgesia, total drug requirement, effect on the course and duration of labour, neonatal outcome, maternal satisfaction and adverse events if any, of ropivacaine 0.2% + 0.5 mcg/mL of dexmedetomidine with that of 0.2% of ropivacaine alone, for epidural labour analgesia.METHODS60 patients were divided in to 2 groups of 30 each RS and RD. RD received 8 mL of ropivacaine with 0.5 mcg/mL of dexmedetomidine while RS group received ropivacaine 8 mL with normal saline through an epidural catheter inserted at lumbar level. haemodynamic parameters were assessed along with APGAR score for neonatal status and maternal satisfaction was documented.RESULTSRopivacaine with dexmedetomidine was found to be a superior combination than plain ropivacaine in providing labour analgesia. The mean drug requirement in RD group (27.46 mL) was less than RS group (30.93 mL). Duration of labour is less in RD group (180.93±21.26 min) compared to RS group (199.49±24.63 min). Neonatal outcome and maternal satisfaction were better in RD group than RS group.CONCLUSIONSMaternal satisfaction with better analgesia was seen when dexmedetomidine was added to ropivacaine group owing to significant results in VAS scores in both the groups also duration of labour was reduced in RD group.