ABSTRACT
Background:Although the role of TIVA has been well described in adult patients but there remains the paucity of such data in paediatric patients for laparoscopic surgeries and moreover the physiological implications of abdominal insufflations are not well documented in paediatric literature and cannot be simply extrapolated from adult data. Methods: 50 ASA grade I/II patients of either sex in the age group of 1 to 12 years, who underwent elective laparoscopic surgeries were divided in two group, total intravenous anaesthesia (Group T) and inhalation anaesthesia (Group G). Variables studied were hemodynamic variables (Heart rate, systolic and diastolic blood pressure), Respiratory parameters (change in EtCO2, Peak inspiratory pressure), Postoperative recovery profile (Agitation, Postoperative nausea and vomiting, Pain), Surgeon’s satisfaction score. Results & Conclusion: TIVA with propofol and sufentanil as compared to inhalational anesthesia with Isoflurane and N2O in paediatric laparoscopic surgery provides better haemodynamic stability, lesser incidence of emergence agitation, short recovery time in PACU, better surgeon satisfaction score. But, it doesn’t have much influence on postoperative nausea vomiting and postoperative pain.
ABSTRACT
Background: Fascia iliaca is one of the most commonly performed and safest block. Local anaesthetic diffuses under the fascia ilIiaca to block femoral nerve, lateral cutaneous femoral nerve, and obturator nerves. Clonidine, α2-adrenergic receptor agonist, has potent central and peripheral antinociceptive properties. Dexmedetomidine, is a potent α2-adrenoceptor agonist with dose dependent α2 receptor sensitivity. Receptors for α2 are found in the peripheral and central nervous system, platelets, and a variety of organs, such as the liver, pancreas, kidney, and eye. It exhibited dose dependent protection against brain matter loss in vivo and improved the neurologic functional deficit induced by the hypoxic ischemic insult. Aim: To compare clonidine and dexmedetomidine as an adjuvant to ropivacaine under ultrasound guided fascia iliaca for post-operative analgesia scheduled for hip and femur surgeries under subarachnoid block. Methods: It was a Randomized controlled trial study. The patients were allocated one of the three groups which are group R (n=30), Control group – 40 ml of 0.25% Ropivacaine in fascia iliaca compartment block, group RC (n=30) Clonidine group– 40ml of 0.25% Ropivacaine+ 0.5μg/kg Clonidine in fascia iliaca compartment block and group RD (n=30) Dexmedetomidine group – 40ml of 0.25% Ropivacaine + 0.5μg/kg Dexmedetomidine in fascia iliaca block by random number chart. 90 patients of both sexes in the age group of 20-60 years were taken in the study. This study was conducted in the department of Anesthesiology, Dr. R.P.G.M.C, Tanda at Kangra, Himachal Pradesh. Results: Time to first rescue analgesia was maximum in RD group as compared to RC group followed by R group and it was statistically significant amongst groups. Mean of total number of rescue analgesic i.e. inj. diclofenac required was 2.60 ± 0.50 (dose) in R group as compared to 1.50 ± 0.51 in RC group and 1.03 ± 0.18 in (RD) group. There was statistically significant difference in need for analgesia amongst R, RC and RD groups (P<.001). Conclusion: It is recommended that dexmedetomidine in a dose of 0.5μgm/kg can be used as an adjunct to ropivacaine (less cardio toxic) under ultrasound guided fascia iliaca compartment block, for better postoperative pain relief and prolonged duration of postoperative analgesia. It reduces the postoperative rescue analgesic requirement with arousable sedation and without any adverse effect.