Dexamethasone as an adjuvant to bupivacaine for post operative pain in supraclavicular branchial plexus block

To compare the onset of block, duration of analgesia and complications when dexamethasone is added to local anaesthetic bupivacaine in supraclavicular brachial plexus block for upper limb surgery. Quasi experimental study. This study was conducted at the Department of Anaesthesia, PIMS, Islamabad from July 2007 to June 2008. total sixty patients were included in this study. 30 patients were given supraclavicular block with 0.5% Bupivacaine plus normal saline and put in Group A and remaining 30 were given 0.5% bupivacaine plus dexamethasone and put in Group B. Study inclusion criteria were surgery of upper limb, age of the patient between 20 years to 60 years and anaesthesia physical status [ASA] I, II, III. Variables recorded were onset of sensory and motor block for both groups and duration of sensory and motor block in both groups. Rescue analgesia requirement and complications were also noted in both groups. Demographically both groups were well watched T. test was used to compare the onset of sensory and motor block, duration of sensory and motor block and numerical pain score between the two groups. Chi-squre test was used to compare rescue analgesia required and complications between the two groups. P-value less than 0.05 was considered statistically significant. The onset of motor block was similar in both groups [p-0.82] while onset of sensory block was earlier in dexamethasone group [p-0.014]. The duration of sensory and motor block were significantly longer in dexamethasone group [B] than Bupivacaine group alone [A] [P=<0.001]. Rescue analgesia required by the bupivacaine alone [A] was much earlier than dexamethasone group [B] [P= < 0.001]. No serious complications were noted in both groups. The addition of dexamethasone to bupivacaine 0.5% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and provides greater pain relief also it shorten the onset of sensory block but has no effect on onset of motor block

Comparison of ondansetron and metoclopramide in the prevention of nausea and vomiting after laparoscopic cholecystectomy under general anaesthesia

To evaluate and compare the antiemetic efficiency of ondansetron with metoclopramide when administered prophylactically for the prevention of post operative nausea and vomiting after laparoscopic cholecystectomy. Prospective, Randomised, Comparative study. The study was conducted at the department of Anaesthesia Fauji Foundation Hospital, Rawalpindi from Sep 2010 to may 2011. Total 90 ASA grade-I and ASA grade-II patients, sex female, and age 35 - 70 years undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomly divided into three groups, 30 in each group. Group-I received 4 mg intravenous ondansetron, group-II received 10 mg, Intravenous nietoclopramide and group-III received intravenous 0.9% normal saline 2 minutes prior to induction of anaesthesia. They received standard General Anaesthesia for surgery. Post operative analgesia was provided with intravenous ketorelac 30 mg. There was no difference among the groups in patient charactertics and risk factors for PONV. Patients were observed for 24 hours after operation for occurrence of nausea and vomiting and requirement of rescue antiemetic. Efficiency of the drug was evaluated as [a] complete response- no nausea and no vomiting. [b] Mild response Nausea with no vomiting [c] Moderate response - 1-2 vomiting episodes I moderate nausea [d] Severe response - > 3 vomiting episodes Isevere nausea. During 1St 24 hours after operation incidence of nausea and vomiting was 77% in patients in placebo group, was 33% in patients in the ondansetron group and 53% in patients in the metoclopramide group. The incidence of PONV was significantly lower in patients who received ondansetron [P < 0.05] as compared to metoclopramide or placebo. Complete response with no nausea and vomiting was higher in patients who received ondansetron [66%] than in patients who received metoclopramide [46%] or placebo [23%]. The incidence of nausea with vomiting [moderate to severe response] was significantly lower with ondansetron [20%] as compared to metoclopramide [34%] and placebo [60%]. There was no need for another rescue antiemetic in [80%] patients, with ondansetron [67%] with metoclopramide, [40%] with placebo. Single intravenous dose of 4 mg ondansetron when administered prophylactically is more effective than 10 mg intravenous metoclopramide in the prevention of PONV after laparoscopic cholecystectomy. Single 4 mg IV dose of ondansetron reduces the incidence and severity of PONV and also requirement of rescue antiemetic in the Post operative period

effect of preoperative fluid therapy on post operative nausea and vomiting [comparison of colloids vs. crystalloids]

The objectives of this study were: To compare the incidence of postoperative nausea and vomiting in both groups. To compare the degree of postoparative pain relief in both groups. The study was done at HDU and Gynae ward II, Nishtar Hospital Multan. It was completed in 5 months period from 2nd jan 2005-2nd June 200511 was a prospective, double blind randomized controlled trial done on 70 patients, belonging to ASA I and II who were admitted for transabdominal hysterectomy. All the patients were randomly allocated to receive 5ml/kg Haes Steril 6% [group I] or 15ml/kg Hartmann's solution [group H] intravenouly shortly, before induction of anaesthesia. During the operation, fluid management was identical in both groups. Postoperatively they were kept in HDU for 12 hours. The severity of nausea, episodes of vomiting, degree of pain, and the need for supplemental antiemetic and analgesics drugs, were assessed by staff at HDU, at 0-1 hr 1-12 hr, for PONV and at 0,6,12 hrs. [for pain. Where as later on at 12-24 hrs postoperatively, these were assessed by a blinded investigator at the respective wards of the patients. Patients were asked to rate their nausea on a 100-mm VAS at 15min intervals throughout recovery [0=no nausea; 100=the worst imaginable nausea]. A score of SO mm or greater was considered significant.: During the first postoperative 24 h, postoperative nausea occurred in 3 patients [8.5%] in the group I, and in 4 patients [11.4%] in-group II [p=<0.05], whereas vomiting occurred in 2 patients in gp I and in 3 patients in gp II. The mean pain scores were also slightly lower in gp I than in gp II. We concluded from our study that colloid .substitutes administered in smaller volume produced same, rather slightly more beneficial effects on PONV and postoperative pain compared to the crystalloids given in larger volume and can therefore be of great benefit to patients with fluid restriction

comparison of epidural and intramuscular buprenorphine in patients following lower abdominal surgery

This Analytical study aimed to assess and compare the efficacy of Epidural route with n the duration of analgesia and degree of ostoperative pain relief in patients undergoing lower abdominal surgery. The objectives of this study were to: compare the duration of analgesia in two regimens, compare the degree of pain relief in two regimens The study was conducted at general surgical wards I and II in Nishtar hospital Multan over a period of six months from 1st April - 30th September 2003. Sixty patients of either sex belonging to age range 40-60 years, of ASA grade I and II, undergoing elective lower abdominal surgery were included in this study. Patients having any clinical or biochemical evidence of systemic involvement were excluded from the study. Patients having local sepsis, or patients with history of allergy or sensitivity to buprenorphine or those suffering with fever during postoperative period were excluded. Sixty patients were included in this study, all were assigned to one of the two groups I and II, using non probability convenience sampling technique. Each group comprised of thirty patients. Group I received epidural Buprenorphine 0.3mg in 9 ml of normal saline, through epidural catheter Group II received parenteral Buprenorphine 0.3 mg. I/M deep into deltoid muscle. All patients underwent surgery under general anaesthesia, but no narcotic analgesia was given in preoperative or intraoperative period. Prior to induction in group I, epidural catheter was passed at L1-2 or L2-3 intervertebral space and at the time of closure of peritoneal cavity 0.3mg Buprenorphine, in 9 ml of normal saline was given in it; where as Group II was given injection Buprenorphine 0.3 mg IM deep into the deltoid muscle at the time of closure of peritoneal cavity" Patients were transfered to the HDU where they remained for 24 hours. Patients were instructed to ask for analgesia as soon as pain at rest returned. In postoperative period pain intensity was evaluated at 0, I, 4, 8,12,16,20,24 hrs interval after completion of operation using a 10 cm Visual Analogue Scale and with the help of McGill questionnaire. In group I, excellent analgesia of longer duration was noted, with no hemodynamic as well as immediate respiratory depressant effects. Moreover, drowsiness as compared to group II was much less