Combined infraclavicular and axillary brachial plexus block for arteriovenous shunts using graft: a comparison study

This study was conducted to evaluate the extent and efficacy of combining infraclavicular and axillary brachial plexus block for arteriovenous shunt using graft versus performing each mentioned block alone. Eighty-two ASA III and IV patients were allocated randomly to receive either true axillary block [Hirshels' technique] [group I, 26 patients], or Infraclavicular block [group II, 28 patients], or combined Infraclavicular and Hirshels' axillary block [group III, 28 patients]. All patients received 40-50ml bupivacaine 0.375%. The extent and efficacy of anesthesia [nerve gaps] complications and duration of analgesia of all groups were recorded and analyzed. The three groups were comparable according to age, gender and weight. The duration of operations was 105_15 minutes, and 18-20 minutes after the completion of block all patients in the three groups demonstrated sufficient surgical anesthesia. Five patients from group I, three patients from group II and two patients from group III needed supplementation with xylocaine subcutaneously or with intravenous analgesics and sedatives [fentanyl 50mcg, ketamine 10-50mg with midazolam l-2mg] during incisions of lateral aspect of arm or forearm [musculocutaneous and radial nerve distribution or intercostobrachial nerves distribution]. Blood taps were recorded in three patients from group I. However, the combined group showed superior anesthesia regarding the three previously mentioned nerves compared with the single site blocks. Combined infraclavicular and axillary block anesthesia demonstrates an extensive sensory and motor block in comparison with performing the same blocks individually

Comparison of infusions of phenylephrine and ephedrine in spinal anaesthesia

Objectives to assess the maternal cardiovascular changes [i.e. hypotension] and neonatal status in healthy women who underwent elective C.S under epidural anaesthesia and to compare the effect of optimal doses of 3 different vasopressors on hypotension and acid-base status in mothers and neonates during spinal anaesthesia [SA] for caesarian section [CS]. the total number of pregnant women who underwent, spinal anaesthesia during c.s were 150 between Jan 1st till 31st Dec 1999 at Q.A.M.H., a total of 15 pregnant women were randomly selected into: group 1 received an infusion of ephedrine 1mg/min [at 60ml/hr]. Group 2 received an infusion of ephedrine 2mg/min [at 120ml/hr] and group 3 was given an infusion of phenylephrine 10 mcg/min [at 60ml/hr] there was no significant difference in maternal age, weight or systolic arterial pressure between the 3 groups. Similarly, there was no significant difference between the 3 groups in the volume of bupivacaine used, time taken for anaesthesia to reach T4, time from insertion of the spinal to delivery of fetus and uterine incision delivery time

Pain relief after laparoscopic cholecystectomy. comparative study

The aim of this study was to determine whether subcutaneous injection of a long-acting local anesthetic at the site of ports of entry or installation of the same drug in the right subdiaphragmatic region would reduce post operative pain or not. The study was conducted on 60 patients who underwent laparoscopic cholecystectomy at King Hussein Medical Center [KHMC] between July 1995 and February 1996.Two scores of pain [visual pain scale and verbal rating scale] were used and assessment was done at two-hour intervals. Those patients were randomly allocated into three groups, group I received 20ml of 0.25% bupivacaine, intraperitoneally in the right subdiaphragmatic area, with the patient in the supine position. Group II received a total of 20 ml of 0.25% bupivacaine injected subcutaneously around the four port sites. Group III received saline with no local anesthetic. There was no significant reduction in the median visual scale or the verbal pain score among the three groups post-operatively. Subcutaneous infiltration with bupivacaine after laparoscopic cholecystectomy or its intraperitoneal instillation has no significant effect in relieving post-operative pain