ABSTRACT
Opioids have been used intrathecally as adjuvant to bupivacaine and ropivacaine for improvement in quality and extending the duration of spinal blockade. We hypothesized that intrathecal ropivacaine provides similar anaesthesia with lesser motor blockade as compared to bupivacaine. So, we conducted this prospective, randomized, double blind study with an aim of comparing the effect of isobaric bupivacaine with fentanyl to isobaric ropivacaine with fentanyl with regards to sensory blockade, motor blockade and quality of analgesia in postoperative period. After ethical committee approval and consent, 100 patients, aged 18 to 60 years, undergoing lower abdomen and lower limb surgery were included in the study. The patients were randomly divided into two groups: Group I received 3 ml 0.5% isobaric bupivacaine plus 20 micro g fentanyl. Group II received 3 ml 0.5% isobaric ropivacaine plus 20 micro g fentanyl. The subarachnoid block was administered in sitting position in L3-L4 inter vertebral space and the study drugs were given at a rate of 0.2 ml/second. The patient was placed in supine position till maximum effect was achieved. The parameters observed included time of onset of sensory blockade, extent of sensory blockade, degree of motor blockade and duration of analgesia. The heart rate, blood pressure, oxygen saturation and respiratory rate were recorded. All the parameters were recorded just after giving spinal anaesthesia, at 5 minute intervals till 15 minutes, then at 15 minute intervals till 180 minutes. Bradycardia and hypotension was treated with inj. atropine, crystalloid solutions and inj. ephedrine IV. Inj. tramadol 1mg/kg was administered as a rescuer analgesic if the patient's VAS score was >3. Any side effects were recorded. The demographic parameters, duration of surgery and the types of surgery were comparable in the two groups. The time taken to achieve T10, T8 and T6 level of sensory block was significantly more [p<0.05] in Group II as compared to Group I, but time to sensory block level was comparable [p=0.981]. Mean time taken to achieve maximum grade of motor blockade was lesser in Group I as compared to Group II [p<0.001]. The sensory block regression to S2 was faster in Group II as compared to Group I [p=0.025]. The motor recovery was comparable in the two groups [p=0.264]. The duration of analgesia was prolonged in Group I as compared to Group II [p=0.027]. The mean pulse rate was comparable in the two groups [p >0.05]. The mean arterial blood pressure [MAP] was comparable [p>0.05] except between 10 min to 30 min intervals where MAP was relatively lower in group I [p<0.05]. The episodes of hypotension was higher in Group I [p=0.001]. We conclude that intrathecal administration of ropivacaine-fentanyl has faster onset and regression of sensory block, delayed onset but comparable regression of motor block and shorter duration of analgesia as compared to intrathecal bupivacaine-fentanyl
ABSTRACT
Measurement of respiratory quotient [RQ] and resting energy expenditure [REE] has been shown to be helpful in designing nutritional regimens. There is a paucity of the literature describing the impact of a feeding regimen on the energy expenditure patterns. Therefore, we studied the effect of continuous vs. intermittent feeding regimen in head-injured patients on mechanical ventilation on RQ and REE After institutional ethical approval, this randomized study was conducted in 40 adult male patients with head injury requiring controlled mode of ventilation. Patients were randomly allocated into two groups. Group C: Feeds [30 kcal/kg/day] were given for 18 h/day, with night rest for 6 h. Group I: Six bolus feeds [30 kcal/kg/day] were given three hourly for 18 h with night rest for 6 h. RQ and REE were recorded every 30 min for 24 h. Blood sugar was measured 4 hourly. Other adverse effects such as feed intolerance, aspiration were noted. Demographic profile and SOFA score were comparable in the two groups. Base line RQ [0.8 vs. 0.86] and REE [1527 vs. 1599 kcal/day] were comparable in both the groups [P>0.05]. RQ was comparable in both groups during the study period at any time of the day [P>0.05]. Base line RQ was compared with all other RQ values measured every half hour and fluctuation from the base line value was insignificant in both groups [P>0.05]. REE was comparable in both the groups throughout the study period [P>0.5]. Adequacy of feeding as assessed by EI/MREE was 105.7% and 105.3% in group C and group I, respectively. There was no significant difference in the blood sugar levels between the two groups [P>0.05]. We found from our study that RQ, REE, and blood sugar remain comparable with two regimens of enteral feeding - continuous vs. intermittent in neurosurgical patients on ventilator support in a ICU setup