ABSTRACT
Background: In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal opioids have been found to fulfil both these objectives. This study was done to evaluate the effects of adding sufentanil to bupivacaine for spinal anesthesia. Methods: 100 ASA grade I/II patients aged between 20 – 60 years undergoing elective lower abdominal, urologic, lower limb surgeries were selected and divided into two groups of 50 each. Group A received 2.5 ml of heavy Bupivacaine, whereas the second group B received 2.5 ml of heavy Bupivacaine with 5 μg Sufentanil. Parameters - Onset and duration of sensory block and motor block, time for two dermatomal segments regression, duration of analgesia, vitals and side effects were assessed. Results: There was no variation in onset of sensory blockade and motor blockade. The time to achieve peak sensory level was 3 minutes earlier in group B. The time for two segment regression and the time to full sensory and motor recovery were prolonged in Group B. Duration of complete and effective analgesia prolonged by 40-60 minutes and the time for first request of analgesic postoperatively was delayed by 70 - 80 minutes in group B. The quality of analgesia was better in group B. Pruritus was the common side effect in group B. Conclusions: Sufentanil potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia with minimal side effects.
ABSTRACT
Background: Pain in labour is an extremely agonising experience for most women. Unrelieved labour pain produces many physiological changes which are detrimental to both the mother and the foetus. Various methods have been used to alleviate this pain. It is now well recognized that the only consistently effective method of pain in labour is lumbar epidural analgesia. Using a higher concentration of local anaesthetic agent to produce analgesia can be associated with undesirable side effects such as motor block, haemodynamic disturbances or interference with the progress of labour. Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. In view of the above, the present study assesses the clinical effectiveness of continuous lumbar epidural analgesia for vaginal delivery by using 0.0625% bupivacaine with 2μg/ml of fentanyl. Methods: Forty parturient admitted to Chennai Medical College and Hospital, Trichy, for vaginal delivery and who were in active labor was given 8 ml of 0.0625% bupivacaine with 2μg/ml of fentanyl. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome. Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes). A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 μg of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate.
ABSTRACT
Background: Regional blocks in the field of anaesthesia were done traditionally with paraesthesia technique. To overcome the demerits with paraesthesia technique, nerve locator was applied for nerve blocks. Later, the application of ultrasonogram for regional blocks got the real time imaging of the nerves and drug administration. This resulted in publications of numerous studies with variable results. Therefore we planned to compare ultrasonogram and nerve locator in popliteal sciatic nerve block in our population. Methods: A prospective, randomized, observer blinded study was planned to compare the nerve stimulator (Group N) and ultrasound (Group U) on duration of „block technique‟, number of needle reinsertions in popliteal sciatic nerve block for ankle and foot surgeries. We included all consented patients aged ≥18 years of both genders belonging to ASA I to III and excluded pregnant mothers, diabetes mellitus, neuropathy, chronic opioid use, positioning difficulty, coagulopathy, nerve block contraindications, local anaesthetic allergic patients. Results: The duration of block technique in Group U = 262.00 ± 108.36 Seconds and Group N = 715.16 ± 234.66 Seconds with statistically significant P value = 0.0001. The average number of needle reinsertions in Group N = 6.05 ± 2.31 and Group U = 2.46 ± 1.11 with statistically significant p value of 0.0001. Therefore the time taken to perform the block and the number of needle reinsertions in Group U is shorter than the Group N. Conclusion: The duration of block technique and number of needle reinsertions are better with ultrasound. Though the onset of motor and sensory blockade were better with ultrasound success rate is not significantly different.
ABSTRACT
Background: Rheumatic Heart Disease remains the most common type of heart disease in pregnancy in developing countries. Over a period of 2 years,129 pregnant patients with Rheumatic Heart Disease attending our outpatient department, were observed from admission till discharge and the clinical course during pregnancy and the maternal, foetal outcomes, and desire of future contraception studied. Methods: Patients were routinely examined every antenatal visit for signs of anemia and congestive cardiac failure. They were usually admitted at 28-32 weeks of gestation unless they presented with symptoms of cardiac failure earlier in pregnancy. Frequency of the antenatal visits depended on the functional cardiac status. Results: The incidence of heart disease was 0.96% for all deliveries during our study period. The incidence of RHD was 71.6%. 65.1% of women gave a h/o rheumatic fever. 45(34.9%) patients had undergone surgical correction and 84(65.1%) did not undergo surgical correction. 95.3% had moderate to severe disease but only 18.6% were in NYHA class III/IV. Hence severity of disease did not correlate with NHYA class. 76.7% of women had vaginal delivery. LSCS was done for obstetric reasons alone. Conclusion: The association of the pre pregnancy functional class with the risk of maternal events raises attention to the possibility of reducing these complications in pregnant women with mitral stenosis by means of early interventions aimed at improving their functional class.