Paravertebral nerve block vs general anaesthesia in cancer breast surgery

The aim of this study to evaluate the effect of thoracic paravertebral nerves block[PVB] as an alternative for general anaesthesia [GA] in cancer breast surgery on haemodynamic, stress responses, pulmonary function tests[PFT] and postoperative pain relief. Fifty patients undergoing for elective simple mastectomy and clearance of axilla allocated for 2 groups. Group 1 [GAG] and group II [PVB]. All patient premedicated by fentanyl 1micro g/kg and 40 micro g midazolam. Group 1 [GAG] received general anaesthesia by propofol 2 mg/kg and 80 mirco g / kg vecuronium and anaesthesia was maintained by gas, oxygen and isoflurane. In PVB group single injection of 0.3 mg/kg bupivacain 0.5% at T4 spine and the patients were sedated by propofol infusion. PVB decreased HR, MABP, blood glucose and plasma cortisol significantly when compared with GAG and significantly improved pulmonary functions tests [FVC and FEVI]. PVB produced significant increase in duration of analgesia and decreased visual analogue scale scores [VAS] when compared with GA. PVB with bupivacain 0.5% at T4 in conjunction with intraoperative sedation was safe and effective for surgical anaesthesia in patient undergoing major breast surgery and attenuated the stress response to surgery and provided complete pain relief postoperative

Comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour

Fifty labouring women were randomized to receive either 0.125% ropivacaine with fentanyl 2 ug/ml or an equivalent concentration of bupivacaine / fentanyl using patient controlled epidural analgesia [PCEA] with settings of :6ml/h basal rate , 5ml bolus, lO.rnin lockout, 30ml/h dose limit.Analgesia, local anaesthetic use, motor block, patient satisfaction and side effects were assessed until the time of delivery. No differences in verbal pain scores, local anesthetic use , patient satisfaction or side effects between groups were observed. Hourly local anesthetic use was similar and did not differ between groups . the mean total volume of ropivacaine /fentanyl administered from epidural catheter placement until delivery was 85.3 +/- 30.6ml ropivacaine and 170.6 +/- 61.2 ug . fentanyl versus 88.2 +/- 25.2ml bupivacaine. and 176.4 +/- 50.4 ug fentanyl PCEA demands and delivered doses were similar between groups however patients administered ropivacaine / fentanyl developed significantly less motor block than an equivalent concentration of bupivacaine / fentanyl.. this statistical significant reduction in motor block decreased the incidence of instrumental delivery in ropivacaine/fentanyl group . Neonatal assessment included APGAR scores umbilical cord blood gas analysis and neurobehavioral testing at delivery,2 and 24h of life using the neurologic and adaptive capacity score [NACS] were reported . Neonatal condition was good and generally similar in all groups. In summary, by using a patient controlled epidural analgesia technique, ropivacaine 0.125% with fentanyl 2ug/ml produces similar analgesia with significantly less motor block than similar concentration of bupivacaine with fentanyl during labour without detrimental effects to the foetus

comparison of laryngeal mask airway with tracheal tube for intra-ocular ophthalmic surgery

Changes in intra-ocular pressure during spontaneous ventilation with a laryngeal mask were compared with controlled ventilation using a tracheal tube in 40 patients undergoing intra-ocular surgery Under general anaesthesia. Intra-ocular pressure was measured before induction, after establishing the airway, at the end of the operation and after removal of the airway device. Anaesthesia was induced with propofol and maintained with isoflurane and nitrous oxide in oxygen. Mean end -tidal carbon dioxide tension was significantly higher during spontaneous ventilation than during controlled ventilation 5 minutes after establishing the airway [42 +/- 0.7 Torr versus 38.5 +/- 0.5 Torr] and at the end of surgery [45.7 +/- 0.7 Torr versus 31.5 +/- 0.2 Torr] [p < 0.001]. Despite this, intra-ocular pressures were lower than the base line and similar in the two groups throughout anaesthesia. At the end of surgery, intraocular pressure [mmHg] was [11.0 +/- 4.5] and [8.2 +/- 3.1] during spontaneous or controlled ventilation respectively, one minute after removal of the device, mean intra-ocular pressure [mmHg] in the tracheal tube group [16.1 +/- 4.5] was slightly higher than base line [15.5 +/- 3.1] and was significantly higher than the laryngeal mask group [10.7 +/- S.4] [p <0.01]. Spontaneous ventilation with a laryngeal mask is an acceptable alternative to controlled ventilation with tracheal intubation in elective intraocular surgery

Thoracic epidural versus intraperitoneal local anaesthetic for postoperative pain relief after laparoscopic or open cholecystectomy

Laparoscopic cholecystectomy [LPC] is increasingly used to treat symptomatic cholelithiasis. In this study, we compared the effects of cholecystectomy by subcostal incision to those of LPC on lung function and endocrine metabolic response. The effects of thoracic epidural analgesia and intraperitoneal local anaesthetics [0.25%] bupivacaine 20 ml for LPC were studied as well. Forty patients undergoing elective cholecystectomy under general anaesthesia were allocated into four study groups, group I, cholecystectomy by subcostal incision [CSI], group II, LPC, group III, LPC and epidural analgesia with 0.5% bupivacanie followed by continuous epidural infusion of 6 ml of 0.5% bupivacaine. Group IV, 0.25% bupivacaine 20 ml administered I.P., forced vital capacity [FVC] and forced expiratory volume in one second [FEV 1] were measured with the patients in a half-setting position. In all groups, sustained decrease in FVC, FEV1 were observed up to 24 hours after surgery. Reduction of FVC was significantly more in group I compared with groups II, III and IV [p < 0.05]. Two hours after surgery, FVC was decreased significantly in groups I, II, III and IV to 29.1, 58.3, 63.6 and 59% of the preoperative values respectively. At that time, FEV1 decreased to 27, 55, 60 and 56% of the preoperative values in groups I, II, III and IV respectively [p < 0.05]. In all groups, plasma glucose and cortisol levels increased after surgery compared with the baseline levels [p <0.05]. At 240 minutes after surgery, a small but significant decrease of cortisol was measured in group III [p < 0.05]. Patients in groups I, II and IV, received significantly more fentanyl during surgery and morphine postoperatively compared with patients in group III [p <0.05]. In group III, epidural analgesia decreased visual analogue pain scores [p <0.05], but there was no difference in pain scores between group I, II and IV. In conclusion, the endocrine metabolic response is not abolished after LPC. Thoracic epidural analgesia decreased postoperative pain and attenuated the metabolic endocrine response, but it did not improve lung function after LPC. Nevertheless, pulmonary function is significantly better after LPC than after cholecystectomy via subcostal incision