Moderate sedation with midazolam- ketamine versus propofolketamine for bone marrow biopsy

Small- dose ketamine in combination with sedative drugs has increasingly been used for sedation and analgesia during local anaesthesia in outpatient procedure. This study compared the efficacy of sedation and analgesia of ketamine midazolam versus ketamine propofol combinations in bone marrow biopsy. Sixty patients of either sex undergoing bone marrow biopsy procedure under local anesthesia participated in this study. They were randomly allocated into two groups of 30 patients each, all received ketamine 0.5 mg /kg with either midazolam 0.05 mg/kg [KM group] or propofol 2.5 mg/kg [KP group]. Supplementary dose of ketamine was administered to achieve adequate sedation level. Time to induce sedation, recovery oxygen time, saturation and adverse effects were recorded. The sedation levels were satisfactory in both groups except two patients in KM group and one in KP group. The most common side effects in KP group were pain on injection and hypoxia, where nausea and vomiting were the commonest side effects with KM group. Induction and recovery times were significantly shorter in KP group. Both combinations provided adequate sedation for bone marrow biopsy procedure but KP offer a quicker onset of sedation and a faster, smoother recovery

Spinal anaesthesia versus combined sciatic femoral nerve block for knee arthroscopy

This study was designed to evaluate the duration required to perform anaesthesia, achieve surgical block and fulfill standardized discharge criteria for knee surgery with spinal anaesthesia versus combined sciatic femoral nerve block. fifty patients ASA 1-11 scheduled for knee hrartoscopy were randomized to receive either spinal anaesthesia with 4 mg of 0.5% hyperbaric bupivacaine [spinal group], or combined sciatic -femoral nerve block with 0.75% ropivacaine and a multiple injection technique [12 ml for femoral nerve block and 18 ml for sciatic nerve block]. Time lasting from skin disinfection to the end of local anaesthetic injection [performance time] and then to achieve surgical anaesthesia [readiness for surgery], time required for block resolution, as well as time for discharge were recorded. Occurrence of adverse events was also recorded. Performance time was longer with sciatic femoral block than spinal block while no differences were observed in the time required to achieve anaesthesia [mean time for sensory block was 6.2 +/- 1.5 min and 8.8 +/- 1.7 min in the spinal and sciatic femoral block respectively and that for motor block was 9.7 +/- 3.6 min and 10.5 +/- 3.5 min]. No differences in haemodynamic parameter or in the visual analogue scale. Patients in the spinal group showed faster resolution of nerve block however no significant differences were observed in the discharge time. Sciatic femoral nerve block with multiple injection technique using ropivacaine 0.75% provided adequate anaesthesia for knee arthroscopy as spinal anaesthesia with no differences in home discharge and less side effects

Caudal additives in pediatric: tramadol versus ketorolac

Lower abdominal and genitourtnary surgeries are often associated with appreciable postoperative pain in children. A single caudal injection provides analgesia only for the duration of action of local anaesthetic. Epidural tramadol has been used to provide analgesia in adult patients without any adverse effects. Also ketorolac has been used Intrathecally and caudally and produced postoperative analgesia. We conducted this study to determine the efficacy and safety of adding tramadol or ketorolac to bupivacaine in prolonging duration of caudal analgesia. This double blind study was conducted in 60 children, aged 2-10 years and undergoing lower abdominal or inguinal surgery. After administration of general anesthesia, patients in group B[bupivacaine] [n= 20] received caudal epidural injection of 0.25% bupivacaine 1 ml/kg, those in group BT [bupivacaine - tramadol] [n=20] received 0.25% bupivacaine 1 ml/kg and tramadol 2 mg/kg and group BK [bupivacaine - ketorolac] [n=20] received 0.25% bupivacaine 1 ml/kg and ketorolac 0.4 ml/kg. Total volume of caudal epidural injection in all patients was 0.5 ml/kg with maximum volume 20 ml. No premedication or intraoperative analgesic was given. Heart rate, blood pressure, respiratory rate. TPPPS pain score and side effects, were recorded for 24 hours postoperatively. Rescue analgesia was given in the form of paracetamol injection 10 mg/kg IM. and total number of doses of analgesic required in the first 24 hours was recorded. Median pain scores showed no significant difference among the three groups in the first 2 hours postoperative, but there were significantly lower scores in Group BT and Group BK after 4 hours compared with Group B [P<0.05] for the rest of monitoring period, duration of analgesia time to first rescue of analgesia were prolonged in the two additive groups compared to the group B. There were no significant side effects in the three studied groups - addition of both tramadol and ketorolac to caudal bupivacaine improve the quality and duration of analgesia with noadverse effects