ABSTRACT
Background: Bupivacaine has been traditionally used as a local anesthetic of choice for regional anesthesia and analgesia. Ropivacaine has been marketed in our country with a claim of better motor profile, better safety profile and an equivalent analgesic profile when used in epidurals for postoperative pain. This study aims to compare both drugs as an epidural infusion in terms of safety, analgesic efficacy by NRS score and patient satisfaction score and motor blockade by modified bromage score in postoperative period
Methodology: 70 patients of ASA grade I or II, of either sex between the age of 20- 65 years, posted for orthopedic lower limb surgery under combined spinal epidural anesthesia were enrolled in this prospective randomised double blind study. The patients were randomly allocated to one of the two groups; Group 1 patients received 0.125% bupivacaine with 2 microg/ml fentanyl, while Group 2 patients received 0.2% ropivacaine, with 2 microg/ml fentanyl as an adjunct in epidural infusion postoperatively. Epidural infusion was started at the rate of 8 ml/hour after either four hours of administration of spinal anesthesia or at an NRS score of three, whichever was earlier. We evaluated the NRS scores, patient satisfaction scores and the need of rescue analgesic. Vital parameters and modified bromage score were also registered
Results: The pain score was similar in both groups at different time intervals, except at 15 and 30 min after starting epidural infusion, where the pain score was significantly lower in Group 2 when compared to Group 1 [p-value 0.007, 0.006 respectively]. Patient satisfaction score was significantly more in Group 2 patients. There was no significant difference in requirement of rescue analgesia in two groups. Modified bromage grade was statistically more in Group 1
Conclusion: We conclude that ropivacaine can be used as an alternative to bupivacaine for postoperative analgesia by epidural infusion, as it provides effective pain control with the added advantage of lower incidence of motor blockade
ABSTRACT
PATIENTS AND METHODS: Thirty operated patients of myelodysplasia were clinically evaluated for the age at presentation, the extent of lesion and neurological deficit. Urological assessment was done with urine cultures, serum creatinine, radiological (ultrasound of kidney, ureters and bladder, voiding cystourethrogram) and urodynamic (water cystometry) parameters. An objective scoring for bladder (Galloway, et al.) was applied. Dimercapto-succinic acid (DMSA) scan was done in all the patients for evidence of renal scars. The results of above investigations were correlated with presence or absence of renal scars (renal injury) on DMSA scan. None of the patients had received any prior bladder care. RESULTS: Twenty one patients had no renal scars and 9 patients had evidence of renal scarring. Patients with renal scars were older at presentation, they had greater degree of hydroureteronephrosis (P < or = 0.001) and vesicoureteric reflux (P < or = 0.005). The incidence of high leak pressures (>25 cm of water, P < or = 0.05), unacceptable bladder volumes (maximum cystometric capacity < 60% for age, P < or = 0.005) and high risk Galloway's score (> 5, P < or = 0.05) was high in patients with associated renal scarring as compared to their nonscarred counterparts. Three of these patients had serum creatinine >1 mg/dl (P < or = 0.005). The incidence of urinary complaints and positive urine cultures was also higher in these patients (NS). CONCLUSION: Increasing age, evidence of hydroureteronephrosis and vesicoureteric reflux, high leak pressures, low bladder volume and high combined Galloway score (>5) define a high risk bladder in our population and predispose to renal injury in patients of myelodysplasia. Early referral for bladder risk assessment and management of all myelodysplasia patients is recommended.