ABSTRACT
Commonly used methods of performing peripheral nerve blocks include elicitation of paresthesia and motor response to an electrical stimulus. The objective of this study was to compare the efficacy and reliability of these two methods in performing sciatic nerve block for lower limb surgery in elderly patients. Sixty patients, 60 - 90 years of age were randomly divided into two groups in this observer blinded study. In Group I Sciatic nerve block was established with a nerve locator and in group II paraesthesia elicitation technique was used. 20 ml of 0.5% bupivacine was administered in both groups. Haemodynamic parameters were recorded before and after the sciatic nerve block. We recorded the time of onset and extent of both sensory and motor blocks. The severity of pain was also noted in both groups. Statistically significant differences were seen in depth of sensory and motor blocks and degree of pain between groups [P < 0.05]. The time of onset of block was same in both groups and haemodynamics remained stable before and after the block. The use of nerve locator is more effective and successful in performing peripheral nerve blocks in comparison to paresthesia elicitation technique
ABSTRACT
The haemodynamic changes encountered in spinal anaesthesia are directly related to the extent of sympathetic block and can be decreased by restricting the block to unilateral sympathetic chain. This prospective quasi experimental study compared the changes in heart rate and blood pressure in unilateral and bilateral spinal anaesthesia to demonstrate that unilateral block caused less haemodynamic changes. Sixty ASA I or II patients aged 20 - 60 years for elective inguinal herniorrhaphy were randomly divided into two groups: group - A [unilateral] and group - B [bilateral]; each having 30 patients. Hyperbaric bupivacaine [15 mg] was injected intrathecally in lateral position. Group A patients were kept in lateral position with surgical side down for 10 minutes. In group B, patient's position was immediately changed to supine. Blood pressure and heart rate were recorded prior to and at every 5 - minute intervals after spinal anaesthesia for a duration of 30 minutes. Chi-square and t-test were applied. Frequency of hypotension was 6.7% in group A and 60% in group B [p = 0.00]. Frequency of bradycardia was 6.7% in group A vs. 10% in group B [p = 0.50] while the frequency of tachycardia was 3.3% in group A and 16% in group B [p = 0.09]. Frequency of hypotension was significantly less in unilateral as compared to bilateral spinal anaesthesia
ABSTRACT
Elective surgery is an important part of a hospital's workload. Whenever a case is put on list, it involves interaction of a number of people and in the same way its postponement affects many parties. The purpose of this study was to highlight the causes of such postponements, their impact on the hospital and to devise an approach to avoid preventable causes. This study was conducted in two operation theatres of Mayo Hospital Lahore over a period of one year i.e. from April 2009 to May 2010. All the patients scheduled to undergo elective surgical procedures in these operation theatres were included. Total number of cases, number of cancellations as well as causes of cancellation were noted. A total 0/252 lists were planned in both theaters and 2394 patients were put on list. Among this total number the operations 0/179 patients [7.47%] were postponed. The highest proportion of postponements was due to time constraints [35.75%]. Other main reasons were patients with uncontrolled blood pressure and cardiac problems [15.08%], treatment of blast victims [11.17%], strikes of the staff [8.37%] and non-availability of ICU bed / ventilator inaddition [5.58%] there were other less common causes as well. As a large proportion of postponements was due to mismanagement of the list time, it was therefore clear that there was lack of proper list planning and unrealistic time allotment for cases. This led to a large number of cancellations at the end of the day. This can be easily prevented by keeping in mind a rough time span taken by each procedure and calculating the total number of cases possible on each table
ABSTRACT
Ilioinguinal and iliohypogastric nerve blocks has been widely used in children undergoing inguinal herniorraphy. This technique may provide insufficient intraoperative analgesia as the inguinal region may receive innervation from genitofemoral nerve. We proposed that the addition of genitofemoral nerve block might improve the quality of analgesia. The objective was to find the efficacy of genitofemoral nerve block in addition to ilioinguinal and iliohypogastric nerve block for better intraoperative pain management in children under going inguinal hernia repair under general anaesthesia. After informed consent, 100 children of 1-10 yrs of age and ASA I or II status undergoing inguinal hernia repair were selected and divided in group I and II of 50 patients each. After induction of general anaesthesia, Group I patients received ilioinguinal and iliohypogastric block using bupivacaine 0.375% at a dose of 0.75 mg/kg, where as patients in group II were given genitofemoral in addition to ilioinguinal and iliohypogastric nerve blocks using bupivacaine 0.375% at a dose of 0.375 mg/kg at each site. Changes in heart rate, systolic, diastolic and mean arterial pressures were recorded before the start of surgery, at skin incision, at sac traction and at the end of surgery as a measure of efficacy of the block. Haemodynamic data was analysed using repeated measures ANOVA. The two groups showed increase in [Heart Rate] but the increase was lesser in group II at sac traction [p<0.05]. In group I all patients had an increase in systolic, diastolic and mean arterial pressure at sac traction while the patients in group II showed no change during the study period [p<0.05]. We conclude that the addition of a genitofemoral nerve block to ilioinguinal and iliohypogastric nerve blocks may contribute to haemodynamic stability during sac traction indicating better pain relief