Comparative evaluation of interscalene and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator

Objective: This study was conducted to compare interscalene block and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator

Methodology: Sixty male patients, age 20-60 years, ASA physical status I or II, scheduled for above right elbow surgery under brachial plexus block, were included in this prospective, randomized study. Patients were randomly allocated into two groups. Block was performed via the interscalene approach in the Group I and combined approach of interscalene with infraclavicular approach in the Group II, using a peripheral nerve stimulator. Total volume of 0.25% bupivacaine was kept 40 ml in both the groups. Onset and duration of sensory and motor blocks, quality of block and complications were noted. Evaluation of sensory and motor blockade onset were performed every 5 min after needle withdrawal and then up to 30 min. Primary outcome was satisfactory block [in terms of complete block, partial failure of block and complete failure of blocks]

All statistical analyses were performed using INSTAT for windows. Continuous variables were tested for normal distribution by the Kolmogorov-Smirnov test. Data was expressed as either mean and standard deviation or numbers and percentages. Demographic data were compared using student's unpaired t test. The monitored and calculated parameters were analyzed using Student's t-test and %[2] test. A p value < 0.05 was considered significant

Results: There was quick onset of sensory [C7-T1 dermatome] and motor block as well as prolonged sensory and motor block was observed in Group II as compared to Group I [P < 0.05]. Number of rescue analgesic requirement in Group I was significantly higher than Group II. Incidence of hoarseness of voice was more in Group I

Conclusions: We conclude that combined approach of interscalene and infraclavicular brachial plexus block is clinically and statistically superior as compared to interscalene brachial plexus block alone in elbow surgery

Medication errors: a matter of serious concern

The incidence of medications errors is increasing and the exact incidence is likely greatly underestimated and under-reported. Although the majority of these errors occur due to lack of knowledge of or failure to follow accepted protocols, look alike medication containers are the primary cause in many cases of drug error related morbidity or even mortality. With the number of drugs and the number of pharmaceutical companies manufacturing the same drug on an increase, the incidence is likely to increase. It is a universal problem that can be found in any operating room throughout the world, as demonstrated by the multi-national representation of many reports on this subject in the literature. This editorial supplements a case report, the 'Clinipics' Registered page and a special article on the topic of hazards of look-alike drug containers published in this issue of Anaesthsia, Pain and Intensive Care. The authors also attempt to present strategies to reduce these medication errors. The development of a non-blame environment where errors are openly reported and discussed and regulations for labeling the drug containers, vials and ampoules is stressed

Syringe swap and similar looking drug containers: a matter of serious concern

Medication error is a leading cause of morbidity and mortality in anesthesia and critical care unit. We present a case report of a 25 years old female patient, scheduled for emergency lower segment caesarean section [LSCS] under spinal anesthesia. Due to a syringe swap, inj. thiopentone sodium was injected inadvertently, instead of inj. ceftazidime. We had to administer general anesthesia to ventilate the patient, the patient which was otherwise unnecessary in this case. Patient was successfully extubated and shifted to postoperative anesthesia recovery room. We present a second case report of a 45 years old male patient with chronic obstructive pulmonary disease [COPD] admitted in Intensive Care Unit [ICU]. This patient inadvertently received atropine instead of metronidazole and was successfully managed. These incidents highlight the importance of proper drug location, double checking of the drugs, and proper anesthesia resident education

Challenges during prolonged mechanical ventilation of a morbidly obese lady with hypothyroidism and sleep apnea syndrome

Obesity, sleep apnea syndrome and hypothyroidism cause management of mechanical ventilation and weaning a difficult task. We report management of mechanical ventilation and subsequent weaning of a morbidly obese lady of BMI 42 kg/m2 with hypothyroidism and sleep apnea for 52 days. To make the matter worse, she had accidental extubations, multiple cardiac arrests, pneumonia and renal dysfunction during her ICU stay

Comparison of sedative efficacy of epidural bupivacaine 0.5% with lignocaine 2% plus adrenaline by measuring BIS guided propofol requirement in gynaecological surgery

Objectives: This study was conducted to compare the sedative ef! cacy of bupivacaine 0.5% with lignocaine 2% plus adrenaline in epidural anaesthesia by using BIS monitor

Study design: A randomized, double blind study

Methodology: Sixty patients, ASA physical status I or II, of age group 20-65 yrs, undergoing elective gynaecological surgery under epidural anaesthesia, were randomly but equally placed into two groups [group-B and group-L]

Patients received [2ml/segment] bupivacaine 0.5% or lignocaine 2% with adrenaline in group-B and group-L respectively, to achieve a sensory block up to T8 level. After con! rmation of sensory blockade, propofol infusion was started at a rate of 100 micro g/kg/min to get a BIS value of " 80 and the time was measured [onset time]. Surgery was allowed to start immediately after the onset time. Propofol infusion was titrated to maintain the BIS value at 60-80. Infusion was stopped at the end of surgery. The time taken to reach the BIS of#90 was recorded as 'recovery time. The amount of propofol consumed for onset of sedation and total amount consumed during the surgery were noted and compared

Results: There was no signi! cant difference regarding demographic data and onset time in both groups [P>0.05]. Recovery time was signi! cantly prolonged in group-B than group-L 5.57+1.25 min and 4.38+0.94 min respectively [P<0.05]. Dose of propofol consumed for onset of sedation was signi! cantly low in group-B than group-L, 17.13+4.22 mg vs. 27.77+8.39 mg respectively [P<0.05]. Total amount of propofol consumed was also signi! Cantly low in group-B than group-L, 140.33+34.59 vs. 184.80+38.21 respectively [P<0.05]

Conclusion: We conclude that epidural block with 0.5% bupivacaine is associated with less propofol consumption as compared with 2% lignocaine with adrenaline to maintain BIS 60-80 and hence is more effective