ABSTRACT
Background: Pain is an individual and subjective experiencewhich can be modulated by several physiological,psychological and environmental factors such as previousexperience, fear, anxiety and cultural factors .The usual trendis to prescribe an opioid or a NSAID for postoperativeanalgesia. NSAIDs also have certain side effects likehemostasis alteration, renal dysfunction, gastrointestinalhemorrhage etc. TAP block is a local anaesthetic block used toprovide analgesia to the anterior and lateral abdominal wall.The present study was conducted to compare pain scores andrescue analgesia required amongst subjects receivingropivacaine and clonidine versus ropivacaine alone.Materials and Methods: A prospective, randomized, doubleblinded control trial undertaking 70 patients was conductedbetween September 2014 to March 2016 at the Department ofAnesthesiology, Northern Railway Central Hospital, New Delhi.Patients undergoing infra umbilical surgery under subarachnoidblock were included hysterectomy, caesarean section,cystolithotomy and bilateral inguinal hernias. All investigatorsinvolved in study were unaware of envelope details throughoutstudy period. Group C was given 20 ml of 0.2% ropivacainewith 25 microgram clonidine on each side, total of 40 ml of0.2% ropivacaine with 50 mcg clonidine. Group R was given 20ml of 0.2% ropivacaine on each side, total 40 ml of 0.2%ropivacaine. The postoperative pain at 1 hr, 3 hr, 6 hr, 9 hr, 12hr,18 hr, 24 hr by VAS score were noted and the totalpostoperative rescue analgesic dose in two groups. All the datathus obtained was arranged in a tabulated form and analyzedusing SPSS software.Results: Total males included in the study were 17 andfemales were 53. There was significant difference in group Cand group R in VAS score. It was consistently lower in group Cwhen compared with group R for first 12 hours. Total amount ofrescue analgesia used in the two groups was significantlydifferent. Total mean 150 mg of diclofenac sodium was given topatients in group C.Conclusion: USG-TAP block when used with adjuvant a2agonist (clonidine) along with local anaesthetic (ropivacaine)leads to prolongation of analgesic effect, lower vas scores andreduced requirement of rescue analgesic.
ABSTRACT
The aim of the study is to compare efficacy of intravenous (i/v) Palonosetron (75mcg), i/v Ondansetron (4mg) and i/v Dexamethasone (5mg) as prophylactic agents for reducing post-operative nausea and vomiting that follows laparoscopic cholecystectomy. Methods: This prospective randomized double blind study was conducted in the Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur. The study participants comprised of patients undergoing elective laparoscopic cholecystectomy surgeries under general anaesthesia. A total of 90 patients i.e. 30 in each of the three groups were enrolled for the study. Enrolled patients were randomly allocated to received with i/v Dexamethasone (5 mg) or i/v Ondansetron (4mg) or i/v Palonosetron (0.075 mg). The patients in the three groups were monitored and symptoms charted on basis of Post Operative Nausea and Vomiting (PONV) scale. Results: Palonosetron 0.075mg single intravenous dose given prior to induction of anaesthesia achieves 100% complete response with 3.33% reported side effect, and none needed rescue antiemetic. Dexamethasone 5mg single intravenous dose given prior to induction of anaesthesia achieves 93.33 % complete response with none reporting side effect and 6.67% needing rescue antiemetic. Ondansetron 4mg single intravenous dose given prior to reversal of neuromuscular blockade achieves 66.67 % complete response with 20% reporting side effect and 33.33 % needing rescue antiemetic. Conclusion: I.V. Palonosetron and Dexamethasone are equally potent and superior antiemetics than Ondansetron in the prevention of PONV in patients undergoing elective laproscopic cholecystectomy under general anaesthesia.
ABSTRACT
Background: Dexmedetomidine is a highly selective α2adrenergic agonist with an affinity of 8 times greater thanclonidine and hence allows the use of higher doses with lessα1 effect. Hence; the present study was undertaken forassessing the efficacy of Dexmedetomidine under combinedspinal epidural anesthesia.Materials and Methods: A total of 100 patients were enrolledin the present study. All the patients received isobariclevobupivacaine intrathecally and dexmedetomidine in normalsaline epidurally. Complete demographic details and clinicalhistory of all the patients was obtained. Preoperativehematological and biochemical profile of all the patients wasobtained. All the anesthetic procedures were carried out underthe hands of skilled and experienced anesthetists. Incidenceof intra-operative and postoperative adverse events wasrecorded separately. All the results were recorded in Microsoftexcel sheet and were analyzed by SPSS software. Chi- squaretest was used for assessment of level of significance.Results: Mean time taken for sensory regression to S1 was356.12 minutes. Mean time taken for rescue analgesia was362.55 minutes. In the present study, hypotension was foundto be present in 4 patients, bradycardia was found to bepresent in 3 patients and nausea and vomiting was found to bepresent in 5 patients.Conclusion: Dexmedetomidine is an effective agent undercombined spinal epidural anesthesia in patients undergoingelective surgical procedures.
ABSTRACT
Background: Lesser doses of local anesthetic in addition withadditives provides the necessary sensory level with enoughanalgesia. Dexmedetomidine is the S enantiomer ofmedetomidine that carries a high degree of specificity foradrenoreceptor. The present study was conducted with the aimto assess the complications and haemodynamic stability withthe use of dexmedetomidine with bupivacaine.Materials and Methods: The present study was conducted ina prospective manner for a period of 1 year at Department ofAnaesthesiology, Lady Hardinge Medical College & Smt. S. K.Hospital, New Delhi, India. No anesthesiologist enrolled in thepresent study was conscious of the group assigned till theentire 30 subjects were enrolled and the study was completed.After verifying a clear and free flow of the CSF, the drugadministration was completed and the subjects were placed atthe supine position. For every patient, heart rate and meanarterial pressure monitoring was done every 2 min for the initial10 minutes after spinal anesthesia, then after every 5 minutestill 30 minutes and then every 30 minutes till complete motorand sensory recovery. All the data thus obtained was arrangedin a tabulated form and analyzed using SPSS software.Probability value of less than 0.05 was regarded as significant.Results: The present study enrolled 30 subjects with15 patients in each group. The mean age of the subjects was39.22+/-4.67 years. The preoperative BP in Group I was94.67+/-8.22 and in group II was 91.52+/-5.38. There was nosignificant difference between them. There was 1 subject eachin Group I and II with nausea and shivering respectively.Conclusion: The study showed no significant alterations in thehaemodynamic stability the side effects between subjects whoreceived bupivacaine alone or bupivacaine plusdexmedetomidine.