Ultrasound guided brachial plexus block

Upper limb procedures are commonly carried out under brachial plexus block alone or in combination with general anesthesia. . The brachial plexus block can be performed by either of the techniques - blind; nerve stimulator [NS]-guided or ultrasound [US]-guided technique. But the introduction of ultrasound has revolutionized the puncture techniques dramatically since last decade. For successful and safe block, direct visualization for diffusion areas of drugs is recommended than targeting the nerves directly. The aim of this article is to review the different ultrasound-guided approaches used for brachial plexus block

Comparison of caudal ropivacaine 0.2% with bupivacaine 0.2% in pediatric patients - a randomized controlled trial

The aim of our study was to compare the efficacy and duration of analgesia of caudally administered 0.2% ropivacaine with 0.2% bupivacaine along with recovery of motor and sensory blockade in pediatric patients undergoing infraumbilical surgery. In this prospective, double blind study, 60 pediatric patients planned for infraumblical surgery, of ASA grade I or II, were randomly allocated in two different groups to receive 1 ml/kg of either 0.2% ropivacaine [Group A] or 0.2% bupivacaine [Group B] via caudal route after induction of general anesthesia. Objective pain score [OPS] and total duration of analgesia along with rescue analgesia were compared in both the groups. Recovery of motor and sensory blockade was also noted. The results were analyzed statistically using student's paired t-test for intergroup comparison and chi square test for nonparametric data or complications. Both the groups were comparable regarding age, weight, sex distribution and duration of surgery. Patients remained hemodynamically stable during intraoperative period in both the groups. The maximum mean sedation score at the beginning of the stay in the recovery room was 0.60 +/- 0.67 and 0.67 +/- 0.71 in Group A and B respectively. Though the OPS were marginally higher in Group B ascompared to Group A but the differences in total duration and quality of analgesia were not statistically significant. Average duration of analgesia was 390.2 +/- 35.16 min and 377.0 +/- 34.41 min in Group A and B respectively. However, motor recovery was faster in ropivacaine group with MPS of 10.00 +/- 0.00 incomparison to 8.80 +/- 0.99 in bupivacaine group [P value <0.01] at 2 hours in postoperative period. Caudal ropivacaine 0.2% is equally effective local anesthetic agent when compared to caudal bupivacaine 0.2% in terms of postoperative analgesia, but with faster motor recovery in pediatric patients

case of homocystinuria: anesthetic implications

We report a case of 12 yr. old male child who presented with diminshed vision for 3-4 years and was found to have supranasal subluxation of lens. He was suspected to have homocystinuria and confirmed by high serum homocysteine level. Homocystinuria is second most common inherited amino acid metabolic disorder, associated with cystathionine-beta-synthetase deficiency. After reducing his serum homocysteine level with medication, patient was taken up for surgery under general anesthesia. During perioperative period prolonged fasting hours and use of nitrous oxide were avoided and use of pneumatic compressions was taken to avoid the various complications and mortality associated with this syndrome