ABSTRACT
Introduction: Caudal block is one of the most popular and commonly used regional anaesthetic procedures in paediatric patients for most surgeries below the umbilicus. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. Aim: The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients. Materials and methods: It was a prospective study, 80 patients randomly selected belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 mg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, pain score and sedation score. Results: The mean duration of analgesia was 10-18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 10 h, Group BF had higher sedation score up to two as compared to that below one on Group BT. P V Praveen Kumar, G Madhavi. Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients. IAIM, 2017; 4(10): 22-29. Page 23 Conclusion: Caudal tramadol compared to caudal fentanyl significantly prolongs the duration of analgesia without any side effects.
ABSTRACT
Introduction: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Magnesium has antinociceptive effects in animal and human models of pain. Materials and methods: 60 patients of either sex, belonging to 45-60 years of age, ASA grade I and II admitted for orthopedic hip surgeries. In the post-operative period when patient first complained of pain, they received either 50 mcg of Fentanyl (GROUP-F) or 50 mcg of Fentanyl plus 50 mg of Magnesium (GROUP-FM) diluted to 6 ml with normal saline. The parameters monitored were duration of analgesia, quality of analgesia (vas and vrs), cardio-respiratory effects: pulse rate, blood pressure (sbp and dbp), and respiratory rate and side effects like: nausea, vomiting, hypotension, sedation, respiratory depression. Results: Mean onset of analgesia in Group F was 16.2 ± 2.67 min and in Group FM was 15.9± 3.4 min. The duration of analgesia in Group F was 160± 18.19 min and in Group FM was 337.3 ± 47.48 min. In our study, there is mild fall in pulse rate and diastolic BP with both groups, more so with Fentanyl plus Magnesium group, and respiratory parameters were stable in both groups. In our study 50 mg of epidural Magnesium coadministered with Fentanyl in Group FM resulted in lower VAS scores at 2,3,4 hours postoperatively. Conclusion: Epidural Magnesium (50 mg) as an adjuvant to epidural Fentanyl (50 mcg) for postoperative analgesia resulted in prolonged duration of analgesia when compared to epidural Fentanyl (50 mcg) alone.
ABSTRACT
Background: In contributing the patient care, Anaesthesia and endotracheal intubation have become a core part of anaesthesiologists. Via nose or mouth, the trans-laryngeal placement of endotracheal tube into the trachea is called endotracheal intubation. Aim: To compare responses of lignocaine and diltiazem and combination of both on cardiovascular endotracheal intubation in healthy, normotensive patients. Materials and methods: This was a prospective randomised study, 80 patients were scheduled for tubectomy, cholecystectomy, appendectomy, abdominal and vaginal hysterectomy. These patients were divided into four groups, 20 in each group. Group I received normal saline, Group II received lignocaine and normal saline, Group III received diltiazem and normal saline, Group IV received diltiazem and lignocaine. Results: Males were 12, 60% and females were 8, 40% in group I, males were 12, 60% and females were 8, 40% in group II, males were 12, 60% and females were 8, 40% in group III and males were 10, 50% and females were 10, 50% in group II. Most of patients were aged between 21-40 years, group I (90%), Group II (82%), Group III (86%) and Group IV (75%). The mean age of group I was 33.98±8.05, group II was 38.78±9.26, group III was 31.87±5.29 and group IV was 35.68±7.89. The attenuation was maximum in Group IV followed by group II and group III, with respect to heart rate and systolic blood pressure. P V Praveen Kumar, P. Archana. Comparative clinical study of attenuation of cardiovascular responses to laryngoscopy intubation diltiazem, lignocaine and combination of diltiazem and lignocaine. IAIM, 2017; 4(10): 8-13. Page 9 Conclusion: In normotensive patients, the combination of diltiazem and lignocaine were more effective than when they were administered diltiazem and lignocaine individually for attenuating hemodynamic changes to laryngoscopy and tracheal intubation.
ABSTRACT
Background: Pain is perceived only by the sufferer as it is a subjective phenomenon. The TCIA (Taxonomy committee of International Association) defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. Aim: The present study was conducted to compare the efficacy of post-operative analgesia with epidural Tramadol in combination with levobupivacaine versus fentanyl. Materials and methods: This study was conducted study was a prospective, randomised comparative study. After ethical committee approval, a total of 100 patients were selected undergoing lower limb and lower abdominal surgeries were included in the study. Inclusion Criteria was patients who had ASA I and ASA II, age between 18-45 years, both males and female patients were included in the study. An informed consent was obtained from all the patients and they were examined thoroughly clinically during the pre-anaesthetic evaluation and routine laboratory investigations were done. 100 patients were allocated into two groups by simple randomisation technique. Group A: Tramadol and Levobupivacaine group (n=50) and Group B: Fentanyl group and Levobupivacaine (n=50). Results: In the present study, mean age in group I was 55.23±2.35, mean age in group II was 56.85±8.24, and male: female ratio was 18:10 in group I and in group II was 15:8. Duration of surgery in group I was 111.50 minutes and in group II was 112.85 minutes. Mean VAS score was P V Praveen Kumar, P. Swathi, P. Balakrishna. Fentanyl with levobupivacaine versus tramadol with levobupivacaine for combined spinal epidural analgesia in labor. IAIM, 2017; 4(10): 1-7. Page 2 less than 1 in both the groups was either equal to 1 or less than 1 during the first 24 hours after first dose of epidural analgesic administration. There was no significant difference in the mean heart rate among both the groups statistically (p>0.05). There was no significant difference in systolic and diastolic blood pressure among both the groups statistically (p>0.05). There was no significant difference in mean arterial blood pressure among both the groups statistically (p>0.05). More side effects were seen in group B i.e. fentanyl along with levobupivacaine. Conclusion: Prolonged analgesia with minimal side effects is provided by adding tramadol to local anesthetic. Fentanyl has certain fetomaternal side-effects, when used as adjuvant to local anesthetic, but it provides a rapid onset of analgesia.