ABSTRACT
A pure s-enantiomer of bupivacaine known as levobupivacaine, is now considered a safer alternative for regional anaesthesia than a racemic solution, bupivacaine since it is as efficacious as bupivacaine, but with better pharmacokinetics. Levobupivacaine is clinically tolerated well in cases requiring regional anaesthesia with both bolus administration and post-operative infusion. There are very few incidence of Adverse Drug Reactions (ADR) if administration is monitored appropriately as most ADRs are due to mistakes causing systemic exposure of drug. Hypersensitivity reaction to drug or pharmacological effects of anaesthesia though rare can also cause ADRs.1 Lidocaine (Xylocaine), is available commonly in a 0.5 % or 1 % solution, though several more concentrations are available. It is the most commonly used infiltrative amide anaesthetic. Higher concentrations show no difference in pharmacodynamics but may increase the risk of toxicity.2 The duration of action may be increased by addition of epinephrine. It can be added in concentrations of 1:100,000 or 1:200,000. This is seen to increase the maximum dose of drug and also reduces blood loss.3 Recent studies have found this combination to be safe to use in nose, ears, fingers and toes. METHODSA randomized comparative study was carried out in a tertiary care teaching hospital, Karad. A total of 112 cases was enrolled in the study who were having chronic suppurative otitis media and who require surgical management by tympanoplasty. Cases with a previous history of ear surgery were excluded. The enrolled cases were classified into group I and group II alternatively and the group I cases were given levobupivacaine 0.5 % and group II were given lidocaine 2 %. Infiltration with local anaesthetic was given in post auricular region. Perioperative analgesics were not given. Post-operative pain was measured by using VAS score and comparison of both groups was done by the Mann Whitney U test. RESULTSLevobupivacaine (8.6 mL) and lidocaine (9.2 mL) used during tympanoplasty in cases were stable throughout the procedure and no post-operative complications were noticed. The mean time of analgesic requirement was 186.43 ± 91.04 minutes and 329.54 ± 135.82 minutes respectively in levobupivacaine group and lidocaine group. The mean quantity of analgesics used was 1.95 ± 1.01 tablets and 3.34 ± 1.10 tablets in the levobupivacaine and lidocaine groups respectively.
ABSTRACT
In tubotympanic Chronic Suppurative Otitis Media (CSOM) the persistent inflammation of mucosa leads to irreversible changes in the middle ear and mastoid cavity. The Eustachian tube has several functions that facilitate the communication of the middle ear cavity with the nasopharynx, nasal cavity, nasal mucosa, and indirectly also with the paranasal sinuses and plays an important role in the disorders of middle ear. The Eustachian tube dysfunction and non-ventilation of middle ear cleft leads to vacuuming once the entrapped air gets absorbed by the mucosal capillaries leading to CSOM. A disease of the nose and paranasal sinuses influences causes dysfunction of the Eustachian tube leading to a middle ear infection. We wanted to study the correlation between nasal and paranasal sinus pathologies and their role in the management safe CSOM. MethodsIn this observational study, a total of one hundred cases of CSOM in the age group of 20 - 60 years was included in the study as per set criteria over a period of 6 to 7 months. All cases with persistent ear discharge were treated medically before undergoing functional endoscopic sinus surgery and septoplasty simultaneously whenever indicated after routine investigations, diagnostic nasal endoscopy (DNE), computed tomography of paranasal sinuses (CT - PNS) and otoendoscopy. A lesion causing dysfunction of ET in nasopharynx such as anatomical variants like medialised uncinate process, enlarged bulla ethmoidalis, enlarged middle turbinate, accessory ostium and deviated nasal septum (DNS) were searched and noted during DNE, FESS, and in CT - PNS. Postoperatively all cases were followed for 3 months using a nasal endoscope and otoendoscope to assess overall improvement. ResultsThere were 55 males and 45 females, with the male : female ratio of 1.22 : 1. Majority of cases were from the age group of 31 - 50 years (59 %). Among the 100 cases of CSOM, deviated nasal septum (62 %) was the most common sinonasal pathology and the majority of the cases (56 %) had ipsilateral mucopurulent discharge in the middle meatus. Confirmatory finding of DNS was 62 % with CT (p < 0.003). There was a significant association between the successful treatment of sinonasal pathology and improvement in the status of CSOM (P < 0.003). ConclusionsIn this study, DNS is the commonest aetiopathological factor for the development of CSOM apart from medialised uncinate process and hypertrophy of middle turbinate. Documentary evidence of CT scan for confirmation of DNS in the management of active safe CSOM having sinonasal pathology was important.