ABSTRACT
Epidural blockade is becoming one of the most useful and versatile procedures in modern anaesthesiology. What is unique is its application to clinical practice, as it can be placed virtually at any spinal level of vertebral column that allows considerable flexibility. Epidural steroid injections through lumbar transforaminal route to treat pain in lower back where radiculopathy is also associated with, are used widely. It has been reported that these procedures in lumber spine are effective clinically for improved physical function in patients as well as relief of pain of short- and long-term duration. We wanted to determine as to whether there is a difference in the efficacy between nonparticulate (e.g. dexamethasone phosphate) and particulate (e.g. triamcinolone acetate) steroids in Lumbar Epidural via transforaminal approach for acute radicular pain in lumber region and adverse effects of the drugs if any. METHODS66 patients, 33 in each group, with dexamethasone phosphate 8 mg or triamcinolone acetate 40 mg for lumbar transforaminal approach epidural steroid injection, were randomized. Observation was done through visual analog scale, short McGill pain questionnaire, revised Oswestry Disability Index before intervention and a month later. RESULTSA difference which was significant statistically in the visual analog score (2.85 ± 0.83 in group T, 5.76 ± 0.75 in group Dx), McGill Pain Questionnaire (3.73 ± 1.15 in group T, 6.55 ± 0.51 in group Dx) and Oswestry Disability Index (18.67 ± 7.13 in group T, 35.83 ± 5.10 in group Dx ) was found in both but was more in triamcinolone group. CONCLUSIONSEfficacy is more in particulate (triamcinolone) than non-particulate (dexamethasone) in epidural injection through lumbar transforaminal with no drug related complication, performed for radiculopathy in lumbar region.
ABSTRACT
Good pain relief after palatoplasty is important as inadequate analgesia with vigorous cry leads to wound dehiscence, removal of sutures and extra nursing care. Decrease in oxygen requirement and cardio-respiratory demand occur with good pain relief and also promotes early recovery. Preoperative opioids have concerns like sedation, respiratory depression and airway compromise. Greater palatine nerve block with bupivacaine is safe and effective without the risk of respiratory depression. The study was done to compare pain relief postoperatively with intravenous fentanyl and greater palatine nerve block in children following palatoplasty. Methods80 children of ASA I & II, between 1 to 7 years were included and allocated into two groups of 40 each. Analgesic medication was given preoperatively after induction of general anaesthesia, children in Group B received greater palatine nerve block with 2 mL 0.25% inj. Bupivacaine (1 mL on each side) and Group F received 2 μg Kg-1 I.V. fentanyl as 2 mL solution. Assessment of pain was done by FLACC scale and recovery profile by Modified Aldrete Score. Haemodynamic monitoring along with side effects was assessed. Data was analysed using SPSS software (Statistical Package of Social Science) version 17.0. p-value of < 0.05 was considered significant. ResultsPatients receiving block showed significantly better recovery profile (9.22 ± 0.39) vs (8.78 ± 0.61), duration of analgesia (482.59 +93.76) vs (174.13 +84.91) and less mean paracetamol consumption (126.66 +18.70) vs (151.79 +60.03) with comparable haemodynamics and side effects. ConclusionsGreater palatine nerve block provides effective postoperative pain relief after palatoplasty in children compared to I.V. fentanyl. It is safe, easy to perform, and free of complications.
ABSTRACT
Saddle block is the most commonly used anaesthetic technique for perianal surgeries in adults. Perianal surgeries under saddle block are considered as day care surgeries. Major disadvantage is that the low volume of spinally given drug won’t prolong duration of postoperative analgesia. Inj. Dexmedetomidine (α2-Adrenoceptor agonist) and Inj. Nalbuphine (opioid agonist-antagonist) were studied as an adjuvant as to whether they increase the duration of post-operative analgesia. Secondary objectives of this study were to compare hemodynamic stability and side effects among Inj. Dexmedetomidine and Inj. Nalbuphine. METHODSA total of 60 patients with American Society of Anaesthesiologist physical Status I and II scheduled for elective perianal surgeries were randomly allocated into two equal groups in this randomized prospective comparative study. Group D received 0.5% hyperbaric bupivacaine 0.8 mL + 5 mcg dexmedetomidine and group N received 0.5% hyperbaric bupivacaine 0.8 mL + 0.6 mg nalbuphine. Onset and duration of sensory and motor blockade, and duration of analgesia were recorded. Post-operative analgesic consumption and side effects were studied for 24 hours. Statistical analysis was done by using descriptive and inferential statistics using Chi- square test and Student’s t-test. RESULTSDemographic characteristics, duration of surgery, onset of sensory and motor block were comparable. Duration of analgesia was 320.26 ± 89.52 min for dexmedetomidine (D) whereas it was 222.23 ± 25.43 min for nalbuphine (N) with a P value of <0.05. No side effects were noted. CONCLUSIONA dose of 5 mcg dexmedetomidine as an adjuvant seems to be optimal for providing postoperative analgesia with better hemodynamic stability.