ABSTRACT
Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anaesthetic drugs and routes of administration. The aim of this study was to evaluate the efficacy and safety of intraarticularly administered inj. ropivacaine 0.25% 20 ml, after arthroscopic knee surgery performed under spinal anaesthesia, for prolonging the duration of post-operative analgesia.METHODSThis is a prospective randomized study conducted among 80 patients of both sexes, of American Society of Anesthesiologists, physical status I and II, undergoing day care arthroscopic knee surgery who were randomly assigned into two groups (R, C). Group R received 20 ml of 0.25% ropivacaine, whereas group C received 20 ml of 0.9% inj. normal saline through intra-articular route at the end of the procedure. Pain was assessed using visual analog scale (VAS) and paracetamol given as rescue analgesic when VAS >4. Time of first analgesic request and total rescue analgesic were noted.RESULTSTime for the requirement of first post-operative rescue analgesia (255.15±26.35 vs. 92.40±12.54) min and total mean rescue analgesic requirement was (1.32±0.52 vs. 3.0±1.0) in group R and C respectively. Group C had higher mean VAS score throughout the study period. No side effects were found among the groups. These two results were clinically and statistically significant (p<0.05).CONCLUSIONSAdministration of intra-articular inj. ropivacaine 0.25%, 20ml, is effective & safe method of management of postoperative pain in patients undergoing arthroscopic knee surgeries, as it prolongs the duration of postoperative analgesia, provides better quality of analgesia with reduced requirement of rescue analgesia without significant side effects.
ABSTRACT
Ropivacaine, a long acting amide local anaesthetic, has reduced potential for neurotoxicity and cardiotoxicity and is considered to block sensory nerves to a greater degree than motor nerves. In today’s world, faster recovery along with minimal side effects and early ambulation after surgeries under spinal anaesthesia are very important. So, this prospective randomized study was aimed at evaluating and comparing the efficacy and safety of intrathecally injected isobaric ropivacaine and intrathecally injected hyperbaric bupivacaine in patients posted for lower abdominal surgeries under spinal anaesthesia.METHODS90 patients belonging to ASA physical status I & II scheduled for lower abdomen surgeries were randomly selected for the study and were divided into two groups of 45 each. Group B received 3 ml of 0.5% hyperbaric (15 mg) bupivacaine intrathecally. Group R received 3 ml of 0.75% isobaric (22.5 mg) ropivacaine intrathecally. Onset and extent of sensory block, onset and duration of motor block, maximum height of sensory block, duration of analgesia, hemodynamic parameters and adverse effects if any were studied. SPSS 20.0 and GraphPad Prism 6.0 were used for the analysis of the data.RESULTSThe mean time for onset of sensory block was significantly faster in group B as compared to group R (8.28±2.2 min v/s 7.98±2.2 min). There was no significant difference between the groups regarding the time for two segment regression. Mean time of onset of motor block was significantly faster in group B. The mean duration of motor blockade was 146.89±14.11 min in group R and 208.91±14.62 min in group B. The mean duration of analgesia was comparable in both the groups. Hemodynamic parameters and side effects were comparable in both the groups.CONCLUSIONS0.75% isobaric ropivacaine provided similar duration of analgesia with a shorter duration of motor block as compared to hyperbaric 0.5% bupivacaine and it also provided adequate level of sensory block for the surgery with minimal intraoperative and postoperative side effects and stable haemodynamics throughout the surgery.
ABSTRACT
Every surgical procedure inflicts pain during the procedure which also continues in the post-operative period as post-operative pain. Intraperitoneal instillation of local anaesthetics in laparoscopic cholecystectomy has been used to reduce postoperative pain and to decrease the need for postoperative analgesics. We wanted to compare intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.METHODSAfter obtaining ethical committee’s clearance and informed consent, sixty patients, aged 20–60 years, of either gender, and American Society of Anaesthesiologists physical status I to II scheduled for laparoscopic cholecystectomy were included and categorized into two groups (n=30). Group B patients received 20 mL of 0.5% bupivacaine intraperitoneally after cholecystectomy and Group R patients received 20 mL of 0.75% ropivacaine intraperitoneally after cholecystectomy. Mean duration of postoperative analgesia and number of doses of rescue analgesic required were observed. Patients were assessed at 0, 2, 4, 8, 12, 18 and 24 hours postoperatively with respect to quality of analgesia (VAS), hemodynamic parameters and side effects.RESULTSMean Time for first rescue analgesic requirement was 148.04 ± 53.47 min in group B and 295.38 ± 74.15 in group R and the difference was statistically significant (p=0.0001). In group R 17 (56.6%) patients did not require any rescue analgesic throughout the study period as compared to 8 (26.6%) patients in group B. The difference between the two groups was statistically significant. (p=0.019). A lower VAS score was observed in group R as compared to group B, with statistically significant difference at 2, 4 and 8 hours respectively. (p= 0.001, 0.003 and 0.032).CONCLUSIONS0.75% ropivacaine is a better alternative to 0.5% bupivacaine when given intraperitoneally for management of postoperative pain in patients undergoing laparoscopic cholecystectomy under general anaesthesia as it prolongs the duration of analgesia, provides a better quality of analgesia till 8 hours postoperatively, with lesser demand and requirement of rescue analgesic in the postoperative period, and has lesser side effects.
ABSTRACT
Major surgeries like hip arthroplasty, knee arthroplasty etc.; are associated with excessive bleeding. Uncontrolled bleeding can lead to increased morbidity and mortality and may necessitate blood transfusions. This prospective, randomized study was designed to evaluate the efficacy and safety of injection tranexamic acid in reducing blood loss and rate of blood transfusion in lower limb orthopaedic surgeries without tourniquet under subarachnoid block.METHODSAfter approval from institutional ethical committee, the study was carried out on 80 patients who were divided into two groups of 40 patients each. Patients in group T received a bolus dose of 10 mg/Kg injection tranexamic acid 10 minutes before induction of anaesthesia and patients in group C received 0.9% 10 ml normal saline. Intraoperative and postoperative blood loss were recorded and added together for total blood loss. Postoperative haemoglobin and haematocrit were evaluated 24 hrs. after surgery. The number of patients who received blood transfusion and the number of units of blood transfused postoperatively were recorded. Early adverse reactions of tranexamic acid were recorded and treated. p<0.05 was considered significant.RESULTSMean intraoperative blood loss in group C (489.75+123.63 ml) was more than group T (450 + 138.66 ml) (p> 0.05). Postoperative blood loss was significantly less in group T (163.67 ± 44.13 ml) as compared to group C (205.43 ± 63.31 ml) (p<0.05). The mean total blood loss was significantly less in group T (613.67 ± 167.40 ml) as compared to group C (695.2 ± 162.44 ml) (p< 0.05). The drop in postoperative haemoglobin and haematocrit was significantly higher in group C as compared to group T (p < 0.0001). Significantly higher number of patients in group C (15) received postoperative blood transfusion as compared to group T (7) (p< 0.05). Acute adverse effects of tranexamic acid and complication of blood transfusion were not seen.CONCLUSIONSInjection tranexamic acid in a bolus dose of 10 mg/Kg is an effective and safe strategy to reduce blood loss and to minimise the rate of blood transfusions in lower limb orthopaedic surgeries without tourniquet under spinal anaesthesia.
ABSTRACT
Background: Central Venous Access (CVA) is acommon requirement in the critically ill patient for avariety of indications including Central VenousPressure (CVP) monitoring, haemodialysis, placementof pulmonary artery catheters, cardiac pacing and foradministration of drugs especially vasoactive,chemotherapy agents and parenteral nutrition.Traditionally, Central Venous Catheter (CVC)placement is performed using Landmark (LM)technique and is associated with complications likearterial puncture, pneumothorax, hemothorax, airembolism, catheter embolism, and cardiac arrhythmias.Use of Ultrasound (US) is currently indicated forvarious clinical situations to reduce complication rate ofLM technique. Aim and Objectives: The purpose of thisstudy was to determine whether US guidance couldimprove the success rate, number of attempts, and rateof acute complications like inadvertent arterialpuncture, hematoma formation, and pneumothorax ofsubclavian venous catheterization. Material andMethods: Sixty patients in need of central venouscatheter were prospectively randomized in two groupsof 30 each. In the LM group patients were catheterizedusing the LM method and in US group patients werecatheterized by real-time US-guidance. Number ofattempts, success rate, access time and complicationslike accidental subclavian artery puncture, haematomaformation, pneumothorax, were recorded. p values<0.05 were considered statistically significant. Results:In the US group 30 (100%) of patients were successfullycannulated with the US guidance while the landmarktechnique was successful in 26 (86.66%) of patients. Inthe US group the success on first attempt was 83.33 %which was a significantly higher from 56.67% achievedin the LM group (p=0.025). The average number ofattempts for successful cannulation in the US group was1.16 ± 0.4, while in the LM group it was 1.56 ± 0.9 withstatistically significant difference (p=0.046). Accesstime was 27.26 ± 04.62 seconds in the US group, whilethe access time was significantly more in the LM group36.56 ± 17.35 seconds (p=0.0062). Conclusion: USguidance during subclavian vein catheterizationincreases overall and first attempt success, improvesaccess time with reduced average number of attemptsand complications.