ABSTRACT
Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate [RL] or tetrastarch hydroxyethyl starch [HES] or succinylated gelatin [SG] in the patients undergoing cesarean section under spinal anesthesia. It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL [n = 32 each] and received 10 ml/kg HES 130/0.4; 10 ml/kg SG [4% modified fluid gelatin] and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure [BP], oxygen saturation was measured. The fall in systolic blood pressure [SBP] [<100 mm Hg] noted among 5 [15.63%], 12 [37.5%] and 14 [43.75%] parturients in groups HES, SG, RL respectively. Vasopressor [phenylephrine] was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor
ABSTRACT
Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anesthetic drugs and routes of administration. The aim of the present study was carried out to compare the efficacy of ropivacaine and levobupivacaine when administered through intra-articular route in controlling pain after day care arthroscopic knee surgery. It was a prospective, double-blinded and randomized controlled study. April 2008-December 2008, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing day care arthroscopic knee surgery were randomly assigned into two groups [R, L]. Group R received 10 ml of 0.75% ropivacaine, whereas group L received 10 ml of 0.50% levobupivacaine through intra-articular route at the end of the procedure. Pain assessed using visual analog scale [VAS] and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were calculated. Based on comparable demographic profiles; time for the requirement of first post-operative rescue analgesia [242.16 +/- 23.86 vs. 366.62 +/- 24.42] min and total mean rescue analgesic requirement was [104.35 +/- 18.96 vs. 76.82 +/- 14.28] mg in group R and L respectively. Group R had higher mean VAS score throughout the study period. No side effects found among the groups. These two results were clinically and statistically significant [P < 0.05]. Hence, it was evident that intra-articular levobupivacaine give better post-operative pain relief, with an increase in time of first analgesic request and decreased need of total post-operative analgesia compared with ropivacaine
ABSTRACT
Postoperative pain is very common distressing symptom after any surgical procedure. Different drugs in different routes have been used for controlling post-arthroscopic pain. No one proved to be ideal. We have compared the analgesic effect of ropivacaine, fentanyl, and dexmedetomidine when administered through the intra-articular route in arthroscopic knee surgery. From March 2008 to July 2010, 99 patients undergoing arthroscopic knee surgery were randomly assigned into three groups [A,B,C] in a prospective double-blinded fashion. Group A received 10 ml of 0.75% ropivacaine, where Group B received 50 microg fentanyl, and Group C received 100 microg of dexmedetomidine through the intra-articular route at the end of procedure. Pain assessed using visual analog scale and diclofenac sodium given as rescue analgesia when VAS >4. Time of first analgesia request and total rescue analgesic used in 24 hours were calculated. Demographic profiles are quite comparable among the groups. Time for requirement of first postoperative rescue analgesia in Group A was 380.61 +/- 22.973 min, in Group B was 326.82 +/- 17.131 min and in Group C was 244.09 +/- 20.096 minutes. Total rescue analgesia requirement was less in Group A [1.394 +/- 0.496] compared to Group B [1.758 +/- 0.435] and Group C [2.546 +/- 0.546]. Group A had higher mean VAS score at 6th and 24th postoperative hours. No side effects found among the groups. Therefore, it suggests that intra-articular ropivacaine gives better postoperative pain relief, with increased time of first analgesic request and decreased need of total postoperative analgesia compared to fentanyl and dexmedetomidine.