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
The Transverses Abdominis Plane (TAP) block is a relatively new regional technique which is often used for sensory blockade of the lower abdominal wall mainly for post-operative pain relief. It causes sensory blockade mainly because of injection of local anaesthetic between the internal oblique and the transverse abdominis muscle. TAP block was performed using a blind landmark technique in the lumbar petit triangle. Nowadays USG guided TAP block is being performed in many centers. TAP block is known to improve postoperative pain, reduce the opioid demand, and also reduce the time to rescue analgesia in patients undergoing lower abdominal surgeries. In our study, we have used TAP block as a main anaesthetic technique in patients posted for unilateral inguinal hernia repair under elective conditions. TAP Block in this study was given with 0.5 % bupivacaine. Duration of anaesthesia / analgesia, effectiveness of block, period of block, cardiac stability and haemodynamic stability were studied. METHODSA prospective observational study was conducted on 30 randomly selected individuals posted for elective inguinal hernia repair who belonged to American Society of Anaesthesiologists classification 1 and 2; age group between 20 and 70 years; satisfying all inclusion and exclusion criteria. All the patients received 0.5 % bupivacaine for TAP block, dose not more than 2.5 mg / Kg body weight. RESULTSWe have found that TAP block gives good anaesthesia for patients posted for inguinal hernia repair with good haemodynamic stability. With inj. Bupivacaine 0.5 % having an onset of anaesthesia at about 7.45 + / - 2.32 minutes (p value < 0.001). The block was complete and effectively elevated nociceptive stimuli. The block lasted till the end of surgery in all cases, with no complications. CONCLUSIONSTAP block other than being the main anaesthetic technique for lower abdominal surgery, also provides good post-operative analgesia with minimal post-operative analgesic requirement with less haemodynamic variations.
ABSTRACT
Supraglottic airway devices (SAD) are used for airway management in patients undergoing general anaesthesia, averting the need of tracheal intubation. Laryngeal mask airway is easy to insert and can be inserted by paramedics also in case of emergency. Here we primarily compared the efficacy of Baska Mask and LMA supreme in terms of ease of insertion. The secondary outcome was assessment of oropharyngeal seal pressure and post op laryngopharyngeal complications. MethodsA sample size of 30 was calculated in each group. Patients were divided into 2 groups, Group B and Group S. After giving premedication, Anaesthesia was induced with propofol 3 mg/Kg and anaesthetic depth will be deepened with 2% sevoflurane in oxygen using bag mask ventilation. An appropriately sized prior lubricated Baska mask and LMA supreme was inserted in Group B and Group S, respectively and ease of insertion was assessed. ResultsThe BM was successfully inserted in 23 patients (76.6%) in the first attempt and LMA supreme was successfully inserted in 29 patients (96.6%) in the first attempt. The difference was found to be statistically significant (P= 0.028). BM created a significantly higher oropharyngeal seal pressure than the LMA supreme group (P < 0.001). No significant difference in postoperative laryngopharyngeal complications was observed. ConclusionsFrom the present study, it is concluded that LMA supreme is easier to insert than BM. The BM creates higher oropharyngeal seal pressure and thus provides a better airway seal than the LMA supreme. The incidence of postoperative laryngopharyngeal complications is similar in both the groups.
ABSTRACT
Thrombophlebitis can be very commonly associated with peripheral venous cannulation. Many a times, thrombophlebitis may go undiagnosed. With serious complications and uncertainty of the treatment, it is always better to prevent its development. Prophylactic topical heparin application can significantly reduce the incidence of thrombophlebitis and also the complications related like deep venous thrombosis and pulmonary embolism which increase the hospital stay. Thus, this study was conducted to evaluate the efficacy of topical heparin in prevention of development of superficial thrombophlebitis.METHODS150 patients in the age group of 20 - 60 years, were randomly allocated to group H (Heparin), group C (Control), with 75 patients in each group. Group C received placebo (normal saline) and group H received topical heparin QPS before the insertion of the cannula on the dorsum of the upper limb and were observed at an interval of 8 hours until 72 hours using Visual Infusion Phlebitis Scale.RESULTSAt the end of 72 hours, score of 0, I, II, and III was observed in 5.33%, 44.00%, 29.33% and 21.33% patients, respectively, in Group C; whereas score of 0, I, and II was observed in 60%, 25.33%, and 14.67% patients, respectively in Group H (P = 0.0001). In Group C, score up to III was observed, whereas maximum score was II in Group H and that too at 72 h in only 14.67% of patients which proves the efficacy of topical QPS of heparin [Table 2].CONCLUSIONSProphylactic topical application of QPS heparin was effective in preventing development of superficial thrombophlebitis.