Comparison of effectiveness of thoracic epidural and paravertebral block for post thoracotomy pain relief

To compare the effects of thoracic epidural and thoracic paravertebral block in post thoracotomy pain relief and early ambulation. Randomized control trial [RCT]. Combined Military Hospital Rawalpindi a tertiary care health facility, from Jan 2007 to Dec 2007. Thoracic epidural block was given in group-A while thoracic paravertebral block was given in group-B patients post operatively. Pain scores were assessed at 30 min intervals after the dose of 0.25% Bupivacaine using visual analogue scale [VAS]. There was no significant difference for pain scores in first 24 hours after surgery between paravertebral block [PVB] and thoracic epidural group measured at 30 min interval. But complication like hypotension occurred less with PVB. Paravertebral block is a safe and effective technique and can to be used more widely for unilateral post thoracotomy pain relief

Tracheal intubation; direct laryngoscopic oral intubation vs fiberoptic bronchoscopic nasal intubation haemodynamic response

Haemodynamic response to direct laryngoscopy and tracheal intubation has always been concern especially in cardiac patients. The use of fiberoptic bronchoscope for endotracheal tube placement may reduce the haemodynamic changes associated with intubation. To compare haemodynamic changes [pulse and mean arterial pressure] following tracheal intubation, using direct laryngoscopic technique with fiberoptic bronchoscopic technique. Randomized Controlled Trial [RCT]. Department of Anaesthesiology, Intensive Care and Pain management Military hospital Rawalpindi. The study was of six months duration starting from April 2008 to October 2008. ASA-I and II patients [n=160] undergoing surgery meeting the inclusion and exclusion criteria.Informed consent was taken from all the patients undergoing the study. Patients were divided in two groups. Patients assigned to Group A got endotracheal intubation through direct laryngoscopic technique and Group B through fiberoptic bronchoscopic technique after induction of general anaesthesia. Pulse and Mean arterial pressure were recorded before induction of anaesthesia and three minutes after the intubation. One hundred and sixty patients were studied. Eighty patients intubated through direct laryngoscopy [Group A] and eighty patients intubated through fiberoptic bronchoscope and it was observed that fiberoptic bronchoscopic intubation is haemodynamically safer as compared to conventional laryngoscopic intubation. The study concluded that bronchoscopic intubation provides better haemodynamic stability than direct laryngoscopic intubation