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Introduction: Pain was defined by Mountcastle in the year1968 as “that sensory experience evoked by stimuli thatinjures”. It is a subjective feeling and failure to relieve pain inany procedure cannot be accepted, both ethically and morally,and adequate pain relief must be treated as basic human right.Pain relief both in peri-operative and post-operative period isthe crux of anaesthesia. The aim of the study was to evaluatethe efficacy of epidural Dexmedetomidine and Clonidine as anadjuvant to Bupivacaine in patients undergoing infraumbilicalsurgeries.Material and Methods: Seventy (70) patients aged 20-60years (ASA I-II) undergoing infraumbilical surgery wererandomly allocated to two groups- Group BD receivingepidurally 15ml Bupivacaine (0.5%) + Dexmedetomidine(1mg/kg) and Group BC receiving 15ml Bupivacaine (0.5%)+ Clonidine (1mg/kg). After securing I/V line, infusionstarted with R/L and under strict aseptic condition, patientswere administered epidural block via 18G Tuohy needlein the sitting or lateral position at L3-L4 intervertebralspace.Results: We observed that the time taken for the onset ofsensory block at T10 level, time for sensory block upto T6 andthe time taken for maximum motor block is less in Group BDcompared to Group BC. Regarding the post-operative block,the time to sensory two segment regression, time to sensoryregression to S1, time for recovery of motor block and timeto first rescue analgesia were more in Group BD compared toGroup BC. And the difference between the two groups weresignificant (p<0.001).Conclusion: On the basis of the findings of our present clinicalstudy, we can come to conclusion that Dexmedetomidine ismore effective epidural adjuvant compared to Clonidine inpatients undergoing infraumbilical surgery.
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Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects.
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The goal of present study is to compare intraoperative and postoperative hemodynamic and sensory/ motor effects of low dose intrathecal butorphanol with bupivacaine versus high dose intrathecal butorphanol with bupivacaine in patients undergoing elective lower limb surgeries. Methods: This randomized, double blind comparative study was conducted in 60 patients belonging to ASA grade I or II, aged 20-60 years admitted for lower limb surgeries under spinal anesthesia. The patients were randomly divided into 2 groups. (A and B, n=30 for each group). Group A received combination of 0.5% hyperbaric bupivacaine (2.5 ml) with low dose butorphanol (25 microgram in 0.5 ml) intrathecally and group B received combination of 0.5% hyperbaric bupivacaine (2.5 ml) and high dose butorphanol (50 microgram in 0.5 ml) intrathecally. Preoperative and intraoperative vitals; side effects; intensity of motor blockade, time of onset of sensory and motor blockade; time taken for peak sensory and motor blockade; time for two segment sensory regression and time for rescue analgesia were compared in both group. Results: Time taken for peak sensory block was significantly lesser in group B and time for two-segment regression of sensory level and time to rescue analgesia were also significantly higher in group B, in which high dose intrathecal butorphanol-bupivacaine mixture was used. There was no difference in time taken to onset of sensory block, time taken to onset of motor block, time taken for peak motor block and in the intensity of motor blockade in using high dose intrathecal butorphanol-bupivacaine mixture as compared to low dose intrathecal butorphanolbupivacaine mixture. Conclusion: We concluded that high dose intrathecal butorphanol (50 μgm) with bupivacaine is well tolerated and potentiates the sensory block better than low dose intrathecal butorphanol (25 μgm) with bupivacaine with out any major side effects. It did not increase postoperative motor block recovery time and has delayed the postoperative analgesic requirement.
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Background: Bilateral Superficial cervical plexus block (BSCPB) is one method of post op analgesia given before General anesthesia as this avoids polypharmacy. Objectives: This prospective randomized, controlled clinical study compared the post-operative analgesic efficacy of BSCPB using Ropivacaine (0.5%) with or without Clonidine (2mcg/kg).It also evaluated the intra operative opioid dosage and hemodynamic responses in patients undergoing thyroid surgeries. Methods: 60 Patients undergoing thyroidectomy were randomized into 3 groups,(Group A) BSCPB using normal saline ,(group B)Ropivacaine (0.5%) , (group C) Ropivacaine (0.5%) with Clonidine (2mcg/kg) before GA. Intra and post-operative hemodynamic responses, fentanyl dosage and the time of rescue analgesia were assessed. Post op pain scores using VAS, nausea, vomiting and sedation were assessed for 24 hours.Results: The mean duration of analgesia is highly significant (p<0.001) in group C. Intra operative fentanyl requirement was significantly lesser in groups B and C (P<0.001). Intra operative hemodynamic changes were significant in Group B and C. Post operative pain scores were significantly lower in groups B and C for the first 24 hours (P<0.001).The time of rescue analgesia in group A was early when compared to group B and C (P<0.001) and in group B when compared to group C .Post operative nausea, vomiting were lower in group B and C. Conclusion: BSCPB performed prior to GA using 0.5% Ropivacaine with or without clonidine was effective in reducing intra and post-operative analgesic requirements. The addition of Clonidine 2mcg/kg had highest analgesic efficacy when compared to Ropivacaine alone.
ABSTRACT
Avaliou-se a confiabilidade e determinou-se a pontuação mínima relacionada à necessidade de intervenção analgésica de uma escala multidimensional para avaliação de dor pós-operatória em gatas submetidas à ovário-histerectomia. Trinta gatas foram filmadas em quatro momentos predeterminados: pré-operatório, pós-operatório antes e depois da analgesia de resgate e às 24 horas após a cirurgia. Quatro observadores, não cientes dos momentos de avaliação, e um observador, considerado padrão-ouro - pesquisador que desenvolveu a escala - , avaliaram os vídeos em ordem aleatória, a partir da aplicação da escala, e determinaram a suficiência ou não de analgesia, baseando-se na experiência clínica. Os vídeos foram reavaliados dois meses após a primeira análise. O grau de concordância entre as avaliações dos diferentes observadores e das avaliações feitas pelo mesmo observador em diferentes ocasiões foi verificado pelo coeficiente de correlação intraclasse, que variou entre bom e muito bom para todos os itens da escala, exceto atividade, atitude e miscelânea de comportamentos que apresentaram confiabilidade moderada. O ponto de corte ótimo (> 7) foi selecionado pela análise descritiva e da curva Receiver Operating Characteristic. Os resultados suportam a confiabilidade em termos de reprodutibilidade e estabilidade e indicam que a terapia analgésica deve ser considerada em pontuações >8.
The aim with this study was to evaluate the reliability, and to establish the minimum score relating to the analgesic intervention of a multidimensional scale for use in assessing postoperative pain in cats undergoing ovariohysterectomy. Thirty cats were video recorded at 4 predetermined moments: prior to surgery, before and after rescue analgesia postoperatively, and 24 hours after surgery. Four observers blind to the times of assessment, and a gold standard observer (researcher who developed the scale) evaluated the video segments in random order using the scale, and determined the adequacy or not of analgesia based on clinical experience. The videos were reassessed two months after the first analysis. The agreement between the assessment of different observers, and the assessment made by the same observer on different occasions has been verified by the intra-class correlation coefficient that ranged from good to very good for all scale items, except activity, attitude and miscellaneous behaviors, which showed moderate reliability. The optimal cutoff point (> 7) was selected based on descriptive analysis and Receiver Operating Characteristic curve. The findings support the reliability in terms of reproducibility and stability, and indicate that analgesic therapy should be considered in scores >8.