Efficacy of port-site infiltration with ropivacaine alone versus ropivacaine with fentanyl for postoperative analgesia in patients undergoing laparoscopic procedures

Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.

Seroprevalence of IgG Antibodies for Dengue among Blood Donors

Dengue fever is endemic India and the prevalence of dengue is on the rise owing to various social and economic factors. Prevalence of asymptomatic dengue infection varies widely from less than 1 % to 80 % in India. Transfusion transmissible dengue has been reported in different parts of the word. Prevalence of subclinical dengue among blood donor poses a threat to the blood supply leading to transfusion transmissible dengue. We wanted to estimate the prevalence of IgG antibodies for Dengue in the blood donor population. METHODSSix hundred and eight whole blood donors were included in the study during the period January 2017 to October 2018. Donor registration and education was done as per the national guidelines. Donors who gave a history of previous dengue or symptoms consistent with dengue were excluded from the study. Serum samples from whole blood donors were tested for IgG antibodies using ELISA technology. RESULTSOf the total of 608 donors, 602 were male donors and 55 % of the donors were in the age group 21 - 30 years. Majority (69 %) of the donors were from urban locations. Anti IgG antibodies for dengue were present in 4.14 % of donors of which 38 % of donors were in the age group 31 - 40 years. Three hundred and eighty-four donors revealed history of fever, myalgia and headache in the past one year. No statistical significance was found between fever, myalgia and the presence of IgG anti-dengue antibodies. CONCLUSIONSThe subclinical or asymptomatic prevalence of dengue infection is low when compared to other studies in other parts of the country. Enquiring into donor history for history of dengue or symptoms of dengue and deferring such donors for a recommended period will prevent transfusion transmissible dengue.

Effects of Intramuscular Dexmedetomidine Versus Clonidine on the Duration of Subarachnoid Block and Analgesia for Lower Limb Orthopedic Surgeries

Background: Alpha-2adrenergic agonists, when used simultaneously as systemic adjuvants to local anesthetics show synergisticaction and improve the quality of spinal anesthesia and prolong the post-operative analgesia. We aimed to study the effects ofintramuscular dexmedetomidine versus clonidine on the duration of bupivacaine sub-arachnoid block, post-operative analgesia,and sedation in patients undergoing lower limb orthopedic surgeries.Materials and Methods: The study design was a prospective, randomized, and double-blind study. Eighty adult consentedpatients of ASA I or II, scheduled for orthopedic lower limb surgeries under spinal block were randomized to two groups of40 patients per group. Group D received IM dexmedetomidine 1 μgkg−1, Group C received IM clonidine 2 μgkg−1, and 30 minbefore the bupivacaine subarachnoid block. The time of onset of sensory and motor block, the time required for completesensory and motor recovery, time of the first request of rescue analgesia, and sedation levels were compared between thegroups. Collected data were analyzed using the student “t” test, Chi-square test/Fisher exact test, and P < 0.05 was consideredstatistically significant.Results: The mean onset time of sensory and motor block was reduced, the mean time required for complete sensory recoverywas increased and the time of the first request of rescue analgesia was prolonged in the dexmedetomidine group comparedto clonidine group with a significant P < 0.05. Ramsay sedation score was higher in the dexmedetomidine group compared toclonidine group (P = 0.003)Conclusion: Premedication with a single dose of intramuscular dexmedetomidine before bupivacaine spinal anesthesia actsas an effective adjuvant and potentiates the quality of block and prolongs post-operative analgesia more than intramuscularclonidine.

Effectiveness of Intra-Articular Ropivacaine for Post-Operative Analgesia in Arthroscopic Knee Surgeries.

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.

Comparison of Caudal Anesthesia and Ilioinguinal Block for Pediatric Inguinal Surgeries and Postoperative Analgesia

Background and Objective: Infants and children undergo a variety of groin procedures that can cause a significant degree ofdiscomfort postoperatively. We aim to compare the caudal block and ilioinguinal/iliohypogastric block using the combination ofropivacaine and dexmedetomidine with regard to efficacy, quality, and duration of post-operative analgesia.Methods: This study included two groups and 60 patients of the age group of 3–12 years. After induction of anesthesia, GroupAreceived caudal block using 1 ml/kg 0.2% ropivacaine + dexmedetomidine 0.3 μg/kg up to maximum of 20 ml. Group B receivednerve locator guided ilioinguinal/iliohypogastric block using 0.75 ml/kg 0.2% ropivacaine + dexmedetomidine 0.3 μg/kg up tomaximum of 20 ml. Postoperatively, patients were monitored for up to 24 h for primary objective of measurement of pain score,duration of analgesia, and number of rescue analgesia required. Statistical analysis performed using independent t-test andChi-square test. P < 0.05 was considered statistically significant.Results: The highest pain score in Group A was 5.93 ± 1.53 and in Group B was 4.93 ± 1.64 (P < 0.05). The average durationof analgesia in Group A and Group B was 372 min and 680 min, respectively (P < 0.05). The mean number of rescue analgesiagiven in Group A was 1.47 and in Group B was 0.96 (P < 0.05).Conclusion: Both caudal block and ilioinguinal block are effective measure of post-operative pain relief in pediatric inguinalsurgeries, but ilioinguinal block is better in terms of efficacy, duration of analgesia, lesser dose of local anesthetic required, andlesser need of rescue analgesia required.

Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

Background: Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.Methods: Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.Results: Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.Conclusions: Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects.

Comparative study of epidural fentanyl and epidural fentanyl with magnesium sulphate for post-operative analgesia in patients undergoing lower limb surgeries

Background: Control of post-operative pain is a major concern for the patients and also for the treating physicians. Various analgesic agents such as opioids, nonopioids through various routes such as oral, intravenous, neuraxial, regional for the management of postoperative pain exist. Magnesium has anti-nociceptive properties with additional enhancement of opioid anti-nociception when used epidurally. Materials and methods: The study was a randomized open labelled controlled trail, conducted in the department of anaesthesiology, Govt. Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu. The data collection for the study was done between June 2016 to June 2017. The study population included people who were undergoing lower limb surgery for various disease conditions. The key outcome variables assessed were highest sensory blockade, time taken for highest sensory level (min), duration of surgery (min), time for regression to L1 (min), duration of analgesia (min). Results: Duration of analgesia was longer in the Magnesium sulphate group, with analgesia lasting for 143.4 +39.57 minutes which was statistically significantly higher compared to Epidural Fentanyl group with 107 (±25.82) minutes. The mean time for regression to L1 was 118 minutes and 119 minutes in group F and FM respectively, there is no statistically significant between two study groups (P value>0.05). There was no statistically significant difference between the groups in the time taken J. Radhika, P. Kayalvizhi. Comparative study of epidural fentanyl and epidural fentanyl with magnesium sulphate for postoperative analgesia in patients undergoing lower limb surgeries. IAIM, 2018; 5(2): 12-19. Page 13 for the highest sensory level (P value>0.05), the duration of surgery and the time taken for the highest sensory level (P value>0.05). Conclusion: Magnesium being a relatively harmless and inexpensive molecule, a non-competitive, Nmethyl-D-aspartate receptor antagonist with its anti-nociceptive properties has a huge role to play in the coming years for postoperative analgesia

Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients

Introduction: Caudal block is one of the most popular and commonly used regional anaesthetic procedures in paediatric patients for most surgeries below the umbilicus. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. Aim: The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients. Materials and methods: It was a prospective study, 80 patients randomly selected belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 mg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, pain score and sedation score. Results: The mean duration of analgesia was 10-18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 10 h, Group BF had higher sedation score up to two as compared to that below one on Group BT. P V Praveen Kumar, G Madhavi. Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients. IAIM, 2017; 4(10): 22-29. Page 23 Conclusion: Caudal tramadol compared to caudal fentanyl significantly prolongs the duration of analgesia without any side effects.

A clinical comparison between bupivacaine midazolam combination and bupivacaine plain in brachial plexus block by supraclavicular approach

Background: The study is to describe the efficacy of Midazolam when used with Bupivacaine as local anesthetic in Supraclavicular brachial plexus block. The focus will be on the onset and analgesic duration of nerve blocks along with any neurotoxic concerns or neuroprotective potential. Materials and methods: A prospective, randomised single blinded study was undertaken in 100 patients posted for upper limb surgeries under supraclavicular brachial plexus block and were assigned into 2 groups, each containing 50 patients.  Control group – Group B: received 30ml Bupivacaine 0.375%  Study group – Group BM: received 30ml of mixture of Bupivacaine 0.375% and Midazolam 0.05mg/kg. Results: The onset of sensory and motor block was significantly faster in group BM compare to Group B (p<0.05). Rescue analgesic requirements were significantly less in group BM compared to group B (P<0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period. Conclusion: Midazolam 0.05mg/kg when addded to 30ml of Bupivacaine 0.375% for supraclavicular brachial plexus block speeds the onset of sensory and motor blocks (P<0.05). The combination produces improved analgesia, resulting in a prolonged effect and reduced requirements for rescue analgesics.

Effect of three different routes of administration of analgesia on gastrointestinal function in parturient undergoing cesarean section / 临床麻醉学杂志

Objective To investigate the effect of three different routes of administration of analgesic on gastrointestinal function in delivery women with cesarean section.Methods From June 2016 to January 2017,90 delivery women cesarean section were treated in our hospital aged 23-35 years with body mass index (BMI) 25-35 kg/m2,ASA physical status Ⅰ or Ⅱ.Parturients were randomly divided into three groups:intravenous analgesia pump group (group J),skin implanted analgesia pump group (P group) and epidural analgesia pump group (group Y).Group J received postoperative intravenous infusion of sufentanil 5 μg and analgesia pump (3 μg/kg sufentanil+ 100 ml saline)connected with venous channels;group P received postoperative Bipi injection of sufentanil 5 μg introcarplaced in the subcutaneous and connected with analgesia pump (3 μg/kg sufentanil+ 100 ml saline);group Y was given epidural injection of 1％ ropivacaine and 0.5％ lidocaine mixture 4 ml,the analgesia pump (0.15％ ropivacaine+50 μg sufentanil+100 ml saline) was connected with epidural catheter.The recovery time of bowel sounds,the time of firstly anal exhaust,48 hours after surgery,the incidence of nausea,vomiting and bloating were recorded.Results The recovery time of bowel sounds [(14.6±2.3) h] and the time of firstly exhaust time [(20.5±7.9) h] in group Y was significantly earlier than in group J [(18.3±3.6) h and (28.7±8.2) h] and group P [(18.8±4.1) h and (27.9±9.3) h] (P＜0.05).The incidence of nausea (17％),and abdominal distention (20.0％) was significantly lower in group Y than in group J (36.7％ and 47.0％) and group P (33.3％ and 43.0％) (P＜0.05).Conclusion Postoperative analgesia pump of epidural pathway is beneficial to restore the gastrointestinal function on the basis of postoperative analgesia.

Comparative Analysis of Unilateral Subarachnoid block with Ankle block for elective foot surgery.

Background: There are many accepted anesthesia techniques for elective foot surgery ranging from general anesthesia to regional anesthesia, regional anesthesia being the preferred method. Regional anesthesia techniques employed for foot surgery includes subarachnoid block, epidural anesthesia and ankle block. Objective: The present study is aimed at providing comparative analysis of ankle block with unilateral subarachnoid block for elective foot surgeries in terms of hemodynamic safety profile and post operative analgesia. Material and Methods: Study includes prospective analysis of 80 ASA II and III patients who underwent elective foot surgery. Patients were randomly divided into two groups of 40 each, Ankle block group (AB) and Unilateral subarachnoid group (US). The parameters recorded for study includes systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale for pain severity, time of first analgesic need and the complications. Results: There were minimal blood pressure changes and heart rate variability in AB group as compared to US group when compared with basal values (p<0.05). The time for first analgesic requirement is prolonged in AB group as compared to US group. The visual analogue scale score was assessed at 2nd ,4th and 6th hours for group AB were lowered as compared to group US (p <0.05).

Comparison of Post-operative Analgesia after Single Shot Caudal Epidural Block Using Bupivacaine with or without Clonidine in Children.

Background: Caudal analgesia with bupivacaine and several adjuvants is a very popular in pediatric anesthesia for providing intra- and post-operative analgesia. Methods: This randomized comparative prospective study of total 60 patients of either sex, of ASA Grade I or Grade II, aged between 01 and 12 years, undergoing elective lower abdominal or perineal surgeries were enrolled after written and informed consent. 60 patients undergoing general anesthesia with laryngoscopy and endotracheal intubation followed by caudal anesthesia for post-operative pain relief were randomly allocated into two groups of 30 patients each, Group B received caudal analgesia with 0.25% plain bupivacaine 0.75 ml/kg and Group C received caudal analgesia with 0.25% bupivacaine 0.75 ml/kg with clonidine 1.5 μg/kg after induction of anesthesia but before starting surgery. Intraoperatively heart rate (HR), systolic blood pressure (SBP), and diastolic BP (DBP) were monitored while in post-operative period we monitored following-objective pain score, sedation score, HR, SBP and DBP and any side effects like post-operative nausea and vomiting, respiratory depression in both the groups. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (2 independent sample t-tests). Sedation score was analyzed by using Mann–Whitney test. Results: The objective pain score was significantly lower, and sedation score was significantly higher in bupivacaine with clonidine group. The HR, SBP, and DBP were significantly on the lower side with bupivacaine with clonidine group when compared to plain bupivacaine group, but bradycardia was not statistically significant. Hemodynamic stability and post-operative pain-free period in bupivacaine with clonidine group was more than plain bupivacaine group which was beneficial in surgeries like hypospadias repair. Conclusion: Single shot caudal epidural with the addition of clonidine to bupivacaine is efficient in prolonging the duration of analgesia of plain bupivacaine with minimal or no side effect.

Ketamine and levobupivacaine versus levobupivacaine alone for post operative analgesia and side effects in lower abdominal surgeries in children A comparative study

Background: Different additive drugs such as opioids, epinephrine, clonidine, and neostigmine have been used along with local anaesthetics to improve the duration and quality of analgesia. Few studies have demonstrated the increase of efficacy in various aspects after combining dexmedetomidine and ropivacaine and dexmedetomidine to caudal bupivacaine in pediatric major abdominal cancer surgeries. Objectives: The present study was designed to compare the duration of postoperative analgesia and the incidence of any side effects of single-dose caudal levobupivacaine with ketamine versus levobupivacaine alone in childrens undergoing lower abdominal surgeries. Materials and methods: A total of 50 pediatric patients, 2–4 years of age, were included in the study. They were divided into two groups: group A (n = 25) received levobupivacaine, whereas group B (n = 25) received ketamine with levobupivacaine. Postoperative duration of analgesia and postoperative complications were recorded in all the childrens. Mohan K, Mohana Rupa L. Ketamine and levobupivacaine versus levobupivacaine alone for post operative analgesia and side effects in lower abdominal surgeries in children – A comparative study. IAIM, 2016; 3(10): 70-73. Page 71 Results: The duration of postoperative analgesia was longer in group B than in group A, which was statistically significant. Few postoperative complications were recorded in group B. Conclusion: Combination of ketamine with levobupivacaine by caudal epidural administration produced an additive analgesic effect with few side effects when compare to levobupivacaine alone.

Post-operative analgesic efficacy of fentanyl via different routes A comparative study of nebulisation, intranasal and intravenous routes

Background: Pain is main post operative adverse outcomes causing patient distress, prolonging hospital stay, and increasing the incidence of admissions after surgery. Study was done to assess and compare the post-operative analgesic effects of fentanyl via nebulisation, intranasal and intravenous routes to provide better analgesia, anxiolysis and sedation to the patient. Materials and methods: After approval from ethical committee of SPMC, Bikaner and written informed valid consent from patients, sixty patients of either sex belonging to ASA class I and II, were randomised into three group (Group I - Nebulised Fentanyl, Group II - Intranasal Fentanyl, Group III - Intravenous Fentanyl). With all aseptic precaution, subarachnoid block was instilated via 23/25 gauze spinal needle by injecting sufficient dose of bupivacaine heavy 5% to achieve an adequate sensory and motor block for the proposed surgery. When patient complained pain 1st time, fentanyl was given via nebulisation in group I, intranasal in group II, and intravenous in group III with dose 4 mcg/kg, 1.5 mcg/kg, 2 mcg/kg respectively. Patients were assessed for pain by VAS score. For statistical data, SPSS 10.0 software was used. Results: In present study, Ramsay sedation score, patient satisfaction score and duration of analgesia was better in group II as compared to group I and III. Group III had lesser time of onset of analgesia in comparison to group II and I respectively. Singh R, Pareek A, Kumari M, Khilji MY, Sirohiya P. Post-operative analgesic efficacy of fentanyl via different routes – A comparative study of nebulisation, intranasal and intravenous routes. IAIM, 2016; 3(6): 16-22. Page 17 Conclusion: On the basis of analgesic efficacy, we concluded that intranasal group was better than nebulisation and intravenous route.

Efficacy and safety of intravenous acetaminophen versus intravenous butorphanol as post-operative analgesic in obstetrics and gynecology: a comparative study.

The purpose of this study is to provide effective pain management by administration of an analgesic that gives the patients maximum satisfaction. The goal was to evaluate and compare the analgesics efficacy of acetaminophen with butorphanol; to determine if there is an overall decrease in opioid consumption and opioid-related adverse effects; and detect any adverse effects of acetaminophen as post-operative analgesics. Methods: In this randomized parallel-group controlled trial, post-operative patients were given either 1 g intravenous (IV) acetaminophen or 2 g IV butorphanol as post-operative analgesics. The post‑operative pain was evaluated by pain intensity scales and was measured at rest and during a deep breath over 24 h. If the reading in the pain intensity scale was above 5 then rescue medicine injection. Tramadol 100 mg IV SOS was given in both the groups. Any adverse effects reported by the patients were recorded. Results: The butorphanol group achieved slightly better pain ratings in the first 2 h and acetaminophen group after 6 h post-operatively. The overall visual analogue scale score across time was significantly lower for acetaminophen group than the butorphanol group (p = 0.02). The secondary outcome measure, rescue analgesic consumption (injection tramadol) was comparable between the two groups. Side-effects were less in acetaminophen than butorphanol, predominantly headache and sedation which was seen in butorphanol but was absent in acetaminophen. Conclusion: IV acetaminophen is an effective analgesic in obstetric and gynaecological surgeries with a good safety profile. When used in combination with opioids, they reduce opioid consumption, and this reduction is sufficient to reduce opioid-induced adverse effects.

Comparision of Caudal Ropivacaine, Ropivacaine Plus Ketamine and Ropivacaine Plus Fentanyl Administration for Postoperative Analgesia in Children.

Introduction: The purpose of the study was to compare the analgesic quality and duration of Ropivacaine 0.2% with the addition of Fentanyl (1 mcg/kg) with that of Ropivacaine 0.2% and the addition of Ketamine (0.5 mg/kg) and also compare the post complications. Materials and Methods: Ninety children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of three groups: caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine in normal saline (Group R) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Ketamine 0.5 mg/kg (Group RK) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Fentanyl 1 mcg/kg (Group RF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results: The mean duration of analgesia was significantly longer in Group RK (629.06 ± 286.32 min) than other two groups P < 0.05. The pain score assessed using FLACC scale was compared between the three groups, and children in Group RK had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group RK. Ketamine in a dose of 0.5 mg/kg added to 0.2% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of Ropivacaine, without any side effects in compare to Ropivacaine alone or Fentanyl. Conclusion: We conclude that Ketamine in a dose of 0.5 mg/kg, added to 0.2% Ropivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia without any side effects.

Simple Modification of Caudal Epidural Anesthesia Technique in Pre-school Children for Improved Success rate, Safety and Quality of Block.

Caudal Epidural Anesthesia (CEA) or Kiddy caudal is a safe and effective method of anesthesia in paediatric patients. Incidence of failed or incomplete block of CEA could be reduced by simple modification of technique with early onset of analgesia, adequate surgical relaxation, rapid and smooth recovery from anesthesia and freedom from post-operative pain. Identification of epidural space using small volume of air and using mixture of lidocaine with epinephrine and bupivacaine for block provides excellent operating conditions with improved success rate avoiding supplementary general anesthetic requirement. Our experience in 120 pre-school children for infraumbilical surgery is described.

Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia

Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.