RESUMEN
Background: Lower limb surgeries are often performed under spinal anesthesia. The conventional anesthetic method for lower limb surgeries is caudal epidural block. The currently available local anesthetic for this purpose is Bupivacaine which has long duration of action of around 6-12 hour. Methods: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II requiring elective lower limb surgery under epidural anesthesia were selected for this prospective, randomized, double-blind study. Results: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II, requiring elective gynecological surgery under epidural anesthesia were selected for this study. Cases were randomly allocated into two groups containing 20 cases each. Cases in Group B received Bupivacaine 0.25% and those in Group T received Tramadol 100mg. Conclusion: Current study concluded that both intrathecally administered levobupivacaine and racemic bupivacaine are safe and effective local anaesthetics for lower limb surgeries. Overall parameters observed in this study showed no significant difference between the two forms of the same drug. However, intrathecal levobupivacaine produces less toxicity.
RESUMEN
Background: Brachial plexus piece has reformed the field of regional anaesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without significant difficulties. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Materials & Methods: This Prospective study was done at the Department of Anaesthesiology, Govt. Medical College, Azamgarh. Around 24 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/hand divided into two groups A (n-12) and B (n-12) randomly. Group A - adenosine 6mgs with 28 ml 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 6mgs of adenosine (2ml) at a rate of 5ml/hr. Group B - magnesium sulphate 75 mgs (in 2ml) with 28ml of 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 75mgs of magnesium sulphate (in 2ml) at a rate of 5ml/hr in USG guided placement of infraclavicular catheter. Results: Our Study revealed that Group A had a faster Onset time of sensory and motor block and faster recovery when compared to group B. Group A needed more rescue analgesia than group B. Conclusion: The addition of magnesium sulphate as an additive to bupivacaine in brachial plexus block may be a better choice when prolonged postoperative analgesia is required.
RESUMEN
Background: Psychiatric disorders are highly prevalent and also the leading causes of disability worldwide. Because of multiple factors playing as barriers in help seeking many people who might benefit from the treatment do not obtain it. Data regarding common mental disorders is even more lacking. Methods: Present study was undertaken to assess various treatment barriers affecting help seeking behavior in 156 patients of “neurotic, stress related and somatoform disorders” who were assessed on various tools. The study sample was divided in Aware and Unaware group on the basis of their awareness about psychiatric disorder at the time of onset/initial stages of illness. Results: Inability to recognize patient’s behavioral problem by family members and lack of treatment facility/ resource were important barrier to care. Prevalent nonscientific etiological belief (e.g. supernatural phenomenon, a form of worry or tension) in society also delayed treatment seeking. The observations of present study have helped in revealing the barriers in treatment seeking for patients of neurotic and stress related disorders. Raising awareness about these disorders in community and making psychiatric easily accessible to general population will be helpful in overcoming these barriers.