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Background: The changing trend from an inpatient to outpatient has urged us to use short-acting local anesthetic with adjuvantssuch as opioids to intensify sensory block without affecting sympathetic blockade in spinal anesthesia. This study was designedto compare the safety and efficacy of 25 µg fentanyl as an adjuvant to either 10 mg levobupivacaine or 40 mg chloroprocaineintrathecally.Materials and Methods: In this prospective, randomized, clinical trial, 60 patients of 18–60 years were randomly divided into twogroups of 30 each, to receive either 4 ml of 1% chloroprocaine (40 mg) plus 25 µg fentanyl (Group C) or 2 ml of 0.5% isobariclevobupivacaine (10 mg) plus 25 µg fentanyl (Group L) intrathecally. Patients were monitored for 24 h for sensory and motor blockcharacteristics as a primary outcome and post-operative analgesia, hemodynamics, and side effects as a secondary outcome.Results: Onset of sensory block and time to maximum sensory block were rapid in Group C (2.53 ± 1.20 min and 4.40 ± 1.45 min)as compared to Group L (4.43 ± 1.12 min and 8.10 ± 0.83 min) (P < 0.001). The maximum sensory block was T4 in Group C and T6in Group L. Maximum Bromage score was 2 in both groups but achieved earlier in Group C as compared to Group L (P < 0.001).Duration of sensory and motor block was significantly prolonged in Group L (264.47 ± 29.97 min and 173.80 ± 31.47 min)as compared to Group C (101.50 ± 10.30 min and 75.93 ± 10.41 min). The total duration of analgesia was also prolonged inGroup L (259.83 ± 29.60 min) as compared to Group C (96.50 ± 9.84 min). Patients remained hemodynamically stable and nosignificant side effects and complications were noted.Conclusion: Chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with theadvantages of faster block resolution.
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Background: Instillation of intraperitoneal lignocaine, bupivacaine, levobupivacaine, and ropivacaine has been used followinglaparoscopic gynecological and general surgical procedures to reduce post-operative pain through randomized trials formany years. Hence, the present study was undertaken for assessing and comparing the efficacy of intraperitoneal instillationof levobupivacaine (0.25%) and ropivacaine (0.25%) for post-operative analgesia in patients undergoing laparoscopiccholecystectomy (LC).Materials and Methods: Ninety patients were enrolled and were randomly divided into three groups of 30 each. Group L:Patients were given 20 ml of 0.5% levobupivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume40 ml by adding normal saline (NS), intraperitoneally after gallbladder removal. Group R: Patients were given 20 ml of 0.5%ropivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume 40ml by adding NS, intraperitoneallyafter gallbladder removal. Group C: Patients were given 40 ml of NS. Postoperatively, the patients were assessed for painutilizing visual analog scale (VAS). The results were statistically analyzed using latest software.Results: The mean VAS score reading was lower in Group L and Group R in comparison to Group C at all the time intervals. Thenumber of patients requiring rescue analgesia was significantly higher in Group C in comparison to other study groups. Amongthe L group and R group, the number of patients requiring rescue analgesia was lower in Group L in comparison to Group R.Conclusion: Intraperitoneal instillation of local anesthetic solution in LC provided effective post-operative analgesia, butanalgesia provided by levobupivacaine plus dexmedetomidine was significantly better than ropivacaine plus dexmedetomidine
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Background: Several methods have been used to blunt the cardiovascular response associated with laryngoscopyand tracheal intubation in susceptible patients to prevent myocardial ischemia and cerebrovascular events. For almost75 years measures are taken to prevent such responses with more focus on pharmacological methods as compared tonon-pharmacological methods. Our study has focused on non-pharmacological methods in the form of using different kindof laryngoscopes in the American Society of Anesthesiologists (ASA) Group I and II patients to compare hemodynamicresponses and electrocardiographic changes in three groups, namely, Macintosh, McCoy, and Video laryngoscope (primaryaim) and also to assess the intubation time, number of attempts and complications (bleeding, laceration, dental injury, andsore throat) if any (secondary aim).Materials and Methods: This study was conducted on 90 patients of the ASA Grade I and II posted for elective opencholecystectomy surgeries under general anesthesia. Patients were allotted into three groups: Group A (Macintosh), GroupB (McCoy), and Group C (Video) and they were intubated with their respective laryngoscopes and hemodynamic parametersat 0, 1, 3, 5, 7, and 10 min after laryngoscopy were recorded along with time of intubation and any complications associatedwith the procedure.Results: The time of intubation was shortest with Group C (Video) when compared with Group A (Macintosh) and Group B(McCoy). Hemodynamic changes of patients were lowest in Group C (Video) than Group B (McCoy) and highest with Group A(Macintosh). Furthermore, number of attempts at intubation was higher with Macintosh and McCoy as compared to with Videolaryngoscope group. Likewise, more complications such as dental injury and injury to oral mucosa were seen with Macintoshlaryngoscope than McCoy and least with Video laryngoscope. The results were compiled and analyzed using software IBMSPSS 26 to draw relevant conclusions.Conclusion: Thus, we can see that with the use of Video laryngoscope, lesser alterations in hemodynamics are produced whichcan reduce the incidences of myocardial ischemia and cerebrovascular accidents in susceptible patients. Furthermore, lessertime taken by Video laryngoscope in intubation again reduces the stress response to laryngoscopy in susceptible patients.Laryngoscopy by Video laryngoscope is comparatively easy when compared with Macintosh and McCoy laryngoscopes asnumber of attempts and complication rate was lesser with Video laryngoscope.
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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.
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Background: Subarachnoid block (SAB) is a widely used regional anesthetic technique for infraumbilical surgeries.Aims: The study was conducted to compare intrathecal nalbuphine with different doses of bupivacaine in infraumbilical surgerieswith respect to hemodynamic changes, side effects, onset and duration of sensory as well as motor blockade, and duration ofanalgesia.Materials and Methods: After obtaining Institutional Ethics Committee approval, a prospective study was conducted on90 patients belonging to American society of Anesthesiology Grades I and II, aged 18–60 years and scheduled for infraumbilicalsurgeries using SAB. Three Groups A, B, and C each with 30 patients were given 0.8 mg nalbuphine along with 10, 12.5, and15 mg of hyperbaric bupivacaine, respectively.Statistical Analysis: Chi-square and unpaired “t” test and following results were observed.Results: Mean onset of sensory block until T10 dermatome was 2.59 ± 0.43, 2.49 ± 0.30, and 2.44–0.33 min while its totalduration was 102.23 ± 5.81, 110.10.83 ± 83, and 136.33 ± 6.15 min in Groups A, B, and C. Maximum motor blockade wasachieved in 7.55 ± 0.57, 7.41 ± 0.51, and 7.30 ± 0.62 min and mean duration of motor block was 145.27 ± 11.80, 155.00 ± 11.58,and 188.00 ± 10.27 min in Groups A, B, and C. Mean time of total duration of the analgesia in Groups A, B, and C was 240.83 ±36.34, 413.77 ± 68.60, and 719.90 ± 99.93 min. Patients in Group C had hypotension at 8th and 10th min intraoperatively whileother parameters and side effects were non-significant.Conclusion: About 0.8 mg of nalbuphine when combined with 12.5 mg of hyperbaric bupivacaine had optimum duration ofanalgesia and sensory block with lesser hemodynamic alterations and side effects.
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Background: Adequate post-operative analgesia is the prime duty of anesthesiologist and several adjuvants have been usedalong with local anesthetics to prolong the duration of brachial plexus block. The present study aimed to compare the effect ofnalbuphine and magnesium sulfate as an adjuvant to ropivacaine and ropivacaine alone in nerve stimulator guided supraclavicularbrachial plexus block in patients scheduled for orthopedic upper limb surgeries.Materials and Methods: A total of 90 patients of in the age group of 20–65 years of either sex of the American Society ofAnesthesiologists Grade I and II were divided into three groups of 30 each. Group R received 30 ml of 0.75% ropivacaine alone,Group RM received 30 ml of 0.75% ropivacaine plus 150 mg of magnesium sulfate, and Group RN received 30 ml of 0.75%ropivacaine plus 20 mg of nalbuphine. All the groups were compared with respect to onset and duration of sensory and motorblockade, post-operative analgesia, need for rescue analgesia, hemodynamics, and side effects.Results: Onset of sensory and motor block was earliest in Group RN and was highly significant (P < 0.001) when compared toGroup R and Group RM. Mean duration of post-operative analgesia was 8.70 ± 1.18 h in Group R, 11.73 ± 1.23 h in Group RM,and 14.40 ± 1.25 in Group RN. Duration of sensory and motor block and post-operative analgesia were significantly prolonged(P < 0.001) both in Group RM and Group RN when compared to Group R.Conclusion: Both nalbuphine and magnesium sulfate are effective adjuvant as compared to ropivacaine alone as they prolong theduration of block as well as post-operative analgesia when used for supraclavicular brachial plexus block. However, nalbuphinehas proven to be a better adjuvant as compared to magnesium sulfate as it also results in earlier onset of sensory and motorblock and better patient and surgeon satisfaction scores.