RESUMEN
Background: Supraclavicular approach for brachial plexus block offers an alternative anesthesia for upper extremity surgery.Addition of opioid agents in local anesthetic solutions for prolongation of analgesia through brachial plexus block has beenvery effective in controlling post-operative pain. The time to request for the 1st dose of rescue analgesia can be prolonged byadding buprenorphine or butorphanol in local anesthetic solutions.Methodology: After institutional ethical committee approval, 60 American Society of Anesthesiologists I/II patients wererandomized for this study. They belong to either gender, aged between 18 and 55 years of age. Patients who required brachialplexus block through supraclavicular approach were included and the study drugs were administered according to groupallocation into Group I and Group II. Sensory and motor block characteristics were monitored and recorded in all patients,complications as well. Hemodynamic monitoring was done every 5 min interval in the intraoperative period and every 15 minintervals in the post-operative period. Patients were administered rescue analgesia postoperatively when visual analog scale(VAS) scores were ≥4. Data were analyzed statistically.Results: Onset time to sensory block was 3.1 (1.1) min in Group I and 4.9 (1) min in Group II, and there was statistically significantdifference between groups (P < 0.0001). Onset time to motor block was 5.4 (1.3) min in Group I and 9.3 (1.5) min in Group II,and the difference between groups was found to be significant statistically (P < 0.0001). The time to 1st request of analgesiawas found to be statistically significantly between I and II groups (354.8 [55.6] vs. 448.3 [34.4] min, P < 0.0001), respectively.Conclusion: Both buprenorphine and butorphanol produced effective analgesia in combination with local anesthetics withoutsignificant side effects, but buprenorphine produced prolonged analgesia when compared to butorphanol.
RESUMEN
The purpose of our study was to analyze current indications for surgery in pleuropulmonary tuberculosis [TB]. We present our experience with TB patients presenting with indications for surgery between 1998 and 2003. Material and The indications for surgical intervention included 220 cases of empyema, mediastinal lymphadenopathy 48 cases, hemoptysis 25 cases, destroyed lung 24 cases, undiagnosed pleural effusion 24 cases, bronchiectasis 18 cases, cavitary lesion with MDRTB 13 cases and pulmonary aspergilloma 10 cases. Thirteen patients with multidrug-resistant tuberculosis required surgical intervention, although 26 were treated with second line drugs during this period. The techniques utilized included decortication in 152 cases, lobectomy in 62 cases, rib resection for pleural drainage in 50 cases, anterior mediastinotomy in 48 cases, pneumonectomy in 28 cases, open pleural biopsy in 24 cases, and thoracoplasty in 18 cases. In 12 patients [3.1%], two procedures were performed, and in one case, 3 procedures. In 65 cases [17%] there were complications, of which persistent air leakage after decortication and pulmonary resection was the most frequent [n=26]. There was a mortality rate of 2.8% [11 cases]. Conclusions: In our experience, surgery in the treatment of TB is indicated to resolve sequalae or complications, since cases of simple or multidrug-resistant TB can be managed pharmacologically. The morbidity and mortality rates in our series were acceptable