RESUMEN
Shoulder arthroscopic surgeries can produce intense postoperative pain. Interscalene block provides good analgesia after shoulder surgery, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block along with axillary nerve block was recently proposed as an alternative to interscalene block, but evidence of its comparative efficacy is conflicting. The aim of our study was to compare suprascapular and axillary nerve blocks with interscalene block in shoulder surgery for postoperative analgesia. Methods: A total of 76 patients scheduled for shoulder arthroscopic surgery were equally divided into two groups of 38patients each: Interscalene (ISB) group and suprascapular with axillary nerve (SHB) group. Both the nerve block was achieved by both ultrasound and nerve stimulator guidance. Visual analogue scale score was evaluated at 1, 4, 6, 12, and 24 h postoperatively. The time to first analgesia request, total analgesic requirement for 24 hr postoperatively, patient satisfaction, and any complications were recorded. Results: SHB provided equivalent analgesia to ISB in terms of post operative VAS scores.Time to 1st analgesia request was 7.2±1.3 hr in ISB group and 5.9±1.2 hr in SHB group which was not statistically significant.Patient satisfaction scores were significantly higher in SHB group compared to ISB group. Complication like subjective dyspnea and weakness of arm was significantly higher in ISB group compared to SHB group. Conclusions: SHB was as effective as ISB for postoperative pain relief but with fewer complications due to selective blockade of suprascapular and axillary nerve.
RESUMEN
Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus block prolongs motor and sensory blockade. However, the effect of dexamethasone when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in supraclavicular brachial plexus block. Methods: Ultrasound guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi square test and Student’s t test were used for statistical analysis. Results: Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. Conclusions: The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.
RESUMEN
Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study for the diagnosis of subclinical CTS in patients with hypothyroidism before and after hormone replacement therapy. Methods: Sixty patients diagnosed with hypothyroidism were included in this study. Electrodiagnostic workup and ultrasonographic assessment of both right and left median nerves were done at the initial time of diagnosis and 3 months of euthyroid state after hormone replacement. Results: The comparison between right and left median nerves motor and sensory functions before and after treatment showed a significant change (P < 0.001). Right median nerve distal and proximal CSA were 13.5±1.4 mm2 and 10.6±1.5 mm2 respectively. On the left side CSA values were 13.1±2.1 mm2 and 9.9±0.5 mm2 respectively. After hormone replacement, values changed to 11.0±1.4 mm2 (distal) and 0.086±.003 mm2 (proximal) on the right side and 11.0±1.6 mm2 (distal) and 8.2±.0.4 mm2 (proximal) on the left side. 40 patients showed significant electrophysiological and radiological improvement with hormonal control. Conclusions: The US for median nerve cross sectional area can be used as a noninvasive diagnostic method which may be used for prognostication of CTS.
RESUMEN
To determine the etiology of headache in patients undergoing computed tomography (CT) scan of brain both with or without neurologic abnormality in South Odisha. Methods: A prospective study of six months duration was carried out at the M. K. C. G Medical College & hospital. It included 200 patients who underwent a brain CT for headache. CT findings of patients were analyzed. Results: The total number of our patients was 200. These etiologies were stroke (15%), followed by tumor(11%),sinusitis(7.5%),trauma (7.5%), abscesses(5%) and encephalitis (4%). Conclusions: CT of brain has revealed in 62.5% of cases as normal and detected the various causes in rest of cases.