addition of clonidine or fentanyl to lidocaine in local anaesthetic technique for testicular sperm extraction [TESE] a comparative study

A group of forty-five ASA I or II patients scheduled for testicular sperm extraction under local analgesia and sedation were studied. In order to improve the efficacy of local anaesthetic drug and better postoperative pain control, clonidine or fentanyl were added to lidocaine. The patients were randomly allocated into three equal groups. All patients received I.V midazolam and pethidine for sedation and glycopyrrolate premedication. In control group, lidocaine was used alone for local technique, however clonidine was added to lidocaine in the second group and fentanyl was added to lidocaine in the third group. Pulse and blood pressure were determined. Sedation and postoperative analgesia were assessed by subjective scoring. All groups showed haemodynamic stability. The mean sedation score was significantly higher in clonidine and fentanyl groups, the postoperative pain intensity and analgesic requirements were significantly less in clonidine group than in control and fentanyl groups. These results confirm that adding clonidine to lidocaine provides an effective safe analgesia for TESE with better postoperative analgesia and early ambulation

Haemodynamic, pulmonary gas exchange and acid base changes in response to induced hypotensive anaesthesia by nitroglycerin

Nitroglycerin [TNG] was administered to 15 adult ASA I or II patients undergoing elective surgical procedures in which excessive blood loss is a problem. The desired level of mean blood pressure of [50-65 mmhg] was achieved after 8.33 +/- 1.39 min and upon drug withdrawal the mean blood pressure returned to its normal value after 20.6 +/- 2.87 min TNG produced significant reduction of heart rate venous pressures, cardiac output, systemic and pulmonary vascular resistances and stroke work indeces when compared with the values before administration of TNG [control values] TNG resulted in significant decrease in P[a]o2 and significant increase in P[v]o2 and venous admixture. Available oxygen and oxygen consumption showed significant decrease in comparison with the control values after TNG infusion. No significant changes were observed in acid base data. In conclusion TNG was found to be an effective drug for smooth hypotensive anaesthesia [dry bloodless field] provided the availability of experience and proper monitoring. Overshooting of blood pressure was not observed either at induction of phypotension or following restoration of normal blood pressure. As TNG affects mainly the capacitance vessels, the diastolic blood pressure was kept at a higher level and it maintained the coronary perfusion pressure, in addition to the reduced O2 consumption and absence of tachycardia with TNG infusion. It is strongly recommended to be used in patients with ischaemic heart disease

Bupivacaine wound infiltration using catheter technique for post inguinal herniorrhaphy pain relief

A simple technique of bupivacaine wound infiltration using epidural catheter and comparing it with the standard intramuscular pethidine administration was studied for postoperative pain relief after inguinal herniorrhaphy. There was a marked pain relief after both drugs with singfunction low visual analogue scale [VAS] values compared to the values taken before drug administration. However, patients receiving bupivacaine had significantly lower VAS. The onset of analgesia was significantly shorter in bupivacaine than in pethidine groups. No additional pethidine was required in both groups. No complications nor side effects related to toxicity, infection or impaired wound healing were encountered. This form of analgesia using catheter technique in minor surgical procedures is safe, effective and easily administered. It is suitable for routine use, but especially may be beneficial for patients with impaired preoperative ventilatory function