Comparative evaluation of intra-articular administration of morphine, bupivacaine and morphine with bupivcaine for post operative analgesia following video knee arthroscopy

Post arthroscopy analgesia has been provided with intra-articular bupivacaine, but the duration of analgesia was short. In contrast intra-articular morphine has been shown to produce significant but delayed post-operative analgesia. So, the combination of intra-articular morphine and bupivacaine may be the ideal analgesic after knee arthroscopoy. Our work was done to clarify this suggestion, seventy five patients ASA grade I and II, aged 20-60 years, undergoing elective knee arthroscopy under general anesthesia, were randomized into three groups: group I received morphine 2 mg in 20cc saline, group II received 20cc of 0.25% of bupivacaine, group III received morphine 2 mg in 20cc of 0.25% of bupivacaine intra-articularly. The visual analogue score [VAS] were performed at 1, 3, 6, 12, and 24 hours post operatively. Group III had significantly lower VAS compared to the other groups at the end of the study, so morphine and bupivacaine provides superior post operative analgesia for up to 24 hours versus bupivacaine or morphine individually

Comparative study to evaluate the effect of alkalinization of lignocaine hydrochioride on supra-clavicular brachial pllexus block

Alkalinization of 2% lignocaine hydrochloride with adrenaline leads to alteration in its onset of action and duration of action. 60 patients requiring upper limb surgery between the age group of 20-60 years of either sex, ASA grade I and II were randomly allocated into three equal groups. Group I received 20 ml of standard 2% lignocaine hydrochloride with adrenaline [pH=3.21]. Group II received 20 ml of freshly prepared solution by addition of 1 ml 8.4% sodium bicarbonate [w/v] to the standard solution [pH=6.21]. Group III received 20 ml of alkalinized standard solution prepared by addition of 2 ml 8.4% sidium bicarbonat [w/v] [pH=6.67]. Supra clavicular brachial plexus block technique was used for drug administration. Onset of sensory block, onset of motor block, quality of block and duration of block was assessed using standard parameters. It was obsrved that raising the pH of the solution from 3.21 to 6.21produced a reduction in latency of sensory block [from 18.35 mins to 10.35mins], a reduction in latency of motor block [from 20.65 mins to 12.2 mins] and increased the duration of block. Further increased of pH from 6.21 to 6.67 did not confer any added advantage. Frequency of complete block in solution with pH 6.21 was seen to increase as compared to pH 3.21 solution [35% to 80%]

Comparative study to evaluate positioning of double-lumen endobroncheal tubes and the correlation between clinical and the role of fiber optic brochoscopy in thoracic anesthesia

Fiber optic bronchoscopy has been recommended to verify and the position of double lumen tubes [DLT], but this remains controversial. We studied the role of brochoscopy for placing and monitoring DLTs, after blind intubation and after positioning of the patient. 25 other patients undergoing thoracotomy were studied. Clinical criteria suggested good positioning in all cases, however, subsequent bronchoscopy revealed mal-position in 4 cases. A DLT was considered mal-positioned when it had to be moved> 0.5 cm to correct its position. Critical mal-position were those that might have affected patients safety or influenced the surgical procedure if left uncorrected. Bronchoscopic finding included bronchial cuff herniation and obstruction of left upper lobe brunchus. So, after blind intubation and the patient positioning, about one fifth of DLTs required repositioning. Routine fiber optic bronchoscopy is therefore recommended after intubation and after patients positioning