Evaluation of Dexamethasone for Postoperative Analgesia in Elderly Patients.

Background: Glucocorticoids are well known for their analgesic, anti-inflammatory , immune-modulating and antiemetic effects. The present study is done to see the effects of single dose IV administration of dexamethasone for postoperative analgesia in elderly patients on selective population of Bundelkhand region hospitalized for lower limb orthopaedic surgeries under spinal blockade. We found that duration of analgesia was dose dependent and patient receiving dexamethasone had better pain tolerability. Methods: Study was carried out on 120 patients of either sex, more than 60 year of age. The patients were than randomly divided into four groups of 30 patients each. Group I(C): Patients were given 4 ml saline intravenously to serve as control group. Group II (D-8): Patients were given 8 mg dexamethasone diluted to 4ml iv. Group III (D-12): Patients were given 12 mg dexamethasone diluted to 4ml iv. Group IV (D-16): Patients were given 16 mg dexamethasone diluted to 4ml iv. Pt. were observed for the following data: a. Onset of sensory block – tested by appearance of paresthesia, b. Time to reach peak of sensory & motor blockade, c. Recovery of sensory & motor function, d. Duration of anesthesia, e. Duration of complete analgesia- assessed by first demand for analgesic. Results: No significant difference among the study groups, which were slightly earlier than the control group while comparing time of onset of sensory/motor block. Duration of analgesia (time of onset of sensory block to first demand of analgesics): was maximum (545.03±45.25 min.) in group IV followed by group III (305.36±25.35 min.), which was found to be highly significant (p < 0.001) in comparison to group I (155.06±12.27 min) Group IV > Group III > Group II> Group I. Conclusion: Onset of sensory and motor block was comparable in all the four groups. Duration of analgesia was dose dependent with 16 mg dose providing maximum duration of post-operative analgesia at rest in comparison to 12 mg and 8 mg dose.

The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH in children undergoing elective surgery.

The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH was studied in 75 children of American Society of Anesthetists (ASA) grade I and grade II undergoing elective surgery. Group I patients fasted from midnight and acted as control. Group II patients received 5 ml/kg plain water orally 3 hours before surgery. Group III children received 5 ml/kg of plain water and 2 mg/kg of ranitidine orally 3 hours before surgery. Mean volume of gastric aspirate was comparable in all 3 groups (p > 0.05). Mean pH was significantly higher in ranitidine treated patients (5.12 +/- 1.73) as compared to non-ranitidine treated patients (2.26 +/- 0.57 and 2.53 +/ 0.79 in group I and group II respectively). Number of patients at risk (pH < or = 2.5 and volume > or = 0.4 ml/kg) was not significantly different in group I and group II. Mean thirst and behaviour scores were significantly higher in fluid treated patients (groups II and III) as compared to control (p < 0.01). To conclude, administration of pre-operative water (5 ml/kg) along with ranitidine (2 mg/kg) favourably modifies gastric fluid volume and pH, improves patient behaviour and minimises the number of patients at risk of aspiration pneumonitis, should the child aspirate.