A Comparative Study of Bupivacaine Vs Ropivacaine Wound Instillation through Surgical Drain for Postoperative Analgesia in Modified Radical Mastectomy

Introduction: Modified radical mastectomy (MRM) isassociated with extensive tissue dissection and substantialpostoperative pain. Various modes of postoperative analgesiahave been used to alleviate the suffering of these patients.One of that is wound instillation, in our study we comparedthe effects of bupivacaine and ropivacaine for post-operativeanalgesia when instilled through the surgical drains in patientsundergoing MRM.Material and methods: After obtaining the InstitutionalEthics Committee approval and written informed consent,60 female patients aged between 18 and 60 years withAmerican Society of Anaesthesiologist status I/II scheduledto undergo MRM were enrolled for the study. Patients wererandomised into two groups (30 each), a total of 40 cc of eitherbupivacaine (0.125%) or ropivacaine (0.2%) instilled throughsurgical drains. Visual analogue score and hemodynamicswere compared in the postoperative period every 2 hourlytill 12 hours. Quantitative data were compared by usingunpaired t-test and qualitative data by using Chi-Square testand Fisher’s Exact test.Results: Duration of analgesia was found to be significantlylonger in bupivacaine group (512.37±63.06 minutes) ascompared to ropivacaine (427.97±43.26 minutes) (p<0.0001). Systolic and diastolic blood pressure were high andstatistically significant in bupivacaine group as compared toropivacaine but clinically not significant.Conclusion: Both local anaesthetics, bupivacaine andropivacaine showed near similar pharmacological effectshowever the duration of analgesia was observed more withbupivacaine when instilled through the surgical drains. Woundinstillation, being a non-invasive technique is an effectivemode of providing postoperative analgesia in MRM ascompare to other invasive modalities.

Lateral Vs Classical Approach of Supraclavicular Brachial Plexus Block for Orthopedic Surgeries below Mid-Humerus: A Comparative Study.

Introduction: Supraclavicular brachial plexus blockwith classical approach is used to provide anaesthesia fororthopaedic upper limb surgeries. This approach is safe but notdevoid of complication, therefore we compared a alternativelateral approach with classical approach in terms of sensoryand motor blockade, tourniquet tolerance and complication.Material and Methods: After obtaining the ethics committeeapproval 64 patients posted for orthopaedic surgeries belowmid humerus under supraclavicular block were enrolled. Theywere divided into two groups (32 each), Group C receivedclassical approach and Group L received lateral approachwith the help of nerve stimulator. A mixture of adrenalized2% lignocaine (5-7mg/kg) and plain 0.5% bupivacaine (2mg/kg)(total volume 30 ml) was used. Onset time of sensory andmotor block, duration of sensory and motor block, durationof analgesia, tourniquet tolerance and complications (if any)were noted and compared in both the groups. Quantitative datawere compared by using unpaired T test and qualitative databy using Chi-Square test and Fisher’s Exact test (2X2 tables).Results: The mean times to onset of sensory and motorblockade and the mean duration of sensory and motorblockade did not differ between the two groups. Mean durationof analgesia with lateral approach is found to be longer butstatistically not significant. Tourniquet tolerance was goodand no pneumothorax observed in lateral approach.Conclusion: Lateral approach has shown to be a safealternative to classical approach for supraclavicular brachialplexus block in terms of adequacy of block, tourniquettolerance and complications.