Comparison of ropivacaine and bupivacaine as single-shot epidural anaesthesia for orthopaedic surgery

To compare the efficacy and side-effects of 0.5% ropivacaine with that of 0.5% bupivacaine when used for single-shot epidural anaesthesia for orthopaedic surgery. Randomized controlled trial. Department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of eight months from June 2013 to January 2014. The study was carried out in 60 ASA physical status I, II or III patients undergoing elective lower extremity orthopedic surgery. Two groups of 30 patients each received single-shot epidural anaesthesia either with ropivacaine 0.5% [ropivacaine group] or bupivacaine 0.5% [bupivacaine group]. Onset, time for maximum height and median height of sensory block was assessed as well as time to two segment recession. Modified Bromage scale was used for motor blockade. Total duration of motor block and common side effects were also recorded. The patients in both groups were similar in age, height, weight, gender and ASA status. There was no significant difference in onset of sensory block and time for maximum height of sensory block. The median heighest level of sensory block was T6 [T5-T8] for ropivacaine group and T5 [T4-T7] for bupivacaine group. Time for two segment regression and duration of sensory block were also comparable for both groups. The total duration of motor block was significantly more in bupivacaine group [159 min vs 134.2 min, p< 0.001]. Modified Bromage scale was also significantly higher in bupivacaine group [2.86 vs 1.96 min, p<0.001]. Side effects like hypotension, bradycardia, nausea, vomiting and shivering were similar in both groups. Epidural administration of 0.5% ropivacaine provided effective and good quality anaesthesia. Motor blockade was of less duration as compared to equivalent dose of 0.5% bupivacaine, which may offer potential benefit of early patient mobilization after orthopaedic surgery

Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique

To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. Randomized controlled trial. Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. A total of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. Access time was significantly less in real-time ultrasound group [34.95 +/- 11.47 vs. 146.59 +/- 40.20 seconds, p < 0.001]. Cannulation was performed in first attempt in 99% of patients in ultrasound group as compared to 89% of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate [9% vs. 1%] and haematoma formation [7% vs. 0%] were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group [6% vs. 0%]. Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein

Zolmitriptan is effective in relieving post-dura! puncture headache in young parturients

This comparative study was designed to assess the efficacy of zolmitriptan, a triptan widely employed as first-line therapy for migraine, in relieving post-dural puncture headache in parturients who were operated for cesarian section under spinal anesthesia. The study was carried out at department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of twelve months from August 2012 to July 2013. We enrolled 60 adult parturients who complained of post-dural puncture headache in post-partum period. They were divided into two equal groups of 30 each; Group-1 [Z-group] received zolmitriptan along with other supportive treatment for spinal headache and Group-2, control group [C-group] was given only supportive treatment. Efficacy of zolmitriptan in relieving post-dural puncture headache [PDPH] was studied and frequency of complications of the drug were noted. After 6 hours, 60% patients of Z-group got relief from headache. While in control group only 36.66% patients were pain free [p 0.016]. After 12 hours, relief from headache was noted in 70% patients of zolmitriptan-group while in C-group only 46.66% were relieved [p 0.015]. After a period of 24 hours results were 86.66% vs. 63.33% [p 0.006]. After 48 hours, in Z-group 96.66% patients were pain free, while in C-group 63.33% were free from headache [p 0.001]. There was no change in results for Z-group after 72 hours. In contrast, in C-group 80% were pain free and 20% patients were still symptomatic. Borderline statistical significance was present [p 0.046]. The study revealed that anti-migraine drug zolmitriptan in combination with supportive treatment is effective in relieving PDPH in parturients

Placental site trophoblastic tumour

Placental Site Trophoblastic Tumour is a rare neoplastic condition developing from intermediate trophoblastic part of cytotrophoblast. Although grouped under Gestational Trophoblastic Neoplasias [GTNs], PSTT varies in its origin, presentation, diagnosis and response to treatment from other GTNs. Delay in treatment due to late presentation or diagnosis is common. Surgery in the form of hysterectomy is the main treatment option but uterus preserving surgical options have been suggested in case of future fertility desire

Epidural anaesthesia; single-shot for day-case knee arthroscopy using a 50-50 mixture of lignocaine and bupivacaine

To compare the benefits and adverse effects of three different drug combinations when used for single-shot epidural anaesthesia for day-case arthroscopy. Prospective, random, double-blind study. A 250 bedded secondary care hospital. From October 2005 to Feb 2007. We studied 75 adult male patients, aged between 23 to 63 years, weight <100 kg, ASA physical status I or II undergoing elective knee arthroscopy as day-case procedure/Patients were randomly divided into three groups [25 patients in each group] and single-shot epidural anaesthesia was performed using a total of 20 ml epidural lignocaine 2% [Group 1] bupivacaine 0.5% [Group 2] or a mixture containing lignocaine 2% and bupivacaine 0.5%, 10 ml each [Group 3]. Time to achieve maximum height [in minutes] was similar in group-1 and group-3 [10 +/- 4 and 11 +/- 2], but it was significantly longer in group-2 [20 +/- 3]. Block time was comparable in group-2 and 3 [130 +/- 25 and 118 +/- 37] but it was significantly shorter in group-1 [60 +/- 20]. Post-operative discharge time was longest in the group-2, and comparable in group-1 and S.The incidence of complications like bradycardia, hypotension, nausea and vomiting were more in group-2 and less in group-1 and group-3. Inadequate anaesthesia was more in group-1 and least in other two groups. Four patients of group-1 needed rescue analgesia and two from same group needed general anaesthesia as compared to none in group-2 and group-3. In 4-point patient satisfaction scale, maximum patients from Group-3 rated it perfect while most patients from group-1 were not satisfied with the quality of anaesthesia. The results of our study show that a 50-50 mixture of lignocaine and bupivacaine with fentanyl 50 pg when used for single-shot epidural anaesthesia for day case knee arthroscopy, provides better quality of analgesia, with fewerincidences of side effects and more patient satisfaction as compared to lignocaine or bupivacaine alone

Post-operative pain; multi-modal analgesia technique is superior to conventional single analgesia

To compare the efficacy of a multi-modal analgesic regime with conventional single drug analgesic therapy after total abdominal hysterectomy under general anaesthesia. Prospective, random clinical trial. A 250 bedded secondary care hospital. From march 2006 to September 2006. In this study, forty ASA 1-2 middle aged females presenting for elective total abdominal hysterectomy were randomized to receive multi modal pain treatment with oral celecoxib, intravenous tramadol, incisional bupivacaine and intramuscular diclofenac sodium until hospital discharge [Group I] or conventional therapy with intravenous nalbuphine peri and post-operatively [Group II]. Both groups received general anaesthesia. Visual analog pain score was recorded in recovery room, then 4 hourly during the first 12 hr, and then 6 hourly for next 12 hours. Post-operative analgesia was managed with diclofenac sodium 75mg im and nalbuphine 10mg im every 6 hourly in respective groups. Request for additional analgesic was noted and dealt accordingly. Incidence of side effects and surgical complications were recorded. In the recovery room only one patient of Group one [multi-modal group] [n=20] experienced severe pain as compared to 4 patients of group two 'single analgesic group [n=20] [5% vs, 40%]. In next 24 hours, pain score were considerably lower in group one as compared to group two. After 24 hours 15 patients had no pain on VRS as compared to 11 patients [75% vs. 55%]. Four patients of group two needed rescue analgesia while none of multi-modal group demanded it. Incidence respiratory depression, nausea and vomiting were also lower in multi-modal group. Multimodal analgesic regime is an effective tool in reducing the postoperative pain after major gynaecological surgery. By employing multimodal analgesic technique incidence of side effects like respiratory depression, nausea and vomiting were also reduced and patient satisfaction was more

Preloading before spinal anaesthesia for caesarian section. A comparison between colloid and crystalloid preload

To compare the preloading effect of 500 ml hydroxyethyl starch [HES] 6% with 1000 ml of Ringer's lactate to prevent hypotension in spinal anaesthesia for elective cesarean section. Randomized clinical trial. PAF hospital Islamabad, from November 2005 to March 2006. The trial was conducted in two groups of healthy women, scheduled to have elective cesarean section with no fetal compromise. The first group received HES 6% 500 ml [HES group] [n=25] and the second group was infused with 1000 ml Ringer's lactate [RL group] [n=25], in 15 minutes before administering spinal anaesthesia. The incidence of hypotension [systolic B.P < 90 mm Hg or <80% of baseline], and incidence of nausea and/ or vomiting were recorded. Neonatal outcome was aasessed by apgar scoring at 1, 5 and 10 min. The incidence of hypotension was lower in HES group than RL group. Hypotension occurred in 9 out of 25 women [36%] who received HES 6%, while 15 out of 25 women [60%] of RL group developed hypotension. The incidence of nausea and or vomiting was also lower in HES group [24% vs. 40%]. Neonatal outcome was good and similar in both groups preloading preganant ladies undergoing elective cesarean section, with 500 ml HES 6%, 15 min before induction of spinal anaesthesia decreases the incidence of hypotension more than preloading with 1000 ml Ringer's lactate