RESUMO
Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and complications of lower limb amputations among patients admitted to MMIMSR, Mullana, Ambala, India, which is a tertiary care centre.METHODSThis was a prospective, observational study that was conducted at MMIMSR, Ambala, for a period of 18 months. 50 patients underwent lower limb amputations in our hospital during the study period.RESULTSThe age ranged between 23 to 85 years. Males outnumbered females by a ratio of 4.5:1. Toe disarticulations were the most common. Diabetes mellitus (DM) was the most common cause (62%) followed by Non-DM peripheral vascular disease (PVD) (22%). Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Hospital stay ranged from 6 days to 40 days.CONCLUSIONSAlthough trauma is still the most common cause of lower limb amputations (LLA) in the developing nations, amputations for complications of diabetes is on the rise and may be the leading aetiology in future. Diabetic gangrene followed by PVD were the common causes of amputation in our settings. The study shows that most of the causes are potentially avoidable. Community health education programmes that are primarily focussing on road safety measures, early presentation to the physician and good diabetic control are pivotal to decrease the incidence of amputations for preventable indications.
RESUMO
Background: Bupivacaine has been traditionally used as a local anesthetic of choice for regional anesthesia and analgesia. Ropivacaine has been marketed in our country with a claim of better motor profile, better safety profile and an equivalent analgesic profile when used in epidurals for postoperative pain. This study aims to compare both drugs as an epidural infusion in terms of safety, analgesic efficacy by NRS score and patient satisfaction score and motor blockade by modified bromage score in postoperative period
Methodology: 70 patients of ASA grade I or II, of either sex between the age of 20- 65 years, posted for orthopedic lower limb surgery under combined spinal epidural anesthesia were enrolled in this prospective randomised double blind study. The patients were randomly allocated to one of the two groups; Group 1 patients received 0.125% bupivacaine with 2 microg/ml fentanyl, while Group 2 patients received 0.2% ropivacaine, with 2 microg/ml fentanyl as an adjunct in epidural infusion postoperatively. Epidural infusion was started at the rate of 8 ml/hour after either four hours of administration of spinal anesthesia or at an NRS score of three, whichever was earlier. We evaluated the NRS scores, patient satisfaction scores and the need of rescue analgesic. Vital parameters and modified bromage score were also registered
Results: The pain score was similar in both groups at different time intervals, except at 15 and 30 min after starting epidural infusion, where the pain score was significantly lower in Group 2 when compared to Group 1 [p-value 0.007, 0.006 respectively]. Patient satisfaction score was significantly more in Group 2 patients. There was no significant difference in requirement of rescue analgesia in two groups. Modified bromage grade was statistically more in Group 1
Conclusion: We conclude that ropivacaine can be used as an alternative to bupivacaine for postoperative analgesia by epidural infusion, as it provides effective pain control with the added advantage of lower incidence of motor blockade