Comparison of Analgesic Effects of Levobupivacaine (0.25%) versus Bupivacaine (0.25%) using Ultrasound Guided Transversus Abdominis Plane Block in Total Abdominal Hysterectomy under General Anesthesia — An Interventional Study

Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.

Effect of Intra-Operative Intravenous Crystalloid Infusion on Post-Operative Nausea and Vomiting after Diagnostic Gynaecological Laparoscopy- Comparison of 30 mL/Kg & 15 mL/Kg.

Laparoscopic procedures have the advantages of minimal incision, early recovery, lesser post-operative pain and early ambulation. However, they are associated with an increased incidence of post-operative nausea and vomiting (PONV), which is all the more frequent in gynaecological laparoscopic surgeries. In our study, we have evaluated the effectiveness of intra-operative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy.METHODSInformed consent was obtained and patients were randomly divided into two groups. Group 1 received 30 mL/Kg intravenous crystalloid infusion intra operatively and group 2 received 15 mL/Kg intravenous crystalloid infusion. Incidence of nausea, incidence of emesis (retching or vomiting), the amount of rescue antiemetic used, and the haemodynamic parameters were noted in the postoperative period for 12 hours for both the groups.RESULTSIncidence of PONV was much more in group 2 in 0, 1, 2, 3, 4, 6 hours post operatively and rescue antiemetic use was much more in group 2 in total 12 hours post-operative period. There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2.CONCLUSIONSIntra-operative administration of 30 mL/Kg of crystalloid infusion significantly reduces the incidence of PONV and rescue antiemetic use compared to 15 mL/Kg crystalloid infusion in diagnostic gynaecological laparoscopy. So, it can be used as a non-pharmacological method for prophylaxis of PONV.

Pressor responses following insertion of laryngeal mask airway in patients with controlled hypertension: comparison with tracheal intubation.

The present study was undertaken in patients with controlled hypertension to determine the pressor responses following insertion of laryngeal mask airway (LMA) as compared to endotracheal intubation. Two hundred patients with controlled hypertension of either sex, belonging to ASA II undergoing elective surgical procedures of 11/2 to 2 hours duration, were studied in a randomised manner into two equal groups: A(n =100) and B(n = 100) depending on whether LMA or endotracheal tube was used. General anaesthesia and controlled ventilation was undertaken according to standard procedure. Baseline and preinsertion values of heart rate, systolic blood pressure, and diastolic blood pressure were recorded and repeated at 1, 2 and 3 minutes after insertion of LMA or endotracheal intubation. The results showed that increase in systolic and diastolic blood pressure following endotracheal intubation (group A) was much more as compared to LMA (group B) (p<0.01). Heart rate also increased from baseline value in endotracheal intubation group than in LMA (P<0.05). To conclude insertion of LMA was associated with lesser pressure response as compared to endotracheal intubation in patients with controlled hypertension. It is an effective method to avoid laryngoscopic pressor response during endotracheal intubation in hypertensive patients.