RESUMO
To compare the onset of block, duration of analgesia and complications when dexamethasone is added to local anaesthetic bupivacaine in supraclavicular brachial plexus block for upper limb surgery. Quasi experimental study. This study was conducted at the Department of Anaesthesia, PIMS, Islamabad from July 2007 to June 2008. total sixty patients were included in this study. 30 patients were given supraclavicular block with 0.5% Bupivacaine plus normal saline and put in Group A and remaining 30 were given 0.5% bupivacaine plus dexamethasone and put in Group B. Study inclusion criteria were surgery of upper limb, age of the patient between 20 years to 60 years and anaesthesia physical status [ASA] I, II, III. Variables recorded were onset of sensory and motor block for both groups and duration of sensory and motor block in both groups. Rescue analgesia requirement and complications were also noted in both groups. Demographically both groups were well watched T. test was used to compare the onset of sensory and motor block, duration of sensory and motor block and numerical pain score between the two groups. Chi-squre test was used to compare rescue analgesia required and complications between the two groups. P-value less than 0.05 was considered statistically significant. The onset of motor block was similar in both groups [p-0.82] while onset of sensory block was earlier in dexamethasone group [p-0.014]. The duration of sensory and motor block were significantly longer in dexamethasone group [B] than Bupivacaine group alone [A] [P=<0.001]. Rescue analgesia required by the bupivacaine alone [A] was much earlier than dexamethasone group [B] [P= < 0.001]. No serious complications were noted in both groups. The addition of dexamethasone to bupivacaine 0.5% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and provides greater pain relief also it shorten the onset of sensory block but has no effect on onset of motor block
RESUMO
General anesthesia is most frequently used for lumbar disc surgery despite the evidence that spinal anesthesia is as safe and may offer some additional advantages. The purpose of this study was to compare the intraoperative parameters and postoperative outcome after spinal and general anesthesia in demographically well matched patients undergoing elective lumbar Decompressive surgery. Prospective randomized controlled study. This study was carried out DHQ Hospital Mirpur AJK from January 2007 and May 2010. In this randomized controlled study we analyzed the outcome obtained in 44 patients in whom either spinal or general anesthesia was induced for lumber disc surgery. The variables recorded were anesthesia related class, surgical diagnosis, disc levels operated and pre, peri and postoperative measurements of variables like BP, and heart rate. All aspects of surgery, recovery, post anesthesia care and pain management were same irrespective of anesthetic type The narcotic and antiemetic requirement and length of stay in the hospital and incidence of urinary retention were also recorded in the post operative course. Demographically both groups were well matched. Anesthesia time was longer in patients receiving GA with increased heart rate and MABP perioperatively. There was more nausea and greater requirements for antiemetic and analgesics in patients receiving. GA [p value<0.05]. Perioperative heart rate and MABP was on normal side and there was no urinary retention in patients who received spinal anesthesia. Spinal anesthesia was a safe and effective as GA for patients undergoing lumbar Decompressive surgery. Spinal anesthesia had added advantages of short anesthesia duration, decreased antiemetic and analgesic requirements. GA general anesthesia, HR heart rate, I/V intravenous, MAP mean arterial pressure, PACU post anesthesia care unit, RCT randomized controlled trial, SA spinal anesthesia