comparison of granisetron and nitroglycerine for attenuating rocuronium pain: a double-blinded randomized, placebo controlled trial

The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain. One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading [ASA] I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G: received 2 granisetron [1mg/ml] diluted with 3 ml of 0.9% normal saline] while the Group C: received 5 ml of 0.9% normal saline. Group N: received 200 micro g of nitroglycerine diluted to a total of 5 ml[with 0.9% normal saline]. It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec.Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale [0-10] with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement [grade 0], movement only wrist [grade 1], movement to the upper arm and shoulder of injected arm [grade 2] or generalized movements [grade3] was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done. 1. At 0 seconds, in group G number of patients who experienced with drawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable with drawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48% of patients had VAS score of 2-3. We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery

To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively . Prospective, randomized, double-blind study. Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine [1 micro g/kg] and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. Two sample unpaired t-test and the correlation r test. The duration of analgesia from the time of administration of block in group A was 667.72 +/- 210.74 min compared to 558.48 +/- 150.28 min in group B [P<0.05]. Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects

Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine

Propofol has the disadvantage of causing pain or discomfort on injection. The aim of the study was to assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain. One hundred American Society of Anesthesiology [ASA] I and II adults, scheduled for various elective surgical procedures under general anesthesia [GA], were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous [i.v.] magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0-3 which corresponds to no, mild, moderate and severe pain was recorded. All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control. Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection

Study of post dural puncture headache with 27g quincke and whitacre needles in obstetrics / non obstetrics patients

The proposed study was carried out in the department of Anaesthesiology, Intensive care and Pain management, Himalayan Institute of Medical Sciences. Swami Rama Nagar, Dehradun. A total of 120 patients of ASA I and II obstetric and non-obstetric undergoing elective/emergency surgery under subarachnoid block were included under the study. To evaluate the frequency of PDPH during spinal anaesthesia using 27 gauge Quincke vs 27G whitacre needle in obstetric/non obstetric patient. In our study patients were in the age group of 15-75 years. Most of the patients in our study belong to ASA Grade I. There was 2%, 1%, 4%and 3%hypotension in-group A, B, C,D respectively. There was 2%, 4% shivering in-group A,C respectively and 1% each in group B,D. In our study failed spinal with 27G Quincke needle was in one case [3.33%] in-group C where successful subarachnoid was performed with a thicken spinal needle 23G Quincke. There was no incidence of PDPH in-group A and D, while 1[2%] patient in-group B and 2[4%] in group C. All the three patients were for lower section caesarean section and were young and had undergone more than one attempt to perform spinal block. The headache severity was from mild to moderate and no epidural blood patch was applied