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

Epidural anaesthesia; Comparison as an alternative to general anaesthesia in open cholecystectomy

To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamic changes and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epidural anaesthesia. Quasi experimental study. Combined Military Hospital Rawalpindi from 15 October 2007 to 15 April 2008. American Society of Anaesthesiology [ASA] physical status [PS] I and ll patient of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group A [n=30] received general anaesthesia [GA] and group B [n=29] received thoracic epidural anaesthesia [EA], Patients of both the groups were assessed for peri-operative haemodynamic changes, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain P-value. P-value of less than 0.05 was considered significant. 9 out of 30 patients [30%] of group "A" [general anaesthesia] and 4 out of 29 patients [13.79%] in group "B" [epidural anaesthesia] had vomiting. Shivering was seen in 3 out of 30 [10%] in group "A" [general anaesthesia] and 1 out of 29 [3.44%] patient in group "B" [epidural anaesthesia]. Urinary retention was seen in 1 out of 30 [3.33%] in group "A" [general anaesthesia] and B out of 29 [27.5%] in group "B" [epidural anaesthesia]. Urinary retention was relieved by psychotherapy. None of the patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility [passage of flatus and start of oral sips]. ln group "A" [general anaesthesia] 6 patients [20%] started oral sips in first post operative day, 16 patients [53.33%] on second post operative day, 8 patients [26.66%] in third post operative day. ln the group "B" [epidural anaesthesia] 13 patients [44.8%] started oral sips on first post operative day, 15 [51.72%] on second post operative day and one patient [3.44%] on third post operative day. Regarding the length of hospital stay 17 patient [56.66%] of group "A" [general anaesthesia] were discharge by third post operative day and 22 patient [75.77] were discharge by third post operative day in group "B" [epidural anaesthesia]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomiting in patients undergoing open cholecystectomy.

Local analgesia comparison of premixed lignocaine and adrenaline with freshly prepared lignocaine and adrenaline

To compare the analgesic effect of commercially available premixed injection of lignocaine 2% and adrenaline in 1:100,000 dilution with that of freshly prepared solution by mixing adrenaline in suitable quantity to 2% plain lignocaine just before the time of injection for tooth extraction in patients of dental caries. Descriptive Interventional Study. Armed Forces Institute of Dentistry [AFID] Rawalpindi from March 2006 to August 2006. Patients and A total of 50 patients of dental caries, who were scheduled for tooth extraction, were divided into 2 groups of 25 each. Group A was provided analgesia with commercially available premixed injection of lignocaine and adrenaline and group B was provided analgesia with freshly prepared solution of plain lignocaine and adrenaline. In group A, good quality analgesia sufficient enough for tooth extraction, was achieved in 19 patients whereas in group B good quality analgesia was achieved in 23 patients. Freshly prepared mixture of plain lignocaine and adrenaline gives better analgesic effect than that of commercially available solution of lignocaine with adrenaline

Post operative analgesia following open cholecystectomy; is intermittent epidural bupivacain bolus administration more effective than continuous administration?

Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Quasi Experimental study. Jan2010 to June 2010. Military Hospital Rawalpindi. This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Purposive [non probability] sampling. Patient who received intermittent boluses [group B] required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125% bupivacain

Development of negative pressure pulmonary oedema secondary to postextubation laryngospasm

Negative Pressure Pulmonary Oedema [NPPE] immediately after general anaesthesia is a rare but life threatening complication, caused by an increased fluid in the interstitial spaces and alveoli due to forced inspiratory efforts against tightly closed glottis. Once developed, it impairs gas exchange and causes hypoxemia and if not treated promptly may lead to respiratory failure. Management involves maintaining airway, diuretics and positive pressure ventilation. Affected cases recover completely with appropriate treatment but death may occur if treatment is delayed. We present here three cases that developed post-extubation NPPE after short spells of laryngospasm. All of the three cases recovered completely after management with diuretics and venitlatory support with added PEEP