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

Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique

To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. Randomized controlled trial. Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. A total of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. Access time was significantly less in real-time ultrasound group [34.95 +/- 11.47 vs. 146.59 +/- 40.20 seconds, p < 0.001]. Cannulation was performed in first attempt in 99% of patients in ultrasound group as compared to 89% of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate [9% vs. 1%] and haematoma formation [7% vs. 0%] were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group [6% vs. 0%]. Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein

Zolmitriptan is effective in relieving post-dura! puncture headache in young parturients

This comparative study was designed to assess the efficacy of zolmitriptan, a triptan widely employed as first-line therapy for migraine, in relieving post-dural puncture headache in parturients who were operated for cesarian section under spinal anesthesia. The study was carried out at department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of twelve months from August 2012 to July 2013. We enrolled 60 adult parturients who complained of post-dural puncture headache in post-partum period. They were divided into two equal groups of 30 each; Group-1 [Z-group] received zolmitriptan along with other supportive treatment for spinal headache and Group-2, control group [C-group] was given only supportive treatment. Efficacy of zolmitriptan in relieving post-dural puncture headache [PDPH] was studied and frequency of complications of the drug were noted. After 6 hours, 60% patients of Z-group got relief from headache. While in control group only 36.66% patients were pain free [p 0.016]. After 12 hours, relief from headache was noted in 70% patients of zolmitriptan-group while in C-group only 46.66% were relieved [p 0.015]. After a period of 24 hours results were 86.66% vs. 63.33% [p 0.006]. After 48 hours, in Z-group 96.66% patients were pain free, while in C-group 63.33% were free from headache [p 0.001]. There was no change in results for Z-group after 72 hours. In contrast, in C-group 80% were pain free and 20% patients were still symptomatic. Borderline statistical significance was present [p 0.046]. The study revealed that anti-migraine drug zolmitriptan in combination with supportive treatment is effective in relieving PDPH in parturients