Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Colorectal Surgery

Background: Transmuscular Quadratus Lumborum Block (TQLB) is a newer modality for postoperative pain management. But, its efficacy after laparoscopic colorectal surgery is little researched. The aim of our trial was to access the analgesic efficacy of TQLB in colorectal surgery.Methods:This study was done in 64 patients posted for colorectal surgery who were divided into two groups of 32 each. TQLB was given bilaterally in group RQ with 20 ml of 0.375% ropivacaine and in group SQ with 20 ml saline. Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary endpoint. Secondary endpoints were total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications.Results:The time required for first analgesic demand was 3.9� 0.8hrs in RQ group and 0.1� 0.2 hrs in group SQ which was statistically significant. The total paracetamol consumption in 24 hours was1.2� 0.4 gm in group RQ and 2.9� 0.7gm in group SQ ,the difference being remarkable.Conclusion:Transmuscular quadratus lumborum block can produce quality analgesia after laparoscopic colorectal surgery. TQLB not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

A Comparison of Intrathecal Isobaric Ropivacaine 0.5% and 0.75% for Orthopaedic Lower Limb Surgeries and Lower Abdominal Surgeries.

Background: Aim: This study was done to evaluate the onset, extent and duration of sensory and motor block and side effects of ropivacaine when used in spinal anaesthesia in lower limb orthopedic and lower abdominal surgery. Methods: A prospective randomized double blind study was conducted on 60 patients of ASA status I and II, posted for lower limb orthopaedic and lower abdominal surgery. All patients were randomly allocated into two groups of 30 each; group I received 3ml of isobaric ropivacaine 0.5%(15mg) and group II received 3ml of 0.75% (22.5mg)isobaric ropivacaine in subarachnoid block. The onset, extent, duration of sensory and motor block and side effects were recorded. Results: Onset of sensory block and highest level of sensory block achieved was comparable in both the groups. The duration of sensory block at T10 and total duration of sensory blockade was prolonged in-group II in comparison to group I, which was statistically significant. The onset time of motor block was comparable in both groups. Time to maximum degree of motor block was longer in group I (17.45±6.63min) compared to group II(11.04±4.26min) which was statistically significant. Total duration of motor block was longer in group II(152.60±23.02min) compared to group I( 112.62±13.72min)which was statistically significant. Conclusion: 0.75% ropivacaine when used in spinal subarachnoid block prolonged the sensory and motor block in comparison to 0.5% ropivacaine.

Comparison of Invasive vs Noninvasive mechanical Ventilation in Acute Exacerbation of COPD Patient for Ease of Ventilation Weaning & Outcome.

Background: Acute exacerbation of the COPD can cause respiratory failure which requires ICU and mechanical ventilation. But invasive mode of ventilation associated with various complications, weaning failure, lengthy hospital stay and more mortality and morbidity. So our aim in the study was to compare it with the noninvasive mode and their outcome. Methods: A prospective randomized non blind study was undertaken in 104 patients of either sex, age group 35 to 65 with acute exacerbation of COPD. Patients were randomized in to either group odd or even number basis, one group received Non Invasive Ventilation (NIV) and other group received Invasive Mechanical Ventilation (IMV).Ease of ventilation was studied by serial estimation of tidal volume (TV), respiratory rate (RR), pressure support needed (PC above PEEP), PaCO2, Ph at 0 , 4th ,12th, 24th , 48th hr of Mechanical ventilation and at the beginning of weaning .Ease of weaning was studied in terms of time needed for weaning, Number of weaning trials attempted, Percentage of weaning failure, Complications faced. Results: The mean tidal volume requirement was more in NIV group when compared to IMV group. Mean of Respiratory rate at the time of admission in NIV group was high, and there was gradual reduction in respiratory rate over time. At the time of admission mean PaCO2, PaO2, Ph were not statistically significant in both the groups but with time the improvement in PaCO2 was better in IMV group when compared to NIV group (p value < 0.001) and the correction of ph was rapid in IMV group when compared with NIV group.(p value <0.001). Patients on IMV needed more time for weaning when compared to NIV group. More number of weaning attempts were required in IMV group. Conclusion: IMV was a better mode for maintenance and NIV was better for weaning and overall outcome of ventilation of COPD patient. So NIV may be preferred as mode of choice unless there is chance of complication due to it.

A Comparative Study of the Effects of Intrathecal Tramadol and Intrathecal Fentanyl as Adjuvants with 0.5% Bupivacaine Heavy in Lower Limb Surgery.

Background: The aim of this study is to compare the effects of tramadol and Fentanyl as intrathecal adjuvant to hyperbaric Bupivacaine in lower limb surgeries under spinal anaesthesia. Methods: 100 patients of ASA status I and II posted for lower limb surgery were randomly divided into two groups. Group T was administered Hyperbaric Bupivacaine 15 mg + tramadol 25 mg, group F was administered Hyperbaric Bupivacaine 15 mg + Fentanyl 25 μg. Hemodynamic parameters, duration and quality of sensory and motor block and any side effects were assessed. Results: Intrathecal tramadol and intrathecal fentanyl acted synergistically to potentiate bupivacaine induced sensory spinal block. Excellent surgical anaesthesia and an extended analgesia were observed in the post-operative period with minimum side effects in both groups. Conclusion: Addition of either intrathecal tramadol or fentanyl to bupivacaine produced comparable hemodynamic changes, post-operative analgesia and sensory blockade.

Preemptive Oral Gabapentin and Pregabilin for Post- Operative Pain Management after Surgery under Spinal Subarachnoid Block.

Background: Pregabalin has been used and found effective in preventing neuropathic component of acute nociceptive pain during and after surgery. We conducted a study to compare the effect of oral gabapentin and pregabalin on different block characteristics. Methods: A total of 90 ASA grade I and II patients posted for elective surgeries were randomized into 3 groups (groups A, B and C 30 patients each). One hour before entering into the operation theatre the blinded drug selected for the study was given with a sip of water. Group A – received identical placebo capsule, Group B-received 600 mg of gabapentin capsule and Group C- received 150 mg of pregabalin capsule. Spinal anaesthesia was performed at the L3-L4 interspace. 3.5 ml of 0.5% bupivacaine heavy injected over 30 sec through a 25 G spinal needle. VAS score at first rescue analgesia, mean time of onset of analgesia, level of sensory block at 5 min and 10 min interval, onset of motor block, total duration of analgesia and total requirement of rescue analgesia were observed. Hemodynamics parameters and side effects were recorded in all patients. Results: A significantly longer mean duration of effective analgesia in group C was observed compared with other groups (p<0.001). The mean duration of effective analgesia in group C was 535.16 ± 32.86 min versus 151.83 ±16. 21 minutes in group A and 302.00 ± 24.26 minutes in group B. The mean numbers of doses of rescue analgesia in the first 24 hours in group A, B and C were 4.7 ± 0.65, 4.1 ± 0.66 and 3.9 ± 0.614 respectively. (P value <0.001). Conclusion: We conclude that pre-emptive use of gabapentin 600mg and pregabalin 150 mg orally significantly reduces the postoperative rescue analgesic requirement and increases the duration of postoperative analgesia in patients undergoing elective surgeries under spinal anaesthesia.

A Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Hyperbaric Bupivacaine for Lower Limb Surgery: A Double Blind Controlled Study.

Background: The aim of this study is to compare the effects of Dexmedetomidine and Fentanyl as intrathecal adjuvant to Bupivacaine on the onset and duration of sensory and motor block in orthopaedic lower limb surgeries. Methods: Ninety patients of ASA status I and II posted for lower limb surgery were randomly divided into three groups. Group D was administered Hyperbaric Bupivacaine 15 mg + Dexmedetomidine 5μg in 0.5 ml normal saline, group F was administered Hyperbaric Bupivacaine 15 mg + Fentanyl 25 μg in 0.5 ml normal saline and group C were administered Hyperbaric Bupivacaine 15 mg plus in 0.5 ml normal saline. Duration and quality of sensory and motor block were assessed. Results: Sensory and motor block in-group D patients were longer than group F and C patients. Conclusion: Intrathecal dexmedetomidine when added to bupivacaine heavy (0.5%) provide better and prolonged analgesia in comparison to fentanyl.

Dexmedetomidine and clonidine as an adjuvant to epidural anaesthesia: A prospective randomized, double blind study of their effect on postoperative sensory and motor block characteristics.

Background: Many researchers have been done to find an ideal adjuvant to ropivacaine in regional anaesthesia that inhibits intra and post-operative pain and prolong the duration of anaesthesia without any side effects. Aim: This study was conducted to evaluate the onset, extent and duration of sensory and motor block and side effects of clonidine or dexmedetomidine when used as an adjuvant to ropivacaine in epidural anaesthesia in lower limb orthopaedic surgery. Methods: A prospective randomized study was conducted on 60 patients of American society of anaesthesiologists’ status I and II, posted for lower limb orthopaedic surgery. All patients were randomly allocated into two groups of 30 each; group I was ropivacaine - clonidine group (RC) and group II was ropivacaine - dexmedetomidine group (RD). Group I (RC) patients received 16 ml of 0.75% ropivacaine and clonidine 2 mcg/kg. Group II (RD) patients received 16 ml of 0.75% ropivacaine and dexmedetomidine 1.5 mcg/kg. The onset, extent, duration of sensory and motor blocks, and side effects were recorded. Results: Dexmedetomidine had a visible edge over clonidine as it enabled an earlier onset and longer duration of sensory and motor block. Sedation scores were statistically significant with the RD group in comparison to RC group. The RD group showed visible superiority over the RC group in various post-operative block characteristics like the weaning of sensory and motor block, prolonged post-operative analgesia. Conclusion: Dexmedetomidine was a better alternative to clonidine as an adjuvant to ropivacaine in epidural anaesthesia in orthopaedic lower limb surgeries.

The Effects of Two Different Doses of Clonidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block- A Randomized Controlled Study.

Background: Several clinical studies have shown that clonidine prolongs sensory motor blockade when used with bupivacaine but ideal doses of clonidine on ropivacaine is not well defined and to evaluate the effect of two doses of clonidine on ropivacaine, for supraclavicular brachial plexus blockade. Methods: In a prospective randomized double blind study supraclavicular brachial plexus blockade were performed in 80 patients using 35 ml ropivacaine (0.5%). Group A (n=40) had 2 μg/kg clonidine and in Group B (n=40) 1 μg/kg clonidine added to ropivacaine. Sensory and motor blockade was assessed every 5 min till 30 min and at 15 min interval thereafter. Results: Mean sensory onset time in group A was 10.42 ± 5.5 min and in group B was 15.83 ± 6.51 min, which was statistically significant. Patients of group A had a mean motor onset time 14.35 ± 7.8 min and patients of group B had a mean motor onset time 18.53 ± 7.61 min, the difference being statistically significant. Mean duration of sensory block in group A was 484.13 ± 63.1 min and in group B was 390.83 ± 72.63 min, which was statistically significant. Patients in-group A had a mean duration of motor block 550 +60.1 min and patients in group B had a mean duration of motor block 430.43+68.5 min, which was statistically significant. Conclusion: The addition of clonidine in dose of 2 μg/kg to ropivacaine for brachial plexus blockade, increases the onset and duration of motor and sensory block significantly.