RESUMO
Background: Post dural puncture headache (PDPH) is a serious complication of spinal anaesthesia and incidence is more particularly in parturient. Aims & Objective: The present study was designed to investigate the use of 27 Gauge (G) spinal needle for spinal anaesthesia in Caesarean section in terms of success and PDPH rate. Material and Methods: We included total 50 female patients of aged 20-40 years old, were administered spinal anaesthesia with 27G Quincke spinal needle for Caesarean section by same investigator having enough experience. Redirections and attempts for lumbar puncture, success rates of spinal anaesthesia and PDPH were recorded. Results: We succeeded in 49 patients (98%) to administer spinal anaesthesia. The mean attempt and redirections for lumbar puncture were 1.1 and 1.24 respectively. We found PDPH in 1 patient (2%), which was mild in severity and subsided within two days. Conclusion: Spinal anaesthesia using a 27G Quincke spinal needle, in experienced hands can have successful spinal block with reduced PDPH rates in patients undergoing Caesarean section.
RESUMO
Background: Unavailability of ultrasound and unpredictable success with traditional blind technique makes Transversus Abdominis Plane Block under-utilized in developing country like India. Aims & Objective: The present study was designed to evaluate the analgesic efficacy of Surgeon-assisted Transversus Abdominis Plane Block as an adjuvant to routine analgesic in reducing pain score during first 12 hours postoperatively in patients undergoing open cholecystectomy. Material and Methods: This was randomized, double-blinded, controlled, clinical trial carried out in tertiary care, teaching hospital. All the patients received a routine general anaesthesia with standard monitoring. Group A received routine analgesic which included Diclofenac sodium 75 mg intravenously (IV) at 8 hourly and group B received routine analgesic & Transversus Abdominis Plane Block with 15 ml of bupivacaine 0.25% at the end of surgery. Visual analogue score for pain, incidence of post-operative nausea and vomiting and demand of rescue opioid (Tramadol 2 mg/kg IV) in post-operative period were assessed every 2 hourly up to 12 hours after the surgery by an investigator blinded to group allocation. Results: Transversus Abdominis Plane block reduced visual analogue scale for pain on emergence and at all postoperative time points up to 12 hours (p < 0.0009). The incidence of post-operative nausea and vomiting, and demand of rescue opioid in the first 12 postoperative hours were also reduced (p < 0.0001). There were no complications attributable to the block. Conclusion: Transversus Abdominis Plane Block is effective as an adjuvant to routine analgesic to reduce pain after open cholecystectomy and reduces post-operative opioid demand and nausea & vomiting.