Effect of microcurrent skin patch on the epidural fentanyl requirements for post operative pain relief of total hip arthroplasty

Major orthopedic surgery that cause considerable pain like total hip arthroplasty, requires good post operative pain management. Microcurrent therapy [MCT] is a new therapy whereby electric current is provided in literally millionth of an ampere. MCT comes as two self adherent active electrode patches linked by a cable efficacy of MCT in the management of musculoskeletal pain and enhancement of wound healing has been reported. To study the effect of microcurrent therapy [MCT] on the epidural fentanyl requirements and degree of wound healing after total hip arthroplasty. Twenty eight patients undergoing total hip replacement [THR] were randomly allocated into two groups. Group I: had micro current skin patches [two adhesive electrode] attached above the site of operation in addition to the lumbar epidural catheter. Post operative epidural fentanyl infusion with a syringe pump given at a rate ranged between 25 and 75 microgram per hour to keep visual analogue pain score [VAS] less than 3/10. Group II had only continuous epidural infusion with fentanyl at the same range to keep VAS less than 3/1 without MCT. There was statistically significant lower mean epidural fentanyl requirement in Group I [23.24 microgram] when compared to Group II [58.36 microgram]. There was 23% incidence of dermatitis in Group I due to application of micro-current skin patch which resolved by treatment. There was statistically significant higher frequency of grade 1 of wound healing in the microcurrent group [41.3%] when compared to Group II [7.2%]. Grade 2 and 3 were more frequent in Group II] The microcurrent skin therapy lead to reduction in the requirements of the post operative epidural fentanyl with improvement of degrees of wound healing but with considerable incidence of skin dermatitis after total hip arthroplasty

Propofol pharmacokinetics in infants

Infant and children differ markedly from adult patients. Since the production of propofol, it has gained popularity as an agent for both induction and maintenance of anaesthesia for adults and children. There has been a lack of pharmacokinetic studies in children less than 3 years. Was to determine the complete pharmacokinetic profile of propofol in infants [2-24 months]. Forty eight patients were randomly assigned into 4 groups, each group has 12 patients. They were scheduled to undergo superficial body surgery of I hour expected duration. Venous blood samples were collected and analyzed used high performance liquid chromatography [HPLC].Non linear mixed effects modelling [NONMEM] software program was used to analyze the pharmacokinetic data. The pharmacokinetic of propofol in infants followed two compartement model with systemic clearance -[Cl] 29.77 +/- 9.46 ml kg[-1] min[-1], central volume of distribution [Vc] 0.62 +/- 0.24 l kg[-1], and the volume at steady state [Vss] 1.67 +/- 0.26 l kg[-1]. The context sensitive half life [HL] was 0.24 +/- 0.02 h. The infants have a larger volume of distribution and a higher clearance of propofol. Therefore, the induction and maintenance doses should be increased in this young age with using population based pharmacokinetic parameters for accurate propofol dosing strategy

Analgesia for tracheoesophageal fistula repair in neonates: a comparison of single shot thoracic paravertebral block and epidural block with ropivacaine

Perioperative pain treatment in neonates is often insufficient .we aimed to compare a single shot thoracic paravertebral and epidural block with ropivacine for analgesia of tracheoesophageal fistula repair in neonates. This study was carried out on 24 neonates, they were randomly allocated into two groups after general anesthesia, Group I had a single shot unilateral thoracic paravertebral block with 1ml/kg body weight of ropivacaine 0.375% and Group II had thoracic epidural block with 1ml/kg body weight of 0.375% ropivacaine. Mean heart rate and blood pressure, Mean concentration of Sevoflurane, neonatal infant pain Score [NIPS] were measured in both groups. There was no statistically significant difference in the mean sevoflurane concentration in both groups [2.1 +/- 0.34%] in group I versus 1.9 +/- 0.8%] in group II, There was statistically significant more decrease in the heart rate and mean blood pressure in the paravertebral group more than the epidural group. There was also equianalgesia effect regarding NIPS in both groups but longer duration of analgesia in the paravertebral group. Thoracic paravertebral block has equianalgesia effect with longer duration of analgesia and less decrease in the heart rate and mean blood pressure when compared to t horacic epidural block for analgesia of tracheoesophageal fistula repair in neonates

Effect of intravenous administration of dexmedetomjdine on the duration of caudal analgesia with ropivacaine in pediatrics

Dexmedetomidine is a highly selective alpha 2 agonist with potential utility in clinical anaesthesia for its sedative, anesthestic sparing and smypathlytic properties.Rrecent studies has reported a spinal site of action of dexmedetomidine in animals. The aim of the present study was to detect the effect of prior intravenous administration of dexmedetomidine on the duration of caudal analgesia with ropivacaine in pediatrics. This study was carried out on 34 children ASA I or II, age range between 2 and 4 scheduled for elective hypospadius repair, they were randomly allocated into two groups each 17 patients, Group I [Dexmedetomidine group] received 1 microgram /kg of dexmedetomidine in 50 ml of normal saline infused over 10 minutes just before genral anaesthesia and caudal analgesia with ropivacaine 0.375% of volume 0.75 ml l kg. Group II, 50 ml normal saline infused before general analgesia and the same caudal analgesia as in group I. Hear rate and blood pressure, post operative pain score by Toddler preschooler post operative pain score [TPPPS] and time of first administration of analgesics in both groups. There was statistically significant lower TPPPS in group I at 120, 150, 180, 210, 240, 300 minutes [3.2 +/- 0.7, 3.5 +/- 1.3, 3.6 +/- 1.2, 3.9 +/- 1.2, 4.6 +/- 0.3, 3.6 +/- 1.2] respectively when compared to group II at the same time of measurements TPPPS was [4.9 +/- 0.6, 5.1 +/- 1.4, 5.6 +/- 0.7, 5.4 +/- 1.2, 5.7 +/- 1.2, 4.9 +/- 2.3] respectively. Intravenous administration of dexmedetomidine prior to caudal analgesia with ropivacaine has an advantage of prolongation of low post operative pain sore in pediatrics