Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Low-quality scientific evidence for the continuation of universal Vitamin A supplementation among under 5 children in India.

Vitamin A supplementation (VAS) is presently being undertaken in India among under 5 (U5) children for two possible benefits (i) to prevent nutritional blindness due to Vitamin A deficiency (VAD) and (ii) to reduce U5 mortality. The existing scientific evidence suggests that nutritional blindness due to VAD has been virtually eliminated and also the difference between U5 mortality rate and infant mortality rate is very low for VAS to have any meaningful impact. On the contrary, scientific evidence indicates that there could be side effects of the administration of mega dose of Vitamin A (MDVA). These side effects of MDVA have not been systematically investigated. The universal VAS should be discontinued immediately as there are no likely benefits to U5 children.

Impact of Sex of The Previous Child on the Out Come of Subsequent Pregnancy.

Survival of the semi allogeneic fetus in uterus without rejection is an immunological paradox . The antigenic dissimilarity is pronounced when XX mother Carries an XY fetus Pervious birth of a boy negatively affects the obstetrical future in female where these has been a supposed failure of immunological tolerance of pregnancy. Out of all the obstetrical complication assessed, IUGR turned out to be the most strongly associated with pervious Male Baby. PIH turned out to be the most common complication associated with pregnancy. Rate of LBW was also significantly more in women with previous male child. Oligo - hydromnios was also found to be significantly associated with history of having previous male child. PROM was also seen more frequently in cases that had a preceding male child. Pre -Eclampsia was also significantly associated with history of having a previous male child. A total of 1350 cases were studied. As expected, 64.89% of the cases included in the study went uneventful. There were 22.52 % vs. 12.59% eventful pregnancies in women with previous male and previousfemale child respectively (p = 0.0001).27.04% pregnancies went uneventful in women with previous male compared to 37.85% in women with previous female child (p = 0.0001).The study clearly shows that there is a lesser predilection of obstetrical mishaps happening to women whose first child is a female compared to those who have a previous male child.