Evaluation of intraperitoneal bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: a prospective randomized trial

This study was conducted to evaluate the quality and duration of postoperative analgesia with intraperitoneal instillation of 0.5% bupivacaine after laparoscopic cholecystectomy. In a prospective, randomized, double blind, placebo controlled study, 60 ASA grade I and II female patients of age groups 20-60 yrs, undergoing elective laparoscopic cholecystectomy under general anesthesia were equally distributed into two groups. In Group B [study group] 20 ml of 0.5% bupivacaine and in Group S [placebo group] 20 ml of normal saline were injected intraperitoneally after gall bladder extraction. A visual analogue scale which consisted of a 10 cm scale with markings at equal intervals, where 0 represented no pain and 10 represented worst imaginable pain, was used to assess postoperative pain at predetermined time intervals. Two way repeated AN OVA test was used for studying inter group variation in different parameters over time. Pearson chi square test and unpaired t-test was applied to analyze differences in categorical and numerical variables respectively. A p value <0.05 was considered significant. The mean VAS score was less in Group B compared to Group S at all time intervals. VAS score showed greater decline between 1st and 2nd hour in Group B as compared to Group S. No difference was observed in total intra operative dose [in/xg] of fentanyl [127.5 +/- 12.0 vs. 126.7 +/- 13-0, p>0.05] and frequency of postoperative analgesic use [3.97 +/- 0.85 vs. 3-93 +/- 0.83, p>0.05] in Group S vs. Group B respectively. Intraperitoneal bupivacaine provides a simple technique to be used as a part of multimodal approach even though exclusive use of intraperitoneal bupivacaine as a mode of pain relief is not adequate. Use of the correct volume, dose and concentration of drug to bring about this result is of essence

Anesthetic management for removal of a huge intra-abdominal tumor: a case report

Large ovarian tumors are not very uncommon in rural India and developing countries, due to delayed reporting by the patients to the scarce healthcare facilities available, hence anesthesiologists must be aware of the anesthetic challenges that one may have to face in these cases. We report perioperative anesthetic management for a large ovarian tumor which was successfully removed. The tumor weighed 32 kg with a fluid volume of 15 lit

Comparison of intravenous butorphanol, ondansetron and tramadol for control of shivering during regional anesthesia: a prospective, randomized double-blind study

We conducted this study to compare the efficacy and safety of butorphanol, ondansetron and tramadol for control of shivering in patients undergoing surgical procedures under spinal anesthesia. In this prospective double-blind, randomized, controlled study, 150 patients of both genders, 18-60 years old, ASA I or II, booked for elective surgery under spinal anesthesia were randomly distributed into three groups of 50 each. Each patient, who developed shivering, was given either 0.03 mg/kg of inj. butorphanol 1% [Group-B], 0.06 mg/kg of inj. ondansetron [Group-O] or 1.0 mg/kg of inj. tramadol 1% [Group-T] IV. Demographic characteristics, incidence of shivering, response rate after 1, 3, 5, 10 and 20 min, recurrence rate, hemodynamic parameters and complications were observed. All patients were relieved of shivering after butorphanol; 66.6% of them were relieved within 1 min, 93.33% within 3 min and 100% within 5 min. Ondansetron could relieve shivering in only 29.4% of the patients; 5.88% within 1, 11.76% within 3, 23.52% within 10 and 29.4% within 20 min. Tramadol relieved shivering in 92.30%; 46.15% within 1, 84.61% within 3 and 92.30% within 5 min respectively [p < 0.05]. Recurrence of shivering was observed in 26.67% of butorphanol group and 15.38% of tramadol group [p> 0.05]. Ondansetron was not found to be much effective for the control of shivering during regional anesthesia. Butorphanol and tramadol were equally effective in controlling shivering under regional anesthesia, the only difference being in their onset of action. Butorphanol was quicker in onset which is essential for control of shivering and should be preferred

Anesthetic considerations in Morquio syndrome: a case report

Anesthetic challenges in Morquio syndrome include the respiratory problems due to restrictive defect in the thoracic cage, upper airway obstruction during head flexion, atlantoaxial instability and compression of the cervical spinal cord due to hypoplasia of the dens, complicating intubation. After pre-anesthetic check up and informed written consent, the patient was premedicated with glycopyrrolate 0.08 mg and fentanyl 10 mcg. Induction was done with inhalational anesthetic agent sevoflurane along with Oxygen [O[2]] and Nitrous oxide [N[2]O] maintaining the spontaneous respiration. Intubation was done with Flexo metallic tube [FMT] no. 24 through right nostril avoiding forceful movements at atlantoaxial joint and cervical spine. Maintenance and recovery was uneventful. Paramount in the anaesthetic care of such patients is a thorough preoperative evaluation of airway in addition to cardiac, respiratory, neurological function. Inhalational induction technique may be useful in difficult intubation

Comparison of different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section

The necessity to find out the lowest possible effective dose of clonidine to avoid its known side effects like hypotension, bradycardia and sedation prompted us to design present study. We compared different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia in patients undergoing caesarian section aiming to find out the lowest possible effective dose. In a prospective, double-blind, randomized controlled study, 60 parturients 18 to 35 years of age, ASA grade I or II, posted for caesarian section were randomly distributed into three equal groups, BC60, BC30 and BC15. Patients were given 2.0 ml of hyperbaric bupivacaine 0.5% with 60 micro g, 30 micro g or 15 micro g of clonidine intrathecally respectively. Hemodynamic parameters, onset, peak and duration of sensory and motor block, level of sedation and duration of postoperative analgesia were compared. All groups were comparable with respect to demographic profile, onset, peak and duration of sensory and motor block and overall hemodynamic stability. We observed dose dependent variability in duration of analgesia and sedation. Duration of analgesia was significantly higher in BC60 group as compared to the other two groups [598.7 +/- 140.47 vs. 436.65 +/- 149.84 and 387.1 +/- 97.05 minutes respectively]. Sedation was also more in BC 60 group. Addition of 60 micro g clonidine to intrathecal bupivacaine provides longer duration of postoperative analgesia than 15 micro g or 30micro g but with more sedation. We get fairly good analgesia with less sedation in 15micro g and 30micro g clonidine and are better options when sedation is not desirable