Thoracic epidural for post-thoracotomy and thoracomyoplasty pain: a comparative study of three concentrations of fentanyl with plain ropivacaine

Optimum pain relief after thoracotomy is essential to reduce atelectasis and postoperative pneumonias. The aim of this prospective, double blind, randomised controlled trial was to compare the analgesic and adverse effects of three concentrations of fentanyl with 0.2% ropivacaine in thoracic epidural in patients undergoing thoracotomy and thoracomyolpasty. After getting approval from Ethical Committee, this study was performed in 60 patients of either sex, aged 18-60 years, American Society of Anaesthesiology [ASA] grade I to III. Informed consent was taken from all of the patients, who were recruited and divided into three groups of 20 patients in each group. Patients scheduled for elective thoracotomy surgery were enrolled in the study. Patients with preexisting motor and sensory deficit, addicted to hypnosedative drugs, on chronic opioid or analgesic therapy, sensitive to local anaesthetic or study medication, or having contraindications to regional anesthesia were excluded from this study. In patients, with whom communication difficulties prevented reliable assessment, were also excluded. Patients received either 2.5micro g/ml [Group I], 5.0micro g/ml [Group II] or 7.5micro g/ml of fentanyl [Group III] respectively, with ropivacaine 0.2% via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation was assessed using a visual analogue scale [VAS] and observer verbal ranking score [OVRS] at 2, 6, 12 and 24 hours. Sedation scores were also noted. Adverse effects were simultaneously assessed. There was no significant difference in the baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain relief, i.e. a VAS scores >40 and OVRS >2, at each of the four assessments postoperatively, was higher in Group I than with Group II or Group III [p < 0.05]. In Group III, four [20%] patients had a sedation score >3 compared with one [5%] in Group II. No patient in Group I had a sedation score >3 [p < 0.05]. In addition, all patients experienced pruritus in Group I compared with 10% and 5% in Group II and Group I respectively. 30% of the patients had emetic symptoms in Group III, compared to 20% and 5% in Group II and Group I respectively [p < 05]. We conclude that a thoracic epidural bolus of 10 ml ropivacaine 0.2% with fentanyl 5.0 micro g/ml provides the optimal balance between pain relief and sedation

Airway management in a patient with a large mass in scapular region: a case report

Airway management is one of the most important routine tasks performed by an anesthesiologist. Adept airway management is an essential skill for an anesthesiologist. Although practice guidelines and algorithms may help in such situations, but vigilance and a timely decision remain all important in such a situation. We encountered a patient with a rapidly enlarging subscapular mass due to which maintenance of supine position on the operating table for laryngoscopy and intubation was almost impossible. We had little options for airway management during general anesthesia in this patient. We present our method of successful management in this case and reiterate the role of different methods of correct positioning and intubation in such circumstances

comparative study of the effect of parentral and oral glutamine on biochemical parameters and on the duration of ICU stay in critically ill patients

To study the comparative effects of parenteral and oral glutamine therapy on biochemical parameters and reduction in the hospital stay of critically ill patients. Randomized controlled trial. 120 critically ill patients aged 16-60 years admitted to Trauma Ventilatory Unit, Trauma centre King George Medical University, Lucknow. The patients were randomly divided into 3 equal groups, 40 in each group: Group A [control group] received no glutamine; Group B received oral glutamine 20 g/d for 5 days and Group C received l-alanyl-l-glutamine dipeptide 0.3 g/kg/d by intravenous infusion for 5 days. Complete blood count was done at regular intervals of 24 hours. Total proteins and serum albumin were recorded at 5 day intervals. Single blinding was done. The total leukocyte counts [TLC] levels in all the three groups increased after the treatment and the observed increase was least evident in Group C [18.7%], followed by Group B [32.5%] and it was the highest in Group A [38.2%]. A similar observation was made for CRP and lymphocyte levels in all of the three groups. However, a significant decrease was found in total protein and albumin levels. The mean duration of hospital stay of Group C was the least followed by Group B and Group A. Parenteral glutamine in a dose of 0.3 g/kg/d was more efficacious than 20 g/d oral glutamine in increasing/decreasing in the biochemical parameters after the therapy. The duration of hospital stay was similar in all the groups after treatment

Japanese encephalitis

We present a case of Japanese encephalopathy, which posed serious problems during diagnosis as well management. Our patient had to be nursed in ICU and mechanically ventilated for a prolonged period [more than 50 days] and was successfully weaned, but with difficulty and with sustained and careful monitoring and flexible planning. A multispecialty approach made all the difference between life and death

Comparative study of intrathecal hyperbaric versus isobaric ropivacaine: a randomized control trial

Hyperbaric ropivacaine produce more reliable sensory and motor block, with faster onset, better quality of muscles relaxation than isobaric ropivacaine. So, this study was designed to compare the efficacy of hyperbaric ropivacaine with isobaric ropivacaine in patients undergoing lower abdominal surgery. A randomized controlled double blind study in two groups of patients. group A [n=35] received 3 ml of isobaric ropivacaine 6 mg/ml [18 mg]. Group B [n=35] received 3 ml of hyperbaric ropivacaine 6 mg/ml [18 mg]. The onset and duration of sensory block at dermatome level T10, maximum upper and lower spread of sensory block, intensity, and duration of motor block were recorded. Block characteristics were compared using the two-tailed Mann - Whitney U-test. The proportion of side effects was compared using the Chi-square test. The median time of onset of sensory block at the T10 dermatome was 4.4 +/- 1.3 min in group B and 6.0 +/- 1.03 min in group A. The median time to maximum block height was 16.7 +/- 3.7 min in group A and 12.03 +/- 1.96 min in group B. The median duration of complete motor recovery [B0] was significantly shorter in the heavy ropivacaine group [166.5 +/- 11.7 min] compared with the isobaric ropivacaine group [192.9 +/- 9.6 min]. Intrathecal hyperbaric ropivacaine provides more rapid, adequate, and good quality of sensory and motor block with rapid post-operative recovery as compare to isobaric ropivacaine