Paravertebral nerve block vs general anaesthesia in cancer breast surgery

The aim of this study to evaluate the effect of thoracic paravertebral nerves block[PVB] as an alternative for general anaesthesia [GA] in cancer breast surgery on haemodynamic, stress responses, pulmonary function tests[PFT] and postoperative pain relief. Fifty patients undergoing for elective simple mastectomy and clearance of axilla allocated for 2 groups. Group 1 [GAG] and group II [PVB]. All patient premedicated by fentanyl 1micro g/kg and 40 micro g midazolam. Group 1 [GAG] received general anaesthesia by propofol 2 mg/kg and 80 mirco g / kg vecuronium and anaesthesia was maintained by gas, oxygen and isoflurane. In PVB group single injection of 0.3 mg/kg bupivacain 0.5% at T4 spine and the patients were sedated by propofol infusion. PVB decreased HR, MABP, blood glucose and plasma cortisol significantly when compared with GAG and significantly improved pulmonary functions tests [FVC and FEVI]. PVB produced significant increase in duration of analgesia and decreased visual analogue scale scores [VAS] when compared with GA. PVB with bupivacain 0.5% at T4 in conjunction with intraoperative sedation was safe and effective for surgical anaesthesia in patient undergoing major breast surgery and attenuated the stress response to surgery and provided complete pain relief postoperative

Addition of low dose meperidine [pethidine] to bupivacaine spinal anaesthesa: effects on shivesing and characteristics of block

The aim of this study was to investigate whether prophylactic intrathecal 20mg meperidine added to 0.5% hyperbaric bupivacaine would influence the incidence and severity of shivering in patients receiving spinal anaesthesia and whether it would affect the duration of sensory and motor blockade as well as postoperative analgesia Eighty patients of ASA physical status I or II presenting for surgery of inguinal hernia were divided into two equal groups according to the type of solution injected in the subarachnojd space. Patients of group I received 2Omg meperidine in addition to 0.5% bupivacaine while patients of group II received 0.5% bupivacajne alone. Shivering occurred in 5% of patients of group I and in 70% of patients in group II No single patient in group I experienced grade 2 or 3 shivering. The duration of sensory and motor blockade was significantly prolonged with addition of meperidire. Prolonged postoperative analgesia was obtained in meperidine - bupivacaine group which lasted for 19.4 +/- 4.5 hours compared to 9.6 +/- 2.8 in bupivacaine group. 70% of patients had no pain and required no analgesia up to 24 hours as regards complications pruritis occurred in the first group only [5 patients] which was experienced in the face and upper chest No early or late respiratory depression occurred in first group. it can be concluded that intrathecal 20mg meperidine added to bupivacaine reduced significantly the incidence and severity of shivering and significantly prolonged the duration of sensory and motor blockade as well as Postoperative analgesia with no deleterious effects on patients