Efficacy of Intra-articular Dexmedetomidine versus Buprenorphine for Postoperative Analgesia following Knee Arthroscopy: A Comparative Study.

BACKGROUND: Arthroscopic knee surgery is most commonly performed minimally invasive surgical procedure in orthopaedics. Postoperative pain relief is must for early mobilisation that reduces patient's morbidity and improves postoperative recovery. AIMS AND OBJECTIVES: We sought to compare analgesic efficacy of intraarticular buprenorphine with dexmedetomidine following arthroscopic surgery of knee. SETTINGS AND DESIGN: A prospective , randomized controlled double blinded study was conducted involving 60 patients undergoing arthroscopic knee surgery. MATERIALS AND METHODS: Patients were allocated into group B (n = 30) and group D (n = 30) receiving 100 µg of intraarticular buprenorphine and 100 µg of intraarticular dexmedetomidine respectively. Parameters observed were the time to first rescue analgesia , the number of patients requiring rescue analgesia with in next 24 hours, Visual analogue scale (VAS) at rest and on mobilization at 1st, 2nd, 4th, 8th, 12th and 24th hour. STATISTICAL ANALYSIS: Quantitative data were analyzed by unpaired student's t test and categorical data by Fisher's exact test. A P < 0.05 was considered to be significant. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS 19.0, SPSS Inc., Chicago, IL, USA). RESULTS: Time to first rescue analgesia was significantly longer in patients receiving in group B. VAS scores at rest were comparable between the groups at 1st, 2nd, 4th and 8th hour but significantly low with intraarticular buprenorphine than intraarticular dexmedetomidine at 12th and 24th hour. VAS scores on ambulation were comparable at 1st, 2nd and 4th hour but significantly higher in dexmedetomidine group as compared to buprenorphine at 8th, 12th and 24th hour. CONCLUSION: Intraarticular buprenorphine 100 µg provides longer duration of analgesia with decreased postoperative rescue analgesic requirement as compared to 100 µg intraarticular dexmedetomidine.

Gossypiboma complicated with paraspinal abscess and lumbar sinus: An uncommon complication of posterior lumbar spinal surgery.

A 42-year-old female presented with the complaint of purulent discharging sinus over posterior lumbar area following one month of lumbar spinal surgery for prolapsed intervertebral disc. Gossypiboma complicated with paraspinal abscess and sinus track formation over posterior lumbar area was diagnosed in magnetic resonance imaging which was confirmed in re- exploration of lumbar spinal operative site.

Acute hemorrhage within intradural extramedullary schwannoma in cervical spine presenting with quadriparesis.

Schwannoma with acute hemorrhage is rarely seen. A 44-years-old male patient presented with complaint of neck pain and acute onset of quadriparesis. Magnetic resonance imaging (MRI) of his cervical spine revealed evidence of an intradural extramedullary tumor with intratumoral acute hemorrhage. He was operated in emergency and the mass was found to be schwannoma with acute hemorrhage. Post operatively the patient improved significantly. Though schwannomas show microscopic intratumoral hemorrhage and necrosis at times, schwannoma with acute hemorrhage resulting acute onset of neurological deficit is very uncommon.