Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia.

BACKGROUND AND AIMS: Adductor canal block (ACB) is now an established component of multimodal analgesia for knee replacement surgery and is slowly replacing femoral nerve block (FNB). It is also gaining popularity for providing pain relief in knee arthroscopies including anterior cruciate ligament reconstruction surgery (ACLR). Data is lacking from the Indian subcontinent on comparing ACB to the traditional FNB for ACLR. Hence, we conducted the present study to compare ACB and FNB in ACLR under general anesthesia. MATERIAL AND METHODS: Sixty patients were randomized to receive either ACB or FNB under ultrasound guidance. Postoperatively, quadriceps muscle strength (straight leg raise and time up and go; TUG test) and quality of analgesia (numeric rating scale; NRS and patient satisfaction score) were assessed every 6 hour, and thereafter, up to 48 hours. The time of rescue analgesia and total analgesic consumption (tramadol) were also recorded. Data was statistically analyzed and P < 0.05 was considered to be significant. RESULTS: Patients receiving ACB had significantly less quadriceps weakness (P < 0.001) compared to FNB on postoperative day (POD) 1. In addition, patient satisfaction score was statistically higher (P < 0.05) in FNB on POD1. Both the above parameters were comparable on POD2. No statistically significant difference was recorded in NRS, time for rescue analgesia, and total analgesic consumption among the two groups. CONCLUSION: ACB preserves quadriceps motor strength while providing analgesia comparable to FNB in patients undergoing ACLR. However, patient satisfaction score is better with FNB than ACB.

The Analgesic Efficacy of Dexamethasone Added to Ropivacaine in Transversus Abdominis Plane Block for Transabdominal Hysterectomy under Subarachnoid Block.

BACKGROUND AND AIMS: Ultrasound-guided transversus abdominis plane (TAP) block has been proven as a safe and effective analgesic technique for several lower abdominal surgeries. Various adjuvants have been used to intensify the quality and prolong the local anesthetic effect. We evaluated the analgesic efficacy of dexamethasone addition to ropivacaine in TAP block following open abdominal hysterectomy. MATERIALS AND METHODS: After clearance from the Institutional Ethics Committee, a double-blind, prospective, randomized study was carried out on sixty patients aged 40-60 years posted for elective open abdominal hysterectomy comparing bilateral TAP block using 20 ml of 0.5% ropivacaine + 1 ml of 0.9% saline (control Group R) or 20 ml of 0.5% ropivacaine + 4 mg dexamethasone (Group RD). The aim of our study was to observe postoperative pain score (visual analog scale [VAS]), time for first analgesic (TFA) demand, total analgesic consumption, and incidence of nausea or vomiting. STATISTICAL ANALYSIS: Chi-square test and Student's t-test were used, and P < 0.05 was considered as statistically significant. RESULTS: Postoperative VAS pain scores were significantly lower at 4, 6, and 12 h in Group RD as compared to Group R (P < 0.05). Significantly longer TFA (13.2 ± 7.6 vs. 7.1 ± 4.6 h, P < 0.001) with lesser tramadol requirement in first 24 h (50.2 ± 34 vs. 94 ± 35 mg, P < 0.001) were observed in Group RD as compared to Group R. Incidence of nausea or vomiting was statistically insignificant between the groups (P > 0.05). CONCLUSIONS: Addition of dexamethasone to ropivacaine TAP block prolonged the postoperative analgesia and reduced analgesic requirement following abdominal hysterectomy.

Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy.

CONTEXT: Spinal anesthesia (SA) was combined with general anesthesia (GA) for achieving hemodynamic stability in laparoscopic hysterectomy. AIMS: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. SETTINGS AND DESIGN: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. MATERIALS AND METHODS: Patients were randomly assigned to receive SA with GA (group SGA) or plain GA (group GA). Group SGA received 10 mg bupivacaine (heavy) for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. STATISTICAL ANALYSIS USED: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA) was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR), mean arterial pressure (MAP), SPO2, and etCO2 was done with Student's t-test or Mann-Whitney test, wherever applicable. RESULTS: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01). Group GA showed additional requirement of metoprolol (53.33%) and higher concentration of isoflurane (P < 0.001) to combat the increased MAP. Recovery was early and quick in group SGA as against group GA (P = 0.000). There were no adverse/residual effects of SA. CONCLUSION: The hemodynamic repercussions during pneumoperitoneum can be effectively attenuated by combining SA and GA, without any adverse effects.

Twin pregnancy with HELLP syndrome complicated with acute renal failure for emergency cesarean section: An unusual case and its anesthetic management.

Acute renal failure is not common in pregnancy. However, the incidence rises when pregnancy is complicated with Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP) syndrome, which itself is a rare occurrence. We had an unusual case of HELLP syndrome in twin pregnancy with deranged renal profile for emergency cesarean section. We report the case, its anesthetic management for emergency cesarean section, and perioperative supportive treatment for acute renal failure.

Dexmedetomidine as an anesthetic adjuvant in laparoscopic surgery: An observational study using entropy monitoring.

BACKGROUND: Dexmedetomidine is a highly selective α(2) agonist with properties of sedation, analgesia and anxiolysis, making it an ideal anesthetic adjuvant. Using an anesthetic adjuvant that decreases requirement of anesthetics and analgesics may predispose the patient to awareness. We monitored the depth of anesthesia (DOA) using entropy to avoid unwanted awareness under anesthesia. MATERIALS AND METHODS: 30 patients, American Society of Anesthesiologists grade I and II, aged between 18 to 50 years of either gender undergoing laparoscopic surgeries under general anesthesia were studied. Loading dose infusion of dexmedetomidine was started 1 mcg/kg for 15 minutes and patients were premedicated. Routine induction with propofol and fentanyl was carried out, and maintenance infusion of dexmedetomidine 0.2 mcg/kg/hr was given. Patients were monitored with standard monitoring, and in addition, the DOA was monitored with entropy. RESULTS: A 62.5% reduction (0.75 mg/kg) in the induction dose of propofol was observed, with a 30% less end-tidal concentration of isoflurane requirement for maintenance of anesthesia, while maintaining the adequate DOA. CONCLUSION: Dexmedetomidine is an effective anesthetic adjuvant that can be safely used in laparoscopy without the fear of awareness under anesthesia.

A very rare case of Cushing's disease for cesarean section: What the anesthesiololgist needs to know.

Cushing's syndrome is uncommon in pregnancy, and Cushing's disease being the cause for this syndrome is still rare. We had the opportunity to manage such a patient admitted for cesarean section. Here, we describe the evaluation of a patient with Cushing's syndrome in pregnancy along with its anesthetic implications. By describing this case, we intend to emphasize the role of the anaesthesiologist as a peri operative physician.

Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia.

Sixty ASA grade I/II patients scheduled for elective short laparoscopic procedures under spinal anaesthesia were divided into two groups of 30 each. The first group (group C) received 3.5 ml of hyperbaric bupivacaine with 30 mcg of clonidine. The second group (group B) received plain bupivacaine 3.5 ml. Till date, the limiting factor for use of spinal anaesthesia for laparoscopy was patient's discomfort due to shoulder tip pain. From our study it can be concluded that bupivacaine along with clonidine in low doses provides good sedation and analgesia in intraoperative and post-operative period and at the same time abolishes shoulder tip pain during laparoscopic procedures. In addition, no significant changes in haemodynamics occur with the low dose of clonidine used.