RESUMO
BACKGROUND: Peripheral nerve blocks have taken over as the principle technique for upper limb surgeries. A number of adjuvants have been tried individually, but very few studies have investigated the cumulative effect of two or more adjuvants given together along with local anesthetic. AIM: This study aimed to evaluate the effect of addition of sodium bicarbonate to dexamethasone and ropivacaine in supraclavicular brachial plexus block. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) 1 and 2 patients posted upper limb orthopedic procedures. MATERIALS AND METHODS: Ninety ASA 1 and 2 patients were selected and divided into three groups of 30 each: Group R received 30 mL of 0.75% ropivacaine plus 4 mL normal saline; Group RD 30 mL of 0.75% ropivacaine, 2 mL normal saline and 2 mL of dexamethasone were given; Group RB 30 mL of 0.75% ropivacaine plus 2 mL of dexamethasone and 2 mL of sodium bicarbonate. Onset and duration of sensory and motor block and postoperative pain scores were studied in each group. STATISTICAL ANALYSIS: Student's independent t-test was employed for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal-Wallis test was used for postoperative pain score data. RESULTS: Addition of sodium bicarbonate to dexamethasone and ropivacaine quickens onset and prolongs duration of sensory and motor block. CONCLUSION: Sodium bicarbonate produces a synergistic and potentiating effect with dexamethasone as adjuvant in supraclavicular brachial plexus block.
RESUMO
BACKGROUND: Traditional analgesics such as diclofenac and celecoxib have long been used in lumbosacral spine surgeries. Recently, preemptive single-shot caudal analgesia has been investigated by some workers with favorable results. We hypothesized that the thoracic route would not only allow preemptive but also postoperative analgesia through catheter insertion. AIM: We aimed at studying the feasibility and efficacy of thoracic epidural analgesia (TEA) in lumbosacral spine surgeries. SETTINGS AND DESIGN: This was a prospective, randomized, controlled study that comprised 60 American Society of Anesthesiologist (ASA) Physical Status I and II patients posted for lumbosacral spine surgeries. MATERIALS AND METHODS: Sixty ASA I and II patients were randomly divided into two groups: Group T - TEA was given using 0.2% ropivacaine 10 mL preemptive and postoperatively. Group C patients were given analgesia with intramuscular diclofenac 75 mg. Hemodynamic parameters, postoperative Visual Analog Scale scores, and neurological complications were noted. STATISTICAL ANALYSIS: Student's independent t-test for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal-Wallis test was used for postoperative pain data. RESULTS: Duration and quality of analgesia were superior in Group T. There were more hemodynamic alterations in Group C but no neurological complication in any patient. CONCLUSION: TEA proves to be an effective analgesic technique for lumbosacral spine surgeries.
RESUMO
BACKGROUND: Caudal anesthesia has emerged as a reliable and effective anesthetic technique in the pediatric age group. However, the limited duration of action of the local anesthetic drugs proves to one of the major hindrances in the complete utilization of caudal block as an effective analgesic technique. To overcome this shortcoming, adjuvant drugs were introduced into clinical practice. AIM: Our aim was to determine which of the two drugs - dexamethasone and tramadol - serves as a better adjuvant for caudal analgesia in pediatric patients. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anesthesiologist (ASA) physical status I and II pediatric patients posted for lower abdominal surgeries. MATERIALS AND METHODS: Ninety ASA physical status I and II children aged 5-12 years posted for lower abdominal surgeries were chosen. They were randomly divided into three groups - Group R received 0.5 ml.kg-1 of 0.2% ropivacaine plus 0.9% normal saline; Group T received 0.5 ml.kg-1 of 0.2% ropivacaine plus 2 mg.kg-1 tramadol; and Group D received 0.5 ml.kg-1 of 0.2% ropivacaine plus 0.1 mg.kg-1 dexamethasone. Postoperative pain was assessed using a modified objective pain score and time to first rescue analgesia (duration of sensory block) was recorded. Postoperative sedation and any other postoperative adverse effects were noted. STATISTICAL ANALYSIS: Student's independent t-test was employed for comparing continuous variables and Chi-square test for categorical variables. Kruskal-Wallis test was used for postoperative pain and sedation score data. RESULTS: The duration of sensory block was significantly longer with dexamethasone than tramadol. No significant postoperative sedation or any other adverse effect was noted in any patient. CONCLUSION: Dexamethasone is superior to tramadol as an adjuvant to ropivacaine for pediatric lower abdominal surgeries.
