Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients.

BACKGROUND AND AIMS: Central neuraxial block and general anaesthesia in patients with significant comorbidities are associated with considerable peri-operative morbidity and mortality. This study aims to delineate peripheral nerve block as a suitable alternative technique in high-risk patients posted for below-knee surgery. METHODS: Twenty patients with the American Society of Anesthesiologist's (ASA) physical status grade III and IV, aged 30-80 years, scheduled for below-knee surgery from May 2018 to February 2019 were enrolled in this prospective study. All patients received ultrasound-guided popliteal sciatic block with 20 ml 0.5% ropivacaine and adductor canal block with 10 ml 0.375% ropivacaine. The peripheral nerve block success rate, sensory and motor block onset time, haemodynamic parameters, duration of post-operative analgesia and patient's satisfaction were recorded. Descriptive statistics of the study were calculated and the data was analysed using an SPSS statistics 21.0 program. RESULT: Surgery was performed successfully with no additional analgesic requirement in all patients. The mean duration for sensory and motor block onset time was 3.35 ± 0.49 (mean ± standard deviation) and 4.65 ± 0.48 (mean ± standard deviation) minutes respectively. Haemodynamic parameters were maintained stable throughout the procedure. The average duration of postoperative analgesia was 7.5 ± 0.8 (mean ± standard deviation) hours. Patient overall satisfaction as assessed, by three-point Lickert's scale, was satisfactory. CONCLUSION: Ultrasound-guided combined popliteal sciatic and adductor canal block is an effective alternative anaesthetic technique for below-knee surgeries with stability of haemodynamic parameters and pain management in high-risk patients.

Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases.

AIM: To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve. MATERIALS AND METHODS: This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58). RESULTS: 89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days. CONCLUSION: Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.

Successful management of a renal fungal ball in a pretermature neonate: A case report and review of literature.

Invasive fungal infection is common in the present day NICUs - generally manifesting as candiduria or candida sepsis. Fungal balls in the kidneys are very uncommon and most are amenable to higher antifungal agents. However, we had a child who did not respond to such measures and ultimately needed a surgical removal of the fungal ball in his kidney. We report this case along with a review of literature to highlight about this uncommon, but an important cause of persistent sepsis in pre-term infants and to review the treatment options including a surgical removal.