Comparison of Epidural Bupivacaine and Dexmedetomidine with Bupivacaine and Fentanyl for Postoperative Pain Relief in Lower Limb Orthopedic Surgery.

CONTEXT: Different trials have shown that multimodal analgesia through different techniques is associated with superior pain relief. Opioids as epidural adjunct to local anesthetics have been in use for long and α2 agonists are being increasingly used for same. The present study aims at comparing the hemodynamic, sedative, and analgesic effects of epidurally administered fentanyl and dexmedetomidine when combined with bupivacaine. AIMS: The aim of this study was to compare the efficacy of epidural dexmedetomidine with bupivacaine versus epidural fentanyl with bupivacaine for postoperative pain relief. SUBJECTS AND METHODS: In this ongoing randomized double-blind study, 70 patients with ASA physical status classes I and II of either sex between 20 and 60 years scheduled for lower limb orthopedic surgeries under epidural block were randomly divided into two Groups (n = 35). After epidural block with 15 ml of 0.5% bupivacaine, Group I received 1 µg/kg of fentanyl and Group II received 1 µg/kg of dexmedetomidine. Onset and duration of sensory block, motor block, and time to request for the first postoperative analgesia were recorded. STATISTICAL ANALYSIS USED: The statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) Version 15.0 Statistical Analysis Software, Mann-Whitney U-test and Chi-square test. RESULTS: The time to achieve T10 sensory block was early in Group I (dexmedetomidine) (8.10 + 1.03 min) as compared to Group II (15.03 + 1.67 min). Onset of motor was earlier in Group I (15.10 + 1.49 min) as compared to Group II (22.77 + 1.41 min). In Group I (dexmedetomidine), the majority of patients required 2-3 rescue doses, while in Group II (fentanyl), the majority of patients required 3-4 rescue doses. CONCLUSIONS: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant due to early onset of sensory anesthesia, prolonged postoperative analgesia, and lower consumption of rescue analgesia.

To Evaluate the Efficacy of Fentanyl and Dexmedetomidine as Adjuvant to Ropivacaine in Brachial Plexus Block: A Double-blind, Prospective, Randomized Study.

CONTEXT: Anesthesia and analgesia for surgeries to the upper extremity are commonly provided using brachial plexus anesthesia. There are limited or almost no studies comparing the use of ropivacaine with fentanyl to ropivacaine with dexmedetomidine. AIMS: To compare the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine for brachial plexus block among patients undergoing upper limb orthopedic surgeries. SETTINGS AND DESIGN: This was a prospective, randomized, double-blinded study. SUBJECTS AND METHODS: The patients were randomly divided into three groups of 35 each using computerized randomization table. Group I patients received 3 mg/kg of 0.75% ropivacaine with 1 µg/kg of fentanyl diluted with normal saline (NS) to make a total volume of 35 ml. Group II patients received 3 mg/kg of 0.75% ropivacaine with 1 µg/kg of dexmedetomidine diluted with NS to make a total volume of 35 ml. Group III patients received 3 mg/kg of 0.75% ropivacaine with NS making a total volume of 35 ml. STATISTICAL ANALYSIS USED: Statistical analysis was performed using Statistical Package for Social Sciences, version 15.0. Analysis of variance followed by independent samples t-test was performed for parametric data, and Kruskal-Wallis test followed by Mann-Whitney U-test was performed for nonparametric data. RESULTS: Mean motor and sensory block onset time was minimum in Group I and maximum in Group III while mean duration of sensory and motor block was maximum in Group I and minimum in Group III. Time taken for first rescue analgesic dose was also maximum in Group I and minimum in Group III. CONCLUSIONS: It can be concluded that 3 mg/kg of 0.75% ropivacaine along with 1 µg/kg of fentanyl diluted with NS to make a total volume of 35 ml was the most efficacious regimen for brachial plexus block among patients undergoing upper limb orthopedic surgeries.

Comparison of ropivacaine with levobupivacaine under epidural anesthesia in the lower limb orthopedic surgeries: A randomized study.

CONTEXT: Epidural anesthesia is nowadays considered as the gold standard anesthetic technique for lower limb orthopedic surgeries, and the present study was conducted to evaluate the efficacy of levobupivacaine and ropivacaine in terms of onset, duration of sensory and motor block with duration of postoperative analgesia in patients undergoing lower limb orthopedic surgeries under epidural anesthesia. AIMS: To compare the efficacy of 15 mL of levobupivacaine 0.5% with that of 15 mL of ropivacaine 0.75% in patients undergoing lower limb orthopedic surgeries under epidural anesthesia and to determine the better of the two agents with respect to onset, duration of sensory and motor blockade, postoperative analgesia, and adverse effects; if any. SETTINGS AND DESIGN: A double-blind randomized study. SUBJECTS AND METHODS: A total of seventy patients planned to undergo elective lower limb orthopedic surgeries fulfilling the criteria were enrolled in the study. Group I (n = 35): Received 15 mL 0.5% levobupivacaine epidurally. Group II (n = 35): Received 15 mL 0.75% ropivacaine epidurally. STATISTICAL ANALYSIS: Statistical Analysis was done by Statistical Package for Social Sciences (SPSS Version 15.0) statistical analysis software. The values were represented in number (%) and mean ± standard deviation. RESULTS: Time to achieve sensory onset and motor onset were significantly lower in Group II (17.86 ± 2.51 and 23.14 ± 2.73) as compared to Group I (26.14 ± 2.45 and 31.43 ± 2.59) while the duration of sensory block was significantly higher in Group II (173.29 ± 6.29 min) as compared to Group I (156.71 ± 6.96 min). Although motor block duration of Group I (142.43 ± 8.43 min) was higher than that of Group II (141.43 ± 12.81 min), but this difference was not found to be statistically significant. CONCLUSIONS: The inference drawn from this discussion, in general, indicated that both the drugs are comparable for block onset, quality, and duration along with similar hemodynamic profile when given in same concentration. However, relatively better response of ropivacaine for block onset and duration as obtained in the present study coupled with higher but statistically.

A study to compare the overall effectiveness between midazolam and dexmedetomidine during monitored anesthesia care: A randomized prospective study.

BACKGROUND: Monitored anesthesia care (MAC) combines intravenous sedation along with local anesthetic infiltration or nerve block. Several drugs have been used for MAC, but all are associated with complications. Dexmedetomidine is a selective α2-adrenoceptor agonist with both sedative and analgesic properties and is devoid of respiratory depressant effects. Its short elimination half-life makes it an attractive agent for sedation during MAC. AIM: Comparative evaluation of dexmedetomidine and midazolam for MAC. METHODS: In this prospective, randomized, double-blind study, 50 American Society of Anesthesiologist I and II patients undergoing a surgical or diagnostic procedure of <1 h requiring MAC were enrolled. Dexmedetomidine-ketamine (Group "KD") patients (n = 25) received intravenous (I.V.) dexmedetomidine 1 mcg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine. Midazolam-ketamine patients (n = 25) received I.V. midazolam 0.05 mg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine to get a targeted level of sedation (≤4 using Observer's Assessment of Alertness/Sedation Scale score). Inadequate sedation (e.g., 15% increase in mean arterial blood pressure or heart rate, decrease in degree of calmness, increase in respiratory rate, physical movement) was treated by a ketamine bolus of 0.5 mg/kg as a rescue analgesia. STATISTICAL ANALYSIS: The statistical tests used in the study are unpaired Student's t-test for continuous variables and Chi-square test for categorical variables. Mann-Whitney test was used to assess the patient and surgeon satisfaction. Data were expressed as mean ± standard deviation. Value of P < 0.05 is considered significant and P < 0.0001 as highly significant. RESULTS: Clinically desired sedation and analgesia was achieved earlier and better with dexmedetomidine. Patients and surgeons satisfaction were significantly higher with dexmedetomidine. The requirement of additional sedation and analgesia was less in dexmedetomidine (KD) group. CONCLUSION: During MAC dexmedetomidine provides better sedation and analgesia than midazolam.

Effects of different types of pharyngeal packing in patients undergoing nasal surgery: A comparative study.

CONTEXT: Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction. AIMS: To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery. SETTINGS AND DESIGN: A randomized comparative study. SUBJECTS AND METHODS: After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - inwhich the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed. STATISTICAL ANALYSIS USED: T-test to compare the age, while Chi-square test and Fisher's exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation. RESULTS: Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups. CONCLUSION: We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients undergoing nasal surgeries might lead to a reduction of the same.

I-gel saves the day: Bradycardia and apnea in a patient undergoing burr hole and evacuation for a subdural hematoma under scalp block.

Awake craniotomy is generally performed in scalped block, although it is safe, but this procedure can sometimes produce severe hemodynamic disturbances. Here, we reported a case of 32-year-old male, who came for burr hole and during the craniotomy performed under scalped block developed bradycardia and became apneic as manifested by the absence of ETCO2 and no chest excursions. An I-gel was inserted rather than intubating the patient and the case was managed very well and which showed the importance of supraglottic airway devices in our day to day practice.

Malpositioning of central venous cannula inserted through internal jugular vein after failed cannulation through ipsilateral subclavian vein.

The anesthesiologist is frequently involved in the task of achieving central venous access either for intraoperative uses or postoperative purposes or Intensive Care Unit care. We are usually aware of the common complications of subclavian approach, such as arterial puncture, bleeding, pneumothorax, misplacement in the ipsilateral internal jugular vein (IJV) or contralateral brachiocephalic or subclavian vein. In this case report, we highlight the possibility of malpositioning of central venous cannula inserted through IJV into the anterior extra pleural plane after failed subclavian cannulation attempts.