RESUMO
Background: The most common approach to managing severe pain following femoral fracture is with intravenous systemic analgesics, such as opioid analgesics and non-steroidal anti-inflammatory drugs associated with side effects such as respiratory depression, nausea, and vomiting. These side effects might be intolerable in trauma patients and may result in under treatment of pain. Improving the quality of analgesia may reduce these intolerable side effects. Our study compared the efficacy of fascia iliaca compartment block (FICB) with intravenous analgesics for preoperative pain management of femoral fractures. Patients and Methods: The study was a quality improvement prospective randomised study, where 50 patients aged between 18 and 65 years, and American society of anesthesiologists I and II were recruited into two groups. Group A received FICB with a combination of 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline 1:200,000 made up to 30 mL, while group B received placebo FICB using 30 mL normal saline. Also, group B received a combination of intravenous paracetamol 15 mg/kg not exceeding 900 mg and tramadol 1 mg/kg not exceeding 100 mg, while group A received an equal volume as normal saline intravenously. Results: The study revealed no significant difference in age, gender, associated injuries, X-ray description of fractures, and mechanism of injuries; however, there was a significant difference in the NRS-pain score at 30 min, summed pain intensity difference for 4 h and patient satisfaction in the FICB group compared to the standard group. Conclusion: The study revealed that FICB results in better pain control compared to a combination of intravenous tramadol and paracetamol in patients with femoral fractures.
RESUMO
Background: Following propofol induction, suxamethonium tremendously improves intubating conditions in children and has been the gold standard agent for this purpose. However, suxamethonium could be absolutely contraindicated in some patients. Fentanyl, a short acting opioid, has been investigated as a suitable alternative with varying results. Aim and Objectives: This study compares the ease of tracheal intubation between propofol-suxamethonium (1.5 mg/kg) and propofol-fentanyl (3 mcg/kg) during general anaesthesia among children. Patients and Methods: In this double-blind randomised controlled study, 84 ASA I or II patients booked for elective surgery under general anaesthesia requiring tracheal intubation were randomised into two groups (F and S). Induction was with propofol 3 mg/kg over 30 s followed by either fentanyl 3 mcg/kg or suxamethonium 1.5 mg/kg. Two minutes later, there was an attempt at intubation and intubating conditions were assessed using Steyn's modification of Helbo-Hansen's score (ease of laryngoscopy, jaw relaxation, coughing, vocal cord position, and limb movement). Results: All patients in both groups had successful intubation at the first attempt. Patients in group S (suxamethonium) had significantly better overall intubating conditions compared to those in group F (fentanyl) (p=0.0001), 85.7% in group S compared to 21.4% in group F had excellent intubation condition. None of the patients in the two groups demonstrated fair or poor intubation condition. Conclusion: A combination of propofol-fentanyl can be used as an alternative to propofol-suxamethonium to ease intubation in paediatric patients.
RESUMO
Background: Supraglottic airway devices (SADs) may be used during laparoscopic procedures in place of the often utilised endotracheal tube. The Proseal laryngeal mask airway (PLMA) is designed with an inflatable cuff, which provides an excellent oropharyngeal seal, and the I-gel is a newer SAD designed with a softer and noninflatable cuff and sharing similar features with PLMA. Aim and Objectives: This study compared the ease of insertion, haemodynamic and ventilatory parameters as well as morbidities associated with these SADs when used for airway management during diagnostic laparoscopic procedures. Patients and Methods: Eighty American Society of Anaesthesiologist I and II patients aged 18-60 years undergoing diagnostic laparoscopic surgery under controlled ventilation had either I-gel or PLMA used for airway management. Anaesthesia was induced with standard dose of propofol, patient received atracurium, fentanyl and the SAD inserted. Pulse oximetry, capnography, noninvasive blood pressure, oropharyngeal leak pressure (OLP), and evidence of pharyngolaryngeal morbidity were assessed. Data were analysed using the Statistical Package for Social Sciences version 21.0. The quantitative variables were analysed using the Student's t test and the qualitative using the Chi-square test. A P value of less than 0.05 was considered significant. Results: The success rates at first insertion for I-gel and PLMA were 95% and 80%, respectively (P = 0.04). The mean changes in mean arterial pressure following insertion were 9.6 mmHg (±4.7) and 10.6 mmHg (±8) for I-gel and PLMA, respectively (P = 0.02). The OLP during insufflation was higher in the PLMA (35.8 cmH2O) than in the I-gel group (27.9 cmH2O) (P = 0.57). In the I-gel group, 12.5% of the patients had oropharyngeal morbidities compared with 37.5% in the PLMA group (P = 0.009). Conclusion: Both I-gel and PLMA provide optimal ventilation during abdominal insufflation, with PLMA providing a better oropharyngeal seal, whereas I-gel has a better haemodynamic profile.
