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Indian Journal of Anesthesia and Analgesia

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Efficacy and Safety of Promethazine Hydrochloride as a Local Analgesia in Comparison with Bupivacaine Hydrochloride, in Various Peripheral Nerve Blocks

Anup Chandnani , Darshan Shukla1 , Anup Chandnani2 , P. Kumar3

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Indian Journal of Anesthesia and Analgesia 6(3):p 905-909, May-June 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6319.30

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Darshan Shukla, Anup Chandnani, P. Kumar. Efficacy and Safety of Promethazine Hydrochloride as a Local Analgesia in Comparison with Bupivacaine Hydrochloride, in Various Peripheral Nerve Blocks. Indian J Anesth Analg. 2019;6(3):905-909.

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Received : N/A         Accepted : N/A          Published : N/A

Abstract

Abolishing the pain conduction in sensory nerves – this idea would have definitely come from progressive physicians. Various local anesthetic agents since 1860 have been isolated and synthesized till dates which have their action mediated through nerve conduction blockade. But there are other agents who can inhibit conduction to varying degrees, in a nerve and other excitable tissues – like H1 – blockers, Antihistaminics, Anti convulsants, opioids, Marine Biotoxins. Phenothiazine derivative of H1 – blocking agents viz. Promethazine and Diphenhydremine have potent local anesthetic activity as compared to procaine (a amide local anesthetic) when injected locally. Promethazine is widely used as anti emetic, anti histaminic and hypnotic agent by oral, introa muscular, intra venous and trans rectal route but its local anesthetic property has not been fully utilized and advocated in clinical practice. A careful search to literature was done and this study was undertaken to study the use of promethazine in aspect to onset of action, intra operative analgesia, post operative analgesia, sedation along with other complications as compared to Bupivacaine. Sixty patients of ASA status I & II, undergoing elective surgery like Hydrocelectomy, circumcision and others to be operated under regional blocks were randomly divided in two groups: Group I to receive Inj. Promethazine hydrochloride (2 mg/kg) diluted to make a volume of 15 ml, Group II to receive Inj. Bupivacaine 0.25% (2 mg/kg) to a maximum of 15 ml and patients were observed for onset of analgesia, duration, requirement of rescue analgesic using 4 point pain score and post operative sedation using Cook’s Sedation Score along with hemodynamic stability and any other known complications. It was found that there was good analgesia in both the groups per operatively with good hemodynamic stability all throughout the surgery and surgery accomplished satisfactorily with no side effects except drowsiness seen in Group I specially of age > 45 years. Hence, promethazine can be considered as a safe alternative to standard local anesthetics for superficial surface surgeries where sensitivity to local anesthetics is a problem.

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Darshan Shukla, Anup Chandnani, P. Kumar. Efficacy and Safety of Promethazine Hydrochloride as a Local Analgesia in Comparison with Bupivacaine Hydrochloride, in Various Peripheral Nerve Blocks. Indian J Anesth Analg. 2019;6(3):905-909.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6319.30

Keywords

Promethazine; Bupivacaine; Cook’s Sedation Score; 4 Point Analgesia Score.

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