Indian Journal of Anesthesia and Analgesia

Caudal epidural is a commonly used approach for epidural for different intervention. It is used commonly to treat painful coccyx pain.We report an unusual complication of coccygeal pain after caudal epidural steroid injection given for treatment of L5-S1 Prolapsed disc causing right S1 root pain.

Epidural blocks are very important part of anaesthesia practice for providing anaesthesia/analgesia in various surgical and painful conditions. Breakage of an epidural catheter is a rare complication which disturbs patient, anaesthesiologist as well as operating surgeon. We describe the occurrence of such an event where epidural catheter fragment was found to be missing at the time of removal. We would also highlight the common reasons mentioned in literature that can precipitate such events and recommendations to prevent them.

Extrapleural pneumonectomy is a radical and aggressive surgery for malignant pleural tumors. Anaesthesia management in these patients is highly a challenging task for anesthesiologists due to increased risk of perioperative morbidity and mortality. We present a case report of 45 year old female with spindle cell sarcoma for extrapleural pneumonectomy it represents our institution experience in anaesthesia care. An understand of the unique physiological consequences of this procedure,preoperative assessment of cardiopulmonary function,thoracic epidural, physiotherapy, high vigilance, team work, collaboration with surgeon helps to improve perioperative outcome of patients.

Background and Objectives: Transversus abdominis plane block is widely practised peripheral nerve block and has been shown to provide postoperative pain relief following various abdominal surgeries. Proper pain management is essential for optimizing clinical outcomes and early ambulation post operatively. Alpha-2 agonists are mixed with local anesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. We compared addition of clonidine as an adjuvant to bupivacaine in transversus abdominis plane block with respect to duration of analgesia and total analgesic requirement in 24 hours. Methods: Sixty ASA I and II patients scheduled for elective or emergency laparoscopic appendicectomy were divided into two equal groups in a randomized double-blinded fashion. Group B received bilateral USG guided TAP block with 15ml of 0.25% bupivacaine (total of 30ml). Group C received bilateral USG guided TAP block with 15ml of 0.25% bupivacaine + clonidine 1mcg/kg (total of 30ml + clonidine 2mcg/kg). Duration of analgesia and total analgesic requirement in 24 hours were studied. Hemodynamic parameters like pulse rate, systolic and diastolic BP and possible side effects were observed. Results: Duration of analgesia in Group B and Group C was 11.18 ± 2.51 hrs and 19.73 ± 2.33 hrs respectively. Total analgesic requirement in 24-hours in Group B and Group C was 2.63 ± 0.67 and 1.20 ± 0.48 respectively. Conclusion: Clonidine as an adjunct to bupivacaine in bilateral USG guided TAP block provides prolonged and sustained pain relief with reduced analgesic requirement and lesser side effects as compared to bupivacaine alone.

Background: Epidural anaesthesia is a central neuraxial block technique which has the ability to prolong or extend the block via an indwelling catheter. Ropivacaine is a long-acting amino amide local anaesthetic. The onset of sensory and motor blockade may be delayed with ropivacaine. Fentanyl is a commonly used adjuvant for neuraxial block and dexmedetomidine has been used increasingly as adjuvant due to the added benefits and lower side effects. The present study is being undertaken to evaluate quality of epidural anaesthesia using fentanyl and dexmedetomidine as adjuvants to ropivacaine in infra umbilical surgeries for post operative analgesia. Aims: The major aim of the study was to compare the quality of epidural anaesthesia for post-operative analgesia using fentanyl and dexmedetomidine as adjuvants to ropivacaine in infra umbilical surgeries. Materials and Methods: 60 patients of both genders aged 18–60 years, ASA I/II physical status undergoing elective infra-umbilical surgeries were randomized into 2 groups. Group RD(n=30) patients received 17ml of 0.75% Ropivacaine + 1μg/kg Dexmedetomidine and group RF (n=30) patients received 17ml of 0.75% Ropivacaine + 1μg/kg Fentanyl. Epidural block characteristics observed included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to first rescue analgesic and local anesthetic consumption. Data was compiled and analysed using ANOVA, Chi-square test and Fisher’s exact test. Value of P<0.05 is considered significant. Results: Demographic data was comparable between the 2 groups. Heart rate and mean arterial pressure values were lower in RD group compared to RF group. Time to onset of analgesia was 9.56 + 1.32 min in group RF and 7.28 + 1.27 min in group RD (p value < 0.001). Maximum sensory level achieved was T5 in group RF whereas in group RD it was T4 (p value < 0.001). Time taken to achieve maximum sensory level [12.82 + 2.74 min vs 17.54 + 2.88 min] (p value<0.001) and time for complete motor blockade [17.24 + 2.56 min vs 22.71 + 2.50 min] (p value<0.001) in minutes were earlier in group RD compared to group RF. Duration of analgesia was 367.80 + 12.59 min in group RD and 237.94 +14.08 min in group RF. There was significant difference in mean total dose consumption of local anaesthetic used over 24 hours post-operatively. Conclusion: Dexmedetomidine is a better epidural adjuvant for post-operative analgesia compared to fentanyl as it provides prolonged post-operative analgesia and lower consumption of local anaesthetic.

Context: The study was designed to compare the characteristics and hemodynamic effects subclavian central venous catheterisation done under spontaneous respiration versus mechanical ventilation. Aims: To compare the characteristics and hemodynamic effects of infraclavicular subclavian central venous catheterisation done under spontaneous respiration versus mechanical ventilation. Settings and Design: prospective cross-sectional study. Methods and Material: A prospective randomised cross-sectional study was undertaken in 100 patients requiring subclavian venous catheterisation. They were randomised by computer generated random number table to receive the venous cannulation either during spontaneous or mechanical ventilation. The characteristics i.e success or failure, successful cannulation in first attempt, number of attempts, time taken ; and hemodynamic effects i.e heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured in patients with spontaneous respiration and with mechanical ventilation. Hemodynamic variables were measured every 2 minutes till successful catheterisation and till 10 minutes after successful catheterisation. Statistical analysis used: Statistical Package for Social Sciences (SPSS) version 21.0. Results: The demographic variables were comparable in both the groups. Failure to cannulate occurred in total of 8 patients and were comparable among the groups. Successful catheterisation in first attempt was possible in 66% patients breathing spontaneously versus 72% in mechanically ventilated patients (p=0.517). Time to successful catheterisation were also comparable between groups (145.42 ± 56.54 secvs 133.38 ± 36.78 sec, p = 0.582). Heart rate variability >20% of baseline occurred in 22% vs 4% in spontaneously breathing and mechanically ventilated patients ( p = 0.015 ). The systolic, diastolic and MAP were comparable between the groups. Conclusions: The characteristics of infraclavicular subclavian central venous catheterisation are similar regardless of mechanical ventilation and spontaneous respiration. The infraclavicular subclavian venous catheterisation done under spontaneous respiration may result in significant heart rate variability.

Keymessages: The characteristics of infraclavicular subclavian central venous catheterisation are similar regardless of mechanical ventilation and spontaneous respiration. The infraclavicular subclavian venous catheterisation done under spontaneous respiration may result in significant heart rate variability.

Background: The control of cancer pain still is a significant problem in patients undergoing major oncological surgical procedures. The use of high dose opioids has resulted in multiple side effects. The present study was carried out to analyze the effectiveness of a 5% lidocaine patch in patients with cancer pain undergoing mastectomy. Methods: This was a prospective randomized control trial. Sixty patients were included in the study. Group A patients have 5% lidocaine patch applied, and in Group B, a placebo patch was used. Demographic profile, the severity of pain score, and opioid requirement, at the beginning and conclusion of the treatment, patients’ impression, drug-related side effects all were noted. Results: 60 patients took part in the study, with fourteen days mean follow up. The Mean Verbal Numerical Scale (VNS) score was 3.5 in Group A and 6.76 in Group B at Day 1(P=0.00), and VNS Score was 4.06 in Group A and 7.3 in Group B at Day 5(P=0.00). At days 10 and 14, both the groups had no statistically significant difference in pain score. The opioid requirement in group A was significantly less, the average being 636.67 mg and in Group B being 2123.34 mg. Conclusions: 5 % lidocaine patch was found to be useful for short period management of neuropathic pain along with allodynia derived from a painful scar. But its long term usefulness is yet to be validated.

Objective: To study and compare the effectiveness of intravenous dexmedetomidine and esmolol in attenuating sympathomimetic response to direct laryngoscopy and endotracheal intubation. Methods: 100 patients aged between 18 years to 50 years of either sex belonging to ASA class I and II with Mallampatti grading I and II posted for various elective surgeries under general anaesthesia were divided into two groups. Group D received dexmedetomidine 1 µg/kg and group E received esmolol 2 mg/kg. Heart rate, blood pressure and ECG were recorded at baseline, after premedication, after induction, after intubation, 1,2,3,5 and 10min after intubation. Results: Heart rate and blood pressure at various intervals were noted and compared between the two groups. The attenuation of heart rate was more in dexmedetomidine group than the patients who received esmolol. Conclusion: Dexmedetomidine is safe and more effective than Esmolol in attenuating the haemodynamic response to direct laryngoscopy and endotracheal intubation in patients undergoing surgical procedures under general anaesthesia.

Aims: To determine the efficacy and safety of prophylactic ondansetron and granisetron with adjuvant dexamethasone in the prevention of PONV in patients of middle ear surgery. •     To assess the requirement of doses of rescue antiemetic in the postoperative period. •     To note the side effect of both the drugs if any Settings and Design: Prospective, randomized, single blind study. Methods and Material: After institutional review board approval and informed written consent from patients, total 100 patients were randomly assign in two groups of each 50. Group O received intravenously inj. dexamethasone 8mg two minute before induction and inj. ondansetron 4 mg diluted in 5cc NS, half hour before extubation. Group G received intravenously inj. dexamethasone 8 mg two minute before induction and inj. granisetron 1mg diluted in 5cc NS, half hour before extubation. Premedication was given to all patients. General anesthesia was given to all the patients. At the end of surgery, trachea was extubated when patient had spontaneous breathing and follow verbal command. After extubation, all the patients were shifted to post-anesthesia recovery room [PACU] and observed for post operative nausea and vomiting for 24 hours at interval of 0–2 hours, 2–6 hours, 6–12 hours,12–18 hours and 18–24 hours. Episodes of post operative nausea and vomiting were identified by spontaneous complaints by the patients. Statistical analysis used: Data were analysed by using unpaired t -test, Chi-square test. Results: Both the groups were comparable with regard to demographic data and hemodynamic parameters. The incidence of mean PONV score at different time interval was high in group O compare to group G but, the p value was more than 0.05 which was statistically not significant. The requirement of rescue antiemetic was more in group O (16%) compare to group G (6%) but, the p value was more than 0.05 which was statistically not significant. Complete response in 24 hours was more in group G (82%) compare to group O (72%) but, the p value was more than 0.05 which was statistically not significant. The incidence of PONV in 24 hours was high in group O (28%) compare to group G (18%) but, the p value was more than 0.05 which was statistically not significant. Incidence of side effects were comparable in both the groups (p value >0.05). So, in our study both the groups were comparable in prevention of PONV in middle ear surgery under general anesthesia. Conclusion: Both ondansetron and Granisetron with dexamethasone as adjuvant were equally effective and safe for prevention of post operative nausea and vomiting [PONV] in middle ear surgery. Requirement of rescue antiemetic was comparable in both the groups. Minimal side effects were observed in both the groups. So, combination of dexamethasone 8 mg with either Granisetron 1 mg or ondansetron 4 mg was equally effective and safe in prevention of post operative nausea and vomiting in middle ear surgery under general anesthesia.

Context: Bladder injury and perforation is a major problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia which can be overcome using obturator nerve block. Aims: To evaluate obturator nerve block (ONB) using peripheral nerve stimulator during TURBT. Subjects and Methods: Twenty adult male patients underwent TURBT under spinal anesthesia. ONB was performed with peripheral nerve stimulator. Data was assessed in terms of primary endpoints - the occurrence of obturator jerk, injury or perforation of bladder, and surgeon satisfaction in terms of ability to resect the tumor, number of surgical interruptions and number of blood transfusions required. Results: In our study, there was reduction in obturator jerk but not complete abolition, during resection of bladder tumor. Bleeding was observed, however no bladder perforation occurred. Conclusions: We conclude that ONB, when administered along with spinal anesthesia for TURBT, is feasible, simple and safe method of anesthesia to overcome adductor contraction. ONB with peripheral nerve stimulator is more precise and extremely efficient, although not absolute during TURBT.

Background: Endotracheal intubation and laryngoscopy are often associated with increased sympathetic response due to stimulation of laryngeal and tracheal sensory receptors. This can be harmful especially in patients who have cardiac issues, hypertension, etc. and can be associated with increased morbidity and mortality. Attenuation of pressor response can prevent sympathetic stimulation. Aim: To evaluate and compare oral Clonidine and intravenous Esmolol for attenuation of pressor response during laryngoscopy and endotracheal intubation. Materials and methods: 60 patients were divided into two groups after satisfying the inclusion and exclusion criteria. Group-A received clonidine orally at a dose of 150 mcg, around 75–90 minutes before elective surgery. Group-B received intravenous esmolol at a dose of 1.5mg/kg, 2 minutes prior to laryngoscopy. HR, SBP, DBP, MAP were recorded at time of shifting to operation theatre (T0), subsequent to administration of premedications (T1), prior to laryngoscopy (T2), subsequent to intubation (T3), at 1 minute (T4), 3 minutes (T5), 5 minutes (T6) and 10 minutes (T7) subsequent to intubation. Side effects if any were recorded. Results: There was significant suppression of HR, SBP, DBP and MAP at T3, T4, T5, T6 and T7 in Group B that received Intravenous esmolol. There were no serious adverse events in either of the group. Conclusion: Esmolol can be an effective pharmacological agent that can be used for attenuation of pressor response during laryngoscopy and endotracheal intubation. We suggest conducting similar study in patients with significant co-morbidities for a more comprehensive analysis.

Context: Dexmetedomidine, an alpha 2 agonist as adjuvant to spinal anesthesia for prolongation of sensory, motor block, postoperative analgesia. Aims: We studied effectiveness of intravenous dexmedetomidine in prolonging duration of subarachnoid block when administered as bolus and bolus plus infusion dose. Methods and Material: 100 ASA 1 and 2 patients scheduled to undergo elective surgeries under SAB were randomly allocated into two groups. After SAB,Group B received 1 μg/kg of dexmedetomidine bolus over 10 min and group Ireceived 0.5 mcg/kg over 10 mins followed by 0.5 mcg/kg over next 60 mins.Time of onset, duration of sensor and motor blockage, hemodynamic stability and sedation score were observed in both group patients. Statistical analysis used: Results were evaluated by applying paired t test and P value using SPSS statistical software. Results: Time to onset of sensory blockade (T10) in group B was 4.3 ±1.02 mins and group I - 5.2±1.6 mins. Time of onset of motor blockade in group B and I was 4.6 ± 1.01 and 5.5 ± 1.4 mins respectively. Two segment regression time was prolonged in group I – 124 ± 11.51 mins as compared to group B 110± 12.2 mins. Time to achieve complete sensory recovery in group B was 211 ± 10.2 min and group I was 240 ± 9.24 min. Time to achieve complete motor recovery in group B and I was 196 ± 9.6 and 219 ± 6.2 min respectively. Conclusions: Both dosage regimens of dexmedetomidine can be used for prolongation of spinal anaesthesia with bupivacine. Time of onset of block is faster in bolus group however bolus plus infusion dosage provides more prolonged sensory and motor regression of block.

Key messages: Intravenous Dexmedetomidine can be Used as an Adjuvant for Prolongation of Spinal Anaesthesia in Bolus as Well as Bolus and Infusion Doses.
 

Background and Objectives: Inguinal hernia repair done under peripheral nerve block provides many advantages compared to spinal or general anaesthesia. The aim of this study is to compare the functional outcome of Ultrasound guided ilioinguinal and iliohypogastric nerve block with spinal anaesthesia using 0.5% bupivacaine in terms of duration of post-operative analgesia, hemodynamic stability, time for ambulation, hospital stay and side effects. Methods: Forty adult patients aged 30 – 70 years with BMI 18 – 29.9 kg/m2 belonging to ASA physical status I & II undergoing elective open inguinal hernia repair were divided randomly into two groups of 20 to receive either Ultrasound guided ilioinguinal and iliohypogastric nerve block (Group U) using 0.5% bupivacaine 0.3 ml/kg or spinal anaesthesia (Group S) using 0.5% hyperbaric bupivacaine 3 ml (15 mg). Intra operative HR, SBP, DBP, MAP, SpO2 were recorded. Post-operatively patients were monitored for VAS score, ambulation time, time for first rescue analgesia, duration of hospital stay and side effects. Recorded data was compared between two groups using SPSS software. Qualitative data and quantitative data were compared using Chisquare test and independent‘t’ test respectively. A p value of less than 0.05 was taken as significant. Results and Discussion: The time for onset of sensory block was longer in Group U than for Group S. Mean VAS scores were less and duration of analgesia was longer in Group U than Group S. There was significant fall in SBP, DBP and MAP in Group S during the intraoperative period compared to Group U. The ambulation time and duration of hospital stay in Group S were much longer than Group U. Conclusion: Ultrasound guided Ilioinguinal & Iliohypogastric nerve block can be a safe alternative to spinal anaesthesia for elective unilateral inguinal hernia repair.

Background: Caudal epidural is a proven technique for providing analgesia for lower spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilization. Now, with ultrasound, we can visualize the caudal space and can see both the needle position and the injection. This has made the technique much more reliable. Aim: To compare the analgesic and sedative effects Clonidine and dexemedetomidine a selective α2-agonist drugs when used caudal epidurally as an adjuvant to ropivacaine and also to evaluate the feasibility of ultrasound guided caudal block in patients undergoing lumbar spine surgery. Settings and Design: A Comparative, Prospective randomized, controlled two group’s clinical study of 60 adults undergoing lumbosacral surgeries. Materials and Methods: 60 patients were allocated into any one of two groups of 30 patients each, by means of computer-generated randomization: Group RD: Patients receiving caudal block with injected Ropivacaine 0.2% 20 ml+1μg/kg of injdexmedetomidine. Group RC: Patients receiving Ropivacaine 0.2% 20 ml + 2μg/kg clonidine. Statistical Methods: Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two or more groups, Non-parametric setting for Qualitative data analysis. Fisher exact test used when cell samples are very small. Results: The duration of postoperative analgesia was more in RD GROUP compared Patients in RC GROUP, which is statistically significant P=0.005**. Significant lower mean VAS score at 480min [P < 0.001] and 720 min [P 0.010] in RD group compared to RC group with minimal sedation score and hemodynamic disturbances. Conclusion: Dexmedetomidine is a better neuraxial adjuvant to ropivacaine when compared to clonidine for providing prolonged post-operative analgesia with lower pain score and stable cardiorespiratory parameters.

Background: Brachial plexus block has evolved as an important tool in the anaesthesiologists armamentarium as a safe alternative to general anaesthesia for upper limb surgery, providing complete muscle relaxation, stable intraoperative haemodynamic and smooth transition to postoperative pain relief1 reducing the need for opioid analgesics. But it has been observed that the brachial plexus block alone doesn’t prevent the tourniquet pain entirely because of varied mechanisms. The primary aim of this study was to determine whether a subcutaneous ring of local anaesthetic (0.5% ropivacaine) on the inner aspect of the upper arm just distal to axillary crease will significantly decrease tourniquet pain. Approach of hypothesis: In this study 100 patients with comparable demographics in Group A (ASA I and II) underwent USG guided subcutaneous axillary ring injection with 15 ml of local anaesthetic 0.5% ropivacaine for supraclavicular block and 5 ml of 0.5% ropivacainefor axillary ring block. Group B (ASA I and II) also included 100 patients who received only USG guided supraclavicular block using 15 ml of 0.5% ropivacaine prior to inflation of an upper arm tourniquet. Result: It was observed that Group A who receivedboth supraclavicular block and axillary ring block tolerated the upper arm tourniquet for a longer period than those who received only supraclavicular block (mean of 36.9 min vs. 6.9 min) (p = 0.014) respectively. Conclusion: We demonstrated that axillary ring block will decrease tourniquet pain which leads to discomfort is a common obstacle in anaesthetic management and increase tourniquet tolerance period even with excellent regional anaesthesia of the upper extremity.

Introduction: Post tonsillectomy pain relief is commonly inadequate as the pharynx is continuously active, swallowing saliva. I. m. Diclofenac provides good pain relief but pricks are usually unwelcome by children and it may cause dangerous side effects like inhibition of platelet aggregation (post op hemorrhage) and kidney problems. I.v Paracetamol is a good and safe alternative and the study was conducted to compare the 2 drugs. Aims: To evaluate onset of analgesia, duration and efficacy of analgesia, and adverse effects if any between the 2 drugs. Settings and design: 100 cases aged between 10 and 40 years posted selectively for tonsillectomy under general anaesthesia were randomly selected and divided into 2 groups. Groups P received Paracetamol 1g I.v for those more than 50 kg and 15 mg/kg for those between 30 and 50 kg over 10 min after delivery of second tonsil and this time was taken as time 0. Group D received inj. Diclofenac I.m 75 mg at the same time. Subsequently data regarding pain relief at 30 min,1h, 2h, 4h and 6h using Visual Analog Scale was collected. Duration of analgesia, number of patients asking for rescue analgesia were recorded. Statistical Analysis: This was done using Student test and Chi square tests as and where needed. Results: Comparison of pain scores 30 min and 1 h after drug administration showed superior pain relief with Paracetamol and at 4 and 6h better pain relief with Inj. Diclofenac. Duration of analgesia was significantly longer with inj Diclofenac. Conclusion: We concluded that both I.v Paracetamol and I.m Diclofenac have equal efficacy. The onset was early in Inj. Paracetamol and longer with inj. Diclofenac.

Background and Aims: Subarachnoid block using short-acting drugs like chloroprocaine may be preferred in ambulatory surgeries. Various adjuncts are being added to local anesthetics to enhance the quality of analgesia. Fentanyl given by intrathecal route with local anesthetics has antinociceptive and synergistic effect. Our study aimed to elucidate the effects of adding fentanyl to 1% 2-chloroprocaine on duration of sensory block and analgesia for subarachnoid block. Methods: A prospective, randomized, double-blind study was conducted on a hundred patients of ASA physical status I/II, age group 18–80 years scheduled for elective infra-umbilical surgeries. Patients were allocated into two groups of 50 each to receive either 5 ml (50 mg) of chloroprocaine with 0.5 ml of normal saline (Group A) or 5 ml (50 mg) of chloroprocaine with 0.5 ml of fentanyl 25 µg (Group B). Block characteristics, duration of analgesia and complications were assessed. Results: Sensory and motor block were achieved faster in chloroprocaine-fentanyl group. Duration of sensory and motor block, analgesia and return of voiding function, were significantly prolonged in Group B. No difference was noted in maximum motor block and ambulation time. Eight patients in Group B developed pruritus. Chi-Square and Student’s unpaired t-test were used to analyse results, using Epi info version 7.2.1.0 statistical software. Conclusion: Isobaric chloroprocaine and fentanyl mixture enhanced the duration of sensory block, analgesia and motor block without increasing ambulation time but with delay in return of voiding reflex.

Introduction: Regional nerve blocks of the upper extremity avoid the polypharmacy and stress of laryngoscopy and tracheal intubation associated with general anaesthesia. Drug administration at the supraclavicular level offers comprehensive anaesthesia for the complete limb. Post-operative analgesia may be provided by either adding additives to the local anaesthetics or placing a catheter in place. Clonidine (alpha 2 adrenergic receptor agonist) is a classic additive to local anaesthetic in various regional procedures.

Aim: To compare efficacy of clonidine added as an adjuvant to bupivacaine with plain bupivacaine alone in supraclavicular brachial plexus block.

Methodology: Fifty ASA I and II patients coming for upper limb surgeries were assigned randomly into two equal groups. Group S: received 35 ml of 0.25% Bupivacaine and 0.5 ml of normal saline 0.9%. Group C: received 35 ml of 0.25% Bupivacaine and Clonidine 75mcg (0.5 ml). Onset and duration of sensory and motor blockade and complications, if any were documented.

Results: Demographic variables were comparable. There was a statistically significant faster onset and prolonged duration of block in clonidine group when compared to plain bupivacaine (p<0.05). Clonidine also produced sedation which however did not require any clinical intervention.

Conclusion: We conclude that clonidine causes earlier onset, prolongs the duration of sensory and motor block with sedation and without any significant clinical side effects when added to bupivacaine in brachial plexus block

Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endo tracheal intubation.

Aims: To evaluate the feasibility of TEA for various upper abdominal surgeries using 0.5% bupivacaine.

Patients and Methods: This was a clinical study of 50 selected patients undergoing elective upper abdominal surgery under TEA conducted at hospitals attached to JJM Medical college Davangere for a period of 3 years. All thoracic epidural anaesthesia was performed under aseptic conditions at T 8/9 interspinous space using a size 18G Tuohy needle and catheter inserted at appropriate level. A test dose of 3 ml 2% lignocaine with adrenaline was used in all patients ,after which a single dose of 10 ml 0.5% bupivacaine was injected steadly at a rate 0.5 ml per sec. The operative conditions was assessed on basis of sedation and analgesia requirement, as well as response to mesentric traction. Surgeons opinion with regard to muscle relaxation was taken. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Information obtained included age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed under guidance of statician.

Results: 50 patients under went major abdominal surgeries. The mean age was 35.3 +_ 9.4 yrs (20-50), with male to female ratio of 1:1. Onset of analgesia was of 17.4 +_2.1 min (15-22), 88% of patients had Grade 1 analgesia, 68% of patients had good muscle relaxation, hemodynamic changes was significant with 6 patients having bradycardia and was treated with Ing atropine.

Conclusion: Thoracic epidural anaesthesia for upper abdominal surgeries provide good analgesia and muscle relaxation with minimal amount of drug used . Hemodynamic changes are significant. Post operative complications were minimal and was managed satisfactorily

Introduction: Paravertebral nerve blocks provide excellent pain relief and inhibit the neuroendocrine stress response to surgical trauma, which suggests that a very high quality afferent block can be affected. Aim was to assess the efficacy of paravertebral block use in conjunction with general anaesthesia for better postoperative pain management in comparison to general anaesthesia alone.

Materials and Methods: As per the criteria total of 120 patients were included in the study. Group A received general anaesthesia only and group B patients received paravertebral block long with general anaesthesia. All patients underwent preoperative assessment prior to surgery. The patients were instructed on the use of the Visual Analogue Scale (VAS 0–10) and Numerical Rating Scale (NRS 0–4).

Results: When VAS score of both the groups are compared the score in group B was found to be lower than in group A. When NRS score of both the groups are compared the score in group B was found to be lower than in comparison to group A.

Conclusion: Paravertebral block reduces incidence of postoperative nausea and vomiting in comparison to general anaesthesia alone. Paravertebral block leads to significantly reduced consumption of opioids in the postoperative period in comparison to general anaesthesia alone.

Introduction: Entropy of electroencephalogram (EEG) quantifies the degree of chaos, complexity or irregularity of the EEG signal. The EEG activity would show more regularity in anaesthetized, than in awake patients. In recent years, Propofol is used commonly as an intravenous induction agent during General Anaesthesia as the recovery is smooth and clear. Aims: To Study the effect of spectral entropy on the requirement of Propofol during induction of Anaesthesia.

Materials and Methods: 40 patients belonging to ASA grade 1 and ASA grade 2 undergoing spine surgeries under general anaesthesia were taken in the age group of 20 years to 60 years and randomly allocated to 2 groups after taking approval from institutional ethics committee.

Results: The demographic profile (age, age wise distribution, gender wise distribution, weight, weight wise distribution, height, height wise distribution) was comparable in both the groups. Haemodynamic parameters (heart rate, systolic, diastolic blood pressure and entropy parameters) were comparable in both the groups. The amount of propofol per kg dose decreased from 2mg/kg to 1.4mg/kg when induction was done using the entropy sensor. This decrease in the dose was statistically significant with p<0.05. This decrease in the total dosage was 25.3% and 27.8% with respect to the total dose and per kg dose of propofol respectively. The end result showed that inclusion of entropy monitor during general anaesthesia for induction with propofol decreased the requirement of propofol for induction when compared with propofol requirement without entropy monitoring. This decrease in propofol requirement was statistically significant. However the hemodynamic stability was not significantly different in both the groups.

Conclusion: Propofol, an intravenous induction drugwhile monitoring the depth of anaesthesia with spectral entropy, the requirement of propofol during induction of anaesthesia is significantly reduced in comparision when induction of anaesthesia was done without spectral entropy monitoring

The primary aim is to compare the effectiveness of non-opioid analgesics over opioids in the intraoperativepain management.The secondary objective to compare the intraoperative hemodynamic variables, requirement of additional analgesia intraoperativelyand to assess the side effects in both groups. The study was approved by the University’s institutional ethics committee(Reg No. ECR 518/Inst/MH/2014/RR-17) and written informed consent was obtained from all subjects participating in the trial. The study was registered prior to patient enrollment at BHARATI VIDYAPEETH MEDICAL COLLEGE institutional ethics committee (REF: BVDUMC/IEC/51, Principal investigator: Dr. Ashish Nair, Date of registration:10th October 2017). This prospective comparative study enrolled a sample of 60 patients undergoing ENT surgeries, with 30 in each group.Non-Opioid group receivedpreoperative Intravenous (IV) dexmedetomidine 1mcg/kg started as infusion 15 mins prior to induction followed by a Maintenance dose of 0.5mcg/kgand the Opioid group received IV fentanyl 1mcg/kg as bolus prior to induction and were supplemented with 0.5mcg/kg as and when required. Intraoperative haemodynamic variables and analgesic requirement were monitored and were observed postoperatively till the patient received rescue analgesia as IV paracetamol 1gm.Results: The haemodynamic variables at different time interval after intubation was statistically more significant in the Non-Opioid group as compared to Opioid group. Additional analgesia requirement was
higher in the Opioid group (26.67%) as compared to Non-Opioid group (10%). Patients in the Non-Opioid group were better sedated and more comfortable post-operatively.Conclusion: Opioid free anaesthesia is a better alternative in maintaining intraoperative haemodynamic parameters and pain management as compared to the Opioid drugs.

Introduction: Etomidate is recommended for induction in patients with poor left ventricular (LV) function.Thiopentone has been the routine induction agent of anaesthesia since 1930‘s because of its rapid and predictable action. Hence the present study allows evaluation of Etomidate in comparison with Thiopentone sodium as an induction agent.

Materials and Methods: Total of 120 patients between the age ranges of 20 to 70 years were included in the study. All the patients were scheduled to undergo the elective surgery under general anaesthesia. They weredivided into two groups: Group A: comprised of 60 patients induced with injection etomidate 0.3 mg/kg IV for general anaesthesia. Group B: comprised of 60 patients induced with injection Thiopentone 5 mg/kg IV forgeneral anaesthesia.

Results: The mean induction time for etomidate for group A was found to be 23±5 seconds and the meaninduction time for Thiopentone for group B was found to be 33±6 seconds. There is significant increase in heart rate after intubation in thiopentone group as compared to etomidate group. During induction there was decrease in respiratory rate in both groups and when the comparison was done the more decrease was found in group B that is in patients with thiopentone group. 

Conclusion: By the present study it can be concluded the induction time was lesser in Etomidate and the incidence of aponea was more in Thiopentone. Etomidate is an effective and rapid acting induction anestheticagent with good cardiovascular stability and respiratory stability. Its side effects can be reduced to minimum by proper premedication and suitable IV Anaesthetic techniques.

Introduction: Pain is a conscious experience that result from brain activity in response to a various stimulusand engages the sensory, emotional and cognitive process of the brain. Pain can be classified based on painphysiology, intensity, temporal characteristics, type of tissue affected, and syndrome.

Aims: A comparing adenosine as a perioperative analgesic as an adjuvant.Materials and Methods: It is a randomised double-blind and controlled comparative study was conducted infifty adult patients scheduled for various procedures under general anaesthesia. The patients in the age group of 25–50 years were taken for the study. Adenosine was compared with opioid (fentanyl) analgesia. The study involves n=25 study group n=25 control group.

Results: Control group received opioid analgesia injection fentanyl 2mcg\kg body weight started afterintubation. The mean duration of surgery in both groups ranged between 75–90 mins.In comparision perioperative infusion of adenosine showed statistically significant stabilisation of hemodynamicsintraoperatively and postoperatively over the control group. The VAS scoring suggested that adenosine group carried a good analgesic effect intraoperatively and postoperatively in comparison with control group.Thereare no significant side effects in adenosine group in comparison with control group.

Conclusion: The observation suggested that cumulative effect of adenosine infusion carried a good analgesic effect and hemodynamic stabilization in post operative period. In post operative period patients who received adenosine not required any opiod or analgesic supplementation.