Indian Journal of Anesthesia and Analgesia

Segmental Thoracic spinal anesthesia for modified Radical Mastectomy in patients with compromised Pulmonary Function Test provides good hemodynamic stability, and adequate intraoperative and postoperative analgesia, with patient satisfaction. Here, we present a 60 years old patient with carcinoma of the breast posted for Modified Radical Mastectomy under Segmental Thoracic Spinal Anaesthesia.

Background: Acute metabolic acidemia, defined as a decrease in blood pH originating from a primary reduction in bicarbonate concentration that is accompanied by an appropriate secondary reduction in PaCO2 and is present for up to a few days, can impair hemodynamics and increase mortality, particularly when severe (arterial blood pH<7.20). Septic shock constitutes an important cause of morbidity and mortality in the critically ill patient. The Surviving Sepsis Campaign recommends against treatment with bicarbonate in patients with lactic acidosis due to hypo perfusion when pH is >7.15 but does not explicate what should be done in cases with lower pH.

Methodology: Prospective randomized, Double-blind controlled study was conducted in ICU of Bangalore Medical College and Research Institute, Bangalore for a period of 4 months (November 2020 to February 2021). Sample size calculation was based on previous prospective, randomized double bind, controlled study by Jung B et al, calculated to be 27 in each group.

Results: Mean age of subjects in Study group was 43.7 ± 14.0 years and in control group was 43.3 ± 17.1 years. A statistically significant difference was found in mean final pH and HCO3 levels and with respect to need for ventilation and Multi Organ Dysfunction Syndrome among the groups.

Conclusion: Metabolic acidosis is a common acid-base disorder and its management should be directed by the current guidelines of therapy. Rational treatment of metabolic acidosis in sepsis is directed towards addressing the underlying causes of acidosis and optimizing tissue oxygen delivery through optimization of cardiopulmonary parameters. Limitations of the previous studies prevent reaching definite conclusions and further investigations are required in order to ensure the validity of this therapeutic approach.

Introduction: Laproscopic Cholecystectomy is a standard technique for symptomatic cholelithiasis. It is most commonly performed day care surgery. On the day of surgery pt experiences vague abdominal and shoulder pain. As the discharge is delayed due to lack of adequate analgesia, provision of adequate analgesia is of utmost importance. Objective: To compare the efficacy of postoperative analgesia after intraperitoneal instillation of 0.375% Ropivacaine with Dexmedetomidine vs 0.375% Ropivacaine with Clonidine

Materials and Methods: 40 patients posted for laproscopic cholecystectomy were randomly divided into two groups A and B. Group A received 20 ml of 0.375% Ropivacaine with 1mcg/ kg of Dexmedetomididne and Group B received 0.375% Ropivacaine with 1mcg/Kg Clonidine intraperitoneally through the 10mm supraumbilical port before closure. Pain was recorded on Visual Analog Scale at frequent intervals for 24 hrs postoperatively and categorised as either mild, moderate or severe. Inj. Diclofenac 75mg iv was administered as rescue analgesic in pts with moderate to severe pain.

Results: PostoperativeVAS score showed a statistically significant difference between both groups with lower values in Group A compared to Group B. (P< 0.05 ). The amount of rescue analgesia used was also less with dexmedetomidine as adjuvant.

Conclusion: Ropivacaine 0.375% with 1mcg/kg Dexmedetomidine provided better postoperative analgesia and significantly less requirement of rescue analgesia as compared to 0.375% Ropivacaine with 1mcg/kg clonidine.

Aims: A study was performed to evaluate the effect of dexmedetomidine added to ropivacaine on Supraclavicular brachial Plexus block characteristics, postoperative analgesia, haemodynamics and sedation.

Methods: Sixty patients, of ASA grade Ι & ΙΙ of either sex, aged 21 to 60 years, who were undergoing various bony orthopaedic surgeries on the upper limb under supraclavicular brachial plexus block were randomly allocated in to two equal groups of 30 patients each to recieve 29 ml ropivacaine 0.75% plus 1ml saline (group R) and 29 ml ropivacaine 0.75% plus dexmedetomidine 1µg/kg body weight in 1ml saline (group RD) in supraclavicular brachial plexus block. Onset and duration of sensory blocks and motor blocks, duration of analgesia, perioperative haemodynamic parameters, VAS and sedation scores were assessed.

Results: Both groups were comparable with regard to demographic data. The onset of sensory and motor block were significantly earlier in group RD as compared to group R. Duration of motor block and analgesia were significantly longer in group RD as compared to group R. Sedation score were significantly higher in group RD. Though HR, NIBP and Respiratory rate were significantly decreased in group RD, however all patients remained haemodynamically stable.

Conclusion: Dexmedetomidine (1µg/kg) is a good adjuvant to ropivacaine (0.75%) has faster onset, early and prolonged duration of sensory and motor blockade and increased duration of analgesia, with arousable sedation in supraclavicular brachial plexus block for upper limb surgeries

Background: Pain relief in labour has always been surrounded with myths and controversies. Hence providing effective and safe analgesia during labour has remain an ongoing challenge. This study was undertaken to compare fentanyl and clonidine with ropivacaine in epidural labour analgesia.

Methods: A total of 60 term parturients with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labour analgesia were divided into two groups. Group RF (n=30) patients received 10ml solution comprising 0.1% ropivacaine with fentanyl 20mcg. Group RC (n=30) patients received 10ml of 0.1% ropivacaine with clonidine 60mcg. Characteristics of the block, onset and duration of analgesia and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with a 10-point visual analogue scale. Mode of delivery and neonatal APGAR scores were recorded.

Result: At baseline, groups were matched demographically, haemodynamically as well as for intensity of pain. A significant difference among groups in VAS was observed from 120min intervals and lowest values were in group RC. No significant difference was observed in haemodynamic parameters, mode of delivery and expulsive efforts. Total analgesic dose and top up dose requirement was more in group RF. Six percent of patients in group RF and 10 percent of patients in group RC developed nausea.

Conclusion: Ropivacaine 0.1% was effective in decreasing labour pain without any motor blockade. Clonidine was superior to fentanyl as an adjuvant in labour without any significant feto-maternal adverse effects.