A comparison of effect of preemptive use of oral gabapentin and pregabalin for acute postoperative pain after Partial Thyroidectomy

Background and Aims: Preemptive analgesia is defined as a treatment that is initiated before surgery in order to prevent the establishment of central sensitization evoked by the incisional and inflammatory injuries occurring during surgery and postoperative period. Pregabalinas considered in abolishing neuropathie component of acute nociceptive pain of surgery. Materials and methods: A study was done to know the effect of oral gabapentin and pregabalinath control group for post-operative analgesia. Materials and Methods: A total of 90 ASA grade I and II patients posted for elective Partial thyroidectomy were randomized into 3 groups (group A, B and C of 30 patients each). One hour before surgery the blinded drug selected for the study was given with a sip of water. Group C- received identical placebo tablet, Group B- received 800 mg of gabapentin tablet and Group A - received 150 mg of pregabalinablet . VAS score recorded for initial rescue analgesia, total duration of analgesia and total requirement of rescue analgesia were observed as primary outcome. Hemodynamics andside effects were recorded as secondary outcome in patients. Results: The analgesic requirement in both Pregabalinand Gabapentin groups are lower than the control group.&nbsp

Dexmedetomidine versus ketamine infusion to alleviate propofol injection pain

Introduction: Propofol a widely used anesthetic agent administered for induction and maintenance of anesthesia, post operative and ICU sedation and anticonvulsant agent. Pain on injection is a common complain during propofol administration. Many drugs like local anesthetic, opiates, esmolol, clonidine, ketamine have been tried to alleviate propofol injection pain. Here we have compared the effect of dexmedetomidine and ketamine in alleviating propofol injection pain. Materials and methods: 108 patients of either sexes, in the age groups 20-50 years, posted for routine surgical procedure under general anaesthesia were included in the study. The cases were randomly divided into 2 groups of 54 each. Group-D:-Patients received dexmedetomidine 0.5µg/kg in 20 ml Normal saline at a rate of 120 ml / hr Infused over 10 min. Group-K:- Patient received ketamine 0.5mg/kg in  20ml Normal saline at a rate of 120ml/hr infused over 10 mins. Immediately after infusion, 1% propofol in a dose of 2mg/kg IV was given over 20 seconds. Starting from the time of injection, the patients were assessed for pain by asking an open ended question, “Does it Hurts” in every 5 seconds until the patient become unresponsive. Degree of pain score was advocated by “McCririck and Hunter Scale

A comparative study of postoperative acidemia after intraoperative administration of balanced crystalloid (Plasma-lyte A@) versus 0.9% sodium chloride in gastrointestinal surgery

Background: The administration of intravenous fluids is one of the most common and universal interventions in medicine. Fluid therapy is the most challenging and debated aspect of perioperative care. Plasma-lyte A® Injection (multiple electrolytes injection, type 1, USP) is indicated as a source of water and electrolytes or as an alkalinizing agent. 0.9% sodium chloride is an isotonic crystalloid solution having a sodium concentration higher is useful in replacing fluid and electrolyte loss. Aims and Objectives: The study was designed to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% NaCl on acid-base balance in the post-operative period in patients undergoing gastrointestinal surgery. Materials and Methods: Eighty consenting patients of ASA-l and ASA-II who underwent Gastrointestinal surgery were at first randomly allocated to 2 groups. One group received Plasma-Lyte A® as the sole crystalloid and the other group received 0.9% sodium chloride. Results: Serum Na+ conc. of the groups were comparable and no difference was shown at the time of induction, but postoperatively at 12 h, there was a significant increase in group 2. There was no significant difference in serum K+ concentration in both the groups except at 6 h postoperatively when there was an increase in K+ concentration in group 1. Serum Cl− concentration was having no significant difference at the time of induction and 1 h intraoperative, but postoperatively at 1, 6, and 12 h the Cl− concentration significantly increased in group 2. HCO3− concentration of the two groups had no difference between them throughout the study period. The pH of patients in both the groups showed no statistically significant difference during the entire procedure (P>0.05). A significant decrease in pH observed in 0.9% sodium chloride group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 min. Conclusion: Both plasma-lyte A and 0.9% sodium chloride can be used safely as intravenous infusion fluid without altering pH status and blood electrolyte concentration in patients undergoing gastrointestinal surgery

A comparative study of train-of-four (TOF) count at corrugator supercilii and at adductor pollicis reflecting abdominal muscles relaxation

Introduction: Diaphragm and lateral abdominal muscles frequently show sparing effects to muscle relaxants. This study compared visual estimation of neuromuscular transmission of corrugator supercilii and adductor pollicis (AP) with electromyographic measurements of lateral abdominal wall muscles during recovery from vecuronium-induced intense neuromuscular block. Methods: 60 patients undergoing elective surgeries under general anesthesia  were included. Following loss of consciousness, supramaximal stimulations were applied using electrical nerve stimlators to left 10th intercostal, ulnar and facial nerves. Electromyographic activity (EMG) of abdominal wall muscles were measured. After Inj. Vecuronium 0.1 mg/kg, Electromyographic activity measurements counted the visually detectable train-of-four (TOF) responses at corrugator supercilii and adductor pollicis. The onset time, the duration of action and quantitative measurements of neuromuscular block were done. Observations: Clinical duration of action of vecuronium almost coincided with train-of-four response at corrugators supercilii where as train-of-four recovery at adductor policis occurred late during recovery stage. Corrugators supercilii had a stronger positive correlation with abdominal muscles relaxation as compared to the adductor policies. Corrugators supercilii had a stronger correlation coefficient (0.910 vs 0.417) than adductor policis with respect to abdominal muscle. It indicated that corrugator supercilii is a better predictor than AP to measure abdominal muscle relaxation

COMPARISON OF NOREPINEPHRINE AND PHENYLEPHRINE BOLUSES FOR THE TREATMENT OF HYPOTENSION DURING SPINAL ANESTHESIA FOR CESAREAN SECTION.: Spinal anesthesia induced hypotension

Introduction:  Phenylephrine in small boluses of 50 to 100µgm or infusion is commonly used to treat hypotension following spinal anesthesia in addition to fluids transfusion and compression stockings in lower limbs. Noradrenaline, the preferred drug for the management of hypotension in shock is now being tried to treat hypotension following spinal anesthesia in small increments. The present study was carried out to compare the efficacy of noradrenalin over phenylephrine in treating hypotension following spinal anesthesia.   Materials and Methods:  A hundred patients undergoing cesarean section were randomly divided into two groups. One group received phenylephrine 50µgm intravenous bolus and the other group received noradrenalin 4µgm intravenous bolus to treat hypotension following spinal anesthesia. The doses of phenylephrine and noradrenaline required to treat spinal hypotension, the incidence of bradycardia, hypotension, nausea, and vomiting in the mother and fetal outcome were recorded.  Observation:  The number of boluses of vasopressors required to treat hypotension was significantly lower in the noradrenaline group (Group NE=1.36±0.563, Group PE=2.00±0.699, p-value=0.000). The frequency of bradycardia was higher in the phenylephrine group and was statistically significant (Group NE=2 (4%), Group PE=11 (22%) p-value=0.015). Maternal complications such as nausea vomiting and shivering were comparable between the groups. The fetal parameters were also comparable between the two groups.   Conclusion:  Noradrenaline boluses are equally effective as phenylephrine in treating spinal anesthesia-induced hypotension. The incidence of side effects is comparable between the groups.  Recommendation:  Norepinephrine should be considered as an alternative to phenylephrine in spinal anesthesia-induced hypotension