Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia

Seroprevalence of Chlamydia trachomatis infection among pregnant women and their outcome

Background: Genitourinary infections either sexually transmitted or by other means are a major concern among women, particularly young adults and teens. The objective was to find out seroprevalence of Chlamydia trachomatis infection in pregnant women and its effect on pregnancy outcome.Methods: the present study was carried out in the department of obstetrics and gynaecology, King George Medical University of Lucknow, Uttar Pradesh, India, over a period of September 2003 to July 2004. Total 120 pregnant women were included in the study, these pregnant women were selected according to their will in taking part in the study irrespective of age and parity. 2 ml of blood sample was collected and determination of antichlamydial IgM antibody was done by VIRCELL SL IgM ELISA Kit in microbiology department. Prevalence of chlamydia trachomatis in pregnant women were assessed and correlated with age group, parity, socioeconomic status, previous obstetric outcome, anaemia, PROM, mode of termination according to gestational age, perinatal outcome regards birthweight, and adverse neonatal outcome.Results: Out of 120 cases, total 70 (58.33%) were positive while the remaining 50 cases were negative. 80 cases were followed till delivery in which 66.25% were positive for antichlamydial IgM antibody. There was significant association of previous history of 2-3 abortion and preterm delivery with IgM positive cases. Low birth weight deliveries were 78% and very low birth weight was 100% in positive cases. Caesarean section at <37 weeks of gestation, IUGR and low APGAR score were significantly high in IgM positive group. 100% PROM cases were IgM positive.Conclusions: The prevalence of chlamydia trachomatis infection among pregnant women in our population is high and is strongly associated with premature rupture of membranes, IUGR, LBW, and low APGAR score deliveries

Comparison of landmark and real-time ultrasound-guided epidural catheter placement in the pediatric population: a prospective randomized comparative trial

Background Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients. Methods This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications. Results The median (interquartile range) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT (P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. Conclusions The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups

Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial

Background Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. Methods Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study's primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results The median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients

Anesthesia in a child operated for cleft lip associated with Patau's syndrome

Patients with Patau's syndrome (Trisomy 13) have multiple craniofacial, cardiac, neurological and renal anomalies with very less life expectancy. Among craniofacial anomalies cleft lip and palate are common. These craniofacial and cardiac anomalies present difficulties with anesthesia. We therefore describe the anesthetic management in the case of a Trisomy 13 child for operated for cleft lip at 10 months of age. Resumo: Os pacientes com síndrome de Patau (trissomia 13) apresentam várias anomalias craniofaciais, cardíacas, neurológicas e renais, com expectativa de vida bem menor. Entre as anomalias craniofaciais, o lábio leporino e a fenda palatina são comuns. Essas anomalias craniofaciais e cardíacas apresentam dificuldades na anestesia. Portanto, descrevemos o manejo anestésico em uma criança de 10 meses de idade com Trissomia 13 submetida à cirurgia de lábio leporino. Keywords: Patau's syndrome, Cleft lip, Cleft palate, Paediatric anesthesia, Palavras-chave: Síndrome de Patau, Lábio leporino, Fenda palatina, Anestesia pediátric

Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block

Context: Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia. Aim: We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries. Settings and Design: Double-blinded randomized controlled trial. Materials and Methods: Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 μg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h. Results: The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects. Conclusion: Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects

Anesthesia in a child operated for cleft lip associated with Patau's syndrome

Abstract Patients with Patau's syndrome (Trisomy 13) have multiple craniofacial, cardiac, neurological and renal anomalies with very less life expectancy. Among craniofacial anomalies cleft lip and palate are common. These craniofacial and cardiac anomalies present difficulties with anesthesia. We therefore describe the anesthetic management in the case of a Trisomy 13 child for operated for cleft lip at 10 months of age

Comparison of analgesic efficacy of perineural dexamethasone in rectus sheath block and intravenous dexamethasone with levobupivacaine in bilateral rectus sheath block for patients undergoing midline abdominal surgery: a randomized controlled trial

Abstract Background Dexamethasone is used in regional analgesia to prolong the duration of analgesia and anaesthesia. The perineural and intravenous (IV) dexamethasone in fascial plane block have conflicting results. The study aimed to compare analgesic efficacy of perineurally and intravenously dexamethasone in rectus sheath block (RSB). This prospective, double-blinded, randomized control study was conducted in 105 patients, equally divided in three groups. All the patients received ultrasound-guided RSB block with 20 ml of 0.25% levobupivacaine on each side. Additionally, in group A, 1-ml normal saline (NS) on each side in RSB block and 2-ml NS IV; in group B, 4-mg dexamethasone on each side in RSB block and 2-ml NS IV; and in group C, 1-ml NS on each side in RSB block and 8-mg dexamethasone IV. The primary objective of the study was the duration of analgesia, and secondary objectives were total morphine consumption in the first 24 h, numeric rating scale (NRS) scores at rest and on cough, complications and patient’s satisfaction score. Results The duration of analgesia was maximum in group B (935.91 ± 121.82 min) and then in group C (730.31 ± 129.64 min) and group A (418.34 ± 29.22 min) (P < 0.0001). The morphine consumption and mean NRS score (at rest and cough) were lowest in group B and then group C and group A (P < 0.0001). Conclusions The perineural dexamethasone as an adjuvant to levobupivacaine prolongs the duration of analgesia with decreased analgesic requirements compared to intravenous dexamethasone in bilateral RSB in patients undergoing midline laparotomy surgery