A cross sectional study to measure prevalence of DVT in subacute and chronic spinal cord injury patients without any chemical prophylaxis

Background: Prevalence of DVT in patients with sub-acute and chronic SCI has only been reported in a limited number of studies. Knowing the incidence of thromboembolic events in the sub-acute and chronic rehabilitation phase is important to estimate disease risk and facilitate evidence based prevention. We sought to determine the prevalence of DVT in patients of subacute and chronic phases post spinal cord injury without any chemical prophylaxis.Methods: Between June 2016 and April 2018, all cases of sub-acute and chronic spinal cord injury, undergoing rehabilitation at our centre were studied. Patients with pre-existing coagulopathy/hypercoagulable state/ bleeding diathesis or on medications for these conditions, tobacco smokers, chronic alcoholics and obese individuals were excluded from the study. All patients enrolled in the study were given mechanical DVT prophylaxis and followed institutional rehabilitation protocol. They were evaluated at 3 months, 6 months and 9 months by clinical examination and CDFI for any evidence of DVT.Results: Out of 60 patients studied, 04 patients developed DVT (3 in ASIA grade A and 1 in ASIA grade B patient). 75% (3 cases) of the cases were detected in the first 3 months and only one case was detected between 3-6 moths post Spinal cord injury. The prevalence of DVT in our study, in subacute and chronic cases of spinal cord injury was 6.67%.Conclusions: Our study is in concurrence with the existing literature about the low prevalence of DVT in Southeast Asian population which doesn’t warrant DVT chemoprophylaxis in subacute and chronic SCI cases

Clinical comparison between femoral transfixation and bioscrew fixation using hamstring tendon graft for ACL reconstruction

Background: One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. There is no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically.Methods: 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In group A; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter.Results: At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laity tests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score.Conclusions: Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests, instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels.

Dexmedetomidine as an adjuvant drug for ultrasound guided interscalene block for shoulder arthroscopic surgeries: prospective observational study

Introduction: Arthroscopic shoulder surgeries can be done under general anaesthesia, regional anaesthesia or a combination of both. In patients undergoing shoulder arthroscopy, pain can persist for more than 48 hours in the postoperative period despite multimodal analgesia, thus making pain control challenging for anesthesiologists. Materials and Methods: Institutional ethics committee approval was sought before commencing this prospective observational study. Patients of American Society of Anaesthesiologists physical status (ASA PS) I or II, aged 19-76 years of either gender scheduled for elective arthroscopic shoulder surgeries (Surgery done in lateral position) under interscalene block using 50 mcg of Dexmedetomidine as adjuvants along with  15 mL of 2% lignocaine and 15 mL of 0.5% bupivacaine were included in the study. Patients who refused to participate, those with neurological deficits, known allergy to local anaesthetics and history of seizures were excluded. Informed consent was obtained from all participants. Consultant anaesthesiologists administered the USG guided interscalene blocks with 15 mL of 2% lignocaine and 15 mL of 0.5% bupivacaine and Dexmedetomidine as adjuvant. Ultrasound guided interscalene block using linear probe and 26G needle without using nerve stimulator.Results: Fifty five male and eight female patients participated in the study. Fifty patients belonged to ASA PS I and 13 patients belonged to ASA PS II. Age, weight and the duration of surgery were comparable between all the patients. Dexmedetomidine as an adjuvant to lignocaine and bupivacaine prolongs ultrasound guided interscalene blockade is more efficaciently in hastening the onset, prolonging sensorimotor blockade and delaying the time for request of rescue analgesia.Conclusion: Dexmedetomidine as an adjuvant to lignocaine and bupivacaine prolongs ultrasound guided interscalene blockade is more efficaciently in hastening the onset, prolonging sensorimotor blockade and delaying the time for request of rescue analgesia. Dexmedetomidine also provides Intraoperative sedation, which is very helpful for conducting the surgery. Keywords: Arthroscopic, Dexmedetomidine, lignocaine, interscalene blockad

Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range) number of skin punctures were 2 (2-4) in group US and 3 (2-5) in group NS (P =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine