Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries

Background: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine. Materials and Methods: The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A (n = 50) and 150 mg of 0.75% ropivacaine with dexmedetomidine (1 μg/kg) in Group B (n = 50). Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fisher′s exact test and Student t-test. P < 0.05 was considered to be significant and P < 0.001 as highly significant. Results: Significant difference was observed in relation to the duration of sensory block (375.20 ± 15.97 min in Group A and 535.18 ± 19.85 min in Group B [P - 0.000]), duration of motor block (259.80 ± 15.48 min in Group A and 385.92 ± 17.71 min in Group B [P - 0.000]), duration of post-operative analgesia (312.64 ± 16.21 min in Group A and 496.56 ± 16.08 min in Group B [P < 0.001]) and consequently low doses of rescue analgesia in Group B (1.44 ± 0.501) as compared to Group A (2.56 ± 0.67). Sedation score was significantly more in Group B in the post-operative period. Conclusion: Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine

Comparison of 0.5% Ropivacaine with 0.5% Ropivacaine and Magnesium sulphate in supraclavicular brachial plexus block for forelimb and hand surgeries

Objectives: Supraclavicular Brachial Plexus is commonly used for forelimb and hand surgeries. A lot of research is going on to increase the duration of sensory and motor blockade by the addition of adjuvants with the local anesthetics. We evaluated the effect of adding magnesium sulphate to ropivacaine for supraclavicular brachial plexus blockade. Our primary parameters were the onset and duration of sensory and motor block and duration of analgesia. Methods: 60 patients posted for elective forearm and hand surgeries under supraclavicular brachial plexus block were divided into two equal groups (Group RM and RN) in a double blind fashion. In Group RM 30ml 0.5% ropivacaine plus 150 mg magnesium sulphate in (1 ml 0.9% saline) and in group RN 1ml of normal saline was added to ropivacaine. Results: Both the groups have similar demographic profile and time of onset of senory and motor block but the duration of senory and motor blockade and duration of analgesia were significantly longer in RM group than RN group. Intraoperative hemodynamics were compareable amoung two groups and no considerable side effects were noted in both the groups. Conclusion: It can be concluded from our study that by addition of magnesium sulphate to local anesthetics in supraclavicular brachial plexus block may increase the duration of senory and motor blockade and duration of analgesia with no appreciable side effects, however duration of onset of sensory and motor blockade was more in magnesium sulphate group

Comparison of local anaesthesia versus spinal anaesthesia for peri anal disorders

Background: Peri anal disorders are associated with high morbidity and can be managed surgically both under spinal as well as local anaesthesia. Objectives: The study evaluates the results of anal surgery when performed under local anaesthesia as compared to spinal anaesthesia with respect to parameters like post operative pain, nausea, vomiting, analgesia requirement, voiding problem and bleeding. Material and Methods: The study included 50 patients divided in two groups (A and B) of 25 each. The patients of group A and group B were operated under local and spinal anaesthesia respectively. The patients were assessed postoperatively at 6 hrs, 8 hrs and 12 hrs on day one and then on subsequent days for different parameters like post operative pain, need and duration of analgesia required, bleeding, voiding problems and associated nausea. Result: The results of two groups were then compared and analysed. In group A 56% of patients required analgesia 8 hourly as compared to 40% in group B. No analgesics were required 3 days after the surgery in both the groups. Difficulty in voiding was seen in 12% of patients in group A as compared to 28% in group B. There was no post operative bleeding except for 4 patients in group A. Most of the patients of group A had hospital stay of 2.3±0.46 days postoperatively while those in group B stayed for 3.4±0.53 days. Conclusion: The study reveals favoured local anaesthesia over spinal anaesthesia for peri anal surgeries because of simplicity in administration of anaesthetic agent, less need of analgesia, lesser hospital stay, lesser incidence of nausea and vomiting and no need for catheterisation

Comparative evaluation of Intrathecal Fentanyl with different doses of Bupivacaine on lower limb surgery

Introduction: Intrathecal administration of opioids and local anaesthetics provides good analgesia. Fentanyl potentiates the afferent surgical blockade and improves both intra and post operative analgesia. The synergism between intrathecal opioids and local anaestheticsachieves a reliable spinal anaesthesia with minimal hypotension. The optimal doses and dilutions of intrathecal combination of bupivacaine and fentanyl remain a subject of discussion. Therefore, we designed this study to compare the effects of different doses of hyperbaric bupivacaine 0.5% (10 mg, 12.5 mg, 15 mg) with fentanyl 25 microgram in subarachnoid block on quality of anaesthesia and recovery. Objectives: To observe sensory and motor blockcharacteristics and effects of different doses of bupivacaine on haemodynamic parameters. Method: A prospective randomized study was carried out on three groups of 20 each. Group A patients were given 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 µg and 0.9% normal saline 1.5 ml. Group B patients were given with 0.5% hyperbaric bupivacaine 12.5 mg, fentanyl 25 µg and 0.9% normal saline 1ml. Group C patients were given 0.5% hyperbaric bupivacaine 15 mg, fentanyl 25 µg and 0.9% normal saline 0.5 ml. Results: Duration of sensory block was prolonged in group C (139.50±16.05 minutes) than group A (129.00±18.32 minutes). On statistical comparison, group B and C (126.25±15.29 minutes and 132.75±10.70 minutes respectively) had significant prolonged duration of motor block than group A (114.00±18.11 minutes). Conclusion: Fentanyl 25µg with 0.5% hyperbaric bupivacaine 12.5 mg is superior in terms of characteristics of sensory and motor block and haemodynamic stability

Comparative Evaluation of Ketamine - Propofol, Fentanyl - Propofol and Butorphanol-Propofol on Haemodynamics and Laryngeal Mask Airway Insertion Conditions

Background:Laryngeal mask airway is a non invasive supraglottic device which has led to a radical change in the management of modern general anaesthesia. Propofol as a single agent is unsatisfactory and to overcome problems associated with LMA insertions. In the present study, we evaluated the haemodynamic changes and laryngeal mask airway insertion conditions comparing ketamine and opioids as adjuncts to propofol. Patients and Methods: 90 patients were randomly divided into 3 groups of 30 each. In Group PK-ketamine 0.5mg kg -1, in Group PF-fentanyl 1ug kg -1 and in Group PB - butorphanol 20ug kg -1 was given intravenously immediately before induction with propofol 2.5 mg kg -1 . Jaw relaxation was assessed according to Young′s criteria and the overall conditions according to modified Scheme of Lund and Stovener. Results: The mean total dose of propofol required in Group PK was 160.37 ± 15.75mg, in Group PF 156.22 ± 17.18 mg and in Group PB 140.08 ± 18.97 mg. The incidence of absolute jaw relaxation was highest in Group PB (93.33%) patients, intermediate in Group PF (53.33%) patients and lowest in Group PK i.e. 36.66% patients. Excellent insertion conditions were observed in 12 (40%) patients in Group PK and 13 (43.33%) patients in Group PF and in 26 (86.67%) patients in Group PB. Group PK showed more rise in systolic and diastolic blood pressure and heart rate post LMA insertion as compared to Group PF and Group PB. Conclusion: It is concluded that addition of butorphanol to propofol for LMA insertion provided absolute jaw relaxation and excellent insertion conditions with stable haemodynamics Side effects like coughing, gagging, lacrimation and laryngospasm were lower as compared to the other two groups

Comparative study of ketorolac versus butorphanol as an adjuvant in Intravenous regional anaesthesia (IVRA)

Background: Intravenous regional anaesthesia (IVRA) is simple, effective technique for upper limb orthopaedic surgeries specifically in developing countries like India because of cost- effectiveness. IVRA is also called Bier’s block after the name of its inventor August Bier. Aim: Present study was carried out to evaluate the effects of adding either butorphanol or ketorolac to lignocaine during Bier’s block. Materials and Methods: In a prospective randomized double blind study, 60 patients of age group 18-65 years of either sex with weight range of 65-70 kg of ASA grade I- III were randomly allocated into two groups of 30 each. Group I received butorphanol 1mg added to 3mg/kg lignocaine and group II received ketorolac 30 mg added to 3mg/kg lignocaine. Sensory and motor block onset, regression time, intraoperative and postoperative VAS score, duration of analgesia, total analgesic consumption in first 24 hr and side effects were noted. Statistical analysis of data was based on chi square test and post hoc test. Results: Demographic profile in both the groups was same. Duration of analgesia was significantly prolonged in group II(10.8 ±6.42) as compared to group I(3.02±1.52). In both the groups, patients remained haemodynamically stable and side effects and complications were also comparable. Conclusion: Ketorolac with lignocaine in IVRA provides prolonged post-operative analgesia as compared to butorphanol and lesser number of patients require rescue analgesia intraoperatively as well as postoperatively without any significant side effects

Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block

Introduction: There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anaesthesia. Method: A prospective randomized study was carried out which included 60 adult patients between the ages of 18-65 years of ASA grade I and II who underwent upper limb orthopaedic surgeries. Group A received 30 ml of 0.5% levobupivacaine with 150µg of clonidine and Group B received admixture of 30 ml of 0.5% levobupivacaine with 100 µg of Dexmedetomidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed. Results: Duration of postoperative analgesia in group A was 14.36±0.36 minutes and in group B was 16.90±2.29 minutes. Hence from the above observation, the duration of analgesia in group B is longer than group A which is statistically highly significant (p&lt;0.001). Conclusion: Dexmedetomidine as an adjuvant 0.5% levobupivacaine is more effective in prolonging the duration of sensory and motor block and post operative analgesia compare to clonidine as an adjuvant to 0.5% levobupivacaine

Additive effect of butorphanol in supraclavicular brachial plexus block

Introduction: Increasing the quality of regional anaesthesia has always been an area of interest for anaesthesiologist. Butorphanol is a synthetic opioid analgesic having partial agonist at μ &amp; agonistic activity at kappa opioid receptor. It use has been done as a single drug as well as in combination with a local anaesthetic for axillary brachial plexus blockade. Material and Methods: 60 Patients were allocated randomly into one of the two groups of 30 patients each to receive supraclavicular brachial plexus block. In Group B, 30 ml of 0.5% bupivacaine hydrochloride plus 1ml normal saline and in Group BB, 30 ml of 0.5% Bupivacaine hydrochloride plus 1ml butorphanol (2mg). Onset time of sensory &amp; motor block, duration of motor block &amp; post operative analgesia was observed. Results: The mean duration of sensory block was 4.27 ± 0.51 hrs in group B and 9.10 ± 0.71 hrs in group BB and mean duration of motor block was 3.57 ± 0.56 hrs in group B and 5.13 ± 0.51 hours in group BB. The difference in the two groups was found to be statistically highly significant (&lt; 0.001). The duration of post operative analgesia was 5.27 ± 0.77 in group B and 11.37 ± 0.85 in group BB (p &lt; 0.001). Conclusion: Addition of butorphanol 2mg with bupivacaine prolongs the duration of blockade and postoperative analgesia in supraclavicular brachial plexus blockade without compromising the haemodynamic parameters or producing any significant adverse drug reactions

Comparison of midazolam versus clonazepam as premedication scheduled for elective abdominal hysterectomies

Background and aim: Anxiety is one of the most common problem which affect the patient during surgical procedures. Thus, anxiolytics have a primary role as premedication preoperatively. With this background, we designed this study to compare anxiolytic effects of oral midazolam and oral clonazepam. Methods: Study was carried out in 80 patients scheduled for elective Abdominal hysterectomy and were divided into group of 40 each. Group M 40 patients were given Tab Midazolam 10 mg, 45 min before surgery. Group C of 40 patients were given Tab Clonazepam 2 mg, 45 min before surgery with a sip of water. All hemodynamic parameters, sedation score, satisfactory score, Hamitlon Anxiety Rating Scale were noted. The patient characteristics were analysed using “Chi-square test” and inter group comparison of the parametric data was done using the “unpaired t-test using software IBM SPSS 17.0. Results: Clonazepam is better anxiolytic than midazolam and has longer duration of anxiolytic effects and with minimal side effects and better hemodynamic stability than midazolam. Conclusion: Tab Clonazepam can be used as premedication to allay anxiety in the patients undergoing elective surgeries

Conflicts in operating room: Focus on causes and resolution

The operation theater (OT) environment is the most complex and volatile workplace where two coequal physicians share responsibility of one patient. Difference in information, opinion, values, experience and interests between a surgeon and anesthesiologist may arise while working in high-pressure environments like OT, which may trigger conflict. Quality of patient care depends on effective teamwork for which multidisciplinary communication is an essential part. Troubled relationships leads to conflicts and conflicts leads to stressful work environment which hinders the safe discharge of patient care. Unresolved conflicts can harm the relationship but when handled in a positive way it provides an opportunity for growth and ultimately strengthening the bond between two people. By learning the skills to resolve conflict, we can keep our professional relationship healthy and strong which is an important component of good patient care