Comparison Between Fractionated and Single Bolus Dose of Local Anaesthetic (Bupivacaine 0.5% Heavy) in Elective Lower Segment Caeserean Section

Context :  Fractionated dose of local anaesthetic in spinal anaesthesia has been compared with single bolus dose in terms of hemodynamic stability. Aims: Comparison of fractionated dose versus  single bolus dose injection of local anaesthetic  in spinal anaesthesia for patients undergoing elective   caesarean section. Go to:Settings and Design: This prospective comparative study was conducted at a tertiary care hospital in central India. Methods and material: 200 healthy female parturients who were scheduled for elective caesarean section were allocated randomly into two groups- one that received fractionated dose and another that received single bolus dose of bupivacaine heavy (0.5%). With patient in sitting position subarachnoid block was established using dose according to height of the patient(0.07mg/cm height of patient). The single bolus group B recieved bupivacaine in single bolus over 10s. In Fractionated dose group F, patients recieved 2/3rd of the total calculated dose given initially followed by 1/3rd dose after 90s,both at a rate 0.2ml/s. After injection of initial 2/3rd dose, the syringe was kept attached to the spinal needle for the remaining 90s, after which remaining one third dose was administered. Data assessed were the number of hypotensive episodes and number of times vasopressors had to be given. Statistical Analysis: The data was collected using Microsoft excel and Statistical Package for Social Sciences (SSPS ver. 21). Results: There was statistically significant difference between the hemodynamic stability for the two groups.Conclusion:  Fractionated dose of local anaesthetic was found to be hemodynamically more stable than single bolus dose.  Keywords: hypotension,singlebolusdose,fractionated dose, hemodynamic stability

Effects of preoperative gabapentin on postoperative relief of pain in patients scheduled for surgery under general anaesthesia

Background: To evaluate the effects of preoperative Gabapentin on postoperative relief of pain in patients scheduled for surgery under general anaesthesia. Post-operative ward and OT Department of Anaesthesia, JAH, GR Medical College, Gwalior, Madhya Pradesh, India.Methods: The sixty patients subjected to ASA grade I and II posted for elective surgeries under general anaesthesia were randomized into 2 groups. One and half hour before surgery, Gabapentin 600 mg and placebo was given blindly to selected patients for the study. The postoperative pain was assessed with visual analogue score. Pain and side effects assessment were performed.Results: Total 60 patients of ASA grade I and II posted for elective surgeries under GA were randomized into 2 groups. One and half hour before surgery, the drug selected for the study was given blindly with a sip of water. The mean (±SD) of VAS score was 5.86±0.34 in Group B and 5.10±0.84 in Group A. VAS score was significantly lower in Group A. With oral Gabapentin time required for rescue analgesia is delayed as compared to control group. The mean (±SD) TRA-1 was 38.40±24.61 in Group B and 44.03±8.94 in Group A.Conclusions: Preoperative oral Gabapentin significantly decreases the severity of pain postoperatively as compared to placebo in patients posted for surgery. Time for analgesic requirement is more with oral Gabapentin. The VAS score was lower in Gabapentin group