Comparative study between ultrasound guided modified pectoral nerve block versus erector spinae block in breast surgeries-prospective randomised comparative study

Background: Breast cancer is the most common cancer in women, comprising approximately 25% of all cases. Failure to provide effective pain control is associated with poor quality of recovery & chronic postsurgical pain after breast surgery. According to a recently published PROSPECT guideline, pectoral nerve (PECS) blocks seem to be an effective alternative to PVB for postsurgical pain management in breast surgery. In order to relieve post-operative pain in patients undergoing MRM, in this study we compared the efficacy of modified pectoral nerve block versus erector spinae plane block for breast cancer surgeries. Methods: A comparative study was conducted among 80 female patients of age 25-65 years scheduled for modified radical mastectomy surgery with ASA class I and II after obtaining approval from ethical committee. Written informed consent was obtained and research process were explained to the patients. They were randomly allocated into two groups of 40 each. Group 1: was assigned to receive 0.2% Ropivacaine 25ml for Erector spinae block and Group 2: Was assigned to receive 0.2% ropivacaine 25 ml for modified pectoral nerve block, p value <0.05 was considered statistically significant. Results: In patients receiving modified pectoral nerve block (PEC 2) there was considerably lesser opioid consumption, Ionger duration of analgesia and lesser postoperative pain score as compared to patients receiving erector spinae block (ESP) for modified radical mastectomy surgeries. Conclusions: Modified Pectoral nerve block is a potential analgesic technique in breast surgeries since it has less perioperative opioid consumption, proIonged duration of anaIgesia, Iesser postoperative pain score when compared to Erector Spinae block

Efficacy of 0.5% levobupivacaine with clonidine 30 μg versus 0.5% levobupivacaine with 150 μg buprenorphine for USG guided interscalene brachial plexus block for shoulder, upper and middle humerus surgeries: a prospective randomized double blinded comparative study

Background: Ultrasound imaging is increasingly used for peripheral nerve blocks, offering real-time visualization of nerves, surrounding structures, and needle tips. Levobupivacaine, a local anesthetic, provides excellent intraoperative and postoperative analgesia. Buprenorphine, a partial µ-opioid receptor agonist, and clonidine, an α2 adrenergic agonist, also offer postoperative analgesia. We aimed to compare levobupivacaine with clonidine versus levobupivacaine with buprenorphine for ultrasound-guided interscalene block for shoulder and upper-arm surgeries. This study aimed to determine the onset and duration of sensory and motor block, duration of postoperative analgesia, hemodynamics, complications, and sedation. Methods: Patients scheduled for elective shoulder and upper-middle humerus surgeries received either levobupivacaine with clonidine or levobupivacaine with buprenorphine. Assessments include onset and duration of sensory and motor blockade, analgesia duration, sedation, side effects, and block quality. Onset and duration of sensory and motor blockade, and analgesia duration was analyzed using unpaired T-Test. Results: Levobupivacaine with clonidine group showed longer duration of analgesia (595±148 mins) compared to levobupivacaine with buprenorphine group (445±44.16 mins), with a significant difference (P<0.039). Conclusions: Levobupivacaine with clonidine provided excellent blockade quality, and both clonidine and buprenorphine added to levobupivacaine offered good surgical and postoperative analgesia. However, levobupivacaine with clonidine significantly prolonged postoperative analgesia compared to buprenorphine

USG guided indices as a tool for prediction of difficult airway in obese: an observational study

Background: Now a days, Ultrasound has been the gold standard and an invaluable tool in the field of regional anaesthesia, especially for upper limb and truncal blocks where general anesthesia is associated with high risk and also in patients posted for general anesthesia with anticipated difficult airway. Recently, few studies have published the importance of Ultrasound in the evaluation of airway and related procedures. Aim of this study is to evaluate the use of USG guided indices for prediction of difficult airway in obese patients and correlating them with clinical parameters. Methods: This study was a prospective observational study done in a tertiary health care center, Government General hospital, Kakinada over a duration of two months from August 2022 to September 2022. Eight Ultrasound parameters like tongue thickness, skin to hyoid distance, pre-epiglottic space, skin to midpoint of vocal cords, skin to thyroid isthmus, anterior soft tissue thickness at suprasternal notch, hyomental distance and thyromental distance were correlated with clinical evaluation (Cormacke-lehane grading) in this study and conclusions were drawn. Results: Out of 30 cases studied, 20 (70%) were predicted to be difficult with Ultrasound airway examination and 16 (53.3%) were found to have difficulty in intubation clinically. Conclusions: The following USG indices like pre-epiglottic space, Skin to midpoint of vocal cords, Anterior soft tissue thickness at Suprasternal notch, Hyomental distance in mid-extended position and thyromental distance were found to be clinically correlated to predict difficult airway and intubation in obese patients

A randomized clinical trial of intrathecal magnesium sulfate versus midazolam with epidural administration of 0.75% ropivacaine for patients with preeclampsia scheduled for elective cesarean section

Background and Aims: Magnesium sulfate and midazolam have been used as adjuvants to local anesthetics via intrathecal and epidural routes to augment the quality of block and prolong postoperative analgesia. This study compares addition of intrathecal magnesium sulfate versus intrathecal midazolam to epidurally administered isobaric ropivacaine as a part of combined spinal epidural technique in pre-eclamptic parturients undergoing elective cesarean section. Material and Methods: After institutional ethics committee approval and written informed consent, 50 pre-eclamptic parturients were randomly allocated to one of the two groups of 25 each to either receive intrathecal magnesium sulfate (50 mg) or intrathecal midazolam (1 mg) in combination with epidural ropivacaine (0.75%; 14–16 ml). The onset and duration of sensory and motor blockade, duration of postoperative analgesia, postoperative visual analogue scores for pain, and perioperative side effects were noted. Data were analyzed statistically using Graphpad.com software. Results: Onset times to sensory and motor blockade were faster in midazolam than in magnesium group (P < 0.01). Duration of sensory and motor blockade, and time to first request of analgesia were significantly longer in the magnesium group compared to the midazolam group (P < 0.01). The fetal outcomes according to APGAR scores were comparable in both the groups, the median APGAR score at 1 minute was 8 and at 5 minutes was 10 in both the groups. Conclusion: Intrathecal magnesium with epidural ropivacaine significantly prolonged postoperative analgesia compared to intrathecal midazolam without any complications. Perioperative hemodynamics were comparable in both groups