Post-operative wound infiltration with dexmedetomidine and magnesium sulphate as adjuvant to levobupivacaine for lumbar laminectomy: a prospective, double blinded, randomized controlled study

Background: Wound infiltration with local anaesthetic is safe and effective technique for providing postoperative analgesia following lumbar laminectomy. The objective of this study was to compare the efficacy of local wound infiltration on postoperative analgesia with levobupivacaine, levobupivacaine plus magnesium sulphate and levobupivacaine plus dexmedetomidine in patient undergoing lumbar laminectomy.Methods: Ninety adult patients were randomly allocated into three groups. After the completion of lumbar laminectomy, the drug was locally infiltrated into the paravertebral muscles on either side. Group L received 10 ml of 0.5% levobupivacaine plus 10 ml normal saline, group LM received 10 ml of 0.5% levobupivacaine plus 500 mg magnesium sulphate (1 ml) plus 9 ml normal saline, group LD received 10 ml of 0.5% levobupivacaine plus 50 µg dexmedetomidine (0.5 ml) plus 9.5 ml normal saline. Postoperative visual analogue scale (VAS) pain score at 0, 1, 2, 4, 6, 8, 12 and 24 hours, time to first rescue analgesic drug and its total dose, quality of recovery score (QoR) and side effects were noted.Results: Postoperative VAS was significantly higher in group L as compared to group LM and LD (p<0.05). The time to first rescue analgesic drug was significantly longer in group LD (11.07±7.20 hr) than group LM (6.20±2.64 hr) and group L (3.93±2.70 hr) (p<0.001). The QoR score was significantly better in group LD as compared to group LM and L postoperatively (<0.01).Conclusions: Addition of magnesium sulphate or dexmedetomidine to levobupivacaine for local wound infiltration demonstrated enhanced postoperative analgesia.

Comparative analysis of injection clonidine and injection dexmedetomidine added to injection bupivacaine for spinal anaesthesia in lower abdominal surgeries

Background:Efficacy of sub-arachnoid block can be improved by addition of various adjuvants to local anesthetics. Intrathecal administration of clonidine or dexmedetomidine has improved the quality of spinal anesthesia in terms of longer duration of post-operative analgesia with comparatively lesser side effects. In present study we compared the onset and duration of motor and sensory block, hemodynamic effects, post-operative analgesia and adverse effects of clonidine and dexmedetomidine used intrathecally with bupivacaine.Methods: Present study was conducted in 150 patients (ASA class I and II) undergoing lower abdominal surgeries. Patients were randomly divided into three group’s viz. B, C and D. Group B received bupivacaine (12.5 mg), group C received clonidine (30 µg) with bupivacaine and group D received dexmedetomidine (5 µg) with bupivacaine. Volume of administered drug was set at 3ml in all the groups. The onset time to reach peak sensory and motor block level, regression time to sensory and motor block, hemodynamic changes and side effects if any were assessed and recorded.Results: In our study we observed that there was no significant difference in patient demography and duration of surgical procedure. The time to onset of sensory blockage was similar in all the three groups but time to onset of motor block was shorter in group C and D compared to group B. Total duration of sensory and motor block was significantly higher in group D compared to group C and B. The duration of sensory block in group D was 139.58+14.49, in group C it was 122.46+18.55 and in group B it was 100+13.43 minutes. The duration of motor block in group D was 250.40+27.33, in group C it was 229.28+23.68 and in group B it was 175.64+17.41 minutes.Conclusions: It was concluded that though both clonidine and dexmedetomidine prolonged duration of sensory and motor block of Bupivacaine, Dexmedetomidine is better in terms of longer duration of action.

Developing competency among interns in palliative care of critically ill patients

Background: Palliative care has become increasingly important in the last decades with rise in needy patients and subsequent shortage of health care professional serving palliative care, making it a global public health concern. Patients and methods: Educational interventional study conducted in Department of Anaesthesiology of a tertiary care teaching institute. Pre-post test by standardized validated multiple choice questions for assessment of knowledge and awareness was conducted before and after the session. Interactive didactic lectures integrated with faculty narrative from Department of Palliative Care, demonstration among small groups, and live demonstration on patients under aegis of Anaesthesia Department were given after pre-test. Feedback questionnaire in the form of Likert’s scale for assessment of students’ satisfaction and attitude was done at end of session. Results: Fifty (50) interns participated in the study. Out of 50, 28 (56%) were male and 22 (44%) were female interns. Mean pre-test score was 8.82 ± 2.13 (range 4–12) out of total 20. Mean post-test score was 14.44 ± 1.72 (range 11–17). The pre and post test results difference was significant (p &lt; 0.0001). Percentage gain in knowledge and awareness was 63.95%. Conclusions: Most professionals will need basic skills of various management modalities in supportive therapy in near future to fully fill demand of palliative care which is going to be doubled within next few decades so the need for conducting more such sessions regularly amongst young budding doctors including interns at very early stage to develop competency for palliative care was observed

Neuraxial techniques of labour analgesia

In recent years, many neuraxial techniques have been introduced to initiate and maintain labour analgesia, with low-dose mixtures of local anaesthetics and opioids, which have improved the quality of analgesia and made it safer for both mother and neonate. An independent search of the databases of PubMed, Medline, and Cochrane controlled trial data was conducted by two researchers, and randomized controlled trials that compared different methods of neuraxial analgesia and the different techniques of maintaining labor analgesia were retrieved and analyzed. The advantages, disadvantages, and indications of each technique along with the doses of intrathecal and epidural drugs are discussed. The myths and controversies involving neuraxial labor analgesia and the current consensus on their effect on the maternal and foetal outcomes are also outlined

Peri-operative management of severe pre-eclampsia with kyphoscoliosis and poliomyelitis for emergency caesarean section

A 37 years old primigravida, 31 weeks gestation with severe preeclampsia [BP = 180/120 mm Hg] with severe kyphoscoliosis and polio affecting right lower limb was admitted in emergency with complaint of blurring of vision and pedal edema. An emergency caesarean section was conducted under general anaesthesia because of a failed spinal anaesthesia. Perioperative anaesthetic management and her postoperative course are discussed

Efficacy and safety of conventional epidural versus combined spinal epidural in percutaneous nephrolithotomy (PCNL): A prospective and randomized clinical study

Objectives: To compare the efficacy and safety of conventional epidural (ED) versus combined spinal epidural (CSE) in percutaneous nephrolithotomy with addition of opiods and dexmedetomidine. Methods: This prospective, randomized and double blinded clinical study was conducted in the in patients undergoing Percutaneous Nephrolithotomy (PCNL). Group CSE had received combined spinal epidural anaesthesia and Group ED given conventional epidural anaesthesia. Time to first rescue analgesic, total dose of rescue analgesic along with hemodynamic parameters were compared upto 24 hours. Patient, surgeon satisfaction score and post operative complications were also compared. Results: Time from onset of sensory block to first requirement of analgesia was prolonged in group CSE (218.4±18.30 min) as compared to group ED (210±17.88 min). (p&lt;0.001) Mean time for 1st rescue analgesia post-operatively was highly significant in group CSE (2.42±0.49) as compared to group ED (2.08±0.28). (p&lt;0.0001) Total dose of levobupivacaine required was high in group ED (49.66±7.02) as compared to group CSE (45.66±3.12). (p&lt;0.001) In group ED surgeon score was good in 20(44.44%) patients and which was highly significant. In group CSE surgeon score was excellent in 41(91.1%) patients and which was highly significant. (p&lt;0.001) Post-operative complications in both the group were comparable. (p&gt;0.05) Conclusion: This study concluded that though both the anaesthesia techniques are safe and efficient with each having its own benefits. CSE had proven superiority over the epidural technique

Comparison of Quality of Recovery (QoR-15) following the administration of intravenous lignocaine and fentanyl in patients undergoing septoplasty under general anaesthesia: A double-blinded, randomised, controlled trial

Background and Aims: Recovery from surgery and anaesthesia is usually observed through conventional indicators. The Quality of Recovery (QoR-15) score was specially designed to measure psychometric and functional recovery from the patient's perspective. This study aimed to evaluate QoR-15 following the administration of intravenous (IV) lignocaine or IV fentanyl in patients undergoing septoplasty surgery. Methods: This randomised, controlled trial was conducted on 64 patients of American Society of Anesthesiologists (ASA) physical status I and II, of either sex, of ages between 18 and 60 years, and who were scheduled for septoplasty. The primary end point was to compare the quality of recovery following the administration of IV lignocaine(group L) and IV fentanyl (group F) using the QoR-15 score in patients undergoing septoplasty. Secondary end points were to compare postoperative analgesia, recovery characteristics, and adverse effects in both groups. Statistical analysis was done using the Shapiro–Wilk test, paired t test/ Wilcoxon signed-rank test, and unpaired t test/Mann–Whitney U test. A P-value 9 and gastrointestinal recovery was shorter in group L compared to group F. Conclusion: Both IV lignocaine and IV fentanyl improved postoperative QoR-15 score; however, lignocaine had a higher postoperative QoR-15 score than fentanyl, in addition to showing early discharge readiness, better analgesia, and better recovery profile in patients following septoplasty surgery

“Comparison Of Levobupivacaine With Two Different Adjuvants (Dexamethasone Vs Dexmedetomidine) In Ultrasonography Guided Transversus Abdominis Plane Block For Unilateral Inguinal Herniorrhaphy : A Randomized Double Blinded Control Trial”

Background and Aims: Ultrasonography (USG) guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in patients undergoing intraabdominal surgery. This study was aimed to compare the post operative analgesia, haemodynamic variables, sedation and adverse effects of levobupivacaine with two different adjuvants (dexamethasone and dexmedetomidine) in USG guided TAP block for patients undergoing unilateral inguinal herniorrhaphy under subarachnoid block. Methods: A double-blind randomized control study, conducted on 96 patients, allocated in three groups of 32 each. Patients in group C received 0.25% levobupivacaine (20 ml) with normal saline (2 ml), group D1 received 0.25% levobupivacaine (20 ml) added with 0.1mg/kg dexamethasone (2 ml) and group D2 received 0.25% levobupivacaine added with 0.5mcg/kg dexmedetomidine diluted in NS (2ml). Pain was assessed using Visual Analogue Scale (VAS).Time for request of first analgesia (TFA) , total number and total dose of rescue analgesic &nbsp;in 24 hour were recorded. Statistical analysis was done using unpaired Student’s t-test and ANOVA. Results: At 12 and 24 hours &gt;30% patients had VAS ≥4 in control group while it was &lt;10% in groups D1 and D2 (p&lt;0.001). TFA was earliest in control group (6.10±0.96 h) as compared to group D1(7.26±1.22 h) and group D2(7.49±1.02 h) (p&lt;0.001). Total number and total dose of analgesic given was highest in control group than other two groups (p&lt;0.001). However, it was comparable between group D1 and D2 (p&lt;0.05). &nbsp;Conclusion: Dexamethasone and dexmedetomidine when added as adjuvant to levobupivacaine for TAP significantly prolonged the duration of post operative analgesia as compared to levobupivacaine alone, however it was found to be comparable between adjuvant groups. Keywords: Ultrasonography (USG) guided transversus abdominis plane (TAP) block, postoperative analgesia, levobupivacaine, dexamethasone, dexmedetomidin