Comparative study of duration of analgesia with epidural bupivacaine and bupivacaine with tramadol in lower limb surgeries

Background: The administration of local anaesthetic and opioid mixture via epidural route is excellent for post-operative pain during lower limb surgeries. This combination provides better quality of analgesia, lower side effects and high level of patient satisfaction. Therefore, this study was taken up to evaluate the efficacy safety, tolerance and side effects for the combination of tramadol and bupivacaine in the management of post-operative pain.Methods: This was a prospective study where a total of 40 patients; 20 each in group I and II were selected. Patients who were admitted for lower limb surgeries   in age range of 18-50yrs and belonged to ASA grade I &II.  Group A was given epidural bupivacaine 0.5% and group B was given epidural bupivacaine 0.5% with tramadol 50mg. The parameters studied were onset of action, quality of anesthesia, degree of motor blockade, duration of analgesia, hemodynamic alterations, intraoperative and postoperative complications. Pain was evaluated with verbal score. Results were evaluated statistically.Results: The mean duration of analgesia was significantly longer in patients with tramadol. The quality of analgesia and pain scores were better in patients who were administered tramadol.  The number of drug doses required was significantly reduced by addition of tramadol.Conclusions: Tramadol is a safe and effective adjuvant to epidural bupivacaine for prolongation of total duration of analgesia in lower limb surgeries

Variations in anesthetic requirements with body mass index in patients undergoing trans vaginal oocyte retrieval

Background: Various techniques have been described for ultrasound guided trans-vaginal oocyte retrieval (TVOR). No single technique has been found to be superior to others. In many centers, paracervical block (PCB) is used, either alone or in conjunction with sedation for pain relief during TVOR. This aim of this study is to evaluate the variations in anaesthetic requirements with body mass index (BMI) in patients undergoing transvaginal oocyte retrieval (TVOR).Methods: This study comprised of 70 women aged between 20 to 40 years. All patients were classified according to WHO classification into four groups on the basis of their BMI. Parameters like effectiveness of paracervical block (PCB), requirement of additional anesthetic drug (propofol), time required for surgery and numbers of oocytes retrieved were studied for each group. The correlation of all these parameters with BMI was noted and statistically evaluated.Results: PCB alone was not sufficient and all patients required additional propofol for successfully completing the procedure. The requirement of propofol increased with increase in BMI of the patients. The amount of rescue propofol required in patients with BMI>30 was significantly higher as compared to females with BMI<30, irrespective of the time taken during the procedure or the oocyte retrieved. A positive correlation was also observed between number of oocyte retrieved and time taken for surgery.Conclusions: PCB is quite useful in patients with normal BMI, but it proved to be totally ineffective in obese patients (BMI>30) undergoing TVOR. The requirement of additional propofol and time taken to successfully conduct the procedure is significantly high in patients with high BMI. These alterations in anesthetic parameters with change in BMI have vital implications and they should be taken into consideration while managing obese patients undergoing TVOR

The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB

To assessand and compare the effect of two doses of chloroprocaine with buprenorphine for saddle anaesthesia in perianal surgery

Introduction: Saddle block is effective in patients experiencing perianal surgery in terms of postoperative recovery and analgesic consumption within 24 hours after surgery. Chloroprocaine was developed to meet the need for a short acting local anaesthetic that is reliable and has a favorable safety profile. Objectives: To study two different doses of chloroprocaine with buprenorphine for saddle anaesthesia in perianal surgery. Material and Methods: 100 Patients of ASA Gr I & II were taken for perianal surgeries are kept in sitting position under all aseptic and antiseptic precautions SAB was given using 25/23G spinal needle in sitting position. A fixed dose of chlorprocaine with bupernorphine was injected in L4-L5 intervertebral space. Patients were assessed for pain score on VAS in post operative period.Patients were monitored for pulse , BP, respiratory rate , SPO2at regular intervals on a prestructured proforma. All the data were entered in master chart and statistically analysed. Results: Mean age of patients in Group A was 41.47 ± 9.06 years whereas in Group B was 35.66 ±12.12 years. The study groups comprised of 68 males and 32 females. Mean heart rate of patients in Group A group in preoperative was 55.52±6.14 whereas in group Group B was 54.80±5.79. Mean HR in Group A and Group B was found statistically insignificant (p=0.547). Mean SBP in Group A in preoperative was 102.9 ±22.41 and in Group B was 101.2±4.79.When we compared the mean SBP in Group A and Group B was found statistically insignificant (p=0.601) and Mean DBP in Group A in preoperative was 83.62±4.79 and in Group B was 83.12±8.7. When we compared the mean SBP in Group A and Group B it was found statistically insignificant (p=0.722). Mean RR in Group A in preoperative was 16.54 ±0.67 and Group B was 16.48 ±0.64 and Mean RR in Group A in intraoperative was 17.1 ± 0.83 and group B was 17.14±078. In our study we compared the mean time taken to achieve sensory block. In group A it was 2.54±0.50 min.. In group B the mean time taken to achieve sensory block was 2.38 ±0.49 min. It appears that 0.8ml Chloroprocaine might causes faster onset of sensory block and the difference between group A and B is statistically significant (p=0.0001). VAS score was significantly high in Group A as compared to Group B at 2nd and 6th hours respectively. Whereas VAS score was comparable at 12 and 24th hours in both the groups as revealed by insignificant p values. Conclusion: From our observations and data analysis we reach to the conclusion that for saddle block with higher dose we can allow surgery for longer time but the duration of postoperative analgesia remains same in both the group

Pneumocephalus after epidural injection: A rare complication of a common procedure

Our patient with prolapsed intervertebral disc at L3–L4 was given lumbar epidural steroid injection using loss of resistance to air technique with 3 ml of air. After 5–6 h, she developed severe frontal and temporal headache with few episodes of nonprojectile vomiting, followed by disorientation and agitation. An urgent magnetic resonance imaging was done which revealed pneumocephalus

Pygopagus Conjoined Twins for Separation Surgery: an Interesting Experience

Conjoined twins are rarely encountered in the clinical practice of the anaesthetist and the issues that have to be considered in their anaesthetic management are unique and fascinating. Pygopagus are one of the rare type of conjoined twins with only a handful of cases reported in the literature. We present the case of one and half month old male pygopagus conjoined twins who were joined together dorsally in lower lumbar and sacral region and shared a single thecal sac. They were brought to our hospital for separation surgery

Effect of body mass index on the efficacy of paracervical block for ultrasound-guided transvaginal oocyte retrieval as assessed by requirement of rescue propofol

Background and Aims: Oocyte retrieval is the only vital aspect of in vitro fertilization requiring anesthesia. Previous studies have shown the inconclusive role of paracervical block (PCB) in transvaginal oocyte retrieval (TVOR) under ultrasound guidance. This study was planned to observe the role and efficacy of PCB as measured by the amount of propofol used as rescue in patients undergoing TVOR and grading it on the basis of body mass index (BMI). Methods: This prospective, comparative study, conducted over 1 year, recruited 140 American Society of Anesthesiologists I and II patients and divided into two groups as follows: Group A received PCB with 20 ml of 1% lignocaine and Group B received no PCB. Total propofol consumed, BMI, time taken, oocytes retrieved, postprocedure visual analog scale score, and complications were noted. In both the groups, patients were then divided into underweight, normal, overweight, and obese according to BMI. Statistical analysis was done using Statistical Package Mini Tab Version 17.0. The primary objective was to study the efficacy of PCB as estimated by amount of propofol required during the procedure. The secondary aim was to assess the effect of BMI on the efficacy of PCB. Results: Propofol requirement was found to be significantly more (P < 0.05) in Group B patients (172.14 ± 64.15) in comparison to Group A (132.14 ± 66.11). Amount of propofol required in normal BMI and overweight patients was significantly higher in Group B. No significant difference was observed in underweight, and obese patients in both the groups. Conclusion: PCB reduces the consumption of propofol in normal BMI patients. Underweight and obese population do not benefit from PCB

Variations in anesthetic requirements with body mass index in patients undergoing trans vaginal oocyte retrieval

Background: Various techniques have been described for ultrasound guided trans-vaginal oocyte retrieval (TVOR). No single technique has been found to be superior to others. In many centers, paracervical block (PCB) is used, either alone or in conjunction with sedation for pain relief during TVOR. This aim of this study is to evaluate the variations in anaesthetic requirements with body mass index (BMI) in patients undergoing transvaginal oocyte retrieval (TVOR).Methods: This study comprised of 70 women aged between 20 to 40 years. All patients were classified according to WHO classification into four groups on the basis of their BMI. Parameters like effectiveness of paracervical block (PCB), requirement of additional anesthetic drug (propofol), time required for surgery and numbers of oocytes retrieved were studied for each group. The correlation of all these parameters with BMI was noted and statistically evaluated.Results: PCB alone was not sufficient and all patients required additional propofol for successfully completing the procedure. The requirement of propofol increased with increase in BMI of the patients. The amount of rescue propofol required in patients with BMI&gt;30 was significantly higher as compared to females with BMI&lt;30, irrespective of the time taken during the procedure or the oocyte retrieved. A positive correlation was also observed between number of oocyte retrieved and time taken for surgery.Conclusions: PCB is quite useful in patients with normal BMI, but it proved to be totally ineffective in obese patients (BMI&gt;30) undergoing TVOR. The requirement of additional propofol and time taken to successfully conduct the procedure is significantly high in patients with high BMI. These alterations in anesthetic parameters with change in BMI have vital implications and they should be taken into consideration while managing obese patients undergoing TVOR

An evaluation of the addition of Dexmedetomidine to Levobupivacaine for supraclavicular brachial plexus block in upper limb orthopaedic surgeries

Background and objectives: Adjuncts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Dexmedetomidine, a selective α2-adrenoceptor agonist, has been used as an adjuvant during regional and local anesthesia. The purpose of this study was to assess the effect of dexmedetomidine added to Levobupivacaine in supraclavicular brachial plexus block. Methods: A prospective, randomized, single blinded pilot study was conducted on 40 ASA I or II adult patients undergoing upper limb orthopaedic surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group L(n = 20) were administered 29mL of 0.5% Levobupivacaine plus 1 ml NS and group LD (n=20) were given 29 ml of 0.5% levobupivacaine with dexmedetomidine 1µg/kg. The onset time and duration of sensory and motor blockade were recorded. Results: The onset of sensory and motor block was significantly faster in Group LD compared to Group L (P &lt; 0.05). Rescue analgesic requirements were significantly less in Group LD compared to Group L (P &lt; 0.05). Conclusion: Dexmedetomidine(1µg/kg) in combination with 29mL of levobupivacaine (0.5%) hastened onset of sensory and motor block . and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events