A Study of Comparison of Post-Operative Analgesia after Single-Shot Caudal Epidural Block Using Bupivacaine with or without Clonidine in Children

Introduction: Lower abdominal surgeries are one of the most frequently performed surgeries in the pediatric age group. A large number of these operations are done as day-care procedures.Caudal block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of sacral-segment surgery. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. There is no fear of neurological sequelaeas in the past.Several studies have demonstrated that Clonidine added to the local anesthetic in caudal block both enhances and prolongs the analgesia produced by the block without the unpleasant or hazardous sideeffects associated with the use of other adjuvant drugs like opioids, epinephrine and some newer adjuvants like neostigmine and dexmedetomidine. Our study aimed to evaluate the efficacy of single-dose caudal epidural Clonidine in prolonging the post-operative analgesia when mixed with Bupivacaine in children.Materials and MethodsSixty children of ASA I and ASA II physical status, between 1 and 12 years of age, who underwent elective lower abdominal surgeries, were randomly divided into two groups B (N=30) and C (N=30). All the children were administered general anesthesia. After induction, a single-shot caudal block was administered using 0.25% Bupivacaine (group B) and 1.5 mg/kg of Clonidine hydrochloride (group C). Vital monitoring was done intraoperatively as per institutional protocol. Post-operative monitoring was done in the post-anesthesia care unit (PACU) for 2–3 hours and in the ward for next 24 hours. Data with respect to duration of surgery, duration of pain-free period, time to void and any other complications was compiled. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (unpaired t-test).ResultsThis study was undertaken to evaluate the efficacy of Clonidine in prolonging post-operative analgesia of Bupivacaine when given caudally in 60 children undergoing lower abdominal surgeries. The duration of pain-free period with caudal Bupivacaine with Clonidine (group C) is significantly longer than caudalBupivacaine (group B). The duration of pain relief was 20.4 hours in group C as compared to 14.2 hours in group B. This is statistically significant (p<0.05).ConclusionWe conclude that adding Clonidine 1.5 mg/kg to Bupivacaine 0.25% for caudal anesthesia in children undergoing lower abdominal surgeries enhances and prolongs postoperative analgesia compared to caudal Bupivacaine 0.25% alone. Clonidine may be the drug of choice to prolong the duration of caudal anesthesiaprovided by a single injection in children

A comparative study of ropivacaine 0.5% versus ropivacaine 0.75% for spinal anesthesia in lower limb orthopedic surgery in ASA Grade – I/II adult patients: A prospective study

Aims and Objectives: The aim of the study was to compare the clinical efficacy and safety of isobaric ropivacaine 0.5% and 0.75% in spinal anesthesia under: (a) Onset and duration of sensory and motor block, (b) duration of analgesia, and (c) adverse effects. Methods: A total of 60 patients undergoing elective lower limb orthopedic surgery under spinal anesthesia were divided into two groups (I and II) of 30 each. Group I received 3ml of isobaric ropivacaine 0.5% Group II received 3 ml of isobaric ropivacaine 0.75%. The study parameters were recorded at baseline and then at specified intervals. Statistics: By professional statisticians using SPSS 18 version. Student t-test was used for continuous variables, and Chi-square test was used for discrete variables. Results: The onset of sensory blockage in Group I was 3.17 ± 1.29 min and 2.60 ± 1.19 min in Group II which was statistically not significant (P &gt; 0.05). The onset of motor blockade in Group I was 3.90 ± 1.54 min and 3.10 ± 0.96 min in Group II which was statistically significant (P &lt; 0.05). Median time to reach the highest level of analgesia was 12.4 ± 2.81 min in Group I, and 10.7 ± 2.56 min in Group II. The difference was statistically significant. Regression of sensory level to T10 dermatome in Group I was 99.64 ± 21.30 min and 139.66 ± 25.70 min in Group II which was statistically significant (P &lt; 0.05). Duration of the motor blockade in Group I was 126 ± 14.53 min and 175 ± 30.60 min in Group II which was statistically significant (P &lt; 0.05). The time of the first request of analgesics in Group I was 130 ± 16.24 min and 171.1 ± 32.77 min in Group II which was statistically significant (P &lt; 0.05). There were no significant differences in the adverse effects of both drugs. Conclusions: Intrathecal isobaric ropivacaine 0.75% in comparison to isobaric ropivacaine 0.5%: (1) Produces quicker onset of motor block and prolonged duration of sensory and motor block. (2) Does not alter hemodynamic stability. (3) Has no difference in the onset of sensory block.&nbsp

Clinicopathological study of cerebellar astrocytoma in children

Introduction: The first successful treatment of a pediatric brain tumor was in 1879 when Sir William Macewen successfully removed a meningioma from a 14-year-old girl. Brain tumors are the most common form of solid tumors and the leading cause of death from solid tumors in children (SEER program 1975–1999). Materials and Methods: Study area: This study was conducted at Bangur Institute of Neuroscience (BIN) and S.S.K.M Hospital. Study Population: Patients attending BIN OPD and admitting in BIN and S.S.K.M Hospital wards were selected. Inclusion Criteria: The following criteria were included in the study: (a) Patients with the diagnosis of cerebellar astrocytomas after magnetic resonance imaging investigation, (b) patients giving consent to be included in the study, and (c) patient willing to come for follow up. Study Period: The study period was 2 years (from September 1, 2010, to December 31, 2012). Sample Size: All diagnosed cases of cerebellar astrocytoma during the stated period. Exclusion Criteria: Patients not willing for the study were excluded from the study. Study Design: This was a non-randomized prospective clinical study. Pilocytic astrocytomas are the most common pediatric brain tumors in our population and are most commonly located in the cerebellum. Results: Most of the patients, 20 (90.9%), had neurological improvement on discharge. 1 patient (4.5%) died during the hospital course. The follow-up time period ranged from 3 months to 2 years, with a mean follow-up period of 1.5 years. Recurrence was observed in 5 patients (22.72%), but reoperation was done in 3 patients (13.63%). Of them, 1 patient (4.5%) received radiotherapy in spite of that recurrence was developed in 1.5 years. 2 patients (9.09%) have been kept under observation because these are asymptomatic. The solid consistency of tumors led to a poor prognosis, as it was associated with a greater number of ICU admissions, recurrence of tumors, and repeat surgeries (13.63%). The follow-up time period ranged from 3 months to 2 years, with a mean follow-up period of 1.5 years. Conclusion: A “wait and see” strategy is justified in patients with non-progressive recurrent or residual cerebellar LGG after primary tumor resection (23.30) radiotherapy can be considered

A study on coagulation profile of patients thrombolysed with streptokinase in acute st-elevation myocardial infarction

Introduction: a study on coagulation profile of patients thrombolysed with streptokinase in acute st-elevation&nbsp;myocardial infarction.aims and objectives of study1.To find the changes in the coagulation system after thrombolysis with streptokinase in st elevation myocardial infarction. 2.To postulate about the timing of starting heparinisation after thrombolysis with streptokinase in st elevation myocardial infarction. Materials and methods- is a cross sectional observational study of patients admitted with acute st elevation myocardial infarction(stemi) who were candidates for thrombolysis. Coagulation assay protocol-Whole blood is collected at baseline and at intervals of 3, 6, &amp; 9hrs following initiation of thrombolysis. Results and conclusion: Early heparinisation may be considered in those patients who have non resolving st segment 90 minutes after thrombolysis , or those patients who have continuing pain even after thrombolysis..A significant correlation was found between aptt at 6hours and aptt at 9 hours that is patients who were in the therapeutic range at the end of 6 hours were also maintained at the end of 9 hours probably due to heparinisation at the end of 6 hours after thrombolysis.3.There is suboptimal&nbsp;&nbsp;anticoagulation in MI. Keywords: coagulation,myocardial,CAD,factors,burden

Combined spinal epidural for labor analgesia comparison of two different doses of intrathecal bupivacaine 1.25 mg and fentanyl 25 µg with bupivacaine 2.5 mg and fentanyl 25 µg

Background and Objective: The responsibility of the anesthetist in obstetrics is very high. This study compares two different low doses of intrathecal bupivacaine 1.25 mg and 2.5 mg along with 25 µg fentanyl as the spinal component of combined spinal epidural (CSE) analgesia in the early part of labor, followed by epidural top-up. Methodology: Approval was obtained from the institutional review board and written informed consent was obtained from 60 healthy term primigravida or the second gravid parturients, with cephalic singleton pregnancy between 36 and 42 weeks, ASA Grade I/II patients. The study was conducted using low-dose intrathecal bupivacaine 1.25 mg and fentanyl 25 µg (GroupI) with bupivacaine 2.5 mg and fentanyl 25 µg (Group II) as the spinal component of CSE analgesia in the early part of labor. We compared the two with respect to their onset, duration of sensory and motor block, quality of analgesia during early part of labor and the side effects of the drugs. Results: The onset of analgesia was equally rapid with both groups within 5 min, lower incidence of motor block with Group I compared to Group II. Duration of analgesia was longer in Group II, associated with higher dermatome levels of sensory block with longer time for regression of the block. Coclusion: We found that bupivacaine 1.25 mg was as effective as bupivacaine 2.5 mg when added to fentanyl 25 µg for CSE.&nbsp

Comparison of CPAP preoxygenation versus conventional preoxygenation on duration of safe apnoea time in patients undergoing elective surgery under general anaesthesia

Anesthesia induction usually leads to apnoea, during apnoea, oxygenation depends on the oxygen reserves stored within the body .While breathing room air these stores are quantitatively low. As we cannot perfectly predict the difficulty in airway management, desirability of maximal preoxygenation is theoretically present for all patients. Induction of general anaesthesia per se as also the use of 100% oxygen during preoxygenation results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. Therefore this randomized, controlled study was undertaken to compare the effect of CPAP (continuous positive airway pressure) preoxygenationvs conventional preoxygenation on duration of safe apnoea time in patients posted for elective surgery under general anaesthesia. After obtaining approval from the institutional review board and institutional ethics committee and prior consent from participants, 60 adult patients scheduled for elective surgery under general anaesthesia were randomized into two groups- PEEP group and ZEEP group. Patients in PEEP group were preoxygenated with CPAP of 5 cm of H2O with 100% oxygen for five minutes and in ZEEP group no CPAP was used. Duration of safe apnoea time (taken as till Spo2 reached 94%) and ABG analysis at various time intervals was done for each group.The comparison of normally distributed continuous variables between the groups was performed using Student’s t test. Nominal categorical data between the groups were compared using Chi-squared test or Fisher’s exact test as appropriate. P value less than 0.05 was considered statistically significant. We found out that the duration of safe apnoea time was significantly longer in PEEP group (408.90 ± 32.73) as compared to ZEEP group (257.70 ± 12.79 s) ( P value less than 0.001).PaO2 after preoxygenation was also significantly higher in PEEP group (416.62 ± 28.72 mmHg) as compared to ZEEP group (367.02 ± 14.29 mmHg) ( P value less than 0.001).We concluded that the application of continuous positive airway pressure during preoxygenation is a simple, well tolerated technique that may have advantages especially in those patients in whom difficulty in airway management is anticipated, those who are at increased risk of desaturation such as morbidly obese patients and when assisted ventilation is not applied such as during rapid sequence induction

Comparision of 1% chloroprocaine and 1% chloroprocaine with fentanyl in infraumbilical surgical procedures under spinal anaesthesia

Background: In the ambulatory setting, day by day there is an increase in the use of spinal anaesthesia. Antioxidant- and preservative-free form of 2-chloroprocaine (1%) has been re-emerged as a short-acting local anesthetic for use in spinal anesthesia.In this study,we evaluate the efficacy of 1% Chloroprocaine and 1 % Chloroprocaine with Fentanyl in spinal anaesthesia and any untoward side effects and complications associated with the study drugs and technique. Material and Methods: For this prospective, ramdomizes ,comparative study we recruited a total of 100 adult patient for infraumblical surgeries under spinal anaesthesia were randomly divided into two groups (n=50 each).Group C (n=50) received 30 mg 1% chloroprocaine with 0.5ml normal saline and Group CF (n=50) received 30 mg 1% chloroprocaine with 25mcg Fentanyl (0.5ml). Result: Faster Onset of sensory and motor blockade was seen in the group CF duration of spinal anesthesia and sensory and motor block duration is prolonged in group CF.(p&lt;0.001) Duration ofanalgesia was significantly prolonged in the group CF when compared to group C(87.5±11 vs132.5±4.9min p&lt;0.001) hemodynamic parameter insignificant with less side effect in both group. Conclusion: The addition of Fentanyl to intrathecal 1% chloroprocaine will increase the duration and quality of both sensory and motor blockade in spinal anaesthesia as compared to 1% chloroprocaine alone

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