A comparative study of efficacy of midazolam and triclofos as oral premedication in children undergoing minor surgical procedures

Background: In Paediatric population, premedication is oftenly used to decrease preoperative anxiety, facilitate separation from parents and to get acceptance for face mask induction. Our study was aimed to compare the efficacy of oral midazolamandoral Triclofos as premedicants in children as sedatives, anxiolytics and to promote acceptance of facemask. Patients & Methods: Our study is prospective, randomized, double blind, controlled study involving fifty ASA-1 children between 1 to 10 years of age, undergoing elective surgery. Group A patients was allotted oral Midazolam 0.5mg kg-1 while Group B patients received Triclofos 75mg kg-1 orally as premedication. Assessment of the allowance of premedication, degree of sedation, level of anxiolysis and acceptance of face mask was done by separate scoring methods at intervals of 30 minute (till a maximum of 3 assessments) up to the child was shifted to the operating room. A parental questionnaire was useful to judge the parental satisfaction. Results: In Group A, 21 patients (82%) were awake, but calm and 4 patient (18%) was asleep during the first assessment done 30 minutes after the administration of the drug, while in Group B, only 2 patients (10%) were awake and calm and 23 patients (90%) of the patients were asleep (p value 0.000). In Group I, 13 patients (55%) did not resist the face mask and 12 patients (44%) showed slight resistance while in Group B, 2 patients (11%) showed no resistance to face mask and 13 patients (55%) showed slight resistance. Facemask acceptance was more in Group A (p value of 0.014). Conclusion: Conclusion from our study was that oral Triclofos has better premedication effect as children were sedated, calm and asleep whereas children those received oral midazolam as premedication were awake but calm and quality of face mask acceptance was better

Comparing the Efficacy of Intra-articular Dexmedetomidine versus Buprenorphine for Postoperative Analgesia Following Arthroscopic Knee Surgeries: A Prospective Interventional Study

Introduction: Arthroscopy for knee surgery is the most often used minimally invasive orthopaedic surgical technique. Postoperative discomfort can be caused by irritation to the nerve endings in the synovial tissue, the fat pad in the front of the knee, and the joint capsule that can take place during the excision and resection. Aim: To compare the efficacy of Intra-Articular (IA) dexmedetomidine versus buprenorphine for postoperative analgesia following arthroscopic knee surgeries. Materials and Methods: A prospective interventional study was carried out for a period of one and a half years from January 2021 to June 2022 at Department of Anaesthesiology B.L.D.E. (Deemed to be University) Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India. Around 80 patients of both genders of American Society of Anaesthesiologists (ASA) grade I and II who were scheduled for arthroscopic knee surgeries were randomly divided into two equal groups of 40 each. After the operation was finished, the patients in each group received the respective medications intra-articularly through an arthroscopy port. Group D received Inj. Dexmedetomidine 100 mcg+ Inj. Bupivacaine 0.25%, 20 mL. Injections of buprenorphine 100 mcg and bupivacaine at a concentration of 0.25% , 20 mL were given to the participants in group B. Immediately following surgery, the patient’s temperature, pulse, Mean Arterial Pressure (MAP), and Visual Analogue Scale (VAS) score for pain were all monitored and recorded at the 1st, 2nd, 4th, 8th, 12th and 24th hour. Time to first rescue analgesia, the number of patients requiring rescue analgesia within the next 24 h, the visual analog scale at rest, and on mobilisation at 1st, 2nd, 4th, 8th, 12th, and 24 hour were measured. Side-effects like sedation, pruritis, nausea, vomiting, respiratory depression, and hypotension were also monitored. Descriptive statistics were reported as mean (SD) for continuous variables, and frequencies (percentage) for categorical variables. Data were statistically evaluated with IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 26.0, IBM Corp., Chicago, IL. Results: The mean age of the study participants was 38.38±11.30 years among the buprenorphine group and 36.40±12.07 years among the Dexmedetomidine group. Among the Buprenorphine group 52.5% were females and 47.5% were males. There was a statistically significant difference in VAS score at rest and mobilisation between the groups. The mean time for first rescue analgesia was longer for the buprenorphine group 1016.22±137.54 minutes and for the dexmedetomidine group, it was 523.67±117.47 minutes. Rescue analgesia was given to 9 (22.5%) in the buprenorphine and 18 (45%) in the dexmedetomidine group. Conclusion: In comparison to IA dexmedetomidine, buprenorphine produces analgesia for a longer period of time and reduces the amount of postoperative rescue analgesic that is required