A STUDY TO EVALUATE THE EFFECT OF ADDING CLONIDINE TO ROPIVACAINE FOR AXILLARY PLEXUS BLOCKADE

Aims and objectives- The present study was undertaken to evaluate the effect of adding Clonidine to Ropivacaine for axillary plexus blockade. Material and methods- A total of 60 adult patients having physical status grade I or II according to American Society of Anaesthesiologists ( ASA ) undergoing hand or forearm surgery under axillary plexus blockade using nerve stimulator were included in the study. Patients were randomly allocated to one of the two groups. Each group consisted of 30 patients. Group 1 patients received 35 ml of Ropivacaine 0.5 % + 1 ml of normal saline.Group 2 patients received 35 ml of Ropivacaine + 1 ml of clonidine ( 150 µg). Sensory block, motor block and sedation were assessed every 5 minutes for 30 minutes. Postoperatively assessment was done every 15 minutes till complete regression of sensory and motor block. Results- Mean sensory onset time in patients of group 1 was 26.48 ± 7.88 min and in patients of group 2 was 26.55 ± 8.06 min, which was insignificant statistically. Patients of group 1 had a mean motor onset time 35.51 ± 10.4 min and patients of group 2 had a mean motor onset time 37.06 ± 14.19min, the difference being statistically comparable. Mean duration of sensory block in patients of group 1 was 422 ± 163.10 min and in patients of group 2 was 438 ± 133.93 min, which was statistically comparable. Patients belonging to group 1 had a mean duration of motor block 404 ± 160.60 min and patients belonging to group 2 had a mean duration of motor block 388 ± 151.63 min, which was statistically comparable. Conclusion- Addition of Clonidine ( 150 µg) is of no benefit in the onset and duration of axillary plexus block

Anaesthetic Considerations in a Patient with Deep Vein Thrombosis on Warfarin for Emergency Surgery - A Case Report

Anaesthesiologists very often face the challenging task of providing anaesthesia to patients on oral anticoagulant therapy, for elective and emergency surgeries. Rapid reversal of anticoagulation for emergency surgery can be achieved by replacement of coagulation factors with fresh frozen plasma or prothrombin complex concentrate and simultaneous administration of vitamin K for sustained reversal. The present case report of a 26 year female, on warfarin for thromboprophylaxis, scheduled for laparotomy, is followed by a brief discussion on anticoagulation reversal and anaesthesia

Appearance of phantom limb pain after spinal anesthesia

Phantom limb pain which is basically neuropathic in nature resulting from functional changes in peripheral and central pain pathways subsequent to amputation, is challenging to treat. We report an interesting case of phantom limb pain during the regression phase of spinal anesthesia in a patient to be operated for revision amputation for chronic ulcer

Anaesthetic Management of a Patient with Arthrogryposis Multiplex Congenita: A Case Report

Arthrogryposis multiplex congenita first described in 1905, is a rare congenital syndrome affecting 1 in 3000 births. It is characterized by multiple joint contractures found throughout the body and may be associated with multiple congenital anomalies like cleft palate, genitourinary defects, gastroschisis and cardiac defects. Hence appropriate evaluation should be done to rule out congenital abnormalities. Anaesthetic management may be complicated by difficult intravenous access, difficult positioning, difficult regional blockade and difficult airway. Anticipating difficulties and keeping alternate arrangements and preparation is required

Anaesthetic Management of a Patient with Arthrogryposis Multiplex Congenita: A Case Report

Arthrogryposis multiplex congenita first described in 1905, is a rare congenital syndrome affecting 1 in 3000 births. It is characterized by multiple joint contractures found throughout the body and may be associated with multiple congenital anomalies like cleft palate, genitourinary defects, gastroschisis and cardiac defects. Hence appropriate evaluation should be done to rule out congenital abnormalities. Anaesthetic management may be complicated by difficult intravenous access, difficult positioning, difficult regional blockade and difficult airway. Anticipating difficulties and keeping alternate arrangements and preparation is required

Apert syndrome: Anaesthetic concerns and challenges

Apert syndrome is a congenital autosomal dominant disease characterized by brachycephaly, craniosynotosis, midface hypoplasia, hypertelorism, choanal stenosis, multidigit hand and foot syndactyly. Anaesthetic management of a child with Apert syndrome poses a great challenge to anaesthesiologist. The child should be evaluated thoroughly by history, examination and investigations for associated anamolies and managed accordingly. There is no definite recommendation for general or regional anaesthesia and also there are no known contraindications to specific anaesthetic agent and drug. However, whenever possible, regional anaesthesia should be preferred as the incidence of obstructive sleep apnoea is high in these patients. If general anaesthesia is planned, difficult airway cart should be kept ready. Temperature monitoring should be done intraoperatively and the patient should be monitored postoperatively for signs of airway obstruction