BACKGROUND Endotracheal intubation is an integral part of the modern anaesthesia techniques for major surgical procedures. Extubation are associated with various cardiovascular and airway responses leading to tachycardia, hypertension, arrhythmias, myocardial ischemia, coughing, agitation, bronchospasm etc., Many techniques and drugs have been proposed to attenuate airway and cardiovascular responses. This study intends to compare the effect of Dexmedetomidine & Lidocaine on haemodynamic responses and airway reflexes during tracheal extubation. MATERIALS AND METHODS After getting Ethical Committee clearance and written informed consent, double blinded randomised clinical trial study was conducted. 100 patients of ASA grade 1 & 2 aged between 16 to 60 years of either gender undergoing surgery under general anaesthesia were randomized into 2 groups with 50 each. Group D received Dexmedetomidine 0.75 mcg/kg and Group L received Lidocaine 1.5 mg/kg, both diluted to 10ml and given intravenously over 1min. Pulse rate, systolic, mean and diastolic blood pressure was recorded at the time of administration of the drug, at 1min, 3min, 5min after administering the drug and at extubation. Also, post extubation at 1min, 3min, 5min, 10min, 15min, 20min, 25min and 30min, it was recorded. Extubation quality was rated using extubation quality using 5-point scale. Sedation level was evaluated using Ramsay Sedation Scale. Any incidence of cough, laryngospasm, bronchospasm or desaturation was observed. Time at which the rescue analgesia was required post extubation was recorded. RESULTS The quality of extubation in group D was significantly better than group L (p<0.05). The sedation level was significantly higher in Group D as compared to Group L (p<0.01). The Time gap between the end of the surgery and the time of requirement of first dose of rescue analgesic was significantly higher in group D than in group L. MAP values showed a significant difference between the two groups (p<0.001) at various time intervals. The incidence of hypotension was noted during the study period was statistically significant. CONCLUSION Single bolus 0.75 mcg/kg dose of dexmedetomidine is an effective method to attenuate the haemodynamic response to endotracheal extubation in patients undergoing surgery under General anaesthesia and decreased the complications associated with extubation.
Objective: Low back pain is a very troublesome and common issue among patients irrespective of age and sex and is very difficult to manage with conservative management. It can lead to disability and mental issues. Methods: After ethical committee approval, a prospective, randomised, double-blind comparative study on 40 patients aged 20-70 years, suffering from lumbar radicular pain was carried out by two different approaches i.e., conventional transforaminal and Kambin’s triangle approach and epidural steroids were administered. Change in pain intensity using the Verbal Numerical Rating Scale was recorded as our primary outcome. Change in functional status using Oswestry Disability Index and Patient Satisfaction Score were our secondary outcomes. Any adverse event, complication, failure was also noted. Results: Multiple logistic regression showed no difference in pain relief or improvement of functional status due to variable differences like the age, sex, disc level or the type of approach. Conclusion: Both approaches of transforaminal epidural steroid injection were effective in reducing pain and increasing functional status significantly. There was no significant difference in their effectiveness and neither was superior to the other. Keywords: Low back pain, transforaminal approach, Kambin’s triangle approach
Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.
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