BACKGROUND:Brachial plexus block is a suitable alternative to general anesthesia for surgeries of upper limb and it can be performed even in patients who are not adequately fit for general anesthesia. The significance of brachial plexus block has increased in recent years due to renewed interest in day care surgery. Lignocaine hydrochloride has been used extensively for brachial plexus block and it has the disadvantage of having short duration of action. Opioids when added to anesthetic mixtures may improve and prolong the action of local anesthetics during peripheral nerve blocks. Such postoperative pain control can reduce both narcotic requirements and narcotic induced side effects. Studies have shown the efficacy of opioids as analgesic adjuvants in prolonging the duration of brachial plexus block. With this background in mind, this study was conducted to compare the onset and duration of sensory and motor block produced by a mixture of lignocaine and adrenaline with that produced by a mixture of fentanyl, lignocaine and adrenaline. Aims: To assess the effectiveness of addition of fentanyl to a mixture of lignocaine and adrenaline in prolonging the duration of analgesia and motor block for upper limb orthopedic surgeries. MATERIALS AND METHODS:This multi-center randomized control study was conducted in two tertiary care centers in 80 patients underwent elective upper limb orthopedic surgeries and they were allocated into two groups of 40 each group L and group F. the classical approach of supraclavicular brachial plexus block. Drug used were 30ml of lignocaine 1.5%+adrenaline 5mcg/ml +0.5ml normal saline in group L and 30ml of lignocaine 1.5% + adrenaline 5mcg/ml + fentanyl 50mcg in group F. Adequacy of block was assessed by the pin prick test and temperature test. Motor power was assessed by the modified Lowett scale. Sedation was monitored using the modified Ramsay scale. An assessment was made for onset of analgesia, onset of motor block, duration of analgesia, duration of motor block and occurrence of any side effects during the first 24 hours of the postoperative period. Subjective assessment of post-operative analgesia was done by direct questioning of the patient and by a five point pain scores. Data's were analyzed using computer software, Statistical Package for Social Science (SPSS) 16th version. OBSERVATION AND RESULTS: The mean onset of sensory block in the lignocaine group was 6.6±1.52 and in the lignocaine-fentanyl group 10.22±2.58. The mean onset of motor block was 8±1.97 in the lignocaine group and 11.39±3.57 in lignocaine-fentanyl group. The mean duration of sensory block was 105.73±9.45 in lignocaine group and 170.28±12.28 in lignocaine-fentanyl group. The mean duration of motor block motor block was 95.93±10.65 in lignocaine group and 178.33±12.37 in the lignocaine-fentanyl group. CONCLUSION: Addition of fentanyl to lignocaine-adrenaline in brachial plexus blocks will significantly delay the onset of sensory and motor block and significantly prolongs the duration of sensory and mo...
BACKGROUND: Good pain relief following caesarian section is of great importance and intrathecal opioids provide good quality postoperative analgesia for longer duration. So the following study describes a comparative study between intrathecal morphine and intrathecal buprenorphine for postoperative pain relief following caesarian section (CS) under subarachnoid blockade. AIMS:The study was conducted to compare intrathecal morphine and buprenorphine for post of analgesia following CS, to achieve analgesia without sedation for better maternal child bondage and to popularize intrathecal opioids. MATERIALS AND METHODS: 60 patients posted for CS under SAB were randomly allocated into group A and group B of 30 each, the group A received morphine 0.1 mg and buprenorphine 0.03 mg was given for group B patients along with the local anaesthetic. Subjective assessment of post-operative analgesia was done by direct questioning of the patient and by a five point pain scores. Duration of analgesia was taken as the time interval between the time of injection of intrathecal opiate and the time at which the patient felt pain and requested for additional analgesics. Data's were analyzed using SPSS 16th version. OBSERVATION AND RESULTS: The mean duration of post-operative analgesia with intrathecal morphine was 24.19+4.8 hours and that with buprenorphine was only 11.7+3.28 hours. Over weight patients reported a lower mean duration of analgesia. None of the patients in the study showed any bradycardia, hypotension, desaturation or respiratory depression. Intrathecal opiates decreased the parenteral opiate requirements. The main side effects noticed were nausea in about 43% of patients in morphine group and 33% of patients in buprenorphine group. CONCLUSIONS: Intrathecal morphine 0.1 mg gives good post-operative analgesia of longer duration than buprenorphine 0.03mg. The quality of analgesia provided by intrathecal morphine was superior to intrathecal buprenorphine. There was no incidence of respiratory depression or sedation.
BACKGROUND: Treatment of rheumatic mitral stenosis ranges from conservative medical management to closed mitral valvotomy and the more recent balloon mitral valvoplasty. This is a prospective study to compare the results of closed mitral valvotomy with percutaneous balloon valvoplasty in 100 cases (50 patients in each group) of rheumatic non-calcific mitral stenosis. MATERIALS AND METHODS:From November 2011 to March 2012, 50 patient underwent closed mitral valvotomy and another 50 had percutaneous balloon mitral valvoplasty. Balloon mitral valvoplasty was performed by Inoue technique and closed mitral valvotomy was carried out through standard anterolateral thoracotomy with transventricular gradual Tubbs dilatation. NYHA functional status, left atrial size, transmitral end diastolic gradient, mean diastolic gradient and mitral valve area were recorded. The results at the 4 day post procedure and the results at the 6 months follow up were compared. RESULTS: Residual atrial septal defect (ASD) was present in 6 patients at 6 month follow up after balloon mitral valvoplasty. Severe mitral regurgitation occurred in 3 cases of closed mitral valvotomy group as compared to 7 cases of balloon mitral valvoplasty group. Urgent mitral valve replacement was needed in 2 patient of balloon mitral valvoplasty group. There was single mortality in each group. CONCLUSION: No statistical significant difference between the result of closed mitral valvotomy and balloon mitral valvoplasty but better outcome obtained by closed mitral valvotomy. Hemodynamic and functional improvement was sustained through 6 month of follow up in both groups. Procedural cost of closed mitral valvotomy was significantly lower than the procedural cost of balloon mitral valvoplasty. KEYWORDS: closed mitral valvotomy, balloon mitral valvoplasty, rheumatic non-calcific mitral stenosis.INTRODUCTION: Treatment of rheumatic mitral stenosis ranges from conservative medical management to closed mitral valvotomy and the more recent, minimally invasive balloon mitral valvoplasty. Improvement of symptoms after closed mitral valvotomy was demonstrated many years ago. 1-3 Refinement in technique and the routine use of metal dilator have produced sustained clinical improvement at low risk. Percutaneous balloon mitral valvoplasty evolved from balloon valvoplasty for pulmonary valve stenosis. This prospective study was designed to compare the result of closed mitral valvotomy with balloon mitral valvoplasty over a period of 6 months.
This is a long term follow up of 54 patients with post infarct left ventricular aneurysm, operated over a period of 5 years, from 2005 to 2010, in a rural cardiac centre. This study aims at assessing efficacy of simple linear closure technique and its long term results. Follow up was done over a period of 2 to 5 years by clinical examination and 2D echocardiography. MATERIALS AND METHODS: 54 patients underwent surgery for left ventricular aneurysm. Age ranged from 50-70 years. 50 patients were operated electively and 4 patients within 15 days of acute myocardial infarction. All were approached by median sternotomy incision. Aortic canulation was done after heparinisation (3mg/kg). Aorto-bicaval canulation was employed and membrane oxygenators were used in all patients. After cross clamping the aorta, blood cardioplegia was used in all patients. Aortic cross clamp time varied from 40-90 min and bypass time varied from 90-120 min. Aneurysm was resected and sutured with 2/0 prolene and Teflon felt reinforcement with CABG as concomitant procedure in some. Inotropic support with adrenaline, dopamine or dobutamine was used in all patients. IABP was employed in 48 patients. All patients were electively ventilated for 24-48 hours. 6 required re exploration due to bleeding. 10 patients had mild MR which was left alone. RESULTS: 54 patients were operated for left ventricular aneurysm over a period of 5 years. 4 patients died postoperatively due to low cardiac output and arrhythmias. Follow up was done clinically and with 2D Echocardiography. At the end of 2 years, 22 patients showed no further improvement in LVEF, 32 patients LVEF improved by 10-15%. All patients required decongestive management. 6 patients died at the end of 2 years. CONCLUSION: Timely and planned surgery with simple techniques, for left ventricular aneurysms can give acceptable mortality and morbidity, in a rural cardiac Centre.
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