Background: Transversus abdominis plane (TAP) block is a recently described technique to provide analgesia in lower abdominal surgery. The technique has been refined by ultrasound (US) guidance to deliver the local anaesthetic into the neurofascial plane between the internal oblique and the transversus abdominis muscles. We evaluated the analgesic efficacy of US-guided TAP block in patients undergoing caesarean delivery. Methods: Fifty women undergoing caesarean section were randomised to undergo bilateral TAP block with ropivacaine 0.5% (N = 25) versus placebo (N = 25), in addition to standard postoperative analgesia comprising of oral acetaminophen (600 mg) 6 hourly, with IV morphine (3 mg) analgesia for 'breakthrough' pain. Each patient was assessed postoperatively by a blinded investigator for morphine usage, average pain score, nausea, vomiting, pruritus, drowsiness and satisfaction with pain relief. Results: In the TAP group, postoperative morphine requirements up to 24 hours were significantly reduced (median 18.0 mg) compared with the placebo group (median 33 mg). Patients in the TAP group reported lower visual analogue scale scores than patients in the placebo group. Fewer patients required antiemetic in the TAP group. There were no local complications attributable to the TAP block. Conclusion: US-guided bilateral TAP block used in conjunction with oral acetaminophen significantly reduces the need for IV morphine and is an effective component in a multimodal strategy for postoperative analgesia following caesarean delivery.
Background: General anesthesia is preferred for clavicular surgeries. With the advent of ultrasound-guided technology, interscalene brachial plexus block with superficial cervical nerve block has become a new option for providing intraoperative anesthesia and postoperative analgesia for surgeries of the clavicle. Aims and Objectives: The present study compares the ultrasound-guided interscalene brachial plexus nerve block combined with superficial cervical nerve block to general anesthesia in clavicular surgery. Settings and Design: This study was a randomized controlled trial in a tertiary care setting. Materials and Methods: A total of 60 patients between 18 and 60 years who were scheduled for clavicular surgeries were randomly and equally divided into Group B and Group G. Group B received ultrasound-guided interscalene brachial plexus block with superficial cervical nerve block. Group G received general anesthesia. Time duration between start of anesthesia to the incision time, intraoperative vitals, and time spent in postanesthesia care unit, postoperative pain scores, postoperative analgesic consumption, and complications were noted and compared. Statistical Analysis: Statistical analyses were done using SPSS software 20.0. Normality tests were applied, and accordingly, parametric and nonparametric tests were used to calculate the results. Results: The demographic data were comparable in both the groups. Time duration between start of anesthesia to the incision time was significantly more in Group B than in Group G. The time spent in postanesthesia care unit and postoperative pain scores were significantly more in Group G than Group B. Total postoperative opioid consumption was significantly less in Group B than in Group G. Conclusion: Ultrasound-guided interscalene brachial plexus block combined with superficial cervical nerve block is a safe and effective mode of anesthesia in comparison to general anesthesia for clavicle surgeries.
BackgroundTo compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery.MethodsA total of 60 patients (age 18–70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block.ResultsThe duration of analgesia was found to be significantly longer in Group H (17.02 ± 0.45 h) than in the Group L patients (14.29 ± 0.45 h) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity.ConclusionsDexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.
Snake bite is very common in India. Ischemic stroke after snake bite has been described in the literature sparsely. Furthermore, the onset of stroke and its clinical reversibility is a rarity. Here, we present a case of snake bite with ischemic stroke which has clinically reversible outcome.
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