Background: Local anesthetics are now widely used, as they have a good safety profile and are available in long acting preparation. They provide the benefit of analgesia without systemic side effects that may result from use of enterally and parenterally administered drugs.Methods: This prospective randomized double-blind study was conducted on 100 patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy. Patients were randomized to receive either 0.5% of 3mg/kg of Ropivacaine diluted in 100 ml NS, instillation at intraperitoneal space before creation of pneumoperitoneum (group I) or 100 ml NS instillation at intra peritoneal space before creation of pneumoperitoneum (group II). VAS score for pain abdomen as well as shoulder were recorded postoperatively at various time intervals and compared in both the groups. Total analgesic consumption in 24hrs was also noted and compared.Results: The mean postoperative VAS score for abdomen and shoulder pain was significantly (p values<0.05) lower in group I than in group II till 24 hrs postoperatively. The latency time from end of operation to first analgesic requirement was significantly longer in group I than in group II.Conclusions: Intraperitoneal instillation of Ropivacaine before the creation of pneumoperitoneum significantly decreased the total abdominal pain, shoulder tip pain with lower analgesic consumption. As it is safe and without apparent side effects, we believe that intraperitoneal instillation of local anaesthetic in patients undergoing elective laparoscopic cholecystectomy is an effective modality for postoperative pain management.
BACKGROUND Awake nasal or oral flexible fiberoptic intubation (AFOI) is the airway management technique of choice in known or anticipated difficult airway, severe cervical stenosis, Chiari malformation, unstable cervical fracture, limited mouth opening as in temporomandibular disease, mandibular-maxillary fixation, severe facial burn and vertebral artery insufficiency. [1] Fiberoptic intubation is the best, easiest and most successful method for awake intubation. MATERIALS AND METHODS A prospective, comparative and randomized study was conducted on 100 patients undergoing elective surgery under general anaesthesia. Patients were randomly divided into two groups of 50 each. Group I: Patient received bolus of I.V. fentanyl 1 ug/kg+ propofol 1 mg/kg so as to achieve an adequate level of sedation i.e. RSS=3. Group II: Patient received bolus of I.V. nalbuphine 0.2 mg/kg + propofol 1 mg/kg to achieve adequate level of sedation. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure, mean arterial pressure), SpO2, EtCO2, total comfort scale and patient's tolerance were assessed during preoxygenation, fiberscope insertion and endotracheal intubation. RESULTS Significant difference (p<0.05) between two groups in terms of HR, SBP, DBP, MAP, total comfort score and patient tolerance was seen during fiberscope insertion and endotracheal intubation. CONCLUSION Fentanyl plus propofol regimes are suitable for fiberoptic intubation. Fentanyl plus propofol appeared to offer better tolerance, preservation of an airway and spontaneous ventilation, while maintaining haemodynamic stability.
Background – The aim of this study is to compare safety and efficacy of bupivacaine 0.5% of 2ml (10mg) with 25mcg fentanyl and levobupivacaine 0.5% of 2ml with 25mcg fentanyl when given intrathecally in patients of Transurethral Resection of Prostate/Bladder Tumor Surgeries Methods–After local ethics committee approval,60 patients were selected according to eligibility criteria and a written informed consent was obtained from each patient after explaining the technique prior to inclusion in this study in their own vernacular language and randomly allocated in two groups of 30 each. GROUP I: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl intrathecally to achieve an adequate level of anaesthesia.GROUP II: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl inrathecally to achieve adequate level of anaesthesia.Spinal block was performed by an anaesthesiologist consultant. Patients were monitored for sensory blockade,motor blockade,Ramsay sedation score,VAS score and complications. Hemodynamics were compared in both the groups. Observations –In this study we evaluated and compared 0.5% bupivacaine and fentanyl with 0.5% levobupivacaine and fentanyl in terms of intraoperative hemodynamic changes, onset & duration of sensory block, onset of motor block, level of sedation and occurance of complications when given intrathecally for transurethral resection of prostate/bladder tumors.It was observed that sensory blockade qualities were comparable in both the groups. However, motor blockade was significantly reduced in group-II(Levobupivacaine) as compared to groupI(Bupivacaine). Patients in Group II had better hemodynamic stability,good patient and surgeon satisfaction and fewer side effects as compared to Group I. Conclusion –0.5% Levobupivacaine plus fentanyl provides less motor blockade,better hemodynamic stability and fewer side effects in patients undergoing TURP/TURBT compared to 0.5% bupivacaine plus fentanyl.
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