Background:
Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreaticobiliary diseases. It is a potentially uncomfortable procedure that needs to be performed under conscious sedation. Safe and effective sedation protocol is the need of an hour.
Aims:
This study aims to evaluate the requirement of propofol using midazolam and dexmedetomidine as premedication for ERCP. The degree of comfort experienced by endoscopist and the patients was also assessed.
Materials and Methods:
A total of sixty patients were enrolled in a randomized, assessor-blinded study in the age group of 40–80 years, American Society of Anesthesiologists physical class II–III undergoing elective ERCP procedures. They were divided into two groups of 30 each. Group D (
n
= 30): Dexmedetomidine (100 μg/mL + 18 mL saline) loading dose at 1 μg/kg intravenous (IV) over 10 min followed by 0.5 μg/kg/h infusion, and Group M (
n
= 30): Midazolam at 0.05 mg/kg IV bolus over 10 min followed by normal saline infusion under hemodynamic monitoring. Satisfaction scores, total propofol requirement, and complications such as gagging, restlessness, agitation, postoperative nausea and vomiting were noted and analyzed statistically.
Statistical Analysis:
Statistical analysis was performed using SSPS 17.0 software (SPSS Inc., 233 South Wacker Drive, Chicago, USA). The Chi-square test was applied for nonparametric data and parametric numerical data, unpaired
t
-test for intergroup comparison, and repeated measures ANOVA for intragroup comparison. Results were expressed as a mean ± standard deviation. Value of
P
< 0.05 was considered statistically significant and <0.001 as highly significant.
Results:
Surgeons and patients were more satisfied and comfortable along with less requirement of propofol in the dexmedetomidine group. The incidence of complications was also less in the dexmedetomidine group as compared to that of midazolam group.
Conclusion:
Both dexmedetomidine and midazolam can be safely administered as an anesthetic adjuvant to propofol for short procedures like ERCP's. Dexmedetomidine provided intense and better sedation quality along with lesser requirement of propofol doses. Moreover, it provided stable hemodynamic conditions and good recovery characteristics as compared to midazolam group.
Introduction: Severe pain in the fractured femur makes it difficult to position a patient for spinal anesthesia. Femoral nerve block (FNB) has been studied for relief of pain, but studies are inconclusive regarding the superiority of one technique over another, i.e., nerve stimulation vs ultrasound for guidance. Aims and objectives: This study aims to compare the ease of positioning for spinal anesthesia in fracture femur cases using two different techniques of localization of femoral nerve for the block. Materials and methods: In this prospective, randomized, single-blind study, 60 patients of fracture femur were allocated in two equal groups of nerve stimulator (group NS) and ultrasound-guided (group US) femoral nerves block and compared regarding ease of positioning, duration of analgesia, and need for rescue doses of tramadol using SPSS version 26. Results: The patients in the two groups were similar in age, sex, weight, BMI, and initial pain severity (p = 0.920). The visual analog scale (VAS) scores within the groups were markedly reduced at 15 minutes in both the groups (p = 0.000) and between the two groups pain relief was more in group US than group NS at 5 and 10 minutes (p = 0.000 and p = 0.034, respectively), but, was comparable at 15 minutes (p = 0.310). The ease of positioning was observed in 27 patients in group US vs 20 patients NS (p = 0.028) as grade-I (comfortable), whereas grade II (discomfort) present in 3 vs 9 patients (p = 0.053), and grade III (uncomfortable) was seen only in one patient in group NS. The duration of analgesia in group US vs NS was 464.0 ± 170.61 and 282.9 ± 126.85 minutes, respectively (p = 0.003) and lesser need for rescue dose of tramadol (134.20 ± 23.20 vs 174.43.83 ± 47.74 mg) (p = 0.002). The vascular puncture was the main complication observed in group NS. Conclusion: Both the techniques of FNB provided adequate analgesia for fracture femur pain, but the ultrasound technique provided earlyonset, better patient comfort, and longer duration of analgesia than the landmark nerves stimulation technique.
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