Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children. Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption. Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I. Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.
Introduction: Spinal anaesthesia is considered as gold standard for caesarean section due to its advantages of rapid and predictable onset, no airway handling, safe to mother and minimal drug exposure to fetus. But spinal anaesthesia caesarean section is associated with high incidence of IONV. Role of ondansetrone as antiemetic is well established. Not many studies are there for low dose ketamine in prevention of IONV. Materials and Methods: A total of 225 pregnant patients scheduled for CS under spinal anaesthesia were included and divided into three groups Group I -Patients who received low dose ketamine, group II-Patients who received ondansetron, group III-Patients who received normal saline. The patients were compared for intraoperative hemodynamic parameters, IONV, side effects like sedation and shivering. Results: The results of this study showed low dose ketamine group (group I) 26.6% and ondansetron (group II) 32% had lower incidence of IONV in comparison to control group 49.3%. Conclusion:Low dose ketamine and ondansetron are both good agents for reduction of IONV during CS in pregnant patients under spinal anaesthesia without significant adverse effects.
Background: Transversus abdominis plane block is an important regional anaesthesia technique for postoperative analgesia after caesarean section. Addition of adjuvants to local anaesthetic in TAP block helps in improving the duration of analgesia. Objective of current study was to compare clonidine and dexmedetomidine as adjuvants to 0.2% ropivacaine in USG guided TAP block for duration of postoperative analgesia in caesarean section under spinal anaesthesia.Methods: A total of 75 pregnant patients belonging to ASA I-II scheduled for caesarean section were included and divided into three groups; Group I-0.2% Ropivacaine plus normal saline, Group II-0.2% Ropivacaine plus 50 mcg clonidine and Group III-0.2% ropivacaine plus 50 mcg dexmedetomidine. The patients were compared for duration of analgesia, total number and amount of rescue analgesia utilized in 24 hours.Results: The mean duration of analgesia was found to be more (statistically significant p<0.05) and number as well as amount of rescue analgesic doses were reduced in group III as compared to group I and group II.Conclusions: Dexmedetomidine is a better alternative to clonidine as adjuvant for 0.2% ropivacaine in USG guided TAP block to extend the duration of postoperative analgesia and decreased 24-hour analgesic requirement in caesarean section.
Background: Laparoscopic tubal ligation have advantages of minimally invasive surgical technique, without risk of major haemorrhage, early postoperative ambulation and alimentation, making it suitable for ambulatory surgery. The choice of aneasthesia for laparoscopic ligation hence should consider the anaesthetic agents with a rapid onset of action and fast recovery time, with minimal problems for intraoperative control of haemodynamic, airway and pain relief as well as take consideration of the safety, quality, efficacy, and utilization of resources available to the given situation.Methods: A total of 100 patients aged from 18 to 45 years who were scheduled to undergo laparoscopic tubal ligation were divided into Group I- Ketamine plus pentazocine group (n=50), Group II- Propofol plus fentanyl group (n=50) and studied for the intraoperative parameters (hemodynamic and respiratory profile), recovery time, postoperative side effects and discharge time.Results: Intraoperatively MAP and HR were consistently higher in group I as compared to group II. Incidence of apnea and need for bag and mask ventilation was significantly more in Group II than in Group I as was the incidence of Bradycardia. Postoperative nausea and vomiting, psychomimetic effects were significantly more in Group I than in Group II. The time to reach modified PADSS ≥9 (discharge time) was significantly longer in group I (140.3±12.82 min than in group II 102.2±9.2 min), P<0.01.Conclusions: Combination of ketamine and pentazocine gives good anaesthetic conditions during procedure with less incidence of airway and haemodynamic complications intraoperatively but more incidence of postoperative side effects like nausea, vomiting, psycomimetic effects, and time to meet discharge criteria, compared to propofol plus fentanyl.
Coins are commonly ingested foreign body (FB) in children, particularly the area just below the cricopharyngeus muscle, being the most common site of lodgement. The aim of the present study was to evaluate the effectiveness of point-of-care ultrasound (POCUS) of the upper airway as an investigation arm to guide and assist the clinical management of foreign body coin in children with expectant management for spontaneous passage. A total of 50 children with coin in upper oesophagus were chosen and POCUS was done in the preoperative area. Those in whom coin was visualised on POCUS were taken for retrieval under general anaesthesia and in whom coin was not visualised were taken for 2 nd X-ray to confirm passage. In 50 children with a coin in upper oesophagus, point-of-care ultrasound (POCUS) showed the presence of coin in 44 children (confirmed on esophagoscopy) and spontaneous passage in 6 children (confirmed on 2 nd X-ray), thus resulting in the reduction of approximately 88% of 2 nd check X-ray to demonstrate the position of coin.
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