Shoulder surgery varies from simple diagnostic arthroscopy to major total shoulder arthroplasty. Patients present for shoulder surgery may be young and t with a sports injury or elderly sick with rheumatoid arthritis need arthroplasty of the shoulder joint. Choice of anaesthesia based on the type of surgery, and the comorbidity of a patient. Management of severe postoperative pain is a major challenge for the anaesthesiologist. Regional anaesthetic techniques effectively control static as well as dynamic pain and facilitate early mobilization. However regional blocks are not free from the side effects or complications
Background: The study is aimed to compare the effects of intrathecal fentanyl and intrathecal morphine combined with 0.5% hyperbaric bupivacaine on the quality of postoperative pain control for unilateral inguinal hernia repair in adult male population. Fifty –ve patients aged 18-60 years with American Society of Anesthesiologists physical status I-IIMaterials and Methods: scheduled for elective inguinal hernia repair surgery were enrolled in this prospective randomized double blinded study. Patients received spinal anesthesia with either 25 mcg fentanyl plus 15 mg heavy bupivacaine intrathecally (group F, n=55) or 0.2 mg morphine plus 15 mg heavy bupivacaine intrathecally (group M, n=55).Hemodynamic parameters, time to rst analgesic requirement, postoperative pain scores, the number of analgesic requirements and side effects over postoperative 24 h were recorded Pain scores were signicantly lower in group MResults: compared with group F in the postoperative 24 h. The time to rst analgesic requirement was higher in group M than group F. Analgesic requirement was higher in group F than group M for the rst 24 hours, postoperative We concluded that the addition of 0.2 mgConclusion: morphine intrathecally to 15 mg heavy bupivacaine provides improved postoperative analgesia than 25 mcg fentanyl for inguinal hernia repair under spinal anesthesia.
Background: This study is aimed to assess an optimal dose of ketamine infusion for management of early postoperative pain in elective laparoscopic cholecystectomy. Intensity of pain, requirement of rescue analgesics and tness to discharge were assessed during immediate postoperative period. Methodology: Randomised controlled prospective clinical trial was conducted in 140 patients of laparoscopic cholecystectomy and, allocated in four groups of 35 each. Standard anaesthetic regimen was used in all patients, using propofol for induction, atracurium for muscle relaxation and isourane for maintenance of anaesthesia. Continuous infusion of the test drug was administered by intravenous cannula placed in alternate hand -1 -1 from start of port placement till wound closure. Group K1, K2 and K3 received an infusion of ketamine hydrochloride at a rate of 20 µg kg min , 30 -1 -1 -1 -1 µg kg min and, 40 µg kg min respectively, while Group N received normal saline. Postoperative pain score, requirement of rescue analgesia, degrees of sedation and postoperative cognitive function were examined postoperatively. Results: -1 Visual analog scale score ≥ 4 was considered signicant pain and, rescue analgesic injection diclofenac sodium 75mg kg was administered. Duration of analgesia was 130.71 ± 82.41, 457.14 ± 150.373, 520.97 ± 189.338 and, 524.83 ± 141.436 minutes in group N, K1, K2 and K3 respectively. Out of 35 patients 28, 4, 0 and, 0 patients required three doses of diclofenac sodium in 24 hours in N, K1, K2 and K3 group respectively. Conclusions: -1 -1 Continuous infusion of ketamine hydrochloride at a rate of 30 µg kg min during intraoperative period provide effective pain relief during early postoperative period without inuencing cognitive function of the patients.
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