Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block. Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.
Introduction: Shivering is frequently seen after subarachnoid block. Subarachnoid block impairs the thermoregulation system by inhibiting tonic vasoconstriction with redistribution of blood flow and core heat from the trunk to the peripheral tissue. Intraoperative shivering leads to increase in oxygen consumption and carbon dioxide production. This causes an increase in heart rate, blood pressure resulting in exacerbation of ischemic heart disease, increased risk of hypoxemia, intraocular pressure, intracranial pressure, metabolic rate, lactic acidosis, pain at the surgical site and discomfort to the patient. Objective: To assess the effectiveness of Dexamethasone in preventing intraoperative shivering in patients of cesarean delivery under subarachnoid block. Methodology: This was a hospital based prospective, comparative, cross sectional study which was conducted from February 2019 to July 2019 among 88 pregnant patients of age group 18 to 35 years old, American Society of Anesthesiologists (ASA) physical status 1 and 2, posted for elective or emergency caesarean delivery at Birat Medical College and Teaching Hospital (BMCTH). Operation room temperature was recorded by a wall thermometer and maintained during surgery between 20 to 25 degree Celsius and intravenous fluids were kept at this temperature. Patients were divided into two equal groups. Group S (study group) patients received 2 ml or 8mg of dexamethasone IV (As a premedication before giving subarachnoid block) while group C (control group) patients received 2 ml of normal saline. If the patients shivered according to classification of shivering, the prophylaxis was regarded as ineffective. Results: Patients undergoing caesarean delivery under subarachnoid block had significantly reduced (p value = 0.002) intraopera tive shivering who received prophylactic dexamethasone (group S). Conclusion: The prophylactic use of 8mg i.v dexamethasone was significant in prevention of shivering in Nepalese population who underwent caesarean delivery under subarachnoid block.
Introduction: It is essential that all the medical professionals should have adequate skill for basic life support (BLS) for better outcome of cardiac arrest patients. The objective of the study is to assess the knowledge and awareness of BLS among the medical doctors, nursing staffs and health care paramedics working in Birat Medical College and Teaching Hospital, Biratnagar. Methodology: A three-month duration observational questionnaire-based survey was conducted at Birat Medical College and Teaching Hospital, Biratnagar to assess the knowledge, awareness of basic life support among the medical doctors, nursing staffs and health care paramedics. A total of ten questions were designed to assess the knowledge and awareness regarding BLS skill. Three questions were designed to assess the previous experiences on cardiac arrest situation and BLS training. Similarly, two additional questions were added to assess the self-grading of BLS knowledge which included poor, below average, good and excellent. Result: It was observed that only 14% participants had previous BLS training. Surprisingly, 76% of the participants had encountered cardiac arrest situation in their clinical practice but they were managing those cases with limited knowledge on BLS. The correct answer to the self-structured questionnaire were ticked by less than 50% of participants and majority of the participants came below average on self-grading of the knowledge and awareness suggesting the need of easy accessibility of BLS training centers in the eastern part of Nepal. Conclusion: This study revealed that the knowledge and awareness of basic life support skills among the various staffs was mostly below average to poor. Significant amount of cost effective BLS trainings must be conducted so as to develop competent staffs by various training centers
Orthopaedic surgeons and the surgical team not only face health hazards faced by most of the physicians in any medical field but also hazards specific to the practice of orthopaedic surgery. Common health hazards are related to radiation, infections, surgical smoke, noise, chemicals, physical and it may be psychological. The aim of this article is to review the hazards and raise the awareness for the safety of orthopaedic surgeon and the surgical team as well as patient and newly introduced surgical team member in Operation Theater.
Introduction: Subarachnoid block is commonly employed technique for lower abdominal and lower limb procedures. Bupivacaine and ropivacaine are commonly used local anesthetics for subarachnoid block. The aim of this study is to compare the efficacy and safety of isobaric Ropivacaine over hyperbaric Bupivacaine. Methods: This was a prospective comparative study for a duration of six months. 60 ASA grade I-II adult patients between 16-60 years undergoing lower limb surgery under spinal anesthesia were randomized into two groups. Group I including patients who received 15 mg of hyperbaric bupivacaine 0.5% and group II including patients who received 22.5 mg of isobaric ropivacaine 0.75%. The onset and duration of sensory and motor block and hemodynamics including heart rate (HR), non invasive mean arterial blood pressure (MAP) and respiratory depression were recorded. Data were entered in Microsoft excel and statistical analysis was done by chi square test and T test using SPSS (version 23.0). Results: Both the groups were demographically statistically insignificant. Successful block was attained in all patients in both groups. The sensory onset and motor onset were significantly delayed in the Ropivacaine Group compared to the Bupivacaine Group P<0.001. There was no significant difference in the hemodynamics (heart rate and mean arterial pressure ). Conclusions: Though isobaric ropivacaine provided lesser degree of sensory and motor block with delayed onset compared to hyperbaric bupivacaine, it can effectively and safely used in subarachnoid block in lower limb surgeries without any major hemodynamic changes and adverse effects.
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