Background: During orthopaedic surgical procedures such as trigger finger repair or tendon repair, differential nerve block (DNB) can permit intraoperative assessment of adequacy of surgery. The current study was undertaken to compare the efficacy and safety of 0.15% ropivacaine and 0.1285% ropivacaine in producing DNB for hand surgeries. Methods: This was a randomized controlled trial of 40 participants, aged 18-60 years, either gender, ASA I/II requiring hand or forearm surgery. Participants were randomized to receive 25 ml of either 0.15% (Group R15) or 0.1285% ropivacaine (Group R1285). Onset of sensory and motor block, requirement of additional analgesia or general anaesthesia for surgery was noted. Results: DNB was achieved in 18/20 (90%) patients in Group R15 and in 10/20 (50%) patients in Group R1285 (P=0.057). In group R15, mean time to achieve DNB was 15.26±3.5minutes and it was12.78±5.6 minutes in R1285 group (P=0.165). Mean duration of DNB was 15.52±3.7 minutes among R15 and 18.89±3.3 minutes among R1285 (P=0.027). Duration of surgery was 20 minutes in both groups. Two patients (10%) in each group developed full motor block and 8 (40%) patients among R1285 needed general anaesthesia. Conclusion: Differential block sufficient to permit surgery of short duration is possible with both concentrations but success rate is higher with 0.15% ropivacaine.
Background and Aims:
Digital technique of proseal laryngeal mask airway (PLMA) insertion carries high chance of failed first attempt successful placement. We aimed to compare the number of attempts taken for correct placement of bougie-preloaded PLMA versus traditional digital insertion technique. Ease of insertion, time taken, hemodynamic responses during insertion, and evidence of trauma were also assessed.
Material and Methods:
This prospective, randomized, open-label study was performed in 60 patients. All patients were administered general anesthesia according to a standardized protocol.After induction of general anesthesia in group P, proseal insertion was performed following the traditional digital technique. In group B, bougie-preloaded PLMA was used. A soft gum elastic bougie was passed through the gastric channel of PLMA, with 15cm protruding distally through the gastric port. Attempts at successful insertion and ease of insertion were noted.
Results:
Time taken for successful insertion was significantly shorter in group B compared to group P (15.3 ± 4.5 vs. 57 ± 12.02 s, respectively). The first attempt success in group B was 90% versus 60% in group P. The number of moderate to hard insertion was significantly lesser in group B (10 vs. 40, respectively). Blood stain on device was seen in 3.3% in group B compared to 30% in group P. MAP at insertion and at 1, 3, and 5 min was significantly higher in group P. Heart rates were comparable.
Conclusion:
Bougie-preloaded proseal insertion has significantly higher first attempt insertion success rates and is significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.
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