Extracorporeal membrane oxygenation (ECMO) is a modality utilized for partially or completely supporting the cardiac and/or pulmonary function. There are multiple vascular access techniques depending upon the necessity and the mode of ECMO used. ECMO has evolved over the years as an integral part of the cardiac care discipline. Historically, this lifesaving modality began as an extension of cardiopulmonary bypass and was associated with adverse outcomes. Currently, ECMO has evolved as an accepted and viable solution to patients with severe cardiac/respiratory/cardiorespiratory failure that is refractory to conservative management. The outcomes of patients on ECMO are dependent on multiple factors originating from demographic and pathophysiological status of patients as well as the control of homeostasis during ECMO within the acceptable range. Various studies have been published by many practitioners over past decades since the dawn of ECMO era. A brief review of such experience is summated, and a conclusion is derived about the clinical course of the patients on ECMO, while adding the author’s experience about the same in a tertiary care large-volume center.
Background and Aims: Ultrasound guided adductor canal block (ACB) is a modality for providing analgesia after arthroscopic anterior cruciate ligament repair surgery. Intra-articular infiltration of analgesics in the knee joint acts on the free nerve endings at the operative site and provides analgesia. We aim to compare the analgesic efficacy and opioid consumption between these two modalities. Material and Methods: Sixty patients were randomized to receive either ACB under ultrasound guidance (group A) or intra-articular infiltration (group B). Post-operatively time of rescue analgesia and opioid consumption were noted. Quality of analgesia was assessed every 2 hours until 6 hours, then every 6 hours until 24 hour post-operative period between the two groups. Data was analysed statistically and P value < 0.05 was considered significant. Results: Time of rescue analgesia was comparable in both the groups (p value 0.4317). NRS scores in ACB group and intra-articular infiltration group were comparable till first 6 hours (p value 0.4519) but increased in intra-articular infiltration group at 12 th hour (p value <0.0001) and 18 th hour (p value <0.0117) as compared to group receiving ACB. The opioid consumption was more in intra-articular infiltration group than ACB group although not statistically significant (p value 0.6319). Conclusion: ACB is a better modality for postoperative analgesia after arthroscopic anterior cruciate ligament repair surgery as analgesia of intra-articular infiltration wears off in 12-24 hour period which is crucial for early ambulation and from rehabilitation point of view.
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