Background and aims: Epidural analgesia has been considerably used for postoperative analgesia in Orthopaedic surgeries, however, combination of opioid and non-opioid medications in the perioperative period seems to provide an effective alternative. Objectives: To compare the efficacy of pre-emptive multimodal analgesia with combined spinal epidural for postoperative analgesia in lower limb arthroplasties. Materials and methods: 50 patients scheduled for elective lower limb Arthroplasties were randomly divided into two groups. Spinal anaesthesia with 2.5ml of 0.5% Bupivacaine (heavy) plus 0.5ml (25µg) Fentanyl was given in both the groups for procedure. Group I received Cap. Pregabalin 150mg and Inj Paracetamol 1000mg IV 1 hour before surgery and 75mg 12 hourly and 1000mg IV 8 hourly respectively, while Group II received epidural top up with 10 ml of 0.125% bupivacaine 8 hourly, both for 3 days postoperatively. Perioperative haemodynamics, postoperative VAS, rescue analgesics requirement, and Patient satisfaction level were monitored for 72 hours. Results: Postoperative VAS score was significantly higher in Group II from 4th hour postoperatively, and, accordingly, more patients in this group required rescue analgesia (21 and 20 in Group II vs 10 and 1 in group I in 12-24 hrs and 24-36 hrs respectively with p value <0.001). Modified Bromage score, haemodynamics and side effect profiles were comparable in the groups, however, patient satisfaction level was more in Group I (p value <0.001) after 72 hours. Conclusion: Pre-emptive multimodal analgesia can be used as an effective alternative to epidural for postoperative analgesia in patients undergoing lower limb joint replacement surgeries. Keywords: Pre-emptive multimodal analgesia, Combined spinal epidural analgesia, Lower limb arthroplasties, Postoperative analgesia
Background: Supraglottic airway devices are more efficient than endotracheal intubation in management of difficult airway and hemodynamic response.
Aims and Objectives: This study was undertaken for to compare laryngeal mask airway (LMA) Classic and I-Gel in terms of ease of insertion, insertion attempts, time taken for insertion, hemodynamic change, and adverse events after administering muscle relaxants for airway management in short surgical procedures.
Materials and Methods: A total of 120 patients of American Society of Anaesthesiologist 1 and II, aged between 18 and 50 years with Malampatti score 1 and II posted for elective short surgical cases were randomly allotted into two groups (n=60 in each), Group A for LMA Classic and Group B for I-gel. Patients were pre oxygenated with 100% O2 and pre-medicated. After induction and proper muscle relaxation, LMA Classic or I-GEL was inserted. The time and number of insertion attempts were assessed. Heart rate, Blood pressure, SpO2 recorded at the time of insertion, 1, 3, 5, and 10 min following insertion. The recorded results were analyzed statistically.
Results: The mean insertion time of Group A was 34.80±3.193 and Group B was 21.72±1.975. P<0.001 and in Group B all patients were successfully intubated at first attempt whereas in Group B 23.33% patients required second attempts. Hemodynamic changes were also less with Group B.
Conclusion: I-Gel has better hemodynamic stability. Ease of Insertion, insertion attempts and time taken for insertion are more convenient for I-Gel than LMA Classic after administering muscle relaxants.
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