Background: Laryngoscopy and tracheal intubation lead to stress response which is characterized by transient rise in blood pressure and heart rate. This response is tolerated well in normal individuals but can lead to significant morbidity and mortality in patients with cardiovascular and cerebrovascular diseases. Search for the better drugs to suppress these responses is going on through decades. Aim of Study: To compare the effects of IV nitroglycerin alone and in combination with IV lignocaine, on attenuation of stress response to end tracheal intubation. Material and Methods: This is a randomized, double blind study conducted in 60patients admitted for operation at NGMCTH, between June 2018 to November 2018. Patients were of 16- 60 years age groups and belonging to ASA group I and II. Patients were divided into two groups: Group I IV Nitroglycerin 500 mcg+ NS 3 ml. (n=30) and Group IIIV Nitroglycerin 500 mcg+ IV Lignocaine 63 mg (n=30). Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart rate (HR) were measured and Rate Pressure Product (RPP) calculated. Results: Baseline values were comparable in both groups. Post Intubation, there was significant decrease in SBP at 0,1,3 and 5 minutes while DBP and MAP significantly decreased at 1, 3 and 5 minutes, in both groups. Significant tachycardia was noted in both groups at 0,1and 3 minutes, and RPP remained unchanged in both groups. Conclusion: Nitroglycerin significantly decreases blood pressure, prevents rise in RPP but does not attenuate heart rate after end tracheal intubation. There is no benefit of adding IV lignocaine to IV nitroglycerin for attenuation of stress response to end tracheal intubation.
Background:In peripheral nerve blocks, adjuvants are added to local anaesthetics to improve the quality of anaesthesia and analgesia. We designed this randomized single blinded prospective study to compare the analgesic efficacy of tramadol used as an adjuvant to bupivacaine for supraclavicular brachial plexus block in patients undergoing orthopaedic surgeries of upper limb. Aim of study: In this study, we aimed to compare onset, duration and quality of analgesia along with respiratory, hemodynamic changes with tramadol as adjuvant to bupivacaine in supraclavicular brachial plexus block in the patients undergoing upper limb surgery. Method: In this prospective randomized control trial, two groups of 30 patients each were investigated. 28 ml. of 0.5% bupivacaine (plain) with 2 ml. normal saline was administered in group -I and 28 ml. of 0.5% bupivacaine (plain) with 2ml. (100 mg.) tramadol was administered in group -II. The onset of sensory and motor block, duration of analgesia, respiratory/hemodynamic parameters and post-operatively quality of analgesia via visual analogue scale were assessed. Results: The duration and quality of analgesia was significantly increased by adding tramadol in bupivacaine than bupivacaine alone (p=<0.001 and <0.001) whereas there was no statistically significant difference in onset of motor (p=>0.35) and sensory block (p=>0.75) and also hemodynamic and respiratory parameters.(HR p=>0.1, MAP p=>0.5, and SPO p=>0.5). Conclusion: The study suggests that tramadol when added to bupivacaine 2 for supraclavicular brachial plexus block enhances the quality of anaesthesia and analgesia without affecting respiratory/hemodynamic parameters.
Objectives: The objective of this study was to compare propofol-ketamine combination with propofol-butorphanol combination for short surgical procedures in terms of hemodynamic and respiratory stability, postoperative sedation, postoperative nausea and vomiting and effect of abolishing pain on injection with propofol. Methods: This was a randomized double blinded study conducted in 60 patients belonging to ASA I &II, aged between 16 -60 years. Patients were divided into two groups: Group-B: Propofol-Butorphanol combination (n=30) and Group-K: Propofol-Ketamine combination (n=30). The baseline values for the heart rate, mean arterial pressure and SPO recorded and every 5 minutes after induction of anesthesia. Results: In Butorphanol group MAP at 5, 10, 2 15, 20, 25 and 30 minutes after induction was significantly lesser but heart rate at 10, 15, 20, 25 and30 minutes after induction was significantly greater than in the Ketamine group with the p value of < 0.05. From 20-30 minutes post induction, SPO in Butorphanol 2 group was significantly less than in the Ketamine group with the p value of < 0.05. Pain after injection of propofol was significantly greater in Ketamine group with the p value of 0.008. There was no statistically significant sedation and post operative nausea and vomiting among the groups. Conclusion: Propofol-Ketamine combination provided better hemodynamic and respiratory stability than Propofol-Butorpanol combination however pain on injection with propofol was greater in Propofol-ketamine combination.
Background: Regional anaesthesia for fixation of clavicle fracture is a new concept. Various techniques of regional anaesthesia are being tried to find the optimal type. Combined interscalene and superficial cervical plexus block is widely accepted. Aim of Study: This study aims to compare the efficacy of interscalene block (ISB) with combined interscalene block and superficial cervical plexus block (ISB+ SCPB) for clavicular plating. Material and Methods: This prospective, hospital based comparative study was conducted from March 2019 to October 2019, in the department of anaesthesiology, Nepalgunj Medical College. 60 ASA category I and II patients undergoing clavicular plating and belonging to age group 16-65 years were enrolled. Patients were divided into two groups: Group I: ISB (n=30), Group II: ISB+ SCPB (n=30). Blocks were given using landmark technique. Primary outcome measures were conversion to general anesthesia (GA), requirement of supplemental analgesia and patient satisfaction. Secondary outcome measures were sensory and motor block, duration of analgesia and complications. These outcome measures were compared between the groups. Results: No patient required conversion to GA. The number of patient requiring supplemental analgesia was significantly higher in ISB group in comparison to ISB+ SCPB. Patient satisfaction was excellent in both groups. No statistically significant complications were seen in either group. Conclusion: Interscalene block combined with Superficial Cervical Plexus Block (ISB + SCPB) has better efficacy than Interscalene block (ISB) alone for clavicular plating. Nevertheless, both techniques avoid GA and provide excellent patient satisfaction level.
Introduction: Effective post-operative analgesia is mandatory following cesarean section (CS), as parturients need to recover quickly to breast feed and provide care for their newborns. Till date no single drug has been able to achieve this goal. Multimodal analgesia with opioids and non-steroidal anti-inflammatory drugs (NSAID) combination has shown promising results. Aims: To compare the analgesic efficacy, patient satisfaction and maternal adverse effects, between intravenous (IV) tramadol and multimodal analgesia with IV tramadol and IV ketorolac combination for post cesarean section analgesia. Methods: This is a prospective, randomized and single-blinded comparative study, conducted in 60 parturients who underwent Lower Segment Cesarian Section. They were divided into two groups: Group 1 (IV Tramadol 50 mg given 8 hourly) and Group 2 (IV Tramadol 50 mg + IV Ketorolac 30 mg given 8 hourly). IV Promethazine was given with each dose of tramadol in both groups. Results: The (Visual analogue scale) VAS scores were significantly low in IV tramadol + IV ketrolac group than with IV tramadol alone group at 2 hours and 12 hours with p value of 0.003 and 0.08 respectively. Rescue analgesia was significantly reduced in group 2 (p value 0.005). Patient satisfaction was good in group 2 and fair in group 1(p value 0.002). No maternal side effects were found. Conclusion: IV tramadol and IV ketorolac combination used for post cesarean section analgesia significantly decreases post-operative pain, need of rescue analgesia and significantly increases patient satisfaction in comparison to IV tramadol alone.
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