The obstetric population has been most vulnerable in this COVID-19 pandemic. We could not retrieve any study evaluating the safety and efficacy of anaesthetic techniques in parturients with COVID-19 undergoing caesarean delivery (CD) from South Asian Sub-continent. We, herein present the detailed clinical analysis and anaesthetic management of a case series of seven parturient with COVID-19 undergoing CD under subarachnoid block (SAB) in a tertiary care designated COVID hospital in the city of Delhi between June and December 2020. Herein, we report 7 parturients with mild COVID-19 disease undergoing CD under SAB. Our observations are that the use of SAB was associated with transient haemodynamic perturbations in terms of hypotension in 3 patients and bradycardia in one patient. The neonatal outcome was observed to be favourable. To conclude, our experience is that SAB is safe and effective for parturient with mildly symptomatic COVID-19 disease; however, was found to be associated with transient haemodynamic changes exclusively in parturients with anaemia.
Background and Aims: Clonidine as an adjuvant has not been evaluated in rectus sheath block (RSB) for postoperative pain management in incisional hernia repair. The study aims to evaluate clonidine as an adjuvant in single-shot RSB along with general anesthesia (GA). Material and Methods: This randomized, double-blind controlled study was conducted following IEC-Human approval and written informed consent from 30 patients of either sex, aged 16 to 60 years, ASA physical status I or II undergoing midline incisional hernia repair under GA. All patients received ultrasound-guided bilateral RSB following administration of GA. The subjects enrolled in the study were randomly allocated to receive either normal saline 1 mL (group B) or clonidine 1 μg/kg diluted to 1 mL with normal saline (group BC) as adjuvant along with 9 mL bupivacaine hydrochloride 0.25%. Inj. tramadol 1 mg/kg was administered for rescue analgesia. The primary outcome was the time to first request for analgesia, and secondary outcomes were total consumption of rescue analgesic over 24 h, numerical rating score (NRS), patients’ satisfaction, hemodynamics, and side effects. Unpaired t-test and Chi-square test were used. Results: On intergroup analysis, the mean time to first request for analgesia (in min) was significantly higher in group BC i.e., [9.60 (± 5.23) vs 5.33 (± 3.53); ( P < 0.034]; whereas, the mean rescue analgesic consumption in 24 h (in mg) was higher in group B i.e., [(88.00 ± 60.97) vs (46.00 ± 48.08)]; ( P < 0.045)]. Hemodynamic parameters i.e., mean blood pressure and heart rate were comparable between the two groups, and there were no side effects. Conclusion: Clonidine as an adjuvant in single-shot ultasonography (USG)-guided RSB along with GA is efficacious for postoperative pain management following midline incisional hernia repair.
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