BACKGROUND The aim of this study was to evaluate the effects of dexamethasone and magnesium sulfate as additives to local anaesthetic solution containing lignocaine and bupivacaine in supraclavicular brachial plexus block. MATERIALS AND METHODS A prospective randomised double blind control study was conducted on 90 healthy patients of ASA grade I, II of age group 18-50 years scheduled for upper limb surgeries under supraclavicular block. Patients were allocated to three groups of 30 each as a control group (S) received only local anaesthetic, group getting dexamethasone as additive (SD) and group getting magnesium sulfate as additive to local anaesthetics (SM).Parameters observed were time of onset of sensory and motor block, duration of analgesia and side effects. RESULTS Onset of sensory block was most rapid in Group SD and was statistically significant when compared to Group S (p<0.01) and Group SM (p<0.01). The meantime for sensory block onset was 11.07 ± 2.033 mins in Group S, 6.80 ± 2.384 minutes in Group SD and 8.70± 1.896 minutes in Group SM. Mean time for onset of motor block in Group S, Group SM, and Group SD was 13.17± 2.66 minutes, 10.27± 2.39 minutes and 9.40 ± 2.29 mins respectively. Onset of motor block was earliest in Group SD and this was statistically significant when compared to Group S (p<0.01) but statistically insignificant (p=0.526) between Group SD and Group SM. Duration of analgesia was found to be highest in Group SD with mean duration of analgesia (738.33 ± 187.69 minutes) and in Group S it was (308.33 ± 60.05 minutes) and Group SM was 628.02 ± 182.06 minutes. It was statistically significant when compared to Group S (p<0.01) and Group SM (p<0.01).
BACKGROUND AND AIMSSupraclavicular brachial plexus block is ideal for upper limb surgical procedures. Dexamethasone and potassium chloride have been used as adjuncts to prolong analgesia. We aimed to compare the effects of addition of dexamethasone or potassium chloride to local anaesthetic solution of bupivacaine and lignocaine on the onset time of sensory and motor blockade and duration of blockade in supraclavicular brachial plexus block in patients undergoing upper extremity surgeries.
BACKGROUND AND AIMSIn this era of high technology, we still face an ageless problem in anaesthesia -the difficult airway. In 1997, Smarajith Sur Roy of India introduced a new airway index to predict difficult intubation. Aim of the study is to compare the new airway index with modified Mallampati classification and also with Cormack and Lehane grading for predicting intubation difficulty.
BACKGROUND Neuraxial blocks are the most common method of anaesthesia in abdominal hysterectomies and epidural technique has been used widely to provide both anaesthesia and postoperative analgesia. It has become a common practice to use polypharmacy approach for treatment of intra and postoperative pain, because no drug has yet been identified that specifically inhibit nociception without side effects. The aim of the study is to compare the effects of magnesium sulphate versus preservative-free ketamine as an adjunct to epidural bupivacaine for postoperative analgesia in abdominal hysterectomy. MATERIALS AND METHODS After obtaining informed consent, the patients were divided into 3 groups of 40 each to receive 20 mL 0.5% bupivacaine (group B), 19 mL 0.5% bupivacaine + 50 mg magnesium sulphate (group BM), 19 mL 0.5% bupivacaine + 50 mg preservative-free ketamine (group BK). Epidural catheter was inserted at L1-L2 space using standard technique. Correct placement was confirmed by a test dose of 2% lignocaine + adrenaline 1 in 2 lakhs. Postoperative analgesia were assessed by VAS score and 0.125% bupivacaine infusion and 1 g paracetamol IV infusion was given as rescue analgesics when VAS ≥4. Onset duration, motor block and side effects were also monitored. RESULTS Mean time of duration of onset in group B, BM, BK were 20, 14, 18 minutes, respectively. Mean time for rescue analgesia were 180, 240 and 480 minutes in group 1, 2 and 3, respectively. These differences were statistically significant. The side effects noticed in each group were not statistically significant. CONCLUSION The onset of effect is faster when magnesium sulphate were added as an adjunct to bupivacaine as compared to preservativefree ketamine. The postoperative analgesia is found to be more with preservative-free ketamine as compared to magnesium sulphate without any significant side effects.
BACKGROUND AND AIMS Postoperative Nausea and Vomiting (PONV) is one of the most common and distressing problems after anaesthesia and surgery. 5-HT3 receptor antagonist ondansetron is widely used for PONV prophylaxis. P6 acupoint stimulation, a non-pharmacological technique is a simple, inexpensive, and effective method for prevention of PONV. We compared the efficacy of P6 acupoint stimulation against monotherapy with intravenous ondansetron for prophylaxis of PONV. METHODS One hundred American Society of Anaesthesiologists-I or II patients, aged between 18 and 65 years, scheduled for thyroidectomy under general anaesthesia were included in this prospective, randomised, double-blind study. The patients were randomised into two groups: Group A (acupuncture) and Group O (ondansetron). PONV was assessed in two epochs of 0-6 and 6-24 hrs. Primary outcome measure was incidence of PONV and secondary outcome measures were severity of PONV, need for rescue antiemetic, overall patient satisfaction, and side effects to either intervention. Outcome was compared using Mann-Whitney U-test or chi-square test as applicable. RESULTS Data of 100 patients were analysed. The incidence of PONV was similar during the 24 hrs. period in both groups. Complete response was seen in 82% of patients in both groups in the first 6 hrs. and in 98% in the late postoperative period. There was no difference in the requirement of rescue antiemetic or severity of PONV between the groups. Over all patient satisfaction was comparable in both groups. CONCLUSION P6 acupoint stimulation is safe, inexpensive, and equally effective as monotherapy with intravenous ondansetron in preventing PONV.
BACKGROUND Rocuronium is a newer non-depolarising muscle relaxant with faster onset of action than other non-depolarising muscle relaxants that could be an alternative to succinylcholine in rapid sequence intubation where succinylcholine is contraindicated. Based on onset of action, 0.9-1.2 mg/kg dose of rocuronium may be necessary as an alternative to succinylcholine at the cost of increased clinical duration. In this study, 0.6 mg/kg rocuronium with priming was compared against a single intubating dose of 0.9 mg/kg to know the influence of priming technique on the onset times and intubating conditions. MATERIALS AND METHODS A total of 60 patients were randomly allocated to two groups of 30 each. Group A (priming group) received 0.06 mg/kg of rocuronium as priming dose and 0.54 mg/kg rocuronium as intubating dose 3 minutes after priming. Group B (single intubating dose group) received a single intubating dose of 0.9 mg/kg. The onset time of intubation (loss of T1 of TOF stimulation) and intubating conditions were assessed. Continuous measurements were presented as mean±SD using 't' test and categorical measurements were presented as number (%). RESULTS Demographic data were comparable with respect to age, sex and weight. The onset time of intubation was 60±13.6 seconds in group A and 60±15.7 seconds in group B. Excellent to good intubation conditions were obtained in both groups. CONCLUSION Priming technique hastens the onset of action of rocuronium and with priming we can reduce the dose of rocuronium used for intubation thereby reducing the duration of action.
BACKGROUND Postoperative nausea and vomiting is the most common distressing symptom after surgery. Women undergoing laparoscopic surgeries are particularly at risk. This study compares the antiemetic efficacy of ondansetron and palonosetron in females undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS A total of 80 subjects between 18-65 years were randomly allocated into two groups of 40 each, Group O and Group P. Patients in Group O received injection ondansetron 4 mg intravenously and those in Group P received injection palonosetron 0.075 mg intravenously just prior to induction of anaesthesia. The incidence of postoperative nausea and vomiting (PONV), rescue antiemetics and any side effects were recorded in the first 24 hours. At the end of 24 hours, patient satisfaction was assessed with a 5-point scale. RESULTS The incidence of PONV requirement of rescue antiemetics and patient satisfaction score were comparable in both groups. There was no significant difference in side effects seen between the two groups. CONCLUSION The effects of palonosetron in preventing PONV was comparable to that of ondansetron after laparoscopic surgery.
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