In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postoperative nausea and vomiting (PONV) in 168 children (aged 2-15 yr) scheduled for strabismus surgery. Patients received IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) immediately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomiting were assessed at 0-2, 2-6, and 6-24 h after surgery. Blood glucose was measured preoperatively and at 4 h after study drug administration. Wound healing and infection were assessed after 1 wk. More patients in group S had vomiting at 0-2, 2-6, and 6-24 h (P = 0.001, P = 0.003, and P = 0.04, respectively) and required larger doses of rescue antiemetics compared with the dexamethasone groups. Fewer patients in the dexamethasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). No significant increase in postoperative blood glucose levels was observed and wound healing was satisfactory in all four groups. The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery.
Background: To provide adequate intraoperative anaesthesia and postoperative analgesia for orthopaedic surgery continues to be a procedural challenge. The administration of brachial plexus anaesthesia can be facilitated through nerve stimulation or by ultrasound guidance. Hence study was conducted to compare differences in these techniques in patients undergoing interscalene brachial plexus block (ISSB).Methods: In this prospective, randomized, observer-blinded study, 60 patients (Male=41, Female=19) were scheduled for orthopaedic shoulder and upper arm surgeries matching inclusion and exclusion criteria. Patients were randomly allocated to either Ultrasound (US, n=30) group or Nerve Stimulator (NS, n=30) group through a computer-generated randomization.Results: There was significant difference between US and NS group with respect to average number of attempts taken, block performance time (BPT), onset of sensory and motor block, duration of motor block and patient satisfaction score. Whereas not much significant difference was observed in duration of sensory block, block success rate and incidence of post operative side effects.Conclusions: The results suggest that US guided ISBB is significantly superior to NS guided block in terms of faster onset of action; lower number of attempts to locate Interscalene brachial plexus; longer duration of block and overall success rate with favourable tolerability at real-life scenario.
<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> < 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.
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