Background:Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.Aim:The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section.Setting and Design:Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block.Materials and Methods:Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any.Statistical Analysis:Unpaired t-test and Chi-square test were used.Results:Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed.Conclusion:Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.
Introduction: Anaesthesiology is a fast growing branch of medicine. There is marked shortage of anaesthesiologists in India and this hinders the growth of surgical and interventional specialities which hinges on well-trained, enthusiastic anaesthesiology support. Exploring the perceptions about the speciality among Postgraduate (PG) students could help in planning strategies to make a career choice in anaesthesiology look more attractive. Aim: To explore the motivational factors for the choice of anaesthesiology for postgraduation, various aspects of PG training, stress among PGs and satisfaction with career choice in order to delineate the perceptions about the speciality among the medical graduates and to find out avenues for improvement to make the speciality more attractive. Materials and Methods: A cross-sectional questionnaire-based survey was distributed among 300 PG students in anaesthesiology who attended various national level conferences in India and state level conferences in Kerala between November 2015 and March 2018. Data collected was statistically analysed using R software version 3.1. All the quantitative variables were summarised as mean±SD (Standard Deviation) or median with IQR (Inter Quartile Range) depending on the distribution. Qualitative variables were summarised as proportions. Association between factors was analysed using Chi-square test or Fisher’s-exact test. Results: Anaesthesiology was the first career preference for only 34.63% (n=88) of the participants. Predominant reasons for choosing anaesthesiology included unavailability of other specialities (32.8%, n=82) and good job opportunities without need of super specialisation (32%, n=80). After joining anaesthesiology, majority (68%, n=175) were satisfied with their career choice. Satisfaction with PG training, assessed by the Likert scale was high among the participants and majority suggested improvements especially in theory classes, case discussions and simulation. Stress was experienced by 60% (n=154) of participants ascribed mainly due to lack of time for academics due to high workload. Conclusion: Improving awareness among public health professionals and medical students and increasing Undergraduate (UG) exposure to the subject would increase the proportion of students joining anaesthesiology with genuine interest and improve the recruitment profile. Modifications in training and measures to reduce stress during training should also be considered.
Background: Central venous pressure (CVP) measurement is a reliable method for evaluating intravascular volume status and cardiac function, but it is an invasive method that results in some well known complications. To compare CVP with peripheral venous pressure (PVP) transduced from a peripheral intra venous catheter and to assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during neurosurgical procedures. Methods: Twenty five adult patients with ASA 1and 2 undergoing craniotomy procedures lasting more than three hours were studied in this prospective clinical trial. A subclavian central vein catheter and a 18-G peripheral intravenous catheter over forearm dedicated to measuring PVP were placed in all patients after standard general endotracheal anaesthesia induction and institution of mechanical ventilation. Peripheral venous pressure and CVP were recorded every 5 minutes and/or during predetermined, well-defined surgical events. Simultaneous invasive mean arterial pressure, urine output were also monitored. Results: Peripheral venous pressure correlated highly with CVP in every patient, and the overall correlation among all patients calculated using a random-effects regression model was r = 0.893 ( P b 0.0001). A Bland-Altman analysis used to determine the accuracy of PVP in comparison to CVP yielded a bias of -4.12 mmHg and a precision of 1.99 mmHg. Conclusion: Our study confirms that PVP correlates with CVP even under adverse hemodynamic conditions in patients undergoing major neurosurgical procedures.
Introduction: Total Knee Arthroplasty (TKA) surgeries are associated with moderate to severe postoperative pain. Inadequate analgesia leads to patient distress, suboptimal knee mobilisation and complications due to delayed rehabilitation. Peripheral nerve blocks and central neuraxial techniques are in the vanguard of various analgesic strategies to minimise pain after TKA. Aim: To compare the effects of Continuous Epidural Analgesia (CEA) and Continuous Femoral Nerve Block (CFNB) on postoperative analgesia, knee rehabilitation and adverse effects after TKA surgeries. Materials and Methods: A prospective cohort study was conducted among 90 patients undergoing unilateral TKA at the Government Medical College, Kozhikode, Kerala, India. They were divided into two groups of 45 each. CEA (Group E) and CFNB (Group F) were given for postoperative pain management. Effectiveness of postoperative analgesia was measured by Numerical Rating Scale (NRS) scores at 6, 12, 24, 48 and 72 hours and also by need for rescue analgesics during the first 48 hours. Postoperative knee rehabilitation indices were measured on 1st, 2nd and 3rd Postoperative Days (POD). Incidence of adverse effects in each group was also noted. Continuous variables were analysed using students t-test, categorical variables using Chi-square test and NRS scores using Mann Whitney U test. Results: NRS scores were similar in both CEA (E) and CFNB (F) groups. On POD 1, 75.6% of group E and 71.1% of group F (p=0.630), on POD 2, 71.1% of group E and 68.9% of group F (p=0.818) and on POD 3, 62.2% of group E and 66.7% of group F (p=0.66) achieved specific rehabilitation indices. There was no statistically significant difference in pain scores, rescue analgesic requirement and rehabilitation indices between the two groups. No significant adverse effects were noted in either group. Conclusion: CFNB is as effective as continuous epidural block for postoperative analgesia and knee rehabilitation after TKA without any significant side-effects.
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