Background: Total abdominal hysterectomy (TAH) is a major surgical procedure associated with significant post-operative pain and discomfort. Ultrasound-guided (USG) quadratus lumborum (QL) and transversus abdominis plane (TAP) block are regional analgesic techniques that have role in post-operative pain management after TAH.
Aims and Objectives: This study aims to compare quality of post-operative analgesia and analgesic consumption in USG-guided QL block and TAP block in patients undergoing TAH under spinal anesthesia.
Materials and Methods: Hundred patients scheduled for TAH were observed over a period of 2 years. The patients who had received either TAP block or QL block were assigned in two groups. Patients who received TAP block after spinal anesthesia were labeled as Group A and patients who received QL block after spinal anesthesia were labeled as Group B. Postoperatively, VAS score, rescue analgesia, analgesic consumption, and hemodynamic parameters were observed at 0, 1, 3 6, 9, 12, 18, 24, and 48 h. Statistical Analysis: Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. P<0.05 was considered statistically significant.
Results: Time for rescue analgesic requirement was higher in the Group B than the Group A (mean±SD: 16.5±3.096 h vs. 8.5±1.998 h) (P<0.001). Group B had significantly less analgesic demand (P<0.001) at 12, 24, and 48 h postoperatively. The VAS at rest and movement was significantly reduced in Group B at all times. Hemodynamic parameters and post-operative side effects between two groups remained insignificant.
Conclusion: USG-guided quadratus lumber block provided prolonged analgesia as compared to TAP block in patients undergoing TAH after spinal anesthesia. USG-guided quadratus lumber block provides better multimodal post-operative analgesia relief in patients.
Background: Awake fiber-optic nasal intubation is a gold standard management of difficult airway in temporal mandibular (TM) joint ankylosis.
Aims and Objectives: We compared topical lignocaine nebulization with airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis.
Materials and Methods: Fifty patients of either gender were randomly allocated into two groups of 25 each. Group I received 10 ml of 2% lignocaine nebulization over a period for 20 min. Group II received bilateral superior laryngeal nerve block and transtracheal recurrent laryngeal nerve block (each with 2 ml of 2% lignocaine). Awake fiber-optic bronchoscopy-guided nasal intubation was done in all patients. All the patients received sedation during the procedure. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t-test was used to analyze parametric data, while the Mann–Whitney U-test was applied to non-parametric data and Fisher’s test to categorical data. P<0.05 was considered statistically significant.
Results: The time taken for intubation was significantly shorter in Group II [110.2 (14.6) s compared with Group I (211.0 [22.3] s) (P=0.028 ss). The intubating conditions and degree of patient comfort were better in Group II compared with Group I. Although all patients were successfully intubated, patient satisfaction was higher in Group II.
Conclusion: Airway nerve block is a better way of anesthetizing airway as compared to nebulization for awake fiber-optic nasal intubation. However, nebulization with lignocaine may be an alternative in situations where nerve blocks are not feasible or may be used as an adjuvant to nerve blocks.
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