Context: Ultrasound (US) guided supraclavicular brachial plexus block (SBPB) provides predictable dense blockade. Inclusion of additives to local anaesthetics alters the quality of blockade. Aim:To assess the block characteristics of ropivacaine alone and with additives in US guided SBPB. Materials and Methods:Prospective, double blinded randomized controlled trial. Sixty patients undergoing elective upper limb surgeries under SBPB were randomly allocated to one of 3 groups: Group RR (who received 30ml of 0.5% ropivacaine), Group RD (30ml of 0.5% ropivacaine with 1 µ g/kg of dexmedetomidine) and Group RM (30ml of 0.5% ropivacaine with 50µ g/kg of midazolam). After administration of block with above drugs, the block characteristics were assessed every 3mins till onset of complete blockade, every 30mins for 6hrs, then hourly for 24hrs. Apart from sensory and motor blockade, sedation score was also assessed. Results:The duration of blockade (min) was significantly longer in Group RD (907 ± 205) compared to Group RR (597 ± 101) and Group RM (605 ± 188). There was no difference among the groups with respect to onset of sensory and motor blockade. The sedation scores were significantly higher in Group RD (median = 3) and Group RM (median = 2). Conclusion:Addition of dexmedetomidine to ropivacaine in ultrasound guided supraclavicular brachial plexus block prolongs both sensory and motor blockade. Both dexmedetomidine and midazolam when added to ropivacaine produce significant sedation.
Conventional E-C technique of mask holding is unreliable during single person bag mask ventilation (BMV) due mainly to leak around the mask and inexperience of the persons. In this manikin study, conventional E-C technique was compared with E-O technique during single person BMV both with experienced (n = 50) and novice (n = 50) volunteers. The E-O technique involved encircling the mask neck with the web between thumb and index finger while the other digits provided chin lift. Two independent observers recorded the chest expansion as 1 (nil), 2 (minimal), 3 (moderate) and 4 (good). For analysis ideal and average chest expansion were clubbed as acceptable. E-C technique in experienced volunteers showed acceptable results in 49 (31 + 18) occasions, while with novices acceptable is 39 (17 + 22). With E-O technique, expansion was acceptable in 47 (38 + 9) experienced volunteers, and acceptable in 46 (32 + 14) novices. (P = 0.003). In cross over analysis for experienced volunteers, similar chest expansion was obtained on 30 occasions with both techniques, E-C better than E-O on 8 and E-O better than E-C on 12 occasions. Novices had comparable results on 17 occasions, E-C better than E-O on 8 and E-O better than E-C on 25 occasions (P = 0.016). The conventionally taught E-C technique of single person BMV provides acceptable chest expansion on most occasions with experienced operators than novices. Novices should use E-O technique as the first choice for single person BMV. Both techniques may be used interchangeably when one fails.
Background: We compared the analgesic efficacy of a transdermal diclofenac patch 100 mg (NuPatch ® 100, Zydus Cadila, Ahmedabad, India) and intramuscular diclofenac sodium 75 mg (Voveran ® , Novartis, India) for postoperative analgesia, and the associated side-effects of the transdermal diclofenac patch. Method: Sixty participants in the study were randomly allocated to two groups of 30 each, by a computer-generated randomisation table. The anaesthetic procedure was standardised. A transdermal diclofenac patch 100 mg was applied to the participants in the study group at the beginning of the surgery. In the control group, 75 mg of diclofenac sodium was given intramuscularly half an hour before the end of surgery. Pain was assessed postoperatively at two-, six-, and 12-hour intervals using a visual analogue scale (VAS). An injection of tramadol 2 mg/kg was administered intramuscularly as rescue analgesia. The study ended when the patients asked for rescue analgesia, or when the VAS score was > 5. Results: The mean duration of analgesia in the control group was 7 hours 28 minutes, and in study group, it was 8 hours 6 minutes, which was comparable (p-value < 0.341). Conclusion: Intraoperative application of a single dose of 100 mg transdermal diclofenac patch is as effective as a single dose of intramuscular diclofenac (75 mg) for acute postoperative pain, without any significant side-effects.
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