Background: Saddle spinal block is the first choice anesthetic technique for adults undergoing peri-anal surgeries. It prevents unnecessary high levels of analgesia and sympathetic block. However, it may not provide prolonged analgesia. This study aims to investigate analgesic effects of dexmedetomidine when added to hyperbaric bupivacaine in saddle spinal block.Methods: Fifty otherwise healthy adults scheduled for uncomplicated peri-anal surgery were randomly allocated into two equal groups in this double-blinded study. Group A received hyperbaric bupivacaine five milligrams; group B received hyperbaric bupivacaine five milligrams plus dexmedetomidine five micrograms intrathecally. Patients remained seated for ten minutes. Time to first analgesic request by patients was the primary end point. Onset and extent of sensory block, and, magnitude and duration of motor block were assessed. Post-operative analgesic consumption and side effects were studied for 24 hours. Student's t-test for quantitative variables and Chi-square test for categorical variables were used for statistical analysis.Results: Patients in group B had a significantly prolonged duration of analgesia (group B, 501 ± 306 minutes; group A, 284 ± 58 minutes) and significantly reduced analgesic requirement than patients in group A. Sensory block in first sacral dermatome appeared significantly earlier in group B. Peak sensory block, magnitude of motor block, and side effects were not significantly different between groups A and B. Conclusions:Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine in saddle spinal block prolongs duration of analgesia and decreases analgesic requirement with no added side effects.
Background: General anaesthesia and regional anaesthesia both are used for upper extremity surgeries. Bier's Block using local anaesthetic alone or in combination with other adjuvants provides effective analgesia intraoperatively as well as postoperatively with fewer complications as compared to general anaesthesia. Objective: This study was designed to compare effectiveness, haemodynamic alterations and total duration of analgesia with Lidocaine versus Lidocaine plus Verapamil in Bier's Block. Methods: This is a prospective randomised double blind trial conducted in Kathmandu Medical College Teaching Hospital from February 2012 to December 2012 after approval from the ethical committee and informed consent from the participants. Total 40 adult patients of age 20 to 50 years, weight 50 to 70 kg, of both gender, belonging to American Society of Anaesthesiologists Physical Status I and II undergoing elective distal upper extrimity surgery lasting at one to one and half hours with Bier's Block were included in this study. They were randomly divided into two groups of twenty each to receive either 40 ml of 0.5% Lidocaine alone (Group A) or 40 ml of 0.5% Lidocaine plus 2.5 mg Verapamil (Group B). The two groups were compared in terms of onset and recovery from sensory and motor blockade, tourniquet pain tolerance time, duration of analgesia, alteration of haemodynamics and major side effects. Data analysis was done by Microsoft Offi ce Excel 2007 [Polystat, Microsoft Offi ce Excel worksheet.XLS] using student's two tailed t test. Categorical paramatres were tested by Fisher Exact test and p-value of <0.05 was considered statistically signifi cant. Result: Onset of sensory blockade was faster in group B (Mean± SD: 3.07± 0.25 minutes) as compared to group A (Mean± SD: 5.59 ± 0.41 minutes). The onset of motor block in group B was 10.4 ± 0.77 minutes versus 13.17 ± 1.45 minutes in group A. Recovery of sensory block in group B occurred at 29.95 ± 6.96 minutes versus 11.45 ± 2.16 minutes in group A. Similarly recovery of motor block in group B occurred in 13.6 ± 1.79 minutes versus 7.65 ± 1.04 minutes in group A. Tolerance of fi rst tourniquet pain in group B was long 41.15 ± 3.82 minutes versus 22.00 ± 2.9) minutes in group A. Second tourniquet pain tolerance time was again longer (48.25 ± 3.96 minutes) in group B versus 28.05 ± 4.84 minutes in group A. Total duration of analgesia was more in group B (207.25 ± 21.1 minutes) versus 32.2 ± 5.78 minutes in group A. Total consumption of analgesic (Tramadol) in 24 hours in group B was lesser than group A (47.5 ± 38.0 mg versus 112.5 ± 35.8 mg). All these differences were signifi cant statistically (p value <0.05). Both of the groups showed stable haemodynamic parameters intraoperatively as well as postoperatively without any signifi cant adverse effects. Conclusion: Addition of Verapamil to Lidocaine was more effective than Lidocaine alone in Bier's block.
Background: Pancytopenia is not a disease entity but a triad of findings that result from a number of disease processes. These disorders may affect bone marrow either primarily or secondarily, resulting in the manifestation of pancytopenia. Objective: To identify the various causes of pancytopenia in patients attending to Star hospital, Kathmandu, Nepal. Methods: Fifty two patients with pancytopenia were included in this study from June 2011 to June 2012. Complete blood count, peripheral blood smear, bone marrow aspiration and trephine biopsies were performed according to standard methods. Results: Out of 52 cases, there were 26 cases(50%) of aplastic anaemia, 18 cases(34.61%) of megaloblastic anaemia, 4 cases(7.69%) of acute leukemia, 2cases(3.84%) of erythroid hyperplasia, 1 case(1.92%) of metastatic tumor and 1 case(1.92%) of multiple myeloma. Conclusion: Aplastic anaemia and megaloblastic anaemia were the most common causes of pancytopenia in this study.
This is a case report of successful use of ultrasound for stellate ganglion (SG) blocks in CRPS I in 11 patients using local anesthetic bupivacaine with injection dexmedetomidine as an adjunct. Ultrasound helped us to deposit Local anesthetics in target area without any noticeable side effects and trauma to adjacent structures.
Introduction: Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia. Methods: In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analysis. Results: Duration of analgesia was prolonged in Group B (326 min ±91) as compared to 217 min ±98 in Group A (P value <0.05). Sensory and motor block durations were significantly prolonged in Group B. Time taken to reach significant peak sensory block level was earlier in Group B. Significant reductions in incidence of visceral pain, shivering and analgesic requirements were observed in Dexmedetomidine group, without increased need of medications for altered hemodynamic parameters. Conclusions: Dexmedetomidineas an intrathecal adjuvant to hyperbaric Bupivacaine in spinal anaesthesia prolongs duration of analgesia and sensory block with minimal adverse effects. Keywords: Bupivacaine; Dexmedetomidine; intrathecal adjuvant; spinal anaesthesia.
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