We report a case of fibroid uterus with Wolff–Parkinson–White (WPW) syndrome in a 48-year-old female, posted for elective hysterectomy. Patient gave history of short recurrent episodes of palpitation and electrocardiograph confirmed the diagnosis of WPW syndrome. The anaesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia like paroxysmal supra-ventricular tachycardia (PSVT) and atrial fibrillation (AF). Epidural anaesthesia is preferred compared to general anaesthesia to avoid polypharmacy, noxious stimuli of laryngoscopy and intubation. To deal with perioperative complications like PSVT and AF, anti-arrhythmic drugs like adenosine, beta blockers and defibrillator should be kept ready. Perioperative monitoring is essential as patients can develop complications.
BACKGROUND Various adjuvants augment efficacy of local anaesthetics by reducing dose, adverse reactions and prolonging postoperative analgesia. Nalbuphine, as an adjuvant in peripheral nerve blocks, especially Supraclavicular Brachial Plexus Block, a preferred technique is not much studied, hence this study. Our study was done to compare analgesic effect of nalbuphine in two different doses, (0.1 mg/kg) vs. (0.2 mg/kg) as an adjuvant to 0.5% 30 mL bupivacaine in supraclavicular brachial plexus block and study its side effects and complications in patients undergoing upper arm surgery. MATERIALS AND METHODS This is a prospective, comparative, randomised, double-blinded study. All patients of study group were randomly assigned into one of the three groups with sample size of 30 in each group. Two test group received 0.1 mg/kg and 0.2 mg/kg of nalbuphine, while third group received 5 mL of normal saline as adjuvant to 30 mL of 0.5% bupivacaine for Supraclavicular Brachial Plexus Block. Anaesthetist was blinded to treatment groups and observer blinded to nature of drug given. Patient outcomes in terms of duration of postoperative analgesia, durations and quality of sensory, motor blockade and adverse effects were recorded and subjected to statistical analysis. Statistical analysis was done by using SPSS 21 computer program software. RESULTS Addition of 0.1 mg/kg and 0.2 mg/kg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with a significant increase in the duration of both sensory and motor block. CONCLUSION Nalbuphine added to bupivacaine for supraclavicular brachial plexus block in both doses are equipotent and resulted in prolongation of analgesia, reduced requirement of rescue analgesic in postoperative period without any appreciable adverse effect.
BACKGROUNDAlpha 2 agonists as adjuvants to local anaesthetics in brachial plexus blocks augment the local anaesthetic effects and reduces the analgesic requirements postoperatively. This study was designed to evaluate the analgesic effects of clonidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus (SCBP) block.
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