BACKGROUND Hip surgery is one of the common surgeries performed in orthopaedics. It is mainly done in elderly population as they are more prone to fractures, due to osteoporotic bone and tendency to fall. Pain reduction is a major concern in this group due to advanced age and associated comorbid conditions. In addition to patient suffering, pain leads to increased hospital stay and morbidity due to delirium. Effort has been made to reduce pain by giving opioids, NSAIDS, long acting intrathecal opioids, epidurals and recently using nerve blocks especially using ultrasound. Several blocks have been tried like femoral nerve block, three in one block, fascia iliaca block and sciatic block. The advantage of intraoperative block is the continuation of effect in post-operative period, less requirement of opioids and early mobilization, less delirium and overall less initial mortality. Here we tried to study the effect of intraoperative 35% ropivacaine and dexmedetomidine 50 micrograms given as FICB. MATERIALS AND METHODS 50 elderly patients with only hip fracture admitted between 2017 to 2018, above 60 years of age, were subjected to the study. Patients included those who consented to procedure under spinal anaesthesia. They were explained about the procedure, the willingness for block, the risk factors involved and taught about VAS scale for pain assessment. Inclusion Criteria-Elderly patients above 60 years of age, male/female, hip surgery alone, cases done under spinal with 5% bupivacaine. Exclusion Criteria-Patients with contraindications for block like coagulopathy-including drug induced, infection at site, inguinal hernia, poor mentation, stroke, patient refusal, allergy to any of the drug component, patient with bradycardia with heart rate less than 60. RESULTS The patients who were given preoperative blocks were having analgesia for over 8 hours to 18.3 hours. They had a satisfactory VAS score of less than 3 up to 24 hr with paracetamol and rescue doses of tramadol. CONCLUSION FICB is effective fascial plane block for post-operative hip pain. It reduces the post-operative stay. Mixing dexmedetomidine increases the total duration by 18-24.3 hrs. with minimum hemodynamic instability and sedation.
Background: Postoperative (PO) pain relief following major surgeries had been a challenging task. Adequate pain control is essential for early
mobilisation and wellbeing of surgical patients. Incidence of PO pain following abdominal surgeries is higher when transverse lower abdominal
incisions are done as in Total Abdominal Hysterectomy (TAH). Performing Transversus Abdominis Plane (TAP) block reduces the PO pain.
Various adjuvants like clonidine, epinephrine and magnesium sulphate have been added to local anaesthetics to prolong the duration of TAPblock.
The aim of this study was to investigate the effects of adding MgSO4 as an adjuvant to bupivacaine in TAP block for PO analgesia in patients
undergoing TAH under spinal anaesthesia. Methods: 100 patients belonging to ASA1 or 2 scheduled for TAH under Sub Arachnoid Block (SAB)
were randomly assigned into two groups- BM and B. All patients were given SAB with 15 mg of 0.5% hyperbaric Bupivacaine and TAH was done.
USG guided TAPblock was given once SAB sensory level regressed to T8 dermatome. Group BM received 16ml 0.25% Bupivacaine (40mg) with
150 mg magnesium sulphate injected on each side while Group B received 16 ml 0.25% Bupivacaine only. Patients were asked to rate their pain on
a 10 cm VAS scale at time 0 (time of completion of TAPblock),2,4,6,12 and 24 hours. Rescue analgesia with Inj. morphine was provided whenever
VAS score was > 3. Results: Patients in magnesium sulphate group had prolonged analgesia as compared to the control group. The heart rate and
blood pressure response were signicantly lower in that group. Morphine requirement for PO analgesia was also signicantly reduced in group
BM. No complications were seen in either group. Conclusion: Adding Magnesium sulphate to Bupivacaine in TAP block in TAH patients
prolonged the duration of PO analgesia.
BACKGROUNDIncomplete recovery from muscle relaxants is a potentially hazardous condition. Calcium ions play a significant role in neuromuscular transmission. This study is to find out whether Ca 2+ administration after reversal with neostigmine and glycopyrrolate could enhance the recovery from neuromuscular blockade.
Polymyositis is a sub-acute inflammatory myopathy affecting adults. It can be associated as paraneoplastic disease with a progressive symmetrical weakness. Pharyngeal neck and flexor muscles may be involved leading to dysphagia, difficulty in neck holding and it may involve the respiratory muscles.
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