Background Laparoscopic cholecystectomy has changed the surgical management of cholelithiasis and has become the mainstay of the management of uncomplicated gallstone disease. Adequate postoperative pain relief leading to early ambulation is imperative for patient satisfaction and early discharge of the patient. The use of ultrasound in anesthetic practice has ushered in a new era of ultrasound-guided blocks for postoperative analgesia, replacing the conventional methods. This study compares two modalities of postoperative pain relief, namely the oblique subcostal transversus abdominis plane block and the newer erector spinae plane block for patients undergoing laparoscopic cholecystectomy. Results Sixty patients between the age group 18 to 75 of ASA grades I, II, and III were enrolled in the study. The erector spinae plane block group showed lower numerical rating scores up to 12 h, a longer time period for the requirement of first rescue analgesic, and lower total analgesic consumption postoperatively compared to the oblique subcostal transversus abdominis plane block group. Both blocks were found to have minimal side effects. Conclusions The erector spinae plane block is superior to the oblique subcostal transversus abdominis plane block in that it affords lower pain scores and a longer duration of analgesia and reduces the total analgesic consumption after laparoscopic cholecystectomy. Trial registration Clinical Trials Registry of India/CTRI/2020/10/028603/ registered on 23 October 2020 http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=47807&EncHid=18303.55562&modid=1&compid=19
Background: This study was conducted at Civil Hospital, BJ Medical College, Ahmedabad, after approval from the ethical committee. Fifty patients admitted in our hospital undergoing lower extremity surgeries under spinal anaesthesia were included in the study. Subjects and Methods: Patients in the age group 18-60 years were selected including 45 males and 5 females. 39 patients had a ASA grade I and 11 patients had ASA grade II. Various lower limb and orthopaedic surgeries like arthroscopic ligaments repair, tibial and flap surgeries were included. Result: The duration of surgeries ranged from 45 to 270 minutes. 2% (1 patient) attained a maximum level of T4, 22% (11 patients) had a maximum level of T6 , 26% (13 patients) had a maximum level of T8. Maximum number of patients, 44% (20 patients) had a level of T10. 6% (3 patients) had attained a maximum level of T12. Three patients did not achieve complete motor level.By the end of 15 minutes, 86% (43) patients had achieved a complete motor block.By the end of 20 minutes 94% (47) patients had attained a complete motor block. The mean time for complete motor block was 10.59 minutes (S.D.±4.7).Conclusion: A study was conducted in 50 patients belonging to ASA grade I and II posted for lower limb surgeries. They received 3.5ml of 0.75% isobaric Ropivacaine in L2-3 interspace. All patients were preloaded with 1000 ml of ringer lactate. Following institution of subarachoid block sensory characteristics such as onset of sensory block, maximum level achieved, duration of sensory block and request for first dose of rescue analgesics were studied. Motor blockade characteristics such as onset of motor block, duration and quality of motor blockade were studied. Onset of sensory block till T10 level was found to be 8.5minutes with a complete regression in 229.28minutes.
To produce a blood less field for middle ear surgery performed with operating microscope, controlled hypotention is essential which achieve by means of Inhalational agents and Esmolol.The goal of the study was to assess the effects of Desflurane and Sevoflurane vs esmolol in terms of creating controlled hypotension, intraoperative blood loss, surgeon satisfaction with the surgical field, and complications. From December 2019 to July 2021, a prospective, randomised, double-blind trial was undertaken. A total of 100 patients, ranging in age from 18 to 60 years, were recruited and had elective middle ear procedures in the Department of Oto-rhino-laryngology operating theatre. Simple randomization (computer-generated) was used to divide the patients into two groups: Group S and Group D. Inj. Esmolol 0.5 mg/kg was administered as a loading dose, followed by a continuous infusion, and Propofol 2 mg/kg was used to produce anaesthesia. Inj. Vecuronium (0.1mg/kg) was administered to help with laryngoscopy and intubation. Oxygen, Nitrous oxide, Sevoflurane 1-3 percent (Group S) or Desflurane 3-6 percent (Group D) and intermittent InjVecuronium (0.05 mg/kg) were used to maintain anaesthesia. Intraoperative haemodynamics, six-point bleeding score, surgeon satisfaction, and postoperative Aldrete recovery score were all observed. Microsoft Excel was used to input and evaluate the data.When comparing Group S to Group D, haemodynamic measures were significantly different (p value 0.05). When comparing Group S to Group D, the six-point bleeding score and surgeon satisfaction score were considerably higher in Group S (p value 0.05). Within 5 minutes of surgery, 100% of patients in Group D and 76% of patients in Group S had achieved an aldrete score of 9,10.In middle ear surgery, sevoflurane produces more controlled hypotension. When compared to the Desflurane group, the sevoflurane group had superior surgical field vision and a higher surgeon satisfaction score. When compared to the Sevoflurane group, the Desflurane group had a superior post-operative Aldrete recovery score.
We report the anesthetic management of a 6-year-old female child with lung cyst who underwent thoracoscopy followed by minithoracotomy for resection of lung cyst. Intraoperative controlled ventilation with modified Ayer's T-piece allowed better surgical access and enabled complete resection of the lesion as well as ETCO 2 and hemodynamic parameters were maintained. Lumber epidural catheter placed in thoracic region provided good post-operative analgesia. The child was extubated on table and had uneventful recovery.
A 48-year-old, 52 kg, male patient was admitted with a history of fever, chronic dry cough, difficulty in breathing on exertion, pain on left scapular region, and intermittent abdominal pain for 2 months.
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