Introduction
It is a common practice to infiltrate 2% lignocaine with 1:2,00,000 adrenaline for Type 1 Tympanoplasty, even when the surgery is done under general anaesthesia. The purpose of this study is to evaluate the necessity of infiltration of lidocaine with adrenaline (2% lidocaine with 1:2,00,000 adrenaline) in Type 1 Tympanoplasty surgeries performed under general anaesthesia in terms of per-operative bleeding and post-operative pain relief.
Materials and Methods
A double blinded, prospective randomized comparative study was conducted in a tertiary care centre. A total of 50 patients planned for Type 1 Tympanoplasty under general anaesthesia, for chronic otitis media, inactive, mucosal disease were selected and divided into two groups randomly. Group A (25 patients) received local infiltration of 2% Lidocaine with 1:2,00,000 adrenaline and Group B (25 patients) patients received infiltration of sterile water. The per -operative bleeding and post-operative pain relief were assessedat 2nd, 4th and 6th post-operative hour in both the groups and the results were analysed.
Results
P value for per operative bleeding was <0.77 (non-significant). And the P value for post-operative pain relief at 2nd hour was <0.002 (significant). But the P value for 4th (<0.133) and 6th (<0.358) post-operative hours were not significant.
Conclusion
Infiltration of 2% lidocaine with 1:2,00,000 adrenaline, doesn’t have any significant impact in per-operative bleeding and post-operative pain relief at 4th and 6th hour. But there is a significant pain relief, for 2 hours after surgery, when 2% lidocaine with 1:2,00,000 adrenaline is used for infiltration.
Introduction Stapes surgery for otosclerosis is a precise surgical procedure. To achieve excellent hearing results, a firm and stable attachment of the prosthesis to the long process of incus (LPI) is necessary. The present study provides details on the attachment site in two dimensions to choose an appropriate prosthesis and to ensure firm attachment for better surgical outcomes.
Objective To study the diameter of the LPI and its relevance in determining the piston, used in stapes surgery by an in vivo method.
Methods This study was conducted in 41 patients who underwent stapedotomy, where both Anteroposterior (AP) and Mediolateral (ML) diameters of the LPI were measured at the site of attachment of the piston using specially designed instruments, intraoperatively.Radiological data were obtained to measure the LPI diameter from the normal ears of 46 patients. It was measured from both the right and left side, hence 92 LPI diameters were obtained.
Results The most commonly used site for prosthesis attachment is between 1–1.5 mm away from the tip of the LPI. We found great variability in the diameters of LPI in the attachment site, with the AP diameter ranging between 0.6 -1.5mm and the ML diameter ranging between 0.5mm-1.2 mm.
Conclusion Pistons by design have characteristics of gripping incus that will vary between types. Based on LPI dimensions, ideal piston types with appropriate inner loop diameters are suggested in this study. HRCT before surgery should include measurements of the LPI as a guide to the choice of the prosthesis during surgery.
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