A variety of receptor mediated nociception on peripheral sensory axons and the peripheral administration of appropriate drugs (adjuncts) may have analgesic benefit without the disadvantage of systemic adverse effects and it may also allow reduction in the total dose of local anaesthetic used. Recent studies suggest that α2 agonists when combined with local anaesthetics extends the duration of regional anaesthesia. Thus, in the present study, we investigated the effects of adding dexmedetomidine 50 µg to a 30 mL of local anaesthetic solution in supraclavicular brachial plexus block with respect to onset and duration of motor and sensory block and duration of analgesia. METHODSSixty patients scheduled for elective forearm surgery were divided into two equal groups in a randomised double blind fashion. In group C (n=30), 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+0.5 mL of normal saline and in group D (n=30) 20 mL of 0.5% bupivacaine+10 mL of 2% lignocaine+50 µg dexmedetomidine were given for supraclavicular brachial plexus block using peripheral nerve stimulator. Onset and duration of sensory and motor block were assessed along with total duration of analgesia. Demographic and haemodynamic data were subjected to student's t-test and for statistical analysis of onset time and duration of sensory and motor blocks and total duration of analgesia, unpaired t-test was applied. P-value <0.05 was considered as statistically significant and P-value <0.001 as highly significant. RESULTSDexmedetomidine added as an adjuvant to local anaesthetic agents for supraclavicular block shortens onset time and significantly prolongs the duration of sensory and motor blocks and duration of analgesia.
INTRODUCTIONSubarachnoid (spinal) block is a safe and effective form of anaesthesia when the surgical site is located on the lower extremities or perineum. It is simpler, cheaper and offers better physiological benefits with lesser complications than general anaesthesia. 1 It can be given by either median or paramedian approach. For the midline approach, the desired interspace is palpated and local anaesthetic is injected into the skin and subcutaneous tissue. The introducer is placed with a cephalad angle of 10 to 15 degree followed by passing of the spinal needle through the introducer. The needle goes through the subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, and subarachnoid mater in order to reach the subarachnoid space. If the patient has a heavily calcified interspinous ligament (as seen in elderly patients) or difficulty in flexing the spine, a paramedian approach is used for spinal anaesthesia.After identifying the correct level for spinal anaesthesia placement, the spinous process is palpated. The needle is inserted 1 cm lateral to this point and directed toward the middle of the interspace. The ligamentum flavum is usually the first resistance felt. When the spinal needle goes though the dura mater, a pop is often appreciated. Accurate identification of the subarachnoid space is very important as multiple attempts at needle ABSTRACT Background: Spinal anaesthesia in elderly patients is frequently associated with significant technical difficulties. Spinal anaesthesia can be given by either paramedian or median approach. Paramedian approach has been used as an alternative in case of failure with median approach. The goal of this study is to determine which of these two approaches should be preferred as a first choice of spinal anaesthesia in elderly patients. Methods: The study included 100 patients of either sex, aged 50 years and above, who received spinal anaesthesia either with the midline approach (group M, n=50) or paramedian approach (group PM, n=50). Results: The success rate of paramedian group was 100% as compared to 96 % in median group. The first attempt success rate was 90% in group PM and 70% in group M. Paraesthesia was felt in 5 patients (10%) in midline group and in 2 patients (4%) in paramedian group. Hemorrhagic tap was seen in 2 patients each in both the groups . None of the patients in Group M had postdural puncture headache (PDPH) as opposed to 2 patients in Group M. Conclusions: Thus the study conclude that paramedian approach is a better approach for spinal anaesthesia in elderly patients in terms of success rate, success at first attempt, complications like paraesthesia, PDPH and failure of subarachnoid block. Thus study recommends the routine use of paramedian approach for sub-arachnoid block in elderly patients as first choice.
Objective The purpose of this study was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparotomy for hemoperitoneum in ectopic pregnancy and also safety of homologous blood transfusion along with autologous blood transfusion. Method Fresh blood, from peritoneal cavity, was collected for autotransfusion in sterile dish, filtered through eight layers of sterile gauze pieces, and collected in a sterile bowl. The collected blood was transferred into blood infusion bag containing citrate phosphate dextrose adenine solution in the proportion of five parts of blood to one part of citrate solution. Results Mean volume of autologous blood transfused in patients without homologous transfusion was 573 ± 328. Mean preoperative hemoglobin was 4.95 ± 1.5, and postoperative hemoglobin was 6.85 ± 1.3. Hence, rise in hemoglobin was 1.9 g%. Autologous blood volume transfused in 29 patients (who required homologous blood transfusion) was 488 ± 216. Preoperative hemoglobin was 4.35 ± 1.94. The result was compared with other studies. Conclusion Intraoperative autologous blood transfusion enabled the performance of laparotomy in hemodynamically unstable ectopic pregnancy patients without availability of homologous blood transfusion. Homologous blood transfusion is compatible with autologous blood transfusion.
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