BACKGROUND Numerous attempts have been made in the past to attenuate the haemodynamic responses occurring during laparoscopic cholecystectomy. The present study compared the effect of three opioids namely Butorphanol, Fentanyl and Nalbuphine in obtundation of haemodynamic responses in laparoscopic cholecystectomy in terms of Heart rate, BP (SBP, DBP and MAP) and secondary aim was to calculate duration of analgesia and sedation score. MATERIALS AND METHODS This was a randomised study comparing three opioid drugs-nalbuphine, fentanyl and butorphanol. It was carried out on 75 patients of either sex aged 18-60 years scheduled for elective laparoscopic cholecystectomy under GA. Subjects were enrolled into three groups-Group B (n= 25) patients received inj. Butorphanol 25 mcg/kg IV, Group F (n= 25) received inj. Fentanyl 2 mcg/kg IV and Group N (n= 25) patients received inj. Nalbuphine 0.2 mg/kg 5 minutes before the induction. RESULT At the time of extubation, mean MAP in Group B, F and N was 99.88, 95.32 and 97.24 respectively. This difference is highly significant when compared statistically (p value is 0.005). CONCLUSION With this study, we conclude that the administration of intravenous fentanyl and nalbuphine five minutes prior to induction of anaesthesia helps in better obtundation of haemodynamic responses to laparoscopic cholecystectomy than butorphanol.
Background: Caudal epidural block is one of the most common regional techniques in paediatric anesthesia. It is safe, easy to perform and has been found to be very effective in children undergoing infra-umbilical surgeries .Ropivacaine produces differential neuraxial blockade with less motor block and reduced cardiovascular toxicity. Various adjuvants are added to increase the duration of action of local anesthetics. The aim of our study was to evaluate the action of fentanyl on duration of postoperative analgesia when added as an adjunct to ropivacaine in paediatric population of age 3-8 years undergoing infraumbilical surgeries. Methods: A double blind, prospective, comparative and randomized study was conducted on 50 paediatric patients undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 25 each by simple envelope method. After securing airway, caudal anaesthesia was given. Group R received 0.2% ropivacaine 0.5ml/kg and Group RF – received 0.2% ropivacaine 0.5ml/kg with fentanyl 0.5mcg/kg. Post-operative pain was assessed by face, legs, activity, cry and consolability pain assessment scale for 24 h. Duration of motor blockade and side effects were noted. The hemodynamics, duration of post-operative analgesia and number of rescue analgesia needed was noted and analyzed statistically. Results: Mean duration of analgesia in ropivacaine group is 441.60±102.29 minutes (7.35hrs) and in ropivacaine fentanyl group was 892±313.84 (14.86hrs). Statistically the difference was highly significant as p value was <0.001. Conclusions: Fentanyl as an adjuvant to ropivacaine for caudal block has significantly improved analgesic efficacy and increased the duration of post-operative analgesia in children undergoing infraumbilical surgery.
Purpose: This prospective study is to compare the supraclavicular and infraclavicular approaches of brachial plexus block for upper limb surgery using 0.05mg of dexmedetomidine and 30ml of 0.5% ropivacaine. Method: This prospective, randomized controlled trial was conducted at Govt. Medical College, Rajindra Hospital, Patiala on sixty patients in two groups (group S and group I) of 30 each of 18 to 65 yrs of age of either sex of ASA grade I or II scheduled for upper limb surgery. In both supraclavicular and infraclavicular approach the drug injected was 30ml of 0.5% ropivacaine and 0.05mg of dexmedetomidine. Result: We found that in patients with comparable demographic parameters there was no statistically significant difference in hemodynamic parameters, onset and duration of sensory and motor block, duration of analgesia and patient satisfaction score between the groups. There was no statistically significant difference in the quality of block in either group. No episode of pneumothorax, Horner’s syndrome or local anaesthesia toxicity occurred in any of the group. Accidental vascular puncture occurred in four out of thirty patients in supraclavicular group and none in infraclavicular group. Conclusion: This study concluded that infraclavicular approach is more safe than supraclavicular approach in upper limb surgeries (elbow proximally to hand distally).
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