Background
Postoperative analgesia in laparoscopic cholecystectomy significantly affects the ambulation and discharge of the patient. This study compares fentanyl and dexmedetomidine as adjuvants to bupivacaine in intraperitoneal instillation after LC, in terms of their impact on ambulation, analgesic efficacy and recovery profile. Ninety patients were randomised into three groups with thirty patients in each group; group BF was administered 20 ml of 2 μg/kg fentanyl + 0.25% bupivacaine, group BD received 20 ml of 1μg/kg dexmedetomidine + 0.25% bupivacaine and group B received 20 ml of 0.25% bupivacaine only. After 8 h, Post-Anaesthesia Discharge Scoring System (PADS) scored for determining home readiness. Analgesic profile was assessed using Verbal Rating Scale and rescue analgesia requirement seen. Sedation was scored using Ramsay sedation scoring.
Results
Group B had significantly higher VRS and rescue analgesia requirements whilst groups BF and BD had a similar analgesic profile. Ramsay sedation scores were significantly higher in group BD when compared to groups BF and B. However, the PADS score remained comparable in all three groups (P = 0.113). The trial was retrospectively registered with the clinical trial registry of India CTRI/2019/07/020466.
Conclusion
Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine or fentanyl significantly reduces postoperative pain scores in comparison to bupivacaine alone, in patients undergoing ambulatory laparoscopic cholecystectomy. However, fentanyl may be preferred over dexmedetomidine, because it causes less sedation and achieves a better PADS score.
INTRODUCTIONThe use of USG (ultrasound) guided peripheral nerve block is a relatively new technique that is rapidly gaining popularity over more traditional techniques of peripheral nerve stimulators and parasthesia.1 Use of ultrasound not only avoids the injury to the nerves associated with blind paraesthesia technique but also decreases the total dose ABSTRACT Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block. Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher's exact test. Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block. Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.
Phocomelia is a rare congenital disorder seen in new borns. It means 'seal limbs' derived from greek language. The incidence of this disorder is very low, and true phocomelia cases are further low, hence there are not many studies on this disorder. Thalidomide was responsible for bringing this drug into limelight. In this report we have described two cases of isolated nonsyndromic phocomelia where there was no history to drug or radiation exposure during intra-uterine period thus showing that there are factors other than thalidomide, which needs to be studied.
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