Upasna Bhatia | Gujarat University (original) (raw)
Papers by Upasna Bhatia
Indian Journal of Applied-Basic Medical Sciences, 2017
Ain-Shams Journal of Anesthesiology, Oct 23, 2022
Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possib... more Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/ kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T 5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T 8 dermatome.
Electronic journal of general medicine, Dec 3, 2016
Background. Preemptive analgesia is an antinociceptive treatment that prevents establishment of a... more Background. Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Gabapentin, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug and is claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. Methods Fifty patients of ASA grade I and II were assigned to receive oral 600mg Gabapentin or Placebo 2 hours before surgery. Surgeries were conducted under spinal anesthesia. Post operatively pain was assessed by visual analogue score (VAS) at 2, 4, 8, 12 and 24 hrs. Patients were given rescue analgesic on demand. Sedation score and total numbers of analgesics during first 24 hours postoperatively were noted. Results. Gabapentin group resulted in faster onset of motor and sensory block, significantly longer duration of analgesia, substantial reduction in post-operative pain and the rescue analgesics. Patients remained in sleeping but cooperative state and Gabapentin group were not associated with side effects when compared with placebo group. Conclusions. Preemptive use of Gabapentin 600mg orally significantly prolongs the analgesia with reducing postoperative pain and rescue analgesics in patients undergoing total abdominal hysterectomy under spinal anesthesia.
Indian Journal of Clinical Anaesthesia, May 15, 2020
Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 th to 12 th th... more Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 th to 12 th thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries. Materials and Methods: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia. Results: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points-1hr, 2 hr, and 3hr till 16hrs. (P < 0.00001). The mean duration of analgesia in three groups was 9.30±0.92 hrs in Gp L, 13.02±1.17 hrs in Gp R and 6.2± 0.83hrs in Gp B respectively. This difference was statistically significant (p =< 0.0001). Conclusions: Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.
International Journal of Advanced Research
Background: For many decennia, local anaesthetics have been utilised for wound infiltration analg... more Background: For many decennia, local anaesthetics have been utilised for wound infiltration analgesia. α -2 Adrenoceptors as adjuvants have an advantageous effect in prolonging the time of peripheral nerve blocks is a locally mediated action and not replicated by given systemically. An increasing impact on lignocaine-induced suppression of the C-fibre action potential is thought to be the cause of its synergistic activity with lignocaine in extending the duration. we evaluated Dexmedetomidine and clonidine when administered with lignocaine during infiltration anaesthesia for tympanoplasty. Methodology: 50 patients of 18-60 years who were enrolled for tympanoplasty under local anaesthesia were arbitrarily split into two equal groups. 12 ml of 2% lignocaine with adrenaline + clonidine + 1 ug/kg were injected into Group C (n = 25), and 12 ml of 2% lignocaine with adrenaline + dexmedetomidine + 1 ug/kg were injected into Group D (n = 25). Hemodynamic parameters, sedation score, analges...
Ain Shams Journal of Anesthesiology, Oct 23, 2022
Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possib... more Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/ kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T 5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T 8 dermatome.
Indian Journal of Applied-Basic Medical Sciences, 2019
International Journal of Medical Anesthesiology, 2021
International Journal of Medical Anesthesiology, 2022
Background and Aims: There has been increasing number of mucormycosis cases as post covid sequala... more Background and Aims: There has been increasing number of mucormycosis cases as post covid sequalae during second wave of covid pandemic. Our study focussed on challenges in anaesthetic management of surgical resection of post covid rhino-orbito-cerebral mucormycosis. Methods: We did a retrospective case study of 60 patients posted during May-June 2020 posted for surgical resection of Rhino-orbito-cerebral mucormycosis under General Anaesthesia. All patients were operated irrespective of altered laboratory biomarkers, remnant of covid-19 disease. Results: Demographic and clinical parameters, and laboratory biomarkers were reviewed for each patient. Patients had median age of 55 years (23-85 years). Patients belonged to ASA physical status I: II: III (10: 40:10). The most common associated co-morbidity with median elevated Fasting blood sugar level 162 (63-711) followed by hypertension (48%). 85% patients were on steroid therapy (continued from covid disease treatment). 6% were hypothyroid patients. Invasive arterial monitoring was performed in 13.3% patients with femoral central line cannulation done in 85% of cases. 21% patients were shifted to ICU intubated and the rest were shifted with NRBM as a preventive measure. 23% had revision surgery whose mallampatti score was upgraded from I to III. Conclusions: Necessary precautions should be taken for difficult airway caused by fungal debris in oropharyngeal airway and supraglottic edema. So is the importance of Post ICU care because of comorbidities and post covid sequalae's.
Anesthesia: Essays and Researches, 2021
Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of p... more Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of primiparous women described the pain of uterine contractions as unbearable extremely severe or excruciating. Aims: Our study aimed to relieve pain suffering of mother and to decrease fetal acidosis to make the delivery process safer for mother and baby. Settings and Design: Thus, epidural labor analgesia was designed comparing ropivacaine-fentanyl (RF) and bupivacaine-fentanyl (BF) as intermittent bolus technique. Materials and Methods: Sixty women who requested epidural analgesia having ≥3 cm cervical dilatation were allocated in two groups, one group received RF and the other group received BF. Each group received study drug 16 mL with 50 μg fentanyl and top of 10 mL and 25 μg fentanyl when visual analog scale (VAS) ≥3. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes were compared. Statistical Analysis: For skewed data or ordered categorical data, nonpara...
Journal of Pediatric Surgery, 2017
Introduction: Despite its minimally invasive approach, laparoscopic surgery can cause considerabl... more Introduction: Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic singleincision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge. Methods: We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n = 136) with those who received LAI (n = 139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge. Results: Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p b 0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p b 0.0001) and mean pain scores (1.26 vs. 1.77; p b 0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93 min vs. 41.56 min; p = 0.047). Conclusion: Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67 min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric singleincision laparoscopic surgery. Retrospective comparative study: LEVEL III EVIDENCE.
International Journal of Scientific Research, 2012
International Journal of Scientific Research, 2012
Clonidine is added to intrathecal Bupivacaine to improve intraoperative analgesia and to increase... more Clonidine is added to intrathecal Bupivacaine to improve intraoperative analgesia and to increase the dura-
International Journal of Scientific Research, 2012
(Ex. Anesthesia resident) ABSTRACT INTRODUCTION- The addition of clonidine to local anesthetic so... more (Ex. Anesthesia resident) ABSTRACT INTRODUCTION- The addition of clonidine to local anesthetic solutions improves peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia. With this background, we undertook this study to determine the analgesic efficiency of clonidine in two different doses(0.5 µg/kg and 1 µg/kg ) in axillary brachial plexus block. AIMS AND OBJECTIVES- 1) To compare onset and duration of sensory and motor block. 2) Sedation score3) Vital parameters4) Duration of post-operative analgesia and complications. MATERIAL AND METHOD- The present study was conducted in 60 patients undergoing upper limb surgeries(both elective and emergency) having ASA grade-1 and 2 physical status. The patients were randomly allocated into 3 groups A,B and C each having 20 patients. Base line vitals like HR, BP, ECG, Spo2 were noted. Sensory block was assessed by pin prick method.motor block was assessed by Hallmen scale. Sedation score by Chenik -sedation score. SUMMARY AND CONCLUSION- Our study suggests that a small dose of clonidine produced late sensory and motor onset with enhancement of the quality of the peripheral block from local anesthetics and limits it's α-2 side effect to sedation. The addition of clonidine produces longer analgesia. Thus we recommend clonidine in 1 µg/kg dose as an adjuvant in axillary brachial plexus block for prolongation of post operative analgesia.
Anesthesia: Essays and Researches, 2017
Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pre... more Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, "episiotomy infiltration" becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1st day of postpartum period. We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection. Majority of the patients, 94.2% in our study, had no idea about labor analgesia, and only 2.5% of all the patients expressed their interest to deliver without suffering from labor pains. One hundred and twenty pregnant female patients scheduled for full-term vaginal delivery were assigned into lignocaine and lignocaine-clonidine group according to infiltration they received. Pain scoring using visual analog scale and maternal satisfaction scale was monitored. At the end of the research project, the data were compiled and analyzed using appropriate statistical tests. Duration of analgesia after episiotomy during sitting, walking, and squatting was 22.7 ± 1.32, 21.73 ± 1.47, and 19.875 ± 1.48 h in clonidine + lignocaine group and 6.06 ± 1.26, 5.33 ± 1.18, and 4.01 ± 1.28 h in lignocaine only group, respectively, which was highly statistically significant P < 0001. Clonidine when added to 2% lignocaine infiltration in episiotomy improves the quality and significantly enhances the duration of analgesia.
Peritonsillar infiltration with 0.25 % Bupivacaine for premptive analgesia in Paediatric patients
Indian Journal of Applied-Basic Medical Sciences, 2015
Ain-Shams Journal of Anaesthesiology, 2017
Background With the advent of opioid receptors, a variety of opioid agents are added to local ane... more Background With the advent of opioid receptors, a variety of opioid agents are added to local anesthetic mixtures used in peripheral blocks to improve the quality and duration of block. In this study, we compared the effect of butorphanol and tramadol as adjuvant agents for orthopedic upper extremity surgery. Patients and methods This study was carried out on 50 patients aged between 18 and 60 years, of American Society of Anesthesiologists grades I and II, of either sexes in each group, undergoing orthopedic upper limb surgeries through axillary brachial plexus block. An injection of butorphanol 2 mg (group B) and that of tramadol 100 mg (group T) were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade, and occurrence of any complications were studied in both groups. All patients were observed for analgesia postoperatively by visual analog scale pain score. Results In our study, the onset time (minutes) of sensory and motor blockade was delay...
To determine the efficacy of Nalbuphine in comparison to clonidine in preventing increase in hear... more To determine the efficacy of Nalbuphine in comparison to clonidine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and tracheal intubation. Methodology: This double blind randomized controlled trial was conducted on 60 ASA grade I– II patients scheduled for General anaesthesia. Patients were randomly allocated to receive clonidine 3μg/kg (group I , n=30) or Nalbuphine 0.2 mg/ kg (group II n=30) Each patient was given study drug 15 min before intubation. Anaesthesia was then induced with Thiopentone (6mg/ kg) and succinyl choline (2mg/kg ) IV was given for orotracheal intubation. Heart rate and mean arterial pressures were recorded before the administration of the study drug, baseline value ,3 minutes ,immediately after tracheal intubation and then after every 1 minute up to 5 minutes and then after 10 minutes of intubation Results: Clonidine significantly attenuated the sympathetic response to laryngoscopy and intubation. Nalbuphine reduce...
Indian Journal of Applied-Basic Medical Sciences, 2017
Ain-Shams Journal of Anesthesiology, Oct 23, 2022
Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possib... more Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/ kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T 5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T 8 dermatome.
Electronic journal of general medicine, Dec 3, 2016
Background. Preemptive analgesia is an antinociceptive treatment that prevents establishment of a... more Background. Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Gabapentin, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug and is claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. Methods Fifty patients of ASA grade I and II were assigned to receive oral 600mg Gabapentin or Placebo 2 hours before surgery. Surgeries were conducted under spinal anesthesia. Post operatively pain was assessed by visual analogue score (VAS) at 2, 4, 8, 12 and 24 hrs. Patients were given rescue analgesic on demand. Sedation score and total numbers of analgesics during first 24 hours postoperatively were noted. Results. Gabapentin group resulted in faster onset of motor and sensory block, significantly longer duration of analgesia, substantial reduction in post-operative pain and the rescue analgesics. Patients remained in sleeping but cooperative state and Gabapentin group were not associated with side effects when compared with placebo group. Conclusions. Preemptive use of Gabapentin 600mg orally significantly prolongs the analgesia with reducing postoperative pain and rescue analgesics in patients undergoing total abdominal hysterectomy under spinal anesthesia.
Indian Journal of Clinical Anaesthesia, May 15, 2020
Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 th to 12 th th... more Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 th to 12 th thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries. Materials and Methods: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia. Results: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points-1hr, 2 hr, and 3hr till 16hrs. (P < 0.00001). The mean duration of analgesia in three groups was 9.30±0.92 hrs in Gp L, 13.02±1.17 hrs in Gp R and 6.2± 0.83hrs in Gp B respectively. This difference was statistically significant (p =< 0.0001). Conclusions: Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.
International Journal of Advanced Research
Background: For many decennia, local anaesthetics have been utilised for wound infiltration analg... more Background: For many decennia, local anaesthetics have been utilised for wound infiltration analgesia. α -2 Adrenoceptors as adjuvants have an advantageous effect in prolonging the time of peripheral nerve blocks is a locally mediated action and not replicated by given systemically. An increasing impact on lignocaine-induced suppression of the C-fibre action potential is thought to be the cause of its synergistic activity with lignocaine in extending the duration. we evaluated Dexmedetomidine and clonidine when administered with lignocaine during infiltration anaesthesia for tympanoplasty. Methodology: 50 patients of 18-60 years who were enrolled for tympanoplasty under local anaesthesia were arbitrarily split into two equal groups. 12 ml of 2% lignocaine with adrenaline + clonidine + 1 ug/kg were injected into Group C (n = 25), and 12 ml of 2% lignocaine with adrenaline + dexmedetomidine + 1 ug/kg were injected into Group D (n = 25). Hemodynamic parameters, sedation score, analges...
Ain Shams Journal of Anesthesiology, Oct 23, 2022
Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possib... more Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/ kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T 5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T 8 dermatome.
Indian Journal of Applied-Basic Medical Sciences, 2019
International Journal of Medical Anesthesiology, 2021
International Journal of Medical Anesthesiology, 2022
Background and Aims: There has been increasing number of mucormycosis cases as post covid sequala... more Background and Aims: There has been increasing number of mucormycosis cases as post covid sequalae during second wave of covid pandemic. Our study focussed on challenges in anaesthetic management of surgical resection of post covid rhino-orbito-cerebral mucormycosis. Methods: We did a retrospective case study of 60 patients posted during May-June 2020 posted for surgical resection of Rhino-orbito-cerebral mucormycosis under General Anaesthesia. All patients were operated irrespective of altered laboratory biomarkers, remnant of covid-19 disease. Results: Demographic and clinical parameters, and laboratory biomarkers were reviewed for each patient. Patients had median age of 55 years (23-85 years). Patients belonged to ASA physical status I: II: III (10: 40:10). The most common associated co-morbidity with median elevated Fasting blood sugar level 162 (63-711) followed by hypertension (48%). 85% patients were on steroid therapy (continued from covid disease treatment). 6% were hypothyroid patients. Invasive arterial monitoring was performed in 13.3% patients with femoral central line cannulation done in 85% of cases. 21% patients were shifted to ICU intubated and the rest were shifted with NRBM as a preventive measure. 23% had revision surgery whose mallampatti score was upgraded from I to III. Conclusions: Necessary precautions should be taken for difficult airway caused by fungal debris in oropharyngeal airway and supraglottic edema. So is the importance of Post ICU care because of comorbidities and post covid sequalae's.
Anesthesia: Essays and Researches, 2021
Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of p... more Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of primiparous women described the pain of uterine contractions as unbearable extremely severe or excruciating. Aims: Our study aimed to relieve pain suffering of mother and to decrease fetal acidosis to make the delivery process safer for mother and baby. Settings and Design: Thus, epidural labor analgesia was designed comparing ropivacaine-fentanyl (RF) and bupivacaine-fentanyl (BF) as intermittent bolus technique. Materials and Methods: Sixty women who requested epidural analgesia having ≥3 cm cervical dilatation were allocated in two groups, one group received RF and the other group received BF. Each group received study drug 16 mL with 50 μg fentanyl and top of 10 mL and 25 μg fentanyl when visual analog scale (VAS) ≥3. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes were compared. Statistical Analysis: For skewed data or ordered categorical data, nonpara...
Journal of Pediatric Surgery, 2017
Introduction: Despite its minimally invasive approach, laparoscopic surgery can cause considerabl... more Introduction: Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic singleincision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge. Methods: We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n = 136) with those who received LAI (n = 139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge. Results: Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p b 0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p b 0.0001) and mean pain scores (1.26 vs. 1.77; p b 0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93 min vs. 41.56 min; p = 0.047). Conclusion: Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67 min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric singleincision laparoscopic surgery. Retrospective comparative study: LEVEL III EVIDENCE.
International Journal of Scientific Research, 2012
International Journal of Scientific Research, 2012
Clonidine is added to intrathecal Bupivacaine to improve intraoperative analgesia and to increase... more Clonidine is added to intrathecal Bupivacaine to improve intraoperative analgesia and to increase the dura-
International Journal of Scientific Research, 2012
(Ex. Anesthesia resident) ABSTRACT INTRODUCTION- The addition of clonidine to local anesthetic so... more (Ex. Anesthesia resident) ABSTRACT INTRODUCTION- The addition of clonidine to local anesthetic solutions improves peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia. With this background, we undertook this study to determine the analgesic efficiency of clonidine in two different doses(0.5 µg/kg and 1 µg/kg ) in axillary brachial plexus block. AIMS AND OBJECTIVES- 1) To compare onset and duration of sensory and motor block. 2) Sedation score3) Vital parameters4) Duration of post-operative analgesia and complications. MATERIAL AND METHOD- The present study was conducted in 60 patients undergoing upper limb surgeries(both elective and emergency) having ASA grade-1 and 2 physical status. The patients were randomly allocated into 3 groups A,B and C each having 20 patients. Base line vitals like HR, BP, ECG, Spo2 were noted. Sensory block was assessed by pin prick method.motor block was assessed by Hallmen scale. Sedation score by Chenik -sedation score. SUMMARY AND CONCLUSION- Our study suggests that a small dose of clonidine produced late sensory and motor onset with enhancement of the quality of the peripheral block from local anesthetics and limits it's α-2 side effect to sedation. The addition of clonidine produces longer analgesia. Thus we recommend clonidine in 1 µg/kg dose as an adjuvant in axillary brachial plexus block for prolongation of post operative analgesia.
Anesthesia: Essays and Researches, 2017
Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pre... more Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, "episiotomy infiltration" becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1st day of postpartum period. We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection. Majority of the patients, 94.2% in our study, had no idea about labor analgesia, and only 2.5% of all the patients expressed their interest to deliver without suffering from labor pains. One hundred and twenty pregnant female patients scheduled for full-term vaginal delivery were assigned into lignocaine and lignocaine-clonidine group according to infiltration they received. Pain scoring using visual analog scale and maternal satisfaction scale was monitored. At the end of the research project, the data were compiled and analyzed using appropriate statistical tests. Duration of analgesia after episiotomy during sitting, walking, and squatting was 22.7 ± 1.32, 21.73 ± 1.47, and 19.875 ± 1.48 h in clonidine + lignocaine group and 6.06 ± 1.26, 5.33 ± 1.18, and 4.01 ± 1.28 h in lignocaine only group, respectively, which was highly statistically significant P < 0001. Clonidine when added to 2% lignocaine infiltration in episiotomy improves the quality and significantly enhances the duration of analgesia.
Peritonsillar infiltration with 0.25 % Bupivacaine for premptive analgesia in Paediatric patients
Indian Journal of Applied-Basic Medical Sciences, 2015
Ain-Shams Journal of Anaesthesiology, 2017
Background With the advent of opioid receptors, a variety of opioid agents are added to local ane... more Background With the advent of opioid receptors, a variety of opioid agents are added to local anesthetic mixtures used in peripheral blocks to improve the quality and duration of block. In this study, we compared the effect of butorphanol and tramadol as adjuvant agents for orthopedic upper extremity surgery. Patients and methods This study was carried out on 50 patients aged between 18 and 60 years, of American Society of Anesthesiologists grades I and II, of either sexes in each group, undergoing orthopedic upper limb surgeries through axillary brachial plexus block. An injection of butorphanol 2 mg (group B) and that of tramadol 100 mg (group T) were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade, and occurrence of any complications were studied in both groups. All patients were observed for analgesia postoperatively by visual analog scale pain score. Results In our study, the onset time (minutes) of sensory and motor blockade was delay...
To determine the efficacy of Nalbuphine in comparison to clonidine in preventing increase in hear... more To determine the efficacy of Nalbuphine in comparison to clonidine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and tracheal intubation. Methodology: This double blind randomized controlled trial was conducted on 60 ASA grade I– II patients scheduled for General anaesthesia. Patients were randomly allocated to receive clonidine 3μg/kg (group I , n=30) or Nalbuphine 0.2 mg/ kg (group II n=30) Each patient was given study drug 15 min before intubation. Anaesthesia was then induced with Thiopentone (6mg/ kg) and succinyl choline (2mg/kg ) IV was given for orotracheal intubation. Heart rate and mean arterial pressures were recorded before the administration of the study drug, baseline value ,3 minutes ,immediately after tracheal intubation and then after every 1 minute up to 5 minutes and then after 10 minutes of intubation Results: Clonidine significantly attenuated the sympathetic response to laryngoscopy and intubation. Nalbuphine reduce...