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Background: Subarachnoid anaesthesia is now used primarily for infraumbilical surgery. The relati... more Background: Subarachnoid anaesthesia is now used primarily for infraumbilical surgery. The relatively short duration of analgesia, which was a limiting factor, is eliminated by mixing an adjuvant with intrathecal bupivacaine. Our objective is to determine the optimal intrathecal dexmedetomidine dosage to be used during infraumbilical surgery in conjunction with 0.5% hyperbaric bupivacaine. Material and Methods: A parallel group, double blind, randomised controlled experiment was conducted at Department of Anaesthesia, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, with 60 adult patients scheduled for infraumbilical surgery under subarachnoid block. Each person received 3.2 mL (16.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0 and D10.0 (n = 30 each) additionally received intrathecal doses of 5.0and 10.0 μg of dexmedetomidine as an adjuvant. Vital signs, information regarding the onset and duration of the sensory and motor block, time to attain peak level of sensory and motor blockade, the time to first rescue analgesia, the total duration of analgesia and other details were recorded at regular intervals. Postoperative analgesia was assessed using a visual analogue scale at 15 and 30 minutes, then every 30 minutes for the following two hours, and then every hour for the following six hours. Sedation, hypotension, and bradycardia were among the adverse effects that were noted as needing rapid medical intervention. Results: The maximum sensory level reached by Group D10.0 was higher than that of the other group. There was a significant and dosedependent reduction in the mean time to peak sensory block (3.9 and 2.9 min; P 0.001) and peak motor block (5.6and 4.8 min; P 0.001) and a prolongation of postoperative analgesia duration (206.9 and 244.0 min) with increasing doses of dexmedetomidine (5.0and 10.0 μg) respectively. Hemodynamic effects and adverse outcomes were similar between the two groups. Conclusion: Intrathecal dexmedetomidine (10.0 μg) extends the duration of postoperative analgesia in spinal anaesthesia when used as an adjuvant to 0.5% hyperbaric bupivacaine (16.0 mg). Despite the small absolute changes, the results are better compared to dosage of 5 μg as an adjuvant intrathecally to 0.5% hyperbaric bupivacaine.
Background: The Transversus Abdominis Plane Block (TAPB) is a method of regional anaesthesia. Aft... more Background: The Transversus Abdominis Plane Block (TAPB) is a method of regional anaesthesia. After lower abdominal surgery, it produces analgesia, especially when parietal wall discomfort constitutes a significant portion of pain. By depositing local anaesthetic over the transversus abdominis muscle, it permits sensory blocking of the lower abdominal wall's skin and muscles. In a doubleblinded, prospective, randomized controlled clinical study, we assessed the effectiveness of TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower segment caesarean section. Materials and Methods: TAP Block was randomly administered to 60 parturients having elective or emergency LSCS and divided into two groups. Group B-TAP Block with 0.25percent Bupivacaine 20 ml each side (n=30). Group R-TAP Block with 0.25percent Ropivacaine 20 ml each side (n=30). At the conclusion of the procedure, TAP Block was done using 20 ml of either 0.25 percent ropivacaine or 0.25 percent bupivacaine on each side. A blinded observer evaluated each patient postoperatively at 30 minutes, 2, 4, 6, 12 and 24 hours after surgery. Result: Both clinically and statistically, the outcomes in the two groups were comparable. The mean duration of analgesia was 1419.93 minutes in Group B and 1343.81 minutes in Group R, both of which had statistically significant standard deviations of ± 126.9 minutes and ± 32.18 minutes, respectively. Conclusion: When administered in a TAP Block to provide postoperative analgesia following lower segment caesarean section surgery, 0.25 percent Bupivacaine provided a comparatively longer duration of analgesia, lesser VAS Scores than Ropivacaine. Both medications have a very good safety profile. Both medications have exceptional therapeutic value in terms of dependability & potent analgesia.
Journal of Anaesthesiology Clinical Pharmacology, 2020
Background and Aims: Peripheral nerve blocks in neurosurgical practice attenuate most stressful r... more Background and Aims: Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision. Material and Methods: After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software. Results: The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. (P = 0.02 at T1, P = 0.03 at T2). Conclusions: Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.
17th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care, Apr 1, 2016
Background: Various airway devices have been used successfully for endotracheal intubation of sim... more Background: Various airway devices have been used successfully for endotracheal intubation of simulated patients with cervical collar. This study was done to compare AirTraq and McCoy for intubation characteristics and haemodynamic parameters following endotracheal intubation in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery. Methods: After Institutional Ethical Committee approval, a prospective randomised comparative study was designed on 60 American Society of Anesthesiologists I and II patients involving single level ACDF with mild to no neurological deficit. Following standard anaesthesia protocol and manual in-line stabilisation applied along with cervical collar or pin traction, all the patients were intubated either with AirTraq or McCoy. The time taken for intubation, Intubation Difficulty Scale (IDS) score, comfort grading and haemodynamic parameters were noted following intubation. Statistical Analysis: The categorical data were compared using Chi-square test and the continuous variables were compared between the groups using paired sample t-test. Repeated ANOVA was tested for haemodynamic data at each measurement time point, and Tukey post hoc was used for within the group comparisons at different timings following intubation. Results: The mean intubation time was 24.41 ± 14.8 s in AirTraq group which was statistically significant compared to McCoy group 38.96 ± 15.55 s (P = 0.001). The IDS score and comfort grading were statistically significant in Group A compared to Group M. The changes in heart rate and mean arterial pressure following intubation were comparable in both the groups. Conclusion: AirTraq improves the grade of glottic visualisation with minimal assistance. It also minimised the time taken for intubation and had stable haemodynamics with increased comfort to the anaesthetist.
Background: Subarachnoid anaesthesia is now used primarily for infraumbilical surgery. The relati... more Background: Subarachnoid anaesthesia is now used primarily for infraumbilical surgery. The relatively short duration of analgesia, which was a limiting factor, is eliminated by mixing an adjuvant with intrathecal bupivacaine. Our objective is to determine the optimal intrathecal dexmedetomidine dosage to be used during infraumbilical surgery in conjunction with 0.5% hyperbaric bupivacaine. Material and Methods: A parallel group, double blind, randomised controlled experiment was conducted at Department of Anaesthesia, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, with 60 adult patients scheduled for infraumbilical surgery under subarachnoid block. Each person received 3.2 mL (16.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0 and D10.0 (n = 30 each) additionally received intrathecal doses of 5.0and 10.0 μg of dexmedetomidine as an adjuvant. Vital signs, information regarding the onset and duration of the sensory and motor block, time to attain peak level of sensory and motor blockade, the time to first rescue analgesia, the total duration of analgesia and other details were recorded at regular intervals. Postoperative analgesia was assessed using a visual analogue scale at 15 and 30 minutes, then every 30 minutes for the following two hours, and then every hour for the following six hours. Sedation, hypotension, and bradycardia were among the adverse effects that were noted as needing rapid medical intervention. Results: The maximum sensory level reached by Group D10.0 was higher than that of the other group. There was a significant and dosedependent reduction in the mean time to peak sensory block (3.9 and 2.9 min; P 0.001) and peak motor block (5.6and 4.8 min; P 0.001) and a prolongation of postoperative analgesia duration (206.9 and 244.0 min) with increasing doses of dexmedetomidine (5.0and 10.0 μg) respectively. Hemodynamic effects and adverse outcomes were similar between the two groups. Conclusion: Intrathecal dexmedetomidine (10.0 μg) extends the duration of postoperative analgesia in spinal anaesthesia when used as an adjuvant to 0.5% hyperbaric bupivacaine (16.0 mg). Despite the small absolute changes, the results are better compared to dosage of 5 μg as an adjuvant intrathecally to 0.5% hyperbaric bupivacaine.
Background: The Transversus Abdominis Plane Block (TAPB) is a method of regional anaesthesia. Aft... more Background: The Transversus Abdominis Plane Block (TAPB) is a method of regional anaesthesia. After lower abdominal surgery, it produces analgesia, especially when parietal wall discomfort constitutes a significant portion of pain. By depositing local anaesthetic over the transversus abdominis muscle, it permits sensory blocking of the lower abdominal wall's skin and muscles. In a doubleblinded, prospective, randomized controlled clinical study, we assessed the effectiveness of TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower segment caesarean section. Materials and Methods: TAP Block was randomly administered to 60 parturients having elective or emergency LSCS and divided into two groups. Group B-TAP Block with 0.25percent Bupivacaine 20 ml each side (n=30). Group R-TAP Block with 0.25percent Ropivacaine 20 ml each side (n=30). At the conclusion of the procedure, TAP Block was done using 20 ml of either 0.25 percent ropivacaine or 0.25 percent bupivacaine on each side. A blinded observer evaluated each patient postoperatively at 30 minutes, 2, 4, 6, 12 and 24 hours after surgery. Result: Both clinically and statistically, the outcomes in the two groups were comparable. The mean duration of analgesia was 1419.93 minutes in Group B and 1343.81 minutes in Group R, both of which had statistically significant standard deviations of ± 126.9 minutes and ± 32.18 minutes, respectively. Conclusion: When administered in a TAP Block to provide postoperative analgesia following lower segment caesarean section surgery, 0.25 percent Bupivacaine provided a comparatively longer duration of analgesia, lesser VAS Scores than Ropivacaine. Both medications have a very good safety profile. Both medications have exceptional therapeutic value in terms of dependability & potent analgesia.
Journal of Anaesthesiology Clinical Pharmacology, 2020
Background and Aims: Peripheral nerve blocks in neurosurgical practice attenuate most stressful r... more Background and Aims: Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision. Material and Methods: After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software. Results: The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. (P = 0.02 at T1, P = 0.03 at T2). Conclusions: Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.
17th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care, Apr 1, 2016
Background: Various airway devices have been used successfully for endotracheal intubation of sim... more Background: Various airway devices have been used successfully for endotracheal intubation of simulated patients with cervical collar. This study was done to compare AirTraq and McCoy for intubation characteristics and haemodynamic parameters following endotracheal intubation in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery. Methods: After Institutional Ethical Committee approval, a prospective randomised comparative study was designed on 60 American Society of Anesthesiologists I and II patients involving single level ACDF with mild to no neurological deficit. Following standard anaesthesia protocol and manual in-line stabilisation applied along with cervical collar or pin traction, all the patients were intubated either with AirTraq or McCoy. The time taken for intubation, Intubation Difficulty Scale (IDS) score, comfort grading and haemodynamic parameters were noted following intubation. Statistical Analysis: The categorical data were compared using Chi-square test and the continuous variables were compared between the groups using paired sample t-test. Repeated ANOVA was tested for haemodynamic data at each measurement time point, and Tukey post hoc was used for within the group comparisons at different timings following intubation. Results: The mean intubation time was 24.41 ± 14.8 s in AirTraq group which was statistically significant compared to McCoy group 38.96 ± 15.55 s (P = 0.001). The IDS score and comfort grading were statistically significant in Group A compared to Group M. The changes in heart rate and mean arterial pressure following intubation were comparable in both the groups. Conclusion: AirTraq improves the grade of glottic visualisation with minimal assistance. It also minimised the time taken for intubation and had stable haemodynamics with increased comfort to the anaesthetist.