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Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Opioid induced hyperalgesia (OIH) is a state of nociceptive sensitisation caused by ex... more BACKGROUND Opioid induced hyperalgesia (OIH) is a state of nociceptive sensitisation caused by exposure to opioids probably due to paradoxical sensitization to painful stimuli. The aim of the study is to study the presence of OIH in acute pain management and to compare the ability of intravenous paracetamol and intravenous dexmedetomidine in allaying OIH in patients receiving epidural Fentanyl following total abdominal hysterectomy. MATERIALS AND METHODS The study was an observational study including sixty patients divided into three groups. All three groups received Epidural Fentanyl as infusion at the rate of 10-15 mcg/hr with intravenous fentanyl bolus as rescue analgesic on Post-Operative Day 1(POD), Group F-On POD 2 received Inj. Fentanyl 50 mcg iv 8th hourly and SOS. Group P-On POD 2 received Inj. Paracetamol 1 gm iv and inj fentanyl SOS. Group DOn POD 2 received Inj. Dexmedetomidine iv as infusion @ 0.02mcg/kg/hr and Inj. Fentanyl SOS. Pain was assessed using visual analogue score (VAS) at 4,12,24,48 hrs and at dressing change on POD 2. RESULTS No statistically significant difference in Pain scores at 4,12,24,48 hrs. Statistically significant difference in pain scores at dressing change was noted in group F ,but no significant difference in VAS between Group P and D.{VAS at dressing change: Group F=4.20; Group P=3.05; Group D=2.70} CONCLUSION PAIN sensed by patients during dressing change was significantly more in patients receiving opioids alone as opposed to a combination of opioids with paracetamol and dexmedetomidine.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Centr... more BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Central venous catheterization is now an unavoidable component for invasive monitoring and management. Central venous access was first given by Aubaniac 1 in 1953. Cannulation of the internal jugular vein is a procedure commonly performed by anaesthetists, in both the perioperative period and in intensive care. 2 The internal jugular route for central venous access has been described as early as in 1966 by Hermosura. 3 The very first and one of the most commonly followed method for central venous catheterization remains a blind surface landmarkguided technique. Ultrasonography guidance in central venous cannulation has converted a blind procedure into a procedure under vision which helps in reducing the complication rates. The aim of the study is to compare three ultrasound guided techniques (short axis vs long axis vs oblique axis) for cannulation of the right internal jugular vein. METHODS This is an observational study conducted among 151 patients who fulfilled the inclusion criteria and who had given a written informed consent. The patients were divided into groups of 51 each. Group 1-Short axis approach (SAX), Group 2-Long axis approach (LAX), Group 3-Oblique axis approach (OAX). The outcome variables used were-1. Successful cannulation with the designated approach, 2. First needle pass success n (%), 3. Number of needle passes, 4. Cannulation time (s). 5. Complications. RESULTS The findings of the study indicate that Oblique axis approach to IJV cannulation is better than Long or Short axis approach in terms of number of needle passes, first needle pass success, and cannulation time. There was no statistically significant difference in complication rates among the three groups. CONCLUSIONS It can be concluded that while performing ultrasound guided Internal Jugular Vein cannulation, the Oblique axis approach can be considered as a safe and effective approach.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND Shivering is a very unpleasant, physiologically stressful sensation for the patient un... more BACKGROUND Shivering is a very unpleasant, physiologically stressful sensation for the patient undergoing surgery. Spinal anaesthesia impairs the thermoregulatory control, increasing the sweating threshold and decreasing vasoconstriction and shivering threshold. 1 The combination of anaesthetic induced thermoregulatory impairment and exposure to a cool environment makes most unwarmed surgical patients hypothermic. Around 40-60% of patients under regional anaesthesia develop shivering. 2,3 The aim of this study was to evaluate the efficacy and safety of oral clonidine in the control of shivering in patients undergoing elective urological surgeries under subarachnoid block. METHODS The study was an observational study including 100 patients fulfilling the inclusion criteria who had given a written informed consent. Patients were divided into study and control groups of 50 each with the test group receiving 150 mcg of oral clonidine 90 mins prior to the surgery. Grading of shivering was done as per the grading in the study of Wrench et al (1997) for six 10 min. intervals for first hour of surgery and sedation was assessed using Modified Ramsay Sedation Scale 4 for 30 min intervals for the first 3 hours following onset of surgery. RESULTS The overall incidence of shivering was significantly low (p<0.0001) across all the time periods in the Clonidine group. The severity of shivering was also significantly low in Clonidine group across all time periods. No statistically significant difference in sedation was seen among the two groups across all time intervals. CONCLUSIONS Oral clonidine at a dose of 150 µg administered 90 minutes before subarachnoid block in urological surgeries affected a significant reduction in the intensity and severity of post subarachnoid block shivering.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Opioid induced hyperalgesia (OIH) is a state of nociceptive sensitisation caused by ex... more BACKGROUND Opioid induced hyperalgesia (OIH) is a state of nociceptive sensitisation caused by exposure to opioids probably due to paradoxical sensitization to painful stimuli. The aim of the study is to study the presence of OIH in acute pain management and to compare the ability of intravenous paracetamol and intravenous dexmedetomidine in allaying OIH in patients receiving epidural Fentanyl following total abdominal hysterectomy. MATERIALS AND METHODS The study was an observational study including sixty patients divided into three groups. All three groups received Epidural Fentanyl as infusion at the rate of 10-15 mcg/hr with intravenous fentanyl bolus as rescue analgesic on Post-Operative Day 1(POD), Group F-On POD 2 received Inj. Fentanyl 50 mcg iv 8th hourly and SOS. Group P-On POD 2 received Inj. Paracetamol 1 gm iv and inj fentanyl SOS. Group DOn POD 2 received Inj. Dexmedetomidine iv as infusion @ 0.02mcg/kg/hr and Inj. Fentanyl SOS. Pain was assessed using visual analogue score (VAS) at 4,12,24,48 hrs and at dressing change on POD 2. RESULTS No statistically significant difference in Pain scores at 4,12,24,48 hrs. Statistically significant difference in pain scores at dressing change was noted in group F ,but no significant difference in VAS between Group P and D.{VAS at dressing change: Group F=4.20; Group P=3.05; Group D=2.70} CONCLUSION PAIN sensed by patients during dressing change was significantly more in patients receiving opioids alone as opposed to a combination of opioids with paracetamol and dexmedetomidine.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Centr... more BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Central venous catheterization is now an unavoidable component for invasive monitoring and management. Central venous access was first given by Aubaniac 1 in 1953. Cannulation of the internal jugular vein is a procedure commonly performed by anaesthetists, in both the perioperative period and in intensive care. 2 The internal jugular route for central venous access has been described as early as in 1966 by Hermosura. 3 The very first and one of the most commonly followed method for central venous catheterization remains a blind surface landmarkguided technique. Ultrasonography guidance in central venous cannulation has converted a blind procedure into a procedure under vision which helps in reducing the complication rates. The aim of the study is to compare three ultrasound guided techniques (short axis vs long axis vs oblique axis) for cannulation of the right internal jugular vein. METHODS This is an observational study conducted among 151 patients who fulfilled the inclusion criteria and who had given a written informed consent. The patients were divided into groups of 51 each. Group 1-Short axis approach (SAX), Group 2-Long axis approach (LAX), Group 3-Oblique axis approach (OAX). The outcome variables used were-1. Successful cannulation with the designated approach, 2. First needle pass success n (%), 3. Number of needle passes, 4. Cannulation time (s). 5. Complications. RESULTS The findings of the study indicate that Oblique axis approach to IJV cannulation is better than Long or Short axis approach in terms of number of needle passes, first needle pass success, and cannulation time. There was no statistically significant difference in complication rates among the three groups. CONCLUSIONS It can be concluded that while performing ultrasound guided Internal Jugular Vein cannulation, the Oblique axis approach can be considered as a safe and effective approach.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND Shivering is a very unpleasant, physiologically stressful sensation for the patient un... more BACKGROUND Shivering is a very unpleasant, physiologically stressful sensation for the patient undergoing surgery. Spinal anaesthesia impairs the thermoregulatory control, increasing the sweating threshold and decreasing vasoconstriction and shivering threshold. 1 The combination of anaesthetic induced thermoregulatory impairment and exposure to a cool environment makes most unwarmed surgical patients hypothermic. Around 40-60% of patients under regional anaesthesia develop shivering. 2,3 The aim of this study was to evaluate the efficacy and safety of oral clonidine in the control of shivering in patients undergoing elective urological surgeries under subarachnoid block. METHODS The study was an observational study including 100 patients fulfilling the inclusion criteria who had given a written informed consent. Patients were divided into study and control groups of 50 each with the test group receiving 150 mcg of oral clonidine 90 mins prior to the surgery. Grading of shivering was done as per the grading in the study of Wrench et al (1997) for six 10 min. intervals for first hour of surgery and sedation was assessed using Modified Ramsay Sedation Scale 4 for 30 min intervals for the first 3 hours following onset of surgery. RESULTS The overall incidence of shivering was significantly low (p<0.0001) across all the time periods in the Clonidine group. The severity of shivering was also significantly low in Clonidine group across all time periods. No statistically significant difference in sedation was seen among the two groups across all time intervals. CONCLUSIONS Oral clonidine at a dose of 150 µg administered 90 minutes before subarachnoid block in urological surgeries affected a significant reduction in the intensity and severity of post subarachnoid block shivering.