Kaushal Kishor Kabir

Abstract

Context: To evaluate efficacy and safety of diclofenac transdermal patch with intramuscular diclofenac injection as preemptive analgesia in post operative patients undergoing inguinal hernioplasty. Aims: We aim to compare the duration and quality of analgesia provided by diclofenac trans dermal patch and intramuscular injection and to estimate time at which patients demand rescue analgesia after surgery. Settings Design: This randomized comparative study was conducted at a tertiary care hospital in central India. Materials and Methods: 60 healthy patients divided into two groups of 30 each, scheduled for elective inguinal hernioplasty under subarachnoid block were taken. Sample size calculation was based on the difference of means of two independent samples. A transdermal diclofenac patch containing 100 mg of diclofenac diethylamine was applied to the participants in the study group just before the induction of anesthesia. In the control group, 75 mg of diclofenac sodium Inj. was given intramuscularly half-an-hour before the end of surgery. Data for postoperative pain was assessed at 2, 4, 6, 8, 12, 16 and 24 hours by using a visual analogue scale (VAS) score and verbal rating scale (VRS) score and analysed using upaired t test. Results: Statistical difference in duration, quality of pre-emptive analgesia and Significant time of rescue analgesia was found between the two groups in terms of postoperative pain in patients undergoing inguinal hernioplasty. Conclusion: Tran dermal diclofenac patch (100 mg) is a better analgesic route than intramuscular diclofenac sodium (75 mg) for pre-emptive analgesia in patients undergoing inguinal hernioplasty. Keywords: Transdermal Patch, Preemptive analgesia, Post operative pain, Visual analogue scale.

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Abstract

Context: To evaluate whether Fractionated dose is an alternative to single bolus dose in spinal anaesthesia in terms of haemodynamic stability, total analgesic duration and quality of sensory and motor block. Aims: we aim to compare between fractionated and single bolus dose of local anaesthetic in subarachnoid block in elective LSCS. Settings and Design: This prospective comparative study was conducted at a tertiary care hospital in central India. Materials and Methods: 200 healthy female patients were randomly divided into groups (100 in each) group F (fractionated group) and group B (single bolus group). Subarachnoid block was given in sitting position in both the groups with 0.5% hyperbaric bupivacaine according to the height of the patient (0.07mg/cm) height. Group B was given single bolus dose over 10 seconds. Group F received 2/3rd of the dose initially followed by 1/3rd dose after 90 sec, the rate was 0.2ml/sec in both the groups. In group F, syringe was kept attached to the spinal needle after 2/3rd dose for 90 sec, after which the remaining 1/3rd dose was given. Data assessed was onset, level and duration of sensory block. Onset of sensory block assessed by pin prick sensation. Onset, duration &regression of motor block was also assessed. Duration of analgesia and the number of hypertensive episodes was also noted. Statistical Analysis used: Collected data was analysed using Microsoft excel and Statistical Package for Social Sciences (SPSS ver. 21). Results: Significant statistical difference was found between the two groups in terms of haemodynamic stability, characteristic of block, time of first rescue analgesia and total duration of analgesia. Conclusions: Fractionated group was found to be more haemodynamically stable with good quality sensory and motor block. Keywords: Hypotension, Motor blockade, Single bolus dose, Fractionated dose.

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