Shivanand L K

Abstract

Introduction: Peripheral nerve blocks are becoming popular day by day because of their relative safety and precision. The present study aimed to compare the effectiveness of clonidine versus midazolam as an adjuvant to local anesthetics in ultrasound guided supraclavicular brachial plexus block. Materials and Methods: A prospective randomised control study where total of 100 adult patients of either sex, aged between 18 -60 years of ASA physical status 1 and 2 undergoing elective upper limb surgeries were divided equally into two groups by computer generated random number method. Group C: where inj. clonidine -150mcg was used as an adjuvant in addition to inj xylocain plain 2% -10ml and inj bupivacaine plain 0.5%- 20ml in ultrasound guided supraclavicular brachial plexus block. Group M: where inj. Midazolam (preservative free)- 5mg was used as an adjuvant in addition to local anesthetics as mentioned above for group C. In both groups onset of sensory block, onset of motor block, duration of sensory block, duration of motor block, sedation measured by sedation scale(culebras), post operative analgesia using VAS at 0 min, 30min, 1hr, 2hr, 3hr, 6hr and 12hr were recorded. Results: Post operative analgesia was significantly prolonged in Group C (VAS

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Introduction: Laparoscopic surgeries are commonly performed surgical procedures in day to day practice. These patients require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. Opioids, such as morphine, delivered using a patient-controlled analgesia device, remain the mainstay of postoperative analgesic regimens for such patients. TAP block is a regional anaesthetic technique that has been applied as one segment of a multimodal pain regimen in abdominal surgeries. Addition of dexamethasone as adjuvant to bupivacaine in TAP block provides prolonged post-operative analgesia and better pain control than LA alone. The duration of LA was longer with decreased VAS scores and the time of request for rescue morphine doses was less in dexamethasone group. Objectives: Evaluate efficacy of TAP block in providing post-operative analgesia in laparoscopic surgeries. Evaluate pain severity using VAS. Evaluate need for rescue analgesia. Evaluate safety and adverse effects of TAP block. Group 1 - 15 ml 0.25% Bupivacaine with Dexamethasone 8mg on both sides if surgical incision involved both sides of rectus sheath. Group 2 - 15 ml 0.25% Bupivacaine with normal saline. Results: The duration of analgesia increased considerably in study group. The time for request of analgesia was increased (364.7 min) in study group when compared to control group (148.0 min). Conclusion: dexamethasone to TAP block produces immense post-operative analgesia along with reduced VAS score, increased the duration of analgesia and reduced rescue analgesic dose requirements. Keywords: TAP block, Dexamethasone, VAS score.

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Abstract

Introduction: After the birth of the baby if the placenta is not expulsed within 30 minutes of the delivery, it is termed as retained placenta. The incidence of retained placenta is 2% of deliveries world-wide and is an important cause for maternal mortality and morbidity. Nitroglycerine (NTG) is an organic nitrate that relaxes smooth muscles and produces a generalized vasodilatation. As it relaxes the smooth muscle, it is also used as a uterine relaxant for manual placental removal. Aims and Objectives: To know the efficacy and safety of intravenous NTG in manual removal of placenta and to know the hemodynamic effects during the procedure. Materials and Methods: Total number of patients included in this study were 40. Patients were divided in two groups, each group having 20 patients each. Group 1 patients were administered with 100 microgm of NTG and group 2 patients with 150 microgm of NTG. Clinical parameters and complications were studied and compared between the two groups. Placenta was observed for separation and graded as easily separated, separated with assistance, difficult to separate, failed to separate. The clinical parameters like hypotension, tachycardia, headache after awakening, palpitation after awakening were compared between the two groups. Results: In group 1, we observed that placenta was easily separatedin 12 patients (60%), separated with assistance in 3 patients (15%), difficult to separate in 3 patients (15%) and in 2 patients (10%) placenta was not separated. In group 2, we observed that, placenta was easily separated in 14 patients (70%), separated with assistance in 2 patients (10%), difficult to separate in 2 patients (10%) and in 2 patients (10%) placenta was not separated. Conclusion: Intravenous NTG is an effective and safe method for manual removal of placenta with a dose of 100 microgram. Keywords: Intravenous, Nitroglycerinr, Retained placenta.

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