Anita Sharma

Abstract

Introduction: COVID-19 pandemic has been the major cause of mortality around the globe due to highly infectious nature of the virus and its tendency to cause serious manifestations like pneumonia, acute respiratory distress syndrome (ARDS) and ultimately respiratory failure. The incidence of patients developing pneumothorax and subcutaneous emphysema are also on the rise which has further increased the mortality. We conducted a retrospective analysis of COVID-19 patients who turned RT-PCR negative but still required intensive care, to see the incidence of pneumothorax and subcutaneous emphysema in ventilated as well as non-ventilated patients. Materials and Methods: The data was collected from the hospital patient records between October 1, 2020 and May 31, 2021. The hospital medical records were used to furnish the various demographic, clinical and treatment details. Results: Out of 102 patients received in intensive care unit (ICU) during the study period, 9 developed pneumo-thorax and 4 of them also developed subcutaneous emphysema. 7 patients were male and 2 were female with median age of 52 years. Right sided pneumothorax was found in 7 patients while left lung was involved in 2 patients. Lab investigations of all these patients revealed raised inflammatory markers. Diagnosis was confirmed by clinical findings and chest X-ray findings. 7 patients had associated comorbidities like diabetes, hypertension etc. Conclusion: The occurrence of pneumothorax and subcutaneous emphysema in COVID-19 patients indicate the severity of the illness. Other factors like raised inflammatory markers, male gender, associated co-morbidities like diabetes, hypertension and old age have also been linked with increased incidence of pneumothorax and subcutaneous emphysema.   Keywords: COVID- 19, ICU, Pneumothoarx, Subcutaneous emphysema.

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Abstract

Pericapsular nerve group (PENG) block is a novel approach for providing peri-operative analgesia wherein the articular branches of femoral nerve, obturator nerve and accessory obturator nerve are blocked. It has been found to be very effective as a regional anaesthesia technique during hip surgeries. We, hereby evaluated the USG guided PENG block with 0.25% bupivacaine (20ml) in 4 patients scheduled to undergo hip fracture surgeries. There was significant reduction in the pain scores both at resting position and 15 degree leg raise after the institution of block in all patients. All patients could sit upright during the institution of spinal anaesthesia. Keywords: Bupivacaine, PENG block, Regional analgesia, Hip surgery.

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Abstract

Background: Spinal anaesthesia is being routinely used for lower abdominal and lower limb surgeries. Bupivacaine is the commonly used anaesthetic agent because of its longer duration of action. Various intrathecal adjuvants like midazolam are sometimes added to enhance the anaesthetic effects and increase the duration of analgesia. We, hereby evaluated the effects of intrathecal midazolam 2mg as an adjuvant to bupivacaine during spinal anaesthesia in orthopaedic surgery. Materials and Methods: A total of 60 patients of age 20-50 years were randomly divided into two groups: BM-who received 3.2ml bupivacaine and 0.4ml(2mg) midazolam; and BS-who received 3.2 ml bupivacaine and 0.4ml normal saline. Results: Mean duration of analgesia was prolonged in the midazolam group (429.33+/-59.54 min) as compared to controls (252+/-42.22 min) (p=0.00). The number of injection diclofenac as rescue analgesic were also significantly less in BM group. Time to achieve maximum sensory level(T4) was also significantly less in BM group. Time to two segment regression and the duration of motor block were more in the midazolam group. Conclusion: Intrathecal midazolam as an adjuvant significantly prolongs the duration of analgesia and decreases the requirement of rescue analgesia when combined with bupivacaine during spinal anaesthesia. The dose of 2mg seems to safe and effective to achieve the desired results.   Keywords: Adjuvants, Analgesia, Midazolam, Sensory level.

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