RESUMEN
BACKGROUND: Regional anaesthesia offers the anaesthesiologist, the surgeon, as well as the patient advantages over general anaesthesia such as being conscious through the surgery, avoiding multiple drugs, better haemodynamic stability, excellent postoperative analgesia, and faster per oral consumption post surgery. Compared with the axillary approach, the brachial plexus block at the level of the clavicle can anaesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. AIM: The aim of the study was to compare the effect of both supraclavicular and infraclavicular brachial plexus blocks in terms of time taken for onset, performance, and block success. MATERIALS AND METHODS: Sixty patients undergoing below-elbow upper limb surgeries were randomized into two groups: (i) supraclavicular (Group S) and (ii) infraclavicular (Group I). All patients received 30ml 0f 0.5% bupivacaine as the local anesthetic of choice. The block performance time, time taken for onset of sensory and motor blockade, total duration of block, and hemodynamic parameters were observed. The block performance times and the onset of the sensory blockade were the primary outcomes while the duration of the block and hemodynamic parameters were secondary outcomes. Two two-tailed independent sample t-tests will be used to compare the variables. RESULTS: We observed that the block performance time for the infraclavicular block (mean 14.833 minutes) was longer than the supraclavicular block (mean 10.37 minutes). This was statistically significant with p <0.001. In terms of onset of sensory blockade, the infraclavicular group (13.667 minutes) had a quicker onset compared to the supraclavicular group (17.333 minutes). This was also statistically significant with p <0.001. The mean total duration of sensory and motor blockade was similar in both groups (p-value of 0.341 and 0.791 respectively) and there was no statistical difference. There was no hemodynamic instability or complications in our study. CONCLUSION: Ultrasound-guided infraclavicular block is a relatively safer technique when compared to the supraclavicular technique with faster onset. The time taken for administering the infraclavicular block can be reduced by repeated exposure to the technique.
RESUMEN
Background and Aims: Ultrasound-guided central venous (CV) cannulation is the standard of care for inserting CV catheter in the right internal jugular vein (RIJV). However, mechanical complications can still occur. The primary objective of this study was to compare the incidence of posterior vessel wall puncture (PVWP) using conventional needle holding technique with pen holding method of needle holding technique for IJV cannulation. Secondary objectives were comparison of other mechanical complications, access time and ease of the procedure. Methods: This prospective, randomised parallel-group study included 90 patients. Patients requiring ultrasound-guided RIJV cannulation under general anaesthesia were randomised into two groups P (n = 45) and C (n = 45). In group C, the RIJV was cannulated using the conventional needle holding technique. In group P, the pen holding method of needle holding technique was used. Incidence of PVWP, complications (arterial puncture, haematoma) number of attempts for successful cannulation, time to insertion of guidewire and performer's ease were compared. The data were analysed using Statistical Package for the Social Sciences (SPSS version 24.0). A P value less than 0.05 was considered statistically significant. Results: In our study, there was no significant difference in incidence of PVWP and complications between the two groups. Number of attempts and time for successful guidewire insertion were comparable. Ease of the procedure was scored a median of 10 in both the groups. Conclusion: There was no significant difference in the incidence of PVWP between the two techniques in this study, necessitating further evaluation of this novel technique.
RESUMEN
AIMS: The aim of this study was to determine the effect of change of patients' position during laryngoscopy on laryngoscopic view and to evaluate the effect of body mass index (BMI) and neck circumference on laryngoscopic view in both the positions. METHODOLOGY: A prospective, unblinded observational study was done with patients and laryngoscopists acting as their own controls. The study included 300 patients of ASA classes I and II aged more than 18 years who were scheduled to undergo general anesthesia. Detailed airway assessment including neck circumference and BMI of the patients was done. Initially, the patients were placed in the Head-Elevated Laryngoscopic Position (HELP) on the operating table. After proper intravenous induction, an experienced anesthesiologist did direct laryngoscopy with a suitable size Macintosh blade and assessed the C and L grades (HELP score). Immediately, the patients were repositioned to conventional sniff position and the C and L grades reassessed (sniff score). Both the scores were compared later on. RESULTS: HELP provided a view better than or equal to sniff in 94% cases, whereas in only 6% of the cases, sniff provided a view better than HELP. HELP provided better view for laryngoscopy. Moreover, neck circumference as a parameter was more helpful in predicting difficult laryngoscopy compared to BMI. CONCLUSION: HELP should be the ideal intubating position in all patients irrespective of ages and sexes with or without predilections for difficult airway.
