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Introduction: Abdominal wall blocks, in conjunction with multimodal analgesia, have demonstrated efficacy in providing post-operative analgesia, reducing opioid requirements in patients undergoing inguinal hernia repair. The inguinal region is primarily innervated by the ilioinguinal nerve (IIN) and iliohypogastric nerve (IIH). Posterior transverse abdominis plane block (pTAP) and fascia transversalis plane block (TFP) have been observed to reliably block IIN and IIH. We hypothesized that posterior TAP block (pTAP) owing to its potential paravertebral spread will provide better post-operative analgesia than TFP block in patients undergoing unilateral open inguinal hernia repair. Methods: This prospective, randomized, single-blind, two-arm parallel study was conducted over a duration of one year for which sixty patients undergoing unilateral open inguinal hernia repair under spinal anesthesia were enrolled. They were equally and randomly assigned to receive either preoperative pTAP block or TFP block. The primary aim of the study was to compare median static and dynamic NRS scores during a 24-hour period, with the secondary aim to compare the number of patients who required rescue analgesics in each group. Results: All enrolled patients completed the study. Results showed no statistically significant difference in median static NRS scores between Group pTAP and Group TFP at the designated time of observation during the 24-hour period [1.2 (0.4-1.60 vs. 1 (0.6-1)]. Group pTAP reported a higher median dynamic NRS scores during the 24-hour period [2.6 (1.2-3) v/s 2 (1.6-2.4); P < 0.035], although this difference was clinically insignificant. The mean time to request for the first rescue analgesia was comparable (11.7 h v/s 12 h; P = 0.99). In all the patients of both groups, loss of pinprick and cold touch sensation was observed at T10, T12, and L1 dermatomal levels. However, sensory assessment at T6 and T8 levels showed variability between the two groups (P > 0.05). Conclusion: In conjunction with background analgesia and the use of dexamethasone as an adjuvant, both blocks (pTAP and TFP) were observed to be equally effective for post-operative pain relief with similar patient satisfaction scores.
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OBJECTIVES: The number of accident cases is increasing day by day, so as the challenges. With an emphasis on trauma care, the government started a 120 bedded level I trauma centre in northern India catering to a population of 2.8 million in June 2018. Through this article, we aimed to share our experience of blunt abdominal trauma management from a new level I trauma centre. MATERIAL AND METHODS: In this retrospective observational study, historical analysis of all available records from July 2018 to March 2020 was done. Inclusion criteria included blunt trauma abdomen with or without associated injuries. Data regarding age, sex, mechanism of injury, time taken to reach the hospital, the pattern of solid organs and hollow viscus injuries, associated extra abdominal injuries, mode of treatment, complications, length of ICU and hospital stay, and mortality were reviewed. RESULTS: Overall, 154 cases sustained abdominal injuries during the study period. Seventy-five percent were male. The most common cause of blunt trauma abdomen was road traffic crashes. Operative management was required in 57 (37.01%) cases while 97(62.98%) were managed non-operatively (NOM). Mean ICU stay was 05.73 days, while the average hospital stay was 12 days (range 10-60 days). Procedures performed included splenectomy, liver repair, primary closure of bowel injury, and stoma formation. Complications occured in 16.88% cases and the overall mortality rate was 11.68%. CONCLUSION: The study revealed that among 154 cases of fatal blunt abdominal trauma, road traffic crash was the most common cause of blunt abdominal trauma, predominantly affecting males. The visceral and peritoneal injury frequently perceived was liver in 40 cases (25.9%), spleen 66 (43%), intestine 21(13.6%) and kidney 13 cases (09%). Abdominal injury was associated with other injuries like head, chest and extremity injuries in 52.5% cases. Duration of injury, presence of associated injury and preoperative ventilation requirement were independent predictors of mortality apart from contributary factors such as clinical presentation, organ involved and presence of complications.
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CONTEXT: Fractures of femur and hip surgeries pose a challenge because of excruciating pain. Fascia iliaca compartment block is an effective and easily learned procedure to decrease postoperative pain score and dosage of opioid. Many adjuvants are combined with local anesthetics to prolong the postoperative analgesia. AIMS: The aim was to study duration of postoperative analgesia in terms of Numeric Rating Scale (NRS), number of times rescue analgesic used, any adverse effect, and patient satisfaction score. SETTINGS AND DESIGN: Operation theatre of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. MATERIALS AND METHODS: The present study was retrospective study with 203 patients evaluated. Based on the combination of the anesthesia and drugs, study patients were divided into six groups. Pain scores were assessed at 6 hourly intervals for 24 h. STATISTICAL ANALYSIS USED: Kruskal-Wallis H-test used to compare NRS as well as age and duration of anesthesia. Chi-square test/Fisher's exact test used to compare the proportions. RESULTS: Postoperative analgesia was comparable and insignificant (P > 0.05) at 0, 6, 12 h in all six groups. Better postoperative analgesia was observed with dexmedetomidine and dexamethasone as adjuvant at 18 h, dexmedetomidine as adjuvant in comparison to dexamethasone as adjuvant at 24 h. Rescue analgesia in postoperative period was required maximum in plain bupivacaine. Satisfaction levels were good and excellent in dexmedetomidine and dexamethasone as adjuvant. CONCLUSIONS: Addition of dexmedetomidine to bupivacaine provides longer duration, good quality postoperative analgesia, reduced requirement for rescue analgesic, lesser postoperative nausea and vomiting, and better satisfaction levels.
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BACKGROUND AND OBJECTIVE: Ropivacaine owing to its propensity of causing motor blockade of reduced duration, is preferred for ambulatory day care surgery. Intrathecal ropivacaine has shown effective analgesia for lower limb surgery. Our study plans to evaluate spinal ropivacaine in three different doses in patients undergoing day care perineal surgery. METHODOLGY: 90 ASA-I patients scheduled to undergo day care perineal surgery were randomized to receive intrathecal ropivacaine. Group I (n=30) received 15mg of intrathecal ropivacaine, Group II (n=30) received 18.75 mg of intrathecal ropivacaine and Group III (n=30) received 22.5 mg of intrathecal ropivacaine. Onset of sensory block at T 10, peak sensory block level, duration of sensory block, onset and duration of motor block and relevant safety data were recorded. RESULT: Onset of analgesia was significantly shorter in Group III (3.5 min ; P <0.0001). However, time taken for peak sensory blockade was comparable in group II and III (12.76 and 11.93 mins). Duration of analgesia was longer and statistically significant in Group III (201.6 mins: P <0.0001) when compared to Group I and II. Onset of motor block was observed to be shortest in Group III (6.7 mins) and duration of motor block was longest in Group III (153.73 mins). These two parameters were statistically significant than Group I and II (P <0.0001). CONCLUSION: Intrathecal ropivacaine in a dose of 18.75 and 22.5 mg were observed to be equally effective in providing satisfactory analgesia. However, higher dose was associated with profound sensory and motor block.
