Defecation and Micturition may Cause Syncope in COVID-19 Patients on High Oxygen Requirement.

How to cite this article: Naaz S, Kumar A, Sahay N, Kumar R, Ozair E, Valiaparambath A. Defecation and Micturition may Cause Syncope in COVID-19 Patients on High Oxygen Requirement. Indian J Crit Care Med 2021;25(5):599-600.

Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy.

OBJECTIVE: Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH). METHODS: This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention. RESULTS: There was a significant difference in the duration of analgesia among the groups (P » .00). It was significantly longer in group Q (mean » 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean » 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean » 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P » .001) and the cumulative analgesic consumption (P » .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block. CONCLUSION: It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect.

A unique case of hoarseness of voice following left supraclavicular brachial plexus block.

Hoarseness of voice following supraclavicular brachial plexus block is a rare complication and is seen in 1.3% of cases. It has been reported in cases of right supraclavicular brachial block exclusively. The reason for this is the course of recurrent laryngeal nerve which is not the same in the left and right sides. Here we report a case of left supraclavicular brachial plexus block following which the patient developed hoarseness of voice.

A Comparative Study of Analgesic Effect of Intrathecal Nalbuphine and Fentanyl as Adjuvant in Lower Limb Orthopaedic Surgery.

INTRODUCTION: Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Nalbuphine is an agonist-antagonist and acts on kappa receptors providing analgesia. AIM: The study aims to compare the analgesic efficacy of fentanyl with that of two doses of nalbuphine when used with injection bupivacaine heavy in spinal anaesthesia. MATERIALS AND METHODS: A randomised, double blinded, prospective study on 90 patients of ASA I and II undergoing lower limb orthopaedic surgery under subarachnoid block was done. Patients were randomly allocated into three groups (n=30). Each group received 12.5 mg of 0.5% of injection bupivacaine heavy along with either 25 µg of 0.5 ml fentanyl (Group F) or 0.8 mg of 0.5 ml nalbuphine (Group NL) or 1.6 mg of 0.5 ml nalbuphine (Group NH). Characteristics of sensory and motor blocks, haemodynamic changes, duration and quality of analgesia, adverse effects, sedation, VRS score and analgesic requirement were studied at different time interval intraoperatively and till 24 hours of block. RESULTS: The duration of analgesia (in minute) was 441±119.69 in NL Group, 450±103.38 in NH Group and 300.0±88.53 in Group F (p=0.05). There was no significant difference regarding block characteristics and haemodynamic parameters. Total 24 hours analgesic requirement was titrated by analgesic score which was 2.25±0.7 (NH Group), 1.875±0.83 (NL Group) and 3.375±1.77 (F Group) p=0.0186 by ANOVA. The adverse effects of NL Group were least. CONCLUSION: There was no significant advantage of intrathecal fentanyl or 1.6 mg nalbuphine over low dose 0.8 mg nalbuphine.

Optimal Dose of Intrathecal Dexmedetomidine in Lower Abdominal Surgeries in Average Indian Adult.

BACKGROUND: Dexmedetomidine, a selective alpha2 adrenoceptor agonist, has been used as adjuvant to spinal anaesthesia. AIM: To find out the optimum dose of dexmedetomidine to be used in lower abdomen surgery intrathecally. MATERIALS AND METHODS: This was a randomized, controlled, double blinded study which included adult ASA I and II patients. They were allocated into five groups (n=20). Patients allergic to drugs to be used in the study and those with co-existing neurological disorders, coagulopathies, cardiac diseases, obesity and hypertension were excluded. Groups were designed as 2.5ml hyperbaric bupivacaine with 0.5ml saline (Control) or 0.5ml dexmedetomidine: 5mcg (D1), 10mcg (D2), 15 mcg (D3) and 20mcg (D4). Data were collected for 10 point VRS for pain, Bromage motor block, Ramsay sedation score, haemodynamics, time of first rescue analgesia (TRA) and any adverse effects and groups were analysed using one way analysis of variance (ANOVA) by SPSS16.0 (p-value <0.05 significant). RESULTS: The mean duration of analgesia and need of first rescue analgesics are 201.5±29.1 mins in control group but in D1 group 259.1±15.2 mins, D2 310.7±48.1mins, D3 540.3±51.6 mins and D4 702.4±52 mins. p=0.003. The mean highest VRS score along with analgesic requirements were significantly reduced in dexemeditomidine groups, but D3 and D4 had hypotension which needed correction. CONCLUSION: Weighing the prolongation of anesthesia and analgesia and side effects we conclude that 10 mcg of dexmedetomidine is optimum intrathecal dose.

Dexmedetomidine in current anaesthesia practice- a review.

Dexmedetomidine is an alpha 2 adrenergic receptor agonist, even ten times more selective than clonidine. It is a very versatile drug in anaesthesia practice, finding place in increasing number of clinical scenarios and is no more limited to intensive care unit (ICU) sedation. It is analgesic, has anaesthetic sparing effect, sympatholytic property, useful in other procedural sedation and also has cardiovascular stabilizing property. It reduces delirium and preserves respiratory function which adds benefits to its uses. The aim of this review is to make awareness of its role in present anaesthesia and discuss its limitations at the same time.