Enhanced Recovery After Surgery Protocol in Emergency Laparotomy: A Randomized Control Study.

Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) protocols in elective surgeries but its effectiveness in emergency surgeries has been nominally studied. We aimed at studying the feasibility and effectiveness of ERAS protocols in patients undergoing emergency abdominal surgery for intestinal perforation and small bowel obstruction and compare their surgical outcomes with conventional care. Materials and methods This prospective randomized study was performed for a period of 16 months. A total of 100 patients presenting either with intestinal perforation or acute small bowel obstruction were recruited; 50 each in the ERAS and the conventional care groups. The primary outcomes studied were the postoperative length of stay and 30-day morbidity and mortality. Results It was seen that the median (interquartile range) of the duration of hospital stay in the ERAS group was 4 (1) days while it was 7 (3) days in the conventional care group, which was statistically significant (W = 323.000, p ≤ 0.001). Similarly, postoperative morbidities like a chest infection and surgical site infections) were significant in the conventional care group. Conclusion The ERAS protocols are safe and effective in emergency surgeries and result in a better postoperative outcome.

Analgesic Effect of Intra-articular Morphine or Dexmedetomidine Added with Levobupivacaine in Arthroscopic Knee Surgeries - A Comparative Evaluation.

INTRODUCTION: Knee arthroscopy is associated with variable amount of postoperative pain. In an attempt to improve postoperative analgesia, intra-articular injection of local anaesthetic in combination with other agent have been studied. However, the best combination is not known. AIM: To compare the analgesic efficacy of intra-articular injection of morphine and dexmedetomidine when added with levobupivacaine in arthroscopic knee surgeries. MATERIALS AND METHODS: Seventy eight patients, scheduled to undergo elective arthroscopic procedure under spinal anaesthesia were recruited for the study. All the patients received 18 ml of 0.25% levobupivacaine however in addition to this Group M patients received 8 mg (2 ml) morphine, Group D patients received 100µg (2 ml) of dexmedetomidine while Group C patients received 2 ml of isotonic saline intra-articularly. Postoperatively the intensity of pain was assessed using Numerical Rating Scale (NRS). Rescue analgesia was given at NRS ≥ 4. The duration of analgesia and total diclofenac consumption was noted. RESULTS: The mean duration of analgesia was longest in Group M (576.20±67.09 minutes) followed by Group D (460.93±38.95 minutes) and Group C (370.27±58.80 minutes) statistically this difference was found to be highly significant (p-value < 0.001). Total consumption of diclofenac in 24 hours was found lowest in group M (86.25±27.48 mg) followed by group D (110.87±44.48 mg) and group C (141.35±44.13 mg) this difference was found to be highly significant (p-value < 0.001). CONCLUSION: Morphine when added with levobupivacaine in patients undergoing arthroscopic knee surgery improves the quality and prolongs the duration of postoperative analgesia.

In Spinal Anaesthesia for Cesarean Section the Temperature of Bupivacaine Affects the Onset of Shivering but Not the Incidence: A Randomized Control Trial.

INTRODUCTION: Postoperative shivering is a frequent event after cesarean section under spinal anaesthesia. Shivering is uncomfortable for the patient and may interfere with monitoring. The exact aetiology of shivering is unknown and therefore has no definite treatment. AIM: The temperature of injectate affects the spread of drug and so its effect. Therefore the aim of this study was to compare the effect of temperature of bupivacaine on post-spinal shivering in cesarean section. MATERIALS AND METHODS: In this prospective, randomized, controlled, double-blind clinical trial 105 ASA-I/II pregnant women scheduled for caesarean section under spinal anaesthesia were selected and randomized into three groups of 35 each. In all pregnant women spinal anaesthesia was achieved with 2.2 ml of 0.5% hyperbaric bupivacaine given either at L3-L4 or L4-L5 interspace. The temperature of bupivacaine was adjusted to 4°C (group T4), 22°C (group T22) and 37°C (group T37). Shivering characteristic, onset and incidence was noted. All three groups were compared using analysis of variance (ANOVA), adverse effects was compared using chi-square test and Kruskal-Wallis H-test. The p-value < 0.05-considered as significant and p-value <0.01-considered highly significant. RESULTS: There were no differences between the groups regarding age, weight, height, amount of fluid used and blood loss. The incidence of shivering was 51.42%, 51.42% and 45.71% in group T4, group T22 and group T37 respectively, this difference in the incidence was statistically not significant (p=0.858). However, the onset of shivering was earliest (9.87±1.82 min) in group T4 as compared to 14.27±3.02 min and 12.16±2.89 min in group T22 and group T37 respectively and this difference in the onset was highly significant (p= 0.0001). CONCLUSION: In spinal anaesthesia for cesarean section, the temperature of bupivacaine does not influence the overall incidence of post spinal shivering; however cold bupivacaine can provoke early onset of shivering.