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Background and Aims: Laparoscopic cholecystectomy (LC) is a widely accepted surgical procedure associated with postoperative pain. This study was done to compare peripheral nerve stimulator (PNS)-guided serratus anterior plane block (SAP) and transversus abdominis plane (TAP) block for postoperative analgesia for patients undergoing LC. Methods: Following approval from the ethical committee, 70 patients for LC were randomly assigned to Group S: SAP block and Group T: TAP block. The blocks were performed under PNS guidance, and 20 ml of 0.375% ropivacaine was administered. The severity of pain was measured using a visual analogue scale (VAS). The study's primary objective was the evaluation of the postoperative VAS score. The time of the first dose of rescue analgesia and total tramadol consumption for 24 h postoperatively were secondary objectives. All the statistical calculation was done using statistical analyses for Social Sciences for Windows version 23.0 (IBM Corp, NY, USA). Results: Lower VAS score was seen in patients of TAP block at rest as well as movement at 6 h (P = 0.001), 12 h (P = 0.001) and 18 h (P = 0.001) postoperatively compared with SAP. The TAP group showed a significantly increased time of first rescue analgesic compared to the SAP group (7.97 ± 0.51 vs. 5.89 ± 1.45, P = 0.001). Tramadol usage was significantly higher in the SAP group than in the TAP group (128.9 ± 36.22 vs. 72.43 ± 44.80, P = 0.001). Conclusion: TAP block guided by the PNS improves postoperative pain with less tramadol consumption and during the postoperative period without significant complications.
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Context: The context of the study is to compare and find better muscle relaxant between rocuronium and vecuronium for intubation and maintenance under general anesthesia in patients undergoing laparoscopic cholecystectomy. Aims: The aim of the study is to measure intubating condition, hemodynamic changes during intubation and also during maintenance of general anesthesia and to record complications, if any. Settings and Design: A prospective clinical study conducted in the Department of Anesthesiology in tertiary care center. Materials and Methods: A total of 100 patients of the American Society of Anesthesiologists Classes Grade I and II were planned for laparoscopic cholecystectomy were divided into two groups of 50 each. The subjects in the control and study group were put under anesthesia using injection propofol 2.0 mg.kg-1 along with injection vecuronium 0.10 mg.kg-1 and injection propofol 2.0 mg.kg-1 along with injection rocuronium 0.60 mg.kg-1, respectively. Hemodynamic monitoring and oxygen saturation (SPO2) were recorded at various intervals. Statistical Analysis Used: All the collected data were imported into Microsoft Excel, and the statistical analysis was done by using SPSS 25.0 version. Results: The mean heart rate before and after carboperitoneum at different time intervals and before and after extubation was significantly lower in vecuronium group. The mean systolic blood pressure and mean arterial pressure at 1 and 5 minutes after extubation were significantly more among vecuronium group. Conclusions: Rocuronium is reasonably cardiostable, produces excellent intubation conditions, has a shorter duration of action, and shows minimal cumulative effect.
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BACKGROUND: Clonidine is a commonly used agent for premedication through oral, intravenous, and intramuscular route. Very few studies mentioned intramuscular clonidine as premedication. AIMS AND OBJECTIVES: The aim of the present study is to compare oral and intramuscular clonidine as predication agent in bupivacaine spinal anesthesia patients. MATERIALS AND METHODS: In our study, recruited patients were randomly allocated in three groups of 32 each. All patients received intrathecal bupivacaine heavy 3 mL with oral 150 µg clonidine in Group 1, intramuscular 150 µg clonidine in Group 2, and oral placebo tablet in Group 3 1 h before taking the patient in operation theater. We have assessed for duration of sensory block, duration of motor block, duration of analgesia, sedation score, and hemodynamic changes in groups. STATISTICAL ANALYSIS: The parametric data were expressed as mean ± standard deviation. Primary analysis of parametric data between the two groups was done by student's t-test, and among three groups, analysis of variance was used. RESULTS: Duration of motor block was found significantly high in Group 2 than Group 1 (208.06 ± 9.48 vs. 200.25 ± 9.42; P < 0.05). Duration of sensory block was also found significantly high in Group 2 than Group 1 (219.69 ± 9.44 vs. 210.25 ± 9.68; P < 0.05). Time to give first dose of analgesia was also found greater in Group 2 than Group 1 (234.66 ± 11.76 vs. 217.75 ± 10.09; P < 0.05). Sedation score and other side effects were found statistically nonsignificant between Group 1 and 2. CONCLUSION: We can conclude that preoperative intramuscular clonidine is a better alternate of oral clonidine for bupivacaine spinal anesthesia in terms of long duration of motor and sensory block and less requirement of analgesic with clinically insignificant side effects.
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Background and Aims: Hysterectomy, probably the most common non-pregnancy related surgery performed in gynaecology, is associated with moderate to severe post-operative pain. Wound infiltration with local anaesthetic agent reduces the transmission of pain from the wound, in addition, local inflammatory response to the injury is also suppressed. The infiltration of local anaesthesia can be done either pre- or post-operatively. The present study was designed to determine the efficacy of pre-incisional infiltration versus post-incisional infiltration with 0.25% Bupivacaine in providing post-operative pain relief in patients undergoing abdominal hysterectomy. Methods: In Prospective Interventional Randomised study, 90 female patients posted for elective abdominal hysterectomy under general anaesthesia were randomly allocated into three equal groups of 30 patients each. Group I: Patients receiving subcutaneous infiltration with 40 mL of 0.25% Bupivacaine 5 mins before skin incision. Group II: Patients receiving subcutaneous infiltration of surgical area with 40 mL of 0.25% Bupivacaine at end of surgery (after peritoneal closure). Group III Control Group: Patients receiving no local anaesthetic infiltration. Observations were made for the duration of effective analgesia from end of the surgery until the first use of rescue analgesic along with the frequency and cumulative amount of rescue analgesics in 24 hours. Results: We found that at baseline, pain score of patients in Group III (3.87±1.17) was maximum followed by that in Group I (2.57±0.90) and minimum in Group II (2.20±0.61). Requirement of first analgesia was earliest in Group III (79.50±23.90 minutes) followed by Group I (136.83±13.16 minutes) and last in Group II (146.17±12.78 minutes), in addition, cumulative dose of analgesia was required by patients in Group III (152.50±36.76 mg) followed by that in Group I (132.50±37.80 mg) and minimum by that in Group II (115.00±38.06 mg). Conclusion: Subcutaneous infiltration of Bupivacaine either pre-incisional or post-incisional, helped to reduce the immediate post-operative pain intensity, delayed the first rescue analgesic requirement, reduced the post-operative dose and frequency of rescue analgesia. However, post-incisional intervention had an edge over pre-incisional intervention.