Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

BACKGROUND AND AIMS: Erector spinae plane (ESP) block is an interfascial plane block given at the paraspinal region and provides effective visceral and somatic analgesia. Transversus abdominis plane (TAP) block is also an interfascial block that provides adequate somatic pain control. We conducted this study to compare the analgesic efficacy of ESP and TAP blocks with ropivacaine for 48 h after the cesarean section. MATERIAL AND METHODS: Sixty patients scheduled for elective cesarean section under spinal anesthesia, randomly divided into ESP block (n = 30) or TAP block (n = 30) groups. After completion of surgery, ultrasound-guided ESP or TAP block was given using 0.2% ropivacaine (0.2 ml/kg on either side). Postoperatively visual analogue scale (VAS) score and analgesic requirement of each patient was assessed at regular interval for 48 h by a blinded investigator. Statistical analysis was done using SPSS version 21. Student's t-test and Chi-square test were used for demographic and other data. RESULTS: ESP block provided prolonged analgesia compared to the TAP block, andthe mean time to first rescue analgesia was 43.53 h and 12.07 h, respectively (P < 0.001). The requirement for total analgesic was also significantly less in the ESP group compared to the TAP group (P < 0.001). CONCLUSION: ESP block provided prolonged analgesia with a significant decrease in analgesic requirement compared to TAP block and can be used as a standard technique for post-cesarean analgesia.

Diaphragmatic and Pulmonary Functions Following an Ultrasound-Guided Supraclavicular Approach Versus a Costoclavicular Approach of a Brachial Plexus Block: A Randomized Study.

INTRODUCTION: A costoclavicular brachial plexus block is an emerging infraclavicular approach that targets the cords lateral to the axillary artery, providing rapid onset of sensory-motor blockade. However, the incidence of hemi-diaphragmatic paralysis (HDP), a potential complication, remains unclear compared to the widely used supraclavicular (SC) approach. This study aimed to compare the incidence of HDP between ultrasound-guided costoclavicular and SC brachial plexus blocks. OBJECTIVES: To compare the influence of ultrasound-guided SC and costoclavicular brachial plexus blocks on diaphragmatic excursion, thickness, and contractility along with pulmonary function. MATERIALS AND METHODS:  This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing below-shoulder surgeries. Patients were randomized to receive either ultrasound-guided SC (Group S) or costoclavicular (Group C) brachial plexus block with 0.5% levobupivacaine. The diaphragmatic function was assessed using ultrasonographic evaluation of diaphragm thickness and diaphragmatic thickness fraction (DTF) pre- and postblock. Pulmonary function tests (PFTs) (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR)) were performed preblock and two hours postblock. Block characteristics were compared. RESULTS: The SC group exhibited a significantly larger reduction in DTF from preblock to postblock compared to the costoclavicular group (mean ΔDTF: 34.38% vs. 14.01%, p<0.01). Both groups showed significant declines in FVC, FEV1, and PEFR postblock, but the magnitude of deterioration was significantly greater in the SC group, displaying no significant difference in block characteristics. CONCLUSION: The costoclavicular brachial plexus block demonstrated superior preservation of diaphragmatic contractility and lesser deterioration of PFTs compared to the SC approach while being equally effective. These findings highlight the potential benefits of the costoclavicular technique in minimizing diaphragmatic dysfunction and respiratory impairment, particularly in patients at risk for respiratory complications.

Evaluation of Efficacy of Oral Ketamine and Midazolam Combination Drug in Different Doses in Different Groups Used for Moderate Sedation in Pediatric Dentistry Randomized-comparative Trial.

Background: Dental phobia and apprehension in children lead to difficulty with behavior management. During dental procedure if a child had a bad experience, he will develop greater apprehension, which makes further treatment difficult. Aim and objective: The aim and objective of the present study is to assess and compare the sedation and wake-up behavior status of oral combinations of three different doses of ketamine and midazolam drugs in three different groups mixed in 1 mL of honey. Methodology: This study was a randomized, clinical study that included patients ranging from 3 to 9 years of age with American Society of Anesthesiologists-I status with carious teeth, were randomly allocated among three groups where group (A) received 0.2 mg/kg of oral midazolam and 5 mg/kg oral ketamine combination drugs, group (B) received 0.3 mg/kg of oral midazolam with 3 mg/kg of oral ketamine combination drugs and group (C) received 0.4 mg/kg of oral midazolam with 2 mg/kg of oral ketamine combination drugs mixed in 1 mL of honey.Child patient's who fulfilled the inclusion criteria, heart rate, blood pressure, and oxygen saturation was recorded from starting of the treatment until discharged from the monitoring room. Ease of treatment completion was evaluated according to the Houpt scale, patients' behavior, sedation, and wake-up behavior status were evaluated with modified observer assessment of alertness and sedation scale (MOAAS). Results: In the study, various doses of ketamine-midazolam combination drugs in three different groups resulted in a clement increase in heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) during the procedure but variations among the groups were not significant. As per MOAAS, the sedation success rate in group B (83.3%) was more than group A (66.6%) and group C (66.6%).All the three groups equally showed the same i.e., (91.6%), behavior score during treatment. Ease of treatment completion was excellent in group B (83.3%) followed by group A and group C [i.e.], (66.7%). Whereas, wake-up behavior score as per MOAAS scale was found to be calm and cooperative in group B (91.7%) followed by group C (88.9%) and group A (83.3%). Conclusion: In the present study oral ketamine-midazolam combination drugs can be used without harm and effectively as moderate sedation in an uncooperative pediatric patient. How to cite this article: Thakur S, Verma K, Singhal P, et al. Evaluation of Efficacy of Oral Ketamine and Midazolam Combination Drug in Different Doses in Different Groups Used for Moderate Sedation in Pediatric Dentistry Randomized-comparative Trial. Int J Clin Pediatr Dent 2021;14(S-2):S151-S156.

Erector spinae plane block for complete surgical anaesthesia and postoperative analgesia for breast surgeries: A prospective feasibility study of 30 cases.

BACKGROUND AND AIMS: Several regional anaesthesia techniques have been described for carcinoma of the breast surgeries in the past but all of them failed to provide adequate surgical anaesthesia and are associated with multiple complications, thus limiting their use. This prospective study was designed to assess the efficacy of erector spinae plane (ESP) block to provide complete surgical anaesthesia without general anaesthesia (GA) and postoperative analgesia in patients undergoing modified radical mastectomy (MRM) surgery. METHODS: Thirty females of the American Society of Anaesthesiologists physical status I, II or III scheduled for MRM were included in the study to receive unilateral ultrasound-guided ESP block preoperatively (25 ml of 0.5% bupivacaine with dexamethasone 8 mg on the operating side). The primary objective of the study was to evaluate the efficacy of ESP block to provide complete surgical anaesthesia in terms of total number of cases converted to GA. RESULTS: Our study shows that ultrasound-guided single-shot ESP block provided complete surgical anaesthesia in all the patients within an average of 31.50 minutes and an average long-lasting postoperative analgesia of 41.73 hours following MRM. CONCLUSION: Our study proves that ESP block is a novel, predictable, secure, and safe option for carcinoma of the breast surgery. Thus, ESP block would surely provide a clinical advantage in these population group.

Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial.

BACKGROUND AND AIMS: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS. METHODS: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test. RESULTS: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times. CONCLUSION: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.

Characterizing Antibody Responses to Plasmodium vivax and Plasmodium falciparum Antigens in India Using Genome-Scale Protein Microarrays.

Understanding naturally acquired immune responses to Plasmodium in India is key to improving malaria surveillance and diagnostic tools. Here we describe serological profiling of immune responses at three sites in India by probing protein microarrays consisting of 515 Plasmodium vivax and 500 Plasmodium falciparum proteins with 353 plasma samples. A total of 236 malaria-positive (symptomatic and asymptomatic) plasma samples and 117 malaria-negative samples were collected at three field sites in Raurkela, Nadiad, and Chennai. Indian samples showed significant seroreactivity to 265 P. vivax and 373 P. falciparum antigens, but overall seroreactivity to P. vivax antigens was lower compared to P. falciparum antigens. We identified the most immunogenic antigens of both Plasmodium species that were recognized at all three sites in India, as well as P. falciparum antigens that were associated with asymptomatic malaria. This is the first genome-scale analysis of serological responses to the two major species of malaria parasite in India. The range of immune responses characterized in different endemic settings argues for targeted surveillance approaches tailored to the diverse epidemiology of malaria across the world.

Evaluation of the use of complementary and alternative medicine in the largest United States-Mexico border city.

STUDY OBJECTIVE: To evaluate the use of complementary and alternative medicine (CAM) in the El Paso, Texas, region. DESIGN: Prospective observational study conducted from April-October 2000. SETTING: Several hospitals and clinics. SUBJECTS: Five hundred forty-seven participants. INTERVENTION: Semi-structured interview with a bilingual questionnaire. MEASUREMENTS AND MAIN RESULTS: Complementary and alternative medicine was used in 77% of our population. The most common CAM providers were massage therapists (19.4%) and herbalists (12.4%). The most common herbal or home remedies were chamomile (13.1%) and aloe vera (8.5%). The most common nutritional or commercial products were multivitamins (16%), ginseng (3.6%), and ginkgo biloba (2.8%). We identified 599 CAM usages that could result in drug interactions, disease interactions, or adverse reactions. CONCLUSIONS: A wide range of CAM use was documented in this study. Our results indicate that Hispanics in this area use CAM at a higher rate than national trends. Many of these therapies can adversely affect a variety of disease states and drug therapies.