ABSTRACT
Background: Transmuscular Quadratus Lumborum Block (TQLB) is a newer modality for postoperative pain management. But, its efficacy after laparoscopic colorectal surgery is little researched. The aim of our trial was to access the analgesic efficacy of TQLB in colorectal surgery.Methods:This study was done in 64 patients posted for colorectal surgery who were divided into two groups of 32 each. TQLB was given bilaterally in group RQ with 20 ml of 0.375% ropivacaine and in group SQ with 20 ml saline. Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary endpoint. Secondary endpoints were total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications.Results:The time required for first analgesic demand was 3.9� 0.8hrs in RQ group and 0.1� 0.2 hrs in group SQ which was statistically significant. The total paracetamol consumption in 24 hours was1.2� 0.4 gm in group RQ and 2.9� 0.7gm in group SQ ,the difference being remarkable.Conclusion:Transmuscular quadratus lumborum block can produce quality analgesia after laparoscopic colorectal surgery. TQLB not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.
ABSTRACT
EHPVO more commonly involves children from the lower socioeconomic strata in developing countries. Variceal bleeding is the most common presentation.. Management with endoscopic means provide temporary palliation. It is believed that surgery carries high mortality and rebleeding rates and is followed by portosystemic encephalopathy and postsplenectomy sepsis. However, a proximal splenorenal shunt is a definitive procedure that may be more suitable for children, particularly in those who have limited access to medical facilities.Our aim was to evaluate the results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction. Methods: Between Aug 2017 & Jan 2019, we performed 20 elective proximal splenorenal shunts for EHPVO in the Department of Surgical Gastroenterology, SCB Medical College, Cuttack. Outcome was evaluated in term of rebleeding, encephalopathy, and pneumococcal infection. Results: Rebleeding occurred in 4 cases, pneumococcal infection & encephalopathy was detected in one patient & one patient died during follow up. Conclusion: A proximal splenorenal shunt, a one-time procedure with a low mortality rate and good long-term results, is an effective treatment for children in India with extrahepatic portal venous obstruction.