A randomized, controlled trial of comparison of a continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) using 0.2% ropivacaine for postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA).

BACKGROUND AND AIMS: Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine. MATERIAL AND METHODS: Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any. RESULTS: The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance. CONCLUSION: CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.

Oily fraction of Semecarpus anacardium Linn nuts involves protein kinase C activation for its pro-inflammatory response.

The oily fraction (non polar fraction-NPF) of S. anacardium (SA) significantly increased the expression of protein kinase C-delta (PKC-delta) in macrophages in concentration dependent manner, which was similar to phorbol myristate acetate (PMA) response. Further, H-7 (1-(5-isoquinolinesulphonyl)-2-methylpiperazine), an inhibitor of PKC significantly inhibited this NPF mediated response in a concentration dependent manner. In the post treatment kinetics, H-7 showed this inhibition only up to 6 min post NPF/PMA addition, but in similar condition, quercetin, a flavone with reported antioxidant property, showed this inhibition only up to 2 min. The results clearly suggest that oily fraction of SA nuts enhances the expression of PKC protein, which may be responsible for its reported pro-inflammatory property.

LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases.

BACKGROUND: Laryngeal mask airway (LMA) C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. METHODS: This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient's neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. RESULTS: Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%). Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec). Minor mucosal injury was noted in four patients. CONCLUSION: LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.

Enhanced antilipopolysaccharide (LPS) induced changes in macrophage functions by Rubia cordifolia (RC) embedded with Au nanoparticles.

In this paper, we have shown that gold nanoparticles (Au (NPs)) embedded in Rubia cordifolia (RC) matrix (RC-Au (NPs)) exhibit a high therapeutic value relating to its anti-inflammatory characteristics. It was prepared by utilizing the reducing properties of RC to convert HAuCl4 into Au (NPs). In order to compare its effectiveness, with respect to Au (NPs), the latter was synthesized separately by reducing HAuCl4 with lemon extract. These Au (NPs) along with RC-Au (NPs) were characterized by X-ray diffractometry (XRD), transmission electron microscopy (TEM), and UV-visible spectroscopy. The enhancement in anti-inflammatory characteristics was assessed as its inhibitory potential for lipopolysaccharide (LPS)-induced nitric oxide (NO) release, by rat peritoneal macrophages. The RC-Au (NPs) significantly enhanced its potential to inhibit NO release, which was reported in terms of inhibitory concentration for 50% inhibition (IC50=11.98 ng/ml), as compared to either RC extract (IC50=47 × 10(3)ng/ml) or to Au (NPs) (IC50=587.50 ng/ml).

Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication.

BACKGROUND: Clonidine has emerged as an attractive premedication desirable in laparoscopic surgery wherein significant hemodynamic stress response is seen. The minimum safe and effective dose of intravenous clonidine to attenuate the hemodynamic stress response during laparoscopic surgery has however not yet been determined. MATERIALS AND METHODS: This prospective, randomized, double-blind controlled study was conducted on 90 adults of ASA physical status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized to one of the three groups (n= 30). Group I received 100 ml of normal saline, while groups II and III received 1 µg/ kg and 2 µg/ kg of clonidine respectively, intravenous, in 100 ml of normal saline along. All patients received glycopyrrolate 0.004 mg/kg and tramadol 1.5 mg/kg intravenously, 30 min before induction. Hemodynamic variables (heart rate, systolic, diastolic, mean arterial pressure), SpO2, and sedation score were recorded at specific timings. MAP above 20% from baseline was considered significant and treated with nitroglycerine. RESULTS: In group I, there was a significant increase in hemodynamic variables during intubation pneumoperitoneum and extubation (P<0.001). Clonidine given 1 µg/kg intravenous attenuated hemodynamic stress response to pneumoperitoneum (P<0.05), but not that associated with intubation and extubation. Clonidine 2 µg/kg intravenous prevented hemodynamic stress response to pneumoperitoneum and that associated with intubation and extubation (P<0.05). As against 14 and 2 patients in groups I and II respectively, no patient required nitroglycerine infusion in group III. CONCLUSIONS: Clonidine, 2 µg/ kg intravenously, 30 min before induction is safe and effective in preventing the hemodynamic stress response during laparoscopic cholecystectomy.