Ultrasound versus Nerve Stimulator Guided Obturator Nerve Block in Patients Undergoing Transurethral Resection of Bladder Tumor.

BACKGROUND: Urinary bladder cancer is more common in geriatric population. Transurethral resection of bladder tumor remains the mainstay of treatment. It is usually performed under subarachnoid block. However, obturator nerve is spared in subarachnoid block that can produce adductor jerk, which is associated with bladder injury, rupture, incomplete resection of tumor and hematoma. To overcome this jerk, selective obturator nerve block is commonly performed. Thus, we conducted this study to compare the efficacy of ultrasound and nerve stimulator-guided techniques for obturator nerve block. METHODS: This is a prospective, comparative study conducted at a tertiary care hospital in Nepal. Sixty patients, scheduled to undergo Transurethral Resection of Bladder Tumor for lateral and posterolateral wall bladder cancer under subarachnoid block were enrolled and divided into two group having thirty patients in each groups. Group I received 15 ml of 0.25% Bupivacaine to block obturator nerve by using peripheral nerve stimulator. Group II received the same amount of Bupivacaine to block obturator nerve under ultrasound guidance. We evaluated the success of the block, ease of the procedure and complications. RESULTS: The adductor reflex was present in 23.33% of cases with nerve stimulator guided obturator nerve block, whereas, it was16.66% in ultrasound guided technique (p=0.75). The success rate of obturator nerve block was 76.66% in nerve stimulator guided technique, whereas 83.33% in ultrasound guided technique (p= 0.21). 83.33% of obturator nerve block was found to be easy in nerve stimulator guided technique, whereas 66.66 % in ultrasound guided technique (p = 0.14). There were no major complications noted. CONCLUSIONS: The findings of this study conclude that both ultrasound and nerve stimulator guided techniques equally abolished the adductor reflexes. Both techniques are easy to perform and safe.

Solitary rectal ulcer syndrome in a young adult - A surgeon's dilemma with rectal carcinoma.

The presentation of solitary rectal ulcer syndrome is very similar to a wide variety of conditions including inflammatory bowel diseases, ischemic colitis and rectal carcinoma. Histopathological examination comes as an important tool for its diagnosis. Hence, high index of suspicion is required for early diagnosis of this rare condition.

Subarachnoid Block in Prone Position for lower limb surgery.

Subarachnoid block is a safe and effective regional anesthesia technique. It is usually carried out in sitting or lateral position but it can also be performed in prone position. Here we report two cases of flame burn over bilateral gluteal region extending to the posterior and lateral aspect of both thighs, who were planned for debridement and split skin grafting. Both patients had difficulty in siting and lying on either side of lateral position. We had administered subarachnoid block in prone position taking into consideration of patient's comfort and the nature of the procedure. Both patients remained hemodynamically stable throughout the procedure and their post-operative periods were uneventful. Keywords: Burn; prone position; subarachnoid block.

Analgesic Effect of Caudal Bupivacaine with or without Clonidine in Pediatric Patient.

BACKGROUND: Caudal analgesia has long been the cornerstone to successful pain management in children undergoing abdominal and lower limb surgeries. Its analgesic duration with single shot injection is however limited. So adjuvants are used with local anesthetics in an attempt to increase the duration of caudal analgesia. This study aims to investigate the duration of analgesia provided by Clonidine when added to caudal Bupivacaine. METHODS: A randomized, double blinded, comparative study was conducted on 64 patients, aged two to seven years, scheduled for unilateral inguinal hernia repair. Patients were randomly allocated into two groups of 32 each, with group A receiving bupivacaine two milligram/kilogram and group B receiving bupivacaine two milligram/kilogram with one microgram/kilogramclonidine, (total volume of injectate was one milliliter/kilogram). Duration of analgesia, hemodynamic response and adverse effects, if any were noted. RESULTS: Mean duration of analgesia in group A was 264.12 ± 68.77 minutes and in group B was 520 ± 57.37 minutes, p-value <0.001.Incidence of vomiting was 9% in group A compared to 6% in group B. CONCLUSIONS: Clonidineas an adjuvant to caudal bupivacaine prolongs the duration of analgesia without increasing the adverse effects.