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Background and Aims: Recommendations on paediatric single-injection local anaesthetic (LA) dosing for peripheral nerve blocks (PNBs) are based on the children's weight and limited by weight-based toxicity concerns. In this study, we assessed the extent of circumferential spread and block characteristics following the injection of an age-based volume (age in years = LA volume) of 0.25% bupivacaine following popliteal sciatic nerve block (PSNB). Methods: Thirty children aged between 2 and 12 years with the American Society of Anesthesiologists (ASA) physical status I and II and undergoing foot and ankle surgical procedures were given single-injection ultrasound-guided subparaneural PSNB using 0.25% bupivacaine at age-based LA volume after the administration of anaesthesia. The circumferential pattern of LA spread (primary objective) was assessed along the nerve (both cephalad and caudal) using ultrasound from the point of administration and the block characteristics in terms of duration of sensory block. Results: The mean [standard deviation (SD)] cephalic circumferential LA spread distance was 2.52 (0.68) [95% confidence interval (CI): 2.27-2.76] cm. The mean (SD) caudal circumferential LA spread distance was 2.27 (0.48) [95% CI: 2.09-2.44] cm. The mean (SD) duration of the sensory block was 9.03 (0.97) [95% CI: 8.67-9.38] h. Conclusion: The age-based LA volume of bupivacaine for ultrasound-guided PSNB resulted in a longitudinal circumferential spread of around 4.7 cm (adding both cephalic and caudal spread) and provided adequate analgesia for nine postoperative hours.
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Background and Aims: The safety of conventional regional nerve block techniques in patients with established neuropathies, such as diabetic peripheral neuropathy (DPN), is still unclear. We designed this prospective dose finding study to identify the minimum effective local anaesthetic volume of 0.5% bupivacaine for ultrasound-guided subparaneural popliteal sciatic nerve block in 90% of DPN patients undergoing below-knee surgery (MELAV90). Methods: Fifty-three patients with diabetic peripheral neuropathy and scheduled for below knee surgical procedure received popliteal sciatic nerve block under ultrasound guidance. The initial local anaesthetic volume used was 10 ml of 0.5% bupivacaine. The subsequent local anaesthetic volume allocation was based on biased-coin-design. Accordingly, the local anaesthetic volume given to each subject was based on the block outcome of the previous patient. The study included patients prospectively until 45 successful blocks were obtained. The primary measurement was the minimum effective local anaesthetic volume resulting in a successful subparaneural popliteal sciatic nerve block in 90% of DPN patients. The MELAV90 was calculated using isotonic regression and a 95% confidence interval bootstrapping method. Results: The study included 53 patients to obtain 45 successful blocks. The MELAV90 of 0.5% bupivacaine was obtained at 5.85 ml (95% confidence interval, 5.72 to 6.22 ml). Eight patients needed supplemental anaesthesia to complete the surgery. No other complications were noted. Conclusion: For patients with diabetic peripheral neuropathy undergoing below-knee surgery, the MELAV90 of 0.5% bupivacaine for subparaneural popliteal sciatic nerve to achieve surgical anaesthesia was 5.85 ml.
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Background and Aims: The efficacy of bilateral nasociliary and maxillary nerve blocks combined with general anaesthesia on intraoperative opioids consumption, emergence and recovery outcomes in adult patients is not well established. We conducted this study to test the hypothesis that the above blocks, combined with general anaesthesia, decrease the intraoperative opioid consumption following nasal surgery. Methods: In this prospective, double-blinded, randomised controlled study, 51 adult patients undergoing elective nasal surgery under general anaesthesia were randomised into one of two groups. Group A (n = 26) received bilateral nasociliary and maxillary nerve blocks with 12 mL of equal volumes of 0.5% bupivacaine and 2% lignocaine after induction of general anaesthesia. Group B (n = 25) did not receive any block (control group). The primary endpoint was the total intraoperative dose of fentanyl consumed. The secondary endpoints were the grade of cough, emergence agitation, the grade of post-operative nausea and vomiting, time to the first analgesia and time to post-anaesthesia care unit discharge. Results: The mean total intraoperative fentanyl dose (µg) was significantly lower in group A than in group B (2.31 ± 11.76 vs. 41.20 ± 31.00, P = 0.00). The incidence of emergence agitation was lower in group A than group B (11.5% vs. 88%, P = 0.00). The time to the first analgesia was significantly longer in group A than group B (543.27 vs. 199.84 min, P = 0.017). Conclusion: The pre-emptive administration of bilateral nasociliary and maxillary nerve block for nasal surgery is an effective technique for reducing the intraoperative dose of fentanyl and emergence agitation.
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BACKGROUND: Electroconvulsive therapy (ECT) is a widely used treatment modality for mental disorders such as major depression, bipolar affective disorder (BPAD) and catatonia. However, it is considered as one of the most controversial and misunderstood procedures, especially among caregivers. METHODS: An experimental pre-test, post-test design was adopted. Forty caregivers of persons with schizophrenia (n = 12), depression (n = 13), BPAD with mania (n = 8), and BPAD with depression (n = 7) were selected using convenience sampling. The caregiver's knowledge and attitude toward ECT were assessed before and after the intervention with a single session video-assisted teaching on ECT. The data collection tool used to assess the caregiver's knowledge and attitude was based on a pre-validated questionnaire. RESULTS: The pre-test evaluation demonstrated poor knowledge among 12 (30%) and a moderate level of knowledge on the remaining 28 (70%) of the study subjects. The attitude scores revealed a neutral attitude among 47.5% and a conservative attitude among 10% of the subjects toward ECT. There was a significant improvement in both mean (±SD) knowledge (13.4 ± 4.7 vs 25.6 ± 2.9) and attitude (10.7 ± 3.5 vs 14.6 ± 3.9) scores following intervention with video-assisted teaching. CONCLUSION: A single session involving video-assisted teaching improves the knowledge and attitude toward ECT among caregivers by removing the myths and misconceptions about ECT.
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BACKGROUND AND AIMS: Anaesthetics are implicated in cognitive dysfunction, taste and odour deficits in the postoperative period. We aimed to assess the effect of isoflurane, sevoflurane, propofol and regional anaesthesia on the olfactory threshold, olfactory identification and endocrine regulation of associative memory in the postoperative period. METHODS: In this observer-blinded randomised controlled study, 164 patients (>50 years) with the American Society of Anesthesiologists I and II status were randomised into one of four groups to receive regional anaesthesia, general anaesthesia with sevoflurane, general anaesthesia with isoflurane and total intravenous anaesthesia with propofol. Hindi Mental State Examination, olfactory threshold and olfactory identification were tested at 12 h preoperatively (T0), at 3 h postoperatively (T1) and at the time of discharge or postoperative day 3 (T2). In addition, serum melatonin levels were estimated at T0 and T1. The olfactory threshold was tested with n-butyl alcohol and olfactory identification with the University of Pennsylvania Smell Identification Test (UPSIT). Data were analysed using the one-way analysis of variance, Kruskal-Wallis or Mann-whitney tests. RESULTS: The olfactory identification scores were lower with patients receiving sevoflurane-based anaesthesia at 3 h postoperatively (T1) when compared to preoperative (T0) (median 19.5 vs. 22; P = 0.01). This was accompanied by a significant postoperative reduction of plasma melatonin levels in sevoflurane group when compared to other groups (17.34 ± 4.8 pg/ml vs 23.2 ± 3.5 pg/ml; P < 0.001). CONCLUSION: Sevoflurane was associated with short-term olfactory identification impairment with a concomitant reduction in melatonin levels illustrating a possible humoral mechanism.