Manpreet Singh

Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine

The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg−1 with pethidine 0.5 mg.kg−1 for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. Tramadol in doses of 1, 2 and 3 mg.kg−1, pethidine 0.5 mg.kg−1 or normal saline were administered at the time of wound closure. All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg−1 had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.

Cubitus varus: problem and solution

Abstract A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15° or more, with 5 having more than 30° of varus. The osteotomy was fixed by three different methods. In 8 cases the osteotomy was fixed with 2 parallel Kirschner wies (group K). A modified French technique (group TBW) was used in 25 cases and held with a figure-of-8 wire loop tightened over the screw heads. In the last 6 cases the osteotomy was fixed with an external fixator (group EF). The only poor result (i.e. loss of carrying angle of more than 10° and loss of flexion and extension of 20° or more) was in group K due to pin tract infection and loosening of the K-wires. In the TBW group 5 patients lost some degree of correction, and none became infected. In the EF group no patient suffered pin tract infection or loss of correction. Based on our experience and results, we feel that the best age at which to correct cubitus varus deformity was 6–11 years and that the external fixator is a safe, effective and reliable method to fix the osteotomy. We propose this method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required, can also be performed. It also avoids a second operation for implant removal.

Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain

epiglottis/glottis/hypopharynx could not be seen and the straight end of the gum-elastic bougie was directed blindly and without resistance along the right posterior pharyngeal wall until the distal portion was 10 cm beyond the laryngopharynx. A size 5 ProSeal LMA was railroaded into position along its drain tube and the cuff inflated with 20 mL of air. Ventilation, however, was impossible with high airway pressures and airway obstruction. The proposed algorithm was followed, but the mechanical obstruction tests and recommended manoeuvres failed to solve the problem. Remembering that ‘whatever remains, however improbable, must be the truth’, the gum-elastic bougie was advanced and resistance was encountered after approximately 10 cm, indicating tracheal placement. The ProSeal LMA was rapidly exchanged for a tracheal tube, which passed easily along the bougie and provided unobstructed ventilation once the bougie was removed. The lowest SPO2 was 94% and there were no other problems. An alternative solution would have been to reinsert the bougie along the left posterior pharyngeal wall to reposition it in the oesophagus. Based on an audit of our experience with the gum-elastic bougie-guided technique during routine use, we estimate that the frequency of inadvertent tracheal placement is around 1 : 5000. In principle, inadvertent tracheal placement is more likely in the difficult airway scenario, as the hypopharynx may not been seen at laryngoscopy. The proposed algorithm has been modified to accommodate this rare but important scenario (Fig.).

Intravenous Dexamethasone Causes Perineal Pain and Pruritus

Background: Dexamethasone has been used for postoperative nausea and vomiting (PONV). Single dose dexamethasone in premedication does not cause any side effect. During our previous published study conducted on effect of dexamethasone for PONV, an unusual side effect of excruciating pain and perineal itching immediately following administration of this drug was observed. The present prospective incidence study was conducted in tertiary hospital of East Delhi, India to find out incidence and management of severe perineal pain and perineal pruritus immediately post-administration of dexamethasone. Methods: 30 ASA 1 or 2 males (Group 1) and 30 ASA 1 or 2 females (Group 2) patients were selected to find incidence and intensity of pain after dexamethasone administration in both sexes posted for routine ophthalmologic, ENT and gastrointestinal surgeries. An intravenous canula (18 G) was inserted ringer lactate fluid was started. Dexamethasone in dose of 0.15 mg/kg was administered (after dilution with normal saline to 5 ml volume) along with i.v. fluid. Immediately patients were asked for any discomfort, pain/pruritus. Onset of pain & duration of pain was noted. Intensity of pain was assessed with 11 point Numeric pain scale and Simple descriptive pain intensity scale and Chi-Square test was applied with P value of <0.05 was considered as significant. Any other adverse effect was noted, if any. Results: Seventy percent male patients suffered no pain as compared to 43.3% female patients (p<0.05). Only 30% male patients had suffered pain as compared to 56% female patients with similar perineal pruritus incidence and similar mean pain/pruritus onset time. The mean duration of persistence of pain was 23 seconds and 29 seconds in group 1 and 2 respectively. Conclusion: Perineal itching or excruciating pain in patients receiving dexamethasone is more common in female patients with incidence more than 55%. The pain subsides on its own without any treatment.

Femorosciatic nerve block for lower limb orthopedic surgeries

Abstract Femorosciatic block is an important peripheral nerve block that can be used in surgeries of lower limb. The present study was conducted to evaluate the efficacy of femorosciatic nerve block via posterior approach for lower limb orthopedic surgeries. A total of 40 ASA grade I or II patients were taken for this prospective double-blind study. Various orthopedic surgeries were selected and femoro-sciatic blocks were made. Adequate amount of drug was injected, and effect was evaluated via pin-prick method. The extent of sensory blockade of both nerves, success rate, and intensity of pain were measured. The success of block was observed in 90% patients, and only 4 patients required supplementation of analgesia or general anesthesia. Femorosciatic blockade is an effective and safe technique for lower limbs orthopedic surgeries.

Comparison of efficacy of epidural fentanyl and pentazocine for lower limb orthopedic surgeries

Abstract Epidural opioids have been recently used for postoperative pain relief. The present study was conducted for comparing the efficacy of analgesia produced by epidural pentazocine and fentanyl for lower limb surgeries. In this prospective double-blind study, 60 patients of either sex belonging to ASA grade I and II, aged 20-60 years were equally divided into two groups to receive either 50μg fentanyl + 20 mL of 0.5% bupivacaine (Group I) or 30 mg pentazocine + 20 mL of 0.5% bupivacaine (Group II) epidurally for the lower limb orthopedic surgeries. Patients were observed for onset, duration, and potency of analgesia with both the drugs besides side effects. Both the drugs produced significant analgesia (assessed by Magills classification of degree of pain). Onset of analgesia was similar for both the drugs, but pentazocine showed significant longer duration of action than fentanyl. The incidence of side effects was also similar for both the drugs. Epidural pentazocine provides longer duration of analgesia than epidural fentanyl with similar side effects.