Nidhi Panda

Brachial plexus block with midazolam and bupivacaine improves analgesia.

PurposeAdjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anesthetics when given epidurally or intrathecally. The purpose of this study was to assess the effect of midazolam added to brachial plexus anesthesia.MethodsA prospective, randomized, double blind study was conducted on 40 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 20) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 20) were given 30 mL of 0.5% bupivacaine with midazolam 50 μg·kg-1. Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hr postoperatively.ResultsThe onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Pain scores were significantly higher in Group B compared to Group BM from two hours to 24 hr postoperatively (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period.ConclusionMidazolam (50 μg·kg-1) in combination with 30 mL of bupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events. Objectif : Un ajout aux anesthésiques locaux pour le bloc du plexus brachial peut améliorer la qualité et la durée de ľanalgésie. Le midazolam, une benzodiazépine hydrosoluble, administré par voie péridurale ou intrathécale, produit de ľantinociception et améliore ľeffet des anesthésiques locaux. Nous avons évalué ľeffet du midazolam ajouté à ľanesthésie du plexus brachial.RésuméMéthodeUne étude prospective, randomisée et à double insu a été menée auprès de 40 adultes ďétat physique ASA I ou II devant être opérés aux membres supérieurs sous anesthésie supraclaviculaire du plexus brachial. Les patients ont été répartis aléatoirement en deux groupes. Ceux du groupe B (n = 20) ont reçu 30 mL de bupivacaïne à 0,5 % et ceux du groupe BM (n = 20) ont eu 30 mL de bupivacaïne à 0,5 % avec 50 μg·kg-1 de midazolam. Les variables hémodynamiques, les scores de douleur et les demandes ďanalgésiques de secours ont été notés pendant 24 h après ľopération.RésultatsLe délai ďinstallation du bloc sensitif et moteur a été significativement plus court chez les patients du groupe BM, comparé au groupe B (P < 0,05). De 2 h à 24 h après ľopération, les douleurs ont été plus importantes dans le groupe B (P <0,05) et les demandes ďanalgésiques de secours ont été moindres dans le groupe BM (P < 0,05). Après ľopération, ľhémodynamique et les scores de sédation ne différaient pas ďun groupe à ľautre.ConclusionLe midazolam (50 µg·kg-1) combiné à 30 mL de bupivacaïne (0,5 %) a accéléré ľinstallation du bloc sensitif et moteur et amélioré ľanalgésie postopératoire sans produire ďeffets indésirables lors du bloc du plexus brachial.

A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section

BACKGROUND Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. We therefore studied the effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia in patients with mild preeclampsia undergoing caesarean section. METHODS Sixty women with mild preeclampsia undergoing caesarean section were included in a prospective, double blind, placebo-controlled trial. Patients were randomly assigned to receive spinal anaesthesia with 2 mL 0.5% hyperbaric bupivacaine and 25 microg fentanyl with either 0.1 mL of 0.9% sodium chloride (control group) or 0.1 mL of 50% magnesium sulphate (50 mg) (magnesium group). Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesia requirements were studied. RESULTS The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (229.3 vs. 187.7 min) and motor block (200 vs. 175.3 min) were significantly longer in the magnesium group. Diclofenac requirement for 24 h following surgery was significantly lower in the magnesium group (147.5 vs.182.5 mg, P=0.02). Haemodynamic parameters and side effect profile were similar in the two groups. CONCLUSIONS In parturients with mild preeclampsia undergoing caesarean delivery, the addition of magnesium sulphate 50 mg to the intrathecal combination of bupivacaine and fentanyl prolongs the duration of analgesia and reduces postoperative analgesic requirements without additional side effects.

Comparison of propofol versus propofol-ketamine combination for sedation during spinal anesthesia in children: randomized clinical trial of efficacy and safety

Objectives:  This study was designed to compare the efficacy and safety of propofol vs propofol‐ketamine combination for sedation during pediatric spinal anesthesia.

Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients

STUDY OBJECTIVE To study the minimal effective dose of magnesium sulfate to control blood pressure (BP) during intubation in hypertensive patients. DESIGN Prospective, randomized, double-blind study. SETTING Operating room of an academic medical center. PATIENTS 80 adult, ASA physical status 1 and 2, controlled hypertensive patients undergoing elective surgery under general anesthesia and requiring endotracheal intubation. INTERVENTIONS Patients were randomized to 4 groups. Patients in study groups received a magnesium sulfate infusion at a dose of 30 (Group I), 40 (Group II), or 50 mg/kg (Group III) before induction of anesthesia, while patients in control group (Group IV) received a 1.5 mg/kg lidocaine bolus 90 seconds before intubation. Anesthesia was induced and maintained with a propofol infusion. Laryngoscopy and intubation were performed 4 minutes after administration of vecuronium. MEASUREMENTS Heart rate (HR) and BP were recorded before, during, and after endotracheal intubation for 10 minutes. Measures to manage hemodynamic instability were recorded. Serum magnesium levels were also recorded. MAIN RESULTS The changes in HR were comparable among groups. Mean arterial pressure (MAP) was maintained within normal limits in Group I patients while Groups II and III patients showed a significant decrease in MAP (P = 0.01) compared with baseline. A total of 6 patients (30%) in Group II and 10 patients (50%) in Group III required interventions (P = 0.001). No patient in Group I and only one patient (5%) in Group IV required intervention. CONCLUSIONS Magnesium 30 mg/kg is the optimum dose to control BP during intubation in hypertensive patients. A further increase in the dose of magnesium may cause significant hypotension.

Comparison of Small Dose Ketamine and Dexmedetomidine Infusion for Postoperative Analgesia in Spine Surgery--A Prospective Randomized Double-blind Placebo Controlled Study.

Background: High doses of opioids are frequently used to treat postoperative pain after spine surgery. This leads to opioid-related side effects like nausea, vomiting, respiratory depression, etc. The current study is an attempt to find a safe analgesic adjuvant, which will afford opioid sparing property. Method: Sixty-six patients undergoing spine surgery were randomized into 1 of the 3 groups—group K (ketamine bolus 0.25 mg/kg followed by infusion of 0.25 mg/kg/h with midazolam bolus 10 &mgr;g/kg and infusion of 10 &mgr;g/kg/h mixed in the same infusion pump), group D (dexmedetomidine bolus 0.5 &mgr;g/kg followed by 0.3 &mgr;g/kg/h infusion), and group C (normal saline). Study drugs were started in the postoperative period and continued for 24 hours. Pain-free period, pain scores, rescue analgesic (morphine) requirements, and side effects were noted for 48 hours postoperatively. Result: Mean pain-free periods in the ketamine group (860 min) and the dexmedetomidine group (580 min) were longer than in the saline group (265 min) (P<0.002) during the observation period of 48 hours. There was a significant decrease in the rescue analgesic requirement in both ketamine and dexmedetomidine group (P<0.05) (cumulative morphine requirement at 24 h—group C 15.64±9.31 mg, group D 6.89±5.88 mg, group K 2.45±2.06 mg; at 48 h—group C 21.09±12.88 mg, group D 7.98±7.72 mg, group K 2.59±1.97 mg). Hemodynamics were maintained within normal range in all the groups. Patients in ketamine and dexmedetomidine groups were sedated, but none required assistance for maintaining airway patency. Few patients in the ketamine group had nausea, dizziness, and diplopia, but the difference was insignificant in comparison with other groups (P>0.05). Conclusions: Infusion of low-dose ketamine and dexmedetomidine both provide good postoperative analgesia with minimal side effects. Both of the tested analgesic regimes can be used safely and effectively for postoperative pain relief in patients after spine surgery.

Dose-response study of intrathecal fentanyl added to bupivacaine in infants undergoing lower abdominal and urologic surgery.

Background:  Intrathecal (IT) adjuncts often are used to enhance the duration of spinal bupivacaine. Fentanyl is a spinal analgesic that could be a useful adjunct, and enhances the duration and quality of sensory block in adult surgical and obstetric population. However, no data exist to assess the dose–response characteristics of IT fentanyl when added to bupivacaine in infants.

Intrathecal clonidine decreases propofol sedation requirements during spinal anesthesia in infants

Background:  Propofol is a popular agent for providing procedural sedation in pediatric population during lumbar puncture and spinal anesthesia. Adjuvants like clonidine and fentanyl are administered intrathecally to prolong the duration of spinal anesthesia and to provide postoperative analgesia. We studied the propofol requirement after intrathecal administration of clonidine or fentanyl in infants undergoing lower abdominal surgeries.

Comparison of low-dose ketamine to midazolam for sedation during pediatric urodynamic study

Aim of sedation during pediatric urodynamic studies (UDS) is a calm and cooperative child while not affecting measurements. We compared the effectiveness of midazolam to low‐dose ketamine infusion for sedation and their impact on urodynamics.

A comparison of McCoy, TruView, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine

Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and TruView laryngoscopes in patients with immobilized cervical spine. Materials and Methods: 60 adult patients of ASA grade I-II with immobilized cervical spine undergoing elective cervical spine surgery were enrolled. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with isoflurane and nitrous oxide in oxygen. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh, McCoy, or TruView laryngoscopes. When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Hemodynamic parameters and any airway complications were also recorded. Results: TruView reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the TruView laryngoscope group. However, there were no differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a TruView laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

Tramadol Added to Bupivacaine Does Not Prolong Analgesia of Continuous Psoas Compartment Block

The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15). Visual analog scale pain score was not significantly different between the groups during the 48‐hour follow‐up period. Rescue analgesic consumption, nausea and vomiting, and the satisfaction scores were comparable between the groups (P > 0.05). Success with catheter placement adjacent to the lumbar plexus was 100%, and none of the patients developed any catheter‐related complications. In conclusion, tramadol does not provide a clinically significant analgesic action as an adjunct to 0.25% bupivacaine for CPCB.