Sulekha Saxena

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

Background: The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation. Methods: Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Students t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses. Results: There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001). Conclusion: The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

Evaluation of intubating conditions using stylet by conventional through-tube technique and through Murphy's eye in patients with high Mallampati scores

Background: Difficult intubation is always a nightmare for an Anaesthetist. This study was planned to study the alternative method of stylet use during difficult oro-tracheal intubation. Outcome measures assessed were ease of intubation, hemodynamic stability and reducing complications. Materials and Methods: A cohort of 60 patients of Mallampati class III patients was formed and patients were divided into two groups. In group 1 patients, conventional through tube method was used for inserting stylet, whereas, in group 2 patients, Murphy′s eye was used for inserting malleable flexi tip stylet. Results: Hemodynamic stability in terms of mean arterial blood pressure and heart rate was observed in group 2. Intubating time, number of attempts of successful intubation and post operative pharyngo-laryngeal complications was also low in group 2 patients. Conclusion: The use of Murphy′s eye to pass stylet during difficult airway manoeuvre is a safe alternative over conventional rail-road technique.

Comparative study of intrathecal hyperbaric versus isobaric ropivacaine: A randomized control trial

Background: Hyperbaric ropivacaine produce more reliable sensory and motor block, with faster onset, better quality of muscles relaxation than isobaric ropivacaine. So, this study was designed to compare the efficacy of hyperbaric ropivacaine with isobaric ropivacaine in patients undergoing lower abdominal surgery. Methods: A randomized controlled double blind study in two groups of patients. group A (n=35) received 3 ml of isobaric ropivacaine 6 mg/ml (18 mg). Group B (n=35) received 3 ml of hyperbaric ropivacaine 6 mg/ml (18 mg). The onset and duration of sensory block at dermatome level T10, maximum upper and lower spread of sensory block, intensity, and duration of motor block were recorded. Statistical Analysis: Block characteristics were compared using the two-tailed Mann – Whitney U-test. The proportion of side effects was compared using the Chi-square test. Results: The median time of onset of sensory block at the T10 dermatome was 4.4±1.3 min in group B and 6.0±1.03 min in group A. The median time to maximum block height was 16.7±3.7 min in group A and 12.03±1.96 min in group B. The median duration of complete motor recovery (B0) was significantly shorter in the heavy ropivacaine group (166.5±11.7 min) compared with the isobaric ropivacaine group (192.9±9.6 min). Conclusions: Intrathecal hyperbaric ropivacaine provides more rapid, adequate, and good quality of sensory and motor block with rapid post-operative recovery as compare to isobaric ropivacaine.

Whipple's Operation Under Lumber Epidural Analgesia and Sedation

Whipples operation can be carried out either under general anaesthesia or continuous epidural anaesthesia with sedation. We report three cases that were managed successfully and we found that the combination of lumbar epidural analgesia with sedation is safer and beneficial as compared to those who undergo Whipples operation under general anaesthesia. For the last three decades epidural analgesia has been the part of anaesthesia practice. Epidural analgesia can be a useful method of pain management various situations. It facilitates early mobilization and also avoids perioperative pulmonary complications especially after major thoracic or upper abdominal surgeries. The combination of continuous epidural analgesia with sedation has many advantages in prolonged major upper abdominal surgeries. Keywords- Whipples operation, general anaesthesia, continuous epidural anaesthesia, sedation, upper abdominal surgery. I. Case Report We present 3 cases where regional anaesthesia technique combined with sedation for whipples operation was employed successfully. Three patients with obstructive jaundice secondary to periampullary carcinoma posted for whipples surgery. The diagnosis was confirmed by blood biochemistry, CT scan, ERCP and biopsy. General physical and systemic examination and vital parameters was essentially the same in all the patients. On pre-anaesthetic examination, an informed consent was taken and patients were thoroughly explained about the procedure and technique of lumbar epidural anaesthesia. After taking the patients in operation theater, patient were monitored for HR, BP, ECG, SpO2 and temperature. Intra Venous access was secured with 18 G cannula on the dorsum of hand and preloading was done with ringers lactate solution 10-15ml kg-1. under full aseptic precaution an epidural catheter was inserted in the epidural space at L1-L2 level. The tip of catheter was advanced to T4. A test dose of 3 ml of 2% xylocaine with adrenaline 5 µg ml-1 was given after insuring correct placement the bolus dose of local anaesthetics (10ml of 2% lignocaine and 10ml of 0.5% bupivacaine and 50 micro g of fentanyl) was given followed by bolus dose of 6ml 0.5% bupivacaine hourly. Central venous cannulation was done and CVP maintained between 8-10 cm of normal saline. Opioids were not used. Urine output monitoring was done and maintained between 1.5-2 ml kg-1 hr-1. Blood loss was adequately replaced by PRBCs, FFPs and other IV fluids. Average blood loss in all 3 cases was 2-3 liters. The duration of surgery was approximately 8 hours. Propofol infusion 10ml hr-1 was used in all cases for sedation along with midazolam @ 2 ml/hour. Vital signs were monitered and maintained through out intraoperative period. All patients were fully conscious, oriented and with stable vitals. Postoperative x-ray Chest was normal in all cases. Postoperative pain relief was given with lumber epidural infusion. Bowel sounds were audible on 3rd postoperative day. Biochemistry, haematological and Blood Gas parameters was within normal limits. Patients remained comfortable, without pain and were discharged on 3-4th postoperative day from the ICU. epidural catheter was removed before discharge. All the 3 patients were ambulatory and with no complaint of pain.