scholarly journals Comparison of Fascia Iliaca Block with Intravenous Paracetamol, as Postoperative Analgesic Method for Femur Surgery

2020 ◽  
Vol 5 (1) ◽  
pp. 13-16
Author(s):  
Praveen kumar Shekhrajka ◽  
Dhaval kumar C Patel
Keyword(s):  
Intrathecal Injection ◽  
Early Mobilization ◽  
Time Interval ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Group I ◽  
Intravenous Paracetamol ◽  
Number Of Patients ◽  
Fascia Iliaca Block ◽  
Total Burden

Background: Postoperative pain is extremely unpleasant which causes severe discomfort to the patient as well as it increases the anxiety, hospital stay so overall total burden. Objectives: Comparison of efficacy between fascia iliaca block with intravenous paracetamol, as postoperative analgesic method after femur surgery. Simultaneously requirement of other analgesics in the first 24 hours.Subjects and Methods:Prospective longitudinal study conducted in patients belonging to age group of 18 to 65 years posted for femur surgeries. All patients were received Intrathecal injection of 3.5 ml of 0.5% hyperbaric bupivacaine and divided into two groups. After completion of surgery Group I received the Fascia Iliaca block with thirty ml of 0.25% of injection bupivacaine and Group II received injection Paracetamol one gram intravenously. Duration of analgesia, time from block / iv PCM to 1st rescue analgesia, number of patients as well as total doses of required rescue analgesics in 1st 24 hours were observed postoperatively.Results:From One hour onwards at all the time interval, mean pain scores was less in FIB group as compared to PCM group(p<0.001). In FIB group 15 (42%) patients had more than 24 hours and 11(32%) patients had 12-24 hours of analgesia, where as in PCM Group not a single patient had more than 12 hours of analgesia. In FIB group only 20 (57%) patients required rescue analgesic as compared to 35 (100%) patients in PCM group.Conclusion:In FIB insertion point is away from femoral vessels and can be provided without nerve stimulator. Post-operative it is extremely crucial to provide analgesia specially initial 24 hours. FIB can provide prolong duration of analgesia, so helps in early mobilization and early rehabilitation as well as it also reduces opioid requirements. Thus, Fascia iliaca block is an effective, easy and affordable method for postoperative analgesia and can be used safely as a part of multimodal approach to pain relief after femur surgery.

scholarly journals The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

2017 ◽  
Vol 6 (1) ◽  
pp. 191
Author(s):  
Neetu Gupta ◽  
Pooja Jain ◽  
M. Kapadia ◽  
Sadhana Sanwatsarkar ◽  
Dipti Saxena ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Time Interval ◽  
Rescue Analgesia ◽  
Subarachnoid Block ◽  
Fracture Femur ◽  
Before And After ◽  
Visual Analogous Scale ◽  
Fascia Iliaca Block ◽  
Fascia Iliaca Compartment Block

Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB.

scholarly journals The importance of age in terms of fistula patency in chronic hemodialysis patients: 7-year follow-up

2020 ◽  
Vol 4 (4) ◽  
pp. 06-12
Author(s):  
Ferhat Borulu ◽  
◽  
Bilgehan Erkut ◽  
Keyword(s):  
Arteriovenous Fistula ◽  
Operative Procedure ◽  
Primary Patency ◽  
Time Interval ◽  
Secondary Patency ◽  
Indirect Inguinal Hernia ◽  
Group I ◽  
Number Of Patients ◽  
Over 40 Years

Background: Patients with kidney failure need dialysis until transplant or die. Hemodialysis is one of the preferred methods for these patients. Many studies have been conducted on the factors affecting the patency of arteriovenous fistulas, which are frequently used for hemodialysis. In this study, we investigated the importance of age. Methods: 442 patients (256 men, 186 women) who underwent arteriovenous fistula operation between May 2013 and Oct 2020 were retrospectively analyzed. Surgical operations were performed by 5 different cardiovascular surgeons for hemodialysis in two different institutions in our region. The patients were divided into two groups, Group I (number of patients under 40 years old; n = 201) and Group II (number of patients over 40 years old; n = 241). The primary patency was the time interval between the formation of arteriovenous fistula and any intervention for initial thrombosis and recanalization. Secondary patency was not evaluated in this study. The effects of age on primary exposure rates were investigated for both groups. Results: Primary arteriovenous fistula patency rates were lower in patients over 40 years of age. For this reason, more care should be taken in surgery to create fistulas in patients over the age of 40, and the follow-up of patients should be done more tightly. Conclusion: Complicated external hernias occur in all age groups but are more common in older age and show preponderance in males. All patients present with irreducible swelling with no cough impulse. The indirect inguinal hernia is the most common type and herniorrhaphy is the most preferred operative procedure in the complicated hernia. Wound sepsis was the most common complication. Morbidity and mortality may be attenuated with proper surgical and post-operative management. Keywords: Arteriovenous fistula; hemodialysis; age; surgery; patency

Comparison between Intrathecal Nalbuphine and Bupivacaine versus Fentanyl and Bupivacaine For Postoperative Analgesia After Lower Abdominal Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S F Ibrahim ◽  
R Y Ataallah ◽  
F A Abdelmalek ◽  
M M Hamisa
Keyword(s):  
Side Effects ◽  
Respiratory Depression ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Intrathecal Injection ◽  
Arterial Oxygen ◽  
Epidural Administration ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Fentanyl Group

Abstract The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation. Aim of Study The purpose of this study was to assess the spinally mediated analgesic effects postoperativally of intrathecal Nalbuphine plus bupivacaine after lower abdominal surgeries in comparison to intrathecal bupivacaine plus fentanyl Patients & Methods : 60 patients came to Ain-shams Hospital for lower abdominal surgeries, They were randomly allocated into two equal groups (30 patients each) group F and group N. Group F : Bupivacaine-Fentanyl Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphin Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.5 mg) Nalbuphine. All patients were assessed and monitored for: Hemodynamics: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, onset of motor block, duration of analgesia & 1st rescue analgesia, duration of motor block, adverse effects as: hypotension, bradycardia, respiratory depression, pruritus, shivering, nausea and vomiting were recorded. Results & Conclusion Addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia the duration of postoperative analgesia is nearly the same in nalbuphine group & the fentanyl group. There is more rapid onset of motor block in fentanyl group than in nalbuphine group but with no difference in sensory or motor block regression. No respiratory depression or degree of sedation occurs in both groups. Hemodynamic stability & side effects incidence are the same in both groups

scholarly journals Intrathecal Dexmedetomidine, Ketamine, and their Combination Added to Bupivacaine for Postoperative Analgesia in Major Abdominal Cancer Surgery

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E829-E839
Author(s):  
Ahmad MA El-Rahman
Keyword(s):  
Postoperative Analgesia ◽  
Academic Medical Center ◽  
Small Sample ◽  
Cancer Surgery ◽  
Morphine Consumption ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background: Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P < 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone. Key words: Intrathecal, ketamine, dexmedetomidine, lower abdominal cancer surgery

A COMPARATIVE STUDY OF INTRATHECAL DEXMEDETOMIDINE WITH 0.5% HYPERBARIC BUPIVACAINE AND INTRATHECAL FENTANYL WITH 0.5% HYPERBARIC BUPIVACAINE IN INFRA UMBILICAL SURGERIES

2021 ◽  
pp. 43-46
Author(s):  
Rahul Agarwal ◽  
R B M Krishna
Keyword(s):  
Regional Anaesthesia ◽  
Motor Block ◽  
West Bengal ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Surgical Incision ◽  
Group I ◽  
Study Population ◽  
The Mean

INTRODUCTION: Regional anaesthesia is the preferred technique for most infra-umbilical surgeries. It allows the patient to remain awake, minimizes or completely avoids the problem associated with airway management. With spinal anaesthesia, the onset of anaesthesia is more rapid allowing the surgical incision to be made sooner and also provides post operative analgesia. AIM: To determine the duration of analgesia determined by the rst demand for rescue analgesia in two groups of a dened study population. To compare intraoperative hemodynamics between two groups of population. To note the incidence of any complications in either group, specically sedation and pruritus. MATERIALS AND METHODS: This study was undertaken in Command Hospital (EC), Kolkata (West Bengal, India) during the period Mar 2017 to Feb 2018. One hundred twenty patients, scheduled for infra-umbilical surgeries belonging to ASAI and II were included in the study. The study population was randomly divided into two groups with 60 patients in each group. RESULT: Association of ASA vs. group was not statistically signicant (p=0.6985). Association of Comorbidity vs. group was not statistically signicant (p=0.9833). Association of diagnosis/surgery vs. group was statistically signicant (p=0.0301). We found that in group-I, the mean duration of motor block (mean ± s.d.) of patients was 359.3333 ± 34.3431 min. In group-II, the mean duration of motor block (mean ± s.d.) of patients was 265.7167 ± 28.4737 min. Difference of mean duration of motor block vs. group was statistically signicant (p<0.0001). CONCLUSION:Intrathecal dexmedetomidine with 0.5% hyperbaric bupivacaine produces excellent surgical analgesia and an extended analgesia in postoperative period. Intrathecal dexmedetomidine with 0.5% hyperbaric bupivacaine increases the duration of sensory and motor blockade.

Histopathological Changes during Infected Wound Healing in Cow Calves by the Use of Silver Nano Particle Gel and Povidone Iodine

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Yogendra Singh ◽  
B. P. Shukla, ◽  
Supriya Shukla, ◽  
Reshma Jain ◽  
Aditya P. Jaiswal
Keyword(s):  
Povidone Iodine ◽  
Treated Group ◽  
Time Interval ◽  
Nano Particle ◽  
Infected Wound ◽  
Histopathological Changes ◽  
Group I ◽  
Infected Wounds ◽  
Group Ii ◽  
Silver Nano Particle

The present study was conducted on 12 cow calves with infected wounds, irrespective of sex and breed, divided into two groups having 6 cow calves each. The animals of group I were treated with silver nano particle gel and the animals of group II were treated with povidone iodine dressing for 7 consecutive days. Histopathological changes were recorded at different time interval in both the groups. Studies revealed that there was marked re-epitheliazation and hyperplasia with considerable thickening of epidermis and large amount of collagen deposition in granulation tissue in group I as compared to group II. Histopatathological findings clearly suggest that the group treated with silver nano particle gel showed better and faster healing of wound as compared to povidone iodine treated group. Therefore clinical use of silver nano particle gel can be advocated for wound dressing in cow calves.

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

scholarly journals Anticarcinogenic effect of probiotic fermented milk and chlorophyllin on aflatoxin-B1-induced liver carcinogenesis in rats

2011 ◽  
Vol 107 (7) ◽  
pp. 1006-1016 ◽  
Author(s):  
M. Kumar ◽  
V. Verma ◽  
R. Nagpal ◽  
A. Kumar ◽  
P. V. Behare ◽  
...  
Keyword(s):  
Wistar Rats ◽  
Lactobacillus Rhamnosus ◽  
Thiobarbituric Acid ◽  
Fermented Milk ◽  
Hepatoprotective Effect ◽  
Control Group ◽  
Time Interval ◽  
Group I ◽  
Male Wistar Rats ◽  
Aflatoxin B

The present investigation was carried out to evaluate the hepatoprotective effect of probiotic fermented milk (FM) containing Lactobacillus rhamnosus GG and Lactobacillus casei strain Shirota, alone as well as in combination with chlorophyllin (CHL) as an antioxidant agent in male Wistar rats administered aflatoxin-B1 (AFB1). AFB1 was injected intraperitoneally at the rate of 450 μg/kg body weight per animal twice a week for 6 weeks, maintaining an equal time interval between the two consecutive AFB1 administrations. A total of 125 male Wistar rats were randomly allocated to five groups, each group having twenty-five animals. Group I was offered FM containing L. rhamnosus GG and L. casei strain Shirota. Group II was administered AFB1 and served as the control group; group III was administered FM-AFB1, in which besides administering AFB1, FM was also offered. Group IV was offered CHL and AFB1, and group V was offered both FM and CHL along with AFB1. The rats were euthanised at the 15th and 25th week of the experiment and examined for the biochemical and hepatopathological profile. A significant reduction in thiobarbituric acid-reactive substances (TBARS) was observed in the FM–CHL–AFB1 group compared with the AFB1 control group. FM alone or in combination with CHL was found to show a significant (P < 0·05) hepatoprotective effect by lowering the levels of TBARS and by enhancing the activities of antioxidant enzymes such as glutathione peroxidase, superoxide dismutase, catalase and glutathione-S-transferase, indicating that probiotic FM alone or in combination with CHL possesses a potent protective effect against AFB1-induced hepatic damage.

'Aorta code' implementation and preliminary results of a multidisciplinary protocol for patients with acute aortic syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Ferrera Duran ◽  
I Vilacosta ◽  
J Perez-Villacastin ◽  
P Busca ◽  
A Carrero ◽  
...  
Keyword(s):  
Emergency Room ◽  
Aortic Surgery ◽  
Referral Hospital ◽  
Acute Aortic Syndrome ◽  
Preliminary Results ◽  
Group I ◽  
Aortic Pathology ◽  
Number Of Patients ◽  
Group Ii ◽  
Patient’S Outcome

Abstract Background Expediting life-saving care for patients with acute aortic syndrome (AAS) through multi-disciplinary code protocols is a potential method to improve outcomes. Other code protocols for cardiovascular emergencies, such as ST-elevation myocardial infarction and stroke have shown excellent results. Aim To examine the implementation and preliminary results of a code protocol “Aorta Code” for patients with AAS in a healthcare framework of a 4-hospital network in our city by reviewing the number of patients detected, patient's transference time, aortic surgery and patient's outcome during a trial period of 10 months (April 2019-January 2020). A comparison with a previous 2-year period with standard of care management of AAS was performed. Methods “Aorta Code” uses a specific diagnostic algorithm to improve detection of patients with AAS at the emergency room, facilitates their quick transfer to the referral hospital by activating a paging system, and places acute cardiovascular care unit, operating room and surgeons specialized in aortic pathology on standby. Results Compared to a previous 2-year period (2017–2018) (group I), the current implementation of “Aorta Code” in a period of 10 months (group II) in our 4-hospital network involving the healthcare of 1.100000 inhabitants resulted in the detection of more patients with AAS (group-I: n=18 patients (0.8 patients/month), group-II: n=19 patients (1.9 patients/month); p=0.013). AAS detection in secondary hospitals importantly increased (33.3% vs 63.8%, p=0.07). The “Aorta Code” achieved a significant decrease in patient's transference time to referral hospital (group-I: median 259 min (IQR 150–1911), group-II: median 129 min (IQR 95.5–167.25); p=0.035). There was a marked reduction in the number of surgeons involved in the “Aorta Code” (group-I= 7 cardiac, 6 vascular, group-II= 2 cardiac, 2 vascular). Thirty-day mortality was lower in group-II in the whole AAS cohort (group-I= 22.2%, group-II= 12.5%; p=0.660) and in type A AAS (28.6% vs 18.2%, p=0.661). Misdiagnosis rate (false-calls): 11 patients (7 of them with non-acute aortic disease). Conclusion “Aorta Code” facilitates detecting patients with AAS at the emergency room, speeds them to the referral hospital center, allows patients to be treated by surgeons specialized in aortic surgery and improves patient's outcome. Further prospective studies examining the utility of “Aorta Code” are warranted. Funding Acknowledgement Type of funding source: None

Video laparoscopic diagnostics and surgical tactics for acute diseases of abdominal organs

2021 ◽  
pp. 17-24
Author(s):  
A. S. Ermolov ◽  
V. T. Samsonov ◽  
P. A. Yartsev ◽  
A. A. Gulyaev
Keyword(s):  
Clinical Diagnosis ◽  
Definitive Diagnosis ◽  
Concomitant Disease ◽  
Group Iii ◽  
Abdominal Organs ◽  
Group I ◽  
Number Of Patients ◽  
Video Laparoscopy ◽  
Surgical Tactics ◽  
Diagnosis Of Diseases

The article presents the results of video laparoscopy (VLS) performed in 2008–2019 in 5,599 patients in order to diagnose acute diseases of the abdominal organs requiring emergency surgery, identify competing and concomitant diseases, and determine treatment tactics. 2,442 (43.6 %) of them made up group I, with no doubt; 2,656 (47.4 %) – II group, with presumptive reliability; and 501 (9.0 %) – group III, with an unclear clinical diagnosis of the disease. In 2,326 (95.2 %) patients of group I with VLS, the clinical diagnosis was confirmed, in 100 (4.1 %) other diseases were revealed, and in 16 (0.7 %) the diagnosis was not established. Competing diseases were found in 8 patients and concomitant diseases in 4. In 1,641 (61.8 %) patients of group II, VLS made it possible to clarify and differentiate the clinical diagnosis of diseases, in 929 (35.0 %) – to identify other diseases, and in 86 (3.2 %) the diagnosis was not possible. When performing differential diagnosis, 126 other diseases were identified more than the number of patients. Competing diseases were found in 6 patients and concomitant diseases in 6 patients. 356 (71.0 %) patients of group III with VLS were diagnosed with major diseases, 75 (15.0 %) had other diseases, and 70 (14.0 %) were not diagnosed. In 4 patients, competing diseases were found, and in 1 – concomitant disease. Of the 5,427 (96.9 %) patients with the definitive diagnosis of the disease established with VLS, 3,828 (70.5 %) were found to be able to perform VLS operations, in 10 (0.3 %) of them – simultaneous with competing diseases.

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