scholarly journals Laparoscopic morphological aspects and tentative explanation of the aetiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients

2021 ◽  
Vol 13 (4) ◽  
pp. 369-375
Author(s):  
M Possover
Keyword(s):  
Sciatic Nerve ◽  
Lower Limb ◽  
Neurological Disorders ◽  
Retroperitoneal Fibrosis ◽  
Lower Limbs ◽  
Foot Drop ◽  
Time Interval ◽  
Morphological Aspects ◽  
Group 2 ◽  
Group 1

Background: Endometriosis of the sciatic nerve (ESN) is considered a rare disease. How can endometriosis develop within the sciatic nerve; a structure which has nothing in common with the uterus either anatomically or functionally, and why it occurs in the absence of any retroperitoneal/parametric endometriosis, is unknown. A better understanding of the pathophysiology of this enigmatic disease may improve its diagnosis and therapy. Materials and Methods: From a pool of 452 patients operated for ESN, only patients with “isolated” endometriosis of the sciatic nerve” confirmed at laparoscopy were included in this study. Patients with suspicion of ESN by extension from a parametric, ovarian or other intraperitoneal deeply infiltrating endometriosis were excluded from this study. Main outcome measure: All information acquired during the preoperative patient’s medical history and clinical examination were collected and compared with the morphological aspects of the disease observed by the laparoscopic treatment. Patients were classified into three groups according to the time interval between the onset of sciatic pain and the time of surgery: less than 1 year (Group 1), between 1 and 3 years (Group 2), and more than 3 years (Group 3). Results: Two hundred sixty-seven consecutive patients were included in this study. In Group 1 (n=67), 76% of the patients presented with cyclical sciatica, without sensory or motor disorders of the lower limbs. Laparoscopic exploration found in the great majority of these patients only the presence of an isolated endometrioma in the nerve itself, the size of which was proportional to the time elapsed since the onset of pain. In Group 2 (n=83), pain had become constant in 91% of the patients with neurological disorders of the lower limb (foot drop, Trendelenburg gait, atrophied muscles) in about 30% of patients. Laparoscopic examination revealed, in addition to intraneural cystic lesions, a retroperitoneal fibrosis in more than 80% of the patients. In the third group (N=117), more than 80% of the patients presented with neurological disorders of the lower limb, with, on laparoscopic examination, massive retroperitoneal fibrosis with endometriomas in the nerve and adjacent pelvic wall muscles in all patients and an infiltration of the obturator nerve in 41% of patients. Conclusions: The different morphologic aspects of ESN do not correspond to different forms of the disease, but obviously to one single disease at different stages of its evolution. ENS starts first with the development of an endometrioma within the sciatic nerve, then develops in a second step a perineural fibrosis that expands into the whole retroperitoneal space and finally involves surrounding anatomical structures. The ESN is a very particular pathology because it induces a completely new aspect on the pathogenesis of endometriosis: all hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread or the metaplasia theory cannot explain the pathogenesis of this disease. ESN obviously does not develop from “genital metastatic cells”. A possible hypothesis for explanation the pathogenesis of ESN, could consist in the development of endometriosis of the nerve from progenitor stem cells present within the nerve, pluripotent cells which, for an as yet unknown reason (possibly in connection with iterative inflammations and micro-damages of the nerve itself), mutate and proliferate to form endometriosis.

scholarly journals Audio-visual stimulation in conjunction with functional electrical stimulation to address upper limb and lower limb movement disorder

2016 ◽  
Vol 26 (2) ◽  
Author(s):  
Deepesh Kumar ◽  
Sunny Verma ◽  
Sutapa Bhattacharya ◽  
Uttama Lahiri
Keyword(s):  
Electrical Stimulation ◽  
Movement Disorder ◽  
Upper Limb ◽  
Functional Electrical Stimulation ◽  
Lower Limb ◽  
Neurological Disorders ◽  
Visual Stimulation ◽  
Lower Limbs ◽  
Lower Limb Movement ◽  
Rehabilitation Exercises

Neurological disorders often manifest themselves in the form of movement deficit on the part of the patient. Conventional rehabilitation often used to address these deficits, though powerful are often monotonous in nature. Adequate audio-visual stimulation can prove to be motivational. In the research presented here we indicate the applicability of audio-visual stimulation to rehabilitation exercises to address at least some of the movement deficits for upper and lower limbs. Added to the audio-visual stimulation, we also use Functional Electrical Stimulation (FES). In our presented research we also show the applicability of FES in conjunction with audio-visual stimulation delivered through VR-based platform for grasping skills of patients with movement disorder.

scholarly journals Sealing ability of two commonly used root canal sealers with and with out smear layer

2014 ◽  
Vol 2 (4) ◽  
pp. 327
Author(s):  
Nazish Fatima ◽  
Mehwish Hussain
Keyword(s):  
Smear Layer ◽  
Repeated Measure ◽  
Time Interval ◽  
Sealing Ability ◽  
Nail Polish ◽  
Ah Plus ◽  
Time Periods ◽  
Group 2 ◽  
Crown Roots ◽  
Group 1

AIM: The aim of current research was to find out the sealing ability of two commonly used sealers in the presence and absence of smear layer at different time interval. MATERIAL AND METHODS: Total of 180 single rooted vital teeth were used. Transversal section was made with the help of digital slow speed cutting saw to divide the root and crown part. After removal of crown roots part was instrumented and prepared. The 180 teeth were randomly divided into two equal groups (n=90) 1 and 2. In group 1 the smear layer was kept intact but it was removed from group 2 with EDTA (17%). Group 1 was then divided into two sub-groups, A1, A2. Group 2 was again separated into two sub-groups, B1 and B2. Each sub-group contained of 45 samples. In sub-groups A1 and B1, AH Plus sealer, in sub-groups A2 and B2, Ketac-endo sealer and cold lateral condensation technique was used for obturation with gutta percha. All samples were kept in an incubator at 37°C for 24 hours, with help of nail polish/varnish all samples root surfaces was painted only excluding apical area after words each sub group were further divided in to three groups of 15 to represent immersion periods of 7,15 and 30 days. All samples were then kept in 5 % methylene blue dye solution at 37o c for their respective time periods. After specific time period, the roots of every group were cut longitudinally and evaluate under a stereomicroscopes to evaluate apical micro leakage in millimeter. Data was subjected to Repeated measure ANOVA with post-hoc analysis using Tukey and bonferroni tests. RESULTS: Overall analysis indicated significant reduction in sealing ability canals in with and without smear layer over different time periods (p <0.0001). CONCLUSION: Current study has concluded that AH plus sealer provides significantly better seal in the absence of smear layer than in the presence of smear layer in addition it gave better seal than Ketac-Endo sealer in the absence and presence of smear layer.

scholarly journals Perioperative Hemodynamic Changes During Video-Assisted Thoracoscopic Decortication for empyema

2017 ◽  
Vol 11 (1) ◽  
pp. 88-96
Author(s):  
Fang-Ting Chen ◽  
An-Hsun Chou ◽  
Chun-Yu Chen ◽  
Pei-Chi Ting ◽  
Ming-Wen Yang ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Lateral Decubitus Position ◽  
Time Interval ◽  
Hemodynamic Parameters ◽  
Hemodynamic Changes ◽  
Video Assisted ◽  
Lateral Decubitus ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background and Objective: Hemodynamic consequences during video-assisted thoracoscopic surgery (VATS) with decortication during empyema drainage are unclear. The aim of the study was to assess the perioperative hemodynamic changes decortication during empyema drainage. Methods: A prospective study enrolled 23 patients with empyema who underwent decortication. Hemodynamic parameters were continuously obtained at 15 time points: supine two lung ventilation after induction, lateral decubitus position and two lung ventilation, lateral decubitus position and one-lung ventilation, every 5 min after decortication upto 60 minutes and at the end of surgery. We divided patients into three groups according to microorganisms, group 1: patients with no growth of organism; group 2: patients with staphylococcus aureus and pseudomonas; group 3: patients with streptococcus, yeast and fungus, gram-positive bacilli, and mycobacterium tuberculosis. The hemodynamic variables were recorded by the third-generation Vigileo/FloTracTM system and variables for each time interval were compared with the baseline by Wilcoxon Signed Ranks Test. Results: In group 1, hemodynamic parameters showed no significant changes over time. However, in group 2 and 3, both CO and CI increased 10 to 15 minutes after decortication and remained elevated during the remainder of surgery. However, SVR and SVRI decreased 10 to 15 minutes after decortication in both groups, especially, with a more significant decrease noted in group 2 than group 3. Conclusion: Close perioperative hemodynamic monitoring during decortication in empyema patients is required because of potential hemodynamic disturbances especially patients with toxic microorganisms.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

Safe Out-of-Hospital Treatment of Chest Pain Without Direct Medical Control

1996 ◽  
Vol 11 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Mara McErlean ◽  
Nancy Raccio-Robak ◽  
Joel M. Bartfield ◽  
Daniel Hermes
Keyword(s):  
Chest Pain ◽  
Adult Patients ◽  
Categorical Variables ◽  
Hospital Treatment ◽  
Time Interval ◽  
Medical Control ◽  
Physician Contact ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractIntroduction:The use of direct medical control (DMC) in the out-of-hospital setting often is beneficial, but has the disadvantage of consuming emergency medical services (EMS) resources.Hypothesis:Uncomplicated, nontrauma, adult patients with chest pain can be treated safely and transported by paramedics without DMC.Methods:Retrospective chart review of all nontrauma, adult patients with chest pain treated in a combined rural and suburban EMS system during a 2-year period (December 1990 through November 1992) was conducted. Before November 1991, DMC was mandatory for all patients with chest pain. Beginning 01 November 1991, if a patient had resolution of pain either spontaneously, with administration of oxygen, or after a single dose of nitroglycerin, DMC was at the discretion of the paramedic. Using the above criteria for inclusion, three study groups were defined: Group 1, before protocol change; Group 2, after protocol change without DMC; and Group 3, after protocol change when physician contact was obtained, but not required. These groups were compared for the following parameters: 1) scene time; 2) time to administration of first dose of nitroglycerin; 3) time interval between measurement of vital signs; 4) oxygen use; 5) intravenous access; and 6) electrocardiographic monitoring. Continuous and categorical variables were analyzed by multivariate and univariate analysis of variance and chi-square tests, respectively.Results:Of 308 nontrauma, adult patients with chest pain, 71 met inclusion criteria in Group 1, 40 in Group 2, and 34 in Group 3. No statistically significant differences were identified in any of the study parameters.Conclusion:Adult patients with chest pain who have no other symptoms or complicating conditions can be treated appropriately by paramedics without DMC.

scholarly journals Central nervous system metastases from breast carcinoma: a clinical and laboratorial study in 47 patients

1998 ◽  
Vol 56 (2) ◽  
pp. 188-192 ◽  
Author(s):  
ALUÍZIO B.B. MACHADO ◽  
ALEXANDRE A.C. MACHADO ◽  
JOSÉ ALEXANDRE M. BARBUTO ◽  
RICARDO M. DE OLIVEIRA
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Methods ◽  
Motor Deficits ◽  
Time Interval ◽  
Central Nervous System Metastases ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Csf Examination ◽  
Group 1

In this retrospective study, 47 patients with clinical diagnosis of central nervous system metastases of breast cancer were evaluated by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The patients were divided in 2 groups: 1, without leptomeningeal neoplasm and 2, with leptomeningeal neoplasm. In the group 2, the time interval between the primary disease and the central nervous system metastasis as well as the survival time were shorter than in group 1 (40 and 4.3 months in group 2 versus 57 and 10 months respectively, in group 1). In both groups the most common neurological symptoms and signs were intracranial hypertension and motor deficits. The most sensitive diagnostic methods were CT and MRI in group 1, and the CSF examination in group 2. The use of the tumor markers CEA and CA-15.3 in the routine examination of CSF showed promising results, mainly in leptomeningeal forms.

scholarly journals Steady-State Pharmacokinetics of Tenofovir-Based Regimens in HIV-Infected Pediatric Patients

2011 ◽  
Vol 55 (9) ◽  
pp. 4290-4294 ◽  
Author(s):  
Jennifer R. King ◽  
Ram Yogev ◽  
Patrick Jean-Philippe ◽  
Bobbie Graham ◽  
Andrew Wiznia ◽  
...  
Keyword(s):  
Fixed Dose ◽  
Target Range ◽  
Pharmacokinetic Parameters ◽  
Time Interval ◽  
Minimum Concentration ◽  
Once Daily ◽  
Daily Group ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACTHIV-infected children are treated with tenofovir in combination with other, potentially interacting, antiretroviral agents. We report the pharmacokinetic parameters of tenofovir in combination with efavirenz, darunavir-ritonavir, or atazanavir-ritonavir in HIV-infected children. HIV-infected patients 8 to 18 years of age receiving a tenofovir (300 mg)-based regimen containing efavirenz (300 or 600 mg) once daily (group 1), darunavir (300 or 600 mg)-ritonavir (100 mg) twice daily (group 2), or atazanavir (150 to 400 mg)-ritonavir (100 mg) once daily (group 3) were enrolled. Plasma samples were collected over a 24-h time interval. The 90% confidence intervals (90% CI) of the geometric means for the area under the plasma concentration-time curve (AUC) and the minimum concentration of drug in serum (Cmin) of each antiretroviral were computed and checked for overlap with intervals bracketing published values obtained in adult or pediatric studies demonstrating safety and/or efficacy. Group 1 efavirenz plasma concentrations were observed to be higher in patients receiving fixed-dose combination tablets compared with subjects receiving the individual formulation. In group 2, tenofovir and darunavir exposure was observed to be lower than expected. In group 3, tenofovir and atazanavir administered concomitantly produced exposures similar to those published for adult patients. The 90% CI of AUC andCminfor tenofovir overlapped the target range for all combinations. Informal comparisons of treatment groups did not indicate any advantage to any combination with respect to tenofovir exposure. Further study of exposures achieved with antiretrovirals administered in combination is warranted.

scholarly journals Glucocorticoids do not influence the effect of radioiodine therapy in Graves’ disease

2005 ◽  
Vol 153 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Berit E Jensen ◽  
Steen J Bonnema ◽  
Laszlo Hegedüs
Keyword(s):  
Thyroid Peroxidase ◽  
Graves Disease ◽  
Time Interval ◽  
Cure Rate ◽  
Radiation Induced ◽  
Eye Symptoms ◽  
High Concentrations ◽  
Group 2 ◽  
First Time ◽  
Group 1

Objective: We evaluated, in a retrospective study, whether glucocorticoids given in order to avoid initiation or aggravation of ophthalmopathy during radioiodine (131I) therapy have an inadvertent effect on the final thyroid function. Methods: Consecutive patients with Graves’ disease (median age 50 years, range 21–82 years) treated with 131I therapy for the first time were included. Ninety-six patients (group 1) were given prednisolone (25 mg daily for 30 days beginning 2 days before 131I therapy) because of present or previous mild ophthalmopathy or the presence of risk factors (tobacco smoking and high concentrations of TSH-receptor antibodies) for developing this complication. One hundred and eleven patients received 131I therapy without prednisolone prophylaxis (group 2). Results: The patients in group 1 were younger than those in group 2 (44.6±12.0 years versus 51.3±15.1 years; P = 0.001). At 1 year post therapy the patients were classified as hypothyroid, euthyroid or hyperthyroid. In group 1, the numbers of patients were 23, 35 and 38, respectively, while the corresponding numbers in group 2 were 26, 40 and 45, respectively (P = 0.99 between groups). The cure rate (attainment of euthyroidism or hypothyroidism) was 60% in group 1 and 59% in group 2 (P = 0.97). No significant between-group difference was found, neither in the median time-interval until development of hypothyroidism nor until recurrence of the hyperthyroid-ism. Using logistic regression the cure rate correlated negatively with age (P = 0.041) and the size of the thyroid gland (P = 0.010) and positively with serum TSH at treatment (P = 0.034), whereas no significant impact was found for the use of prednisolone, gender, smoking, presence of anti-thyroid peroxidase antibodies, use of anti-thyroid drugs or the presence of eye symptoms. Conclusions: Although glucocorticoids in some contexts seem to attenuate the radiation-induced oxidative stress this had no impact on the final outcome following 131I therapy of patients with Graves’ disease.

scholarly journals The Appropriate Time Interval Between Hysteroscopic Polypectomy and the Start of FET : A Retrospective Corchort Study

2020 ◽  
Author(s):  
Zhong-Kai Wang ◽  
Hong-Wu Qiao ◽  
She-Ling Wu ◽  
Wen Zhang ◽  
Xiao-Na Yu ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Time Interval ◽  
Miscarriage Rate ◽  
Endometrial Polyps ◽  
Group 4 ◽  
Academic Center ◽  
Group 2 ◽  
Group 1

Abstract Objective: To investigate when is the appropriate time interval between hysteroscopic polypectomy and the start of FET cyclesDesign: Retrospective cohort study. Setting: Academic center. Patient(s): All patients diagnosed with endometrial polyps undergoing hysteroscopic polypectomy before FET.Intervention(s): Hysteroscopic polypectomy.MainOutcomeMeasure(s): Patients were divided into four groups based on the time interval between hysteroscopic polypectomy and the start of FET Demographics, baseline FET characteristics, pregnancy outcomes after FET were compared among the groups. A total of 1703 patients met inclusion criteria: 547 patients in group 1 who underwent FET after hysteroscopic polypectomy 1-3menses cycles, 389 patients in group 2 who underwent FET after hysteroscopic polypectomy 4-6 menses cycles, 421 patients in group 3 who underwent FET after hysteroscopic polypectomy 7-12menses cycles, and 373 patients in group 4 who underwent FET after hysteroscopic polypectomy more than 12 menses cycles, whats more the group 1 were divided into 3 groups depend on the time interval between hysteroscopic polypectomy and the start of FET. The FET outcomes were compared.Result(s): There were no differences in the mean number of embryos transferred. The overall pregnancy outcomes were similar for groups 1, 2, 3,and 4: implantation rate (38%, 38.2%, 39.5%and 36.8, respectively), clinical pregnancy rate (51.9%, 48%, 53.2and 50%), spontaneous miscarriage rate (8.4%,8.4%, 12.2and 8.9%), and live birth rate (42.4%. 40.4%, 42.8% and 40.9%). Conclusion(s): IVF outcomes seem to be unrelated to the time interval between the hysteroscopic polyp resection and the initiation of the FET; The abortion rates may be lower if the treatment is started in the first few months post operatively.

scholarly journals COMPARISON OF BUPIVACAINE AND BUPIVACAINE WITH FENTANYL IN LOWER LIMB ORTHOPAEDIC SURGERIES

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Dr. Suraj Dahale ◽  
Dr. Satish Kale
Keyword(s):  
Lower Limb ◽  
Randomized Study ◽  
Medical Science ◽  
Sensory Block ◽  
Single Shot ◽  
Onset Of Action ◽  
Analgesic Requirement ◽  
Axonal Membrane ◽  
Group 2 ◽  
Group 1

INTRODUCTION: A commonly used technique for lower limb surgeries is subarachnoid blockade. If there is inadequate control of pain, will affect quality, and functional recovery, also there is chance of postsurgical complications, and the risk of persistent postsurgical pain. Use of epidural analgesic technique for lower limb surgeries should provide better pain relief with minimal side effects, leading to improved outcome. Bupivacaine hydrochloride is a local anaesthetic drug, which was used clinically in 1963. Bupivacaine acts mainly by blockade of voltage-gated Na+ channels in the axonal membrane and possibly has a further effect on presynaptic inhibition of calcium channels. Fentanyl is a powerful synthetic opioid which is similar to morphine but is 50 - 100 times more potent, which is used to treat patients with severe pain, especially after surgeries. MATERIAL AND METHODS: This prospective randomized study was conducted in the department of anaesthesiology at Rajiv Gandhi Institute of Medical Science, Adilabad, to compare single shot epidural 8ml 0.5 % bupivacaine alone verses 8ml 0.5% bupivacaine along with 0.50 mcg Fentanyl. Total of 80 patients with ASA(American society of anaesthesiologists)  I and II with age group between 24 to 56 years were included and 40 patients each were randomly placed in bupivacaine alone group (Group 1) and fentanyl in combination with bupivacaine group (Group 2). Written informed consent from all the patients was obtained. RESULTS: Mean (SD) systolic blood pressure was observed to be 128.45(12.47) and 130.25(11.55) in group 1 and group 2 respectively. Mean time for T 10 sensory block was significantly earlier in group 2 12.03(1.12) compared to group 1 18.24(2.54). Onset of motor block was observed to differ significantly, where onset was significantly earlier in group 2 23.17(1.77) in comparison to group 1 28.45(1.49). The first analgesic requirement in Group 1 was earlier at 198.20 + 11.49 min as compared to Group 2 at 279.34 + 18.42 min. CONCLUSION: Bupivacaine with Fentanyl enhances the onset of action and duration of effect for two segment regression. In present study the time to achieve T10 sensory block was early in Group 2 12.03(1.12) compared to group1 18.24(2.54).Onset of group2 23.17(1.77) in comparison to group1 28.45(1.49). Time of first analgesic requirement was found to be earlier at 279.34 + 18.42 minutes in group2 in comparison to group1 198.20 + 11.49 minutes.

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