scholarly journals Comparison of Efficacy between Intramuscular Diclofenac and Transdermal Diclofenac Patch for Postoperative Analgesia in Patients Undergoing Lower Limb Surgery Under Sub Arachnoid Block in Jawaharlal Nehru Medical College, Wardha, India

2021 ◽  
pp. 113-120
Author(s):  
Anjali Modak ◽  
Harindanath S. Kumar
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Diclofenac Sodium ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Subarachnoid Block ◽  
Lower Limb Surgery

Background: To compare the analgesic efficacy of transdermal Diclofenac patch (100 mg) with intramuscular Diclofenac sodium (75 mg) for postoperative analgesia and to know the side effects of transdermal Diclofenac patch. Methods: 60 ASA I and II patients, of either sex, aged 15 and above, scheduled for lower limb surgery under subarachnoid block were included in the study. All were allocated randomly by computer generated randomization sheet into two groups of 30 each. Subarachnoid block was administered using 0.5% hyperbaric Bupivacaine. Participants in the study group were applied with a transdermal Diclofenac patch containing 100 mg of Diclofenac diethylamine at the beginning of the surgery. In the control group 75 mg of Diclofenac sodium was given intramuscularly half an hour before the end of surgery. Pain was assessed postoperatively using visual analogue scale. Injection Tramadol 2 mg was administered intramuscularly as rescue analgesia. The data obtained was analyzed using chi - square test and unpaired student’s ‘t’test. Results: The mean time at which rescue analgesia was administered in the control group was 7 hours 28 min and in study group was 20 hours 6min.The time at which rescue analgesics were required in the study group was significantly prolonged (p<0.0001). The amount of Inj. Tramadol required as rescue analgesia in the control group was 189.33 mg. ± 16.38 mg. and in study group it was 97 mg. ± 7.24 mg and this was found to be statistically significant (p<0.0001). When the side effects were compared they were not significant. Conclusions: Based on the results obtained we conclude that, the intraoperative application of 100 mg transdermal Diclofenac diethylamine patch significantly prolongs the time at which patient requires rescue analgesia without any significant side effects. Rescue analgesic requirement was also significantly lower in the study group.

scholarly journals COMPARATIVE STUDY OF INTRATHECAL FENTANYL WITH HYPERBARIC BUPIVACAINE TO IMPROVE PERIOPERATIVE ANALGESIA IN PATIENT UNDERGOING ORTHOPEDIC SURGERY

2021 ◽  
pp. 55-58
Author(s):  
Rahul Wagh ◽  
Swapnil Sangale ◽  
Nagesh Jambure
Keyword(s):  
Side Effects ◽  
Lower Limb ◽  
Motor Block ◽  
Control Group ◽  
Study Group ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS, patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures, cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods. Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine, pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if any, in patients undergoing lower limb surgeries. Materials and Methods: After approval from the local ethics committee and with written informed consent from patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients belonging to American Society of Anesthesiologists (ASA)classification I &amp; II, aged between 18-60 years, posted for elective lower limb surgeries, were randomly allocated for the study. Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only. Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex distribution. Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative analgesics. Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic disturbance and better postoperative outcome with/ minimum side effects.

scholarly journals Randomized clinical study comparing safety and efficacy of adjuvant intrathecal clonidine versus normal saline along with bupivacaine anaesthesia in lower limb surgery patients

2017 ◽  
Vol 6 (12) ◽  
pp. 2804
Author(s):  
Brijesh Kumar ◽  
Kiran Shetty ◽  
Vijaya Kiran Shetty ◽  
Suresha K. R.
Keyword(s):  
Side Effects ◽  
Normal Saline ◽  
Lower Limb ◽  
Motor Block ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Safety And Efficacy ◽  
Randomized Clinical Study ◽  
Intrathecal Clonidine

Background: Various adjuvants have been used in intrathecal anesthesia to avoid intraoperative visceral and somatic pain and prolong postoperative analgesia. Clonidine, partially selective α2-agonist, is being evaluated as a neuraxial adjuvant with intrathecal bupivacaine. The objective of the study was to evaluate and compare safety and efficacy of intrathecal clonidine as adjuvant to bupivacaine with control normal saline.Methods: American Society of Anesthesiologist grade 1 and 2 patients (60 patients) were randomly divided into two groups of 30 patients each for lower limb surgeries. Study group injected with intrathecal 3ml of 0.5% Bupivacaine heavy (15mg) + 1µg/kg of clonidine and control group injected with 3ml of 0.5% Bupivacaine heavy (15mg) + equivalent dose of normal saline. The onset and duration of sensory and motor block, duration of analgesia, and the incidence of side effects in both groups were observed and compared.Results: Time for 2 segment regressions in study group was 186.17±25.92 minutes compared to control was 103.20±19.15 minutes (p value<0.001). Total duration of analgesia in control was 226.50±35.69 minutes and in the study group was 465.67±100.37 minutes (p value<0.001). The average duration of motor block in control group was 181.17±26.12 minutes compared to study group was 217.80±41.51 minutes (p value<0.001). The small dose of intrathecal clonidine is not significantly associated with systemic side effects such as bradycardia and hypotension.Conclusions: Clonidine added to bupivacaine for intrathecal anesthesia effectively increases the duration of sensory block, duration of motor block and duration of analgesia and does not produce any significant hemodynamic changes. No significant side effects are associated with it.

scholarly journals EFFECT OF INTRAVENOUS VERSUS INTRATHECAL DEXMEDETOMIDINE ON CHARACTERISTICS OF HYPERBARIC BUPIVACAINE SPINAL ANESTHESIA IN LOWER LIMB SURGERY

2018 ◽  
Vol 11 (7) ◽  
pp. 427
Author(s):  
Laxman K Senapati ◽  
Priyadarsini Samanta
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Infusion Pump ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Lower Limb Surgery

Objectives: Dexmedetomidine was shown to prolong the duration of spinal anesthesia and enhance post-operative analgesia. The aim of the study was to compare the effect of intravenous (IV) versus intrathecal (IT) administration of dexmedetomidine on bupivacaine spinal anesthesia in patients undergoing lower limb surgery.Methods: A prospective randomized controlled study was conducted during the year 2014–15. 60 American Society of Anesthesiologists physical status I–II aged 18–60 years scheduled for lower limb surgery under spinal anesthesia were assigned randomly to two groups: (1) IT group (IT group) (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 μg of dexmedetomidine intrathecally (100 μg/1 ml ampoule drawn in 40 IU/ml insulin syringe making 5 μg=2 IU=0.05 ml) and (2) IV group (IV group) (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml of normal saline intrathecally followed 5 min later by IV dexmedetomidine 0.5 μg/kg by infusion pump over 10 min as a single dose.Results: The IT group had a statistically significantly earlier sensory onset to T10 and shorter time from injection to highest sensory level (p<0.001). The regression times of two dermatomes, regression time to S1 dermatome and time to reach Bromage 3 motor block were significantly less in the IT group, whereas regression time to Bromage 0 was prolonged (p<0.001). The IT group showed a significantly longer time to the use of rescue analgesia and less analgesic consumption in first 24 h than the IV group (p<0.001). Furthermore, the intensity of pain was significantly less in the IT group as compared to IV group (p<0.001). Compared with IV group, the IT group had low sedation score, fewer overall side effects, which was statistically not significant (p>0.05).Conclusion: In bupivacaine spinal anesthesia for limb surgeries, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects compared to the IV route of administration.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

scholarly journals Postoperative analgesia with the use of peripheral nerve block of the foot and ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Kelly Stéfani ◽  
Gabriel Ferraz
Keyword(s):  
Peripheral Nerve ◽  
Pain Intensity ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Peripheral Nerve Block ◽  
Control Group ◽  
Study Group ◽  
Foot And Ankle ◽  
The Mean

Category: Basic Sciences/Biologics Introduction/Purpose: Peripheral nerve block in the foot and ankle is usually used for anesthesia in forefoot and midfoot surgeries. However, since the postoperative analgesia obtained is prolonged, we can expand its use, as an adjuvant after the end of the spinal or general anesthesia. The aim of this study was to evaluate the use of peripheral nerve block of the foot and ankle as a method of postoperative analgesia. Methods: A prospective, randomized, blinding study was performed. The study group included 30 patients (32 feet) submitted to peripheral anesthetic block after surgery with spinal anesthesia and the control group (30 patients, 31 feet) were patients not submitted to nerve block. The inclusion criterion was: patients submitted to foot and ankle surgery at our institution. Patients answered the questionnaire postoperatively, with the measurement of pain intensity by the Visual Analog Scale (VAS) and the time of onset of pain. All local peripheral block was performed by the same orthopedic team with 20 mL of Ropivacaine at a concentration of 7.5 mg / mL (0.75%). Results: The mean patient age was 52,5 years, and the majority of patients were women (66%). The results showed a statistically significant difference between the control group and the study group, with a longer time of postoperative analgesia (p <0.001) and lower pain intensity in the immediate postoperative period (p <0.001) in patients submitted to blockade anesthetic. There was no statistical difference between the two groups regarding pain intensity on the first and second postoperative day. Conclusion: In the study group, the mean postoperative pain (six hours after surgery) was lower when compared to the control group, with statistical significance. This result showed that the ankle block helped to control pain, in a safe and effective mode. The use of ropivacaine presents a sensitive block similar to bupivacaine, but with shorter motor block, allowing early initiation of rehabilitation. The study demonstrated that peripheral nerve block in the foot and ankle region can be used effectively in postoperative analgesia, reducing pain intensity in the immediate postoperative period and also prolonging analgesia and thus maximizing physiotherapy postoperative period.

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

scholarly journals Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Josef Attia ◽  
Amany Abo Elhussien ◽  
Mostafa Zaki
Keyword(s):  
Side Effects ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B ◽  
Limited Duration

Background. Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Aim of the Work. The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects. Patient and Methods. Sixty adult patients of both sexes, divided into three. Group C received 2.5 mL bupivacaine and 0.5 mL saline 0.9%. Group A received 2.5 mL bupivacaine and 0.5 mL midazolam. Group B received 2.5 mL bupivacaine and 0.5 mL magnesium sulphate. Results. As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C. Conclusions. These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

A Comparative Study to verify the Efficacy of Preoperative Intravenous Tranexamic Acid in Control of Tonsillectomy Bleeding

2016 ◽  
Vol 8 (1) ◽  
pp. 22-25 ◽  
Author(s):  
KB Prashanth ◽  
S Abhilash
Keyword(s):  
Side Effects ◽  
Tranexamic Acid ◽  
Comparative Study ◽  
Intravenous Dose ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Not Given ◽  
Single Intravenous Dose ◽  
Group I

ABSTRACT Objectives This study was conducted to assess the efficacy of the drug tranexamic acid administered preoperatively in controlling the bleeding during tonsillectomy intraoperatively. Materials and methods A total of 50 patients who underwent tonsillectomy were randomized into two groups. Group I (study group): Intravenous tranexamic acid was given with dose of 10 mg/kg. Group II (control group): Tranexamic acid injection was not given. Intraoperative amount of bleeding was assessed in each case. Results The study group had significant reduction in bleeding and the p-value was <0.05, which was statistically significant, when compared to control group. There were no side effects of the drug observed. Conclusion Single intravenous dose of tranexamic acid at a dose of 10 mg/kg preoperatively is effective in control of tonsillectomy bleeding. How to cite this article Santosh UP, Prashanth KB, Abhilash S. A Comparative Study to verify the Efficacy of Preoperative Intravenous Tranexamic Acid in Control of Tonsillectomy Bleeding. Int J Otorhinolaryngol Clin 2016;8(1):22-25.

scholarly journals Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 10-13
Author(s):  
Bimochan Piya ◽  
Abhishek Bhattarai
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Diclofenac Sodium ◽  
Study Groups ◽  
Ureteral Stones ◽  
Control Group ◽  
P Value ◽  
Expulsion Rate ◽  
Group A ◽  
Group B

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones. Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group. Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively.  It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient. Conclusion:  The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

scholarly journals Proximal Trauma Increases Risk of Venous Thrombosis in Soft Tissue Reconstruction of Open Lower Limb Fractures

2021 ◽  
Vol 7 ◽  
Author(s):  
Nilay G. Yalcin ◽  
Frank Bruscino-Raiola ◽  
Scott Ferris
Keyword(s):  
Limb Salvage ◽  
Free Flap ◽  
Lower Limb ◽  
Pelvic Injury ◽  
Control Group ◽  
Study Group ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Thrombosis Rate ◽  
Trauma Group

Lower limb salvage after major trauma is a complex undertaking. For patients who have suffered multi-level trauma to their lower limb we postulated that pelvic injury or ipsilateral lower limb injury proximal to the site of a free flap may increase the rate of post-operative complications. All patients who underwent lower limb free flap reconstruction as a result of acute trauma between January 2010 and December 2017 were included. The patients were divided into the study group (50 patients), who sustained a lower limb or pelvic injury proximal to the free flap site, and control group (91 patients) who did not sustain proximal lower limb or pelvic trauma. Complication rates were compared between the two groups. Overall, the proximal trauma group anastomotic thrombosis rate of 18.0% was significantly higher than the control group thrombosis rate of 2.2%. There was no statically significant difference in rates of hematoma, swelling or infection. Flap loss rate in the proximal trauma group was 4.0%, compared to the control group at 2.2%. All patients with a failed flap went onto have a successful reconstruction with a subsequent flap in the acute admission and there were no amputations. In the proximal injury study group despite the significantly increased rate of microvascular thrombosis requiring revision, the ultimate primary free flap survival rate was still 96%. Overall, severe coexisting proximal trauma predicted a higher venous microvascular complication rate but was not a contraindication to limb salvage.

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