Ultrasound Guided Thoracic Paravertebral Block as an Analgesic Technique for Tracheoesophageal Fistula repair : A Case Report

Ultrasound has now become an eye of anaesthesiologist and has encouraged for its pervasive use. Its considerable use in the perioperative period for various invasive purposes has added an extra caution to prevent unforeseen complications over blind blocks. The ultrasound-guided thoracic paravertebral block provides excellent perioperative analgesia following thoracic surgery. It can be given as a single shot or a continuous infusion technique placing a catheter. Here the local anesthetic agent is deposited in the paravertebral space from where the spinal nerve emerges which are devoid of coverings and are sensitive to local anesthetics. Even a single-shot block provides analgesia of 4-6 dermatomal levels. The use of local anesthetics using ultrasound not only adds safety measures to minimize procedural complications but also reduces the perioperative requirement of opioids. It also helps in the reduction of postoperative pulmonary complications and early extubation following thoracic surgery. We report a case series where single-shot ultrasound-guided unilateral paravertebral blocks were used as an analgesic technique for the repair of tracheoesophageal fistula in neonates. After delivering anesthesia and confirming the correct placement of the endotracheal tube the neonate was kept on the left lateral position to undergo right thoracotomy and repair of fistula. Scanning at T4 level with a linear probe was done to identify the transverse process, pleura, costotransverse ligament, intercostal muscle, and the paravertebral space where the local anesthetic agent was deposited under aseptic precautions. Tenting of pleura was the endpoint for the completion of the block. The extensive use of various regional anesthetic technique has significantly improved the postoperative outcome of the patients along with adequate perioperative pain management.

Persistent pain relief following a single injection of a local anesthetic for neuropathic abdominal wall and groin pain

Objectives It is our experience that a small portion of patients with neuropathic abdominal wall pain syndromes such as the anterior cutaneous nerve entrapment syndrome (ACNES) have a long term beneficial response following just one single tender point injection (TPI) with a local anesthetic agent. This report focuses on the phenomenon of ongoing pain relief following a single local anesthetic injection in neuropathic abdominal wall and groin pain syndromes. Methods This report is an overview based on earlier studies from a center of expertise for neuropathic abdominal wall and groin pain syndromes. All studies on neuropathic abdominal wall and groin pain syndromes reporting on efficacy of a diagnostic TPI using a local anesthetic agent were included. Results A total of 10 studies including 834 patients fulfilled study criteria. Each of these 10 studies found that approximately 10% (range, 4–25%) of the cases experienced persistent pain relief after a single TPI with lidocaine 1%. Conclusions Persistent pain relief after a single TPI using a local anesthetic agent may be observed in approximately one of 10 patients suffering from neuropathic abdominal wall or groin pain syndromes. When a patient is suspected of having a neuropathic abdominal wall or groin pain syndrome, a single TPI using a local anesthetic agent should be administered as long term pain relief may occasionally occur.

INFLUENCE OF CLONIDINE WITH LOCAL ANESTHESIA ON DURATION OF ANALGESIA IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED CONTROLLED TRIAL.

Introduction: Since the 80's, clonidine has been used as an adjunct to local anesthetics agents in various regional techniques to extend the duration of block. The results of previous studies on the usefulness of clonidine on brachial plexus block have been mixed. To evaluate the efcacy of clonidine, as Material and Methods: an adjunct to the ropovacaine in supraclavicular branchial plexuses on the onset and duration of sensory and motor block. Observations and Results: the onset of sensory and motor bock is the same whether patients receive ropivacaine alone or in combination with clonidine. However duration of both sensory and motor block is signicantly prolonged in Ropivacaine and clonidine group . Clonidine Hcl can s Conclusion: afely be used as an adjunct to local anesthetic agent in supraclavicular brachial plexus block to enhance onset and duration of sensory and motor block and provide better postoperative pain relief in upper limb surgeries.

TO STUDY ANALGESIC EFFECT OF 0.25% BUPIVACAINE VS 0.25% ROPIVACAINE IN “3 IN 1” FEMORAL NERVE BLOCK FOR KNEE SURGERIES

Background: Total knee replacement (TKR) and other knee surgeries are amongst the most painful orthopedic procedure, mandating effective postoperative pain management. Ropivacaine is a New Local anesthetic Agent With Minimal CVS Toxicity. The primary aim of is to study effect of 3 in 1 femoral Aims: nerve block for providing pain relief with Ropivacaine (0.25%). Secondary aim is to compare the effect of Ropivacaine 0.25% with Bupivacaine( 0.25%) in providing 3 in 1 femoral nerve block. Material and Methods: A prospective randomised study was carried out in 36 ASA I & II patients undergoing knee surgery surgeries were divided into two groups of 18. Group (R) received Ropivacaine (0.25%) 40 ml. Group (B) received Bupivacaine (0.25%) 40 ml. Results: Demographic and hemodynamic parameters were statistically not signicant. The duration of analgesia is longer with Group R (7.83±0.98) than Group B (6.33±0.76) (p<0.001) which is statistically very signicant. Observing VAS score Group R shows signicantly (p<0.05) lower values th th th than Group B for at 4 to 8 hours & than at 24 hour. Ropivacaine is signicantly more effective in postoperative duration of pain. No Adverse events noted in the both groups. Conclusion: Postoperative 3 in 1 femoral nerve block with 0.25% ropivacaine is effective in providing pain relief and duration of analgesia is more in comparison to 0.25% bupivacaine.

Awareness of Using Articaine in Children by Dentists in Chennai- A Questionnaire Survey

Articaine is a short acting local anesthetic agent which is used for minor surgeries. Although there is reluctance to use it on children, studies have shown that it is safe to use it in pediatric patients above the age of 4 years. This survey aimed to analyse the awareness on the use of articaine in children among dentists. A questionnaire containing questions about articaine, it’s properties and the participant’s general view about the local anesthetic was distributed to the dental students and private practitioners in Chennai. The results were statistically analyzed using Chi Square test. Moreover, 65% of the participants were using articaine in children, 26.51% preferred using articaine in children below the age of 4. On the other hand, 43.18% were unsure about the choice of articaine as their default local anesthetic agent. This survey showed that dental students and the participants with 0-5 years of experience used articaine as a local anesthetic in children with the difference being statistically not significant(p>0.05). Moreover, male dentists showed more willingness to prefer articaine as their default local anesthetic agent compared to females, however the difference was not statistically significant (p>0.05).

Randomized Clinical Trial of Anesthetic Efficacy of Buffered Versus Conventional Local Anesthetic Agent in Patient with Symptomatic Irreversible Pulpitis

Local anesthetics are used to alleviate pain and discomfort of the patient during root canal therapy. Effective pain control is an absolute essential for better patient compliance and attitude towards the treatment. The purpose of the study was to observe the onset of action of local anesthesia, its duration of action and pain experienced by the patient during treatment procedure. Patients diagnosed with symptomatic irreversible pulpitis and no changes in the periapical tissues indicated for endodontic management were included in the study. The study was a double blinded randomised clinical trial. The non-randomization procedure allocated 32 teeth with symptomatic irreversible pulpitis, 8 teeth to each control group (group I treated by conventional 2% Lignocaine and group III treated by conventional 4% Articaine HCL) and 8 teeth to each experimental group (group II treated by buffered 2% Lignocaine and group IV treated by buffered 4% Articaine HCL).The buffering of local anesthetic agent improves the efficacy, onset of action and longevity of the local anesthetic agent. Buffered local anesthetics can be used in place of conventional local anesthetic agents. Long term clinical trials will be required to observe the result and to draw a comment and conclusion.