AN OBSERVATIONAL STUDY TO COMPARE THE EFFICACY OF ROPIVACAINE ALONE AND ROPIVACAINE WITH DEXMEDETOMIDINE IN ULTRASOUND GUIDED FASCIA ILIACA COMPARTMENT BLOCK FOR ANALGESIA IN POSITIONING OF THE PATIENT IN SUBARACHNOID BLOCK PERFORMED IN UNILATERAL FEMUR FRACTURE SURGERY

Introduction: Patients encountered with fracture shaft and neck femur require some anaesthesia or pain relief to allow radiological, orthopedic and other procedures to be performed. Regional anaesthesia is the most widely used an aesthetic technique for orthopedic procedures in lower limbs.Fascia iliaca blocks provide a safe, cheap and effective form of pain relief for patients with neck of femur fractures. Animal studies have proven the combination of dexmedetomidine with ropivacaine to be safe and neuro-protective. Fascia iliaca compartment block which involve femoral nerve, lateral cutaneous nerve of thigh and obturator nerve. This study is designed to compare Fascia Iliaca Compartment Block under ultrasound guidance with ropivacaine and ropivacaine plus dexmedetomidine positioning during spinal anesthesia in femur fractures. Material and methods: This study was conducted at Mahatma Gandhi hospital and Mathuradas Mathur hospital, Jodhpur during January 2019–January 2020. 60 Patients admitted in Orthopaedic ward age group 21-60 yrs. of both sex were the source of data. Patients undergoing elective surgery for fracture femur (neck of femur and intertrochanteric) under SAB were included in the study. We divided the cases into 2 groups of 30 each, as GROUP R: Patients were received 30 ml 0.50% Inj. ropivacaine + 2 ml Normal saline with a total volume of 32 ml in unilateral FICB. GROUP RD: Patients were received 30 ml 0.50% Inj. Ropivacaine + 2 ml Inj. Dexmeditomidine (0.5mcg/Kg) with a total volume of 32 ml in unilateral FICB. Standard protocol followed to administering regional anaesthesia. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study results in that Fascia Iliaca Compartment Block with combination of ropivacaine and dexmedetomidine is more efficacious than ropivacaine alone for positioning during spinal anaesthesia in surgery for fracture femur. Key words: Spinal Anaesthesia, Fascia Iliaca Compartment Block, Ropivacaine, Dexmedetomidine.

To Compare the Incidence of Post-Dural Puncture Headache Using 25G Quincke and 25G Whitacre Spinal Needles in Patients Undergoing Lower Segment Caesarean Section

BACKGROUND Spinal anaesthesia is the first preference of anaesthesia in obstetric surgery. Post dural puncture headache (PDPH) is more common after C-section in young parturients. In the present world which is developing and fast-paced, brisk recovery along with minimal side effects & importantly early ambulation are now the need of the hour. This headache is more worrying to the mother who is required to tend to the newborn baby. This study compared the incidence of PDPH subsequent to subarachnoid blockade for lower segment Caesarean section (LSCS) 25G Whitacre & 25G Quincke needles. We wanted to compare the incidence of PDPH using 25G Quincke and 25G Whitacre spinal needles in patients undergoing LSCS. METHODS Two hundred (ASA II) American Society of Anaesthesiologists 11 females who were pregnant and in the age group of 20 - 50 years, planned to get sub-arachnoid blockade for C-section, were assigned randomly into two equal groups (N = 100 each). Both groups received spinal anaesthesia with 25-gauge Quincke and 25 gauge Whitacre needle. Postoperatively, incidence, site, onset, severity and duration of headache was studied. RESULTS The incidence of post spinal headache was 6 % in the Quincke group. No patients in Whitacre group had PDPH. The number of lumbar punctures required for successful sub arachnoid block was recorded in both the groups. 92 % patients from group Q and 88 % patients from group W required only one puncture. 8 % patients from group Q and 12 % patients from group W required two punctures. CONCLUSIONS It is prudent to conclude that 25G Whitacre spinal needle is a better alternative to 25G Quincke needle for reducing the incidence of post dural puncture headache in patients undergoing lower segment Caesarean section. KEY WORDS Spinal Anaesthesia, Post Dural Puncture Headache, Caesarean Section

Effect of Site of Injection on Spread of Spinal Anaesthesia with Hyperbaric Bupivacaine

Ninety unpremeditated patients (20-40 years) undergoing caesarean section were allocated randomly to receive 0.5% hyperbaric bupivacaine 2ml at the site of L2-3, L3-4 and L4-5 intervertebral space. Spinal injection was performed to all patients with a 25-gauge Quincke spinal needle. The onset time of analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min was significantly higher after injection at L2-3. But the maximum height (T4) of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different among the three groups. Key words: Spinal anaesthesia, hyperbaric bupivacaine, site of injection, spread of anaesthesia. Journal of BSA, Vol. 20, No. 2, July 2007 p.51-55

Supraventricular Tachycardia during Regional Anaesthesia (Spinal Anaesthesia)

Supraventricular tachycardia, though not very common may develop in any patient under spinal anaesthesia. A 50 years old lady admitted at square hospital through the emergency unit with left loin pain and fever with chill. She was already diagnosed as a case of left ureteric stone and was scheduled for Ureteorenoscopic Intracorporeal Pneumatic Lithotripsy (URS-ICPL) under spinal anaesthesia. During anaesthesia, she developed supraventricular tachycardia of unknown origin. Ultrashort-acting (3-blocker was given slowly. As there was no improvement, intravenous propranolol was given slowly, which resulted in a conversion to sinus rhythm. This paper discussed methods of cardio version for patients with supraventricular tachycardia in such clinical settings. Key words: Spinal anaesthesia, SVT. Journal of BSA, Vol. 21, No. 1, January 2008 56-58

Effect of Site of Injection on Spread of Spinal Anaesthesia with Hyperbaric Bupivacaine

Spinal Anaesthesia during caesarean section is popular world wide. The aim of the study was the explore the efficacy of spinal Anaesthesia with hyperbaric bupivacaine at different intervertebral space in lower uterine caesarean section. Ninety unpremeditated patients (20-40 years) undergoing caesarean section were allocated randomly to receive 0.5% hyperbaric bupivacaine 2ml at the site of L2-3, L3-4 and L4-5 intervertebral space. Spinal injection was performed to all patients with a 25-gauge Quincke spinal needle. The onset time of analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min was significantly higher after injection at L2-3. But the maximum height (T4) of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different among the three groups. So we can conclude that onset of Analgesia is altered by the site of injection, but the overall analgesia level achieved remain unchanged. Key words: Spinal anaesthesia, hyperbaric bupivacane, site of injection, spread of anaesthesia. doi: 10.3329/bjog.v23i1.3052 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 15-19