A Prospective Study to Compare the Effects of General Anaesthesia and Regional Anaesthesia among Patients Posted for Laparoscopic Appendicectomy, in SV Medical College, Tirupati, Andhra Pradesh

BACKGROUND We wanted to compare the effects of general anaesthesia and regional anaesthesia in cases posted for laparoscopic appendicectomy and also compare various parameters like hemodynamic changes, postoperative analgesia, and postoperative complications in both the techniques. METHODS After obtaining permission from scientific and ethical committee of SVMC, Tirupati, we conducted the study on 60 patients attending SV Medical College, Tirupati from September 2018 to August 2019, who were in ASA GRADE 1 & 2, and posted for laparoscopic appendicectomy. We divided them into two groups Group - S – those who received spinal anaesthesia & Group - G – those who received general anaesthesia. RESULTS 60 patients of ASA 1 and 2 were taken up for laparoscopic appendicectomy from September 2018 to August 2019. Out of 60 patients, 30 patients were grouped under Group - S, Other 30 patients grouped under Group - G. Intraoperative vitals, including blood pressure, heart rate, oxygen saturation, and respiratory rate and end-tidal CO2 levels, were within baseline values, whereas postoperative analgesia was better in Group - S than Group - G. There were 3 patients in the spinal group who developed postoperative hypotension and were managed with injection mephentermine sulphate. Out of 30 in each group, 11 patients in spinal, and 22 patients in GA group developed postoperative nausea and vomiting, which subsided with antiemetics. There were 4 patients in spinal, and 3 patients in the GA group who complained of shoulder tip pain in the postoperative period. Patients had minimal pain and no requirement of analgesia in the initial 3 hours of the postoperative period in the spinal group. CONCLUSIONS Patients who underwent laparoscopic appendicectomy under spinal anaesthesia (Group - S) showed significant postoperative analgesia (P - value < 0.05) and better haemodynamic stability than the patients who underwent laparoscopic appendicectomy under general anaesthesia (Group - G), But alertness for any emergency by anaesthesiologist was more needed in spinal anaesthesia than general anaesthesia because airway was not protected, and patient was taking spontaneous respirations. KEYWORDS RA - Regional Anaesthesia, SA - Spinal Anaesthesia, GA - General Anaesthesia, PONV (Postoperative Nausea & Vomiting)

Effectiveness of Spinal Analgesia for Labor Pain Compared with Epidural Analgesia

Objectives: This study aimed to compare the analgesic effect of single-dose spinal versus epidural analgesia for labor pain to verify if applying a single dose spinal analgesia is an efficient technique for labor pain management as an alternative for epidural analgesia. Methods: A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal analgesia (n = 64) and epidural analgesia (n = 64). The latter received a bolus dose of 16 mL of 0.125% bupivacaine and 50 μg fentanyl and repeated 5 - 10 mL of bolus dose. The former received 2.5 mg hyperbaric bupivacaine plus 50μg fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of analgesia, mode of delivery, the duration of labor, side effects, and maternal satisfaction were also compared. Results: There were no significant differences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after analgesia between the two groups. Measured pain after 30 (P = 0.0001) and 90 min (P = 0.01) was significantly lower in the spinal group than the epidural group. However, there was no significant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0.002). The mean duration of analgesia was longer in the spinal group than the epidural group (P = 0.0001). Conclusions: According to the findings, single-dose spinal analgesia, compared to epidural analgesia, is a safe, fast, and efficient technique for labor analgesia, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.

Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: a retrospective cohort study

Background: Anesthesia is needed to ensure both maternal and fetal safety during cesarean sections. This retrospective cohort study compared maternal and fetal outcomes between general and spinal anesthesia for cesarean section based on perioperative hemodynamic parameters (pre- and postoperative systolic blood pressure, heart rate), mean difference of hematocrit and estimated blood loss, and neonatal Apgar scores at 1 and 5 min.Methods: Data from electronic medical records of 331 singleton pregnancies between January 2016 and December 2018 were analyzed retrospectively; 44 cases were excluded, and 287 cases were assigned to the general group (n = 141) or spinal group (n = 146).Results: Postoperative hemodynamic parameters were significantly higher in the general group than the spinal group (systolic blood pressure: 136.8 ± 16.7 vs. 119.3 ± 12.7 mmHg, heart rate: 93.2 ± 16.8 vs. 71.0 ± 12.7 beats/min, respectively, P < 0.001). The mean difference between the pre- and postoperative hematocrit was also significantly greater in the general than spinal group (4.8 ± 3.4% vs. 2.3 ± 3.9%, respectively, P < 0.001). The estimated blood loss was significantly lower in the spinal than general group (819.9 ± 81.9 vs. 856.7 ± 117.9 ml, P < 0.001). There was a significantly larger proportion of newborns with 5-min Apgar scores < 7 in the general than spinal group (6/141 [4.3%] vs. 0/146 [0%], respectively, P = 0.012). Conclusions: General group is associated with more maternal blood loss and a larger proportion of newborns with 5-min Apgar scores < 7 than spinal group during cesarean sections.

Ultrasound guided peripheral nerve block as alternative to subarachnoid block in total hip replacement arthroplasty: a retrospective study

Background: Ultrasound guided peripheral nerve blocks have become increasingly popular in the lower limb orthopaedic and gaining more acceptances in total hip replacement surger­ies too. The main objective of this study was to compare peripheral nerve block and spinal anesthesia for total hip replacement surgeries. Methods: In this retrospective study, total patients that underwent total hip replacement in our institution during specific time period were included for the study. They were divided into spinal and peripheral nerve block groups, and data were collected for the analysis. USG guided lumbar plexus, sacral plexus, superior gluteal nerve block was done and conventional landmark technique was done for spinal group. Mean arterial blood pressure, total fluid con­sumption, total fentanyl consumption, pain scores and incidence of nausea was compared. Results: We included 43 patients for the study in which 23 patients were included in nerve block group, and 20 patients in the spinal group. In compared to spinal group, nerve block group had more stable mean arterial blood pressure (P <0.05), less total fluid consumption (P=.000), lower pain scores and fentanyl consumption (P <0.05), and less incidence of nausea (4% to 20%). Conclusions: Peripheral nerve block can be good alternative to spinal anesthesia for total hip replacement surgeries, with more hemodynamic stability and better pain management along with less opioid and fluid consumption.

Preliminary findings and outcomes associated with the use of a continuous spinal protocol for labor pain relief following accidental dural puncture

BackgroundVarious interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture.MethodsWe reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery.ResultsThere were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied.ConclusionPatients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.

Maximal Subgroups and Irreducible Representations of Generalized Multi-Edge Spinal Groups

Let p ≥ 3 be a prime. A generalized multi-edge spinal group $$G = \langle \{ a\} \cup \{ b_i^{(j)} {\rm \mid }1 \le j \le p,\, 1 \le i \le r_j\} \rangle \le {\rm Aut}(T)$$ is a subgroup of the automorphism group of a regular p-adic rooted tree T that is generated by one rooted automorphism a and p families $b^{(j)}_{1}, \ldots, b^{(j)}_{r_{j}}$ of directed automorphisms, each family sharing a common directed path disjoint from the paths of the other families. This notion generalizes the concepts of multi-edge spinal groups, including the widely studied GGS groups (named after Grigorchuk, Gupta and Sidki), and extended Gupta–Sidki groups that were introduced by Pervova [‘Profinite completions of some groups acting on trees, J. Algebra310 (2007), 858–879’]. Extending techniques that were developed in these more special cases, we prove: generalized multi-edge spinal groups that are torsion have no maximal subgroups of infinite index. Furthermore, we use tree enveloping algebras, which were introduced by Sidki [‘A primitive ring associated to a Burnside 3-group, J. London Math. Soc.55 (1997), 55–64’] and Bartholdi [‘Branch rings, thinned rings, tree enveloping rings, Israel J. Math.154 (2006), 93–139’], to show that certain generalized multi-edge spinal groups admit faithful infinite-dimensional irreducible representations over the prime field ℤ/pℤ.

Comparative study in prolapse lumbar intervertebral disc (PLID) surgery by spinal vs general anaesthesia

Background Lumbar discectomy is most commonly performed under general anaesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anaesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under spinal anesthesia. Objective We have compared patient satisfaction between spinal versus general anaesthesia in patients for single level lumbar surgery. Methods Eighty consecutive patients of ASA grade I-II were recruited and randomized into two equal groups, with half of this patients receiving spinal anaesthesia (n-40) and the remainder general anaesthesia (n-40). A comprehensive postoperative evaluation was carried out documenting any anaesthetic complications, pace of physiological and functional recovery and patient satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 and 24 hours; patient level of satisfaction during the stay on the ward using verbal rating scale (VRS) as it was detected by A p-value < 0.05 were considered as significant. Results Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. Perioperative hypotension in 25 % of patients and none was hypertensive in spinal group and in G/A Group 05% of patients was hypotensive and 20% were hypertensive. Postoperative pain intensity more in G/A group than spinal group. Patient satisfaction in spinal group was more comparative to G/A group. Conclusion Spinal anaesthesia ensures better operating conditions, better postoperative pain control and a quicker postoperative recovery when compared to general anaesthesia for single level lumbar spine surgery DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18173 Journal of BSA, 2009; 23(2): 47-50

Neurological deterioration after foramen magnum decompression for Chiari malformation Type I: old or new pathology?

Object Decompression of the foramen magnum is widely accepted as the procedure of choice for patients with Chiari malformation Type I (CM-I). This study was undertaken to determine the mechanisms responsible for neurological deterioration after foramen magnum decompression and the results of secondary interventions. Methods Between 1987 and 2010, 559 patients with CM-I presented, 107 of whom had already undergone a foramen magnum decompression, which included a syrinx shunt in 27 patients. Forty patients who were neurologically stable did not undergo another operation. Sixty-seven patients with progressive symptoms received a recommendation for surgery, which was refused by 16 patients, while 51 patients underwent a total of 61 secondary operations. Hospital and outpatient records, radiographic studies, and intraoperative images were analyzed. Additional follow-up information was obtained by telephone calls and questionnaires. Short-term results were determined after 3 and 12 months, and long-term outcomes were evaluated using Kaplan-Meier statistics. Results Sixty-one secondary operations were performed after a foramen magnum decompression. Of these 61 operations, 15 involved spinal pathologies not related to the foramen magnum (spinal group), while 46 operations were required for a foramen magnum issue (foramen magnum group). Except for occipital pain and swallowing disturbances, the clinical course was comparable in both groups. In the spinal group, 5 syrinx shunt catheters were removed because of nerve root irritations or spinal cord tethering. Eight patients underwent a total of 10 operations on their cervical spine for radiculopathies or a myelopathy. No permanent surgical morbidity occurred in this group. In the foramen magnum group, 1 patient required a ventriculoperitoneal shunt for hydrocephalus 7 months after decompression. The remaining 45 secondary interventions were foramen magnum revisions, of which 10 were combined with craniocervical fusion. Intraoperatively, arachnoid scarring with obstruction of the foramen of Magendie was the most common finding. Complication rates for foramen magnum revisions were similar to first decompressions, whereas permanent surgical morbidity was higher at 8.9%. Postoperative clinical improvements were marginal in both surgical groups. With the exception of 1 patient who underwent syrinx catheter removal and had a history of postoperative meningitis, all patients in the spinal group were able to be stabilized neurologically. Long-term results in the foramen magnum group revealed clinical stabilizations in 66% for at least 5 years. Conclusions Neurological deterioration in patients after a foramen magnum decompression for CM-I may be related to new spinal pathologies, craniocervical instability, or recurrent CSF flow obstruction at the foramen magnum. Whereas surgery for spinal pathologies is regularly followed by clinical stabilization, the rate of long-term success for foramen magnum revisions was limited to 66% for 5 years due to severe arachnoid scarring in a significant proportion of these patients. Therefore, foramen magnum revisions should be restricted to patients with progressive symptoms.