Physical, Biochemical, Cytological, Bacteriological Screening of Carpal hygroma Fluid vis-a-vis Surgical Management of Carpal hygroma in Cattle and Buffaloes- A report of 15 Cases

Fifteen animals affected with unilateral 9 and bilateral 6 carpal hygroma were presented with the history of swelling on the anterior aspect of the carpus since 3-18 month. Hygroma fluid samples from all the cases were aseptically collected for physical, biochemical, cytological and bacteriological investigations. The colour of hygroma fluid was pale yellow with slight deposits. Glucose, chloride and total protein levels were 43±4.08 mmol/dL, 107±6.50 mmol/dL and 3.20 g/dL, respectively. Cytological examination revealed cell count of 150 cells/µL, 20% neutrophils and 80% lymphocytes. Moreover, mild (+) cellular degeneration changes were also seen. The hygroma fluid samples from all animals were screened for brucellosis. Two cows were found positive for Brucella in tube agglutination test with antibody titres of 160 and 320 IU, respectively. Whereas, the hygroma fluid samples from other animals showed no growth on culture. Surgical excision of carpal hygroma in all cases was done under xylazine sedation (@ 0.02mg/kg body wt) and intravenous regional anaesthesia (IVRA). In brucella infected cows (n=2), hygroma sacs were excised en mass. Skin sutures were applied and the limb was put in fiber-glass cast for 10 days. In bilateral cases, the hygroma of one limb was treated at first instant followed by counter limb after 15 days. In all cases, the wound healing occurred by first intention without any complication. It was concluded that brucella organism may be present in hygroma fluid and due precaution are required while collecting fluid samples. The presence of hygroma may be considered as evidence of brucellosis in the herd. The owners should be advised not to breed such animals in future.

TO COMPARE THE EFFECTS OF ROPIVACAINE(1.8mg/kg) WITH FENTANYL (50μg) AND ROPIVACAINE (1.8mg/kg) WITH CLONIDINE (75μg) FOR INTRAVENOUS REGIONAL ANAESTHESIA (IVRA) FOR UPPER LIMB AND LOWER LIMB SURGERIES

Introduction: Intravenous Regional Anaesthesia (IVRA) is indicatedfor short surgical procedures of upper extremity(below elbow) and of lower extremity (below knee). The aim of this randomised double-blind controlled study was to investigate the effects of adding Injection Clonidine as adjuvant to Injection Ropivacaine and Injection Fentanyl as adjuvant to injection Ropivacaine for IVRA in patients undergoing upper limb (below elbow) and lower limb (below knee) surgeries. Sixty adult ASA I and II patients Material and methods: of either sex in the age range of 20 to 60 years were randomly divided equally into 2 groups of 30 each. Group A received Injection Ropivacaine(0.75%) 1.8 mg/kgwith Injection Clonidine75µg/kg and Group B received Injection Ropivacaine (0.75%) 1.8 mg/kg with Injection Fentanyl 50 µg/kg. Results: Sensory onset showed high statistically signicant difference with Group A having earlier onset at 28.50 19.96 seconds as compared to Group B at 238 111.95 seconds (P<0.0001). Comparison of peak sensory showed high signicant statistical difference with Group A having earlier onset at 194 223.21 seconds as compared to Group B at 720 217.19 seconds (P<0.0001). The sensory wearoff between both the groups were highly signicant statistically showing Group A at 1150 ± 486.19 seconds as compared with Group B 184 ± 112.45 seconds (P<0.0001). The Visual Analogue Score in post operative ward just after completion of surgery show Group B having higher VAS score as compared with Group A.The time for rescue analgesia was prolonged in Group A as compared with Group B. Conclusion: Adding Clonidine to Ropivacaine improved the quality of anaesthesia and post-operative analgesia in Intravenous Regional Anaesthesia as compared to when Fentanyl was added to Ropivacaine.

Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial

Background and objectives Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Methods In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. Results In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusion An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. Trial registration This trial was registered as NCT03411551.

Comparison of magnesium sulphate as an adjuvant to lignocaine with lignocaine alone in intravenous regional anaesthesia for upper limb surgery in improving tourniquet pain.

Objectives: To compare mean time to the first analgesic requirement with the Magnesium sulfate with lignocaine and lignocaine alone under intravenous regional anaesthesia for upper limb surgery. Study Design: Randomized Controlled Trial. Setting: Operative Rooms of Shaikh Zayed Hospital, Lahore. Period: October 2, 2018 to April 2, 2019. Material & Methods: For the analysis, a total of 150 (75 subjects per group) were selected that fulfilled the inclusion criteria. Those subjects were allocated by the use of the tables to two separate anesthetic regimes. Lignocaine plus magnesium sulphate was given to experimental group (M) as an adjunct and control group (L) was given simple IVRA with lignocaine. Mean Atrial Pressure, Heart Rate, and SpO2 were tracked every 2 minutes after start of anesthesia before and after use of the tourniquet. All the patients will be counseled to report if they experience tourniquet pain. When patients complained of tourniquet pain it was assessed on VAS of l-10 and patient was given analgesia if pain >3 on VAS. The data were collected and analyzed in SPSS v25.0. The median time for analgesics was used in both groups for the analysis of the independent t-test. A p-value of 0.05 was estimated significant. Results: 150 patients were enrolled. Mean time to first analgesic requirement is greater with the Magnesium sulfate with lignocaine and lignocaine alone in patients undergoing upper limb surgery under intravenous regional anaesthesia 51.9±4.2 minutes vs. 32.1±4.4 minutes (p=0.000). Conclusion: The findings indicate that the tourniquet pain is reduced by adding magnesium sulphate as an adjuvant to lignocaine.

Distal Intravenous Regional Anaesthesia for Claw Diseases in Bovines

The bovine having surgical ailments of claw, were divided in to two groups having six animals/limbs in each group. Tourniquet for standard and modified intravenous regional anesthesia (IVRA), was placed circumferentially at the middle of the metacarpus and just below dewclaw in group I and II, respectively. Lignocaine was injected @ 4 mg/kg and 2 mg/kg b.wt. in group I and group II animals, respectively. In group I, pulse rate increased significantly P andlt; 0.05 at 20 and 30 minutes. Heart rate increased significantly P andlt; 0.05 at 20 minute and 30 minute interval in group I and II animals, respectively. In animal of both groups, oxygen saturation significantly P andlt; 0.05 decreased during study time period. Systolic pressure significantly increased at 15, 20 and 20 minutes in group I animals. It was concluded that modified IVRA technique was safer as compared to standard IVRA..