Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.048
Heena Sanghavi, V. Shelgaonkar
: Transversus abdominis plane (TAP) block has emerged as a safe, reliable, and efficient technique to provide post-operative analgesia for a range of abdominal procedures and has been shown to minimize the usage of opioids in the perioperative period. This paper compares the overall efficacy and safety of TAP block for postoperative analgesia in abdominal surgeries, by two techniques (blind v/s USG). Eighty patients, ASA grade I-II, 18-60 years age group, posted for abdominal surgery like appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy and exploratory laparotomy under GA. They were divided into two groups to undergo blind or USG-guided TAP block. At the end of the procedure, before the reversal, both groups received a TAP block with Inj. Bupivacaine 0.25% 20cc on each side in supine position. Patients were followed up for 24 hours, and pain scores were measured using a visual analogue scale. Inj. Diclofenac was given as rescue analgesic and Inj. Tramadol was used for breakthrough pain. Total analgesic requirement for 24 hours and complications if any, were noted.: VAS score was found to be significantly lower in USG- guided group at various time intervals till 12 hours (2.05 ± 0.75 vs 2.98 ± 1.03) in the USG-guided group as compared to the blind group (p<0.05). Time to first rescue analgesic was significantly prolonged in USG- the guided group being 19.68 ± 4.90 hours than the blind technique of 13.48 ± 6.86 hours (p <0.001). The number of rescue analgesics required in the USG-guided group was significantly lower than the blind technique (p<0.05).: USG-guided group had significantly less pain scores postoperatively and a reduced number of analgesic requirements. This resulted in fewer opioid-mediated side effects. TAP block can serve as a part of multimodal analgesia with enhanced recovery after abdominal surgery. The USG-guided approach helped in achieving near perfect block which is evident by pain scores and reduced analgesics required.
经腹平面阻滞(TAP)已成为一种安全、可靠、有效的技术，可为一系列腹部手术提供术后镇痛，并已被证明可最大限度地减少围手术期阿片类药物的使用。通过两种技术(盲法v/s USG)比较TAP阻滞用于腹部手术术后镇痛的总体疗效和安全性。80例患者，ASA I-II级，年龄18-60岁，在GA下进行阑尾切除、阑尾穿孔、脐、脐旁、切口及腹侧疝修补、子宫切除、剖腹探查等腹部手术。他们被分为两组，分别进行盲法或usg引导的TAP阻滞。在手术结束，逆转之前，两组都接受了注射Inj的TAP阻滞。布比卡因0.25%，每侧20cc，仰卧位。患者随访24小时，采用视觉模拟量表测量疼痛评分。Inj。双氯芬酸作为抢救性镇痛药和静脉注射。曲马多用于突破性疼痛。记录24小时的总镇痛需求和并发症(如有)。USG引导组VAS评分在12 h前各时间间隔均明显低于盲组(2.05±0.75 vs 2.98±1.03)(p<0.05)。USG组首次抢救镇痛时间为19.68±4.90 h，明显长于盲法组的13.48±6.86 h (p <0.001)。usg引导组所需抢救镇痛药数量显著低于盲法组(p<0.05)。usg引导组术后疼痛评分明显降低，镇痛需求减少。这减少了阿片类药物介导的副作用。TAP阻滞可作为多模式镇痛的一部分，提高腹部手术后的恢复。usg引导的方法有助于实现接近完美的阻滞，这是明显的疼痛评分和减少止痛药所需。
{"title":"Efficacy of ultrasound-guided TAP block for postoperative pain relief in abdominal surgeries: A prospective, randomized controlled trial","authors":"Heena Sanghavi, V. Shelgaonkar","doi":"10.18231/j.ijca.2023.048","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.048","url":null,"abstract":": Transversus abdominis plane (TAP) block has emerged as a safe, reliable, and efficient technique to provide post-operative analgesia for a range of abdominal procedures and has been shown to minimize the usage of opioids in the perioperative period. This paper compares the overall efficacy and safety of TAP block for postoperative analgesia in abdominal surgeries, by two techniques (blind v/s USG). Eighty patients, ASA grade I-II, 18-60 years age group, posted for abdominal surgery like appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy and exploratory laparotomy under GA. They were divided into two groups to undergo blind or USG-guided TAP block. At the end of the procedure, before the reversal, both groups received a TAP block with Inj. Bupivacaine 0.25% 20cc on each side in supine position. Patients were followed up for 24 hours, and pain scores were measured using a visual analogue scale. Inj. Diclofenac was given as rescue analgesic and Inj. Tramadol was used for breakthrough pain. Total analgesic requirement for 24 hours and complications if any, were noted.: VAS score was found to be significantly lower in USG- guided group at various time intervals till 12 hours (2.05 ± 0.75 vs 2.98 ± 1.03) in the USG-guided group as compared to the blind group (p<0.05). Time to first rescue analgesic was significantly prolonged in USG- the guided group being 19.68 ± 4.90 hours than the blind technique of 13.48 ± 6.86 hours (p <0.001). The number of rescue analgesics required in the USG-guided group was significantly lower than the blind technique (p<0.05).: USG-guided group had significantly less pain scores postoperatively and a reduced number of analgesic requirements. This resulted in fewer opioid-mediated side effects. TAP block can serve as a part of multimodal analgesia with enhanced recovery after abdominal surgery. The USG-guided approach helped in achieving near perfect block which is evident by pain scores and reduced analgesics required.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76509439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.056
Kanika Gupta, Swati Agarwal, Rajesh Misra
Caudal blocks have been recommended for surgical procedures mainly below umbilicus. Their use has increased in paediatric cases as they are easy to perform with low complication rates. There have been reports of this technique being performed as a sole anaesthetic in children who may not be a suitable candidate for general anaesthesia. This study was conducted with an aim to compare the traditionally used landmark guided technique of caudal block with ultrasound-guided technique in terms of intra-operative analgesia, haemodynamic parameters, time required to perform block and demand for rescue analgesia.This prospective randomized comparative study was carried out in 68 paediatric patients divided in two study groups (Group C and Group U) undergoing elective lower gastrointestinal and genito-urinary tract surgeries over a period of two years in a tertiary care hospital.The intra-operative haemodynamic parameters were comparable in both the groups. There was a significant increase in time taken to perform the block in Group U as compared to Group C (6.5 minutes v/s 15 minutes) (p-value <0.001). The success rate at first puncture was 52.2% in Group C and 47.8% in Group U. The majority of patients were relaxed and comfortable in the 1st hour post-operatively. The requirement of rescue analgesia in the post-operative period was comparable in both the groups. The conventional technique is easier and less time consuming as compared to the ultrasound-guided technique, which is newer and the practitioner needs expertise. The quality of analgesia provided by both the techniques is comparable. The frequency of complications associated with the block are fewer with the ultrasound-guided approach. Ultrasonography is the modality of choice specially in cases where detection of sacral anatomy and landmarks is difficult. However, further studies are needed to establish the role of ultrasonography in performing caudal block.
{"title":"Comparison of ultrasound-guided versus conventional technique for caudal block in paediatric patients","authors":"Kanika Gupta, Swati Agarwal, Rajesh Misra","doi":"10.18231/j.ijca.2023.056","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.056","url":null,"abstract":"Caudal blocks have been recommended for surgical procedures mainly below umbilicus. Their use has increased in paediatric cases as they are easy to perform with low complication rates. There have been reports of this technique being performed as a sole anaesthetic in children who may not be a suitable candidate for general anaesthesia. This study was conducted with an aim to compare the traditionally used landmark guided technique of caudal block with ultrasound-guided technique in terms of intra-operative analgesia, haemodynamic parameters, time required to perform block and demand for rescue analgesia.This prospective randomized comparative study was carried out in 68 paediatric patients divided in two study groups (Group C and Group U) undergoing elective lower gastrointestinal and genito-urinary tract surgeries over a period of two years in a tertiary care hospital.The intra-operative haemodynamic parameters were comparable in both the groups. There was a significant increase in time taken to perform the block in Group U as compared to Group C (6.5 minutes v/s 15 minutes) (p-value <0.001). The success rate at first puncture was 52.2% in Group C and 47.8% in Group U. The majority of patients were relaxed and comfortable in the 1st hour post-operatively. The requirement of rescue analgesia in the post-operative period was comparable in both the groups. The conventional technique is easier and less time consuming as compared to the ultrasound-guided technique, which is newer and the practitioner needs expertise. The quality of analgesia provided by both the techniques is comparable. The frequency of complications associated with the block are fewer with the ultrasound-guided approach. Ultrasonography is the modality of choice specially in cases where detection of sacral anatomy and landmarks is difficult. However, further studies are needed to establish the role of ultrasonography in performing caudal block.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"351 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80039934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.051
Shilpashri A M, Seema Chikkanagoudar
: Brachial plexus block is a widely used regional anaesthesia technique for upper limb surgeries, with regional techniques gaining popularity over general anaesthesia. Recent advancements in anatomical sonography have improved the understanding and application of ultrasound-guided techniques. Ultrasound enables accurate needle placement /and real-time monitoring of drug distribution, enhancing the effectiveness and safety of the procedure.: The objective of this study is to compare the effectiveness of supraclavicular brachial plexus block using the landmark technique and ultrasound-guided technique in terms of procedure time, onset and duration of sensory and motor blockade, effectiveness of the block, and complication rate. This prospective, randomized controlled study included 60 patients aged between 18 and 60 years, of either sex, belonging to ASA grade I and II, and undergoing elective or emergency upper limb surgeries (elbow, forearm, and hand surgeries). The patients were divided into two groups: Group LM (Landmark technique) and Group US (Ultrasound technique). Each patient received a supraclavicular brachial plexus block using either technique with 25ml of 0.5% ropivacaine, and relevant parameters were recorded.: The success rate was higher in Group US compared to Group LM, and no complications were observed. The onset of blockade was significantly faster, and the duration of the block was longer with the ultrasound-guided technique compared to the landmark technique. However, the time taken to administer the block was longer with the ultrasound technique.: Ultrasound-guided supraclavicular block is a safer technique with a higher success rate, providing more effective and prolonged block compared to the conventional landmark technique.
{"title":"Comparison of landmark technique versus ultrasound guided technique for supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized trial","authors":"Shilpashri A M, Seema Chikkanagoudar","doi":"10.18231/j.ijca.2023.051","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.051","url":null,"abstract":": Brachial plexus block is a widely used regional anaesthesia technique for upper limb surgeries, with regional techniques gaining popularity over general anaesthesia. Recent advancements in anatomical sonography have improved the understanding and application of ultrasound-guided techniques. Ultrasound enables accurate needle placement /and real-time monitoring of drug distribution, enhancing the effectiveness and safety of the procedure.: The objective of this study is to compare the effectiveness of supraclavicular brachial plexus block using the landmark technique and ultrasound-guided technique in terms of procedure time, onset and duration of sensory and motor blockade, effectiveness of the block, and complication rate. This prospective, randomized controlled study included 60 patients aged between 18 and 60 years, of either sex, belonging to ASA grade I and II, and undergoing elective or emergency upper limb surgeries (elbow, forearm, and hand surgeries). The patients were divided into two groups: Group LM (Landmark technique) and Group US (Ultrasound technique). Each patient received a supraclavicular brachial plexus block using either technique with 25ml of 0.5% ropivacaine, and relevant parameters were recorded.: The success rate was higher in Group US compared to Group LM, and no complications were observed. The onset of blockade was significantly faster, and the duration of the block was longer with the ultrasound-guided technique compared to the landmark technique. However, the time taken to administer the block was longer with the ultrasound technique.: Ultrasound-guided supraclavicular block is a safer technique with a higher success rate, providing more effective and prolonged block compared to the conventional landmark technique.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91328546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.053
Shubha Hodarkar, Anil Kumar Jain
This survey aimed to understand the use of neuromuscular blockers (NMBs) with respect to neuromuscular monitoring, reversal of residual neuromuscular block, and incidence of adverse events among Indian anaesthesiologists.A 40-item questionnaire was sent to 250 anaesthesiologists across India via email and their responses were statistically analysed.The response rate was 50%. To facilitate tracheal intubation, 81.0% respondents preferred cisatracurium, 72.2% preferred atracurium, 43.7% preferred vecuronium, 58.7% preferred rocuronium, and 70.6% preferred succinylcholine. Safety and recovery time are the most important criteria for an ideal NMB. About 84% respondents expressed concerns about the adverse effects of NMBs, especially recovery of neuromuscular function (31.1%) and hemodynamic effects (26.4%). The train-of-four (TOF) ratio for residual paralysis was not checked by 57% respondents. Reversal agents were used by >2/3 respondents; however, 86.5% used them after cisatracurium was used. Concerns about adverse effects of anticholinesterase/antimuscarinic agents were expressed by 63.4% respondents, while 85% expressed the need for availability of sugammadex in India. Almost two-thirds opined that conventional nerve stimulators and quantitative TOF monitors should be available in the operating room.The survey showed that safety and recovery time are the most important parameters in selecting an NMB. Cisatracurium was the most widely used NMB for tracheal intubation because of its safety, duration of action, less anaphylactic reactions, and fewer hemodynamic fluctuations. The use of TOF for monitoring was low. While reversal agents were used by >2/3 respondents, many respondents used them after cisatracurium was used as an NMB.
{"title":"Propensity of use of neuromuscular blocking agents among Indian anaesthesiologists: A questionnaire-based survey","authors":"Shubha Hodarkar, Anil Kumar Jain","doi":"10.18231/j.ijca.2023.053","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.053","url":null,"abstract":"This survey aimed to understand the use of neuromuscular blockers (NMBs) with respect to neuromuscular monitoring, reversal of residual neuromuscular block, and incidence of adverse events among Indian anaesthesiologists.A 40-item questionnaire was sent to 250 anaesthesiologists across India via email and their responses were statistically analysed.The response rate was 50%. To facilitate tracheal intubation, 81.0% respondents preferred cisatracurium, 72.2% preferred atracurium, 43.7% preferred vecuronium, 58.7% preferred rocuronium, and 70.6% preferred succinylcholine. Safety and recovery time are the most important criteria for an ideal NMB. About 84% respondents expressed concerns about the adverse effects of NMBs, especially recovery of neuromuscular function (31.1%) and hemodynamic effects (26.4%). The train-of-four (TOF) ratio for residual paralysis was not checked by 57% respondents. Reversal agents were used by >2/3 respondents; however, 86.5% used them after cisatracurium was used. Concerns about adverse effects of anticholinesterase/antimuscarinic agents were expressed by 63.4% respondents, while 85% expressed the need for availability of sugammadex in India. Almost two-thirds opined that conventional nerve stimulators and quantitative TOF monitors should be available in the operating room.The survey showed that safety and recovery time are the most important parameters in selecting an NMB. Cisatracurium was the most widely used NMB for tracheal intubation because of its safety, duration of action, less anaphylactic reactions, and fewer hemodynamic fluctuations. The use of TOF for monitoring was low. While reversal agents were used by >2/3 respondents, many respondents used them after cisatracurium was used as an NMB.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91262891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.068
Swati Panwar
{"title":"Cerebral palsy: Encounter to unforeseen state of affairs","authors":"Swati Panwar","doi":"10.18231/j.ijca.2023.068","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.068","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135353121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.054
Shruthi R, Achyutha Setty Jutoor
Laparoscopic cholecystectomy is the standard and most accepted technique for Cholecystectomies due to lesser postop pain and short recovery time.The origin of abdominal and shoulder pain after laparoscopic procedures has led to the use of intra peritoneal instillation of local anaesthetic agent to reduce postoperative pain. To assess the efficacy and quality of postoperative analgesia between the study groups using Visual Analogue Scale (VAS) score at various time intervals along with side effects if any.: 60 patients belonging to ASA 1 and 11 categories posted for Laparoscopic Cholecystectomy were given General Anaesthesia. After completion of surgery, before removing the trocar, anaesthetic study solution was sprayed on the surface of liver, gall bladder bed, right sub-diaphragmatic space, and port sites in Trendelenburg position. Volume and dilution of two drugs were same in both groups. Bupivacaine (0.25%) 50 mL; Dexmedetomidine (1 µg/kg) (BD) or Clonidine (1 µg/kg) (BC) was used. VAS score, Heart rate and BP measured at various time intervals and the time of first rescue analgesia noted.: VAS of BD group was 5.27 ± 0.64 to 3.70 ± 0.837 from 1 hour to 6 hour post extubation, when compared to BC group of 6.03 ± 0.669 in 1 hour reduced to 4.17 ± 0.699 at 6 hour post extubation. Dexmedetomidine combination significantly reduced the total dose of rescue analgesic required in 24 hours as compared to Clonidine combination.
{"title":"A randomised, prospective, double blind study of intraperitoneal instillation of 0.25% bupivacaine with clonidine versus 0.25% bupivacaine with dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy","authors":"Shruthi R, Achyutha Setty Jutoor","doi":"10.18231/j.ijca.2023.054","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.054","url":null,"abstract":"Laparoscopic cholecystectomy is the standard and most accepted technique for Cholecystectomies due to lesser postop pain and short recovery time.The origin of abdominal and shoulder pain after laparoscopic procedures has led to the use of intra peritoneal instillation of local anaesthetic agent to reduce postoperative pain. To assess the efficacy and quality of postoperative analgesia between the study groups using Visual Analogue Scale (VAS) score at various time intervals along with side effects if any.: 60 patients belonging to ASA 1 and 11 categories posted for Laparoscopic Cholecystectomy were given General Anaesthesia. After completion of surgery, before removing the trocar, anaesthetic study solution was sprayed on the surface of liver, gall bladder bed, right sub-diaphragmatic space, and port sites in Trendelenburg position. Volume and dilution of two drugs were same in both groups. Bupivacaine (0.25%) 50 mL; Dexmedetomidine (1 µg/kg) (BD) or Clonidine (1 µg/kg) (BC) was used. VAS score, Heart rate and BP measured at various time intervals and the time of first rescue analgesia noted.: VAS of BD group was 5.27 ± 0.64 to 3.70 ± 0.837 from 1 hour to 6 hour post extubation, when compared to BC group of 6.03 ± 0.669 in 1 hour reduced to 4.17 ± 0.699 at 6 hour post extubation. Dexmedetomidine combination significantly reduced the total dose of rescue analgesic required in 24 hours as compared to Clonidine combination.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"190 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74760589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.064
Sathya Narayana Reddy, Amal Govind, Surya Teja, Saroj R. Dudi
IgE-mediated hypersensitivity reactions (HRs) to local anaesthetics are extremely uncommon. One of the most widely used local anaesthetics for minor dental and other surgical procedures is lidocaine. The incidence of anaphylactic reaction by Inj. Lidocaine among global population is <1%. The first anaphylactic reaction reported in 1902. A 69-year-old female patient shifted to community hospital emergency department. She presented with complaints of vertigo, anxiety, tachypnoea, hypoxia, and sudden onset of breathlessness. History revealed on administration of Inj. Lidocaine a local anaesthesia to her before knee surgery developed above-mentioned symptoms after 15 minutes. After receiving her from OT patient vitals observed as pulse rate-97bpm, GRBS-140mg/dl, blood pressure-170/70mmHg, spo95% with 0. On emergency basis treated her with anti-histamines (Inj. Chlorpheniramine), steroids (Inj. Hydrocortisone-400mg, Inj.solumedrol-1gm), oxygen support of 7 to 8 lit/min, after 4 days she recovered completely and discharged. We used a scale (Naranjo scale) to evaluate the severity of the adverse drug reaction as per scale, score was five that indicates probability of happening adverse reaction. We conclude the case as anaphylactic reaction to lidocaine could have been cause of the event. It is important to collect patients complete past medical history and their allergic history. Also by giving importance to drug sensitivity testing at least to the list of drugs that are reported to show allergic reactions or anaphylactic reactions in post marketing surveillance. Optimised management protocols can save both the patient life and dilemma faced by physicians.
{"title":"Lidocaine-induced anaphylactic shock – A case report","authors":"Sathya Narayana Reddy, Amal Govind, Surya Teja, Saroj R. Dudi","doi":"10.18231/j.ijca.2023.064","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.064","url":null,"abstract":"IgE-mediated hypersensitivity reactions (HRs) to local anaesthetics are extremely uncommon. One of the most widely used local anaesthetics for minor dental and other surgical procedures is lidocaine. The incidence of anaphylactic reaction by Inj. Lidocaine among global population is <1%. The first anaphylactic reaction reported in 1902. A 69-year-old female patient shifted to community hospital emergency department. She presented with complaints of vertigo, anxiety, tachypnoea, hypoxia, and sudden onset of breathlessness. History revealed on administration of Inj. Lidocaine a local anaesthesia to her before knee surgery developed above-mentioned symptoms after 15 minutes. After receiving her from OT patient vitals observed as pulse rate-97bpm, GRBS-140mg/dl, blood pressure-170/70mmHg, spo95% with 0. On emergency basis treated her with anti-histamines (Inj. Chlorpheniramine), steroids (Inj. Hydrocortisone-400mg, Inj.solumedrol-1gm), oxygen support of 7 to 8 lit/min, after 4 days she recovered completely and discharged. We used a scale (Naranjo scale) to evaluate the severity of the adverse drug reaction as per scale, score was five that indicates probability of happening adverse reaction. We conclude the case as anaphylactic reaction to lidocaine could have been cause of the event. It is important to collect patients complete past medical history and their allergic history. Also by giving importance to drug sensitivity testing at least to the list of drugs that are reported to show allergic reactions or anaphylactic reactions in post marketing surveillance. Optimised management protocols can save both the patient life and dilemma faced by physicians.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87002680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.047
Lalit Gupta
{"title":"The pivotal impact of ChatGPT on scholarly publishing","authors":"Lalit Gupta","doi":"10.18231/j.ijca.2023.047","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.047","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76594687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.18231/j.ijca.2023.050
Mohana Sharadchandra Shewalkar, M. Sangawar, Puja Madhukar Shinde, S. Cham, Akshay Nagorao Shende
Propofol is a widely used intravenous anaesthetic that is known to cause distressing local pain at the site of injection. Ketamine pretreatment is one of the methods proposed to attenuate Propofol injection pain due to its local anaesthetic properties.The present study was undertaken to evaluate the efficacy of low dose (100 mcg/kg) I.V. Ketamine in decreasing I.V. Propofol injection pain by using McCrirrick and Hunter scale.72 adult patients of ASA Physical status 1 and 2 of either sex undergoing elective surgical procedure under general anaesthesia were randomly allocated into two groups.Group- A (n=36): Pre-treatment with Ketamine 100µg/kg (1ml) and Group- B (n=36): pre-treatment with 0.9% Normal Saline (1ml).Comparison between group A and group B using McCrirrick and Hunter Evaluation Scale at 5,10 and 15 seconds intervals were statistically highly significant (p value<0.0001). None of the patients in group A experienced moderate or severe pain at all 3 intervals as compared to group B. McCrirrick and Hunter evaluation score mean values were also highly significant at all time intervals between both the groups. Hemodynamic parameters, EtCO and SpO were comparable between two groups. There was no incidence of any adverse effects in both the groups. I.V. Ketamine in a dose of 100mcg/kg with tourniquet as pretreatment before Propofol was useful in significantly reducing the incidence and severity of pain without any adverse haemodynamic effect.
异丙酚是一种广泛使用的静脉麻醉药，已知会引起注射部位的局部疼痛。氯胺酮的局部麻醉特性使其预处理成为减轻异丙酚注射疼痛的方法之一。本研究采用McCrirrick和Hunter评分法评价低剂量(100 mcg/kg)氯胺酮静脉注射减轻异丙酚静脉注射疼痛的疗效。选择在全麻条件下择期行外科手术的身体状态为1、2的成人ASA患者72例，随机分为两组。A组(n=36):氯胺酮100µg/kg (1ml)预处理;B组(n=36): 0.9%生理盐水(1ml)预处理。采用McCrirrick and Hunter评价量表，间隔5、10、15秒A组与B组比较，差异均有显著统计学意义(p值<0.0001)。与b组相比，A组患者在所有3个时间间隔内均没有出现中度或重度疼痛。McCrirrick和Hunter评估评分平均值在两组之间的所有时间间隔内也具有高度显著性。两组间血流动力学参数、EtCO和SpO具有可比性。两组均未发生任何不良反应。异丙酚前静脉注射氯胺酮100mcg/kg，止血带作为预处理，可显著降低疼痛发生率和严重程度，且无不良血流动力学影响。
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