Indian Journal of Anaesthesia最新文献

Background and aims: Tourniquet-induced hypertension (TH) remains an unresolved issue. Various techniques, such as peripheral nerve blocks, peri-femoral artery blocks, and subcutaneous infiltration, have been explored to address this. The primary objective was to compare the incidence of TH during lower-limb surgery under general anaesthesia between peri-femoral artery block and subcutaneous infiltration, combined with femoral and sciatic nerve blocks. Secondary objectives included intraoperative intravenous fentanyl and antihypertensive uses, as well as postoperative pain scores.

Methods: This single-centre, double-blind, randomised controlled trial involved 58 patients scheduled for elective lower-limb surgery. Participants were assigned to the peri-femoral artery block (P-FAB) or subcutaneous infiltration (SI) groups. All patients received general anaesthesia alongside femoral and sciatic nerve blocks. TH was defined as a 30% increase in systolic blood pressure from baseline. Pain was assessed using a numerical rating scale in the post-anaesthetic care unit and at 4, 8, 12, and 24 h post-surgery. Unpaired t-test, Chi-square, and Mann-Whitney U test were used for analysis. A P value less than 0.05 was considered to be statistically significant.

Results: There were no significant differences in the incidence of TH between the P-FAB and SI groups (P = 1.00). Similarly, no significant differences were observed in intraoperative fentanyl (P = 0.459) or antihypertensive use (P = 0.992). Pain scores across all measured aspects, including thigh and incision sites, were also not significantly different between groups (P > 0.05).

Conclusions: In lower-limb surgery, adding a peri-femoral artery block to general anaesthesia with femoral and sciatic nerve blocks did not reduce the incidence of TH compared to subcutaneous infiltration.

Background and aims: In hip surgeries, the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca (SIFI) block are commonly employed perioperative regional analgesia techniques. This study aimed to compare functional outcomes regarding quadriceps muscle strength and weight-bearing capacity between PENG and SIFI blocks after hip surgery.

Methods: In this single-centre, double-blinded, randomised trial, 60 patients undergoing hip surgeries under subarachnoid block were randomised into either Group P (PENG block) or Group S (SIFI block). Blocks were administered under ultrasound guidance with 30 mL of 0.2% ropivacaine and 4 mg dexamethasone. Functional mobility was assessed 24 and 48 h postoperatively by measuring quadriceps strength and maximum weight-bearing capacity. Analgesic efficacy was also evaluated by comparing visual analogue score (VAS) scores at 24 h, total opioid consumption over 24 h, and duration of analgesia. Statistical analysis included Student's t-test, Chi-square, and Z-test as appropriate, with statistical significance set at P < 0.05.

Results: Group P demonstrated significantly higher quadriceps-muscle strength at 24 h (P = 0.025) and 48 h (P = 0.002) post surgery. More patients in Group P achieved superior weight-bearing grades at 24 h (P = 0.002) post surgery compared to Group S. VAS scores were significantly lower in Group P at 24 h post surgery (P = 0.006). Group P also showed a prolonged duration of analgesia (P = 0.019) and lower mean opioid consumption (P = 0.001) compared to Group S.

Conclusion: The PENG block may be superior to the SIFI block in terms of functional outcomes with better quadriceps strength, enhanced weight-bearing, and provision of more effective postoperative analgesia in hip surgery patients.

Background and aims: Second-generation supraglottic airway devices (SADs) are used for ventilation and a conduit for fibreoptic-guided tracheal intubation (FGI). LMA Protector is a novel second-generation SAD with a wide airway lumen to pass an adequately sized tracheal tube. Few authors have compared LMA Protector with i-gel for FGI using reinforced tubes, and their results have been contradictory. Polyvinyl chloride (PVC) endotracheal tube (ETT) is the most commonly used ETT in the operation theatre and critical care units. Hence, we conducted this study to compare FGI through i-gel and LMA Protector using PVC ETT.

Methods: After institutional committee approval and trial registration, 66 patients aged 18-70 years with American Society of Anesthesiologists physical status I/II were recruited for this randomised study. Patients were randomly allocated to groups LP and IG. The primary outcome was to compare time to tracheal intubation via two SADs. Insertion characteristics such as the number of insertion attempts, mean time of insertion, oropharyngeal leak pressure, and intubation characteristics (time to view carina, number of attempts, etc.) were considered secondary outcomes. Independent Student's t-test and Mann-Whitney U test were applied for normally distributed and non-normally distributed quantitative variables, respectively.

Results: Demographic parameters were comparable in the two groups (P > 0.05). The time to view the carina, tracheal intubation time, other insertion characteristics, and adverse effects were comparable between the groups (P > 0.05).

Conclusion: LMA Protector and i-gel are technically comparable conduits for fibreoptic-guided tracheal intubation in adult paralysed patients.