Mridul Dhar, P. Talawar, Sameer Sharma, D. Tripathy, Vaishali Gupta, Pragya Varshney
There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.
{"title":"A randomised trial comparing block characteristics of a mixture versus sequential injections of lignocaine and ropivacaine for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery","authors":"Mridul Dhar, P. Talawar, Sameer Sharma, D. Tripathy, Vaishali Gupta, Pragya Varshney","doi":"10.4103/ija.ija_1122_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1122_23","url":null,"abstract":"\u0000 \u0000 There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries.\u0000 \u0000 \u0000 \u0000 A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications.\u0000 \u0000 \u0000 \u0000 Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications.\u0000 \u0000 \u0000 \u0000 Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997694","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}
{"title":"Enhanced monitoring for postoperative hospital wards – Evidence to implementation","authors":"Prateek Upadhyay, M. H. Hicks, Ashish K. Khanna","doi":"10.4103/ija.ija_360_24","DOIUrl":"https://doi.org/10.4103/ija.ija_360_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000294","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}
Binayak Deb, Kulbhushan Saini, S. Arora, Sanjay Kumar, S. Soni, Manu Saini
Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. This randomised controlled trial recruited 106 adult patients (18–65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro–Wilk test, and the independent samples t-test or the Mann–Whitney U test was used to compare continuous variables. Fisher’s exact test was used to assess any non-random associations between the categorical variables. The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.
{"title":"Olanzapine versus standard antiemetic prophylaxis for the prevention of post-discharge nausea and vomiting after propofol-based general anaesthesia: A randomised controlled trial","authors":"Binayak Deb, Kulbhushan Saini, S. Arora, Sanjay Kumar, S. Soni, Manu Saini","doi":"10.4103/ija.ija_1162_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1162_23","url":null,"abstract":"\u0000 \u0000 Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention.\u0000 \u0000 \u0000 \u0000 This randomised controlled trial recruited 106 adult patients (18–65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro–Wilk test, and the independent samples t-test or the Mann–Whitney U test was used to compare continuous variables. Fisher’s exact test was used to assess any non-random associations between the categorical variables.\u0000 \u0000 \u0000 \u0000 The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups.\u0000 \u0000 \u0000 \u0000 A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999207","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}
{"title":"Induction agents for emergency airway management in critically ill patients","authors":"Asad Khawaja, K. Karamchandani","doi":"10.4103/ija.ija_380_24","DOIUrl":"https://doi.org/10.4103/ija.ija_380_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999037","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}
Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.
{"title":"Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis","authors":"Aanchal Purohit, Mohan Kumar, Niraj Kumar, A. Bindra, Sharmishtha Pathak, Anuradha Yadav","doi":"10.4103/ija.ija_790_23","DOIUrl":"https://doi.org/10.4103/ija.ija_790_23","url":null,"abstract":"\u0000 \u0000 Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients.\u0000 \u0000 \u0000 \u0000 A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias.\u0000 \u0000 \u0000 \u0000 In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group.\u0000 \u0000 \u0000 \u0000 This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710805","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}
Vasanth Raokadam, V. Thiruvenkatarajan, G. Bouras, Alex Zhang, A. Psaltis
During endoscopic sinus surgery, anaesthetic conditions significantly impact the intraoperative surgical field and bleeding during emergence. While the endotracheal tube (ETT) has been traditionally used in sinus surgery, a reinforced laryngeal mask airway (RLMA) that produces less upper airway stimulation may result in smoother emergence. A randomised controlled trial of 72 patients undergoing elective sinus surgery was conducted, with the allocation of airway technique to either ETT with a throat pack or RLMA. The primary outcome measure was emergence time, measured by time to opening eyes on commands at the cessation of anaesthesia, and the secondary outcomes were time to removal of airway device, remifentanil use, procedure times, mean arterial pressure (MAP) and the RLMA grade of blood contamination. The continuous variables were analysed using Student’s t-tests and discrete variables, count tables were analysed using Fisher’s exact tests. There was no significant difference in the emergence time between the ETT and RLMA groups (P = 0.83). Remifentanil use was significantly higher in the ETT group than in the RLMA group (P = 0.022). The ETT group showed a significantly increased total anaesthetic time (P = 0.01). MAP was not significant during preinduction, maintenance or post-RMLA removal. The highest grade of contamination was grade 2 in RLMA. RLMA had lower rates of postoperative adverse events. RLMA comparable to ETT in terms of emergence time. The RMLA group had lower remifentanil use, anaesthesia duration and fewer postoperative adverse events such as cough and throat pain.
在内窥镜鼻窦手术中，麻醉条件对术中手术野和清醒时的出血有很大影响。虽然气管插管（ETT）一直被用于鼻窦手术，但加强型喉罩通气道（RLMA）对上呼吸道的刺激较小，可能会使患者更顺利地苏醒。 一项随机对照试验对 72 名接受择期鼻窦手术的患者进行了研究，将气道技术分配给带喉袋的 ETT 或 RLMA。主要结果指标是苏醒时间，以麻醉停止时根据指令睁开眼睛的时间来衡量，次要结果指标是移除气道装置的时间、瑞芬太尼的使用、手术时间、平均动脉压（MAP）和 RLMA 血液污染等级。连续变量采用学生 t 检验进行分析，离散变量、计数表采用费雪精确检验进行分析。 ETT 组和 RLMA 组的苏醒时间无明显差异（P = 0.83）。ETT 组的瑞芬太尼用量明显高于 RLMA 组（P = 0.022）。ETT 组的总麻醉时间明显增加（P = 0.01）。在诱导前、维持过程中或移除 RMLA 后，MAP 均无明显变化。RLMA 的污染等级最高，为 2 级。RLMA 术后不良反应发生率较低。 就出现时间而言，RLMA 与 ETT 相当。RMLA 组的瑞芬太尼用量和麻醉持续时间较短，术后不良反应（如咳嗽和喉咙痛）较少。
{"title":"Emergence characteristics comparing endotracheal tube to reinforced laryngeal mask airway during endoscopic sinus surgery – A randomised controlled study","authors":"Vasanth Raokadam, V. Thiruvenkatarajan, G. Bouras, Alex Zhang, A. Psaltis","doi":"10.4103/ija.ija_966_23","DOIUrl":"https://doi.org/10.4103/ija.ija_966_23","url":null,"abstract":"\u0000 \u0000 During endoscopic sinus surgery, anaesthetic conditions significantly impact the intraoperative surgical field and bleeding during emergence. While the endotracheal tube (ETT) has been traditionally used in sinus surgery, a reinforced laryngeal mask airway (RLMA) that produces less upper airway stimulation may result in smoother emergence.\u0000 \u0000 \u0000 \u0000 A randomised controlled trial of 72 patients undergoing elective sinus surgery was conducted, with the allocation of airway technique to either ETT with a throat pack or RLMA. The primary outcome measure was emergence time, measured by time to opening eyes on commands at the cessation of anaesthesia, and the secondary outcomes were time to removal of airway device, remifentanil use, procedure times, mean arterial pressure (MAP) and the RLMA grade of blood contamination. The continuous variables were analysed using Student’s t-tests and discrete variables, count tables were analysed using Fisher’s exact tests.\u0000 \u0000 \u0000 \u0000 There was no significant difference in the emergence time between the ETT and RLMA groups (P = 0.83). Remifentanil use was significantly higher in the ETT group than in the RLMA group (P = 0.022). The ETT group showed a significantly increased total anaesthetic time (P = 0.01). MAP was not significant during preinduction, maintenance or post-RMLA removal. The highest grade of contamination was grade 2 in RLMA. RLMA had lower rates of postoperative adverse events.\u0000 \u0000 \u0000 \u0000 RLMA comparable to ETT in terms of emergence time. The RMLA group had lower remifentanil use, anaesthesia duration and fewer postoperative adverse events such as cough and throat pain.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711098","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}
{"title":"Maximising the benefit of new technologies in airway management","authors":"P. Ward, A. F. McNarry","doi":"10.4103/ija.ija_337_24","DOIUrl":"https://doi.org/10.4103/ija.ija_337_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709133","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}
Sanya Arora, B. Govardhane, Vanchula Srinivasan, Gayatri Karandikar
In patients undergoing cancer surgeries with anticipated difficult airway, awake fibreoptic nasotracheal intubation (AFONI) is critical for securing the airway. However, different doses of dexmedetomidine (DEX) are yet to be evaluated in these patients. Thus, we compared three doses of DEX for AFONI in patients undergoing oromaxillofacial and oral malignancy surgeries. In this randomised, double-blind study, 90 patients aged 18–60 years of either gender, with American Society of Anesthesiologists physical status I/II, and undergoing elective oromaxillofacial and oral malignancy surgeries were randomised to three groups: Group D1 (0.5 µg/kg DEX), Group D2 (1 µg/kg DEX), and Group D3 (1.5 µg/kg DEX). The primary outcome measure was the airway obstruction score. Secondary outcome measures were intubation scores (including vocal movement, coughing, and limb movements) and a 5-point fibreoptic intubation comfort score. Sedation was assessed using the Ramsay sedation score (RSS). One-way ANOVA and Chi-square test were used to assess the association between quantitative and qualitative variables, respectively. A P value of <0.05 was considered statistically significant. The airway obstruction score was comparable between the groups (P = 0.78). Similarly, vocal movement (P = 0.15), coughing (P = 0.31), limb movement (P = 0.51), and 5-point fibreoptic intubation comfort score (P = 0.49) did not differ between the groups. The mean RSS was significantly greater in Group D3 than in Groups D1 and D2 (P = 0.001). In combination with topical spray and airway block, all three doses of DEX resulted in comparable airway obstruction scores and thus provided favourable conditions for AFONI.
{"title":"Evaluation of different doses of dexmedetomidine for awake fibreoptic nasotracheal intubation in patients undergoing oromaxillofacial and oral malignancy surgeries: A randomised, double-blind study","authors":"Sanya Arora, B. Govardhane, Vanchula Srinivasan, Gayatri Karandikar","doi":"10.4103/ija.ija_1004_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1004_23","url":null,"abstract":"\u0000 \u0000 In patients undergoing cancer surgeries with anticipated difficult airway, awake fibreoptic nasotracheal intubation (AFONI) is critical for securing the airway. However, different doses of dexmedetomidine (DEX) are yet to be evaluated in these patients. Thus, we compared three doses of DEX for AFONI in patients undergoing oromaxillofacial and oral malignancy surgeries.\u0000 \u0000 \u0000 \u0000 In this randomised, double-blind study, 90 patients aged 18–60 years of either gender, with American Society of Anesthesiologists physical status I/II, and undergoing elective oromaxillofacial and oral malignancy surgeries were randomised to three groups: Group D1 (0.5 µg/kg DEX), Group D2 (1 µg/kg DEX), and Group D3 (1.5 µg/kg DEX). The primary outcome measure was the airway obstruction score. Secondary outcome measures were intubation scores (including vocal movement, coughing, and limb movements) and a 5-point fibreoptic intubation comfort score. Sedation was assessed using the Ramsay sedation score (RSS). One-way ANOVA and Chi-square test were used to assess the association between quantitative and qualitative variables, respectively. A P value of <0.05 was considered statistically significant.\u0000 \u0000 \u0000 \u0000 The airway obstruction score was comparable between the groups (P = 0.78). Similarly, vocal movement (P = 0.15), coughing (P = 0.31), limb movement (P = 0.51), and 5-point fibreoptic intubation comfort score (P = 0.49) did not differ between the groups. The mean RSS was significantly greater in Group D3 than in Groups D1 and D2 (P = 0.001).\u0000 \u0000 \u0000 \u0000 In combination with topical spray and airway block, all three doses of DEX resulted in comparable airway obstruction scores and thus provided favourable conditions for AFONI.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710713","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}
Sandeep S. N. Sujatha, Kapil Gupta, Sushil Guria, Priyanka H. Chhabra
Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann–Whitney U test was used to compare continuous variables. NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31–1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000). US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR.
膝神经阻滞（GNB）可选择性地阻滞关节分支并保留运动功能，因此有利于患者尽早下床活动和更快出院。本研究旨在比较超声（US）引导下的膝关节神经阻滞与内收肌管阻滞（ACB）对接受关节镜前交叉韧带重建术（ACLR）患者的镇痛效果。 这项随机双盲研究针对 38 名接受关节镜前交叉韧带重建术的成人进行。GNB组患者（n = 19）在US引导下使用3毫升0.25%布比卡因和2毫克地塞米松进行GNB。ACB 组（19 人）患者在 US 引导下接受 ACB，使用 20 毫升 0.25% 布比卡因和 6 毫克地塞米松。术后通过静脉注射吗啡进行患者自控镇痛（PCA）。主要结果是24小时内的数字评分量表（NRS）疼痛评分，次要结果是镇痛持续时间和24小时吗啡消耗量。采用卡方检验来检验分类变量之间的统计学意义。独立 t 检验或曼-惠特尼 U 检验用于比较连续变量。 两组患者休息时的 NRS 评分和 24 小时体力活动时的 NRS 评分相似（分别为 P = 0.429 和 P = 0.101）。两组抢救镇痛的平均时间相当（GNB 组：820.79 [483.65] min [95% 置信区间{CI}：603.31-1038.27] ACB 组：858.95 [460.06] min [95% CI：652.08, 1065.82]，P = 0.805），两组 24 h 的平均吗啡消耗量也相当（P = 1.000）。 对于接受关节镜 ACLR 的患者，US 引导 GNB 的镇痛效果与 US 引导 ACB 相似。
{"title":"Comparison of genicular nerve block with adductor canal block for postoperative pain management in patients undergoing arthroscopic knee ligament reconstruction: A randomised controlled trial","authors":"Sandeep S. N. Sujatha, Kapil Gupta, Sushil Guria, Priyanka H. Chhabra","doi":"10.4103/ija.ija_994_23","DOIUrl":"https://doi.org/10.4103/ija.ija_994_23","url":null,"abstract":"\u0000 \u0000 Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR).\u0000 \u0000 \u0000 \u0000 This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann–Whitney U test was used to compare continuous variables.\u0000 \u0000 \u0000 \u0000 NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31–1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000).\u0000 \u0000 \u0000 \u0000 US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712205","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}
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