Pub Date : 2022-07-01DOI: 10.4103/joacc.joacc_94_21
Abinaya Ramachandran, S. Segaran, Nikithamani, R. Ranjan
Pregnancy makes a patient undergo diverse physiological changes and predisposes them to many pathological disorders such as pre-eclampsia, eclampsia, cortical vein thrombosis, and pituitary apoplexy. Any intervention during pregnancy presents a unique challenge as it affects two individuals. Once diagnosed with a clinical condition, they are prone to further medical, obstetric and anaesthetic complications. Herein, we report the anaesthetic management of a 32-year-old female previously diagnosed with pituitary adenoma and now presenting with twin pregnancy for emergency caesarean section along with emphasis on the anaesthetic concerns pertinent to brain tumours in pregnancy.
{"title":"Neuraxial anaesthesia in a parturient with space occupying lesion in brain for caesarean section: Demystifying the myth – A case report with review","authors":"Abinaya Ramachandran, S. Segaran, Nikithamani, R. Ranjan","doi":"10.4103/joacc.joacc_94_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_94_21","url":null,"abstract":"Pregnancy makes a patient undergo diverse physiological changes and predisposes them to many pathological disorders such as pre-eclampsia, eclampsia, cortical vein thrombosis, and pituitary apoplexy. Any intervention during pregnancy presents a unique challenge as it affects two individuals. Once diagnosed with a clinical condition, they are prone to further medical, obstetric and anaesthetic complications. Herein, we report the anaesthetic management of a 32-year-old female previously diagnosed with pituitary adenoma and now presenting with twin pregnancy for emergency caesarean section along with emphasis on the anaesthetic concerns pertinent to brain tumours in pregnancy.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42847065","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}
Background: Nalbuphine when used as an adjuvant to hyperbaric bupivacaine has improved the quality of perioperative analgesia. Fentanyl is a lipophilic opioid with a rapid onset and does not cause respiratory depression and improves duration of sensory anesthesia without producing significant side effects. The aim of this study was to compare intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine for postoperative analgesia in lower segment cesarean section. Methods: A total of 100 American Society of Anesthesiologists (ASA) Physical Status (PS) I and II parturients were enrolled for lower segment cesarean section. Parturients were randomly allocated into 2 groups - Group F (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + fentanyl 20 μg (0.4 ml) and Group N (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + nalbuphine 0.4 mg (0.4 ml) under subarachnoid block (total volume = 2 ml). Time of onset and duration of sensory and motor block, Visual Analog Scale (VAS) score, duration of analgesia, sedation, rescue analgesic consumption, APGAR score, hemodynamic changes and adverse effects were noted. Results: Onset of sensory and motor block were significantly faster in Group F while duration of sensory block was significantly longer in Group N (P < 0.05). Duration of analgesia was also significantly longer in Group N (214.34 ± 9.31 min) compared to Group F (195.00 ± 9.18 min) (P < 0.001). No significant hemodynamic changes and adverse effects were noted in both groups (P > 0.05). Conclusion: Both of these drugs can be effectively used as an adjuvant to hyperbaric 0.5% bupivacaine in subarachnoid block for parturients undergoing lower segment cesarean section.
{"title":"A comparison between intrathecal nalbuphine versus fentanyl as an adjuvant with 0.5% hyperbaric bupivacaine for postoperative analgesia in parturients undergoing lower segment cesarean section","authors":"Neena Jain, S. Sethi, Amrit Saini, Veena Patodi, Kavita Jain, Beena Thada","doi":"10.4103/joacc.joacc_67_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_67_21","url":null,"abstract":"Background: Nalbuphine when used as an adjuvant to hyperbaric bupivacaine has improved the quality of perioperative analgesia. Fentanyl is a lipophilic opioid with a rapid onset and does not cause respiratory depression and improves duration of sensory anesthesia without producing significant side effects. The aim of this study was to compare intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine for postoperative analgesia in lower segment cesarean section. Methods: A total of 100 American Society of Anesthesiologists (ASA) Physical Status (PS) I and II parturients were enrolled for lower segment cesarean section. Parturients were randomly allocated into 2 groups - Group F (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + fentanyl 20 μg (0.4 ml) and Group N (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + nalbuphine 0.4 mg (0.4 ml) under subarachnoid block (total volume = 2 ml). Time of onset and duration of sensory and motor block, Visual Analog Scale (VAS) score, duration of analgesia, sedation, rescue analgesic consumption, APGAR score, hemodynamic changes and adverse effects were noted. Results: Onset of sensory and motor block were significantly faster in Group F while duration of sensory block was significantly longer in Group N (P < 0.05). Duration of analgesia was also significantly longer in Group N (214.34 ± 9.31 min) compared to Group F (195.00 ± 9.18 min) (P < 0.001). No significant hemodynamic changes and adverse effects were noted in both groups (P > 0.05). Conclusion: Both of these drugs can be effectively used as an adjuvant to hyperbaric 0.5% bupivacaine in subarachnoid block for parturients undergoing lower segment cesarean section.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41876861","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 : 2022-07-01DOI: 10.4103/joacc.joacc_17_22
Manpreet Kaur, Bharat Yalla, A. Trikha
Medication errors in a parturient can be devastating as two lives are involved. Owing to the absence of critical incident reporting in parurients in multiple countries of the world, these errors are underreported. We herein discuss the common medication errors in a parturient, the published literature, and the management protocols practiced.
{"title":"Medication errors in a parturient: A huge cost to two lives","authors":"Manpreet Kaur, Bharat Yalla, A. Trikha","doi":"10.4103/joacc.joacc_17_22","DOIUrl":"https://doi.org/10.4103/joacc.joacc_17_22","url":null,"abstract":"Medication errors in a parturient can be devastating as two lives are involved. Owing to the absence of critical incident reporting in parurients in multiple countries of the world, these errors are underreported. We herein discuss the common medication errors in a parturient, the published literature, and the management protocols practiced.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48077067","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 : 2022-01-01DOI: 10.4103/joacc.joacc_74_21
Eesha Banerjee, S. Samanta, Soumya Samal
Antiphospholipid syndrome (APLA) is an acquired autoimmune disorder, clinically characterised by the development of thrombosis and obstetric morbidities comprising recurrent miscarriages, fetal deaths and premature births resulting from placental insufficiency such as intrauterine growth restriction and pre-eclampsia. It is the most common acquired hypercoagulable state where the focus of management is anticoagulation for the prevention of thrombosis.We report three cases of primary APLA syndrome in parturients at term with history of multiple abortions, being managed with oral aspirin and low molecular weight heparin posted for elective caesarian section. All three parturients were given single shot atraumatic spinal anaesthesia achieving a level of sensory blockade up to T6 since their coagulation profile showed no abnormalities. Antiphospholipid-antibody syndrome requires a multidisciplinary approach during pregnancy where use of anticoagulants may lead to dilemma of their perioperative continuation. Discontinuation of anticoagulants is a double-edged sword requiring careful deliberation on the part of anaesthetist to reduce the risk of perioperative bleeding.
{"title":"Spinal anaesthesia, a special consideration in antiphospholipid antibody syndrome in pregnancy: A case series","authors":"Eesha Banerjee, S. Samanta, Soumya Samal","doi":"10.4103/joacc.joacc_74_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_74_21","url":null,"abstract":"Antiphospholipid syndrome (APLA) is an acquired autoimmune disorder, clinically characterised by the development of thrombosis and obstetric morbidities comprising recurrent miscarriages, fetal deaths and premature births resulting from placental insufficiency such as intrauterine growth restriction and pre-eclampsia. It is the most common acquired hypercoagulable state where the focus of management is anticoagulation for the prevention of thrombosis.We report three cases of primary APLA syndrome in parturients at term with history of multiple abortions, being managed with oral aspirin and low molecular weight heparin posted for elective caesarian section. All three parturients were given single shot atraumatic spinal anaesthesia achieving a level of sensory blockade up to T6 since their coagulation profile showed no abnormalities. Antiphospholipid-antibody syndrome requires a multidisciplinary approach during pregnancy where use of anticoagulants may lead to dilemma of their perioperative continuation. Discontinuation of anticoagulants is a double-edged sword requiring careful deliberation on the part of anaesthetist to reduce the risk of perioperative bleeding.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43367950","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 : 2022-01-01DOI: 10.4103/joacc.joacc_33_21
Jigisha Badheka, V. Oza, Nitin Manat, Mayur Patel
Background: Oxytocin (OT) is routinely administered during caesarean delivery to prevent and treat postpartum haemorrhage (PPH). The common adverse effects of intravenous OT are tachycardia, hypotension, chest pain, Electrocardiogram (ECG) changes, nausea and vomiting. We aimed to compare the uterine contractility, haemodynamic changes, need for other uterotonics and adverse effects by comparing the intravenous bolus dose versus infusion dose of OT while retaining its benefits. Methods: Sixty patients undergoing elective caesarean delivery under spinal anaesthesia were randomised to receive OT 3 IU as a bolus (repeat 3 IU at an interval of 3 min) in group B (Bolus) or as an infusion 1 IU per minute in group I (infusion). The uterine tone was assessed by a blinded obstetrician as either adequate or inadequate. The intraoperative heart rate, blood pressure, blood loss and any other adverse events were recorded. Results: The adequacy of uterine tone was more sustained and the requirement of other uterotonics was less in group I. The heart rate increased to 20–25 beats/min at 3–5 min in group B and 8–10 beats/min at 2–4 mins and reached the baseline at 8–9 min in group B as well as in group I. Also, a significant fall in the mean blood pressure was observed at 3–5 min in group B. The ECG changes (ST-T changes) were more common in group B compared to group I. There was no significant difference in the estimated blood loss between the two groups. Conclusion: The infusion dose of OT provides more haemodynamic stability, better uterine tone and fewer adverse effects compared to the bolus dose.
{"title":"Comparison of intravenous infusion versus bolus dose of oxytocin in elective caesarean delivery: A prospective, randomised study","authors":"Jigisha Badheka, V. Oza, Nitin Manat, Mayur Patel","doi":"10.4103/joacc.joacc_33_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_33_21","url":null,"abstract":"Background: Oxytocin (OT) is routinely administered during caesarean delivery to prevent and treat postpartum haemorrhage (PPH). The common adverse effects of intravenous OT are tachycardia, hypotension, chest pain, Electrocardiogram (ECG) changes, nausea and vomiting. We aimed to compare the uterine contractility, haemodynamic changes, need for other uterotonics and adverse effects by comparing the intravenous bolus dose versus infusion dose of OT while retaining its benefits. Methods: Sixty patients undergoing elective caesarean delivery under spinal anaesthesia were randomised to receive OT 3 IU as a bolus (repeat 3 IU at an interval of 3 min) in group B (Bolus) or as an infusion 1 IU per minute in group I (infusion). The uterine tone was assessed by a blinded obstetrician as either adequate or inadequate. The intraoperative heart rate, blood pressure, blood loss and any other adverse events were recorded. Results: The adequacy of uterine tone was more sustained and the requirement of other uterotonics was less in group I. The heart rate increased to 20–25 beats/min at 3–5 min in group B and 8–10 beats/min at 2–4 mins and reached the baseline at 8–9 min in group B as well as in group I. Also, a significant fall in the mean blood pressure was observed at 3–5 min in group B. The ECG changes (ST-T changes) were more common in group B compared to group I. There was no significant difference in the estimated blood loss between the two groups. Conclusion: The infusion dose of OT provides more haemodynamic stability, better uterine tone and fewer adverse effects compared to the bolus dose.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42710096","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 : 2022-01-01DOI: 10.4103/joacc.joacc_81_21
M. Smith, James Walker, Sukruta Pradhan, F. Newton
Pregnancy-associated strokes are rare but can have detrimental effects on both mother and baby. A young female patient, 6 days postpartum, suffered a spontaneous intraparenchymal haemorrhage (IPH) and subarachnoid haemorrhage (SAH). The patient exhibited aphasia, right facial droop and right hemiparesis. Serial imaging showed no vascular malformation or other cause of her haemorrhages. Our pregnant patient presented with concurrent IPH and SAH. Given the timing of her stroke and the absence of underlying vascular lesion, it is possible her stroke was a case of IPH and SAH due to reversible cerebral vasoconstriction syndrome (RCVS). More specifically, it may reflect postpartum angiopathy, a subtype of RCVS presenting around 5 days postpartum. Alternatively, this could simply be a subarachnoid extension of a primary IPH.
{"title":"Spontaneous postpartum intracranial haemorrhage: A case report","authors":"M. Smith, James Walker, Sukruta Pradhan, F. Newton","doi":"10.4103/joacc.joacc_81_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_81_21","url":null,"abstract":"Pregnancy-associated strokes are rare but can have detrimental effects on both mother and baby. A young female patient, 6 days postpartum, suffered a spontaneous intraparenchymal haemorrhage (IPH) and subarachnoid haemorrhage (SAH). The patient exhibited aphasia, right facial droop and right hemiparesis. Serial imaging showed no vascular malformation or other cause of her haemorrhages. Our pregnant patient presented with concurrent IPH and SAH. Given the timing of her stroke and the absence of underlying vascular lesion, it is possible her stroke was a case of IPH and SAH due to reversible cerebral vasoconstriction syndrome (RCVS). More specifically, it may reflect postpartum angiopathy, a subtype of RCVS presenting around 5 days postpartum. Alternatively, this could simply be a subarachnoid extension of a primary IPH.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44224842","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 : 2022-01-01DOI: 10.4103/joacc.joacc_106_21
P. Sookaromdee, V. Wiwanitkit
{"title":"Pregnancy in thalassemia: Correspondence","authors":"P. Sookaromdee, V. Wiwanitkit","doi":"10.4103/joacc.joacc_106_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_106_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48935973","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 : 2022-01-01DOI: 10.4103/joacc.joacc_71_21
H. Misran, David W. Hoppe, Andrew Colls, Y. Ohashi
We present the anaesthetic management of a parturient with myogenic differentiation-1 gene-related congenital myopathy who presented for urgent caesarean section due to pre-eclampsia and respiratory failure. The challenges we faced include chronic respiratory failure with diaphragmatic dysfunction, difficulties with neuraxial anaesthesia, potential risk of triggering malignant hyperthermia in an unknown myopathy, and the complexities of multidisciplinary team involvement. As there is limited medical literature regarding this condition, we believe this is the first case report describing the anaesthetic care of a pregnant patient with this rare congenital myopathy.
{"title":"Anaesthetic considerations for the parturient with myogenic differentiation-1 gene-related congenital myopathy and pre-eclampsia: A case report","authors":"H. Misran, David W. Hoppe, Andrew Colls, Y. Ohashi","doi":"10.4103/joacc.joacc_71_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_71_21","url":null,"abstract":"We present the anaesthetic management of a parturient with myogenic differentiation-1 gene-related congenital myopathy who presented for urgent caesarean section due to pre-eclampsia and respiratory failure. The challenges we faced include chronic respiratory failure with diaphragmatic dysfunction, difficulties with neuraxial anaesthesia, potential risk of triggering malignant hyperthermia in an unknown myopathy, and the complexities of multidisciplinary team involvement. As there is limited medical literature regarding this condition, we believe this is the first case report describing the anaesthetic care of a pregnant patient with this rare congenital myopathy.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42794948","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 : 2022-01-01DOI: 10.4103/joacc.joacc_108_21
A. Trikha, Manpreet Kaur
{"title":"High flow nasal cannula (HFNC) and video laryngoscope (VL) as essential adjuncts in management of obstetric difficult airway: Efficacious tools or simply an industry push!","authors":"A. Trikha, Manpreet Kaur","doi":"10.4103/joacc.joacc_108_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_108_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49389432","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 : 2022-01-01DOI: 10.4103/joacc.joacc_28_21
Damodar Puchakala, V. Joshi, Avanish Bhardwaj
Background: Pain after Caesarean section is described as moderate to severe by most patients. Ultrasound guided transversus abdominis plane (TAP) block is now increasingly being used for postoperative analgesia in lower abdominal surgeries. Hence this study was undertaken to compare 0.25% Bupivacaine with 0.375% Ropivacaine for postoperative analgesia using TAP block in caesarean section. Methods: Seventy patients were randomized into Group B (n = 35) and Group R (n = 35). TAP block was administered after completion of surgery under ultrasound guidance using 15 mL of 0.25% Bupivacaine in Group B and 15 mL of 0.375% Ropivacaine in Group R on each side of the abdomen. Time to requirement of first analgesic dosage was observed in both the groups. Total analgesic requirement in the first 24 h, visual analogue scale (VAS) scores at 2, 4, 6, 8, 12 and 24 h, patient satisfaction and complications were also noted. Results: Mean time for the first dose of rescue analgesia after completion of surgery was 298.2 ± 93.6 min in Group B and 447.6 ± 85.2 min in Group R (P = 0.0001). Total requirement of Diclofenac Sodium injection was 162.86 ± 46.88 mg in Group B whereas it was only 130.71 ± 44.49 mg in Group R (P = 0.003). VAS at 4,6 and 8 h after surgery were significantly lower in the Ropivacaine group. Conclusion: 0.375% Ropivacaine provided longer duration of analgesia and resulted in lesser analgesic requirement than 0.25% Bupivacaine when used in TAP block after caesarean section.
{"title":"Evaluation of 0.25% bupivacaine vs. 0.375% ropivacaine for postoperative analgesia using ultrasound guided transversus abdominis plane block for caesarean section: A comparative study","authors":"Damodar Puchakala, V. Joshi, Avanish Bhardwaj","doi":"10.4103/joacc.joacc_28_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_28_21","url":null,"abstract":"Background: Pain after Caesarean section is described as moderate to severe by most patients. Ultrasound guided transversus abdominis plane (TAP) block is now increasingly being used for postoperative analgesia in lower abdominal surgeries. Hence this study was undertaken to compare 0.25% Bupivacaine with 0.375% Ropivacaine for postoperative analgesia using TAP block in caesarean section. Methods: Seventy patients were randomized into Group B (n = 35) and Group R (n = 35). TAP block was administered after completion of surgery under ultrasound guidance using 15 mL of 0.25% Bupivacaine in Group B and 15 mL of 0.375% Ropivacaine in Group R on each side of the abdomen. Time to requirement of first analgesic dosage was observed in both the groups. Total analgesic requirement in the first 24 h, visual analogue scale (VAS) scores at 2, 4, 6, 8, 12 and 24 h, patient satisfaction and complications were also noted. Results: Mean time for the first dose of rescue analgesia after completion of surgery was 298.2 ± 93.6 min in Group B and 447.6 ± 85.2 min in Group R (P = 0.0001). Total requirement of Diclofenac Sodium injection was 162.86 ± 46.88 mg in Group B whereas it was only 130.71 ± 44.49 mg in Group R (P = 0.003). VAS at 4,6 and 8 h after surgery were significantly lower in the Ropivacaine group. Conclusion: 0.375% Ropivacaine provided longer duration of analgesia and resulted in lesser analgesic requirement than 0.25% Bupivacaine when used in TAP block after caesarean section.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48838084","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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