Labor pain is consistently ranked high on the various pain rating scales, when compared to other painful life experiences, and the experience of labor during the process of childbirth is both complex and subjective. Though patient-controlled epidural analgesia (PCEA) using dilute concentrations of local anesthetics (LAs) has been a popular method to control labor pain, yet the optimal dose and regimen for PCEA remain ambiguous. So, the present study was undertaken to evaluate the safety and efficacy of three different concentrations of ropivacaine for labor analgesia using PCEA. Seventy-five healthy nulliparous women who gave voluntary consent for labor analgesia using PCEA were randomly assigned to three groups to receive three different ropivacaine concentrations (0.0625%, 0.1%, and 0.125%) with adjuvant fentanyl 2 μg/ml, after double-blinding. Analgesic efficacy, neuraxial blockade, vital parameters, neonatal outcomes, maternal satisfaction, and side effects were assessed. Primary outcome was total dose of ropivacaine consumed in milligrams. Number of pain breakthroughs (Visual Analog Score >4) and PCEA demand and rescue boluses were found to be statistically more in group 0.0625% (P < 0.01), followed by group 0.1% and were the least in 0.125%. Still, total drug consumed in milligrams was significantly less in 0.0625% group. Maternal satisfaction was comparable among the three groups (P = 0.33). There was no significant difference in maternal side effects and neonatal APGAR scores among the three groups. When three different concentrations of ropivacaine, that is, 0.0625%, 0.1%, and 0.125%, are used for labor analgesia, the use of 0.125% ropivacaine leads to higher total amount of ropivacaine consumed. Despite the lower efficacy in terms of breakthrough pain episodes observed with a 0.0625% ropivacaine concentration for labor analgesia, maternal satisfaction remained consistent across all three doses of ropivacaine. PCEA demand and rescue boluses for the lowest concentration, that is, 0.0625%; and did not affect maternal satisfaction with the management of labor pain.
{"title":"Comparison of efficacy and safety of three different concentrations of ropivacaine for labor pain management using patient-controlled epidural analgesia (PCEA): A double-blind, randomized controlled trial","authors":"Pooja Bihani, Medha Vyas, Shikha Soni, Rishabh Jaju, Sarita Janweja, Usha Choudhary","doi":"10.4103/joacp.joacp_159_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_159_23","url":null,"abstract":"\u0000 \u0000 \u0000 Labor pain is consistently ranked high on the various pain rating scales, when compared to other painful life experiences, and the experience of labor during the process of childbirth is both complex and subjective. Though patient-controlled epidural analgesia (PCEA) using dilute concentrations of local anesthetics (LAs) has been a popular method to control labor pain, yet the optimal dose and regimen for PCEA remain ambiguous. So, the present study was undertaken to evaluate the safety and efficacy of three different concentrations of ropivacaine for labor analgesia using PCEA.\u0000 \u0000 \u0000 \u0000 Seventy-five healthy nulliparous women who gave voluntary consent for labor analgesia using PCEA were randomly assigned to three groups to receive three different ropivacaine concentrations (0.0625%, 0.1%, and 0.125%) with adjuvant fentanyl 2 μg/ml, after double-blinding. Analgesic efficacy, neuraxial blockade, vital parameters, neonatal outcomes, maternal satisfaction, and side effects were assessed. Primary outcome was total dose of ropivacaine consumed in milligrams.\u0000 \u0000 \u0000 \u0000 Number of pain breakthroughs (Visual Analog Score >4) and PCEA demand and rescue boluses were found to be statistically more in group 0.0625% (P < 0.01), followed by group 0.1% and were the least in 0.125%. Still, total drug consumed in milligrams was significantly less in 0.0625% group. Maternal satisfaction was comparable among the three groups (P = 0.33). There was no significant difference in maternal side effects and neonatal APGAR scores among the three groups.\u0000 \u0000 \u0000 \u0000 When three different concentrations of ropivacaine, that is, 0.0625%, 0.1%, and 0.125%, are used for labor analgesia, the use of 0.125% ropivacaine leads to higher total amount of ropivacaine consumed. Despite the lower efficacy in terms of breakthrough pain episodes observed with a 0.0625% ropivacaine concentration for labor analgesia, maternal satisfaction remained consistent across all three doses of ropivacaine. PCEA demand and rescue boluses for the lowest concentration, that is, 0.0625%; and did not affect maternal satisfaction with the management of labor pain.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"45 192","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140236870","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}
Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.
麻醉后恢复阶段的出院谵妄（ED）是一项重大挑战，尤其是在儿科患者中，其发生率从 2% 到 80%不等。本研究旨在评估和比较异丙酚和右美托咪定在解决接受七氟醚麻醉的儿科患者谵妄问题方面的效果。主要目的是确定两种治疗方法的 ED 发生率，次要结果包括术后疼痛、血液动力学反应和并发症的发生。 该试验共招募了 80 名 2-6 岁的儿童，计划在全身麻醉下进行脐下短小手术。在手术完成前 10 分钟注射丙泊酚（1 毫克/千克）或右美托咪定（0.3 微克/千克）。拔管后每 5 分钟使用儿科麻醉后谵妄量表对 ED 进行评估，得分超过 12 分表示 ED。术后镇静采用拉姆塞镇静量表进行评估，而疼痛程度则通过面部、腿部、活动、哭泣和舒适度（FLACC）评分来确定。对任何潜在并发症都进行了密切监测。 D 组和 P 组拔管时的 ED 发生率分别为 2.50%和 70%，拔管后 5、10、15 和 30 分钟的 ED 发生率呈持续下降趋势。拔管时的相对风险比为 4.103（95% 置信区间：2.49-6.76），显示使用右美托咪定后 ED 风险显著降低了 4.1 倍。右美托咪定组的术后疼痛发生率较低。 与异丙酚相比，右美托咪定在手术完成前给药，在减少儿童患者全身麻醉期间的 ED 和术后疼痛方面表现出更优越的疗效。
{"title":"Comparison of bolus dose administration of propofol and dexmedetomidine for incidence of emergence delirium in pediatric patients undergoing surgery with general anesthesia: A randomized, double-blind trial","authors":"Vidya Tharu, Naveen Paliwal, Pooja Bihani, Sarita Janweja, Rishabh Jaju, Sunil Kothari","doi":"10.4103/joacp.joacp_373_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_373_23","url":null,"abstract":"\u0000 \u0000 \u0000 Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications.\u0000 \u0000 \u0000 \u0000 Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored.\u0000 \u0000 \u0000 \u0000 The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain.\u0000 \u0000 \u0000 \u0000 In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"10 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238832","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 : 2024-03-15DOI: 10.4103/joacp.joacp_355_23
Ganga Prasad, Sohini Ray
{"title":"Tuohy needle as a guide for successful single-space combined spinal and epidural anesthesia: A novel approach","authors":"Ganga Prasad, Sohini Ray","doi":"10.4103/joacp.joacp_355_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_355_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"119 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238086","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}
Regional techniques are a part of multimodal analgesia following cesarean delivery. Cesarean delivery warrants a regional technique, which can provide somatic and visceral analgesia-like quadratus lumborum block (QLB) and erector spinae plane block (ESPB). In this study, we investigated the non-inferiority of ESPB at T12 and transmuscular-QLB (TQLB) at L2-L3 for postoperative analgesia in cesarean delivery. In this prospective, randomized, non-inferiority trial, 124 patients undergoing cesarean delivery were enrolled to receive bilateral TQLB or ESPB with 20 mL of 0.25% ropivacaine on each side. All patients received prophylactic acetaminophen and ketorolac for 2 days. Our primary objective was to compare the total tramadol consumption in the first 48 h between the two groups. Secondary objectives were to compare cumulative tramadol consumption, postoperative Numeric Rating Scale (NRS) score at rest, and with movement at various time points, the time for first rescue analgesic requirement, development of complications related to the block, and patient satisfaction with analgesia between the two groups. The total tramadol consumption in 48 h (47.3 ± 34.9 mg in ESPB and 50.9 ± 38.7 mg in TQLB), duration of first rescue analgesic (22.8 ± 15.8 h in ESPB and 22.7 ± 15.6 h in TQLB), and patient satisfaction were similar between the two groups. Both groups had similar pain scores except at rest at 6 h and on movement at 4 h, 6 h, and 36 h, whereas the ESPB group had lower NRS scores (P < 0.05). The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB post-caesarean delivery. What is already known about the topic: Cesarean delivery warrants a regional analgesia technique which can provide somatic and visceral analgesia postoperatively. While quadratus lumborum block (QLB) is a well-established technique for cesarean delivery there are very few comparative studies on erector spinae plane block (ESPB) in cesarean delivery. In the studies comparing ESPB for other lower abdominal procedures, it has been given at T9 only. What new information this study adds: The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB performed at L2-L3 with the same volume post-cesarean delivery and can be an important addition to multimodal analgesia protocols after cesarean delivery.
{"title":"Comparison of ultrasound-guided erector spinae plane block versus transmuscular quadratus lumborum block for postoperative analgesia after caesarean delivery: a prospective randomized non-inferiority clinical trial","authors":"Reesha Joshi, Ram Jeevan, Selvaraju V. Amutha, Lakshmi Ramakrishnan, Naveen Ramji Natarajan","doi":"10.4103/joacp.joacp_71_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_71_23","url":null,"abstract":"\u0000 \u0000 \u0000 Regional techniques are a part of multimodal analgesia following cesarean delivery. Cesarean delivery warrants a regional technique, which can provide somatic and visceral analgesia-like quadratus lumborum block (QLB) and erector spinae plane block (ESPB). In this study, we investigated the non-inferiority of ESPB at T12 and transmuscular-QLB (TQLB) at L2-L3 for postoperative analgesia in cesarean delivery.\u0000 \u0000 \u0000 \u0000 In this prospective, randomized, non-inferiority trial, 124 patients undergoing cesarean delivery were enrolled to receive bilateral TQLB or ESPB with 20 mL of 0.25% ropivacaine on each side. All patients received prophylactic acetaminophen and ketorolac for 2 days. Our primary objective was to compare the total tramadol consumption in the first 48 h between the two groups. Secondary objectives were to compare cumulative tramadol consumption, postoperative Numeric Rating Scale (NRS) score at rest, and with movement at various time points, the time for first rescue analgesic requirement, development of complications related to the block, and patient satisfaction with analgesia between the two groups.\u0000 \u0000 \u0000 \u0000 The total tramadol consumption in 48 h (47.3 ± 34.9 mg in ESPB and 50.9 ± 38.7 mg in TQLB), duration of first rescue analgesic (22.8 ± 15.8 h in ESPB and 22.7 ± 15.6 h in TQLB), and patient satisfaction were similar between the two groups. Both groups had similar pain scores except at rest at 6 h and on movement at 4 h, 6 h, and 36 h, whereas the ESPB group had lower NRS scores (P < 0.05).\u0000 \u0000 \u0000 \u0000 The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB post-caesarean delivery.\u0000 \u0000 \u0000 \u0000 \u0000 What is already known about the topic: Cesarean delivery warrants a regional analgesia technique which can provide somatic and visceral analgesia postoperatively. While quadratus lumborum block (QLB) is a well-established technique for cesarean delivery there are very few comparative studies on erector spinae plane block (ESPB) in cesarean delivery. In the studies comparing ESPB for other lower abdominal procedures, it has been given at T9 only.\u0000 \u0000 What new information this study adds: The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB performed at L2-L3 with the same volume post-cesarean delivery and can be an important addition to multimodal analgesia protocols after cesarean delivery.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"39 153","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140236886","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}
Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well. Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery. A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P < 0.001), with better pain scores (P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block. The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients.
{"title":"Comparison of anterior, posterior, and lateral approaches of ultrasound-guided quadratus lumborum block in an adult patient undergoing inguinal hernia surgery: A prospective randomized controlled trial","authors":"Ajeet Kumar, C. Sinha, Soumya Singh, Amarjeet Kumar, Anil Kumar, Diti Priya","doi":"10.4103/joacp.joacp_75_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_75_23","url":null,"abstract":"\u0000 \u0000 \u0000 Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well.\u0000 \u0000 \u0000 \u0000 Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery.\u0000 \u0000 \u0000 \u0000 A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P < 0.001), with better pain scores (P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block.\u0000 \u0000 \u0000 \u0000 The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"4 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140237232","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 : 2024-02-08DOI: 10.4103/joacp.joacp_88_23
P. Kurhekar, Sam Blessy Sheba, Sathyasuba Meenakshisundaram, R. Sethuraman, Neeta Parlikar
Bolus epidural dexmedetomidine provides potent analgesia but the incidence of hemodynamic instability is high. There are only a few studies that have evaluated the efficacy of epidural dexmedetomidine infusion but none of them compared different doses to find the optimum safe dose. We compared the analgesic efficacy and safety of two different doses of dexmedetomidine in continuous epidural for postoperative analgesia. Patients undergoing lower limb surgeries were divided randomly into two groups: Group I (n = 36) received an epidural infusion of 0.1% ropivacaine + 0.5 μg/kg/24 h of dexmedetomidine and Group II (n = 36) received epidural infusion 0.1% ropivacaine + 1 μg/kg/24 h of dexmedetomidine. Both groups received epidural infusion at the rate of 5 ml/h over 48 h postoperatively. Pain scores, demand for rescue analgesics, hemodynamic parameters, and sedation scores were compared between the groups. Statistical analysis was done using an independent t-test and Chi-square test. 1 μg/kg group (Group II) had a significantly reduced pain score at all time intervals and less demand for rescue analgesia (P = 0.03). The severity of pain was more in the 0.5 μg/kg group (Group I), at all times (P = 0.000). Incidence hypotension was higher in Group II. Bradycardia was seen in two patients in Group II and none in Group I. Dexmedetomidine in a dose of 1 μg/kg/24 h with 5 ml of 0.1% ropivacaine through epidural infusion provides better analgesia with a safe hemodynamic profile. Key message: Epidural dexmedetomidine can cause profound hypotension. The optimum, safe dose of dexmedetomidine is not known. In our study, we observed that continuous epidural infusion of 1 μg/kg/24 h dexmedetomidine provides better analgesia with acceptable hemodynamic variations.
硬膜外注射右美托咪定可提供强效镇痛，但血流动力学不稳定的发生率很高。只有少数研究对硬膜外输注右美托咪定的疗效进行了评估，但没有一项研究对不同剂量进行了比较，以找到最佳安全剂量。我们比较了两种不同剂量的右美托咪定连续硬膜外用于术后镇痛的镇痛效果和安全性。 接受下肢手术的患者被随机分为两组：第一组（36 人）硬膜外输注 0.1% 罗哌卡因 + 0.5 μg/kg/24 h 右美托咪定，第二组（36 人）硬膜外输注 0.1% 罗哌卡因 + 1 μg/kg/24 h 右美托咪定。两组患者均在术后 48 小时内以 5 毫升/小时的速度进行硬膜外输注。对两组患者的疼痛评分、镇痛药需求量、血流动力学参数和镇静评分进行比较。统计分析采用独立 t 检验和卡方检验。 1 μg/kg 组（II 组）在所有时间间隔内的疼痛评分都明显降低，对镇痛药的需求也更少（P = 0.03）。0.5 μg/kg组（I组）在所有时间段的疼痛程度都更严重（P = 0.000）。第二组的低血压发生率更高。右美托咪定的剂量为 1 μg/kg/24 h，并通过硬膜外输注 5 ml 0.1% 罗哌卡因，可提供更好的镇痛效果和安全的血流动力学特征。 关键信息：硬膜外注射右美托咪定可导致深度低血压。右美托咪定的最佳安全剂量尚不清楚。在我们的研究中，我们观察到硬膜外连续输注 1 μg/kg/24 h 右美托咪定可提供更好的镇痛效果，且血液动力学变化可接受。
{"title":"Comparison of two different doses of dexmedetomidine for continuous epidural analgesia for lower limb surgeries: A randomized double-blind study","authors":"P. Kurhekar, Sam Blessy Sheba, Sathyasuba Meenakshisundaram, R. Sethuraman, Neeta Parlikar","doi":"10.4103/joacp.joacp_88_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_88_23","url":null,"abstract":"\u0000 \u0000 \u0000 Bolus epidural dexmedetomidine provides potent analgesia but the incidence of hemodynamic instability is high. There are only a few studies that have evaluated the efficacy of epidural dexmedetomidine infusion but none of them compared different doses to find the optimum safe dose. We compared the analgesic efficacy and safety of two different doses of dexmedetomidine in continuous epidural for postoperative analgesia.\u0000 \u0000 \u0000 \u0000 Patients undergoing lower limb surgeries were divided randomly into two groups: Group I (n = 36) received an epidural infusion of 0.1% ropivacaine + 0.5 μg/kg/24 h of dexmedetomidine and Group II (n = 36) received epidural infusion 0.1% ropivacaine + 1 μg/kg/24 h of dexmedetomidine. Both groups received epidural infusion at the rate of 5 ml/h over 48 h postoperatively. Pain scores, demand for rescue analgesics, hemodynamic parameters, and sedation scores were compared between the groups. Statistical analysis was done using an independent t-test and Chi-square test.\u0000 \u0000 \u0000 \u0000 1 μg/kg group (Group II) had a significantly reduced pain score at all time intervals and less demand for rescue analgesia (P = 0.03). The severity of pain was more in the 0.5 μg/kg group (Group I), at all times (P = 0.000). Incidence hypotension was higher in Group II. Bradycardia was seen in two patients in Group II and none in Group I.\u0000 \u0000 \u0000 \u0000 Dexmedetomidine in a dose of 1 μg/kg/24 h with 5 ml of 0.1% ropivacaine through epidural infusion provides better analgesia with a safe hemodynamic profile.\u0000 \u0000 Key message: Epidural dexmedetomidine can cause profound hypotension. The optimum, safe dose of dexmedetomidine is not known. In our study, we observed that continuous epidural infusion of 1 μg/kg/24 h dexmedetomidine provides better analgesia with acceptable hemodynamic variations.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"171 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139793720","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":"Positioning dilemma in a complicated case. Utilizing OT table for ingenious positioning","authors":"Nikita Choudhary, Abhishek Nagarajappa, Puneet Khanna, Sarina Karayi","doi":"10.4103/joacp.joacp_191_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_191_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"84 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139851559","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 : 2024-02-08DOI: 10.4103/joacp.joacp_75_22
Saiteja Kodamanchili, Priyanka Tn, A. Anand, Rajesh Panda
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Starvation of long duration during third trimester of pregnancy is undesirable as it is associated with accelerated fasting leading to hypoglycemia, raised plasma free fatty acid (FFA) levels, and increased plasma/urinary ketones. Carbohydrate (CHO)-rich drinks given preoperatively may ameliorate these deleterious effects. The enhanced recovery after surgery (ERAS) guidelines for perioperative care recommend that oral CHO fluid supplementation 2 h before cesarean delivery may be offered to nondiabetic pregnant women. The aim of the study was to evaluate the role of preoperative oral CHO loading for the prevention of perioperative ketoacidosis in elective cesarean deliveries. One hundred and twenty American Society of Anesthesiologists (ASA) II/III parturients undergoing elective cesarean section under subarachnoid block (SAB) were divided into two groups of 60 each after they gave written informed consent. Group A parturients received 400 ml of filtered water 2 h before surgery. Group B parturients received 400 ml of nonparticulate CHO drink 2 h before surgery. The primary outcome was the incidence of ketonuria studied by the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety score, dominant hand grip strength, and the quality of recovery score. The urine ketone levels were positive (+1) in 8.3% parturients in group A and 1.7% parturients in the CHO group (P value- 0.094). The hunger and thirst scores as well as the modified Beck’s anxiety scores were significantly lower in the CHO group (P value- 0.002). Dominant hand grip strength was preserved in both the groups (P value- 0.827). The quality of recovery score was significantly improved in the CHO group (P value- 0.002). No serious adverse effects were noted in either group. Oral CHO drink is safe when administered 2 h before uncomplicated elective cesarean deliveries. It may have a positive influence on a wide range of perioperative markers of clinical outcome.
在妊娠三个月内长时间饥饿是不可取的，因为这会加速禁食，导致低血糖、血浆游离脂肪酸（FFA）水平升高以及血浆/尿酮体增加。术前饮用富含碳水化合物（CHO）的饮料可减轻这些有害影响。加强术后恢复（ERAS）围术期护理指南建议，可在剖宫产前 2 小时为非糖尿病孕妇提供口服 CHO 补充液。本研究旨在评估术前口服 CHO 补充剂对预防择期剖宫产围手术期酮症酸中毒的作用。 120名美国麻醉医师协会（ASA）II/III级产妇在蛛网膜下腔阻滞（SAB）下接受择期剖宫产手术，在获得书面知情同意后被分为两组，每组60人。A 组产妇在术前 2 小时饮用 400 毫升过滤水。B 组产妇在手术前 2 小时饮用 400 毫升无颗粒 CHO 饮料。主要结果是用量尺法检测酮尿的发生率。次要结果包括饥饿和口渴评分、焦虑评分、优势手握力和恢复质量评分。 尿酮水平呈阳性（+1）的 A 组产妇占 8.3%，CHO 组产妇占 1.7%（P 值为 0.094）。CHO 组的饥饿和口渴评分以及改良贝克焦虑评分均显著降低（P 值- 0.002）。两组患者的惯用手握力均保持不变（P 值- 0.827）。CHO 组的康复质量评分明显提高（P 值- 0.002）。两组均未发现严重不良反应。 在无并发症的择期剖宫产前 2 小时口服 CHO 饮料是安全的。口服 CHO 饮料可能对围术期临床结果的各种指标产生积极影响。
{"title":"Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery","authors":"Ankita Sharma, Udeyana Singh, Gurpreeti Kaur, Anju Grewal, S. Maingi, Swati Tidyal","doi":"10.4103/joacp.joacp_172_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_172_23","url":null,"abstract":"\u0000 \u0000 \u0000 Starvation of long duration during third trimester of pregnancy is undesirable as it is associated with accelerated fasting leading to hypoglycemia, raised plasma free fatty acid (FFA) levels, and increased plasma/urinary ketones. Carbohydrate (CHO)-rich drinks given preoperatively may ameliorate these deleterious effects. The enhanced recovery after surgery (ERAS) guidelines for perioperative care recommend that oral CHO fluid supplementation 2 h before cesarean delivery may be offered to nondiabetic pregnant women. The aim of the study was to evaluate the role of preoperative oral CHO loading for the prevention of perioperative ketoacidosis in elective cesarean deliveries.\u0000 \u0000 \u0000 \u0000 One hundred and twenty American Society of Anesthesiologists (ASA) II/III parturients undergoing elective cesarean section under subarachnoid block (SAB) were divided into two groups of 60 each after they gave written informed consent. Group A parturients received 400 ml of filtered water 2 h before surgery. Group B parturients received 400 ml of nonparticulate CHO drink 2 h before surgery. The primary outcome was the incidence of ketonuria studied by the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety score, dominant hand grip strength, and the quality of recovery score.\u0000 \u0000 \u0000 \u0000 The urine ketone levels were positive (+1) in 8.3% parturients in group A and 1.7% parturients in the CHO group (P value- 0.094). The hunger and thirst scores as well as the modified Beck’s anxiety scores were significantly lower in the CHO group (P value- 0.002). Dominant hand grip strength was preserved in both the groups (P value- 0.827). The quality of recovery score was significantly improved in the CHO group (P value- 0.002). No serious adverse effects were noted in either group.\u0000 \u0000 \u0000 \u0000 Oral CHO drink is safe when administered 2 h before uncomplicated elective cesarean deliveries. It may have a positive influence on a wide range of perioperative markers of clinical outcome.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139852333","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 : 2024-02-08DOI: 10.4103/joacp.joacp_195_22
Dhwani S. Walavalkar, Deepa Kane, Priti S Devalkar, Ramesh Chandan, Nimisha Thakur
{"title":"A curious case of the vanishing bone disease: Anesthesia management","authors":"Dhwani S. Walavalkar, Deepa Kane, Priti S Devalkar, Ramesh Chandan, Nimisha Thakur","doi":"10.4103/joacp.joacp_195_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_195_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139854044","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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