Background: Pain management is a major challenge after any surgery. Painful experiences in post operative period leads to unwanted side effects like altered metabolic response, aggravated autonomic reflexes, causing ileus, nausea, impairs coagulation, delays wound healing and delays mobilization. To prevent such effects we use opioids, local anaesthetics and NSAIDs. In this study we aimed to compare the postoperative analgesic effects of gelfoam Soaked with ropivacaine and gelfoam soaked with dexamethasone with Placebo in a single-level lumbar laminectomy. Materials and Methods: 98 patients scheduled to undergo single-level lumbar laminectomy under general anesthesia in the age group between 18 and 60 years were enrolled in the study. They were randomly divided in three equal groups. Data was collected for post operative pain score and other side effects. All tests were evaluated for 95% confidence limits. P <0.05 was considered significant. Results: VAS score in placebo was 4.133 ± 1.105, in ropivacaine group was 1.866 ± 0.899 and in ropivacaine with dexamethasone group was 1.7 ± 0.749, which was highly significant with P < 0.0001. Total analgesia consumption with tramadol was 279.1 ± 41.77 mg in the placebo group, 124.6 ± 43.44 mg in the ropivacaine group (R), and 97.7 ± 39.92 mg in the ropivacaine and dexamethasone group (RD). Conclusion: Gelfoam soaked in 0.5% ropivacaine and 0.9% NS when placed epidurally provides adequate postoperative analgesia. Gelfoam soaked in 0.5% ropivacaine and 2 mL dexamethasone when placed epidurally provides prolonged postoperative analgesia. No side effects were noted in the 0.5% ropivacaine and 2 mL dexamethasone group.
Background: Most of the previous studies comparing epidural analgesia (EA) with intravenous (i.v.) analgesia in blunt trauma chest (BTC) patients are retrospective in nature. This prospective, observational study was done to evaluate the effect of EA with i.v. analgesia in BTC patients who were managed by noninvasive ventilation (NIV). Aim: The aim of this study was to compare the effect of EA with i.v. analgesia in BTC patients managed conservatively with NIV and to compare the length of intensive care unit (ICU) stay. Settings and Design: A prospective observational study was conducted in tertiary-level ICU patients. Materials and Methods: Adult patients of BTC neither requiring surgery nor invasive mechanical ventilation were included. Patients with contraindication to NIV or EA were excluded. Forty-six patients were divided into two groups. One group received EA and other i.v. analgesia. Oxygenation and pain relief were compared in terms of PaO2/FiO2 ratio and Visual Analog Scale (VAS), respectively. Statistical Analysis: Result interpretation was done using the Student’s t-test and Chi-squire test. Results: At 36 h after EA and thereafter up to 72 h, there was significant difference in P/F ratio. Better oxygenation was noted in EA group. Patient’s VAS scoring shows significantly low (P < 0.001) in patients receiving EA after 1 h. Mean ICU stay in EA and i.v. group was 10.17 ± 4.697 and 13.83 ± 4.96 days, respectively (P = 0.013). Conclusions: EA provides excellent pain relief as compared to i.v. analgesia, which results in improved respiratory exchange, effective coughing, better secretions clearance, and higher P/F ratio. ICU stay was significantly lower in patients receiving EA.
Background and Aims: Propofol is a potent intravenous (i.v.) anesthetic that attenuates pharyngeal, laryngeal, and tracheal reflexes and provides an adequate depth of anesthesia for intubation. However, its major disadvantage is the fall in blood pressure (BP) and heart rate (HR). Ephedrine being a potent alpha-adrenergic vasoconstrictor and a beta-adrenergic cardiac stimulant can combat this hemodynamic effect of propofol. The objective of this study was to compare the decrease in hypotension and bradycardia caused by propofol with two prophylactic doses of ephedrine. Further, the intubating conditions with prophylactic ephedrine with atracurium were noted. Settings and Design: Patients posted for elective surgeries under general anesthesia in a tertiary care hospital in South India were recruited by randomized computer-generated tables and allocated using sealed envelopes into three groups after written informed consent. A randomized control study was done between three groups of patients who received saline, 100 μg.kg−1 or 150 μg.kg−1 of ephedrine. Materials and Methods: A total of 87 patients between 18 and 59 years of the American Society of Anesthesiologists physical status classes I and II were recruited and randomized into three groups of 29 each. Each group received normal saline (S1), 100 μg.kg−1 (E1) and 150 μg.kg−1 (E2) of ephedrine i.v. All patients were given i.v fentanyl 2 μg.kg−1, followed by the study drug depending on the group they were in. This was immediately followed by 2 μg.kg−1 of propofol i.v over 30s. Muscle relaxation was given with atracurium and patients were intubated 3 min later. The patients’ HR, systolic and diastolic BPs (SBP and DBP), and mean arterial pressures (MAPs) were recorded at preinduction, 2 min after induction, 1 min after intubation, then 3 min, 5 min, 10 min, 15 min, and 30 min later. Further, the anesthesiologist intubating assessed the conditions of intubation and later scored it. Statistical Analysis: The Chi-square test was used as the test of significance for the qualitative data. Continuous data were represented as mean and standard deviation. Analysis of variance was the test of significance used to identify the mean difference between more than two groups for quantitative and qualitative data. “Paired t-test” was used as the test of significance for paired data. P value (Probability that the result is true) of <0.05 was considered statistically significant after assuming all the rules of statistical tests. Results: Mean HR was significantly higher in the E2 Group than in the E1 and S1 Groups. Mean SBP, DBP, and MAP were higher in the E2 Group, followed by E1 and lower in the S1 Group during these intervals. Hence, all groups had hypotension effects from induction but the least was noted with the group that received 150 μg.kg−1 of ephedrine. All groups had similar intubating conditions with no significant difference between the groups. Conclusion: 100 μg.kg−1 and 150 μg.kg−1 of ephedrine had significant effects in reducing the hypotension associated with propofol, however, high doses also caused significant tachycardia.
Low back pain generally involves lumbosacral radicular syndrome, nerve root pain, and nerve root entrapment/irritation. Management options for patients are variable and diverging. To the highlight the efficacy of combined early decompressive surgery plus intraoperative steroid injections in terms of postoperative back pain in patients managed by our combined team. A prospective study conducted by reviewing all consecutive patients managed, over a 1-year period (2018-2019). This study showed that adjunct use of intraoperative foraminal and epidural steroids injections to treat back pain in patients with degenerative spine disease could significantly improve the pain score which leads to significant decrease in working days off and the need for pain killer medications or even obviating the usage rate.
