Indian journal of anaesthesia
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Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. ⋯ The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.
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Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. ⋯ Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.
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Ketamine, a N-methyl-D-aspartate receptor antagonist inhibits central sensitization due to peripheral nociception thus potentiating the analgesic effect of morphine. The purpose of our study was to evaluate the effect of adding small-dose ketamine in a multimodal regimen of postoperative patient-controlled epidural analgesia (PCEA). One hundred patients of American Society of Anesthesiologists physical status I-II, undergoing major upper abdominal surgery were randomly allocated to two groups. ⋯ The mean morphine consumption in group I after 1(st)and 2(nd)postoperative day was 8.38±2.85 and 7.64±1.95 mg, respectively, compared to 6.81±1.35 and 6.25±1.22 mg (P<0.05) in group II. Although group II consumed significantly less morphine, pain relief at rest and at movement after 6, 12, 24 and 48 hours, postoperatively was significantly better in group II (P<0.05) than in group I. These findings suggest that adding small-dose ketamine to a multimodal PCEA regimen provides better postoperative analgesia and reduces morphine consumption.
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Both sevoflurane and desflurane have shorter emergence times compared to isoflurane based anaesthesia. Because of its pharmacological properties, desflurane appears to yield a rapid early and intermediate recovery compared with sevoflurane. The aim of this study was to assess the maintenance and emergence characteristics after anaesthesia with sevoflurane or desflurane. ⋯ The intraoperative haemodynamic characteristics were comparable with both sevoflurane and desflurane. Both sevoflurane and desflurane provide a similar time to home readiness despite a faster early recovery with desflurane. The intraoperative haemodynamics are similar with both the agents.
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This study was undertaken to study efficacy of single dose of intravenous magnesium sulphate to reduce post-operative pain in patients undergoing inguinal surgery. One hundred patients undergoing inguinal surgery were divided randomly in two groups of 50 each. The patients of magnesium sulphate group (Group-I) received magnesium sulphate 50 mg/kg in 250 ml of isotonic sodium chloride solution IV whereas patients in control group (Group-II) received same volume of isotonic sodium chloride over 30 minutes preoperatively. ⋯ Patients in group-I were more sedated as compared to group-II [sedation score 1.86 vs. 1.40 (P=0.000)]. Rescue analgesia requirement postoperatively in first 4, 8 and 16 hrs was significantly lower in patients of group-1 than in group- II [1.9 vs. 3.8 (P<0.05), 25.50 vs. 52.50 (P<0.05) and 0.000 vs. 7.5 (P<0.05)]. Preoperative magnesium sulphate infusion decreases postop pain and requirement of rescue analgesia.