Journal of the Indian Medical Association
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Randomized Controlled Trial Comparative Study
A comparative study of duration of postoperative analgesia between epidural bupivacaine and epidural clonidine plus bupivacaine in lumbar laminectomy surgery under general anaesthesia.
A randomised prospective double-blind placebo controlled study was undertaken in 60 patients of ASA-I and II, scheduled for lumbar laminectomy under general anaesthesia using thiopentone, fentanyl, artracurium, N2O/O2 and isoflurane. After obtaining written Informed consent from all patients, they were randomly allocated to two equal groups ie, group A (n = 30) and group B (n = 30). Group A patients received clonidine 0.5 ml (75 microg) plus 5 ml 0.25% bupivacaine and group B patients received 5 ml 0.25% bupivacaine plus 0.5 ml of normal saline (NS) as a control through epidural route placed by the surgeon at the closure of the surgery. ⋯ No clinically significant difference was found in heart rate, blood pressure, respiratory rate, oxygen saturation and motor blockade. Sedation score was slightly higher in group A, which was not significant. So small dose of clonidine (75 microg) as an adjuvant to 5 ml 0.25% bupivacaine in epidural route following lumbar laminectomy significantly prolonged postoperative analgesia and improved patient satisfaction without any clinically significant adverse reaction.
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Randomized Controlled Trial Comparative Study
Comparison of neonatal outcome in women with severe pre-eclampsia undergoing caesarean section under spinal or general anaesthesia.
Ideal method of anaesthesia during caesarean section in women with severe pre-eclampsia is difficult to decide. The aim and objective of the study were to compare neonatal outcome in women with severe pre-eclampsia, undergoing caesarean section in intrapartum period, either under general or spinal anaesthesia. Women with severe pre-eclampsia, undergoing caesarean section in intrapartum period, were included in the study. ⋯ Subgroup analysis in the population with pre-operative scalp blood pH < 7.2, neonatal umbilical artery base deficit was significantly higher in general anaesthesia group. Five minutes APGAR score was comparable but resuscitation at birth was more common in the general anaesthesia group. Correlation coefficient between maternal base deficit and foetal base deficit in this subgroup was 0.42 (p = 0.05) and -0.57 (p < 0.05) respectively for general and spinal anaesthesia.
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Randomized Controlled Trial
Analgesic effect of low gynaecological surgery under general anaesthesia.
Gabapentin has been used in the treatment of neuropathic pain as well as postoperative pain with good result. This study was done to investigate the effect of gabapentin in day-case gynaecological surgery under general anaesthesia. A randomised, placebo controlled, double blind study was undertaken on 200 patients of ASA I and II, aged 20 and 50 years, body weight of 50 +/- 0.06 kg undergoing day case gynaecological surgery under general anaesthesia. ⋯ Group-A patients showed lower VAS scores than the patients in group-B at 1st, 3rd and 6th hours postoperatively (p < 0.05). Moreover the total amount of rescue analgesic required in the immediate postoperative period observed for six hours was much higher in the group-B patients than in the patients in group-A (p <0.05). To conclude, the study showed that gabapentin used in low dose has got analgesic efficacy in the patients following day-case gynaecological surgery under general anaesthesia and has also significantly reduced the total requirement of rescue analgesic in the immediate postoperative period.
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Randomized Controlled Trial Comparative Study
A comparative clinical study of injection clonidine versus midazolam in supraclavicular brachial plexus block for sedation and postoperative analgesia: a study of 60 cases.
A randomised clinical study was conducted in 60 ASA I-II patients undergoing elective upper limb orthopaedic surgeries (duration of surgery < or =120 minutes). All the patients were divided into two groups (n=30 each), group C (clonidine) and group M (midazolam). All were premedicated with injection glycopyrrolate 0.2 mg intramuscular 30 minutes before surgery and given injection bupivacaine 0.5% plain 20 ml and injection lignocaine 2% plain 10 ml in supraclavicular brachial plexus block. ⋯ In group M 5 patients required 1 dose and 23 patients required 2 doses and 2 patients required 3 doses in 24hours, though the data was not statistically significant. No complication was observed in any patient in both the groups. So injection clonidine provides better postoperative analgesia and more sedation than midazolam.
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Randomized Controlled Trial Comparative Study
Comparative study of postoperative analgesia and sedation after upper abdominal surgery with thoracic epidural administration of bupivacaine with/without midazolam.
Currently continuous epidural administration of local anaesthetics with opioids is widely used for postoperative analgesia. To avoid the side-effects of opioids a drug that can replace opioids is most welcome. Midazolam not only has no side-effects but also has the advantages of sedation and amnesia. ⋯ Statistically significant differences in pulse, BP, RR and SpO2 were not seen. Better sedation, analgesia scores and amnesia were noted in patients belonging to group B as compared to patients of group A. This combination may thus replace routinely used combinations of opioids and local anaesthetics.