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ULTRASOUND GUIDED PERICAPSULAR NERVE GROUP (PENG) BLOCK FOR HIP SURGERY: A RANDOMIZED CONTROLLED STUDY COMPARING ROPIVACAINE WITH DEXMEDETOMIDINE AND ROPIVACAINE WITH DEXAMETHASONE

2025-05-01T00:00:00Z

Title: ULTRASOUND GUIDED PERICAPSULAR NERVE GROUP (PENG) BLOCK FOR HIP SURGERY: A RANDOMIZED CONTROLLED STUDY COMPARING ROPIVACAINE WITH DEXMEDETOMIDINE AND ROPIVACAINE WITH DEXAMETHASONE Authors: THIRIVEEDI DINESH KUMAR Abstract: Background: Hip fractures are prevalent among the elderly and associated with significant morbidity and postoperative pain. Effective regional anesthesia techniques, such as the Pericapsular Nerve Group (PENG) block, can enhance analgesia and facilitate optimal patient positioning for spinal anesthesia. This study was conducted to compare the efficacy of ultrasound-guided PENG block using 0.5% ropivacaine combined with either dexmedetomidine or dexamethasone in patients undergoing hip surgery, focusing on pain relief during patient positioning and duration of postoperative analgesia. Methods: This randomized controlled trial included 48 patients undergoing hip surgery under spinal anesthesia. Patients were randomized into two groups: Group A received ropivacaine with dexamethasone (8 mg), while Group B received PENG block with ropivacaine and dexmedetomidine (1 mcg/kg). Pain scores were measured using the Visual Analog Scale (VAS) at various intervals, including during patient positioning and postoperatively. The duration until first rescue analgesia and total rescue analgesic requirement were also assessed. Results: Group B demonstrated significantly prolonged analgesia (445.0 ± 17.4 min vs. 388.9 ± 19.0 min, p<0.05) and reduced rescue analgesic consumption (1.9 ± 0.6 vs. 2.5 ± 0.7, p<0.05) compared to Group A. No significant differences were found in intraoperative hemodynamics or adverse effects. Conclusion: PENG block is effective for facilitating patient positioning for spinal anesthesia. Adding dexmedetomidine to ropivacaine prolongs postoperative analgesia and reduces analgesic requirements more effectively than dexamethasone

BODY MASS INDEX AND SPREAD OF LOCAL ANAESTHETIC IN SUB ARACHNOID BLOCK:AN OBSERVATIONAL STUDY

2025-05-01T00:00:00Z

Title: BODY MASS INDEX AND SPREAD OF LOCAL ANAESTHETIC IN SUB ARACHNOID BLOCK:AN OBSERVATIONAL STUDY Authors: THUMMALA SUSMITHA Abstract: Background: Subarachnoid block (SAB), commonly known as spinal anaesthesia, is a widely utilized regional anaesthetic technique for abdomen and lower limbs surgery. The effectiveness and distribution of local anaesthetic agents administered via SAB are influenced by a range of physiological and demographic factors, with body mass index (BMI) being a significant contributor. Elevated BMI, particularly in obese individuals, has been associated with changes in cerebrospinal fluid (CSF) volume and flow dynamics, which can alter the spread, onset, and duration of the anaesthetic effect. These alterations may result in unpredictable anaesthetic responses, underscoring the importance of assessing the role of BMI in determining the characteristics and efficacy of spinal anaesthesia. Aim: To compare the spread, onset, and recovery characteristics of local anaesthetic in spinal anaesthesia between obese and non-obese patients undergoing elective lower abdominal surgeries. Material & Methods: A comparative study involving 110 patients aged 18 to 59 years and classified as ASA physical status I–II was conducted at R.L. Jalappa Hospital and Research Centre. The participants were stratified into two groups based on body mass index (BMI): Group 1 included patients with BMI <25 kg/m² (n=55), and Group 2 comprised those with BMI >25 kg/m² (n=55). Spinal anaesthesia was administered uniformly. Key anaesthetic parameters—including the onset time of sensory and motor blockade, time to achieve maximum block height, and duration of block recovery—were systematically recorded. Data analysis was performed using SPSS version 26.0, with statistical significance set at a p-value less than 0.05. xx Results: Obese patients (Group 2) demonstrated a significantly longer onset time and duration for both sensory and motor blocks compared to non-obese patients (p<0.05). However, there was no significant difference in the duration of surgery or anaesthesia between the two groups. Conclusion: BMI significantly influences the pharmacodynamics of spinal anaesthesia. Obese patients exhibit delayed onset and prolonged duration of spinal block, highlighting the need for individualized anaesthetic dosing and monitoring to enhance patient safety and efficacy of spinal anaesthesia in higher BMI populations

ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING CLONIDINE VERSUS DEXMEDETOMIDINE AS ADJUVANTS TO ROPIVACAINE FOR POST-OPERATIVE ANALGESIA IN UPPER LIMB SURGERIES

2025-06-01T00:00:00Z

Title: ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING CLONIDINE VERSUS DEXMEDETOMIDINE AS ADJUVANTS TO ROPIVACAINE FOR POST-OPERATIVE ANALGESIA IN UPPER LIMB SURGERIES Authors: TARUN KUMAR.R Abstract: Introduction: Brachial plexus blocks are widely used for upper limb surgeries, with various adjuvants being employed to enhance block quality and prolong postop analgesia. This study compared the efficacy of clonidine versus dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper limb surgeries. Methods: This prospective, randomized, double-blind study included 106 ASA I-II patients aged 18-60 years undergoing upper limb surgeries. Patients were randomly allocated into two groups (n=53 each): Group A received 30 ml of 0.5% ropivacaine with clonidine 2 μg/kg, and Group B received 30 ml of 0.5% ropivacaine with dexmedetomidine 1 μg/kg. Primary outcomes measured included onset and duration of sensory and motor blockade, time to first rescue analgesia, pain scores, and adverse effects. Results: Demographic profiles were comparable between groups. The dexmedetomidine group demonstrated significantly faster onset of sensory block (6.95±1.47 vs 9.28±1.80 min, p<0.001) and motor block (8.70±2.00 vs 12.08±2.40 min, p<0.001). Block duration was also superior with dexmedetomidine for both sensory (668.26±41.65 vs 551.81±43.93 min, p<0.001) and motor components (595.06±42.37 vs 497.94±46.61 min, p<0.001). The dexmedetomidine group exhibited prolonged time to first rescue analgesia (716.45±76.88 vs 579.15±57.30 min, p<0.001), lower pain scores at rescue (3.28±1.10 vs 4.51±1.09, p<0.001), and reduced analgesic requirements (1.92±0.85 vs 3.51±1.15 doses, p<0.001). Hemodynamic parameters remained stable in both groups, with no significant differences in the incidence of adverse effects. Conclusion: Dexmedetomidine is superior to clonidine as an adjuvant to ropivacaine in xxi ultrasound-guided supraclavicular brachial plexus block, providing faster onset, prolonged duration of blockade, extended postoperative analgesia, and a favourable safety profile for patients undergoing upper limb surgeries

EVALUATION OF DIFFERENT AIRWAY TESTS IN PREDICTING DIFFICULT AIRWAY IN ELDERLY DIABETIC AND NON- DIABETIC PATIENT’S UNDERGOING SURGERY UNDER GENERAL ANAESTHESIA

2025-05-01T00:00:00Z

Title: EVALUATION OF DIFFERENT AIRWAY TESTS IN PREDICTING DIFFICULT AIRWAY IN ELDERLY DIABETIC AND NON- DIABETIC PATIENT’S UNDERGOING SURGERY UNDER GENERAL ANAESTHESIA Authors: SADVI A. S Abstract: Introduction: Diabetes mellitus is associated with changes in connective tissue and joint mobility that may affect airway anatomy and increase the risk of difficult intubation. The purpose of this research was to investigate and compare the effectiveness of several airway assessment measures in forecasting problematic airways among older diabetic and non-diabetic individuals having general anaesthesia. Methods: This prospective observational study included “92 diabetic and 92 non-diabetic patients aged ≥60 years scheduled for elective surgery under general anaesthesia. Preoperative airway assessment included Modified Mallampati Score (MMS), Upper Lip Bite Test (ULBT), and Palm Print Sign (PPS). Intraoperative findings of Cormack-Lehane grading, number of intubation attempts, time taken for intubation, and need for alternative methods were recorded. The predictive value of each airway test for difficult laryngoscopy was analysed. Results: Demographic profiles were comparable between groups. Class III ULBT was significantly more prevalent in diabetic patients (38.0% vs. 4.3%, p < 0.001), as were difficult Palm Print Sign grades (26.1% vs. 7.6%, p = 0.001). Difficult laryngoscopy was encountered in 34.8% of diabetic patients compared to 17.6% of non-diabetic patients (p = 0.010). Prolonged intubation time (>1 minute) was significantly more frequent in diabetic patients (10.9% vs. 3.3%, p = 0.048). In diabetic patients, ULBT demonstrated the highest sensitivity (90.6%) and excellent specificity (90.0%) for predicting difficult laryngoscopy, followed by MMS (sensitivity 75.0%, specificity 100%) and PPS (sensitivity 65.6%, specificity 95.0%). In non-diabetic patients, MMS showed the highest sensitivity (75.0%), while ULBT and PPS had lower sensitivity but excellent specificity. xvi Conclusion: Elderly diabetic patients have a significantly higher incidence of difficult laryngoscopy and prolonged intubation time compared to non-diabetic patients. Upper Lip Bite Test is the most sensitive predictor of difficult laryngoscopy in elderly diabetic patients, while Modified Mallampati Score performs better in non-diabetic patients”. Comprehensive preoperative airway assessment using multiple tests is recommended for elderly diabetic patients to anticipate and manage difficult airways effectively