Limb Surgery Research Articles

Quality of Life and Patient Satisfaction After the Provision of an Orthopedic Knee Scooter.

Partial or total avoidance of weight-bearing by a lower limb is regularly needed after trauma and surgery. There are approximately 200 such cases per 100 000 persons per year. Forearm crutches have mainly been used in Germany until now to keep these patients mobile. For those who lack the strength or co - ordination needed to use crutches, a wheelchair may become necessary, or they might find themselves forced to continue weightbearing on the affected limb, with possible impending adverse consequences and complications. The supplementary use of a new type of orthopedic scooter by patients who must avoid weight-bearing by a lower limb, wholly or in part, was studied in a multicenter randomized controlled trial involving 88 subjects. The endpoints were improvement in quality of life (EQ5D, SF36) and improved abilities in everyday life (retrospective registration: DRKS00032980). Patients who used orthopedic knee scooters (KS) reported a better overall state of health more frequently than those who used forearm crutches (UC) (SF-36 score: 67 [KS group], 95% CI [61; 73]; 59 [UC group], [53; 64]). They also reported less anxiety and depressed mood, greater mobility, and more independence than the patients who used crutches. In addition, they more frequently reported being able to transport themselves 4 x 500 meters in less than 20 minutes (n 30 [KS], 63.8% [48.5; 77.3]; n 6 [UC], 14.6% [5.6, 29.2]). The supplementary use of an orthopedic knee scooter can improve these patients' mobility and independence and prolong the distance over which they can transport themselves. For many patients, this form of treatment may well shorten the time of their total or partial inability to work and thus lower the socioeconomic costs of lower limb injuries and surgery.

Outcome of Subarachnoid Block with Low Dose Bupivacaine and Fentanyl for Lower Limb Vascular Surgeries in Patients with Coronary Artery Disease

Subarachnoid block (SAB) with local anesthetics and opioids (fentanyl) and able to perform spinal anesthesia because of the synergistic effects and allow top use of low dose local anesthetics which results in a stable hemodynamic state. A randomized clinical trial was conducted to observe the cardiovascular effects of subarachnoid block (SAB) with low dose bupivacaine and fentanyl on patient with coronary artery disease, between January 2021 and December 2022. A total of 36 patients who had known case of coronary artery disease. All patients underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 25 µg fentanyl. In each patient, 1 mg I/V midazolam was used and if needed subsequent may be given. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded. Our study shows at the 90-minutes of spinal block, patients with EF ≤40% experienced a decrease of 10.5% in systolic blood pressure, while those with EF>40% experienced a larger decrease of 19%. At the 90-minutes of spinal block, percentage decrease was higher in the EF>40% group (19.5% vs. 14%) in diastolic blood pressure. At the 90-minutes of spinal block, patients with EF ≤ 40% experienced a decrease of 13% in MAP, while those with EF>40% experienced a larger decrease of 19%. The findings demonstrate that patients with EF>40% exhibited larger percentage decreases in systolic blood pressure, diastolic blood pressure, and MAP compared to those with EF ≤40%. The difference was statically significant (P<0.05). Our study recommends subarachnoid block with low dose of bupivacaine and fentanyl is effective in lower limbs surgeries for patients with coronary artery disease particularly with low EF. CBMJ 2024 July: vol. 13 no. 02 P: 169-175

Effect of Abdominal Girth and Vertebral Column Length in Spread of Spinal Anesthesia for Lower Limb Surgery: A Prospective Study

Background: Subarachnoid spread of local anesthetics is quite erratic and is determined by several factors. There is a high predictive for the spread of spinal anaesthesia in terms of abdominal girth and vertebral column length. Our study is designed to determine the effect of abdominal girth and vertebral column length with cephalad spread of spinal anaesthesia for a given dose of 0.5% hyperbaric bupivacaine in Nepalese patients. Materials and Methods: In this prospective observational study, a total 100 patients of ASA PS I-II, aged16-65 years and undergoing lower extremity surgery under spinal anesthesia were enrolled. 2.8 mL of 0.5% hyperbaric bupivacaine was injected intrathecally at L3-4 interspace in sitting position. Extent of sensory blockade was assessed for 60 min. Simple linear regression, multiple linear regression and Pearson’s correlation coefficient analysis were performed to determine the correlation between patient variables viz abdominal girth, vertebral column length, height, weight, body mass index and age and maximum sensory block height. Results: Abdominal girth and vertebral column length correlated significantly with the maximal sensory block height after intrathecal administration of a fixed dose of 0.5% hyperbaric bupivacaine by all the three statistical tools used. Conclusion: Abdominal girth and vertebral column lengthcorrelate significantly with the maximal sensory block height in Nepalese patients receiving a fixed dose subarachnoid block with 0.5% hyperbaric bupivacaine

Evaluating patient satisfaction with WALANT for hand surgery: a comprehensive questionnaire-based study.

There has been an increase in the popularity of the wide-awake local anesthesia no-tourniquet (WALANT) procedure for various upper limb surgeries. The present study aims to conduct a comprehensive analysis of the satisfaction levels of 106 patients, considering factors such as age, gender, comorbidities, and the specific procedures they underwent. The present study was a retrospective cohort study conducted to analyze the overall satisfaction of a cohort of 106 patients who underwent various surgical procedures of the hand between 2018 and 2023. The satisfaction was assessed with a questionnaire comprising 13 questions/statements adjusted to a standard Swiss grading system (from 1 = I strongly agree to 6 = I strongly disagree). Overall satisfaction with WALANT was high, with most patients expressing positive experiences. Patients with hypertension reported similar satisfaction levels compared to those without, while diabetic patients experienced significantly higher anxiety levels during the procedure (p > 0.05). WALANT exhibits versatility as an anesthesia choice, demonstrating efficacy in both routine and complex hand surgeries. Our survey-based study reveals a high satisfaction level across diverse procedures. When assessing the correlation between WALANT satisfaction and patient comorbidities, hypertension displayed no significant impact, while diabetic patients reported heightened anxiety. Importantly, patient satisfaction remained consistently high even within the subgroup with comorbidities. Our results underscore WALANT's reliability in upper limb surgery, showcasing its usefulness and positive outcomes across a broad range of patients and surgical procedures.

Modified dorsal recumbent position versus lithotomy position for flexible ureteroscopic lithotomy: a multicenter prospective randomized controlled clinical trial.

The lithotomy position (LP) may pose limitations and discomfort for elderly patients and those with a history of lower limb surgery, potentially leading to an increased risk of complications. And the LP is the conventional position during flexible ureteroscopic lithotomy for the treatment of ureteral calculi. However, it has some disadvantages, such as peripheral nerve injury and deep venous thrombosis in the lower limbs, etc. Therefore, we performed a new approach, which is named as modified dorsal recumbent position (MDRP). Currently, there is a lack of systematic analysis and standardization regarding the surgical positioning for flexible ureteroscopic lithotripsy. The objective of the study was to assess whether there were any disparities in the overall duration of the procedure when comparing the MDRP with the LP. The investigation of the optimal position for flexible ureteroscopic lithotomy is essential for enhancing patient safety and comfort. This is a prospective, multicenter, randomized clinical trial. A total of 144 patients with renal or ureteral calculi from April 2021 to June 2022 were enrolled. Eligible patients were randomized to the MDRP group (n=72) or LP group (n=72). The patient's demographics, the placement of the surgical position (time of position placement, time of disinfection and towel laying, time of position return, degree of medical fatigue) and the operation safety (time of operation, time of ureteroscope from bladder neck to ureteral orifice, heart rate, blood pressure) of two groups were compared and analyzed. Between the two groups, the body positioning time (93.8±31.6 vs. 134.8±40.1 s, P=0.02), operation time (71.8±36.7 vs. 77.7±48.6 min, P=0.04), the time from the bladder neck to the ureteral orifice of the flexible ureteroscope spent by the doctors (3.4±4.7 vs. 10.3±14.7 s, P<0.001) and incidence rate of patient's lower limb soreness (19.4% vs. 49.7%, P=0.01) in the MDRP group were significantly shorter than those in the LP group. However, there was no significant difference in the stone removal rate (87.6% vs. 85.4%, P=0.09) or postoperative hospitalization days (4.3±1.4 vs. 4.1±1.6 d, P=0.08) between the two groups. This trial showed that the MDRP could not only effectively shorten the operation time, shorten the time from the bladder neck to the ureteral orifice of the ureteroscopic lithotripsy, but also place the patient's body in a functional position, stabilize the blood pressure during the operation, improve the comfort of the patient. Chinese Clinical Trial Registry (No. ChiCTR2100053416).

The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial

Study objectiveThis study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management. DesignA single-center, double-blind, randomized controlled trial was conducted. SettingThe study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward. PatientsEnrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries. InterventionsPatients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group. MeasurementsLUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment. Main resultsIntention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups. ConclusionsCompared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.

INTRAOPERATIVE USE OF DEFENSIVE ANTIBACTERIAL COATING (DAC) FOR COMPLEX SURGERIES IN COMPLEX HOSTS

Periprosthetic joint infections (PJIs) and osteosynthesis-associated infections (OSIs) present significant challenges in trauma and orthopaedic surgery, substantially impacting patient morbidity, mortality, and economic burden. This concern is heightened in patients with pre-existing comorbidities, such as diabetes mellitus, which are not always modifiable at presentation. A novel intraoperative strategy to prevent these infections is the use of Defensive Antibacterial Coating (DAC), a bio-absorbable antibiotic-containing hydrogel applied to implant surfaces at implantation, acting as a physical barrier to prevent infection.The purpose of this study is to assess the use of a commercially available hydrogel (DAC), highlighting its characteristics that make it suitable for managing PJIs and OSIs in orthopaedics and traumatology. Twenty-five patients who underwent complex orthopaedic procedures with intraoperative application of DAC between March 2022 and April 2023 at a single hospital site were included. Post-operative assessment encompassed clinical, laboratory, and radiographic examinations.In this study, 25 patients were included, with a mean age of 70 ± 14.77 years and an average ASA grade of 2.46 ± 0.78. The cohort presented an average Charleston Comorbidity score of 5.45 ± 2.24. The procedures included 8 periprosthetic fractures, 8 foot and ankle surgeries, 5 upper limb surgeries, and 4 elective hip and knee surgeries. Follow-up assessments at 6 weeks and 6 months revealed no evidence of PJI or OSI in any patients, nor were any treatments for PJI or OSI required during the interim period.DAC demonstrated efficacy in preventing infections in high-risk patients undergoing complex orthopaedic procedures. Our findings warrant further investigation into the use of DAC in complex hosts with randomized control trials.

Comparison of the systolic blood pressure and limb occlusion pressure methods in determining effective tourniquet pressure in upper limb surgeries

Introduction: The importance of a tourniquet to a surgeon cannot be overemphasised. Pneumatic tourniquet pressure is usually determined by systolic blood pressure (SBP), but a new emerging method, the limb occlusion pressure (LOP) appears more promising, especially in upper limb surgeries. We compare the effectiveness of the SBP and LOP methods in determining the tourniquet pressure in forearm bone surgeries. Material and Methods: This study was a prospective comparative study involving 60 forearm bone surgeries conducted over a 1-year period with randomisation into two groups. Those whose tourniquet pressure was determined using the SBP method (Group A) and those whose pressure was determined using the LOP method (Group B). Data collected included the tourniquet pressure, tourniquet performance using a Likert scale as well as tourniquet-related complications were noted. Analysis was done with the Statistical Package for the Social Sciences (version 22 trademark of the International Business Machine) and Excel (version 13.0, Microsoft, Redmond, WA). Results: There was a statistically significant difference in the mean tourniquet pressure between the two groups (SBP = 234.43 ± 11.87 mmHg; LOP = 199.17 ± 16.44 mmHg, P &lt; 0.001). Both methods provided a satisfactory dry field throughout the tourniquet duration with no statistically significant difference in the tourniquet performance between the two groups. Although two cases of tourniquet-related nerve palsy were noted in the SBP group, it was not statistically significant (P = 0.355). Conclusion: The LOP method provided a satisfactory dry surgical field at a lower tourniquet pressure than the SBP method with no complications.

Greater ischiatic notch plane versus parasacral block in dogs undergoing pelvic limb surgery: a retrospective noninferiority cohort study on perioperative opioid consumption

ObjectiveTo compare perioperative opioid consumption in dogs undergoing pelvic limb surgeries and receiving a lumbosacral plexus block by combining a lumbar [lateral pre-iliac (LPI)] block with a lumbosacral trunk [i.e. parasacral (PS group) or greater ischiatic notch plane (GIN group)] block.Study design Retrospective, descriptive, exploratory, noninferiority cohort study. MethodsMedical records of 37 client-owned dogs were analyzed. Intraoperative (primary outcome) and postoperative (24 hours) opioid use, 24 hour cumulative pain scores and prevalence of complications were compared between the two groups. Opioid use was quantified in morphine equivalents (ME, mg kg–1 ). The noninferiority limit for intraoperative opioid consumption was set at 0.05 ME kg–1 hour–1. Demographic data, procedure duration, surgery type and perioperative dexmedetomidine and ketamine use were also collected. A t-test or Wilcoxon rank-sum test, a Fisher's exact test and multivariable linear regression were used. Significance was set at p < 0.05. ResultsThe GIN and PS groups comprised 17 and 20 dogs, respectively. Total intraoperative ME consumption was 0.17 (0.11–0.21) and 0.22 (0.16–0.30) mg kg–1 hour–1 for the GIN and PS groups, respectively (p = 0.077). The noninferiority analysis adjusted by surgery type and body mass revealed that the mean difference between the groups (GIN – PS) was –0.039 (95% CI –0.11–0.03, p = 0.247) ME mg kg–1 hour–1, indicating that the GIN group was not inferior to the PS group regarding intraoperative ME consumption. Dexmedetomidine and ketamine use, postoperative ME consumption and pain scores were similar between groups. Conclusions and clinical relevanceThis retrospective study and preliminary observations support the clinical use of the GIN plane block, demonstrating its noninferiority to the PS block when combined with the LPI block for multimodal perioperative analgesia in dogs undergoing pelvic limb surgeries.

Comparison of Outcomes of Intravenous Dexamethasone Versus Placebo as Adjunct to Local Anaesthetic Brachial Plexus Block for Upper Limb Surgery

Introduction: Dexamethasone has been tested in combination with different local anesthetics with varying degree of results including increase in intensity and duration of block. Objectives: To compare the outcomes of intravenous dexamethasone versus placebo as adjunct to local anesthetic brachial plexus block for upper limb surgery. Study design: Randomized controlled trial Setting: Department of Anesthesia, pain management and intensive care Holy Family Hospital, Rawalpindi. Study duration: 7th November 2019 till 6th May 2020. Materials &amp; Methods: A total of 10 0 patients of either gender aged 18 to 60 years admitted for upper limb surgery were included. Patients with pregnancy, DM, block failure and contraindication to brachial plexus block were excluded. Patients in group A received a block injection with 30ml of 0.5% bupivacaine along with 2ml of intravenous dexamethasone. Group B patients received 30ml of 0.5% bupivacaine for block injection and 2ml of normal saline intravenously. Block success was confirmed using the sensory and motor examination of the upper limb. Block duration was recorded in hours, opioid consumption was recorded in intravenous morphine equivalents in first 24 hours, visual analogue scores for pain on scale of 0-10 at upper limb at rest was recorded at 8 and 24 hours. Results: In our study, duration of local anesthetic brachial plexus block in dexamethasone and placebo group were 16.12 ± 1.33 hrs and 9.77 ± 1.26 hrs respectively with p-value = 0.0001. Opioid consumption in Morphine Equivalents at 24 hrs in local anesthetic brachial plexus block and placebo group were 16.48 ± 2.60 vs 22.68 ± 3.78 with p-value &lt; 0.0001 respectively. Conclusion: This study concluded that intravenous dexamethasone has better outcomes as compared to intravenous saline as adjunct to local anesthetic brachial plexus block for upper limb surgery.

Comparison of Ropivacaine with or without Fentanyl in Spinal Anaesthesia for Lower Limb Surgeries

Introduction: Spinal anaesthesia is a preferred technique used for lower limb orthopaedic surgeries. Ropivacaine with its short duration of motor blockade and provision for early ambulation along with addition of spinal additives has proven beneficial to the patient. This prospective, double-blind, randomized controlled study set out to evaluate the effects of 0.75% isobaric ropivacaine with fentanyl versus 0.75% isobaric ropivacaine during lower limb orthopaedic surgeries performed under spinal anaesthesia. Methods: The study enrolled 74 patients, aged 18-65 years of either sex, ASA PS I and II, planned for lower limb orthopaedic surgeries. Patients were randomly allocated to receive either 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of normal saline (Group R) or 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of fentanyl (25mcg) (Group RF). Results: The demographic profile, onset time of sensory block to T10 dermatome, time for complete motor blockade, maximum block height, duration of motor block, and haemodynamic parameters did not significantly differ between the two groups. Group R took 200.27 ± 21.28 minutes for the S2 dermatome segment regression, while Group RF took 284.59 ± 32.88 minutes (p-value&lt;0.001). Group RF experienced analgesia for a longer duration (335.68±22.18 min) than Group R (240.00±28.28 min) (p-value&lt;0.001). Conclusion: Fentanyl greatly extends the duration of S2 segment regression and analgesia when combined with ropivacaine; the effects on haemodynamics and motor blockade is clinically negligible and side effects are minimal.

A Comparative Study between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in USG - Guided Supraclavicular Block in Upper Limb Surgeries

A Comparative Study between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in USG - Guided Supraclavicular Block in Upper Limb Surgeries

Comparison of Two Different Dexmedetomidine Doses and Their Effect on the Duration of Spinal Anesthesia in Lower Limb Amputation Surgeries

Abstract Background Spinal anesthesia is a very common technique used in lower limb surgeries. Dexmedetomidine is a highly selective α2-adrenergic agonist which has been used as pre-medication and as an adjuvant to general anesthesia. It is found that injection of dexmedetomidine intrathecally prolongs both sensory and motor block and has antinociceptive action for both visceral and somatic pain by depressing the release of nociceptive C fibers transmission and hyperpolarization of post synaptic dorsal horn cells. Objective To compare the effect of addition of different doses of dexmedetomidine to bupivacaine on the duration of spinal anesthesia, quality of block, intraoperative and postoperative complications and postoperative analgesia in patients undergoing lower limb amputation surgeries. Methods This prospective double blind randomized controlled clinical trial was done on sixty six adult patients of both sexes, aging from 21 to 60 years old, ASA I and II presented to Ain Shams University Hospitals for lower limb amputation surgeries were involved in this study during the period from July 2021 till May 2022. Results The addition of dexmedetomidine to bupivacaine in spinal anesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. It was significantly faster in group B (2.1 ± 0.124) compared with A and C groups (2.64 ± 0.34) and (4.72± 0.31) respectively and in group A compared with group C. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia Time to first call for rescue analgesia was significantly longer in group B (350 ± 45 mins) compared with A(287.41 ± 40.83 mins) and C(192 ± 42 mins) groups and in group B compared with group A. Also, there was significant difference in number of analgesic doses in group B compared to A and C groups and in group B compared to group A. Lower VAS scores with minimal adverse effects and hemodynamic stability. Comparing two different doses of dexmedetomidine showed that 15μg dexmedetomidine caused more prolongation of the spinal block duration and the time of postoperative analgesia than dexamethasone. It also decreased shivering during spinal anesthesia with only 4 patients compared to group A with 8 patients and group C with 9 patients. Conclusion 5μg dexmedetomidine seems to be an attractive as an adjuvant to spinal bupivacaine in surgical procedures. It provided good quality of intraoperative analgesia, hemodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia. Unfortunately, it had not any effect on incidence or severity of phantom pain and sensation in lower limb amputation surgery, but 15μg had better time of analgesia and longer time till the patient needed rescue analgesia with lower VAS score with no remarkable difference in the side effect as revealed.

Efficacy of ultrasound-guided classical versus parasacral parallel shift technique of sacral plexus block for lower limb surgeries - A randomised controlled trial.

Ultrasound-guided sacral plexus block has been used for anaesthesia and analgesia in lower limb surgeries. This study aimed to compare the block performance characteristics after ultrasound-guided (USG) sacral plexus nerve block (SNB) using the parasacral parallel shift (PSPS) approach versus the classical approach in patients undergoing orthopaedic below-knee limb surgeries. In this randomised study, 144 adult patients were randomised to receive USG SNB either by the classical approach (Group C) or the PSPS approach (Group P). A fixed dose of 20 ml of 0.5% ropivacaine was administered. Patients also received USG femoral nerve block with 10 ml of 0.5% ropivacaine. The primary outcome was the scanning time between the two groups. Secondary outcomes were the needling time, sensory and motor block onset and postoperative analgesic characteristics between the two groups. A P value of <0.05 was considered statistically significant. The needling time and the scanning time were significantly lesser in Group P than in Group C (P < 0.05). Complete sensory and motor nerve blockade of the sciatic nerve was significantly higher in Group P (P = 0.029). Block performance time, time for sensory block and time for motor block were significantly less in Group P compared to Group C (P < 0.001). The postoperative analgesic characteristics were comparable between the two groups. The sacral plexus block with ultrasound-guided parasacral parallel shift technique had a lower block performance time with lesser needling and scanning time than the classical approach.

A comparative study of efficacy of intravenous dexmedetomidine with perineural dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block in upper limb surgery

Background: In supraclavicular brachial plexus block, to prolong the duration of analgesia, many adjuvants have been tried in the past in many studies but an ideal adjuvant remains yet to be discovered. Dexmedetomidine, a selective Alfa-2 adrenergic agonist when added to local anesthetic has been reported to prolong the block duration and post-operative analgesia in various regional blocks. Aims and Objectives: The aims and objectives are to study the onset and duration of sensory and motor blockade, postoperative analgesia, and hemodynamic effects of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block. Materials and Methods: Sixty patients aged between 18 and 60 years, American Society of Anesthesiologists class I and II, of both sexes, scheduled for upper limb surgery under supraclavicular brachial plexus block were randomly allocated into 2 groups. Group-A received 20 mL of 0.5% ropivacaine in brachial plexus block with 1 μg/kg dexmedetomidine as adjuvant perineurally and Group-B received 20 mL 0.5% ropivacaine in brachial plexus block with dexmedetomidine intravenous infusion at 1 μg/kg over 10 min. Intraoperatively non-invasive blood pressure, heart rate, SpO2, and sedation were recorded every 5 min for the first 10 min and every 15 min thereafter till the end. Time of first rescue analgesic, intensity of postoperative pain, and total analgesic required were recorded. Results: Onset of sensory and motor block was faster in Group-A than Group-B. Duration of analgesia was prolonged in Group-A than Group-B. Hemodynamic stability was better maintained in Group-A than Group-B. Sedation was better in Group B. Conclusion: Dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block is more efficacious in providing faster onset of motor and sensory blocks and prolonging duration of postoperative analgesia with better hemodynamic stability.

Association between suction tip culture and surgical site infection in elective clean orthopedic lower limb surgeries

Background: Surgical site infections (SSIs) can be caused by various factors, including contamination of the surgical field. Perioperative cultures can be employed in clean orthopedic procedures to detect bacterial contamination that may occur during surgery. Aims and Objectives: The study aimed to evaluate the correlation between suction tip cultures and surgical wounds in clean orthopedic surgeries. Materials and Methods: A cross-sectional study was conducted at Yenepoya Medical College Hospital, Mangalore, Karnataka, with 250 patients in whom drain tips were sent for culture and followed up for 3 months to assess for SSI. Skin commensals from the nasal and groin samples were analyzed for the presence of bacteria. Results: A total of 250 patients meeting the inclusion and exclusion criteria were included. Thirty patients were positive for drain tip culture, and 12 (4.8%) patients had SSI during the 3rd month follow-up period, showing a statistically significant relationship between drain tip culture and SSIs (P=0.001). Skin commensals constituted 67% (nasal) and 100% in the groin of perioperative contaminants, accounting for 4.8% of SSIs. Conclusion: Suction drain tip culture and skin commensal analysis may be good predictors of SSIs. Intraoperative surgical site contaminants can be identified using perioperative cultures. Timely administration of suitable antibiotics and local wound care for perioperative contamination can help minimize the incidence of SSI.

Macro-réimplantation du membre supérieur : état des lieux en 2024

Macro-amputations are extremely serious traumas and represent one of the rare extreme emergencies in hand and upper limb surgery. Their rarity, especially in our developed countries, makes their treatment relatively unknown by surgical and anesthetic teams. However, the action plan to use during a macro-reimplantation, the decisive elements of pre- and post-operative management, and the key stages of the surgery, must be perfectly known, because they determine the success of a major reimplantation, for the limb survival and the future functional result. After a brief historical overview, the literature review proposed here provides an opportunity for an update on these formidable injuries and propose a treatment algorithm to guide the medical team in the management of these complex patients.

Chirality in Local Anaesthetics: “Comparison of Efficacy and Tolerability of Epidural 0.5% Levobupivacaine, Ropivacaine 0.75% and 0.5% Racemic Mixture Bupivacaine in Patients coming for Elecive Lower Abdominal and Lower Limb Surgeries

The aim of the study is to compare the efficacy and tolerability of 0.5% Levobupivacaine, 0.75% Ropivacaine and 0,5% Racemic Mixture Bupivacaine, in patients undergoing lower abdominal and lower limb surgery.84 patients, ASA grade 1 and 2, were randomised to receive an epidural injection of study drug (17 ml 0.5% Levobpivacaine in Group L,17 ml of 0.75% Ropivacaine in group R and 17 ml 0.5% Racemic Mixture Bupivacaine in group B).

An unusual case of hoarseness of voice after left supraclavicular brachial plexus block

Supraclavicular brachial plexus block (SBPB) is a commonly used regional anesthetic technique for upper limb surgeries in orthopaedic patients. It provides intraoperative anesthesia and postoperative analgesia. SBPB can be administered using either a landmark approach or ultrasound guidance (USG). The use of ultrasound has reduced the complications associated with the block by providing excellent real-time visualization of the pleura, vessels, and plexus in relation to needle insertion. However, complications can still arise even with USG-guided block if a large volume of local anesthetics is used. In fact, a large volume is not necessary when performing USG-guided blocks.We report a case of a 25-year-old male who presented with hoarseness of voice after receiving a USG-guided supraclavicular block (left side) due to recurrent laryngeal nerve (RLN) block. While RLN block is more common in interscalene blocks, it is a rare complication in SBPB, with very few reported cases of hoarseness of voice due to RLN block after SBPB.

Comparative study of tramadol and nalbuphine as an adjuvant to ropivacaine in supraclavicular block: A cross sectional observational study

Brachial plexus block via supraclavicular approach performed with the help of ultrasound assistance, is a promising anaesthetic alternative for upper limb surgery, when compared with general anaesthesia. It provides good surgical anaesthesia and better post-operative analgesia. We compared the anaesthetic and analgesic efficacy of two additives, nalbuphine and tramadol with 0.375% ropivacaine.A double-blind, cross-sectional study, performed prospectively on 82 patients who were randomly assigned into Group N (41) and Group T (41). Patients were posted for surgical procedure of upper limb under supraclavicular brachial plexus block. Group N received inj. Ropivacaine 0.375% 25 ml plus 1ml (10 mg) of Nalbuphine plus 1ml of normal saline. Patients in Group T received inj. Ropivacaine 0.375% 25 ml with Inj. Tramadol 2 ml (100 mg). Total volume was 27 ml in both groups. Duration of postoperative analgesia was the primary outcome of our study. The secondary outcomes were the sensory and motor block characteristics (onset and duration), change in hemodynamic parameters and side effects.A statistically significant difference was noted in the duration of postoperative analgesia [Group N: 648.27 (± 124.69) minutes, Group T: 514.73 (± 43.15) minutes; P &amp;#60;0.001]. In terms of onset of both sensory and motor block no statistically significant difference was noted. A significant difference was noted in duration of sensory block (Group N: 545.85 ± 118.13 min; Group T: 416.71 ± 50.43 min; P &amp;#60;0.001). The mean duration of motor block was 482.93 ± 120.07 min in nalbuphine group and 356.59 ± 43.74 min in tramadol group; P &amp;#60;0.001.Nalbuphine 10mg is a better adjuvant to 0.375% ropivacaine when compared with tramadol 100 mg. It prolongs the duration of sensory block and motor block and increases the duration of analgesia postoperatively.