Lower Limb Surgery Research Articles

Prevalence of Sciatica in Female Tailors

Background: Pain in low back region is the usual problem in general population, and especially common in those population where the majority of people sit. Prolonged sitting position or poor body ergonomics are the main source of developing low back pain and Sciatic nerve tightness, which can progress to sciatica. Adolescents and younger people are more likely to adopt poor posture and body ergonomics, which leads to sciatic nerve tightness. The purpose of this study was to determine the prevalence of sciatica among female tailors. Objective: To evaluate Sciatica in female tailors in Jhelum, Punjab Pakistan. Methodology: With a sample size of 318, a cross-sectional study was conducted on female tailors of District Jhelum. This study was done from March-June 2022 to September 2022 by using a non-probability convenient sampling technique, by selecting a female tailors of Jhelum, Punjab, who were between 18-60 years age, having work experience of at-least 1 year , who takes 1-2 times break , using a sitting /standing sewing machine for a long duration of time while a female tailors who having a history of lower limb surgery. Data were collected by using a self-created questionnaire with a reliability of 0.661, which was calculated after a pilot study considering inclusion and exclusion criteria. Patients were screened and asked for consult to participate in study. SLR test and VAS scale were used to assess the sciatica and pain in female tailors respectively. Results: About 318 participants took part in the study, with the primary findings indicating that Sciatic nerve tightness were found in 162(50.9percent) of tailors who had a positive diagnostic test (SLR test). Other respondents were found to have negative test results, indicating that they did not match the selection criteria. Practical Implication: It can be controlled by reducing risk factors of sciatica and to raise knowledge about low back pain and sciatica, so that people can avoid and protect them from low back pain and sciatica. Conclusion(s): It is concluded that female tailors are more prone to develop sciatica who are obese, work for long duration in sitting position. It can be controlled by reducing risk factors of sciatica and to raise knowledge about low back pain and sciatica, so that people can avoid and protect them from low back pain and sciatica. Keywords: Prevalence, Sciatica, SLR, Low Back Pain, Musculoskeletal Disease, VAS Scale.

Peripheral Nerve Blocks as Anaesthetic Choice for Asymptomatic Severe Aortic Stenosis for Emergency Lower Limb Surgeries: A Case Report

Peripheral Nerve Blocks as Anaesthetic Choice for Asymptomatic Severe Aortic Stenosis for Emergency Lower Limb Surgeries: A Case Report

A Study of the Clinical Effects of Sequential Combined Spinal Epidural Anesthesia and Spinal Anesthesia in Patients Undergoing Orthopedic Surgeries.

In orthopedic surgeries, there has been an increase in the usage of the neuraxial blockade to provide excellent surgical conditions and prolonged postoperative analgesia. The introduction of the sequential combined spinal epidural anesthesia (SCSEA) technique provides benefits for both spinal anesthesia (SA) and epiduralanesthesia. The focus of this study was to analyze the time needed to attain a desired level of sensory block, to compare the period of sensory block, and to study the intraoperative hemodynamics in the SCSEA and SA groups. The study was conducted on patients admitted for elective lower limb orthopedic surgeries. The sample size for this prospective randomized study is two groups of 67 subjects each. Patients aged between 18 and 65 years, posted for orthopedic surgeries for two to three hours, and of American Society of Anaesthesiologists (ASA) Grades 1 and 2 were included and divided into two groups. Group A patients received SCSEA with an epidural-test dose of 3 ml lignocaine (2%) with adrenaline and spinal bupivacaine (0.5%) of 1.5 ml-7.5 mg + fentanyl .25 mic if the sensory level was below T8. An epidural top-up was given with 2 ml per segment of 0.5% bupivacaine to bring the sensory level to T8. Group B patients received SA with spinal bupivacaine (0.5%) of 3 ml-15 mg + fentanyl .25 mic. Intraoperative hemodynamics, the duration to achieve a sensory level of T8, the time for two-segment regression of sensory block, and the complications that occurred were recorded. The study included a total of 134 subjects with each group having 67 subjects admitted for lower limb surgery. The mean value (SD) of the time taken to attain sensory block in the SCSEA group was prolonged when compared to the SA group (7.15 ± 0.75 and 5.01 ± 0.88). The time for two-segment regression in the SCSEA group was 86.77 ± 3.60and the SA group was 106.4 ± 8.01, which indicated that the SA group has a longer and better sensory block. Substantially, the study shows that the SCSEA group (P< 0.05) has better hemodynamics when compared to the SA group. The SCSEA technique has better intraoperative hemodynamic stability with a longer analgesic effect when compared to SA. SA shows a sudden change in hemodynamics but reveals a greatersensory block.

The prevalence of deep Venous thrombosis of the lower extremity in hospitalised bedridden orthopaedic patients: a pilot study.

To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis. The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22. Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all. There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

“A COMPARATIVE STUDY OF 0.2% ROPIVACAINE VERSUS 0.2% ROPIVACAINE PLUS TRAMADOL FOR EPIDURAL POSTOPERATIVE ANALGESIA FOR ORTHOPAEDIC SURGERIES”

Background And Objective: Postoperative analgesia can be achieved by various modalities. Out of which epidural analgesia offers a good reliable pain relief. Addition of opioids enhances the onset of analgesia and prolongs the duration. This study aims in comparative evaluation of 0.2% ropivacaine versus 0.2% ropivacaine plus tramadol for postoperative analgesia. Methods: 60 patients of age 18-70 years with ASA grade I &amp; II, undergoing elective lower limb surgeries under epidural anaesthesia were randomly taken into each of the 2 groups. For post operative pain management 0.2% ropivacaine 10ml in group R and 0.2% ropivacaine 9ml plus tramadol 1 ml (50mg) total of 10ml in group RT. Patients were monitored for onset, duration and quality of analgesia, hemodynamic stability and for any side effects. Results: The groups were similar with respect to age, sex, ASA, HR, SBP, DBP and Spo2. VAS after top up signicantly lower in the group N (p&lt;0.001). Anti-emetic therapy use was signicantly lower in the group R (p&lt;0.001). Rescue analgesic use was signicantly lower in the group RT (p&lt;0.001). Mean time interval between top ups was signicantly higher in group R (p&lt;0.001). Duration of analgesia is signicantly higher in Group RT (p&lt;0.001). Conclusion: Addition of tramadol to 0.2 % Ropivacaine in epidural route for post operative pain managementprovidesbetter pain relief and patient satisfaction than 0.2 % Ropivacaine alone.

To Evaluate the Efficacy of Ultrasonography Guided Lumbar Plexus Block for Postoperative Analgesia in Lower Limb Surgeries

To Evaluate the Efficacy of Ultrasonography Guided Lumbar Plexus Block for Postoperative Analgesia in Lower Limb Surgeries

COMPARATIVE EVALUATION OF EPIDURAL BUPIVACAINE WITH MAGNESIUM SULPHATE AND LEVOBUPIVACAINE WITH MAGNESIUM SULPHATE IN GERIATRIC AGE GROUP IN LOWER LIMB SURGERIES

Introduction :Bupivacaine is local anaesthetic drug consist of R &amp; S enantiomers. Levobupivacaine a cardiostable S enantiomer of Bupivaciane. Magnesium sulphate a promising noncompititive blocker of NMDA receptor by inhibition calcium Inux in cell. We want to study addition of Magnesium Sulphate to both Bupivacaine 0.5% &amp; Levobupivacaine 0.5% for epidural anaesthesia in lower limb surgeries. to compare efcacy of epidural Inj. Bupivac Aims &amp; Objectives: aine 0.5% plus Magnesium sulphate with Inj. Levobupivacaine 0.5% plus Magnesium Sulphate on onset of sensory &amp; motor blockade, intraoperative hemodynamics , requirement of rst analgesiac &amp; side effects in elderly patients posted for lower limb surgeries. A randomised prospective double blind Material and Method: study in 60 geriatric patient posted for lower limb surgeries. After epidural space identication Inj. Bupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group B or Inj. Levobupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group L. Onset of sensory blockade and motor blockade, two segment regression, demand of rst analgesic, intraoperative hemodynamics and postoperative complications were documented and compared Observation: Mean time required for onset of sensory block was 6.27±1.48 min in Group B and 6.3±1.76 min in group L respectively. onset motor block times of 7.43±1.38 in group B while 8.13±1.81 mins in group L which were No statistically signicant difference. Group L required 20.1±4.87 mins for reaching maximum sensory block compared to 13.33±2.17 mins in group B which was statistically signicant difference with early achievement of higher sensory level in group B. The time required for two segment regression was longer, at 133±19.01 minutes in group B compared to 114.47±10.28 minutes in the group L which found statistically signicant difference. Group B required rst analgesics quite latter 241.33±29.39 at mins compared to 203±20.54 mins in group L. This was found to be statistically signicant difference indicating that Bupivacaine is having longer duration of analgesia compared to Levobupivacaine. 3 patients had hypotension in group while 1 in group L. Shivering noticed 6 in Group L compared to 3 in group B. vomiting in 3 patients in each group.only 1 patient had itching in group b. Intraoperative hemodynamic parameters were having statistically insignicant difference. Conclusion: We can conclude that effect of Magnesium sulphate as an additive to Levobupivacaine and Bupivacaine provide good haemodynamic and respiratory stability, Comparable onset of sensory and motor blockade with prolongation of postoperative analgesia in bupivacaine group indicating that Bupivacaine with Magnesium sulphate provides prolonged analgesia as compared to Levobupivacaine with Magnesium Sulphate.

COMPARING THE EFFICACY OF FENTANYL VS. BUTORPHANOL AS ADJUVANTS IN LUMBAR SUBARACHNOID BLOCK WITH BUPIVACAINE FOR PATIENTS UNDERGOING LOWER LIMB SURGERIES

Spinal anesthesia is the most commonly used technique for lower abdominal and lower limb surgeries. Intrathecally, administered local anaesthetics and opioids have been shown to have a synergistic analgesic effect, hence requiring relatively lower dosage. Neuraxial opioids also allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Adjuvants used include Fentanyl, morphine, buprenorphine, butorphanol, sufentanil. A prospective observational study was conducted in 354 patients of age group (20 – 60yrs) and ASA grade 1 and 2. A total of 177 patients received 25 mcg Fentanyl along with 3ml 0.5% Bupivacaine (H) and remaining 177 received 250 mcg Butorphanol along with 3ml 0.5% Bupivacaine (H). Duration of analgesia (sensory block), onset of sensory and motor blockade, duration of motor blockade , hemodynamic changes and adverse effects were compared. From the study it was found that Butorphanol was signicantly better than Fentanyl in providing longer duration of analgesia. Butorphanol as adjuvant to hyperbaric 0.5% Bupivacaine 3ml in itrathecal route for lowerlimb surgeries offered better hemodynamic stability and provided effective and relatively safe anaesthesia.

A COMPARATIVE STUDY BETWEEN EPIDURAL NALBUPHINE AND FENTANYL WITH BUPIVACAINE FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERIES

Background:The shorter duration of action of typical local anaesthetics used for spinal anaesthesia demands the early need for postoperative analgesia. Epidural analgesic administration reduces the stress reaction to pain and surgery, reduces the requirement for systemic analgesics, and promotes early rehab.1 It was discovered that using opioids as an adjuvant to local anaesthetics has synergistic effects. The advantages of this combination were improved pain alleviation, motor sparing, and less toxicity.2 Objective:To compare the efficacy of epidural analgesia by using fentanyl and nalbuphine as adjuvants along with bupivacaine following lower limb surgeries with respect to Onset, Duration, and side effects. Meterials and Methods:Prospective randomized doubled blind comparative study would be conducted on 60 adult patients of ASA grade I &amp; II in the age group of 18 to 59 years of either sex, posted for lower limb surgeries after taking informed written consent. Patients were randomly divided on an alternative basis into 2 groups of 30 each. In study conducted in AL-AMEEN MEDICAL COLLEGE. VIJAYAPUR, KARNATAKA during the period of April 2021 to December 2022. If visual analogue score is more than one ,GROUP A: Patient received 50ug of fentanyl + 2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). GROUP B: Patient received 5mg of nalbuphine +2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). . Noting onset and duration analgesia also monitoring of patients SBP,DBP,SpO2,RR,VAS score till 15 min followed by 30 min,1hr ,2hr,4hr ,6hr,8hr is done and asked for any side effects like nausea ,vomiting, pruritis ,sedation and urinary retention. Conclusion: Epidural fentanyl has faster onset of action compared to nalbuphine and has longer duration of action compared to nalbuphine , for post operative epidural analgesia. There was no any statistically significant side effects in any of the two groups.

The effect of 6% hydroxyethyl starch 130/0.4 preloading on the blood glucose levels in diabetic patients undergoing orthopedic surgery with spinal anesthesia: a randomized pilot study.

Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes. Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer's solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min). A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764). There were no significant changes in blood glucose levels when lactated Ringer's solution or 6% HES-130 was used. When compared to the lactated Ringer's solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

Pethidine Versus Tramadol for Post-Anaesthetic Shivering Control in Patients Going Through Elective Surgery under Spinal Anaesthesia

Objective: To assess the efficacy of Pethidine versus Tramadol in controlling shivering after spinal anaesthesia in patients selected for lower limb surgery.&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration of the Study: Department of Anaesthesiology, Combined Military Hospital, Multan Pakistan, from Jun 2019 to Dec 2020.&#x0D; Methodology: Seventy-four individuals (aged: 18 to 65 years) selected through non-probability consecutive sampling for elective lower limb orthopaedic procedures under spinal anaesthesia were included in the study. The patients were distributed among two groups through computer-generated random numbers to receive Tramadol at a dose of 0.5 mg/kg (Group-T) or Pethidine at 0.5 mg/kg (Group-P). The frequency of post-anaesthetic shivering was recorded in all patients.&#x0D; Results: The average age of patients in Groups T and P were 30.2 ± 9 years and 34.5 ± 10 years, respectively. Fifty (67.6%) patients were males, while 24(32.4%) were females. Post-anaesthetic shivering was reported in 37(78.7%) patients in the Tramadol- Group compared to 26(96.3 percent) patients in the Pethidine- Group (p = 0.041).&#x0D; Conclusion: Tramadol caused less post-anaesthetic shivering than Pethidine after spinal anaesthesia in our sample of patients undergoing lower limb surgery.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL BUPIVACAINE IN INFRAUMBILICAL SURGERIES

Background Early postoperative mobilization, minimal pain and recovery are desirable features of modern anaesthesia post surgery. Epidural anaesthesia is most commonly used for providing postoperative analgesia. To achieve this, larger volume of local anaesthetics are used epidurally which increased the possibility of local anaesthetic toxicity. To reduce the local anaesthetic toxicity adjuvants to epidural infusion such as opioids, α2 agonists, benzodiazipines are added. Present study is done to evaluate the efcacy of dexmed Objective: etomidine and fentanyl for studying the duration of postoperative analgesia and sedation. Methodology: 80 patients of ASA grade I and II posted for elective lower abdominal and lower limb surgeries were selected for our study.They were premedicated with table tranitidine 150mg and tablet alprazolam 0.25mg night prior to surgery. Baseline parameters of vitals were recorded. Patients were preloaded with Ringer lactate solution of 15ml/kg . Under strict aseptic precautions, epidural catheter was introduced at L3-L4 space and test dose was given using 3ml of 2% Lignocaine with adrenaline followed by SAB given with injection hyperbaric bupivacaine 0.5% 15mg. After 90 min of subarachnoid block they were injected either 25ml of 0.125% bupivacaine with 0.5μg/kg dexmedetomidine or 25 ml 0.125% bupivacaine with 1μg/kg fentanyl epidurally at a rate of 5ml/hour using syringe pump. Rescue analgesia was supplemented with injection morphine 0.1mg/kg through intravenous route. Duration of analgesia , hemodynamic parameters and sedation score were noted. Analgesic effect was noted by visual analogue scale. Patients were observed for side effects Duration of postoperative analgesia, hemodynamic stability Results: and sedation were better with dexmedetomidine than fentanyl. Dexmedetomidine is a better adjuvant to epidural b Conclusion: upivacaine than fentanyl in terms of prolonged duration of analgesia with better sedation and hemodynamic parameters

ANALGESIC EFFICACY OF LOW DOSE INTRATHECAL NEOSTIGMINE IN COMBINATION WITH FENTANYL AND BUPIVACAINE FOR LOWER ABDOMINAL AND LOWER LIMB SURGERY-A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY

BACKGROUND: Intrathecal (IT) neostigmine has been used as an adjunct to spinal anesthesia. The purpose of this study was to determine whether a combination of low-dose neostigmine IT would enhance analgesia of a xed dose of fentanyl IT, in patients undergoing lower abdominal and lower limb surgeries To e AIM: valuate the analgesic efcacy of low dose intrathecal Neostigmine in combination with Fentanyl and Bupivacaine for lower abdominal and lower limb surgeries. OBJECTIVES: 1. To compare the onset of sensory and motor blockade. 2. To evaluate the piont of maximum sensory blockade. 3. To assess the VAS pain score,rst rescue analgesia time and adverse effects. METHODOLOGY: After obtaining approval from institutional ethics committe and informed consent,50 patients with ASA class I and II patients posted for elective lower abdominal and lower limb surgeries were selected and randomly divided into two gruops. GROUP A: Intrathecal Bupivacaine 12.5mg(2.5ml)+Fentany 20mcg (0.4ml)+ Normal saline (0.1ml) (Total 3ml). GROUP B: Intrathecal Bupivacaine 12.5mg(2.5ml)+Fentany 20mcg (0.4ml)+ Neostigmine 1mcg (0.1ml) (Total 3ml). Statistical analysis wa RESULTS: s done with paired t-test,student t test and chi square test .The p-valve p&lt;0.005 was considered statistically signicant.Both the groups showed statistically signicant differance in terms of sensory blockade and recovery of sensory blockade.Group B showed the early onset of sensory blockade and prolonged recovery time. CONCLUSION : Intrathecal neostigmine precipitated the onset of motor and sensory blockade and prolongs the block signicantly when used with Bupivacaine and Fentanyl in spinal anaesthesia in a low dose.

COMPARATIVE STUDY OF CLONIDINE AND FENTANYLAS ADJUVANTS TO INTRATHECAL ROPIVACAINE TO ASSESS THE DURATION OF ANALGESIA IN LOWER LIMB SURGERIES.

Objective: Ropivacaine has the benet of providing appropriate intraoperative anaesthesia and effective postoperative analgesia when used for lower limb procedures under spinal anaesthesia, but some patients still experience pain after the medication has taken its full course of action. Adjuvants added to local anaesthetics have the advantage of extending the sensory-motor block's duration and lowering the overall dose necessary.4 This study compared Clonidine and Fentanyl as adjuvants to intrathecal ropivacaine in enhancing the quality of anaesthesia by postponing the requirement for analgesics. Methods: 100 Patients who were undergoing lower limb surgeries were selected for the study and divided into two groups of 50 each. Patients were randomly allocated to one of the two groups using envelope method for blinding the investigator. GROUP A patients received 2.5ml 0.75% Ropivacaine(18.75mg) + Clonidine(60μg) 0.2ml, GROUP B patients received 2.5ml 0.75% ropivacaine(18.75mg) +Fentanyl (20mcg) 0.2ml. The following parameters were noted: Time of injection of subarachnoid block, Time of onset of sensory block at T10 level, Time of onset of motor block, Duration of motor block, Degree of sedation. Results and discussion: No difference in the onset of sensory and motor blockade between the two groups. There was statistically signicant prolongation in the duration of motor blockade in clonidine group 195.6 minutes when compared with fentanyl group 157.8 minutes (p &lt; 0.001). Analgesic duration was signicantly higher in clonidine group 321.70 ± 48.93 min when compared with fentanyl group 273.60 min (p = &lt; 0.001).The difference in haemodynamic parameters – heart rate, systolic &amp; diastolic blood pressure, mean arterial pressure (except for systolic blood pressure at 150 minutes) were statistically insignicant between both the groups. Sedation was slightly higher in the fentanyl group when compared to clonidine group but was statistically insignicant. None of the patients required supplemental oxygen, analgesia, or anxiolysis intraoperatively. No signicant difference in the incidence of complications like bradycardia, hypotension, respiratory depression etc between the two groups. Conclusion: In our study subarachnoid block with 0.75% isobaric ropivacaine (2.5ml) for lower limb surgeries with addition of clonidine 60mcg as anaesthetic adjuvant has advantage over fentanyl 20 mcg, as it increases the duration of spinal anaesthesia and increases postoperative analgesic duration. No signicant complications were recorded in both study groups

A COMPARATIVE STUDY OF CLONIDINE AS ADJUVANT TO ROPIVACAINE AND ROPIVACAINE ALONE IN EPIDURAL ANESTHESIA FOR LOWER LIMB SURGERIES

Introduction:Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Due to similar analgesic properties, lesser motor blockade and decreased cardiotoxic tendency ropivacaine is increasingly used instead of bupivacaine now a days. Clonidine has been frequently used as an adjunct to local anesthetics because it improves the quality of anesthesia, reduces the dose requirement of the anesthetic agent and provides a more stable cardiovascular course. Aims And Objectives: 1. To evaluate effect of ropivacaine alone in epidural anaesthesia for lower limb surgeries. 2. To evaluate effect of clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. 3. To compare effect of ropivacaine alone and clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. Material And Method: The study was conducted in the department of Anaesthesiology, GGS Medical College, Faridkot, after approval by Hospital Ethical Committee. Written informed consent was obtained from each patient. The total of 90 patients were allocated into 2 groups of 45 patients each:1.Group R (n=45) - 19 ml of 0.75% ropivacaine + 1 ml of normal saline (20 ml) 2.Group RC (n=45)-19 ml of 0.75% ropivacaine + 75μg of clonidine diluted to 1 ml (20 ml). The onset time for sensory and motor block, the maximum level of sensory block , duration of analgesia and side effects were recorded. The demographic prole were comparable in terms Results: of age, sex, weight which was statistically nonsignicant in both the groups. Clonidine group (RC) had rapid onset of sensory and motor blockade (p=0.001) and prolonged duration analgesia (p=0.001). There was no statistically signicant difference in HR, SBP, DBP, MAP monitored at various intervals between the two groups. Conclusion: The use of Clonidine as an adjuvant to Ropivacaine for epidural anaesthesia produces early onset of sensory and motor blockage and prolonged the duration of analgesia as compared to ropivacaine alone, with minimal changes in haemodynamic parameters and adverse effects.

“TWO DIFFERENT DOSES OF INTRATHECAL CLONIDINE FOR POST - OPERATIVE ANALGESIA IN LOWER LIMB SURGERIES - A COMPARISON"

Background and Aim : Clonidine is added to intrathecal bupivacaine to increase the duration of block and provide postoperative analgesia. The study aimed to compare two different doses of clonidine with bupivacaine in lower limb surgery, and to know the optimal analgesic dose of clonidine. In this single blind randomize Methods: d, prospective comparative study, forty patients of the ASA grade I or II, posted for lower limb surgery, were randomly allocated into two groups. Group C-30 received 3 mL of 0.5% hyperbaric bupivacaine with 30 µg of clonidine and Group C-15 received 3 mL of 0.5% hyperbaric bupivacaine with 15 µg of clonidine. The mean onset of block, regression by two segments, duration of analgesia , hemodynamic parameters and adverse effects were assessed. Data analysis was done with statistical software SPSS Ver. 20 with Unpaired T test and Chi-square test. Onset of block was signicantly faster (p &lt; 0.01) with Results: Group C30 than Group C15 ( 0.98 ± 0.07 min vs 1.34 ± 0.19 min) , whereas regression by two segments(192.45 ± 10.69 min vs 168.20 ± 7.89 min) and duration of analgesia (233.25 ± 23.23 mins vs 179.75 ± 9.06min) was signicantly prolonged in Group C30 than Group C15. Incidence of adverse events was comparable and not statistically signicant (p &gt; 0.05) in Group C15 (40%) than in Group C30 (60%). Both doses Conclusion: of clonidine provide equally safe, effective and excellent quality of post-operative analgesia. 30mcg of Clonidine is the optimal analgesic dose for lower limb surgeries due to faster onset , longer time for regression by two segments and prolonged duration of post-operative analgesia without any signicant adverse effects.

Comparison of anesthetic and analgesic effect of isobaric 0.5% ropivacaine versus levobupivacaine with fentanyl as adjuvant in lower limb surgeries under spinal anesthesia- a randomized double-blind, interventional study

Background: Spinal anesthesia is a widely used technique for lower abdomen and lower limb surgeries. We used opioids as an adjuvant to attain a dense block and increase the duration of surgery. The purpose of the study is to compare the anesthetic and analgesic effects of intrathecal isobaric 0.5% ropivacaine-fentanyl versus isobaric 0.5% levobupivacaine-fentanyl in patients undergoing lower limb surgeries. Material and methods: This prospective randomized double-blind interventional study was carried out in ASA I and II, aged 18 to 60 years. Injection Isobaric ropivacaine (0.5%) 2.5 ml with injection fentanyl 0.5 ml (25 μg) intrathecally in group A (n=30) and Inj. Isobaric levobupivacaine isobaric (0.5%) 2.5 ml with injection fentanyl 0.5 ml (25 μg) intrathecally in group B (n=30) was used. The sealed envelope method was used for group allocation. Results: Both groups' demographic and hemodynamic data were comparable. There was a faster onset of sensory and motor block in the levobupivacaine group than in the ropivacaine group with fentanyl, and the result was statistically significant. (P value &lt;0.001). Two-segment regression mean time was statistically significant between groups (P value &gt; 0.008). Sensory and motor block durations were shorter in the ropivacaine than in the levobupivacaine with the fentanyl group. There is a statistically significant difference between the two groups' time to first-dose rescue analgesia. Conclusion: We deduce in our study that using intrathecal 2.5 ml of 0.5% ropivacaine with 0.5ml fentanyl (25 micrograms) helps in early ambulation and can be used in day-care lower limb surgeries when compared with levobupivacaine.

Anesthetic challenges in patients with ankylosing spondylitis requiring lower limb surgery – A case report and literature review

Ankylosing spondylitis is one of the global top health burdens and patients affected by it frequently require surgery related to disease progression, such as orthopedic surgery. These patients may prove difficult to manage from an anesthetic standpoint, regardless of the anesthetic technique employed, mainly given the potential for difficult airway access and related comorbidities. We present the case of a 52-year-old male posted for urgent cemented total hip arthroplasty with associated bilateral pulmonary fibrosis and an anticipated difficult airway in whom regional anesthesia was performed with satisfactory results, with a favorable intraoperative and postoperative course. The literature review explores the anesthetic techniques employed when a tailored approach is required in managing patients with ankylosing spondylitis.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO BUPIVACAINE FOR POSTOPERATIVE EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

Background:Pain is pathologic entity,noxious stimulus and a most common problems challenging the anaesthetist.Regional anaesthesia is a safe,inexpensive technique that inhibits the nerve transmission to relieve pain and also provide postoperative analgesia.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexmedetomedine is α2 receptor antagonist with analgesic and sedative properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of epidural bupivacaine with Magnesium sulphate and dexmedetomidine. Methods: After approval of ethical committee and informed written consent A prospective randomised study was conducted with Sixty ASA grade I and II patients aged between 18-60 years undergoing lower limb surgeries were divided into two groups of 30 each .Group BM and Group BD received 10ml of 0.125% bupivacaine with 100mg of 20%MgSo4 and 12.5mcg of dexmedetomidine respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia were recorded postoperatively.Epidural analgesia was given when VAS score was more than 4. Results:VAS was significantly less in group BM,time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with bupivacaine provides prolonged postoperative analgesia compared with Dexmedetomidine without any systemic side effects.

A clinico-radiological study of Peripheral Arterial Disease in patients with type 2 Diabetes Mellitus using ankle-brachial index and peripheral arterial doppler

Background: Peripheral Arterial Disease (PAD) is an important complication of Diabetes Mellitus (DM). PAD is a part of systemic illness caused by atherosclerosis, resulting in arterial narrowing. Hence PAD is a marker of atherosclerosis in other parts of the vascular system, especially in the arteries supplying the brain and heart. Over two - third of the patients with PAD are asymptomatic, resulting in inadequate treatment of their risk factors. There is a need to screen every DM patient for effective treatment of PAD and the risk factors. Ankle-brachial Index (ABI) is a useful test for the same. Objective: The objective of the study was to find out the incidence of PAD in DM and the factors affecting it. Materials and Methods: It was a hospital-based prospective observational study. In all, 200 diabetic patients from tertiary care hospital (outpatient and indoor) were screened for PAD using ABI, and those showing ABI &lt; 0.9 were further confirmed using Duplex Ultrasonography (DUS). Smokers and patients with a previous history of lower limb surgery, vasculopathy, or trauma were excluded from the study. Factors affecting the incidence of PAD were also studied. Results: Overall incidence of PAD was 10% using ABI as a screening test, confirmed with DUS. Male gender, aging, obesity, duration of DM, poor control of DM, hypertension, coronary artery disease, cerebrovascular disease, hyperlipidemia, and presence of retinopathy were found to be adversely affecting risk factors for PAD. Conclusion: ABI is a bedside, simple, reliable, non-invasive, and cost-effective clinical test for diagnosing PAD, a marker of atherosclerosis in the body. There is a need to screen for PAD, even in asymptomatic patients, for its early detection and management of risk factors.