Acute pain service (APS) ensures provision of effective and safe postoperative pain relief. The following cases describe a potentially fatal error in managing patients who receive epidural analgesia postoperatively.
Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints.
Post Arthroscopic intra-articular analgesia is a better method to avoid post-operative pain after arthroscopic surgery, thus avoiding the adverse effects of systemic analgesics. In this prospective randomized double blind study conducted on 90 patients, 30 patients in group A received 20 ml of intra-articular saline, 30 patients in Group B received 10 ml of intra-articular saline and 10 ml of 0.25% bupivacaine and 30 patients in Group C received 10 ml of 0.25% bupivacaine, 1 ml (30 mg) of ketorolac and 9 ml of saline intra-articularly. Ambulatory status, duration of analgesia and requirement for supplemented analgesia were compared in these three groups. Patients receiving this intra-articular analgesic combination of bupivacaine and ketorolac required significantly less supplemental postoperative analgesics. This combination significantly prolonged the duration of analgesia. Patients receiving this combination of drugs for intra-articular analgesia ambulated earlier.
We studied 95 patients who underwent knee Arthroscopy under local anaesthesia between JANUARY 1995 till 1997. Materials used were 1% Xylocaine and 0.25% Bupivacaine of 20 mls each combined with midazolam 2 mg and IV pethidine 30 mgm for sedation. The patients were attached to monitors (pulse Oxymeter, ECG and BP and pulse recorders) and blood less field was created using a tornquet. The procedures lasted about 45 minutes. 90 out of 95 patients completed the procedures successfully without any complications. 2 developed respiratory embarrassments and were intubated and ventilated. 3 procedures abandoned and converted to general anaesthesia. The range of procedures done include meniscectomy, meniscal repair, synovial biopsy, debridement for osteoarthrosis, shaving of osteophytes, drilling of cartilage and bones and removal of loose bodies. This study is to show that knee arthroscopy under LA is a safe alternative in hospitals where GA time is limited.
The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.