European Journal of Molecular & Clinical Medicine

Introduction: Circumcision is a painful procedure in children for which various methods are being used for pain relief. The aim of this study was to compare caudal block and penile block using ropivacaine for post-operative analgesia in paediatric patient posted for circumcision.
Methods and Materials: It was a prospective, randomised, double blinded study over a period of 6 months in 40 male patients, age between 1-7 years. The patients were divided in to two groups 20 each. GROUP C received caudal block with 0.2ml/kg of 0.25% ropivacaine by 23-G 1½ needle through sacral hiatus. GROUP P received penile block with 0.2ml/kg of 0.25% ropivacaine by 23G needle. The postoperative pain was evaluated by FLACC (Face, Legs, Activity, Crying and Consolability) pain Scale. The patient's Postoperative pain was recorded using emergence numerical pain score on a scale of 0-10: The Facial expression, Leg activity, Crying and Consolability and on Visual Analogue Scale (VAS) score.
Results: We found that the mean pulse rate in Group C was less than Group P which was statistically significant at 4, 8, 24 hours. But the changes were not clinically significant. It was found that the mean VAS Scores were on lower side in Group C when compared to Group P. The mean VAS Score ranged from 2.5 to 4.75 in Group C and 3.4 to 5.45 in Group P.
Conclusion: We have demonstrated that although penile block is a safe and effective method of providing post-circumcision analgesia, Caudal block is superior in terms of its reliability, prolonged duration of action and in reducing post-operative pain score.

Background: Femur fracture causes moderate to severe pain which requires effective analgesia both preoperatively and postoperatively. Multimodal analgesic regimens which includes non-steroidal anti-inflammatory drugs, opioids and regional analgesic techniques have been used in femur fracture patients so far. Peripheral blocks was initially done with either paresthesia technique or nerve stimulation-based technique. Ultrasound guided needle &catheter placement is observed to be technically superior, more accurate, being placed in peripheral location probably increases the safety of USG guided compared with other techniques.
Aim & Objective:

To study USG guided femoral nerve block for positioning of femur fracture patient for subarachnoid block.
To evaluate the efficacy of ultrasonography guided femoral nerve block for pain relief in femur fracture patients.
To study VAS (visual analogue scale) before and after block.
Study of hemodynamic changes before and after block.

Methods:
Study design: Prospective Observational Study.
Study setting: Anesthesia department of tertiary care centre.
Study duration: 2 years (from…. to….).
Study population: The study population included all the cases with Surgeries involving lower limbs admitted at a tertiary care center.
Sample size: 40.
Results: Our study was done on 40 patients which included 13 females and 27 male patients. There were 9 (22.5%) patients between age of 20-40 years,13 (32.5%) patients between age
 
 
 
of 40-60 years and 18(45%) patients between 60-80 years. The youngest patient in our study was 22 years and oldest patient was 80 years. ASA distribution with 21 (52.5%) ASA 1 patients and 19 (47.5%) ASA 2 patients. there were 44% patients having intertrochanteric fracture of femur, 28% patients having femur shaft fractures and 28% patients having neck of femur fracture. VAS score 26 patients had no pain and 14 patients had mild pain. the FEMORAL block had a fall in systolic and diastolic bp up to 20 mins after the block, but there was no major hemodynamic change after the block. No patients during the study had hypotension or hypertension after the femoral block. Among the study population, 98% USG guided femoral nerve block were successful with 2% failure rate as in this study we calculated success rate from percent of successful blocks to supplemental analgesia for patient positioning.
Conclusions: USG guided femoral nerve block with 0.25% bupivacaine is a better choice for pre-operative pain relief of pain in femur fracture patients with high success rate and good post-operative analgesia with no complication

Background:Hyperbaric bupivacaine 0.5% (l0mg) with fentanyl 15mcg(0.3ml) and (2)
Hyperbaric bupivacaine 0.5% (10mg) with clonidine 45mcg. Objectives: The study
compared the onset and duration of action of intrathecal hyperbaric bupivacaine 0.5
percent and fentanyl 15mcg (group-I) to intrathecal hyperbaric bupivacaine 0.5 percent
and clonidine 45 mcg (group-II) in spinal anaesthesia in LSCS. The combination of
bupivacaine with fentanyl or clonidine assists anesthesiologists in alleviating
intraoperative discomfort by delivering superior analgesia to patients without extending
recovery.
Materials and Methods: The study included 80 female patients with ASA grade I (n=40
in each group). The time of onset of sensory and motor block, duration of analgesia, 2-
segment regression, intraoperative discomfort, hemodynamic stability, time to
micturition, visual analogue score, and postoperative analgesic requirements were all
evaluated.
Results: In group II, the onset of sensory and motor block was substantially later than
in group I (p0.001). Hemodynamic alterations did not differ between groups (p>0.05).
Intraoperatively, 1 patient reported pruritis, and 2 patients had postoperative urinary
II78.506.12min and groupII-—121.284.09 min) and regression of sensory level to L2
dermatome (group-I - 142.206.73 min and group II 166.405.79 min) were significantly
longer in group II (p0.001). The duration of analgesia in group II was 210.186.79
minutes, whereas in group II it was 323.5610.53 minutes, which is significant (p0.001).
The VAS scores in group II were considerably lower after 3 hours (p0.05), 6 hours
(p0.001), and 12hours (p0.001).
Conclusion: The addition of intrathecal clonidine 45 mcg to hyperbaric bupivacaine in
spinal anaesthesia gives greater analgesia with less perioperative discomfort, a longer
duration of analgesia, and a reduction in postoperative analgesic requirements.

Knee osteoarthritis (OA) being the commonest joint disease has an incidence of 30% in population above 60 yrs. Proximal Fibular osteotomy (PFO) though in exploratory stage has aroused lot of interest in orthopedic surgeons as it seems to be most simple, affordable, safe surgery without any insertion of implants. A prospective study based on 30 knees with medial compartment knee osteoarthritis treated surgically in department of Orthopaedics for a period of 2 years. The data was collected using structured proforma, consent and functional outcome analysed based on Visual Analogue Score and American Knee Society Score. They were evaluated using Visual Analogue Score which was decreased from pre op 7.52 to post op 3.2 and American Knee Society Score which improved from pre op 44.9 to post op 74.1 where Good outcome was found in 23 knees (76.6%), excellent outcome was found in 3 knees (10%), fair outcome was observed in 4 knees (13.33%). Only 2 out of 30 knees had EHL weakness as complications which eventually recovered completely by end of 12 months.