Periyannan, G (2018) Comparision of safety and efficacy of unilateral paravertebral block with subarachnoid block for inguinal hernia repair. Masters thesis, Madras Medical College, Chennai.
|
Text
201000118periyannan.pdf Download (5MB) | Preview |
|
|
Text
201000118periyannan_abstract.pdf Download (193kB) | Preview |
Abstract
INTRODUCTION: Inguinal herniorrhaphy (IH) is a common day care procedure. It can be performed under generalanaesthesia (GA) peripheral nerve blockade, subarachnoid block (SAB) or paravertebral block (PVB). PVB is providing long‑lasting unilateral anaesthesia, haemodynamic stability, early ambulation and prolonged pain relief. PVB produces ipsilateral segmental analgesia through injection of local anaesthetic onto the spinal nerve roots alongside the vertebral column. It is advocated predominantly for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia or renal surgery This study was undertaken to compare safety and efficacy between unilateral PVBs and SAB in patients undergoing IH. AIM OF THE STUDY: 1. Duration of post operative analgesia (Post operative Visual Analogue Scale pain score), 2. Time to reach the discharge citeria (Modified post- anaesthetic discharge scoring), 3. Intra operative and post operativehaemodynamics, 4. Total rescue analgesic consumption. METHODOLOGY: This study was done at the Institute of Anaesthesiology and critical care, Madras Medical College between April to September 2017. The aim of this study is to Compare the safety and efficacy of Unilateral paravertebral block with Subarachnoid block for Inguinal hernia repair Patients were excluded if they had a history of sensitivity to local anesthetic, bleeding disorders or receiving anticoagulant, spine or chest wall deformity orpregnancy. Before surgery patients were randomly allocated according to thecomputer generated sequence into two equal groups. Group P (PVB = 30 patients) received ipsilatera Paravertebral block from T10 to L2 with 5ml of bupivacaine (0.5%) with 1: 400,000 epinephrine at each segment. while the group S (SAB=30 patients)received Sub arachnoid block with 12.5ml of hyperbaric bupivacaine (0.5%). PVB was performed with thepatient in sitting position from T10 to L2 thoracic vertebra under completeaseptic precaution with low resistant technique with saline using an 25- G Quincke needle seeking contact with the transverse process of the thoracicvertebra then sliding the needle caudally for 1–1.5 cm into the paravertebral space and 5 ml of bupivacaine 0.5% with 1:400,000 epinephrine at each segment was injected. SAB block wasperformed while the patient in sitting position infiltration of the skin at puncture site with 2 ml of xylocaine 2%, 25- G Quincke the needle was inserted in L3 L4 space injected 12.5mg ( 2.5ml) of hyperbaric bupivacaine (0.5%) in subarachnoid space. Hypotension was defined as a decrease of more than20% of the base line MBP and was treated with increments of 6 mg bolus doses of ephedrine iv and 250 ml fluid bolus. Intra operative haemodynamics was monitored. After the surgery patients was shifted to ward. VAS Score and Modified post anesthesia discharge scoring observed. Postoperative analgesia was provided with tramadol. Pain intensity was measured using VAS pain score. Nausea lasting more than 10 min or vomiting was treated with ondansetron 4 mg. Complications related to local anesthetic drug and PVB technique likepneumothorax or epidural spread of local anesthetic as evidenced by test for sensory deficit on contralateral side were also recorded. Chest X-ray was requested for any patient in PVB group if had any difficulty of breath, desaturated or had diminished air entry at any time after the block. Primaryoutcome was the time to first analgesia in minutes to first registration of VAS pain score >6. Secondary outcome measures were mean VAS scores,intraandpost operative hemodynamic variables and postoperative nausea and vomiting (PONV). CONCLUSION: It is concluded that paravertebral block might be an alternative to spinal anaesthesia method in inguinal hernia surgery as it provides adequate anaesthesia during perioperative period and high quality analgesia during the postoperative period.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | safety ; efficacy ; unilateral paravertebral block ; subarachnoid block ; inguinal hernia repair ; Comparision study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Aug 2018 04:14 |
| Last Modified: | 22 Aug 2018 04:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9339 |
Actions (login required)
 |
View Item |
