No abstract

Spinal anaesthesia is advantageous as compare to general anaesthesia for cesarean section especially in preeclampsia as it avoids the complications of general anaesthesia. To improve the quality of sensory and motor blockade and prolong the duration of postoperative analgesia, we had used tramadol and magnesium sulfate intrathecally with the primary aim to assess sensory and motor blockade and postoperative analgesia. Material and Methods: This prospective randomized control study included sixty preeclamptic parturient having more than 36 weeks of pregnancy with controlled hypertension aged 18-40 years with single pregnancy, planned for caesarean section of ASAPS II, III and able to understand VAS score were included. Parturients were randomly assigned to g roup LT (injection Levobupivacaine 0.5%, 1.5ml + injection Tramadol 25 mg,0.5ml) and group LM (injection Levobupivacaine 0.5%, 1.5ml + injection Magnesium sulfate 100 mg,0.5ml) using computer generated random numbers and the assignment was sealed in envelopes for concealment. They were assessed for sensory blockade, motor blockade and postoperative analgesia. Results: The onset of sensory block was late in group LM [102sec (102-105) sec] in comparison to group LT [69sec (66-72) sec, P<0.0001]. The time to attain peak sensory level was late in group LM [2min (1.9-2) min] in comparison to group LT [1.6min (1.5-1.6) min, P<0.0001]. The motor block onset was delayed in group LM [93.5sec (92-95) sec] compared to group LT [60sec (58-63) sec, P<0.0001]. The duration of post-operative analgesia was extended further for group LM [570min (540-600) min], in comparison to group LT [357min (342-360) min, P<0.0001]. Conclusion:Intrathecal magnesium sulfate can be considered as a desirable adjuvant to Levobupivacaine in mild preeclamptic parturients undergoing cesarean section compared to tramadol.

Pain during positioning in patients with fracture femur results in improper position and makes subarachnoid block difficult. The aim of our study was to evaluate femoral nerve block and intravenous fentanyl for positioning the patient for subarachnoid block. Material and Methods: This open labelled prospective, clinical study was carried out in 60 patients aged 18-70 years of either sex, of ASAPS/ EASAPS-I, II and III, posted for fracture femur surgery under subarachnoid block and likely to have pain while positioning and who understand VAS score. Patients with contraindications to subarachnoid block, allergy to study drugs, history of drug or alcohol abuse, patient with multiple fractures and unable to understand VAS score were excluded from the study. Patients were assigned into two groups alternately in Group FNB (femoral nerve block was given) and Group FENT (intravenous Fentanyl 1µg/kg was given) for positioning before subarachnoid block. Assessment of pain was done using VAS score before and after positioning, time taken to achieve position, quality of position, patient acceptance and additional doses of fentanyl requirement during positioning. Patients were also observed for sedation score, pulse rate, NIBP and oxygen saturation. Results: VAS score 10 minutes after giving analgesia and during positioning was less in group FNB (1.97±0.56) as compared to group FENT (2.87±0.35), which was statistically very highly significant (P < 0.0001). None of the patient required additional dose in either group. Conclusion: FNB provides adequate analgesia, hence satisfactory positioning for sub arachnoid block with stable hemodynamics as compared to intravenous fentanyl.