Background:Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique.Aims:We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia.Materials and Methods:Forty adult patients between the age groups of 25 and 65 years undergoing coronary artery bypass grafting or valve surgeries through midline sternotomy under general anesthesia were enrolled in the study. Patients were randomly allocated into two groups with 20 in each group. Group 1 patients did not receive Pecs block, whereas Group 2 patients received bilateral Pecs block postoperatively. Patients were extubated once they fulfilled extubation criteria. Ventilator duration was recorded. Patients were interrogated for pain by visual analog scale (VAS) scoring at rest and cough. Inspiratory flow rate was assessed using incentive spirometry.Results:Pecs group patients required lesser duration of ventilator support (P < 0.0001) in comparison to control group. Pain scores at rest and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were comparable between two groups. Peak inspiratory flow rates were higher in Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05). Thirty-four episodes of rescue analgesia were given in control group, whereas in Pecs group, there were only four episodes of rescue analgesia.Conclusion:Pecs block is technically simple and effective technique and can be used as part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and outcome.

Background and Aims:Perioperative myocardial ischaemia (PMI) is one of the known complications during off pump coronary artery bypass (OPCAB) surgeries. The length of hospital stay is considerably prolonged in patients with PMI. Myocardial protection is an area which is being widely researched currently to prevent or reduce the incidence of PMI. Over the last decade it has become clear that volatile anaesthetic agents are protective in the setting of PMI and reperfusion. Hence, we planned to study the effect of two different volatile anaesthetics as myocardial protective agents in OPCAB surgery.Methods:A total of 40 patients were enrolled for the study; Group A (sevoflurane, n = 20) and Group B (desflurane, n = 20). All patients had a baseline measurement of Trop-T, creatine phosphokinase-MB (CPKMB) and myocardial performance index (MPI) pre-operatively, which was repeated 4 h after the surgery. Chi-square/Fisher test was used to find the significance of the differences between the two agents.Results:Patients were comparable in demographic, baseline, biochemical and echo criteria. Post-operative CPKMB levels (desflurane - 30.85 ± 2.69 u/L; sevoflurane - 29.05 ± 5.26 u/L, P = 0.7) and number of Trop-T positive patients (Sevoflurane - 9; desflurane - 6, P ≥ 0.05) were comparable. Post-operative MPI indicated decreased left ventricular function in sevoflurane group as compared to desflurane group (P ≤ 0.03).Conclusion:Desflurane exerts better cardioprotective effect than sevoflurane as indicated by better MPI in OPCAB surgeries.

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INTRODUCTIONPelvic injuries are associated with high-energy trauma and hence they are haemodynamically unstable. Severity and stability of the injury will depend on upon the mechanism of injury and integrity of osseo ligamentous complexes of the pelvic ring. The pubic symphysis is an amphiarthrodial joint with fibrocartilaginous disc stabilised by the superior and inferior arcuate ligaments. Pubic Diastasis indicates a disruption of the pelvic ring and an unstable pelvis. According to Young and Burgess classification APC I are stable and APC II, APC III are unstable fractures as they result in high energy trauma associated with urorectal and neurological complications and hence surgery is indicated.1 Early non-invasive stabilisation using a pelvic binder, external fixators and C-clamps are used to manage for life-threatening bleeding. It has been reported that pubic diastasis is approximately 24% of pelvic injuries.2 Management of APC II fractures, i.e., the symphysis gap more than 2.5 cm and posterior displacement less than 1 mm is always open reduction and internal fixation.3-8 Open reduction and internal fixation of pubic diastasis using plate facilitates absolute reduction and is now an excellent method of stabilisation with the belief that the reduction gap less than 1 cm is a significant, predicting the long-ABSTRACT Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period. Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year. Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results. Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.