Context and Aims:Spinal anesthesia though gaining popularity in children, the misconceptions regarding its safety and feasibility can be better known with greater use and experience. The objective of this study was to evaluate the success rate, complications and hemodynamic stability related to pediatric spinal anesthesia.Materials and Methods:In this 1-year prospective study, 102 pediatric patients aged 6 months to 14 years undergoing infraumbilical and lower extremity surgery were included. Spinal anesthesia was administered using hyperbaric bupivacaine 0.5% in a dose of 0.5 mg/kg (for child < 5 kg), 0.4 mg/kg (for 5-15 kg), 0.3 mg/kg (for >15 kg) in L4-L5 space under all aseptic precautions after sedation. Demographic data, vital parameters, supplemental sedation, number of attempts for lumbar puncture, sensory-motor block characteristics, and complications were noted.Results:Spinal anesthesia was successful in 98 (97.1%) patients. Remaining 4 (3.9%) were failures and were given general anesthesia. Lumbar puncture was successful in first attempt (60 [58.82%]) or 2nd attempt (42 [41.18%]). There was no significant change in vital parameters. Mean peak sensory level was T 6.35 ± 1.20 (T4-T8). Mean sensory level at the end of surgery was T 8.11 ± 1.42 (T6-T10). Modified Bromage score was 3 in 98 (96.08%) patients. Sensory and motor block recovery was complete in all patients. Mean time to two segment regression was 43.97 ± 10.72 (30-70) min. Mean time to return Bromage score to 0 was 111.95 ± 20.54 (70-160). Mean duration of surgery was 52.5 ± 16.056 (25-95) min. Incidence of complications was minimal with hypotension occurring in 2 (2%) and shivering in 3 (2.9%) patients.Conclusion:Pediatric spinal anesthesia is a safe and effective anesthetic technique for lower abdominal and lower limb surgeries of shorter duration (<90 min) with high success rate. Owing to, its early motor recovery, it can be a preferred technique for day case surgeries in the pediatric population.

BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a part of multimodal postoperative analgesia. OBJECTIVES: A prospective randomized double blind placebo controlled study was conducted to investigate the efficacy of wound infiltration using bupivacaine versus ropivacaine with fentanyl for postoperative analgesia. METHOD: 93 female patients of ASA grade I/II posted for abdominal hysterectomy under spinal anesthesia were randomly divided into three groups destined to receive wound infiltration at the end of surgery using 14.5 ml 0.5% isobaric solution of either bupivacaine or ropivacaine along with 0.5 ml (25 mcg) fentanyl in group BF and RF respectively, and with 15 ml normal saline in control group (Group S). All patients received diclofenac 75 mg I.M. (B.D.) and rescue analgesic butorphanol 1 mg was given if pain occurs. Postoperative analgesia in terms of visual analogue score rescue opioids consumption in 24 hour period, and satisfaction score of patient, surgeon and anesthesiologist was compared. Rescue opioid (butorphanol) consumption in 24 hours was significantly higher in group S (61 mg), as compared to group BF (21 mg) and group RF (26 mg), p= 0.000. However group BF and group RF were comparable p=0.473. (Group S > group RF~ Group BF). Mean VAS score at rest, cough and movement was significantly less and satisfaction of patient, surgeon and anesthesiologist was significantly higher in group BF than in group RF than in group S, p<0.05. CONCLUSION: We conclude that wound infiltration using bupivacaine or ropivacaine with fentanyl is an easy, safe and effective technique for providing postoperative analgesia. Moreover, bupivacaine seems to be superior to ropivacaine in wound infiltration in terms of significantly less pain score and better satisfaction score.