Background:Lumbar spine surgery demands intense analgesia. Preemptive multimodal analgesia (MMA) is a novel approach to attenuate the stress response to surgical stimulus.Aims:The aim of the study was to assess the intraoperative morphine consumption in patients undergoing lumbar spine surgery.Patients and Methods:A randomized, prospective, double-blind study involving 42 patients belonging to the American Society of Anesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Preemptive analgesia was practiced in both the groups. Intraoperative morphine consumption was documented.Statistical Methods:Intraoperative morphine consumption between the two groups was compared using Mann–Whitney U-test. Postextubation sedation score between the two groups was compared using Chi-square test and presented as number and percentage. P < 5% was considered statistically significant.Results:Intraoperative morphine consumption was significantly low in the study group (P < 0.001). Postextubation sedation score was comparable between the two groups.Conclusion:Preemptive MMA has demonstrated significant morphine sparing effect intraoperatively in patients undergoing lumbar spine surgeries.

Background:Multimodal analgesia (MMA) by synergy with volatile anesthetics minimizes their use thus decreasing operation theater pollution and greenhouse gas emission.Aims:To estimate minimum alveolar concentration (MAC) requirement of isoflurane (ISO) for skin incision with use of MMA in the study group versus conventional regime in the control group for a constant bispectral index (BIS). To observe the side effects of analgesic drugs administered in the study.Settings and Design:Forty-two patients of American Society of Anesthesiologist Class I and II scheduled for lumbar spine surgery were included in this prospective, randomized, double-blind, clinical study. They were randomly allocated into two groups of 21 each.Materials and Methods:Group A (MMA group/study group) received injections diclofenac sodium, paracetamol, clonidine, and fentanyl and local infiltration (bupivacaine with adrenaline). Group B (conventional regime group/control group) received injections paracetamol and fentanyl and local infiltration (saline with adrenaline). Preemptive analgesia was practiced in the study. The MAC of ISO for skin incision was documented.Statistical Analysis Used:Independent sample t-test: To compare MACISO for skin incision between the two groups. One sample t-test: To compare the standard mean concentration with the means of the two groups. Chi-square test: To compare adverse effects between the groups. P < 5% was considered statistically significant.Results:The MACISO requirement was significantly lower in the study group at the time of skin incision for BIS of 50–55 compared to the control group (P < 0.001). Post extubation, 43% had nausea and 9% had vomiting in the control group. None of the patients in either group had intraoperative awareness.Conclusion:We conclude that preemptive MMA has synergistic effect with ISO. It effectively reduces MACISO to skin incision to a greater degree.

In patients with concomitant occurrence of maxillofacial and basilar skull fractures, open reduction and internal fixation is the treatment. It requires intermittent intra operative dental occlusion which precludes oral or nasal intubation. In such cases submental intubation (SMI) is a recognized technique in practice. We describe a modified technique for smooth exteriorization of the endotracheal tube (ETT) during SMI. As the SMI technique is unusual for the performer, emphasis is laid on the applied aspects to minimize probable complications during the procedure. With the modified technique we performed SMI uneventfully on five patients

Background:Lumbar spine surgery is associated with hemodynamic variations at intubation, change of position, and skin incision. A balanced anesthesia with multimodal analgesia (MMA) is necessary to attenuate these changes.Aim:To assess the relative effectiveness of preemptive MMA compared with the conventional analgesic regime in suppressing the hemodynamic response to endotracheal intubation, prone positioning, and skin incision.Settings and Design:A randomized, prospective study involving 42 patients belonging to the American Society of Anesthesiologists Physical Status 1 and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each.Materials and Methods:Forty-two patients were randomly allocated into Groups A and B. Group A (study group) received diclofenac, paracetamol, clonidine, and bupivacaine with adrenaline skin infiltration and Group B (control group) injection paracetamol and saline with adrenaline skin infiltration.Statistical Analysis Used:Hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) between the groups following intubation, prone position, and skin incision were noted and compared using repeated measure analysis of variance. One sample t-test was used to compare the standard mean concentration with the means of the study and control groups. P < 5% being considered statistically significant.Results:In the study group, HR, SBP, DBP, and MAP were lower at intubation and change of position as compared to the control group and were statistically significant.Conclusion:Preemptive MMA with balanced anesthesia is effective in attenuating the hemodynamic responses to multiple noxious stimuli during lumbar spine surgery.