No abstract

Background:For ages various adjuvants have been tried to prolong axillary brachial plexus block. We compared the effect of adding dexmedetomidine versus clonidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.Materials and Methods:A total of 90 patients (20-40 years) posted for ambulatory elective hand surgery under axillary brachial plexus block were divided into two equal groups (groups ropivacaine dexmedetomidine [RD] and ropivacaine clonidine [RC]) in a randomized, double-blind fashion. In group RD (n = 45) 30 ml 0.5% ropivacaine + 100 μg of dexmedetomidine and group RC (n = 45) 30 ml 0.5% ropivacaine + 75 μg clonidine were administered in axillary plexus block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient.Results:Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group RC. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group RC. Postoperative VAS value at 18 h were significantly lower in group RD (P < 0.05). Intraoperative hemodynamics were insignificantly lower in group RD (P < 0.05) without any appreciable side-effects.Conclusion:It can be concluded that adding dexmedetomidine to axillary plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects.

BACKGROUND:The study was to evaluate the surgical outcomes of arthroscopic repair of post-traumatic Bankart lesions with the use of suture anchors. Patients with >20% bony lesions, SLAP (superior labral tear from anterior to posterior) lesions and multi-directional instability were excluded. The patients were followed up for a period of minimum 4 years. MATERIALS AND METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors in 35 patients with traumatic recurrent anterior instability of the shoulder. The mean age at operation was 25.71 years. The patients were evaluated pre-operatively and at follow-up using the UCLA (University of California Los Angeles) shoulder scoring system and the modified Rowe scores, which were 6.2 and 29.3 respectively pre-operatively. RESULTS: The UCLA shoulder scoring system and the modified Rowe scores at follow-up were 32 and 72.57 respectively and both improvements were significant. The Modified Rowe Shoulder Scoring System showed 14 patients having excellent results, 12 patients good, 6 patients fair and 3 patients with poor results. One patient had subluxation and another had positive apprehension test. Five patients had discomfort/pain with arm in abducted and externally rotated position but negative apprehension test. Remaining 28 patients had negative apprehension test; no subluxation. Significant improvements occurred for each motion tested for each follow up visit. CONCLUSION: We conclude that arthroscopic Bankart lesion repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion having good results with respect to pain relief, stability and function. KEYWORDS: Arthroscopic Bankart repair, Anterior shoulder instability, UCLA (University of California Los Angeles) shoulder rating scale. INTRODUCTION:The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. According to one estimate, up to 96% of acute shoulder dislocations were traumatic in origin. (1) Anterior instability is the most common form of shoulder instability. (2) Recurrent anterior shoulder instability results in a functional disability for the patient, in terms of both shoulder function and general health status. (3) The use of arthroscopy has improved the recognition of pathologic findings in shoulder instability and allowed a better understanding of the etiology of instability and the correlation between symptom and lesion patterns.Arthroscopic treatment of shoulder instability due to Bankart lesion introduced some advantages compared with open Bankart lesion repair procedure. The Arthroscopic method offers a less invasive technique of Bankart repair.

No abstract

No abstract