Neurotransmitters in the spinal cord attenuate or amplify the pain signals from the periphery. Substance P, calcitonin and gene related peptides amplify while endogenous opioids, norepinephrine, serotonin, GABA and glycine attenuate the pain signal. Nociceptive impulse reaches the thalamus by second order neurons in the spinothalamic, spinoreticular and spinomesencephalic tracts. This study included 60 children, of both genders, coming for various elective infra-umbilical surgical procedures such as herniotomy, circumcision, orchidopexy, urethroplasty etc. After obtaining clearance from the hospital ethical committee a written informed consent was obtained from parents before commencing the study. The baseline oxygen saturation (SpO2) was 98.67 ± 1.24% in group B. In group D, the baseline oxygen saturation (SpO2) was 98.17 ± 1.51%. There was no significant difference between the groups. At 5, 15 and 30 minutes SpO2 values were 99 ± 0.74%, 98.1% ± 0.89 and 97.9% ± 1.24 respectively in group B and 98.23% ± 1.4, 98.67% ± 1.18 and 98.6% ± 1.04 24 respectively in group D. The differences were statistically significant but clinically insignificant.

Caudal epidural analgesia is one of the most commonly performed regional techniques in paediatric anaesthesia for intra and post-operative analgesia. However, the duration of analgesia is limited by the duration of action of local anaesthetics. Addition of opioids like morphine, fentanyl is associated with side effects like respiratory depression, urinary retention and pruritus. Dexmedetomidine a α2 agonist is known for its analgesic effects with lesser side effects. Hence, this study was conducted to know the efficacy and safety of addition of dexmedetomidine to bupivacaine in a single shot caudal block in children. This study was conducted among 60 children in the age group of 1 -10 years coming for various elective infraumbilical surgical procedures. They were divided into two groups of 30 each. Group B received caudal 0.25% bupivacaine 1ml/kg and group D received caudal 0.25% bupivacaine 1ml/kg with dexmedetomidine 1 μg/kg. The pain score in the two groups were similar up to 2 hours after surgery but was higher in group B at the end of 3rd and 4th hour compared with group D. This study showed that the addition of dexmedetomidine in the dose of 1μg/kg to 0.25% bupivacaine 1ml/kg reduced the anaesthetic requirement, prolonged the duration of analgesia with less post operative analgesic requirement after a single shot caudal block with minimal side effects in children.

Tuffier's line intersects the spine at the L4 spinous process or at the L4-L5 intervertebral space. Full-term parturient women undergo various physical changes. Therefore, determining the vertebral level with Tuffier's line based on palpation inevitably is not very accurate. This study aimed to use ultrasound to verify the difference between vertebral levels for the palpated Tuffier's line in parturient and non-parturient women in the lateral decubitus position. In this study, consecutively enrolled 20 parturient women at 27-35 weeks of gestation and 20 non-parturient women scheduled for regional anesthesia. In the left lateral position, the location of the vertebra was identified using ultrasonography. We marked every intervertebral space from L5 to L2 vertebra, divided each spinous process into two equal parts, and numbered the spaces sequentially from 1 to 9. A Tuffier's line was drawn by palpating, recorded the vertebral level that this line intersected. The mean value of an arbitrary number of vertebral level of Tuffier's line was 5.4 ± 0.9 in the non-pregnant group and this represents L4-lower vertebral level. In the pregnant group, the mean value was 2.0 ± 1.0 which represents L3-lower vertebral level. There was a significant difference between the two groups (P < 0.05).

No abstract

No abstract