Browsing by Author "BK, Bhattarai"
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Publication Analgesia after inguinal herniotomy in children: Combination of simplified (Single Puncture) ilioinguinal and iliohypogastric nerve blocks and wound infiltration vs. caudal block with 0.25% bupivacaine(Kathmandu University, 2005) BK, Bhattarai; TR , Rahman; BP, Sah; UR, TuladharObjective: To assess whether simplified ilioinguinal and iliohypogastric nerve block in combination with minimal wound infiltration with local anaesthetic is better than caudal block with local anaesthetic alone in children undergoing inguinal herniotomy for easy transition to safe oral analgesia. Subject and Methods: Sixty children of both sexes undergoing herniotomy were allocated randomly to receive either simplified (single puncture) ilioinguinal and iliohypogastric nerve block described by Dalens in combination with small volume wound infiltration with 0.1ml/kg of 0.25% bupivacaine (Group I) or caudal block with 1 ml/kg of 0.25% bupivacaine (Group II) at the end of surgery under general anaesthesia using halothane in oxygen and nitrous oxide mixture. Duration of analgesia, complication associated, parents and children’s satisfaction were compared. Results: The mean duration of analgesia was 253±102.6 minutes in group I as compared to 219.6±48.4 minutes in group II. Six (20%) patients in group I and two (6.67%) patients in group II required parenteral analgesic. Complications and parents and children’s satisfaction were comparable in both the groups. Conclusion: Simplified ilioinguinal and iliohypogastric nerve blocks described by Dalens in combination with small volume local anaesthetic wound infiltration with its longer mean duration of analgesia offers better safety margin to start oral analgesics than caudal block with local anaesthetic alone in children undergoing herniotomy. Larger studies may further confirm the findings. Key words: Simplified ilioinguinal and iliohypogastric nerve blocks, wound infiltration, caudal blockPublication Brachial plexus block as a sole anaesthetic technique in upper extremity fracture/dislocation in children: Subclavian perivascular vs parascalene approach(Kathmandu University, 2006) BK, Bhattarai; PR, BaralObjective: To compare parascalene approach of brachial plexus block with the classical subclavian perivascular approach as a sole anaesthetic technique in children undergoing closed manipulation for fracture/dislocation around the elbow. Materials and methods: Sixty children (age 6-13 years) undergoing closed manipulation for fracture/dislocation around the elbow were randomly assigned to two groups, Group I (n=30) receiving brachial plexus block using Winnie’s classical subclavian perivascular approach and Group II (n=30) receiving brachial plexus block using parascalene approach described by Dalens. Time required for performing the block, onset of analgesia, sensory block to pin prick, adequacy of relaxation, complications and acceptance of the technique to the children, parents and the surgeons were compared. Results: Time required for performing the block (6.3±2.2 min vs. 8.2±2.4 min), onset of subjective analgesia (4.1±1.6 min vs. 5.2±1.4 min) and onset of sensory block to pinprick (6.8±2.1 min vs. 8.6±1.7 min) were significantly shorter in Group I as compared to Group II (p<0.01). Acceptance of the techniques by the children, parents and the surgeons, and the overall success rates were high and comparable between the groups. Complications were minor and the incidence was low in both the groups except Horner’s syndrome in 46.7% of patients in Group II. Conclusion: Parascalene approach to brachial plexus block is comparable to classical subclavian perivascular approach in safety, success rate and acceptance in children undergoing closed manipulation and reduction of fracture/dislocation around the elbow. Key words: brachial block, children, parascalene, regional anaesthesiaPublication Percutaneous dilational tracheostomy: An initial experience in community based teaching hospital(Kathmandu University, 2006) S, Joshi; B, Agrawal; GP, Deo; BK, Bhattarai; TR, Rahman; BK, BiswasPercutaneous dilational tracheostomy (PDT) is frequently performed in the intensive care unit to prevent the long term complications associated with prolonged endotracheal intubation. Objective: To report the analysis of our experience with percutaneous dilation tracheostomy. Study Design: A prospective documentation of 40 patients who received percutaneous dilational tracheostomy in a multidisciplinary intensive care unit during a 12-month period. Method: The patients demographic, indications of intubation and PDT, time required to perform the procedure, complications and the outcome of these patients in the intensive care unit were noted. Result: Among 425 patients, 40 underwent percutaneous dilational tracheostomy that included 22 females and 18 males with the median age of 35 years. Prolonged ventilatory support was the most common indication for tracheostomy. The average duration of intubation before PDT was 5 days. Median procedure time was 20 minutes. Complications included minor bleeding in two (5%), subcutaneous emphysema with pneumothorax in two patients (5%), tracheal stenosis in three (7.5%), tracheo-esophageal fistula and glottic granuloma in one patient each (2.5%). Among forty patients, 28 (70%) were discharged to the ward, 8 died in intensive care unit and 4 left hospital against medical advice. Conclusion: Percutaneous dilational tracheostomy is a safe, quick and effective way for long term airway management in critically ill patients.