Browsing by Author "BR, Shrestha"
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Publication A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: Insertion characteristics and complications(Kathmandu University, 2003) S, Tabedar; SK, Maharjan; BR, Shrestha; BM, ShresthaObjective: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. Method: 60 pregnant women (aged 19-35yrs and weighing 58 –67kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. Result: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 %( 5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. Conclusion: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle. Key Words: Anaesthetic technique, spinal; equipment, spinal needles; complications, headache.Publication A comparison of haemodynamic responses with pethidine vs. butorphanol in open cholecystectomy cases(Kathmandu University, 2004) S, Tabedar; SK, Maharjan; BR, Shrestha; S, ShresthaObjective: The present study was undertaken to compare the haemodynamic responses with pethidine vs. Butorphanol intraoperatively in open cholecystectomy cases in KMCTH. Method: In this randomized study, all together 40 patients undergoing routine cholecystectomy surgery were included. Group A received Pethidine 1mg/kg and Group B received Butorphanol 0.04mg/kg intraoperatively. Heart rate and blood pressure were recorded before injection of the drug, after injection, before intubation, after intubation, before skin incision, after incision, before extubation and after extubation Data analysis was done using independent sample “t” test. Result: Our study showed no statistical significance in haemodynamic responses with either pethidine or Butorphanol in open cholecystectomy cases. Conclusion: Both drugs appear equally good analgesics in our study. Key words: analgesics, pethidine, Butorphanol, haemodynamic responses, surgery, cholecystectomy.Publication Bilateral simultaneous total knee replacement under combined spinal epidural anaesthesia(Kathmandu Unviversity, 2005) BR, Shrestha; Nagendra KCThis is a case report of 68 yrs old lady who underwent simultaneous both knee joint replacement for chronic and advanced osteoarthritis. The case was performed solely under combined spinal and epidural anaesthesia (CSE). CSE is a neuroaxial block performed for different types of lower limb and abdominal surgeries. Key words: total knee replacement, combined spinal epidural, anaesthesiaPublication Inter pleural catheter technique for perioperative pain management(Kathmandu University, 2003) BR, Shrestha; S, Tabadar; S, Maharjan; SR, AmatyaNA.Publication Peripartum cardiomyopathy undergoing caesarean section under epidural anaesthesia(Kathmandu University, 2006) BR, Shrestha; C, ThapaPurpose: To report a case of peripartum dilated cardiomyopathy presenting for emergency caesarean section, this was successfully managed with Epidural Anaesthesia. Clinical features: A parturient suffering from idiopathic peripartum cardiomyopathy (E.F. 18%) was brought for an emergency caesarean section. Epidural anaesthesia was performed and 2% Lignocaine with adrenaline total 13ml was injected into the epidural space. The patient’s haemodynamic status was monitored with NIBP, ECG, pulse oximetry. Patient’s perioperative course was uneventful. Conclusion: In patients suffering from peripartum cardiomyopathy, undergoing caesarean section epidural anaesthesia is an acceptable anaesthetic alternative. Key words: Cardiomyopathy, epidural, caesarean section, anaesthesiaPublication Supraclavicular brachial plexus block with and without dexamethasone - A comparative study(Kathmandu University, 2003) BR, Shrestha; SK, Maharjan; S, TabedarTo compare the analgesic efficacy of local aesthetic with and without dexamethasone in supraclavicular brachial plexus block. Methods: Forty patients undergoing arm, forearm and hand surgeries were randomly selected. The forty patients were divided in two groups of 20 each. In-group one, a brachial plexus block was done with 40-50 ml of local anaesthetic with 1:200,000 adrenaline and in the other group the block was performed with the same amount of local anaesthetics with dexamethasone. The onset of action and duration of analgesia in the two groups were compared and any complications of the procedure were noted. Statistical analysis was done using the independent sample t-test. Results: The two groups were comparable in respect to age, sex, and weight. There was significant faster onset of action and prolonged duration of analgesia in the dexamethasone group than in the other group. There were no complications. Conclusion: Addition of dexamethasone for brachial plexus block significantly prolongs the duration of analgesia without any unwanted effects.Publication Tramadol along with local anaesthetics in the penile block for the children undergoing circumcision(Kathmandu University, 2005) BR, Shrestha; B, BistaObjective: This study was to find out the total duration of postoperative analgesia following circumcision in children when Tramadol was used as an adjunct to local anaesthetics in penile block. Methods: Forty children of age 5 – 13 yrs, ASA I & II were enrolled in this study. Patients were premedicated with ketamine and atropine intramuscularly prior to separation from their parents and IV cannulation. Penile block was then performed under strict aseptic precautions with paramedian approach by 3cm long 23g ordinary needle where 4 ml of mixture of local anaesthetics and tramadol was given on each side of the base of penis at 11 and 2 o~ clock positions. Duration of analgesia was recorded from the time of completion of surgery till the patients’ first complain of pain and when additional analgesic was given. Intraoperative analgesia duration achieved by the penile block was not included in this study due to unavoidable overlapping of sedation and analgesia produced by the premedicated IM Ketamine (4-5 mg/kg) ,which lasts for 25 minutes to 30 minutes. Unless complicated, this is the usual surgery time in our hospital for this procedure. Because of this reason, the sedation score was not used in this study. Moreover, paediatric sedation score remains too impractical and unreliable in our context. Results: Addition of Tramadol with local anaesthetics in penile block prolonged the postoperative analgesia even up to 40hours. Conclusion: Tramadol as an adjunct with Local Anaesthetics extends the duration of postoperative analgesia and can be used safely for this purpose in the children. Key words: Penile Block, Circumcision, Tramadol, Postoperative Analgesia.