Browsing by Author "Sah, BP"
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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) Bhattarai, BK; Rahman, TR; Sah, BP; Tuladhar, URObjective: 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 Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study(Kathmandu University, 2008) Yadav, RK; Sah, BP; Kumar, P; Singh, SNAbstract Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The groupA [Lignocaine with adrenaline (1.5%)], groupB [Lignocaine with adrenaline (1.5%)] +500μg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon’s score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4 ±0.8 , 3.8±1.8 mins in group A,B and C respectively and the Mean onset of motor blockade were 7.7± 2.0, 7.0±1.8, 6.0 ± 2.1mins in group A,B and C respectively. Similarly Mean Complete sensory block in 10.6 ±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2 ±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically signi cant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was signi cantly (p- 0.005) lower. The mean VAS was signi cantly lower in groupC in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement.