Sara Mary Thomas
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Pain Relief and Post-Operative Outcome in Patients Receiving Tramadol via Thoracic Epidural versus Intravenous Method in Coronary Artery Bypass Graft Surgery Jigisha Mehta; Dr. Mrugank Bhavsar; Sara Mary Thomas; Pooja Shah; Dinesh Chauhan
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14767

Abstract

Background & Objectives:Acute pain is common after cardiac surgery and can keep patients fromparticipating in activities that prevent postoperative complications especially respiratory complications.Accurate assessment and understanding of pain are vital for providing satisfactory pain control andoptimizing recovery.Our aim of the study was to compare pain relief and post-operative outcome in patients receiving Tramadolvia Thoracic epidural versus intravenous method in coronary artery bypass graft surgery.Methodology: Sixty patients aging 40-65 years posted for off pump coronary artery bypass graft surgerywere selected. They were randomly assigned into two groups.Group IVA (n = 30) received Inj. Tramadol(1 mg/kgiv)and Group TEA (n = 30) received Tramadol 0.5 mg/kgepidurallyhalf an hour before shiftingin cardiac recovery room. Hemodynamic parameters like Heart rate, systolic and diastolic blood pressure,pulmonary artery pressure were recorder for 72 hours postoperatively. We have compared extubation timein both the groups. Pain was assessed by visual analogue scale (VAS). Any patients with the VAS more than4 were treated with rescue analgesic. Duration of analgesia and total no. of rescue analgesia were recorded.Duration of stay in cardiac recovery room and in hospital was also recorded.Observation & Results: We have observed statistically significant difference in hemodynamic parametersbetween two groups with better stability in TEA group from shifting till next 72 hours. Extubation time wasalso earlier in TEA group. Mean duration of analgesia and VAS score was also better TEA group. All theseled to shorter length of cardiac recovery stay and earlier discharge from the hospital with less complication.Conclusion: Thoracic epidural analgesia is better than intravenous technique in terms of earlyextubation,maintaining hemodynamic stability and better postoperative analgesia with reduced length ofcardiac recovery and hospital stay.
A Comparitive Study Between Magnesium Sulphate Versus Dexamethasone as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block Sara Mary Thomas; A. Anjali; Jayshri B. Desai; Sujay Thakkar
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15937

Abstract

Introduction: Magnesium Sulphate and Dexamethasone are used as adjuvants to local anaesthetics inregional anaesthesia to improve the quality of blockObjective: To compare the efficacy of magnesium sulphate and dexamethasone on the characteristics of theblock and its effect on postoperative analgesia when added as an additive to bupivacaine in supraclavicularbrachial plexus block.Materials and Methods: Fifty patients belonging to American Society of Anaesthesiologists (ASA) GradeI and II, aged between 18 to 55 years, scheduled for elective upper limb surgeries under supraclavicularbrachial plexus block were enrolled in this study. Patients were equally divided into two groups : group Mreceived 0.5% Bupivacaine 30ml with 10% Magnesium sulphate 5 ml (500mg) and group D received 0.5%Bupivacaine 30ml with Dexamethasone 2ml (8mg) + Normal saline 3ml. Onset and duration of sensory andmotor block , duration of postoperative analgesia and any complications were observed.Results: In our study the demographic profile of patients, duration of surgery and ASA status between thetwo groups were comparable. Onset of sensory block was earlier in group D than group M (17.12±0.93minutes and 19.40 ±1.08 minutes respectively, p=0.001). Duration of motor block and analgesia were longerin group D as compared to group M (479.00 ±50.83 minutes vs 346.40 ±32.77 minutes respectively, p=0.001 for motor block and 533.80 ±59.80 minutes vs 415.00 ±57.23 minutes respectively, p=0.001 foranalgesia). No significant side effects were noted.Conclusion: Dexamethasone is a better adjuvant than Magnesium Sulphate when added to bupivacaine insupraclavicular brachial plexus block as it prolongs duration of motor block and analgesia significantly withminimal side effects.