2026-01-30
Ankur Sharma, Lalit Gupta, Devang Bharti, Kirti Nath Saxena, Kapil Chaudhary
Background: Laparoscopic cholecystectomy (LC) has become the standard procedure for gallbladder removal, but is associated with significant postoperative pain. This study aims to compare the analgesic efficacy of ultrasound-guided erector spinae plane (ESP) and subcostal transversus abdominis plane (TAP) block in patients undergoing elective LC. Methods: Forty ASA I/II patients, aged 18 – 60 years, were randomised to receive ESP (group E, n=20) or TAP (group T, n=20) block after standard general anaesthesia induction. The primary outcome was time to first rescue analgesia in the postoperative period. Secondary outcomes included total postoperative analgesic consumption, perioperative haemodynamics, stress response markers, random blood sugar (RBS), total leucocyte count (TLC), C-reactive protein (CRP), and serum cortisol. Results: Group E had significantly prolonged time to first rescue analgesia [654 (SD: 58.20) (95% CI: 626.76, 681.24) min vs. 482.40 (SD: 60.00) (95%CI: 454.26, 510.54) min, p< 0.001], lower NRS scores (at 6, 12 and 24-h intervals, p< 0.05) and higher patient satisfaction scores [5.80 (SD:0.63) (95%CI: 5.505, 6.095) vs. 4.10 (SD: 1.48) (95%CI: 3.407, 4.793), p < 0.001] compared to group T. CRP and serum cortisol levels were also significantly lower in Group E (p<0.05). Intraoperative haemodynamics and total postoperative analgesic requirement remained comparable between the groups. Conclusion: ESP block provides prolonged analgesia and higher patient satisfaction compared to the subcostal TAP block in patients undergoing LC, along with a favourable effect on surgical stress response.
2026-01-30
V. Reshma, Mayank Kumar, Mamta Sinha, Sarita Ramchandani, Rashmi Dubey, Monica Malhotra
Background: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery that frequently leads to post-operative pain. Ultrasound (US)-guided bilateral erector spinae plane block (ESPB) is a relatively safe technique that has good analgesic effects for various surgeries. This study aimed to compare the analgesic efficacy of US-guided ESPB with port-site infiltration in patients undergoing elective laparoscopic cholecystectomy. Methods: Sixty patients undergoing elective LC were recruited and randomized into two groups. Group ES received bilateral US-guided ESPB with 20 ml 0.375% ropivacaine at each side and port-site infiltration with 20 ml 0.9% normal saline (NS). Group PS received port-site infiltration with 20 ml 0.375% ropivacaine and bilateral US-guided ESPB with 20 ml 0.9% NS on each side. The primary outcome was the time to first request of analgesia, whereas total dose of intraoperative rescue fentanyl requirement, total doses of rescue analgesics required post-operatively in 24h, visual analogue scale (VAS) scores up to 24 h and time to mobilization were the secondary outcomes. Results: The mean time to first request of analgesia was prolonged in Group ES (8.87 ± 3.27 hours) than in Group PS (2.63 ± 1.85 hours); (P < 0.001). Additionally, patients in group PS required more intraoperative fentanyl, needed more rescue analgesia post-operatively and had higher VAS scores at rest during 24 hours. Conclusion: US-guided bilateral ESPB provides better post-operative analgesia than port-site infiltration after LC surgery. Moreover, ESPB increases the mean time to first rescue analgesia, reduces pain scores and total opioid consumption.
2026-01-30
D. D. N. P. Jayasekara, R. Mallawaarachchi, W. Jayawaradhane, G. H. S. Fernando, M. P. M. Devindi
No abstract available
2026-01-30
L. Kavisekara, S. Madugalle, M. Prabodini, A. Ratnayake, S. Samarasinghe, B. Samarasinghe, K. Pussepitiya
Vicarious contrast excretion, a rare phenomenon, involves the excretion of intravascular contrast material through non-urinary routes. This atypical occurrence can lead to unexpected findings on imaging studies, causing diagnostic challenges. We present a case of a 62-year-old obese lady with a complex medical history, including diabetes mellitus, hypertension, bronchial asthma, and osteoarthritis, who presented with a right-sided popliteal deep vein thrombosis (DVT). Sudden onset dyspnea and desaturation raised suspicion of pulmonary embolism, prompting contrast-enhanced computed tomography pulmonary angiography (CTPA). The patient was electively intubated and was hypotensive following the event. Due to difficult intravenous access, bilateral external jugular veins were utilized for contrast administration initially on the right side, followed by the left side. However, extravasation occurred from both sides, leading to suboptimal CTPA images. Non-contrast computed tomography was performed, revealing contrast in the gastrointestinal tract from the stomach up to the distal colon. Endoscopy ruled out perforation. Subsequent non-contrast scan replicated the phenomenon, with delayed clearance of contrast from luminal surfaces, without any major pathology, confirming the diagnosis of vicarious contrast excretion. The patient was later managed as a respiratory tract infection with septic shock and discharged to the ward. Vicarious contrast excretion poses a diagnostic conundrum, particularly in patients with comorbidities complicating standard imaging protocols. Extravasation of contract media, hypotension and renal impairment are risk factors for its development. This rare complication altered the diagnostic pathway, emphasizing the importance of considering alternative excretion routes in challenging cases.
2026-01-30
R. Sachin, S. K. Saif Ali, M. Kishore, A. Parameswari
Endoscopic nasal procedures are traditionally performed under general anaesthesia (GA), which may increase the risk of perioperative major adverse cardiac events in patients with underlying cardiac disease. We report the successful use of ultrasound-guided supra-zygomatic maxillary nerve block (SZMNB) combined with intravenous dexmedetomidine sedation as the sole anaesthetic technique in a 38-year-old male with moderate left ventricular systolic dysfunction undergoing endoscopic septoplasty. Supplemental buccal oxygenation via a size 4 oral RAE tube ensured optimal oxygen delivery without obstructing the surgical field. The patient remained comfortable and hemodynamically stable throughout, with no requirement for airway instrumentation or postoperative opioids. This case demonstrates that SZMNB with dexmedetomidine sedation can serve as a safe and effective alternative to GA in selected high-risk cardiac patients undergoing nasal endoscopic surgery, ensuring perioperative cardiopulmonary stability and enhancing recovery.
2026-01-30
Srinivas Lavanya, Kaur Navdeep, Turai Ashwini, Shivashankar Archana, Krishna Pooja
Background: Hypotension is a common adverse effect observed in patients undergoing spinal anaesthesia, particularly in older adults. Prophylactic administration of agents like glycopyrrolate and ondansetron has been explored to mitigate this risk. In this study, we aimed to compare the efficacy of intravenous glycopyrrolate and ondansetron in preventing spinal anaesthesia-induced hypotension in patients undergoing trans-urethral resection of prostate (TURP). The secondary objective was to determine the requirement for ephedrine across the study groups. Methodology: A total of 135 patients in the American Society of Anaesthesiologists (ASA) physical status I or II category, scheduled for elective TURP surgery under spinal anaesthesia, were enrolled in the study. Patients were randomly assigned to three groups: Group A (n = 45) received 0.2 mg of glycopyrrolate, Group B (n = 45) received 4 mg of ondansetron, and Group C (n = 45) received 2 mL of normal saline intravenously, 5 minutes before spinal anaesthesia. Following the standard spinal anaesthesia procedure, vital signs were monitored to detect hypotension. Ephedrine requirements across the study groups were also measured. Results: Group A demonstrated the lowest incidence of hypotension (26.6%; CI: 14.6–41.1), followed by Group B (33.3%; CI: 20.0–48.2), compared to Group C (55.5%; CI: 40.0–70.1) (p < 0.001). Ephedrine was required in 22.2% (95% CI: 11.2–36.9), 28.8% (95% CI: 16.6–44.0), and 48.8% (95% CI: 33.3–64.5) in Groups A, B, and C, respectively (p = 0.020). Conclusion: Both ondansetron and glycopyrrolate effectively reduced the incidence of hypotension following spinal anaesthesia in patients undergoing TURP surgery. Although the incidence of hypotension was numerically lower with glycopyrrolate than with ondansetron, this difference was not statistically significant. Their prophylactic use may enhance haemodynamic stability in this high-risk group.
2026-01-30
R. Choudhary, V. Bansal, R. Sharma, L. Gupta
Mandibulofacial dysostosis, commonly known as Treacher-Collins syndrome, is a rare congenital craniofacial disorder that presents significant challenges in airway management due to facial anatomical deformities. These difficulties are further compounded in paediatric patients, particularly during surgeries such as cleft lip and palate repair. This case report describes the perioperative airway management of a 4-year-old male with Treacher-Collins syndrome undergoing cleft surgery. The child’s preoperative assessment revealed typical features of the syndrome, including micrognathia, retrognathia, and hypoplasia of facial bones, indicating a high risk for difficult intubation. Intraoperatively, accidental displacement of the endotracheal tube led to rapid desaturation. An Air-Q™ intubating laryngeal mask airway (LMA) was immediately inserted, thereby ensuring adequate ventilation and a rapid improvement in oxygen saturation. Once the patient was stabilised, fibre-optic-assisted intubation was successfully performed through the Air-Q, and surgery continued without further complications. Its use as a conduit for fibre-optic intubation not only provides hands-free ventilation but also helps reduce the risk of airway trauma and obstruction. This case illustrates the use of the Air-Q as a rescue airway conduit in a paediatric patient with Treacher-Collins Syndrome, highlighting its potential to improve perioperative safety and preparedness.