Combined use and comparison of local anaesthetic and analgesics epidurally in operative and post-operative pain management

With a noble intention to reduce postoperative pain of our patients in the study “Combined use and comparison of local anaesthetic and analgesicsepidurally inoperative and post-operative pain management” was carried out at the department of Anaesthesiology, KPC medical college and hospital, Kolkata, to observe potency and duration of analgesic action of these drugs when administer epidurally along with local anaestheticdrug and comparative study in between them. One hundred twenty patients in total with physical status of ASA Grade-I and II, scheduled for lower limbs and urogenital surgery were randomly allocated to six groups with equal number-i.e. twenty (20) in each group. Group-B (n=20) received only bupivacaine (2 mg/Kg; plain (0.5%) as a single-shot epidural injection; Group-BC received bupivacaine as per Group-B plus clonidine (3 g/Kg) as a single-shot epidural injection; Group-BN received bupivacaine plus neostigmine (5 g/Kg); Group-BF received bupivacaine plus fentanyl (1 g/Kg); Group-BK received bupivacaine plus ketamine (0.5 mg/Kg) and Group-BM received bupivacaine plus midazolam (0.05 mg/Kg) as a single shot epidural injection and all additives used epidurally, preservative free (in all groups). The patients were monitored intra-operatively from the beginning to end of anaesthesia and post-operatively in terms of pulse rate, blood pressure, pain VAS-score, peripheral oxygen saturation (SpO2), capnography (ETCO2), peripheral and central (core) temp.(oC), degree of motor blockade, sedation score, amnesia, post-operative nausea and vomiting(PONV) and other side effects at a frequent intervals. Post-operatively in post-anaesthesia care unit (PACU) all vitals (specially BP, HR, RR, temp.) along with pain-VAS, Sedation Score, Bromage Score, SpO2, ETO2 and other effects of the individual administered drug also monitored. These assessment were done in PACU at 1st, 2nd, 4, 6, 8, 10, 12, 16, 18, 24th post-operative hour. Fasteronset, better operative relaxation and good post-operative analgesia are achieved by clonidine-bupivacaine group. Prolonged post-operative sedation and analgesia is achieved by midazolam-bupivacaine group.