Indian Journal of Anaesthesia

: 2020  |  Volume : 64  |  Issue : 13  |  Page : 83--86

Ludhiana E Poster Award Abstracts


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 SIngle needle thoracic paravertebral block as an alternative to general anaesthesia for modified radical mastectomy operation: A randomised controlled study

Archana Roy, Pratibha Bhunia, Sampriti Sadhukhan, Dipankar Mukherjee

Nilratan Sircar Medical College, KOLKATA.

Background and Aims: Conventionally,surgery for breast carcinoma is done under general anaesthesia(GA).Recently thoracic paravertebral block(TPVB) is gaining popularity as it produces unilateral block and minimal haemodynamic changes.It also facilitates post-op analgesia,early ambulation,and reduces hospital stay. Aim was to evaluate efficacy of single needle TPVB with catheter using 0.5% bupivacaine as a sole anaesthetic approach for Modified radical mastectomy(MRM).

Methods: 60 consenting ASA I & II, females aged 30 -60yrs scheduled for modified radical mastectomy were randomly assigned into 2groups: Gr.P(n=30),Gr.G(n=30). Gr.P: TPVB was given using 18G touhy needle.Epidural catheter inserted 2-3cm inside the paravertebral space at T4 level.INJ BUPIVACAINE 0.5% isobaric 20ml injected through catheter.IV infusion of Dexmedetomidine started for sedation. Gr.G: GA with midazolam,fentanyl,propofol and atracurium. Measured parametres were Baseline, Intra-op haemodynamics,induction time,recovery time,fentanyl requirement,average blood loss and post-op pain score by VAS at 0,1/2,1,2,4,8,12,24hrs,duration of analgesia,patient and surgeon satisfaction scores(PSS,SSS),incidence of post-op nausea vomiting(PONV).



Induction was prolonged in Gr.P(2.25±3.66min),though recovery was faster(1.61±0.69min) in comparison to Gr.G. Also intraoperatively Gr.P required less fentanyl and had less blood loss. Post-op VAS scores,incidence of PONV were significantly more in GA patients. SSS,PSS were similar.

Conclusion: TPVB may be a reasonable alternative to GA for MRM as it provides adequate intra and post-op analgesia with minimal adverse events.


Sahu A, Kumar R, Hussain M, Gupta A, Raghwendra KH. Comparisons of single-injection thoracic paravertebral block with ropivacaine and bupivacaine in breast cancer surgery: A prospective, randomized, double-blinded study. Anesth Essays Res. 2016;10(3):655–660. doi:10.4103/0259-1162.191109James Simpson, Arun Ariyarathenam, Julie Dunn, and Pete Ford, “Breast Surgery Using Thoracic Paravertebral Blockade and Sedation Alone,” Anesthesiology Research and Practice, vol. 2014, Article ID 127467, 4 pages, 2014.

 Ultrasound guided determination of optimal angle of needle insertion for successful caudal block in pediatric patients”

Hulakund SY, AJAY B C, Anilkumar Ganeshnavar

S Nijalingappa Medical College, Bagalkot

Background and Aims : Caudal epidural block is one of the most common regional techniques in paediatric anesthesia. Failure rate of placement of needle into the caudal epidural space can be upto 25% with conventional method. In this study, our aim is to estimate the optimal angle of needle insertion for successful caudal block, and also to calculate number of puncture attempts, procedural time and other complications by ultrasound imaging.

Methods: After obtaining ethical committee clearance and written consent from guardian, ASA grade I&II patients aged between 6-72 months undergoing infra-umbilical surgeries were included in the study. After general anaesthesia with laryngeal mask airway placement caudal block was given using ultrasound. To estimate the optimal angle, an imaginary line was drawn parallel to the sacral base on the longitudinal view, and the angle between the imaginary line and the needle was measured. puncture attempts, procedural time and complications were noted. Data was entered in excel sheet and analysed using SPSS software version 19.

Results: Calculated median optimal angle was 19.220 [14–25]. First attempt was taken in 34 / 37 (91.89%) and second attempt was taken in 3 / 37 (8.10%) children. Average time taken to insert needle is 14.25 seconds. and there were no complications.


Conclusion: The optimal angle showed no significant correlation with age, weight & height. We conclude that the needle should be inserted at about 200 to the skin to avoid puncture of the bone and potential intra-osseous and intravascular injection


Park JH, Koo BN, Kim JY, Cho JE, Kim WO, Kil HK. Determination of the optimal angle for needle insertion during caudal block in children using ultrasound imaging. Anaesthesia. 2006;61(10):946–9. Erbüyün K, Açıkgöz B, Ok G, Yılmaz Ö, Temeltaş G, Tekin İ, et al. The role of ultrasound guidance in pediatric caudal block. Saudi Med J. 2016;37(2):147–50.

 Hyperthermic intraperitoneal chemotherapy (HIPEC): Anaesthetic implications & outcomes redefined

Finija Francis V, Mariam Koshi Thomas, Rakesh Rajagopal, Akhil Babu

Institution:Jubilee Mission Medical College, Thrissur

Background and aims: Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has emerged as a treatment modality for selected patients with peritoneal surface malignancies. This technique involves infusing chemotherapeutic agents heated to 42°C to 43°C into the peritoneal cavity following resection of visible tumor.Anaesthetic management of CRS with HIPEC are complex . It involves major surgical resection,perioperative fluid and blood loss , electrolyte and acid–base disturbances. There are variations in body temperature during cytoreduction and HIPEC . It requires proper planning, coordination with surgeons and vigilance in perioperative period for successful outcome . the present study tried to analyze the perioperative management of patients undergoing CRS with HIPEC

Methods: Retrospective analysis of 8 patients with ovarian carcinoma who underwent CRS with HIPEC during the year June 2018 to June 2019 in Jubilee mission medical college Thrissur was done after obtaining ethical committee clearance. Data was collected on patient characteristics, duration of surgery, changes of body temperature, heart rate, mean arterial blood pressure (MAP), need for vasopressor support, intraoperative fluid requirement, urine output, estimated blood loss and blood transfusion. Data also collected on metabolic derangements, length of post operative invasive ventilation, length of ICU stay. Descriptive statistical analyses using measures of central tendency (mean, median, mode) and variance(range ) was performed on all variables.

Results: A total of 8 patients were evaluated with median age being around 66 years.Median duration of surgery extended upto 7 hours during which intravenous fluid administered ranged between 3.5 L and 10.5 L(median-7 L). Significant blood loss of 0.7 L(0.5 -2 L ) was seen during cytoreduction phase. 6 out of 8 patients needed blood transfusion with median of 1 PRBC(0-3). The need for norepinephrine infusion was observed in 50% of patients to keep MAP of ±20% . Body temperature increased upto a median of 37.5°C during the HIPEC phase.Out of 8 patients 7 of them required post operative invasive ventilation of 19.5 hours.

Conclusion: CRS+HIPEC is a high risk procedure associated with major hemodynamic and metabolic changes. This study suggests that meticulous management and monitoring of different physiological systems help in successful outcome of patients who undergo demanding surgeries like CRS with HIPEC.


Gupta N, Kumar V, Garg R, Bharti SJ, Mishra S, Bhatnagar S. Anesthetic implications in hyperthermic intraperitoneal chemotherapy. J Anaesthesiol Clin Pharmacol. 2019;35(1):3-11.Schmidt, C., Creutzenberg, M., Piso, P., Hobbhahn, J. and Bucher, M. (2008), Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia, 63: 389-395.

 USG Guided Thoracolumbar Paravertebral Block As Sole Anaesthetic Technique For Inguinal Hernia Surgeries – A Case Series.

R. Preya, Sivashanmugam.T, Smriti Jha, Afreen Nahar

Mahathma Gandhi Medical College And Hospital, Pondicherry

Abstract: Locoregional techniques as sole anaesthetic technique are associated with less hemodynamic changes, prolonged analgesia, devoid of side effects like nausea, sore throat in the postoperative period, and better patient comfort compared to general anaesthesia and central neuraxial techniques. Quadratus lumborum block, transverse abdominis plane block, ilioinguinal-iliohypogastric nerve block are used for postoperative analgesia. They cannot be used as a sole anaesthetic technique as they are not able to cover all the nerves required for hernia surgeries. Landmark guided thoracolumbar paravertebral block was used as the sole anaesthetic technique for Hernioplasty.1 In this case series, described a stepwise approach for identification of thoracolumbar paravertebral space using Ultrasound and the block dynamics in five patients. Using a systematic scanning technique, we identified the paravertebral space of T11, T12, L1, L2 vertebrae (Fig 1) and 20ml of the local anaesthetic mixture was injected as 5 ml aliquots in each space. The hernial sac was infiltrated with 10 ml of LA mixture under ultrasound guidance. The sensory loss was observed from midline umbilicus( T10 ) to 5cm below the inguinal region ( L2) in both anterior and posterior aspect of the ipsilateral parietal wall of the abdomen. Out of 5 patients, the surgical anaesthesia was satisfactory in 4 patient, and one patient required General anaesthesia during the sac manipulation. The mean time required for the first analgesic requirement is 5.5±1.2 hours. We are proposing that Ultrasound-guided paravertebral block with spermatic cord injection is a feasible peripheral nerve block technique for hernioplasty.

{Figure 1}


Paravertebral block anaesthesia for inguinal hernia repair. World J Surg. 2003 Apr;27(4):425-9.

 Catheter associated blood stream infections in the central intensive care unit.

Sandeep Dey, Abhijit Tarat, Amio Kumar Deori

Assam Medical College and Hospital (AMCH), Dibrugarh, Assam.

Background and Aims: Catheter Related Blood Stream Infections (CRBSI) is a frequent complication of central venous cannulation and accounts for majority (around 14%) of hospital acquired infections in intensive care. Catheter related blood stream infections are also considered as the first and most preventable classes of nosocomial infections. This study was done to characterize the population profile and microbial characteristics of CRBSI in the Central ICU (CICU) of AMCH. Additionally the CRBSI rate, duration of catheterization for CRBSI to develop was also estimated.

Methods: A prospective observational study was conducted in the CICU of AMCH on 100 patients over a period of one year after taking approval from the Institutional Ethical Committee. Patients over 18 years with no other initial source of infection and where consent could be obtained were included. Data regarding the patients and disease, indication, infections, organisms isolated, ICU stay, events such as death were collected and analysed.

Results: CRBSI was seen after ≥ 11 days of CVC insertion. There was no statistically difference in the duration of ICU stay in patients with or without CRBSI (12 ± 4.6 days versus 12 ± 8 days, p=1). CRBSI was more common with internal jugular vein (IJV) catheterisation (n=1/8, 12.5%), when catheterization was done in emergency (n=2/13, 15.38%) tand amongst patients with history of polytrauma (42.85%, p=0.000009) or hollow viscus perforation (25%, p=001513).


Conclusion: CRBSI rate was high in our institute which calls for the need of antibiotic stewardship program as well as tighter bundle care protocol and staff training.


Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med. 2000 March; 132(5):391-402. O'Grady NP, Alexander M, Burns LA et al. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May; 52(9):162-93.

 Evaluation of analgesic efficacy of bupivacaine and ropivacaine given through landmark guided erector spinae plane block in laparoscopic choleycystectomy

Nachiket Solanki, Reshma Korat, Divyang Shah

Institution: Smimer Medical College, Surat.

Background & Aims: Erector spinae plane block(ESPB) is emerging as effective method for post-operative analgesia. The main aim of the study is to assess analgesic efficacy of landmark guided ESP block in patients undergoing laparoscopic Cholecystectomy. Duration of post-operative analgesia between Ropivacaine and Bupivacaine is compared.

Methods: Thirty patients of ASA grading I,II & III aged between 18-60 years scheduled for elective laparoscopic cholecystectomy were selected. Prior to induction, under all aseptic precaution ESP block was given. Using C7 spinous process as reference, T9 spinous process was palpated. 3cm from midline from this point, 22G spinal needle was inserted and advanced perpendicular to skin in all planes to contact transverse process of T10 vertebra. Needle was withdrawn 1-2mm and 20cc local anaesthetic solution injected bilaterally.General anaesthesia was given and maintained as standard technique. After completion of surgery patient was extubated. VAS score was used for post-operative pain assessment.

Results: Landmark guided ESP block is less time consuming, does not need extra equipment with no added risk of local anaesthetic systemic toxicity. It reduces postoperative VAS score and additional analgesic requirement. Ropivacaine is better in terms of post-operative analgesia than Bupivacaine.

{Figure 2}

Conclusion: Landmark guided ESP block is simple, safe and most effective supplemental technique as a part of the multimodal post-operative analgesic regimen.


Petsas D, Pogiatzi V, Galatidis T, et al. Erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a case report. J Pain Res. 2018;11:1983–1990. Published 2018 Sep 24. doi:10.2147/JPR.S164489Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ul- trasound-guided erector spinae plane block for postoperative analgesia in laparo- scopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth 2018;49(Sep):101–6.

 The anaesthesiologist and eeg

N. Karthikadevi, Shalini Jain, K.K.Arora

Mahatma Gandhi Memorial Medical College, Indore.

ABSTRACT: Electroencephalographic (EEG) recordings present an opportunity to monitor changes in human brain electrical activity during changing states of consciousness like sleep or general anesthesia. Frontal EEG recordings during surgical interventions with anesthetic-induced unconsciousness help to estimate the patient's level of unconsciousness. Use of these monitors to assess depth of anesthesia are in increasing trends but their usage is suboptimal. These monitors record the frontal EEG and process it through algorithms that yield an index number. This index alone has proven unreliable. Brain function under anesthesia has now changed from depth of anesthesia to adequacy/quality of anesthesia. Technology advances in EEG will make us able to provide better care for our patients, allowing more refined control and better monitoring preventing Delirium, Postoperative Cognitive Dysfuction etc. With an example of a case showing inconsistent EEG findings.


Kreuzer M. EEG Based Monitoring of General Anesthesia: Taking the Next Steps. Front Comput Neurosci. 2017;11:56. Published 2017 Jun 22. doi:10.3389/fncom.2017.00056Shalbaf R, Behnam H, Jelveh Moghadam H. Monitoring depth of anesthesia using combination of EEG measure and hemodynamic variables. Cogn Neurodyn. 2015;9(1):41–51. doi:10.1007/s11571-014-9295-z