Brachial plexus block avoids unwanted complications due to administration of various drugs in general anesthesia and in the process of upper airway instrumentation. See the complete profile on LinkedIn and discover Krishnaveni’s connections and jobs at similar companies.Brachial plexus block is especially intended for the upper limb surgeries. Krishnaveni has 5 jobs listed on their profile. View Krishnaveni Sivakumar’s profile on LinkedIn, the world’s largest professional community. UGC CARE, UGC CARE list, ugc approved journal, UGC CARE, UGC CARE list, UGC CARE list of Journal, UGCCARE, care journal list, UGC-CARE list, New UGC-CARE Reference List, New ugc care journal list, Research Journal, Research Journal Publication, Research Paper, Low cost research journal, Free of cost paper publication in Research Journal, High impact factor journal, Journal, Research paper.
John Xiating Cai krishnaveni karanam Leonora Wongkaren Humaira Akhter.Peripheral nerve blocks are usually performed using conventional local anesthetics. Churchillkrishnaveni karanam specializes in HTML, CSS, MySQL, C, Visual Basic, JavaScript. Use of ultrasound for the performance of supraclavicular block has become the gold standard since it enables the clinician to deposit the local anesthetic close to the nerves in real time and is usually devoid of complications.Human Resource Development: A Researchers PerspectiveR Krishnaveni, READY READERS, STAGE ZERO, BOOK 12, SOCKS, SINGLE COPY (Celebration Press Ready Readers)MODERN CURRICULUM PRESS, Rainbow Recorder Course Level 3 Starter bookGeoffrey Winters, The Great Republic (Random House Large Print)Winston S.
Krishnaveni Gorantla is an obstetrician affiliated with Community Hospital in Munster, IN. As levobupivacaine is less cardio and neurotoxicity compared to racemic bupivacaine, it is considered to be safer to use when compared to bupivacaine.Dr. In this way, the transmission of the nerve impulses stops. When the minimum local analgesic concentration is reached close to the membranes of the axons, the molecules block the sodium channels, in the resting position. The mechanism of action of levobupivacaine is similar to that of racemic bupivacaine. Levobupivacaine is a long-acting local anesthetic with lesser cardiotoxicity and neurotoxicity than bupivacaine.
Patients with previous history or clinical presentation with central or peripheral neurological disease, coagulopathy, infection at the site of injection, patient allergic to any of the study drugs and those unable to cooperate were excluded from the study. The study was done to evaluate the efficacy of 100 mg tramadol, or 8 mg dexamethasone added as an adjuvant to 20 ml of 0.5% levobupivacaine in ultrasound-guided supraclavicular brachial plexus block for prolongation of postoperative analgesia for the upper limb surgery.After obtaining Institutional Ethical Committee approval and informed patient consent, sixty adult patients of the American Society of Anesthesiologists Physical Status I and II who were scheduled for elective upper limb surgeries aged 18–65 years were included for this double-blinded, randomized controlled study. Dexamethasone acts on glucocorticoid receptor which increases the activity of inhibitory potassium channels on nociceptive C-fibers which prolongs the duration of local anesthesia. Steroids suppress the synthesis and secretion of various inflammatory mediators which prolongs the period of analgesia.
Another anesthesiologist blinded to the study drugs performed the block procedures and recorded all the data. An anesthesiologist who was not involved in the procedure prepared the study drugs according to the randomization as per sealed envelope technique. All patients received IV midazolam 0.03 mg/kg before the block for anxiolysis. Standard monitoring was used throughout the procedure, including noninvasive blood pressure, electrocardiogram and pulse oximetry. Patients were optimally positioned for the performance of ultrasound-guided supraclavicular brachial plexus block. After arrival in the operating theater, an 18G intravenous (IV) cannula was secured.
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Patients in whom complete sensory or motor blockade was not achieved at the end of 45 min were excluded from the study, and further anesthetic management was decided by attending anesthesiologist. Patients were evaluated every 2 min till the development of complete sensory and motor block till 45 min. Time at which drug was injected was noted. Group dexamethasone (Group D) - thirty patients received local anesthetic mixture containing 20 ml of 0.5% levobupivacaine plus 2 ml of dexamethasone (1 ml = 4 mg). Group tramadol (Group T) - thirty patients received local anesthetic mixture containing 20 ml of 0.5% levobupivacaine plus 2 ml of tramadol (1 ml = 50 mg).
Scale 2 - normal motor function (power 4/5, 5/5), Scale 1 - weakness against resistance (power 3/5, 2/5), Scale 0 - paresis/no motor power (power 0/5, 1/5) for the four terminal branches. Scale 2 - perceives both touch and temperature, Scale 1 - perceives only touch, Scale 0 - neither perceives touch nor temperature in the territory of musculocutaneous nerve, median nerve, ulnar nerve, and radial nerve (RN).CONsolidated Standards of Reporting Trials 2010 flow sheetSimilarly, motor blockade was assessed on a three-point qualitative scale. Sensory block was assessed by three-point qualitative scale (perseverance of cold sensation to ether-soaked cotton).
Verbal numerical rating scale (VNRS) was used to evaluate and record pain in the recovery room after arrival at 0, 2, 4, 6, 8, 10, 12, 24, and 48 h. Inadequate block was considered whenever the patient complained of pain and the anesthetic management was decided by the attending anesthesiologist and the patient was to be excluded from the study.At the end of surgery, the patient was transferred to postanesthesia care unit where block regression and postoperative pain were assessed. Readiness for surgery was decided by loss of surgical site pain while attempting motor maneuvers, at least Scale 1 sensory and motor loss in all four nerve territories. When patients were not able to move or raise the hand actively, the block was considered as the complete motor block, and the time was noted and recorded as onset of motor blockade.
Twenty-four hours later, sensory and motor assessment was performed to determine any residual block or neurological deficit for 48 h. Duration of analgesia was defined as time lapse between onset of sensory blockade and patient's pain score (VNRS) reaching more than 4 and administration of rescue analgesia.Patients were monitored for 24 h for the presence of complications and side effects including pruritus, nausea and vomiting. Duration of motor blockade was noted as time gap between onset of motor blockade and scale two motor power on finger flexion.
There is no statistically significance in onset of motor blockade between two groups ( P = 0.039).The mean time duration of analgesia in Group D was 1300.83 min and in Group T was 820.47 min, and this was statistically significant ( P < 0.001). There was no statistical difference between the two groups ( P = 0.490).The mean onset time of motor blockade following supraclavicular brachial plexus block in Group D was 13 ± 4.8 min and 15 ± 5.3 min in Group T. The block was effective in all the patients, and none of them were excluded from the study.The mean onset time of sensory block in Group D was 5.80 ± 1.97 min and in Group T was 6.33 ± 3.71 min. There was no statistical difference in sex distribution between two groups ( P = 0.789).The number of bony procedures and soft tissue procedures were comparable between both the Group D and Group T ( P = 0.551). There was no statistical difference in age distribution between two groups ( P = 0.182).There were 12 female and 18 male patients in Group D and in Group T had 10 female and 20 male patients.
To the best of our knowledge, there are no studies comparing tramadol and dexamethasone as adjuvants to levobupivacaine for performing ultrasound-guided supraclavicular brachial plexus block.The supraclavicular block is a widely used regional nerve block in upper limb surgeries. We studied the onset of sensory and motor blockade, duration of motor blockade, and duration of analgesia. We have compared tramadol and dexamethasone as adjuvants to levobupivacaine for the performance of ultrasound-guided supraclavicular block. In this study, we performed ultrasound-guided supraclavicular block on patients undergoing upper limb surgery.
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