Background: Pruritus is a common complication of intrathecal opioids and numerous medications have been used to prevent or treat this complication. However, the efficacy of these medications vary. The choice of medications also depends on the availability and the cost. We performed a randomised double-blind study to evaluate whether nalbuphine is as effective as chlorpheniramine, a medication that is commonly used for treating pruritus for the treatment of intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section. Materials and Methods: Two hundred and thirty four parturients with American Society of Anaesthesiologists (ASA) physical status I or II who had intrathecal opioid-induced pruritus were assigned to receive either intravenous nalbuphine (4 mg eight-hourly) or intravenous chlorpheniramine (5 mg eight-hourly) for a period of 24 hours. Pruritus was assessed using a qualitative scale at pre-treatment, six, nine, 12 and 24 hours post-treatment. Results The occurrence of intrathecal opioid-induced pruritus was significantly reduced in parturients treated with intravenous nalbuphine as compared to intravenous chlorpheniramine at all intervals studied. Conclusion: In conclusion, nalbuphine is more effective than chlorpheniramine in reducing intrathecal opioid-induced pruritus for parturients undergoing lower-segment caesarean section.
Anesthesia ; Histamine H1 Antagonists ; Injections, Spinal ; Analgesics, Opioid ; Pregnancy

We report a rare case of an 18 year old girl with Sturge- Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients.

Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5% bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1% bupivacaine and 2 μg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. : Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.

Introduction: Pulmonary aspiration of gastric contents is a potentially life threatening complication of general anaesthesia especially in high risk patients undergoing emergency anaesthesia. Classically,ranitidine has been used to reduce gastric pH and volume. Esomeprazole, the S-isomer of omeprazole, is a newer generation proton pump inhibitor whose effect on gastric pH and volume in emergency surgeries has not been determined. Materials and Methods: This was a prospective, randomised, double blind study to compare the effect of intravenous esomeprazole and ranitidine on gastric pH and volume in patients undergoing emergency appendicectomy. Following induction of anaesthesia, seventy patients of American Society of Anesthesiologists physical status I or II had their gastric contents aspirated via a nasogastric tube. They were then randomised to receive either intravenous esomeprazole 40 mg or intravenous ranitidine 50 mg. A second aspiration of gastric contents was done three hours later. The pH and volume of gastric contents of both aspirations were recorded. Results: Both intravenous esomeprazole and ranitidine significantly reduced the gastric fluid acidity (p=0.001) and volume (p=0.001). There were no significant differences measured between the two groups in terms of gastric fluid pH (p=0.86) and gastric fluid volume (p=0.14) after administration of study drugs. Conclusion Esomeprazole and ranitidine given intravenously were both comparable in reducing the volume and acidity of gastric secretions in patients undergoing emergency appendicectomy.