Publications

Background: Multimodal analgesia (MMA) by synergy with volatile anesthetics minimizes their
use thus decreasing operation theater pollution and greenhouse gas emission.
Aims: To estimate minimum alveolar concentration (MAC) requirement of isoflurane (ISO) for
skin incision with use of MMA in the study group versus conventional regime in the control group
for a constant bispectral index (BIS). To observe the side effects of analgesic drugs administered
in the study.
Settings and Design: Forty‑two patients of American Society of Anesthesiologist Class I and II
scheduled for lumbar spine surgery were included in this prospective, randomized, double‑blind,
clinical study. They were randomly allocated into two groups of 21 each.
Materials and Methods: Group A (MMA group/study group) received injections diclofenac
sodium, paracetamol, clonidine, and fentanyl and local infiltration (bupivacaine with adrenaline).
Group B (conventional regime group/control group) received injections paracetamol and fentanyl
and local infiltration (saline with adrenaline). Preemptive analgesia was practiced in the study. The
MAC of ISO for skin incision was documented.
Statistical Analysis Used: Independent sample t‑test: To compare MACISO for skin incision
between the two groups. One sample t‑test: To compare the standard mean concentration with
the means of the two groups. Chi‑square test: To compare adverse effects between the groups.
P < 5% was considered statistically significant.
Results: The MACISO requirement was significantly lower in the study group at the time of skin
incision for BIS of 50–55 compared to the control group (P < 0.001). Post extubation, 43% had
nausea and 9% had vomiting in the control group. None of the patients in either group had
intraoperative awareness.