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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Efficacy of Ropivacaine alone Versus Ropivacaine with Dexmedetomidine in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Study
Correspondence Address :
Dr. T Kiran Kumar,
Assistant Professor, Department of Anaesthesiology and Critical Care Medicine, Afzalgunj, Hyderabad-500012, Telangana, India.
E-mail: sunildockmc@gmail.com
Introduction: The Supraclavicular Brachial (SCB) plexus block for upper limb surgeries has emerged as a rapid and reliable technique compared to general anaesthesia. With the advent of Ultrasound (US), the SCB plexus block has become an easy, accurate and popular procedure to perform. Dexmedetomidine, as an adjuvant to local anaesthetics, has improved the quality of the blocks.
Aim: To compare the onset and duration of sensory and motor blockade of 0.5% ropivacaine versus 0.5% ropivacaine with 25 μg dexmedetomidine, as well as to assess the haemodynamic parameters in the SCB plexus block.
Materials and Methods: This randomised controlled study was conducted at Osmania Medical College and General Hospital, Hyderabad, Telangana, India which included 60 adult patients {American Society of Anaesthesiologists (ASA) I and II} scheduled for elective upper limb surgery under SCB, according to the inclusion criteria. The patients were randomised into group R (n=30), which received 30 mL of ropivacaine with 1 mL of saline and group RD (n=30), which received 30 mL of ropivacaine with 25 μg of dexmedetomidine. The onset and duration of sensory and motor block, the duration of analgesia, haemodynamic parameters and any complications were recorded, tabulated in an Excel sheet and analysed using an unpaired t-test.
Results: The demographic data among both groups were comparable, with a male predominance. The onset of sensory and motor block was faster in group RD compared to group R, respectively (4.78±1.68 mins vs. 7.87±1.98 mins, p-value <0.001) and (8.4±2.34 mins vs. 12.3±2.95 mins, p-value <0.001). The duration of sensory and motor block was longer in group RD compared to group R, respectively (807.5±165.51 mins vs. 485±81.31 mins, p-value <0.001) and (685±62.74 mins vs. 465±72.62 mins, p-value <0.001). Haemodynamic stability was well maintained without any complications in group RD.
Conclusion: The addition of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided SCB accelerates the onset of sensory and motor block, prolongs the duration of the block and analgesia, thereby improving the quality of the SCB.
Adjuvants, Analgesia, Upper limb
The SCB plexus block for upper limb surgeries has emerged as a safe technique, with a rapid and reliable onset compared to general anaesthesia; it is being considered a spinal technique for the upper limb. Various techniques have been documented in the literature for SCB, but the use of US for the administration of SCB improves accuracy and success rates (95%). It has emerged as a safer and more effective technique (1),(2),(3),(4),(5). Ropivacaine provides a good amount of pain relief with less motor blockade, as it has a greater degree of motor-to-sensory differentiation, which helps in early postoperative mobilisation. Additionally, it has less cardiotoxic effect than bupivacaine, making it more suitable for SCB (1),(2).
Various adjuvants have been tried in SCB, as they extend the period of analgesia and reduce the local anaesthetic dose requirement, thereby minimising systemic adverse effects. Dexmedetomidine is one of these adjuvants, with a highly selective α-2 agonistic activity (α-2 to α-1 activity 1620:1) compared to Clonidine (α-2 to α-1 activity 220:1) and it does not cause respiratory depression (1),(2),(6). Dexmedetomidine binds and inhibits the release of nor adrenaline from presynaptic α-2 receptors in the sympathetic nervous system and non adrenergic receptors in the central nervous system (1).
Dexmedetomidine has a profound anxiolytic and sedative effect by acting on the locus coeruleus, with no respiratory depression. It reduces sympathetic tone and attenuates the neuroendocrine and haemodynamic response to anaesthesia and surgery. It decreases intraoperative anaesthetic requirements by improving sedation and analgesia, leading to better patient satisfaction. Moreover, it reduces postoperative analgesic requirements in those painful procedures. When used as an adjuvant in regional anaesthesia along with a local anaesthetic at a dose of 1 μg/kg, dexmedetomidine improves the quality of intraoperative anaesthesia and postoperative analgesia, as well as enhances cardiovascular stability without any adverse effects (7),(8),(9),(10).
A lower dose of dexmedetomidine does not provide adequate analgesia, while higher doses can cause unusual bradycardia and hypotension. The optimal dose of dexmedetomidine as an adjuvant in regional nerve blocks is yet to be determined (11),(12). The literature on dexmedetomidine dosing as an adjuvant in SCB is limited; to our knowledge, there have only been five studies conducted using dexmedetomidine in SCB with ropivacaine. Out of these, only one study has compared a dose of 25 μg of dexmedetomidine in addition to ropivacaine in SCB (1),(13),(14),(15). This study focused on examining the effect of adding dexmedetomidine as an adjuvant to ropivacaine in SCB on intraoperative and postoperative analgesia during upper limb surgeries. The primary objective of the study was to evaluate the onset and duration of SCB plexus block, while the secondary objective was to assess haemodynamic stability and drug-related side-effects.
This was a randomised controlled study conducted Osmania Medical College and General Hospital, Hyderabad, Telangana, India over a period of one year during June 2019 to May 2020. Institutional Ethical Committee (IEC) clearance was obtained(ECR/300/Inst/AP/2013/RR-19), informed and written consent was obtained from the participants.
Inclusion criteria: Subjects aged between 18 and 60 years, ASA I and II, undergoing upper limb surgeries, were included in the study.
Exclusion criteria: Subjects with ASA III and IV classifications, bleeding disorders, nerve injuries, neuropathy and pneumothorax were excluded from the study.
Sample size calculation: The sample size was calculated based on a previous study by Dash LK et al., considering the mean difference in the time of onset of motor blockade to be 4.38 minutes, with an anticipated standard deviation of 5.83 minutes, at a significance level of 5% and a power of 80% (13). Based on this data, 28 patients were required in each group, assuming a screen failure rate of 7%. Accordingly, 30 patients were recruited and randomly allocated into two groups using the “slips in box technique” (group R - Control group and group RD - Test group) (Table/Fig 1).
Study Procedure
All subjects underwent a preanaesthesia evaluation and the orders were followed. The subjects were positioned supine with their heads turned to the contralateral side after securing intravenous access in the non surgical hand. The SCB plexus block was performed under all aseptic precautions with the assistance of US. Group R subjects received 30 mL of 0.5% ropivacaine and 1 mL of saline, while group RD subjects received 30 mL of 0.5% ropivacaine and 25 μg of dexmedetomidine mixed with saline to make a total volume of 1 mL (1).
Sensory block was assessed using a pinprick three-point scale: {0 - Normal sensation, 1 - Loss of sensation to pinprick (analgesia), 2 - Loss of sensation to touch (anaesthesia)}. Motor blockade was assessed using the Modified Bromage Scale: {Grade 0 - No block, total arm and forearm flexion; Grade I - Partial block, total forearm and partial arm flexion; Grade II - Almost complete block, inability to flex the arm and decreased ability to flex the forearm; Grade III - Total block, inability to flex both arm and forearm} after the injection of the drug, assessed every two minutes until 30 minutes.
The onset of sensory block (the interval between the administration of the drug and complete sensory block), the onset of motor block (the interval between the administration of the drug and complete motor block), the duration of sensory block (the interval between the onset of sensory block and the first rescue analgesia) and the duration of motor block (the interval between the onset of motor block and complete recovery of power) were assessed. Haemodynamic monitoring was conducted every five minutes for the first hour and every 15 minutes until the end of the procedure. Adverse events, such as nausea, vomiting, sedation and respiratory depression, if any, were noted.
Statistical Analysis
Data was collected and tabulated into an Excel sheet. The data was expressed as means and percentages. Statistical analysis was conducted using Statistical Package for the Social Sciences {SPSS version 21.0 (14 days free trial)}, specifically through an unpaired t-test and the results are documented.
Both study groups were comparable in demographic characteristics such as age, weight, height and ASA grade (Table/Fig 2).
The onset of sensory block was faster in group RD compared to group R. Similarly, the onset of motor block was also earlier in group RD when compared to group R. The mean duration of sensory block was significantly longer in group RD than in group R. Likewise, the mean duration of motor block was also significantly longer in group RD compared to group R (Table/Fig 3).
The haemodynamic parameters, such as heart rate, systolic blood pressure and diastolic blood pressure, were similar in both groups intraoperatively and good haemodynamic stability was observed in both groups. There was significant difference in systolic and diastolic blood pressures between the groups. Additionally, there were no incidences of bradycardia, hypotension, or other side-effects in either group (Table/Fig 4).
Dexmedetomidine is being used for intravenous sedation, analgesia, regional anaesthesia and even in intensive care units for sedation. Its use in spinal and epidural anaesthesia as an adjuvant has increased in the recent past. Literature on its usage in SCB as an adjuvant is limited. Present study investigated the effect of adding dexmedetomidine to ropivacaine on the quality of anaesthesia (1),(7),(16). Ropivacaine is comparable to bupivacaine in all aspects, except for its decreased motor blockade, which helps in early, pain-free mobilisation of the limb. The duration of analgesia is shorter with the plain usage of local anesthetic in SCB compared to the utilisation of adjuvants. Dexmedetomidine is an excellent adjuvant to local anaesthetics for prolonging the duration of analgesia in SCB (17),(18).
In present study, demographic data regarding age, height, weight, gender and ASA physical status were comparable and the differences between the parameters among both groups were statistically not significant, which was similar to findings in other studies as well (1),(13). In present study, the ropivacaine with dexmedetomidine group (group RD) showed a faster onset of sensory block compared to the plain Ropivacaine group (group R) (4.78±1.68 mins vs. 7.87±1.98 mins, p-value<0.001). Similarly, the onset of motor blockade was earlier in group RD than in group R (8.4±2.34 mins vs. 12.3±2.95 mins, p-value<0.001). Similar findings were observed when using Dexmedetomidine as an adjuvant to Bupivacaine in SCB by Agarwal S et al., (19). Jun Z et al., also recorded similar findings in their study by using dexmedetomidine as an adjuvant to ropivacaine. Additionally, they concluded that dexmedetomidine reduced upper limb ischaemia-reperfusion injury caused by the tourniquet (20). Pandya N et al., also observed a faster onset, longer duration of blockade and longer duration of analgesia (15).
Present study analysed the effect of 25 μg of dexmedetomidine as an adjuvant to 30 mL of ropivacaine, as this dose of dexmedetomidine has been shown to reduce the chances of bradycardia and hypotension compared to higher doses, while still providing similar effects on sensory and motor block, analgesia and enhanced quality of the block. This dosing of ropivacaine has been studied in various other studies in SCB (21),(22),(23),(24). In present study, the mean duration of motor blockade was significantly longer in group RD than in group R (685±62.74 mins vs. 465±72.62 mins, p-value<0.001). Similarly, the duration of analgesia was longer in group RD than in group R (807.5±165.51 mins vs. 485±81.31 mins, p-value<0.001). Similar findings were documented by Sudani C et al., and Pandya N et al., who concluded that the utilisation of dexmedetomidine as an adjuvant to ropivacaine in SCB prolongs the duration of motor blockade and analgesia (1),(15).
Limitation(s)
As this study was conducted at a single centre, the findings may not be generalised. Large multricentric studies should be conducted in future for more generalised results.
Dexmedetomidine, administered as an adjuvant at a dose of 25 μg in combination with ropivacaine during an ultrasound-guided SCB, demonstrates a faster onset of sensory and motor block. It also prolongs the duration of sensory blockade, motor blockade and analgesia, resulting in decreased postoperative analgesic requirements and providing a high-quality block for patients. Additionally, it offers excellent haemodynamic stability with minimal complications, positioning dexmedetomidine as one of the best adjuvants to ropivacaine for SCB.
DOI: 10.7860/JCDR/2025/77638.20703
Date of Submission: Jan 01, 2025
Date of Peer Review: Jan 16, 2025
Date of Acceptance: Feb 10, 2025
Date of Publishing: Mar 01, 2025
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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