English

Abstract

Epidural Analgesia is used for relief of pain during and following surgical operations, for relief of chronic pain, for relief of pain in labour, reduction of bleeding by producing sympathetic blockade and hypotension during surgery or to supplement light general anaesthesia, thereby suppressing the transmission of afferent impulses and autonomic and hormonal response to surgery. The commonly used drugs for epidural analgesia are 2% xylocaine and 0.5% bupivacaine. Mixing of the local anaesthetics and altering the pH have been found to be safe and cost effective.1,2 our study was a prospective randomized controlled double blind study to investigate effect of the benefits of usage of a compounded solution (2% xylocaine and 0.5% bupivacaine in a 1:1 ratio) over a single drug (0.5% bupivacaine) and ascertain whether it can be recommended for routine use in epidural analgesia in regular anaesthetic practice.3,4,5 The following parameters are Studied 1) The time of onset of analgesia. 2) The quality of analgesia. 3) The degree of motor blockade. 4) Duration of analgesia. 5) Safety of compounding local anaesthetics. METHODS AND MATERIAL: One Hundred Adult Patients of either sex ranging between 20-60 years of age belonging to ASA grade 1 and II were studied. All patients were at random divided into 2 groups fifty in each group. Group A received 0.5% bupivacaine 15cc. Group B received a mixture of 0.5% bupivacine and 2% xylocaine (7.5cc + 7.5cc) RESULTS: Mean time of onset of analgesia in group B was lower (11.50 + 2.05) as compared to group A (22.24 + 2.18) and this difference was statistically highly significant (P<0.001). 16% of group A and 6% of group B required to be changed over to general anaesthesia. Grade IV motor blockade was seen only in 24% of group A and 30% of the group B which is significant. Mean duration of action in group A was higher (128.90 + 6.70) than in group B (98.30 + 5.29) and this difference was statistically significant. CONCLUSIONS: The compounded solution of 0.5% bupivacaine and 2% lignocaine in 1:1 ratio totaling 15cc is superior to 0.5% bupivacaine alone as single agent for epidural blockade in view of rapid onset, better motor and sensory blockade, and better quality of analgesia and less incidence of complications.