Administration Of Bupivacaine Research Articles

Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

ObjectivesTo evaluate the efficacy and safety of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery.DesignMeta-analysis.Data sources and study eligibility criteriaA comprehensive literature search, using Medline (1966–2014), the Cochrane Central...

Local anaesthetic systemic toxicity

Access the CPD MCQs for this issue online here ### Key points Well-placed local anaesthetics (LAs) can yield great clinical benefits. But systemic toxicity related to their use can be devastating. The highly publicized case in 2004 of Mayra Cabrera, a theatre nurse who died shortly after delivery of her baby boy when her epidural infusion of bupivacaine was mistakenly connected to her i.v. line, reminds us to be vigilant and to learn from such rare events. While prevention is clearly the most important element in avoiding morbidity and mortality associated with local anaesthetic systemic toxicity (LAST), such cases still occur despite best practice. Knowing how to manage these uncommon events is vital. In this review, we cover LA toxicity, its incidence, clinical features, risk factors, prevention, and management and examine i.v. lipid emulsion (ILE) therapy in more detail. LAST has been recognized for more than a hundred years, but the precise incidence is currently unknown. In 1928, the American Medical Association reported 40 deaths attributable to LAs.1 Cocaine was responsible for half of these deaths, but procaine was also implicated. These findings prompted the search for less toxic agents. Lidocaine, first synthesized in 1944, was the first amide LA to be used clinically. However, in 1979, the potentially fatal toxicity of amide LAs was highlighted by Albright.2 More recently, studies from 1993 …

Epinephrine reversed high-concentration bupivacaine-induced inhibition of calcium channels and transient outward potassium current channels, but not on sodium channel in ventricular myocytes of rats.

BackgroundEpinephrine is a first-line drug for cardiopulmonary resuscitation, but its efficacy in the treatment of bupivacaine-induced cardiac toxicity is still in question. We hypothesized that epinephrine can reverse cardiac inhibition of bupivacaine by modulating ion flows through the ventricular myocyte membrane channels of rats. The aim of this study was to observe and report the effects of epinephrine on high-concentration bupivacaine-induced inhibition of sodium (INa), L-type calcium (ICa-L), and transient outward potassium (Ito) currents in the ventricular myocytes of rats.MethodsThe ventricular myocytes were isolated from Sprague-Dawley rats (250-300 g) by acute enzymatic dissociation. The whole-cell patch clamp technique was used to record the ion channel currents in single ventricular myocytes both before and after administration of medications.ResultAdministration of bupivacaine 100 μmol/L significantly reduced INa, (P < 0.05). However, administration of bupivacaine 100 μmol/L in conjunction with epinephrine 0.15 μg/ml had no effect in restoring INa to its previous state. Similarly, a sharp decline of ICa-L and Ito was observed after administration of bupivacaine 100 μmol/L (P < 0.05). In contrast to INa, ICa-L and Ito were significantly improved after the administration of the aforementioned combination of bupivacaine and epinephrine (P < 0.05).ConclusionEpinephrine can reverse high-concentration bupivacaine induced inhibition of ICa-L and Ito, but not INa. Thus, epinephrine’s effectiveness in reversal of bupivacaine-induced cardiac toxicity secondary to sodium channel inhibition may be limited.

Comparación de bloqueo del plexo braquial por vía interescalénica y administración de anestésico local intraarticular en el manejo del dolor en el postoperatorio de cirugía artroscópica del hombro

Background and objectivesIn this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intraarticular bupivacaine carried out with bupivacaine. MethodsIn the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given vía intraarticular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia with morphine was used in all three groups for postoperative analgesia. ResultsIn the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24h was lower than in the other 2 groups. Morphine consumption in the IA group was lower than in the control group in the period from 0-6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6thh (P<.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6thh were lower than in the control group (P<.05). ConclusionISPBl plexus block was found to be more effective than intraarticular local anesthetic injection for postoperative analgesia.

Impact of liposome bupivacaine on the adequacy of pain management and patient experiences following aesthetic surgery: Results from an observational study

Background Despite the efficacy of opioid analgesics for postsurgical pain, they are associated with side effects that may complicate recovery. Liposome bupivacaine is a prolonged-release formulation of bupivacaine approved for intraoperative administration at the surgical site for postsurgical analgesia. Objectives To evaluate the effect of a single intraoperative administration of liposome bupivacaine on postsurgical pain, opioid use and opioid-related side effects in subjects undergoing breast surgery and/or abdominoplasty. Methods In the present phase IV, multicentre, prospective observational study, subjects received a single intraoperative administration (266 mg) of liposome bupivacaine. Rescue analgesia was available to all subjects as needed. Outcome measures, assessed through postoperative day 3, included postsurgical pain intensity (11-point numerical rating scale), opioid consumption and overall benefit of analgesic score. Results were evaluated comparing investigators' previous experience with similar surgeries. Results Forty-nine subjects entered the study: 34 underwent breast surgery only and 15 underwent abdominoplasty with or without breast surgery (six underwent breast surgery in addition to abdominoplasty). Mean numerical rating scale pain scores remained ≤4.3 from discharge through postoperative day 3. Median daily oral opioid consumption was approximately 1.0 tablet postoperatively on the day of surgery and was approximately 2.0 tablets by postoperative day 3. Mean overall benefit of analgesic score ranged between 2.8 and 4.9 throughout the study. Conclusion In this particular subject population, liposome bupivacaine was associated with low pain intensity scores and reduced opioid consumption compared with the investigators' previous experiences. Subjects' satisfaction with postsurgical analgesia was high, with a low burden of opioid-related side effects.

CANCER PAIN MANAGEMENT: ROLE OF INTRATHECAL ALCOHOL: A CASE REPORT

A 34 year old lady was found to be in acute pain due to metastatic phaeochromocytoma following involvement of L5, S1 & S2 vertebrae. She was treated with series of MIBG scanning and ablation and surgical option was refused by the patient. She was suffering from rapidly increasing radicular pain of the lower limbs which was being managed with oral and injectable opioids. The team of doctors treating her decided to give epidural opioids and bupivacaine initially but the total dose of the drug and frequency was found to be gradually increased. Therefore, continous administration of intathecal opiods and bupivacaine was given but the same problem occured after a few weeks and pain relief was minimal. Ultimately intrathecal absolute alcohol was given as there were no more options left. The patient had dramatic pain relief till her death.

Comparison of two bupivacaine delivery methods to control postoperative pain after enucleation in dogs

To compare the efficacy of a preoperative retrobulbar injection of bupivacaine to an intraoperative splash block of bupivacaine in controlling postoperative pain following enucleation in dogs. Prospective, randomized, double-masked clinical study of 31 client owned dogs with end-stage ophthalmic disease requiring enucleation. Dogs admitted for unilateral enucleation were randomly assigned to receive bupivacaine 0.5% (1 mL/kg) into the retrobulbar space either via an inferior-temporal palpebral (ITP) injection preoperatively or an intraoperative splash block. Pain was assessed prior to pre-anesthetic sedation and at 0, 0.25, 0.5, 1, 2, 4 6, 8, and 24 hours (H) after extubation by masked observers using a previously described subjective pain scoring system. Rescue analgesia was initiated if overall pain score was >9 or if the score in any category at any time point was >3. There were no adverse reactions. One of 15 dogs that received bupivacaine via a preoperative retrobulbar ITP injection required rescue analgesia. There was no significant difference between groups with regard to the need for rescue analgesia or pain scores at any time point or overall. Pain control using an intraoperative orbital splash administration of bupivacaine is not significantly different to a preoperative retrobulbar injection of bupivacaine.

Impact of liposome bupivacaine on the adequacy of pain management and patient experiences following aesthetic surgery: Results from an observational study.

Despite the efficacy of opioid analgesics for postsurgical pain, they are associated with side effects that may complicate recovery. Liposome bupivacaine is a prolonged-release formulation of bupivacaine approved for intraoperative administration at the surgical site for postsurgical analgesia. To evaluate the effect of a single intraoperative administration of liposome bupivacaine on postsurgical pain, opioid use and opioid-related side effects in subjects undergoing breast surgery and/or abdominoplasty. In the present phase IV, multicentre, prospective observational study, subjects received a single intraoperative administration (266 mg) of liposome bupivacaine. Rescue analgesia was available to all subjects as needed. Outcome measures, assessed through postoperative day 3, included postsurgical pain intensity (11-point numerical rating scale), opioid consumption and overall benefit of analgesic score. Results were evaluated comparing investigators' previous experience with similar surgeries. Forty-nine subjects entered the study: 34 underwent breast surgery only and 15 underwent abdominoplasty with or without breast surgery (six underwent breast surgery in addition to abdominoplasty). Mean numerical rating scale pain scores remained ≤4.3 from discharge through postoperative day 3. Median daily oral opioid consumption was approximately 1.0 tablet postoperatively on the day of surgery and was approximately 2.0 tablets by postoperative day 3. Mean overall benefit of analgesic score ranged between 2.8 and 4.9 throughout the study. In this particular subject population, liposome bupivacaine was associated with low pain intensity scores and reduced opioid consumption compared with the investigators' previous experiences. Subjects' satisfaction with postsurgical analgesia was high, with a low burden of opioid-related side effects.

Hypothermia Following Intra-Thecal Morphine Injection during Cesarean Section a Case Report and Literature Review

Introduction: Perioperative hypothermia is a common phenomenon with a wide differential diagnosis. We present a unique case of hypothermia following cesarean section under spinal anesthesia. Case report: A 32 years old female, first IVF pregnancy with twins, underwent cesarean section under spinal administration of bupivacaine and morphine. About four hours after operation’s end, body temperature was measured at 35.4oC per rectum, which later reached a nadir of 32.8oC, restoring to normal range only after four hours. During the incident, the patient was hemodynamically stable, with vital signs at the normal range. Discussion: This case presents differential diagnoses, the most relevant of which are infection, hypovolemia, endocrinopathy, environmental conditions, iatrogenic causes and the administration of anesthetics. We discuss supporting and contradicting evidence for each relevant diagnosis, reaching a concluding diagnosis of intrathecalmorphine induced hypothermia. Summary: This case highlights the importance of differential diagnosis and temperature follow-up after spinal injection of morphine.

Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy.

Background:Nonsteroidal anti-inflammatory drugs used for postoperative analgesia have considerable adverse effects, with paracetamol having a different mechanism of action, superior side effect profile and availability in intravenous (IV) form, this study was conducted to compare intra-peritoneal bupivacaine with IV paracetamol for postoperative analgesia following laparoscopic cholecystectomy.Aim:The aim was to compare the efficacy of intra-peritoneal administration of bupivacaine 0.5% and IV acetaminophen for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.Settings and Design:Randomized, prospective trial.Materials and Methods:A total of 60 patients of American Society of Anesthesiologists physical Status I and II scheduled for laparoscopic cholecystectomy were enrolled for this study. Group I received 2 mg/kg of 0.5% bupivacaine as local intra-peritoneal application and Group II patients received IV 1 g paracetamol 6th hourly. Postoperatively, the patients were assessed for pain utilizing Visual Analog Scale (VAS), Visual Rating Prince Henry Scale (VRS), shoulder pain. The total number of patients requiring rescue analgesia and any side-effects were noted.Statistical Analysis:Data analysis was performed using Students unpaired t-test. SPSS version 11.5 was used.Results:The VAS was significantly higher in Group I compared with Group II at 8th, 12th and 24th postoperative hour. At 1st and 4th postoperative hours, VAS was comparable between the two groups. Although the VRS was higher in Group I compared with Group II at 12th and 24th postoperative hour; the difference was statistically significant only at 24th postoperative hour. None of the patients in either of the groups had shoulder pain up to 8 h postoperative. The total number of patients requiring analgesics was higher in Group II than Group I at 1st postoperative hour.Conclusion:Although local anesthetic infiltration and intra-peritoneal administration of 0.5% bupivacaine decreases the severity of incisional, visceral and shoulder pain in the early postoperative period, IV paracetamol provides sustained pain relief for 24 postoperative hours after elective laparoscopic cholecystectomy.

Effect of ondansetron on sensory level produced by intrathecal bupivacaine

Background: For spinal anesthesia there are drugs which can increase the level and quality of analgesia. Any drug which decreases sensory block level in spinal anesthesia is of great concern as it may need analgesic, sedative, supplement or even conversion to general anesthesia. Ondansetron is one such drug which has been reported to decrease the height of sensory block achieved after subarachnoid administration of bupivacaine. In this prospective observational study, we studied the effect of administration of ondansetron on the level of the sensory block achieved after subarachnoid blockade. Methods: In Group II, 4 mg ondansetron was given and 15 mins before giving spinal anesthesia Group II against control group receiving 2 ml saline intravenous (Group I). 15 mins before giving spinal anesthesia. Both groups received 3.5 ml of bupivacaine heavy was given intrathecally. Sensory and motor block was assessed 5, 15, and 30 mins. We analyzed both highest spinal block level achieved and time to regress to L1 level. Results: We found that in Group II both highest level of sensory block (T6 by median method) duration to regress to L1 level (1.43±0.22 hrs) was lesser as compared to group I and Group III T4 by median method and time to regress from T6 to L1 Group I 2.03±0.06 hrs Group III 1.84±0.27 hrs. Motor block did not differ between groups. Conclusions: We concluded that probably ondansetron was responsible for lower spinal block level and early recovery from spinal anesthesia after intrathecal bupivacaine and should not be given empirically for nausea and vomiting.

A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection

Background: Iatrogenic meningitis after spinal anesthesia is a rare condition. Most cases of iatrogenic meningitis have a bacterial etiology; however, there are a few reports of chemical meningitis associated with intrathecal administration of bupivacaine. Case Report: A 74-year-old man underwent cystoscopy, with anesthesia by intrathecal bupivacaine hydrochloride injection. Two hours post-procedurally, he complained of a severe headache and his mental status subsequently deteriorated from alertness to confusion. Cerebrospinal fluid examination on the day of admission showed an increase in cell count (841/mm 3 ; polymorphonuclear 78%: mononuclear 10%) and total protein (460 mg/dL). His clinical findings and laboratory abnormalities were consistent with the diagnosis of bupivacaine-induced chemical meningitis, rather than the bacterial meningitis. Conclusion: We report a case of chemical meningitis after spinal anesthesia with bupivacaine. Differential diagnosis should include chemical meningitis in cases of meningitis after spinal anesthesia. J Neurocrit Care 2014;7(2):122-124

A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection

Background: Iatrogenic meningitis after spinal anesthesia is a rare condition. Most cases of iatrogenic meningitis have a bacterial etiology; however, there are a few reports of chemical meningitis associated with intrathecal administration of bupivacaine. Case Report: A 74-year-old man underwent cystoscopy, with anesthesia by intrathecal bupivacaine hydrochloride injection. Two hours post-procedurally, he complained of a severe headache and his mental status subsequently deteriorated from alertness to confusion. Cerebrospinal fluid examination on the day of admission showed an increase in cell count (841/mm3; polymorphonuclear 78%: mononuclear 10%) and total protein (460 mg/dL). His clinical findings and laboratory abnormalities were consistent with the diagnosis of bupivacaine-induced chemical meningitis, rather than the bacterial meningitis. Conclusion: We report a case of chemical meningitis after spinal anesthesia with bupivacaine. Differential diagnosis should include chemical meningitis in cases of meningitis after spinal anesthesia. Key Words: Meningitis; Spinal anesthesia; Bupivacaine

Effects of opium addiction on level of sensory block in spinal anesthesia with bupivacaine for lower abdomen and limb surgery: a case-control study.

Background:In clinical practice, the level of sensory block in spinal anesthesia in opium abusers is lower than that in non-abusers because of adaptive changes caused by opium use.Objectives:The aim of this study was to investigate the level of sensory block resulting from the intrathecal administration of 0.5% bupivacaine in opium abuser patients undergoing lower extremity and lower abdominal surgeries.Patients and Methods:A total of 100 patients who were candidates of elective lower extremity orthopedic and lower abdominal surgeries were recruited and assigned to two groups based on their history of opium addiction (Case or control). Both groups underwent the same anesthesia procedure and pinprick test was used to assess the level of anesthesia.Results:No statistically significant difference was observed between groups regarding age, duration of the surgery, and type of surgery. The frequency of addiction was higher in males than in females. The level of sensory block at three minutes was significantly lower in the opium abuser group (P = 0.006). The mean time to achieve T10 sensory block was 10.33 ± 5.79 minutes in the opium abusers and 6.89 ± 3.88 minutes in the controls (P = 0.001). The level of the highest sensory block was lower in the opium abuser group (P = 0.002).Conclusions:The findings of this study suggested that after induction of spinal anesthesia with intrathecal administration of bupivacaine, chronic opium abusers would have a lower level of sensory block in comparison with patients without a history of opium abuse.

Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

Background and objectivesIn this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. MethodsIn the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. ResultsIn the ISPB group, morphine consumption in the periods between 0–4, 6–12 and 12–24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6th hours (p<0.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p<0.05). ConclusionInterscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

The effect of liposomal bupivacaine injection during total hip arthroplasty: a controlled cohort study.

BackgroundMultimodal analgesia following total hip arthroplasty has been shown to improve patient satisfaction, participation with physical therapy, and allow early return to self care. Liposomal bupivacaine is a formulation of local anesthetic which has the potential to provide anesthesia for up to 72 hours following administration. The purpose of this study was to compare the effectiveness of liposomal bupivacaine with bupivacaine following total hip arthroplasty.MethodsA retrospective chart review was performed on 28 patients undergoing total hip arthroplasty or hip resurfacing who received intraoperative administration of liposomal bupivacaine. A control group of 30 patients who had previously undergone total hip arthroplasty or hip resurfacing and had received intraoperative administration of bupivacaine also underwent a chart review. Length of stay, post-operative opioid use, and pain scores were compared for both groups.ResultsThe average length of stay in the study group was 1.93 days and the control group length of stay was 2.47 days (p ≤ 0.05). Morphine equivalent use was less in the study group during the first 24 hours compared to the control group (p ≤0.05). During the second and third 24 hours the morphine equivalent use difference was not statistically significant. Visual analogue scores were not significantly different between groups at any time point.ConclusionLiposomal bupivacaine administration during total hip arthroplasty appears to decrease the need for opioid use post operatively and decrease length of stay. The results of this study justify the need for a well-designed randomized controlled trial utilizing liposomal bupivacaine as part of multimodal analgesia during THA.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-310) contains supplementary material, which is available to authorized users.

Changes in neuronal ionic currents after extracellular and intracellular administration of afobazol and bupivacaine

The action of anxiolytic afobazol (2-mercaptobenzimidazolum derivative) in concentration 1 mM and local anesthetic bupivacaine in concentrations 0,5-1 mM on ionic currents of isolated neurons of Lymnaea stagnalis and Planorbarius corneus was studied. The method of intracellular dialysis was used in the experiment. Afobazol and bupivacaine after intracellular administration was shown not to possess their inhibition effect of ionic currents, typical for extracellular administration of drugs. It is suggested that pharmacological targets or bindind sits for these drugs are located on external surface of neuronal membrane.

The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study

BackgroundLabor epidural analgesia is highly effective, but can be limited by slow onset and incomplete blockade. The administration of warmed, compared to room temperature, bupivacaine has resulted in more rapid onset epidural anesthesia. We hypothesized that the administration of bupivacaine with fentanyl at 37°C versus 20°C would result in improved initial and ongoing labor epidural analgesia. MethodsIn this prospective, randomized, doubled blinded study, 54 nulliparous, laboring women were randomized to receive epidural bupivacaine 0.125% with fentanyl 2μg/mL (20mL initial and 6mL hourly boluses) at either 37°C or 20°C. Pain verbal rating scores (VRS), sensory level, oral temperature, and side effects were assessed after epidural loading (time 0), at 5, 10, 15, 20, 30, 60min, and at hourly intervals. The primary outcome was the time to achieve initial satisfactory analgesia (VRS ⩽3). Secondary outcomes included ongoing quality of sensory blockade, body temperature and shivering. ResultsThere were no differences between groups in patient demographics, initial pain scores, cervical dilatation, body temperature or mode of delivery. Epidural bupivacaine at 37°C resulted in shorter mean (±SD) analgesic onset time (9.2±4.7 vs. 16.0±10.5min, P=0.005) and improved analgesia for the first 15min after initial bolus (P=0.001–0.03). Although patient temperature increased during the study (P<0.01), there were no differences between the groups (P=0.09). Six (24%) and 10 (40%) patients experienced shivering in the 37°C and 20°C groups, respectively (P=0.23). ConclusionsThe administration of epidural 0.125% bupivacaine with fentanyl 2μg/mL at 37°C versus 20°C resulted in more rapid onset and improved labor analgesia for the first 15min. There was no evidence of improved ongoing labor analgesia or differences in side effects between groups.

Intraperitoneal bupivacaine effect on postoperative nausea and vomiting following laparoscopic cholecystectomy.

Background:Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors.Objectives:The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV.Patients and Methods:This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times.Results:There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation.Conclusions:Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.

English

INTRODUCTION: Central neuraxial blocks with local anaesthetics are popular techniques of anaesthesia which have been extensively used for lower abdominal surgery. Subarachnoid block is a simple technique which requires a small dose of local anaesthetic to provide rapid and reliable surgical anaesthesia and minimal risk of drug toxicity. Duration of spinal anaesthesia may be prolonged by addition of opioids, clonidine, neostigmine, or vasoconstrictor agents to the local anesthetic drug for better post-op pain relief. Intrathecal addition of a low dose of α2-agonist like clonidine or dexmedetomidine results in significant prolongation of the duration of the sensory and motor blockade induced by hyperbaric bupivacaine. This study is designed to investigate the effects of intravenous dexmedetomidine on the duration of sensory and motor blockade induced by intrathecal administration of bupivacaine, and its associated adverse events. AIMS AND OBJEVCTIVES: To determine effect of intravenous Dexmedetomidine on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess the incidence of intra operative side effects, if any. STUDY SETTING: This study was done under the department of Anaesthesiology, Azeezia Medical College from March 2013 to October 2013. STUDY DESIGN: A double blind prospective randomized control study was done.50 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named A and B using computer generated randomization. INTERPRETATIONS AND CONCLUSION: The duration of analgesia of subarachnoid block with heavy 0.5% bupivacaine with intravenous infusion of saline and dexmedetomidine were compared. Post-operative pain was evaluated by Visual Analogue Scale. Duration of analgesia is the time taken from the administration of the drug to the time when the patient complains of pain of > 50 in Visual Analogue Scale. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. There were no significant differences between the groups for the time of onset of sensory blockade and time to achieve maximum sensory blockade. Incidence of hypotension and bradycardia were not clinically and statistically significant in both groups. Incidence of postoperative nausea and vomiting was also similar in both the groups. Side effect like respiratory depression not observed in either group. In conclusion, Intravenous infusion of dexmedetomidine added to subarachnoid block with bupivacaine offered prolonged analgesia in adult patients undergoing herniorrhaphies, without increasing the