Administration Of Spinal Anesthesia Research Articles

Effect of intravenous palonosetron on hypotension induced by spinal anesthesia for cesarean section: A randomized controlled trial.

The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3-507.8 μg versus 428.0 μg [interquartile range, 305.0-507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.

Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions

: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

Impact of Temperature on the Quality of Local Anesthetic Effect during Subarachnoid Block

In contrast to general anesthesia, which affects the entire body, spinal anesthesia specifically targets a limited area, leading to a temporary loss of sensory and motor function. The duration of the effect varies on many factors depending on the specific anesthetic agent used, level of injections given and, baricity, dose, temperature and, many more factors. The temperature of the administered bupivacaine solution has been recognized as a potential modulator of its onset of action, influencing factors such as speed, depth, and duration of anesthesia. The temperature of the medication can influence the speed at which the local anesthetic takes effect. Warmer solutions may have a faster onset of action compared to colder ones. The duration of anesthesia may also be affected, with warmer solutions potentially providing a more prolonged effect. The temperature of the injected medication can influence the patient's comfort during the administration of spinal anesthesia. The present analysis indicates that there is a definite relationship between the temperature of the injected local anesthetic and the quality of the block achieved.

Global Issues in Obstetric Anesthesia: Perspectives From South Africa, Japan, China, Latin America, and North America

(Int J Obstet Anesth. 2023:54:103648) Anesthesia provision varies worldwide, and obstetric anesthesia in particular is highly variable. The first country discussed in this article is South Africa, which is classified as a low-income to middle-income country. South Africa has high patient mortality related to cesarean delivery. The epidural rates for labor in South Africa are &lt;5%, which is considered extremely low. Approximately one-third of maternal deaths investigated occurred following the administration of spinal anesthesia. In South Africa, it is 3 times more likely for maternal mortality to occur following cesarean delivery than vaginal birth. The mortality rates following a cesarean delivery in South Africa are also 50 times higher than in other regions of the world. Training has been implemented to reduce these statistics, although the level of preparedness following this training has been questioned.

Effect of Prewarming on Skin Temperature Changes After Spinal Anesthesia in Transurethral Resection of the Bladder

PurposeMonitoring of peripheral skin temperature changes is an objective and rapid method to evaluate the success of neuraxial block after spinal anesthesia. The aim of this study is to investigate the effect of prewarming on peripheral temperature changes after the administration of spinal anesthesia. DesignRandomized, prospective, single-blind study. MethodsIn this study, patients scheduled for transurethral resection of the bladder surgery under spinal anesthesia were divided into two groups: those with active prewarming and those without active prewarming. The groups were compared in core and skin temperature changes after administration of spinal anesthesia, length of stay in the postanesthesia care unit, shivering score, and the thermal comfort scale. FindingsA statistically significant difference was found between the groups on time for a 1 °C increase in ankle and toe skin temperatures (P < .001). There was a statistically significant difference between the groups in core temperature measurements (P < .001). When thermal comfort was compared between the groups, a statistically significant difference was found (P < .001). Patients' shivering score (P = .704), and length of stay in the postanesthesia care unit (P = .059) between the groups were similar. ConclusionsSkin temperature changes in the prewarming group were lower, and this group had a lower rate of increase than the nonprewarming group. Therefore, skin temperature changes in the lower extremity can be used to determine the success of spinal anesthesia in patients who are prewarmed, with the awareness of these differences.

Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection

Introduction: Spinal Anaesthesia (SA) has stood as the most favoured and dependable technique in regional anaesthesia for the past century. However, despite its widespread use, there are instances of occasional SA failure. Currently, there is no straightforward, cost-effective, and easily administered real-time test-aside from the positive aspiration of Cerebrospinal Fluid (CSF)-that can reliably confirm the deposition of local anaesthetic in the subarachnoid space. Aim: To evaluate the predictive value of subjective sensations (warmth/tingling/numbness) during the administration of SA for enhancing success rates. Materials and Methods: A prospective observational study preceeded the recruitment of 500 patients for this investigation. Following the confirmation of CSF aspiration upon injecting the SA drug, Bupivacaine, patients were queried about the sensations of warmth and/or tingling numbness in the lower limb, saddle part, and inner thighs. This assessment was conducted at 30 seconds and one minute after injection. Additionally, patients were asked to report any increase in the area and/or intensity of these sensations. The adequacy of SA was determined by achieving a sensory block upto the desired dermatome level and reaching a Bromage scale score of IV. Evaluations were performed at two minutes, five minutes, 10 minutes, and 15 minutes from the initiation of SA. Results: The population, predominantly ASA Class-I (60%) and II (40%), exhibited a median age of 45 years, with 54% being male. Intraoperative vital signs, including Heart Rate (HR), Systolic Blood Pressures (SBP), and Diastolic Blood Pressures (DBP), showed a consistent declining trend post-SA administration. Efficacy assessments revealed that Bromage Grade-IV was achieved in 99% of patients at 15 minutes. Notably, subjective sensations of warmth, tingling, and/or numbness proved to be robust predictors of successful SA, with a 218-fold increased likelihood. The diagnostic model demonstrated a high sensitivity of 98%, specificity of 85%, and a Positive Predictive Value (PPV) exceeding 99%. Conclusion: This study highlights the crucial role of warmth, tingling, and numbness as reliable indicators for successful SA, supported by a robust 97% success rate. Incorporating these patient-reported sensations in assessments provides a practical and accessible approach to improve the efficacy of SA procedures.

Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review.

Numerous advantages, including a quick start and consistent anesthesia, are provided by spinal anesthesia, a method often utilized in contemporary medicine for various surgical operations. However, it has some hazards, just like any medical procedure.With an emphasis on identifying and assessing the risk factors associated with administering spinal anesthesia, the review analyzes published literature and clinical investigations carried out in the field of anesthesia. Various key factors, including technique-related procedural and patient-related aspects, can influence the effectiveness of spinal anesthesia. Among these factors are age, sex, body mass index, concurrent conditions (such as cardiovascular disease, diabetes, and respiratory problems), pre-existing neurological issues, allergies, and a history of adverse responses to anesthesia drugs. Additionally, the chance of problems might be increased by physical abnormalities or malformations in the spinal canal and vertebral column. The safety and effectiveness of spinal anesthesia depend significantly on procedural factors, such as the type and dosage of anesthesia agents administered and the patient's position and alignment maintained during the entire surgical procedure and the injection rate. Increased risks can also be caused by inadequate monitoring and a slow response to unfavorable circumstances. Risk factors related to the technique include the expertise and competency of the anesthesiologist or medical professional carrying out the procedure. Inadequate post-procedure monitoring, inadvertent dural puncture, and improper needle placement might lead to complications during or after the spinal anesthesia administration. This review emphasizes the need for a complete preoperative assessment, suitable patient selection, and rigorous procedural planning to reduce the likelihood of problems during the administration of spinal anesthesia. It also emphasizes the significance of ongoing monitoring and timely management of adverse events to guarantee patient safety and the best results. Healthcare professionals may put preventative measures in place and follow best practices to limit possible consequences efficiently by recognizing the risk factors associated with spinal anesthesia. This review helps encourage safer anesthesia practices and improvepatient care as medical knowledge and technology advance. However, further study and evidence-based recommendations are required to enhance patient outcomes and risk assessment.

Administration of Spinal Anesthesia in the Jack-knife Prone Position for Anorectal Surgeries

At the institution, anorectal surgeries are often done in prone-jackknife position, under Monitored Anesthesia Care (MAC) combined with either local infiltration or intrathecal spinal anesthesia. The traditional technique for spinal anesthesia is done with 0.75% hyperbaric Bupivacaine in a sitting position and the patient remains in this position for 10-15 minutes before turning into a prone jackknife position for the surgery. The other approach for spinal anesthesia is done while patient is already in a jackknife prone position and using 0.25% hypobaric Tetracaine, former technique is easier than the latter however demands a longer knife-to-skin time and patients are potentially prone for more hemodynamic instability. In this case series, three male adults who underwent anorectal surgery in the jackknife position with jack-knife position for spinal anesthesia and mild MAC has been described. The operating time was more efficient, the perioperative course and recovery were uneventful. Patient and staff satisfactions were encouraging and promising for the jackknife spinal anesthesia technique. A short acting hyperbaric local anesthetic will further enhance efficiency by shortening recovery and discharge time.

Anesthesia Management in Laparotomy of Gastric Perforation Peritonitis: A Case Report and Literature Review

Gastric perforation has the potential to induce acute peritonitis, leading to intense pain and a significant mortality risk. A female patient, aged 67, presented with symptoms of intense abdominal pain affecting all regions of the abdomen and extending to the shoulder. The pain does not alleviate with rest and is aggravated by physical activity and coughing. The Chest X-ray examination revealed the presence of cardiomegaly, characterized by an enlarged heart and aortic elongation. The Abdomen X-ray examination revealed the presence of a pneumoperitoneum. Laparotomy may be conducted in individuals with gastric perforation to identify the pneumoperitoneum's underlying aetiology. The utilization of a concurrent administration of spinal anaesthesia (SA) and general anaesthesia (GA) demonstrates the effective reduction of hemodynamic impact during pneumoperitoneum while avoiding any associated adverse effects.

Role Of Granisetron In Minimising Use Of Meperidine As A Rescue Drug For Post Spinal Shivering.

Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug. Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron,15 minutes before spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not. 67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001). Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication.

Effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia in lower abdominal surgery, Randomized controlled trial

BackgroundThe purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia.MethodsTwo hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects.ResultsThe Dexa group had significantly delayed onset of 2 dermatomes regression (P < 0.001) compared to the control group. Additionally, the Dexa group had significantly longer duration of both sensory block (P = 0.01) and motor block (P < 0.001). The Dexa group had significantly longer duration until the first postoperative analgesic request (P < 0.001) and a lower incidence of side effects compared to the control group.ConclusionAlthough the intravenous administration of dexamethasone had a limited effect on the duration of hyperbaric bupivacaine spinal anesthesia, it improved postoperative VAS scores compared to the control group and decreased overall postoperative analgesic consumption. Therefore, it can be considered a valuable addition to postoperative multimodal analgesia strategies, aiming to minimize total analgesic consumption.Clinical trial registrationID: NCT04778189 (2/3/2021).

Magnitude and associated factors of post Dural puncture headache after spinal anesthesia in surgical patients at comprehensive specialized referral hospital, 2021: A multi-center cross-sectional study

BackgroundPost-Dural Puncture Headache (PDPH) is a common problem that happens after the Dura-arachnoid puncture during the procedure for diagnosis, therapy, and spinal anesthesia administration. This study aimed to assess the magnitude and associated factors of post-dural puncture headache (PDPH) after spinal anesthesia in surgical patients. MethodA multi-center institution-based cross-sectional study was conducted from September 1 to November 30, 2021, on 402 patients who came for an operation under spinal anesthesia. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) window version 26. Data were collected using a structured questionnaire. Descriptive statistics were expressed in percentages and presented with tables and figures. Both Bivariable and multivariable logistic analyses were done to identify the magnitude and associated factors of post-Dural puncture headache (PDPH) after spinal anesthesia in surgical patients. P < 0.05 with 95 % CI was set as statistical significance. ResultThe magnitude of post-Dural puncture headache (PDPH) after spinal anesthesia in surgical patients was 39.2[95 % CI = (34.7–44.1)]. Multivariable logistic analyses showed that being female [AOR = 3.5;95 %CI = (1.89,6.47)], patents who are nonsmokers [AOR = 2.3; 95 %CI = (1.23, 4.39)], cutting type of needle [AOR = 2.8;95 %CI = (1.39,5.68)] cephalic needle direction [AOR = 7.4;95 %CI = (3.95,14)] number of attempts more than two[AOR = 6.9; 95 %CI = (6.65,13.3)] were factors significantly associated with post-Dural puncture headache. ConclusionThe magnitude of post-Dura puncture headache (PDPH) after spinal anesthesia in surgical patients in this study was high. This study showed that a small spinal needle was much better than a large cutting spinal needle in the frequency of post-dural puncture headaches. In addition, the events were associated with frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage. We recommend the use of a small spinal needle; to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

Efficacy of spinal anesthesia—ultrasound guided versus landmark-based, in patients undergoing spinal anesthesia: a prospective cross-sectional study

Abstract Objective: This research aims to assess the effectiveness and practical value of ultrasound imaging (US group) in minimizing the discomfort and potential hazards associated with spinal anesthesia compared to traditional landmark-based (LM group) approaches. Materials and Methods: In this prospective, randomized comparative investigation, 80 patients were enrolled to undergo spinal anesthesia using either the landmark-based or ultrasound-guided method, with an equal distribution of 40 patients in each respective group. The study recorded various parameters, including evaluation duration, count of needle insertion attempts, instances of redirection, duration of spinal anesthesia, overall procedure time (comprising assessment and administration of spinal anesthesia), and measurement of intrathecal space depth. Patient comfort was evaluated employing a visual analog scale (VAS). Results: Demographic characteristics, including age, gender, and body mass index, exhibited no notable differences. The overall procedure time was approximately 2–3 min for the LM group and 3–4 min for the US group, with a statistically significant difference (P &lt; 0.0001). The initial successful needle insertion rate was considerably more critical in the US group (52.5%) than in the LM group (10%). The distance from the skin to the subarachnoid space was notably more remarkable in the US group, with a statistically significant distinction from the LM group (P = 0.034). The successful spinal needle placement rate was 77.5% in the US group, significantly surpassing the LM group’s rate of 25% (P &lt; 0.05). Regarding patient comfort assessed using the VAS, the US group demonstrated significantly greater comfort levels than the LM group. In the US group, every patient reported a VAS score of &lt;4, whereas only 27.5% achieved the same level of comfort in the LM group. Conclusion: Our study provides evidence supporting the utility of pre-procedural ultrasound evaluation of the subarachnoid space as an effective tool for achieving successful lumbar punctures in patients receiving spinal anesthesia. Compared to the traditional landmark technique, this approach reduces the number of attempts required while enhancing patient comfort.

A comparative study of intravenous fentanyl and ultrasound-guided femoral nerve block for positioning during spinal anaesthesia in femur fracture surgeries

Objective: To assist in the administration of spinal anesthesia for patients undergoing femur fracture procedures, we conducted comparison research to compare the analgesic efficiency of intravenous fentanyl against ultrasound-guided femoral nerve block (FNB). Material and Methods: A group of 112 patients ranging in age from 18 to 70 years old who had ASA Physical Status I and II and were having femur fracture procedures under spinal anaesthesia participated in the randomised, prospective, interventional trial. These individuals were divided into two groups through a random assignment process. Group FENT (n = 56) received Intravenous fentanyl 1 microgram/kilogram (µg/kg) and five minutes before positioning for spinal anaesthetic, group FNB (n = 56) received ultrasound-guided FNB with 20 millilitres (ml), 1.5% lignocaine and adrenaline (1:200,000). Results: Comparison of pain scores during positioning using the Visual Analog Scale (VAS) revealed that Group FENT had a score of 1.95 ± 0.585, whereas Group FNB had a score of 0.61 ± 0.562 (p-value 0.001). The FNB group demonstrated superior patient positioning quality. Patient satisfaction was similar in both groups, and no significant side effects were observed. Conclusion: FNB offers enhanced analgesia, improved patient positioning, higher patient satisfaction, reduced reliance on additional analgesia, and fewer side effects compared to intravenous fentanyl for spinal anesthesia.

A comparative study of intravenous fentanyl and ultrasound-guided femoral nerve block for positioning during spinal anaesthesia in femur fracture surgeries

Objective: To assist in the administration of spinal anesthesia for patients undergoing femur fracture procedures, we conducted comparison research to compare the analgesic efficiency of intravenous fentanyl against ultrasound-guided femoral nerve block (FNB). Material and Methods: A group of 112 patients ranging in age from 18 to 70 years old who had ASA Physical Status I and II and were having femur fracture procedures under spinal anaesthesia participated in the randomised, prospective, interventional trial. These individuals were divided into two groups through a random assignment process. Group FENT (n = 56) received Intravenous fentanyl 1 microgram/kilogram (µg/kg) and five minutes before positioning for spinal anaesthetic, group FNB (n = 56) received ultrasound-guided FNB with 20 millilitres (ml), 1.5% lignocaine and adrenaline (1:200,000). Results: Comparison of pain scores during positioning using the Visual Analog Scale (VAS) revealed that Group FENT had a score of 1.95 ± 0.585, whereas Group FNB had a score of 0.61 ± 0.562 (p-value 0.001). The FNB group demonstrated superior patient positioning quality. Patient satisfaction was similar in both groups, and no significant side effects were observed. Conclusion: FNB offers enhanced analgesia, improved patient positioning, higher patient satisfaction, reduced reliance on additional analgesia, and fewer side effects compared to intravenous fentanyl for spinal anesthesia.

Ketamine as a pre-emptive analgesia in patients undergoing caesarean delivery under spinal anesthesia

BACKGROUND &amp; OBJECTIVES: Lower segment caesarean section (LSCS) leads to moderate to severe pain in the patient. Pain severity is directly proportional to the functional limitations and depression in the postpartum period, making it essential to provide good pain relief after surgery. Maternal wellbeing and better nursing care of newborn requires good postoperative analgesia with minimal side effects. The main objective of the study was to evaluate the analgesic effect of intravenous low-dose ketamine, when administered pre-emptively, in patients undergoing caesarean delivery under spinal anesthesia.&#x0D; METHODOLOGY: Two groups were made, each with 50 full-term pregnant females with a plan of caesarean section under spinal anesthesia. Group-A received spinal anesthesia with bupivacaine 0.5% along with intravenous placebo of 2cc normal saline, whereas group-B received 0.5mg/kg ketamine intravenously after administration of spinal anesthesia but before the start of surgical incision. Pain intensity was monitored using a visual rating pain scale (VRS), till the need for the first analgesic dose postoperatively.&#x0D; RESULTS: Both groups were comparable in terms of age and weight. Analgesia was markedly prolonged, and postoperative pain scores were significantly less in Group-B (ketamine group) as compared to Group-A; with p-value&lt; 0.001, demonstrating analgesic properties of ketamine when administered pre-emptively as an intravenous dose.&#x0D; CONCLUSION: Our study concluded that pre-emptive analgesic dose of ketamine (administered before surgical incision), leads to prolong analgesia in post-operative period in patients who underwent LSCS under spinal anesthesia.

COMPARISON OF 0.5% LEVOBUPIVACAINE- FENTANYLAND 0.5% ROPIVACAINE-FENTANYL IN INFRAUMBILICAL SURGERIES

Spinal anaesthesia is a commonly performed procedure when the surgical site is located on the lower abdomen, perineum or lower extremities. The advantages are an awake and spontaneously breathing patient, minimal drug costs, reduction of poly-pharmacy and rapid patient turnover. Regional anesthesia techniques have seen numerous modifications over the last two decades with the advent of many new and safer local anesthetics. Presently, hyperbaric bupivacaine is the most commonly used drug for administration of spinal anaesthesia. Levobupivacaine and ropivacaine have recently become available in India for clinical use. Very few studies have been done comparing these two drugs in India. Hence, present study was undertaken to compare 0.5% Levobupivacaine (isobaric)-fentanyl(25µg) and 0.5% Ropivacaine (isobaric)-fentanyl(25µg)with regards to onset and duration of blockade infra umbilical surgeries in spinal anaesthesia. Methods and materials- this is a hospital based randomized double blinded comparative clinical study. Adult patients scheduled for elective infra umbilical surgeries under spinal anaesthesia. Eighty patients were randomized to two groups: group LF and RF (n=40 for each group). All patients received drug volume of 3.5ml containing 3 ml isobaric levobupivacaine (15 mg) + 0.5 ml (25 mcg) fentanyl in group LF, and 3ml isobaric ropivacaine (15mg) + 0.5 ml (25 smcg) fentanyl in group RF. The time for completion of intrathecal administration of study drugs injection is considered as TIME 0. The following parameters were observed – time of onset and duration of sensory block, motor block. Results: In the present study, mean onset of sensory block was faster in Group LF (5.25±0.74 min) than in Group RF (6.53 ± 0.51 min) and was statistically significant (p value &lt; 0.001). In the present study, mean onset of motor block was faster in Group LF (7.25±0.98 min) than in Group LF (11.2 ± 0.61 min) and was statistically significant (p value &lt;0.001). Conclusion: LF group provided better sensory and motor blockade with higher dermatome coverage than RF group.

Does change in cervical dilation after anesthesia impact latency after cerclage placement?

Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.

Effect of music listening on perioperative anxiety, acute pain and pain catastrophizing in women undergoing elective cesarean delivery: a randomized controlled trial

BackgroundAnxiety may adversely impact mother and her newborn. Music listening is a safe and efficacious treatment that may to reduce perioperative anxiety. The effect on acute pain and pain catastrophizing scores remains unclear. We aimed to determine whether perioperative music listening reduces anxiety, acute pain, and pain catastrophizing scale (PCS) scores following elective cesarean delivery under spinal anesthesia.MethodsAfter randomization into music listening and control groups, baseline patient characteristics, visual analog scale-anxiety (VAS-A) scores, pain scores, PCS total and sub-scores, and music preferences were collected preoperatively. Before surgery, parturients in the experimental group listened to music of their own choice for 30 min. Music listening was continued during administration of spinal anesthesia and cesarean delivery, and for 30 min following surgery. Postoperative VAS-A score, acute pain score, PCS scores, music preferences, satisfaction score, and feedback were recorded.ResultsWe analyzed 108 parturients (music: n = 53; control: n = 55). Music listening was associated with reduced postoperative VAS-A (mean difference (MD) -1.43, 95%CI -0.63 to -2.22), PCS total score (MD -6.39, 95%CI -2.11 to -10.66), PCS sub-scores on rumination (MD -1.68, 95%CI -0.12 to -3.25), magnification (MD -1.53, 95%CI -0.45 to -2.62), and helplessness (MD -3.17, 95%CI -1.29 to -5.06) sub-scores. There was no significant difference in postoperative acute pain scores. The majority (> 95%) of parturients reported “excellent” and “good” satisfaction with music listening, and most provided positive feedback.ConclusionPerioperative music listening was associated with reduced postoperative anxiety and lower pain catastrophizing. Based on the good patient satisfaction and positive feedback received, the use of music listening in the obstetric setting is recommended.Trial registrationThis study was registered on Clinicaltrials.gov NCT03415620 on 30/01/2018.