Anesthesia For Lower Abdominal Surgery Research Articles

COMPARATIVE EVALUATION BETWEEN INTRATHECAL HYPERBARIC ROPIVACAINE 0.75% ALONE VERSUS INTRATHECAL HYPERBARIC ROPIVACAINE 0.75% AND DEXMEDETOMIDINE IN LOWER ABDOMINAL SURGERIES

Objective: Spinal anesthesia is preferred for lower abdominal surgeries due to its benefits like reduced stress response and lower risk of complications. However, the limited duration of local anesthetics has led to the exploration of adjuvants like dexmedetomidine, which is known to enhance and prolong the anesthetic effect without significant respiratory depression. Methods: This prospective, randomized study involved 60 ASA I-II patients undergoing lower abdominal surgery, divided into three groups: Group A received intrathecal hyperbaric ropivacaine 0.75% with normal saline, Group B with ropivacaine 0.75% and 2.5 mcg dexmedetomidine, and Group C with ropivacaine 0.75% and 5 mcg dexmedetomidine. The study measured onset and duration of sensory and motor block, hemodynamic parameters, and side effects. Results: Adding dexmedetomidine enhanced the onset and duration of both sensory and motor blocks. Group C, which received 5 mcg dexmedetomidine, showed the fastest onset and longest duration of block, with stable hemodynamics and minimal side effects compared to ropivacaine alone. Conclusion: The study concludes that intrathecal dexmedetomidine at 5 mcg with ropivacaine 0.75% significantly improves the efficacy of spinal anesthesia for lower abdominal surgeries, suggesting that this combination could be an effective and safe option for enhancing surgical anesthesia.

Effect of Intravenous versus Intrathecal Dexmedetomidine on Potentiation of Spinal Anesthesia in Lower Abdominal Surgeries in Pediatric Patients

Abstract Background regional anesthesia in children was first studied by August Bier in 1899. Since then, spinal anesthesia was practiced for years, and several cases were published in 1909- 1910. After some years, it fell into disuse owing to the introduction of various muscle relaxants and inhalational agents. Aim of the Work to compare the effectiveness and feasibility of dexmedetomidine intravenously and intra-thecally in potentiation and prolongation of spinal anesthesia in pediatric population undergoing lower abdominal surgeries. Patients and Methods this study is a prospective randomized single-blind Clinical trial. study setting pediatric surgery operating theatre, Ain Shams University Hospitals, Cairo, Egypt. Study Period 6 months. This study was carried out on children aging from 1year till 7 years of age who were undergo elective lower abdominal surgeries. Results the major obstacle for routine use of spinal anesthesia in pediatric patients is the short block duration provided with the plain SAB hence the use of adjuvants to overcome this defect were considered. The current clinical trial attempts to synthesize the evidence regarding the safety and efficacy of dexmedetomidine as an adjuvant with the most common spinal anesthetic, bupivacaine. The intrathecal route appear more effective in prolongation of duration of motor block and maintaining an adequate sensory level with slower two segment regression course which can be explained by the previously speculated anti-nociceptive effects of the intrathecal route of dexmedetomidine and its action at the level of spinal cord. Intravenous route seems to provide deeper level of sedation when compared to intrathecal route which can be explained by its higher level and bioavailability in the blood which provides a more satisfactory centrally inhibiting action. Conclusion dexmedetomidine as an adjunct to spinal anesthesia in pediatric lower abdominal surgeries either intravenous or intrathecal can potentiate the motor and sensory block and provide good postoperative analgesia without exerting hemodynamic compromise or significant adverse events. While intrathecal route provide better prolongation of the motor and sensory blockade and also provide longer postoperative analgesia than intravenous route.

Analgesic Efficacy of IV Dexamethasone vs Intrathecal Dexamethasone as an Adjuvant to Spinal Anesthesia in Lower Abdominal Surgeries

Analgesic Efficacy of IV Dexamethasone vs Intrathecal Dexamethasone as an Adjuvant to Spinal Anesthesia in Lower Abdominal Surgeries

Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery

Background & Objective: Postanesthetic shivering is one of the many complications during recovery that is marked by vasoconstriction and involuntary movements in several muscle groups and psychologically is an incredibly uncomfortable experience for the patient. The 5-HT3 receptor antagonist granisetron can potentially be used to manage postanesthetic shivering through the thermoregulation neurotransmission system. This study aims to compare the effects of administering 10 µg/kg or 40 µg/kg of granisetron intravenously on the grade of shivering post spinal anesthesia in lower abdominal surgeries. Methodology: This study was a single-blind experimental study conducted on 30 patients who underwent spinal anesthesia for lower abdominal surgeries in Dr. Hasan Sadikin Hospital Bandung. There were no statistical differences of age, weight, height, BMI, core temperature before anesthesia, block height, room temperature, total bleeding, input volume, duration of surgery, and use of ephedrine between the two intervention groups. Results: Administration of 40 µg/kg intravenous granisetron could maintain the body temperature above 36.56 °C , better than the 10 µg/kg intravenous granisetron with the lowest temperature at 35.31 °C. Regarding the grade of shivering, administration of 40 µg/kg granisetron IV was able to improve postanesthetic shivering up to grade 2 in 3 (20%) patients, while 10 µg/kg intravenous granisetron improved grade of shivering to grade 3 in 5 (33%) patients, these results were statistically significant (P < 0.05). Conclusion: In conclusion, administration of granisetron 40 µg/kg IV reduces the incidence and severity of shivering post spinal anesthesia, and maintains a better core temperature compared to granisetron 10 µg/kg IV.Keywords: 5-Ht3 Receptor Antagonist; Granisetron; Postanesthetic Shivering; Prophylaxis
 Citation: Wahid WR, Pradian E, Prihartono MA. Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery. Anaesth. pain intensive care 2023;27(4):553−557; DOI: 10.35975/apic.v27i4.2265
 Received: October 20, 2021; Reviewed: March 19, 2023; Accepted: June 22, 2023

Efficacy of Dexamethasone as an Adjuvant to Bupivacaine in Caudal Anaesthesia for Lower Abdominal Surgeries in Children

Efficacy of Dexamethasone as an Adjuvant to Bupivacaine in Caudal Anaesthesia for Lower Abdominal Surgeries in Children

Comparative study of intrathecal tramadol and fentanyl as adjuvants in lower abdominal surgeries

Spinal anesthesia is preferred choice of anesthesia in lower abdominal surgeries for a long time. However, the problem with this is limited duration of action, so for long duration surgeries alternatives are required.
 The aim: to compare the intra-operative effects of a low dose of intrathecal tramadol and intrathecal fentanyl with hyperbaric bupivacaine hydrochloride.
 Materials and methods: prospective randomized control study for a duration of study is one year. 50 patients, aged 18 years to 60 years, belonging to ASA physical status I and II, posted for elective lower abdominal surgeries under spinal anaesthesia were chosen.
 These patients were divided into two groups: group BT- this group of patients received 2.5 mL volume of 0.5 % hyperbaric bupivacaine with 25 mg of tramadol intrathecally. Group BF- this group of patients received 2.5 mL volume of 0.5 % hyperbaric bupivacaine with 25 μg of fentanyl intrathecally.
 Results: demographic parameters in both the groups are not statistically significant. The association between the differences in duration of surgeries of both the study groups is not statistically. The association between the differences in mean time of onset of sensory block and motor block of both the study groups was comparable with p>0.05
 The duration of sensory block (analgesia) and duration of motor block difference between the two means was statistically significant with p<0.0000001. The difference between the mean VAS score at 3 hours and at 20 hours was statistically significant with p<0.05. Among the study BT group, 52 % needed 2 analgesics and 48 % needed 3 doses of analgesics. Among BF group, 6 % needed only one dose of analgesics and 44 % needed 2 doses of analgesics. The difference between the two was statistically significant with p<0.000002. The association between the hemodynamic variables between both the groups at the end of procedure was statistically significant with p<0.05.
 Conclusions: Intrathecal fentanyl and tramadol produced a similar onset of sensory and motor blocks. Fentanyl provided better duration and quality of postoperative analgesia compared to tramadol

Prilocaine Fentanyl versus Bupivacaine-Fentanyl in Subarachnoid Anesthesia for Lower Abdominal Surgeries

Introduction and aim: Spinal anesthesia is a commonly and conveniently used for lower abdominal surgeries. The research on different drugs for spinal anesthesia is still ongoing to find out the standard and ideal drug. The current work aimed to compare efficacy and safety profile between prilocaine versus bupivacaine in spinal anesthesia for lower abdominal surgeries.
 Methodology: Ninety patients scheduled for elective lower abdominal surgeries were included and randomly assigned to one of two equal groups. All patients were preoperatively assessed by clinical and laboratory investigations. Hemodynamic monitoring was assessed intraoperatively every 5 minutes. Sensory and motor blockade and postoperative pain and time for first analgesic request were recorded. The primary outcomes were efficacy of block (onset of sensory block, onset and intensity of motor block and duration of action). The Secondary outcomes were hemodynamic changes, post-operative analgesia, and patient satisfaction.
 Results: The time for the onset of the highest sensory block was shorter among P than B group (5.91±1.84 vs 8.26±1.98 minutes, respectively). Similarly, the time for the onset of the highest motor block level and PACU length of stay (minutes) was significantly shorter among P than B groups. The postoperative pain score was reduced in P than B group. The time for first analgesic request was shorter among P than B group (192.44±11.21 vs 235.77±29.44 minutes). Sensory regression to L1 was shorter among P than B groups. The motor regarrisons at one hour showed significant difference. The postoperative systolic blood pressure was significantly reduced in B than P group, with increased hypotension in B than P group (17.8% vs 4.4%, respectively). On the other side, no significant difference was observed for other complications or satisfaction score.
 Conclusion: The combination of prilocaine and fentanyl is superior than bupivacaine and fentanyl for subarachnoid anesthesia in lower abdominal surgery.

A comparison of laryngeal mask airway I-gel and Supreme during general anesthesia for lower abdominal surgery in children

Background: Both laryngeal mask airway I-gel and Supreme have been available for clinical use, but there was no comparison between two devices. This study was designed to compare the efficacy and complications of the laryngeal mask airway I-gel and Supreme in children undergoing general anesthesia for lower abdominal surgery. Methods: One hundred and twenty children were randomly assigned to either the I-gel or the Supreme group (60 children in each group). All patients of the two groups received the same protocol of general anesthesia. Evaluation criteria included successful mask insertion rate, ease of insertion, insertion time, and number of adjustments needed during anesthesia maintenace and postoperative complications. Results: There were no differences in the demographic data between the two groups. The success rate of insertion in the first attempt of the I-gel group was 94.8% and the Supreme group (98.3%) (p>0.05). According to ease of placement, grade 1 (very easy) ratios of Supreme, and I-gel were 40% and 3.3%, respectively (p<0.01). The insertion time of the I-gel was longer than that of Supreme (p < 0.05). The rate of airway manipulations during anesthesia maintenance of Supreme, and I-gel group were 5% and 11.7%, respectively (p > 0.05). The most common complication was cough, with the rate of 17% in I-gel group and 5% in Supreme group (p<0.05). There were no differences in other complications between both groups. Conclusions: Both I-gel and Supreme provided a satisfactory airway during general anesthesia in children. Insertion of Supreme was significantly easier and more rapid than insertion of I-gel, and the incidence of cough after surgery was significantly lower with Supreme than I-gel. Key words: Laryngeal mask airway, I-gel, Supreme, children

698.16961 Original Article Anaesthesia Section Analgesic Effect of Intrathecal Nalbuphine in Comparison with Fentanyl as an Adjuvant with Hyperbaric Bupivacaine (0.5%) during Spinal Anaesthesia in Lower Abdominal Surgery: A Double-blinded Randomised Clinical Study

Introduction: Local anaesthetics are sometimes added with intrathecal adjuvants. Nalbuphine is a synthetic agonistantagonist of opioid μ receptor. Fentanyl is a highly potent lipophilic synthetic opioid with rapid onset of action and it acts like morphine. It can be used during spinal anaesthesia for the purpose of decreasing the postoperative pain. Aim: To compare the safety and efficacy of preservative free intrathecal nalbuphine and fentanyl as additives to intrathecal hyperbaric bupivacaine (0.5%) for spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical study was undertaken at Calcutta National Medical College and Hospital, India during March 2020 to August 2021 in which a total of 100 patients, belonging to American Society of Anaesthesiology (ASA) I and II and undergoing elective lower abdominal surgery, were randomised into two equal group of 50 each. Group N received intrathecally 0.5 mg of nalbuphine with 3 mL (15 mg) of 0.5% hyperbaric bupivacaine, and Group F received 25 µg of Fentanyl with 3 mL (15 mg) of 0.5% hyperbaric. Visual Analogue Scale (VAS) score, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at varied intervals during intraoperative and postoperative period. Results: Significantly lower (p<0.001) mean VAS scores was observed beyond six hour of postoperative period in the group F. No significant changes (p>0.05) in SBP, DBP, MAP and HR were there between the groups. Few adverse effects like (hypotension, bradycardia, nausea, vomiting) were observed more in the fentanyl group which was statistically insignificant (p>0.05). Conclusion: Intrathecal fentanyl as compared to nalbuphine produces a significant postoperative analgesia when administered as an adjuvant with hyperbaric bupivacaine in cases of lower abdominal surgery.

Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries: a randomized clinical study.

Introductionto evaluate the effects of intravenous (IV) dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries.Methodsthis prospective randomized double blind study was done on 60 patients with ASA grade I/II undergoing lower abdominal surgeries under bupivacaine spinal anaesthesia. They were allocated to group-1 and group-2. Group-1 (control group) received normal saline and group-2 (study group) received IV dexmedetomidine 1 µg/kg over 10 min as premedication. Five minutes after premedication, subarachnoid block (SAB) was given with 3 ml of 0.5% hyperbaric bupivacaine following which sensory and motor blockade, hemodynamic changes, sedation, and complications of the surgery were recorded and this data was analyzed statistically using χ2 test, corrected χ2 test, Fisher´s exact test, and test of proportion (Z-test).Resultsthe results of the present study showed that in group-2 there was significant decrease in the onset of sensory block, higher level of sensory blockade achieved, less time required to attain highest level of anaesthesia, prolonged time required for 2 dermatomal regression, prolonged duration of sensory blockade, prolonged duration of analgesia, decrease in onset of motor blockade, no significant increase in duration of motor blockade, there was overall hemodynamic stability except for few cases of bradycardia responding to atropine and hypotension responding to mephentramine, adequate and acceptable intraoperative sedation, and significantly less incidence of shivering in perioperative period.ConclusionIV infusion of dexmedetomidine 1 µg/kg body weight prior to SAB can be recommended to achieve better sensory blockade and adequate hemodynamic stability and sedation.

Comparative Study of Isobaric Levobupivacaine Alone and Isobaric Levobupivacaine with Fentanyl for Spinal Anaesthesia in Lower Abdominal Surgeries

Introduction: Levobupivacaine 0.5% and racemic bupivacaine 0.5% are equally effective in spinal anaesthesia with less systemic toxicity seen with levobupivacaine. Fentanyl has been used as an adjunct to racemic bupivacaine in spinal anaesthesia. This study was designed to study on the intrathecal use of 0.5% levobupivacaine with fentanyl in elective lower abdominal surgeries. Methods: A prospective randomized controlled double blind study was conducted in100 patients of ASA I and II physical status posted for elective lower abdominal surgeries under subarachnoid block, randomized into 2 groups with 50 patients each, received either 3 ml of 0.5% isobaric levobupivacaine (group L) or 2.8 mL of 0.5% levobupivacaine with fentanyl 10 µg in 0.2 mL (group F). Hemodynamic parameters, time for onset of sensory and motor blockade, maximum height of sensory block and total duration of sensory and motor blockade were recorded. Intraoperative or postoperative side effects werenoted. Results: There were no significant differences between the two groups in the haemodynamic changes, and quality of sensory and motor block. Anaesthesia was adequate and patient satisfaction was good in all cases. Sideeffects were minor and infrequent with both regimes. Conclusions: We conclude that,in terms of efficacy, 2.8 mL of 0.5% levobupivacaine with fentanyl 10µg is comparable to 3 mL of 0.5% levobupivacaine alone in spinal anaesthesia for lower abdominal surgeries. Further studies may be directed to find the optimal combination of levobupivacaine and opioid for spinal anaesthesia. Keywords: Levobupivacaine; Analgesics; Opioid; Fentanyl; Anesthetic techniques; Anaesthesia; Spinal.

A Prospective Randomised Double Blind Study of Intrathecal Fentanyl and Dexmedetomidine Added to Low Dose Bupivacaine for Spinal Anesthesia for Lower Abdominal Surgeries

Background and Aims. The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects and also to prolong analgesia. In this study, we aimed to find out whether quality of anaesthesia is better with low dose bupivacaine and fentanyl or with low dose bupivacaine and dexmedetomidine Methods. This prospective randomised double-blinded study was carried out in a AL-Zahra teaching Hospital a 150 patients by randomly allocating them into two groups using a computer generated randomisation table. Group F (n = 75) received bupivacaine 0.5% heavy (0.8 ml)+fentanyl 25 μg (0.5 ml) + normal saline 0.3 ml and Group D (n = 75) received bupivacaine 0.5% heavy (0.8 ml) + dexmedetomidine 5 μg (0.05 ml) + normal saline 0.75 ml, aiming for a final concentration of 0.25% of bupivacaine (1.6 ml), administered intrathecally. Time to reach sensory blockade to T10 segment, peak sensory block level (PSBL), time to reach peak block, time to two segment regression (TTSR), the degree of motor block, side-effects, and the perioperative analgesic requirements were assessed. Results. there were no significant differences between the groups in the time to reach T10 segment block (P > 0.05) and TTSR (P > 0.05);time to reach PSBL (P < 0.05) and modified Bromage scales (P < 0.05) were significant. PSBL (P = 0.000) and time to first analgesic request (P = 0.000) were highly significant. All patients were haemodynamically stable and no significant difference in adverse effects was observed. Conclusion .Both groups provided adequate anaesthesia for all lower abdominal surgeries with haemodynamic stability. Dexmedetomidine is superior to fentanyl since it facilitates the spread of the block and offers longer post-operative analgesic duration. Keywords : Dexmedetomidine, fentanyl, low dose bupivacaine, opioids, spinal anaesthesia DOI: 10.7176/JHMN/90-09 Publication date: June 30 th 2021

Comparative Study between Analgesic Effects of Intrathecal Administration of Midazolam Versus Tramadol with Bupivacaine for Infra-Umbilical Surgeries

Background: The administration of bupivacaine intrathecally as a regional anesthesia is commonly used to provide anesthesia for lower abdominal surgeries. The motor blockage of bupivacaine provides adequate blockage, which allows the surgeons to do their work comfortably and also provides effective postoperative analgesia in early postoperative period. However, adding adjuvants to the local anesthetics to prolong the period of postoperative analgesia after fading of the spinal anesthesia was tried in many studies. These supplements as regard to postoperative pain relief are beneficial as they decrease or abolish the need for the administration of analgesics and their associated complications. Objective: To compare the analgesic effect of intrathecal midazolam versus intrathecal tramadol when added to bupivacaine during spinal anesthesia after infra-umbilical surgeries. Patients and methods: In our study we included 80 patients scheduled for elective surgeries in the lower abdomen and lower limbs (infra-umbilical surgeries) under spinal anesthesia. They were randomly divided to one of two groups. Group M received 10 mg of hyperbaric bupivacaine + 2 mg midazolam, and group T received 10 mg of bupivacaine + 20 mg of tramadol (total is 3cc in both groups). The comparison was done by using the visual analogue scale (VAS) for assessing postoperative pain score and recording the duration of postoperative analgesia. Results: The postoperative analgesia duration was significantly higher in the tramadol group than midazolam group (P<0.05). Conclusion: Addition of 20 mg tramadol to bupivacaine during spinal anesthesia provides longer duration of analgesia when compared to intrathecal midazolam 2.0 mg.

Effects of intrathecal dexmedetomidine versus intravenous dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in Lower abdominal surgeries: A RCT

Dexmedetomidine is a highly selective α2-adrenoceptor agonist which produces dose-dependent sedation and analgesia without respiratory depression. It prolongs the duration of local anaesthetics by different routes of administration. This study was aimed to compare the effect of intrathecal (IT) versus intravenous (IV) dexmedetomidine on bupivacaine spinal anaesthesia in patients undergoing lower abdominal surgery. This prospective double-blinded randomized controlled study was conducted on 60 patients randomly divided equally into 2 groups. Group A (IT group) (n=30) received 3ml of 0.5% hyperbaric bupivacaine and 10μg of dexmedetomidine intrathecally and Group B (IV group) (n=30) received premedication with IV dexmedetomidine 0.5μg/kg and then 3ml of 0.5% hyperbaric bupivacaine plus 0.1ml of normal saline intrathecally. We observed that in bupivacaine spinal anaesthesia, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects as compared to premedication with IV dexmedetomidine.

Comparative Study between Analgesic Effects of Intrathecal Administration of Midazolam Versus Tramadol with Bupivacaine for Infra-Umbilical Surgeries

Background: The administration of bupivacaine intrathecally as a regional anesthesia is commonly used to provide anesthesia for lower abdominal surgeries. The motor blockage of bupivacaine provides adequate blockage, which allows the surgeons to do their work comfortably and also provides effective postoperative analgesia in early postoperative period. However, adding adjuvants to the local anesthetics to prolong the period of postoperative analgesia after fading of the spinal anesthesia was tried in many studies. These supplements as regard to postoperative pain relief are beneficial as they decrease or abolish the need for the administration of analgesics and their associated complications. Objective: To compare the analgesic effect of intrathecal midazolam versus intrathecal tramadol when added to bupivacaine during spinal anesthesia after infra-umbilical surgeries. Patients and methods: In our study we included 80 patients scheduled for elective surgeries in the lower abdomen and lower limbs (infra-umbilical surgeries) under spinal anesthesia. They were randomly divided to one of two groups. Group M received 10 mg of hyperbaric bupivacaine + 2 mg midazolam, and group T received 10 mg of bupivacaine + 20 mg of tramadol (total is 3cc in both groups). The comparison was done by using the visual analogue scale (VAS) for assessing postoperative pain score and recording the duration of postoperative analgesia. Results: The postoperative analgesia duration was significantly higher in the tramadol group than midazolam group (P<0.05). Conclusion: Addition of 20 mg tramadol to bupivacaine during spinal anesthesia provides longer duration of analgesia when compared to intrathecal midazolam 2.0 mg.

To Determine the Efficacy of Intrathecal Dexmedetomedine and Fentanyl as Adjuvants to Spinal Anesthesia for Lower Abdominal Surgeries Below the Level of Umbilicus - A Prospective Randomized Controlled Double Blinded Study

Abstract Background: Spinal anesthesia is widely used regional anesthesia technique; however, postoperative analgesia is a major problem. The duration of analgesia can be prolonged by the addition of intrathecal adjuvants. Hence, this study is aimed to assess the characteristics of spinal block between the groups. Patients and Methods: One hundred and twenty-six adult patients were enrolled in this study. Patients were randomized into three groups of 42 in each group by the computer-generated numbers. Group A received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 25 mcg fentanyl (0.5 ml), Group B received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 5 mcg dexmedetomidine (0.1 ml) + 0.4 ml normal saline (NS), and Group C received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 0.5 ml NS. Block characteristics and hemodynamic changes were recorded between the groups. Results: Time to achieve sensory block (T10) and motor block (M1) were faster in Group B when compared to Group A and C (P &lt; 0.001). Duration of sensory block and motor block was longer with Group B (450.12 ± 22.295 min and 390.12 ± 22.551 min) when compared to Group A (380.71 ± 13.331 min and 320.71 ± 13.403 min) and Group C (220.10 ± 14.635 min and 180.10 ± 14.355 min). Time for first rescue analgesia was also longer in Group B when compared to Groups A and C (P &lt; 0.001). Conclusion: Intrathecal dexmedetomidine provides effective prolongation of sensory and motor block as adjuvant to hyperbaric bupivacaine in spinal anesthesia.

Anelgesic Efficacy of Intra-Thecal Tramadol as a Spinal Adjunct to 0.5% Heavy Bupivacaine in Lower Abdominal Surgery

Introduction: Hyperbaric Bupivacaine is the most widely used local anesthetic. A number of adjuvants have been used with local anesthetic agents in order to improve the quality and duration of analgesia and anesthesia. This study was carried out to assess the efficacy of intrathecal Tramadol as a spinal adjunct to prolong the duration of spinal anesthesia in lower abdominal surgeries.&#x0D; Materials and Methods: Sixty patients aged between 18 to 80 years, were randomly divided into two groups - Tramadol and Placebo group. Spinal anesthesia was given by using 25 Gauge Quinke spinal needle in sitting position with midline approach. Patients belonging to Tramadol group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Tramadol (25mg) and patients belonging to Placebo group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Normal Saline. In the postoperative ward, duration of analgesia was assessed by the time when first rescue analgesia was given. Visual Analogue Scale for pain was noted at the time of rescue analgesia. The total amount of opioid consumed over 24 hour postoperative period was noted. Hemodynamic like heart rate, systolic, diastolic and mean arterial blood pressures were also noted. Data were analyzed using independent t-test for continuous variables and chi-square test for categorical variables, p value &lt;0.05 was considered significant.&#x0D; Results: The two groups were comparable with respect to age, weight, sex, ASA grading and duration of surgery. Mean duration of effective analgesia was 231.53 ± 22.00 min in Tramadol group and 125.40 ± 8.86 min in Placebo group (p = 0.001). The mean total amount of opioid consumption in 24 hours postoperative period was 145.00 ± 30.31 mg in Tramadol group and 171.67 ± 36.39 mg in Placebo group (p = 0.003). Mean of Heart rate, systolic, diastolic and mean arterial blood pressures were not significant between the two groups. Incidence of nausea and vomiting was statistically significant between the two groups with a p value of 0.010. Hypotension and bradycardia was statistically not significant between the two groups.&#x0D; Conclusion: Tramadol was effective adjuvant to hyperbaric bupivacaine for intrathecal use to increase the duration of spinal anesthesia in patients undergoing lower abdominal surgeries.

Spinal Versus Caudal Anesthesia in Lower Abdominal Surgeries in Pediatrics

Background: Regional anesthesia in pediatric surgery alone or combination with light general anesthesia provides several advantages, the most significant is intra- and post-operative pain relief. Aim of the work: This study aimed to compare spinal to caudal anesthesia in children undergoing lower abdominal surgeries regarding [sensory and motor block as a primary outcome], hemodynamics and postoperative pain as a secondary outcome. Patients and Methods:This study was a prospective randomized comparative clinical single-blind study. It included 40 children [ASA I or II] of both sexes, aged [3-9 years] undergoing lower abdominal surgeries. Patients were randomly assigned into one of two groups [20 patients in each group]. group [S] undergo spinal anesthesia, group [C] undergoes caudal anesthesia. To assess the following parameters; sensory and motor block, heart rate, mean arterial blood pressure and postoperative pain. Results: Spinal anesthesia has a rapid onset of sensory block, more intensity than caudal anesthesia, but of shorter duration. Caudal anesthesia provides more time of motor block than spinal anesthesia. There was no statistically significant difference between groups regarding mean arterial pressure, but caudal anesthesia has more tachycardia than spinal anesthesia, and caudal anesthesia provides better postoperative analgesia more than spinal anesthesia. Conclusion: Regional anesthesia in pediatrics is an effective and safe option. Caudal and spinal are both effective, however caudal have relatively more duration of postoperative analgesia and motor block than spinal anesthesia.

Evaluating the effect of intramuscular dexmedetomidine or clonidine on the duration of anaesthesia and analgesia for lower abdominal surgeries under sub-arachnoid block

Spinal anaesthesia in the form of subarachnoid block is the common modality of anaesthesia for lower abdominal surgeries. However, its main drawback is the limited duration of anaesthesia and analgesia. To overcome this several adjuncts to spinal anaesthesia have been tried by various routes to prolong the duration of action. We aimed at evaluating the effect of intramuscular Dexmedetomidine or Clonidine on the anaesthetic and analgesic effect after subarachnoid Bupivacaine.: 90 patients undergoing lower abdominal surgeries were randomized to 3 groups of 30 each to receive normal saline or 1µg/kg Dexmedetomidine or 2µg/kg Clonidine intramuscularly 30 minutes prior to spinal anaesthesia. Patient’s sedation score, duration of sensory, motor block and request for first analgesic following surgery were noted.: Baseline characteristics were comparable among the 3 groups, the onset time of sensory and motor block was not different for the 3 groups. Sedation was greater for the Dexmedetomidine and Clonidine group than the control. Duration of anaesthesia and analgesia was significantly prolonged in Dexmedetomidine group when compared to the others.Intramuscular Dexmedetomidine or Clonidine given by intramuscular route prior to lower abdominal surgeries prolongs the duration of anaesthesia and analgesia without causing significant side effects.

Effects of Adding Three Different Doses of Magnesium Sulfate to Bupivacaine in Epidural Anesthesia for Lower Abdominal Surgeries

Effects of Adding Three Different Doses of Magnesium Sulfate to Bupivacaine in Epidural Anesthesia for Lower Abdominal Surgeries