Anaesthesia For Lower Limb Surgery Research Articles

Comparison of Ropivacaine with or without Fentanyl in Spinal Anaesthesia for Lower Limb Surgeries

Introduction: Spinal anaesthesia is a preferred technique used for lower limb orthopaedic surgeries. Ropivacaine with its short duration of motor blockade and provision for early ambulation along with addition of spinal additives has proven beneficial to the patient. This prospective, double-blind, randomized controlled study set out to evaluate the effects of 0.75% isobaric ropivacaine with fentanyl versus 0.75% isobaric ropivacaine during lower limb orthopaedic surgeries performed under spinal anaesthesia. Methods: The study enrolled 74 patients, aged 18-65 years of either sex, ASA PS I and II, planned for lower limb orthopaedic surgeries. Patients were randomly allocated to receive either 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of normal saline (Group R) or 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of fentanyl (25mcg) (Group RF). Results: The demographic profile, onset time of sensory block to T10 dermatome, time for complete motor blockade, maximum block height, duration of motor block, and haemodynamic parameters did not significantly differ between the two groups. Group R took 200.27 ± 21.28 minutes for the S2 dermatome segment regression, while Group RF took 284.59 ± 32.88 minutes (p-value<0.001). Group RF experienced analgesia for a longer duration (335.68±22.18 min) than Group R (240.00±28.28 min) (p-value<0.001). Conclusion: Fentanyl greatly extends the duration of S2 segment regression and analgesia when combined with ropivacaine; the effects on haemodynamics and motor blockade is clinically negligible and side effects are minimal.

Comparison of Ropivacaine with or without Fentanyl in Spinal Anaesthesia for Lower Limb Surgeries

Introduction: Spinal anaesthesia is a preferred technique used for lower limb orthopaedic surgeries. Ropivacaine with its short duration of motor blockade and provision for early ambulation along with addition of spinal additives has proven beneficial to the patient. This prospective, double-blind, randomized controlled study set out to evaluate the effects of 0.75% isobaric ropivacaine with fentanyl versus 0.75% isobaric ropivacaine during lower limb orthopaedic surgeries performed under spinal anaesthesia. Methods: The study enrolled 74 patients, aged 18-65 years of either sex, ASA PS I and II, planned for lower limb orthopaedic surgeries. Patients were randomly allocated to receive either 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of normal saline (Group R) or 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of fentanyl (25mcg) (Group RF). Results: The demographic profile, onset time of sensory block to T10 dermatome, time for complete motor blockade, maximum block height, duration of motor block, and haemodynamic parameters did not significantly differ between the two groups. Group R took 200.27 ± 21.28 minutes for the S2 dermatome segment regression, while Group RF took 284.59 ± 32.88 minutes (p-value<0.001). Group RF experienced analgesia for a longer duration (335.68±22.18 min) than Group R (240.00±28.28 min) (p-value<0.001). Conclusion: Fentanyl greatly extends the duration of S2 segment regression and analgesia when combined with ropivacaine; the effects on haemodynamics and motor blockade is clinically negligible and side effects are minimal.

SPINAL ANESTHESIA WITH ROPIVACAINE FOR LOWER LIMB SURGERY

Objectives: To evaluate the anesthetic effect and impacts on respiration, circulation, and some undesirable consequences of spinal anesthesia with ropivacaine in patients who are scheduled for lower limb surgery. Methods: A clinical interventional study, a randomized group with comparative analysis on 70 patients who were indicated for lower limb surgery at the Department of Surgery - Anesthesia and Resuscitation, Military Hospital 121, Military Region 9 (Can Tho province) from November 2022 to June 2023, randomly divided into 2 groups: Group R (35 patients treated with ropivacaine) and group B (35 patients treated with bupivacaine). Evaluate and compare the criteria of anesthetic effects, intraoperative movement inhibition, and postoperative pain relief. Record the effects of some criteria on circulation, respiration, and unwanted effects related to the anesthetic method. Results: All patients in both groups achieved a good level of anesthesia. In lower limb surgery, the effective pain relief time following spinal anesthesia with ropivacaine was 145.09 ± 7.03 minutes, and the movement inhibition duration was 97.60 ± 7.10 minutes. The effects of ropivacaine on circulation and respiration were minimal, and its side effects, such as bradycardia (5.71%), hypotension (2.86%), and shivering (2.86%), were mild, temporary, and readily managed. Conclusion: Ropivacaine provided effective and safe spinal anesthesia for lower limb surgery, and short-term mobility, and provided pain relief postoperatively. It caused some modest, temporary side effects that were easily managed, but it had little influence on breathing and circulation.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (<0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Effect on Onset and Duration of Sensory and Motor Block with Single Bolus Dose of Intravenous Dexmedetomidine as an Adjuvant on Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Limb Surgery

Background: The hyperbaric bupivacaine is being widely used for spinal anesthesia in lower limb surgeries. Dexmedetomidine can be used intravenously as well as an intrathecal injection along with spinal anesthesia for surgery below the umbilicus.
 Materials and Methods: This was a prospective, randomized double blinded study, where 100 patients posted for elective lower limb surgery under spinal anesthesia were divided into two groups. Group A received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous infusion of 0.5 μg /kg/hour of dexmedetomidine over a period of ten minutes. Group B received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous normal saline over a period of ten minutes.
 Results: The onset of sensory block was 3.19 ± 0.31 minutes in group A whereas 4.5 ± 0.22 minutes in group B. The onset of motor block was 4.28 ± 1.02 minutes in group A whereas 7.12 ± 0.87 in group B. The onset and duration of sensory and motor block were statistically significant. Regarding duration of sensory block, group A had 186.5 ± 14.04 minutes whereas group B had 148.2 ± 11.31 minutes with p value <0.001. The duration of motor block was 142 ± 11.42 minutes in group A whereas 122.4 ± 8.28 minutes in group B with p value <0.001. The duration of postoperative analgesia was prolonged in group A when compared with group B.
 Conclusion: Dexmedetomidine used as a single intravenous injection along with spinal anesthesia with 0.5% bupivacaine tends to shortens the onset of both sensory and motor blocks and increases the duration of sensory and motor blocks. It also prolongs the duration of analgesia with minimal or no changes in hemodynamic parameters.

Effect of Dexmedotomin on spinal anesthesia in lower limb surgery.

Effect of Dexmedotomin on spinal anesthesia in lower limb surgery.

Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial

Background & Objective: Opioids and α2 adrenergic receptor agonists are commonly used as adjuvants to intrathecal local anesthetics to improve the quality and duration of spinal anesthesia (SA). Fentanyl and dexmedetomidine (DEX) are the most commonly used opioid and α2 agonist respectively. We compared the efficacy of these two when used as adjuvants to hyperbaric bupivacaine for SA for lower limb surgeries.
 Methods: A total of 54 patients were randomly assigned to receive unilateral spinal anesthesia with bupivacaine 2.5 ml. Group F (n = 27) received 25 μg fentanyl, and Group D received 10 μg DEX added to the spinal bupivacaine. Time to first analgesic request was the primary outcome, while sensory and motor block characteristics, nalbuphine consumption as rescue analgesic, pain scores, side effects and sedation levels were the secondary outcomes.
 Results: Patients receiving dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia for lower limb surgeries had a significantly longer time to rescue analgesia than those receiving fentanyl. The mean time to rescue analgesia in Group D was 409.63 ± 74.60 min vs. 295.93 ± 36.72 min (P = 0.000) in the Group F. Also, patients in Group D had significantly longer sensory and motor blocks.
 Conclusion: Intrathecal dexmedetomidine 10 μg seems to be a good alternative to fentanyl 25 μg when used as an adjuvant in unilateral spinal anesthesia for lower limb orthopedic surgeries with better quality postoperative analgesia and with minimal side effects.
 Abbreviations: DEX - Dexmedetomidine; NYHA - New York Heart Association; BMI - Body mass index; MBP - Mean blood pressure; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; VAS - Visual Analog Scale
 Key words: Dexmedetomidine; Fentanyl; Bupivacaine; Anesthesia, Spinal
 Citation: Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial. Anaesth. pain intensive care 2023;27(4):456−463. DOI: 10.35975/apic.v27i4.2191
 Received: March 30, 2023; Reviewed: April 22, 2023; Accepted: April 22, 2023

COMPARATIVE EVALUATION OF EPIDURAL BUPIVACAINE WITH MAGNESIUM SULPHATE AND LEVOBUPIVACAINE WITH MAGNESIUM SULPHATE IN GERIATRIC AGE GROUP IN LOWER LIMB SURGERIES

Introduction :Bupivacaine is local anaesthetic drug consist of R & S enantiomers. Levobupivacaine a cardiostable S enantiomer of Bupivaciane. Magnesium sulphate a promising noncompititive blocker of NMDA receptor by inhibition calcium Inux in cell. We want to study addition of Magnesium Sulphate to both Bupivacaine 0.5% & Levobupivacaine 0.5% for epidural anaesthesia in lower limb surgeries. to compare efcacy of epidural Inj. Bupivac Aims & Objectives: aine 0.5% plus Magnesium sulphate with Inj. Levobupivacaine 0.5% plus Magnesium Sulphate on onset of sensory & motor blockade, intraoperative hemodynamics , requirement of rst analgesiac & side effects in elderly patients posted for lower limb surgeries. A randomised prospective double blind Material and Method: study in 60 geriatric patient posted for lower limb surgeries. After epidural space identication Inj. Bupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group B or Inj. Levobupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group L. Onset of sensory blockade and motor blockade, two segment regression, demand of rst analgesic, intraoperative hemodynamics and postoperative complications were documented and compared Observation: Mean time required for onset of sensory block was 6.27±1.48 min in Group B and 6.3±1.76 min in group L respectively. onset motor block times of 7.43±1.38 in group B while 8.13±1.81 mins in group L which were No statistically signicant difference. Group L required 20.1±4.87 mins for reaching maximum sensory block compared to 13.33±2.17 mins in group B which was statistically signicant difference with early achievement of higher sensory level in group B. The time required for two segment regression was longer, at 133±19.01 minutes in group B compared to 114.47±10.28 minutes in the group L which found statistically signicant difference. Group B required rst analgesics quite latter 241.33±29.39 at mins compared to 203±20.54 mins in group L. This was found to be statistically signicant difference indicating that Bupivacaine is having longer duration of analgesia compared to Levobupivacaine. 3 patients had hypotension in group while 1 in group L. Shivering noticed 6 in Group L compared to 3 in group B. vomiting in 3 patients in each group.only 1 patient had itching in group b. Intraoperative hemodynamic parameters were having statistically insignicant difference. Conclusion: We can conclude that effect of Magnesium sulphate as an additive to Levobupivacaine and Bupivacaine provide good haemodynamic and respiratory stability, Comparable onset of sensory and motor blockade with prolongation of postoperative analgesia in bupivacaine group indicating that Bupivacaine with Magnesium sulphate provides prolonged analgesia as compared to Levobupivacaine with Magnesium Sulphate.

A COMPARATIVE STUDY OF CLONIDINE AS ADJUVANT TO ROPIVACAINE AND ROPIVACAINE ALONE IN EPIDURAL ANESTHESIA FOR LOWER LIMB SURGERIES

Introduction:Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Due to similar analgesic properties, lesser motor blockade and decreased cardiotoxic tendency ropivacaine is increasingly used instead of bupivacaine now a days. Clonidine has been frequently used as an adjunct to local anesthetics because it improves the quality of anesthesia, reduces the dose requirement of the anesthetic agent and provides a more stable cardiovascular course. Aims And Objectives: 1. To evaluate effect of ropivacaine alone in epidural anaesthesia for lower limb surgeries. 2. To evaluate effect of clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. 3. To compare effect of ropivacaine alone and clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. Material And Method: The study was conducted in the department of Anaesthesiology, GGS Medical College, Faridkot, after approval by Hospital Ethical Committee. Written informed consent was obtained from each patient. The total of 90 patients were allocated into 2 groups of 45 patients each:1.Group R (n=45) - 19 ml of 0.75% ropivacaine + 1 ml of normal saline (20 ml) 2.Group RC (n=45)-19 ml of 0.75% ropivacaine + 75μg of clonidine diluted to 1 ml (20 ml). The onset time for sensory and motor block, the maximum level of sensory block , duration of analgesia and side effects were recorded. The demographic prole were comparable in terms Results: of age, sex, weight which was statistically nonsignicant in both the groups. Clonidine group (RC) had rapid onset of sensory and motor blockade (p=0.001) and prolonged duration analgesia (p=0.001). There was no statistically signicant difference in HR, SBP, DBP, MAP monitored at various intervals between the two groups. Conclusion: The use of Clonidine as an adjuvant to Ropivacaine for epidural anaesthesia produces early onset of sensory and motor blockage and prolonged the duration of analgesia as compared to ropivacaine alone, with minimal changes in haemodynamic parameters and adverse effects.

Comparison of the efficacy of 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine for spinal anesthesia in lower limb surgeries

Various advantages of isobaric bupivacaine, levobupivacaine, and hyperbaric bupivacaine are described. There are no studies reliably determining the benefits of these forms of bupivacaine. The purpose of the study was to compare the efficacy of spinal anesthesia (SA) performed with 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine. The clinical study was approved by the ethics committee. The sample size was calculated for a confidence level of 99%. 111 patients were randomly allocated into 3 equal groups for spinal anesthesia in lower limb surgeries. In group 1 (1B) spinal anesthesia was performed with 3 ml of 0.5% isobaric bupivacaine (n = 37); in group 2 (2L)—3 ml of 0.5% levobupivacaine (n = 37), in group 3 (3H)—3 ml of 0.5% hyperbaric bupivacaine (n = 37). The criterion for assessing the effectiveness of anesthesia was the need to switch to another type of anesthesia (criterion-no anesthesia), or the need for additional use of narcotic analgesics or local anesthesia during surgery (criterion-reporting of painful feelings during the operation). In 1B anesthesia efficiency by the criterion of additional intraoperative analgesia was 100% (37 patients; 95% CI [0.88–1.0]); 2L—86.4%; (31 patients; 95% CI [0.68–0.92]); 3H—72.9% (27 patients; 95% CI [0.56–0.84]). There were significant differences between groups 1B and 2L: p < 0.05 (p = 0.0104). There were no significant differences between groups 2L and 3H (p = 0.2587). All patients in group 1B developed complete sensory block (++) within 4 (3; 5) min. In group 2L complete sensory block developed in 34 patients (89.4%) within 9 (5; 14) min, in group 3H sensory block developed in all patients within 3 (2.5; 4). The duration of analgesia period between 1B and 2L did not statistically differ (p = 0.73). In 3H the duration of analgesia was 170 (150; 200) min. The study found 83.7% efficacy of levobupivacaine and 72.9% efficacy of hyperbaric bupivacaine in comparison with isobaric bupivacaine (100%) when administered intrathecally in equal volumes and amounts (by the criterion of additional intraoperative analgesia).Trial registration: NCT05184465 (Initial Release: 12/01/2021; date of first publication—11/01/2022).

Safety and Efficacy of Combined Lumbar Plexus, Sciatic Nerve, Femoral Nerve Blocks in Failed Spinal Anaesthesia for Lower Limb Surgeries: A Prospective Clinical Study

Safety and Efficacy of Combined Lumbar Plexus, Sciatic Nerve, Femoral Nerve Blocks in Failed Spinal Anaesthesia for Lower Limb Surgeries: A Prospective Clinical Study

Anti-shivering effect of intrathecal tramadol versus intravenous tramadol in patients Received spinal anesthesia for lower limb surgery. A randomized controlled clinical trial

ABSTRACT Background Shivering occurs in 40–60% of patients under spinal anesthesia. Prophylaxis with intravenous tramadol produces a dose-dependent reduction in the incidence of shivering. Intrathecal Tramadol is used safely as an adjuvant in a dose up to 20 mg. Few studies tested the anti-shivering efficacy of intrathecal tramadol. However, no study compared the anti-shivering effect of the two different routes of tramadol. The aim is to compare the anti-shivering effect of intrathecal versus intravenous tramadol. This study was a randomized, triple-blinded parallel-design clinical trial, conducted in orthopedic operating room in our university hospital Material and Methods The study included 86 patients of ASA I & II aged 18 years or more who underwent lower limb orthopedic surgery that lasted less than 2 hours under spinal anesthesia. Patients were randomly allocated into two equal groups: control intravenous (IV) group and interventional intrathecal (IT) group. We used Amadol ampoules 100 mg/2 ml (Adwia company). Intervention The control group received IT 15 mg bupivacaine and then IV tramadol 0.25 mg/kg in 5 ml normal saline. The interventional group received 20 mg IT tramadol added to 15 mg bupivacaine then IV 5 ml normal saline. The patients were observed for intraoperative shivering, the primary outcome. Intraoperative hemodynamics, postoperative shivering, and its score were all recorded. Postoperative complications such as nausea, vomiting, and hypotension were documented. Results Intraoperative shivering was observed in 18.6% of the patients in IV group compared to 4.6% of patients in the IT group with a P-value of 0.047. Conclusions IT tramadol is more efficient in preventing post-spinal shivering compared to IV tramadol.

The comparison of clonidine and dexmedetomidine as an adjuvant to 0.5% bupivacaine in epidural anaesthesia for lower limb surgeries

Background and Objectives: Epidural anesthesia is a popular technique for providing anesthesia for lower limb surgeries. Dexmedetomidine and Clonidine are known to enhance the effect of local anaesthetics. The purpose of this study was to compare the impact of dexmedetomidine and clonidine on the onset and duration of epidural anaesthesia using bupivacaine. Methods: After IEC approval, a prospective, randomized, double blinded study was conducted on 60 ASA I and II adult patients undergoing lower limb surgeries under epidural anaesthesia. Patients were randomly divided into Group A receiving 0.5% isobaric bupivacaine 15 ml with dexmedetomidine 1 μg/kg and Group B receiving 0.5% isobaric bupivacaine 15 ml with clonidine 2 μg/kg epidurally. Onset and duration of sensory and motor blocks, duration of analgesia, sedation, and adverse effects were assessed.Results: The onset of sensory and motor block was significantly faster in Gr A compared to Gr B (p< 0.05). The duration of sensory and motor block was significantly more in Gr D compared to Gr M. Mean arterial pressures were comparable between the groups in the intraoperative period. However, sedation scores with dexmedetomidine were better than clonidine. No other adverse event was observed.Conclusion: Dexmedetomidine in combination with 15 ml bupivacaine (0.5%) hastened onset of sensory and motor block, and prolonged the duration of sensory and motor block when used for epidural, without producing any adverse events.

Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery

The objective of this research was to explore the effect of perioperative anesthesia management for patients based on the concept of enhanced recovery after surgery (ERAS) and the application value of the computed tomography (CT) localization method in lumbar spinal nerve anesthesia, reducing the damage caused by anesthesia. One hundred and twenty patients who underwent the lumbar spinal anesthesia in lower limb surgery were selected as the research subjects. According to puncture positioning and nursing intention, the patients were classified into the control group with 30 patients (method of anatomical landmarks), CT group with 50 patients (the CT localization), and ERAS group with 40 patients (the CT localization and the ERAS management). The effects of the anesthesia positioning method and the ERAS management were compared and analyzed. The results showed that d (0.32) and r (0.27) of exponential filtering function were notably smaller than those of R-L filtering function (d = 0.40, r = 0.39) and of S-R filtering function (d = 0.37, r = 0.36) (P < 0.05). Puncture time ((9.23 ± 0.32) min vs. (13.11 ± 0.45) min), puncture direction change (20% vs. 33.33%), abnormal puncture sensation (22% vs. 40%), and nerve root touch (4% vs. 23.33%) in the CT group were all lower than those in the control group. The proportion of Degree I anesthesia effect (94%) of the CT group was greatly higher than that of the control group (76.67%) (P < 0.05). The VAS score, time of activity and gastrointestinal function recovery, and the incidence of adverse reactions (2.5% vs. 28%) in the ERAS group were lower than those in the CT group (P < 0.05). All in all, the CT localization method can improve the difficulty of anesthesia puncture and improve the anesthetic effect; the ERAS nursing concept can improve the postoperative pain of patients and contribute to the prognosis of patients and have a good clinical value.

Comparison of Fentanyl and Nalbuphine as an Adjuvant to Bupivacaine for Spinal Anesthesia in Lower Limb Surgeries

Background: Opioids commonly used as adjuvant anaesthetics during spinal anesthesia, are favored technique for lower limb surgeries. Nalbuphine is an opioid adjuvant that acts as antagonist at μ-receptors and agonist at k-receptors that work reasonably potent analgesia. In this study we compare the efficacy of epidural Fentanyl with bupivacaine versus Epidural Nalbuphine with Bupivacaine for post-operative pain relief in lower limb surgeries.&#x0D; Methods: Altogether 80 patients of lower limb surgeries were randomly allocated into two groups. 40 patients in Group I (Inj. 0.5% Bupivacaine (H) 2.5ml + Inj. Fentanyl 25mcg (0.5ml) and 40 patients in Group II (Inj. 0.5% Bupivacaine (H) 2.5ml+ Inj. Nalbuphine 5mg (0.5ml). Age of patients ranged from 18-65 years of age and male:female ratio in the present study was 1: 0.5. Patients in both the above groups were comparable on age, gender, anthropometric variables, and baseline hemodynamic variables.&#x0D; Results: In the study the mean age (36.30±14.10) of group II was comparatively more than the group I (33.88±9.42) while the mean weight (61.80±11.33) of group II was also comparatively more than group I mean weight (53.80±15.59). And the mean value of duration of surgery for the group I was (112.93±12.22) while it was (110.63±10.26) for group II. A significant difference was found in weight. The intergroup comparison of level of motor blockade where in group I the level of motor blockade was (65.0%) at 2 min (B/S-1) while in group II level of blockade (70.0%) at 2 min (B/S-1) after that from 8 min to 130 min it was (100%). The level of sensory blockade of group I (72.5%) at 2 min while it was (72.5%) at 6 min after that it was NA from 8 min to 130 min and in the group II level of sensory blockade (50.0%) at 2 min and (50.0%) at 8 min after that it was (100%) from 10 min to 130 min. During Intergroup Comparison of VAS significant differences was found at 30 min and 480 min.&#x0D; Conclusion: Nalbuphine when compared to Fentanyl is almost safe and hemodynamically stable drug that can be used as an adjuvant in combined spinal epidural anesthesia with similar safety profile as for Fentanyl.

Investigating the Effect of the 10° Reverse Trendelenburg Position on Spinal Block Characteristics and Hemodynamic Parameters in Lower Limb Surgeries.

Introduction: The primary goal of spinal anesthesia in lower limb surgeries is to achieve a successful sensory and motor block. Adequate level of spinal block for lower limb orthopedic surgery is T10. Due to multiple factors affecting the level of spinal anesthesia, it is not always easy to control the level of spinal anesthesia.We proposed that maintaining patients in a 10° reverse Trendelenburg position after spinal anesthesia can significantly control the height of the sensory block, resulting in stable hemodynamics.Materials and methods: This study is a single centric, prospective, single-blinded randomized clinical trial (CTRI/2018/08/015455) conducted in a tertiary care center in Sub-Himalayan region in India from July 2018 to June 2019. Total 60 patients fulfilling our inclusion and exclusion criteria were recruited in the study and were divided into two groups. In the supine group, patients were positioned in the supine position, and in the Trendelenburg group, patients were positioned in a 10° reverse Trendelenburg position after administering spinal anesthesia with 12.5 mg bupivacaine heavy. The two groups were compared in terms of sensory block, motor block, and analgesia duration. Heart rate, blood pressure, mean arterial pressure, and hypotension were also compared between the two groups.Results: Duration of sensory block, motor block, and analgesia were significantly higher in patients of the reverse Trendelenburg group (group T) compared to the supine group (group S). In group T, 26.6% had a sensory block level above T8, whereas in group S, 86.6% of patients had a sensory block level above T8. No hypotension was observed in the Trendelenburg group, which was present in 33% of patients in the supine group (group S).Conclusion: Ten-degree reverse Trendelenburg position immediately after giving spinal anesthesia significantly limits the level of sensory block and provides better hemodynamic stability, and can be more beneficial, especially in geriatric patients and other high-risk patients for lower limb surgeries.

A Comparative Study of Intrathecal Hyperbaric Bupivacaine 0.5% with Morphine and Dexmedetomidine in Lower Limb Orthopedic Surgeries: A Double-Blind Randomized Clinical Trial.

Pain and its alleviation have been a challenge for humans for centuries. Sub arachnoid block is most commonly practiced method for anaesthesia for lower limb surgeries. Adjuvants like opioids and alpha 2 agonists have proven benefits in augmentation of effects of local anaesthetics for spinal anesthesia. The aim of this study was to compare the effects of morphine and dexmedetomidine for sub arachnoid block in lower limb orthopaedic surgeries. This is a prospective randomised controlled trial done in 120 patients who were posted for lower limb orthopaedic surgery. Along with bupivacaine, Group A received intrathecal dexmedetomidine while group B received intrathecal morphine. the demographic profile was comparable in both the groups. The mean duration of motor block in Group A was 359.33 ± 34.4 and in Group B was 265.71 ± 28.47. The duration of rescue analgesia was almost double in Group A as compared to Group B with P < 0.0001 (CL 95%). Intrathecal dexmedetomidine and morphine both provided good postoperative analgesia. Dexmedetomidine provided a longer duration of analgesia than morphine, thereby increasing the time for first rescue analgesia, but at the cost of greater side effects.

COMPARISONS OF EFFECTS OF DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADDITIVE IN INTRATHECAL BLOCKADE WITH 0.5% HYPERBARIC BUPIVACAINE IN LOWER LIMB ORTHOPEDIC SURGERIES

INTRODUCTION Lower limb surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, but neuraxial blockade is the preferred mode of anaesthesia. Spinal block is still therst choice because of its rapid onset, superior blockade, low risk of infection as from catheter in situ, 1 less failure rates and cost-effectiveness. Intrathecal local anaesthesia alone is associated with relatively short duration of action and thus early analgesic intervention is needed in post-operative period. AIMS AND OBJECTIVES With use of dexmedetomidine in 3 different graded doses with hyperbaric bupivacaine intrathecally as regional anaesthesia for lower limb surgeries. MATERIALS AND METHODOLOGY This Prospective double blinded randomized controlled study. The study will be conducted in adult patients aged between 18-50 years undergoing lower limb surgeries under spinal anaesthesia in orthopedic OT, dept. of Anaethesiology, Medical college &amp; hospital, Kolkata. Duration of the study One year (9 months for data collection &amp; 3 months for data analysis, review&amp; report writing). Total 63 patients in our study. RESULTS We found the mean of two segment regression time from highest sensory level in Group B was 130.56min; in group C was 171.34min; ingroup D was 217.85min So, block regression was signicantly slower with the addition of intrathecal dexmedetomidine (Group D) as compared to group C &amp; B ( P &lt; 0.0001) The mean regression time to S1 from highest sensory level for Group Bwas 289.43 min ( SD- 12.43) For Group C, the mean regression time to S1 from highest sensory level was 402.71 min ( SD- 28.60) For Group D, the mean regression time to S1 from highest sensory level was 584.43min ( SD- 38.92) Overall the mean regression time to S1 from highest sensory level was 425.52 min ( SD- 125.71) The sensory regression time to S1 from highest sensory level was signicantly higher with increasing dose of dexmedetomidine i. e. D&gt;C&gt;B . (P&lt; 0.0001). CONCLUSION We recommend the use of 10mcg of intrathecal dexmedetomidine as an adjuvant to bupivacaine as it seems to be a good alternative to other additives for long duration surgical procedures due to its profound intrathecal anesthetic and analgesic properties. It provides good quality of intraoperative analgesia, thermodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia.

Review on Clinical Research Progress of B-ultrasound-guided Nerve Block Anesthesia for Lower Limb Surgery

Review on Clinical Research Progress of B-ultrasound-guided Nerve Block Anesthesia for Lower Limb Surgery