Onset Of Block Research Articles

A Phase I Study of the Pharmacokinetics, Pharmacodynamics, and Safety of Liposomal Bupivacaine for Sciatic Nerve Block in the Popliteal Fossa for Bunionectomy

AbstractThis trial assessed the pharmacokinetics, pharmacodynamics, and safety of liposomal bupivacaine given via ultrasound‐guided popliteal sciatic nerve block with or without immediate‐release bupivacaine hydrochloride in adults having bunionectomies. Forty‐five adults were enrolled into four sequential cohorts: (1) liposomal bupivacaine 266 mg with bupivacaine hydrochloride 50 mg; (2) liposomal bupivacaine 133 mg with bupivacaine hydrochloride 50 mg; (3) liposomal bupivacaine 266 mg; or (4) bupivacaine hydrochloride 100 mg. Outcomes included pharmacokinetics (e.g., bupivacaine maximum plasma concentration [Cmax]), onset and duration of motor and sensory nerve block, and safety. Liposomal bupivacaine admixed with bupivacaine hydrochloride produced biphasic bupivacaine plasma disposition profiles with two distinct peaks. Geometric mean Cmax of the early peak ranged from 235 to 421 ng/mL and the geometric mean of the late Cmax was ∼30%–50% lower than the early peak. Median time to sensory block onset was 18 to 29 min in all cohorts. Sensory blocks lasted about twice as long with liposomal bupivacaine (median, 119–167 h) than with bupivacaine hydrochloride alone (median, 67 h). There were no serious adverse events. In conclusion, liposomal bupivacaine provided prolonged sensory nerve block when given as popliteal sciatic nerve blocks with or without bupivacaine hydrochloride, and bupivacaine plasma concentrations were well below the lower bound of the toxicity threshold of 2000 ng/mL for all cohorts.

Ultrasound-guided popliteal sciatic nerve block for surgical anesthesia in wound care patients with ongoing anticoagulant/antiaggregant therapy: A single-center, prospective study.

Ultrasound-guided peripheral nerve blocks may be a good alternative in patients under antithrombotic drugs. We evaluated the efficacy of ultrasound-guided popliteal sciatic nerve block in patients undergoing lower extremity wound debridement of whom antithrombotic drugs could not be stopped. We focused on hemorrhagic complications related to sciatic nerve block. Wound care patients followed by Cardiovascular Surgery Department scheduled for lower extremity wound surgery were included in this prospective observational study. Data was collected between March 2021 and September 2022. All patient were under antithrombotic therapy and discontinuation of anticoagulant drugs were not possible. Single-insertion and multiple-injection sciatic nerve block at popliteal region was applied to all patients under ultrasound guidance. Primary outcome was the rate of hemorrhage. Secondary outcomes were block onset times, block success and postoperative analgesia times. Data of 105 patients was evaluated, 87 were male and 18 were female. Mean patient age was 61.92 ± 10.06, mean patient body mass index was 25.68 ± 6.33. All patients were under 1 or more antithrombotic drugs. Only one minor hematoma was detected by postoperative ultrasonography control in 1 patient. Hemorrhage complication rate was 1 of 105 (% 0.95, 95% CI, 0.00024-0.051). Overall block success rate was 99.05%. Mean block onset time was 16.27 ± 5.69 minutes. Mean postoperative analgesia time was 19.5 ± 11.22 hours. Sciatic nerve block under ultrasound guidance using in-plane technique was safe and provided sufficient surgical anesthesia and postoperative analgesia for lower extremity wound debridement surgery in patients on antithrombotic drugs.

A Comparative Study between Ultrasound-guided Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Versus Infraclavicular Block Alone

Abstract Background: Peripheral nerve blocks can be used alone as the sole “surgical” anesthetic technique as the initial step in providing prolonged postoperative analgesia. There are studies, where accurate deposition of local anesthetic perineurally has the potential to improve the success rate and reduce the incidence of complications of the infraclavicular block. We hypothesized whether a combined block of the infraclavicular brachial plexus and distal median, radial, and ulnar nerves would accelerate upper extremity anesthesia compared with an infraclavicular block alone. Materials and Methods: This study was a prospective randomized control study conducted among 60 patients undergoing elective and emergency wrist and hand surgeries. A group of 30 patients received an infraclavicular block with 30 mL of a local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine from Group A. Group B received an infraclavicular block with 15 mL of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine along with distal median, radial, and ulnar nerve blockade with 5 mL each of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine. Pain score, assessment of sensory and motor functions, block performance time, and surgical anesthesia were observed. Results: The mean block performance time of Group A was 10.9 ± 1.1 min and Group B was 14.7 ± 0.5 min. The difference between the two groups’ block performance minutes was statistically significant (P < 0.001). The difference in the onset of the sensory block between the two groups was statistically significant (P < 0.001). The mean onset of motor blockade between the two groups was statistically very highly significant (P < 0.001). The mean of Group A was 5.0 ± 0.2 and Group B was 2.1 ± 0.4. Conclusion: From this study, we conclude that using an approximately equivalent dose of local anesthetics, combining ultrasound-guided infraclavicular block with distal median, radial, and ulnar nerve blockade shortens the onset time of sensory and motor block with improved block consistency compared to infraclavicular block alone.

Variants for dosing of rocuronium taken into obesity during general anesthesia in gynecological laparoscopic surgery

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p < 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

Train-of-four ratio, counts and post tetanic counts with the Tetragraph electromyograph in comparison to mechanomyography.

Automated EMG devices to detect compound muscle action potentials from the adductor pollicis muscle in response to ulnar nerve stimulation, regardless of hand and thumb position, may serve as a better reference ("gold standard") for clinical assessment of neuromuscular function than traditional mechanomyography (MMG) systems that need custom design and validation in lab settings. This evaluation compared the TetraGraph EMG system against a validated MMG device to investigate the accuracy and repeatability of this quantitative EMG monitor for detecting onset, offset and deep neuromuscular block. Simultaneous muscle action potential recordings from the EMG neuromuscular monitor and muscle contractions from an in-house developed MMG monitor in response to ulnar nerve stimulation were obtained from patients having elective surgery requiring neuromuscular block. Train-of-four (TOF) ratios, TOF counts, and post-tetanic counts (PTCs) were recorded simultaneously from the same hand muscle and compared. In total, 685 pairs of simultaneous TOF ratios were evaluated. The mean difference (bias) of TOF ratios between devices was small (-2.1%). TOF counts from 285 data pairs were within a count of 2 or less 96% of the time. During deep block, PTC comparisons from 215 data pairs were within a count of 2 or less 95% of the time. These findings, along with prior EMG device evaluations, indicate that real-time EMG neuromuscular monitoring technology to detect muscle action potentials from the adductor pollicis in the clinical setting is closely aligned with the force of thumb contraction determined from MMG. The accuracy of quantitative EMG technology of the TetraGraph EMG system lends strong support for this monitor, along with other similarly validated EMG monitors, to become a clinical standard for all phases (onset, depth and reversal) of neuromuscular block in clinical practice.

Impacts of Greenland Ice Sheet on Blocking in Idealized Simulations

Abstract As the only remaining ice sheet in the Northern Hemisphere, the Greenland ice sheet (GrIS) plays a crucial role in influencing atmospheric circulations, particularly with its rapid melting under global warming. In this paper, the influences of GrIS topography and surface thermal conditions are investigated by a series of aquaplanet experiments. The results show that the GrIS topography induces stationary waves and favors more blocking events through the generation of negative potential vorticity (PV) anomalies, while it tends to suppress local storm activities through the induced stationary waves. The surface cooling center of the GrIS is found to strengthen the jet streams by enhancing the meridional temperature gradient and thermal wind, while it causes the PV and static stability to increase during near-Greenland blocking days, thereby disfavoring blocking onset. Altogether, the topography and surface thermal effects of GrIS appear to compete with each other so that the net effect would determine the final response. Nevertheless, nonlinearity is found in both GrIS-topography alone and GrIS-surface temperature alone experiments, where nonlinear responses of atmospheric circulation are detected when the GrIS topography height or surface temperature exceeds their critical values, respectively. Hence, through this study, the response of the blocking in the vicinity of Greenland to the combined effects of topography and surface thermal conditions may shed light on comprehending the underlying mechanism of blocking alteration in a changing climate. Significance Statement Although there have been numerous observation-based studies showing that the blocking around Greenland has increased over the past few decades, which is a predominant driver in accelerating the Greenland ice sheet (GrIS) melting, the reasons for this change are still unclear. In addition, the impact of GrIS on blocking still needs investigation. Through idealized aquaplanet simulations, this study examines the effect of GrIS’s topography and surface thermal conditions upon blocking onset. It suggests the nonlinearity of the blocking response in the vicinity of Greenland to the combined effects in the variation of the height and surface temperature of GrIS. This study will enhance our understanding of possible changes in blocking due to global warming.

Effect of low-volume ropivacaine in ultrasound-guided superior trunk block on diaphragmatic movement in patients undergoing shoulder arthroscopy: a randomized controlled trial

ObjectivesThe incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy.MethodsPatients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery.ResultsCompared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups.ConclusionIn shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL.Trial registration: We registered the study at chictr.org (ChiCTR2200057543 , 14/03/2022.https://www.chictr.ogr.cn

Study To Assess The Onset And Duration Of Sensory And Motor Block In Both Groups (IV Dexamethasone Compared To Normal Saline) In Patients Undergoing Below Umbilical Surgeries

Study To Assess The Onset And Duration Of Sensory And Motor Block In Both Groups (IV Dexamethasone Compared To Normal Saline) In Patients Undergoing Below Umbilical Surgeries

Comparison of Duration of Action in Spinal Anesthesia of 0.5% Bupivacaine and 0.5% Bupivacaine with Dexmedetomidine

Background: Spinal anesthesia is a common technique for surgeries below the navel, utilizing bupivacaine, a local anesthetic. Adding adjuncts like dexmedetomidine may enhance the efficacy and duration of the block.Objective: To compare the duration of action of 0.5% bupivacaine versus 0.5% bupivacaine with dexmedetomidine in spinal anesthesia.Methods: This quasi-experimental trial included 60 patients aged 20-60 years, ASA grade 1 or 2, undergoing general, plastic, orthopedic, or urological surgery at CMH Karachi. Patients were non-randomly assigned to Group B (0.5% bupivacaine, n=30) or Group BD (0.5% bupivacaine plus 5 mcg dexmedetomidine, n=30). Onset and duration of sensory and motor blocks, duration of analgesia, and adverse effects were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered significant.Results: Group BD showed faster onset of sensory block (7.08 ± 0.54 mins vs. 13.48 ± 0.73 mins, p < 0.001) and motor block (10.32 ± 0.91 mins vs. 17.55 ± 0.69 mins, p < 0.001). Duration of motor block was longer in Group BD (284.06 ± 5.64 mins vs. 133.93 ± 5.72 mins, p < 0.001), as was duration of analgesia (218.07 ± 4.86 mins vs. 125.36 ± 5.42 mins, p < 0.001).Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine significantly enhances the onset and duration of spinal anesthesia with a comparable safety profile.

Buprenorphine with Bupivacaine 0.5% Heavy Versus Clonidine with Bupivacaine 0.5% Heavy Versus Bupivacaine 0.5% Heavy Alone in Patients Undergoing Total Abdominal Hysterectomy: A Comparative Study

Background and Aims: This research aimed to determine which of three spinal anaesthetic medication combinations—clonidine–bupivacaine, buprenorphine–bupivacaine and bupivacaine alone—is the most effective for total abdominal hysterectomy. Material and Methods: In this prospective study, approved by the Institutional Ethical Committee, 120 patients aged 35–60 years scheduled for elective total abdominal hysterectomy under spinal anaesthesia were included, following informed consent. Comprehensive pre-anaesthetic assessments, including detailed medical histories, clinical examinations and routine surgical investigations, were conducted. The study, spanning 24 months, utilised purposive sampling and a cross-sectional design. The inclusion criteria encompassed ASA I and II patients aged 35–60 years, undergoing elective total abdominal hysterectomy with a weight exceeding 45 kg, height over 150 cm, and valid informed consent. Exclusion criteria involved ASA Class III or higher, patient unwillingness for spinal anaesthesia, gross spinal deformities, bleeding diathesis, known allergy to the test drug, history of cardiac, respiratory, or central nervous system disease, hepatic or renal dysfunction and elevated intracranial pressure. Results: The onset time of sensory blockade was faster in the Bupivacaine + Buprenorphine group than in the Clonidine + Bupivacaine group, with the Bupivacaine group exhibiting the slowest onset. The Bupivacaine + Buprenorphine group had a significantly faster onset of motor block than the Clonidine + Bupivacaine and Bupivacaine groups. The total duration of motor block was shorter in both the Bupivacaine + Buprenorphine and Bupivacaine groups than in the Clonidine + Bupivacaine group. The Clonidine + Bupivacaine group showed higher incidences of bradycardia and hypotension than the other groups. The Bupivacaine + Buprenorphine group reported more side effects, including chest pain, cough, nausea and vomiting, than the other groups. Conclusion: This study found that spinal clonidine, in comparison to bupivacaine alone, gives better post-operative analgesia and sensory and motor blockage over a longer period of time.

Ultrasound-Guided Lumbar Plexus-Sciatic Nerve Blocks Versus Epidurals for Orthopaedic Surgeries: A Study to Compare the Competency of Novice Anaesthesiology Residents in a High-Volume Level 1 Trauma Centre.

The relative merits of peripheral nerve blocks (PNB) over central neuraxial anaesthesia and the advantages of the above two techniques over general anaesthesia for surgical interventions of the lower limb are well established. The competency of anaesthetic trainees in a high-volume level 1 trauma centre in administering dual ultrasound and nerve stimulator-guided lumbar plexus-sciatic nerve block(DUNLuPS) vs. epidural anaesthesia (EA) was compared by reporting the adequacy of anaesthesia with the two techniques, time taken for the performance of block, time of onset of sensoryblock (TOSB), and time of onset of motor block (TOMB). This prospective, randomized, study enrolled 92 patients aged 18-80 years with lower limb fractures admitted in trauma triage and scheduled for surgery. Thepatients were randomly allocated equally into the EA group and the DUNLuPS group. A total of 20 anaesthesia trainees in the third year of residencywith clinical experience of more than 15 independent lumbar plexus-sciatic nerve blocks were included in the study.A volume of 20 ml of 0.5% ropivacaine was administered in the lumbar plexus (Shamrock technique) but the volume used for sciatic nerve (subgluteal approach) was varied so that the cumulative dose did not exceed 3 mg/kg. For each block, the onset of nerve blockade was assessed every five minutes, and the assessments continued for an additional 30 minutes after the nerve blocks were finished. Clinical characteristics and adequacy of anaesthesia were comparable, i.e., 95.65% and93.47% success in the EA (n = 46) and DUNLuPS (n = 46) groups, respectively. Performance time was significantly more in the DUNLuPS group but followed by significantly less TOSB and TOMB. The time for the first analgesic request was 351.63 ± 148.70 minutes in the DUNLuPS group and 147.60 ± 52.65 minutes in the EAgroup (p < 0.0001). Both EA and DUNLuPS provide effective and comparable intra-operative anaesthesia for orthopaedic lower limb surgeries (OLLS) when administered by residents with more than two years of experience (third year of residency)in ultrasound-guided regional nerve blocks in a high-volume level 1 trauma centre. Statistically significant differences in the block performance characteristicshad no clinical advantage as it was compensated by the faster onset time in the DUNLuPS group. Post-operative pain management was better in the DUNLuPS group, sothe practice and conduct of anaesthesia for trauma patients should focus on the establishment of "block rooms" and timely training of residents in the former so that the advantages can be extended to the patient population.

Comparative Analysis of Intrathecal Bupivacaine With Fentanyl Versus Intrathecal Bupivacaine With Midazolam in Lower Abdominal and Lower Limb Surgeries.

Many different adjuvants are added intrathecally along with local anaesthetics to prolong intraoperative and postoperative analgesia. Hence, this study aimed to compare intrathecal bupivacaine with fentanyl and bupivacaine with midazolam in lower abdominal and lower limb surgeries. Following permission from the Hospital Ethical Committee (Research Protocol No.: IESC/PGS/2022/143), the study was conducted on a sample of 60 patients, divided into two groups, Group F and Group M, with 30 patients each, representing the American Society of Anaesthesiologist's (ASA) grades I and II. The patients were between the ages of 18 and 60 and featured both males and females, scheduled to undergo elective surgical procedures on the lower abdomen and lower limbs via spinal anaesthesia. Group "F": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (25 mcg) of fentanyl (preservative-free) intrathecally. Group "M": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (2.5 mg) of midazolam (preservative-free) intrathecally. The primary aim was to study the onset of motor and sensory block and duration of analgesia with the addition of midazolam or fentanyl to 0.5% heavy bupivacaine in the sub-arachnoid block. A secondary aim was to evaluate the quality of anaesthesia and postoperative analgesia, determine the haemodynamic stability in the intraoperative and postoperative period in the two study groups, andobserve any adverse effects of study drugs. Group F exhibited a substantially longer duration for both sensory (211.5 vs. 154.4 min) and motor blockade (269.8 vs. 214.6 min) compared to Group M, as well as a rapid onset time for both sensory (2.6 vs. 3.3 min) and motor blockade (3.1 vs. 3.9 min). Also, Group F had a significantly longer duration of effective analgesia compared to Group M (266 ± 15.9 vs. 197.6 ± 13.7 minutes). The addition of 0.5 ml (2.5 mg) Midazolam with 0.5% hyperbaric Bupivacaine intrathecally prolonged the duration of anaesthesia and postoperative analgesia; however, fentanyl 0.5 ml (25 mcg) has a more prolonged duration of intraoperative and postoperative analgesia.

Comparative Study of Injection Butorphanol Versus Injection Fentanyl with Injection Ropivacaine in Ultrasound Guided Supraclavicular Block to Evaluate Sensory and Motor Block Characteristics

BACKGROUND Regional anaesthetic technique has many advantages over general anesthesia. The supraclavicular brachial plexus block due to its rapid onset and reliability offers dense anesthesia of brachial plexus for surgeries at or distal to elbow. The additives like injection Fentanyl and injection Butorphanol along with 0.5% injection Bupivacaine have been proved to be efficient for supraclavicular block. However their effects haven't been compared by using them as additives in 0.5% Injection Ropivacaine. Aims To compare the sensory and motor block characteristics of injection Butorphanol and injection Fentanyl in injection Ropivacaine. METHODS This prospective single blinded randomised control study included 60 patients (ASA I or II; 18- 60 yrs) scheduled for upper limb surgeries. Patients were randomly allocated to two groups of 30 each and supraclavicular block was given as per distribution (Group B: 30 ml 0.5 % injection Ropivacaine with 2mg injection Butorphanol and Group F: 30 ml 0.5 % injection Ropivacaine with 100 mcg injection Fentanyl). The hemodynamic parameters were recorded at baseline, post block and till 45 mins. Sensory and motor block assessments were done along with sedation score determination. Duration of sensory and motor block was noted. RESULTS The group with injection Fentanyl as additive had earlier onset of motor blockade. Time required to achieve sensory blockade was less in Group F. Duration of sensory and motor block prolonged in Group F. CONCLUSIONS Injection Fentanyl as additive in injection Ropivacaine provided earlier onset of motor block and decreased total time required to achieve maximum sensory block with prolonged duration and decreased requirements of rescue analgesia.

Effect of ultrasound-guided nerve blocks on anesthesia and pulmonary function in patients undergoing distal radius fracture surgery.

This study aimed to assess the impact of ultrasound (US)-guided nerve blocks (NBs) on anesthesia and their protective effect on pulmonary function (PF) in patients undergoing distal radius fracture (DRF) surgery. A total of 122 patients undergoing DRF surgery between April 2020 and June 2023 were included. According to the type of peripheral NB technique, these patients were randomized into a control group (CG; n = 60) receiving brachial plexus block (BPB) using blinded techniques, and an observation group (OG; n = 62) receiving US-guided supraclavicular BPB. Anesthetic effects, BPB-related indexes, adverse events, PF parameters (forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow), and serum biochemical indexes (interleukin [IL]-6/10) were compared. The OG showed a relatively higher proportion of good anesthetic effects, shorter onset and completion times of block, and longer block duration compared to the CG, with a lower AE rate. Despite reductions in PF parameters and IL-10 levels after intervention, the OG maintained higher values than the CG. IL-6 levels increased significantly in the OG but remained lower than in the CG. In conclusion, US-guided NBs demonstrated significant anesthetic efficacy and apparently reduced anesthesia adverse events while also exerting a protective effect on PF in DRF surgery patients.

Prilocaine vs bupivacaine in spinal anesthesia for urologic endoscopy: clinical trials &amp; historical overview

Introduction. In the evolving landscape of anesthetic practices for short-duration urologic procedures, the quest for an anesthetic agent that balances efficacy with minimal side effects remains a significant clinical challenge.The objective was to compare the efficacy and safety of 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia.Materials and methods. A comparative analysis was performed in terms of onset and duration of sensory and motor block, incidence of side effects (hypotension and bradycardia), and overall patient outcomes in urologic endoscopy. The research sample was divided into two groups, each consisting of 20 patients. In one case, spinal anesthesia was performed using 2% hyperbaric prilocaine (40 mg) + fentanyl 25 mcg, in the other – 0.5% hyperbaric bupivacaine (10 mg) + fentanyl 25 mcg.Results. Prilocaine offers a faster onset of sensory and motor block and a shorter duration of sensory block compared to bupivacaine. Prilocaine also showed a quicker recovery of full motor function and had a significantly lower incidence of side effects such as hypotension and bradycardia.Conclusion. These results suggest that 2% hyperbaric prilocaine could be an alternative to 0.5% hyperbaric bupivacaine in spinal anesthesia for urologic endoscopy, especially in procedures requiring quick recovery. The promising results of prilocaine in such short-duration surgeries can also prompt a reevaluation of anesthesia protocols across various surgical interventions and lead to enhanced patient outcomes, emphasizing safety, comfort, and efficacy of surgical care.

A Comparative Study of Combined Spinal Epidural Anesthesia Versus Spinal Anesthesia in Major Lower Limb Orthopedic Surgeries.

Background Neuraxial blockade includes epidural and spinal anesthesia (SA) that have gained wide acceptance for major lower limb orthopedic surgery. Both techniques are competent in rendering surgical anesthesia and pain relief, with specific advantages and disadvantages. SA has the merits of rapid onset and adequate anesthesia with a small volume of the drug but has significant hypotension and unpredictable duration. Epidural anesthesia allows for finer control over analgesia and the duration of anesthesia but requires more substantial volumes of drugs and is slower in onset. Combined spinal-epidural anesthesia (CSEA) combines the rapid commencement of action of SA with flexibility in epidural anesthesia, thus optimizing the management of the intraoperative and postoperative phases. This study aims to evaluate hemodynamic changes, compare the severity and duration of sensory and motor block, and track any problems related to CSEA and SA in major lower limb orthopedic procedures. Additionally, this study contrasts the hemodynamic, motor, and sensory changes in the two groups. Methodology A total of 30 individuals were randomized to one of two groups in this prospective comparative trial, which included 60 patients receiving major lower limb orthopedic surgery and meeting the American Society of Anesthesiologists physical status I-II criteria. Group A received CSEA, and Group B received SA. The degree and duration of sensory and motor blockade, hemodynamic changes, and complications were all recorded. A p-value of less than 0.05 was used to evaluate statistical significance using Student's t-test and chi-square test. Results The onset of sensory block in our study was earlier in Group B compared to Group A. In both groups, hemodynamic stability was maintained throughout the study. We recorded the onset/duration of sensory and motor block and hemodynamic changes and took mean values to find any significant difference. Postoperative complications and rescue analgesic requirements were monitored and managed and were a part of our study. Conclusions This study compared CSEA and SA regarding the severity and duration of sensory and motor block, hemodynamic stability, and associated complications in major lower limb orthopedic surgeries. The results shed light on the advantages and shortcomings of each anesthesia technique and, therefore, will help choose the correct method of anesthesia in a given surgery.

Enhancing postoperative analgesia in carotid endarterectomy patients: The potential of ultrasound-guided carotid sheath block combined with superficial cervical plexus block: A randomised trial.

Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB. Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann-Whitney U or log-rank test was used to analyse the distinction of selected variables. The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block (P = 0.029) and an extended time to first analgesia (P = 0.003). The sensory block was also substantially extended in the Subject group (P = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group (P = 0.048). NLR showed minimal disparity between the groups (P = 0.125). Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.

Comparative study of different doses of intrathecal clonidine as an adjuvant to bupivacaine for lower limb surgeries: A prospective observational study

Clinical studies suggested that intrathecal clonidine as an adjuvant to hyperbaric bupivacaine prolongs sensory as well as the motor block of spinal anesthesia, decreases local anesthetic drug requirement, and provides postoperative analgesia.In the present study, we have examined the effects of two distinct clonidine dosages administered intrathecally as an adjuvant to hyperbaric bupivacaine in individuals undergoing elective lower limb operations, to find out the optimal dose among them. Two groups of thirty patients each posted for lower limb surgery were included in this study. Patients in Group A Received inj. bupivacaine (hyperbaric) 0.5% 3ml (15 mg) + inj. clonidine 0.2 ml (30 µg) + normal saline 0.1 ml intrathecally, in Group B patients received inj. bupivacaine (hyperbaric) 0.5% 3ml (15 mg) + inj.clonidine 0.3 ml (45 µg) intrathecally.Throughout spinal anesthesia; both groups were prospectively observed for various parameters.Compared to patients in group A, patients in group B experienced sensory and motor block for longer durations of time. As compared to group A patients, group B patients experienced increased hypotension, bradycardia, and dry mouth; however, overall adverse effects are mild and easily treated. In addition, we observed that group B patients experienced analgesia for a longer duration of time than did Group A patients. Addition of intrathecal clonidine to bupivacaine significantly hastens the onset of sensory and motor block, provides excellent surgical analgesia, prolongs the duration of superior quality postoperative analgesia and reduced postoperative analgesic requirements with relative hemodynamic stability.

Comparative evaluation of intrathecal hyperbaric bupivacaine alone versus combined with dexmedetomidine for cesarean sections

Background &amp; Objective: This study examined the use of dexmedetomidine 5 μg as an adjuvant to 10 mg of intrathecal hyperbaric 0.5% bupivacaine in elective cesarean sections and aimed to assess dexmedetomidine’s impact on block characteristics and post-operative pain management. As spinal anesthesia is commonly employed for cesarean deliveries, the study seeks to determine whether the addition of dexmedetomidine as an adjuvant can prolong the duration and enhance the quality of the block, leading to improved post-operative pain relief. Methodology: This randomized controlled trial included 100 parturients undergoing elective cesarean section over a period of six months. Participants were allocated to either Group B or Group D using a non-random consecutive sampling technique. In Group D, 2 mL of 0.5% bupivacaine mixed with 0.05 mL of dexmedetomidine (5µg) was injected intrathecally, while Group B received 2 mL of 0.5% hyperbaric bupivacaine along with an equivalent volume of saline. Sensory and motor block assessments were conducted prior to the start of surgery. Post-operatively, the duration of motor block and post-operative pain relief were assessed. Results: The addition of dexmedetomidine as an adjuvant to intrathecal bupivacaine resulted in significant reductions in the onset time of sensory block (4.22 ± 0.79 min vs 5.66 ± 1.21 min) and motor block (4.20 ± 0.81min vs 6.32 ± 1.20 min) (P &lt; 0.001). Furthermore, the duration of motor block was longer in the dexmedetomidine + bupivacaine group compared to the bupivacaine alone group (7.32 ± 0.95 h vs 4.38 ± 1.27 h). Additionally, patients who received intrathecal dexmedetomidine as an adjuvant to bupivacaine experienced significantly longer durations of post-operative analgesia (7.32 ± 0.95 h) as compared to the bupivacaine alone group (4.38 ± 1.27 h) (P &lt; 0.001). Conclusion: Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine extends the duration of analgesia and motor block, providing prolonged pain relief. Additionally, it exhibits an early onset of sensory and motor block, ensuring prompt pain relief and rapid anesthesia onset. Clinical Trial Registration: [www.clinicaltrials.gov], identifier: ID NCT05469529 Abbreviations: CS - cesarean section; OT - Operation Theater; SA - Spinal anesthesia; VAS - visual analogue scale; Keywords: cesarean section, dexmedetomidine, bupivacaine, spinal anesthesia Citation: Qureshi RA, Jadoon H, Shabbir M. Comparative evaluation of intrathecal hyperbaric bupivacaine alone versus combined with dexmedetomidine for cesarean sections. Anaesth. pain intensive care 2024;28(5):866−870. DOI: 10.35975/apic.v28i5.2558 Received: December 03, 2023; Reviewed: December 15, 2023; Accepted: August 16, 2024

The impact of different doses of intrathecal dexmedetomidine used as adjuvant to hyperbaric prilocaine in short ambulatory procedures under spinal anesthesia: a randomized controlled study

Objective: This study aimed to determine the most effective dose of dexmedetomidine as an adjuvant to prilocaine in spinal anesthesia. Methods: Sixty-nine adult patients (21 to 65 y) scheduled for elective surgeries under spinal anesthesia were included in the study. Patients received spinal anesthesia with 3 mL of prilocaine and 0.5 mL dexmedetomidine of dose according to randomization of 5,10 and15 µg (D5, D10 and D15 respectively). Time of the first request of analgesia was set as a primary outcome. Results: Time of the first request of rescue opioid was significantly shorter in D5 group (8 ± 6 h) compared to D15group (21 ± 4 h) (P &lt; 0.018). 24 h of postoperative Nalbuphine consumption was higher in D5 group (4.67 ± 0.59 mg) compared to D15 group (2.5 ± 0.71 mg) (P = 0.012). The onset of sensory and motor blocks was significantly earlier in group D15 and D10 compared to group D5. Group D15 showed a significantly prolonged duration of sensory and motor blockade than Groups D10 and D5. The duration of sensory and motor blockade was significantly prolonged in group D10 compared with group D5 (P &lt; 0.001). Conclusion: 10 and 15 μg dexmedetomidine as an adjuvant to prilocaine in spinal anesthesia shortened the onset of both sensory and motor block, prolonged the duration of sensory block, motor block, and the time to first analgesic. Clinical trial registration: The study was registered on Pan African Clinical Trial Registry (www.pactr.org) (ID: PACTR202204558879194-April 2022). Keywords: Intrathecal Dexmedetomidine; Hyperbaric prilocaine; Ambulatory Surgery; Spinal Anesthesia Citation: Biekhet EG, Elazzazi H, Hussein W, Zedan M, Abdelhamid BM. The impact of different doses of intrathecal dexmedetomidine used as adjuvant to hyperbaric prilocaine in short ambulatory procedures under spinal anesthesia: a randomized controlled study. Anaesth. pain intensive care 2024;28(4):664−672; DOI: 10.35975/apic.v28i4.2509 Received: February 20, 2024; Reviewed: April 01, 2024; Accepted: April 20, 2024