Epidural Bupivacaine Research Articles

Comparative study of analgesic effect of epidural ketamine vs. epidural tramadol in patients undergoing mastectomy under thoracic epidural anesthesia

ABSTRACT Breast surgery under epidural procedure is a secure, accepted alternative to general anesthesia and can increase the outcome postoperatively with less cost. Postoperative analgesia provides a better outcome, early regain of activity with the least side effects, and early discharge. This study compares the analgesic efficacy of thoracic epidural ketamine versus thoracic epidural tramadol when added to bupivacaine at 0.5% for patients who underwent mastectomy under epidural anesthesia. Methods Our study included 50 female participants belonging to the 18–60-year-old age group who were epidurally anesthetized for mastectomy operation. Participants were randomly assigned to the ketamine group (epidural bupivacaine and ketamine 50 mg) (KG) and the tramadol group (epidural bupivacaine and tramadol 1 mg/kg) (TG). Pain was measured using the visual analog scale (VAS), and the consumption of rescue analgesia was recorded as well. Nausea and vomiting, sedatives, and vasopressors were recorded and compared between both groups. Results KG showed a decrease in VAS scores, less consumption of rescue analgesia, lesser need for antiemetic, and has demanded for more sedation in comparison with TG when observed in the post-anesthesia care unit (PACU) for 24 h postoperatively. Our study could not detect significant differences between groups among recorded demographic data, hemodynamic parameters, or the need for vasopressors. Conclusion Epidural ketamine provided a better analgesia and less need to rescue analgesia, less incidence of nausea and vomiting, but more sedation when compared with epidural tramadol at a dose of 1 mg/kg

A Comparison between the Post-Operative Pain Relief in Total Hystrectomy with Epidural Bupivacaine and TAP Block

Background: Anesthesia is essential in the treatment of postoperative pain. Epidural analgesia and trans versus abdominis plane (TAP) block are possible options for analgesia for abdominal surgery. Objective: The main objective of the study is to evaluate and compare the efficacy of epidural bupivacaine and trans versus abdominus plane (TAP) block to provide better post-operative pain relief in total abdominal hysterectomy. Study design and place of study: This study was a prospective randomized control trial conducted at Department of anesthesiology, Liaquat National Hospital, Karachi for the period July 2017- July, 2018. Methods: Total 101 patients were enrolled thorough pre anesthetic assessment before surgery and an informed and written consent was obtained. Patients were allocated in group A and B after taking all ASA monitoring, participants in group A had an epidural catheter passed while Group B patients were given transversus abdominis plane block intra-operatively. A Visual Analogue Scale (VAS) score was used to assess anxiety levels. Statistical test like the chi-square test was used, with a p-value of 0.05 being considered statistically significant Results: Total 101 participants enrolled, the average age was 45.48 ± 1.06 (Age Rang 30-60years). The mean age of patient in Epidural Group was 47.02± 7.62 as ccompared with TAP Block Group was 43.56± 13.35 with p-value 0.007. Majority of the patients has ASA II, 39(61.9%) and 24(38.1%) respectively with p-value 0.240. Pain score at 10 minutes in epidural and TAP Block was reported as 2.16±2.1o and 3.0±2.94 (mild pain) with p-value 0.000 while after 6 hours, the VAS pain score showed mild pain in epidural group as 1.96±1.67 but moderate to severe pain was observed in TAP block patients as 4.28±1.56 with insignificant p-value 0.162. Study findings will help care taker staff for Post-Operative Pain Relief after the surgery , the benefits of single shot TAP block could be of advantage in situations where epidural analgesia is contraindicated or not desired. Conclusion: The study concluded better pain relief in patients with epidural bupivacaine when compared with TAP block. Keywords: TAP Transversus Abdominus Plane ASA Physical Status Score VAS Visual Analogue Scale Epidural block, postoperative pain relief, Total Abdominal Hysterectomy, Transversus Abdominis Plane Block

Dose-response relationship between epidural bupivacaine dose and mortality risk after surgical resection of nonsmall-cell lung cancer.

Preclinical studies have shown that local anesthetics may modify the growth and invasion of cancer cells. However, few clinical studies have evaluated their impact on cancer outcomes after tumor resection. In this single-center cohort study, patients who underwent surgical resection of stage IA through IIIB nonsmall-cell lung cancer and used patient-controlled epidural analgesia from 2005 to 2015 were recruited and followed until May 2017. Data of the epidural bupivacaine dose for each patient were obtained from infusion pump machines. Proportional hazards regression models were used to analyze the associations between bupivacaine dose with postoperative cancer recurrence and all-cause mortality. A total of 464 patients were analyzed. Among these patients, the mean bupivacaine dose was 352 mg (± standard deviation 74 mg). After adjusting for important clinical and pathological covariates, a significant dose-response relationship was observed between epidural bupivacaine dose and all-cause mortality (adjusted hazard ratio: 1.008, 95% confidence interval: 1.001-1.016, p = 0.029). The association between bupivacaine dose and cancer recurrence were not significant (adjusted hazard ratio: 1.000, 95% confidence interval: 0.997-1.002, p = 0.771). Age, sex, body mass index, mean daily maximum pain score, and pathological perineural infiltration were independently associated with bupivacaine dose. A dose-dependent association was found between epidural bupivacaine dose and long-term mortality among patients following surgical resection of nonsmall-cell lung cancer. Our findings do not support the hypothetical anticancer benefits of local anesthetics. More studies are needed to elucidate the role of local anesthetics in cancer treatment.

Modern approach to perioperative pain relief using various modern methods and anesthetics

Adequate postoperative analgesia remains unresolved problem of the acute pain treatment. In spite of wide choice of different groups of analgesics, epidural analgesia is the most adequate and efficient method of the postoperative analgesia. Continuous epidural analgesia is broadly used for postoperative pain relief. Such approach has own advantage over periodic administration of anesthetics into epidural space. These positive effects include constant level of the good pain relief, possibility of patients to participate in process of the pain management, reduction of probability of infectious complications in accordance with the use of epidurals and others. Besides, continues epidural infusion vastly reduces the load on medical stuff. Using electronic pumps for prolonged epidural analgesia has its own advantages and disadvantages. Disposable infusion pumps have not these disadvantages, in contrast of electric infusion pumps. Local anesthetics except their main effect possess anti-inflammatory action. This effect is not only under low plasma concentration, which does not possess cardiotoxic action. Such low plasma concentrations are possible to reach only under prolonged epidural infusion. At present, for prolonged epidural infusion bupivacaine and ropivacaine are most often used. Ropivacain possesses beside advantage over other local anesthetics. Ropivacaine is less cardiotoxic, than bupivacaine.

Suppression of perioperative stress response in elective abdominal surgery: A randomized comparison between dexmedetomidine and epidural block.

Stress response after surgery induces local and systemic inflammation which may be detrimental if it goes unchecked. Blockade of afferent neurons or inhibition of hypothalamic function may mitigate the stress response. A total of 50 consenting adult ASA I/II patients undergoing elective abdominal surgery were randomized to receive either dexmedetomidine (Group D) or epidural bupivacaine (Group E) in addition to balanced general anesthesia. Laparoscopic surgery, contraindications to epidural administration, history of psychiatric disorders, obesity (BMI >30 kg/m2), on beta blockers or continuous steroid therapy for >5 days over last 1 year, and known case of endocrine abnormalities or malignancy were excluded. Serum cortisol, blood glucose, and blood urea were estimated. Hemodynamic parameters, total dose of dexmedetomidine, bupivacaine, emergence characteristics, and analgesic consumption over 24 h postoperatively were recorded. Statistical comparisons were done using Student's t-test, repeated measure analysis of variance followed by Dunnett's test, generalized linear model and Chi-square/Fisher's exact test. A P value <0.05 was considered significant. Serum cortisol levels were significantly lower in group E than group D 24 h after surgery (P = 0.029). Intraoperative and postoperative glucose level was lower in group E compared with group D. Time to request of first rescue analgesic was longer in group E than group D (P = 0.040). There was no significant difference between the number of doses of paracetamol required in the postoperative period (P = 0.198). Epidural bupivacaine was more effective than intravenous dexmedetomidine for suppression of neuroendocrine and metabolic response to surgery. Dexmedetomidine provided better hemodynamic stability at the time of noxious stimuli and postoperatively.

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.

A prospective randomised trial comparing the analgesic efficacy of postoperative infusion of epidural bupivacaine and ropivacaine in orthopaedic surgeries

Background: Epidural administration of local anaesthetic provides effective pain relief. Commonly used epidural local anaesthetics are bupivacaine and ropivacaine. Most studies compared these drugs along with an opioid or any other adjuvants like clonidine, dexmedetomidine etc. Our aim was to compare the analgesic efficacy and safety of continuous infusion of epidural ropivacaine and bupivacaine without any adjuvants in postoperative patients. Materials and methods: A prospective randomized clinical study was conducted in a tertiary care hospital in 60 patients between the age groups of 20-years and 60-years undergoing elective lower limb orthopaedic procedures. Total patients were divided into two groups (A and B) of 30 each. Continuous epidural infusion was started with 6ml per hour of 0.125% bupivacaine in Group A and 6ml per hour of 0.2% ropivacaine in Group B postoperatively. After the commencement of epidural infusions, heart rate, blood pressure, Visual Analogue Score (VAS) and supplementary analgesic requirement were monitored postoperatively for 48 hrs. Results: Our observations showed no significant difference in haemodynamic parameters like heart rate and blood pressure. VAS showed a statistically significant difference with higher mean VAS score in Group B patients at one hour (p value = 0.0126), 12 hrs (p value = 0.031) and 24 hrs (p value = 0.0421) as compared to Group A. Add on analgesic requirement was also higher for Group B patients. Conclusions: Both bupivacaine and ropivacaine can be used effectively for postoperative analgesia but bupivacaine has a superior analgesic efficacy than ropivacaine with similar safety profile.

Effect of Epidural Dexmedetomidine vs Nalbuphine for Labor Analgesia:#xd;A randomized clinical trial

ABSTRACT Background The addition of dexmedetomidine or nalbuphine to epidural bupivacaine was tested to decrease labor pain in women undergoing normal delivery. Patients and Methods Sixty-four patients were randomly allocated into 2 groups of 32 parturients, each with consent from the parturient. Groups A and B received a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) through the epidural catheter, then a top-up dose of 6 ml volume consisting of 5 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) was given when the VAS score becomes 4 or more, and a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 10 mg nalbuphine (1 ml volume) through the epidural and a top-up dose of 5 ml of 0.25% bupivacaine and 2 mg nalbuphine (1 ml volume) were given, respectively. Assessments included the VAS score, vital data monitoring, duration of stages of labor, APGAR score, and adverse effects. Results Both groups had satisfactory labor analgesia, but those in the dexmedetomidine group had lower pain scores than those in the nalbuphine group, because dexmedetomidine had a faster onset than nalbuphine. Conclusion Epidural dexmedetomidine seems to offer some advantages over epidural nalbuphine. Thus, it can be used safely as an adjuvant to epidural bupivacaine in labor analgesia.

The effect of intraoperative epidural levobupivacaine administration in lumbar disc surgery for postoperative pain

Aim: Postoperative pain is an essential problem that affects morbidity in surgical cases. We aimed to provide maximal benefits with minimal side effects, facilitate the recovery period, accelerate mobilization, and provide patient safety and comfort through the usage of the drug and method of our choice to provide postoperative analgesia.Material and Method: Our study included 60 elective or urgent lumbar disc surgery cases. The patients were randomly divided into two groups; (a) The Group S; patients receiving general anesthesia and intraoperative epidural saline injection, and (b) The Group L; patients receiving general anesthesia and intraoperative epidural 2.5 mg/mL levobupivacaine 10 mL injection. The patient’s hemodynamic parameters were monitored perioperatively. To all patients, in case of necessity, patient-controlled analgesia with IV morphine was administered. The pain assessment was done using a numeric pain rating scale and visual analog scale. In addition, morphine usage during the 24 hours, pain scores, mobilization time, patient satisfaction, and side effects were evaluated.Results: In the levobupivacaine group, the pain scores were lower during the whole trial, the morphine consumption in the 24 hour period was lower, the first time of mobilization was shorter, the patient satisfaction was more remarkable, and this group was more clinically significant considering side effects.Conclusion: The usage of epidural bupivacaine combined with IV morphine instead of IV morphine alone for postoperative analgesia is more beneficial for early mobilization, reducing complications, and better patient satisfaction

Multimodal analgesia after open abdominal surgery: epidural versus intravenous patient-controlled

Background: Abdominal surgery is a type of surgery with a high percentage in general surgery department. After this surgery, pain is severe and multimodal analgesia is recommended. The objective of this study was to evaluate the effectiveness of epidural analgesia with intravenous bupivacaine-fentanyl plus paracetamol compared with ketorolac plus paracetamol and intravenous morphine as rescue. Materials and methods: In a randomized controlled clinical trial, 70 patients aged 18 years or older, ASA I - III, with an indication for open abdominal surgery were randomly divided into two treatment groups. The PCEA group received bupivacaine 0.1% + fentanyl 2mcg/ml and intravenous paracetamol, the IV-PCA group received ketorolac and paracetamol combined with intravenous morphine as rescue. VAS scores at rest and on movement, patient satisfaction, side effects. Results: VAS scores at rest and on movement in both groups were less than 4 in the first 48 hours postoperatively and in the PCEA group lower than the IV-PCA group (p &lt; 0.05). The level of very satisfied in the PCEA group was statistically significantly higher than in the IV-PCA group (71.4% versus 22.9%). Satisfaction level in group IV-PCA accounted for 71.4%. Side effects of the two groups were low rate and mild. Conclusion: Multimodal analgesia by using epidural bupivacaine - fentanyl combined with intravenous paracetamol was more effective than ketorolac combined with intravenous paracetamol and rescue by intravenous morphine after open abdominal surgery. In cases where epidural analgesia is not applied, intravenous multimodal analgesia also provides good analgesia. Key words: open abdominal surgery, multimodal analgesia, epidural, intravenous.

Comparison of Effect of Meperidine Versus Fentanyl as an Adjuvant to Epidural Bupivacaine on Duration of Labor: A Randomized Controlled Study

Epidural analgesia (EA) is one of the best pain relief for many pregnant women in labor. This study was conducted to evaluate the effect of epidural analgesia provided by a combination of bupivacaine plus meperidine or fentanyl on the mother, fetus, and labor process in term nulliparous women. A total of 558 nulliparous women were randomized into two groups of 279 subjects. The BF (Bupivacaine-Fentanyl) group received 16 ml bupivacaine 0.125% plus 50 mg fentanyl as a loading dose; then, an intermittent bolus of the same solution was administered once the patient requested analgesia. The BM (Bupivacaine-Meperidine) group received a loading dose of 16 ml bupivacaine 0.125% plus 20 mg meperidine followed by an intermittent bolus of the same solution if the patient requested analgesia. The time of labor phases 1 and 2 and the incidence of side effects were recorded. After the intervention, the pain score was significantly lower in the meperidine group compared to the fentanyl group during labor (P=0.006). The duration of the active phase of labor (P=0.04) and the rate of cesarean section (P=0.01) were significantly higher in the fentanyl group compared to the meperidine group. The duration of the second stage of labor was not significantly different between the two groups (P=0.24). Apgar score was significantly higher in the meperidine group. This study found that epidural meperidine could be a suitable alternative to fentanyl for improving pain relief and shortening the active phase of delivery without increasing the risk of the neonatal low Apgar score.

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life

Molar incisor hypomineralization (MIH) affects the first permanent molars and permanent incisors whose formative embryological process develops around birth and the first year of life. This study’s main objective is to assess the relationship between MIH, on the one hand, with the administration during childbirth of epidural bupivacaine, intramuscular meperidine with haloperidol, synthetic intravenous oxytocin, and prostaglandins such as dinoprostone vaginally, and on the other hand, with suffered pathologies during the first year of life. Cross-sectional retrospective study was carried out on 111 children who attended dental check-ups. Oral examination was carried out to determine MIH involvement. Data on the administration of medications during delivery and the illnesses suffered by the children in the first year of life were taken from the hospital records. Significant relationship with Pearson's chi-square was found between the presence of MIH and the administration of meperidine with haloperidol intramuscularly and the vaginal administration of dinoprostone during labour. Also in children who have suffered serious infections and those who have received antibiotics in early childhood. In recent years there has been a growing trend in many countries to medicalize childbirth even above what the World Health Organization recommends. Some of the drugs used in these protocols could be involved in the appearance of dental mineralization alterations of the MIH type and this would help to explain the increase in its prevalence.

Efficacy of intraoperative epidural dexamethasone and bupivacaine in reduction of pain and disability following lumbar discectomy.

ABSTRACTBackground:In lumbar disc herniation, although surgery can provide relief from pain in the low back and lower extremities, many drugs can provide more relief; thus, the aim was the evaluation of epidural dexamethasone and bupivacaine efficacy in lumbar disc herniation surgery.Methods:A total of 42 cases were evaluated in a triple-blind randomized clinical trial study. Patients were divided into intervention and control groups based on permuted block randomization. The patient’s condition was assessed based on the Visual Analogue Scale (VAS) at 3, 6, 12, and 24 h and 1, 3, and 6 months after surgery. In addition, the patient’s disability was assessed by Oswestry disability index (ODI) at 1 and 6 months after surgery.Results:Of the 42 evaluated cases, age (44.0 ± 12.4, P = 0.4) and hospitalization duration (1.9 ± 0.3 days, P = 0.02) had statistically significant difference between two groups. The severity of low back pain before surgery was 2.9 ± 1.9 (P = 0.74), and 3 hours after surgery was 4.9 ± 1.9 in the control group and 2.8 ± 1.3 in the intervention group (P = 0.03), and there was a statistically significant difference between the two groups. In addition, based on the repeated measure test, there was no significant difference between the two groups. ODI value was before surgery 31.7 ± 8.3 (P = 0.77), 5.2 ± 2.4 (P = 0.9) at 1 month after surgery, and 4.5 ± 1.8 (P = 0.6) at 6 months after surgery, and there was no statistically significant difference between the two groups.Conclusion:Dexamethasone and bupivacaine can be effective in post-operation pain control, although this difference between the two groups was not statistically significant.

Comparison Between Epidural Bupivacaine with and without Magnesium Sulphate in Patients Undergoing Elective Total Abdominal Hysterectomy: A Double-blinded Randomised Clinical Trial

Introduction: The effectiveness of a local anaestheticis increased by the addition of an adjuvant. Magnesium sulphate along with bupivacaine is effective in reducing the pain and extending the analgesia period. Aim: To compare the duration of analgesia among subjects receiving plain bupivacaine and bupivacaine with magnesium sulphate among patients undergoing total abdominal hysterectomy. Materials and Methods: This double-blinded randomised clinical trial was conducted in Department of Anaesthesiology at Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India, (tertiary care center) between November 2019 and October 2021. The study was done among 50 subjects undergoing elective total abdominal hysterectomy. The subjects were divided into two groups, one group received only bupivacaine while the other group received bupivacaine with 500 mg magnesium sulphate. Onset and duration of blocks were observed. Haemodynamic parameters were monitored intraoperatively and postoperatively. Data was analysed using Chi-square test, Fischer’s exact test. Results: Demographic variables like age (p-value=0.17), height (p-value=0.62), weight (p-value=0.14) and BMI (p-value=0.24) were comparable between the two groups. The mean duration of analgesia was significantly more among the bupivacaine and magnesium sulphate group (416.72±93.6) in comparison to the bupivacaine alone group (204.56±71.25). The bupivacaine and magnesium sulphate group required two doses of rescue analgesia in 24 hours, while the other group required four doses of analgesia. Significantly more side-effects were noted among the bupivacaine alone group (12 vs 6) (p-value=0.04). Conclusion: The study showed that bupivacaine and magnesium sulphate group showed less intraoperative side effects, reduced postoperative VAS score increased duration of analgesia, decreased requirement of analgesia required in 24 hours and reduced postoperative side-effects.

Reversal of Bupivacaine 0.5% Epidural Anesthesia Using Epidural Saline Washout

Background: Prolonged motor and sensory block following epidural anesthesia has been associated with patient dissatisfaction. Administration of epidural crystalloids in patient who had received bupivacaine 0.75% and lidocaine 2% epidural anesthesia. However, bupivacaine 0.5% is commonly used in our institutional and the effectiveness of bolus of NS in non-obstetrical patients undergoing 0.5% bupivacaine epidural anesthesia has not been investigated. The objective of this study was to determine the relationship of normal saline (NS) epidural flush volume to the recovery of motor and sensory block and its hemodynamic stability (blood pressure and heart rate) in non-obstetrical patients undergoing epidural anesthesia using 0.5% bupivacaine. Methods: Following surgery, subjects with T6 dermatome level of sensory, were randomized to 2 treatment groups. Group 1 (control, n = 11) received 1-mL epidural normal saline (NS). Group 2 (experimental, n = 11) received an epidural bolus of 30-mL NS. Assesment of motor and sensory block was performed at 15-minute intervals until complete motor and sensory recovery. Hemodynamic stability (blood pressure and heart rate) between two groups were also monitor every 15-minutes and determined. Results: Times to full motor recovery were significantly faster in the epidural bolus of 30-mL groups than in the control group (69 ± 19.66 vs 95 ± 11.83; p = 0.0017).). Conclusions: A more rapid recovery of motor block in patients undergoing 0.5% bupivacaine epidural anesthesia can be achieved with the use of 30-mL NS epidural washout, with hemodynamic stability.

Effects of Magnesium Sulphate (MgSO4) Versus Fentanyl as an Adjuvant to Epidural Bupivacaine in Lower Abdominal Surgeries

Background: In modern anaesthesia practice, a number of agents are used as adjuncts with epidural local anesthetics to achieve good perioperative hemodynamic stability as well as prolong the postoperative analgesia period. Among the different adjuvants, Fentanyl and Magnesium sulphate shows the promising results. Objectives: To study the effects of Magnesium Sulphate (MgSO4) versus Fentanyl as an Adjuvant to single-shot Epidural Plain Bupivacaine in Lower Abdominal Surgeries. Methods: It is a randomized controlled trail study, carried out in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital Dhaka. Study populations were patients of ASA Status I-II planned for lower abdominal surgery under single-shot epidural anaesthesia. Study populations were randomly allocated into one of the three groups, of 25 each- group C, M&amp;F. Group C-Patients received plain bupivacaine 0.5% 20 ml. Group M - Patients plain bupivacaine 0.5%(19 ml)+500 mg magnesium sulphate (1ml) and group F received plain bupivacaine 0.5% (19 ml)+50μg Fentanyl (1ml). Data were processed and analyzed by SPSS version 22.0. Results: It was found that the onset of sensory block at T8 was faster in Group M and F (14.2±2.5 min &amp; 13.8±2.2 min) than Group C (18.5±3.1 min). On comparison of the required time to achievement of sensory loss between groups, required time was 11-15 minutes in 12(48.0%) patients of Group-M, 15(60.0%) in group F versus 16-20 minutes in 12(48.0%) patients of Group-C. The result was significant (*p-value &lt; 0.05). In this study duration of sensory block was longer in Group-M ˃Group-F˃ group C. Result was significant between groups (p&lt;0.01). But the motor block was almost similar between groups. No statistically significant difference was seen in between groups. It was evident that intensity of pain was lower up to 6 hrs. After anaesthesia, following that pain increases and analgesic also required in all groups, comparatively ........

Epidural Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for Anesthesia in Knee Surgeries

Abstract Background Epidural anesthesia is one of the preferred modes of regional anesthesia for lower limb orthopedic surgeries. This technique provides not only peri-operative anesthesia but also post-operative analgesia. Bupivacaine is commonly used local anesthetic in epidural anesthesia, many adjuvants added to local anesthetics to enhance the quality and duration of surgical anesthesia, among them are opioids, alpha 2 agonists. Opioids like fentanyl have been a popular choice, it offers faster onset and prolongs the duration of analgesia. Recently, alpha 2 agonists like clonidine and dexmedetomidine have been also used in prolonging the duration of epidural analgesia. Aim of the Work To compare the efficacy of using fentanyl and dexmedetomidine with bupivacaine in epidural block for knee surgeries, the time of onset of sensory, motor blockade and the duration of this blockade. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. It was a prospective double-blind randomized clinical study. Study period was 6 months. Results A total of 50 patients out of 71 consecutive patients met the inclusion criteria and consented for study. These 50 patients were randomized into two groups of 25 each. Out of the total patients, 33 were male and 17 were female. Conclusion Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl as it shows faster onset of sensory and motor block, lesser time to attain maximum sensory level and prolonged duration of anesthesia.

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to Addition of Fentanyl in Patients undergoing Lower Limb Orthopedic Surgery under Combined Spinal Epidural Anathesia

Abstract Background The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objectives The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia. Patients and Methods After approval of ethical committee in our study and obtaining written informed consent from eligible patients the study was conducted on 60 patients classified to ASA I and II scheduled for lower limb orthopedic surgery. The study presents double armed randomized interventional prospective study including patients allocated into two equal groups each consists of 30 patients. Group (A): patients received magnesium sulphate added to bupivacaine in epidural, Group (B): patients received fentanyl added to bupivacaine in epidural Results The results of their study showed that the maximum level of sensory blockade was significantly higher in the combined fentanyl with magnesium group as compared with fentanyl group alone and magnesium sulphate group alone. The duration of sensory blockade of the combined fentanyl and magnesium group was significantly prolonged as compared to the other two groups as for the other two group the difference in the blockade duration was insignificant Conclusion We concluded that either magnesium sulfate (75 mg) combined with (10 ml) 0.25% Bupivacaine or fentanyl (1 µg/kg) combined with (10 ml) 0.25% Bupivacaine in combined spinal epidural improves intraoperative analgesia and prolongs early postoperative analgesia in lower limb orthopedic surgeries. The duration of analgesia was more prolonged in magnesium sulphate group than in the fentanyl group and this difference was statistically significant.

ANALGESIC EFFICACY AND HAEMODYNAMIC PROFILE OF DEXMEDETOMIDINE VERSUS FENTANYL AS EPIDURAL ADJUVANTS – A PROSPECTIVE STUDY

BACKGROUND: Combined spinal epidural anaesthesia is the most popular anaesthetic technique for major gynaecological surgeries. Epidural adjuvants enhance the quality and duration of surgical anaesthesia. Adjuvants like opioids or alpha 2 agonists provide a dose sparing effects on local anaesthetics and accelerate the onset of sensory blockade of epidural anaesthesia. Our study was aimed to compare the hemodynamic, sedative and analgesia potentiating effects of Dexmedetomidine and Fentanyl when added to epidural Bupivacaine for gynaecological surgeries. METHODOLOGY: Patients of ASA Grade I and II, aged between 30 and 65 years who were scheduled for major gynaecological surgeries were included in the study. Patients were randomly divided into two groups, Group D (N = 51) and Group F (N = 51). Group D received epidural injection of 0.5 mcg/kg of Dexmedetomidine diluted to 5ml with Normal Saline (NS) and Group F received 0.5mcg/ kg of Fentanyl diluted to 5 ml with NS, in addition to a spinal dose of 3ml of 0.5 % Bupivacaine. When two segment regression of sensory level was noted, epidural block was supplemented with 0.5 mcg /kg of the study drug in combination with 1.5 ml/segment of 0.5% Bupivacaine. Duration of sensory block, motor block, and incidence of bradycardia, hypotension, nausea and pruritus were assessed. RESULTS: The duration of analgesia and motor block were signicantly longer in the Dexmedetomidine group. The incidence of bradycardia was more in the Dexmedetomidine group, but the incidence of hypotension was nearly the same. CONCLUSION: Dexmedetomidine seems to be a better alternative to Fentanyl as an epidural adjuvant due to early onset of sensory anaesthesia and prolonged postoperative analgesia.

Comparative Evaluation of two Doses of Epidural Butorphanol with Bupivacaine for Postoperative Analgesia

Background: Postoperative analgesia is very important to prevent subjective discomfort, early mobilization and shortened hospital stay. Opioids addition to local anesthetics improve the quality of analgesia. Present study was designed to evaluate and compare the duration and efficacy of two different doses of epidural Butorphanol for postoperative analgesia. Patients and Methods: This prospective, randomized double blinded study was conducted on 75 patients in the age group of 20-60 years of either sex, with ASA class I and II scheduled for elective lower limb orthopedic surgeries under combined spinal epidural anesthesia after taking the informed consent and approval from hospital ethical committee. Group allocation, group I (n=25) received epidural 0.25 % bupivacaine, group II (n= 25) patients received 0.25% epidural Bupivacaine and 1 mg Butorphanol, group ΙΙΙ (n= 25) patients received 0.25% epidural Bupivacaine and 2 mg Butorphanol. Postoperatively VAS, sedation score, vitals &amp; side effects were observed. Injections were given on achieving VAS&gt;3. Results: Onset of analgesia was significantly shorter in group III as compare to group II and group I. Duration of analgesia was longest in group ΙII 9.95±0.43 hour which was significantly greater than group I 3.90±0.32 hours and group ΙΙ 6.06±0.26 hours. Postoperative VAS scores at different intervals were lower in group III than group II and group I (group III&lt; group II&lt; group I). Sedation scores were significantly higher in butorphanol group with no major adverse effects. Conclusion: Butorphanol 2 mg with 0.25% bupivacaine appears to be the optimal dose to produce a more rapid onset and longer duration of analgesia with no adverse effects. Keywords: Epidural; Postoperativanalgesia; Butorphanol.