Bupivacaine Group Research Articles

COMPARE THE ANALGESIC EFFICACY OF 0.25% BUPIVACAINE AND 0.25% BUPIVACAINE WITH 0.9 μG/KG DEXMEDETOMIDINE IN TAP BLOCK

Objectives: The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. Despite a relatively low risk of complications and a high success rate using modern techniques, TAP blocks remain overwhelmingly underutilized. The objective is to compare the analgesic efficacy of 0.25% bupivacaine and 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine in TAP block as a part of a multimodal analgesia regimen for post-cesarean delivery pain management. Methods: Patients more than 18 years old posted for elective/emergency caesarean section in ABVGMC, Vidisha, Madhya Pradesh. After approval from the institutional ethical committee and written informed patients consent, 20 each pregnant women were included in the both study group. Group A: TAP block with 0.25% bupivacaine 20 mL each side Group B: TAP block with 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine 20 mL each side. We studied TAP block in patients posted for elective caesarean section. Results: The women received 0.25% bupivacaine or 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine. The median visual analogue scale (VAS) for pain was significantly higher in the bupivacaine Group A at 12 h with compare to Group B. Overall, there was no difference in VAS score at 0.5, 2, 4, 6, and 24 h demands between the two groups. The mean time to first rescue analgesia in Group A was 14.6±5.5 h and in Group B was 16.8±4.2 h. Conclusion: We conclude that the using dexmedetomidine as an additive to bupivacaine in ultrasound-guided TAP block for elective/emergency caesarean section provides prolonged duration of post-operative analgesia, and lowered VAS pain scores. The addition of dexmedetomidine to bupivacaine also reduced the total dose of opioid requirement in the first 24 h after caesarean section.

Comparing the Effect of Intrathecal Injection of Pethidine with that of Bupivacaine on Hemodynamics in Hip Surgery: A Double Blinded Clinical Trial

Background: The use of regional anesthesia for lower limb orthopedic surgery is preferable to general anesthesia. In some studies comparing regional anesthesia and general anesthesia, the one-month mortality of patients undergoing regional surgery was significantly lower. Given the relative advantages observed about intrathecal injection of pethidine, including fewer side effects, and longer postoperative analgesia, in combination with effective sensory, motor, and sympathetic blocks, we sought to compare the influence of intrathecal injection of pethidine and bupivacaine on the hemodynamics of patients. Methods: In this double blind randomized parallel trial, patients undergoing surgery with femoral and hip fractures, were divided into two groups. In the first group bupivacaine and in the second group pethidine were used for spinal anesthesia. Hemodynamic changes were examined and recorded during surgery. The results were analyzed by SPSS18 software Results: 67 patients undergoing surgery with femoral and hip fractures, were divided into two groups of 30 and 37 individuals. The mean heart rate in patients with a high risk of surgery was higher in the group receiving pethidine compared to the group of bupivacaine, with a Cohen's effect size of 0.294. This effect size is evaluated as average, while the rate of mean arterial pressure with Cohen's effect size of 0.511 was evaluated as large. Conclusion: Pethidine can be a good alternative to bupivacaine, especially in patients at high risk of surgery, given its hemodynamic stability.

The anesthetic and recovery profiles of low-dose hypobaric mepivacaine and bupivacaine for spinal anesthesia in total hip and knee arthroplasty: a prospective observational study.

Same-day mobilization and early hospital discharge is increasingly emphasized following hip and knee arthroplasty. One challenge of spinal anesthesia in this setting is achieving adequate block height while avoiding excessively large local anesthetic doses and prolonged motor and sensory blockade. Using a hypobaric local anesthetic solution is one potential strategy, as its intrathecal distribution can be reliably manipulated by patient positioning to achieve adequate block height independent of dose. We conducted a prospective observational study to determine the clinical characteristics of spinal anesthesia with low-dose hypobaric mepivacaine and bupivacaine in patients undergoing hip and knee arthroplasty. Thirty patients scheduled for same-day discharge received 51mg of hypobaric 1.5% mepivacaine and 30 patients scheduled for inpatient stay received 10mg of hypobaric 0.33% bupivacaine. The mean (standard deviation) time to achieve sensory blockade at or above L1 and T10 in the operative limb was 5.7 (1.8) and 7.3 (3.3) min with mepivacaine and 6.2 (2.6) and 8.1 (4.8) min with bupivacaine, respectively. Anesthesia was adequate for surgical commencement in all patients regardless of spinal injection level. Four patients required anesthetic supplementation for surgical completion. Sensory block duration at or above T10 and L1 in the operative limb was 97 (27) and 115 (37) min with mepivacaine and 127 (32) and 161 (34) min with bupivacaine, respectively. Motor function returned by 145 (37) and 217 (43) min in mepivacaine and bupivacaine groups, respectively. The anesthetic profiles of low-dosehypobaric mepivacaine and bupivacaine were favorable for fast-track hip and knee arthroplasty with short and predictable operating times.

Topical bupivacaine effect on the response to awake extubation during emergence from general anesthesia in patients undergoing elective thyroidectomy. A randomized controlled study

BackgroundA desirable combination of smooth extubation, even with prolonged extubation, and an easy maneuver to apply is difficult to achieve. This study aimed to evaluate the efficacy of 0.5% topical bupivacaine for reducing cough, postoperative sore throat, and hemodynamic fluctuations during extubation in patients undergoing thyroidectomy. MethodsForty-eight patients scheduled for thyroidectomy were randomly assigned to two equal groups (24 each): group (C) patients received 5 ml of 0.9% normal saline topically, and group (B) patients received 5 ml of 0.5% bupivacaine topically 15 min, around the tracheal tube, before the expected end of surgery, followed by manual ventilation to obtain air bubbles distributed throughout the entire airway mucosa. The primary outcomes were the incidence and grade of cough. The secondary outcomes were the incidence and degree of postoperative sore throat, extubation time, hemodynamic changes during extubation, and side effects. ResultsThere was a statistically significant decrease in the incidence and the severity of cough in the bupivacaine group compared to the control group. Moreover, the severity of sore throat, as assessed by the VAS score, was lower in the bupivacaine group up to 12 hours postoperatively. The hemodynamic parameters significantly increased in the control group in the peri-extubation period compared to the bupivacaine group, with no difference in extubation time or side effects. ConclusionThe use of topical bupivacaine around the ETT significantly reduced the incidence and severity of cough and postoperative sore throat with less hemodynamic fluctuations during the periextubation period in patients undergoing thyroidectomy.

INTRAOPERATIVE LOCAL BUPIVACAINE WOUND INFILTRATION VERSUS TRADITIONAL SYSTEMATIC ANALGESIA: A COMPARISON IN TERM OF POST-OPERATIVE PAIN

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.

BN SO06 - Comparison of local infiltration of tramadol versus bupivacaine for Post-operative pain relief

Abstract Background To compare the mean pain score of local infiltration of tramadol and bupivacaine among patients undergoing hernioplasty, a Tertiary Care Hospital, Karachi. Method Quantitative and qualitative data was collected, presented and analyzed. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification independent t test was applied taking p-value of ≤0.05 as significant. Results Mean postoperative pain at 24 hours in tramadol versus bupivacaine group was 1.65±0.58 and 1.72±0.82 respectively. P-value was 0.001. Conclusion Locally infiltrated tramadol prior to herniorrhaphy wound closure provides better pain relief compared to bupivacaine in adult patients

Comparing the Effect of Topical Lignocaine and Bupivacaine in Nasal Packs for Pain Relief in Post Operative Nasal Surgery Patients

This randomized controlled trial compared the analgesic efficacy of lignocaine, bupivacaine, and placebo nasal packs in patients undergoing nasal surgeries, including septoplasty and functional endoscopic sinus surgery (FESS). A total of 100 patients, aged 18–60 years, were randomly assigned into three groups: lignocaine (n=34), bupivacaine (n=33), and placebo (n=33). Postoperative pain was assessed using the Visual Analog Scale (VAS) over 24 hours. Additional analgesic requirements, side effects, recovery time, and length of hospital stay were recorded. Bupivacaine provided significantly lower pain scores at all intervals compared to lignocaine and placebo (p < 0.05). The bupivacaine group had a lower need for additional analgesics (39.4%) compared to lignocaine (76.5%) and placebo (81.8%) (p = 0.041). Side effects such as nausea and vomiting were similar across all groups. The bupivacaine group experienced a shorter hospital stay (2.0 days) compared to the lignocaine (2.5 days) and placebo (3.0 days) groups (p = 0.038). In conclusion, bupivacaine-soaked nasal packs offer superior pain relief, reduce the need for additional analgesics, and shorten hospital stays, making it a preferable option for postoperative pain management in nasal surgeries.

Liposomal Bupivacaine Versus Plain Bupivacaine for Pain Control Following Congenital Cardiac Surgery.

Pain control following cardiac surgery can be challenging, and inadequate pain control is associated with postoperative complications. Liposomal bupivacaine can improve postoperative pain control due to its prolonged duration compared with plain bupivacaine. However, there is a paucity of data regarding its efficacy in congenital cardiac surgery. The primary outcome was to compare opioid requirements between liposomal bupivacaine and plain bupivacaine for local infiltration in pediatric patients undergoing cardiac surgical procedures via a median sternotomy approach. Secondary outcomes included antiemetic use, adjunct pain medication use, length of stay, and pain scores. This single center retrospective study analyzed data from 2017 to 2022 involving patients who underwent congenital cardiac surgery via median sternotomy. Sixty-three patients who received liposomal bupivacaine were matched with 33 patients who received plain bupivacaine. Patient data were extracted from the electronic medical record and underwent statistical analysis using Wilcoxon, χ2, and Fisher exact tests. There were no demographic differences between the two groups. Postoperative opioid use did not differ significantly between the liposomal bupivacaine and plain bupivacaine groups. The liposomal bupivacaine group had increased acetaminophen and antiemetic use, while the plain bupivacaine group had increased ketorolac use. Otherwise, there were no significant differences in secondary outcomes, including length of stay. Liposomal bupivacaine may not offer any advantage over plain bupivacaine in congenital cardiac postoperative pain control.

Adequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception.

Background/Objectives: Hemodynamic instability and inappropriate postoperative pain perception (IPPP) with their consequences constitute an anesthesiological challenge in patients undergoing primary elective open lumbar infrarenal aortic aneurysm repair (OLIAAR) under general anesthesia (GA), as suboptimal administration of intravenous rescue opioid analgesics (IROAs), whose titration is optimized by Adequacy of Anaesthesia (AoA) guidance, constitutes a risk of adverse events. Intravenous or thoracic epidural anesthesia (TEA) techniques of preventive analgesia have been added to GA to minimize these adverse events. Methods: Seventy-five patients undergoing OLIAAR were randomly assigned to receive TEA with 0.2% ropivacaine (RPV) with fentanyl (FNT) 2.5 μg/mL (RPV group) or 0.2% bupivacaine (BPV) with FNT 2.5 μg/mL (BPV group) or intravenous metamizole/tramadol (MT group). IROA using FNT during GA was administered under AoA guidance. Systemic morphine was administered as a rescue agent in all groups postoperatively in the case of IPPP, assessed using the Numeric Pain Rating Score > 3. The maximum score at admission and the minimum at discharge from the postoperative care unit to the Department of Vascular Surgery, perioperative hemodynamic stability, and demand for rescue opioid analgesia were analyzed. Results: Ultimately, 57 patients were analyzed. In 49% of patients undergoing OLIAAR, preventive analgesia did not prevent the incidence of IPPP, which was not statistically significant between groups. No case of acute postoperative pain perception was noted in the RPV group, but at the cost of statistically significant minimum mean arterial pressure values, reflecting hemodynamic instability, with clinical significance < 65mmHg. Demand for postoperative morphine was not statistically significantly different between groups, contrary to significantly lower doses of IROA using FNT in patients receiving TEA. Conclusions: AoA guidance for IROA administration with FNT blunted the preventive analgesia effect of TEA compared with intravenous MT that ensured proper perioperative hemodynamic stability along with adequate postoperative pain control with acceptable demand for postoperative morphine.

Comparison of Ropivacaine and Bupivacaine in Intraperitoneal Instillation for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Introduction Laparoscopic cholecystectomy, despite its several advantages, is sometimes associated with discomfort due to pain in the immediate postoperative period. Effective management of this pain is critical for enhancing recovery, minimizing complications, and facilitating early discharge. The use of local anesthetics for intra-abdominal analgesia, specifically bupivacaine and ropivacaine, has been investigated as a means to improve postoperative pain control. This study aims to compare the analgesic efficacy of intra-peritoneal ropivacaine versus bupivacaine following laparoscopic cholecystectomy. Methods This prospective, randomized, comparative study was conducted after obtaining institutional ethics committee clearance. Sixty ASA grade I/II patients, aged 18 to 65 years, undergoing elective laparoscopic cholecystectomy were enrolled. Patients were randomly assigned to receive either 35 ml of 0.375% ropivacaine (Group R) or 35 ml of 0.25% bupivacaine (Group B) administered intra-peritoneally. Analgesic efficacy was assessed using Visual Analogue Scale (VAS) scores, heart rate monitoring, and the requirement for rescue analgesia. Data were collected at various time intervals and analyzed using statistical methods. Results Mean heart rate values were significantly lower in Group R compared to Group B from the 2nd to 8th hour and at the 18th hour postoperatively (p < 0.05). The mean VAS scores for pain at rest were significantly lower in Group R compared to Group B from the 8th to 24th hour (p < 0.001). A substantially higher proportion of patients in Group B required rescue analgesia compared to Group R (p < 0.05). Specifically, 16.7% of patients in Group R required rescue analgesia versus 43.3% in Group B. The time to the first dose of rescue analgesia was longer in Group R (8.4±3.6 hours) compared to Group B (6.8±11.3 hours), though this difference was not statistically significant (p > 0.05). Total analgesic consumption was significantly higher in Group B (20.5±3.2 mg) compared to Group R (14.6±2.8 mg) (p < 0.001). Conclusion Ropivacaine provides superior postoperative analgesia compared to bupivacaine when used for intra-peritoneal instillation in laparoscopic cholecystectomy. The findings support the use of ropivacaine for effective pain management in this surgical context, potentially leading to improved patient outcomes and reduced opioid consumption.

A Comparative Study Of Intrathecal 0.5% Hyperbaric Bupivacaine And Intrathecal 0.75% Hyperbaric Ropivacaine In Lower Abdominal Surgeries.

Background: Spinal anaesthesia has been widely used since its introduction in 1898 due to its safety and advantages over general anaesthesia. However, traditional agents like bupivacaine have some disadvantages, including cardiovascular effects and longer duration of action. Ropivacaine has emerged as a potential alternative with reduced cardiovascular toxicity. The study was aimed to compare the efficacy and suitability of 0.75% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine in patients undergoing lower limb and endoscopic urological surgeries, evaluating onset, quality, duration of block, and incidence of complications. Materials and Methods: A prospective randomized trial was conducted with 130 patients (65 per group) aged 16-60 years, ASA grades 1 &amp; 2. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine, while Group R received 3.0 ml of 0.75% hyperbaric ropivacaine. Onset of anaesthesia, quality of block, duration, hemodynamic parameters, and complications were assessed. Results: Ropivacaine showed faster sensory and motor recovery, better hemodynamic stability, and fewer side effects compared to bupivacaine. The onset of sensory block was slightly faster with bupivacaine (2.17 vs 2.54 minutes), but ropivacaine had a shorter duration of sensory (114.7 vs 158 minutes) and motor block (112 vs 130 minutes). Ropivacaine group experienced less hypotension (4.6% vs 7.7%) and no bradycardia or vomiting compared to the bupivacaine group. Conclusion: Hyperbaric ropivacaine 0.75% was found to be a comparable and safer alternative to hyperbaric bupivacaine 0.5% for patients undergoing lower abdominal surgery, offering faster recovery and better hemodynamic stability

Randomized Clinical Trial Comparing Mixed Liposomal Bupivacaine versus Continuous Catheter for Interscalene Block during Shoulder Arthroplasty: A Comparison of Analgesia, Patient Experience, and Cost

BackgroundContinuous interscalene catheters extend analgesia beyond 24 hours but are resource-intensive, while the efficacy of liposomal bupivacaine for single-injection interscalene blocks remains uncertain. The purpose of this investigation was to examine the analgesic efficacy, quality of recovery, and treatment costs between interscalene nerve block using either an indwelling catheter or single shot block using liposomal bupivacaine, in patients undergoing shoulder arthroplasty. MethodsIn this single-center, parallel, unblinded, randomized clinical trial, 83 patients undergoing primary shoulder arthroplasty were assigned to either a continuous interscalene catheter group (n=44) or a single-injection liposomal bupivacaine interscalene block group (n=39). The interscalene catheter group received a 15-20 mL bolus of 0.5% bupivacaine HCl followed by continuous infusion at 8 mL/h for 69 hours. The single-injection interscalene group received 10 mL (133 mg) liposomal bupivacaine with 5 mL of 0.5% bupivacaine HCl. The primary outcome was pain at rest 24 hours post-surgery. Secondary outcomes included pain scores, opioid consumption, complications, quality of recovery, and a time-driven activity-based cost analysis through postoperative day 3. ResultsThere was no significant difference in median pain scores at 24 hours between the continuous interscalene catheter group and the single-injection liposomal bupivacaine group (1.0 [0.0, 2.0] vs. 1.0 [0.0, 3.0]; P=0.433). Comparable analgesia was observed through postoperative day 3, with no differences in opioid consumption or quality of recovery. No serious adverse events were reported; however, 16% of patients in the continuous catheter group experienced dislodgement or leakage. Liposomal bupivacaine was associated with a 28% reduction in costs compared to the continuous catheter approach. ConclusionSingle-injection interscalene block with liposomal bupivacaine provides comparable analgesia to continuous interscalene catheters through postoperative day 3 while offering better value in the perioperative management of shoulder arthroplasty patients.

Ideal Local Anesthetic for Intraperitoneal Gallbladder Bed Infiltration Following Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Background Laparoscopic cholecystectomy is the gold standard operation for symptomatic cholelithiasis; however, pain remains a major factor in increasing morbidity and length of hospital stay. Infiltration of the gallbladder bed with a local anesthetic has been shown to improve postoperative pain after laparoscopic cholecystectomy, although it is unclear which local anesthetic provides superior pain relief. Objective The aim of this study was to compare the efficacy of various local anesthetics on postoperative pain when instilled intraperitoneally in the gallbladder bed following laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomies were randomized into three groups of 30 patients each, depending on the local anesthetic instilled in the gallbladder bed: lignocaine (Group A), bupivacaine (Group B), or a combination of lignocaine and bupivacaine (Group C). Pain was measured using the Visual Analogue Scale (VAS) at two, six, 12, and 24 hours following surgery. Secondary outcomes included vitals, rescue analgesic use, return of bowel function, time to ambulation, and presence of nausea. Results Group C showed the lowest pain scores at all time points compared to the other groups (p < 0.05). Mean arterial pressures and heart rates were lower in Group C than in Group A at two and 24 hours. Return of bowel function and time to ambulation was earlier in Group C than in Group B. No significant complications were noted in any of the groups. Conclusion We conclude that a combination of lignocaine and bupivacaine instillation in the gallbladder bed provides the most effective pain relief following laparoscopic cholecystectomy, without significant complications at the doses used.

Comparative Study between Bupivacaine versus Bupivacaine with Dexmedetomidine in Ultrasound Guided Transversus Abdominis Plane Block as Postoperative Analgesia in Open Inguinal Hernia

Abstract Background A recent myofascial plane block, the transversus abdominal plane block (TAP), has been shown to lessen not only postoperative discomfort after surgery of inguinal hernia but also hospital stay. It is our objective to achieve postoperative satisfaction regarding the pain with the least side effects as related with opioids. Methods The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202301487176282), randomized clinical trial, after obtaining approval from the Research Ethical Committee of Ain Shams University, this study was done in the general surgery theatres of Ain Shams University Hospitals for 12 months. Results In this study, TAP block with dexmedetomidine was more effective than TAP alone as measured by visual analog scale (VAS) scores, regarding first analgesic request and change in vital data. Significant differences in VAS scores were observed at 6 hours up to 24 hours postoperatively (p &amp;lt; 0.01), but not during the first 6 hours. Heart rate was obviously diminished in the Bupivacaine with Dexmedetomidine (BD) group compared to the Bupivacaine (B) group starting at 2 hours postoperatively, while mean blood pressure was eased from 6 hours up to 24 hours postoperatively. Total analgesic consumption and time to first analgesic request were decreased in the BD group, while the incidence of nausea and vomiting were similar between the two groups. Conclusions The addition of dexmedetomidine to bupivacaine in TAP block extends the duration of time at which first dose of rescue analgesia and also reduced the total dose of opioid requirement in the first 24-h postoperatively.

Effectiveness of intra-articular analgesia in reducing postoperative pain after minimally invasive sacroiliac joint fusion: a double-blind randomized controlled trial

During the first postoperative days following minimally invasive sacroiliac joint fusion (MISJF), patients often report serious pain, which contributes to high utilization of painkillers and prevention of early mobilization. This prospective, double-blind randomized controlled trial investigates the effectiveness of intraoperative SIJ infiltration with bupivacaine 0.50% versus placebo (NaCl 0.9%) in 42 patients in reducing postoperative pain after MISJF. The primary outcome was difference in pain between bupivacaine and placebo groups, assessed as fixed factor in a linear mixed model. Secondary outcomes were opioid consumption, patient satisfaction, adverse events, and length of hospital stay. We found that SIJ infiltration with bupivacaine did not affect postoperative pain scores in comparison with placebo, neither as group-effect (p = 0.68), nor dependent on time (group*time: p = 0.87). None of the secondary outcome parameters were affected in the postoperative period in comparison with placebo, including opioid consumption (p = 0.81). To conclude, intra-articular infiltration of the SIJ with bupivacaine at the end of MISJF surgery is not effective in reducing postoperative pain. Hence, we do not recommend routine use of intraoperative SIJ infiltration with analgesia in MISJF.

Comparative Efficacy of Intrathecal Hyperbaric Levobupivacaine With Fentanyl Versus Hyperbaric Bupivacaine With Fentanyl in Elective Cesarean Section.

Background In parturient posted for elective cesarean sections, a widely used local anesthetic in the subarachnoid blockade is racemic hyperbaric bupivacaine. Hyperbaric levobupivacaine, the pure S (-) isomer of bupivacaine, was introduced and has since become more widely used in India because of its short duration of motor blockade and reduced risks of neurotoxicity and cardiotoxicity. This study aimed to compare the characteristics of sensory and motor blockade and side effects of equivalent doses of hyperbaric bupivacaine and levobupivacaine with opioid additive fentanyl in order to extend the duration of analgesia during elective cesarean births. Methodology A total of 130 women classified as American Society of Anesthesiologists (ASA) class I and II who are undergoing elective cesarean sections were enrolled in this randomized, prospective, double-blind comparative study after providing written informed consent. They were randomly assigned to one of two groups: Group LF, which included 65 women, obtained 25 mcg (0.5 ml) of fentanyl and 10 mg (2 ml) of hyperbaric levobupivacaine, or Group BF, which included 65 women, received 25 mcg (0.5 ml) of fentanyl and 10 mg (2 ml) of hyperbaric bupivacaine. Pinprick, cold swab, and the Bromage scale are used to assess the characteristics of sensory and motor blockade; hemodynamic alterations and adverse effects are also observed. Results The levobupivacaine group, consisting of 65 participants aged between 21 and 29 years, exhibited fewer side effects and significantly shorter durations of sensory and motor block compared to the bupivacaine group. In both groups, hemodynamic stability is comparable. Levobupivacaine provides analgesia for a significantly shorter period compared to bupivacaine. Conclusions In cesarean procedures, intrathecal hyperbaric levobupivacaine and fentanyl can be effective alternatives to hyperbaric bupivacaine and fentanyl due to their ability to maintain hemodynamic stability while providing adequate sensory and motor blockade.

Effectiveness of topical bupivacaine versus topical lidocaine/adrenaline mixture for post-adenotonsillectomy pain management

BackgroundThis study aims to compare the topical administration of bupivacaine hydrochloride and lidocaine hydrochloride with epinephrine in alleviating post-tonsillectomy pain. Post-tonsillectomy pain has remained a challenge to both patient and doctors, and local anaesthetic agents applied to the tonsillar fossae post-operatively look promising.MethodsOne hundred and twenty ASA I or II children aged 2–15 years of consenting parents undergoing adenoidectomy and/or tonsillectomy were enrolled in the study. This was a randomized double-blind study in which the children were allocated into either of two groups to receive 5 ml of 0.125% bupivacaine or equal volume of lidocaine plus 1:200,000 adrenaline-soaked swab applied directly on the tonsillar floor within the fossae and/or nasopharynx after haemostasis was secured for 5 min before discontinuation of anaesthesia.ResultsPatients in the bupivacaine group had better extubating condition (p = 0.0001). There was no difference in the time to eye opening in both groups (p-value 0.316). Patients in the lidocaine group had a time to first analgesic request between 1 and 6 h, whereas in the bupivacaine group, about 25 patients (44% of the group) had a time to first analgesic request that exceeded 6 h (6–10 h). The only complication recorded in both groups following oral feeds was vomiting, and there was no difference in both groups (p = 0.968). Overall parental satisfaction was better with bupivacaine group (p = 0.00001).ConclusionTopical application of bupivacaine was associated with better extubation conditions and parental satisfaction when compared to topical lidocaine plus adrenaline while both demonstrated similar time to eye opening, analgesic request, haemodynamic parameters and incidence of complications.

Confirmation of epidural anesthesia with bupivakain in cats by ınfrared thermographic ımaging and SEP

In this study, the usability of electromyelography and infrared thermography was tested to confirm the success of epidural anesthesia. The cats were randomly divided into 2 groups as experimental and control groups. Cats were intubated and placed under inhalation anesthesia in the anesthesia device. SEP recordings were obtained from L7-S1, L6-L7, L6-L5 and L5-L4 intervals before epidural injection. Before epidural injection, infrared thermographic images and rectal temperature were taken from a distance of 50 cm where the areas where surface temperatures were to be measured were clearly visible. Following asepsis and antisepsis, 0.5% bupivacaine in the experimental group and saline in the control group were injected from the lumbosacral region. Infrared thermograms and rectal temperature were taken from each cat 7 times (0.min, 5.min, 10.min, 15.min, 20.min, 25.min and 30.min) for 30 minutes at 5 min intervals after injection. After the last infrared thermogram was recorded, post-epidural SEP was recorded. Rectal temperature values decreased gradually in all cats throughout the anesthesia period and no difference was observed between the groups. A decrease in potential duration and an increase in latency values were recorded in 10 cats with epidural 0.5% bupivacaine administration compared to 10 cats with epidural saline administration. Although there were only statistically significant values the amplitude values were not found to be kinetically significant. No clinically or statistically significant difference was observed in the infrared thermograms taken before epidural injection and 5 minutes after epidural injection in both groups.

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.

Recovery quality of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery: A randomized trial

Study objectiveThis study aimed to investigate the effect of liposomal bupivacaine in transversus abdominis plane block (TAP) on recovery quality after cesarean delivery. DesignA randomized trial. SettingAn operating room, a post-anesthesia care unit, and a hospital ward. PatientsA total of 147 women scheduled for cesarean delivery under spinal anesthesia were enrolled and randomized to receive a TAP block with plain bupivacaine (bupivacaine group), liposomal bupivacaine (liposomal group), or a mixture of plain bupivacaine and liposomal bupivacaine (mixture group). InterventionsThe bupivacaine group received bilateral TAP blocks with plain bupivacaine 50 mg alone. The liposomal group received bilateral TAP blocks with liposomal bupivacaine 266 mg alone. The mixture group received bilateral TAP blocks with plain bupivacaine 50 mg followed by liposomal bupivacaine 266 mg. MeasurementsThe primary outcome was the Quality of Recovery−15 (QoR − 15) score assessed 24 h postoperatively. Secondary outcomes encompassed the QoR − 15 score at 48 h post-surgery, the VAS pain score at rest and with movement at 24, 48, and 72 h postoperatively, opioid consumption within the 0–24 h and 24–48 h periods following surgery, as well as patient's satisfaction with analgesic. Main resultsThe QoR − 15 score at 24 h postoperatively was significantly higher in both the liposomal group and the mixture group compared to the bupivacaine group. Specifically, the QoR − 15 score for the liposomal group versus the bupivacaine group (median [IQR]: 120 [107, 128] vs. 109 [104, 120]; median difference, 7; 95 % CI, 2 to 13; P = 0.011) and for the mixture group versus the bupivacaine group (median [IQR]: 122 [112, 128] vs. 109 [104, 120]; median difference, 9; 95 % CI, 4 to 14; P = 0.001). The QoR − 15 score in both the liposomal group and the mixture group were also higher than those in the bupivacaine group at 48 h postoperatively, though the difference was not clinically meaningful. Additionally, both the liposomal and mixture groups exhibited lower pain score at 24 h and 48 h postoperatively compared to the bupivacaine group, but no significant clinical differences were achieved in either pain scores or opioid consumption. Patients in both the liposomal and mixture groups reported higher satisfaction score with analgesia than those in the bupivacaine group. ConclusionsTAP block using either liposomal bupivacaine or a mixture of plain bupivacaine and liposomal bupivacaine provided superior quality of recovery at 24 h after cesarean delivery compared to using plain bupivacaine alone.