Bupivacaine For Infraumbilical Surgeries Research Articles

Comparison of Postoperative Analgesic Effect of Dexmedetomidine and Morphine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries: A Randomised Clinical Trial

Introduction: Regional anaesthesia is the standard technique for lower limb infraumbilical procedures. To provide a better analgesic profile, adjuvants are added to local anaesthetics to enhance their action. Opioids have been used as an adjuvant for a long-time. With evolving pharmacology, various drugs satisfy the criteria of being an adjuvant. One such drug is Dexmedetomidine, a novel alpha-2 agonist. Aim: To compare the duration of analgesia of intrathecal Morphine and Dexmedetomidine as an adjuvant to bupivacaine in a subarachnoid block for lower limb infraumbilical surgeries. Materials and Methods: In this randomised clinical, doubleblinded study conducted in a multispecialty hospital over the period of June 2020 to February 2021, 70 patients were randomly divided into two groups: Group M received Morphine 125 µg, and Group D received dexmedetomidine 5 µg as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine. The primary outcome was to compare the duration of postoperative analgesia. The secondary results assessed the block characteristics, haemodynamic parameters, rescue analgesic consumption, sedation score, and side-effects like bradycardia, hypotension, nausea, vomiting, pruritus, and respiratory depression. Data was spread in an Excel sheet and descriptive analysis done. Normally distributed continuous variables were compared using a Student’s t-test, and discrete variables were compared using a Chi-square test. A p-value of <0.05 was considered significant. Results: Both groups were similar with respect to age, sex, body mass index, American Society of Anaesthesiologists grading, and duration of surgery. The duration of analgesia was 956.97±120.043 minutes in group M and 392.83±50.354 minutes in group D (p-value <0.001). The total consumption of paracetamol was 1984.71±499.111 mg in group M and 3543.86±406.17 mg in group D. The onset and regression were significantly faster in group D. There was significant hypotension and bradycardia up to the 40th minute and an increase in heart rate, respiratory rate, and mean arterial pressure between 5-7 hours in group D. The sedation score was more in group D for the initial two hours. Postoperatively, the incidence of nausea, vomiting, and pruritus was more in group M. Conclusion: It can be concluded that 125 µg of intrathecal morphine is a better adjuvant to spinal bupivacaine, providing excellent postoperative analgesia compared to 5 µg of intrathecal dexmedetomidine. However, dexmedetomidine had more incidence of hypotension, bradycardia, and sedation when compared to morphine intrathecally.

Randomized controlled study comparing a isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries

Levobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. Present study is undertaken to compare hemodynamic and analgesic characteristics using an isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries. A prospective randomized double blind study was conducted involving 60 patients belonging to ASA gr I & II coming for elective lower abdominal surgeries. They were randomly divided into 2 groups of 30 each. Group I received 3ml of 0.5% hyperbaric bupivacaine, group II received 3ml of 0.5% isobaric levobupivacaine. Hemodynamic parameters like heart rate, NIBP and SpO2 were monitored every 15mins till end of surgery and for 2 hours post operatively. Incidence of side effects such as hypotension, bradycardia and nausea and vomiting were noted. Demographic parameters in both groups were comparable. Onset of sensory block was slow in group L . Level of sensory block was comparable and duration of analgesia at L1(L1regression) was significantly shorter with Levobupivacaine compared to Bupivacaine. Onset of motor blockade was slower and duration of motor blockade was also shorter with levobupivacaine compared to bupivacaine. However all the patients in either group attained complete motor blockade.

COMPARATIVE STUDY OF INTRATHECAL HYPERBARIC BUPIVACAINE 0.5% VERSUS MIDAZOLAM PLUS HYPERBARIC BUPIVACAINE 0.5% MIXTURE FOR INFRAUMBILICAL SURGERIES.

Background: Sub arachnoid block is a commonly used anesthesia technique for all infra umbilical surgeries & there is search for agents and techniques which would prolong local anesthetic action without its deleterious effects. The present study was designed to compare effect of 0.5% of hyperbaric bupivacaine intrathecal versus 0.4ml of intrathecal midazolam with 0.5% of hyperbaric bupivacaine for infra umbilical surgeries. Material And Methods: Present study was single-center, a double-blind trial, conducted in patients of age group 18-60 years with ASA grade I/II posted for elective infraumbilical surgery. 60 patients were divided into Group I received 3ml of 0.5% Bupivacaine heavy and 0.4 ml of 0.9% saline & Group II received 3ml of 0.5% Bupivacaine heavy and 0.4 ml of midazolam (2mg). The meanResults: duration of maximum sensory blockade, maximum motor blockade was more in group II as compared to group I & difference was statistically signicant (p<0.05). Mean duration of surgery was less in group II as compared to group I & difference was statistically signicant (p<0.05). Duration of Motor blockade, duration of sensory blockade, time for two segment regression, time of rescue analgesia was more in group II as compared to group I & difference was statistically signicant (p<0.05). Patients complained of pain faster in Group I than in Group II, VAS score. Midazolam still nds a place in regularConclusion: clinical use as an intrathecal adjuvant with hyperbaric bupivacaine due to its hemodynamic stability and better post-operative analgesia with no signicant adverse effects.

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

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

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

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

Comparative study of intrathecal fentanyl and clonidine as adjuvants to hyperbaric bupivacaine under spinal anaesthesia in infraumbilical surgeries

Background: Opioids are commonly used neuraxial adjuvants with local anaesthetics in subarachnoid block (SAB) for prolongation of analgesia, however Clonidine has shown to improve the quality of blockade without any neurotoxicity. This study assess the quality of SAB using intrathecal fentanyl and clonidine with bupivacaine in infraumbilical surgeries. Methods: After obtaining ethical clearance and informed consent 80 patients were randomly allocated into 2 groups, Group F received 15µg fentanyl and group C received 30µg clonidine with 12.5mg hyperbaric bupivacaine each. The onset time to reach peak sensory and motor level, 2 segment regression time, total duration of motor and sensory blockade, time for first rescue analgesia, hemodynamic changes and side effects were recorded. Results: The patients in group C had significantly prolonged sensory and motor blockade and less and delayed requirement of rescue analgesic than in group F. Conclusion: Intrathecal clonidine as adjuvant is better than fentanyl as it prolongs motor and sensory block and reduced demand of rescue analgesic.

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English

Intrathecal nalbuphine versus intrathecal pentazocine as adjuvant to 0.5% hyperbaric bupivacaine for infraumbilical surgeries under subarachnoid block: A comparative evaluation

Intrathecal nalbuphine versus intrathecal pentazocine as adjuvant to 0.5% hyperbaric bupivacaine for infraumbilical surgeries under subarachnoid block: A comparative evaluation

The relationship of patient characteristics to cephalad spread of spinal anaesthesia after giving 0.5% hyperbaric bupivacaine in infraumbilical surgeries

Background and Aims:Patient characteristics may explain variability of spinal anaesthesia spread to certain extent. Aim- if there is any relationship between patient characteristics – Age, gender, weight, height, body mass index, abdominal girth, vertebral column length (C7-S5) and the cephalad spread of spinal anaesthesia. Methods: In this Randomized Prospective Study, 100 patients of ASA 1 and 2 undergoing elective infraumbilical surgeries were selected. The above mentioned parameters were recorded. 3.5ml of 0.5% hyperbaric bupivacaine was injected in L3-L4 space. Cephalad spread was assessed for loss of temperature sensation and loss of pinprick discrimination at particular intervals and level was recorded. Descriptive statistics, Linear regression analysis and multiple regression analysis were used.Results: Females, height and abdominal girth in females showed significant (p= 0.000), (p= 0.01), (p= 0.01) association.Conclusion: Height, Gender (female) and abdominal girth in females were significantly correlated with the cephalad spread of anesthesia.

Comparative study of morphine or dexmedetomidine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine in infraumbilical surgeries

Background: Morphine and Dexmedetomidine have been used with subarachnoid block for postoperative pain relief, sedation and analgesia. In higher doses, it may produce adverse effect on haemodynamics. Aim and Objective: This study compares the block characteristics and side effects effects of morphine and intrathecal Dexmedetomidine, given with intrathecal bupivacaine. Materials and Methods: A prospective, randomised, double-blinded study was conducted in department of anaesthesiology at a tertiary referral hospital. Eighty patients with American Society of Anaesthesiologists Status I and II were randomly allocated to receive either dexmedetomidine (5 μg) or Morphine (200 mcg) with or 0.5% hyperbaric bupivacaine. Results: Time to first dose of rescue analgesia was significantly more with dexmedetomidine (386.75102.27 min) as compared to Morphine (232.5045.45 min). Duration of motor block was also significantly longer with dexmedetomidine (192.3836.50) than Morphine (155.488.66). There was no significant difference between the two groups in relation to onset of sensory or motor block, time to reach maximum level of sensory block, and the time for two segment regression. Conclusion: Intrathecal dexmedetomidine as compared to Morphine as an adjuvant to intrathecal bupivacaine prolonged the time to first rescue analgesia, without any significant adverse effect.

A Study to Compare the Effect of Intrathecal Midazolam and Nalbuphine as an Adjuvant to Bupivacaine for Infra-umbilical Surgeries

A Study to Compare the Effect of Intrathecal Midazolam and Nalbuphine as an Adjuvant to Bupivacaine for Infra-umbilical Surgeries

Comparison of Intrathecal Midazolam and Fentanyl used as an adjuvant with Hyperbaric Bupivacaine in infraumbilical surgeries: A prospective, randomized, double-blind, interventional study

Comparison of Intrathecal Midazolam and Fentanyl used as an adjuvant with Hyperbaric Bupivacaine in infraumbilical surgeries: A prospective, randomized, double-blind, interventional study

Comparison of Premixed Versus Sequential Administration of Fentanyl as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Infra-Umbilical Surgeries: A Randomized Controlled Study

Comparison of Premixed Versus Sequential Administration of Fentanyl as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Infra-Umbilical Surgeries: A Randomized Controlled Study

A Comparative Study of Low Doses of Intrathecal Ketamine and Midazolam with Bupivacaine for Infraumbilical Surgeries

A Comparative Study of Low Doses of Intrathecal Ketamine and Midazolam with Bupivacaine for Infraumbilical Surgeries

To Compare the Effects of Different Doses of Dexmedetomidine on Intrathecal Bupivacaine in Infraumbilical Surgeries: A Prospective, Randomized, Double-blind Clinical Study.

Introduction:Spinal anesthesia is preferred technique of choice in infraumbalical surgeries. Limitation of this technique is shorter duration of analgesia, so various adjuvants have been used with intrathecal bupivacaine such as fentanyl, clonidine, and dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonist. The aim of our study was to know the effect of different doses of dexmedetomidine on intrathecal bupivacaine.Materials and Methods:The prospective, randomized, double-blind study was conducted in tertiary health care center, on ninety patients of the American Society of Anesthesiology Class I and II, of age group 18–60 years of either sex. They were randomly allocated into three groups. Group BD5 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 5 μg (0.5 ml), Group BD10 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 10 μg (0.5 ml), Group BD15 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 15 μg (0.5 ml) administered intarthecally. The onset and maximum level of sensory block, time to reach maximum level of sensory block, time of two-segment sensory regression, the total duration analgesia, time of rescue analgesia, onset and duration of motor block and heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and oxygen saturation were recorded at various intervals. Moreover, any adverse effects such as bradycardia, hypotension, nausea, vomiting, and sedation were recorded.Results:The onset time of sensory block in Group D5-2.76 ± 1.32, Group D10-2.45 ± 1.50, and Group D15-1.86±0.93, which is statistically significant (P = 0.025). The time taken for two-segment sensory regression Group D5-96.66 ± 33.67, Group D10-116.80 ± 36.27, and Group D15 120.96 ± 30.24, (P = 0.014). The time taken for complete sensory recovery in Group D5-319.83 ± 61.41, Group D10-336.13 ± 61.38, and Group D15-415.20 ± 96.6, which is statistically highly significant (P = 0.000). Time for rescue analgesia in Group D5-377.46 ± 60.05, in Group D10-401.60 ± 61.11, and in Group D15-517.96 ± 97.30, which is statistically highly significant (P < 0.000).Conclusion:We concluded that there was decrease in onset of sensory and motor blockade with the prolongation of duration of anesthesia and analgesia in a dose-dependent manner.

A Comparative Study of Intrathecal Dexmedetomidine and Buprenorphine as Adjuvants to Hyperbaric Bupivacaine for Infraumbilical Surgeries

A Comparative Study of Intrathecal Dexmedetomidine and Buprenorphine as Adjuvants to Hyperbaric Bupivacaine for Infraumbilical Surgeries

Evaluation of Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries.

Various adjuvants like morphine, buprenorphine and fentanyl, clonidine, ketamine are being used in anaesthetic practice since long for improvement of peri-operative analgesia following spinal anaesthesia. Such adjuvants have been helpful in induction of early ambulation but at the cost of their associated adverse effects. Therefore search for an effective adjuvant is still going on. Currently Dexmedetomidine, a highly selective α2-adrenoreceptor agonist is being studied for its adjuvant action in spinal anaesthesia. The present study aims to evaluate the efficacy of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine in spinal anaesthesia in patients undergoing infra-umbilical surgeries. It was a prospective, double blind study among 60 patients undergoing infraumbilical surgeries under spinal anaesthesia. The patients were randomly allocated to 2 groups (Group I and Group II) of 30 each. Group I received hyperbaric bupivacaine (15 mg) alone and Group II received hyperbaric bupivacaine (15 mg) with Dexmedetomidine (5mcg). The onset time of sensory and motor block, regression time of sensory and motor block, duration of analgesia, haemodynamic parameters were recorded both intra and postoperatively. The primary efficacy parameters were to determine the onset and duration of sensory block, motor block and duration of postoperative analgesia. Secondarily any associated haemodynamic changes and adverse effects of Dexmedetomidine were also recorded. Continuous data were analysed using the Student's t-test and categorical variables by two-tailed Fisher-exact test or Chi-square test. Onset of sensory block was 129.33±14.8 seconds in Group II as compared to 208.33±19.18 seconds in Group I with total duration of sensory block as 317.70±16.16 minutes in Group II and 188±11.86 minutes in Group I. Similarly, onset of motor block was 226.33±31.86 minutes and 320.33±29.81 minutes, with total duration of motor block as 286.33±15.15 minutes and 166.5±12.11 minutes in Group II and in Group I respectively. Duration of analgesia was 333.6±20.67 minutes with Dexmedetomidine but 193.67±7.06 minutes in bupivacaine alone group. Dexmedetomidine as an adjuvant had shown early onset of sensory and motor block with longer duration of analgesia and haemodynamic stability in the present study as compared to bupivacaine alone.

Comparative Evaluation between intrathecal sufentanil with bupivacaine to fentanyl with bupivacaine and bupivacaine alone for intraoperative and postoperative analgesia in infraumblical surgeries

This study was conducted to compare sufentanil & fentanyl in combination with bupivacaine for infra-umbilical surgeries. Sixty ASA I and II patients for elective intra-umbilical surgeries under spinal anaesthesia were divided into three groups to receive 15 mg bupivacaine alone, 10 g sufentanil & 25 g fentanyl in combination with 15mg bupivacaine. Onset time of sensory blockade, Duration of side effects, surgical conditions, and quality of the anaesthesia was assessed. The duration of effective analgesia of bupivacaine alone was prolonged with the addition of sufentanil and fentanyl by 179% and 141% respectively. No patient is the sufentanil and fentanyl groups required additional intra-operative analgesics compared with 17.6% of patients in the bupivacaine alone group. There was an increase in incidence of desaturation in the sufentanil group (45%) and fentanyl group (5.6%) compared with the bupivacaine only group (0%). The incidence of pruritus was 35% with sufentanil, 27.8% with fentanyl against 0% with bupivacaine alone. The addition of 10 g of sufentanil and 25 g of fentanyl to improved intraoperative analgesia. However, the incidence of pruritus and episodes of desaturation were increased more with 10 g sufentanil than with 25 g fentanyl.