Characteristics Of Spinal Anesthesia Research Articles

Effect of dexmedetomidine infusion on characteristics of spinal anesthesia with hyperbaric bupivacaine: A randomized controlled trial

Dexmedetomidine is a highly selective and potent α2 agonist having both sedative and analgesic properties. This study was aimed to assess the effects of intravenous dexmedetomidine on sensory, motor, haemodynamic parameters and sedation during subarachnoid block (SAB) with 0.5% hyperbaric bupivacaine. Sixty patients undergoing infraumbilical and lower limb surgeries were allocated into 2 groups, group D (n=30) received dexmedetomidine infusion at the rate of 0.5 µg/kg/h over an hour prior to SAB and continued till the end of surgery whereas patients in group C (n=30) received similar volume of normal saline infusion for the same duration. Onset of sensory block was 63.77 ± 7.42 s in group D compared with 126.2 ± 12.83s in group C. Two segment regression time was 177.03 ± 11.64 min in group D and 85.67 ± 10.32 min in group C and analgesia duration was 287.67 ± 14.84 min in group D and 149 ± 13.16 min in group C. Onset of motor block was 3.95 ± 0.65 min in group D and 4.5 ± 0.62 min in group C. Motor blockade duration was prolonged in group D compared with group C. There was significant difference between the groups in respect to block characteristics. Administration of intravenous dexmedetomidine during SAB hastens the onset and prolongs the duration of sensory and motor block. It also provides conscious sedation and additional analgesia.

An observational study to compare the effect of intravenous dexmedetomidine versus intravenous magnesium sulphate pretreatment on characteristics of spinal anaesthesia

The study was conducted to assess & compare the effect of pretreatment with intravenous Dexmedetomidine and Magnesium sulphate on characteristics of SAB with hyperbaric bupivacaine. 80 ASA grade I and II patients (age: 18-60 years) scheduled for infraumblical surgery under spinal anesthesia were included & randomly divided into group-D (dexmedetomidine 1μ gm/kg) and group-M (magnesium sulfate 50 mg/kg). patients were given prefixed doses of either intravenous dexmedetomidine or Magnesium sulfate 15 mins before SAB. Incidence of hypotension, highest level & duration of sensory & motor blockage, duration of analgesia, vasopressor requirement and incidence of sedation, nausea & vomiting were compared. highest upper level of sensory block after SAB was higher in group-D (p value < 0.001) than group-M. onset of sensory & motor block was earlier & duration of sensory and motor block, time of rescue analgesia was longer in group-D (p value < 0.001). Depth of sedation was higher in group-D though oxygen saturation and respiratory rate was comparable in both groups. Postoperative VAS score (p value < 0.001) was lower in dexmedetomidine group.Study suggests that Intravenous dexmedetomidine at a dose of 1μg/kg is a better adjuvant to 0.5% hyperbaric bupivacaine than MgSo at a dose of 50 mg/kg in infra-umbilical surgeries, with complications of hypotension and bradycardia occurring at acceptable incidences.

Perioperative Anxiolysis and Analgesic Effect after Premedication with Melatonin and Pregabalin in Total Hip Arthroplasty under Spinal Anaesthesia: A Prospective Comparative Trial.

Preoperative anxiety plays a critical role in post-operative pain response and other outcomes. Melatonin is a naturally secreted hormone which has anxiolytic, sedative, and analgesic properties. Pregabalin, analogue of gabapentin which has property of anxiolytic and analgesic effects. Total 96 patients undergoing total hip arthroplasty, divided into 3 groups of 32 each and were given placebo (group I), melatonin 6 mg (group II), and pregabalin 150 mg (group III). Anxiety level, postoperative pain score, sedation level and duration as well as characteristics of spinal anaesthesia were assessed with other vital parameters. Group I showed an increment in the anxiety score from baseline whereas in group II and group III, there was a decline in pre-operative anxiety score from baseline at all the periods of observation and more significantly in group III. Visual analogue scale (VAS) score and total dose of rescue analgesia were highest in group I, but group II and group III were comparable to each other. However, the durations of spinal anaesthesia and motor blockade showed a statistically significant difference with maximum duration in group III followed by II and then I. The level of sedation among the three groups were comparable at all the periods of observation. Pregabalin was found better for perioperative anxiolysis, post-operative analgesia and for prolongation of duration of spinal anaesthesia when compared to melatonin.

Intrathecal Dexmedetomidine Combined With Ropivacaine in Cesarean Section: A Prospective Randomized Double-Blind Controlled Study.

ObjectiveThis study aimed to find the best dose of dexmedetomidine in spinal anesthesia for cesarean section.Methods120 American Society of Anesthesiologists (ASA) Class I and II parturients undergoing elective cesarean delivery under spinal anesthesia were randomly allocated into four groups treated with intrathecal ropivacaine (12 mg) alone (Group R) or in combination with dexmedetomidine 5 μg (Group RD1), 7.5 μg (Group RD2) and 10 μg (Group RD3). Characteristics of spinal anesthesia, hemodynamic changes, adverse effects, stress reactions and neonatal outcomes were recorded in the four groups.ResultsPatients in Group RD1, RD2, and RD3 had significantly longer sustained sensory and motor block time than patients in Group R. All four groups had comparable onset times of sensory and motor block. The time for the level of sensory block to lower to S1 was longer in Group RD1 (411.07 ± 106.66 min), Group RD2 (397.03 ± 125.39 min) and Group RD3 (468.63 ± 116.43 min) than in Group R (273.60 ± 88.34 min) (p < 0.001). The time to recover from motor block to a Bromage score of IV was longer in Group RD1 (353.60.07 ± 137.28 min), Group RD2 (350.57 ± 118.01 min) and Group RD3 (404.67 ± 112.83 min) than in Group R (232.70 ± 93.29) (p < 0.01). The incidence of chills was significantly lower in the Group RD1, RD2, and RD3 than in the Group R (p < 0.001). There was no significant difference in the incidence of adverse effects such as hypotension, bradycardia, nausea, vomiting, hypoxemia and pruritus in the four groups (p > 0.05). There was no statistically significant visceral traction response or fentanyl use in the four groups (p > 0.05). Phenylephrine dosing was significantly higher in Group RD2 and RD3 than in Group R (p < 0.05), and there was no significant difference in phenylephrine dosing between Group RD1 and Group R (p > 0.05). There were no statistical differences in postnatal Apgar scores (1 min, 5 min after birth) (p > 0.05). The postoperative concentrations of β-endorphin (β-EP), cortisol (Cor) and tumor necrosis factor-α (TNF-α) in the Group RD1, RD2, and RD3 were lower than that in Group R (p < 0.05).ConclusionIntrathecal 5μg of dexmedetomidine as an adjuvant to ropivacaine relieved intraoperative chills, did not increase intraoperative and postoperative adverse effects, did not increase the amount of intraoperative vasoconstrictor used, and reduced intraoperative stress reactions as well as prolonged the duration of maternal sensory and motor block, so this dose is appropriate for cesarean section.Clinical Trial Registration:[www.chictr.org.cn/], identifier [ChiCTR2200056052].

EFFICACY OF NEOSTIGMINE METHYLSULFATE AND MAGNESIUM SULFATE AS ADDITIVES TO HYPERBARIC BUPIVACAINE FOR SPINAL ANAESTHESIA: A CLINICAL COMPARATIVE STUDY

Background: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. The aim of the study was to investigate the effect of neostigmineAims: and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. In this prospective, randomized, single-blindSubjects and Methods: study 90 American Society of Anesthesiologist status I and II adult males and females posted for major lower abdominal surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 50

The influence of epidural volume extension on spinal block with hyperbaric bupivacaine for elective knee arthroplasty

BackgroundEpidural volume extension (EVE) via a combined spinal–epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. The aim of this study was to investigate the sensory and motor block characteristics of spinal anesthesia after EVE. Eighty patients enrolled in this prospective, randomized, double-blind study. Group I (n=40) received 10 mg hyperbaric bupivacaine and group II (n=40) first received 10 mg hyperbaric bupivacaine intrathecally and subsequently 10 mL saline via epidural catheter.ResultsIn the first 30 min after combined spinal–epidural anesthesia, the maximum sensory block level was significantly higher in group II than in group I. The Bromage score was significantly higher in group II than in group I at 3–6 and 9 min of the intraoperative period. EVE increased the mean Smax significantly in group 2 than group 1 (p<0.05). Tmax was statistically similar between group 1 and group 2 (p>0.05). EVE significantly altered Time10 and Tadeq in group 2 (p<0.05).ConclusionsEVE with saline (10 mL) offer early onset of sensory and motor block and a high level of sensory block. And also delay supplemental epidural dose requirement intraoperatively.

Comparison of 0.5% levobupivacaine alone and 0.5% levobupivacaine with butorphanol given intrathecally in infraumbilical surgeries.

Introduction: Spinal anaesthesia is the most common neuraxial block used in surgical setting. The main advantage is the high success rate, safety record, rapid onset, predictable duration, minimal side effect and reliable offset. Study aimed to compare Levobupivacaine and Levobupivacaine with Butorphanol in terms of onset of sensory and motor blockade, duration of sensory and motor block, two segment regression time, hemodynamic changes, time for first rescue analgesia and complications in infraumbilical surgeries. Materials and methods: 60 patients of ASA class 1 and 2 of age between 19 to 65 years were selected in the study and divided them into two groups with 30 patients each. Group A - 15 mg (3 ml) of 0.5% Levobupivacaine + 0.1 ml Normal saline. Group B- 15 mg (3 ml) of 0.5% Levobupivacaine + 100 g (0.1 ml) of Butorphanol. All groups received drug at L2-L3 intervertebral space. Result: On comparing both the groups, the duration of sensory and motor blockade was more in group B. The two-segment regression time was more isn group B and the time for the first rescue analgesia was also more in group B. Hemodynamic stability was achieved in group B with minimal change in the parameters and with fewer complications. Conclusion: we concluded that addition of injection Butorphanol with Levobupivacaine gives hemodynamic stability as compared to Levobupivacaine alone intrathecally and also provides longer duration of sensory and motor blockade and superior analgesia than intrathecal levobupivacaine alone. Keywords: spinal anesthesia, analgesia, intrathecal, Levobupivacaine, Butorphanol. Reference: 1. Casey WF. Spinal anaesthesia-A practical guide. Update Anaesth. 2000;12:1-7. 2. Foster RH, Markham A. Levobupivacaine. Drugs. 2000 Mar;59(3):551-79. 3. Attri JP, Kaur G, Kaur S, Kaur R, Mohan B, Kashyap K. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesthesia, essays and researches. 2015 May;9(2):178. 4. Stoelting RK, Hillier SC. Pharmacology and physiology in anesthetic practice. Lippincott Williams &amp; Wilkins; 2012 Jan 11. 5. Eledjam JJ, de la Coussaye JE, Bassoul B, Brugada J. Mechanisms of the cardiac toxicity of bupivacaine. InAnnales Francaises D'anesthesie et de Reanimation 1988 Jan 1 (Vol. 7, No. 3, pp. 204-210). 6. Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac‐bupivacaine following intravenous administration to healthy volunteers. British journal of clinical pharmacology. 1998 Sep;46(3):245-9 7. McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. British Journal of Anaesthesia. 2004 Apr 1;92(4):547-51. 8. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean Journal of Anesthesiology. 2018 Jun;71(3):220. 9. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiologica. 2006 Jul 1;72(7-8):637-44. 10. Şahin AS, Türker G, Bekar A, Bilgin H, Korfalı G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. European Spine Journal. 2014 Mar;23(3):695-700. 11. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, Schindler I. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesthesia &amp; Analgesia. 2002 Jan 1;94(1):194-8. 12. Singh V, Gupta LK, Singh GP. Comparison among intrathecal fentanyl and butorphanol in combination with bupivacaine for lower limb surgeries. Journal of Anaesthesiology Clinical Pharmacology. 2006 Oct 1;22(4):371- 13. Singh SN, Subedi A, Prasad JN, Regmi MC. A comparative study to assess the effect of intrathecal bupivacaine with morphine or butorphanol

A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery.

Purpose: Prophylactic infusion of a vasopressor is preferred as a rational choice in clinical practice in Cesarean delivery. Metaraminol is one of most common vasopressors used in obstetric clinical practice. However, the dose-response of metaraminol has not been fully determined and the optimal infusion dose is unknown. Therefore, this study aimed to determine the median effective dose (ED50) and 90% effective dose (ED90) of weight-based fixed-rate metaraminol infusions for preventing spinal-anesthesia-induced hypotension in patients having combined spinal-epidural anesthesia for elective Caesarean delivery. Methods: One hundred and seventeen patients with singleton pregnancies were enrolled and randomly allocated into one of five groups in this study. Patients received prophylactic metaraminol infusion at a fixed rate of 0, 0.25, 1.0, 1.75 or 2.5 μg/kg/min in each group immediately after induction with intrathecal 10 mg of hyperbaric bupivacaine mixed with 5 μg of sufentanil. An effective prophylactic dose was defined as no occurrence of hypotension during the period of spinal introduction and neonatal delivery. Values for ED50 and ED90 of prophylactic infusion of metaraminol were calculated using probit regression. Characteristics of spinal anesthesia and side effects were recorded. Results: The ED50 and ED90 values of weight-based fixed rate of metaraminol infusion were 0.64 (95% CI, 0.04–1.00) μg/kg/min and 2.00 (95% CI, 1.58–2.95) μg/kg/min respectively. The incidence of hypotension decreased with an increased infusion rate of metaraminol in the five groups (test for trend, p < 0.001). The incidence of hypotension was similar between group 0 and 0.25, but significant higher than other groups; the incidence of hypotension was also similar between group 1.0 and 1.75, but higher than group 2.5. The incidence of reactive hypertension was significantly higher in group 2.5 compared to the other groups. Physician interventions were more frequent in group 0, 0.25 and 2.5 than in group 1.0 and 1.75 (adjusted p < 0.001). No difference was found in neonatal outcomes, including Apgar score and pH value of the umbilical artery. Conclusion: In summary, we have compared four different prophylactic weight-based infusion doses of metaraminol for preventing post-spinal hypotension in Cesarean delivery. The ED50 and ED90 values of metaraminol infusion for preventing spinal anesthesia-induced hypotension were 0.64 μg/kg/min and 2.00 μg/kg/min, respectively. This finding may be helpful for guiding clinical practice and further research.

Evaluation of the effect of intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine

Aims: A study was performed to evaluate the effect of intravenously administered dexmedetomidine just before spinal anaesthesia, on spinal block characteristics, postoperative analgesia, haemodynamics and sedation. Methods: Sixty patients, aged 18 - 50 years of either sex, ASA grade I & II, who were undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia with hyperbaric bupivacaine, were randomly allocated in to two equal groups of 30 patients each to recieve 20 ml of normal saline intravenously (group A) and intravenous dexmedetomidine 0.5 mcg/kg prepared in normal saline to a total volume of 20 ml (group D) over a 10 min period as a single dose just before spinal anaesthesia. Onset and duration of sensory blocks and motor blocks, highest sensory block level, time to 2 segment regression, duration of analgesia, perioperative haemodynamic parameters, VAS and sedation scores were assessed. Results: Both groups were comparable with regard to demographic data. The onset of sensory and motor block were significantly earlier in group D as compared to group A. Duration of motor block and analgesia were significantly longer in group D as compared to group A. Sedation score were significantly higher in group D. Though HR and NIBP were significantly decreased in group D, however all patients remained haemodynamically stable. Conclusion: Bolus dose of intravenous dexmedetomidine 0.5 µg/ kg administered just before spinal anaesthesia prolongs the duration of sensory – motor block and postoperative analgesia with arousable sedation.

Study of spinal anaesthesia with isobaric levobupivacaine and ropivacaine in elective lower limb orthopaedic surgeries

Introduction and Objectives: Levobupivacaine and Ropivacaine, the two S enantiomers of Bupivacaine can be safer alternatives to racemic bupivacaine due to claims of cardiovascular safety profile. Hence, this study was conducted to assess the clinical efficacy of Levobupivacaine and Ropivacaine for spinal anaesthesia for orthopaedic surgeries of lower limbs. Methods and Materials: For this study, 60 adult ASA class I and II patients admitted for elective lower limb orthopaedic surgeries were randomised to 2 groups of n=30 each after approval from ethical committee and informed written consent. Spinal anaesthesia was given with 3ml Levobupivacaine 0.5% (15 mg) to patients in Group L and with 3ml Ropivacaine 0.5% (15 mg) to patients in Group R. Characteristics of spinal anesthesia in the two subsets like analgesia, motor blockade and hemodynamic parameters were observed and adverse effects, if any, were recorded. Data obtained were compiled and analysed with suitable statistical tests. A p-value of 0.05 was considered significant. Results: Onset of sensory and motor block were significantly faster in Group L (7 and 1.87 min) compared to Group R (9.43 min and 3.10 min). The maximum level of analgesia was attained faster in Group L (12.67 mins) compared to Group R (16.67 mins). The two segment regression time and the duration of analgesia were significantly shorter in Group R (72.63 min, 213.93 min) compared to Group L (103.6 min, 251.33 mins) Higher grade of motor blockade was achieved rapidly in Group L (9.03 mins) when compared to Group R (12.63 min). The mean duration of motor blockade was prolonged in Group L (263.67 mins) whereas recovery from motor blockade was earlier in Group R (151.17 mins). Both the groups had stable hemodynamics and adverse effects were not observed in both the groups. Conclusion: Intrathecal isobaric Levobupivacaine 15mg and Ropivacaine 15mg are effective in lower limb orthopaedic surgeries without significant haemodynamic changes. However,

Comparative study of intrathecal nalbuphine versus clonidine as adjuvants to 0.5% isobaric levobupivacaine for elective infra umbilical surgeries

Background and objectives: Various intrathecal adjuvants have been clinically tried for the prolongation of intraoperative and postoperative analgesia. This study aims at evaluating the effects of intrathecal nalbuphine and clonidine as adjuvants to isobaric levobupivacaine in subarachnoid block.&#x0D; Methodology: 60 patients scheduled for elective infra umbilical surgeries were allocated into two groups of thirty each to receive 15 mg of 0.5% isobaric Levobupivacaine with either 1 mg nalbuphine (Group LN) or 30 µg clonidine (Group LC) intrathecally. Characteristics of spinal anesthesia in terms of sensory analgesia and motor blockade were noted. Hemodynamic parameters and adverse effects if any were recorded. Data obtained was compiled and statistically analysed with appropriate tests.&#x0D; Results: Onset of sensory and motor blocks was faster in group LN (2.43 ± 0.93 and 2.2 ± 0.9 min) compared to group LC (3.26 ± 1.04 and 3.13 ± 1.0 min). However, time to two segment regression (186.8 ± 24.5 vs 146.5 ± 21.4), total duration of effective analgesia (384.1 ± 56.6 vs 292.1 ± 40.9) and total duration of motor block (345.3 ± 41.7 vs 235.6 ± 29.5 min) were significantly prolonged in group LC than in group LN. There was no significant difference in hemodynamic changes and adverse effects between the groups.&#x0D; Conclusion: The addition of 30 µg clonidine to intrathecal 0.5% isobaric levobupivacaine as adjuvant, is associated with prolonged sensory and motor blockade with better perioperative analgesia compared to 1 mg nalbuphine.&#x0D; Citation: Shalini A, Kokila N, Manjunatha HG, Supriya L. Comparative study of intrathecal nalbuphine versus clonidine as adjuvants to 0.5% isobaric levobupivacaine for elective infra umbilical surgeries. Anaesth pain &amp; intensive care 2019;23(4)__&#x0D; Received: 21 August 2019, Reviewed: 13 September, 22 November 2019, Accepted: 26 November 2019

Comparison of the efficacy of epidural nalbuphine versus dexmedetomidine on the characteristics of spinal anaesthesia in patients undergoing lower limb orthopaedic surgeries: A prospective randomised, double-blind, placebo-controlled study

Background: Using adjuvants to local anaesthetic agents either intrathecally or epidurally is a common practice for achieving longer duration of a denser neuraxial block to provide adequate intraoperative conditions, for the length of the procedure. Methods: We compared the efficacy of epidural dexmedetomidine or nalbuphine on the characteristics of spinal anaesthesia in patients undergoing lower limb orthopaedic surgeries. Ninety patients were randomly allocated to three groups (n = 30 each). Group D received dexmedetomidine 1.5 μg/kg diluted to 5 mL; Group N received nalbuphine 0.2 mg/kg diluted to 5 mL and Group S received 5 mL of normal saline epidurally 10 min before receiving subarachnoid block (SAB) with 0.5% heavy bupivacaine. Results: The three groups were comparable demographically and haemodynamically. Significantly shorter time for the onset of sensory and motor block (sec), longer duration of sensory and motor blockade (min), higher sedation scores intraoperatively and postoperatively were observed in GroupD compared to other two groups. VAS scores were lower in Group D for a significantly longer period postoperatively, at 60 min, 120 min and 180 min than in other two groups (P Conclusions: Both dexmedetomidine and nalbuphine were found to be useful and safe epidural adjuvants when given prior to SAB. Dexmedetomidine was found to be a better choice of epidural adjuvant when compared to nalbuphine in terms of earlier onset and longer duration of both sensory and motor block, longer post-operative analgesia and useful intraoperative sedation.

Comparison between Magnesium Sulphate and Ketorolac Intravenous Infusion on Characteristics of Spinal Anesthesia

AbstractBackground: Spinal anesthesia is used widely for many procedures, many adjuvants had been used to prolong duration of sensory and motor block and improve post-operative pain.Aim of Study: The aim of this study is to compare the effect of magnesium sulphate and ketorolac intravenous infusion on sensory and motor blockage, hemodynamic pa-rameters, duration of analgesia and side effects during spinal anesthesia.Patients and Methods: Patients were classified randomly into three groups (30 patients each) Group M (Magnesium sulphate Group), Group K (Ketorolac Group), Group C (Con-trol Group). Group M patients received a loading dose of magnesium sulphate 40mg/kg IV over 10min followed by 15mg/kg/h IV infusion, Group K patients received a loading dose of ketorolac (0.4mg/kg) (IV) over 10min followed by 0.8mg/kg/h IV infusion. Group C received 50ml of saline (IV) over 10min followed by saline infusion. After ensuring free flow of cerebrospinal fluid, 3mL of bupivacaine (0.5%) injected Pulse rate, electrocardiography, non-invasive blood pressure and SpO2 monitored continuously. Measurements: Demographic data (age, weight, BMI, ASA physical status). Hemodynamic (HR, MAP, SpO2) before giving study drugs, 10min after giving study drugs and after reaching the maximal level of spinal anesthesia and then every 30min till end of surgery. Onset of sensory blockade has been assessed by pinprick method. Onset of motor blockade has been assessed by modified Bromage Scale. Level of sensory and motor blockade has been checked at 3, 5, 10 and 15min after spinal anesthesia and then every 20min throughout the surgery. Time to achieve complete regression from sensory and motor blockade has been noted. All the durations were calculated considering the time of spinal injection as zero time. Post-operatively analgesia has been assessed by the Visual Analog Scale (VAS). The time at which analgesia was first received and total analgesic requirement in 24h was recorded. Patients observed for any adverse effects such as nausea, hypotension.Results: There were insignificant changes between the three groups in HR and MAP but there was significant decrease in HR and MAP in each group at 10min, maximal level and 30min in comparison with base line. There were insignificant changes in onset and duration of sensory and motor block in the three studied groups.The total dose of analgesic consumption (pethidine (mg)) showed significant decrease in Group M in comparison with Group K & Group C with insignificant change between Group K & Group C.The time of first rescue analgesia showed significant increase in Group M in comparison with Group K & Group C and insignificant changes in Group K in comparison with Group C.Conclusion: Addition of intravenous magnesium sulphate with spinal anaesthesia provides significant decrease in post-operative analgesic requirements and prolongs the time of the first rescue analgesia as compared to intravenous ketorolac with spinal anaesthesia.

Influence of injection rate of hyperbaric bupivacaine 0.75% on spinal anaesthesia in elderly patients with lower limb orthopaedic surgeries. A randomized controlled trial.

To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference in maximum level of sensory block attained (fast = median T4, interquartile range [T4–T6] vs slow = T4 [T4–T6], P = 0.77). There was no difference in mean time (minutes) to reach T10 sensory level (fast = 2.5 ± 1.2 vs slow = 2.2 ± 0.8, P = 0.27); maximum sensory level (fast = 4.2 ± 1.5 vs slow = 3.8 ± 1.2, P = 0.26) and maximum motor block level (min) (fast = 5.9 ± 1.4 vs slow = 5.7 ± 1.2, P = 0.56). The rate of hypotension (fast = 8/30 vs slow = 4/30, P = 0.33), nausea (fast = 5/30 vs slow = 3/30, P = 0.99) and phenylephrine use (fast = 5/30 vs slow = 3/30, P = 0.71) and antiemetic requirement (fast = 1/30 vs slow = 2/30, P = 0.99) was also alike. Conclusion: There is no effect of injection speed of intrathecal (0.75%) bupivacaine on the clinical features of spinal anaesthesia in older patients undergoing lower limb orthopedic surgery.

The Influence of Different Degrees of Temperature of Intrathecal Levobupivacaine on Spinal Block Characteristics in Orthopedic Surgeries: A Prospective Randomized Study.

Background and Aims:The temperature of the local anesthetics may affect the distribution of spinal anesthesia. The aim of the current study is to compare the effects of different degrees of intrathecal levobupivacaine 0.5% on the spinal anesthesia characteristics and shivering in orthopedic surgery.Materials and Methods:A randomized, prospective, and controlled trial was conducted on 120 patients aged 40–70 years with American Society of Anesthesiologists Classes I and II and who scheduled for orthopedic surgery; they were randomly distributed into three groups: Group 1 (L 24°C) – levobupivacaine 0.5% warmed to 24°C; Group 2 (L 30°C) – levobupivacaine 0.5% warmed to 30°C; and Group 3 (L 37°C) – levobupivacaine 0.5% warmed to 37°C. Every patient had received 3 mL of 0.5% levobupivacaine intrathecally. Sensory blockade was tested using the loss of pinprick sensation, whereas the motor block was tested using the modified Bromage scale. The onset and grading of shivering after spinal anesthesia were recorded.Results:The use of intrathecal levobupivacaine 0.5% warmed to either 30°C or 37°C resulted in a significant acceleration of the onset of either sensory or motor blockade with a significant prolongation in the duration in addition to significant delay in the onset of shivering and the time of the first analgesia requirement in comparison to those of spinal anesthesia with levobupivacaine at room temperature (24°C). Notably, a nonsignificant difference in the spinal block characteristics and shivering was observed between Group L 30°C and Group L 37°C.Conclusion:The increasing the temperature of levobupivacaine 0.5% to 30 °C attains more rapid onset of sensory and motor blocks , with prolongation of the onset of shivering. It could be considered as effective equivalent to warming levobupivacaine 0.5%to 37°C in spinal anesthesia.

Effect of intravenous dexmedetomidine on spinal anesthesia with bupivacaine in elective lower abdominal surgeries

Background Few studies have shown the efficacy of intravenous (IV) dexmedetomidine in prolonging prilocaine/bupivacaine/ropivacaine spinal anesthesia in addition to providing good sedation and postoperative analgesia. The present study was designed to evaluate the effect of IV dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine.Purpose The aim of the present study was to evaluate the effect of supplementation of IV dexmedetomidine on the characteristics of spinal anesthesia with hyperbaric bupivacaine in patients undergoing elective lower abdominal surgeries.Patients and methods A total of 50 patients were randomly categorized into two equal groups (25 patients each). In group D, patients received 3 ml (15 mg) of 0.5% of hyperbaric bupivacaine in the subarachnoid space and an IV loading dose of 1 μg/kg of dexmedetomidine through infusion pump over 10 min, followed by a maintenance dose of 0.5 μg/kg/h until the end of surgery. Group C patients received 3 ml (15 mg) of 0.5% of hyperbaric bupivacaine in the subarachnoid space and an equivalent quantity of normal saline IV as loading and maintenance dose until the end of surgery.Results Heart rate and mean arterial blood pressure (BP) were significantly lower in group D in comparison with group C. There was no significant difference between the two groups as regards respiratory rate, pulse oxygen saturation, and onset of sensory and motor block.The duration of sensory block and time to first analgesic requirement were significantly prolonged in group D in comparison with group C.Conclusion IV dexmedetomidine significantly prolongs the duration of sensory block of bupivacaine spinal anesthesia. Dexmedetomidine causes a decrease in heart rate and mean arterial BP. The incidence of bradycardia is significantly high when IV dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine-induced bradycardia is transient and responds to atropine. The changes in BP can be easily managed with a bolus of IV fluids and ephedrine. Dexmedetomidine provides excellent sedation during surgery without significant respiratory depression.

Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia.

Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

Effect of epidural clonidine on characteristics of spinal anaesthesia in patients undergoing gynaecological surgeries: A clinical study.

Background and Aims:Combined spinal–epidural (CSE) anaesthesia is being increasingly used for effective post-operative analgesia. This study was designed to evaluate the effect of epidural clonidine on characteristics of spinal anaesthesia for gynaecological surgeries.Methods:This was a prospective randomised, double-blind, controlled study involving sixty patients belonging to American Society of Anesthesiologists Physical Status I and II who underwent gynaecological surgeries were randomly divided into clonidine (C) group and saline (S) group of thirty each. All patients received CSE anaesthesia. Ten minutes before subarachnoid block (SAB), Group C received clonidine 150 μg diluted to 5 ml in normal saline (NS) and Group S received NS epidurally. Hyperbaric bupivacaine (15 mg) was administered intrathecally for both groups after epidural injection. Sensory and motor block characteristics, analgesia, sedation and haemodynamics were observed. Statistical analysis was performed using appropriate tests.Results:Epidural clonidine produced faster onset (37.83 ± 8.58 s in Group C compared to 50.33 ± 8.80 s in Group S, P = 0.001) and prolonged duration of sensory block (241.17±18.65 minutes in group C compared to 150.33±19.16 minutes in group S, P = 0.001). Time for two segment regression of sensory block was193.67 ± 19.82 min in Group C and 109.33 ± 18.56 min Group S (P < 0.001). The duration of analgesia was 299.00 ± 43.38 min in Group C and 152.50 ± 21.04 min in Group S (P < 0.001). Haemodynamics and sedation scores were comparable between two groups.Conclusion:Administration of clonidine epidurally, 10 min before SAB, caused early onset and prolonged duration of motor blockade and analgesia, without any significant post-operative complication.

Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine.

Background and Aims:Different routes of administration of α2 adrenergic receptor agonists have been found to prolong the duration of spinal block.Material and Methods:One hundred and twenty patients, aged 18-60 years, of ASA physical status I or II posted for elective fixation of fractures of lower limb under spinal anesthesia were selected. Spinal anesthesia was administered with 2.5 ml of 0.5% bupivacaine mixed with 10 μg fentanyl. The patients were randomized to receive intravenous (IV) dexmedetomidine 1 μg/kg/h for 15 min followed by infusion of 0.3 μg/kg/h (Group I), IV Clonidine 2 μg/kg/h for 15 min followed by infusion of 0.5 μg kg/h (Group II) or 15 ml of normal saline for 15 min followed by infusion at 50 ml/h (Group III). Motor and sensory blockade was evaluated using bromage score and pin prick method respectively.Results:The median block height in all groups was T8. Time to achieve block height was fastest in Group I. Time of regression of sensory block to T12/L1 dermatome was 230.75 ± 21.25 min (Group I), 196.25 ± 20.27 min (Group II) and 163.88 ± 15.46 min (Group III) respectively. Regression of motor blocks to Bromage 0/1 was 274 ± 21.25 min, 234.25 ± 32.41 min and 130.12 ± 20.70 min in Groups I, II and III respectively. Bradycardia was seen in one patient in Group I and two patients in Group II. Hypotension was seen in five patients in Group I and seven patients in Group II. First requirement for postoperative analgesic was after 353.13 ± 39.60 min, 314.38 ± 30.64 min and 193.25 ± 17.74 min in Groups I, II and III respectively.Conclusion:IV α2 agonists are useful adjuvants for prolongation of the duration of spinal block. IV dexmedetomidine produces a better clinical profile compared to clonidine.

Intrathecal ropivacaine with fentanyl for LSCS Comparison of hyperbaric and isobaric solution

We compared the characteristics of spinal anesthesia with plain and hyperbaric ropivacaine for LSCS. Method:-In this prospective randomized double blind study 60 pregnant patient of ASA physical status1&2 were given 15mg of either isobaric ropivacaine(n=30) or hyperbaric ropivacaine(n=30) in glucose 8% along with fentanyl 25mcg intrathecally for LSCS. The characteristics of spinal anesthesia, hemodynamic parameters, quality of anesthesia and muscle relaxation as well as duration of post-operative analgesia were compared. RESULT: -There were no significant difference in median time to onset of sensory block at T6 (plain6.33±4.62 vs. hyperbaric 4.52±2.84 minutes; p>0.05), maximum sensory level achieved (plain 8.10±3.92 vs. Hyperbaric 6.63±2.47 min, p>0.05) and onset of grade 3 motor block (plain 8.20±5.38 vs. hyperbaric 6.10±2.38 minutes; p>0.05). Median maximum extent achieved was also comparable, but in group H duration of sensory (plain 206.23±24.42 vs. hyperbaric164.50±30.29 min., p<0.001) and motor blockade (plain170.50±39.19vs hyperbaric 133.33±30.17min; p<0.001) and duration of post-operative analgesia were significantly shorter. Incidences of hypotension were more in the group H (43.33%) compared with group I (23.33%). Quality of anesthesia and muscle relaxation was satisfactory in most patients in either group. Total duration of analgesia was 218.37±28.74min in group H and 239.30±28.28min. In group I(p<0.05). CONCLUSION: 15mg of (0.75%) hyperbaric ropivacaine provides similar, reliable and effective quality of spinal anesthesia with shorter duration of sensory and motor block, when compared with 15mg of (0.75%) isobaric ropivacaine.