Duration Of Effective Analgesia Research Articles

A Comparative Study of Intrathecal Fentanyl and Nalbuphine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries: A Prospective, Double-Blind, Randomized Controlled Study.

Spinal anaesthesia is the most commonly used technique for lower limb orthopaedic surgeries as it is economical and easy to administer. Opioids as adjuvants to local anaesthetics during spinal anaesthesia have played a vital role in reducing post-operative pain qualitatively and effectively. This prospective randomised study was conducted on 100 patients divided into two groups scheduled for lower limb orthopaedic surgeries. Group bupivacaine fentanyl (BF) received 25 mcg of fentanyl with 15 mg of bupivacaine and Group bupivacaine nalbuphine (BN) received 1 mg of nalbuphine and 15 mg of 0.5% bupivacaine. The aim of the study was to compare the analgesic efficacy of intrathecal fentanyl and nalbuphine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia. Duration of effective analgesia, haemodynamic parameters, onset and duration of sensory and motor block, adverse effects, and visual analogue scale (VAS) score were assessed. Duration of effective analgesia was 388±24.88 minutes in the BN group and was higher (p-value <0.001) in comparison to the BF group, which was 304.70±15.76 minutes. Nalbuphine was more effective than fentanyl in providing post-operative analgesia when used as an adjuvant to hyperbaric bupivacaine.

Comparison of Two Different Doses of Nalbuphine With Isobaric Ropivacaine in Patients Undergoing Lower Segment Cesarean Section Under Subarachnoid Block: A Randomized Controlled Trial.

Obstetric analgesia and anesthesia is a challenge in itself. It requires an understanding of the physiological changes during pregnancy and labor and the effect of anesthetic agents on the fetus and newborn. Because neuraxial techniques provide superior analgesia and materno-fetal benefits, their use have increased significantly over the past three decades or so. A combination of local anesthetics like ropivacaine with opioids like nalbuphine has been shown to have additive beneficial effects in subarachnoid block (SAB) in lower segment cesarean section (LSCS). However, the optimal dose combination of ropivacaine and nalbuphine to maximize their benefits and minimize side effects remains to be established. Our study has compared the clinical efficacy and safety of 0.75% isobaric ropivacaine (15 mg) with two different doses of nalbuphine (0.4 mg and 0.6 mg) when given intrathecally for LSCS in terms of quality of sensory and motor blocks, hemodynamic parameters, duration of effective analgesia, Apgar score in newborn, and associated side effects. In this prospective, randomized, double-blind study, a total of 69 parturients between the age of 20-45 years, belonging to American Society of Anesthesiologists (ASA) grade I and II, undergoing cesarean section under SAB were evaluated. Patients were randomly allocated into three groups of 23 each by using the draw-of-lots technique. The patient and the observer were kept blinded as to which dose of drug (intrathecal) was being given to the patient. Patients in Group A received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.3 ml normal saline; patients in Group B received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.4 mg of nalbuphine (0.2 ml) + 0.1 ml normal saline; patients in Group C received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.6 mg of nalbuphine (0.3 ml). The total volume of drug solution in all three groups was 2.3 ml. We found that the time to onset of sensory block was shortest in Group A (5.87±1.290 minutes) followed by Group C (6.00±1.087 minutes) and Group B (6.17±1.696 minutes); time to two-segment regression of sensory block was longest in Group C (101.74±8.996 minutes) followed by Group B (85.87±15.348 minutes) and Group A (65.00±7.071 minutes); duration of effective analgesia was longest in Group C (206.09±18.766 minutes) followed by Group B (183.91±15.880 minutes) and Group A (121.74±11.833 minutes); and time from SAB to complete regression of motor block was longest in Group C (216.52±15.553 minutes) followed by Group B (203.48±20.138 minutes) and Group A (174.78±14.731 minutes). Side effectswere comparable among all three groups. The optimal dose combination in SAB for cesarean section was 15 mg of 0.75% isobaric ropivacaine + 0.6 mg nalbuphine, with minimal side effects.

COMPARISON OF BUPIVACAINE VERSUS BUPIVACAINE WITH FENTANYL INTRATHECALLY IN CESAREAN SECTION

Objectives: The objectives of the study were to evaluate the efficacy and safety of fentanyl with hyperbaric bupivacaine in spinal anesthesia for caesarean section. Methods: This prospective observational study was conducted in anesthesia department of tertiary care teaching hospital of Gujarat. Group A was given 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of normal saline and Group B received 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of injection fentanyl (12.5 μg). Characteristics of sensory blockade, motor blockade, analgesia, APGAR score, surgical variables, hemodynamic parameters, and complications were noted and compared in both the groups. Results: There was no significant difference in onset of sensory block in both groups (p&gt;0.05) but there was statistically significant difference present regarding duration of regression of sensory blockade (p&lt;0.05). Time of motor onset and time to get Grade 0 from Grade 3 block were comparable in both groups (p&gt;0.05). Duration of complete analgesia and duration of effective analgesia were significantly prolonged in Group B as compared to Group A (p&lt;0.001). There was also no statistically significant difference observed in mean pulse rate, systolic blood pressure and diastolic blood pressure, and mean arterial pressure in both the groups during entire period of time (p&gt;0.05). Conclusions: The present study concluded that intrathecal fentanyl 12.5 μg with bupivacaine produce prolonged sensory block as well as post-operative analgesia compared to bupivacaine alone for cesarean section with insignificant hemodynamic changes without affecting neonatal outcome.

Pharmacokinetics and efficacy of a novel long-acting bupivacaine formulation for cornual nerve block in calves.

Local anesthetics are commonly used in farm animals to provide analgesia for painful procedures but can cause adverse effects at high systemic concentrations. The pharmacokinetics and efficacy of a long-acting sucrose acetate isobutyrate (SAIB) bupivacaine formulation following cornual nerve block in calves were compared to lidocaine. Fourteen calves were randomly assigned to one of the treatment groups (i) 5% Bupivacaine-SAIB (BUP-SAIB), n = 7; or (ii) 2% lidocaine (LID), n = 7. Cornual nerve block was performed, and duration of effective analgesia was evaluated by nociceptive threshold testing using a hand-held pressure algometer. Blood samples were collected at various time points and plasma concentrations were analyzed by HPLC. Pharmacokinetic parameters were calculated using a non-compartmental model. The mechanical nociceptive thresholds showed that the novel formulation could desensitize the skin around the horn bud for 18.77 ± 8.88 h (range 8-36 h), compared to 0.79 ± 0.34 h (range 0.5-1.5 h) with lidocaine. The mean maximum plasma concentration (Cmax) of bupivacaine was 152.03 (SD 37.34) ng/mL and its Tmax was 0.39 (SD 0.13) h. The half-life of elimination was 32.79 ± 11.00 h and the rate of clearance was 0.12 ± 0.03 L h-1. No toxicity signs were seen after treatment in either group. The novel formulation produced long-lasting analgesia of several times greater duration than that produced by lidocaine. This study showed that the safety and efficacy of the SAIB formulation justifies further studies in a larger population of animals.

Comparison of clinical efficacy of intrathecal ropivacaine versus ropivacaine with dexmedetomidine in patient posted for infraumbilical surgeries under spinal anesthesia

Background: Data related to clinical efficacy of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia were found to be inadequate, but the efficacy of newer molecules as an adjuvant is investigated constantly. Considering the favorable profile of dexmedetomidine, it could have a potential role as an adjuvant to ropivacaine. Aims and Objectives: The aim of the study was to evaluate the benefits of adding intrathecal dexmedetomidine as an adjunctive along with ropivacaine. The aim of the study was to assess and compare the safety and efficacy, post-operative analgesia, complications, duration of analgesia, and time of rescue analgesia for intrathecal ropivacaine versus a combination of intrathecal ropivacaine with dexmedetomidine. Materials and Methods: An observational study was carried out in 80 patients of either sex between 25 and 60 years of age, ASA Grade 1 and 2, undergoing elective abdominal, and lower limb surgeries. Subjects selected as per set inclusion/exclusion criteria and divided into two groups for spinal anesthesia. Group A: 3 ml of intrathecal 0.75% isobaric ropivacaine with 0.5 ml of normal saline. Group B: 3 ml of intrathecal 0.75% isobaric ropivacaine with 5 mcg preservative free dexmedetomidine in 0.5 ml of normal saline. Vital parameters were noted at 0 min, 1 min, 2 min, 5 min, 10 min, and thereafter every 15 min, till the surgery continued. Onset and the time for maximum sensory blockade were assessed and VAS scoring was done every 10 min till 30 min and thereafter every 15 min. The duration of effective analgesia was recorded along with the duration of sensory regression to S1, and time for administration of rescue analgesia was noted. Results: The combination of ropivacaine with dexmedetomidine was statistically found to be efficacious when compared to ropivacaine alone, as evidenced by statistically significant differences (P&lt;0.05) in VAS scores at 80, 180, and 360 min and duration of regression to S1 level. The differences in time for rescue analgesia were also statistically significant (P&lt;0.05), further proving the advantage for longer lasting analgesia without any additional adverse effects. Conclusion: 5 mcg dexmedetomidine is an attractive alternative as an adjuvant to spinal ropivacaine in surgical procedures, as opposed to ropivacaine alone, without any additional adverse effects.

A double-blind prospective randomised controlled clinical study comparing 0.5% hyperbaric bupivacaine with nalbuphine and 0.5% hyperbaric bupivacaine for spinal anaesthesia in lower limb orthopaedic surgeries

Background: Intrathecal nalbuphine is one such opioid, highly lipid soluble with an agonist action at the kappa and antagonist activity at the muopioid receptors, known cardiovascular stability, minimal dose and volume of this drug that can be added to a local anaesthetic agent.Methods: This prospective randomised double-blind study was conducted to evaluate the effects of adding nalbuphine to 0.5% hyperbaric bupivacaine in spinal anaesthesia to know the efficacy, duration of analgesia, incidence of side effects and complications. Sixty American Society of Anesthesiologists (ASA) grade I and II patients were randomly allocated to Group A and Group B of 30 each who received 0.4 mL (0.4 mg) of nalbuphine and 0.4 mL of normal saline added to 3 mL (15 mg) of 0.5% hyperbaric bupivacaine, respectively. Intraoperative haemodynamic parameters, onset, duration of sensory and motor block, visual analogue scale (VAS) score, duration of effective analgesia and possible side effects were monitored and compared.Results: There was no statistically significant difference in the haemodynamic parameters, onset of blockade, duration of motor blockade and side effects. However, in two-segment regression, time of sensory blockade, duration of effective analgesia and VAS scores in Group A were found statistically significantly higher (P < 0.001) compared to Group B.Conclusions: Intrathecal nalbuphine used as adjuvant to bupivacaine prolongs duration of effective analgesia, without any significant side effects with stable haemodynamic parameters.

Comparative Study of Intrathecal Bupivacaine versus Bupivacaine With Fentanyl for Post-Operative Analgesia in an Elective Cesarean Section at a Tertiary Care Centre

Introduction: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. The finite duration of spinal anaesthesia is the only drawback as compared to general anaesthesia. Therefore combination of local anaesthetics with intrathecal opioids makes it possible to achieve prolonged post-operative analgesia without affecting the mother and the baby. Aims And Objectives: 1)To compare the effectiveness of plain bupivacaine with bupivacaine plus fentanyl for post -operative analgesia among the two groups. 2)To compare the adverse effects among both the groups. Materials and Methods: 154 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 9mg (1.8mL) of 0.5% hyperbaric bupivacaine plus 10 ug (0.2 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups, duration of effective analgesia and its effect on maternal and neonatal outcome was studied. Results: The duration of effective analgesia was significantly more in Group B +F (225.03+2.81)mins compared to Group B (119.90+2.76)mins. The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides effective and prolonged post-operative analgesia with less side effects.

A COMPARISION OF INTRATHECAL HYPERBARIC BUPUVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE ALONE IN GYNAECOLOGICAL SURGERIES FOR POSTOPERATIVE ANALGESIA

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P&lt;0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.

Comparison of Analgesic Efficacy of Levobupivacaine and Levobupivacaine with Nalbuphine in Inguinal Hernia Surgeries Under Subarachnoid Block

Background: Recently there has been an interest to explore the efficacy of nalbuphine as' an adjuvant to local anaesthetic agents. This study was designed to compare its analgesic efficacy when added to levobupivacaine in patients undergoing inguinal hernia surgeries under subarachnoid block. Methods: Fifty patients belonging to ASA I/II, between 18-65 years of age undergoing inguinal hernia repair were randomly allocated to receive subarachnoid block with either 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ normal saline (0.5 ml) (Group-LS) or 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ 1 mg nalbuphine (0.1 ml) + normal saline (0.4 ml) (Group-LN). Onset of sensory block, two segment regression time, time of regression to T12, duration of effective analgesia and intensity of motor block were assessed. Results: Onset of sensory block was comparable in the two groups (P=0.774). Time of regression of sensory block to T12 dermatome was 161.09 ± 40.50 min in group LS and 167.50 ± 50.17 min in group LN (P=0.633).The duration of effective analgesia was 177.39 ± 43.53 min in group LS and 183.75 ± 56.69 min in group LN (P=0.669).Motor block parameters were also comparable.More number of patients in group LN had a sedation score of one as compared to group LS. No major side effects were seen. Conclusion: 12.5 mg levobupivacaine with or without nalbuphine is sufficient for conducting inguinal hernia surgeries. Intrathecal nalbuphine 1 mg did not affect the sensory and motor block characteristics of levobupivacaine.

English

BACKGROUND Postoperative pain is the most challenging task in patients undergoing knee joint surgeries under spinal anaesthesia. Spinal anaesthesia with bupivacaine provides adequate intraoperative conditions but falls short in providing prolonged postoperative pain relief. Intrathecal opioids are synergistic with local anaesthetics and intensify the sensory block without affecting the sympathetic block. This study intends to compare three different doses of intrathecal nalbuphine as an adjuvant to 0.5 % hyperbaric bupivacaine and determine the optimal dose in knee joint surgeries. METHODS A double-blind comparative study was conducted in one hundred and twenty American Society of Anaesthesiologists (ASA) I and II patients undergoing knee joint surgeries in a randomised prospective way. The patients were randomly allocated to A, B, and C groups who received 0.4, 0.8 and 1.2 mg nalbuphine respectively added to 12.5 mg of 0.5 % hyperbaric bupivacaine. The onset, duration of block, duration of effective analgesia, Visual Analogue Scale (VAS) score, and the incidence of adverse effects were studied and compared between the groups. RESULTS The mean onset time of sensory and motor block of group B and C was significantly faster as compared to the onset in group A. The duration of sensory, motor blockade and duration of analgesia were highest with 1.2 mg of nalbuphine followed by 0.8 and 0.4 mg (P &lt; 0.05). VAS readings were comparable in all the groups. Hemodynamic variability among the three groups was comparable. Incidence of adverse effects was highest in group C when compared with others, although it was statistically insignificant (P &gt; 0.05). CONCLUSIONS Nalbuphine in a dose of 0.8 mg when added to 0.5 % hyperbaric bupivacaine for subarachnoid block in patients undergoing knee joint surgeries provides excellent analgesia, prolonged duration of sensory block and motor block, with minimal adverse effects. KEYWORDS Local Anaesthesia, Opioid, Postoperative Pain, Orthopaedic Surgeries

A study of intrathecal low dose bupivacaine and fentanyl versus conventional dose of bupivacaine alone for elective caesarean section

Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.

Role and efficacy of intrathecal bupivacaine (0.5) with the multiple doses of midazolam (1 mg to 2 mg) while lower limb surgeries

Background: Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Discovery of spinal receptors like alpha 2 adrenergic, cholinergic, opioid, NMDA and gamma aminobutyric acid (GABA) and benzodiazepine receptors trigger the use of drugs like neostigmine, clonidine, opioids ketamine, midazolam for their synergistic effect with intrathecal local Anaesthetics. Materials and methods: It was a double blind, prospective, randomised study patients with ASA 1 and 2 was taken. Exclusion criteria were patients with cardiac problem, respiratory problem, coagulation disorders, mental disorders and contraindication to regional block. Day before surgery preanesthetic evaluation was carried and procedure was explain to each patient. 0.5 mg alprazolam and ranitidine 150 mg given bedtime the night before surgery patient is kept NPO overnight. Results: In our study duration of motor block in group 1 and group 2 was 3.22 (hr) ± 0.73 & 3.52±0.77 P value 0.226. Duration of sensory block in group 1 and group 2 was 4.09 (hr) ± 0.88 & 6.69 (hr) ± 1.29 p-value<0.001 significant. There is higher duration of pain free period with group 2. So we can say that intrathecal 2mg Midazo lam added to bupivacaine, duration of postoperative analgesia was significantly prolonged than 1 mg midazolam. Conclusion: The duration of effective analgesia when midazolam is added to intrathecal bupivacaine is significantly prolonged thereby proving that midazolam is a useful adjunct to intrathecal bupivacaine for post-operative analgesia. Effect of intrathecal midazolam is dose dependent 2mg midazolam prolongs the action of bupivacaine with good sedation and no unwanted side effects.

Comparison of Intrathecal Midazolam and Fentanyl Added to Bupivacaine for Spinal Anesthesia in Patients Undergoing Appendicectomy

Introduction: Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. The addition of Fentanyl or Midazolam can provide excellent quality and prolong the duration of analgesia. The study aims to compare the effect of intrathecal Fentanyl with that of intrathecal Midazolam in combination with 0.5% hyperbaric Bupivacaine on the duration and quality of spinal anesthesia in patients undergoing appendicectomy.Materials and Methods: This is a prospective, comparative and interventional study where patients were randomized into two equal groups. The study was conducted in a tertiary referral hospital from July 2018 to December 2018 after ethical approval. Group BF received Fentanyl and group BM received Midazolam The outcomes measured were, peak sensory level, quality of intraoperative analgesia and motor block, duration of effective analgesia, intraoperative and postoperative complications.Results: A total of 44 patients were studied with 22 in each arm. The two groups were comparable in terms of age, weight, height, duration of surgery, and ASA status of the patients. Peak sensory level and degree of motor block were not statistically different in the two arms. Duration of effective analgesia was 293.16±35 min in the BF group and 267.80±32 min in the BM group (p=0.01). Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group.Conclusions: Fentanyl and Midazolam both are equally effi cient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy.

Comparison of Analgesic Efϑicacy of subarachnoid Bupivacaine, Bupivacaine with Fentanyl and Bupivacaine with Nalbuphine An Intragroup Prospective Observational Study

Opioids are added to local anesthetics to extend theduration of spinal analgesia/anaesthesia.The present study was undertaken to compare the analgesic efficacy of subarachnoid hyperbaric bupivacaine 0.5% alone as a control,bupivacaine 0.5% with fentanyl and bupivacaine 0.5% with nalbuphine. Total 150 patients of either sex, ASA grade I and II, between 18 to 60 years and height 150 to 170 cm, posted for elective lower abdominal and lower limb surgeries were enrolled. They were divided into three equal groups. Group B: received 15mg hyperbaric bupivacaine 0.5%(3ml) + 0.5ml normal saline, Group BF: received 15mg hyperbaric bupivacaine 0.5% (3ml) + Inj. Fentanyl25µg(0.5ml) and Group BN: received 15mg hyperbaric bupivacaine 0.5%(3ml) + Inj. Nalbuphine 500µg(0.5ml). The sensorimotor blockade was significantly faster and prolonged in group BF and BN than group B. Quality of analgesia during the procedure was excellent in 90%, 94% and 94% in group B, BF and BN respectively. The duration of effective analgesia in group B (229.80± 43.542min) was significantly shorter in comparison with group BF (359.40 ± 45.955min) and BN (364.20 ± 38.34min), (P= 0.0001). Subarachnoid fentanyl 25µg and nalbuphine 500µg acts as an adjuvant to potentiate localanesthetic bupivacaine with the result that there is prolongation of sensory and motor blockade&amp; extended duration of effective analgesia in early postoperative period, reducing the total consumption of rescue analgesics.

Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries

Background: The post-operative pain in knee arthroscopy procedures can be attributed to irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection1. In the recent years, new interest has focused on the cholinergic system that modulates pain perception and transmission. The present study is designed to compare the efficacy of intra- articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following arthroscopic surgeries.Subjects and Methods:Prospective, Interventional, Randomised study was conducted over 90 patients scheduled for elective arthroscopic knee surgery, who were randomly allocated into three equal groups of 30 patients each. Group I-Bupivacaine with Neostigmine, Group II-Bupivacaine with Fentanyl and Group III-Bupivacaine alone. The study drug combinations were administered Intra-articularly at the conclusion of surgery. Hemodynamic variables and Pain were observed immediately after completion of surgery (Baseline) and thereafter at fixed intervals. The duration of effective analgesia was measured from the “baseline” until the first use of rescue analgesic. The number of rescue analgesics given in 24 hours were also recorded. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software.Results:Requirement for first analgesia was significantly earlier in Group III (146.00±71.66 minutes) as compared to Group II (236.00±111.34 minutes) and Group I (648.00±228.55 minutes). Majority of patients of Group I (90.0%) required rescue analgesia only once while in was twice in Group II (90.00%) and thrice in Group III (86.67%).Conclusion:Intra-articular administration of Neostigmine in combination with Bupivacaine provided a better post-operative analgesic effect with a lower incidence of side effects and lesser requirement of rescue analgesia.

Articaine and Dexmedetomidine - Supplemented Articaine for Arteriovenous Fistula Creation under Ultrasound-guided Supraclavicular Block.

Background:Articaine has emerged as a local anesthetic (LA) that produces sensory and motor blockade shorter than bupivacaine and lower in neurotoxicity than lidocaine. Studies have shown that adding dexmedetomidine to LA produces prolongation of sensory and motor bock duration. Early regain of motor power with adequate analgesia is needed in hemodialysis fistula creation surgery, for early start of physiotherapy. We designed this study to test efficacy of adding dexmedetomidine to articaine on the duration of sensory and motor block.Methods:After university review board approval, written informed consent to participate in the study was obtained. Patients with chronic renal failure undergoing radiocephalic hemodialysis fistula creation were eligible for enrollment in this double-blind, randomized trial. Patients receive either 40 ml of 2% articaine hydrochloride or 40 ml of articaine 2% mixed with dexmedetomidine (1 μg.kg − 1). Sensory block duration in minutes is assessed by pinprick test and motor block duration in minutes is tested by Bromage scale; both are recorded as a primary outcome. Secondary outcomes, including onset of sensory and motor block, time for rescue analgesia, hemodynamic changes, oversedation, and possible side effect, were recorded.Results:Fifty patients were enrolled in the study (25 in the articaine Group A and 25 in the articaine and dexmedetomidine group [AD]). Longer sensory block duration was in Group AD (230–260 min) than in Group A (172–185 min) with P < 0.001. In addition, motor block duration was significantly longer in Group AD than in Group A, (220 ± 110 min), (165 ± 45 min), respectively. The duration of effective analgesia was significantly longer in Group AD (363 ± 134 min) versus in Group A (244 ± 84 min). The onset of block was short and similar between groups.Conclusion:Addition of dexmedetomidine to articaine during arteriovenous fistula creation provide prolongation of sensory and motor block duration and augment analgesia.Trial registration:This trial was registered at Clinical trial.gov https://clinicaltrials.gov/ct2/show/NCT04171349 with the identification number NCT04171349.

Comparison of analgesic efficacy of ultrasound-guided thoracic paravertebral block versus surgeon-guided serratus anterior plane block for acute postoperative pain in patients undergoing thoracotomy for lung surgery-A prospective randomized study.

Context:Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications.Aims:We have compared total morphine consumption in 24 hours following thoracotomy.Settings and Design:This prospective randomized pilot study involved 50 patients undergoing elective thoracotomy for lung surgery at AIIMS, New Delhi.Patients and Methods:Fifty patients undergoing elective thoracotomy were randomly allocated into two groups. In Group I patients, ultrasound (USG)-guided paravertebral catheter was inserted preoperatively and in Group II patients, serratus anterior plane (SAP) catheter was inserted by the surgeon before closure. Ropivacaine bolus (group I: 0.2% 0.1 ml/kg and group II: 0.375% 0.4 ml/kg) was given before extubation, followed by its continuous infusion for 24 hours. If the numerical rating scale (NRS) was >3, then patients were given intravenous (i.v.) morphine 3 mg. Total 24-hour morphine consumption, duration of effective analgesia, hemodynamic parameters, side effects, and overall patient satisfaction were recorded.Statistical Analysis Used:T-test was used to compare the parametric values in both the groups, whereas the Mann–Whitney U-test was performed to compare the nonparametric values.Results:Postoperative morphine requirement in the ParaVertebral Block (PVB) group (8.65 ± 4.27 mg) was less as compared to the SAP group (11.87 ± 6.22 mg) but that was not statistically significant (p 0.052). Postoperative pain scores at rest and on movement, patient satisfaction, and incidence of chronic post-thoracotomy pain were comparable in both the groups.Conclusion:SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.

Postoperative Analgesic Efficacy of Preemptive and Postoperative Lornoxicam or Tramadol in Lumbar Disc Surgery.

To compare preemptive and postoperative analgesic efficacy of tramadol and lornoxicam administered before anaesthesia induction in lumbar discectomy. This randomised, double-blind trial was conducted on 60 ASA I and II patients undergoing lumbar discectomy. Group L (n=30) received 3×8 mg day-1 lornoxicam, and Group T (n=30) received 3×1.5 mg kg-1 day-1 tramadol. A verbal rating scale (VRS), the duration of effective analgesia, the number of additional analgesics used, adverse effects and patient satisfaction were evaluated at the postoperative 30th minute and 1st, 2nd, 4th, 6th, 8th, 12th and 24th hours. There were no significant differences between Groups L and T regarding demographic and clinical characteristics, the number of additional analgesics and the duration of effective analgesia, adverse effects and patient satisfaction. VRS scores of the patients in Group T were significantly higher than those in Group L at the postoperative 30th minute (p=0.050) and the 1st hour (p=0.005). Lornoxicam, which was used for preemptive and postoperative analgesia in lumbar disc surgery, had provided adequate and effective analgesia such as tramadol. Moreover, preemptive analgesia was quite effective in prevention and treatment of postoperative pain.

Comparative Study between the Benefit of Pre-Emptive Pregabalin and Gabapentin on Acute Postoperative Pain for Elective Gynecological Surgery

Gabapentin, and pregabalin had been used in analgesic field some studies. This double blind randomized clinical trial was conducted to evaluate the pre-emptive use of gabapentin 900 mg and pregabalin 300 mg in reducing postoperative pain. Methods: A total number of 75 patients undergoing lower gynecological procedures were prospectively randomized, into three groups (group A, B and C), each group including 25 patients with total 75 patients. Pregabalin, gabapentin or placebo, the pain was assessed on a visual analogue scale (VAS) at 0, 6, 12, 18 & 24 hours postoperatively. Duration of effective analgesia was documented, and administration of extra analgesic doses of meperedine required in the first 24 hours. Results: Patients in the gabapentin or pregabalin had significantly lower VAS scores at 6, 12, 18 and 24 hours, than those in the placebo group. As for rescue analgesia with mepredine consumed in the gabapentin, and pregabalin were significantly less than in the placebo. As for the complications, both drugs had increased incidence of nausea, vomiting and dizziness postoperatively, while no significance was found between all groups as regard hypotension, bradycardia and shivering. Conclusion: Preoperative use of pregabalin or gabapentin provides comparable but significant prolonged postoperative analgesia, less nausea and vomiting compared to placebo after gynecological surgeries. However, it was associated with increased incidence of postoperative dizziness.

A Comparative Study of Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG Guided Axillary Block for Elbow, Forearm and Hand Surgeries

BACKGROUND AND OBJECTIVES: The present clinical study was conducted to evaluate the onset of analgesia, degree of sensory and motor blockade, duration of analgesia and complications between Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG guided axillary brachial plexus block. METHODS: The study was conducted on 60 ASA 1 and 11 patients of either sex posted for various elective or emergency surgeries of the upper limb involving elbow, forearm and hand surgeries. The subjects were divided into two groups, group A receiving axillary brachial plexus block with 0.25% Levobupivacaine alone and group B receiving Levobupivacaine with Dexmeditomidine 0.5μg /kg. Patients’ vital parameters were monitored throughout the procedure and in the post-operative period for 48 hours. A thorough observation was made on onset, quality, duration of analgesia, degree of motor blockade and complications. RESULT: The onset of sensory blockade (mean difference 0.04 minutes, p-value <0.001) and motor blockade (mean difference 0.03 minutes, p-value <0.001) were quicker in group B compared to group A. Both these findings were statistically significant. Both the duration of sensory blockade (mean difference 4.7 hours, p value <0.001), and motor blockade (mean difference 1.8 hours, p value <0.001) were longer in group B compared to group A and both these findings were statistically significant. Time taken for starting of regression (mean difference -1.37 minutes, p-value <0.108) was more in group B compared to Group A, but this finding was not statistically different. All other parameters related to duration of anesthesia including time taken for full motor and sensory recovery were longer in Group B compared to Group A. These differences were statistically significant. There were statistically significant differences in the duration of complete analgesia, duration of effective analgesia and time of first pain medication between the study groups. All these parameters were longer in Group B compared to Group A. The average post anesthesia hemodynamic parameters like heart rate, systolic and diastolic pressures were higher in Group A compared to Group B. The difference in the heart rate and diastolic blood pressure were statistically significant. The post anaesthetic respiratory parameters were almost similar in both the study groups. INTERPRETATION AND CONCLUSION: In this prospective randomized double blinded case control study, Levobupivacaine with Dexmeditomidine seems to be advantageous over plain levobupivacaine in terms of onset, quality and intensity of sensory and motor blockade. The duration of analgesia is both clinically and statistically significantly prolonged in Levobupivacaine with Dexmeditomidine group.