Duration Of Motor Blockade Research Articles

COMPARISON OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT CLONIDINE FOR PERIOPERATIVE ANALGESIA IN LOWER LIMB ORTHOPEDICS SURGERIES

Background: The newer adjutants for spinal anaesthesia (SA) have seen numerous modifications over the last two decades. Various doses of clonidine have been tried in past but optimal dose which balances the ill effects has to be discovered. Therefore, this study was designed to study the effect of clonidine as an adjuvant in SA in terms of duration and complication.
 Methods: Two groups I and II ( with 60 patients each) received either 3.0 ml of Bupivacaine 0.5% heavy + 0.5 ml of normal saline and 2.5 ml of bupivacaine 0.5% heavy + 0.5 ml (75µg) of preservative free clonidine respectively. Various haemodynamic parameters and complication were recorded at baseline than 30 min, 1,2,4,6 and 8 hours after SA.
 Results: Group II shows that addition of clonidine had altered the heart rate and blood pressure significantly for initial two hour duration(p<0.05). No difference in the onset of sensory and motor blockade in both groups. Majority of patients in both group had level of sensory block upto T7 level. Mean VAS score was significantly lower in group II (p<0.001). Group II has prolonged duration of motor blockade (p< 0.00l). The difference in mean duration of analgesia among both the groups was significant indicating that addition of clonidine prolongs the duration of analgesia (p<0.0001). In group II incidence of hypotension and bradycardia is more as compared to group I.
 Conclusion: Intrathecal clonidine in the dose of 75 µg along with bupivacaine 0.5% heavy prolonged postoperative analgesia and motor blockade. It produces sedation in which patients were asleep and easily arousal and haemodynamic changes which could be easily managed.
 Keywords: Intrathecal, Bupivacaine, Clonidine, Orthopedics surgeries, VAS score

Comparative study of intrathecal fentanyl mixed with bupivacaine, tramadol mixed with bupivacaine, midazolam mixed with bupivacaine for peri and post-operative pain relief in lower limb and lower abdominal surgery

Background: Pain relief is of much importance in patients undergoing surgery during perioperative and post-operative period. Various methods have been evolved for providing post-operative pain relief. After effective pain relief a smoother post operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and midazolam used as adjuvant with bupivacaine in intrathecal injection for post operative pain lelief and comparative study had been done. Material and Methods: After the study protocol was approved by the Ethical clearance committee of the IGIMS, Sheikhpura, Patna. Study design was prospective, randomised and double blind techniques. A group of 100 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25 – 65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I- II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (0.5)% 3 cc +.4 cc normal saline], group BT [Bupivacaine (0.5)% 3 cc + 25 mg tramadol], BM [Bupivacaine (0.5)% 3 c.c + 2 mg midazolam], BF [Bupivacaine (0.5)% 3 cc + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space. Results: The study revealed that administration of additives in group BM and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.22 + 1.16) hrs. For group BM it was (12.1+ 2.34) hrs, for group BF (7.6 + 2.86) hrs, for group BT (3.65 + 1.42) hrs. Degree and duration of motor blockade was slightly prolonged in group BM and there was mild modulation in group BF. Conclusion: Addition of adjuvants (fentanyl, midazolam) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.

Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

Background: Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.Methods: Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.Results: Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.Conclusions: Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects.

Intrathecal 1% 2-Chloroprocaine with Fentanyl in Comparison with Ropivacaine (0.5%) with Fentanyl in Day Care Perianal Surgery: Prospective Randomized Comparative Study.

Background:Spinal anesthesia is a reliable and safe technique for perianal surgeries; the changing trend of surgical practice from an inpatient to outpatient has urged us to use lower dose of local anesthetic providing segmental block with adjuvants such as opioids. Ropivacaine is a long acting; amide local anesthetic, with greater sensory motor differentiation. Chloroprocaine (CP) is an amino-ester local anesthetic with a very short half-life. This study was designed to compare CP with ropivacaine for spinal anesthesia in an elective ambulatory setting.Methods:This prospective, randomized, comparative study included 60 adult patients scheduled to undergo perianal surgeries under subarachnoid block with intrathecal 3.0 mL of 1% CP with 12.5 μg fentanyl (Group C) or 1.5 mL of 0.5% ropivacaine with 12.5 μg fentanyl (Group R).Statistical Analysis:Chi-square test used to assess significance for qualitative data, independent t-test for significance of the mean difference between two quantitative variables.Results:Meantime of onset of sensory block at T10 in both the groups were comparable (Group C – 4.7 min, Group R – 4.8 min). Maximum upper level of sensory block was at T8 in both the groups, time for regression of sensory level to L1 was significantly longer with ropivacaine (Group R – 135 min, Group C – 76 min, P < 0.0001), and the duration of motor blockade (Group C – 81 min, Group R – 145 min P < 0.0001) was significantly short in the Group C with early ambulation (160 min).Conclusion:CP provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal ropivacaine.

The Comparative Study of Epidural Anesthesia between Isobaric Ropivacaine 0.5% and Isobaric Bupivacaine 0.5% for Lower Abdominal Surgery.

Aim:The aim of the study was to compare the effectiveness of ropivacaine (0.5%) and bupivacaine (0.5%) in epidural neuraxial blockade for elective lower abdominal surgeries.Methods:The present study was conducted in sixty patients undergoing elective lower abdominal surgeries under epidural anesthesia who were included after satisfying the eligibility criteria. The patients were randomly divided into two groups. An epidural catheter was inserted in cephalad direction using Tuohy epidural needle at L2–L3 or L3–L4 with the help of loss of resistance to air technique. Twenty milliliter of the study drug was given, sensory blockade was tested using the pinprick method, and quality of motor blockade was assessed by the modified Bromage scale.Results:In our study, demographic data comparing age and sex show no statistically significant difference among both the groups. In our study, the mean time for the onset of sensory block consider at T10 in Group B was 10.05 ± 2.1 min and in Group R was 9.8 ± 1.8 min. Moreover, the mean time duration of sensory block in Group B was 5.56 ± 0.059 h and in Group R was 5.34 ± 0.073 h. The onset of motor block in Group B was 4.98 ± 1.07 min and in Group R was 5.28 ± 1.2 min, but the duration of motor block for Group B was 4.63 ± 0.39 h and for Group R was 3.53 ± 0.23 h, which is clinically and statistically significant. The maximum level of sensory blockade for Group B was T4 and for Group R was T5. The range of block in Group B was T10–T4 and in Group R was T10–T35.Conclusion:The onset of sensory block was comparable in both the group, but the duration of sensory block is shorter with ropivacaine compared to bupivacaine. The onset of motor blockade was comparable in both the groups, but the duration of motor blockade was also shorter and the degree of motor block was less intense with ropivacaine compared to bupivacaine.

Comparative Study Between Systemically and Perineurally Administered Tramadol as an Adjunct in Ultrasound Guided Supraclavicular Brachial Plexus Block

Background:brachial plexus block remains the only practical alternative to general anesthesia for significant surgery on the upper limb. It can be extremely useful in patients with significant co-morbidities such as severe respiratory and cardiovascular disease, morbid obesity and in those with potential airway difficulties. Aim of the Work:comparing the efficacy of systemically administered tramadol and perineurally administered tramadol as an adjunct to bupivacaine in supraclavicular brachial plexus blocks on onset of sensory, motor blockade and postoperative analgesia along with demand for rescue analgesic in the postoperative period. Patients and Methods: Group A: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml for block. Group B: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml mixture for block and tramadol (100 mg) diluted to 10 ml intravenously. Group C: bupivacaine 0.5%-20 ml+ lidocaine 2% -5 ml+ tramadol (100 mg). Results: In motor onset block there was a highly significant difference between the three study groups. Also, it was highly significant faster in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Duration of sensory block there was a highly significant difference between the three study groups. It was highly significant longer in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Regarding First request of rescue analgesia there was a highly significant difference between the three study groups. Conclusion:the mixture of tramadol, bupivacaine and lidocaine injected perineurally for supraclavicular brachial plexus block hastens the onset of sensory block, motor block and provides a longer duration of motor blockade and postoperative analgesia as compared to other two groups in which tramadol was either injected intravenously (systemic group) or was not given at all (control group).

RANDOMIZED EVALUATION OF THE INFLUENCE OF INTRAVENOUS USE OF DEXAMETHASON ON POSTOPERATIVE ANALGESIA IN PATIENTS AFTER ARTHROSCOPIC OPERATIONS ON THE KNEE JOINT UNDER THE CONDITIONS OF THE PERIPHERAL REGIONARY BLOCKADE

Aim: to evaluate the effects of intravenous dexamethasone on postoperative analgesia in patients after arthroscopic knee joint surgery in conditions of peripheral regional blockade. Material and methods: 60 patients were included in the study, divided into 2 groups. In the first group, patients underwent peripheral regional blockade of the femoral and sciatic nerves with a 0.5% solution of levobupivacaine. In the second, the traditional peripheral regional blockade was supplemented by intravenous administration of 8 mg (0.4% - 2 ml) of dexamethasone immediately after catarrhization of the peripheral vein. Results: The duration of the sensory blockade in the group using dexamethasone was 25% greater than in the first group. In the postoperative period, patients who were intraoperatively injected with dexamethasone required 33% less additional anesthesia. The duration of motor blockade in the group with dexamethasone was 26.5% higher than in the patients of the first group. Conclusion: intravenous dexamethasone injection with levobupivacaine peripheral regional anesthesia with arthroscopic knee joint surgery, increases the duration of the sensory block and the duration of postoperative analgesia. The use of dexamethasone led to a decrease in the need for additional anesthesia in the early postoperative period.

Effect of Ultrasound-guided Nerve Block With 0.75% Ropivacaine at the Mid-forearm on the Prevalence of Moderate to Severe Pain After Hand Surgery

PurposeThis study tested the hypothesis that ultrasound-guided mid-forearm nerve block with 0.75% ropivacaine reduces the prevalence of moderate to severe pain after wrist and hand surgery, and provides prolonged postoperative analgesia with minimal motor blockade. MethodsThirty patients undergoing elective wrist and hand surgery were randomly assigned to 1 of 2 groups: group R (n = 15) and group NS (n = 15). We combined an ultrasound-guided supraclavicular brachial plexus block with mid-forearm median, radial, and ulnar nerve block in all patients. The supraclavicular brachial plexus was blocked with 20 mL of 1.5% lidocaine, and the mid-forearm nerves were blocked with 15 mL of either 0.75% ropivacaine (group R) or normal saline (5 mL each nerve) (group NS). A blinded observer provided a numeric rating pain score at 1, 2, 6, 12, 24, and 48 hours after surgery. The durations of sensory and motor blockade, patient satisfaction, morphine requirement for postoperative pain rescue, and adverse events were recorded. FindingsThe prevalence of moderate to severe pain in group R was significantly lower than that in group NS (33% vs 86%; P = 0.008). The highest mean (SD) numeric rating pain score (worst pain) in group R was lower than that in group NS (2.7 [1.9] vs 5.6 [2.9]; P = 0.004), and the median (Q1, Q3) amount of morphine required for postoperative pain rescue in group R was lower than that in group NS (0 [0, 6] vs 8 [6, 10]; P = 0.001]. Additionally, there were no differences in the durations of motor blockade between the 2 groups. ImplicationsBased on the findings from this study, ultrasound-guided mid-forearm nerve block with 0.75% ropivacaine significantly reduces the prevalence of moderate to severe pain after wrist and hand surgery, provides long-term postoperative analgesia, and facilitates the return of motor function in the upper limb. Chinese Clinical Trial Registry identifier: ChiCTR-IOR-15007278 (October 2015).

A Study Of Comparison Of 0.8mg Vs 1.4mg Of Intrathecal Nalbuphine In 3.5ml Of Inj. Bupivacaine Heavy 0.5% In Lower Abdominal And Lower Limb Surgeries

Background: Spinal anaesthesia is a commonly employed technique which provides safe, effective, low cost surgical anesthesia with good post-operative analgesia. Nalbuphine is a semi synthetic opioid with mixed antagonist and k agonist properties. In present study we have compared 0.8mg vs 1.4mg of Intrathecal inj. Nalbuphine with inj. bupivacaine heavy 0.5% 3.5cc to determine the most optimal dose for effective anaesthesia and maximum postoperative analgesia in lower abdominal surgeries. We also observed about the common side effects that occur with opioids like, pruritus, nausea, vomiting, sedation. Material and Methods: Patients were randomly allocated into two groups of 30 participants each. They received either nalbuphine 0.8 mg (group A) or nalbuphine 1.4 mg (group B) diluted upto 0.5ml with normal saline, mixed with 17.5 mg of hyperbaric bupivacaine 0.5% (3.5 ml). The onset of sensory blockade, onset of motor blockage, duration of sensory blockade, two-segment regression time from highest level of sensory blockade and duration of motor blockade were recorded following procedure. Results: In this study, we found that intrathecal injection Nalbuphine combined with intrathecal bupivacaine provides faster onset of sensory and motor blockage along with intraoperative hemodynamic stability. Addition of 1.4 mg intrathecal Nalbuphine in comparison with 0.8 mg provides better postoperative analgesia. The duration of sensory and motor blockade were increased without significantly increasing the incidence of side effects such as sedation, pruritus, nausea/vomiting and respiratory depression. Conclusion: In conclusion, Intrathecal Nalbuphine (1.4mg) added to Intrathecal Bupivacaine 0.5% heavy (17.5mg) provides prolonged postoperative analgesia without increasing risk of side effects. Further studies are required to determine optimal dosage of intrathecal Nalbuphine.

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block: A Single-Center, Prospective, Double-Blind, Randomized Controlled Trial.

Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB. Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0.5 μg/kg (DEX 0.5), (3) IV DEX 1.0 μg/kg (DEX 1.0), and (4) IV DEX 2.0 μg/kg (DEX 2.0). The primary outcome was time to the first pain at surgical site. The median (interquartile range) duration of analgesia was significantly prolonged for the DEX 2.0 (874 minutes [727-1153 minutes]) compared with 656 minutes (590-751 minutes), 703 minutes (644-761 minutes), and 696 minutes (615-814 minutes) for the control, DEX 0.5 and DEX 1.0 groups, respectively (P = 0.001, P = 0.008, and P = 0.003, respectively). Postoperative cumulative IV morphine equivalent consumption at 24 hours was significantly lower in the DEX 2.0 compared with the control, DEX 0.5 and DEX 1.0 groups (P < 0.001, P < 0.001, and P = 0.007, respectively). There were no significant differences in the incidence of intraoperative hypotension and the number of patients who required ephedrine after the pairwise group analysis. Also, there were no significant differences on the durations of motor blockade and sedation and the incidence of bradycardia. Intravenous DEX at a dose of 2.0 μg/kg significantly increased the duration of ISBPB analgesia without prolonging motor blockade and reduced the cumulative opioid consumption at the first 24 hours in patients undergoing arthroscopic shoulder surgery. This study was registered at the Clinical Trial Registry of Korea, identifier KCT0002119.

Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty.

BackgroundWith the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty.MethodsWe performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS.ResultsOf the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS.ConclusionsIsobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.

EXPERIENCE OF THE USE OF LEVOBUPIVACAINE FOR SPINAL ANESTHESIA IN UROLOGICAL INTERVENTIONS

The prospective study included data obtained during the surgical treatment of 55 urological patients. In the X10 group (n = 25) for spinal anesthesia used 2 ml of a 0.5% isobaric solution of levobupivacaine (10 mg), in the X15 group (n = 30) - 3 ml of a similar solution (15 mg). Results. The time to the motor blockade of Bromage I in the study groups was 9 ± 3 min versus 8 ± 3 min, p = 0.154, to Bromage III - 18 ± 7 min versus 13 ± 3 min, p = 0.001. In group X10 motor blockade did not develop in 1, reached only the first degree - in 1, only the second degree - in 5 patients. In the X15 group, all patients underwent motor blockade of the third degree, except for 2 patients, in whom block reached only the second degree. The maximum level of sensory blockade in the group X10 was Th8, X15 - Th9. In the X10 group, the upper blockade level, not exceeding Th11, was observed in 11 (44%), and in the X15 group - in 17 (57%) patients. In 6 cases of the X10 group (24%) and 5 cases of the X15 group (17%) had to add sedation or general anesthesia. The duration of motor blockade before the beginning of recovery was 163 ± 57 min versus 195 ± 66 min, p = 0.076, until the motor block regressed completely - 219 ± 66 min versus 290 ± 90 min, p = 0.002. Arterial hypotension was observed in one patient group X10 (4%) and 0 group X15, bradycardia in 7 (28%) and 7 (23%) patients, respectively. There were no transient neurologic symptoms in any cases. Conclusions. Spinal anesthesia with isobaric levobupivacaine was characterized by a slow development of the complete motor block, unpredictably low upper level of the sensory blockade and a long-lasting motor block. It can be used in patients with high risk of arterial hypotension or transient neurologic symptoms, provided sufficient time is available before the operation, the possibility of sedation and / or the addition of general anesthesia.

Effect of different doses of intrathecal nalbuphine as adjuvant to ropivacaine in elective lower limb surgeries: A dose finding study.

Background and Aim:Nalbuphine as an adjuvant intrathecally can produce significant analgesia with minimal side effects. However, no research has been done with isobaric ropivacaine. We, therefore, in this prospective, randomised double-blind study tried to find the optimal dose of intrathecal nalbuphine with isobaric 0.75% ropivacaine for elective lower limb surgeries.Materials and Methods:One hundred American Society of Anaesthesiologists I and II patients undergoing elective lower limb surgery were divided into four groups randomly: groups A, B, C and D, who received 0.5 mL normal saline or 0.4, 0.8 and 1.6 mg nalbuphine made up to 0.5 mL normal saline added to 22.5 mg (total volume 3.5 mL) isobaric 0.75% ropivacaine, respectively. The onset of sensory and motor block, two-segment regression time, duration of sensory and motor block, Visual Analogue Scale (VAS) and the incidence of adverse effects were compared between the groups.Results:The onset of both sensory and motor blockade was faster with addition of 0.4, 0.8 and 1.6 mg of nalbuphine when compared with ropivacaine alone; however, it was not statistically significant (P > 0.05). Two-segment regression time and duration of analgesia and motor blockade were highest with 1.6 mg of nalbuphine followed by 0.8, 0.4 and plain 0.75% ropivacaine (P < 0.05). The duration of sensory blockade in all four groups was slightly more than the duration of motor blockade. VAS readings were comparable in all nalbuphine groups when compared with ropivacaine group. Haemodynamic variability among the four groups was comparable. Incidence of adverse effects was highest in the 1.6-mg group when compared with others, although it was statistically insignificant (P > 0.05).Conclusion:Nalbuphine can be a good alternative to other opioids as an adjuvant intrathecally to prolong postoperative analgesia with a minimal side effect profile. Addition of nalbuphine to isobaric 0.75% ropivacaine gives the added advantage of significant analgesia with early motor recovery. We infer from our study that when compared with 1.6 mg of nalbuphine, both 0.4 and 0.8 mg nalbuphine are equally good as adjuvants to isobaric 0.75% ropivacaine in elective lower limb surgeries with prolonged analgesia, a reliable block with equal efficacy but with lesser side effects.

Comparitive study between levobupivacaine versus bubivacaine in spinal anesthesia for cesarean sections

Background Levobupivacaine showed a lower risk of cardiovascular and central nervous system toxicity than bupivacaine, which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine 0.5% compared with bupivacaine 0.5% for spinal anesthesia for cesarean sections. Aim The aim of this study was to compare the efficacy of levobupivacaine 0.5% versus bupivacaine 0.5% in spinal anesthesia for cesarean section. Patients and methods A total of 60 pregnant women in American Society of Anesthesiologists I–II group scheduled to have an elective cesarean operation were allocated into the study. Patients were randomly divided into two groups (30 patients in each group). Group I (bupivacaine group): in this group, patients received 2.5 ml bupivacaine 0.5%. Group II (levobupivacaine group): in this group, patients received 2.5 ml levobupivacaine 0.5%. Heart rate and mean arterial blood pressure were recorded intraoperatively. The onset time of sensory block and postoperative pain were assessed by visual analogue scale; time of postoperative first rescue of analgesia and duration of motor blockade were assessed by the Bromage score postoperatively. Results There was no significant difference between both groups as regards hemodynamics (heart rate and mean arterial pressure), two-segment regression of sensory block, time of first feeling of pain, total dose of consumption of analgesia, and visual analogue score. There was a significant decrease in the time to reach maximum sensory and motor block in group II compared with group I. Time of two-segment regression of motor block was significantly lower in group II than in group I. Conclusion Adequate surgical anesthesia can be achieved with both levobupivacaine and hyperbaric bupivacaine, as tested by the loss of pinprick sensation in both groups. Levobupivacaine given intrathecally can provide a safe and effective analgesic choice for parturients undergoing elective cesarean section, as the incidence of side effects with its use was significantly lower in comparison with hyperbaric bupivacaine.

A study to compare caudal levobupivacaine, tramadol and a combination of both in paediatric inguinal hernia surgeries.

Background and Aims:Caudal block is a safe and simple method of pain relief in young children with the drawback of a short duration of analgesia which can be overcome by adding various adjuvants to the injected local anaesthetic. We compared the effects of caudal levobupivacaine, tramadol and a combination of both in paediatric patients undergoing inguinal herniotomy.Methods:A total of 78 children aged 1–7 years, planned for inguinal herniotomy were randomly allocated into three groups. Group L received levobupivacaine 0.125% 1 ml/kg, Group T received tramadol 1.5 mg/kg in 0.9% NS and Group LT 1 ml/kg of 0.125% levobupivacaine with 1.5 mg/kg tramadol caudally. The primary outcome was the duration of analgesia. Rescue analgesic doses required, the duration of motor blockade and adverse effects were recorded for 12 h post-operatively. Data was analysed by analysis of variance test, Kruskal-Wallis and Chi-square tests.Results:All groups were comparable with regard to age, sex and duration of surgery. No motor block was observed in any of the patients. The mean duration of analgesia in Group L was 321.46 ± 84.76 min, in Group T was 565.19 ± 107.08 min, and in Group LT was 720 min (P < 0.001). The requirement for rescue analgesia in tramadol group was significantly less as compared to levobupivacaine group. Sedation scores and adverse effects were comparable among all groups.Conclusion:Addition of tramadol to caudal levobupivacaine significantly increased the duration of postoperative analgesia.

Efficacy of caudal levopubivacaine versus bupivacaine in children undergoing lower abdominal surgery: a prospective randomized controlled study

Background Postoperative pain in pediatrics causes psychological and physiological problems; thus, preemptive analgesia is important, even in newborns. Caudal block is a useful adjuvant with general anesthesia and for postoperative analgesia for infraumbilical operations. Levobupivacaine is less cardiotoxic, less neurotoxic, and an equally potent local anesthetic compared with its racemate. Aim Our aim is to compare the efficacy of caudally administered isobaric levobupivacaine 0.25% versus isobaric bupivacaine 0.25% in children undergoing lower abdominal surgery. Patients and methods This study was carried out on 60 children, 1–10 years, American Society of Anesthesiologists I–II, scheduled for elective lower abdominal surgery. Patients were randomized into two equal groups (30 patients in each group): group I: bupivacaine group: patients received 1 ml/kg bupivacaine 0.25%. Group II: levobupivacaine group: patients received 1 ml/kg levobupivacaine 0.25%. The onset time of sensory block, heart rate, mean arterial blood pressure, and respiratory rate were recorded intraoperatively. Postoperative pain was assessed using the Children’s and Infant’s Postoperative Pain Scale; time of postoperative first rescue of analgesia and duration of motor blockade were determined by the Bromage score postoperatively. Results There was no significant difference between both groups in the onset time of sensory block, hemodynamics (heart rate and mean arterial pressure), and respiratory rate. Children’s and Infant’s Postoperative Pain Scale was significantly lower in group I at 120 and 180 min postoperatively. The Bromage score was significantly lower in group ІІ at 15, 30, and 60 min postoperatively. Time till administration of first-rescue analgesia was significantly shorter in group II than group I. Conclusion Using similar doses, bupivacaine produced a higher incidence of residual motor block and longer analgesic block than levobupivacaine. Thus, levobupivacaine is more suitable for short operations and could make it preferable for day case surgery. However, bupivacaine is still more suitable for prolonged operations.

A Comparative Study of Dexmedetomidine and Clonidine as an Adjuvant to Intrathecal Bupivacaine in Lower Abdominal Surgeries.

Context:Spinal block is the first choice for lower abdominal surgeries. Bupivacaine is the most common local anesthetic used but has a shorter duration of action. Many adjuvants have been used to improve the quality of analgesia till postoperative period. In this study, we used α2-agonists.Aims:The aim of this study is to compare the effects of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine with respect to onset and duration of sensory and motor blockade duration of analgesia and incidence of side effects.Settings and Design:This was a prospective randomized double-blind study.Subjects and Methods:One hundred and fifty patients of physical status American Society of Anesthesiologists Classes I and II were randomly divided into Groups B, C, and D each administered with bupivacaine with normal saline, clonidine, and dexmedetomidine, respectively.Statistical Analysis Used:Data were entered into Microsoft excel data sheet. Analysis software used in this study was SPSS 22 version IBM. Categorical data were represented in the form of frequencies and proportions. Chi-square test was the test of significance. Continuous data were represented as mean and standard deviation. Independent t-test was used for mean difference between two groups. P < 0.05 was statistically significant.Results:Mean sensory onset in Group B was 2.8 ± 0.7 min, in Group C was 1.4 ± 0.5 min, and in Group D was 1.2 ± 0.4 min. Mean sensory regression by two segments in Group B was 78.5 ± 9.9 min, in Group C was 136.7 ± 10.7 min, and in Group D was 136.4 ± 11.7 min.Conclusions:α2-agonists with hyperbaric bupivacaine intrathecally have a faster onset of both motor and sensory block. It also prolongs the duration of analgesia.

The Effect of Dexmedetomidine Dosage on Duration of Spinal Anaesthesia using Hyperbaric Bupivacaine for Abdominal and Lower Extremity Surgeries

Spinal anaesthesia is commonly used for abdominal and lower limb surgeries. Dexmedetomidine, a new highly selective α2 agonist drug, is now being evaluated as a potential neuraxial adjuvant. This study has been designed to evaluate the addition of two doses of dexmedetomidine (10μg and 15μg) to 0.5% hyperbaric bupivacaine 3ml intrathecally for elective abdominal and lower limb surgeries. In a simple randomized study, 90 patients aged between 18-60 years of ASA I and II were randomized into three groups i.e., group I, II and III (n=30). All patients received a drug volume of 3.5 ml containing 3 ml hyperbaric bupivacaine (15 mg). They received dexmedetomidine 10μg (Group II) or 15μg (Group III) diluted to 0.5ml with 0.9% saline added to bupivacaine in the same syringe; the control group (Group I) received 0.5ml of 0.9% saline added to bupivacaine. It was found that the onset of sensory block upto T10 and motor block is statistically significantly faster in group II (155.17 sec and 203.83 sec) and III (99.37 sec and 170.13 sec) over group I (263.16 sec and 337.50 sec) in a dose dependent manner. The mean time for two segment regression, the mean time to sensory regression to S1, the mean duration of analgesia and the mean duration of motor blockade is significantly prolonged in Group III (141.67 min, 447.83 min, 400.67 min, 475.17 min) over Group II (106.17 min, 332.83 min, 287.67 min, 346.50 min) and Group II over Group I (97.33 min, 276.67 min, 243.17 min, 276.83 min) in a dose dependent manner (p<0.001). The data reveal that 15 μg of dexmedetomidine added to local anaesthetic in subarachnoid block to be a better adjuvant in prolonging the sensory and motor blockade intraoperatively and the duration of postoperative analgesia compared to 10 μg, without significant adverse effects. It is an attractive option for prolonged surgeries of the lower limb precluding the need for use of general anaesthetics and epidural anaesthesia.

English

60 patients of ASA undergoing upper limb surgeries were randomly assigned into two groups, Group BM (midazolam) and Group B (Bupivacaine) Surgery was done under supraclavicular approach of brachial plexus blockade. The Patients in Group BM received 30ml of 0.375% bupivacaine 5μ/kg midazolam and In group B received 30 ml of 0.375% of bupivacaine. Parameters observed were time of onset of sensory block and motor block, duration of motor blockade, duration of sensory block analgesic, duration of analgesia, sedation score, Haemodynamic and side effects. Study shows that On addition of midazolam to local anaesthetic solution there is difference between the onset of sensory block and onset of motor blockade to bupivacaine 1. On addition of midazolam to local anaesthetic solution significantly prolongs the duration of analgesia in 15-18 hours compared to bupivacaine group which is 8-16 hours. 2. Addition of midazolam to local anaesthetic solution increases the duration of motor blockade by 7-9 hours compared to bupivacaine which is 5-7 hours. 3. On addition of midazolam to local anaesthetic solution increases the duration of sensory block 15 hours compared to bupivacaine which is 5-9 hours. CONCLUSION: The addition of midazolam to local anaesthetic solution in supraclavicular approach to brachial plexus, a) Produces significantly faster onset of sensory & motor blockade. b) Prolongs the duration of sensory & motor blockade and duration of analgesia.

Comparative Study of the Efficacy of Dexmedetomidine and Fentanyl as Adjuvants to Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block.

Supraclavicular brachial plexus block is preferable to general anaesthesia in upper limb surgeries. Various adjuvants have been added to improve the quality of the block and prolong postoperative analgesia. The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and postoperative complications provided by dexmedetomidine and fentanyl as adjuvants to ropivacaine under ultrasound (USG) guidance in supraclavicular block. A total of 80 patients with American Society of Anesthesiologists grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group A received 30 mL of 0.5% ropivacaine with 1 μg kg-1 dexmedetomidine, and group B received 30 mL of 0.5% ropivacaine with 1 μg kg-1 fentanyl for supraclavicular brachial block using USG guidance. The onset and duration of sensory and motor block, time for requirement of rescue analgesia and adverse events during the perioperative period were noted. The onset of sensory blockade was 13.95±1.34 min in the dexmedetomidine group and 14.18±1.41 min in the fentanyl group. There was a highly significant statistical difference in terms of the duration of the sensory blockade, i.e. 801.75±46.07 min with dexmedetomidine compared to 590.25±40.41 min with fentanyl (p<0.0001). The duration of motor blockade was highly statistically significant with 649.56±42.73 min in group A compared to 456.75±32.93 min in group B. Dexmedetomidine prolongs the duration of sensory and motor block and postoperative analgesia as compared to fentanyl when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and is not associated with any major adverse events.